Perceived Barriers to Regular Class Attendance of BCommH Students in University of Community Health, Magway

Education is essential not only for every citizen to survive in dignity but also for nation building. In any education settings, students’ regular class attendance plays a vital role for obtaining good academic achievements. A cross-sectional analytic study was conducted among BCommH students (n=410) of University of Community Health, Magway from October to December 2017 using a mixed method with objectives of exploring their perceived barriers of regular class attendance and possible solutions. Data collected by pretested semi-structured questionnaires were entered into computers and analysed by SPSS software version 18.0 with a significant level of 0.05. Qualitative data were assessed by content analysis. Significant findings related to irregular class attendance were level of previous class [OR = 3.08 (95% CI: 1.6 – 5.91) (p < 0.005)], monthly financial aid from family of MMK 100,000 or more [OR = 2.24 (95% CI: 1.29 – 3.86) (p = 0.003)], travelling pattern to and from campus by other means [OR = 7.76 (95% CI: 2.13 – 28.21) (p < 0.005)] and lunch taking pattern in week days [OR = 1.91 (95% CI: 1.13 – 3.23) (p < 0.025)]. Among the perceived barriers most of students (82.2%) stated illness as a barrier followed by being busy with preparation for examinations (46.4%), getting up late from bed in the morning (41.1%) and lecture room with high indoor temperature (40.5%). In in-depth interviews, students mentioned the reasons of missing classes as weakness in teaching system, their socio-behavioral factors and poor class room conditions. In conclusion the present study unearthed the various perceived barriers and these barriers should be removed by appropriate means including intensive oversight of faculty and staff on the students, reinforced with introduction of time management concepts into curriculum and making teaching learning environment more friendly to and happy for students, leading to more regular attendance among the students finally to achieve their high academic grades

Assessing Behavioral Risk Factors Driving Zoonotic Spillover Among High-risk Populations in Myanmar.

The increasing global emergence of zoonoses warrants improved awareness of activities that predispose vulnerable communities to greater risk of disease. Zoonotic disease outbreaks regularly occur within Myanmar and at its borders partly due to insufficient knowledge of behavioral risks, hindering participatory surveillance and reporting. This study employed a behavioral surveillance strategy among high-risk populations to understand the behavioral risks for zoonotic disease transmission in an effort to identify risk factors for pathogen spillover. To explore behavioral mechanisms of spillover in Myanmar, we aimed to: (1) evaluate the details around animal contact and types of interaction, (2) assess the association between self-reported unusual symptoms (i.e., any illness or sickness that is not known or recognized in the community or diagnosed by medical providers) and animal contact activities and (3) identify the potential risk factors including behavioral practices of self-reported illness. Participants were enrolled at two community sites: Hpa-An and Hmawbi in Southern Myanmar. A behavioral questionnaire was administered to understand participants animal exposures, behaviors and self-reported illnesses. From these responses, associations between (1) animal contact activities and self-reported unusual illnesses, and (2) potential risk factors and self-reported unusual illness were tested. Contact with poultry seemed to be very frequent (91.1%) and many participants reported raising, handling and having poultry in their houses as well as slaughtering or being scratched/bitten by them, followed by contact with rodents (57.8%) and swine (17.9%). Compared to participants who did not have any unusual symptoms, participants who had unusual symptoms in the past year were more likely to have sold dead animals (OR = 13.6, 95% CI 6.8-27.2), slaughtered (OR = 2.4, 95% CI 1.7-3.3), raised (OR = 3.4, 95% CI 2.3-5.0) or handled animals (OR = 2.1, 95% CI 1.2-3.6), and had eaten sick (OR = 4.4, 95% CI 3.0-6.4) and/or dead animals (OR = 6.0, 95% CI 4.1-8.8) in the same year. Odds of having reported unusual symptoms was higher among those involved in animal production business (OR = 3.4, 95% CI 1.9-6.2) and animal-involved livelihoods (OR = 3.3, 95% CI 1.5-7.2) compared to other livelihoods. The results suggest that there is a high level of interaction between humans, livestock and wild animals in communities we investigated in Myanmar. The study highlights the specific high-risk behaviors as they relate to animal contact and demographic risk factors for zoonotic spillover. Our findings contribute to human behavioral data needed to develop targeted interventions to prevent zoonotic disease transmission at human-animal interfaces

Whole-genome sequencing of multidrug-resistant Mycobacterium tuberculosis isolates from Myanmar.

