English Proficiency Assessments of Primary and Secondary Students Participating in English in Action: Third Cohort (2014) Large-Scale Quantitative Study

The purpose of the study was to assess the student learning outcomes of English in Action’s (EIA’s) school-based teacher development programme, in terms of improved English language competence (ELC), against recognised international frameworks (specifically, the Graded Examinations in Spoken English [GESE)]; Trinity College London 2013), which map onto the Common European Framework of Reference for Languages (CEFR). Measurably improved student learning outcomes are the ultimate test of success of a teacher development programme. English Proficiency Assessments 2014 is a repeat of the study on the pilot EIA programme (Cohort 14) (EIA 2012), but focusing only on student ELC. The teachers and hence the students of Cohort 3 are substantially greater in number than in the pilot phase (347,000 primary students and almost 1.7 million secondary students compared with around 700 teachers, 35,000 primary students and over 83,000 secondary students in 2011). To enable this increase in scale, the programme has been delivered through a more decentralised model, with much less direct contact with English language teaching (ELT) experts, a greater embedding of expertise within teacher development materials (especially video), and a greater dependence upon localised peer support. This report addresses the following research question: To what extent do the students of Cohort 3 show improved post-intervention EL proficiencies, in speaking and listening, compared with the Cohort 1 2010 preintervention baseline

Perceptions of English Language Learning and Teaching among Primary and Secondary Teachers and Students Participating in English in Action: Second Cohort (2013)

Executive summary a) Background The purpose of the Perceptions Study 2013 was to explore the perceptions of English language (EL) practices within schools participating in English in Action (EIA) from the point of view of both the teachers and the students. The first part of the study focused on primary and secondary teachers’: - Perceptions of their practices in teaching English; - Attitudes to the communicative language teaching (CLT) approaches being promoted through EIA; -Perceptions of their students’ responses to these approaches; - Opinions of the general usefulness of the EIA programme. The second part of the study explored primary and secondary students : - Current experience in English lessons in EIA intervention schools; - Perceptions and attitudes to EL and learning English. The Perceptions Study 2013 is a repeat of the study of the pilot EIA programme (Cohort 1), carried out in 2010. In addition to understanding the views of the current cohort (Cohort 2), one aim was to see the extent to which there are any changes from Cohort 1 to 2. This 2013 study is part of a set of three studies – including one on teachers’ classroom practice (EIA 2014a), and another on the EL competence of students and teachers (EIA 2014b). b) Research methodology The design of this study was a repeat of that of the previous study (2010) and looked to reveal the perceptions of students and teachers in EIA Cohort 2, enabling a comparison with the study carried out on Cohort 1 in 2010. The research question for the study was thus: - To what extent has the programme been successful in repeating the mid-intervention changes in perceptions of students and teachers seen in Cohort 1, at the much larger scale of Cohort 2? Fieldwork was carried out by researchers from the Institute of Education and Research (IER) at the University of Dhaka in September and October 2013, some 12 months after Cohort 2 teachers began participating in the EIA programme. It took place in a sample of EIA schools across six divisions in Bangladesh and used a multi-layer stratified sampling strategy. Teacher data were collected by a self-completion questionnaire: 269 primary teachers, 123 primary head teachers (HTs) and 143 secondary teachers participated in the study. Primary student data were collected by interview survey, while secondary student data were collected by self-completion questionnaire; a total of 376 primary students and 457 secondary students participated. As this study was carried out using questionnaires only, either self-completed and through interview, the comparison is with the quantitative element of the 2010 study only. c) Key findings: Teachers i) Primary teachers 99% of the primary teachers reported that taking part in EIA helped improve their own English (53% strongly agreed). 89% also felt that EIA has had an impact on their confidence to use more English, and 92% agreed it has had an impact on the way they teach. Primary teachers seemed to be fairly confident about their competence in English, with 87% agreeing that they felt comfortable modelling English for students to repeat. This is reflected in their classroom practice, where they used English three-quarters of the time they talked (EIA 2014a: 17). This links also with the fact that 70% of primary teachers agreed that they use mostly English in the classroom, i.e. their perceptions matched their practice; 80% agreed that it is essential that English teachers speak in English in the classroom for their students to learn English. Primary teachers had mixed opinions about the use of Bangla to support student learning: when asked whether Bangla should be used frequently in English classes for students’ better understanding, 43% felt that students preferred it when their teachers spoke Bangla most of the time; a slightly smaller proportion (38%) felt their students did not prefer it. Most primary teachers (87%) agreed that the focus in their English classes is communication, but that they explain grammar when necessary. 47% of primary teachers thought that grammar rules should be explicitly explained in class, and over half of the teachers (73%) agreed that students’ English improves most quickly if they study and practise grammar. 89% of primary teachers reported they often use activities where the students interact with each other in English. 81% agreed that students like these activities. 98% reported using more pair and group work as a result of EIA and 91% agreed that students play games or sing songs more often now. 99% of primary teachers reported that changes in teaching have improved student motivation, with 57 strongly agreeing. 82% reported that changes in teaching have had a positive impact on student learning. Primary teachers still retained some more traditional notions as being important to their practice, with 95% agreeing that drilling and repetition is common practice, while EIA approaches promote fluency and creativity in language use. 81% felt that error correction was important, while EIA approaches suggest that teachers pay less attention to errors, as this can inhibit students experimenting with language. 81% of primary teachers agreed that students like to interact in English with classmates. (This positive attitude was confirmed by data from the primary students.) In terms of a comparison with the Cohort 1 study in 2010 and the baseline (2009), this study of Cohort 2 confirmed that primary teachers supported the view that English is seen as an important language and that it is necessary to learn it for both jobs and study. For primary teachers, there was a slight increase in the perceived difficulty of English compared with the baseline study (2009). In terms of their reported practice and views in relation to a communicative approach, primary teachers supported it but were somewhat less supportive in 2013 than those in 2010 were. In addition, there was some increase in reported practice and views of traditional elements of English language teaching (ELT), including the role of grammar, error correction and drill and repetition. ii) Secondary teachers 96% of secondary teachers agreed that taking part in EIA helped them to improve their own English. 88% also felt that it has had an impact on their confidence to use more English, and 94% agreed that it has had an impact on the way they teach. Secondary teachers seemed to be fairly confident about their competence in English, with 87% agreeing that they feel comfortable modelling English for students to repeat. 80% of secondary teachers agreed that they use mostly English in the classroom (this finding is corroborated by direct observation [EIA 2014a]); 88% agreed that it is essential that English teachers speak in English in the classroom for their students to learn English. Secondary teachers had mixed opinions about the use of Bangla to support student learning: when asked whether Bangla should be used frequently in English classes for students’ better understanding, 57% disagreed while 27% agreed. About two fifths of secondary teachers felt that their students liked it when the teacher spoke Bangla most of the time (40%), but a similar proportion (38%) felt that their students do not prefer it. A large proportion of secondary teachers (89%) agreed that the focus in their English classes is on communication, but that they explain grammar when necessary. However, over half (58%) thought that grammar rules should be explicitly explained in class and 70% agreed that students’ English improves most quickly if they study and practise grammar. 