Dynamic Treatment Regimes Using Bayesian Additive Regression Trees for Censored Outcomes.

To achieve the goal of providing the best possible care to each individual under their care, physicians need to customize treatments for individuals with the same health state, especially when treating diseases that can progress further and require additional treatments, such as cancer. Making decisions at multiple stages as a disease progresses can be formalized as a dynamic treatment regime (DTR). Most of the existing optimization approaches for estimating dynamic treatment regimes including the popular method of Q-learning were developed in a frequentist context. Recently, a general Bayesian machine learning framework that facilitates using Bayesian regression modeling to optimize DTRs has been proposed. In this article, we adapt this approach to censored outcomes using Bayesian additive regression trees (BART) for each stage under the accelerated failure time modeling framework, along with simulation studies and a real data example that compare the proposed approach with Q-learning. We also develop an R wrapper function that utilizes a standard BART survival model to optimize DTRs for censored outcomes. The wrapper function can easily be extended to accommodate any type of Bayesian machine learning model.

Hybrid support vector regression and crow search algorithm for modeling and multiobjective optimization of microalgae-based wastewater treatment.

Microalgae-based wastewater treatment (and biomass production) is an environmentally benign and energetically efficient technique as compared to traditional practices. The present study is focused on optimization of the major treatment variables such as temperature, light-dark cycle (LD), and nitrogen (N)-to-phosphate (P) ratio (N/P) for the elimination of N and P from tertiary municipal wastewater utilizing Chlorella kessleri microalgae species. In this regard, a hybrid support vector regression (SVR) technique integrated with the crow search algorithm has been applied as a novel modeling/optimization tool. The SVR models were formulated using the experimental data, which were furnished according to the response surface methodology with Box-Behnken Design. Various statistical indicators, including mean absolute percentage error, Taylor diagram, and fractional bias, confirmed the superior performance of SVR models as compared to the response surface methodology (RSM) and generalized linear model (GLM). Finally, the best SVR model was hybridized with the crow search algorithm for single/multi-objective optimizations to acquire the global optimal treatment conditions for maximum N and P removal efficiencies. The best-operating conditions were found to be 29.3°C, 24/0 h/h of LD, and 6:1 of N/P, with N and P elimination efficiencies of 99.97 and 93.48%, respectively. The optimized values were further confirmed by new experimental data.

Genetic gain for rice yield in rainfed environments in India.

The complexity of genotype × environment interactions under drought reduces heritability, which determines the effectiveness of selection for drought tolerance and development of drought tolerant varieties. Genetic progress measured through changes in yield performance over time is important in determining the efficiency of breeding programmes in which test cultivars are replaced each year on the assumption that the new cultivars will surpass the older cultivars. The goal of our study was to determine the annual rate of genetic gain for rice grain yield in a drought-prone rainfed system in a series of multi-environment trials conducted from 2005 to 2014 under the Drought Breeding Network of Indian sites in collaboration with the International Rice Research Institute (IRRI). Our results show a positive trend in grain yield with an annual genetic yield increase of about 0.68 % under irrigated control, 0.87 % under moderate reproductive stage drought stress and 1.9 % under severe reproductive stage drought stress due to breeding efforts. The study also demonstrates the effectiveness of direct selection for grain yield under both irrigated control as well as managed drought stress screening to improve yield in typical rainfed systems. IRRI's drought breeding programme has exhibited a significant positive trend in genetic gain for grain yield over the years under both drought stress as well as favorable irrigated control conditions. Several drought tolerant varieties released from the programme have outperformed the currently grown varieties under varied conditions in the rainfed environments on farmers' fields.

Surface-Acoustic-Wave-Based Lab-on-Chip for Rapid Transport of Cryoprotectants across Cell Membrane for Cryopreservation with Significantly Improved Cell Viability.

Cryopreservation is essential to effectively extend the shelf life of delicate biomaterials while maintaining proper levels of cell functions. Cryopreservation requires a cryoprotective agent (CPA) to suppress intracellular ice formation during freezing, but it must be removed prior to clinical use due to its toxicity. Conventional multistep CPA loading and unloading approaches are time consuming, often creating osmotic shocks and causing mechanical injuries for biological samples. An efficient surface-acoustic-wave- (SAW-) based lab-on-a-chip (LoC) for fast loading and removal of CPAs is presented here. With the SAW-based multistep CPA loading/removal approach, high concentration (3 m) CPA can be successfully loaded and removed in less than 1 min. Results show that the technique causes the least harm to umbilical cord matrix mesenchymal stem cells as compared to conventional method, and an average of 24% higher cell recovery rate is achieved, while preserving the integrity and morphology of the cells. This device is the first of its kind to combine high loading/unloading efficiency, high cell viability, and high throughput into one LoC device, offering not only a more efficient and safer route for CPA loading and removal from cells, but also paving the way for other cryopreservation-dependent applications.

A Simple and Reliable Cooling Approach for the Cryopreservation of Hematopoietic Stem Cells: the Passive Cooling Rate-controlled Technique.

BACKGROUND: Cryopreservation of hematopoietic stem cells (HSCs) has widely been used in stem cell transplantation and cellular therapy treating various human diseases. However, the current conventional cooling approach for the cryopreservation of HSCs has the following potential problems: (1) requirement of a very expensive computer-programmed liquid nitrogen freezer (LNF) for the cooling rate control, (2) a large consumption of liquid nitrogen, (3) periodic breakdown of the LNF due to the mechanical failure of the liquid nitrogen valves (i.e., magnetic-solenoid valves) inside the LNF, and (4) constant monitoring of the LNF operation during the HSCs cooling process. OBJECTIVE: To test and evaluate a simple and reliable approach for the cryopreservation of HSCs using the passive cooling technique. MATERIALS AND METHODS: A passive cooling-rate-controlled device (PCD) was developed and used to cryopreserve HSCs. The PCD is inexpensive, simple, and user-friendly, which needs only the minimum maintenance and no consumption of liquid nitrogen. The PCD was compared to the LNF for the cryopreservation of HSCs in the present study through experiments. The cell viability and functionality were evaluated after cryopreservation. RESULTS: In comparison with the LNF method, the PCD approach enabled high cell viability/survival, recovery rate, and functionality after cryopreservation processes. CONCLUSION: The PCD offers a cost-effective, simple, and reliable approach for the optimal cryopreservation of HSCs.

The application of convolution neural network based cell segmentation during cryopreservation.

For most of the cells, water permeability and plasma membrane properties play a vital role in the optimal protocol for successful cryopreservation. Measuring the water permeability of cells during subzero temperature is essential. So far, there is no perfect segmentation technique to be used for the image processing task on subzero temperature accurately. The ice formation and variable background during freezing posed a significant challenge for most of the conventional segmentation algorithms. Thus, a robust and accurate segmentation approach that can accurately extract cells from extracellular ice that surrounding the cell boundary is needed. Therefore, we propose a convolutional neural network (CNN) architecture similar to U-Net but differs from those conventionally used in computer vision to extract all the cell boundaries as they shrank in the engulfing ice. The images used was obtained from the cryo-stage microscope, and the data was validated using the Hausdorff distance, means ±â€¯standard deviation for different methods of segmentation result using the CNN model. The experimental results prove that the typical CNN model extracts cell borders contour from the background in its subzero state more coherent and effective as compared to other traditional segmentation approaches.

Optimization of prostatic cryosurgery with multi-cryoprobe based on refrigerant flow.

Cryosurgery is a promising novel minimally invasive surgical technique to eradicate carcinoma and non-carcinoma tissues by freezing. In this research, we applied a transient 3D two-phase refrigerant flow model inside the LN2 boiling chamber as well as a bioheat transfer model inside the tissues to evaluate the optimized ablation outcome during prostatic cryosurgery. For the evaluation of the scenarios, a defect function was used that considers non-ablated target tissue (prostate/cancer tissue) as well as ablated healthy tissue, in which the ablated tissue was evaluated using a temperature threshold. Three different configurations using three LN2 cryoprobes were analyzed during the modeling study, and the best configuration with the three LN2 cryoprobes positioned isoscelesly was found. For this configuration, temperature distributions and temperature profiles at specific points within the tissue were investigated numerically. Owing to its low computational cost, the 3D coupled model has an advantage in accurate modeling cryosurgery for curing numerous diseases.

Water-transport and Intracellular Ice Formation of Porcine Adipose-derived Stem Cells during Freezing.

BACKGROUND: Water transport and intracellular ice formation are important processes that relate to cryoinjury of cells upon freezing. To date, no study is reported on the characteristics of water transport and intracellular ice formation in porcine adipose-derived stem cells (pADSC). OBJECTIVE: To study water transport and intracellular ice formation upon freezing of pADSCs at different cooling rates. MATERIALS AND METHODS: The pADSCs were isolated using collagenase digestion from a subcutaneous adipose tissue of a 28-day-old Landrace pig. Freeze experiments were performed in a gas tight chamber of cryomicroscopy stage at different cooling rates between 40°C and -150°C. RESULTS: Water permeability coefficient Lpg and the activation energy ELP decrease with increasing cooling rates for pADSCs. The probability of intracellular ice formation increases with increasing cooling rates, being 0.35, 0.4 and 0.5 for cooling rates at 20, 30 and 60 °C/min respectively. CONCLUSION: Based on the characteristics of water transport and intracellular ice formation in pADSCs, slow freezing is perhaps more suitable for pADSC cryopreservation.

Modeling and experimental studies of enhanced cooling by medical gauze for cell cryopreservation by vitrification.

Vitrification is considered as an important alternative approach to traditional slow freezing method for cryopreservation of cells. A typical cell vitrification procedure involves a non-equilibrium cooling process commonly accomplished in liquid nitrogen, while in which film boiling is believed to greatly hinder heat transfer surrounding the sample, resulting in incomplete vitrification or a much higher critical concentration. In this study, we developed a simple while effective approach, wrapping traditional French-type straw with medical gauze, to greatly enhance convective heat transfer during cooling by suppress film boiling. We further established a coupled heat transfer model for cooling and warming of cell suspensions to investigate the inherent thermodynamic mechanism in this approach. The model describes both the macroscale thermal distributions in extracellular solution and the microscale ice crystallization inside the cells. The simulation indicated that straws wrapped with medical gauze would increase cell survival subject to vitrification cryopreservation by significantly increasing the cooling rate to inhibit intracellular ice formation (IIF). Our experiments on human umbilical vein endothelial cells (HUVECs) further confirmed the predictions in that the cell survival rate was significantly increased by wrapping straws with medical gauze.

Severe acute malnutrition in Asia.

Severe acute malnutrition (SAM) is a common condition that kills children and intellectually maims those who survive. Close to 20 million children under the age of 5 years suffer from SAM globally, and about 1 million of them die each year. Much of this burden takes place in Asia. Six countries in Asia together have more than 12 million children suffering from SAM: 0.6 million in Afghanistan, 0.6 million in Bangladesh, 8.0 million in India, 1.2 million in Indonesia, 1.4 million in Pakistan, and 0.6 million in Yemen. This article is based on a review of SAM burden and intervention programs in Asian countries where, despite the huge numbers of children suffering from the condition, the coverage of interventions is either absent on a national scale or poor. Countries in Asia have to recognize SAM as a major problem and mobilize internal resources for its management. Screening of children in the community for SAM and appropriate referral and back referral require good health systems. Improving grassroots services will not only contribute to improving management of SAM, it will also improve infant and young child feeding and nutrition in general. Ready-to-use therapeutic food (RUTF), the key to home management of SAM without complications, is still not endorsed by many countries because of its unavailability in the countries and its cost. It should preferably be produced locally from locally available food ingredients. Countries in Asia that do not have the capacity to produce RUTF from locally available food ingredients can benefit from other countries in the region that can produce it. Health facilities in all high-burden countries should be staffed and equipped to treat children with SAM. A continuous cascade of training of health staff on management of SAM can offset the damage that results from staff attrition or transfers. The basic nutrition interventions, which include breastfeeding, appropriate complementary feeding, micronutrient supplementation, and management of acute malnutrition, should be scaled up in Asian countries that are plagued with the burden of malnutrition.

Computer simulation-based nanothermal field and tissue damage analysis for cardiac tumor ablation.

Radiofrequency ablation is a nominally invasive technique to eradicate cancerous or non-cancerous cells by heating. However, it is still hampered to acquire a successful cell destruction process due to inappropriate RF intensities that will not entirely obliterate tumorous tissues, causing in treatment failure. In this study, we are acquainted with a nanoassisted RF ablation procedure of cardiac tumor to provide better outcomes for long-term survival rate without any recurrences. A three-dimensional thermo-electric energy model is employed to investigate nanothermal field and ablation efficiency into the left atrium tumor. The cell death model is adopted to quantify the degree of tissue injury while injecting the Fe3O4 nanoparticles concentrations up to 20% into the target tissue. The results reveal that when nanothermal field extents as a function of tissue depth (10 mm) from the electrode tip, the increasing thermal rates were approximately 0.54362%, 3.17039%, and 7.27397% for the particle concentration levels of 7%, 10%, and 15% compared with no-particle case. In the 7% Fe3O4 nanoparticles, 100% fractional damage index is achieved after ablation time of 18 s whereas tissue annihilation approach proceeds longer to complete for no-particle case. The outcomes indicate that injecting nanoparticles may lessen ablation time in surgeries and prevent damage to adjacent healthy tissue.

A Review on Physical Hydrogen Storage: Insights into Influencing Parameters, Energy Consumption, Global Outlook and Bibliographic Analysis.

The transition of the global energy market towards an environment-friendly, sustainable society requires a profound transformation from fossil fuel to zero carbon emission fuel. To cope with this goal production of renewable energy is accelerating worldwide. Hydrogen is a clean energy carrier, due to its clean combustion and abundance. Nonetheless, its storage is a critical challenge to its success. Hydrogen must be stored long after being produced and transported to a storage site. Physical hydrogen storage (PHS) is vital among hydrogen storage modes, and its shortcoming needs to overcome for its successful and economic benefits. This review intends to discuss the techniques and applications of physical hydrogen storage in the state of compressed gas, liquefied hydrogen gas, and cold/cryo compressed gas concerning their working principle, chemical and physical properties, influencing factors for physical hydrogen storage, and transportation, economics, and global outlook. In addition, insights of several probable PHS systems are highlighted. The outcomes of this review envisioned that the PHS still necessitates technological advancements despite having remarkable success. The limitation opens the door to further research, which would be helpful for efficient and long-term physical hydrogen storage.

Caregiving burden and associated factors among family caregivers of individuals with schizophrenia in Bangladesh: A cross-sectional study.

Introduction: Schizophrenia is a severe mental disorder affecting millions worldwide. Family caregivers play a vital role in patient treatment and recovery, but their responsibilities can be physically and emotionally exhausting. There is limited research on caregiver burden in Bangladesh, prompting this study to identify factors associated with the burden among caregivers of schizophrenic patients. Methods: This cross-sectional study collected data from 175 caregivers from January to December 2020 in Dhaka, Bangladesh. A semi-structured questionnaire and a validated Bangla version of the Zarit Burden Interview (ZBI) scale were used to assess the burden of primary caregivers and associated factors in caring for patients with schizophrenia. Results: Participants' mean age was 34.02 ± 10.45 years, with 26.9% in the 34-41 age group. 49.1% were housewives, with most earning 5000 to 15000 taka monthly. Spouses accounted for 28.6% of caregivers. Most patients had an illness duration of less than five years (66.3%). Mean ZBI score was 49.49 ± 12.06, indicating moderate to severe burden. Factors significantly associated with caregiver burden included age, gender, occupation, income, marital status, house condition, relationship with patients, illness stage, and duration. Conclusion: This study highlights the burden experienced by caregivers of schizophrenic patients in Bangladesh and identifies factors associated with the burden. It recommends community interventions and psychosocial provisions to address this issue and inform targeted interventions to reduce caregiver burden. These findings provide insights for a comprehensive plan to manage such cases in the future.

Influence of plant population and nitrogen-fertilizer at various levels on growth and growth efficiency of maize.

Field experiments were conducted to evaluate plant population and N-fertilizer effects on yield and yield components of maize (Zea mays L.). Three levels of plant populations (53000, 66000, and 800,000 plants ha⁻¹ corresponding to spacings of 75 × 25, 60 × 25, and 50 × 25 cm) and 4 doses of N (100, 140, 180, and 220 kg ha⁻¹) were the treatment variables. Results revealed that plant growth, light interception (LI), yield attributes, and grain yield varied significantly due to the variations in population density and N-rates. Crop growth rate (CGR) was the highest with the population of 80,000 ha⁻¹ receiving 220 kg N ha⁻¹, while relative growth rate (RGR) showed an opposite trend of CGR. Light absorption was maximum when most of densely populated plant received the highest amount of N (220 kg N ha⁻¹). Response of soil-plant-analysis development (SPAD) value as well as N-content to N-rates was found significant. Plant height was the maximum at the lowest plant density with the highest amount of N. Plants that received 180 kg N ha⁻¹ with 80,000 plants ha⁻¹ had larger foliage, greater SPAD value, and higher amount of grains cob⁻¹ that contributed to the maximum yield (5.03 t ha⁻¹) and the maximum harvest index (HI) compared to the plants in other treatments.

Trends and determinants of childhood stunting and underweight in Sri Lanka.

INTRODUCTION: Child undernutrition is a major risk factor for child mortality and adult ill-health. Despite substantial progress in most health indicators, undernutrition remains high in Sri Lanka, with recent trends being unclear, owing to methodological differences in national surveys. METHODS: This study uses data from the 1987, 1993, 2000 and 2006-07 Demographic and Health Surveys (DHS) and the 2009 Nutrition and Food Security Survey (NFSS) to investigate trends and determinants of child undernutrition in Sri Lanka. The prevalence rates of stunting, underweight and wasting were re-estimated using the 2006 WHO growth standards to ensure consistency. Multivariate regression analysis was then undertaken to analyse the determinants of height-forage in children aged 9-23 months, and 24-59 months, and the relative impact of key factors was assessed using prediction models. RESULTS: Stunting and wasting substantially improved from 1987 to 2000, but rates stagnated from 2000 to 2006/07. Whilst economic inequalities in under nutrition were greater than in most other countries, the multivariate analysis found that maternal height, household wealth, length of breast-feeding and altitude are significant determinants of stunting, but differences in child feeding practices and other factors were not. Of these, maternal height and household wealth had the most influence. CONCLUSION: The results are consistent with the finding that food insecurity is the main driver of undernutrition, but more research is required to validate this. The strong relationship of child height with maternal height suggests that epigenetic factors, proxied by short maternal height, constrain the applicability of the WHO growth standards in Sri Lanka.

A graphene-like BeS monolayer as a promising gas sensor material with strain and electric field induced tunable response: a first-principles study.

A comprehensive investigation of the gas sensing potential of BeS monolayer has been conducted using DFT calculations. Twelve common pollutant gases: NH3, NO2, NO, CO, CO2, CH4, H2, O2, N2, H2S, H2O and SO2, have been studied. Our analysis reveals defect states in the band structure near the Fermi level and strong hybridization between gas molecule orbitals and the BeS monolayer. We observe higher adsorption energies for NH3 and CO compared to other popular gas sensing materials. The optical properties of CO2 and NO2 adsorbed on the BeS monolayer show increased reflectivity and absorption coefficient in the UV and far infrared region. Tensile strain has minimal impact on adsorption energy, while biaxial compressive strains enhance the gas sensing capability of the BeS monolayer. The application of an electric field offers control over gas adsorption and desorption. We propose the BeS monolayer as a promising candidate for future gas molecule sensing applications due to its high adsorption energy, rapid recovery time, and distinct optical properties.

Multiplexed paper test strip for quantitative bacterial detection.

Rapid, sensitive, on-site detection of bacteria without a need for sophisticated equipment or skilled personnel is extremely important in clinical settings and rapid response scenarios, as well as in resource-limited settings. Here, we report a novel approach for selective and ultra-sensitive multiplexed detection of Escherichia coli (non-pathogenic or pathogenic) using a lab-on-paper test strip (bioactive paper) based on intracellular enzyme (ß-galactosidase (B-GAL) or ß-glucuronidase (GUS)) activity. The test strip is composed of a paper support (0.5 × 8 cm), onto which either 5-bromo-4-chloro-3-indolyl-ß-D: -glucuronide sodium salt (XG), chlorophenol red ß-galactopyranoside (CPRG) or both and FeCl(3) were entrapped using sol-gel-derived silica inks in different zones via an ink-jet printing technique. The sample was lysed and assayed via lateral flow through the FeCl(3) zone to the substrate area to initiate rapid enzyme hydrolysis of the substrate, causing a change from colorless-to-blue (XG hydrolyzed by GUS, indication of nonpathogenic E. coli) and/or yellow to red-magenta (CPRG hydrolyzed by B-GAL, indication of total coliforms). Using immunomagnetic nanoparticles for selective preconcentration, the limit of detection was ~5 colony-forming units (cfu) per milliliter for E. coli O157:H7 and ~20 cfu/mL for E. coli BL21, within 30 min without cell culturing. Thus, these paper test strips could be suitable for detection of viable total coliforms and pathogens in bathing water samples. Moreover, inclusion of a culturing step allows detection of less than 1 cfu in 100 mL within 8 h, making the paper tests strips relevant for detection of multiple pathogens and total coliform bacteria in beverage and food samples.

Trends, inequalities and determinants of low birth weight in Sri Lanka.

INTRODUCTION: This study analyses the DHS 1993, 2000 and 2006-07 and NFSS 2009 survey data to investigate trends, inequalities and determinants of low birth weight (LBW) in Sri Lanka. METHODS: We re-evaluated recent trends in LBW incidence, adjusting for changes in the coverage of DHS surveys to ensure comparability, and used multivariate logistic regression to investigate determinants. We quantified the degree of economic inequality using wealth and concentration indices, and assessed the contribution of determinants to inequality by decomposition. RESULTS: There was a continuing, but slowing decline in LBW incidence, reaching 17% during 2001/02-2006/07, whilst very low birth weight incidence declined from 0.9% to 0.6%. Concentration indices reveal persistent, large economic inequalities in LBW incidence. Maternal body mass index (BMI), height and education, altitude and Indian Tamil ethnicity were the major determinants of LBW, with supply of 'Thriposha' having no significant impact. Accounting for maternal BMI and height largely eliminates the impact of economic status, and reduces the impact of ethnicity. Decomposition analysis reveals the major contributors to the inequalities are maternal BMI (21%), height (12%) and education (14%), ethnicity (9%) and altitude (7%). CONCLUSIONS: The results imply that food insecurity mediates the association of LBW with poverty, and is the major amenable risk factor. The impact of maternal height and Indian Tamil ethnicity suggests that epigenetic mechanisms play a role, and that reductions in LBW incidence will take considerable time. There is a need to substantially improve the effectiveness of interventions to reduce LBW in coming generations.

FeedMaster: A least-cost feed formulation App for minimizing the cost and maximizing milk yield.

Objective: The study aimed to develop and assess an Android app designed for farmers with a low educational status that can formulate a least-cost ration. Materials and Methods: First, a computer-android-based app named BLRI FeedMaster was developed to guide users in formulating a balanced ration at the least cost. A survey was conducted on 30 livestock officers and 18 farmers with 50 cattle to evaluate its efficacy at the field level. The study outcomes were milk yield, feeding cost, milk composition, time, and cost for management before and after using the BLRI FeedMaster app. Descriptive statistics and paired sample t-tests were used to analyze the data. Results: After adopting the BLRI FeedMaster app, a significant increase was observed in daily average milk yield (9.39 ± 0.32 l from 8.37 ± 0.36 l), while a considerable decrease was observed in daily average feed quantity (4.88 ± 0.15 kg from 5.60 ± 0.17 kg) and feed cost (BDT 28.00 ± 0.50 from BDT 29.75 ± 0.49). Besides, the number of visits, time, and cost for seeking professional services regarding feed, health care, and other information was significantly minimized. The number of visits decreased to 0.36 ± 013 from 3.07 ± 0.38, and the consumed time was reduced from 270 ± 34.30 to 235.71 ± 59.42 min (p < 0.05) after adopting the app. Conclusion: Hence, this app was very beneficial for farmers with a low economic and educational background and may ultimately help farmers with profitable animal farming and sustainable production in the least developed countries like Bangladesh.

Evaluation of dedicated COVID-19 hospitals in the pandemic response in Iraq: pandemic preparation within a recovering healthcare infrastructure.

The purpose of this study is to evaluate Iraq's health facility preparedness for the surge of hospitalised cases associated with the ongoing COVID-19 pandemic. In this article, we review pandemic preparedness at both general and tertiary hospitals throughout all districts of Iraq. COVID-19 pandemic preparedness, for the purpose of this review, is defined as: (1) staff to patient ratio, (2) personal protective equipment (PPE) to staff ratio, (3) infection control measures training and compliance and (4) laboratory and surveillance capacity. Despite the designation of facilities as COVID-19 referral hospitals, we did not find any increased preparedness with regard to staffing and PPE allocation. COVID-19 designated hospital reported an increased mean number of respiratory therapists as well as sufficient intensive care unit staff, but this did not reach significant levels. Non-COVID-19 facilities tended to have higher mean numbers of registered nurses, cleaning staff and laboratory staff, whereas the COVID-19 facilities were allocated additional N-95 masks (554.54 vs 147.76), gowns (226.72 vs 104.14) and boot coverings (170.48 vs 86.8) per 10 staff, but none of these differences were statistically significant. Though COVID-19 facilities were able to make increased requisitions for PPE supplies, all facility types reported unfulfilled requisitions, which is more likely a reflection of global storage rather than Iraq's preparedness for the pandemic. Incorporating future pandemic preparedness into health system strengthening efforts across facilities, including supplies, staffing and training acquisition, retention and training, are critical to Iraq's future success in mitigating the ongoing impact of the ongoing COVID-19 pandemic.