Effect of dietary supplementation of plantain herb, lemongrass and their combination on milk yield, immunity, liver enzymes, serum, and milk mineral status in dairy cows.

Objective: This research aimed to assess the effects of dried plantain herb, lemongrass, and their combination on milk yield, immunological, liver enzymatic, serum, and milk mineral status in dairy cows. Materials and Methods: Twenty cows were arbitrarily assigned to 4 diets. Cows were given a basal ration considered as control diet (CL-D) having 14.93% crude protein (CP)and 10.96 MJ ME per kg dry matter (DM). Each cow was given 100 gm plantain, 100 gm lemongrass, and 50 gm plantain + 50 gm lemongrass with CL-D and taken as plantain diet (PT-D), lemongrass diet (LG-D), and plantain-lemongrass diet (PL-D), daily for 63 days, respectively. Blood and milk samples were taken four times at an interval of 14 days. Data were analyzed using a two-way repeated measures analysis of covariance. Results: Better DM consumption and milk yield were observed in the PT-D and LG-D compared to the CL-D (p ≤ 0.05). LG-D improved the milk's total solids, protein, and fat compared to CL-D (p < 0.05). Substantially, herbal groups improved serum albumin and reduced globulin concentrations compared to CL-D. LG-D had the highest serum immunoglobulin G, while herbal groups effectively reduced the liver enzymes compared to CL-D. Herbal groups did not affect serum and milk's calcium and phosphorus concentrations, while LG-D and PL-D substantially improved serum and milk zinc concentrations. Conclusions: Both plantain and lemongrass improved dairy cows' DM consumption and milk yield. Plantain and/or lemongrass enhanced the immune system and liver health, but not serum and milk calcium and phosphorus level. Lemongrass and a combination of plantain and lemongrass increased the serum and milk zinc concentrations.

Health Literacy Among Non-Communicable Disease Service Seekers: A Nationwide Finding from Primary Health Care Settings of Bangladesh.

BACKGROUND: Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. OBJECTIVE: Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. METHODS: In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. KEY RESULTS: Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. CONCLUSIONS: NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12-e20.].

PLAIN LANGUAGE SUMMARY: This study is the first to address the knowledge gap regarding the state of NCD-related health literacy in Bangladesh. The findings of this study can be used by policymakers to create initiatives that will improve the health literacy of people seeking primary health care for NCDs.

In-situ confining selenium within bubble - like carbon nanoshells for ultra-stable Li-Se batteries.

Lithium-selenium (Li-Se) batteries are promising energy storage devices. However, the long-term durability and high-rate performance of the Se cathode have been limited by significant volume expansion and the troublesome shuttle effect of polyselenides during repeated charging/discharging processes. To revolutionize these issues, we applied a top-down strategy through the in-situ trapping of amorphous Se within bubble-like carbon (BLC) frameworks, which can radically minimize the presence of surface-absorbed Se while enhancing Se loading capacity. This ingenious technique successfully encapsulates all Se species within carbon nanoshells, creating a distinct half-filled core-shell structure known as Se@void@BLC. This in-situ trapping approach ensures the efficient management of Se volume changes during repeated discharge and charge cycles. Moreover, an extraordinary Se loading capacity of up to 65.6 wt% is reached. Using the Se@void@BLC as cathode for Li-Se battery, we achieve a high initial Columbic efficiency of 84.2 %, a high reversible capacity of 585 mAh g-1, and an ultralow capacity decay of only 0.0037 % per cycle during 4000 cycles at 10 A g-1.

Migrant workers with COVID-19: a major challenge for Gulf Cooperation Council (GCC) countries to curb the spread of infection.

The six Gulf Cooperation Council (GCC) countries (Saudi Arabia, the United Arab Emirates, Bahrain, Kuwait, Oman and Qatar) host the majority of the estimated 23 million international migrants working in the Arab states. As the COVID-19 pandemic continues to evolve across the GCC states, the health authorities have reported a considerable number of non-national confirmed COVID-19 cases in the region. In Gulf countries, where more than half of the population are foreigners, migrant workers are more likely to contract and spread the disease due to numerous contributing factors. In this regard, unhygienic and overcrowded living conditions, barriers in accessing national or private health services, challenges in accessing accurate health information related to COVID-19, and lack of facemasks and hand hygiene facilities in their housing camps are the major factors that we identified and discuss in this paper. Moreover, we formulated specific recommendations for relevant authorities to overcome the challenges related to migrant workers during this pandemic situation. Because the migrant workers with COVID-19 infection could subsequently lead to more widespread community transmission, protecting this vulnerable group means reducing the risk of transmission for the entire population. It is essential to include migrant workers in all aspects of the response to COVID-19, such as prevention, detection, access to treatment, and containment measures.

Commonly consumed processed packaged foods in Bangladesh are unhealthy and their nutrient contents are not in conformity with the label declaration.

The present study was undertaken to identify the major nutrient content in processed foods commonly consumed in Bangladesh, their label conformity healthiness, and percent daily nutrient contribution. Twenty-four nationally representative composite samples were analyzed using AOAC and other standard methods. Results were compared with label information using a restrictive approach and EU tolerance guidelines. The healthiness of the products was evaluated in terms of the Health Star Rating (HSR) scheme and the UK traffic light labeling system. Among the analyzed samples, fried pulse, chanachur, lozenge, and fried peas had the highest amount of protein, fat, carbohydrates, and dietary fiber, respectively. Biscuits and milk chocolate had high levels of trans fatty acids (TFA) and saturated fatty acids (SFA). It was observed that around half of the products lacked information about saturated fatty acid (46%), followed by total dietary fiber and trans-fat (38% each). Other information was missing in one-fifth of the products, namely protein (17%), total fat (17%), available carbohydrate (17%), energy (17%), sugar (21%), and salt (21%). Label compliance analysis according to the restrictive approach revealed that none of the products accurately reported the salt, sugar, saturated fat, and trans fat content on the label. According to the EU tolerance guideline, approximately half of the products had protein (58%), fat (54%), and carbohydrate (42%) levels that fell within the EU tolerance limit. However, only around one-third of the samples had sugar (21%), salt (38%), and saturated fat (33%) levels that met the EU tolerance limit. In terms of healthiness analysis, according to the HSR, the range of stars was between 0.5 and 2.5 of the foods where fried peas got the highest rating (2.5 stars), while in terms of the UK traffic light system, none of the samples got all green signals. The lozenge got green lights for fat, SFA, and salt contents. It was also found that consumption of 100 g of fried peas or pulse would exceed the acceptable daily limit of salt, sugar, and SFA compared to the daily maximum allowable intake for the 2000 kcal diet recommended by the WHO. However, according to the serving size, biscuits were major contributors of TFA, sugar, and SFA, whereas fried pulse was a key contributor of sodium/salt. Proper regulatory actions should be introduced to promote healthy processed foods with user-friendly front-of-the-pack labeling and monitor their quality to prevent non-communicable diseases (NCDs).

Factors Influencing the Medication Adherence in Adults With Attention-Deficit/Hyperactivity Disorder (ADHD) and Its Impact on Healthcare Utilization.

OBJECTIVE: This study aims to investigate the factors influencing medication adherence among adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and impact of central nervous system stimulants (CNS) adherence on healthcare utilization (HCU). Methods: This was a cross-sectional study using Medical Expenditure Panel Survey 2013 to 2019, with participants (≥18 years of age) with ADHD and had at least one CNS prescription. Multivariate logistic and linear regression were utilized to evaluate the medication adherence and its impact on HCU, respectively. RESULT: Total 798 (10,718,005 weighted) ADHD patients, were mostly White (81%), aged between 18 and 25 (35%), and non-adherent to CNS (65%). The use of extended-release medications (OR = 1.51 [1.03, 2.23]) and new users (OR = 3.46 [2.12, 5.63], p ≤ .05) were positively associated with medication adherence. The adherent group utilized more outpatient visits (0.04 vs. 0.46) and prescription refills (18.38 vs. 31.25) compared to non-adherent. CONCLUSION: Our findings can be applied to improve the medication adherence, patient education, and optimize intervention for adults with ADHD.

The association between polypharmacy and health-related quality of life among non-dialysis chronic kidney disease patients.

