Effect of CYP2D6 genetic variation on patient-reported symptom improvement and side effects among children and adolescents treated with amphetamines.

OBJECTIVES: Amphetamine-based medications are recommended as a first-line pharmacotherapy for the treatment of attention-deficit/hyperactivity disorder in children and adolescents. However, the efficacy and tolerability of these medications vary across individuals, which could be related to interindividual differences in amphetamine metabolism. This study examined if genotype-predicted phenotypes of the cytochrome P450 isozyme CYP2D6 were associated with self-reported side effects and symptom improvement in youth treated with amphetamines. METHODS: Two hundred fourteen participants aged 6-24 who had a history of past or current amphetamine treatment were enrolled from Western Canada. Amphetamine dose and duration information was collected from the participants along with questions regarding adherence, concomitant medications, symptom improvement and side effects. DNA was extracted from saliva samples and genotyped for CYP2D6 . Binomial logistic regression models were used to determine the effect of CYP2D6 metabolizer phenotype with and without correction for phenoconversion on self-reported symptom improvement and side effects. RESULTS: Genotype-predicted CYP2D6 poor metabolizers had significantly higher odds of reporting symptom improvement when compared to intermediate metabolizers (OR = 3.67, 95% CI = 1.15-11.7, P  = 0.029) after correction for phenoconversion and adjusting for sex, age, dose, duration, and adherence. There was no association between CYP2D6 metabolizer phenotype and self-reported side effects. CONCLUSION: Our findings indicate that phenoconverted and genotype-predicted CYP2D6 poor metabolizer phenotype is significantly associated with higher odds of symptom improvement in children and adolescents treated with amphetamine. If replicated, these results could inform the development of future dosing guidelines for amphetamine treatment in children and adolescents.

Repeat breeding: prevalence and potential causes in dairy cows at different milk pocket areas of Bangladesh.

The objective of this study was to figure out the prevalence and probable causes of repeat breeding (RB) in dairy cows. Hence, a cross-sectional study was conducted on randomly selected 265 dairy farms in Sirajganj, Bogura, Rangpur, Satkhira, and Munshiganj districts of Bangladesh from December 2018 to February 2019. Data were collected through a direct interview method using a survey questionnaire. The reproductive organs of repeat breeder cows were examined for pathological, infectious, and functional reasons, and genital tract abnormalities. Additionally, the influence of nutrition, season, and age on the frequency of RB was recorded. The prevalence of RB was 28% among the 3824 cows investigated. Among the total repeat breeder cases, 72.54% of RB cases were found in Holstein-Friesian crossbred, 23.90% in Jersey crossbred, 1.50% in Sahiwal crossbred, and 2.06% in indigenous cows. The prevalence of RB was significantly highest (P < 0.01) in Satkhira (44.35%) and lowest in the Munshiganj district (15.87%). Data indicated that a major proportion of cows significantly (P < 0.05) faced RB problems due to functional causes (34.18%), followed by pathological causes (28.01%), genital tract abnormalities (21.32%), and infectious causes (16.49%). Furthermore, the cows were remarkably (P < 0.001) affected in RB during the summer season and nutritional deficient diseases like milk fever (70%). Age (3-7 years) had a significant (P < 0.001) effect on the RB occurrence (90%) in crossbred cows. However, particular focus should be given to systematic breeding, balanced nutrition, artificial inseminator efficiency, and hygienic inseminating tools to reduce RB incidence in high-yielding crossbred cows.

Effect of police enforcement and extreme social inequalities on violence and mental health among women who sell sex: findings from a cohort study in London, UK.

OBJECTIVES: To examine legal and social determinants of violence, anxiety/depression among sex workers. METHODS: A participatory prospective cohort study among women (inclusive of transgender) ≥18 years, selling sex in the last 3 months in London between 2018 and 2019. We used logistic generalised estimating equation models to measure associations between structural factors on recent (6 months) violence from clients or others (local residents, strangers), depression/anxiety (Patient Health Questionnaire-4). RESULTS: 197 sex workers were recruited (96% cisgender-women; 46% street-based; 54% off-street) and 60% completed a follow-up questionnaire. Street-based sex workers experienced greater inequalities compared with off-street in relation to recent violence from clients (73% vs 36%); police (42% vs 7%); intimate partner violence (IPV) (56% vs 18%) and others (67% vs 17%), as well as homelessness (65% vs 7%) and recent law enforcement (87% vs 9%). Prevalence of any STI was 17.5% (17/97). For street-based sex workers, recent arrest was associated with violence from others (adjusted OR (aOR) 2.77; 95% CI 1.11 to 6.94) and displacement by police was associated with client violence (aOR 4.35; 95% CI 1.36 to 13.90). Financial difficulties were also associated with client violence (aOR 4.66; 95% CI 1.64 to 13.24). Disability (aOR 3.85; 95% CI 1.49 to 9.95) and client violence (aOR 2.55; 95% CI 1.10 to 5.91) were associated with anxiety/depression. For off-street sex workers, financial difficulties (aOR 3.66; 95% CI 1.64 to 8.18), unstable residency (aOR 3.19; 95% CI 1.36 to 7.49), IPV (aOR 3.77; 95% CI 1.30 to 11.00) and alcohol/drug use were associated with client violence (aOR 3.16; 95% CI 1.26 to 7.92), while always screening and refusing clients was protective (aOR 0.36; 95% CI 0.15 to 0.87). Disability (aOR 5.83; 95% CI 2.34 to 14.51), unmet mental health needs (aOR 3.08; 95% CI 1.15 to 8.23) and past eviction (aOR 3.99; 95% CI 1.23 to 12.92) were associated with anxiety/depression. CONCLUSIONS: Violence, anxiety/depression are linked to poverty, unstable housing and police enforcement. We need to modify laws to allow sex workers to work safely and increase availability of housing and mental health services.

The Effect of Systemic Racism and Homophobia on Police Enforcement and Sexual and Emotional Violence among Sex Workers in East London: Findings from a Cohort Study.

There is extensive qualitative evidence of violence and enforcement impacting sex workers who are ethnically or racially minoritized, and gender or sexual minority sex workers, but there is little quantitative evidence. Baseline and follow-up data were collected among 288 sex workers of diverse genders (cis/transgender women and men and non-binary people) in London (2018-2019). Interviewer-administered and self-completed questionnaires included reports of rape, emotional violence, and (un)lawful police encounters. We used generalized estimating equation models (Stata vs 16.1) to measure associations between (i) ethnic/racial identity (Black, Asian, mixed or multiple vs White) and recent (6 months) or past police enforcement and (ii) ethnic/racial and sexual identity (lesbian, gay or bisexual (LGB) vs. heterosexual) with recent rape and emotional violence (there was insufficient data to examine the association with transgender/non-binary identities). Ethnically/racially minoritized sex workers (26.4%) reported more police encounters partly due to increased representation in street settings (51.4% vs 30.7% off-street, p = 0.002). After accounting for street setting, ethnically/racially minoritized sex workers had higher odds of recent arrest (adjusted odds ratio 2.8, 95% CI 1.3-5.8), past imprisonment (aOR 2.3, 95% CI 1.1-5.0), police extortion (aOR 3.3, 95% CI 1.4-7.8), and rape (aOR 3.6, 95% CI 1.1-11.5). LGB-identifying sex workers (55.4%) were more vulnerable to rape (aOR 2.4, 95% CI 1.1-5.2) and emotional violence. Sex workers identifying as ethnically/racially minoritized (aOR 2.1, 95% CI 1.0-4.5), LGB (aOR 2.0, 95% CI 1.0-4.0), or who use drugs (aOR 2.0, 95% CI 1.1-3.8) were more likely to have experienced emotional violence than white-identifying, heterosexual or those who did not use drugs. Experience of any recent police enforcement was associated with increased odds of rape (aOR 3.6, 95% CI 1.3-8.4) and emotional violence (aOR 4.9, 95% CI 1.8-13.0). Findings show how police enforcement disproportionately targets ethnically/racially minoritized sex workers and contributes to increased risk of rape and emotional violence, which is elevated among sexual and ethnically/racially minoritized workers.

Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh.

BACKGROUND: We hypothesized that drinking water, sanitation, handwashing (WSH), and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting. METHODS: Within a subsample of a cluster-randomized, controlled trial in rural Bangladesh, we enrolled pregnant women in 4 arms: control, WSH, child nutrition counseling plus lipid-based nutrient supplements (N), and nutrition plus WSH (N+WSH). Among the birth cohort, we measured biomarkers of gut inflammation (myeloperoxidase, neopterin), permeability (alpha-1-antitrypsin, lactulose, mannitol), and repair (regenerating gene 1ß) at median ages 3, 14, and 28 months. Analysis was intention-to-treat. RESULTS: We assessed 1512 children. At age 3 months, compared to controls, neopterin was reduced by nutrition (-0.21 log nmol/L; 95% confidence interval [CI], -.37, -.05) and N+WSH (-0.20 log nmol/L; 95% CI, -.34, -.06) interventions; similar reductions were observed at 14 months. At 3 months, all interventions reduced lactulose and mannitol (-0.60 to -0.69 log mmol/L). At 28 months, myeloperoxidase was elevated in the WSH and nutrition arms (0.23-0.27 log ng/mL) and lactulose was higher in the WSH arm (0.30 log mmol/L; 95% CI, .07, .53). CONCLUSIONS: Reductions in permeability and inflammation at ages 3 and 14 months suggest that the interventions promoted healthy intestinal maturation; however, by 28 months, the WSH and nutrition arms showed elevated EED biomarkers. These results underscore the importance of developing a better understanding of EED pathophysiology and targeting interventions early in childhood, when they are likely to have the largest benefit to intestinal health. CLINICAL TRIALS REGISTRATION: NCT01590095.

Ingestion of Fecal Bacteria along Multiple Pathways by Young Children in Rural Bangladesh Participating in a Cluster-Randomized Trial of Water, Sanitation, and Hygiene Interventions (WASH Benefits).

Quantifying the contribution of individual exposure pathways to a child's total ingestion of fecal matter could help prioritize interventions to reduce environmental enteropathy and diarrhea. This study used data on fecal contamination of drinking water, food, soil, hands, and objects and second-by-second data on children's contacts with these environmental reservoirs in rural Bangladesh to assess the relative contribution of different pathways to children's ingestion of fecal indicator bacteria and if ingestion decreased with the water, sanitation, and hygiene interventions implemented in the WASH Benefits Trial. Our model estimated that rural Bangladeshi children <36 months old consume 3.6-4.9 log10 most probable number E. coli/day. Among children <6 months, placing objects in the mouth accounted for 60% of E. coli ingested. For children 6-35 months old, mouthing their own hands, direct soil ingestion, and ingestion of contaminated food were the primary pathways of E. coli ingestion. The amount of E. coli ingested by children and the predominant pathways of E. coli ingestion were unchanged by the water, sanitation, and hygiene interventions. These results highlight contaminated soil, children's hands, food, and objects as primary pathways of E. coli ingestion and emphasize the value of intervening along these pathways.

Efficacy of alkyltrimethylammonium bromide for decontaminating salt-cured hides from the red heat causing moderately halophilic bacteria.

