Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence:A qualitative study in Sri Lanka

BACKGROUND: Domestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV. METHOD: This qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis. RESULTS: Survivor related barriers to help seeking included women’s lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure. CONCLUSIONS: Barriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women’s access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13116-w

Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka

BACKGROUND: Toxicology and Emergency medicine textbooks recommend measurement of acetylcholinesterase (AChE) in all symptomatic cases of organophosphorus (OP) poisoning but laboratory facilities are limited in rural Asia. The accuracy of point-of-care (POC) acetylcholinesterase testing has been demonstrated but it remains to be shown whether results would be valued by clinicians. This study aims to assess the effect of seeing AChE POC test results on the knowledge, attitudes and practices of doctors who frequently manage OP poisoning. METHODS: We surveyed 23 clinicians, who had different levels of exposure to seeing AChE levels in OP poisoned patients, on a) knowledge of OP poisoning and biomarker interpretation, b) attitudes towards AChE in guiding poison management, oxime therapy and discharge decisions, and c) practices of ordering AChE in poisoning scenarios. RESULTS: An overall high proportion of doctors valued the test (68-89%). However, we paradoxically found that doctors who were more experienced in seeing AChE results valued the test less. Lower proportions valued the test in guidance of acute poisoning management (50%, p = 0.015) and guidance of oxime therapy (25%, p = 0.008), and it was apparent it would not generally be used to facilitate early discharge. The highest proportion of respondents valued it on admission (p < 0.001). A lack of correlation of test results with the clinical picture, and a perception that the test was a waste of money when compared to clinical observation alone were also comments raised by some of the respondents. Greater experience with seeing AChE test results was associated with increased knowledge (p = 0.034). However, a disproportionate lack of knowledge on interpretation of biomarkers and the pharmacology of oxime therapy (12-50%) was noted, when compared with knowledge on the mechanism of OP poisoning and management (78-90%). CONCLUSIONS: Our findings suggest an AChE POC test may not be valued by rural doctors. The practical use of AChE in OP poisoning management is complex, and a poor understanding of how to interpret test results may have affected its perceived utility. Future research should evaluate the impact of providing both AChE and training in interpretation on clinicians’ attitudes and practice.This research was funded by an international collaborative research grant from the Wellcome Trust/National Health and Medical Research Council, Australia (GR071669)

Nanobeam mechanics: theory and experimental comparison

Various experimental techniques have been used to determine the mechanical properties at the nanoscale, namely, bending tests, nanoindentation tests, resonant excitation tests, etc. [1-3]. Bending of nanowires using an atomic force microscope (AFM) is one of the most popular testing techniques for nanomaterial characterization. Wong et al. [1] performed AFM bending tests to directly measure the force-displacement relation and determined the mechanical properties of cantilever SiC beams by using conventional beam theory. Jing et al. [3] determined the elastic modulus of silver nanowires with diameters ranging from 20 to 140 nm by performing three-point bending tests on suspended nanowires. They found that the apparent Young’s modulus of silver nanowires increased significantly with decreasing wire diameter. Nanobeams are also key components of nanomechanical and nanoelectromechanical systems (NEMS) which are essentially sensors, actuators, machines and electronics at the nanoscale [4]. These devices can be used to measure extremely small displacements and forces that can lead to novel applications in engineering, advanced materials, medicine, computers, communications, etc. Current material processing technology allows for fabrication of NEMS of a few nanometers. The static and dynamic behavior of nanobeams is the principal feature that is exploited in the functional design of NEMS. Beams encountered in microelectromechanical systems (MEMS) are normally analyzed using the classical beam theory as classical theories are applicable at the microscale. However, it has been reported that at the nanoscale the response of beams is size-dependent and the conventional beam theory need to be modified [1-3]. To understand and predict the behavior of nanoscale structures, various modeling approaches have been proposed including atomistic simulation methods. The reason for the size-dependent behaviour at nanoscale is that the fraction of energy stored in surfaces becomes comparable with that in bulk due to the relatively high ratio of surface area to volume of nanoscale structures. Excess energy associated with surface/interface atoms is called surface/interfacial free energy. The ratio of surface free energy g ( J /m2) and Young’s modulus E ( J/m3), g /E, is dimensional (m ) and points to some other inherent parameter of a material [5]. This intrinsic length scale is usually small, in the nanometer range or even smaller. When a material element has one characteristic length comparable to the intrinsic scale, the surface/interface free energy can play an important role in its properties and behaviour. A direct method for analysis of nanoscale structures is to apply atomistic simulations but prohibitive computing cost makes it impractical. This study is motivated by the need to develop a suitable mathematical model to understand the complex size-dependent behavior of nanobeams observed in experiments [1-3, 6, 7] and the need for a simple simulation tool to analyze beams in NEMS and other nanoscale devices. The classical beam theory widely used to analyze nanobeams does not account for important effects at the nanoscale such as surface energy. Gurtin and Murdoch [8, 9] presented a mathematical model that incorporates the effects of surface and interfacial energy into continuum mechanics. A mechanistic model based on the Gurtin-Murdoch theory is first presented to analyze thin and thick nanoscale beams with an arbitrary cross-section. The main contribution of the first part of this study are a set of analytical solutions for static response of thin and thick beams under different loading (point and uniformly distributed loading) and boundary conditions (simply-supported, cantilevered and both ends fixed), and the solution of free vibration characteristics of such beams. Complete details of the analytical solution including the formulation of a new beam theory are given elsewhere [10] and its finite element formulation can be found in Ref. [11]. In the second part of this XXI International Conference on Sustainable Built Environments (ICSBE-2010) Kandy, 13-14 December 2010 study, a model for large deflections of thin beams is developed based on the Gurtin-Murdoch continuum theory and applied to examine the experimental results of Nilsson et al [7] and the classical large deflection beam model used by Søndergaard et al. [12]. The formulation of nonlinear beam theory and solution algorithm is discussed. It is shown for the first time that good agreement with experiments can be obtained by using size-independent mechanical properties such as the bulk elastic modulus and surface residual stress. The model is then applied to show the influence of end boundary conditions and surface residual stress and resulting softening/stiffening effects. The present study shows that solutions obtained from the classical beam theory require careful interpretation when applied to nanobeams and generalization of nanomaterial behavior on the basis of classical beam models could lead to questionable conclusions

The Effectiveness of a 'Train the Trainer' Model of Resuscitation Education for Rural Peripheral Hospital Doctors in Sri Lanka

BACKGROUND Sri Lankan rural doctors based in isolated peripheral hospitals routinely resuscitate critically ill patients but have difficulty accessing training. We tested a train-the-trainer model that could be utilised in isolated rural hospitals. METHODS Eight selected rural hospital non-specialist doctors attended a 2-day instructor course. These "trained trainers" educated their colleagues in advanced cardiac life support at peripheral hospital workshops and we tested their students in resuscitation knowledge and skills pre and post training, and at 6- and 12-weeks. Knowledge was assessed through 30 multiple choice questions (MCQ), and resuscitation skills were assessed by performance in a video recorded simulated scenario of a cardiac arrest using a Resuci Anne Skill Trainer mannequin. RESULTS/DISCUSSION/CONCLUSION Fifty seven doctors were trained. Pre and post training assessment was possible in 51 participants, and 6-week and 12-week follow up was possible for 43, and 38 participants respectively. Mean MCQ scores significantly improved over time (p<0.001), and a significant improvement was noted in "average ventilation volume", "compression count", and "compressions with no error", "adequate depth", "average depth", and "compression rate" (p<0.01). The proportion of participants with compression depth ≥40mm increased post intervention (p<0.05) and at 12-week follow up (p<0.05), and proportion of ventilation volumes between 400-1000mls increased post intervention (p<0.001). A significant increase in the proportion of participants who "checked for responsiveness", "opened the airway", "performed a breathing check", who used the "correct compression ratio", and who used an "appropriate facemask technique" was also noted (p<0.001). A train-the-trainer model of resuscitation education was effective in improving resuscitation knowledge and skills in Sri Lankan rural peripheral hospital doctors. Improvement was sustained to 12 weeks for most components of resuscitation knowledge and skills. Further research is needed to identify which components of training are most effective in leading to sustained improvement in resuscitation.This research was funded by an international collaborative research Wellcome Trust/National Health and Medical Research Council grant GR071669. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Targeting cell surface GRP78 for the treatment of mucormycosis:potential and promising therapeutic approach

Endoplasmic reticulum transmembrane signal transducers generate glucose-regulated protein (GRP78) in response to ER stress. Evidence suggests that the endothelial and epithelial cell surface 78 kDa, GRP78 is necessary for the pathogenesis of some infections. Several anti-GRP78 drugs have been identified and evaluated as potential antiviral therapies. Thus, the suppression of GRP78 is likely to result in multiple promising outcomes in infection management. Mucormycosis is a severe and invasive infection caused by fungi belonging to the order Mucorales. These fungi employ GRP78 receptors on the surfaces of endothelial and epithelial cells to facilitate host cell invasion. The spore coat protein homologous (CotH) cell surface antigens, CotH3 of Mucorales in particular, plays a crucial role in the attachment of fungi to the host cell GRP78. This review article aimed to evaluate the available evidence on the therapeutic potential of targeting GRP78 in the management of mucormycosis. Based on data from in-silico, in-vitro, and animal studies that strongly support the use of csGRP78-targeted inhibitors in anticancer therapies, targeting csGRP78 with GRP78 inhibitors would be a promising strategy for the effective management of mucormycosis.<br/

