Site-to-site cross-talk in OST-B glycosylation of hCEACAM1-IgV.

N-glycosylation is a common posttranslational modification of secreted proteins in eukaryotes. This modification targets asparagine residues within the consensus sequence, N-X-S/T. While this sequence is required for glycosylation, the initial transfer of a high-mannose glycan by oligosaccharyl transferases A or B (OST-A or OST-B) can lead to incomplete occupancy at a given site. Factors that determine the extent of transfer are not well understood, and understanding them may provide insight into the function of these important enzymes. Here, we use mass spectrometry (MS) to simultaneously measure relative occupancies for three N-glycosylation sites on the N-terminal IgV domain of the recombinant glycoprotein, hCEACAM1. We demonstrate that addition is primarily by the OST-B enzyme and propose a kinetic model of OST-B N-glycosylation. Fitting the kinetic model to the MS data yields distinct rates for glycan addition at most sites and suggests a largely stochastic initial order of glycan addition. The model also suggests that glycosylation at one site influences the efficiency of subsequent modifications at the other sites, and glycosylation at the central or N-terminal site leads to dead-end products that seldom lead to full glycosylation of all three sites. Only one path of progressive glycosylation, one initiated by glycosylation at the C-terminal site, can efficiently lead to full occupancy for all three sites. Thus, the hCEACAM1 domain provides an effective model system to study site-specific recognition of glycosylation sequons by OST-B and suggests that the order and efficiency of posttranslational glycosylation is influenced by steric cross-talk between adjoining acceptor sites.

Lipid nanoparticle mediated small interfering RNA delivery as a potential therapy for Alzheimer's disease.

Alzheimer's disease (AD) is a neurodegenerative condition that exhibits a gradual decline in cognitive function and is prevalent among a significant number of individuals globally. The use of small interfering RNA (siRNA) molecules in RNA interference (RNAi) presents a promising therapeutic strategy for AD. Lipid nanoparticles (LNPs) have been developed as a delivery vehicle for siRNA, which can selectively suppress target genes, by enhancing cellular uptake and safeguarding siRNA from degradation. Numerous research studies have exhibited the effectiveness of LNP-mediated siRNA delivery in reducing amyloid beta (Aß) levels and enhancing cognitive function in animal models of AD. The feasibility of employing LNP-mediated siRNA delivery as a therapeutic approach for AD is emphasized by the encouraging outcomes reported in clinical studies for other medical conditions. The use of LNP-mediated siRNA delivery has emerged as a promising strategy to slow down or even reverse the progression of AD by targeting the synthesis of tau phosphorylation and other genes linked to the condition. Improvement of the delivery mechanism and determination of the most suitable siRNA targets are crucial for the efficacious management of AD. This review focuses on the delivery of siRNA through LNPs as a promising therapeutic strategy for AD, based on the available literature.

Removal from the wild endangers the once widespread long-tailed macaque.

In 2022, long-tailed macaques (Macaca fascicularis), a once ubiquitous primate species, was elevated to Endangered on the International Union for Conservation of Nature (IUCN) Red List of Threatened Species. In 2023, recognizing that the long-tailed macaque is threatened by multiple factors: (1) declining native habitats across Southeast Asia; (2) overutilization for scientific, commercial, and recreational purposes; (3) inadequate regulatory mechanisms; and (4) culling due to human-macaque conflicts, a petition for rulemaking was submitted to the United States Fish and Wildlife Service to add the species to the US Endangered Species Act, the nation's most effective law to protect at risk species. The long-tailed macaque remains unprotected across much of its geographical range despite the documented continual decline of the species and related sub-species and the recent IUCN reassessment. This commentary presents a review of the factors that have contributed to the dramatic decline of this keystone species and makes a case for raising the level of protection they receive.

Bioenergy-producing two-stage septic tank and floating wetland for onsite wastewater treatment: Circuit connection and external aeration.

