The strategy for controlling COVID-19 in Kurdistan Regional Government (KRG)/Iraq: Identification, epidemiology, transmission, treatment, and recovery

This study has carried out a mini-review onfirst wave of COVID-19 infection and its control by theKurdistan Regional Government (KRG)/Iraq. COVID-19 infection, which was named by the InternationalCommittee of Taxonomy of Viruses (ICTV) as SARS-CoV-2, is a newly identified coronavirus. The lastcentury has seen the outbreak of numerous life-threatening human pathogens including Nipah, Ebola,Zika, Chikungunya, Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratorysyndrome coronavirus (SARS-CoV), and more recently a novel coronavirus has been observed. COVID-19infection has so far spread to more than 186 countries around the world and KRG/Iraq has not been freefrom this virus. In this survey, the control of COVID-19 infection in KRG as a part of Iraq is discussed indetail. The methods of identification as well as the drugs that are currently in common use to reduce thewide distribution of COVID-19 infection and their effects in countries around the world are considered.So far, 714 positive cases have been reported by the ministry of health in Kurdistan Region Government-Iraq (KRG), among which there have been only 8 deaths, and 420 cases have recovered. Those who diedhad a previous history of a chronic disease such as diabetes, hypertension, heart disease, and hyper-cholesteremia. Alternative medicine based on natural green methods has been widely used by Kurdishpeople in past years for treatment of strong coughs. In the present study, some natural products whichare cost free and effective in enhancing the body's resistance against the virus are considered. A sur-prisingfinding is that the patients in KRG have not in general had a severe cough,flu, or fever. Thepossible explanation may relate to the patients' strong immune systems, since none of them had ahistory of using alcohol and drugs, or of chronic disease. The epidemiology and transmission of the virusare discussed as well

Electrochemical Impedance study of Proton Conducting Polymer Electrolytes based on PVC Doped with Thiocyanate and Plasticized with Glycerol

Solid polymer electrolyte (SPE) system based on poly (vinyl chloride) PVC doped with ammonium thiocyanate (NH4SCN) salt has been prepared by solution cast techniques using glycerol as a plasticizer and THF tetra-hydro furan as a solvent. To examine the electrical properties of the electrolyte films the electrochemical impedance spectroscopy (EIS) has been used. The effect of glycerol on electrical properties and structure of the plasticized PVC-based polymer electrolyte was examined, and the various weight ratio of glycerol plasticizer (%5, %10, %15, and % 20) of PVCNH4SCN weight is well correlated. Electrolytes are the heart of electrochemical devices and their conductivity investigation is crucial from the viewpoint of electrochemical device application. EIS electrode impedance spectroscopy was used to determine the bulk resistance Rb of the films at room temperature. The increase of the ionic conductivity with an increase in the amount of glycerol was observed through an impedance study, and the maximum ionic conductivity was 1.02512 x 10-6 S cm-1 obtained from (PVC-%20 NH4SCN-%20 glycerol) system. Dielectric relaxation studies of the polymer electrolyte film have been studied. The rise of the dielectric polarization of the films is proved by increases in a dielectric constant and dielectric loss. The peaks appeared in the imaginary part of the electric modulus reveals that ion conduction occurs through the viscoelastic relaxation dynamic. In the AC conductivity pattern plateau region ascribed to DC conductivity is appeared

Electrochemical impedance spectroscopy as a novel approach to investigate the influence of metal complexes on electrical properties of poly (vinyl alcohol)(PVA) composites

In the current study, black tea leaves extract solution (TES) as a new green technique is used to fabricate metal-polyphenols complexes (X-polyphenols complex; X= Cu+2, Ce+3, and Cd+2). The metal-complexes are integrated with poly (vinyl alcohol) (PVA) to prepare PVA composite films. The electrical properties of pure PVA and composites are characterized using the electrochemical impedance spectroscopy (EIS) method. The EIS data are fitted to the electrical equivalent circuit to evaluate the impedance parameters of pure PVA and composite films. The trend of DC conductivity is further verified by dielectric analysis. The electrical parameters are considerably improved upon incorporating with the metal-complexes. The effects of the metal-complexes on the modification of PVA are compared together. The PVA composite incorporated with the Cu+2-complex shows the highest DC conductivity and dielectric constant, which is important for application in electrochemical energy storage devices such as batteries and supercapacitors, in comparison with the Ce+3- and Cd+2- complexes

