Wildfire Ashes from the Wildland-Urban Interface Alter Vibrio vulnificus Growth and Gene Expression.

Climate change-induced stressors are contributing to the emergence of infectious diseases, including those caused by marine bacterial pathogens such as Vibrio spp. These stressors alter Vibrio temporal and geographical distribution, resulting in increased spread, exposure, and infection rates, thus facilitating greater Vibrio-human interactions. Concurrently, wildfires are increasing in size, severity, frequency, and spread in the built environment due to climate change, resulting in the emission of contaminants of emerging concern. This study aimed to understand the potential effects of urban interface wildfire ashes on Vibrio vulnificus (V. vulnificus) growth and gene expression using transcriptomic approaches. V. vulnificus was exposed to structural and vegetation ashes and analyzed to identify differentially expressed genes using the HTSeq-DESeq2 strategy. Exposure to wildfire ash altered V. vulnificus growth and gene expression, depending on the trace metal composition of the ash. The high Fe content of the vegetation ash enhanced bacterial growth, while the high Cu, As, and Cr content of the structural ash suppressed growth. Additionally, the overall pattern of upregulated genes and pathways suggests increased virulence potential due to the selection of metal- and antibiotic-resistant strains. Therefore, mixed fire ashes transported and deposited into coastal zones may lead to the selection of environmental reservoirs of Vibrio strains with enhanced antibiotic resistance profiles, increasing public health risk.

Physicochemical Characterization of the Particulate Matter in New Jersey/New York City Area, Resulting from the Canadian Quebec Wildfires in June 2023.

The global increase in wildfires, primarily driven by climate change, significantly affects air quality and health. Wildfire-emitted particulate matter (WFPM) is linked to adverse health effects, yet the toxicological mechanisms are not fully understood given its physicochemical complexity and the lack of spatiotemporal exposure data. This study focuses on the physicochemical characterization of WFPM from a Canadian wildfire in June 2023, which affected over 100 million people in the US Northeast, particularly around New Jersey/New York. Aerosol systems were deployed to characterize WFPM during the 3 day event, revealing unprecedented mass concentrations mainly in the WFPM0.1 and WFPM0.1-2.5 size fractions. Peak WFPM2.5 concentrations reached 317 µg/m3, nearly 10 times the National Ambient Air Quality Standard (NAAQS) 24 h average limit. Chemical analysis showed a high organic-to-total carbon ratio (96%), consistent with brown carbon wildfires nanoparticles. Large concentrations of high-molecular-weight PAHs were found predominantly bound to WFPM0.1, with retene, a molecular marker of biomass burning and a known teratogen, being the most abundant (>70%). Computational modeling estimated a total lung deposition of 9.15 mg over 72 h, highlighting the health risks of WFPM, particularly due to its long-distance travel capability and impact on densely populated areas.

FedSepsis: A Federated Multi-Modal Deep Learning-Based Internet of Medical Things Application for Early Detection of Sepsis from Electronic Health Records Using Raspberry Pi and Jetson Nano Devices.

The concept of the Internet of Medical Things brings a promising option to utilize various electronic health records stored in different medical devices and servers to create practical but secure clinical decision support systems. To achieve such a system, we need to focus on several aspects, most notably the usability aspect of deploying it using low-end devices. This study introduces one such application, namely FedSepsis, for the early detection of sepsis using electronic health records. We incorporate several cutting-edge deep learning techniques for the prediction and natural-language processing tasks. We also explore the multimodality aspect for the better use of electronic health records. A secure distributed machine learning mechanism is essential to building such a practical internet of medical things application. To address this, we analyze two federated learning techniques. Moreover, we use two different kinds of low-computational edge devices, namely Raspberry Pi and Jetson Nano, to address the challenges of using such a system in a practical setting and report the comparisons. We report several critical system-level information about the devices, namely CPU utilization, disk utilization, process CPU threads in use, process memory in use (non-swap), process memory available (non-swap), system memory utilization, temperature, and network traffic. We publish the prediction results with the evaluation metrics area under the receiver operating characteristic curve, the area under the precision-recall curve, and the earliness to predict sepsis in hours. Our results show that the performance is satisfactory, and with a moderate amount of devices, the federated learning setting results are similar to the single server-centric setting. Multimodality provides the best results compared to any single modality in the input features obtained from the electronic health records. Generative adversarial neural networks provide a clear superiority in handling the sparsity of electronic health records. Multimodality with the generative adversarial neural networks provides the best result: the area under the precision-recall curve is 96.55%, the area under the receiver operating characteristic curve is 99.35%, and earliness is 4.56 h. FedSepsis suggests that incorporating such a concept together with low-end computational devices could be beneficial for all the medical sector stakeholders and should be explored further.

