Assessment of the impact of integrated disease surveillance and response system on surveillance management at healthcare facilities in Pakistan.

Background: Disease surveillance is very crucial especially in high vulnerability settings like Pakistan. However, surveillance and outbreak response management are still evolving in the country and research studies are needed to assess the existing system. Aim: To assess the impact of integrated disease surveillance and response system (IDSRS) implemented by the provincial government to strengthen infectious disease surveillance and reporting in 6 districts of Pakistan in 2016. Methods: A baseline cross-sectional assessment of health facilities and the healthcare workforce was conducted in 2016 to identify needs and gaps in public sector health facilities and the health system of 6 selected districts of Khyber Pakhtunkhwa Province, Pakistan. This was followed by a 2018 endline survey of the same facilities using the same variables. Results: Overall, there was improvement in district management and facility level performance (χ2 (1, 314) = 21.19, P < 0.001, V = 0.26). District level management improved significantly in areas with relatively lower Gross Domestic Product (GDP)? χ2(1, 154) = 30.41, P <0.001, V = 0.44). Facilitation domain variables improved in the lower GDP districts (χ2 (1, 74) = 5.76, P = 0.016, V = 0.28) and showed counterintuitive deterioration (χ2 (1, 74) = 4.80, P = 0.028, V = 0.25) in relatively higher GDP areas. Conclusion: IDSRS is effective in improving surveillance and response systems, however, its effectiveness appears to depend on locale-specific economies and can be enhanced by modifying the implementation approach. Better empowerment of the local workforce can contribute to such improvement.

Transient binocular vision loss and pain insensitivity in Klippel-Feil syndrome: a case report.

BACKGROUND: Klippel-Feil syndrome is a rare congenital bone disorder characterized by an abnormal fusion of two or more cervical spine vertebrae. Individuals with Klippel-Feil syndrome exhibit diverse clinical manifestations, including skeletal irregularities, visual and hearing impairments, orofacial anomalies, and anomalies in various internal organs, such as the heart, kidneys, genitourinary system, and nervous system. CASE PRESENTATION: This case report describes a 12-year-old Pashtun female patient who presented with acute bilateral visual loss. The patient had Klippel-Feil syndrome, with the typical clinical triad symptoms of Klippel-Feil syndrome, along with Sprengel's deformity. She also exhibited generalized hypoalgesia, which had previously resulted in widespread burn-related injuries. Upon examination, bilateral optic disc swelling was observed, but intracranial pressure was found to be normal. Extensive investigations yielded normal results, except for hypocalcemia and low vitamin D levels, while parathyroid function remained within the normal range. Visual acuity improved following 2 months of calcium and vitamin D supplementation, suggesting that the visual loss and optic nerve swelling were attributed to hypocalcemia. Given the normal parathyroid function, it is possible that hypocalcemia resulted from low vitamin D levels, which can occur after severe burn scarring. Furthermore, the patient received a provisional diagnosis of congenital insensitivity to pain on the basis of the detailed medical history and the findings of severe and widespread loss of the ability to perceive painful stimuli, as well as impaired temperature sensation. However, due to limitations in genetic testing, confirmation of the congenital insensitivity to pain diagnosis could not be obtained. CONCLUSION: This case highlights a rare presentation of transient binocular vision loss and pain insensitivity in a patient with Klippel-Feil syndrome, emphasizing the importance of considering unusual associations in symptom interpretation.

Enhancing supercapacitor performance of Ni-Co-Mn metal-organic frameworks by compositing it with polyaniline and reduced graphene oxide.

Metal-organic frameworks (MOFs) are one of the most sought-after materials in the domain of supercapacitors and can be tailored to accommodate diverse compositions, making them amenable to facile functionalization. However, their intrinsic specific capacitance as well as energy density is minimal, which hinders their usage for advanced energy storage applications. Therefore, herein, we have prepared six electrodes, i.e., Ni-Co-Mn MOFs, polyaniline (PANI), and reduced graphene oxide (rGO) along with their novel nanocomposites, i.e., C1, C2, and C3, comprising MOFs : PANI : rGO in a mass ratio of 100 : 1 : 0.5, 100 : 1 : 1, and 100 : 1 : 10, respectively. The polyaniline conducting polymer and rGO enabled efficient electron transport, enhanced charge storage processes, substantial surface area facilitating higher loading of active materials, promoting electrochemical reactions, and ultimately enhanced nanocomposite system performance. As a result, scanning electron microscopy (SEM) and X-ray diffraction (XRD) techniques confirmed the successful synthesis and revealed distinct morphological features of the materials. Following electrochemical testing, it was observed that composition C2 exhibited the highest performance, demonstrating a groundbreaking specific capacitance of 1007 F g-1 at 1 A g-1. The device showed a good energy density of 25.11 W h kg-1 and a power density of 860 W kg-1. Remarkably, the device demonstrated a capacity retention of 115% after 1500 cycles, which is a clear indication of the wettability factor, according to the literature. The power law indicated b-values in a range of 0.58-0.64, verifying the hybrid-type behavior of supercapacitors.

Falkner-Skan Flow with Stream-Wise Pressure Gradient and Transfer of Mass over a Dynamic Wall.

In this work, an important model in fluid dynamics is analyzed by a new hybrid neurocomputing algorithm. We have considered the Falkner-Skan (FS) with the stream-wise pressure gradient transfer of mass over a dynamic wall. To analyze the boundary flow of the FS model, we have utilized the global search characteristic of a recently developed heuristic, the Sine Cosine Algorithm (SCA), and the local search characteristic of Sequential Quadratic Programming (SQP). Artificial neural network (ANN) architecture is utilized to construct a series solution of the mathematical model. We have called our technique the ANN-SCA-SQP algorithm. The dynamic of the FS system is observed by varying stream-wise pressure gradient mass transfer and dynamic wall. To validate the effectiveness of ANN-SCA-SQP algorithm, our solutions are compared with state-of-the-art reference solutions. We have repeated a hundred experiments to establish the robustness of our approach. Our experimental outcome validates the superiority of the ANN-SCA-SQP algorithm.

A Hybrid Metaheuristic Based on Neurocomputing for Analysis of Unipolar Electrohydrodynamic Pump Flow.

A unipolar electrohydrodynamic (UP-EHD) pump flow is studied with known electric potential at the emitter and zero electric potential at the collector. The model is designed for electric potential, charge density, and electric field. The dimensionless parameters, namely the electrical source number (Es), the electrical Reynolds number (ReE), and electrical slip number (Esl), are considered with wide ranges of variation to analyze the UP-EHD pump flow. To interpret the pump flow of the UP-EHD model, a hybrid metaheuristic solver is designed, consisting of the recently developed technique sine-cosine algorithm (SCA) and sequential quadratic programming (SQP) under the influence of an artificial neural network. The method is abbreviated as ANN-SCA-SQP. The superiority of the technique is shown by comparing the solution with reference solutions. For a large data set, the technique is executed for one hundred independent experiments. The performance is evaluated through performance operators and convergence plots.

An assessment of the quality of care provided at primary health care centres in camps for internally displaced persons in Iraq in 2018.

INTRODUCTION: The humanitarian crisis in Iraq remains one of the largest and most unstable in the world. In 2014, over 2.5 million civilians were displaced in Iraq; between 2015 and 2017 more than 3 million people continued to be displaced. While health-related research concerning internally displaced persons (IDPs) population has been conducted in many settings, very few have looked at the quality of care delivered in primary health care centres (PHCC) inside camps. The objective of this operational research is to assess the quality of health care services at PHCC in operational IDP camps supported by local and international NGOs (humanitarian partners) as well as the Directorate of Health (DoH) in Iraq at baseline and after 6 months. METHOD: A framework based on five components was used to assess quality of care by assigning a quality-of-care index score. Using a longitudinal design; data were collected through observations of facilities and of patient consultations, as well as health worker and patient exit interviews, in static PHCC in operational IDP camps of Iraq during two different phases: in June (n = 55), and December 2018 (n = 47). These facilities supported more than 500,000 IDPs. Descriptive and statistical analyses were conducted, and the results compared. RESULT: For all camps (n = 47), the average overall quality of care index score increased between the two phases. No specific type of organisation consistently provided a better quality of care. The camp size was unrelated to the quality of care provided at the respective facility. The domain indicators "Client Care" and "Environment and Safety" mostly related to the variation in the general assessment of quality. Patient satisfaction was unrelated to any other domain score. Compared at 0 and after 6-months, the quality of care index score between the type of organisation and governorate showed that feedback positively impacted service delivery after the first assessment. Positive differences in scores also appeared, with notable improvements in Client care and Technical competence. CONCLUSION: Humanitarian partners and the DoH are able to provide quality care, independent of camp size or the number of camps managed, and their cooperation can lead to quick improvements. This research also shows that quality of care assessment in emergency settings can be carried out in formal IDP camps using non-emergency standards.

Community-based surveillance in internally displaced people's camps and urban settings during a complex emergency in Yemen in 2020.

BACKGROUND: The need for early identification of coronavirus disease (COVID-19) cases in communities was high in Yemen during the first wave of the COVID-19 epidemic because most cases presenting to health facilities were severe. Early detection of cases would allow early interventions to interrupt the transmission chains. This study aimed to describe the implementation of community-based surveillance (CBS) in in internally displaced people (IDP) camps and urban settings in Yemen from 15 April 2020 to 30 September 2020. METHODS: Following the Centers for Disease Control and Prevention guidance for evaluation of surveillance systems, we assessed the usefulness and acceptability of CBS. For acceptability, we calculated the proportion of trained volunteers who reported disease alerts. To assess the usefulness, we compared the alerts reported through the electronic diseases early warning system (eDEWS) with the alerts reported through CBS and described the response activities implemented. RESULTS: In Al-Mukalla City, 18% (14/78) of the volunteers reported at least one alert. In IDP camps, 58% (18/31) of volunteers reported at least one alert. In Al-Mukalla City, CBS detected 49 alerts of influenza-like illness, whereas health facilities detected 561 cases of COVID-19. In IDP camps, CBS detected 91 alerts of influenza-like illness, compared to 10 alerts detected through eDEWS. In IDP camps, CBS detected three other syndromes besides influenza-like illness (febrile illness outbreak suspicion, acute diarrhoea, and skin disease). In IDP camps, public health actions were implemented for each disease detected and no further cases were reported. CONCLUSIONS: In Yemen, CBS was useful for detecting suspected outbreaks in IDP camps. CBS implementation did not yield expected results in general communities in urban areas in the early stage of the COVID-19 pandemic when little was known about the disease. In the urban setting, the system failed to detect suspected COVID-19 cases and other diseases despite the ongoing outbreaks reported through eDEWS. In Yemen, as in other countries, feasibility and acceptability studies should be conducted few months before CBS expansion in urban communities. The project should be expanded in IDP camps, by creating COVID-19 and other disease outbreak reporting sites.