Electrospun Ta-MOF/PEBA Nanohybrids and Their CH4 Adsorption Application

For the first time, biocompatible and biodegradable Ta-metal organic framework (MOF)/polyether block amide (PEBA) fibrous polymeric nanostructures were synthesized by ultrasonic and electrospinning routes in this study. The XRD peaks of products were wider, which is due to the significant effect of the ultrasonic and electrospinning methods on the final product. The adsorption/desorption behavior of the nanostructures is similar to that of the third type of isotherm series, which showed mesoporous behavior for the products. The sample has uniform morphology without any evidence of agglomeration. Since the adsorption and trapping of gaseous pollutants are very important, the application of the final Ta-MOF/PEBA fibrous polymeric nanostructures was investigated for CH4 adsorption. In order to achieve the optimal conditions of experiments and also systematic studies of the parameters, fractional factorial design was used. The results showed that by selecting temperature 40°C, time duration 35 min, and pressure 3 bar, the CH4 gas adsorption rate was near 4 mmol/g. Ultrasonic and electrospinning routes as well as immobilization of Ta-MOF in the PEBA fibrous network affect the performance of the final products for CH4 gas adsorption

The Study of Plasticized Amorphous Biopolymer Blend Electrolytes Based on Polyvinyl Alcohol (PVA): Chitosan with High Ion Conductivity for Energy Storage Electrical Double-Layer Capacitors (EDLC) Device Application

In this study, plasticized films of polyvinyl alcohol (PVA): chitosan (CS) based electrolyte impregnated with ammonium thiocyanate (NH4SCN) were successfully prepared using a solution-casting technique. The structural features of the electrolyte films were investigated through the X-ray diffraction (XRD) pattern. The enrichment of the amorphous phase with increasing glycerol concentration was confirmed by observing broad humps. The electrical impedance spectroscopy (EIS) portrays the improvement of ionic conductivity from 10−5 S/cm to 10−3 S/cm upon the addition of plasticizer. The electrolytes incorporated with 28 wt.% and 42 wt.% of glycerol were observed to be mainly ionic conductor as the ionic transference number measurement (TNM) was found to be 0.97 and 0.989, respectively. The linear sweep voltammetry (LSV) investigation indicates that the maximum conducting sample is stable up to 2 V. An electrolyte with the highest conductivity was used to make an energy storage electrical double-layer capacitor (EDLC) device. The cyclic voltammetry (CV) plot depicts no distinguishable peaks in the polarization curve, which means no redox reaction has occurred at the electrode/electrolyte interface. The fabricated EDLC displays the initial specific capacitance, equivalent series resistance, energy density, and power density of 35.5 F/g, 65 Ω, 4.9 Wh/kg, and 399 W/kg, respectively

Structural and electrochemical studies of proton conducting biopolymer blend electrolytes based on MC:Dextran for EDLC device application with high energy density

This study shows preparation and characterization of solid biopolymer electrolyte based on glycerolized methylcellulose (MC): dextran-doped with ammonium thiocyanate (NH4SCN). The nature of electrolyte composition in terms of interaction is characterized using Fourier transform infrared (FTIR) technique. Lowering and shifting in the intensity of the bands are observed with increasing the quantity of glycerol as a plasticizer, confirming complexation between electrolyte components. Ion transport parameters are determined using both of the methods of EIS and FTIR where the parameters are found to be increased with glycerol concentration. The transport number measurement indicates that ions are the primary charge carrier in the conduction mechanism where tion is found to be 0.961. The maximum DC ionic conductivity value is achieved that found to be 1.63 � 10�3 S cm�1. The ESR values are ranged from 300 to 580 O throughout 450 cycles. The technique of linear sweep voltammetry (LSV) shows the electrochemical stability window of 2 V for the conducting samples. The response of cyclic voltammetry (CV) shows an almost rectangular shape without Faradaic peaks. A galvanostatic charge–discharge investigation has shown the initial specific capacitance, energy density, and power density are 133 F g�1, 18.3 Wh Kg�1, and 680 W Kg�1, respectively

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely