Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention.

BackgroundBangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.MethodsUsing data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.ResultsUsing project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.ConclusionThis theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births

EXPERIMENTAL INVESTIGATION OF AUTOMATIC TRANSMISSION FLUID (ATF) IN AN AIR COOLED MINICHANNEL HEAT EXCHANGER

Narrow-channels have been subjected to diversified research and application interests due to miniaturized geometry and lightweight, superior heat transfer characteristics, and better energy efficiency. Automatic Transmission Fluid (ATF) cooling is one of the most important challenges in the automotive industry due to its changing thermo-physical properties as a result of temperature and frictional environment which exist, inside the transmission. In this study, efforts have been accumulated to justify the suitability of Minichannel Heat Exchanger (MICHX) application in characterizing ATF cooling and its flow behaviours. An experimental investigation has been conducted with the aid of a well-equipped closed loop thermal wind tunnel, which uses a wavy finned MICHX as the test specimen. During the experiment, ATF mass flow rates were varied to achieve Reynolds Number of 3 í▄ ReL í▄ 30. The effects of serpentines on ATF heat transfer and flow behaviours were investigated in a laminar flow regime. Heat transfer enhancement was observed due to the serpentine structure. The effects of dimensionless parameters; such as Reynolds number, Nusselt number, Prandtl number, Brinkman number, and Ekert number on heat and mass transfer characteristics were examined. Heat and mass transfer correlations were established while considering variable property ratio. The investigation showed promising heat transfer characteristics and good agreement in flow-field with the established phenomena of MICHX

Low Leakage and Robust Sub-threshold SRAM Cell using Memristor

This work aims to improve the total power dissipation, leakage currents and stability without disturbing the logic state of SRAM cell with concept called sub-threshold operation. Though, sub-threshold SRAM proves to be advantageous but fails with basic 6T SRAM cell during readability and writability. In this paper we have investigated a non-volatile 6T2M (6 Transistors & 2 Memristors) sub-threshold SRAM cell working at lower supply voltage of VDD=0.3V, where Memristor is used to store the information even at power failures and restores previous data with successful read and write operation overcomes the challenge faced. This paper also proposes a new configuration of non-volatile 6T2M (6 Transistors & 2 Memristors) sub-threshold SRAM cell resulting in improved behaviour in terms of power, stability and leakage current where read and write power has improved by 40% and 90% respectively when compared to 6T2M (conventional) SRAM cell. The proposed 6T2M SRAM cell offers good stability of RSNM=65mV and WSNM=93mV which is much improved at low voltage when compared to conventional basic 6T SRAM cell, and improved leakage current of 4.92nA is achieved as compared

Low Power Non-Volatile 7T1M Subthreshold SRAM Cell

A new modified 7T1M non-volatile SRAM cell is presented in this paper for low power applications at subthresholdvoltage (very low voltage) simply by connecting the memristor directly with storage node which is acting as storage elementand adding a transistor in between the two storage nodes with feedback connection gives better performance in terms ofaverage delay, read /write operations and RSNM/WSNM. The memristor based circuits are simulated at subthreshold is anew insight and a new effort in technology made with improvement of approximately 61% and 23% of RSNM and WSNMrespectively compared to existing memory cell 7T1M and power dissipation is decreased by 66% whereas read delay andwrite delay obtained is nominal. Moreover, It has also simulated an adjusting 6T2M and conventional 6T at subthresholdvoltage i.e. VDD=0.3V to compare its stability behaviour at lower supply voltage

Understanding the hydrogeochemical evolution of groundwater in coastal aquifers of southwest Bangladesh

Groundwater development in coastal aquifers of southwest Bangladesh is challenged by both natural and anthropogenic activities resulting in a landward migration of marine waters and increase in the risk of seawater intrusion. In some cases, infiltration of dissolved evaporite salts in the shallow aquifer and presence of connate water in the deep aquifer (DA) are the sources of groundwater salinity other than modern seawater intrusion. A detail investigation of these sources is imperative for a sustainable development and management of coastal aquifers. This work investigates the hydrogeochemical processes affecting groundwater chemistry by interpreting conventional plots, ionic delta, HFE-diagram, stable isotopes, and geochemical modelling. There are three hydrogeological units delineated in this area: upper shallow aquifer (USA) (<100 m bgl), lower shallow aquifer (LSA) (100-200 m bgl) and DA (below 200 m bgl). The hydrochemistry data reveal that the median values of total dissolved solids of the aquifers have a decreasing trend from top to bottom: USA with 7012 mg/l, LSA with 2622 mg/l and DA with 787 mg/l. Sodium is the dominant cation in all waters. The dominant anion in DA is HCO3 - , but in shallow aquifers Cl- . The main water type based on the classification of Stuyfzand (1989) is the brackish to saline NaCl type in the shallow aquifers. The Br- /Clratio and relatively enriched δ18O values in these NaCl waters suggest an origin derived from evaporate dissolution. Reverse cation exchange during intrusion, replacing Na+ with Ca2+, results in CaCl and CaMix water types. These waters infiltrate into the LSA. The water in the DA is mainly fresh NaHCO3+ type which originated by cation exchange from infiltrating fresh water. Ca2+ was replaced by Na+ due to the cation exchange, the water became undersaturated with respect to calcite and secondary calcite dissolution caused elevated bicarbonate concentrations. Near the present-day shoreline and at larger depths, the NaHCO3+ type water mixes with connate water, increasing salinity. The enriched δ18O values in the DA suggest an origin in a warmer climate, implying that this water has infiltrated a long time ago, much farther inland, probably during the Holocene climatic optimum. It can be expected that the salinization of the shallow aquifers will continue to increase if evaporite deposition and seasonal flooding occur. For a sustainable use of the groundwater resource in this coastal region and to prevent from even further worsening of water quality in its shallow aquifers, it is advised to develop future exploitations in the DA

Therapeutic performances of some selected aqua drugs

This study was carried out at the Disease Laboratory of the Faculty of Fisheries, Bangladesh Agricultural University, Mymensingh, Bangladesh to verify the therapeutic performances of six commercial aqua drugs; three doses were selected as less than recommended, recommended and more than recommended to assess their performances. Before starting therapeutic experimental nine climbing perch (Anabas testudineus) and six stinging catfish (Heteropneustes fossilis) were confirmed as diseased ones by their clinical signs. The backswimmers (Notonecta glauca) were collected from faculty of fisheries pond and fish louses (Argulus sp.) were collected from tilapia fishes. Effective doses and their performances were determined on the basis of desired water quality change and clinical signs. It was found that all the drugs performed better at more than recommended doses as follows Aqua Ox performed better at the rate of 0.2 mg/l, GR Plus, 0.0005 ml/l, ID Plus (5%), 0.00026 ml/l; Active Blue, 0.0002 ml/l; Hashpoka Killer, 0.0001 ml/l; and Para Control, 0.001 ml/l. So these doses were suggested as recommended doses

Therapeutic performances of some selected aqua drugs

This study was carried out at the Disease Laboratory of the Faculty of Fisheries, Bangladesh Agricultural University, Mymensingh, Bangladesh to verify the therapeutic performances of six commercial aqua drugs; three doses were selected as less than recommended, recommended and more than recommended to assess their performances. Before starting therapeutic experimental nine climbing perch (Anabas testudineus) and six stinging catfish (Heteropneustes fossilis) were confirmed as diseased ones by their clinical signs. The backswimmers (Notonecta glauca) were collected from faculty of fisheries pond and fish louses (Argulus sp.) were collected from tilapia fishes. Effective doses and their performances were determined on the basis of desired water quality change and clinical signs. It was found that all the drugs performed better at more than recommended doses as follows Aqua Ox performed better at the rate of 0.2 mg/l, GR Plus, 0.0005 ml/l, ID Plus (5%), 0.00026 ml/l; Active Blue, 0.0002 ml/l; Hashpoka Killer, 0.0001 ml/l; and Para Control, 0.001 ml/l. So these doses were suggested as recommended doses

Performance of a validated spontaneous preterm delivery predictor in South Asian and Sub-Saharan African women: a nested case control study.

OBJECTIVES: To address the disproportionate burden of preterm birth (PTB) in low- and middle-income countries, this study aimed to (1) verify the performance of the United States-validated spontaneous PTB (sPTB) predictor, comprised of the IBP4/SHBG protein ratio, in subjects from Bangladesh, Pakistan and Tanzania enrolled in the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, and (2) discover biomarkers that improve performance of IBP4/SHBG in the AMANHI cohort. STUDY DESIGN: The performance of the IBP4/SHBG biomarker was first evaluated in a nested case control validation study, then utilized in a follow-on discovery study performed on the same samples. Levels of serum proteins were measured by targeted mass spectrometry. Differences between the AMANHI and U.S. cohorts were adjusted using body mass index (BMI) and gestational age (GA) at blood draw as covariates. Prediction of sPTB < 37 weeks and < 34 weeks was assessed by area under the receiver operator curve (AUC). In the discovery phase, an artificial intelligence method selected additional protein biomarkers complementary to IBP4/SHBG in the AMANHI cohort. RESULTS: The IBP4/SHBG biomarker significantly predicted sPTB < 37 weeks (n = 88 vs. 171 terms ≥ 37 weeks) after adjusting for BMI and GA at blood draw (AUC= 0.64, 95% CI: 0.57-0.71, p < .001). Performance was similar for sPTB < 34 weeks (n = 17 vs. 184 ≥ 34 weeks): AUC = 0.66, 95% CI: 0.51-0.82, p = .012. The discovery phase of the study showed that the addition of endoglin, prolactin, and tetranectin to the above model resulted in the prediction of sPTB < 37 with an AUC= 0.72 (95% CI: 0.66-0.79, p-value < .001) and prediction of sPTB < 34 with an AUC of 0.78 (95% CI: 0.67-0.90, p < .001). CONCLUSION: A protein biomarker pair developed in the U.S. may have broader application in diverse non-U.S. populations

Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention.

BackgroundBangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.MethodsUsing data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.ResultsUsing project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.ConclusionThis theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births