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This paper presents an improved SOC estimation method for lithium ion batteries in Electric Vehicles using Bayesian optimized feedforward network. This innovative bayesian optimized neural network method attempts to minimize a scalar objective function by extracting hyperpa-rameters (hidden neurons in both layers) using a surrogate model. Furthemore, the hyperparameters are built and data samples are trained and validated. The performance of the proposed deep learning neural network is evaluated. Two reasonable size data samples are ex-tracted from Panasonic 18650PF Li-ion Mendeley datasets that are used for training and valida-tion. RNN and LSTM neural network algorithms offer the common core property of retaining past information and/or hidden states for better SOC estimation. However, the feature of this pro-posed method is the inclusion of Bayesian optimization that chooses optimal double layer hidden neurons. Analysis of results shows that Bayesian optimized feedforward algorithm with average MAPE (0.20%) is the lowest and is the best selection compared with average MAPE for other five deep learning algorithms. In the last quarter of fuel gauge, where fuel anxiety is severe, feed-forward with Bayesian Optimization algorithm is still the best selection (with MAPE of 0.64%).

IntroductionAn increasing number of studies have reported disruptions in health service utilisation due to the COVID-19 pandemic and its associated restrictions. However, little is known about the effect of lifting COVID-19 restrictions on health service utilisation. The objective of this study was to estimate the effect of lifting COVID-19 restrictions on primary care service utilisation in Nepal.MethodsData on utilisation of 10 primary care services were extracted from the Health Management Information System across all health facilities in Nepal. We used a difference-in-differences design and linear fixed effects regressions to estimate the effect of lifting COVID-19 restrictions. The treatment group included palikas that had lifted restrictions in place from 17 August 2020 to 16 September 2020 (Bhadra 2077) and the control group included palikas that had maintained restrictions during that period. The pre-period included the 4 months of national lockdown from 24 March 2020 to 22 July 2020 (Chaitra 2076 to Ashar 2077). Models included month and palika fixed effects and controlled for COVID-19 incidence.ResultsWe found that lifting COVID-19 restrictions was associated with an average increase per palika of 57.5 contraceptive users (95% CI 14.6 to 100.5), 15.6 antenatal care visits (95% CI 5.3 to 25.9) and 1.6 child pneumonia visits (95% CI 0.2 to 2.9). This corresponded to a 9.4% increase in contraceptive users, 34.2% increase in antenatal care visits and 15.6% increase in child pneumonia visits. Utilisation of most other primary care services also increased after lifting restrictions, but coefficients were not statistically significant.ConclusionsDespite the ongoing pandemic, lifting restrictions can lead to an increase in some primary care services. Our results point to a causal link between restrictions and health service utilisation and call for policy makers in low- and middle-income countries to carefully consider the trade-offs of strict lockdowns during future COVID-19 waves or future pandemics.

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

Primary care services are on average of low quality in Nepal. However, there is marked variation in performance of basic clinical and managerial functions between primary health care centers. The determinants of variation in primary care performance in low- and middle-income countries have been understudied relative to the prominence of primary care in national health plans. We used the positive deviance approach to identify best and worst performing primary health care centers in Nepal and investigated perceived drivers of best performance. We selected eight primary health care centers in Province 1, Nepal, using an index of basic clinical and operational activities to identify four best and four worst performing primary health care centers. We conducted semi-structured, in-depth interviews with managers and clinical staff from each of the eight primary health care centers for a total of 32 interviews. We identified the following factors that distinguished best from worst performers: 1) Managing the facility effectively, 2) engaging local leadership, 3) building active community accountability, 4) assessing and responding to facility performance, 5) developing sources of funding, 6) compensating staff fairly, 7) managing clinical staff performance, and 8) promoting uninterrupted availability of supplies and equipment. These findings can be used to inform quality improvement efforts and health system reforms in Nepal and other similarly under-resourced health systems.

Introduction : Evidence based practice (EBP) is the use of current best evidence in making decisions about the care of individual patients. The aim of this study was to explore the practices, attitudes, knowledge and perceived barriers in relation to EBP among faculty members at Patan Academy of Health Sciences (PAHS), Nepal. Methods: This was a cross-sectional survey study. Participants were faculty members (both clinical and non-clinical) at PAHS. The main outcomes were attitude towards the usefulness of EBP, the frequency of use of EBP in practice, and the barriers to carrying out EBP. Results: One hundred and seventy-two faculty members participated in this survey. Ninety five percent knew it was used for clinical decision making and the majority used it for teaching. Senior faculty spent more time on searching for evidence and reading compared to junior faculty. There was no difference between clinical and non-clinical departments. The main barriers to EBP were inadequate teaching learning support by 49% (85/172) followed by inadequate time 30% (52/172). Conclusions: The study showed that faculty at PAHS had a generally positive attitude towards EBP. EBP could be better facilitated by proper teaching and allocation of dedicated time. Keywords : evidence-based practice, faculties, health sciences, attitude- knowledge-behavior

To estimate the use of hospitals for four essential primary care services offered in health centres in low- and middle-income countries and to explore differences in quality between hospitals and health centres.We extracted data from all demographic and health surveys conducted since 2010 on the type of facilities used for obtaining contraceptives, routine antenatal care and care for minor childhood diarrhoea and cough or fever. Using mixed-effects logistic regression models we assessed associations between hospital use and individual and country-level covariates. We assessed competence of care based on the receipt of essential clinical actions during visits. We also analysed three indicators of user experience from countries with available service provision assessment survey data.On average across 56 countries, public hospitals were used as the sole source of care by 16.9% of 126 012 women who obtained contraceptives, 23.1% of 418 236 women who received routine antenatal care, 19.9% of 47 677 children with diarrhoea and 18.5% of 82 082 children with fever or cough. Hospital use was more common in richer countries with higher expenditures on health per capita and among urban residents and wealthier, better-educated women. Antenatal care quality was higher in hospitals in 44 countries. In a subset of eight countries, people using hospitals tended to spend more, report more problems and be somewhat less satisfied with the care received.As countries work towards achieving ambitious health goals, they will need to assess care quality and user preferences to deliver effective primary care services that people want to use.Évaluer l'utilisation des hôpitaux pour quatre services de soins de santé primaires essentiels dans plusieurs centres de santé communautaires situés dans des pays à faible et moyen revenu, et examiner les différences de qualité entre hôpitaux et centres de santé communautaires.Nous avons prélevé des données provenant de toutes les enquêtes démographiques et sanitaires menées depuis 2010 sur le type d'établissement fréquenté pour obtenir des moyens contraceptifs, des soins prénatals de routine ainsi qu'une prise en charge de la diarrhée d'importance mineure, la toux ou la fièvre chez l'enfant. Nous avons employé des modèles de régression logistique à effets mixtes pour examiner les associations entre le recours aux hôpitaux d'une part, et les covariables individuelles et nationales d'autre part. Nous avons mesuré le niveau de compétence des soins en nous fondant sur la réalisation d'actes cliniques essentiels lors des visites. Nous avons également analysé trois indicateurs d'expérience en tant que patient dans les pays où nous avons pu accéder aux résultats d'enquêtes d'évaluation des prestations de service.Selon la moyenne établie sur 56 pays, les hôpitaux publics constituaient l'unique source de soins pour 16,9% des 126 012 femmes qui se sont procuré des contraceptifs, 23,1% des 418 236 femmes qui ont reçu des soins prénatals de routine, 19,9% des 47 677 enfants atteints de diarrhée et 18,5% des 82 082 enfants souffrant de fièvre ou de toux. Le recours aux hôpitaux était plus fréquent dans les pays plus riches où les dépenses en soins de santé par habitant étaient plus élevées, mais aussi parmi les citadines et les femmes plus aisées et mieux instruites. La qualité des soins prénatals était meilleure dans les hôpitaux de 44 pays. Dans un sous-groupe de huit pays, les gens qui se rendaient dans les hôpitaux avaient tendance à dépenser davantage, à signaler plus de problèmes et à se montrer moins satisfaits vis-à-vis des soins prodigués.À mesure que les pays s'efforceront d'atteindre des objectifs sanitaires ambitieux, ils devront évaluer la qualité des soins et les préférences des patients afin de proposer des services de soins de santé primaires efficaces auxquels les gens voudront faire appel.Estimar el uso de los hospitales para cuatro servicios esenciales de atención primaria que se ofrecen en los centros de salud de los países de ingresos bajos y medios, así como estudiar las diferencias de calidad entre los hospitales y los centros de salud.Se obtuvieron los datos de todas las encuestas demográficas y de salud realizadas desde 2010 sobre el tipo de instalaciones que se usan para obtener anticonceptivos, atención prenatal de rutina y atención de la diarrea infantil leve y la tos o la fiebre. Se evaluaron las asociaciones entre el uso de los hospitales y las covariables a nivel individual y nacional mediante la aplicación de modelos de regresión logística de efectos mixtos. También se evaluó la competencia de la atención basada en la recepción de medidas clínicas esenciales durante las consultas. Asimismo, se analizaron tres indicadores de la experiencia de los usuarios de los países que disponían de datos de encuestas de evaluación de la prestación de servicios.En un promedio de 56 países, los hospitales públicos fueron usados como la única fuente de atención por el 16,9 % de 126 012 mujeres que adquirieron anticonceptivos, el 23,1 % de 418 236 mujeres que recibieron atención prenatal de rutina, el 19,9 % de 47 677 niños con diarrea y el 18,5 % de 82 082 niños con fiebre o tos. El uso de los hospitales fue más común en los países más ricos con mayores gastos en salud per cápita y entre los residentes de las zonas urbanas y las mujeres más acaudaladas y mejor educadas. La calidad de la atención prenatal fue superior en los hospitales de 44 países. En un subconjunto de ocho países, las personas que acudieron a los hospitales tendían a gastar más, a reportar más quejas y a estar algo menos satisfechas con la atención recibida.A medida que los países se esfuerzan por alcanzar objetivos sanitarios ambiciosos, tendrán que evaluar la calidad de la atención y las preferencias de los usuarios para prestar los servicios de atención primaria efectivos que las personas pretenden usar.