Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results.

BACKGROUND: World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS: We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS: At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS: These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).

Improving mental health literacy among young people aged 11-15 years in Java, Indonesia: co-development and feasibility testing of a culturally-appropriate, user-centred resource (IMPeTUs) - a study protocol.

BACKGROUND: Depression and anxiety are two of the leading causes of disease burden in low-to-middle income coutnries. The World Health Organisation has engaged in a programme of scaling-up mental health services, but significant challenges remain. Improving mental health literacy in children and young people, a core part of recent, global health strategies has the potential to address some of these challenges. The study aims to co-develop and feasibility test, a culturally-appropriate toolkit to promote depression and anxiety focused mental health literacy and self-management skills in Indonesia, for children aged 11-15 years. METHODS: A mixed methods study comprising four phases. Through a systematic review of existing evidence, phase 1 will review approaches to improve mental health literacy and self-management in South East Asia and critically review current evidence regarding intervention effect. Phase 2 will explore stakeholders' views on depression, anxiety and mental health more broadly and identify priorities for the intervention through the use of semi-structured interviews and/or focus groups with policy makers, clinicians, teachers, adolescent service users, carers and young people aged 11-15. Phase 3 will comprise iterative workshops with local stakeholders to present our findings and co-produce a testable, culturally appropriate toolkit to promote mental health literacy and depression/anxiety focused self-management in 11-15 year olds in Java, Indonesia. Phase 4 comprises feasibility evaluation of our developed intervention via nine in-depth case studies (Jakarta, Bogor and Magelang). We will examine the impact, acceptability and feasibility of our prototype intervention and produce evidence-based guidelines for wider implementation. DISCUSSION: Tools to support mental health literacy and self-management are a low cost way in which mental health services in LMICs can attempt to address the burden of anxiety and depression amongst children and young people. However, this is an underexplored area in Indonesia. Working closely with local stakeholders, this study will design and undertake feasibility evaluation of co-produced mental health literacy and anxiety and depression focussed interactive self-management tools. This abstract has also been published on the funders website (UK Research and Innovation. Improving Mental Health Literacy Among Young People aged 12-15 years in Indonesia 2019).

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia.

BACKGROUND: The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). METHODS: This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. RESULTS: Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. CONCLUSION: The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Characteristics of Bulletproof Vests Made from COPEFB Fiber: Implications on Mechanical, Electrical, and Physical Resistance.

This research aims to examine the characteristics of bulletproof vests from corncob oil palm empty fruit bunch (COPEFB) biocomposite, where mechanical, electrical, and physical resistance tests have been successfully conducted. The variations in the diameter of the twisted thread used to make the basic material for bulletproof vests include 1 mm, 3 mm, 6 mm, and 10 mm, which were tested for their mechanical, electrical, and physical properties. To identify which biocomposite is good at damping bullets, an impact and a firing test were carried out to determine the kinetic energy and the depth of the bullet, respectively. The results showed that the impact value improved with an increase in the diameter of the twisted yarn used. The largest and the lowest impact values were 1.157 kJ and 0.277 kJ on the epoxy sample with a twisted thread diameter of 10 mm and 1 mm, respectively. It was also discovered that the biocomposite samples made from 6 mm to 10 mm twisted threads were the best samples, impermeable to bullets. This was due to the excess natural fiber content which improved the flexibility and absorption of kinetic energy from the high rate of projectile bullets. According to the results of the firing test, some samples are translucent, while others cannot be penetrated by bullet projectiles. The projectile went inside, and the composite was damaged. All the high filler loading samples were translucent to bullets, while some of the low loading samples were translucent and impermeable to bullets. Based on these results, biocomposite samples made of 6 mm and 10 mm twisted yarn are the best samples that are impermeable to bullets.

Evaluating a prototype digital mental health literacy intervention for children and young people aged 11-15 in Java, Indonesia: a mixed methods, multi-site case study evaluation.

