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Robotic-assisted surgery is gaining popularity because of reported improvement in aesthetic outcomes while reducing the occurrence of complications compared with conventional surgical methods. Deep inferior epigastric perforator (DIEP) flap harvesting has a long track record as a viable procedure for autologous reconstruction of the breast. In this literature review, we describe the feasibility of using the robotic platform in DIEP flap harvest.The Preferred Reporting Items for Systemic Reviews and Meta-Analysis methodology was to guide the literature review. PubMed and Scopus databases were searched from inception to June 6, 2022. The Medical Subject Heading terms and keywords used to conduct this search are as described: "Robotic AND deep inferior epigastric perforator AND Breast reconstruction."Seven publications, detailing a total of 56 robotic-assisted DIEP flap harvest procedures, were selected for review. Four publications used the transabdominal preperitoneal approach, whereas 2 exclusively used a totally extraperitoneal approach, and 1 compared the 2 approaches. The measured outcomes included technical feasibility of flap harvest in cadavers, viable flap harvest in live patients, harvest time and pedicle dissection time, pedicle length, fascial incision length, donor site pain, need for postoperative narcotic, donor site morbidity, and hernia formation. Overall, the reviewed articles demonstrated successful DIEP flap harvesting without the need for conversion to the conventional open procedure. Postoperative complications were minimal. Robotic DIEP flap harvest was shown to be safe and there were no reports of donor-site morbidity in the studies reviewed. The main advantages of the robotic approach include decreased postoperative pain and length of hospital stay, along with improved aesthetic outcomes. The main disadvantages are increased operative time and cost.Although at its current iteration, the robotic-assisted DIEP flap is feasible, it may not be practical in all settings. Furthermore, the true benefit of the robotic platform is yet to be determined, as more long-term studies are necessary.

Background: Detecting COVID-19 pneumonia and differentiating it from community acquired pneumonia (CAP) has been a challenging task for healthcare providers since the pandemic began. We therefore aim to develop and evaluate a simple, non-invasive tool to accurately detect COVID-19 by using digital chest X-ray (CXR). Methods and Results: We performed a retrospective, multi-center study in which deep learning frameworks were used to develop the system architecture of the diagnostic tool. The tool was trained and validated by using data from the GitHub database and two hospitals in Bangladesh. Python programming was used to calculate all statistical estimates. Our study revealed that the artificial intelligence (AI)-based diagnostic tool was able to detect COVID-19 accurately by examining chest X-ray (CXR). During the testing phase, the tool could interpret CXR with precision of 0.98, recall/sensitivity of 0.97 and F1 score of 0.97 for COVID-19. The evaluation results showed high sensitivity (90%) and specificity (92%) in detecting COVID-19. The AUC values for COVID-19 and pneumonia were 0.91 and 0.87, respectively. Conclusion: The developed AI-based diagnostic tool can offer the healthcare providers an effective means of detecting and differentiating COVID-19 from other types of pneumonia, thus contributing to reducing the long-term impact of this deadly disease Key Points: • The major strength of this study is that it has led to the development of a technology-based tool that can precisely detect COVID-19 at an early stage and immediately isolate infected patients from the healthy population. • This next generation test can be accessed by healthcare providers remotely and therefore provide an added convenience. • The main limitation is with this tool COVID-19 pneumonia may be confused with other types of pneumonia if the quality of the chest image is too low. Moreover, it focuses only on detecting whether or not the disease is COVID-19, but not its severity.

Recruitment and retention of patients with acute pancreatitis (AP) in clinical studies can be challenging. While some obstacles are similar to other clinical conditions, some are unique to AP. Identifying potential barriers early and developing targeted solutions can help optimize recruitment and retention in AP studies. Such preemptive and detailed planning can help prospective, longitudinal studies focusing on exocrine and endocrine complications of AP in accurately measuring outcomes. This manuscript highlights the challenges in recruitment and retention strategies in AP studies and reviews available resources to create opportunities to address them. We describe the multifaceted approach used by the Recruitment and Retention Committee of the Type 1 Diabetes in Acute Pancreatitis Consortium (T1DAPC), which builds upon earlier experiences to develop a recruitment and retention plan for the DREAM (Diabetes RElated to Acute pancreatitis and its Mechanisms) study.

Obesity and overweight are creating a global epidemic. They are the risk factors for many non-communicable diseases. Rapidly changing diets and lifestyles are fueling the global obesity epidemic. Once being considered as a problem related to affluence, obesity is now growing fast in many developing countries. A study on health complications and activity pattern of obese women from Parbhani city was carried out . Total 210 obese women of age group 30 to 60 years from overweight (120) and obese (90) areas of Parbhani District of Maharashtra was purposively selected. The general information, health status and activity pattern by the obese women were obtained through a well- structured interview schedule. Lipid profile and blood glucose was estimated for a sub sample of 75 subjects who were willing to give blood sample. Blood pressure of a sub sample of 75 selected women was measured. Results of the study revealed that the values of serum cholesterol and triglyceride observed to be high in obese women. The values of HDL and LDL cholesterol of all the women subjects were found to be in the normal category. The values of VLDL cholesterol was observed to be at higher side in (72 per cent) women.Sixty per cent obese women were having normal blood glucose values whereas significantly more number of studied women were suffering from hypertension. From the study it can be concluded that respondents from both the groups were spending their leisure time on watching T.V. as watching T.V. is a sedentary activity which results in less energy expenditure and may lead to development of overweight and obesity.