This study designed a two-stage, electrode-integrated septic tank-floating wetland system and assessed their pollutant removal performances under variable operational conditions. The two-stage system achieved mean organic, nitrogen, phosphorus, and coliform removal percentages of 99, 78, 99, and 97%, respectively, throughout the experimental run. The mean metals (chromium, cadmium, nickel, copper, zinc, lead, iron, and manganese) removal percentages ranged between 81 and 98%. Accumulated sludge, filler media, and the hanging root mass contributed to pollutant removals by supporting physicochemical and biological pathways. The mean effluent organic concentration and coliform number across the two-stage system were 20 mg/L and 1682 CFU/100 mL, respectively, during the closed-circuit protocol, which was beneath the open-circuit-based performance profiles, i.e., 32 mg/L and 2860 CFU/100 mL, respectively. Effluent organic, nitrogen, phosphorus, metals, and coliform number ranges across the two-stage system were 9-17 mg/L, 13-24 mg/L, 1-1.5 mg/L, 0.001-0.2 mg/L, and 1410-2270 CFU/100 mL, respectively during intermittent and continuous aeration periods. The air supply rate differences influenced pollutant removal depending on the associated removal mechanisms. The non-aeration phase produced higher effluent pollutant concentrations than the aeration periods-based profiles. The overall mean power density production of the septic tank ranged between 107 and 596 mW/m3; 110 and 355 mW/m3 with the floating wetland. The bioenergy production capacity of the septic tank was positively correlated to external air supply rates. This study demonstrates the potential application of the novel bioenergy-producing septic tank-floating wetland system for wastewater treatment in decentralized areas.

The proteasome regulates body weight and systemic nutrient metabolism during fasting.

The ubiquitin-proteasome system (UPS) and the autophagy-lysosome pathway are the primary means of degradation in mammalian tissues. We sought to determine the individual contribution of the UPS and autophagy to tissue catabolism during fasting. Mice were overnight fasted for 15 h before regaining food access ("Fed" group, n = 6) or continuing to fast ("Fast" group, n = 7) for 3 h. In addition, to investigate the effects of autophagy on systemic metabolism and tissue degradation, one group of mice was fasted for 18 h and treated with chloroquine ("Fast + CLQ" group, n = 7) and a fourth group of mice was treated with bortezomib ("Fast + Bort" group, n = 7) to assess the contribution of the UPS. Body weight, tissue weight, circulating hormones and metabolites, intracellular signaling pathways, and protein synthesis were investigated. Fasting induced the loss of body weight, liver mass, and white adipose tissue in the Fast and the Fast + CLQ group, whereas the Fast + Bort group maintained tissue and body weight. Fasting reduced glucose and increased ß hydroxybutyrate in the circulation of all mice. Both changes were most profound in the Fast + Bort group compared with the other fasting conditions. Molecular signaling indicated a successful inhibition of hepatic UPS with bortezomib and an upregulation of the PI3K/AKT/mTOR pathway. The latter was further supported by an increase in hepatic protein synthesis with bortezomib. Inhibition of the UPS through bortezomib blocks body weight loss and tissue catabolism during an acute overnight fast in mice. The effects were likely mediated through a combined effect of the drug on biomolecule degradation and synthesis.NEW & NOTEWORTHY Bortezomib treatment prevents tissue and body weight loss during fasting. The loss of proteasome activity with bortezomib exacerbates fasting-induced ketogenesis. During fasting, bortezomib increases AMPK and PI3K/AKT signaling in the liver, which promotes protein synthesis.

Influence of two-dimensional expiratory airflow variations on respiratory particle propagation during pronunciation of the fricative [f].

Propagation of respiratory particles, potentially containing viable viruses, plays a significant role in the transmission of respiratory diseases (e.g., COVID-19) from infected people. Particles are produced in the upper respiratory system and exit the mouth during expiratory events such as sneezing, coughing, talking, and singing. The importance of considering speaking and singing as vectors of particle transmission has been recognized by researchers. Recently, in a companion paper, dynamics of expiratory flow during fricative utterances were explored, and significant variations of airflow jet trajectories were reported. This study focuses on respiratory particle propagation during fricative productions and the effect of airflow variations on particle transport and dispersion as a function of particle size. The commercial ANSYS-Fluent computational fluid dynamics (CFD) software was employed to quantify the fluid flow and particle dispersion from a two-dimensional mouth model of sustained fricative [f] utterance as well as a horizontal jet flow model. The fluid velocity field and particle distributions estimated from the mouth model were compared with those of the horizontal jet flow model. The significant effects of the airflow jet trajectory variations on the pattern of particle transport and dispersion during fricative utterances were studied. Distinct differences between the estimations of the horizontal jet model for particle propagation with those of the mouth model were observed. The importance of considering the vocal tract geometry and the failure of a horizontal jet model to properly estimate the expiratory airflow and respiratory particle propagation during the production of fricative utterances were emphasized.

Lessons learned from pandemic response to COVID-19 in Bangladesh: NGO-based emergency response framework for low- and middle-income countries.

BACKGROUND: Response to COVID-19 pandemic in Bangladesh was led by the Government of Bangladesh aided by Non-Government Organisations (NGO) among others. The aim of the study was to explore the activities of such an NGO to understand the philosophy, aspiration and strategy to plan and implement an effective response to COVID-19 pandemic in Bangladesh. METHODS: A case study of a Bangladeshi NGO called SAJIDA Foundation (SF) is presented. From September to November 2021, using document review, field observation and in-depth interviews, four aspects of their COVID-19 pandemic related activities was explored - a) why and how SF initiated their COVID response; b) what adaptations were made to their usual programmes; c) how SF's response to COVID-19 were designed and what were the anticipated challenges including overcoming measures; and d) perception of the staff about SF's activities related to COVID-19. Fifteen in-depth interviews were conducted with three groups of SF staff: frontliners, managers and leaders. RESULT: The impact of COVID-19 has been beyond health emergencies and posed multidimensional challenges. SF took a two-pronged approach - aid the government to respond to the emergency and adopt an all-inclusive plan to address diverse challenges related to overall well-being of the population. The underlying strategy of their response has been to: define the challenge of COVID-19 and identify required expertise and resources, ensure people's health and social wellbeing, adjust existing organisational processes, ensure functional partnership with other organisations for effective resource and task sharing, and safeguard health and wellbeing of the organisation's own employees. CONCLUSION: The findings suggest a '4C framework' including four components as the basis of a comprehensive response to emergencies by NGOs: 1. Capability assessment to identify who are in need and what is needed; 2. Collaboration with stakeholders to pool resources and expertise; 3. Compassionate leadership to ensure health and social safety of the employees which ensures their dedication in managing the emergency; and 4. Communication for quick and effective decision making, decentralisation, monitoring and coordination. It is expected that this '4C framework' can help NGOs to embark on a comprehensive response to manage emergencies in resource constrained low- and middle-income countries.

A machine learning-based generalized approach for predicting unauthorized immigration flow considering dynamic border security nexus.

Unauthorized immigration has been a long-standing and contentious challenge for developed and developing countries. Numerous continually evolving push and pull factors across international borders, such as economy, employment, population density, unrest, corruption, and climate have driven this migration. Large-scale pandemics such as COVID-19, causing further instability in countries' financial well-being, can initiate or alter emigration flow from different countries. In light of such a complex confluence of factors, climate change, and demographic shifts in migrant communities, it is high time to shift toward machine learning-reinforced generalized approaches from the traditional parametric approaches based on migrant community-specific localized surveys. To our best knowledge, no literature has explored the nonparametric approach and developed a comprehensive database independent of localized surveys to analyze unauthorized migration. This article fills this gap by deploying nine nonparametric machine learning algorithms for predicting unauthorized immigration flow considering the dynamic border security nexus. This framework considers the Seasonal Autoregressive Integrated Moving Average model as the null model. The proposed novel framework removes the dependency on localized survey-based studies and provides a more cost-effective, faster, and big data-friendly approach. This study finds the Bayesian Additive Regression Tree model as the best predictive model.