Conventionally, animal hide and skin necessitates 95% saturated brine solution (SBS) for its preservation. This salt is primarily derived from different sources including solar-saltern, evaporation ponds, etc., which are laden with different types of halophilic micro-organisms. Previous studies confirmed that the presence of moderately halophilic bacteria caused red heat on cured hide, which adversely affects the leather quality and causes substantial economic losses for leather industries. Thus, this investigation was carried out to examine the effects of different concentrations of alkyltrimethylammonium bromide (ATMB) on selected halophilic-bacteria attributed to the deterioration of hide quality. In nutrient broth solution (NBS), ATMB at 250 and 500 ppm reduced individual halo-bacteria, that is, Halomonas halodenitrificans, Halomonas eurihalina, Alkalibacillus haloalkaliphilus and Salimicrobium album, by averages of 0·64 and 1·90, 1·5 and 2·61, 0·90 and 2·27, 1·65 and 3·36 log CFU per ml respectively in 5 min. ATMB treatment in SBS at 500 ppm for 18 h resulted in a reduction of H. halodenitrificans, H. eurihalina, A. haloalkaliphilus and S. album by averages of 1·9, 1·25, 0·96 and 1·34 log CFU per ml respectively, when compared with the controls. Likewise, 5000 ppm ATMB reduced the cocktail population nearly to zero from that cultivated in SBS for 18 h. SIGNIFICANCE AND IMPACT OF THE STUDY: In this investigation, the inhibition of different halophilic bacteria that causes red heat in salt-preserved hides is described for the first time. The antimicrobial susceptibility test executed via solution procedures for selected halophilic bacterial strains (i.e. resistant to the salt environment) revealed significant efficacy of alkyltrimethylammonium bromide (ATMB). The current study suggests that, chemical compound like ATMB could be utilized to prevent red heat-related damage on salt-cured hides caused by halophilic bacteria, which is a persisting concern of the leather industry.

Micromechanisms of Cortical Bone Failure Under Different Loading Conditions.

Bone being a hierarchical composite material has a structure varying from macro- to nanoscale. The arrangement of the components of bone material and the bonding between fibers and matrix gives rise to its unique material properties. In this study, the micromechanisms of cortical bone failure were examined under different loading conditions using scanning electron microscopy. The experimental tests were conducted in longitudinal and transverse directions of bone diaphysis under tensile as well as compressive loading. The results show that bone material has maximum stiffness under longitudinal tensile loading, while the strength is higher under transverse compressive loading. A reverse trend of compressive mechanical properties of bone is observed for longitudinal and transverse loading as compared to trends reported in the previous studies. Therefore, micromechanisms of cortical bone failure were analyzed for different loading conditions to reveal such type of behavior of cortical bone and to correlate bone microstructure with mechanical response of bone.

Assessment of Elastic-Plastic Fracture Behavior of Cortical Bone Using a Small Punch Testing Technique.

The fracture properties of cortical bone are directly coupled to its complex hierarchical structure. The limited availability of bone material from many anatomic locations creates challenges for assessing the effect of bone heterogeneity and anisotropy on fracture properties. The small punch technique was employed to examine the fracture behavior of cortical bone in terms of area under the curve values obtained from load-load point displacement behavior. Fracture toughness of cortical bone was also determined in terms of J-toughness values obtained using a compact tension (CT) test. Area under the curve values obtained from the small punch test were correlated with the J-toughness values of cortical bone. The effects of bone density and compositional parameters on area under the curve and Jtoughness values were also analyzed using linear and multiple regression analysis. Area under the curve and J-toughness values are strongly and positively correlated. Bone density and %mineral content are positively correlated with both area under the curve and J-toughness values. The multiple regression analysis outcomes support these results. Overall, the findings support the hypothesis that area under the curve values obtained from small punch tests can be used to assess the fracture behavior of cortical bone.

Studies on the Stress-Strain Relationship Bovine Cortical Bone Based on Ramberg-Osgood Equation.

