Assessment of biosecurity measures in commercial poultry farms of Rajshahi district in Bangladesh.

The application of biosecurity measures in the poultry sector are essential. Developing and implementing daily biosecurity activities are considered effective methods to prevent infectious diseases on poultry farms. Appropriate farm settings and management reduce the possibility of disease transmission between farms. This study aimed to assess the current biosecurity status of commercial poultry farms in the Rajshahi district of Bangladesh. A cross-sectional study was conducted from June to November 2021, involving 204 poultry farmers in the Rajshahi district, using a multistage sampling technique. Data were collected through face-to-face interviews using a semi-structured questionnaire. The statistically significant (p < 0.05) results found were: most farmers reported that the visitors could not access their farms (broiler vs. layer: 68.1%, 77.0%). A higher proportion of broilers compared to layer farms used company's supplied feed (81.2% vs. 66.7%). A higher proportion of layer (97.8%) farms cleaned the farm's litter within 24 h compared to broiler farms (72.5%). Broiler farms had better records animal mortality than layer farms (76.8% vs. 60.0%). More layer (96.3%) farms compared to broiler (87.0%) farms implemented a vaccination program. The findings of this study revealed that biosecurity measures are well-practiced and implemented in most broiler and layer farms in this region except in a small number of farms. Government authorities should strictly enforce and monitor biosecurity measures in farms that do not practice essential biosecurity measures.

Occupational injuries and risk assessment among stone crushing industry workers: a cross-sectional study.

BACKGROUND AND OBJECTIVES: The prevalence of occupational injuries among blue-collar workers is higher in the stone-crushing industries due to high-risk and iterant nature of the work. These occupational injuries, in turn, caused workers' ill health, as well as death, which eventually diminish the gross domestic product. We aimed at assessing the attributes of occupational injuries and the risk associated with the hazards in the stone-crushing industry. METHODS: This study utilized a questionnaire base cross-sectional survey that was conducted from September 2019 to February 2020. Data were collected from 32 stone-crushing factories of Eastern Bangladesh and analyzed to show their relationship with different variables. The risk levels associated with the frequent hazardous events were measured using a Semi-Quantitative Risk Assessment Matrix. RESULTS: Most of the injuries were found to occur between 12:00 and 16:00 h. Nearly a fifth of the injuries were serious or critical in nature, caused the workers to be absent at least a week. Exposure to excessive dust, working without personal protective equipment (PPE), and improper lifting and handling techniques caused one-third of injuries. Wrist and hand/fingers, back and lower back, feet/toe, eye, knee, arm, neck and head, and ankle were found as most injured body parts. The primary cause of most injuries was the workers' failure to use PPE. All major hazardous events were found to possess a high-risk level. CONCLUSION: Our finding suggests that stone crushing is one of the most hazardous industries and the practitioners must consider the findings when implementing a risk avoidance policy.

Cost of Recommended Diet (CoRD) and Its Affordability in Bangladesh.

The cost of diet has been recognized as a major determinant of overall diet quality and nutritional outcomes. We aimed to estimate the minimum cost and affordability of the recommended diet based on the updated food-based dietary guidelines (FBDG) in Bangladesh. To compute the cost of the recommended diet (CoRD), we collected retail prices of foods corresponding to each of the food groups in the latest Bangladeshi FBDG. For affordability, the household size and daily food expenditure data were used from the most recent Household Income and Expenditure survey (HIES). The CoRD was calculated based on the average number of servings recommended for each food group; the CoRD was adjusted by a deflation factor and divided by the household's daily food expenditure to estimate affordability. We found that the CoRD was $0.87 (83 BDT) per person per day at the national level. Nationally, about 43% of households could not afford the CoRD, with rural areas bearing a disproportionate share of the burden. We also found households to overspend on starchy staples while underspending on protein-rich foods, fruits, and dairy. These findings highlight the need for immediate implementation of interventions to improve the affordability of the CoRD and redesign policy instruments to create a sustainable food system.

Assessment of nutrient adequacy and associated factors among lactating women of rural Bangladesh using observed intake: Findings from Bangladesh Integrated Household Survey 2018-2019.

Lactating women of low- and middle-income countries are prone to develop deficiencies in essential nutrients due to various demographic and socioeconomic components. This study aimed to estimate the adequacy of dietary intake and the determinants of diet quality of lactating women in rural Bangladesh. One-day dietary recall (24-Hour recall) data of 973 lactating women were obtained from the Bangladesh Integrated Household Survey (BIHS) 2018-2019. Nutrient adequacy was determined using the Estimated Average Requirement (EAR) cut-point approach. The molar ratios of phytate to zinc, calcium, and iron were calculated. Mean Adequacy Ratio (MAR) was calculated to measure diet quality, and multiple linear regression analysis was performed to assess the sociodemographic determinants of MAR. While the intakes of protein and carbohydrate were equal to/above the Acceptable Macronutrient Distribution Range (AMDR) among most of the subjects, intakes of total energy and fat were below the reference intakes for 74.4% and 98.3%, respectively. Nutrient adequacy remained unmet for riboflavin, calcium, vitamin A, and folate among most (87.2%-97.6%) of the study population, and the mean (SD) MAR was 0.72 (0.12). Cereals were the major contributor of energy and B vitamins, while protein and iron mainly came from plant-based sources. The molar ratio of phytate to iron was greater than the critical limit among most respondents. Maternal Body Mass Index (BMI) (beta = 0.003, p = .014) and education level (beta = 0.017, p = .038) were associated with their diet quality. The diet of most lactating women in rural Bangladesh indicates the inadequacy of several micronutrients. This can lead to a worsening of the double burden of malnutrition in women. Lactating women should be given special consideration when designing food and nutrition programs for reproductive women in rural Bangladesh.

Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT.

BACKGROUND: Incisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires health-care resources and has a significant associated failure rate. A prospective, multicentre, single-blinded randomised controlled trial was conducted to investigate the clinical effectiveness and cost-effectiveness of the Hughes abdominal closure method compared with standard mass closure following surgery for colorectal cancer. The study randomised, in a 1 : 1 ratio, 802 adult patients (aged ≥ 18 years) undergoing surgical resection for colorectal cancer from 28 surgical departments in UK centres. INTERVENTION: Hughes abdominal closure or standard mass closure. MAIN OUTCOME MEASURES: The primary outcome was the incidence of incisional hernias at 1 year, as assessed by clinical examination. Within-trial cost-effectiveness and cost-utility analyses over 1 year were conducted from an NHS and a social care perspective. A key secondary outcome was quality of life, and other outcomes included the incidence of incisional hernias as detected by computed tomography scanning. RESULTS: The incidence of incisional hernia at 1-year clinical examination was 50 (14.8%) in the Hughes abdominal closure arm compared with 57 (17.1%) in the standard mass closure arm (odds ratio 0.84, 95% confidence interval 0.55 to 1.27; p = 0.4). In year 2, the incidence of incisional hernia was 78 (28.7%) in the Hughes abdominal closure arm compared with 84 (31.8%) in the standard mass closure arm (odds ratio 0.86, 95% confidence interval 0.59 to 1.25; p = 0.43). Computed tomography scanning identified a total of 301 incisional hernias across both arms, compared with 100 identified by clinical examination at the 1-year follow-up. Computed tomography scanning missed 16 incisional hernias that were picked up by clinical examination. Hughes abdominal closure was found to be less cost-effective than standard mass closure. The mean incremental cost for patients undergoing Hughes abdominal closure was £616.45 (95% confidence interval -£699.56 to £1932.47; p = 0.3580). Quality of life did not differ significantly between the study arms at any time point. LIMITATIONS: As this was a pragmatic trial, the control arm allowed surgeon discretion in the approach to standard mass closure, introducing variability in the techniques and equipment used. Intraoperative randomisation may result in a loss of equipoise for some surgeons. Follow-up was limited to 2 years, which may not have been enough time to see a difference in the primary outcome. CONCLUSIONS: Hughes abdominal closure did not significantly reduce the incidence of incisional hernias detected by clinical examination and was less cost-effective at 1 year than standard mass closure in colorectal cancer patients. Computed tomography scanning may be more effective at identifying incisional hernias than clinical examination, but the clinical benefit of this needs further research. FUTURE WORK: An extended follow-up using routinely collected NHS data sets aims to report on incisional hernia rates at 2-5 years post surgery to investigate any potential mortality benefit of the closure methods. Furthermore, the proportion of incisional hernias identified by a computed tomography scan (at 1 and 2 years post surgery), but not during clinical examination (occult hernias), proceeding to surgical repair within 3-5 years after the initial operation will be explored. TRIAL REGISTRATION: This trial is registered as ISRCTN25616490. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 34. See the NIHR Journals Library website for further project information.

Bowel cancer treatment involves surgery for the majority of patients. A complication of this surgery is the formation of a hernia at the site of the incision in the abdominal wall, known as an incisional hernia. The lining of the abdomen, fat or the intestine can squeeze through the gap and form a lump under the skin. An incisional hernia can form any time after surgery and can cause serious complications and pain, and can also affect the patient's quality of life. Surgery to correct incisional hernias is not always successful, so finding a way of preventing them is important. This research compares the traditional way of sewing up the abdomen, where the two sides are brought together in one layer with a continuous thread, with an alternative method called the Hughes abdominal closure method/Hughes repair. In the Hughes repair, a series of horizontal and vertical stitches are arranged to spread the load and ease the tension across the wound. A total of 802 patients from 28 sites in the UK were recruited to the trial. Half of the patients were randomly allocated to have traditional abdominal closure and half were randomised to have Hughes abdominal closure. All were followed up for 1 year after surgery to assess whether or not an incisional hernia had occurred. We also assessed quality of life during follow-up, and we compared the costs and benefits of each procedure to see which option was the better value for money. By comparing the results from the two methods, it was hoped that the best method of abdominal closure to reduce the risk of an incisional hernia occurring would be found. The analysis of the data suggested that the risk of an incisional hernia was no different with either closure method. Furthermore, Hughes abdominal closure was more expensive and provided less value for money than standard abdominal closure.

Assessment of sleep quality and its association with problematic internet use among university students: a cross-sectional investigation in Bangladesh.

OBJECTIVES: Problematic internet use (PIU) is a major behavioral problem that has been closely associated with poor sleep quality in many different countries, but is poorly studied in Bangladesh. This study was conducted to investigate the sleep quality and its association with PIU among university students in Bangladesh. MATERIAL AND METHODS: A cross-sectional study was conducted between May 2019 and December 2019 among 400 students attending four public universities in Bangladesh. The Pittsburgh sleep quality index (PSQI) was used to determine sleep quality and Young's internet addiction test (IAT) was used to describe the degree of PIU. RESULTS: A significant negative association emerged between good sleep quality and PIU (p<0.001). In the multivariate logistic regression, students having PIU were 0.28 folds less likely to have good sleep quality (AOR: 0.28, 95%CI=0.18-0.43, p<0.001) when compared to non-PIU students. In addition, significant associations between sleep quality and socio-demographic and lifestyle factors were identified. CONCLUSION: Implementation of an effective awareness program and development of education strategies are required to reduce internet addictive behaviors and improve sleep quality among Bangladeshi university students.

Assessment of contamination level, pollution risk and source apportionment of heavy metals in the Halda River water, Bangladesh.

This study demonstrates the level of heavy metal pollution in the Halda River, the only natural breeding source of carps in Bangladesh. Water was collected from 12 different sampling points along the Halda River. Water at various locations was found satisfactory in terms of the assessed physicochemical parameters (pH, electrical conductivity, and total dissolved solids). The presence of various cations and anions was also studied using ion chromatography. Atomic absorption spectroscopy was used to identify and quantify various heavy metals in the collected water samples. Among the heavy metals, Cd, Cr, Fe, Pb, Cu, and As concentration exceeded the safe limit suggested by WHO. The calculated heavy metal pollution index and metal index were found higher than the critical index value. The single-factor assessment (P i ) and Nemerow's multi-factor index (P N ) of heavy metals was calculated to find out the degree of pollution in the Halda River. The maximum values of P i (Cd), P i (Pb), P i (As), P i (Cu), and P i (Cr) were determined to be 26.67, 260.00, 17.00, 208.76 and 2.80 respectively. The maximum value of P N was found to be 289.04. The discharge of effluents from various large and small industries near the Halda River is considered to be the major source of the identified heavy metals. Multivariate statistical analysis such as principal component analysis, Pearson correlation matrix and cluster analysis revealed that most of the heavy metals originated from different anthropogenic sources. Multivariate analysis also showed that Co, Mn, Cu, Cr, Pb, Cd, NH4 +, NO3 - mainly came from artificial sources whereas Fe, Ca, As mainly originated from natural sources. Arsenic (As) also came from artificial sources with Cu.

Emergency department clinical leads' experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study.

BACKGROUND: To manage increasing demand for emergency and unscheduled care NHS England policy has promoted services in which patients presenting to Emergency Departments (EDs) with non-urgent problems are directed to general practitioners (GPs) and other primary care clinicians working within or alongside emergency departments. However, the ways that hospitals have implemented primary care services in EDs are varied. The aim of this study was to describe ED clinical leads' experiences of implementing and delivering 'primary care services' and 'emergency medicine services' where GPs were integrated into the ED team. METHODS: We conducted interviews with ED clinical leads in England (n = 19) and Wales (n = 2). We used framework analysis to analyse interview transcripts and explore differences across 'primary care services', 'emergency medicine services' and emergency departments without primary care services. RESULTS: In EDs with separate primary care services, success was reported when having a distinct workforce of primary care clinicians, who improved waiting times and flow by seeing primary care-type patients in a timely way, using fewer investigations, and enabling ED doctors to focus on more acutely unwell patients. Some challenges were: trying to align their service with the policy guidance, inconsistent demand for primary care, accessible community primary care services, difficulties in recruiting GPs, lack of funding, difficulties in agreeing governance protocols and establishing effective streaming pathways. Where GPs were integrated into an ED workforce success was reported as managing the demand for both emergency and primary care and reducing admissions. CONCLUSIONS: Introducing a policy advocating a preferred model of service to address primary care demand was not useful for all emergency departments. To support successful and sustainable primary care services in or alongside EDs, policy makers and commissioners should consider varied ways that GPs can be employed to manage variation in local demand and also local contextual factors such as the ability to recruit and retain GPs, sustainable funding, clear governance frameworks, training, support and guidance for all staff. Whether or not streaming to a separate primary care service is useful also depended on the level of primary care demand.

Effect of an Enhanced Paramedic Acute Stroke Treatment Assessment on Thrombolysis Delivery During Emergency Stroke Care: A Cluster Randomized Clinical Trial.

Importance: Rapid thrombolysis treatment for acute ischemic stroke reduces disability among patients who are carefully selected, but service delivery is challenging. Objective: To determine whether an enhanced Paramedic Acute Stroke Treatment Assessment (PASTA) intervention increased hospital thrombolysis rates. Design, Setting, and Participants: This multicenter, cluster randomized clinical trial took place between December 2015 and July 2018 in 3 ambulance services and 15 hospitals. Clusters were paramedics based within ambulance stations prerandomized to PASTA or standard care. Patients attended by study paramedics were enrolled after admission if a hospital specialist confirmed a stroke and paramedic assessment started within 4 hours of onset. Allocation to PASTA or standard care reflected the attending paramedic's randomization status. Interventions: The PASTA intervention included additional prehospital information collection, a structured hospital handover, practical assistance up to 15 minutes after handover, a predeparture care checklist, and clinician feedback. Standard care reflected national guidelines. Main Outcomes and Measures: Primary outcome was the proportion of patients receiving thrombolysis. Secondary outcomes included time intervals and day 90 health (with poor status defined as a modified Rankin Score >2, to represent dependency or death). Results: A total of 11 478 patients were screened following ambulance transportation; 1391 were eligible and approached, but 177 did not consent. Of 1214 patients enrolled (mean [SD] age, 74.7 [13.2] years; 590 women [48.6%]), 500 were assessed by 242 paramedics trained in the PASTA intervention and 714 were assessed by 355 paramedics continuing with standard care. The paramedics trained in the PASTA intervention took a mean of 13.4 (95% CI, 9.4-17.4) minutes longer (P < .001) to complete patient care episodes. There was less thrombolysis among the patients in the PASTA group, but this was not significant (PASTA group, 197 of 500 patients [39.4%] vs the standard care group, 319 of 714 patients [44.7%]; adjusted odds ratio, 0.81 [95% CI, 0.61-1.08]; P = .15). Time from a paramedic on scene to thrombolysis was a mean of 8.5 minutes longer in the PASTA group (98.1 [37.6] minutes) vs the standard care group (89.4 [31.1] minutes; P = .01). Poor health outcomes did not differ significantly but occurred less often among patients in the PASTA group (313 of 489 patients [64.0%]) vs the standard care group (461 of 690 patients [66.8%]; adjusted odds ratio, 0.86 [95% CI, 0.60-1.20]; P = .39). Conclusions and Relevance: An enhanced paramedic assessment did not facilitate thrombolysis delivery. The unexpected combination of thrombolysis and health outcomes suggests possible alternative influences on treatment decisions by the intervention, requiring further evaluation. Trial Registration: ISRCTN Registry Identifier: ISRCTN12418919.