Socioeconomic and geographic correlates of intimate partner violence in Sri Lanka: Analysis of the 2016 Demographic and Health Survey

Intimate partner violence (IPV) is a serious public health issue and violation of human rights. The prevalence of IPV in South Asia is especially pronounced. We examined the associations between socioeconomic position (SEP), geographical factors and IPV in Sri Lanka using nationally representative data. Data collected from Sri Lanka’s 2016 Demographic and Health Survey were analysed using multilevel logistic regression techniques. A total of 16,390 eligible ever-partnered women aged 15-49 years were included in the analysis. Analyses were also stratified by ethnicity, type of violence, neighbourhood poverty and post-conflict residential status for selected variables. No schooling/primary educational attainment among women (OR 2.46 95% CI 1.83-3.30) and their partners (OR 2.87 95% CI 2.06-4.00), financial insecurity (OR 2.17 95% CI 1.92-2.45) and poor household wealth (OR 2.64 95% CI 2.22-3.13) were the socioeconomic factors that showed the strongest association with any IPV, after adjusting for age and religion. These associations predominately related to physical and/or sexual violence, with weak associations for psychological violence. Women living in a post-conflict environment had a higher risk (OR 2.96 95% CI 2.51-3.49) of IPV compared to other areas. Ethnic minority women (Tamil and Moor) were more likely to reside in post-conflict areas and experience poverty more acutely compared to the majority Sinhala women, which may explain the stronger associations for low SEP, post-conflict residence and IPV found among Tamil and Moor women. Policies and programs to alleviate poverty, as well as community mobilisation and school-based education programs addressing harmful gender norms may be beneficial. Trauma informed approaches are needed in post-conflict settings. Further exploratory studies investigating the complex interplay of individual, household and contextual factors occurring in this setting is required

Competitors’ stock price reactions in response to private equity placements: evidence from a transitional economy

This paper examines whether information conveyed by private equity placement decisions transfers to non-applying companies within the same industry. In particular, it investigates the impact of a company’s announcements of the application for, withdrawal, rejection, approval and completion of private equity placement, while examining the cross-sectional differences of the market performance of their industry counterparts, both in the short- and long-term. It was found that an intra-industry reaction exists; competitors experience a decrease in stock prices in response to the announcement of the application for, approval and completion of private equity placement and an increase in stock prices around the announcement of the withdrawal or rejection of applications. Further, it was found that competitors experience a decrease in their long-term stock performance following private placements. A higher discount on private equity placement is detrimental for private equity (P.E.) issuing companies in the long-term. This study, therefore, provides evidence of the existence of a contagion effect in the long-term while a competitive effect dominates in the short-term

Taxonomic Account of Strobilanthes sp. in Sri Lanka

Strobilanthes is the most species-rich genus coming under Family Acanthaceae which was first described by Blume (1826) from specimens collected in West Java. This is one of the largest and interesting genera in the flora of Sri Lanka. Strobilanthes is widely distributed over tropical South and South East Asia and individual species are restricted to isolated islands. While more than 300 Nelu plant species in which various colorful flowers bloom have spread in Asian countries, more than half of them have been confined to Indian sub-continent. Thirty one species have been reported in Sri Lanka and out of them 26 species are endemic. Shrubs of the genus Stroblilanthes dominate the montane forest understory in Sri Lanka. Species delimitation remains problematic, essentially because many species are poorly known and rarely collected, mainly because of their seasonal flowering pattern. Nevertheless, new species have been described in the past decade and it is possible that others still remain to be discovered. There are some more varieties under few of those species. Also further taxonomic reviews would be resulted with discovering of new species as well in future. In the current study specimens of 15 Strobilanthes species were collected from the different locations of the island for both preparation of herbarium samples and extraction of DNA. Distribution maps were prepared using Arcview GIS. Herbarium samples were prepared and deposited in the national herbarium, Peradeniya. Universally accepted regions of the genome was used for the barcoding study. DNA was extracted from the tissue samples, and the barcode portion of the rbcL, matK and trnH-psbA genes were amplified by PCR. The amplified bands were gel-purified and submitted for sequencing in both directions. The sequencing results for each fragment was used to search available DNA databases. Close matches were quickly identify species that are already present in searched databases. However, if it is a new barcode, not previously deposited in databases, a phylogenetic tree will be built with near relatives for identification of unknown species. Our results show that the DNA barcoding technology can effectively be used for discrimination of Nelu species in Sri Lanka. DNA barcoding together with morphological characterization can be used to resolve the phylogeny of the Genus Strobilanthes.Keywords: Strobilanthes sp., PCR, DNA barcoding, Herbariu