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The transformation of the BRAC MANOSHI programme from humanitarian to a social enterprise model, has made it increasingly urgent to enumerate the minimum number of door-to-door antenatal care (ANC) visits by community health workers (CHWs), for the purpose of effectively improving facility delivery. Thus prevent social exclusion of poor slum communities in Bangladesh with regard to safe motherhood and essential newborn care (ENC). This cross-sectional study was conducted, during March–July, 2015 in slums of Chittagong, Dhaka and Sylhet city corporations of Bangladesh. A census was conducted among 25,700 households covering 10 branch offices of MANOSHI to identify women with a delivery outcome in the preceding three years of the survey. A total of 1100 respondents were interviewed randomly through a structured questionnaire. These women were stratified into three categories-1, 2 & 3, consisting of 497, 205 and 398 women respectively. Women in category-1 did not receive any ANC checkup from the BRAC CHWs, while women in category-2 and category-3 received one to three and ≥four ANC checkups from BRAC CHWs respectively. Data was analysed using STATA Version 13 (Chicago Inc.). Findings revealed that women, who received ≥four ANC checkups from BRAC CHWs, are 25% more likely to avail facility delivery [adjusted Prevalence Ratio (aPR) 1.25; 95% confidence interval (CI) (1.01–1.54)] compared to the women who did not receive any ANC from BRAC CHWs. Women in category-2 [aPR3.64; 95% CI (1.76–7.54)] and in category-3 [aPR5.92; 95% CI (3.04–11.53)] respectively had four and six folds higher tendency to receive postnatal care (PNC) within 48 hours after delivery. Furthermore, facility delivery improved PNC assisted by medically trained providers (MTPs) within 48 hours after delivery and ENC in both categories 2 & 3. The evidence shows that at least four ANC visits of BRAC CHWs can increase institutional delivery, and which can further facilitate PNC and ENC visits. At present, the BRAC MANOSHI programme needs to implement feasible strategies to include pregnant women in the slums in receiving at least four ANC checkups by BRAC CHWs for ensuring safe motherhood and newborn care. [ABSTRACT FROM AUTHOR]

A growth in recreational drug use will lead to a rise in delayed posthypoxic leukoencephalopathy cases. Physicians may inadvertently misdiagnose this rare condition as a primary psychiatric disorder by not maintaining a broad differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Incidence of delayed intracranial hemorrhage (DICH) in patients on warfarin has been controversial. No previous literature has reported the utility of international normalized ratio (INR) in predicting traumatic DICH.Objectives: Utilizing INR to risk stratify head trauma patients who may be managed without repeat imaging.Methods: This was a retrospective study at a Level II trauma center. All patients on warfarin with head injuries from March 2014 to December 31, 2017 were included. Each patient underwent an initial head computed tomography scan (HCT) and subsequent repeat HCT 12 h after. Patients presenting > 12 h after head injury received only one HCT. Two blinded neuroradiologists reviewed each case of DICH. Statistical analysis evaluated Glasgow Coma Scale (GCS), Injury Severity Score (ISS), heart rate, systolic blood pressure (SBP), age, and platelet count.Results: There were 395 patients who qualified for the protocol; 238 were female. Average age was 79 years. Seventy-seven percent of patients underwent repeat HCT. Five resulted in DICH (INR 2.6-3.0), three of which might have been present on initial HCT; incidence rate of 0.51-1.27%. One patient required neurosurgical intervention. Among 80 patients with INR < 2, no DICH was identified, resulting in high sensitivity, but with a wide confidence interval; sensitivity of 100% (95% confidence interval [CI] 47.8-100), specificity 21% (95% CI 16.6-28.9). Correlation of factors: ISS (p = 0.039), GCS (p = 0.978), HR (p = 0.601), SBP (p = 0.198), age (p = 0.014), and platelets (p = 0.281).Conclusion: No patient with INR < 2 suffered DICH, suggesting that warfarin users presenting with INR < 2 may be managed without repeat HCT. For INR > 2, patients age and injury severity can be used for shared decision-making to discharge home with standard head injury precautions and no repeat HCT. [ABSTRACT FROM AUTHOR]