Bone is a complex material that exhibits an amount of plasticity before bone fracture takes place, where the nonlinear relationship between stress and strain is of importance to understand the mechanism behind the fracture. This brief presents our study on the examination of the stress-strain relationship of bovine femoral cortical bone and the relationship representation by employing the Ramberg-Osgood (R-O) equation. Samples were taken and prepared from different locations (upper, middle, and lower) of bone diaphysis and were then subjected to the uniaxial tensile tests under longitudinal and transverse loading conditions, respectively. The stress-strain curves obtained from tests were analyzed via linear regression analysis based on the R-O equation. Our results illustrated that the R-O equation is appropriate to describe the nonlinear stress-strain behavior of cortical bone, while the values of equation parameters vary with the sample locations (upper, middle, and lower) and loading conditions (longitudinal and transverse).

Complementary feeding practices among rural Bangladeshi mothers: Results from WASH Benefits study.

Inappropriate complementary feeding contributes to linear growth faltering in early childhood. Behaviour change interventions have been effective at improving practice, but few studies have investigated the effects of multicomponent integrated interventions. We conducted a cluster-randomized controlled trial in rural Bangladesh in which geographic clusters were randomized into seven arms: water treatment (W), sanitation (S), handwashing (H), water, sanitation, and handwashing (WSH), improved nutrition with infant and young child feeding messages and lipid-based nutrient supplementation for 6- to 24-month olds (N), N+WSH, and control. The objective of this paper was to examine the independent and combined effects of interventions on indicators of complementary feeding. Approximately 1 and 2 years after initiation of the intervention, research assistants surveyed mothers about infant feeding practices. Complementary feeding was examined using the World Health Organization indicators of infant and young child feeding practices. We used Poisson regression models to estimate prevalence ratios and linear regression models for prevalence differences with clustered sandwich estimators to adjust for clustering. A total of 4,718 households from 720 clusters were surveyed at year 1 and 4,667 at year 2. The children in the nutrition arms had a higher prevalence of meeting the minimum dietary diversity score compared with controls (year 1: N: 66.4%; N+WSH: 65.0% vs. C:32.4%; year 2: N: 91.5%; N+WSH: 91.6% vs. C:77.7%). Children in the nutrition arms received diverse food earlier than the children in control arm. In addition, the average consumption of lipid-based nutrient supplementation was >90% in each follow-up. Nutrition-specific interventions could be integrated with nutrition-sensitive interventions such as WSH without compromising the uptake of the nutrition intervention.

Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial.

Background: We evaluated effects of individual and combined water, sanitation, handwashing (WSH), and nutritional interventions on protozoan infections in children. Methods: We randomized geographical clusters of pregnant women in rural Bangladesh into chlorinated drinking water, hygienic sanitation, handwashing, nutrition, combined WSH, nutrition plus WSH (N+WSH), or control arms. Participants were not masked. After approximately 2.5 years of intervention, we measured Giardia, Cryptosporidium, and Entamoeba histolytica prevalence and infection intensity by multiplex real-time polymerase chain reaction of child stool. Analysis was intention-to-treat. Results: Between May 2012 and July 2013, we randomized 5551 pregnant women. At follow-up, among 4102 available women, we enrolled 6694 children into the protozoan assessment. We analyzed stool from 5933 children (aged ~31 months) for protozoan infections. Compared with 35.5% prevalence among controls, Giardia infection prevalence was lower in the sanitation (26.5%; prevalence ratio [PR], 0.75 [95% confidence interval {CI}, .64-.88]), handwashing (28.2%; PR, 0.80 [95% CI, .66-.96]), WSH (29.7%; PR, 0.83 [95% CI, .72-.96]), and N+WSH (26.7%; PR, 0.75 [95% CI, .64-.88]) arms. Water and nutrition interventions had no effect. Low prevalence of E. histolytica and Cryptosporidium (<2%) resulted in imprecise effect estimates. Conclusions: Individual handwashing and hygienic sanitation interventions significantly reduced childhood Giardia infections, and there were no effects of chlorinated drinking water and nutrition improvements in this context. Combined WSH interventions provided no additional benefit. To reduce Giardia infection, individual WSH interventions may be more feasible and cost-effective than combined interventions in similar rural, low-income settings. Clinical Trials Registration: NCT01590095.

