Dynamically Restructuring Nix Cry O Electrocatalyst for Stable Oxygen Evolution Reaction in Real Seawater.

In the pursuit of long-term stability for oxygen evolution reaction (OER) in seawater, retaining the intrinsic catalytic activity is essential but has remained challenging. Herein, we developed a Nix Cry O electrocatalyst that manifested exceptional OER stability in alkaline condition while improving the activity over time by dynamic self-restructuring. In 1 M KOH, Nix Cry O required overpotentials of only 270 and 320 mV to achieve current densities of 100 and 500 mA cm-2 , respectively, with excellent long-term stability exceeding 475 h at 100 mA cm-2 and 280 h at 500 mA cm-2 . The combination of electrochemical measurements and in situ studies revealed that leaching and redistribution of Cr during the prolonged electrolysis resulted in increased electrochemically active surface area. This eventually enhanced the catalyst porosity and improved OER activity. Nix Cry O was further applied in real seawater from the Red Sea (without purification, 1 M KOH added), envisaging that the dynamically evolving porosity can offset the adverse active site-blocking effect posed by the seawater impurities. Remarkably, Nix Cry O exhibited stable operation for 2000, 275 and 100 h in seawater at 10, 100 and 500 mA cm-2 , respectively. The proposed catalyst and the mechanistic insights represented a step towards realization of non-noble metal-based direct seawater splitting.

Data analysis and prediction of the COVID-19 outbreak in the first and second waves for top 5 affected countries in the world.

In this paper, we introduce a SEIATR compartmental model to analyze and predict the COVID-19 outbreak in the Top 5 affected countries in the world, namely the USA, India, Brazil, France, and Russia. The officially confirmed cases and death due to COVID-19 from the day of the official confirmation to June 30, 2021 are considered for each country. Primarily, we use the data to make a comparison between the cumulative cases and deaths due to COVID-19 among these five different countries. This analysis allows us to infer the key parameters associated with the dynamics of the disease for these five different countries. For example, the analysis reveals that the infection rate is much higher in the USA, Brazil, and France compared to that of India and Russia, while the recovery rate is found almost the same for these countries. Further, the death rate is measured higher in Brazil as opposed to India, where it is found much lower among the remaining countries. We then use the SEIART compartmental model to characterize the first and second waves of these countries, as well as to investigate and identify the influential model parameters and nature of the virus transmissibility in respective countries. Besides estimating the time-dependent reproduction number (Rt) for these countries, we also use the model to predict the peak size and the time occurring peak in respective countries. The analysis demonstrates that COVID-19 was observed to be much more infectious in the second wave than the first wave in all countries except France. The results also demonstrate that the epidemic took off very quickly in the USA, India, and Brazil compared to two other countries considered in this study. Furthermore, the prediction of the epidemic peak size and time produced by our model provides a very good agreement with the officially confirmed cases data for all countries expect Brazil.

Development of a Next-Generation Fluorescent Turn-On Sensor to Simultaneously Detect and Detoxify Mercury in Living Samples.

Strategies for simultaneous detection and detoxification of Hg2+ using a single sensor from biological and environmental samples are limited and have not been realized in living organisms so far. We report a highly selective, small molecule "turn-on" fluorescent sensor, PYDMSA, based on the cationic dye Pyronin Y (PY) and chelating agent meso-2,3-dimercaptosuccinic acid (DMSA) for the simultaneous detection and detoxification of inorganic mercury (Hg2+). After Hg2+ detection, concomitant detoxification was carried out with sufficient efficacy in living samples, which makes the sensor unique. PYDMSA exhibits high selectivity for Hg2+ over other competing metal ions with an experimental detection limit of ∼300 pM in aqueous buffer solution. When PYDMSA reacts with Hg2+, the CS-C9 bond in the sensor gets cleaved. This results in the "turn-on" response of the fluorescence probe with a concomitant release of one equivalent of water-soluble Hg2+-DMSA complex which leads to a synchronous detoxifying effect. The sensor by itself is nontoxic to cells in culture and has been used to monitor the real-time uptake of Hg2+ in live cells and zebrafish larvae. Thus, PYDMSA is a unique sensor which can be used to detect and detoxify mercury at the same time in living samples.

Drinking water contributes to high salt consumption in young adults in coastal Bangladesh.