Pilot study of a new type of machine vision-assisted stereotactic neurosurgery for EVD placement.

BACKGROUND: The usage of machine vision technologies for image-based analysis and inspection is increasing. With the advent of the ability to process high-dimension data instantly, the possibilities of machine vision multiply exponentially. Robots now use this technology to assist in surgery. OBJECTIVE: The aim of this study is to explore the efficacy of Surgical Navigation Robot NaoTrac (Brain Navi Biotechnology Co., Ltd.), which utilizes machine vision-inspired technology for patient registration and stereotactic external ventricular drainage (EVD) by the robotic arm. METHODS: Preoperative and postoperative computed tomography (CT) scans were acquired for each case. The surgeons planned the targets and trajectories with the preoperative CT images. The postoperative CT images were utilized in the accuracy measurements. RESULTS: All 14 cases had cerebrospinal fluid drained through the catheter. The NaoTrac placed the catheter into the frontal horn in one attempt in 13 cases and was able to drain CSF in 12 cases. Not a single case had any bleeding or intraoperative complications. The average time spent on the patient registration was 142.8 s. The mean target deviation was 1.68 mm, and the mean angular deviation was 1.99°, all within the accepted tolerance for minimal tissue damage. CONCLUSION: The results of this report demonstrate that machine vision-inspired patient registration is feasible and fast. NaoTrac has demonstrated its accuracy and safety in performing frameless catheter placement in 13 clinical cases. Other stereotactic neurosurgical operations such as stereotactic biopsy, depth electrode placement, deep brain stimulation electrode positioning, and neuroendoscopy may also be benefited from the assistance of NaoTrac.

Robustness and Tracking Performance Evaluation of PID Motion Control of 7 DoF Anthropomorphic Exoskeleton Robot Assisted Upper Limb Rehabilitation.

Upper limb dysfunctions (ULD) are common following a stroke. Annually, more than 15 million people suffer a stroke worldwide. We have developed a 7 degrees of freedom (DoF) exoskeleton robot named the smart robotic exoskeleton (SREx) to provide upper limb rehabilitation therapy. The robot is designed for adults and has an extended range of motion compared to our previously designed ETS-MARSE robot. While providing rehabilitation therapy, the exoskeleton robot is always subject to random disturbance. Moreover, these types of robots manage various patients and different degrees of impairment, which are quite impossible to model and incorporate into the robot dynamics. We hypothesize that a model-independent controller, such as a PID controller, is most suitable for maneuvering a therapeutic exoskeleton robot to provide rehabilitation therapy. This research implemented a model-free proportional-integral-derivative (PID) controller to maneuver a complex 7 DoF anthropomorphic exoskeleton robot (i.e., SREx) to provide a wide variety of upper limb exercises to the different subjects. The robustness and trajectory tracking performance of the PID controller was evaluated with experiments. The results show that a PID controller can effectively control a highly nonlinear and complex exoskeleton-type robot.

The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs.

Global response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).

Variability in expiratory trajectory angles during consonant production by one human subject and from a physical mouth model: Application to respiratory droplet emission.