Assessment of nutritional status of obese women was carried out with an objective to assess nutritional status by assessment of anthropometric measurements, food and nutrient intake by 24 hours recall method. Total 210 obese women of age group 30 to 60 years from overweight (120) and obese (90) areas of Parbhani district of Maharashtra was purposively selected. The general information, anthropometric measurements, dietary pattern by 24 hour recall method by the obese women were obtained through a well- structured interview schedule. Results of the study revealed that the mean value of weight of women was 82.44± 9.25 and the mean value of body height of women was150.6± 5.95, respectively. The BMI of women subjects was 33.22± 4.358, mid upper arm circumference (34.89 ± 3.916). The skinfold thickness of selected women was 20.87± 2.808. The mean values of waist and hip circumference of the subjects were 94.43 ± 3.26 and 114.2 ± 3.54, respectively. The intake of all the nutrients were significantly higher than RDA’s among overweight and obese women except for calcium intake was significantly lower than RDA’s. In conclusion, the study stated that all the respondents were having more than normal BMI. The intake of all the nutrients were significantly higher than RDA’s except calcium intake. The extra amount of energy associated with sedentary lifestyle might had resulted in positive energy balance, ultimately leading to deposition of fat in the adipose tissue. Findings regarding food consumption frequencies concluded that the consumption of calorie rich foods such as bakery products, nuts, oilseeds and dry fruits, soft drinks, sago, street foods and fried items was practiced by studied women which might have resulted in creation of positive energy balance among them.

From the year 2003 when the first walkability scale was published to date, person-environment fit models and empirical research, some of which was published in Health Promotion International, have encapsulated healthy communities in ‘neighborhood walkability’. While there is no doubt that neighborhood walkability positively influences health-seeking behaviors and health, recent models suggest that their measurement and conceptualization have not emphasized the role played by psychosocial and personal factors in aging in place. Thus, the development of scales measuring human ecosystem factors has not recognized all critical factors suited for older adults. In this paper, we aim to draw on relevant literature to frame a more holistic construct, hereby referred to as Socially Active Neighborhoods (SAN), that would better support aging in place in older populations. Through a narrative review based on a systematic search of the literature, we define the scope of SAN and delineate some contextual implications for gerontology, health promotion and psychometric testing. SAN, unlike neighborhood walkability in its current measurement and conceptualization, incorporates critical theory-informed psychosocial factors (i.e. safety and disability friendliness of neighborhood infrastructure) that can encourage older adults with physiological and cognitive limitations to maintain physical and social activities as well as health in later life. The SAN is the result of our adaptation of key person-environment models, including the Context Dynamics in Aging (CODA) framework, that recognizes the role of context in healthy aging.

Objectives. The study aims to determine the social care need among overweight and obese older adults by identifying the number of social care support receipts from different sources. Methods. A sample of 5640 participants (aged 50 years and over) taken from the English Longitudinal Study of Ageing Wave 8 dataset. Multivariate logistic regression analysis was performed to explore the relationship between the study variables. Results. The statistical analyses demonstrated that overweight and obese older adults are the recipients of increasing amounts of informal social care. Moderate and morbidly obese participants are the recipients of increasing amounts of formal care compared to their normal-weight counterparts, with morbid obesity being a strong predictor for receipt of formal care. Conclusions. The present study’s findings demonstrate that for older adults aged 50 years presence of morbid obesity is a strongest predictor for receipt of formal care, and their well-being is not associated with formal or informal care receipt. The findings on how wider lifestyle factors influence the number of social care receipts, from different sources, may help policymakers and healthcare providers to allocate limited resources for adult social care services and promote healthy ageing rather than just focusing on weight loss alone.

Nowadays, many of us are using smartphone with many new applications, technology is expanding day by day. We are visiting implement a virtual assistant based which will solve any college related query. this may work as a university Oriented Intelligence machine. This virtual machine will respond the queries of scholars on college related issues. A chatbot has information stored in its database to spot the sentences and making a call itself as response to answer a given question. the school enquiry chat bot is built using algorithm that analyses queries and understand user’s message. A chatterbot or Chatbot aims to create a conversation between both human and machine. The response principle is matching the input sentence from user. this technical project consists of developing an expert System for faculty enquiry desk. The response principle is matching the input sentence from user. the current technical project consists of developing an expert System for faculty enquiry desk using web-based Chabot, through PHP technology and virtual assistance (Human-machine conversation), transmitting language to a server. The main objective of the Project on Online Chat Application is to manage the main points of Online Chat, Chat Application, Chat History, Chat profile, Users. It manages all the data about Online Chat, Users Online Chat. The project is completely built at administrative end and thus only the administrator is guaranteed the access. the aim of the project is to create an application to cut back the manual work for managing the net Chat, Chat Application, and Chat History. It tracks all the main points about the Chat History, Chat profile, Users. This Chat directly chats with the people using PHP and MySQL where we'll be using HTML and CSS files to resolve any College Related queries like for instance Fees Structure.

Background: Life expectancy (LE) at birth is relatively poor in thelow- and lower-middle-income countries compared to the developed countries. There are many factors for this poor status of LE in these countries. Communicable disease in the human body is found to be one of the main causes. Aim: To determine the effects of communicable diseases on LE at birth in low- and lower-middle-income countries. Methods: Data of 82 low- and lower-middle-income countries were extracted from the World Health Statistics 2018. In this study, the dependent variable is LE at birth, and the communicable diseases such as new Human Immunodeficiency (HIV) infections, Tuberculosis (TB) incidences, Malaria incidences, and Hepatitis-B surface antigen (HBsAg) prevalence among children under 5 years are the independent variables. Descriptive statistics, Pearson’s correlation analysis, and Linear regression model were used to examine the data. Results: The lowest (52.90 years) and highest (76.30 years) LE at birth were observed in Lesotho and Viet Nam, respectively. Pearson’s correlation coefficients identified that new HIV infections, TB incidences, Malaria incidences, and HBsAg prevalence among children under 5 years are highly correlated with the LE at birth. The linear regression analysis reveals that all the selected variables are found to have significant negative effects on LE at birth in low and lowermiddleincome countries. Conclusions: The higher prevalence of communicable diseases contributes to reducing the LE at birth in low and lowermiddleincome countries. So, to raise the LE at birth of a country, the necessary steps should be taken to minimize the incidence and prevalence of communicable diseases. Keywords: Life expectancy; Communicable diseases;Low- and lower-middle-income countries

In this paper, a new robust computational method that applies the geometrical theory of diffraction (GTD) in conjunction with the ray tracing (RT) technique is developed to evaluate the electromagnetic scattering pattern due to a plane wave represented as beam of parallel rays incident on a rough surface of quite arbitrary statistical parameters. The development of the proposed technique is explained in detail taking into consideration the generation of the geometrical model of the rough surface. The Fresnel reflection model is applied under the assumption of arbitrary electrical and optical properties of the rough surface material. Also the polarization of the plane wave primarily incident on the rough surface is taken into consideration. The algorithm developed in the present work accounts for multiple bounces of an incident ray and, hence, it can be considered arbitrary higher-order GTD-RT technique. The accuracy of the obtained results is verified through the comparison with the experimental measurements of the scattering pattern of a light beam incident on rough sheets with specific statistical properties. The numerical results of the present work are concerned with investigating the dependence of the scattering pattern on the surface roughness, refractive index, angle of incidence, and the resolution of the geometric model of the rough surface. Also, it is shown that, for limited resolution of the rough surface model, the accuracy of the calculated scattered field depends on the angle of incidence of the primary beam and the surface roughness.

Several studies have compared physical activity (PA) levels between countries, but none of these studies focused on older adults and occupational PA. This study aimed to assess potential inequalities in older adults’ occupational PA across six countries and to ascertain whether having multiple jobs is a factor that interacts with country of residence to modify inequalities. This study adopted a cross-sectional design with a statistical technique screening for potential covariates. Older adults (mean age = 64 years; range = 50–114 years) from six countries (Russia, Mexico, China, India, Ghana, and South Africa) participated in the study. We utilised data from the first wave of the Study on Global AGEing and Adult Health (SAGE). These data were collected from 2007 to 2010. A random sample of 34,114 older adults completed the survey. We analysed the data with a two-way multivariate analysis of variance after screening for the ultimate covariates. There were differences in occupational PA levels (i.e., vigorous and moderate PA) among the six countries. Occupational PA levels were not significantly associated with having multiple jobs. However, having multiple jobs interacted with country of residence to influence vigorous occupational PA. Older adults from most countries who had more than one job reported more vigorous occupational PA. Older adults’ occupational PA differed among the six countries, and having multiple jobs was associated with more vigorous occupational PA. Older adults who keep multiple jobs at a time may be more active than their counterparts who had one job or were unemployed.

Several studies have compared physical activity (PA) levels between countries, but none of these studies focused on older adults and occupational PA. This study aimed to assess potential inequalities in older adults’ occupational PA across six countries and to ascertain whether having multiple jobs is a factor that interacts with country of residence to modify inequalities. This study adopted a cross-sectional design with a statistical technique screening for potential covariates. Older adults (mean age = 64 years; range = 50–114 years) from six countries (Russia, Mexico, China, India, Ghana, and South Africa) participated in the study. We utilised data from the first wave of the Study on Global AGEing and Adult Health (SAGE). These data were collected from 2007 to 2010. A random sample of 34,114 older adults completed the survey. We analysed the data with a two-way multivariate analysis of variance after screening for the ultimate covariates. There were differences in occupational PA levels (i.e., vigorous and moderate PA) among the six countries. Occupational PA levels were not significantly associated with having multiple jobs. However, having multiple jobs interacted with country of residence to influence vigorous occupational PA. Older adults from most countries who had more than one job reported more vigorous occupational PA. Older adults’ occupational PA differed among the six countries, and having multiple jobs was associated with more vigorous occupational PA. Older adults who keep multiple jobs at a time may be more active than their counterparts who had one job or were unemployed.

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age30 years, duration of hypertension5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODμg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) μg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Background Statins are a cornerstone therapy for management of hypercholesterolaemia in primary and secondary prevention of cardiovascular disease, however there is individual variation regarding efficacy of therapy and adverse side-effects experienced. Purpose Polymorphisms of the SLCO1B1 gene have shown correlation with the risk of statin side-effects and efficacy of treatment, however in real-world clinical practice, their utility remains to be established. Methods We carried out retrospective multiple linear regression analysis using robust standard errors of 129 individuals undergoing genetic testing for the SLCO1B1 polymorphisms rs4149056 and rs2306283 to investigate for an association to statin side effects and efficacy respectively. In addition, logistic regressions which account for the binary nature of the outcomes were performed. The rs4149056 gene has 3 outcomes: T/T (considered least associated with statin intolerance), C/C (considered most associated with statin intolerance) and T/C (considered intermediately associated with statin intolerance). The rs2306283 gene has 3 outcomes: A/A (considered least associated with statin response), G/G (considered most associated with statin response) and A/G (considered intermediately associated with statin response). Results According to multiple regression and logistic regression analyses SLCO1B1 rs4149056 genotypes (C/C and T/C relative to the base type T/T) do not predict the incidence of myalgia, myopathy, creatine kinase rise, liver function derangement or gastrointestinal side effects at 5% significance. SLCO1B1 rs2306283 (G/G and A/G relative to the base type A/A) do not predict LDL response to statins (p-values 0.33 and 0.52 respectively). Conclusions The presence of rs4149056 C/C and T/C genotypes was not associated with an increased risk of statin side-effects. Similarly rs2306283 genotypes did not correlate with the efficacy of statin treatment. These genotype predictors were primarily based on Simvastatin – an earlier generation statin, whereas the majority of the patients in this cohort were treated with more contemporary and widely used statins such as Atorvastatin and Rosuvastatin. We therefore conclude that these genotypic markers may have limited application in modern day clinical practice and that substantial investment of limited resources towards them may not be justified. Funding Acknowledgement Type of funding sources: None.

Background and objectives More people are living alone across the life course: in later life this can have implications for practical and psychosocial support. The Covid pandemic emphasised the importance of this when the UK government restricted movement outside of households to limit the spread of disease. This had important ramifications regarding social contact and practical support. The objectives of this study were to explore the experience of older women living alone during this time, with a focus on health and wellbeing. Research design and methods This study used an Interpretative Phenomenological approach. Semi-structured interviews were undertaken with seven women (aged 65 +), living alone in the UK. Interviews were carried out between May and October 2020. Interpretative Phenomenological Analysis was used to analyse the transcripts. Results Findings show that life course events shaped how living alone was experienced in later life. Convergences and divergences in lived experience were identified. Three superordinate themes emerged from the Interpretative Phenomenological Analysis: Productivity, Ownership, and Interconnectedness. Discussion and implications Findings highlight the importance of life course events in shaping the experience of later life. They also provide a better understanding of the lived experience of living alone as an older woman, increasing knowledge of this group and how living alone can affect health and wellbeing. Implications for research and practice are discussed, such as the importance of recognising the specific support needs for this group in later life, and the need for further knowledge about groups whose needs are not met by standard practice.

The aim of the study was to determine the bacterial-adherence to the experimental pellicle pretreated with commercially available oral-rinse/ photosensitizer (mimicking use of oral-rinse/ photosensitizer before meals).An artificial mouth (NAM) system was used for the development of single-species biofilm (Actinomyces viscosus, Streptococcus mitis and Streptococcus sanguinis respectively). Two commercially available oral-rinses containing active ingredients [Essential oils (EO) and Chlorhexidine gluconate (CHX) were used. Curcumin photosensitizer (PS) was used as a photosensitizer against the microbes. For the adherence study, the experimental pellicle on the beads (in the capillary tubes of the NAM system) was pretreated with the oral-rinse and photosensitizer before the inoculation of bacteria; this would resemble the use of rinse/ photosensitizer before meal. The bacterial population of the biofilm was determined using serial dilution assay and expressed as colony forming unit per ml. Deionized distilled water was used in place of oral-rinse/photosensitizer and served as a negative-control. For the qualitative study, bacterial population viewing was carried out using Scanning Electron Microscope (SEM).It was observed that on treatment with the oral-rinses the bacterial population of S.mitis, S.sanguinis and A.viscosus (adherence) was significantly reduced where the reduction was less for EO-based oral-rinse compared with that of CHX and curcumin PS in the following sequence EOCHXPS (p0.05).From the results, it appears that curcumin photosensitizer and oral-rinses contain CHX to be preferably used before-meal and EO after-meal.

Older women are more likely to live alone in later life in the UK; however, relatively little is known as to how this has an association with poorer health. This paper attempts to fill this research gap, assessing if living alone is a risk factor for poorer health in later life. The Household Panel Survey data, wave 8 were used which was collected during 2017 in the United Kingdom. Women’s household types were divided into three types: living alone, living with a partner and living with others (not a partner). Seven health and wellbeing outcome variables were used. Descriptive analysis and regression analyses examined the role of living alone in predicting health and wellbeing, controlling for demographic and socioeconomic (SES) factors. Results showed significant differences between the household types. However, living alone was not found to be a risk factor for poorer health once SES variables were included in the regression models. While there were differences in the health and wellbeing of the three household composition types, these differences were not found to be significant once demographic and socioeconomic variables were accounted for. Future UK policy should aim to reduce inequalities in SES throughout the life course to improve health and wellbeing in later life. Future research directions include a more detailed examination of the determinants of health of this population.

The study aimed to investigate parental knowledge of tobacco effects on health and parental perceptions on tobacco control measures at households in Dhaka city, Bangladesh. Out of 1436 tobacco-using parents, a total of 400 participants were selected for the cross-sectional survey using a multi-stage probability sampling. Overall knowledge and perceptions of parents were scored. Simple and multiple logistic regressions were performed. There were 19.8% of parents who had good knowledge about health effects of tobacco and 40.8% had positive perception on home initiatives of tobacco control measures respectively. The study revealed that knowledge of overall tobacco effects on health (AOR = 20.92, 95% CI = 2.60-167.83), asthma (AOR = 0.29, 95% CI = 0.17-0.49), infertility (AOR = 0.43, 95% CI = 0.24-0.77) and pre-eclampsia (AOR = 0.36, 95% CI = 0.14-0.90) were significantly increased the odds of parents good knowledge. Whereas, parental perceptions indicate that living in the joint family was positively associated with controlling tobacco use (AOR =3.10, 95% CI = 1.88-5.13). It suggests that health education programs need to be developed to improve parental awareness on the adverse health effects of tobacco-use at households.

The importance of developing an effective action-based model of care for multimorbid patients has become common knowledge, but it remains unclear why researchers in Nigeria have not paid attention to the issue. Hence, this study assessed the quality of health services using the Donabedian model and aimed to recommend an effective hospital care delivery model for older people in Nigeria with multimorbidity. A cross-sectional study using face-to-face data was conducted between October 2021 and February 2022. The reported data were collated, checked, coded, and entered into JISC online survey software and then exported to IBM Statistical Package for Social Science (SPSS) version 27 for analysis, sourced from the University of West London, London, United Kingdom. The data were collected from the outpatient department of four high-volume public secondary hospitals in Niger State (the largest hospital in the three senatorial zones and that of the state capital). Systematic random sampling was used to select 734 patients with two or more chronic diseases (multimorbidity) aged 60 years and above who presented for routine ambulatory outpatient and consented to participate in the study. A Service Availability and Readiness Assessment (SARA) tool was used to assess the structure, and the process quality was assessed by the patients’ experiences as they navigated the care pathway, whereas the outcome was measured using the patients’ overall satisfaction. Using Spearman’s correlation, no statistically significant association was observed between satisfaction level with the healthcare that was received and the five domains of health facility readiness (Total score Basic Amenities, Total score Basic Equipment, Total score infection control, Total score diagnostic capacity, Total score essential drugs), and the general facility readiness. Finally, the process component superseded the structure as the determinant of the quality of healthcare among multimorbid patients in Niger State. The emphasis of the process should be on improving access to quality of care, improving patient–physician relationships and timing, reducing the financial burden of medical care, and building confidence and trust in medical care. Therefore, these factors should be incorporated into designing the healthcare model for multimorbid patients in Nigeria.

Coronary artery disease is the leading cause of death and disability globally. The presentation of Non-ST segment elevation myocardial infarction (NSTEMI) is heterogeneous, with different risk levels in terms of death, infarction and recurrence of infarction. Current evidence suggests that plasma glucose level or hyperglycemia is a mediator of worse prognosis of MI. The objective of the study was to correlate on admission plasma glucose level in non-diabetic patient with in-hospital outcome of patients after first attack of NSTEMI. This prospective analytical study was conducted among purposively selected 280 patients with NSTEMI admitted in coronary care unit of Mymensingh Medical College Hospital during the period of June 2016 to May 2017. Data were collected from the informant by face to face interview, clinical examination and investigations using a pretested semi-structured case record form. Data were analyzed by SPSS. Patients were categorized into two groups; Group A: NSTEMI with admission plasma glucose level below 7.8mmol/l, (n=150, Male-110, Female-40). Group B: NSTEMI with admission plasma glucose level ≥7.8mmol/l, (n=130, Male-95, Female-35). Group B (n=130) is divided into two subgroups. Subgroup-I: NSTEMI with Hyperglycemia (7.8-9.3mmol/l), n = 67 (male 44, female 23), Subgroup-II: NSTEMI with Hyperglycemia (≥9.4mmol/l), n = 63 (male 51, female 12). All Patients were non diabetic excluded by HbA₁c. The mean left ventricular ejection fraction (LVEF) of Group B, Subgroup-II was significantly less than that of Subgroup-I (p0.05). Correlation between LVEF levels and on admission plasma glucose level showed statistically significant moderate negative correlation, suggesting that the higher was the level of on admission plasma glucose level; the lower was the LV ejection fraction level in first attack of NSTEMI patients. Correlation coefficient between Troponin-I and plasma glucose level on admission of the study population (r=0.030) suggesting that the higher was the level of admission plasma glucose level the higher was the Troponin-I level in first attack of NSTEMI patients. The more was the plasma glucose level, less was LVEF, more was the heart failure and prolonged hospital stay. The study showed a strong predictor of adverse in-hospital outcome in the various levels of plasma glucose and NSTEMI. There was association between the concentration of the plasma glucose and the extent, severity of disease in the means of mean LVEF, the rate of heart failure and duration of hospital stay. The importance of this finding is even clear that RBS is a standard, valuable diagnostic tool for evaluation of severity and prediction of outcome of patients with NSTEMI.

The most common cause of premature death in developing countries like Bangladesh is ischaemic heart disease. Cardiac troponin-I (cTnI) is 100 percent tissue specific for the myocardium which has been shown to be a very sensitive and specific biomarker for acute myocardial infarction. As acute myocardial infarction is a stressful condition so, plasma glucose level may also increase in this condition which is stress hyperglycemia and also plasma glucose level may be used for prediction of outcome as it is a cheap and easy available test. The aim of the study is to investigate the impact of the elevation of troponin-I level with plasma glucose level of non-diabetic patients in ST-elevation myocardial infarction. This study which was comparative type of analytical and cross- sectional study carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2021 to December 2021. Data was collected from Cardiology Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 70 subjects participated in this study and were grouped as normoglycemic ST elevation myocardial infarction- Control group (Group I) and non-diabetic hyperglycemic ST elevation myocardial infarction- Study group (Group II). The results were calculated and analyzed by using SPSS. Serum troponin-I was measured by Fluorescence Immunoassay (FIA) and plasma glucose estimated by GOD-PAP method. Data were expressed in mean±SD and statistical significance of difference among the groups were calculated by unpaired Student's 't' test. The correlation between different parameter was done by Pearson's correlation coefficient test. In this study, the result suggests that there is significant positive association between serum troponin-I and plasma glucose level in study group (hyperglycemic non-diabetic STEMI) in comparison to control group (normoglycemic STEMI). So, by this study we recommend that routine estimation of these parameters is important for prevention of complications related to acute myocardial infarction.