Drug-resistant tuberculosis (TB) is a major health threat in Myanmar. An initial study was conducted to explore the potential utility of whole-genome sequencing (WGS) for the diagnosis and management of drug-resistant TB in Myanmar. Fourteen multidrug-resistant Mycobacterium tuberculosis isolates were sequenced. Known resistance genes for a total of nine antibiotics commonly used in the treatment of drug-susceptible and multidrug-resistant TB (MDR-TB) in Myanmar were interrogated through WGS. All 14 isolates were MDR-TB, consistent with the results of phenotypic drug susceptibility testing (DST), and the Beijing lineage predominated. Based on the results of WGS, 9 of the 14 isolates were potentially resistant to at least one of the drugs used in the standard MDR-TB regimen but for which phenotypic DST is not conducted in Myanmar. This study highlights a need for the introduction of second-line DST as part of routine TB diagnosis in Myanmar as well as new classes of TB drugs to construct effective regimens.Professor Sandy Smith Memorial ScholarshipThis is the final version of the article. It first appeared from Elsevier via https://doi.org/10.1016/j.jgar.2016.04.00

Complete genome sequence of a New Zealand Mycobacterium tuberculosis strain responsible for ongoing transmission over the past 30 years.

We report here the complete genome sequence of Mycobacterium tuberculosis strain Colonial S-type 1 (CS1), which has been responsible for ongoing outbreaks of tuberculosis in New Zealand over the past 30 years. CS1 appears to be highly transmissible, with greater rates of progression to active disease, compared to other circulating M. tuberculosis strains; therefore, comparison of its genomic content is of interest

Role of Alanine Racemase Mutations in Mycobacterium tuberculosis d-Cycloserine Resistance.

A screening of more than 1,500 drug-resistant strains of Mycobacterium tuberculosis revealed evolutionary patterns characteristic of positive selection for three alanine racemase (Alr) mutations. We investigated these mutations using molecular modeling, in vitro MIC testing, as well as direct measurements of enzymatic activity, which demonstrated that these mutations likely confer resistance to d-cycloserine

The Community IntraVenous Antibiotic Study (CIVAS): a mixed methods evaluation of patient preferences for and cost effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

Background: Outpatient parenteral antimicrobial therapy (OPAT) is widely used in most developed countries, providing considerable opportunities for improved cost savings. However, it is implemented only partially in the UK, using a variety of service models. Objectives: The aims of this research were to (1) establish the extent of OPAT service models in England and identify their development; (2) evaluate patients’ preferences for different OPAT service delivery models; (3) assess the cost-effectiveness of different OPAT service delivery models; and (4) convene a consensus panel to consider our evidence and make recommendations. Methods: This mixed-methods study included seven centres providing OPAT using four main service models: (1) hospital outpatient (HO) attendance; (2) specialist nurse (SN) visiting at home; (3) general nurse (GN) visiting at home; and (4) self-administration (SA) or carer administration. Health-care providers were surveyed and interviewed to explore the implementation of OPAT services in England. OPAT patients were interviewed to determine key service attributes to develop a discrete choice experiment (DCE). This was used to perform a quantitative analysis of their preferences and attitudes. Anonymised OPAT case data were used to model cost-effectiveness with both Markov and simulation modelling methods. An expert panel reviewed the evidence and made recommendations for future service provision and further research. Results: The systematic review revealed limited robust literature but suggested that HO is least effective and SN is most effective. Qualitative study participants felt that different models of care were suited to different types of patient and they also identified key service attributes. The DCE indicated that type of service was the most important factor, with SN being strongly preferred to HO and SA. Preferences were influenced by attitudes to health care. The results from both Markov and simulation models suggest that a SN model is the optimal service for short treatment courses (up to 7 days). Net monetary benefit (NMB) values for HO, GN and SN services were £2493, £2547 and £2655, respectively. For longer treatment, SA appears to be optimal, although SNs provide slightly higher benefits at increased cost. NMB values for HO, GN, SN and SA services were £8240, £9550, £10,388 and £10,644, respectively. The simulation model provided useful information for planning OPAT services. The expert panel requested more guidance for service providers and commissioners. Overall, they agreed that mixed service models were preferable. Limitations: Recruitment to the qualitative study was suboptimal in the very elderly and ethnic minorities, so the preferences of patients from these groups might not be represented. The study recruited from Yorkshire, so the findings may not be applicable nationally. Conclusions: The quantitative preference analysis and economic modelling favoured a SN model, although there are differences between sociodemographic groups. SA provides cost savings for long-term treatment but is not appropriate for all. Future work: Further research is necessary to replicate our results in other regions and populations and to evaluate mixed service models. The simulation modelling and DCE methods used here may be applicable in other health-care settings. Funding: The National Institute for Health Research Health Service and Delivery Research programme

Performance analysis of multimedia applications over satellite links

In this report, a performance analysis of multimedia services over satellite communications link is presented. The key goal of this project is to analyze and find a solution to significantly improve the throughput and delay performance of multimedia applications over the long-delay satellite network.​Master of Science (Communications Engineering

CRP is a global regulator of carbon catabolism and energy metabolism in Mycobacterium smegmatis

Members of the genus Mycobacterium respire using two terminal respiratory oxidases: a cytochrome bd-type menaquinol oxidase (encoded by cydABDC) or an aa3-type menaquinol-cytochrome c oxidase. During the transition to hypoxic (< 0.1% air saturation) conditions, cytochrome bd is induced in Mycobacterium smegmatis but the molecular mechanism governing this induction remains unknown. Analysis of the proposed cydABDC operon in M. smegmatis under hypoxic conditions revealed that cydAB and cydDC were not polycistronic. A transposon-mediated random mutagenesis was performed and revealed genes involved in redox homeostasis and defense against oxidase stress including KatG and PruC were required for cydAB operon expression. DNA-binding experiments were performed using a cydA promoter as target DNA and a DNA-binding histone-like protein (Hlp) was identified as protein bound to the cydAB promoter region. A cAMP receptor protein (CRP)-binding site (GTGAN6CCACA) was identified in the regulatory region of the cydAB operon and mutations in this sequence caused a significant reduction in cydA-lacZ expression. The M. smegmatis mc2155 genome has two copies of CRP [Msmeg_0539 (Crp1) and Msmeg_6189 (Crp2)]. Phylogenetic analysis suggested that Crp1 is uniquely present in fast-growing mycobacteria, whilst Crp2 is closely related to CRP from other slow- growing mycobacteria. In addition, only Crp1 but not Crp2 could complement a Δcrp mutant of the Gram-negative bacterium, Pectobacterium atrosepticum. To dissect the physiological role of each Crp protein, transcriptional profiling studies using deletion mutants were conducted. Microarray analysis of the crp1 deletion mutant revealed 239 genes were differentially regulated including those involved in carbon catabolism and energy metabolism. However, a crp2-deletion mutant could not be obtained suggesting that this gene is essential for growth in M. smegmatis. Therefore, crp2 was conditionally expressed and transcriptional profiling studies were performed. Microarray analysis of the crp2 overexpression strain showed 58 genes were differentially regulated including genes from many biological processes. Identification of the CRP promoter consensus in M. smegmatis revealed that both Crp1 and Crp2 recognise the same consensus sequence yet the regulon of Crp1 is distinct from that of Crp2. Taken together, these data demonstrate that each Crp could be activated in response to unique signals. The mechanism of how each Crp is activated remains to be elucidated

