Environmental remediation of hazardous pollutants using MXene-perovskite-based photocatalysts: A review.

Photocatalysis utilizing semiconductors offer a cost-effective and promising solution for the removal of pollutants. MXene and perovskites, which possess desirable properties such as a suitable bandgap, stability, and affordability, have emerged as a highly promising material for photocatalytic activity. However, the efficiency of MXene and perovskites is limited by their fast recombination rates and inadequate light harvesting abilities. Nonetheless, several additional modifications have been shown to enhance their performance, thereby warranting further exploration. This study delves into the fundamental principles of reactive species for MXene-perovskites. Various methods of modification of MXene-perovskite-based photocatalysts, including Schottky junction, Z-scheme and S-scheme are analyzed with regard to their operation, differences, identification techniques and reusability. The assemblance of heterojunctions is demonstrated to enhance photocatalytic activity while also suppressing charge carrier recombination. Furthermore, the separation of photocatalysts through magnetic-based methods is also investigated. Consequently, MXene-perovskite-based photocatalysts are seen as an exciting emerging technology that necessitates further research and development.

Use of designing for behaviour change framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8-23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition-sensitive agriculture programme.

Inadequate diet quality is a cause of undernutrition among children 6-23 months of age in Bangladesh, particularly in remote and isolated areas such as Bandarban District. Feeding animal source foods can help to combat stunting and wasting problems among children, but it may not be accessible or acceptable. A barrier analysis using the Designing for Behavior Change Framework was conducted in Bandarban district with participants from 4 ethnic groups, to explore potential barriers and key motivators by examining 12 behavioural determinants of consumption of animal-source food in complementary feeding for children 8-23 months. Data were collected from 45 mothers of children 8-23 months, who provided animal-source foods to their children (doers), and from 45 mothers who did not (non-doers), for a total of 90 interviews. Nine determinants were statistically significantly different between doers and non-doers as follows: self-efficacy, positive consequences, negative consequences, social norms, access, reminders, perceived risk, perceived severity and perceived action efficacy. Nearby access to purchase animal-source foods, rearing poultry or livestock at home and the support of household and community members are enablers to feeding animal-source food. In contrast, these same factors are barriers for non-doers. The lack of money to spend on animal-source foods is also a barrier. An integrated nutrition-sensitive and gender-transformative animal-based food production, and inclusive market programme could increase access to meat and eggs at the household level, increase opportunities to earn income and support gender-equitable household workloads and decision-making for optimal child feeding.

Changes in glycated hemoglobin, diabetes knowledge, quality of life, and anxiety in children and adolescents with type 1 diabetes attending summer camps: A systematic review and meta-analysis.

Diabetes summer camps provide children and adolescents with type 1 diabetes opportunities to learn about the disease and its management in a supportive environment to help improve glycemic control, self-reliance, and quality of life. The objective of this quantitative review was to assess the advantages of attending summer camps and study any adverse psychological effects. Studies with a pre/post study design in children and adolescents attending summer camp were systematically reviewed. Five bibliographic databases were searched and relevant data extracted. Random effects meta-analyses were used to combine the individual study results to derive pooled estimates and meta-regression was used to explore between-study heterogeneity. Studies in the literature report short-term improvements in the glycemic control, diabetes knowledge (DK), quality of life (QOL) anxiety, diabetes self-management, and self-esteem. Thirty-three studies were identified, and those outcomes reported in five or more studies were included in meta-analyses. There were significant benefits with a pooled mean change for glycated hemoglobin (95% CI) of -0.59(-0.95,-0.23)% (-6.4[-10.4,-2.5]mmol/mol), and for standardized DK score of 1.99(1.28,2.70) but corresponding changes for QOL 0.17(-0.06,0.39) and for anxiety -0.32(-0.70, 0.06) were not significant. However, all outcomes showed considerable between-study heterogeneity little of which was explained by study characteristics. The findings suggest short-term benefits of camp on metabolic control, DK, QOL and anxiety in T1D children and adolescents, although the latter two were not statistically significant. Further research is warranted with more methodological rigor and longer-term follow-up to determine if there are long-term benefits associated with camp attendance.