Increasing salinity of freshwater from environmental and anthropogenic influences is threatening the health of 35 million inhabitants in coastal Bangladesh. Yet little is known about the characteristics of their exposure to salt (sodium), a major risk factor for hypertension and related chronic diseases. This research examined sodium consumption levels and associated factors in young adults. We assessed spot urine samples for 282 participants (19-25 years) during May-June 2014 in a rural sub-district in southwestern coastal Bangladesh and measured sodium levels of their potable water sources. The significant factors associated with high sodium consumption were determined from logistic regression analyses. Mean sodium content in tube-well water (885 mg/L) was significantly higher than pond water (738 mg/L) (P = 0.01). Fifty three percent of subjects were consuming sodium at levels above the WHO recommended level (≥2 g/day). The users of tube-well water were more likely to consume sodium above this recommended level than pond water users. Salinity problems are projected to increase with climate change, and with large populations potentially at risk, appropriate public health and behavior-change interventions are an urgent priority for this vulnerable coastal region along with targeted research to better understand sodium exposure pathways and health benefits of alternative water supplies.

Pre-marital sex and its predicting factors among Malaysian youths.

INTRODUCTION: This study aimed to examine the prevalence of pre-marital sex and its predicting factors among youth trainees undergoing a national skill training programme in the state of Malaysia. METHODS: Participants filled up health screening surveys at the beginning of their training period. A total of 1328 out of 1377 trainees were included in the study. Logistic regression was done to determine the potential predicting factors of pre-marital sex among the trainees. RESULTS: Most trainees were 18 years old (97.1%) and 56% were female and 44% were male. The prevalence of pre-marital sex among trainees of these youths was 4.6%. A total of 6.2% of the female trainees as compared to 2.6% of their male counterpart had had pre-marital sex. Analysis using multiple logistic regression revealed only six significant predictor variables which were religion, race, lover, reading or watching porn, masturbation and bullying. CONCLUSION: The prevalence of pre-marital sex amongst Malaysian youths is low as compared to those in developed countries. However, as pre-marital sex and pregnancy outside wedlock are largely socially unacceptable in Malaysia and may be kept hidden from others, the complications and social problems that may follow from this behaviour should be taken into consideration. Measures such as sex education and awareness programmes are needed among youth to curb this phenomenon from becoming a social as well as a public health concern.

Mathematical modeling of the infectious spread and outbreak dynamics of avian influenza with seasonality transmission for chicken farms.

A compartmental model with a time-varying contact rate, the seasonality effect, and its corresponding nonautonomous model are investigated. The model is developed based on the six compartments: susceptible, latent, infected, asymptomatic, treated, and recovered individuals. We determine the effective reproduction number for this nonautonomous system, and analytic discussion shows that at least one positive periodic solution exists for R0>1. The model is simulated using the RK-45 numerical method, and the parameter values for the model are taken from the available literature. From the numerical results, we observe that the degree of seasonality and vaccine efficacy significantly impact the amplitude of the epidemic curve. The latent-infected phase plane shows that periodic solutions exhibit a period-doubling bifurcation as the amplitude of seasonality increases. Finally, the model outcome was compared with the actual field data and found to be consistent.

Palliative radiotherapy: survival prognostic factors - single-centre retrospective cohort study.

OBJECTIVE: Patients with non-curative malignancy can receive palliative radiotherapy (PR) to alleviate symptoms. However, choosing the right patient to receive PR can be challenging, as some patients may not survive long enough to gain benefit. This study aims to identify prognostic factors for overall survival (OS) and 30-day mortality (30DM) following PR and to test these in a real-world cohort. METHOD: A retrospectively collected data set of all adults completing PR between 1 August 2018 and 31 December 2018 at a single centre (n=214, Southend University Hospital NHS Foundation Trust, UK) was used to test prognostic factors. Factors such as demographics, tumour primary, treatment area, fractionation regime, performance status (PS), progressive disease (PD), opioid or steroid use and haemoglobin level, as well as overall survival, were collected. Cox regression was used to examine survival predictors, and logistic regression was used to determine the predictive strength of factors for 30DM. RESULTS: Overall 30DM was 14%. There was significantly worse survival in patients with poor PS (HR 1.2406, 95% CI 0.94 to 1.64. p=0.01). Patients with PS 3 had a median OS of 75 days and were more likely to experience 30DM (OR 6.2, 95% CI 1.226 to 45.42, p=0.03). Patients with PD outside of the radiation field (46%, 30 out of 65 documented) had significantly worse OS (HR 5.24, 95% CI 2.19 to 12.5, p<0.001). CONCLUSION: Poor PS and PD were prognostic of OS and 30DM. Future work should include validation with a prospectively collected cohort.