CRP is a global regulator of carbon catabolism and energy metabolism in Mycobacterium smegmatis

Members of the genus Mycobacterium respire using two terminal respiratory oxidases: a cytochrome bd-type menaquinol oxidase (encoded by cydABDC) or an aa3-type menaquinol-cytochrome c oxidase. During the transition to hypoxic (< 0.1% air saturation) conditions, cytochrome bd is induced in Mycobacterium smegmatis but the molecular mechanism governing this induction remains unknown. Analysis of the proposed cydABDC operon in M. smegmatis under hypoxic conditions revealed that cydAB and cydDC were not polycistronic. A transposon-mediated random mutagenesis was performed and revealed genes involved in redox homeostasis and defense against oxidase stress including KatG and PruC were required for cydAB operon expression. DNA-binding experiments were performed using a cydA promoter as target DNA and a DNA-binding histone-like protein (Hlp) was identified as protein bound to the cydAB promoter region. A cAMP receptor protein (CRP)-binding site (GTGAN6CCACA) was identified in the regulatory region of the cydAB operon and mutations in this sequence caused a significant reduction in cydA-lacZ expression. The M. smegmatis mc2155 genome has two copies of CRP [Msmeg_0539 (Crp1) and Msmeg_6189 (Crp2)]. Phylogenetic analysis suggested that Crp1 is uniquely present in fast-growing mycobacteria, whilst Crp2 is closely related to CRP from other slow- growing mycobacteria. In addition, only Crp1 but not Crp2 could complement a Δcrp mutant of the Gram-negative bacterium, Pectobacterium atrosepticum. To dissect the physiological role of each Crp protein, transcriptional profiling studies using deletion mutants were conducted. Microarray analysis of the crp1 deletion mutant revealed 239 genes were differentially regulated including those involved in carbon catabolism and energy metabolism. However, a crp2-deletion mutant could not be obtained suggesting that this gene is essential for growth in M. smegmatis. Therefore, crp2 was conditionally expressed and transcriptional profiling studies were performed. Microarray analysis of the crp2 overexpression strain showed 58 genes were differentially regulated including genes from many biological processes. Identification of the CRP promoter consensus in M. smegmatis revealed that both Crp1 and Crp2 recognise the same consensus sequence yet the regulon of Crp1 is distinct from that of Crp2. Taken together, these data demonstrate that each Crp could be activated in response to unique signals. The mechanism of how each Crp is activated remains to be elucidated

A STUDY ON REPRODUCTIVE HEALTH LITERACY AMONG YOUTH WORKERS IN INDUSTRIAL ZONE (Case Study in South Dagon Township)

Most of the people in many cultures are reluctant to discuss about reproductive health and sexual education. These may lead to increased incidence of sexually transmitted infections, adolescent pregnancy, unsafe abortion, child marriages. Objective of this study is to assess the knowledge and attitude of reproductive health among youth Industrial workers of South Dagon Township, Yangon Region. Cross-sectional descriptive study was done among 197 youth industrial workers in South Dagon Township. The respondents were between 15-24 year and most of them were high school level and female workers. Most of the youths knew the contraceptive methods and took that service from clinic. According to the knowledge level, most of the male respondents (74.9%) and female (76.9%) had poor knowledge level. According to the attitude level, most of the male respondents (87.0%) and female (64.7%) had poor attitude level. There was a significant association between sex of the respondents and attitudes on sex education and reproductive health and female respondents had better attitude score. Another statistical significant association was found between occupation and attitudes on sexual education, the dependent respondents had better attitude score. No significant association between other socio-demographic characteristics of parents and knowledge of sexual education was seen. Most of the youth agreed to develop easily accessible reproductive health services and knowledge for youths. Most of them concurred to teach sexual education in school curriculum. Improving sexual and reproductive health status for youth requires a multi-sectoral approach that not only addresses young people’s need for their knowledge, practice and quality services, but also important to have supportive and enabling environment. Thus, pilot projects to promote youth’s reproductive health literacy is needed