Current Trend of Using Anti-Hypertensives in Pregnancy and Postpartum Period in a Tertiary Level Hospital.

Hypertensive disorders are one of the most common disorders in pregnancy. They are amongst the major cause of maternal and perinatal morbidity and mortality. Incidence is increasing in developing countries like Bangladesh. This cross sectional descriptive study has done to observe the utilization of antihypertensive drugs in hypertensive disorders of pregnancy and conducted from January 2016 to December 2016 in the department of Pharmacology in collaboration with department of Gynecology and Obstetrics in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Non random purposive sampling technique was used. Total of 300 patients participated in the study, 281 anti partum and 19 postpartum. Age distribution showed 42% patients were in 21-25 years age group. Majority of the participants (91%) were housewife and majority (79%) came from poor socioeconomic status with below SSC education (68%). About 82% patients lived in rural area. Trimester and gravida wise distribution showed most of the participants were 3rd trimester (61%) and primigravida (57%) and only 6% patients belong to postpartum period. In this study preeclampsia was highest (63.8%) among all other types of hypertensive diseases in pregnancy. Majority of the patient were preferred for dual therapy (53%), mono therapy was used in 29% of cases. Most frequently given drug in pregnancy associated hypertension was methyldopa that is 88.33% (single 22.3%, combination 66%). Second most commonly used drug was nifidipine consisting of 47.6% but used in combination in all cases. Average number of anti hypertensive drugs prescribed per prescription was 1.87 and majorities (92%) were from essential drug list but used as trade name. Preeclampsia and eclampsia were more common among the hypertensive disorders in tertiary level hospital cases. Methyldopa was found to be the commonest prescribed antihypertensive in monotherapy and in combination.

Current Trends of Using Antimicrobials and Their Sensitivity Pattern in Infectious Cases at Department of Orthopedics in a Tertiary Care Hospital.

This cross-sectional descriptive study was carried out to analyse the current trends of using antimicrobials at orthopaedics department in different surgical procedures and observe the antimicrobial sensitivity pattern of infective organisms in postoperative wound infection cases at the department of Orthopaedics, Mymensingh Medical College Hospital with collaboration of department of Pharmacology and Therapeutics in Mymensingh Medical College, Mymensingh from January 2016 to December 2016. Among 253 orthopaedics surgical cases Penicillins, Cephalosporins, and Aminoglycoside group were commonly prescribed antimicrobials that had been use postoperatively in most of the Orthopaedics cases. Rate of occurring postoperative wound infection was 18.58%. Pseudomonas aeruginosa (36.17%) was the predominant microorganisms in our study followed by Klebsiellae (12.77%), Proteus (10.64%), Escherichia coli and (6.38%) Enterococcus (4.25%). Pseudomonas aeruginosa exhibited sensitivities to Gentamicin (35.29%), Amikacin (35.29%). Good sensitivities patterns for Klebsiellae in our study were shown to Imipenam (100%), Gentamicin (20%). Sensitivity patterns for Proteus in our study were shown to Imipenam (80%), Gentamicin (20%). Enterococcus in our study showed good sensitivities against Imipenam (100%), Linezolid (100%). Cephalosporin generation showed more resistance.

Mechanical property and quality aspects of rice dried in industrial dryers.

The influence of drying methods on selected mechanical properties and qualities of MR219 rice variety has been investigated. The results showed significant effects of drying methods on bending strength and head rice yields while the average bending strength of paddy were 28.6-31.8 MPa. The effect of drying methods on apparent modulus of elasticity of rice was not significant (204.5-222.4 MPa). The fracture energy of rice varied significantly under control drying but not with industrial drying methods. Higher temperature in drying by IBD contributed in making the grains tougher, where the effect of FBD temperature was positive toward the development of fracture energy inside rice kernel. IBD at temperature above 40 °C resulted in lower bending strength in rice kernels which affected head rice yield. Two stage paddy drying practices with FBD using temperature of 115-125 °C as first stage is still acceptable, and inclined bed dryer either as single stage or as second stage after FBD should be operated at temperature of <40 °C to maintain head rice yield. The whiteness and milling recovery of rice achieved from different drying methods were comparable.