Although Bangladesh has made noticeable progress in reducing the prevalence of stunting, wasting, and being underweight among under-5 children, it has not been very successful in reducing overall severe anthropometric failure (SAF) among them. Therefore, the study aims to identify the prevalence and risk factors of SAF measured by the Composite Index of Severe Anthropometric Failure (CISAF) among under-5 children in Bangladesh.Data was drawn from a cross-sectional Bangladesh Demographic Health Survey (BDHS) conducted in 2017-2018. A bivariate analysis (Chi-square test) and logistic regression analysis were used to estimate the unadjusted, and age and sex-adjusted prevalence of SAF. Odds ratio (OR) and confidence interval (CI) were assessed using logistic regression analysis to identify the various risk factor of SAF.The overall adjusted prevalence of under-5 child SAF was 11.3% (95% CI: 10.6-12.0) and it was highly prevalent among children of uneducated mothers (adjusted, 22%, 95% CI: 17.3-26.8). The key factors associated with SAF were children in the age group 24-35 months (OR: 2.43, 95% CI: 1.83-3.23), children born with low birth weight (OR: 3.14, 95% CI: 2.24-4.97), children of underweight mothers (OR: 1.82, 95% CI: 1.44-2.29), children of parents with no formal education (OR: 2.28, 95% CI: 1.56-3.31) and children from lower socio-economic status (OR: 2.25, 95% CI: 1.55-3.26).Prioritizing and ensuring context-specific interventions addressing individual, community, public policy, and environment level risk factors from policy level to implementation to reduce structural and intermediary determinants of under-5 SAF.

To investigate antifungal and mechanical properties after the impregnation of Dimethyl Amino-ethyl Hexa-decyl Di-methacrylate (DMAHDM) alone or in combination with Nystatin in polymethylmethacrylate.The control group was fabricated by mixing powder and liquid of PMMA at the ratio of 2.5:1 g/mL. The DMAHDM was added to PMMA liquid and were mixed with PMMA powder. The Nystatin (500,000 International Units (IU)) was mixed with PMMA powder, whereby the composite powder was mixed with the DMAHDM-based liquid. The prepared specimens were tested for fungal adhesion testing (at days 1 and 30), impact strength and flexural strength. Oneway ANOVA post-hoc Tukey's test were used for statistical analysis.Statistical analysis for the adhesion assay revealed that the antifungal activities of unaged and aged specimens in experimental groups were statistically significant as compared to control group A. The groups containing DMAHDM with Nystatin have shown statistically reduced flexural strength. The impact strength test revealed that groups containing 20% DMAHDM alone and DMAHDM with Nystatin showed statistically reduced impact strength compared to the control group.Antifungal activities of experimental PMMA resin was increased. The addition of DMAHDM alone in PMMA resin has no deleterious effects on impact and flexural strength, however, at higher concentration values were reduced.

This study investigated the effect of wind speed and air pollution on COVID-19 from March 10, 2020, to October 04, 2020, in Pakistan. Wind speed and COVID-19 had positive correlation in Pakistan and its provinces. The inverted U-shaped dose–response curve was found for wind speed and COVID-19 in Punjab. Initially, the dose–response curve showed a positive link between wind speed and COVID-19 in Pakistan, Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory. Later, it becomes downward sloped in Sindh, Khyber Pakhtunkhwa, and Islamabad Capital Territory. The expected log count of COVID-19 was increased by 0.113 times (Pakistan), 0.074 times (Punjab), 0.042 times (Sindh), and 0.082 times (Khyber Pakhtunkhwa) for a 1 km/h increase in the wind speed. The correlation between particulate matter and COVID-19 was positive (Pakistan, Punjab, and Islamabad Capital Territory) and negative (Sindh). The dose–response curve for particulate matter and COVID-19 had inverted U-shaped (Pakistan, Punjab, and Khyber Pakhtunkhwa) positively sloped (Islamabad Capital Territory), and negatively sloped (Sindh). The inverted U-shaped association shows that the COVID-19 initially increased due to a rise in the particulate matter but reduced when the particulate matter was above the threshold level. The particulate matter was also responsible to wear face masks and restricted mobility. The expected log count of COVID-19 cases was reduced by 0.005 times in Sindh for 1 unit increase in particulate matter. It is recommended to reduce particulate matter to control respiratory problems. The government should use media (print, electronic, social) and educational syllabus to create awareness about precautionary measures.