الغرض تقدير الاعتماد على المستشفيات في خدمات الرعاية الأولية الأساسية التي تقدمها المراكز الصحية البلدان ذات الدخل المنخفض والمتوسط، واستكشاف الفروق في الجودة بين المستشفيات والمراكز الصحية. الطريقة استخرجنا البيانات من جميع المسوح السكانية والصحية التي أجريت منذ عام 2010 حول نوع المرافق المستخدمة للحصول على وسائل منع الحمل، والرعاية الروتينية السابقة للولادة، ورعاية حالات الإسهال والسعال أو الحمى الطفيفة لدى الأطفال. وباستخدام نماذج التحوف اللوجيستي ذات التأثيرات المختلطة، قمنا بتقييم الارتباطات بين الاعتماد على المستشفى، والمتغيرات المشتركة على المستوى الفردي ومستوى البلد. قمنا بتقييم كفاءة الرعاية بناءً على فرص الحصول على الإجراءات السريرية الأساسية أثناء الزيارات. قمنا أيضًا بتحليل ثلاثة مؤشرات لتجربة المستخدم من البلدان التي يتوفر فيها بيانات مسح تقييم تقديم الخدمة. النتائج في المتوسط ​​عبر 56 بلدًا، تم الاعتماد على المستشفيات العامة كمصدر وحيد للرعاية بواسطة 16.9% من 126012 امرأة حصلن على وسائل منع الحمل، و23.1% من 418236 امرأة حصلن على الرعاية الروتينية السابقة للولادة، و19.9% من 47677 طفلاً يعانون من الإسهال، و18.5% من 82082 طفلاً يعانون من الحمى أو السعال. كان الاعتماد على المستشفى أكثر شيوعًا في البلدان الأغنى مع ارتفاع نفقات الصحة للفرد، وبين سكان الحضر، والنساء الأكثر ثراءً والأفضل تعليمًا. كانت جودة الرعاية السابقة للولادة أعلى في المستشفيات في 44 بلدًا. في مجموعة فرعية من ثمانية بلدان، كان الأشخاص الذين يعتمدون على المستشفيات يميلون إلى إنفاق أكثر، والإبلاغ عن المزيد من المشكلات، ويكونون أقل رضا إلى حد ما عن الرعاية التي حصلوا عليها. الاستنتاج بينما تعمل البلدان تجاه تحقيق أهداف صحية طموحة، فإنها سوف تحتاج إلى تقييم جودة الرعاية وتفضيلات المستخدم لتقديم خدمات رعاية أولية فعالة، يرغب الناس في الاعتماد عليها.评估在中低收入国家使用医院来获取卫生中心提供的四类基本的初级护理服务的情况，并探讨医院和卫生中心之间的质量差异。.我们从 2020 年以来开展的所有人口统计和健康调查中提取出相关数据，这些调查涉及用于避孕、常规产前护理以及儿童轻微腹泻咳嗽或发烧护理的设施类型。利用混合效应逻辑回归模型，我们评估了医院使用与个人和国家层面协变量之间的相关性。我们根据就诊期间基本临床行动的接收情况来评估其护理能力。我们还分析了拥有现成的服务提供评估调查数据的国家的三个用户体验指标。.56 个国家平均而言，126012 名获取过避孕药具的女性中，仅选择公立医院的女性占 16.9％；418236 名接受常规产前护理的女性中，占比达 23.1％；47677 名腹泻儿童中，占比达 19.9％；82082 名发烧或咳嗽儿童中，占比达 18.5％。在人均卫生支出较高的富裕国家、城市居民以及较富裕受过良好教育的女性中，选择医院更为普遍。44 个国家的医院产前护理质量较高。其中八个国家，选择医院的人士往往花费更多，报告的问题更多，对所得到的护理也不太满意。.随着多国努力实现宏伟的卫生目标，它们将需要评估护理质量和用户偏好，以提供人们希望使用的有效的初级护理服务。.Оценка использования больниц для оказания четырех основных услуг первичной медико-санитарной помощи, предлагаемых в медицинских центрах в странах с низким и средним уровнем доходов, а также изучение различий в качестве услуг между больницами и медицинскими центрами.Авторы извлекли данные из всех демографических и медицинских опросов, проведенных с 2010 года, о типах учреждений, используемых для получения противозачаточных средств, плановой дородовой помощи и лечения незначительных случаев детской диареи, кашля или лихорадки. Используя модели логистической регрессии со смешанными эффектами, авторы оценили связи между использованием больниц и ковариатами на индивидуальном и национальном уровнях. Авторы оценили компетентность оказания помощи на основе получения необходимых клинических действий во время обращений. Были также проанализированы три показателя опыта пользователей из стран, по которым имеются данные опроса по оценке оказания услуг.В среднем в 56 странах государственные больницы использовались в качестве единственного источника медицинской помощи: 16,9% из 126 012 женщин, получавших противозачаточные средства, 23,1% из 418 236 женщин, получавших плановую дородовую помощь, 19,9% из 47 677 детей с диареей и 18,5% из 82 082 детей с лихорадкой или кашлем. Использование больниц было более распространенным явлением в более богатых странах с более высоким уровнем медицинских расходов на душу населения, а также среди городских жителей и более богатых, более образованных женщин. Качество дородовой помощи было выше в больницах в 44 странах. В подгруппе из восьми стран люди, обращающиеся в больницы, как правило, тратили больше, сообщали о большем количестве проблем и были несколько менее удовлетворены полученной помощью.По мере работы стран над достижением амбициозных целей в области здравоохранения им необходимо будет оценивать качество медицинской помощи и предпочтения пользователей, чтобы предоставлять эффективные услуги первичной медико-санитарной помощи, которыми люди хотят пользоваться.