Immigrants and health system challenges to TB control in Oman

<p>Abstract</p> <p>Background</p> <p>During the past three decades, Oman has made significant progress in controlling TB within it's borders. However, the national TB control program elimination target has yet to be reached. This study aims to explore the perceived roles played by the immigrant population and the private health sector in relation to TB control in Oman.</p> <p>Methods</p> <p>We conducted seventeen interviews with different health care providers. The verbatim transcripts were processed using content analysis.</p> <p>Results</p> <p>Three main themes emerged. Firstly the threat of repatriation faced by underprivileged expatriates, secondly the criticized and forgotten private health sector as a key player and thirdly the user and provider barriers faced by Omani patients in the Omani public health system.</p> <p>Conclusions</p> <p>The study has identified some of the challenges and barriers to TB control in Oman. These challenges are mainly related to unintended negative consequences arising from the current repatriation policy of immigrants and to and the lack of involvement of the private sector in TB control. TB control strategies designed to address these challenges are needed, for Oman to reach its TB elimination targets.</p

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Swelling and shrinkage behaviour of expansive soil blended with lime and fibres

Expansive soils are considered to be highly problematic because of their capacity to significant volume change. They swell during the rainy season as they absorb water and shrink when water evaporates from them during the summer season. Because of this dual swell-shrink behaviour, an expansive soil causes severe distress to many civil engineering structures. Several mitigating techniques are adopted to counteract the problems posed by the expansive soils, either by modifying the properties of the soil by adopting stabilization techniques using lime, cement, fly ash, calcium chloride etc. or by adopting special foundation technique such as construction of belled piers, under-reamed piles, etc. In recent years polymeric fibres have also been used to stabilize the soil as well as to improve the strength of the expansive soils. Hence in the present study lime and fibres have been used in different proportions to study the swelling and shrinkage behavior of expansive soils. Swell tests were performed by varying the fibre content and lime with expansive soils. Tests were also conducted by blending fibres and lime together with expansive soils. In a similar way, shrinkage tests were also performed for the various proportions. The test result show that swelling tends to decrease slightly with an increase in the fibre content, whereas shrinkage tends to decrease significantly upon addition of fibres. Both swelling and shrinkage tends to decrease significantly with increasing lime content. The optimum content of fibre was found to be 2%. So the expansive soil specimens blended with 2% fibres and with varying lime content was tested. It is found that blending 2% fibres and 15% lime together in expansive soils is considered to be more effective in controlling the swelling and shrinkage behaviour