Evaluation of a menstrual hygiene intervention in urban and rural schools in Bangladesh: a pilot study.

Girls' menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance.We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs- reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers' training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression.The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: - 12%; 95% CI: - 22, - 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline (p < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline (p < 0.001). Self-reported absences decreased slightly (PD: - 8%; 95% CI: - 14, - 2).Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.

Federated Semi-Supervised Multi-Task Learning to Detect COVID-19 and Lungs Segmentation Marking Using Chest Radiography Images and Raspberry Pi Devices: An Internet of Medical Things Application.

Internet of Medical Things (IoMT) provides an excellent opportunity to investigate better automatic medical decision support tools with the effective integration of various medical equipment and associated data. This study explores two such medical decision-making tasks, namely COVID-19 detection and lung area segmentation detection, using chest radiography images. We also explore different cutting-edge machine learning techniques, such as federated learning, semi-supervised learning, transfer learning, and multi-task learning to explore the issue. To analyze the applicability of computationally less capable edge devices in the IoMT system, we report the results using Raspberry Pi devices as accuracy, precision, recall, Fscore for COVID-19 detection, and average dice score for lung segmentation detection tasks. We also publish the results obtained through server-centric simulation for comparison. The results show that Raspberry Pi-centric devices provide better performance in lung segmentation detection, and server-centric experiments provide better results in COVID-19 detection. We also discuss the IoMT application-centric settings, utilizing medical data and decision support systems, and posit that such a system could benefit all the stakeholders in the IoMT domain.

Venous thromboembolism rates after hip and knee arthroplasty and hip fractures.

BACKGROUND: The ideal thromboprophylaxis regime following lower limb arthroplasty and proximal femur fractures remains controversial. Guidelines disagree on the type of chemical prophylaxis, its dose or duration. This article describes a method of monitoring venous thromboembolism (VTE) rates following Total Hip (THA), Total Knee Arthroplasty (TKA) and surgery for hip fractures (NOF#). METHODS: Over 3 years, all patients investigated for VTE were analysed using Picture Archiving Communications System (PACS). All positive scans were then cross-referenced using PACS and local registry data to see if they had undergone THA, TKA or NOF# in the preceding 90 days. Mortality data were obtained from the national administrative database, Hospital Episode Statistics. RESULTS: Five thousand seven hundred eighty-eight patients underwent investigation for VTE and there were 29 diagnoses of PE and 24 of DVT. There was a 0.77% rate of symptomatic DVT after THA, 0.05% after TKA and 0.55% after NOF #. The rate of confirmed symptomatic PE for THA was 0.46, 0.27% for TKA and 0.96% for NOF #. Mortality at one-year post-THA was 0.6, 0.6% for TKA and 25.9% after NOF#. All patients contacted either remained within the catchment area for the minimum 90 postoperative days or died within the catchment area. CONCLUSIONS: The 90 day post-operative prevalence of symptomatic VTE of 1.2, 0.3 and 1.5% in THA, TKA and NOF # respectively are similar to other studies using symptomatic and imaging positive VTE as their endpoint. The study uses a method of collecting data which can be utilised in centres where PACS is available.