Sensitive high-throughput single-cell RNA-seq reveals within-clonal transcript correlations in yeast populations.

Single-cell RNA sequencing has revealed extensive cellular heterogeneity within many organisms, but few methods have been developed for microbial clonal populations. The yeast genome displays unusually dense transcript spacing, with interleaved and overlapping transcription from both strands, resulting in a minuscule but complex pool of RNA that is protected by a resilient cell wall. Here, we have developed a sensitive, scalable and inexpensive yeast single-cell RNA-seq (yscRNA-seq) method that digitally counts transcript start sites in a strand- and isoform-specific manner. YscRNA-seq detects the expression of low-abundance, noncoding RNAs and at least half of the protein-coding genome in each cell. In clonal cells, we observed a negative correlation for the expression of sense-antisense pairs, whereas paralogs and divergent transcripts co-expressed. By combining yscRNA-seq with index sorting, we uncovered a linear relationship between cell size and RNA content. Although we detected an average of ~3.5 molecules per gene, the number of expressed isoforms is restricted at the single-cell level. Remarkably, the expression of metabolic genes is highly variable, whereas their stochastic expression primes cells for increased fitness towards the corresponding environmental challenge. These findings suggest that functional transcript diversity acts as a mechanism that provides a selective advantage to individual cells within otherwise transcriptionally heterogeneous populations.

Paramedic Acute Stroke Treatment Assessment (PASTA): study protocol for a randomised controlled trial.

BACKGROUND: Despite evidence from clinical trials that intravenous (IV) thrombolysis is a cost-effective treatment for selected acute ischaemic stroke patients, there remain large variations in the rate of IV thrombolysis delivery between stroke services. This study is evaluating whether an enhanced care pathway delivered by paramedics (the Paramedic Acute Stroke Treatment Assessment (PASTA)) could increase the number of patients who receive IV thrombolysis treatment. METHODS: Study design: Cluster randomised trial with economic analysis and parallel process evaluation. SETTING: National Health Service ambulance services, emergency departments and hyper-acute stroke units within three geographical regions of England and Wales. Randomisation: Ambulance stations within each region are the units of randomisation. According to station allocation, paramedics based at a station deliver the PASTA pathway (intervention) or continue with standard stroke care (control). Study intervention: The PASTA pathway includes structured pre-hospital information collection, prompted pre-notification, structured handover of information in hospital and assistance with simple tasks during the initial hospital assessment. Study-trained intervention group paramedics deliver this pathway to adults within 4 h of suspected stroke onset. Study control: Standard stroke care according to national and local guidelines for the pre-hospital and hospital assessment of suspected stroke. PARTICIPANTS: Participants enrolled in the study are adults with confirmed stroke who were assessed by a study paramedic within 4 h of symptom onset. PRIMARY OUTCOME: Proportion of participants receiving IV thrombolysis. SAMPLE SIZE: 1297 participants provide 90% power to detect a 10% difference in the proportion of patients receiving IV thrombolysis. DISCUSSION: The results from this trial will determine whether an enhanced care pathway delivered by paramedics can increase thrombolysis delivery rates. TRIAL REGISTRATION: ISRCTN registry, ISRCTN12418919 . Registered on 5 November 2015.

Pyrosynthesis of Na3 V2 (PO4 )3 @C Cathodes for Safe and Low-Cost Aqueous Hybrid Batteries.

Rechargeable hybrid aqueous batteries (ReHABs) have emerged as promising sustainable energy-storage devices because all components are environmentally benign and abundant. In this study, a carbon-wrapped sponge-like Na3 V2 (PO4 )3 nanoparticle (NVP@C) cathode is prepared by a simple pyrosynthesis for use in the ReHAB system with impressive rate capability and high cyclability. A high-resolution X-ray diffraction study confirmed the formation of pure Na ion superionic conductor (NASICON) NVP with rhombohedral structure. When tested in the ReHAB system, the NVP@C demonstrated high rate capability (66 mAh g-1 at 32 C) and remarkable cyclability over 1000 cycles (about 72 % of the initial capacity is retained at 30 C). Structural transformation and oxidation change studies of the electrode evaluated by using in situ synchrotron X-ray diffraction and ex situ X-ray photoelectron spectroscopy, respectively, confirmed the high reversibility of the NVP@C electrode in the ReHAB system through a two-phase reaction. The combined strategy of nanosizing and carbon-wrapping in the NVP particles is responsible for the remarkable electrochemical properties. The pyrosynthesis technique appears to be a promising and feasible approach to prepare a high-performance electrode for safe and low-cost ReHAB systems as nextgeneration large-scale energy storage devices.

Health risk assessment of trace elements via dietary intake of 'non-piscine protein source' foodstuffs (meat, milk and egg) in Bangladesh.

Concentrations of six trace elements [chromium (Cr), nickel (Ni), copper (Cu), cadmium (Cd), lead (Pb) and arsenic (As)] were assessed in 'non-piscine protein source' foodstuffs (meat, milk and eggs) to evaluate contamination level and human health risks in Bangladesh. The range of Cr, Ni, Cu, Cd, Pb and As in the investigated foodstuffs was 1.24-2.17, 1.29-2.56, 0.92-2.31, 0.12-0.44, 0.15-0.48 and 0.14-0.57 mg kg fresh weight(-1), respectively. The estimated mean levels of most of the elements were higher than the maximum allowable concentration (MAC) for dietary foods. The estimated daily intakes (EDIs) of Cr and Cd were higher than the maximum tolerable daily intake (MTDI) for children, indicating that they are more susceptible to toxic elements through food consumption. The target hazard quotients (THQs) and target carcinogenic risk (TCR) of As (THQ > 1 and TCR > 10(-4)) for both the adults and children suggest that the consumers of non-piscine foodstuffs (especially cow milk and chicken meat) are exposed chronically to metal pollution with carcinogenic and non-carcinogenic health consequences.

A comprehensive assessment of arsenic in commonly consumed foodstuffs to evaluate the potential health risk in Bangladesh.

Arsenic (As), particularly of its inorganic form (iAs) is highly toxic, and its presence in food composites is a matter of concern for the public health safety, specifically in Bangladesh which is regarded as the most arsenic affected country throughout the world. This study was carried out to investigate the levels of As in the composite samples of commonly consumed foodstuffs collected from 30 different agro-ecological zones for the first time in Bangladesh. Most of the individual food composites contain a considerable amount of As which was, as a whole, in the range of 0.077-1.5mg/kg fw which was lower than those reported from Spain, EU, France, Korea, whereas higher than those of Mexico, Chile, Japan, Cambodia, Hong Kong, Serbia, respectively. Cereals, vegetables, milk, and fish contribute about 90% to the daily intake of inorganic arsenic. Human health risk of dietary iAs was assessed separately for both the rural and urban adults. The estimated daily dietary intakes (EDI) of iAs for the exposed rural (3.5) and urban residents (3.2 µg/kg-BW/day) clearly exceeded the previous provisional tolerable daily intake (PTDI) value of 2.1 µg/kg-BW/day, recommended by the World Health Organization (WHO). From the health point of view, this study concluded that both the rural and urban residents of Bangladesh are exposed to carcinogenic and non-carcinogenic risks who consume As-contaminated water and foodstuffs.