[Display omitted] • GGA/PBE functional has been employed to investigate the adsorption behavior of CP drug on the PBN, AlBN and GaBN nanosheets. • Dopant Al and Ga atom are greatly enhanced the adsorption behaviour of BN nanosheets about 2 or 2.5 times. • Energy gaps drastically decrease about 48.28% and 47.95% after adsorption of CP on the AlBN and GaBN in gas phase. First-principles calculations based on DFT have been carried out to investigate the adsorption behavior of cisplatin (CP) drug on the pristine BN (PBN), Al-doped BN (AlBN) and Ga-doped BN (GaBN) nanosheets in gas and water media. The calculated adsorption energy for CP/PBN complex is about −0.87 eV and −0.41 eV in gas and water media respectively. But after doping Al and Ga atom on BN nanosheet separately, the adsorption energies are greatly enhanced to −2.12 eV (gas phase) and −1.62 eV (water media) for CP/AlBN complex, −1.9 eV (gas phase) and −1.47 eV (water media) for CP/GaBN complex respectively. The electronic properties such as HOMO-LUMO energy gaps drastically decrease about 48.28% and 47.95% in gas phase and 42.27% and 38.41% in water media after adsorption of CP on the AlBN and GaBN respectively. The quantum molecular descriptors predict that AlBN and GaBN show high sensitivity and reactivity than PBN nanosheet. [ABSTRACT FROM AUTHOR]

Background: Emergency department visits due to head injury in the United States have increased significantly over the past decade, and parallel the increasing use of direct oral anticoagulants (DOACs).Objective: We investigated the incidence of delayed intracranial hemorrhage (DICH) in patients with head injury who were taking DOACs.Methods: We conducted a single-center retrospective study at a level II trauma center. All patients with head injury and using DOACs with an initial negative head computed tomography (HCT) scan from March 1, 2014 to December 31, 2017 were included. DICH was identified as a positive finding on repeat HCT performed within 24 h. Each case of DICH underwent blinded review by two additional neuroradiologists. Demographic data were collected; independent t-tests were used to compare group means and linear regression for variable correlations.Results: Two hundred and eighty-seven patients with mean age of 80 years (interquartile range 14 years) met inclusion criteria. Repeat HCT was performed in 224 study participants (78%). Five (1.7%) resulted in DICH, three of which might have been present on initial HCT, with an incidence rate ranging from 0.7% to 1.7%. Only two initial HCTs were read as negative by all three neuroradiologists; 60% disagreed on the initial read. Independent t-test procedures showed an association between DICH and higher Injury Severity Score (ISS).Conclusions: We found a DICH incidence rate of 0.7-1.7%. ISS was statistically significant between the two groups. It is possible that in patients with a subjective estimation of low injury severity, a low mechanism of injury and reasonable outpatient follow-up, patients can be discharged home with standard head injury precautions and no repeat HCT, but further prospective studies are needed. [ABSTRACT FROM AUTHOR]

Background: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors., Objective: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge., Methods: This randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit., Results: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants' mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care., Conclusions: This exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population., (©Bathmapriya Balakrishnan, Lucas Hamrick, Ariful Alam, Jesse Thompson. Originally published in JMIR Formative Research (https://formative.jmir.org), 22.03.2023.)

The DFT study on the adsorption behaviour of the C 24 , B 12 N 12 , and Al 12 N 12 nanocages and their heteronanocages towards the anticancer drug cisplatin (CP) was performed in gas and water media. Among the three pristine nanocages, Al 12 N 12 exhibited high adsorption energy ranging from -1.98 to -1.63 eV in the gas phase and -1.47 to -1.39 eV in water media. However, their heterostructures C 12 -Al 6 N 6 and B 6 N 6 -Al 6 N 6 showed higher interaction energies (-2.22 eV and -2.14 eV for C 12 -Al 6 N 6 and B 6 N 6 -Al 6 N 6 ) with a significant amount of charge transfer. Noteworthy variations in electronic properties were confirmed by FMO analysis and DOS spectra analysis after the adsorption of the cisplatin drug on B 12 N 12 and B 6 N 6 -Al 6 N 6 nanocages. Furthermore, an analysis of quantum molecular descriptors unveiled salient decrement in global hardness and increments in electrophilicity index and global softness occurred after the adsorption of CP on B 12 N 12 and B 6 N 6 -Al 6 N 6 . On the other hand, the above-mentioned fluctuations are not so noteworthy in the case of the adsorption of CP on Al 12 N 12 , C 12 -B 6 N 6 , and C 12 -Al 6 N 6 . Concededly, energy calculation, FMO analysis, ESP map, DOS spectra, quantum molecular descriptors, dipole moment, COSMO surface analysis, QTAIM analysis, and work function analysis predict that B 12 N 12 and B 6 N 6 -Al 6 N 6 nanocages exhibit high sensitivity towards CP drug molecules., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (This journal is © The Royal Society of Chemistry.)