Highly Diastereoselective Synthesis of a HCV NS5B Nucleoside Polymerase Inhibitor.

An asymmetric synthesis of HCV NS5B nucleoside polymerase inhibitor (1) is described. This novel route features several remarkably diastereoselective and high-yielding transformations, including construction of the all-carbon quaternary stereogenic center at C-2 via a thermodynamic aldol reaction. A subsequent glycosylation reaction with activated uracil via C-1 phosphate and installation of the cyclic phosphate group using an achiral phosphorus(III) reagent followed by oxidation provides 1.

If I do not have enough water, then how could I bring additional water for toilet cleaning?! Addressing water scarcity to promote hygienic use of shared toilets in Dhaka, Bangladesh.

OBJECTIVES: Provision of toilets is necessary but not sufficient to impact health as poor maintenance may impair toilet function and discourage their consistent use. Water in urban slums is both scarce and a prerequisite for toilet maintenance behaviours. We describe the development of behaviour change communications and selection of low-cost water storage hardware to facilitate adequate flushing among users of shared toilets. METHODS: We conducted nine focus group discussions and six ranking exercises with adult users of shared toilets (50 females, 35 males), then designed and implemented three pilot interventions to facilitate regular flushing and improve hygienic conditions of shared toilets. We conducted follow-up assessments 1 and 2 months post-pilot including nine in-depth interviews and three focus group discussions with adult residents (23 females, 15 males) and three landlords in the pilot communities. RESULTS: Periodic water scarcity was common in the study communities. Residents felt embarrassed to carry water for flushing. Reserving water adjacent to the shared toilet enabled slum residents to flush regularly. Signs depicting rules for toilet use empowered residents and landlords to communicate these expectations for flushing to transient tenants. Residents in the pilot reported improvements in cleanliness and reduced odour inside toilet cubicles. CONCLUSIONS: Our pilot demonstrates the potential efficacy of low-cost water storage and behaviour change communications to improve maintenance of and user satisfaction with shared toilets in urban slum settings.

Behaviour change intervention to improve shared toilet maintenance and cleanliness in urban slums of Dhaka: a cluster-randomised controlled trial.

OBJECTIVES: Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toilet cleanliness. METHODS: We conducted a cluster-randomised controlled trial among users of 1226 shared toilets in 23 Dhaka slums. We assessed baseline toilet cleanliness in January 2015. The six-month intervention included provision of hardware (bin for solid waste, 4 l flushing bucket, 70 l water reservoir), and behaviour change communication (compound meetings, interpersonal household sessions, signs depicting rules for toilet use). We estimated the adjusted difference in difference (DID) to assess outcomes and accounted for clustering effects using generalised estimating equations. RESULTS: Compared to controls, intervention toilets were more likely to have water available inside toilet cubicles (DID: +4.7%, 95% CI: 0.2, 9.2), access to brush/broom for cleaning (DID: +8.4%, 95% CI: 2, 15) and waste bins (DID: +63%, 95% CI: 59, 66), while less likely to have visible faeces inside the pan (DID: -13%, 95% CI: -19, -5), the smell of faeces (DID: -7.6%, 95% CI: -14, -1.3) and household waste inside the cubicle (DID: -4%, 95% CI: -7, -1). CONCLUSIONS: In one of few efforts to promote shared toilet cleanliness, intervention compounds were significantly more likely to have cleaner toilets after six months. Future research might explore how residents can self-finance toilet maintenance, or employ mass media to reduce per-capita costs of behaviour change.

A training tool to assess laparoscopic image navigation task performance in novice camera assistants.