Fugitive dust emission control study for a developed smart dry fog system.

Air pollution due to dust emission is continuously increasing day by day in mining and allied industrial areas. Mining operations contribute a substantial amount of dust emission at the crushing, screening, and bulk material handling in loading areas. The ambient suspended dust particles create a severe nuisance to workers and local dwellers. For effective controlling of positive dust emission, an innovative automated dry fog dust suppression system (DFDSS) has been developed using hybrid nozzles, sensors, actuators, controllers, screw compressors, air receivers, pumps, motors, and water arrangement with filtration facility. The DFDSS was installed in a crushing and screening plant of an iron ore mine in India. Performance study indicted fugitive dust emission concentration values ranged from 354 to 7040 µg m-3, which was reduced to 91-300 µg m-3 after installation of DFDSS. The reduced values were within the permissible limit of 1200 µg m-3 at a distance of 25 ± 2 m in the predominant downwind direction. The installed DFDSS added a meager addition of moisture content of 0.032% in the handling iron ore material, which was below the acceptable limit of 0.1%. The DFDSS precisely regulated fugitive dust emission from various mining activities without affecting the minerals processing performance. Thus, the DFDSS can be implemented effectively in different mining and allied industries where there is a dust emission problem.

Quantum Signature of a Squeezed Mechanical Oscillator.

Recent optomechanical experiments have observed nonclassical properties in macroscopic mechanical oscillators. A key indicator of such properties is the asymmetry in the strength of the motional sidebands produced in the probe electromagnetic field, which is originated by the noncommutativity between the oscillator ladder operators. Here we extend the analysis to a squeezed state of an oscillator embedded in an optical cavity, produced by the parametric effect originated by a suitable combination of optical fields. The motional sidebands assume a peculiar shape, related to the modified system dynamics, with asymmetric features revealing and quantifying the quantum component of the squeezed oscillator motion.

Identifying predictors of antimicrobial exposure in hospitalized patients using a machine learning approach.

AIMS: Analysis and tracking of antimicrobial utilization (AU) are crucial in antimicrobial stewardship efforts which are used to find effective interventions for controlling antimicrobial resistance. In antimicrobial stewardship, standard risk adjustment models are needed for benchmarking appropriate AU and for fair inter-facility comparison. In this study we identify patient- and facility-level predictors of antimicrobial usage in hospitalized patients using a machine learning approach, which can be used to inform a risk adjustment model to facilitate assessment of AU. To our knowledge, this is the first time machine learning has been applied for this purpose. METHODS AND RESULTS: Patient admission records were retrieved from the Duke Antimicrobial Stewardship Outreach Network which include clinical data for 27 community hospitals in the southeastern United States. Candidate features (predictors) were then generated from these records. The number of features was reduced using a statistical approach, and missing values of the reduced feature set were imputed using bootstrapping and expectation-maximization algorithm. Finally, support vector regression (SVR) and cubist regression (CB) models were applied to find root-mean-square error values which were used to evaluate the selected feature set. The performance of the SVR and CB models was found to be better than that of linear null and negative binomial null models, thereby demonstrating the effectiveness of our selected features. CONCLUSIONS: Relevant patient- and facility-level predictors of antimicrobial usage in days of therapy were obtained and evaluated. The potential predictor set can be used in risk adjustment strategies for benchmarking antimicrobial use. SIGNIFICANCE AND IMPACT OF THE STUDY: One reason for the rapid emergence of antimicrobial resistance is inappropriate use of antibiotics in hospitalized patients. Identifying predictors of antimicrobial exposure using a machine learning technique can improve the use of AU, enhance patient health outcomes, and reduce the infection spread caused by antimicrobial-resistant organisms.

Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa.

BACKGROUND: Worldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers. METHODS: The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method. RESULTS: Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming 'spoilt'. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers' ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace. CONCLUSION: Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support feeding and childcare if global nutrition and development goals are to be met.

Capreomycin resistance prediction in two species of Mycobacterium using a stacked ensemble method.

