Case 2 : Saving the Rural Ontario Maternity Services – Can We Do It?

Inaya, manager of the ‘low-risk’ project at Provincial Council for Maternal and Child Health (PCMCH), had to come up with an integrative solution for the issues encompassing maternity care in Ontario. The low-risk project aims “to design and develop effective low risk maternal and newborn strategy for Ontario (2015-2018) to ensure that all women have an equitable choice of delivery options, and access to the right level of care at the right time, no matter where they live in the province”. In response to external and internal challenges facing Ontario’s hospitals, the province has seen the closure of rural maternity programs over the last few years. The women in communities that are unable to sustain local services must travel to access distant services, and depending on the distance to the nearest referral center, may be away from their homes and communities during the critical pregnancy period and child birth. The separation of pregnant women from their families and communities can cause negative outcomes. The health and economic impacts of the inability to access local maternal programs are well documented. Different stakeholders have indicated the importance of alternative, sustainable models of interprofessional collaboration of midwifery, primary and specialty care, and the efficient allocation of human health resources (PCMCH, 2015). To create the framework of the model, PCMCH formed a leadership team and expert panel consisting of different care providers. Inaya had to identify barriers and potential solutions by engaging different care providers and exploring the challenges from their perspectives. The findings would be used to work with relevant partners, such as associations of different health care professionals, to develop potential solutions for the Ministry. The goal of the case is to provide readers with the opportunity to apply the concept of collaboration and also explore the barriers to achieving inter-professional collaboration from the key stakeholders’ perspectives

A shader based adaptation of selected sixteenth century maps

This research develops a technique focused on shading and texturing, with an emphasis on line work and color, to emulate the unique qualities of copperplate line-engraving from 16th century cartography. A visual analysis of selected maps determines the defining characteristics adapted for three-dimensional computer generated environments. The resulting work is presented in a short time-based animation

Attentional Biases to Foods: The Effects of Caloric Content and Cognitive Restraint

The goal of the present study was to determine whether female restrained and unrestrained eaters demonstrated differential levels of attentional bias to high calorie foods when they were presented as distractors in a flanker task. This task consisted of four blocks of 68 trials in which three food pictures were briefly presented simultaneously on a computer screen. On each trial a high or low calorie target food was presented in the center of a pair of high or low calorie food flanker pictures and participants’ reaction times to answer a basic question about whether they would consume the target food for breakfast were recorded. In Experiment 1, in which all participants were fed a snack prior to engaging in the flanker task, there was no evidence that restrained (n = 29) or unrestrained (n = 37) eaters had an attentional bias. However, in Experiment 2, when participants completed the flanker task while hungry, restrained eaters (n = 27) experienced response conflict only when low calorie targets were flanked by high calorie distractors, whereas unrestrained eaters (n = 46) were distracted by high calorie flankers regardless of the caloric content of the target cue. The results from this implicit task indicate that flankers interfere with hungry participants’ responses to varying degrees depending on their cognitive restraint. Whether attentional bias to food cues subsequently affects food choices and eating behavior is a topic for further investigation

Multi-hazard groundwater risks to water supply from shallow depths: challenges to achieving the sustainable development goals in Bangladesh

Background: Groundwater currently provides 98% of all drinking-water supply in Bangladesh. Groundwater is found throughout Bangladesh but its quality (i.e. arsenic and salinity contamination) and quantity (i.e., water-storage depletion) vary across hydrological environments, posing unique challenges to certain geographical areas and population groups. Yet, no national-scale, multi-parameter groundwater hazard maps currently exist enabling water resources managers and policy makers to identify vulnerable areas to public health. Methods: We develop, for the first time, groundwater multi-hazard maps at the national scale of Bangladesh combining information on arsenic, salinity and water storage. We apply geospatial techniques in ‘R’ programming language and ArcGIS environment, linking hydrological indicators for water quality and quantity to construct risk maps. A range of socio-economic variables including access to drinking and irrigation water supplies and social vulnerability (i.e., poverty) are overlaid on these risk maps to estimate exposures. Results: Our multi-parameter groundwater hazard maps show that a considerable proportion of land area (5% to 24% under extremely-high to high risks) in Bangladesh is currently under combined risk of arsenic and salinity contamination, and groundwater-storage depletion. As small as 6.5 million (2.2 million poor) to 24.4 million (8.6 million poor) people are exposed to a combined risk of high arsenic, salinity and groundwater-storage depletion. Conclusions: Our groundwater hazard maps reveal areas and exposure of population groups to water risks posed by arsenic and salinity contamination and depletion of water storage. These geospatial hazard maps can potentially guide policymakers in prioritizing mitigation and adaptation measures in order to achieve the United Nation’s Sustainable Development Goals across the water, agriculture and public health sectors in Bangladesh

Workplace violence against healthcare workers in rural health facilities of Bangladesh and their quality of life: A cross-sectional study

Background: The prevalence of verbal and physical violence against healthcare workers (HCWs) is reportedly high in Bangladesh. We aimed to determine the prevalence and risk factors associated with violence against HCWs in Bangladesh. Methods: This cross-sectional study was done in May-June 2021 among 378 physicians and nurses working in 19 randomly selected rural government health facilities. A self-administered validated Bangla version of the WHOQOL-BREF questionnaire on workplace violence (WPV) and the quality of life (QoL) was used. Multiple logistic regression analyses were done to find out the independent risk factors of WPV. Results: The prevalence of overall WPV was about 48.0% (psychological 46.6%, physical 5.0%, and sexual harassment 1.9%). However, the WPV reporting rate was very low (27.8%). Being a male (aOR= 2.18; 95% confidence interval: 1.22−3.90) and a physician (aOR = 2.93; 95% CI: 1.56−5.52) had increased the likelihood of experiencing WPV. HCWs who were encouraged to report WPV were less likely to experience WPV (aOR = 0.36; 95% CI: 0.18−0.70). Study participants exposed to WPV had sig-nificantly lower QoL (P<0.01) in all the domains of WHOQOL-BREF (physical, psychological, social, and environmental). Conclusion: The study findings revealed that half of the HCWs working at rural government health facilities experienced WPV, which warrants proper investigation to adopt effective measures to reduce future occurrence. Moreover, the QoL of HCWs working in the aforementioned health facilities was significantly influenced by exposure to WPV

Effect of Source Activity and Source Volume on Intrinsic Uniformity of SPECT Gamma Camera

Purpose: The quality control of the gamma camera is obligatory for the proper diagnosis of the patients. The most intensive and sensitive routine quality control of gamma camera is intrinsic uniformity. The main objective of this research work is to determine the best parameters for daily quality control testing of intrinsic uniformity for dual head Single Photon Emission Computed Tomography (SPECT) gamma camera.Method: The integral and differential intrinsic uniformity test for both Useful Field Of View (UFOV) and Central Field Of View (CFOV) was done by placing a point source of 99mTc in front of the detectors with removed collimators to measure the effect of source activity and source volume on intrinsic uniformity.Result: The result shows that the best intrinsic uniformity image is obtained at activity volume in the range of 0.2 – 0.7 ml in 3 ml syringe with source activity between 70 – 200 MBq since place of point source on the central axis of the detector at a distance from its face equal to five times the diameter of the useful field of view as defined by the lead mask.Conclusion: Finally we can conclude that, the lower the intrinsic uniformity the better the imaging and diagnosis

Salt tolerance QTLs of an endemic rice landrace, \u3ci\u3eHorkuch\u3c/i\u3e at seedling and reproductive stages

