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ObjectiveTo study clinical outcome and risk factors associated with extended-spectrum β-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC) in community-onset bloodstream infections (CO-BSI).MethodsThis was a population-based cohort study including patients with pheno- and genotype-matched ESBL-producing E. coli and non-ESBL- E. coli in urine and blood samples collected in 2009-2018 in southeast Sweden. Seventy-seven episodes of ESBL-UPEC satisfying the inclusion criteria were matched 1:1 with 77 non-ESBL-UPEC for age, gender, and year of culture.ResultsThe most common ST-type and ESBL gene was ST131 (55%), and blaCTX-M-15 (47%), respectively. Risk factors for ESBL-UPEC were: previous genitourinary invasive procedure (RR 4.66; p = 0.005) or history of ESBL-producing E. coli (RR 12.14; p = 0.024). There was significant difference between ESBL-UPEC and non-ESBL-UPEC regarding time to microbiologically appropriate antibiotic therapy (27:15 h vs. 02:14 h; p = 0.999) or sepsis within 36 hours (51% vs. 62%; p = 0.623) was observed.ConclusionThe predominant risk factors for ESBL-UPEC were history of ESBL-Ec infection and history of genitourinary invasive procedure. The overall mortality was low and the delay in appropriate antibiotic therapy did not increase the risk for 30-day mortality or risk for sepsis within 36 hours among patients infected with ESBL UPEC. However, these results must be regarded with some degree of caution due to the small sample size.

ObjectivesThe aim of this study was to investigate the epidemiology of bloodstream infections (BSI) in a Swedish setting, with focus on risk factors for BSI-associated mortality.MethodsA 9-year (2008-2016) retrospective cohort study from electronic records of episodes of bacteremia amongst hospitalized patients in the county of Östergötland, Sweden was conducted. Data on episodes of BSI including microorganisms, antibiotic susceptibility, gender, age, hospital admissions, comorbidity, mortality and aggregated antimicrobial consumption (DDD /1,000 inhabitants/day) were collected and analyzed. Multidrug resistance (MDR) was defined as resistance to at least three groups of antibiotics. MDR bacteria and MRSA, ESBL-producing Enterobacteriaceae, vancomycin-resistant enterococci not fulfilling the MDR criteria were all defined as antimicrobial-resistant (AMR) bacteria and included in the statistical analysis of risk factors for mortality.ResultsIn all, 9,268 cases of BSI were found. The overall 30-day all-cause mortality in the group of patients with BSI was 13%. The incidence of BSI and associated 30-day all-cause mortality per 100,000 hospital admissions increased by 66% and 17% respectively during the nine-year study period. The most common species were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae and Enterococcus faecalis. Independent risk factors for 30-day mortality were age (RR: 1.02 (CI: 1.02-1.03)) and 1, 2 or ≥3 comorbidities RR: 2.06 (CI: 1.68-2.52), 2.79 (CI: 2.27-3.42) and 2.82 (CI: 2.31-3.45) respectively. Almost 3% (n = 245) of all BSIs were caused by AMR bacteria increasing from 12 to 47 per 100,000 hospital admissions 2008-2016 (p = 0.01), but this was not associated with a corresponding increase in mortality risk (RR: 0.89 (CI: 0.81-0.97)).ConclusionComorbidity was the predominant risk factor for 30-day all-cause mortality associated with BSI in this study. The burden of AMR was low and not associated with increased mortality. Patients with BSIs caused by AMR bacteria (MDR, MRSA, ESBL and VRE) were younger, had fewer comorbidities, and the 30-day all-cause mortality was lower in this group.

This study delves into the relationship between individual vaccination aspirations and their repercussions within the SEIRS epidemic framework, exploring effects on vaccination behavior, infection dynamics, and societal outcomes through the Vaccination Game concept. The co-evolution of epidemic dynamics and individual decision-making is examined, utilizing the social efficiency deficit (SED) to quantify a social dilemma. A novel aspiration-based model is compared with the conventional cost-based model. Higher aspiration levels correspond to increased vaccination rates, reducing overall infections. Contrary to assumptions favoring natural infection in low transmission scenarios, vaccination proves pivotal even in such contexts. Elevated transmission and immunity waning rates necessitate intensified vaccination for effective infection control, thereby reducing social dilemmas. Low vaccine efficiency coupled with high transmission rates escalates SED, but a specific vaccine efficacy threshold notably diminishes SED. Lower aspiration levels contribute to vaccine hesitancy, elevating SED, and infection rates. Surpassing an aspiration threshold redirects preferences towards vaccination, aligning with socially optimal scenarios and alleviating social dilemmas. The comparative analysis underscores the aspiration-driven approach outperforms in reducing SED, establishing its reliability in mitigating societal disease impact over the cost-based approach, but the optimal choice depends on specific epidemic conditions

In this research, we introduce a comprehensive epidemiological model that accounts for multiple strains of an infectious disease and two distinct vaccination options. Vaccination stands out as the most effective means to prevent and manage infectious diseases. However, when there are various vaccines available, each with its costs and effectiveness, the decision-making process for individuals becomes paramount. Furthermore, the factor of waning immunity following vaccination also plays a significant role in influencing these choices. To understand how individuals make decisions in the context of multiple strains and waning immunity, we employ a behavioral model, allowing an epidemiological model to be coupled with the dynamics of a decision-making process. Individuals base their choice of vaccination on factors such as the total number of infected individuals and the cost-effectiveness of the vaccine. Our findings indicate that as waning immunity increases, people tend to prioritize vaccines with higher costs and greater efficacy. Moreover, when more contagious strains are present, the equilibrium in vaccine adoption is reached more rapidly. Finally, we delve into the social dilemma inherent in our model by quantifying the social efficiency deficit (SED) under various parameter combinations.

ABSTRACT Due to the spread of resistance, antibiotic exposure receives increasing attention. Ecological consequences for the different niches of individual microbiomes are, however, largely ignored. Here, we report the effects of widely used antibiotics (clindamycin, ciprofloxacin, amoxicillin, and minocycline) with different modes of action on the ecology of both the gut and the oral microbiomes in 66 healthy adults from the United Kingdom and Sweden in a two-center randomized placebo-controlled clinical trial. Feces and saliva were collected at baseline, immediately after exposure, and 1, 2, 4, and 12 months after administration of antibiotics or placebo. Sequences of 16S rRNA gene amplicons from all samples and metagenomic shotgun sequences from selected baseline and post-antibiotic-treatment sample pairs were analyzed. Additionally, metagenomic predictions based on 16S rRNA gene amplicon data were performed using PICRUSt. The salivary microbiome was found to be significantly more robust, whereas the antibiotics negatively affected the fecal microbiome: in particular, health-associated butyrate-producing species became strongly underrepresented. Additionally, exposure to different antibiotics enriched genes associated with antibiotic resistance. In conclusion, healthy individuals, exposed to a single antibiotic treatment, undergo considerable microbial shifts and enrichment in antibiotic resistance in their feces, while their salivary microbiome composition remains unexpectedly stable. The health-related consequences for the gut microbiome should increase the awareness of the individual risks involved with antibiotic use, especially in a (diseased) population with an already dysregulated microbiome. On the other hand, understanding the mechanisms behind the resilience of the oral microbiome toward ecological collapse might prove useful in combating microbial dysbiosis elsewhere in the body. IMPORTANCE Many health care professionals use antibiotic prophylaxis strategies to prevent infection after surgery. This practice is under debate since it enhances the spread of antibiotic resistance. Another important reason to avoid nonessential use of antibiotics, the impact on our microbiome, has hardly received attention. In this study, we assessed the impact of antibiotics on the human microbial ecology at two niches. We followed the oral and gut microbiomes in 66 individuals from before, immediately after, and up to 12 months after exposure to different antibiotic classes. The salivary microbiome recovered quickly and was surprisingly robust toward antibiotic-induced disturbance. The fecal microbiome was severely affected by most antibiotics: for months, health-associated butyrate-producing species became strongly underrepresented. Additionally, there was an enrichment of genes associated with antibiotic resistance. Clearly, even a single antibiotic treatment in healthy individuals contributes to the risk of resistance development and leads to long-lasting detrimental shifts in the gut microbiome.

Purpose: Benign prostate hyperplasia (BPH) is a common age-related chronic condition. Its pathogenesis involves androgen imbalance, inflammation, oxidative stress, and endoplasmic reticulum (ER) stress. This study aims to assess the protective effect of finasteride, a 5α-reductase inhibitor, against testosterone propionate (TP)-induced BPH in rats and explore its potential mechanism of action. Materials and Methods: TP-induced BPH rats received either saline or finasteride (1 mg/kg) orally once a day for 7 weeks. Prior to sacrificing the animals, blood samples were collected. After sacrifice, prostate and tissue around the prostate were dissected from seminal vesical for further analysis. Body weight, prostate weight, dihydrotestosterone (DHT), 5α-reductase type 2 (5-AR2), and prostate-specific antigen (PSA) levels were measured. In addition, HIF-1α, VEGF, MMP-2 expressions in prostate, oxidative stress, inflammation, and ER stress responses were analyzed to understand the mechanism of action of finasteride. Results: Finasteride administration inhibited prostate enlargement, DHT, 5-AR2, and PSA levels in BPH rats. Additionally, finasteride inhibited angiogenesis markers such as HIF-1α, VEGF, and MMP-2. Moreover, components of oxidative stress, inflammation, and ER stress responses were significantly regulated by finasteride treatment. Conclusions: This study suggests that finasteride prevents BPH-associated symptoms by regulating angiogenesis, reactive oxygen species, ER stress responses, and inflammation, another mechanism to explain the effect of the 5α-reductase against BPH.

The emergence of a novel strain during a pandemic, like the current COVID-19, is a major concern to the healthcare system. The most effective strategy to control this type of pandemic is vaccination. Many previous studies suggest that the existing vaccine may not be fully effective against the new strain. Additionally, the new strain's late arrival has a significant impact on the disease dynamics and vaccine coverage. Focusing on these issues, this study presents a two-strain epidemic model in which the new strain appears with a time delay. We considered two vaccination provisions, namely preinfection and postinfection vaccinations, which are governed by human behavioral dynamics. In such a framework, individuals have the option to commit vaccination before being infected with the first strain. Additionally, people who forgo vaccination and become infected with the first train have the chance to be vaccinated (after recovery) in an attempt to avoid infection from the second strain. However, a second strain can infect vaccinated and unvaccinated individuals. People may have additional opportunities to be vaccinated and to protect themselves from the second strain due to the time delay. Considering the cost of the vaccine, the severity of the new strain, and the vaccine's effectiveness, our results indicated that delaying the second strain decreases the peak size of the infected individuals. Finally, by estimating the social efficiency deficit, we discovered that the social dilemma for receiving immunization decreases with the delay in the arrival of the second strain.

Migration of intrauterine fetal death (IUD) products from the uterus to different nearby intra abdominal organ of body especially to urinary bladder is a rare clinical situation to report. Here we are presenting a case , where a woman of 54 years of age presented to us with the history of IUD at 27 weeks of gestation 17 years back with history of passage of hard brittle bony fragment like material with urine and an abdominal lump. Laparotomy was done, some parts of IUD product was found to migrate to urinary bladder cavity, some parts to incompletely invade the intestinal loops & some parts towards the abdominal wall to form the lump. Hysterectomy was done, product was removed and the entire involved organ was repaired successfully and patient cure was uneventful.

Cities worldwide are experiencing rapid urbanization and an increasing population, creating a pressing need for smart infrastructure to enhance citizen services. Dhaka, the capital of Bangladesh, faces similar technological and socio-economic challenges, making it crucial to transform it into a sustainable smart city. This research analyzes the opportunities and challenges of smart cities and Dhaka through SWOT and PESTEL analyses. The study employs a fuzzy rule-based inference system in a MATLAB simulation to calculate the smart city index based on parameters such as governance, transportation, waste management, utility management, healthcare, and industrial automation. The findings reveal that good governance has the highest impact on the smart city index, followed by transportation. The paper proposes a sustainable smart city transportation framework and management technique, outlining future research directions. The proposed framework is expected to impact socio-economic, technological, and environmental aspects positively.

In this research, we introduce a comprehensive epidemiological model that accounts for multiple strains of an infectious disease and two distinct vaccination options. Vaccination stands out as the most effective means to prevent and manage infectious diseases. However, when there are various vaccines available, each with its costs and effectiveness, the decision-making process for individuals becomes paramount. Furthermore, the factor of waning immunity following vaccination also plays a significant role in influencing these choices. To understand how individuals make decisions in the context of multiple strains and waning immunity, we employ a behavioral model, allowing an epidemiological model to be coupled with the dynamics of a decision-making process. Individuals base their choice of vaccination on factors such as the total number of infected individuals and the cost-effectiveness of the vaccine. Our findings indicate that as waning immunity increases, people tend to prioritize vaccines with higher costs and greater efficacy. Moreover, when more contagious strains are present, the equilibrium in vaccine adoption is reached more rapidly. Finally, we delve into the social dilemma inherent in our model by quantifying the social efficiency deficit (SED) under various parameter combinations. [ABSTRACT FROM AUTHOR]

Vestibular migraine (VM) is a leading cause of episodic vertigo, affecting up to 1% of the general population. Despite established diagnostic criteria, there is currently no evidence-based approach for acute treatment of VM, with treatment recommendations generally extrapolated from studies on classical migraine headache. Several small-scale studies have identified flunarizine as a potentially effective prophylactic medication in VM. We conducted a single-centre observational service evaluation study exploring patient experiences of preventative medications over a 28-month period, including flunarizine, for control of VM symptoms. To compare patient experience of flunarizine with other medications, data from patients taking flunarizine were separately analysed. A total of 90% of VM patients taking flunarizine reported symptomatic improvement, compared to only 32% of patients on other medications. Whilst 50% of patients on flunarizine reported side effects. these were not deemed to outweigh the clinical benefits, with most patients deciding to continue treatment. Our data supports the use of flunarizine in VM.

Purpose: Globally, many extension professionals and policy-makers are advocating fee based services, in addressing the fund shortage and sustainable provision of agricultural advisory services. Hence, the article attempts to expose the farmers' willingness to pay (WTP) as agricultural extension in Bangladesh is experiencing chronic fund crisis. Methodology: This study used contingent valuation method (CVM) for investigating farmers' WTP. Logit and Tobit model was employed to assess the determinants of WTP and amount willing to pay (AWTP) respectively. Besides, different qualitative methods were employed to have a deeper understanding of the research problems. Findings: WTP was conditioned by providing quality extension services at farm and/or home of the farmers. The study also focused on farmers preferred mode of payment, criteria influencing payment decisions and the type of services for which they are willing to pay. Paid model can contribute to quality extension services, if started with a market oriented commodity based approach accompanied by adequate crop insurance support. Practical implications: The study considered international experiences and national crisis in delivering extension services that provoke actions towards changing the extension policy of Bangladesh. The findings also prompt the factors that influence the paid extension service delivery for the crop farmers of Bangladesh. Originality: Although, many studies have been conducted on privatisation of agricultural extension around the globe, we are not aware of any single study on crop farmers' willingness to pay for the extension services in Bangladesh.

From a residential point of view, home energy management (HEM) is an essential requirement in order to diminish peak demand and utility tariffs. The integration of renewable energy sources (RESs) together with battery energy storage systems (BESSs) and central battery storage system (CBSS) may promote energy and cost minimization. However, proper home appliance scheduling along with energy storage options is essential to significantly decrease the energy consumption profile and overall expenditure in real-time operation. This paper proposes a cost-effective HEM scheme in the microgrid framework to promote curtailing of energy usage and relevant utility tariff considering both energy storage and renewable sources integration. Usually, the household appliances have different runtime preferences and duration of operation based on user demand. This work considers a simulator designed in the C++ platform to address the domestic customer’s HEM issue based on usages priorities. The positive aspects of merging RESs, BESSs, and CBSSs with the proposed optimal power sharing algorithm (OPSA) are evaluated by considering three distinct case scenarios. Comprehensive analysis of each scenario considering the real-time scheduling of home appliances is conducted to substantiate the efficacy of the outlined energy and cost mitigation schemes. The results obtained demonstrate the effectiveness of the proposed algorithm to enable energy and cost savings up to 37.5% and 45% in comparison to the prevailing methodology.

The steady increase in energy demand for residential consumers requires an efficient energy management scheme. Utility organizations encourage household applicants to engage in residential energy management (REM) system. The utility’s primary goal is to reduce system peak load demand while consumer intends to reduce electricity bills. The benefits of REM can be enhanced with renewable energy sources (RESs), backup battery storage system (BBSS), and optimal power-sharing strategies. This paper aims to reduce energy usages and monetary cost for smart grid communities with an efficient home energy management scheme (HEMS). Normally, the residential consumer deals with numerous smart home appliances that have various operating time priorities depending on consumer preferences. In this paper, a cost-efficient power-sharing technique is developed which works based on priorities of appliances’ operating time. The home appliances are sorted on priority basis and the BBSS are charged and discharged based on the energy availability within the smart grid communities and real time energy pricing. The benefits of optimal power-sharing techniques with the RESs and BBSS are analyzed by taking three different scenarios which are simulated by C++ software package. Extensive case studies are carried out to validate the effectiveness of the proposed energy management scheme. It is demonstrated that the proposed method can save energy and reduce electricity cost up to 35% and 45% compared to the existing methods.