A framework for identifying and selecting long term adaptation policy directions for deltas

Deltas are precarious environments experiencing significant biophysical, and socio-economic changes with the ebb and flow of seasons (including with floods and drought), with infrastructural developments (such as dikes and polders), with the movement of people, and as a result of climate and environmental variability and change. Decisions are being taken about the future of deltas and about the provision of adaptation investment to enable people and the environment to respond to the changing climate and related changes. The paper presents a framework to identify options for, and trade-offs between, long term adaptation strategies in deltas. Using a three step process, we: (1) identify current policy-led adaptations actions in deltas by conducting literature searches on current observable adaptations, potential transformational adaptations and government policy; (2) develop narratives of future adaptation policy directions that take into account investment cost of adaptation and the extent to which significant policy change/political effort is required; and (3) explore trade-offs that occur within each policy direction using a subjective weighting process developed during a collaborative expert workshop. We conclude that the process of developing policy directions for adaptation can assist policy makers in scoping the spectrum of options that exist, while enabling them to consider their own willingness to make significant policy changes within the delta and to initiate transformative change.

Changes of Peak Expiratory Flow Rate in Adult Asthmatic Patient

Asthma is a common pulmonary disorder characterizerized by airway inflammation, airway- hyper reactivity, and reversible airflow obstruction. The classic triad of symptoms is wheezing, chronic episodic dyspnea and chronic cough. The prevalence of asthma increased steadily over the latter part of the last century, first in the developed and then in the developing world. The number of people with asthma in the world may be as high as 334 million. Asthma in Bangladesh appears to be a substantial public health problem: an estimated 11.6 million people including 4.1 million children suffer from asthma-related symptoms. A cross sectional study was conducted from January 1999 to August 1999 on 5642 Bangladeshi people and another same study carried out from November 2009 to April 2010 on 8088 subjects. In 1999 the prevalence of asthma was 6.9% whereas in 2010 it is 6.96%. Airway resistance is always increased during the asthmatic attack. Airways obstruction, such as that caused by asthma, results in a reduced and variable Peak Expiratory Flow Rate (PEFR). PEFR is classically reduced in asthma. Recent asthma guidelines recommended the assessment of severity levels based on the most severe symptoms and peak expiratory flow rate. This descriptive type of cross-sectional study was done to find the changes of Peak expiratory flow rate in adult asthmatic patients and carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2014 to January 2016. Fifty (50) male and 50 (fifty) female adult asthmatic patients aged 18-60 years were included in the study group. They are enrolled from the Department of Medicine, Mymensingh Medical College, Mymensingh, Bangladesh and also from locality. For comparison age matched 50 male and 50 female apparently healthy persons were also studied as control. PEFR was estimated by Wright's Peak flow meter. For statistical analysis unpaired student's 't' test was used. Mean PEFR were significantly decreased in study group in comparison to control group and the result was statistically significant (p<0.001). From this study, it may be concluded that peak expiratory flow rate was decreased in asthmatic patient and there was a significant relation of decline lung function.

Interaction between Hypertension and Asthma in Adult

Asthma has been defined as a chronic inflammatory disorder of the airways that is associated with recruitment of inflammatory cells and the clinical development of wheezing, shortness of breath, chest tightness, and cough. The prevalence of asthma increased steadily over the latter part of the last century, first in the developed and then in the developing world. Current estimates suggest that asthma affects 300 million people worldwide, with a predicted additional 100 million people affected by 2025. This cross sectional study was conducted from January 1999 to August 1999 on 5642 Bangladeshi people and another same study carried out from November 2009 to April 2010 on 8088 subjects. In 1999 the prevalence of asthma was 6.9% whereas in 2010 it is 6.96%. Both asthma and hypertension are spastic disorders of smooth muscle, there is the similarities between these two diseases may predispose the individuals with one disease to the other. This descriptive type of cross-sectional study was done to find the Interaction between hypertension and asthma in adult and carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2014 to January 2016. Fifty (50) male and fifty (50) female adult asthmatic patients aged 18-60 years were included in the study group. They are enrolled from the Department of Medicine, Mymensingh Medical College, Mymensingh and also from locality. For comparison age matched 50 male and 50 female apparently healthy persons were also studied as control. Blood pressure was estimated by auscultatory method by sphygmomanometer. For statistical analysis unpaired student's 't' test was used. Mean blood pressure were significantly increased in study group in comparison to control group and the result was statistically significant (p<0.001). The study findings showed a high prevalence of hypertension among asthmatic patients than non asthmatic healthy persons. From this study, it may be concluded that hypertension and asthma are closely connected.

Effects of stocking density on growth and production in monoculture of Thai sharpunti (Barbonymus gonionotus)

An experiment was carried out to study the density dependent growth of Thai sharpunti (Barbonymusgonionotus) for two months period. Three stocking densities such as 50/decimal, 100/decimal and 150/decimal representing treatment one (T1), treatment two (T2) and treatment three (T3), respectively were tested in three replications. A commercial diet (25% crude protein) was supplied twice daily throughout the study period up to satiation level. The total production of sharpunti was found 14.67 ± 2.05, 27.06 ± 3.09 and 36.87 ± 2.16 kg/decimal in T1, T2 and T3, respectively and they were significantly different (p<0.05) from each other. A higher net benefit of BDT 1079.50 was obtained from T2 where the stocking density was 100/decimal. The present study indicated that the growth and production of Thai sharpunti was density dependent in monoculture systems.Progressive Agriculture 28 (3): 249-252, 2017

Correlation of Troponin-I Level with Left Ventricular Ejection Fraction and In-hospital outcomes after First Attack of Non-ST Segment Elevation Myocardial Infarction

Coronary heart disease (CHD) is the most common cause of heart disease and is the single most important cause of premature death in developed world. Recognizing a patient with ACS is important because the diagnosis triggers both triage and management. cTnI is 100% tissue-specific for the myocardium and it has been shown to be a very sensitive and specific marker for acute myocardial infarction (AMI). Ventricular function is the best predictor of death after an acute coronary syndrome. It serves as a marker of myocardial damage, provides information on systolic function as well as diagnosis and prognosis. The study aimed at investigating the impact of elevated Troponin-I level on LV ejection fraction and in-hospital outcomes in patients with first attack of Non ST-segment Elevation Myocardial Infarction (NSTEMI). This prospective analytical study was conducted in the Department of Cardiology in Mymensingh Medical College Hospital from December 2015 to November 2016. Total 130 first attack of NSTEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I - Patients with first attack of NSTEMI with good LV function (LVEF: ≥55%). Group II - Patients with first attack of NSTEMI with LV systolic dysfunction (LVEF: <55%). Then Troponin-I and LVEF levels were correlated using Pearson's correlation coefficient test. In this study mean Troponin-I of Group I and Group II were 5.53±7.43 and 16.46±15.79ng/ml respectively. It was statistically significant (p<0.05). Echocardiography showed that patients with high Troponin-I level had low ejection fraction (LVEF) and patients with low Troponin-I level had preserved ejection fraction (LVEF). Analysis showed that patients with severe left ventricular systolic dysfunction (LVEF <35%) had the highest level of Troponin-I with worse in-hospital outcomes and vice versa-the patients with the preserved systolic function (LVEF ≥55%) had the lowest levels of Troponin-I with better in-hospital outcomes. In our study, it also showed that the levels of Troponin-I had negative correlation with LV ejection fraction levels, with medium strength of association (r= -0.5394, p=0.001). The study enabled us to conclude that, the higher was the Troponin-I level, the lower was the LV ejection fraction level and thus worse in-hospital outcomes in first attack of NSTEMI patients.

Primary Angioplasty for the Treatment of Acute ST Elevated Myocardial Infarction: Single Centre Experience

Worldwide primary angioplasty is a recommended strategy of reperfusion in patient with acute myocardial infarction as because it ensures reperfusion of the infarct-related vessels more than 90% whereas, with thrombolytics it is only 60-70%. This retrospective observational study includes all patients treated with primary angioplasty at United Hospital from Between March 2007 to January 2011. Total 114 consecutive patients with acute myocardial infarction were treated with primary angioplasty included. Those presented beyond 12 hours of onset of chest pain, in cardiogenic shock, resuscitate and intubated before the procedure were excluded from the study. Majority (89%) of the patient were male, age was minimum 30 years and maximum 90 years, 41.5% were diabetics, 58.4% were hypertensive, 43.5% were dyslipidaemic, 17% were smoker, 29.3% with positive family history. Fifty seven percent patients presented with anterior MI , 42 % with inferior MI and 1% with lateral MI. Left anterior descending (LAD) is the most common vessel involved (57%), followed by Right coronary artery (RCA) 31%, Left circumflex artery (LCX) 8 %, Ramus 1.3% and Graft vessel 2.7%. Our door to balloon time was minimum 23 min, maximum 184 min. We used drug eluting stents for most of the patients, GP IIb- IIIa receptor blockers used in 50% cases and thrombus suction device were used when indicated. We faced complications like arrhythmias in 24%, hypotension in18%, no flow or slow flow in 45%, cardiac arrest in 3% and coronary perforation in 1%. Our overall survival was 97.9%. Primary angioplasty is an emerging area in context of our country. Many of the new centers start this novel strategy which helps to save many lives Primary angioplasty is feasible and safe method of reperfusion in patient with acute myocardial infarction in our center. With the help of our initial experience we can perform PAMI with confidence to those who can afford and who need most.