BACKGROUND: A number of tools for assessing task performance of the laparoscopic camera assistant have been described, but few focus on the acquisition and assessment of the attainment of proficiency in novice laparoscopic camera assistants. Our aim was to develop a simulated objective assessment tool for a novice camera assistant. MATERIALS AND METHODS: A 10-cycle image navigation task tool was developed. This involved a series of 360° clockwise and anticlockwise rotation maneuvers of a 30° laparoscope along its shaft, focusing on a predefined geometric target on a 45° fixed slope in a laparoscopic box trainer. The tasks were to simultaneously maintain neutral horizon, optimum distance, and centering. Task accuracy and time to completion were assessed objectively at 3-s intervals on an unedited video recording. RESULTS: Twenty-nine novice medical students were assessed. Novices improved mean total error and task completion time (first versus fifth cycle, mean errors 15.4 versus 8.4, P = 0.048; mean task time 158.1 versus 92.9 s, P = 0.04). This improvement continued until the task cycle was completed (sixth versus 10th cycles, 7.9 versus 6.2, P = 0.01; 91.9 versus 76.6 s, P < 0.0001). There was a significant decrease in centering errors (5.2 versus 2.4, P = 0.001) and horizon (4.8 versus 2.3, P = 0.004), when comparing the first versus fifth task cycle. It took six cycles for optimum distance to achieve significance (5.4 versus 3.3, P = 0.023). CONCLUSIONS: Using our assessment tool, novices achieved an objective proficiency-gain curve for laparoscopic camera navigation tasks. There was improvement in errors related to maintaining horizon, optimum distance, and centering. Mean task completion time also decreased. This tool could be used as an additional mean of assessment and training in novice surgical trainees.

Piloting a low-cost hardware intervention to reduce improper disposal of solid waste in communal toilets in low-income settlements in Dhaka, Bangladesh.

BACKGROUND: Bangladesh faces daunting challenges in addressing the sanitation needs of its urban poor. Maintaining the cleanliness and functionality of communal toilets is dependent upon periodic emptying of fecal sludge, and cooperation between users of communal toilets. Trash disposal into latrines can block the outflow pipes, rendering the toilets non-functional. METHODS: Pre-intervention: We conducted in-depth interviews with five operators of fecal sludge emptying equipment and five adult residents who were also caregivers of children. We identified factors contributing to improper disposal of trash into communal toilets, a barrier to operation of the equipment, in low-income communities of Dhaka, Bangladesh. Intervention design: We developed behavior change communication materials to discourage waste disposal in toilets, and promote use of waste bins. We conducted six focus group discussions with adult male, female, landlord and children to select the preferred design for waste bins to be placed inside toilets, and finalize communication materials. Post-intervention: We then pilot-tested an intervention package to promote appropriate trash disposal practices and thus facilitate periodic removal of fecal sludge when the latrine pits become full. We conducted 20 in-depth interviews and four focus group discussions with community residents, landlords and cleaners of communal toilets. RESULTS: Barriers to appropriate waste disposal included lack of private location for disposal of menstrual hygiene products, limited options for formal trash collection and disposal, and the use of plastic bags for disposing children's feces. A pilot intervention including behavior change communication and trash bins was implemented in two urban slum communities. Spot checks confirmed that the bins were in place and used. Respondents described positive improvements in the appearance of the toilet and surrounding environment. CONCLUSION: The current practice on the part of local residents of disposing of waste into toilets impedes the safe removal of fecal sludge and impairs toilet functionality. Residents reported positive changes in toilet cleanliness and usability resulting from this intervention, and this both improves the user experience with toilets, and also promotes the sustainability of the entrepreneurial model of Vacutug operators supported by WSUP.

It's not only what you say, it's also how you say it: communicating nipah virus prevention messages during an outbreak in Bangladesh.

BACKGROUND: During a fatal Nipah virus (NiV) outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak. METHODS: We explored residents' beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person. RESULTS: The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients. CONCLUSIONS: During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations.

A comprehensive review on the fate and impact of antibiotic residues in the environment and public health: A special focus on the developing countries.

The widespread application of antibiotics in human and veterinary medicine has led to the pervasive presence of antibiotic residues in the environment, posing a potential hazard to public health. This comprehensive review aims to scrutinize the fate and impact of antibiotic residues, with a particular focus on the context of developing nations. The investigation delves into the diverse pathways facilitating the entry of antibiotics into the environment and meticulously examines their effects on human health. The review delineates the current state of antibiotic residues, evaluates their exposure in developing nations, and elucidates existing removal methodologies. Additionally, it probes into the factors contributing to the endurance and ecotoxicity of antibiotic residues, correlating these aspects with usage rates and associated mortalities in these nations. The study also investigates removal techniques for antibiotic residues, assessing their efficiency in environmental compartments. The concurrent emergence of antibiotic-resistant bacteria, engendered by antibiotic residues, and their adverse ecological threats underscore the necessity for enhanced regulations, vigilant surveillance programs, and the adoption of sustainable alternatives. The review underlines the pivotal role of public education and awareness campaigns in promoting responsible antibiotic use. The synthesis concludes with strategic recommendations, strengthening the imperative for further research encompassing comprehensive monitoring, ecotoxicological effects, alternative strategies, socio-economic considerations, and international collaborations, all aimed at mitigating the detrimental effects of antibiotic residues on human health and the environment. PRACTITIONER POINTS: Antibiotic residues are widely distributed in different environmental compartments. Developing countries use more antibiotics than developed countries. Human and veterinary wastes are one of the most responsible sources of antibiotic pollution. Antibiotics interact with biological systems and trigger pharmacological reactions at low doses. Antibiotics can be removed using modern biological, chemical, and physical-chemical techniques.

Experiences of children's self-wetting (including urinary incontinence) in Cox's Bazar's Rohingya refugee camps, Bangladesh.

Self-wetting is the leakage of urine, either due to the medical condition of urinary incontinence (UI), or because a person does not want to, or cannot, access a toileting facility in time. This study explored the attitudes towards self-wetting and experiences of children (aged five to 11), their caregivers, community leaders and humanitarian practitioners in the Rohingya refugee camps in Cox's Bazar, Bangladesh. We particularly focused on how water, sanitation and hygiene (WASH) and protection interventions might assist in improving these experiences. We purposively selected participants from two camps where our partner organisation works. We conducted Key Informant Interviews (KIIs) with community leaders and camp officials, Story Book (SB) sessions with Rohingya children and in-depth Interviews (IDIs) with caregivers of children who participated in the SB sessions, as well as surveying communal toilets. Self-wetting by children was common and resulted in them feeling embarrassed, upset and uncomfortable, and frightened to use the toilet at night; many children also indicated that they would be punished by their caregivers for self-wetting. Key informants indicated that caregivers have difficulty handling children's self-wetting due to a limited amount of clothing, pillows, and blankets, and difficulty cleaning these items. It was evident that the available toilets are often not appropriate and/or accessible for children. Children in the Rohingya camps appear to self-wet due to both the medical condition of UI and because the sanitation facilities are inappropriate. They are teased by their peers and punished by their caregivers. Although WASH and protection practitioners are unable to drastically alter camp conditions or treat UI, the lives of children who self-wet in these camps could likely be improved by increasing awareness on self-wetting to decrease stigma and ease the concerns of caregivers, increasing the number of child-friendly toilets and increasing the provision of continence management materials.

Evaluation of occupational health and safety intervention for the waste and sanitation workers in Bangladesh during COVID-19.