88% of secondary teachers reported that they often use activities to have the students interact with each other in English. 74% agreed that students like these activities. 92% reported using more pair and group work, whilst 71% agreed that students now play games or sing songs more often than before EIA. 97% of secondary teachers reported that changes in teaching have improved student motivation, with 60% ‘strongly agreeing’. 79% reported that changes in teaching have had a positive impact on student learning. Secondary teachers still perceived some more traditional notions as being important to their practice, with 85% agreeing that drilling and repetition is common practice, in contrast to EIA approaches, which promote fluency and creativity in language use. 88% felt that error correction was important, while EIA approaches suggest teachers pay less attention to errors, as this can inhibit students experimenting with language use. 74% of secondary teachers agreed that students like to interact in English with classmates. In terms of a comparison with the Cohort 1 study in 2010 and the baseline (2009), this study of Cohort 2 confirmed that secondary teachers supported the view that English is seen as an important language and that it is necessary to learn it for both jobs and study. For secondary teachers, there was a slight decrease in the perceived difficulty of English compared with the baseline study (2009). In terms of their reported practice and views in relation to a communicative approach, secondary teachers supported it in 2013 much as they did in 2010. Although their reported practice and views of traditional elements of ELT (including the role of grammar, error correction and drill and repetition) still exist, they are much as they were in 2010. iii) Comparison of teacher perceptions: Primary and secondary - Almost all teachers (99% primary; 96% secondary) reported that taking part in EIA is helping improve their own English. - Most teachers (87% primary; 87% secondary) were comfortable in their competence to model English in the classroom. - Most teachers (70% primary; 80% secondary) reported mostly using English in the classroom. - Most teachers (87% primary; 89% secondary) said the focus of their lessons is on communication, with grammar being explained as required. - Most teachers (89% primary; 88% secondary) reported often using activities to have students interact in English, though singing and playing games are more popular classroom activities for primary teachers than for secondary. - Most teachers (99% primary; 97% secondary) reported improved student motivation as a result of changes to classroom practice. - Over half of secondary teachers (58%) thought grammar rules should be explained explicitly and over two-thirds (70%) thought that students’ English improves most quickly through grammar practice. Less than half of primary teachers (47%) thought that grammar rules should be explained explicitly, and similarly over two-thirds (70%) thought that students’ English improves most quickly through grammar practice. - Most teachers (95% primary; 85% secondary) reported they still commonly practise traditional techniques, such as drilling and repetition. d) Key findings: Students i) Primary students Over half of primary students (64%) reported that their English teachers used English most of the time in their lessons. 69% reported they liked it when their teacher spoke Bangla most of the time. The majority of the primary students reported regularly participating in classroom activities that are promoted in the EIA materials, such as talking in English with classmates, playing games and singing songs. Most primary students reported that these kinds of activities, promoted by EIA, are enjoyable (interacting in English: 79%; games: 95%; songs: 93%). Most also reported that more traditional activities were enjoyable, such as learning grammar rules (95%) and being corrected by the teacher (98%). Most primary students liked learning English (99%). Almost all said that they liked learning English because it is important for them (96%), even if just under a third felt it was difficult to learn (32%). There are no direct comparisons with Cohort 1 in terms of primary students’ views of their teachers’ practice and of their own learning of English, or with the 2009 baseline in terms of difficulty of learning English or its importance to them and to their future. ii) Secondary students About a third of secondary students reported that their English teachers used English most of the time in their lessons (36%). Also, 37% reported that they prefer their teacher speaking Bangla to speaking English, which is a lot lower than in the previous study (61%). Most (69%) said that they liked to speak English in their English lessons. Secondary students also reported participating in classroom activities that are promoted in the EIA materials, including speaking English with classmates (80%), but also playing and singing (though a lot less: 33%). Secondary students reported speaking English with classmates to be an enjoyable aspect of their English lessons (82%); a minority reported playing and singing as enjoyable (35%). Secondary students reported that some EIA teachers still carry out more traditional language learning activities in their English lessons, such as drilling, memorising grammar rules and correcting errors. Secondary students also reported they enjoyed these traditional practices: the large majority (89%) believed that repeating teachers’ sentences helps them learn English. 86% agreed that they liked learning grammar rules in English classes and two-thirds (69%) believed that learning English means learning grammar rules. The majority (95%) said that their English teachers should correct all errors and most liked it (93%). Most secondary students reported having a strong motivation to learn English. 94% agreed that learning English is important in their life; 92% felt that English will help them find a good job and improve their income (74%). Students had mixed feelings about whether English was difficult to learn – a third (33%) felt it was, while 44% felt it wasn’t. In terms of a comparison with the Cohort 1 study in 2010 and the baseline (2009), this study of Cohort 2 confirmed that secondary students supported the view that English is seen as an important language and that it is necessary to learn it for both jobs and study. For secondary students, there is no difference in the perceived difficulty of English compared with the baseline study (2009). In terms of their reporting of their teachers’ practice and their own views in relation to a communicative approach, secondary students show more support for some elements in 2013 - much as they did in 2010 - and less support for other elements. Although their reports of their teachers’ practice and their own views of traditional elements of ELT (including the role of grammar, error correction and drill and repetition) still exist, they are generally less strong than in 2010

Classroom Practices of Primary and Secondary Teachers Participating in English in Action: Second Cohort (2013)

Executive summary a) Background The purpose of this study was to ascertain whether there had been changes in the classroom practice of teachers and students participating in English in Action (EIA) over the period of the 2012–13 intervention (Cohort 2). Previous research in language teaching has established that when teachers take up most of the lesson time talking, this can severely limit students’ opportunities to develop proficiency in the target language (Cook 2008), while a general goal of English language (EL) teachers is to motivate their students to speak and to practise using the target language (Nunan 1991). This study therefore focused upon the extent of teacher and student talk, the use of the target language by both, and the forms of classroom organisation (individual, pair, group or choral work) in which student talk is situated. Of course, the amount of teacher talk is not the only indicator of quality language teaching; the nature of that talk is also important – for example, whether teachers engage the attention of the class, present them with new information in an understandable way and allow them time to ask questions and comment. Classroom Practice 2013 is a repeat of the studies on the pilot EIA programme (Cohort 1) (EIA 2011a & 2012a). The students and teachers of Cohort 2 are sixfold greater in number (4,368 teachers, compared to 751 teachers, in schools). To enable this increase in scale, the programme has been delivered through a more decentralised model, with much less direct contact with English language teaching (ELT) experts, a greater embedding of expertise within teacher development materials (especially video), and a greater dependence upon localised peer support. This study addresses two main questions: 1. To what extent do the teachers of Cohort 2 show improved classroom practice, particularly in relation to the amount and language of student talk, compared with the pre-intervention baseline? 2. To what extent has the programme been successful in repeating the post-intervention improvements in teachers’ classroom practice seen in Cohort 1, at the much larger scale of Cohort 2? b) Research methodology The EIA classroom practice baseline (EIA 2009a & b) was originally adapted from a general classroom observation study, and was geographically limited, due to an uncertain social and political context at the time of the fieldwork. Subsequently the methodology was revised to give more fine-grained data about student and teacher talk, use of the target language, and forms of classroom organisation, and was implemented on a representative sample of EIA teachers, four months after the launch of the pilot programme (EIA 2011a) and again 12–16 months after the programme start (EIA 2012a). The research instrument is a timed observation schedule (see Appendix 1), directly comparable to that used in the earlier studies on the EIA pilot intervention (2010 and 2011). The sample comprised 401 lesson observations – 230 of primary teachers, 145 of secondary teachers, and 26 of primary head teachers. For this study, the practices observed were compared directly (statistically) with the earlier pilot studies (EIA 2011a and 2012a), and indirectly with the earlier baseline (EIA 2009a & b). c) Key findings: Primary classrooms i) Teachers’ talk and activity In the observation of Cohort 2 lessons, average primary teacher talk had dropped to less than half of the lesson time (45%). This represents a very significant reduction in teacher talk from 2009 baseline practices, where teacher talk was the predominant classroom activity. Although this is a higher figure than was found in the 2010 early-intervention observations (34%), it had not caused any reciprocal drop in student talk-time (compared to that found in 2010). Teachers’ use of the target language was very much greater than that observed in the 2009 baseline, and slightly higher (76%) than that found in 2010 (71%) or 2011 (72%). In the observation of Cohort 2 lessons, there was a notable increase in time teachers spent organising and a decrease in time spent presenting when compared with the baseline and with the 2011 study. Primary teachers were using a wide range of activities in the classroom and involving students in these activities. Primary teachers were found to be organising for 32% of the time, presenting 25% of the time, asking questions 23% of the time, and giving feedback 20% of the time. This is a change from the baseline studies (EIA 2009a & b), where teachers were observed to be primarily reading from the textbook and rarely involving students in activities. Compared to 2011, primary teachers spent less talktime ‘asking questions’ (falling from 27% to 23%) and more time ‘organising’ classroom activity (rising to 32% from 22%), and much less time presenting (falling from 40% in 2011, to 25% in 2013). These observations suggest EIA Cohort 2 primary teachers were making great and sustained efforts to increase the use of the target language, and involve students more actively in their English lessons. ii) Students’ talk and activity In the observation of Cohort 2 lessons, average student talk-time accounted for 27% of the lesson. This figure represents a very different situation to the 2009 baseline, where in two-thirds of lessons observed ‘none or hardly any’ of the students spoke. The figure is identical to that found in the 2010 observations. Students’ use of the target language had also increased substantially over the baseline, to 91% of student talk in English. The proportion of primary students’ talk in English was higher than that observed in 2010 (88%) and 2011 (81%), with the difference between 2011 being statistically significant (p<0.05). Almost half (46%) of student talk was observed in the context of choral activities, while approximately a third (36%) was individual student talk. 18% of student talk was pair (10%) or group (8%) work, a figure midway between that observed in 2010 (30%) and 2011 (9%). In all forms of talk organisation, English was the main language used by students (86–91%). The fact that students were often engaged in activities in which they interacted with their classmates marks a notable change from the baseline studies (EIA 2009a & b), which identified few occasions when individual students or groups were encouraged to speak in English (2–4% of the lesson time) and which showed that in most classes students were not interactive at all. d) Key findings: Secondary classrooms i) Teachers’ talk and activity In the observation of Cohort 2 lessons, average secondary teacher talk had dropped to less than half of the lesson time (48%). This represents a very significant reduction in teacher talk from 2009 baseline practices, where teacher talk was the predominant classroom activity. Although this is a higher figure than was found in the 2010 early-intervention observations (33%), it is lower than 2011 (50%), and is not related to any reciprocal drop in student talk-time (compared to that found in 2010 or 2011). Teachers’ use of target language was much greater than that observed in the 2009 baseline, and slightly higher (87%) than that in 2010 (86%) or 2011 (79%). In the observation of Cohort 2 lessons, there was a notable increase in the time teachers spent organising and a decrease in the time spent presenting when compared with the baseline and the 2011 study. Secondary teachers were using a wide range of activities in the classroom and involving students in these activities. They were found to be organising 29% of the time, presenting 32% of the time, asking questions 22% of the time, and giving feedback 17% of the time. This is a change from the baseline studies (EIA 2009a & b), where teachers were observed to be primarily reading from the textbook and rarely involving students in activities. Compared to 2011, secondary teachers spent similar talk-time ‘asking questions’ (22% compared to 23%), more time organising classroom activity (rising from 22% to 29%), and much less time presenting (falling from 45% to 32%). These observations suggest EIA Cohort 2 secondary teachers were making great and sustained efforts to increase the use of the target language, and involve students more actively in their English lessons. ii) Students’ talk and activity In the observation of Cohort 2 lessons, average secondary student talk-time accounted for 24% of the lesson. This figure represents a very different situation to the 2009 baseline, where in two-thirds of lessons observed ‘none or hardly any’ of the students spoke. The figure is about the same as that found in the 2010 (23%) and 2011 (24%) observations. Students’ use of the target language had also increased substantially over the baseline, rising to 87% of student talk in English. The proportion of secondary students’ talk in English was similar to that observed in 2010 (88%) and 2011 (85%). Over half (53%) of student talk observed was individual talk, while 28% was pair (13%) or group (15%) work, a figure similar to that observed in 2011 (27%), but below that observed in 2010 (57%). In all forms of talk organisation, English was the main language used by students in all forms of classroom organisation (85–92% for individual, pair and choral work); though as might be expected, in group work English still predominated (64%), but students used Bangla more (36%) than they did in other forms of organisation. The fact that students were often engaged in activities in which they interacted with their classmates marks a notable change from the baseline studies (EIA 2009a & b), which identified few occasions when individual students or groups were encouraged to speak in English (2–4% of the lesson time) and showed that in most classes students were not interactive at all. e) Conclusions Despite a sixfold increase in scale for Cohort 2, and a more decentralised, peer-supported approach to teacher development, observations of Cohort 2 classroom practices show substantial and important changes compared with the baseline studies, which show teachers making great efforts to promote and model the target language, and to organise increased student participation in lessons. The observations show substantial increases in students’ active participation, with more opportunities to speak and practise the target language. These latest findings mark a notable increase in the time teachers spent organising and a decrease in the time spent presenting when compared with the baseline and with the 2011 study. The results show that both primary and secondary teachers were using a wide range of activities in the classroom and involving students in these activities. In summary, the 2013 cohort of teachers observed in the EIA programme were using more English in their classes, involving students in more activities and encouraging them to spend more of their class time speaking in English

Age-Related Differences of Risk Profile and Angiographic Findings in Patients with Coronary Heart Disease

Background: Coronary heart disease (CHD) is a major health problem which imposes a significant burden on health caresystems because of high morbidity and mortality. Objectives: To compare the risk factors profile for coronary heartdisease in young and old subjects. Methods: Total 100 patients (50 subjects less than 40 years of age and 50 subjectsmore than 40 years of age) with acute coronary syndrome or stable angina who were undergoing coronary angiogram inthe Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University Dhaka, fromJuly 2006 to June 2008 were evaluated for the presence coronary artery disease risk factors e.g. hypertension, dyslipidemiaand smoking. Results: The mean age of the study population in younger group was (33.0 &plusmn; 6.4) years and in older group(52.0&plusmn;8.6). The male to female ratio in both groups was 4:1. Smokers were more in younger group (70.0% vs. 46.0%) (p =0.032). Hypertension was less in the younger group (38.0% vs. 58.0%) (p = 0.045). Presence of diabetes was higher in theolder age group (34.0% vs. 4.0%) (p = 0.001). Higher incidence of family history of coronary heart disease was in theyounger age group. The total cholesterol was higher in older group (182.9 &plusmn; 33.1) vs. (171.1 &plusmn; 24.8 mg/dl) (p = 0.047). 68%of patients of older group and 38% of younger group had stenosis in left anterior descending artery (p = 0.003). Theinvolvement of left circumflex and right coronary artery in older age group were higher (56% and 66% respectively) thanthose in younger group (36% and 40% respectively) (p = 0.045 and p = 0.009). Conclusion: Ischemic heart disease inyounger adults &lt; 40 years had different risk profile characteristics than older patients.Key words: Coronary heart disease; acute coronary syndrome; stable angina; risk factors.DOI: 10.3329/bsmmuj.v3i1.5508BSMMU J 2010; 3(1): 13-1