BACKGROUND AND OBJECTIVE: The United States government spends over $85 billion annually on treating non-dialysis chronic kidney disease (CKD). Patients with CKD are prescribed a multitude of medications to manage numerous comorbidities associated with CKD. Thus, this study aims to investigate the association between polypharmacy and health-related quality of life (HRQoL) in non-dialysis CKD patients. METHODS: This cross-sectional study utilized data from the Medical Expenditure Panel Survey (MEPS) from 2010 through 2019. We classified polypharmacy into three groups based on the number of medication classes: ≤ 4 (minor polypharmacy), 5 through 9 (major polypharmacy), and ≥ 10 (hyperpolypharmacy). To measure HRQoL, a Physical Component Summary (PCS) and a Mental Component Summary (MCS) were obtained from the 12-item Short-Form Health Survey version 2 and Veteran's Rand 12 item. We applied multivariable ordinary least squares regression to assess the association between polypharmacy and HRQoL in non-dialysis CKD patients. RESULTS: A total of 649 CKD patients (weighted n = 667,989) were included. Patients with minor polypharmacy, major polypharmacy, and hyperpolypharmacy were 22.27%, 48.24%, and 29.48%, respectively. Major polypharmacy and hyperpolypharmacy were significantly and negatively associated with lower PCS scores when compared with minor polypharmacy [Beta = -3.12 (95% CI: -3.62, -2.62), p-value<0.001; Beta = -4.13 (95CI: -4.74, -3.52), p-value<0.001]. Similarly, major polypharmacy and hyperpolypharmacy were significantly and negatively associated with lower MCS scores when compared to minor polypharmacy [Beta = -0.38 (95% CI: -0.55, -0.20), p-value<0.001; Beta = -1.70 (95% CI: -2.01, -1.40), p-value<0.001]. The top 5 classes of medications used by CKD patients were antihyperlipidemic (56.31%), beta-adrenergic blockers (49.71%), antidiabetics (42.14%), analgesics (42.17%), and diuretics (39.65%). CONCLUSION: Our study found that both major polypharmacy and hyperpolypharmacy were associated with lower HRQoL among non-dialysis CKD patients. This study highlights the need for further evaluation of the combination of medications taken by non-dialysis CKD patients to minimize unnecessary and inappropriate medication use.

Thiamine utilization and the lack of prescribing standardization: A critical examination.

OBJECTIVES: Thiamine is often prescribed for thiamine deficiency during hospitalization despite the lack of US-based clinical guidelines. This study aims to evaluate thiamine prescribing patterns and key characteristics associated with the deficiency to address gaps in care. METHODS: Data were obtained from electronic health records of hospitalized patients between September 1, 2021, and March 30, 2022. Alcohol use disorder (AUD) was defined by a positive Clinical Institute Withdrawal Assessment score or a positive serum alcohol level upon admission. Geriatric patients were defined as age ≥65. Cohort 1 was defined as: AUD, albumin <4 g/L, INR >1.5, and total bilirubin >3 mg/dL. Cohort 2 was defined as: age >65, albumin <4 g/L, hemoglobin <15 g/dL, and folate <4 ng/mL. A multivariable LASSO regression model was used to identify characteristics associated with higher thiamine dosing (>100 mg/day). RESULTS: Among 780 patients, 520 (66.7%) were identified as AUD, of which 265 (50.1%) were between the ages of 45-64 years. The AUD cohort was significantly different (p < 0.05) in the mean serum albumin 4.16 g/L (IQR: 3.8-4.5), AST 73.55 U/L (23.75-82.00), ALT 52.57 U/L (17.00-57.00), total bilirubin 0.98 (0.3-1.0), and INR 1.1 (0.99-1.12), compared to non-AUD patients with a mean serum albumin 3.75 g/L (3.3-4.2), AST 35.07 U/L (11.00-42.00), ALT 32.77 U/L (5.00-34.00), total bilirubin 0.89 (0.2-0.9), and INR 1.21 (1.0-1.22). In the geriatric cohort, 136 patients (17%) had a mean serum albumin 3.77 g/L (3.4-4.2), AST 38.66 U/L (14.0-41.0), ALT 29.36 U/L (9.0-37.0), total bilirubin 0.62 mg/dL (0.30-0.90), and direct bilirubin 0.12 mg/dL (0.00-0.20), compared to the non-geriatric cohort with a mean serum albumin 4.10 g/L (3.8-4.40), AST 66.44 U/L (21.0-75.0), ALT 50.03 U/L (16.00-53.75), total bilirubin 1.02 mg/dL (0.30-1.00), and direct bilirubin 0.31 mg/dL (0.00-0.20). In cohort 1, 40.6% patients were between 51 and 64 years old, (66.5%) male, and had a BMI <25 (36.4%). In cohort 2, 52.6% were between 65 and 70 years old, (57.9%) male, and had a BMI <25 (57.9%). Cohort 1 were prescribed a dose of 100 mg (47.7 %), oral (63.5%), intramuscular (18.2%), daily (58.9%), one-day duration (49.4%) most frequently. Cohort 2 were prescribed a dose of 100 mg (56.0%), oral (77.2%), daily (77.2%), one-day duration (29.8%) most frequently. The AUD was significantly associated with having a higher dosage (e.g., >100 mg) of thiamine prescribed per day OR 1.62 (1.11-2.37) (p < 0.01). CONCLUSIONS: This study confirms that thiamine prescribing patterns vary during hospitalization and suggest specific laboratory findings may aid in identifying cohorts associated with the deficiency.

Opioid-related polysubstance use and its effect on mortality and health resource utilization among trauma patients.

BACKGROUND: Pre-injury opioid use is common, but the effects of opioid-related polysubstance use on mortality and health resources utilization (HRU) have not been investigated yet. The objective of this study was to investigate the effects of opioid-related polysubstance use on mortality and HRU among patients in trauma centres in the US. METHODS: We conducted a retrospective cross-sectional study using the US National Trauma Databank from the year 2017 to 2019. Patients (≥ 18 years of age) who tested positive for opioids were included. Patients were analysed based on the number of substances used (i.e., opioids only, two substances (opioids + 1 substance), and three or more than three substances (opioids + ≥ 2 substances)), and polysubstance by type (i.e., opioids only, opioids and alcohol, opioids and stimulants, opioids and benzodiazepine, and other combinations). Multivariate logistic regression was used to determine the association between polysubstance use, mortality and HRU (i.e., need for hospital admission, ICU, and mechanical ventilation). RESULTS: Both polysubstance by number and type analyses showed that opioid-related polysubstance use was not significantly associated with mortality compared to opioids only. The odds of hospital admission were higher among the opioids and benzodiazepines group (OR 1.15, 95% CI 1.06-1.24, p < 0.01). The need for ICU was magnified using benzodiazepines and stimulants with opioids (OR 1.44, 95% CI 1.27-1.63, p < 0.01) when compared to the opioids only group. CONCLUSION: Opioid-related pre-injury polysubstance use was associated with higher HRU in trauma patients. The evidence can be used by policymakers and practitioners to improve patient outcomes in trauma centers.

Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh.

BACKGROUND: Secundum atrial septal defect (ASD) is treated following trans-catheter closure in alternative to surgical treatment. Per-intervention selection of device size with balloon occlusive diameter (BOD) often cause tearing or enlarging, causing arrhythmias and hypotension. We assessed the suitability of percutaneous device closure for ASD using 3-dimensional transthoracic echocardiography (3DTTE). OBJECTIVES: This study was conducted to investigate if 3DTTE could be an alternative of balloon sizing for selection of device size in atrial septal defect device closure. DESIGN: It was a cross-sectional comparative study. METHODS: This study was conducted at the department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University for a period of 2 years. Thirty-three purposively selected secundum ASD patients suitable for device closure were included in the study. Ethical permission was taken from the Institutional Review Board and written consent was taken from each patient's guardian. In this study, 3DTTE derived ASD diameter and BOD were compared with that of deployed device size using correlation analysis. RESULTS: Out of 33 patients, 63.6% were female and 36.4% were males had a mean age of 18.07 ± 14.58 years (range 2-55 years). Mean diameter of ASD measured by 2-dimensional (2D) and 3-dimensional (3D) echocardiography were 17.09 ± 6.08 mm and 21.30 ± 6.56 mm, respectively, yielding a significant difference (p < 0.001). 3D echocardiography derived ASDs diameter were highly correlated with device size than BOD and 2D echocardiography derived diameter (2D echocardiography: r = 0.796, p = <0.001, 3D echocardiography: r = 0.960, p = <0.001, BOD: r = 0.840, p = <0.001). CONCLUSION: 3DTTE can accurately measure ASD diameter and can be used as an alternate, effective, and safe method to select device size.

Rational Design of N-Doped Carbon-Coated Cobalt Nanoparticles for Highly Efficient and Durable Photothermal CO2 Conversion.