The efficacy of renal sympathetic denervation (RSD) in the treatment of uncontrolled hypertension (HTN) remains uncertain. A systematic review of randomized controlled trials was performed to evaluate the efficacy and safety of RSD for resistant HTN. PubMed, EMBASE, MEDLINE, Cochrane, Directory of Open Access Journals, CINAHL, and Google Scholar were searched from January 01, 2001, through July 30, 2020. Randomized controlled trials comparing RSD with the sham procedure for uncontrolled HTN were selected. The primary efficacy outcome was the reduction in ambulatory systolic blood pressure. We used random-effects models. Nine prospective clinical trials met the inclusion criteria. The ReSet and Symplicity HTN-3 Trial showed no significant changes because of discrepancies in complete circumferential ablation during RSD. The Relief study, The Radiance HTN solo, and the SPYRAL HTN OFF medical trials showed a significant reduction in systolic blood pressure in the group that had undergone the intervention compared with the sham group attributed to rigorous trial design. In conclusion, our systematic review suggests that efficacy of RSD seems to be superior to sham-controlled interventions provided circumferential denervation is performed. However, difference in efficacy is marginal.

The available evidence suggests that social networks can contribute to physical activity (PA) enjoyment, which is necessary for the maintenance of PA over the life course. This study assessed the associations of active and sedentary social networks with PA enjoyment and ascertained whether walkability moderates or modifies these associations. A cross-sectional design compliant with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) was employed. The participants were 996 community-dwelling older Ghanaians aged 50 years or older. A hierarchical linear regression analysis was used to analyse the data. After adjusting for age and income, the study found that the active social network size (β = 0.09; p < 0.05) and sedentary social network size (β = 0.17; p < 0.001) were positively associated with PA enjoyment. These associations were strengthened by walkability. It is concluded that active and sedentary social networks may better support PA enjoyment in more walkable neighbourhoods. Therefore, enabling older adults to retain social networks and live in more walkable neighbourhoods may be an effective way to improve their PA enjoyment.

The novel Coronavirus (COVID-19) pandemic has become a real challenge for healthcare providers around the world. Recently, it has been recorded that among all the health care professionals dentists, dental assistants, and dental hygienists are at high risk as they are in close contact with patients and are exposed to body fluids of patients. To assess the knowledge and create awareness of changes in the practice of emergency and non – emergency dental procedures during COVID-19 among dental interns. A cross-sectional study was conducted among 100dental interns. As the study was conducted during the pandemic time, a web-based survey was created using google form which composed of a set of 12 structured custom- made questions. The answers were collected and subjected to statistics.It was seen that more than 80% of the dental interns were aware of the guidelines issued by various dental associations regarding changes in dental procedures during COVID-19 pandemic situation. Most of the students were also aware of the term ‘Tele dentistry’ and telecommunications for dental care, consultation and education. Adaptations and adjustments in the dental procedures need to be done to avoid the spread of the disease. Hence, it is important and mandatory for dental professionals and students to be aware of the precautions to be taken when performing emergency as well as non-emergency procedures during this pandemic situation.

Mortality forecasts are essential part for policymaking in any aging society. In recent years, methods to model and forecast mortality have improved considerably. Among them, Lee-Carter method is one of the most influential method. In this paper, Lee-Carter method is applied to forecast mortality and life expectancy of Bangladesh. A functional data analysis approach is used to decompose the smoothed log-mortality rates in Lee-Carter framework for higher goodness-of-fit of the models and for longer forecast horizons. Bangladesh has been experiencing a mortality transition and has gained life expectancy in last few decades. The fitted model here showed higher pace of mortality decline for women in Bangladesh than that of men. The forecasts showed continuation of mortality improvement in long run and by 2060 life expectancy at birth is expected to reach over 80 years for both sexes in Bangladesh. The study also predicts the effect of reduction in infant mortality on the life expectancy in Bangladesh.

Bridges are one of the most susceptible structural elements that can be viciously impacted by tsunami disaster. During the latest few tsunami hazards, a number of bridges were affected severely due...

Intimate partner violence is a persistent social problem in Zimbabwe and has been linked to patriarchal attitudes that promote the superiority of men in marital relationships while denying women agency. Using 2015 Zimbabwe Demographic and Health Survey data, we examined the influence of female autonomy on intimate partner violence. Our analysis was restricted to 2847 women who were in some form of sexual union. Consistent with earlier studies, our results show that more than 40% of the women had experienced some form of intimate partner violence. The most prevalent form of intimate partner violence was emotional violence, followed by physical violence and sexual violence. Low levels of economic autonomy and supportive attitudes towards wife-beating increased the risk of intimate partner violence, while late marriage reduced the risk of all forms of intimate partner violence. Findings provide a basis for interventions that may increase economic control and improve decision making for women, although the association between economic violence and economic decision making requires further research that examines the possibility of reverse causality.

The present study aimed to explore a new source of montmorillonite and to develop an extraction and purification protocol for its isolation from raw clay samples acquired from the Koh-e-Suleiman mountain range in Pakistan. The process involved the collection of raw clay from the source, identification and quantification of montmorillonite. Granulometric extraction and purification protocols increased the montmorillonite content from 21.8–25.1% in the raw clay to 90.1–93.9% after small-scale extraction and 85.33–89.33% on a larger scale. A techno-economic analysis highlighted the practicality and economic benefits of large-scale extraction for industrial applications. This study highlights the existence of a substantial new source of this valuable clay which is currently used across multiple industries including construction, pottery making, pharmaceuticals, cosmetics and engineering. It is intuitively expected that the large-scale extraction of the material will improve the economic condition of the region by providing employment opportunities to locals and may be a valuable resource for export.

Background Intimate partner violence (IPV) is a global public health concern, with women in low- and middle-income countries (LMICs) bearing a disproportionately high burden. This study investigates the prevalence and factors correlated with attitudes regarding wife-beating among Bangladeshi women in urban–rural contexts. Methods A sample of 13,033 urban women and 51,344 rural women data from the Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 were analyzed using the Chi-square test and ordinal logistic regression model. Results The findings reveal that arguing with her husband is the widespread reason for wife-beating in Bangladesh (urban: 17.3%, rural: 21.9%), followed by neglecting the children (urban: 12.7%, rural: 15.8%). About 8% of urban women and 10% of rural women favoured the opinion that refusing to involve sexual intercourse is a legitimate justification for wife-beating. In comparison, around 5% feel that a husband has a right to beat his wife due to burning food. The respondents’ age, education, marital status, number of children, socioeconomic level, any health or physical difficulty, having problems becoming pregnant, and the husband’s age are all significant factors in justifying wife-beating. Conclusions Bangladesh has a massive challenge in eliminating IPV. Women from lower socioeconomic classes, low levels of education, other challenges, and residents of rural areas are particularly more vulnerable than their urban counterparts. Therefore, it is vital to develop a proper action plan that considers women’s education and occupation to raise awareness of the various implications of wife-beating in women, particularly in Bangladesh’s rural areas.

Objective: This study is designed to understand the impacts of demographic events, socioeconomic differentials, health factors’ availability, and environmental reasons which influence life expectancy (LE) globally. Methods: Data of 183 countries were taken from the United Nations agencies. The predicted variable was LE, and the determinants were demographic events, socioeconomic factors, health-related factors, and environmental issues. Descriptive statistics, correlation analysis, and backward multiple regression analysis were used to reach the research objectives. Results: The lowest LEs were found in the African countries; and LE was found significantly associated (p

This article aims to critically review the literature on the consequences of obesity among older adults and its association with health, well-being, and social care need. A search was conducted using, primarily, three databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE) and Academic Search Elite with the help of Boolean operators. Inclusion and exclusion criteria were set to avoid bias in the selection of articles. Publications were reviewed to identify the impact of obesity among older people in terms of health and social care needs and to establish a relation between them. Gaps in the literature have been identified concerning obesity in the older adults, their health status, well-being, and social care need. The research questions were formulated to satisfy these gaps. A conceptual model was developed to map out the theoretical threads to form a diagrammatic representation to satisfy the research questions based on existing literature.The literature review established that the degree of disabilities and comorbidities related to obesity are directly proportionate and identified the gaps in the literature, where further research work is needed. The research objectives were built according to the identified gaps, the research questions were formulated to satisfy the research objectives, and a conceptual framework was also drawn to establish the links between the research questions. This review will guide a way forward to explore the unmet care needs of the aging society.

BackgroundLittle is known about the spatial distribution of idiopathic inflammatory myopathies (IIM) in the United States (U.S.), or their geospatial associations.MethodsWe studied a national myositis patient registry, with cases diagnosed in the contiguous U.S. from 1985–2011 and comprised of dermatomyositis (DM, n = 484), polymyositis (PM, n = 358), and inclusion body myositis (IBM, n = 318) patients. To assess the association of myositis prevalence with distance from roads, we employed log-Gaussian Cox process models, offset with population density.ResultsThe U.S. IIM case distribution demonstrated a higher concentration in the Northest. DM, IBM, and cases with lung disease were more common in the East, whereas PM cases were more common in the Southeast. One area in the West and one area in the South had a significant excess in cases of DM relative to PM and of cases with lung disease relative to those without lung disease, respectively. IIM cases tended to cluster, with between-points interactions more intense in the Northeast and less in the South. There was a trend of a higher prevalence of IIM and its major phenotypes among people living within 50 m of a roadway relative to living beyond 200 m. Demographic characteristics, rural-urban commuting area, and female percentage were significantly associated with the prevalence of IIM and with major phenotypes.ConclusionsUsing a large U.S. database to evaluate the spatial distribution of IIM and its phenotypes, this study suggests clustering in some regions of the U.S. and a possible association of proximity to roadways.

Using the stress process model and data from the 2011–2018 China Health and Retirement Longitudinal Study (CHARLS), this study examined the effect of spousal caregiving intensity on the depression level of older caregivers in China. The moderating role that socioeconomic status plays in the relationship between spouses was explored by constructing multilevel growth models (MGMs). The care intensity for a spouse was found to relate to significantly increased depression levels in older caregivers, while the degree of disability of the spouse being cared for (B = 0.200, p < 0.001) having a greater effect on depression than the duration of care (B = 0.007, p < 0.01). There was a threshold effect where the provision of more than 10 h of care per week for a spouse (B = 0.931, p < 0.001; B = 0.970; p < 0.01) or caring for a disabled spouse with limited ADLs (B = 0.709, p < 0.01; B = 1.326; p < 0.001; B = 1.469, p < 0.01) increased depression in older caregivers. There were moderating influences, including higher professional prestige before retirement (B = −0.006, p < 0.05) and higher annual family income (B = −0.037, p < 0.10), that increased depression related to the spouse’s degree of disability. It was considered that active familism measures should be formulated for older spousal caregivers, especially those with lower socioeconomic status.

ObjectivesThe study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh.DesignA nationally representative cross-sectional study.SettingBangladesh.RespondentsChildren age under 5 years of age.Outcome measureThis study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition.Statistical analysisAdjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis.ResultsAround 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24–35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24–35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father’s occupation, children’s age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition.ConclusionOne-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father’s occupation, children’s age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children.