The COVID-19 pandemic has highlighted the need to improve understanding of droplet transport during expiratory emissions. While historical emphasis has been placed on violent events such as coughing and sneezing, the recognition of asymptomatic and presymptomatic spread has identified the need to consider other modalities, such as speaking. Accurate prediction of infection risk produced by speaking requires knowledge of both the droplet size distributions that are produced, as well as the expiratory flow fields that transport the droplets into the surroundings. This work demonstrates that the expiratory flow field produced by consonant productions is highly unsteady, exhibiting extremely broad inter- and intra-consonant variability, with mean ejection angles varying from ≈+30° to -30°. Furthermore, implementation of a physical mouth model to quantify the expiratory flow fields for fricative pronunciation of [f] and [θ] demonstrates that flow velocities at the lips are higher than previously predicted, reaching 20-30 m/s, and that the resultant trajectories are unstable. Because both large and small droplet transport are directly influenced by the magnitude and trajectory of the expirated air stream, these findings indicate that prior investigations of the flow dynamics during speech have largely underestimated the fluid penetration distances that can be achieved for particular consonant utterances.

Black Garlic and Its Bioactive Compounds on Human Health Diseases: A Review.

Black garlic (BG) is a form of aged garlic obtained from raw garlic (Allium sativum) via Millard reaction under high temperature (60-90 °C) and humidity (70-90%) for a period of time. Several studies reported higher contents of water-soluble antioxidants compounds (S-allyl cysteine, S-allyl-mercapto cysteine), 5-hydroxymethylfurfural, organosulfur compounds, polyphenol, volatile compounds, and products of other Millard reactions compared to fresh garlic after the thermal processing. Recent studies have demonstrated that BG and its bioactive compounds possess a wide range of biological activities and pharmacological properties that preserve and show better efficacy in preventing different types of diseases. Most of these benefits can be attributed to its anti-oxidation, anti-inflammation, anti-obesity, hepatoprotection, hypolipidemia, anti-cancer, anti-allergy, immunomodulation, nephroprotection, cardiovascular protection, and neuroprotection. Substantial studies have been conducted on BG and its components against different common human diseases in the last few decades. Still, a lot of research is ongoing to find out the therapeutic effects of BG. Thus, in this review, we summarized the pre-clinical and clinical studies of BG and its bioactive compounds on human health along with diverse bioactivity, a related mode of action, and also future challenges.

Surface plasmon resonance biosensor based on hexagonal lattice dual-core photonic crystal fiber.

In this paper, the guiding properties and sensor performance are numerically investigated for a dual-core hexagonal lattice photonic crystal fiber sensor based on surface plasmon resonance (SPR). Gold is used as the active plasmonic material in order to create resonance, and it is placed outside the fiber structure to facilitate the fabrication process. The finite-element method is used to numerically investigate the characteristics of the sensor. By means of wavelength and amplitude interrogation methods, it is found that the proposed sensor shows maximum wavelength sensitivity of 16,000 nm/RIU with $6.25 \times {10^{ - 6}}\,\,{\rm RIU}$6.25×10-6RIU resolution and amplitude sensitivity of $2255\,\,{{\rm RIU}^{ - 1}}$2255RIU-1 with $4.40 \times {10^{ - 6}}\,\,{\rm RIU}$4.40×10-6RIU resolution. The proposed SPR sensor can detect the analyte refractive index ranging from 1.33 to 1.40. This work also includes an investigation of the effect of changing the gold layer thickness, air-hole diameter, and analyte layer on the sensor performance from the optimized design. The proposed sensor could be employed to detect biological and biochemical analytes because of its simple design and promising results.

'We have the internet in our hands': Bangladeshi college students' use of ICTs for health information.