Determinants of percent expenditure of household income due to childhood diarrhoea in rural Bangladesh.

There is limited information on percent expenditure of household income due to childhood diarrhoea especially in rural Bangladesh. A total of 4205 children aged <5 years with acute diarrhoea were studied. Percent expenditure was calculated as total expenditure for the diarrhoeal episode divided by monthly family income, multiplied by 100. Overall median percent expenditure was 3·04 (range 0·01-94·35). For Vibrio cholerae it was 6·42 (range 0·52-82·85), for enterotoxigenic Escherichia coli 3·10 (range 0·22-91·87), for Shigella 3·17 (range 0·06-77·80), and for rotavirus 3·08 (range 0·06-48·00). In a multinomial logistic regression model, for the upper tertile of percent expenditure, significant higher odds were found for male sex, travelling a longer distance to reach hospital (⩾median of 4 miles), seeking care elsewhere before attending hospital, vomiting, higher frequency of purging (⩾10 times/day), some or severe dehydration and stunting. V. cholerae was the highest and rotavirus was the least responsible pathogen for percent expenditure of household income due to childhood diarrhoea.

Smear Positive Tuberculosis amongst Suspects Reported to DOTS Corner of Mymensingh Medical College Hospital, Bangladesh.

Sputum microscopy still remains the primary tool for the laboratory diagnosis of tuberculosis. A retrospective study was conducted in the directly observed treatment, short-course (DOTS) corner of Mymensingh Medical College Hospital (MMCH), in Bangladesh from May 2013 to May 2014. The study was designed to evaluate the extent of smear positive microscopy including multi-drug resistance (MDR) amongst tuberculosis suspected cases. A total of 2,361 Pulmonary Tuberculosis (PTB) suspects were noticed to DOTS corner during this period, with the mean age of 43 years. The male female ratio was 2.02:1 and the smear positivity rate was about 10%. Study found majority of the suspects were in the economically productive year of life 20-70 years. Smear negative suspects were not re-evaluated further, though smear negativity does not rule out absence of tuberculosis. Extra pulmonary or non tuberculous mycobacteria were not evaluated in this study. Twenty two patients 0.9% of total 2361 were identified as MDR during the study period where 61 clinically highly suspected cases were sent for GeneXpert that seems to be much lesser than the national rate (3.6% in new cases and 19% in retreated cases). The smear positivity rate of all three (1st, 2nd and 3rd) smear was 94.5%, all the second smear was 100% positive and the third were 95.47% positive. It is evident from this study that two smear microscopy was found sufficiently reliable to diagnose TB. However, further in depth prospective study might be undertaken to ascertain the scenario of this chronic diseases.

Promoting pedestrian safety in Bangladesh: Identifying factors for drivers' yielding behavior at designated crossings using behavior change theories.