Photothermal CO2 hydrogenation to high-value-added chemicals and fuels is an appealing approach to alleviate energy and environmental concerns. However, it still relies on the development of earth-abundant, efficient, and durable catalysts. Here, the design of N-doped carbon-coated Co nanoparticles (NPs), as a photothermal catalyst, synthesized through a two-step pyrolysis of Co-based ZIF-67 precursor, is reported. Consequently, the catalyst exhibits remarkable activity and stability for photothermal CO2 hydrogenation to CO with a 0.75 mol gcat -1 h-1 CO production rate under the full spectrum of light illumination. The high activity and durability of these Co NPs are mainly attributed to the synergy of the attuned size of Co NPs, the thickness of carbon layers, and the N doping species. Impressively, the experimental characterizations and theoretical simulations show that such a simple N-doped carbon coating strategy can effectively facilitate the desorption of generated CO and activation of reactants due to the strong photothermal effect. This work provides a simple and efficient route for the preparation of highly active and durable nonprecious metal catalysts for promising photothermal catalytic reactions.

Medication Regimen Complexity Index Score at Admission as a Predictor of Inpatient Outcomes: A Machine Learning Approach.

BACKGROUND: In the intensive care unit, traditional scoring systems use illness severity and/or organ failure to determine prognosis, and this usually rests on the patient's condition at admission. In spite of the importance of medication reconciliation, the usefulness of home medication histories as predictors of clinical outcomes remains unexplored. METHODS: A retrospective cohort study was conducted using the medical records of 322 intensive care unit (ICU) patients. The predictors of interest included the medication regimen complexity index (MRCI) at admission, the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Sequential Organ Failure Assessment (SOFA) score, or a combination thereof. Outcomes included mortality, length of stay, and the need for mechanical ventilation. Machine learning algorithms were used for outcome classification after correcting for class imbalances in the general population and across the racial continuum. RESULTS: The home medication model could predict all clinical outcomes accurately 70% of the time. Among Whites, it improved to 80%, whereas among non-Whites it remained at 70%. The addition of SOFA and APACHE II yielded the best models among non-Whites and Whites, respectively. SHapley Additive exPlanations (SHAP) values showed that low MRCI scores were associated with reduced mortality and LOS, yet an increased need for mechanical ventilation. CONCLUSION: Home medication histories represent a viable addition to traditional predictors of health outcomes.

Availability of Hypertension and Diabetes Mellitus Care Services at Subdistrict Level in Bangladesh.

BACKGROUND: In Bangladesh, the rapid rise of noncommunicable diseases (NCDs) has become a significant public health concern. This study assesses the readiness of hypertension (HTN)- and diabetes mellitus-related services at primary health-care facilities in Northeast Bangladesh. METHODOLOGY: A cross-sectional survey using a semi-structured interview was conducted between April 2021 and May 2021 among 51 public primary health-care facility staff (upazila health complexes [UHCs]). The NCD-specific service readiness was assessed using an adapted questionnaire from the WHO manual of Service Availability and Readiness Assessment and included four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. For each domain, the mean readiness index score was calculated. Facilities with a readiness score of above 70% were considered to be ready. RESULTS: The diagnostic capacity of the UHCs ranged from 0% to 88.9%, the availability of essential medicine and basic equipment varied between 15.4%-69.2% and 36.4%-100%, respectively, whereas the score in availability of basic amenities was between 57.1% and 100%. The score for the protocol drugs used to manage HTN was 52.9%, whereas for diabetes, it was 88.2%. The average general service readiness score for the facilities was 59.1%. Overall 17.6% of the facilities were assessed to be ready. CONCLUSION: Currently, primary health-care facilities are not ready to implement the national guidelines for diagnosing and treating diabetes and HTN due to shortages of medications, staff, and diagnostic materials.

Comparison of three spot urine formulae and their validation using 24-hour urine sodium for estimation of daily salt intake: a cross-sectional study among Bangladeshi adults.

