Optimal policies for mitigating pandemic costs: a tutorial model.

There have been a number of pharmaceutical and non-pharmaceutical interventions associated with COVID-19 over the past two years. Various non-pharmaceutical interventions were proposed and implemented to control the spread of the COVID-19 pandemic. Most common of these were partial and complete lockdowns that were used in an attempt to minimize the costs associated with mortality, economic losses and social factors, while being subject to constraints such as finite hospital capacity. Here, we use a minimal model posed in terms of optimal control theory to understand the costs and benefits of such strategies. This allows us to determine top-down policies for how to restrict social contact rates given an age-structured model for the dynamics of the disease. Depending on the relative weights allocated to mortality and socioeconomic losses, we see that the optimal strategies range from long-term social-distancing only for the most vulnerable, partial lockdown to ensure not over-running hospitals, and alternating-shifts, all of which lead to significant reduction in mortality and/or socioeconomic losses. Crucially, commonly used strategies that involve long periods of broad lockdown are almost never optimal, as they are highly unstable to reopening and entail high socioeconomic costs. Using parameter estimates from data available for Germany and the USA early in the pandemic, we quantify these policies and use sensitivity analysis in the relevant model parameters and initial conditions to determine the range of robustness of our policies. Finally we also discuss how bottom-up behavioral changes affect the dynamics of the pandemic and show how they can work in tandem with top-down control policies to mitigate pandemic costs even more effectively.

Religious leaders' position toward female genital cutting and their perspectives on the relationship between the Islamic religion and this practice.

This study aimed to understand the position of religious leaders toward female genital cutting (FGC) and their perspectives on the relationship between the Islamic religion and FGC. In-depth interviews were conducted with 29 religious leaders in Erbil governorate, Iraqi Kurdistan region from June 2016 to May 2017 using a semi-structured interview guide. Most interviewees supported the continuation of FGC or thought that it should be at least permissible. Religious requirement and reducing the sexual activity of girls and women were the primary reasons for supporting FGC. The religious leaders disagreed about whether Islam requires, encourages, permits, or discourages the practice. The religious leaders generally agreed that most of the Islamic religious scripts about FGC are weak, and no clear and strong hadiths encourage FGC. However, they believed that some hadiths suggest that Islam requires FGC and that no hadiths prohibit FGC. The absence of open opposition to FGC in a context in which legislation has banned this practice was notable. The position of many religious leaders toward FGC is potentially shaped by the cultural interest in feminine chastity and virginity. Religious leaders need to explore different Islamic law schools and consider the religious disagreement and medical evidence about FGC.

Knowledge and perspectives of female genital cutting among the local religious leaders in Erbil governorate, Iraqi Kurdistan region.

BACKGROUND: Religious leaders are one of the key actors in the issue of female genital cutting (FGC) due to the influential position they have in the community and the frequent association of FGC with the religion. This study aimed to assess the knowledge and perspectives of the local religious leaders in Erbil governorate, Iraqi Kurdistan Region about different aspects of FGC. METHODS: In-depth interviews were conducted with a sample of 29 local religious leaders. A semi-structured questionnaire was used that included questions about their knowledge, understanding, and perspectives on different aspects of FGC such as the reasons for practicing it, their contact and communication with the community regarding the practice and perspectives about banning the practice by law. RESULTS: Participants believed that FGC is useful for reducing or regulating the sexual desire of women to prevent adultery and engagement in pre and extramarital sexual relations and to enhance hygiene of women. They indicated that there is no any risk in doing FGC if there is no excessive cut. Most participants indicated that FGC is attributed to the religion and some considered it a tradition mixed with the religion. People rarely ask the advice of the religious leaders regarding FGC, but they frequently complain about the effects of the practice. Participants did not support having a law to ban FGC either because they thought it would be against the religion's advice on FGC or it will not work. CONCLUSIONS: The local religious leaders lack adequate knowledge about different aspects of FGC particularly the health consequences. There are different and disputing viewpoints about the reasons for practicing FGC, and there is poor support for having a law banning the practice. There is an essential need for enhancing the knowledge of the local religious leaders regarding FGC and its adverse effects on the women's health.

Percutaneous coronary intervention and heart surgery learning needs of patients in Jordan.

AIM: This study aimed to identify and prioritize the perceived learning needs of patients who underwent percutaneous coronary intervention or open-heart surgery. BACKGROUND: Identifying learning needs for post-cardiac intervention patients is essential to establish successful health education programmes based on patient central care. METHODS: A descriptive comparative design was employed on a convenience sample of 260 patients who underwent a percutaneous coronary intervention and 105 patients who underwent open-heart surgery patients. Participants had completed the Patient Learning Needs Scale. Data were collected between 1 October 2014 and 31 June 2015. RESULTS: Patients from the two groups highly requesting health and recovery related information. They scored all learning need topics as important or highly important for them. The top priority learning need for both patient groups was 'information about wound care', and the lowest priority learning need topic was 'physical activity'. CONCLUSIONS: The learning needs of both groups were very close, which indicated that educational secondary prevention programmes' content can be prepared in a unified structure for those patients. Although, specific headings can be used to address the unique needs that emerge from having a specific cardiac interventional procedure. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The fact that wound care and medications are areas of highest learning needs for patients requires health policy decision makers to address these topics at the time of hospital discharge. In addition, a policy focus on considering patients' actual learning needs requires establishment and managerial support. As patients' learning needs might change later after discharge, the health services should be proactive and focus on continuous support for patients after hospital discharge. Secondary prevention programmes should incorporate health education topics based on patients' own views. This can be done by giving higher priority to understand patients' needs, put much more effort into how to meet patients' information needs and to create a more engaging learning environment for patients and their families.

Sonophotocatalytic degradation of trypan blue and vesuvine dyes in the presence of blue light active photocatalyst of Ag3PO4/Bi2S3-HKUST-1-MOF: Central composite optimization and synergistic effect study.

An efficient simultaneous sonophotocatalytic degradation of trypan blue (TB) and vesuvine (VS) using Ag3PO4/Bi2S3-HKUST-1-MOF as a novel visible light active photocatalyst was carried out successfully in a continuous flow-loop reactor equipped to blue LED light. Ag3PO4/Bi2S3-HKUST-1-MOF with activation ability under blue light illumination was synthesized and characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray (EDX), photoluminescence (PL) and diffuse reflectance spectra (DRS). The effect of operational parameters such as the initial TB and VS concentration (5-45mg/L), flow rate (30-110mL/min), irradiation and sonication time (10-30min), pH (3-11) and photocatalyst dosage (0.15-0.35g/L) has been investigated and optimized using central composite design (CCD) combined with desirability function (DF). Maximum sonophotodegradation percentage (98.44% and 99.36% for TB and VS, respectively) was found at optimum condition set as: 25mg/L of each dye, 70mL/min of solution flow rate, 25min of irradiation and sonication time, pH 6 and 0.25g/L of photocatalyst dosage. At optimum conditions, synergistic index value was obtained 2.53 that indicated the hybrid systems including ultrasound irradiation and photocatalysis have higher efficiency compared with sum of the individual processes.

Patient and family/friend satisfaction in a sample of Jordanian Critical Care Units.

AIM: The aim of the study was to assess the validity of family members/friends as proxies by comparing perceptions of satisfaction with care and decision making between critically ill patients and their family/friends. DESIGN: A comparative, descriptive cross-sectional study. SETTING: Seven Critical Care Units across four public and military hospitals in the centre and southern regions of Jordan. METHODS: A modified version of the Family Satisfaction-ICU (FS-ICU) questionnaire was distributed to Critical Care Unit (CCU) patients before hospital discharge. In addition, up to two family members/close friends were also asked to complete the questionnaire. RESULTS: A total of 213 patients (response rate 72%) and 246 family members/friends (response rate 79%) completed and returned the questionnaire. Although the majority of family members/friends and patients were satisfied with overall care, patients were generally significantly less satisfied (mean (SD) care subscale 75.6 (17.8) and 70.9 (17.3), respectively, (p=0.005). When individual items were examined, significant differences in nursing care (family/friends 80.1 (20.7) versus patient 75.9 (22.2), p=0.038) and inclusion in decision making (family/friends 53.9 (33.2) versus patient 62.0 (34.2), p=0.010) were found. CONCLUSION: The study showed a degree of congruence between patients and their family members/friends in relation to their satisfaction with the CCU experience. Thus, views of family/friends may serve as a proxy in assessing care and decision making processes of critically ill patients. RELEVANCE TO CLINICAL PRACTICE: Appropriate training of the critical care team and provision of strategies to address the concerns of patients' families are needed to improve overall patient satisfaction.

Properties of antibacterial polypropylene/nanometal composite fibers.

Melt spinning of polypropylene fibers containing silver and zinc nanoparticles was investigated. The nanometals were generally uniformly dispersed in polypropylene, but aggregation of these materials was observed on fiber surface and in fiber cross-sections. The mechanical properties of the resulted composite fibers with low concentration of nanometal were comparable to those for the control PP yarns. Extruded composite fibers that contained 0.72% silver and 0.60% zinc nanoparticles had outstanding antibacterial efficacy as documented by the percentage count reduction growth of Escherichia coli and Staphylococcus aureus. Fibers containing silver particles had improved antistatic properties.

Rate and risk factors of surgical site infections with antibiotic prophylaxis.

OBJECTIVE: This study is aimed at determining the incidence of surgical site infections, with antibiotic use. Furthermore, to correlate infection with type of operations, length of intervention, number of stitches, pre-operative hospitalization, age and sex of the patient. METHODS: All Yemeni patients (N=601) who underwent surgical intervention, with preoperative antibiotic prophylaxis, at Al-Kuwait University Hospital, Sana'a, Republic of Yemen, during 1st August 2000 through to 30th November 2000 were followed up until stitch removal or discharge. Data was registered in a spreadsheet and processed statistically by statistical package for social sciences 10.0. RESULTS: Overall incidence of surgical site infections was 2.2%, 0.5% in clean operation, 2.8% in clean contaminated, 9.1% in contaminated and 2.3% in dirty operations. Surgical site infections were found positively correlated with duration of operation (P=0.015) and number of stitches (P=0.017), but insignificantly associated with sex, age, type of operation and pre-operative hospitalization. CONCLUSION: In conclusion, surgical site infections, with antibiotic use, were found low. Higher number of stitches and longer duration of operation were the risk factors.