OBJECTIVE: In Bangladesh, drivers' failure to yield to pedestrians at designated crossings poses a significant safety risk and discourages their use of such crossings. The use of behavior change theories could be more appropriate in such complex situations where the interdependent behaviors of drivers and pedestrians interact. While many studies have identified factors that affect drivers' yielding behavior in the literature, fewer efforts have been made to apply behavior change theories in exploring and validating these factors, and to reach a consensus among competing road users. This study is among the first to utilize behavior change theories in Bangladesh to identify pedestrians' safety factors that could promote drivers' yielding behavior, upon which a consensus between drivers and pedestrians could be established. METHODS: A self-reported attitudinal survey was administered to 202 drivers on two highways in Bangladesh with a questionnaire using the capability, opportunity, motivation, and behavior (COM-B) model for the comprehensive coverage of behavior change theories. The focus group interviews were also conducted with 40 pedestrians and 19 drivers who have experience with four crossing sites on the selected highways. The collected data were analyzed using a regression model to identify significant factors influencing the drivers' yielding behavior. These factors were then justified using a deductive thematic coding framework based on behavior change theories. RESULTS: The regression model explained the variance in drivers' yielding by 45.1% with eight factors. The model found seven positive significant contributory factors in the drivers' yielding that could promote pedestrian safety. Of them, the motivation factors were avoiding random crossing by pedestrians, vulnerable groups, assertiveness, and facial fear expressions; and the opportunity factors were traffic signs or advanced yield lines, crossing in groups at specific times, and enforcement. CONCLUSIONS: The study's findings have practical implications for policymakers, highway designers, and other stakeholders involved in promoting pedestrian safety by acknowledging their stake in making any decision that might impact them. Highway designers can use the thematic coding framework to recommend any contributory factors involved, where competing drivers' unwillingness to yield is the primary threat to pedestrians' safety.

Structural, thermodynamic, and magnetic properties of SrFe12O19 hexaferrite modified by co-substitution of Cu and Gd.

A hard magnetic system of SrFe12O19 nanomaterial was modified according to the composition of Sr0.95Gd0.05Fe12-xCuxO19 with x = 0.0, 0.30, and 0.60 using the sol-gel technique. The structures of the samples were evaluated using X-ray diffraction (XRD) along with Rietveld refinement, and an M-type hexaferrite with a hexagonal structure was confirmed with a trace amount of the α-Fe2O3 phase. In addition, transmission electron microscopy (TEM) analysis revealed polycrystalline nanoplates in all samples. Furthermore, the bond structures of the octahedral and tetrahedral sites along with the thermodynamic properties of these ferrites were extracted from the FTIR spectra at room temperature. The Debye temperature (θD) decreased from 755.9 K to 749.3 K due to the co-substitution of Gd3+ at Sr2+ and Cu2+ at Fe3+. The magnetic hysteresis (M-H) measurements revealed that the coercivity decreased from 5.3 kOe to 1.5 kOe along with the highest magnetization saturation (Ms) of 65.2 emu g-1 for the composition Sr0.95Gd0.05Fe11.7Cu0.3O19, which is suitable for industrial application. The effect of local crystalline anisotropy in magnetization was explored using the law of approach to saturation (LAS). Finally, thermo-magnetization was recorded in the range from 400 K to 5 K for cooling under zero field and in the presence of a 100 Oe field, and magnetic transitions were tracked due to the introduction of the foreign atoms of Gd and Cu into SrFe12O19.

Classification of Internal and External Distractions in an Educational VR Environment Using Multimodal Features.

Virtual reality (VR) can potentially enhance student engagement and memory retention in the classroom. However, distraction among participants in a VR-based classroom is a significant concern. Several factors, including mind wandering, external noise, stress, etc., can cause students to become internally and/or externally distracted while learning. To detect distractions, single or multi-modal features can be used. A single modality is found to be insufficient to detect both internal and external distractions, mainly because of individual variability. In this work, we investigated multi-modal features: eye tracking and EEG data, to classify the internal and external distractions in an educational VR environment. We set up our educational VR environment and equipped it for multi-modal data collection. We implemented different machine learning (ML) methods, including k-nearest-neighbors (kNN), Random Forest (RF), one-dimensional convolutional neural network - long short-term memory (1D-CNN-LSTM), and two-dimensional convolutional neural networks (2D-CNN) to classify participants' internal and external distraction states using the multi-modal features. We performed cross-subject, cross-session, and gender-based grouping tests to evaluate our models. We found that the RF classifier achieves the highest accuracy over 83% in the cross-subject test, around 68% to 78% in the cross-session test, and around 90% in the gender-based grouping test compared to other models. SHAP analysis of the extracted features illustrated greater contributions from the occipital and prefrontal regions of the brain, as well as gaze angle, gaze origin, and head rotation features from the eye tracking data.