Salinity has a significant negative impact on production of rice. To cope with the increased soil salinity due to climate change, we need to develop salt tolerant rice varieties that can maintain their high yield. Rice landraces indigenous to coastal Bangladesh can be a great resource to study the genetic basis of salt adaptation. In this study, we implemented a QTL analysis framework with a reciprocal mapping population developed from a salt tolerant landrace Horkuch and a high yielding rice variety IR29. Our aim was to detect genetic loci that contributes to the salt adaptive responses of the two different developmental stages of rice which are very sensitive to salinity stress. We identified 14 QTLs for 9 traits and found that most are unique to specific developmental stages. In addition, we detected a significant effect of the cytoplasmic genome on the QTL model for some traits such as leaf total potassium and filled grain weight. This underscores the importance of considering cytoplasm-nuclear interaction for breeding programs. Finally, we identified QTLs co-localization for multiple traits that highlights the possible constraint of multiple QTL selection for breeding programs due to different contributions of a donor allele for different traits

Unique Genotypic Differences Discovered among Indigenous Bangladeshi Rice Landraces

Bangladesh is a reservoir of diverse rice germplasm and is home to many landraces with unique, important traits. Molecular characterization of these landraces is of value for their identification, preservation, and potential use in breeding programs. Thirty-eight rice landraces from different regions of Bangladesh including some high yielding BRRI varieties were analyzed by 34 polymorphic microsatellite markers yielding a total of 258 reproducible alleles. The analysis could locate 34 unique identifiers for 21 genotypes, making the latter potentially amenable to identity verification. An identity map for these genotypes was constructed with all the 12 chromosomes of the rice genome. Polymorphism information content (PIC) scores of the 34 SSR markers were 0.098 to 0.89 where on average 7.5 alleles were observed. A dendogram constructed using UPGMA clustered the varieties into two major groups and five subgroups. In some cases, the clustering matched with properties like aromaticity, stickiness, salt tolerance, and photoperiod insensitivity. The results will help breeders to work towards the proper utilization of these landraces for parental selection and linkage map construction for discovery of useful alleles

Introducing pulse oximetry for outpatient management of childhood pneumonia::An implementation research adopting a district implementation model in selected rural facilities in Bangladesh

BACKGROUND: Pulse oximetry has potential for identifying hypoxaemic pneumonia and substantially reducing under-five deaths in low- and middle-income countries (LMICs) setting. However, there are few examples of introducing pulse oximetry in resource-constrained paediatric outpatient settings, such as Integrated Management of Childhood Illness (IMCI) services. METHODS: The National IMCI-programme of Bangladesh designed and developed a district implementation model for introducing pulse oximetry in routine IMCI services through stakeholder engagement and demonstrated the model in Kushtia district adopting a health system strengthening approach. Between December 2020 and June 2021, two rounds of assessment were conducted based on WHO's implementation research framework and outcome variables, involving 22 IMCI service-providers and 1680 children presenting with cough/difficulty-in-breathing in 12 health facilities. The data collection procedures included structured-observations, re-assessments, interviews, and data-extraction by trained study personnel. FINDINGS: We observed that IMCI service-providers conducted pulse oximetry assessments on all eligible children in routine outpatient settings, of which 99% of assessments were successful; 85% (95% CI 83,87) in one attempt, and 69% (95% CI 67,71) within one minute. The adherence to standard operating procedure related to pulse oximetry was 92% (95% CI 91,93), and agreement regarding identifying hypoxaemia was 97% (95% CI 96,98). The median performance-time was 36 seconds (IQR 20,75), which was longer among younger children (2-11 months: 44s, IQR 22,78; 12-59 months: 30s, IQR 18,53, p < 0.01) and among those classified as pneumonia/severe-pneumonia than as no-pneumonia (41s, IQR 22,70; 32s, IQR 20,62, p < 0.01). We observed improvements in almost all indicators in round-2. IMCI service-providers and caregivers showed positive attitudes towards using this novel technology for assessing their children. INTERPRETATION: This implementation research study suggested the adoption, feasibility, fidelity, appropriateness, acceptability, and sustainability of pulse oximetry introduction in routine IMCI services in resource-poor settings. The learning may inform the evidence-based scale-up of pulse oximetry linked with an oxygen delivery system in Bangladesh and other LMICs. FUNDING: This research was funded by the UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication