“It’s not easy to acknowledge that I’m ill”: a qualitative investigation into the health seeking behavior of rural Palestinian women

Background: This qualitative study sets to fill a gap in knowledge by exploring the health seeking behaviour of rural women living in the occupied Palestinian territories (oPt). The existing literature on the oPt has so far focused on unravelling the country’s epidemiological and health system profile, but has largely neglected the assessment of factors shaping people’s decisions on health care use. Methods: Based on a conceptual framework rooted in the Anderson behavioural model, we conducted 30 semi-structured interviews with purposely selected women and seven key informant interviews in three purposely selected villages in Ramallah district. Results: Our findings indicate that women delay seeking professional care, use self-prescribed medications and home treatment, and do not use preventive and educational health services. Their health seeking behaviour is the result of the interplay of several factors: their gendered socio-cultural role; their health beliefs; financial affordability and geographical accessibility; their perceptions of the quality of care; and their perceived health needs. Conclusions: Findings are discussed in the light of their policy implications, suggesting that adequate health policy planning ought to take into considerations socio-cultural dimensions beyond those directly pertinent to the health care system

Eff ect of cellulosic matter and container size on cultivation and yield of oyster mushroom Pleurotus ostreatus

When cultivation the oyster mushrooms, we must put ability use locally low-cost wastes in this agricultureviz. houses and shops wastes. The ability of paper wastes (cardboard) and wheat straw were estimated in theoyster mushroom Pleurotus ostreatus production in plastic bottles of different volumes from wastes of housesin Hit city compare as using polyethylene bags. The results showed that the best significant (P < 0.05) cropreached to 143.8 g on bags that capacity 1.5 kg of wheat straw, followed by a rate 64.8 g on the same substratein 0.55 kg plastic bottles. The larger number of flushes was 2.2 flushes/bag for the wheat straw in a bottle(0.55 kg), followed 2.0 flushes/bag by the cardboard in a bag of capacity 1.5 kg. Higher significant (P < 0.05)weight of the body was 120.4 g when grown in a bag 1.5 kg of wheat straw. The cardboard was showed thebiological efficiency 32.5% compared with the wheat straw (control) 25.7% while the higher biological efficiencywas 60.7% followed 45.9% for the wheat straw on bags that capacity 0.5 kg and bottle 0.1 kg, respectively

Oligorotaxane radicals under orders

A strategy for creating foldameric oligorotaxanes composed of only positively charged components is reported. Threadlike components-namely oligoviologens-in which different numbers of 4,4'-bipyridinium (BIPY(2+)) subunits are linked by p-xylylene bridges, are shown to be capable of being threaded by cyclobis(paraquat-p-phenylene) (CBPQT(4+)) rings following the introduction of radical-pairing interactions under reducing conditions. UV/vis/NIR spectroscopic and electrochemical investigations suggest that the reduced oligopseudorotaxanes fold into highly ordered secondary structures as a result of the formation of BIPY(\u2022+) radical cation pairs. Furthermore, by installing bulky stoppers at each end of the oligopseudorotaxanes by means of Cu-free alkyne-azide cycloadditions, their analogous oligorotaxanes, which retain the same stoichiometries as their progenitors, can be prepared. Solution-state studies of the oligorotaxanes indicate that their mechanically interlocked structures lead to the enforced interactions between the dumbbell and ring components, allowing them to fold (contract) in their reduced states and unfold (expand) in their fully oxidized states as a result of Coulombic repulsions. This electrochemically controlled reversible folding and unfolding process, during which the oligorotaxanes experience length contractions and expansions, is reminiscent of the mechanisms of actuation associated with muscle fibers

The effect of cross-contamination in the sequential interfacial polymerization on the RO performance of polyamide bilayer membranes

International audienceIn this study, hexafluoroalcohol-containing polyamide layer (HFAPA) was prepared on top of a conventional polyamide under-layer (REFPA) via sequential interfacial polymerization (SIP) to improve RO separation behavior, and the performance of the resulting bilayer membrane was thoroughly optimized by investigating the effect of cross-contamination in the SIP process. When several coupons of the polyamide bilayer membrane were prepared by SIP of MPD(aq), TMC(hx) and hexafluoroalcohol-containing diamine (HFAMDA)(aq) in the manner of subsequent membrane dipping, unreacted MPD monomer (mostly captured in the porous PSF support) carried over from the 1st interfacial reaction dissolved and accumulated in the 2nd aqueous solution as verified by UV spectroscopic analysis. The MPD contaminant then participated in the 2nd interfacial reaction, forming copolyamide with HFAMDA monomer onto the REFPA. Depending on the amount of MPD contaminant accumulated in the 2nd aqueous solution, the composition of the resulting co-polyamide in the top-layer varied, causing a significant variation of RO performance; the flux was gradually decreased with the increase of MPD contaminants while the salt rejection slightly increased (from 1st coupon toward 4th coupon). This result indicated that a trace amount of MPD contaminant may be necessary to maximize RO separation behavior. Through in-depth performance evaluation of polyamide bilayer membranes prepared by adding various known-amount of MPD into 2nd HFAMDA solution, and also by applying a frame process (2nd amine solution was applied only top surface of membrane) to eliminate uncontrollable MPD contamination, we have successfully demonstrated consistent RO performance, and identified an optimum material composition to provide superior separation performance. The bilayer membrane prepared by adding 1.2 mol% of MPD to the total amount of HFAMDA in the 2nd aqueous solution showed 99.8% NaCl rejection with the water flux of 45 LMH under the cross-flow filtration performed with 2000 ppm NaCl solution at 400 psi, 25 °C

Coinfections in patients hospitalized with COVID-19: a descriptive study from the United Arab Emirates

Purpose: Microbial coinfections in COVID-19 patients carry a risk of poor outcomes. This study aimed to characterize the clinical and microbiological profiles of coinfections in patients with COVID-19. Methods: A retrospective review of the clinical and laboratory records of COVID-19 patients with laboratory-confirmed infections with bacteria, fungi, and viruses was conducted. Only adult COVID-19 patients hospitalized at participating health-care facilities between February 1 and July 31, 2020 were included. Data were collected from the centralized electronic system of Dubai Health Authority hospitals and Sheikh Khalifa General Hospital Umm Al Quwain. Results: Of 29,802 patients hospitalized with COVID-19, 392 (1.3%) had laboratory-confirmed coinfections. The mean age of patients with coinfections was 49.3± 12.5 years, and a majority were male (n=330 of 392, 84.2%). Mean interval to commencement of empirical antibiotics was 1.2± 3.6) days postadmission, with ceftriaxone, azithromycin, and piperacillin–tazobactam the most commonly used. Median interval between admission and first positive culture (mostly from blood, endotracheal aspirates, and urine specimens) was 15 (IQR 8– 25) days. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli were predominant in first positive cultures, with increased occurrence of Stenotrophomonas maltophilia, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Candida auris, and Candida parapsilosis in subsequent cultures. The top three Gram-positive organisms were Staphylococcus epidermidis, Enterococcus faecalis, and Staphylococcus aureus. There was variability in levels of sensitivity to antibiotics and isolates harboring mecA, ESBL, AmpC, and carbapenemase-resistance genes were prevalent. A total of 130 (33.2%) patients died, predominantly those in the intensive-care unit undergoing mechanical ventilation or extracorporeal membrane oxygenation. Conclusion: Despite the low occurrence of coinfections among patients with COVID-19 in our setting, clinical outcomes remained poor. Predominance of Gram-negative pathogens, emergence of Candida species, and prevalence of isolates harboring drug-resistance genes are of concern

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Hardware Development and Interoperability Testing of a Multivendor-IEC-61850-Based Digital Substation

Substations are becoming increasingly reliant on international electrotechnical commission (IEC)-61850-enabled devices. However, device compatibility with these standards does not guarantee interoperability when devices are taken from different manufacturers. If interoperability of multivendor devices can be achieved, then power utilities will be in a position to implement multivendor devices in substations. The study here presents the development and testing of a digital substation test platform that incorporates devices from different manufacturers. The process bus communication and protection operation of the intelligent electronic devices (IEDs) were tested to validate device interoperability. The testbed was tested for two IED process bus communications, generic object-oriented substation event (GOOSE) and sampled measured value (SMV). The GOOSE is travelling between IED to IED with an end-to-end (ETE) delay of 2 ms and the SMV read by the IEDs are the same as the injected real-time substation inputs 220 kV and 1 kA. Three IED protection studies (overcurrent, earth fault, and overvoltage) were performed, and IED response curves were obtained. In addition, data monitoring and client&ndash;server communications were studied using installed software tools. The testbed configuration in this study has faced some real-time challenges regarding differences in device edition, device firmware, and ethernet switch due to its multivendor approach. All the mentioned configuration issues were resolved in this study with successful testing and validation of the testbed. The study of this testbed will provide solutions to the problems associated with a multivendor system faced by substation engineers and will help them in opting for multivendor installations. This system can be extended in the future by installing more multivendor devices with complex network topology and a SCADA system

Application of Fractional Order-PID Control Scheme in Automatic Generation Control of a Deregulated Power System in the Presence of SMES Unit

A fractional order PID (FOPID) control technique for automatic generation control (AGC) in a multi-area power system is presented in this study. To create a reliable controller, a variety of control strategies were used. The load frequency control (LFC) problem in a power system implementing different power transactions, such as bilateral and Poolco transactions, are investigated here. Because any control scheme&rsquo;s performance is only as good as its parameters, the parameters of the designed control scheme were determined using the big bang big crunch (BBBC) algorithm. Furthermore, in this work, the effect of a superconductive magnetic energy storage (SMES) unit is addressed in the given test (two and four area) systems. When confronted with a fluctuation in immediate load, the SMES unit is thought to follow the initial drop in frequency and tie-line power in order to increase LFC. It is evident that the performance of an FOPID control scheme is improved in the presence of an SMES unit and it provides frequency, tie-line power, change in generation with reduced oscillations and settling time

Hardware Development and Interoperability Testing of a Multivendor-IEC-61850-Based Digital Substation

Substations are becoming increasingly reliant on international electrotechnical commission (IEC)-61850-enabled devices. However, device compatibility with these standards does not guarantee interoperability when devices are taken from different manufacturers. If interoperability of multivendor devices can be achieved, then power utilities will be in a position to implement multivendor devices in substations. The study here presents the development and testing of a digital substation test platform that incorporates devices from different manufacturers. The process bus communication and protection operation of the intelligent electronic devices (IEDs) were tested to validate device interoperability. The testbed was tested for two IED process bus communications, generic object-oriented substation event (GOOSE) and sampled measured value (SMV). The GOOSE is travelling between IED to IED with an end-to-end (ETE) delay of 2 ms and the SMV read by the IEDs are the same as the injected real-time substation inputs 220 kV and 1 kA. Three IED protection studies (overcurrent, earth fault, and overvoltage) were performed, and IED response curves were obtained. In addition, data monitoring and client–server communications were studied using installed software tools. The testbed configuration in this study has faced some real-time challenges regarding differences in device edition, device firmware, and ethernet switch due to its multivendor approach. All the mentioned configuration issues were resolved in this study with successful testing and validation of the testbed. The study of this testbed will provide solutions to the problems associated with a multivendor system faced by substation engineers and will help them in opting for multivendor installations. This system can be extended in the future by installing more multivendor devices with complex network topology and a SCADA system