OBJECTIVE: This study aimed to assess the validity of three commonly used (Tanaka, Kawasaki, INTERSALT) methods based on spot urinary sodium excretion against the 24-hour urinary sodium excretion to estimate the dietary salt intake in Bangladesh. DESIGN: A population-based cross-sectional survey. SETTING: A cross-sectional survey was done in an urban and a rural area of Bangladesh in 2012-2013. PARTICIPANTS: 418 community living residents aged 40-59 years participated in the survey and data of 227 subjects who had complete information were analysed for this validation study. OUTCOME MEASURES: The Bland-Altman method was used to evaluate the agreement between the estimated and measured 24-hour urinary sodium. The estimated average salt intake from Tanaka, Kawasaki and INTERSALT methods were plotted against 24-hour urinary sodium excretion. RESULTS: The mean 24-hour estimated salt intake was 10.0 g/day (95% CI 9.3 to 10.6). The mean estimated urinary salt by Tanaka, Kawasaki and INTERSALT methods were 8.5 g/day (95% CI 8.2 to 8.8), 11.4 g/day (95% CI 10.8 to 12.0) and 8.8 g/day (95% CI 8.6 to 9.0), respectively. Compared with the estimated mean salt intake from 24-hour urine collection, the Bland-Altman plot indicated the mean salt intake was overestimated by the Kawasaki method and underestimated by Tanaka and INTERSALT methods. The linear regression line showed the Kawasaki method was the least biased and had the highest intraclass correlation coefficient (0.57, 95% CI 0.45 to 0.67). CONCLUSION: Tanaka, Kawasaki and INTERSALT methods were not appropriate for the estimation of 24-hour urinary sodium excretion from spot urine samples to assess dietary salt intake in Bangladesh. Among the three methods, the Kawasaki method has the highest agreement with the 24-hour urinary sodium excretion concentration in this population.

Evaluating the Medication Regimen Complexity Score as a Predictor of Clinical Outcomes in the Critically Ill.

Background: Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and frequencies. The objective of this study was to examine the relationship between the scores of different MRC tools and the clinical outcomes. Methods: We conducted a retrospective cohort study at Roger William Medical Center, Providence, Rhode Island, which included 317 adult patients admitted to the intensive care unit (ICU) between 1 February 2020 and 30 August 2020. MRC was assessed using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU). A multivariable logistic regression model was used to identify associations among MRC scores, clinical outcomes, and a logistic classifier to predict clinical outcomes. Results: Higher MRC scores were associated with increased mortality, a longer ICU length of stay (LOS), and the need for mechanical ventilation (MV). MRC-ICU scores at 24 h were significantly (p < 0.001) associated with increased ICU mortality, LOS, and MV, with ORs of 1.12 (95% CI: 1.06−1.19), 1.17 (1.1−1.24), and 1.21 (1.14−1.29), respectively. Mortality prediction was similar using both scoring tools (AUC: 0.88 [0.75−0.97] vs. 0.88 [0.76−0.97]. The model with 15 medication classes outperformed others in predicting the ICU LOS and the need for MV with AUCs of 0.82 (0.71−0.93) and 0.87 (0.77−0.96), respectively. Conclusion: Our results demonstrated that both MRC scores were associated with poorer clinical outcomes. The incorporation of MRC scores in real-time therapeutic decision making can aid clinicians to prescribe safer alternatives.

Survival and recovery modeling of acute kidney injury in critically ill adults.

Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I-III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (p-value < 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1-22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14-39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention.

The influence of demographic and meteorological factors on temporal patterns of rotavirus infection in Dhaka, Bangladesh.

To quantify the potential impact of rotavirus vaccines and identify strategies to improve vaccine performance in Bangladesh, a better understanding of the drivers of pre-vaccination rotavirus patterns is required. We developed and fitted mathematical models to 23 years (1990-2012) of weekly rotavirus surveillance data from Dhaka with and without incorporating long-term and seasonal variation in the birth rate and meteorological factors. We performed external model validation using data between 2013 and 2019 from the regions of Dhaka and Matlab. The models showed good agreement with the observed age distribution of rotavirus cases and captured the observed shift in seasonal patterns of rotavirus hospitalizations from biannual to annual peaks. The declining long-term trend in the birth rate in Bangladesh was the key driver of the observed shift from biannual to annual winter rotavirus patterns. Meteorological indices were also important: a 1°C, 1% and 1 mm increase in diurnal temperature range, surface water presence and degree of wetness were associated with a 19%, 3.9% and 0.6% increase in the transmission rate, respectively. The model demonstrated reasonable predictions for both Dhaka and Matlab, and can be used to evaluate the impact of rotavirus vaccination in Bangladesh against changing patterns of disease incidence.

Comparative efficacy of citric acid, Spirulina platensis, and their combination as alternatives to an antibiotic growth promoter on the performances of broilers.