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

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

Post-vaccination campaign coverage evaluation of oral cholera vaccine, oral polio vaccine and measles–rubella vaccine among Forcibly Displaced Myanmar Nationals in Bangladesh

Background: The new influx of Forcibly Displaced Myanmar Nationals (FDMNs) into Bangladesh started in August 2017 through different entry points of Bangladesh. Considering the imminent threat of infectious diseases outbreaks, the Government of Bangladesh (GoB) decided to vaccinate children against three deadly diseases (measles, rubella and poliomyelitis) and oral cholera vaccine (OCV) for all except <1 year children. After completion of the campaigns, post-vaccination campaign evaluation was carried out to assess the coverage of OCV, OPV and MR vaccines during campaigns. Methods: Post-vaccination campaign evaluation was conducted after completion of the 2nd dose of oral cholera vaccine (OCV2) and oral polio vaccine (OPV2) through a cross-sectional survey. The evaluation was conducted in the Balukhali camps under Ukhiya upazilla. Precision-based sample size was calculated to estimate the vaccine coverage. Ninety-two trained interviewers were involved to collect data from the target of approximately 40000 FDMNs between 18 and 25 November 2017. Results: Data were collected from 39,438 FDMNs during the survey period. The highest coverage was observed for OCVs (94% for OCV1 and 92% for OCV2). On the other hand, lower coverage was observed for the other vaccines; the coverage for OPV1, OPV2 and MR were 75%, 88% and 38%, respectively. Unawareness (30.7% did not know about the campaign) was the most notable cause of lowering down MR vaccine coverage. Conclusion: The experience in Bangladesh demonstrates that vaccine campaigns can be successfully implemented as part of a comprehensive response toward disease outbreak among high-risk populations in humanitarian crisis

Anticancer, Cardio-Protective and Anti-Inflammatory Potential of Natural-Sources-Derived Phenolic Acids

Phenolic acids (PAs) are one of the utmost prevalent classes of plant-derived bioactive chemicals. They have a specific taste and odor, and are found in numerous medicinal and food plants, such as Cynomorium coccineum L., Prunus domestica (L.), and Vitis vinifera L. Their biosynthesis, physical and chemical characteristics and structure&ndash;activity relationship are well understood. These phytochemicals and their derivatives exert several bioactivities including but not limited to anticancer, cardioprotective, anti-inflammatory, immune-regulatory and anti-obesity properties. They are strong antioxidants because of hydroxyl groups which play pivotal role in their anticancer, anti-inflammatory and cardioprotective potential. They may play significant role in improving human health owing to anticarcinogenic, anti-arthritis, antihypertensive, anti-stroke, and anti-atherosclerosis activities, as several PAs have demonstrated biological activities against these disease during in vitro and in vivo studies. These PAs exhibited anticancer action by promoting apoptosis, targeting angiogenesis, and reducing abnormal cell growth, while anti-inflammatory activity was attributed to reducing proinflammatory cytokines. Pas exhibited anti-atherosclerotic activity via inhibition of platelets. Moreover, they also reduced cardiovascular complications such as myocardial infarction and stroke by activating Paraoxonase 1. The present review focuses on the plant sources, structure activity relationship, anticancer, anti-inflammatory and cardioprotective actions of PAs that is attributed to modulation of oxidative stress and signal transduction pathways, along with highlighting their mechanism of actions in disease conditions. Further, preclinical and clinical studies must be carried out to evaluate the mechanism of action and drug targets of PAs to understand their therapeutic actions and disease therapy in humans, respectively