AIMS: Predicting bacterial resistance provides valuable information that can assist in clinical decisions. With recent advances in whole genome sequencing technology, the detection of antibiotic resistance (AR) proteins directly from genomic data is becoming feasible. AR genes/proteins can be identified using best-hit methods that work by comparing candidate sequences with known AR genes in public databases. However, these approaches may fail to detect resistance genes with sequences that differ significantly from known sequences. Our goal is to develop a machine learning technique to accurately predict capreomycin resistance in Mycobacteria with low false discovery rates. METHODS AND RESULTS: We present a stacked ensemble learning model as an alternative to traditional DNA sequence alignment-based methods using optimal features generated from the physicochemical, evolutionary and secondary structure properties of protein sequences. We train logistic regression, C5.0 and support vector machine (SVM) algorithms as our base classifiers, and our stacked ensemble predictors combine the results from the base classifiers to achieve higher accuracy. Compared with our most accurate base classifier (SVM), our most accurate stacked ensemble predictor increases training accuracy by 2·43%. Our stacked ensemble predictors achieve test accuracy up to 81·25%. CONCLUSIONS: We developed a stacked ensemble model to predict capreomycin resistance for Mycobacteria with an accuracy >80% using protein sequences with sequence similarity ranging between 10% and 70%. This performance cannot be achieved with best-hit methods due to differences in sequence similarity. SIGNIFICANCE AND IMPACT OF THE STUDY: Today an estimated one-half million cases of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) occur annually worldwide at a great cost. Because capreomycin is a second-line drug used to treat drug-resistant TB, the ability to use a machine learning approach to classify capreomycin-resistant TB in a timely manner is crucial for the successful treatment of MDR or XDR TB.

Effect of air-blowing time and long-term storage on bond strength of universal adhesives to dentin.

OBJECTIVES: To evaluate the effects of air-blowing time and storage time on microtensile bond strength (µTBS) of universal adhesives to dentin. MATERIALS AND METHODS: Ninety flat dentin surfaces from extracted human third molars were bonded with three universal adhesives (Clearfil Universal Bond-CU; G-Premio Bond-GP; Scotchbond Universal Adhesives-SB). Bonded dentin surfaces were air-dried for 5 s, 15 s, or 30 s followed by resin composite built-up. Resin-dentin beams were tested with µTBS test after different storage time in distilled water (24 h and 1 year). Data were analyzed by three-way ANOVA and Duncan test at (α = 0.05). Failure mode and resin-dentin interfaces were observed using a scanning electron microscope (SEM). Specific features of fractured beams after µTBS were further observed using SEM at high magnification. RESULTS: Extension of air-blowing time from 5 s to 30 s increased the 24 h µTBS of CU only. Bond strength of all adhesives significantly decreased after 1-year storage except for CU at 5 s and 30 s of air-blowing time. One-year µTBS were significantly higher when air-blowing times were extended to 15 s for SB and 30 s for CU. Air-blowing time had no influence on GP. CONCLUSION: The effect of air-blowing time and storage time on resin-dentin bond was material-dependent. CLINICAL RELEVANCE: Extended air-blowing time increased the bond strength and bond durability of CU. Extension of air-blowing time to 15 s and 30 s improve the long-term bond strength of SB and CU, respectively.

Imaging Correlations in Heterodyne Spectra for Quantum Displacement Sensing.

The extraordinary sensitivity of the output field of an optical cavity to small quantum-scale displacements has led to breakthroughs such as the first detection of gravitational waves and of the motions of quantum ground-state cooled mechanical oscillators. While heterodyne detection of the output optical field of an optomechanical system exhibits asymmetries which provide a key signature that the mechanical oscillator has attained the quantum regime, important quantum correlations are lost. In turn, homodyning can detect quantum squeezing in an optical quadrature but loses the important sideband asymmetries. Here we introduce and experimentally demonstrate a new technique, subjecting the autocorrelators of the output current to filter functions, which restores the lost heterodyne correlations (whether classical or quantum), drastically augmenting the useful information accessible. The filtering even adjusts for moderate errors in the locking phase of the local oscillator. Hence we demonstrate the single-shot measurement of hundreds of different field quadratures allowing the rapid imaging of detailed features from a simple heterodyne trace. We also obtain a spectrum of hybrid homodyne-heterodyne character, with motional sidebands of combined amplitudes comparable to homodyne. Although investigated here in a thermal regime, the method's robustness and generality represents a promising new approach to sensing of quantum-scale displacements.

Traditional healing practices in rural Bangladesh: a qualitative investigation.

BACKGROUND: Traditional healing practice is an important and integral part of healthcare systems in almost all countries of the world. Very few studies have addressed the holistic scenario of traditional healing practices in Bangladesh, although these serve around 80% of the ailing people. This study explored distinctive forms of traditional healing practices in rural Bangladesh. METHODS: During July to October 2007, the study team conducted 64 unstructured interviews, and 18 key informant interviews with traditional healers and patients from Bhabanipur and Jobra, two adjacent villages in Chittagong district, Bangladesh. The study also used participatory observations of traditional healing activities in the treatment centers. RESULTS: Majority of the community members, especially people of low socioeconomic status, first approached the traditional healers with their medical problems. Only after failure of such treatment did they move to qualified physicians for modern treatment. Interestingly, if this failed, they returned to the traditional healers. This study identified both religious and non-religious healing practices. The key religious healing practices reportedly included Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing practices included Sorcery, Kabiraji, and Home Medicine. Both patients and healers practiced self-medication at home with their indigenous knowledge. Kabiraji was widely practiced based on informal use of local medicinal plants in rural areas. Healers in both Kalami and Bhandari practices resorted to religious rituals, and usually used verses of holy books in healing, which required a firm belief of patients for the treatment to be effective. Sorcerers deliberately used their so-called supernatural power not only to treat a patient but also to cause harm to others upon secret request. The spiritual healing reportedly diagnosed and cured the health problems through communication with sacred spirits. Although the fee for diagnosis was small, spiritual healing required different types of treatment instruments, which made the treatment implicitly expensive. CONCLUSIONS: Traditional healing was widely practiced as the means of primary healthcare in rural areas of Bangladesh, especially among the people with low socioeconomic status. The extent of services showed no decline with the advancement of modern medical sciences; rather it has increased with the passage of time.

Interaction of α-crystallin with some small molecules and its effect on its structure and function.

BACKGROUND: α-Crystallin acts like a molecular chaperone by interacting with its substrate proteins and thus prevents their aggregation. It also interacts with various kinds of small molecules that affect its structure and function. SCOPE OF REVIEW: In this article we will present a review of work done with respect to the interaction of ATP, peptide generated from lens crystallin and other proteins and some bivalent metal ions with α-crystallin and discuss the role of these interactions on its structure and function and cataract formation. We will also discuss the interaction of some hydrophobic fluorescence probes and surface active agents with α-crystallin. MAJOR CONCLUSIONS: Small molecule interaction controls the structure and function of α-crystallin. ATP and Zn+2 stabilize its structure and enhance chaperone function. Therefore the depletion of these small molecules can be detrimental to maintenance of lens transparency. However, the accumulation of small peptides due to protease activity in the lens can also be harmful as the interaction of these peptides with α-crystallin and other crystallin proteins in the lens promotes aggregation and loss of lens transparency. The use of hydrophobic probe has led to a wealth of information regarding the location of substrate binding site and nature of chaperone-substrate interaction. Interaction of surface active agents with α-crystallin has helped us to understand the structural stability and oligomeric dissociation in α-crystallin. GENERAL SIGNIFICANCE: These interactions are very helpful in understanding the mechanistic details of the structural changes and chaperone function of α-crystallin. This article is part of a Special Issue entitled Crystallin Biochemistry in Health and Disease.

Possible roles of the transcription factor Nrf1 (NFE2L1) in neural homeostasis by regulating the gene expression of deubiquitinating enzymes.

The transcription factor Nrf1 (NFE2L1) maintains protein homeostasis (proteostasis) by regulating the gene expression of proteasome subunits in response to proteasome inhibition. The deletion of the Nrf1 gene in neural stem/progenitor cells causes severe neurodegeneration due to the accumulation of ubiquitinated proteins in Purkinje cells and motor neurons (Nrf1 NKO mice). However, the molecular mechanisms governing this neurodegenerative process remain unclear. We demonstrate herein that the loss of Nrf1 leads to the reduced gene expression of the deubiquitinating enzymes (DUBs) but not proteasome subunits in Nrf1 NKO mice between P7 and P18. First, we show that K48-linked polyubiquitinated proteins accumulate in Nrf1-deficient Purkinje cells and cerebral cortex neurons. Nevertheless, loss of Nrf1 does not alter the expression and proteolytic activity of proteasome. A significantly reduced expression of deubiquitinating enzymes was also demonstrated in Nrf1-deficient cerebellar tissue using microarray analysis. The genome database further reveals species-conserved ARE, a Nrf1 recognition element, in the regulatory region of certain DUB genes. Furthermore, we show that Nrf1 can activate Usp9x gene expression related to neurodegeneration. Altogether these findings suggest that neurodegeneration in Nrf1 NKO mice may stem from the dysfunction of the ubiquitin-mediated regulation of neuronal proteins.

Sofosbuvir plus ribavirin in treatment-naïve patients with chronic hepatitis C virus genotype 1 or 3 infection in India.

Until 2014, pegylated interferon plus ribavirin was the recommended standard of care for the treatment of chronic hepatitis C virus (HCV) infection in India. This open-label phase 3b study, conducted across 14 sites in India between 31 March 2014 and 30 November 2015, evaluated the efficacy and safety of sofosbuvir plus ribavirin therapy among treatment-naïve patients with chronic genotype 1 or 3 HCV infection. A total of 117 patients with genotype 1 or 3 HCV infection were randomized 1:1 to receive sofosbuvir 400 mg and weight-based ribavirin (1000 or 1200 mg) daily for 16 or 24 weeks. Among those with genotype 1 infection, the primary efficacy endpoint of sustained virologic response at 12 weeks post-treatment (SVR12) was reported in 90% (95% confidence intervals [CI], 73-98) and 96% (95% CI, 82-100) of patients following 16 and 24 weeks of treatment, respectively. For patients with genotype 3 infection, SVR12 rates were 100% (95% CI, 88-100) and 93% (95% CI, 78-99) after 16 and 24 weeks of therapy, respectively. Adverse events, most of which were mild or moderate in severity, occurred in 69% and 57% of patients receiving 16 and 24 weeks of treatment, respectively. The most common treatment-emergent adverse events were asthenia, headache and cough. Only one patient in the 24-week group discontinued treatment with sofosbuvir during this study. Overall, sofosbuvir plus ribavirin therapy achieved SVR12 rates ≥90% and was well tolerated among treatment-naïve patients with chronic genotype 1 or 3 HCV infection in India.

Straight-to-test colonoscopy for 2-week-wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high-volume unit.

AIM: We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. METHOD: We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA). RESULTS: Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P < 0.0001). STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P < 0.0001) and tissue diagnosis from the referral date (17 days vs 24.5 days; P < 0.0001). Thirty-seven (6.8%) CRCs were detected. Proportionately fewer patients in the STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months. CONCLUSION: STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly.

Coblation® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up.

OBJECTIVES: Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with few published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation® intracapsular tonsillectomy, for both obstructive and infective indications. DESIGN: Prospective case series, March 2013-January 2016, all with completed follow-up. SETTING: Tertiary paediatric otolaryngological practice. PARTICIPANTS: A total of 500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT). MAIN OUTCOME MEASURES: Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and postoperatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure. RESULTS: With a mean follow-up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 postoperatively, P<.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%); otherwise, no complications, delayed discharges or readmissions occurred; 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery. CONCLUSIONS: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

Acinar Cell Carcinoma of the Pancreas: A Case Report.