Impact of Multidisciplinary Heart Failure Clinic on Guideline-Directed Medical Therapy and Clinical Outcomes.

Background: Heart failure (HF) is associated with recurrent hospital admissions and high mortality. Guideline-directed medical therapy has been shown to improve prognosis for patients who have HF with reduced ejection fraction (HFrEF). Despite the proven benefits of guideline-directed medical therapy, its utilization is less than optimal among patients with HF in Malaysia. Objective: To determine the impact of a multidisciplinary team HF (MDT-HF) clinic on the use of guideline-directed medical therapy and patients' clinical outcomes at 1 year. Methods: This retrospective study was conducted in a single cardiac centre in Malaysia. Patients with HFrEF who were enrolled in the MDT-HF clinic between November 2017 and June 2020 were compared with a matched control group who received the standard of care. Data were retrieved from the hospital electronic system and were analyzed using statistical software. Results: A total of 54 patients were included in each group. Patients enrolled in the MDT-HF clinic had higher usage of renin-angiotensin system blockers (54 [100%] vs 47 [87%], p < 0.001) and higher attainment of the target dose for these agents (35 [65%] vs 5 [9%], p < 0.001). At 1 year, the mean left ventricular ejection fraction (LVEF) was significantly greater in the MDT-HF group (35.7% [standard deviation 12.3%] vs 26.2% [standard deviation 8.7%], p < 0.001), and care in the MDT-HF clinic was significantly associated with better functional class, with a lower proportion of patients categorized as having New York Heart Association class III HF at 1 year (1 [2%] vs 14 [26%], p = 0.001). Patients in the MDT-HF group also had a significantly lower rate of readmission for HF (4 [7%] vs 32 [59%], p < 0.001). Conclusions: Patients who received care in the MDT-HF clinic had better use of guideline-directed medical therapy, greater improvement in LVEF, and a lower rate of readmission for HF at 1 year relative to patients who received the standard of care.

Contexte: L'insuffisance cardiaque (IC) est associée à des hospitalisations récurrentes et à une mortalité élevée. Il a été démontré qu'un traitement médical orienté par des lignes directrices améliore le pronostic des patients atteints d'insuffisance cardiaque avec fraction d'éjection réduite (ICFER). Malgré les avantages éprouvés du traitement médical orienté par des lignes directrices, son utilisation est loin d'être optimale chez les patients atteints d'IC en Malaisie. Objectif: Déterminer l'incidence d'une clinique d'IC en équipe multidisciplinaire (IC-ÉM) sur l'utilisation d'un traitement médical orienté par des lignes directrices et les résultats cliniques des patients à 1 an. Méthodes: Cette étude rétrospective a été menée dans un seul centre cardiaque en Malaisie. Les patients atteints d'ICFER inscrits à la clinique d'IC-ÉM entre novembre 2017 et juin 2020 ont été comparés à un groupe témoin apparié ayant reçu des soins standard. Les données ont été extraites du système électronique de l'hôpital et analysées à l'aide d'un logiciel statistique. Résultats: Au total, 54 patients ont été inclus dans chaque groupe. L'utilisation d'inhibiteurs du système rénine-angiotensine était plus élevée chez les patients inscrits à la clinique d'IC-ÉM (54 [100 %] contre 47 [87 %], p < 0,001) et la dose cible pour ces agents était mieux atteinte (35 [65 %] contre 5 [9 %], p < 0,001). Á 1 an, la fraction d'éjection ventriculaire gauche (FÉVG) moyenne était significativement plus élevée chez les patients ayant reçu des soins dans la clinique d'IC-ÉM (35,7 % [écart type 12,3 %] contre 26,2 % [écart type 8,7 %], p < 0,001), et les soins prodigués dans la clinique d'IC-ÉM étaient significativement associés à une meilleure classe fonctionnelle, avec une proportion plus faible de personnes classées comme ayant une IC de classe III selon la New York Heart Association à 1 an (1 [2 %] contre 14 [26 %], p = 0,001). Le taux de réadmission pour IC des patients du groupe IC-ÉM était aussi significativement plus faible (4 [7 %] contre 32 [59 %], p < 0,001). Conclusions: L'utilisation du traitement médical orienté par des lignes directrices chez les patients ayant reçu des soins dans la clinique d'IC-ÉM était meilleure, leur FÉVG s'est améliorée dans une plus grande mesure, et leur taux de réadmission pour IC à 1 an était plus faible par rapport aux patients ayant reçu les soins standard.