BACKGROUND: The Improving Mental Health Literacy Among Children and Young People in Indonesia (IMPeTUs) intervention is a co-produced, evidence-based digital intervention designed to improve anxiety and depression focused mental health literacy and self-management among people aged 11-15 in Java, Indonesia. This study aimed to evaluate the usability, feasibility and preliminary impact of our intervention. METHODS: Mixed methods, multi-site case studies based on a theory of change. Pre-and post-assessments of a range of outcomes and qualitative interviews/focus groups with children and young people (CYP), parents and facilitators. The intervention was implemented in 8 health, school and community sites across Java, Indonesia (Megelang, Jakarta and Bogor). Quantitative data designed to understand the impact of and feasibility of evaluating the intervention collected from 78 CYP who used the intervention were analysed descriptively. Qualitative data from interviews and focus groups collected from 56 CYP, 49 parents/caregivers and 18 facilitators were analysed using framework analysis. RESULTS: Qualitative data analysis indicated high levels of usability and acceptability for the interface aesthetic, personalisation, message presentation and navigation. Participants reported minimal burden and no negative outcomes associated with the intervention. CYP, parents and facilitators identified a range of direct and spill over effects of interventions engagement, some of which were not anticipated at study outset. Quantitative data highlighted the feasibility of intervention evaluation, with high levels of recruitment and retention across study time points. Minimal changes were identified in outcomes pre-to-post intervention, which may in part be due to a lack of scale relevance and/or sensitivity to the intervention mechanisms indicated in the qualitative data. CONCLUSIONS: Digital mental health literacy applications are potentially an acceptable and feasible way to prevent burdens of common mental health problems amongst CYP in Indonesia. Our intervention and evaluative processes will be further refined prior to definitive evaluation.

Electronic thygmonasty model inMimosa pudicabiomimetic robot.

Direct contact of random objects from the open environment to the panel surface of an electronic device may reduce the work efficiency and cause permanent damage. However, there is a possible way to solve this problem, notably by implementing an adaptive structure design inspired by plants. TheMimosa pudicaplant provides several interesting information on its adaptability. Various studies have been conducted on the electrical properties of its organs explaining the phytoactuator and phytosensor cells that function within it. We combined the use of sensors, actuators, and synthetic excitable tissue as the first robot model purposed to mimic the behavior of theM. pudicaplant. The Computer vision method was used to measure leaf angular movement and collected it as plant behavior data based on the mechanical stimulus experiment. The Robot structure has eight arms equipped with sensors, servo motors, and microcontrollers that are operated with two activation system models approach. The first model could imitate the stimulus process received by electronic circuits that generate action potential signals with a maximum voltage of 4.71-5.02 V and a minimum voltage of -5.33 to -3.45 V that propagated from node to node. The second model involves a trained artificial neural network model with a supervised learning pattern that provides 100% accuracy when choosing movement output based on the given combination. This robot imitates theM. pudica's intelligent sensing capabilities and its ability to change the structure shape based on the thygmonasty experiments data which could provide an overview of how plants process information and perform hazard avoidance actions efficiently. Future applications for the technology inspired by the plant's self-defense mechanisms are adaptive intelligent structures that can protect against harmful conditions, particle contamination, and adjusting panel structure to search for desired environmental parameters.

Oil Palm Empty Fruit Bunches as Raw Material of Dissolving Pulp for Viscose Rayon Fiber in Making Textile Products.

The creative fashion industry produces several textile products that play an important role in the national economy. In various countries, this industry has continued to grow along with the strong flow of information technology and e-commerce. The development of textile products for fashion is very dynamic and competitive. Competition is not only about price, but also the quality of organic/synthetic materials, the comfort provided, and designs that change every 4−6 months. Recently, creative fashion not only relies on natural and synthetic polymer-made fibers but also biomass-based waste materials. Therefore, this study aims to manufacture textile products from biomass-based waste materials that can be applied to the creative fashion industry. Two types of raw materials from oil palm empty fruit bunches (EFB), namely, whole-empty fruit bunches (WEFB) and stalk-empty fruit bunches (SEFB), are used as an excellent innovation of rayon viscose fiber (RVF), a noncotton organic yarn capable of providing a solution to the 99% import of global cotton needs. This is expected to increase competitiveness, as well as the added value of palm oil products and their derivatives. The process of manufacturing DP chemically includes prehydrolysis, cooking, bleaching to dissolve the lignin and noncellulosic materials as well as isolation to purify POEFB fiber. Furthermore, DP testing is carried out to determine product quality and compare it with the national product standards. The results show that the alpha-cellulose content reaches >94% with variations in the active alkali of 18%, 20% and 24%. This implies that the WEFB and SEFB are used to fulfill the first requirements of the national standard (SNI 938:2017). The WEFB with an active alkali variation of 24% meets the SNI standard for rayon pulp with a value of S10 = 3.07 and S18 = 7.14%, while all variations of SEFB show opposite results. The use of active alkali at 24% had a brighter color than between 18% and 20%. Additionally, the fiber density of WEFB appears to be higher than that of SEFB. These results correlate positively with DP prepared using 24% alkali as the optimum treatment for all products, as well as the morphological observations performed with scanning electron microscopy (SEM), which shows that WEFB fixated fiber had a larger diameter than SEFB.

Comorbidity between depressive symptoms and chronic conditions - findings from the Indonesia Family Life Survey.

PURPOSE: To estimate the prevalence of symptoms of depression in the population, and to identify patient groups with a history of chronic conditions with the highest risks of comorbid depression. METHODS: Data were drawn from a population-representative sample of 31,447 participants in The Fifth Wave of the Indonesia Family Life Survey (IFLS5) conducted in 2014-15. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale-Revised (CES-D-R 10) that measures symptoms defined by the Diagnostic and Statistical Manual (DSM). Socio-demographic variables controlled for in the adjusted analysis included age, sex, education, and ethnicity. RESULTS: Weighted prevalence of depressive symptoms, above the CES-D-R 10 cut-off, was 22.6% (females=23.0%, males=22.2%). Among those with a chronic condition, the highest risk of comorbid symptoms of depression was observed in those with a memory-related disease (OR=2.64 [1.49-4.68]) or stroke (OR=2.39 [1.75-3.27]). Depressive symptoms were also more commonly reported among people with hypertension, tuberculosis, asthma, other lung conditions, heart problems, liver diseases, arthritis or rheumatism, kidney diseases, stomach or digestive diseases. CONCLUSIONS: Symptoms of depression are common in the general Indonesian population, and comorbidities are high in those with a history of chronic conditions, supporting the need for mental health care in patients presenting for physical diseases. Future research of clinical and patient samples will provide data in those who may be at increased risks.

Evaluating the acceptability of a co-produced and co-delivered mental health public engagement festival: Mental Health Matters, Jakarta, Indonesia.

BACKGROUND: Public engagement events are an important early strategy in developing a meaningful research agenda, which is more impactful and beneficial to the population. Evidence indicates the potential of such activities to promote mental health literacy. However, this has not yet been explored in Indonesia. AIM: This paper describes a mental health public engagement festival carried out in Indonesia in November 2018 and uses evaluation data to consider the acceptability and use of such activities in Indonesia in the future. METHOD: Evaluation data was collected from 324 of the 737 people who attended a six-day mental health festival comprising 18 events including public lectures, film screenings, arts activities, exercise classes and panel discussions. Attendees were asked to evaluate the festival in terms of its quality, benefits and areas for improvement. Descriptive statistics were used to analyse the evaluation data. 87 service users, carers, academics and professionals also engaged in a research prioritisation exercise to collaboratively determine mental health research priorities for Indonesia. RESULTS: Participants evaluated the festival extremely positively with a significant majority (92%) rating the quality of the festival as good or excellent. Attendees reported an increase in their understanding of mental health issues and identified intended behaviour change including an increased propensity for future engagement with mental health research. Key strengths of the festival included the central role of patients, carers and the local community in the design and delivery of the festival which promoted emotional engagement and development of shared understanding and the use of international experts which in attendees' opinion further enhanced the credibility of festival activities. CONCLUSION: This manuscript indicates that a co-produced mental health public engagement festival is a potentially acceptable way to increase awareness of mental health in Indonesian populations. Future festivals should be larger in scope and target men, older people and the general public to maximise benefit and incorporate rigorous evaluation of effectiveness.

Evaluation of the Performance of Helmet Prototypes Fabricated from Acrylonitrile Butadiene Styrene Composites Filled with Natural Resource.

The performance of helmet prototypes fabricated from acrylonitrile butadiene styrene composites filled with oil palm empty fruit bunch fibers was evaluated. The fibers were produced using a milling procedure, while the composites were fabricated using a single-screw extrusion. The physical characteristics of the produced fibers, which are water content, size, and density, were investigated. In addition, the mechanical properties of the produced helmets, including shock absorption, yield stress, frequency, and head injury criterion (HIC), were examined. The impact strength of the produced helmets increases with the rise of filler content. In addition, the helmets were also able to withstand a considerable pressure such that the transmitted pressure was far under the maximum value acceptable by the human skull. The present work also found that HICs exhibited by the investigated helmet prototypes fulfill all the practical guidelines as permitted by the Indonesian government. In terms of novelty, such innovation can be considered the first invention in Indonesia since the endorsement of the use of motorcycle helmets.

A comprehensive review of epilepsy in the Arab world.

PURPOSE: We conducted a comprehensive review of the epidemiology of epilepsy in the Arab world. METHODS: Epidemiological literature about epilepsy from 22 countries of the Arab League was searched in French and English using several keywords (specific and wider) and combinations, individually for each country. The search was conducted on Google first and then on PubMed. The results are presented as counts, proportions, and medians along with 95% confidence intervals (CI). Unpaired t-test with unequal variance and regressions were performed, altogether and individually, for lifetime and active epilepsy prevalence as well as incidence. RESULTS: Google provided 21 prevalence, four camp and nine incidence estimates while PubMed provided ten such estimates; none of them was identified by Google. No epidemiological data about epilepsy was found from 10/22 countries. Excluding pediatric studies, 13 prevalence estimates from six countries were identified. Including pediatric studies, 21 estimates from nine countries were found. Median lifetime and active epilepsy prevalence were 7.5/1000 (95% CI 2.6-12.3, range 1.9-12.9) and 4.4/1000 (95% CI 2.1-9.3, range 2.1-9.3), respectively, excluding pediatric studies (1984-2014, N=244081). Median incidence was 56.0/100,000 (n=9, N=122484, 95% CI 13.7-147.9, range 10.4-190). CONCLUSION: The fact that no epidemiological data about epilepsy is available in the public domain for almost one half of all Arab countries offers opportunities for future research. This thorough review of existing literature demonstrates a prevalence of epilepsy three times higher than previously reported for this region. The median incidence is similar to other regions of the world, e.g. North America. Google yielded additional valuable sources not indexed in PubMed and provided pertinent references more quickly.

Association of rs1344706 in the ZNF804A gene with schizophrenia in a case/control sample from Indonesia.

BACKGROUND: Association of rs1344706 in the ZNF804A gene (2q32.1) with schizophrenia was first reported in a genome wide scan conducted in a sample of 479 cases and replicated in 6666 cases. Subsequently, evidence by replication was obtained in several samples with European- and Asian ancestral background. METHODS: We report ascertainment, clinical characterization, quality control, and determination of ancestral background of a case control sample from Indonesia, comprising 1067 cases and 1111 ancestry matched controls. Genotyping was performed using a fluorescence-based allelic discrimination assay (TaqMan SNP genotyping assay) and a newly designed PCR-RFLP assay for confirmation of rs1344706 genotypes. RESULTS: We confirmed association of the T-allele of rs1344706 with schizophrenia in a newly ascertained sample from Indonesia with Southeast Asian ancestral background (P=0.019, OR=1.155, 95%, CI 1.025-1.301). In addition, we studied several SNPs in the vicinity of rs1344706, for which nominally significant results had been reported. None of the association P values of the additional SNPs exceeded that of rs1344706. CONCLUSION: We provide additional evidence for association of the ZNF804A gene with schizophrenia. We conclude that rs1344706 or a yet unknown polymorphism in linkage disequilibrium is also involved in conferring susceptibility to schizophrenia in samples with different (Asian) ancestral backgrounds.