Acinar cell carcinoma (ACC) of the pancreas is a very rare neoplasm. We report a case of pancreatic acinar cell carcinoma involving the uncinate process of the pancreas. A 45 year old man presented with a painful upper abdominal mass without any jaundice or weight loss. Computed Tomography (CT) and Magnetic Resonance Cholangio-Pancreatography (MRCP) indicated a mass lesion in the uncinate process of the pancreas. He underwent Whipple's procedure (Pancreaticoduodenectomy). Histological slides revealed features of Acinar cell carcinoma (ACC) in the uncinate process of the pancreas and a lymph node.

Outcome of Pregnancy Related Acute Kidney Injury Observed in a Tertiary Care Hospital.

This prospective case control study was carried out in Mymensingh Medical College Hospital (MMCH) from April 2011 to March 2012. The main objective of the study was to determine the short term maternal outcome of pregnancy related Acute Kidney Injury and to identify aetiological factors and to observe clinical features of pregnancy related Acute Kidney Injury. Total 60 pregnant women with AKI were included in the study as sample and equal (60) number of pregnant women with normal renal function was taken as control. Mean ages (±SD) of study and control group were observed 31.6±6.9 years and 25.5±4.7 years respectively. It was observed that most patients were from rural area with low income group. Most women were multiparous and presented in third trimester and postpartum period. Majority of the study subjects did not receive antenatal care at any stage of pregnancy. Fifty (86.7%) of the study subjects were oligo-anuric, forty-nine (81.7%) were edematous and fifty one (85%) were anaemic. Twenty-five (41.7%) patients presented with abnormal vaginal bleeding. Sepsis (including septic abortion and puerperal sepsis) was responsible for of Pregnancy Related AKI (PR-AKI) in more than two fifths of cases. Haemorrhage (APH & PPH combined) was the next common cause of Pregnancy Related AKI (PR-AKI). Toxemia of Pregnancy was responsible in one fourth of cases. Dialysis (HD & IPD combined) was required for two fifths of the patients. Rest patients were treated conservatively with antibiotics, blood transfusion, maintenance of fluid and electrolytes balance etc. Maternal outcome of Pregnancy related acute kidney injury was considered for the period of patient's hospital staying. 56.6% patients recovered completely, 15.0% patients recovered partially, 6.7% did not recover at the time of hospital discharge; while 21.7% died. So it can be concluded that, pregnancy related acute kidney injury is a critical condition, associated with worse prognosis.

Factors Influencing the Initiation of Smokeless Tobacco Consumption Among Low Socioeconomic Community in Bangladesh: A Qualitative Investigation.

This study explored factors influencing the initiation of smokeless tobacco (SLT) consumption in a low socioeconomic urban community in Bangladesh. The study conducted four focus group discussions among 33 informants involves school teachers, community leaders, women, and betel-nut shops owners. The results were prepared by thematic analysis of the transcripts where informants mean age was 30 ( SD ± 6.8) years with varying level of education. Tradition of hospitality, curiosity, offer from an elderly person, and avoiding nausea during pregnancy and at time of quitting smoking were key factors for the initiation of SLT consumption. The results also revealed most people were aware about the danger of SLT consumption but, in practice, consumed frequently. The research suggested that doctors might advise people not to use any form of SLT while they seeking health services. Furthermore, community-based awareness program could minimize the wider use of SLT among low-income community in Bangladesh.

Community Involvement in Health Systems Strengthening to Improve Global Health Outcomes: A Review of Guidelines and Potential Roles.

Definitions of health systems strengthening (HSS) have been limited in their inclusion of communities, despite evidence that community involvement improves program effectiveness for many health interventions. We review 15 frameworks for HSS, highlighting how communities are represented and find few delineated roles for community members or organizations. This review raises the need for a cohesive definition of community involvement in HSS and well-described activities that communities can play in the process. We discuss how communities can engage with HSS in four different areas-planning and priority-setting; program implementation; monitoring, evaluation, and quality improvement; and advocacy-and how these activities could be better incorporated into key HSS frameworks. We argue for more carefully designed interactions between health systems policies and structures, planned health systems improvements, and local communities. These interactions should consider local community inputs, strengths, cultural and social assets, as well as limitations in and opportunities for increasing capacity for better health outcomes.