Novice driver crashes: The relation between putative causal factors, countermeasures, real world implementations, and policy - A case study in simple, scalable solutions.

Novice drivers are at a greatly inflated risk of crashing. This led in the 20th century to numerous attempts to develop training programs that could reduce their crash risk. Yet, none proved effective. Novice drivers were largely considered careless, not clueless. This article is a case study in the United States of how a better understanding of the causes of novice driver crashes led to training countermeasures targeting teen driving behaviors with known associations with crashes. These effects on behaviors were large enough and long-lasting enough to convince insurance companies to develop training programs that they offered around the country to teen drivers. The success of the training programs at reducing the frequency of behaviors linked to crashes also led to several large-scale evaluations of the effect of the training programs on actual crashes. A reduction in crashes was observed. The cumulative effect has now led to state driver licensing agencies considering as a matter of policy both to include items testing the behaviors linked to crashes on licensing exams and to require training on safety critical behaviors. The effort has been ongoing for over a quarter century and is continuing. The case study highlights the critical elements that made it possible to move from a paradigm shift in the understanding of crash causes to the development and evaluation of crash countermeasures, to the implementation of those crash countermeasures, and to subsequent policy changes at the state and federal level. Key among these elements is the development of simple, scalable solutions.

Impact of vaccination on the entire population and dose-response relation of COVID-19.

Objective: The objective of this study is to develop a mathematical model for the COVID-19 pandemic including vaccination, the transmissibility of the virus-pathogen dose-response relationship, vaccine efficiency, and vaccination rate. Methods: The Runge-Kutta (RK-45) method was applied to solve the proposed model with MATLAB code and the calculated results show the dynamics of the individuals in each compartment. The data of total death due to the COVID-19 pandemic in the case of the USA were collected from GitHub and the re-use of this data needs no ethical clearance. The control reproduction number was used to assess the dose-response relationship and critical vaccination coverage. Results: We have calculated the probability of infection and the infection risk against the different exposure doses and the virus copies, respectively. The results show that the probability of infection increases with the increasing exposure dose for certain virus copies and the risk of infection decreases with the increasing of virus copies for a certain exposure dose. The results also show that the critical vaccination coverage demands increase with an increase in transmission rate and decrease with increasing vaccine efficacy. Conclusions: It was seen that the critical vaccination coverage corresponding to an increased transmission rate rise sharply in the beginning and then reached a threshold. Moreover, the real data of the total death cases in the USA were compared with the fitted curved of the model which validated the proposed model. Vaccination against COVID-19 is essential to control the pandemic, and achieving high vaccine uptake in the population can reduce the pandemic as fast as possible.

Objetivo: El objetivo de este estudio es desarrollar un modelo matemático para la pandemia de COVID-19 que incluya la vacunación, la transmisibilidad de la relación dosis-respuesta virus-patógeno, la eficacia de la vacuna y la tasa de vacunación. Métodos: Se aplicó el método de Runge-Kutta (RK-45) para resolver el modelo propuesto con código MATLAB y los resultados calculados muestran la dinámica de los individuos en cada compartimento. Los datos de muerte total por la pandemia de COVID-19 en el caso de EE. UU. se recopilaron de GitHub y la reutilización de estos datos no necesita autorización ética. El número de reproducción de control se utilizó para evaluar la relación dosis-respuesta y la cobertura de vacunación crítica. Resultados: Hemos calculado la probabilidad de infección y el riesgo de infección frente a las diferentes dosis de exposición y las copias del virus, respectivamente. Los resultados muestran que la probabilidad de infección aumenta con el aumento de la dosis de exposición para ciertas copias del virus y el riesgo de infección disminuye con el aumento de las copias del virus para una determinada dosis de exposición. Los resultados también muestran que las demandas críticas de cobertura de vacunación aumentan con el aumento de la tasa de transmisión y disminuyen con el aumento de la eficacia de la vacuna. Conclusiones: Se observó que las coberturas críticas de vacunación correspondientes a una mayor tasa de transmisión aumentaron bruscamente al principio y luego alcanzaron un umbral. Además, se compararon los datos reales del total de casos de muerte en EE. UU. con la curva ajustada del modelo que validó el modelo propuesto. La vacunación contra el COVID-19 es fundamental para controlar la pandemia, y lograr una alta captación de vacunas en la población puede reducir la pandemia lo más rápido posible.

A Meta-Analysis of eHealth Interventions on Ischaemic Heart Disease Health Outcomes.

Background: Electronic Health (eHealth) interventions as a secondary prevention tool to empower patients' health in decision-making and behaviour. Objective: With the growing body of evidence supporting the use of eHealth interventions, the intention is to conduct a meta-analysis on various health outcomes of eHealth interventions among ischaemic heart disease (IHD) patients. Methods: Based on PRISMA guidelines, eligible studies were searched through databases of Web of Science, Scopus, PubMed, EBSCOHost, and SAGE (PROSPERO registration CRD42021290091). Inclusion criteria were English language and randomised controlled trials published between 2011 to 2021 exploring health outcomes that empower IHD patients with eHealth interventions. RevMan 5.4 was utilised for meta-analysis, sensitivity analysis, and risk of bias (RoB) assessment while GRADE software for generating findings of physical health outcomes. Non-physical health outcomes were analysed using SWiM (synthesis without meta-analysis) method. Results: This review included 10 studies, whereby, six studies with 895 participants' data were pooled for physical health outcomes. Overall, the RoB varied significantly across domains, with the majority was low risks, a substantial proportion of high risks and a sizeable proportion of unclear. With GRADE evidence of moderate to high quality, eHealth interventions improved low density lipoprotien (LDL) levels in IHD patients when compared to usual care after 12 months of interventions (SMD -0.26, 95% CI [-0.45, -0.06], I2 = 0%, p = 0.01). Significance appraisal in each domain of the non-physical health outcomes found significant findings for medication adherence, physical activity and dietary behaviour, while half of the non-significant findings were found for other behavioural outcomes, psychological and quality of life. Conclusions: Electronic Health interventions are found effective at lowering LDL cholesterol in long-term but benefits remain inconclusive for other physical and non-physical health outcomes for IHD patients. Integrating sustainable patient empowerment strategies with the advancement of eHealth interventions by utilising appropriate frameworks is recommended for future research.

Stabilizing ruthenium dioxide with cation-anchored sulfate for durable oxygen evolution in proton-exchange membrane water electrolyzers.

Ruthenium dioxide is the most promising alternative to the prevailing but expensive iridium-based catalysts for the oxygen evolution reaction in proton-exchange membrane water electrolyzers. However, the under-coordinated lattice oxygen of ruthenium dioxide is prone to over-oxidation, and oxygen vacancies are formed at high oxidation potentials under acidic corrosive conditions. Consequently, ruthenium atoms adjacent to oxygen vacancies are oxidized into soluble high-valence derivatives, causing the collapse of the ruthenium dioxide crystal structure and leading to its poor stability. Here, we report an oxyanion protection strategy to prevent the formation of oxygen vacancies on the ruthenium dioxide surface by forming coordination-saturated lattice oxygen. Combining density functional theory calculations, electrochemical measurements, and a suite of operando spectroscopies, we showcase that barium-anchored sulfate can greatly impede ruthenium loss and extend the lifetime of ruthenium-based catalysts during acidic oxygen evolution, while maintaining the activity. This work paves a new way for designing stable and active anode catalysts toward acidic water splitting.

Influence of Molasses Residue on Treatment of Cow Manure in an Anaerobic Filter with Perforated Weed Membrane and a Conventional Reactor: Variations of Organic Loading and a Machine Learning Application.