BACKGROUND: Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers' control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students' usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this. METHODS: This study relies on two surveys: a 2013-2014 General Survey that randomly sampled 854 households drawn from the general population and a 2015 Student Survey that randomly sampled 436 students from two Mirzapur colleges. Select focus group discussions and in-depth interviews were undertaken with students. Icddr,b's Ethical Review Board granted ethical clearance. RESULTS: The data show that Mirzapur's college students are economically relatively well positioned, more likely to own mobile and smart phones, and more aware of the internet than the general population. They are interested in health information and use phones and computers to access information. Moreover, they use digital technology to share previously-discreet information, adding value to that information and bypassing former gatekeepers. But access to health information is not entirely unfettered, affecting male and female students differently, and powerful gatekeepers, both old and new, can still control sources of information. CONCLUSION: Personal searches for SRH and the resultant online information shared through discrete, personal face-to-face discussions has some potential to challenge social norms. This is particularly so for women students, as sharing information may enable them to bypass gatekeepers and make decisions about reproduction. This suggests that digital health information seeking may be exercising a disruptive effect within the health sector. However, the extent of this disruption may depend, not on students' mobile phone usage, but on the degree to which powerful new gatekeepers are able to retain control over and market SRH information through students' peer-to-peer sharing.

Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda.

BACKGROUND: The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening. METHODS: This paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams' experiences along four potential uses of ToCs, namely planning, communication, learning and accountability. RESULTS: The three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams' experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams' initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes. CONCLUSIONS: The ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement.

The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study.

BACKGROUND: Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh. METHODS: A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors. RESULTS: Increasing travel time to the nearest EmOC facility is found to act as a strong deterrent to seeking care for the urban poor in Sylhet. Logistic regression results indicate that a 5-min increase in travel time to the nearest EmOC facility is associated with a 30 % decrease (0.655 odds ratio, 95 % CI: 0.529-0.811) in the likelihood of delivery at an EmOC facility rather than at home. Moreover, the impact of travel time varies substantially between public, NGO and private facilities. A 5-min increase in travel time from a private EmOC facility is associated with a 32.9 % decrease in the likelihood of delivering at a private facility, while for public and Non-Government Organizations (NGO) EmOC facilities, the impact is lower (28.2 and 28.6 % decrease respectively). Other strong determinants of delivery at an EmOC facility are the use of antenatal care and mother's formal education, while Muslim mothers are found to be more likely to deliver at home. CONCLUSIONS: Geospatial evidence points to the need to strengthen referral and emergency transport systems in order to reduce urban travel time, and establish or relocate EmOC facilities closer to where the poor reside. However, female education and antenatal care coverage remain the most important determinants of facility delivery.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis.

BACKGROUND: Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices. METHODS: Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used. RESULTS: Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk. CONCLUSION: The IDUs' experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.

Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh.

BACKGROUND: Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. Our study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention. METHODS: The study was conducted in Chakaria, a remote rural area in south-eastern Bangladesh during April-May 2013. Twelve village doctors were selected purposively from a pool of 55 village doctors who participated in the mobile health (mHealth) intervention. In depth interviews were conducted to collect data. The data were manually analysed using themes that emerged. RESULT: The village doctors talked about both business benefits (access to formal doctors, getting support for decision making, and being entitled to call trained doctors) and personal benefits (both financial and non-financial). Some of the major barriers mentioned were technical problems related to accessing the call centre, charging consultation fees, and unfamiliarity with the call centre physicians. CONCLUSION: Village doctors saw many benefits to having a business relationship with the trained doctors that the mHealth intervention provided. mHealth through call centres has the potential to ensure consultation services to populations through existing informal healthcare providers in settings with a shortage of qualified healthcare providers.

Innovation for universal health coverage in Bangladesh: a call to action.

A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges. Central to the reform process will be the development of a multipronged strategic approach that: responds to existing demands in a way that assures affordable, equitable, high-quality health care from a pluralistic health system; anticipates health-care needs in a period of rapid health and social transition; and addresses underlying structural issues that otherwise might hamper progress. A pragmatic reform agenda for achieving universal health coverage in Bangladesh should include development of a long-term national human resources policy and action plan, establishment of a national insurance system, building of an interoperable electronic health information system, investment to strengthen the capacity of the Ministry of Health and Family Welfare, and creation of a supraministerial council on health. Greater political, financial, and technical investment to implement this reform agenda offers the prospect of a stronger, more resilient, sustainable, and equitable health system.