Objective: A 35-day-long trial was conducted to compare the consequences of supplementing citric acid (CA), Spirulina platensis, and their combination as natural substitutes for antibiotic growth promoters (AGP) on the productive performance, dressing percentage, and blood serum metabolites of broilers. Materials and Methods: A total of 150-day-old Cobb-500 broiler chicks were randomly assigned to 5 dietary treatment groups, each having 30 chicks in it (10 chicks per replicate cage). The dietary groups were as follows: 1- Control (corn-soybean-based), 2- Control + antibiotic (Enrofloxacin, 10 mg/kg bodyweight), 3- Control + 1% S. platensis, 4- Control + 0.5% CA, and 5- Control + 1% spirulina + 0.5% CA. Starting from day 7 up to day 21, antibiotics were administered via water; spirulina and CA were offered via feed. Results: When compared to the control, all dietary supplements significantly (p < 0.05) improved broiler growth performance. However, dressing characteristics and serum metabolites (serum creatinine, albumin, and uric acid) were not influenced (p > 0.05) by dietary changes, except cholesterol level (p < 0.05). Supplementation with antibiotics, CA, and spirulina produced comparable results. Among them, the CA-fed group recorded the highest live weight, weight gain, feed intake, improved feed conversion ratio, and the lowest serum cholesterol level (106.5 mg/dl). The combination group performed better than the control, but not as well as their single supplementations. Conclusions: CA and S. platensis might both be good candidates as natural alternatives to AGP (Enrofloxacin). But, among them, CA performed better in terms of production performance.

Scalable Spray Drying Production of Amorphous V2 O5 -EGO 2D Heterostructured Xerogels for High-Rate and High-Capacity Aqueous Zinc Ion Batteries.

Rechargeable aqueous zinc-ion batteries (ZIBs) are promising in stationary grid energy storage due to their advantages in safety and cost-effectiveness, and the search for competent cathode materials is one core task in the development of ZIBs. Herein, the authors design a 2D heterostructure combining amorphous vanadium pentoxide and electrochemically produced graphene oxide (EGO) using a fast and scalable spray drying technique. The unique 2D heterostructured xerogel is achieved by controlling the concentration of EGO in the precursor solution. Driven by the improved electrochemical kinetics, the resultant xerogel can deliver an excellent rate capability (334 mAh g-1 at 5 A g-1 ) as well as a high specific capacity (462 mAh g-1 at 0.2 A g-1 ) as the cathode material in ZIB. It is also shown that the coin cell constructed based on spray-dried xerogel can output steady, high energy densities over a broad power density window. This work provides a scalable and cost-effective approach for making high performance electrode materials from cheap sources through existing industrialized materials processing.

Hydrogen Spillover-Bridged Volmer/Tafel Processes Enabling Ampere-Level Current Density Alkaline Hydrogen Evolution Reaction under Low Overpotential.

Water-alkaline electrolysis holds a great promise for industry-scale hydrogen production but is hindered by the lack of enabling hydrogen evolution reaction electrocatalysts to operate at ampere-level current densities under low overpotentials. Here, we report the use of hydrogen spillover-bridged water dissociation/hydrogen formation processes occurring at the synergistically hybridized Ni3S2/Cr2S3 sites to incapacitate the inhibition effect of high-current-density-induced high hydrogen coverage at the water dissociation site and concurrently promote Volmer/Tafel processes. The mechanistic insights critically important to enable ampere-level current density operation are depicted from the experimental and theoretical studies. The Volmer process is drastically boosted by the strong H2O adsorption at Cr5c sites of Cr2S3, the efficient H2O* dissociation via a heterolytic cleavage process (Cr5c-H2O* + S3c(#) → Cr5c-OH* + S3c-H#) on the Cr5c/S3c sites in Cr2S3, and the rapid desorption of OH* from Cr5c sites of Cr2S3 via a new water-assisted desorption mechanism (Cr5c-OH* + H2O(aq) → Cr5c-H2O* + OH-(aq)), while the efficient Tafel process is achieved through hydrogen spillover to rapidly transfer H# from the synergistically located H-rich site (Cr2S3) to the H-deficient site (Ni3S2) with excellent hydrogen formation activity. As a result, the hybridized Ni3S2/Cr2S3 electrocatalyst can readily achieve a current density of 3.5 A cm-2 under an overpotential of 251 ± 3 mV in 1.0 M KOH electrolyte. The concept exemplified in this work provides a useful means to address the shortfalls of ampere-level current-density-tolerant Hydrogen evolution reaction (HER) electrocatalysts.