This study highlighted the influence of molasses residue (MR) on the anaerobic treatment of cow manure (CM) at various organic loading and mixing ratios of these two substrates. Further investigation was conducted on a model-fitting comparison between a kinetic study and an artificial neural network (ANN) using biomethane potential (BMP) test data. A continuous stirred tank reactor (CSTR) and an anaerobic filter with a perforated membrane (AF) were fed with similar substrate at the organic loading rates of (OLR) 1 to OLR 7 g/L/day. Following the inhibition signs at OLR 7 (50:50 mixing ratio), 30:70 and 70:30 ratios were applied. Both the CSTR and the AF with the co-digestion substrate (CM + MR) successfully enhanced the performance, where the CSTR resulted in higher biogas production (29 L/d), SMP (1.24 LCH4/gVSadded), and VS removal (>80%) at the optimum OLR 5 g/L/day. Likewise, the AF showed an increment of 69% for biogas production at OLR 4 g/L/day. The modified Gompertz (MG), logistic (LG), and first order (FO) were the applied kinetic models. Meanwhile, two sets of ANN models were developed, using feedforward back propagation. The FO model provided the best fit with Root Mean Square Error (RMSE) (57.204) and correlation coefficient (R2) 0.94035. Moreover, implementing the ANN algorithms resulted in 0.164 and 0.97164 for RMSE and R2, respectively. This reveals that the ANN model exhibited higher predictive accuracy, and was proven as a more robust system to control the performance and to function as a precursor in commercial applications as compared to the kinetic models. The highest projection electrical energy produced from the on-farm scale (OFS) for the AF and the CSTR was 101 kWh and 425 kWh, respectively. This investigation indicates the high potential of MR as the most suitable co-substrate in CM treatment for the enhancement of energy production and the betterment of waste management in a large-scale application.

Mathematical modeling of bird flu with vaccination and treatment for the poultry farms.

A deterministic six-compartmental model was developed based on the progression of the disease in poultry, the epidemiological status of the individuals, and intervention measures. The Runge-Kutta method is applied to calculate the variables of the system of equations of the proposed model. The evolution of the epidemic provides some results, such as reproduction number, vaccine efficiency, and antiviral treatment. Numerical results show that the outbreak sizes known as the infected curves increase and decrease with the vaccine limitation rate and treatment rate, respectively, for a specific transmission rate. The calculated results of the reproduction number indicate that avian influenza would spread when vaccine efficiency is less than 70%, and the primary reproduction number is greater than 1. Finally, the disease-free equilibrium of the model is found locally and globally asymptotically stable for R0 < 1.

Multisystem Inflammatory Syndrome of a Neonate From a COVID-19-Infected Mother: A Case Report.

In neonates, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 - COVID-19) is lower. There is the potential for vertical transmission of SARS-CoV-2. To date, only a few reports suggest this possibility. Neonates usually have mild symptoms, but some develop multisystem involvement, which is a concern. COVID-19 infections have been reported both in pregnant women and their neonates. However, the evidence of vertical or horizontal transmission modes has not been fully established. We recorded a case study where a 33-year-old mother was tested positive for COVID-19 infection by RT-PCR during her 27th week of gestation and needed ventilator support for her respiratory distress at that time for 11 days. Subsequently, she gave birth to a female baby at the 35th week via a lower uterine segment cesarean section. The neonate manifested a severe multisystem inflammatory syndrome associated with her possible COVID-19 infection. Sharing her uncommon clinical presentation, immunological syndrome, and disease outcome are noteworthy for similar unforeseen pediatric case management to help guide future investigations and care.

Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study.

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO 'Watch' list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

Trends of 2019-nCoV in South Asian countries and prediction of the epidemic peaks.

A deterministic compartmental model of the corona virus diseases has been introduced to investigate the current outbreak and epidemic peaks of the 2019-nCoV in South Asian countries. We have done details analysis of the above mentioning model and demonstrated its application using publicly reported data. Based on the reported data, we have determined the new infective rate, ß = 0.0017, ß = 0.00069, ß = 0.0011 and ß = 0.00047 for India, Pakistan, Bangladesh and Afghanistan, respectively and these values are not found for other countries due to insufficient data. According to present model, the epidemic under the most restrictive measures was observed of peak on around June 29 in Bangladesh with a peak size of 4100 infectious individuals which was closed to real size of 4014. In the same way, the model results also showed that the epidemic peaks were found on around September 16 in India, June 13 in Pakistan and on June 5 in Afghanistan with the peak sizes of 97,500, 6950 and 935, respectively those were closed to the real values. In addition, we have derived a model-implied basic reproduction number for each day of currently infected cases so that the mitigation and defeat strategies can be imposed to control the size of the epidemic.

Patients' time in therapeutic range on warfarin among atrial fibrillation patients in Warfarin Medication Therapy Adherence Clinic.

BACKGROUND: The quality of warfarin therapy can be determined by the time in the therapeutic range (TTR) of international normalized ratio (INR). The estimated minimum TTR needed to achieve a benefit from warfarin therapy is ≥ 60%. AIM: To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy. METHODS: A retrospective observational study was conducted at a cardiology referral center in Selangor, Malaysia. A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included. Patients' clinical data, information related to warfarin therapy, and INR readings were traced through electronic Hospital Information system. A data collection form was used for data collection. The percentage of days when INR was within range was calculated using the Rosendaal method. The poor INR control category was defined as a TTR < 60%. Predictors for poor TTR were further determined by using logistic regression. RESULTS: A total of 420 patients [54.0% male; mean age 65.7 (10.9) years] were included. The calculated mean and median TTR were 60.6% ± 20.6% and 64% (interquartile range 48%-75%), respectively. Of the included patients, 57.6% (n = 242) were in the good control category and 42.4% (n = 178) were in the poor control category. The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7% and 67.3%. A high HAS-BLED score of ≥ 3 was associated with poor TTR (adjusted odds ratio, 2.525; 95% confidence interval: 1.6-3.9, P < 0.001). CONCLUSION: In our population, a high HAS-BLED score was associated with poor TTR. This could provide an important insight when initiating an oral anticoagulant for these patients. Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.

A Quality Improvement Approach to Reduce 30-day Readmissions and Mortality in Patients with Acute Decompensated Heart Failure.

OBJECTIVES: Heart failure [HF] hospital readmissions are a continued challenge in the care of HF patients, which contribute substantially to the high costs of the disease and high mortality rate in lower to middle income country. We implemented a quality improvement project to improve patient outcomes and resource utilization. METHODS: This study was a prospective cohort design with a historical comparison group. It was conducted to assess the difference in 30-day readmissions and mortality and to assess compliance rate with HF guideline between the historical pre-intervention audit 1 cohort and prospective post-intervention audit 2 cohorts. Audit 1 cohort were recruited from January to February 2019, whereas, audit 2 cohort which received the bundled intervention program were recruited from July to December 2019. Clinical outcomes were compared between cohorts using 30-day readmissions and mortality. RESULTS: A total of 50 and 164 patients were included in audit 1 and audit 2 cohort, respectively. Patients in the audit 2 cohort were younger [63.0 ± 14.5 in audit 1 vs 56.5 ± 12.7 in audit 2, p = 0.003] and majority were male [50.0% in audit 1 vs 72.0% in audit2, p = 0.004]. Thirty-day readmissions were significantly different [36.0% audit 1 vs. 22.0% audit 2, p = 0.045], but the mortality rates were similar [4.0%% audit 1 vs. 5.5% audit 2, p = 0.677] between two cohorts. CONCLUSION: A significant decrease in 30-day readmissions was observed in the post-intervention audit 2 cohort in our setting. Further study in larger population and prolong study follow-up is warranted.

Enhancement of Bioreactor Performance Using Acclimatised Seed Sludge in Anaerobic Treatment of Chicken Slaughterhouse Wastewater: Laboratory Achievement, Energy Recovery, and Its Commercial-Scale Potential.

Lack of good management practice of chicken slaughterhouse wastewater (CSWW) has caused pollution into water bodies. In this study, the potential of seed sludge acclimatised modified synthetic wastewater (MSWW) on bioreactor performance and energy recovery of CSWW treatment was investigated. Two sets of upflow anaerobic sludge blanket (UASB) reactors were employed. The seed sludge in UASB 2 was acclimatised with MSWW for 30 days. In UASB 1, no acclimatisation process was undertaken on seed sludge for control purposes. After the acclimatisation process of UASB 2, both reactors were supplied with CSWW under the same condition of organic loading rate (OLR = 0.5 to 6 gCOD/L/d) and mesophilic condition (37 °C). COD removal efficiencies of UASB 2 were >80% all through the steady-state of the OLR applied. Meanwhile, a drastic decrease in overall performance was observed in UASB 1 when the OLR was increased to 3, 4, 5, and 6 gCOD/L/d. Energy recovery from laboratory scale and projected value from commercial-scale bioreactor were 0.056 kWh and 790.49 kWh per day, respectively. Preliminary design of an on-site commercial-scale anaerobic reactor was proposed at a capacity of 60 m3.