Waste and sanitation workers in South-Asian countries are vulnerable to injuries and diseases, including COVID-19. In Bangladesh, an intervention was implemented during COVID-19 to lower these workers' occupational health risks through training and PPE distribution. We assessed how the intervention affected their occupational health behaviors using a randomized cluster trial in 10 Bangladeshi cities, including seven intervention and three control areas. We conducted 499 surveys (Control-152, Intervention-347) and 47 structured observations (Control:15, Intervention:32) at baseline and 499 surveys (Control:150, Intervention:349) and 50 structured observations (Control:15, Intervention:35) at endline. To evaluate the impact of intervention at the endline, we used the difference in difference (DID) method. Compared to control, workers from intervention areas were more likely to have increased knowledge of using/maintaining PPEs (adjusted DID: 21%, CI: 8, 33), major COVID-19 transmission causes (adjusted DID: 27%, CI: 14, 40), and preventive measures (adjusted DID: 12%, CI: -0.6, 25), and improved attitude about using PPEs (adjusted DID: 36%, CI: 22, 49), washing PPEs (adjusted DID: 20%, CI: 8, 32). The intervention was more likely to improve workers' self-reported practice of taking adequate precautions after getting back from work (adjusted DID: 37%, CI: 27, 47) and changing/cleaning masks every day (adjusted DID: 47%, CI: 0.03, 94), and observed practices of maintaining coughing etiquette (DID: 20%, CI: 0.2, 40) at workplace and handwashing before wearing PPEs (DID: 27%, CI: 2, 52), after finishing work (DID: 31%, CI: -7, 69) & during work intervals (DID: 30%, CI: -33, 93). There was not much improvement in observed practices of mask use (DID: 1%, CI: -40, 42), handwashing before meals (DID: 2%, CI: -61, 65), and after toilet (DID: 7%, CI: -41, 55). This intervention has improved the knowledge, attitude and practice of the workers about critical occupational risk mitigation, which may be replicated in similar settings. Future interventions need to address occupational health-related injuries and health complications, introduce regular health checkups/insurance for the workers, create a balance between the quality and comfort of the PPEs and ensure a mechanism to ensure a regular supply of PPEs.

Institutional capacity assessment in the lens of implementation research: Capacity of the local institutions in delivering WASH services at Cox's Bazar district, Bangladesh.

BACKGROUND: The influx of Forcibly Displaced Myanmar Nationals (FDMNs) has left the Southwest coastal district of Cox's Bazar with one of the greatest contemporary humanitarian crises, stressing the existing water, sanitation, and hygiene (WASH) resources and services. This study aimed to assess the existing capacity of local institutions involved in delivering WASH services and identify relevant recommendations for intervention strategies. METHODS: We used a qualitative approach, including interviews and capacity assessment workshops with institutions engaged in WASH service delivery. We conducted five key informant interviews (KII) with sub-district level officials of the Department of Public Health Engineering (DPHE), Directorate General of Health Services (DGHS), Directorate of Primary Education (DPE) and Bangladesh Rural Advancement Committee (BRAC) to have a general idea of WASH service mechanisms. Seven capacity assessment workshops were organized with the relevant district and sub-district level stakeholders from August 2019 to September 2019. These workshops followed three key areas: i) knowledge of policy, organizational strategy, guidelines, and framework; ii) institutional arrangements for service delivery such as planning, implementation, coordination, monitoring, and reporting; and iii) availability and management of human, financial and infrastructural resources. Data were categorized using thematic content analysis. RESULTS: The majority of stakeholders lacked awareness of national WASH policies. Furthermore, the top-down planning approaches resulted in activities that were not context-specific, and lack of coordination between multiple institutions compromised the optimal WASH service delivery at the local level. Shortage of human resources in delivering sustainable WASH services, inadequate supervision, and inadequate evaluation of activities also required further improvement, as identified by WASH stakeholders. CONCLUSION: Research evidence suggests that decision-makers, donors, and development partners should consider learning from the WASH implementers and stakeholders about their existing capacity, gaps, and opportunities before planning for any WASH intervention in any particular area.

Two decades of endemic dengue in Bangladesh (2000-2022): trends, seasonality, and impact of temperature and rainfall patterns on transmission dynamics.

The objectives of this study were to compare dengue virus (DENV) cases, deaths, case-fatality ratio [CFR], and meteorological parameters between the first and the recent decades of this century (2000-2010 vs. 2011-2022) and to describe the trends, seasonality, and impact of change of temperature and rainfall patterns on transmission dynamics of dengue in Bangladesh. For the period 2000-2022, dengue cases and death data from Bangladesh's Ministry of Health and Family Welfare's website, and meteorological data from the Bangladesh Meteorological Department were analyzed. A Poisson regression model was performed to identify the impact of meteorological parameters on the monthly dengue cases. A forecast of dengue cases was performed using an autoregressive integrated moving average model. Over the past 23 yr, a total of 244,246 dengue cases were reported including 849 deaths (CFR = 0.35%). The mean annual number of dengue cases increased 8 times during the second decade, with 2,216 cases during 2000-2010 vs. 18,321 cases during 2011-2022. The mean annual number of deaths doubled (21 vs. 46), but the overall CFR has decreased by one-third (0.69% vs. 0.23%). Concurrently, the annual mean temperature increased by 0.49 °C, and rainfall decreased by 314 mm with altered precipitation seasonality. Monthly mean temperature (Incidence risk ratio [IRR]: 1.26), first-lagged rainfall (IRR: 1.08), and second-lagged rainfall (IRR: 1.17) were significantly associated with monthly dengue cases. The increased local temperature and changes in rainfall seasonality might have contributed to the increased dengue cases in Bangladesh.

Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018.

BACKGROUND: The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh. OBJECTIVES: This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh. METHODS: We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes. RESULTS: Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time. CONCLUSION: This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.

Combined PCL and PLC reconstruction in chronic posterolateral instability.

PURPOSE: The posterolateral corner (PLC) is more likely to be injured in combination with the posterior cruciate ligament (PCL) or the anterior cruciate ligament than in isolation. This leads to instability of the knee and loss of function. We hypothesised that combined PCL and PLC reconstruction would restore sufficient stability to allow improvement in patient symptoms and function. METHODS: 19 patients who underwent arthroscopic-assisted single-bundle PCL and PLC reconstruction by a single surgeon were analysed retrospectively. The PLC reconstruction was a modified Larson reconstruction of the lateral collateral ligament and the popliteofibular ligament. The IKDC and Tegner scores were used to assess outcome. Dial test and varus laxity were used to assess improvements in clinical laxity. Posterior laxity was tested using the KT-1000. RESULTS: The mean follow-up was 38 months (±(2× standard deviations), ±12.3). There were no postoperative complications. All patients had less than 5 mm posterior step-off. 17 of 19 patients had negative dial and varus stress tests. Measured range of motion was reduced by a mean of 10°, but patients did not report any daily activities restrictions. Tegner scores improved from a median pre-operative value of 2 (range 1-4) to 6 (4-9) at final follow-up. The mean postoperative IKDC score was 86 (±11). CONCLUSIONS: Subjectively, the knee stability achieved allowed daily activities. However, there were remaining abnormalities in range of motion, posterior drawer and rotational laxity, suggesting that normal knee laxity was not restored. LEVEL OF EVIDENCE: IV.

Performance Analysis of an α-Graphyne Nano-Field Effect Transistor.

Graphyne has attractive electronic properties that make it a possible replacement of silicon in FET technology. In FET technology, the goal is to achieve low power dissipation and lower subthreshold swing. In this study, we focused on achieving these goals and studied the electronic properties of α-graphyne nanoribbons. We simulated the transfer and output characteristics of an α-graphyne ballistic nanoribbon FET. We used the tight-binding model with nearest-neighbor approximation to obtain the band structure which gives the same band structure as the one found from the DFT. In order to simulate the I-V characteristics of the transistor we used the non-equilibrium Green's function (NEGF) formalism. The results show that the modeled FET can provide a high Ion/Ioff ratio and low subthreshold swing. We also studied the effects of defects as defects cannot be avoided in any practical device. The study shows that the Ion/Ioff ratio and subthreshold swing improves as defects are added, but the delay time and dynamic power dissipation worsen.