Hypoxia Inducible Factor 1: A Urinary Biomarker of Kidney Disease

Identifying noninvasive biomarkers of kidney disease is valuable for diagnostic and therapeutic purposes. Hypoxia inducible factor 1 (HIF-1) expression is known to be elevated in the kidneys in several renal disease pathologies. We hypothesized that the urinary HIF-1a mRNA level may be a suitable biomarker for expression of this protein in chronic kidney disease (CKD). We compared HIF-1a mRNA levels from urine pellets of CKD and healthy subjects. To ensure that urinary HIF-1a mRNA is of kidney origin, we examined colocalization of HIF-1a mRNA with two kidney specific markers in urine cells. We found that HIF-1a mRNA is readily quantifiable in urine pellets and its expression was significantly higher in CKD patients compared with healthy adults. We also showed that the urinary HIF-1a mRNA comes primarily from cells of renal origin. Our data suggest that urinary HIF-1a mRNA is a potential biomarker in CKD and can be noninvasively assessed in patients.

Spatial metrology of dopants in silicon with exact lattice site precision

Scaling of Si-based nanoelectronics has reached the regime where device function is affected not only by the presence of individual dopants, but also by their positions in the crystal. Determination of the precise dopant location is an unsolved problem in applications from channel doping in ultrascaled transistors to quantum information processing. Here, we establish a metrology combining low-temperature scanning tunnelling microscopy (STM) imaging and a comprehensive quantum treatment of the dopant-STM system to pinpoint the exact coordinates of the dopant in the Si crystal. The technique is underpinned by the observation that STM images contain atomic-sized features in ordered patterns that are highly sensitive to the STM tip orbital and the absolute dopant lattice site. The demonstrated ability to determine the locations of P and As dopants to 5 nm depths will provide critical information for the design and optimization of nanoscale devices for classical and quantum computing applications.

Quantum simulation of the Hubbard model with dopant atoms in silicon

In quantum simulation, many-body phenomena are probed in controllable quantum systems. Recently, simulation of Bose-Hubbard Hamiltonians using cold atoms revealed previously hidden local correlations. However, fermionic many-body Hubbard phenomena such as unconventional superconductivity and spin liquids are more difficult to simulate using cold atoms. To date the required single-site measurements and cooling remain problematic, while only ensemble measurements have been achieved. Here we simulate a two-site Hubbard Hamiltonian at low effective temperatures with single-site resolution using subsurface dopants in silicon. We measure quasi-particle tunnelling maps of spin-resolved states with atomic resolution, finding interference processes from which the entanglement entropy and Hubbard interactions are quantified. Entanglement, determined by spin and orbital degrees of freedom, increases with increasing valence bond length. We find separation-tunable Hubbard interaction strengths that are suitable for simulating strongly correlated phenomena in larger arrays of dopants, establishing dopants as a platform for quantum simulation of the Hubbard model.

Depression and quality of life in hospitalised patients with congestive heart failure (CHF): A cross-sectional study from Karachi, Pakistan

Introduction

There is strong association between depression and mortality rates among patients with CHF. Despite the massive burden of cardiac disease as well as that of depression in Pakistan, there is limited data regarding the prevalence of depression in patients suffering from CHF. The aim of this study was to assess prevalence of depression in patients with CHF and to compare the health related quality of life of depressed and non-depressed patients with CHF.

Methods

A total of 1009 patients diagnosed with CHF were recruited from different public hospitals in Karachi, Pakistan. Depression was assessed at baseline using the Beck Depression Inventory (BDI) and health related quality of life was assessed using Euro Qol (EQ-5D).

Results

Of the 1009 participants recruited to the study, 66.4% (n = 670) met the threshold for depression using the BDI measure. Of the depressed patients, 66.7% (n = 447) were male. Preliminary results indicate that participants who were depressed at baseline had poorer health related quality of life on EQ-5D measures as compared to those who were non-depressed (mean EQ-5D descriptive score 10.45 in depressed patients vs 7.37 in non-depressed patients and mean EQ-5D visual scale score 35.09 in depressed patients vs 52.19 in non-depressed patients).

Conclusion

Considering the high prevalence of depression and its serious negative impact on quality of life of patients suffering from chronic physical illness, it is important to design and test culturally adapted psychosocial interventions to reduce depression and improve quality of life for these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ambras Syndrome: First Reported Case in Bangladesh and its Oral Rehabilitation

People with rare hypertrichosis syndromes became crowd-drawing money-making phenomena in many 19th century sideshow acts. These individuals have been referred to as dog-men, hair-men, and werewolves. In 1993, Baumister et al. described congenital hypertrichosis lanuginose or Ambras syndrome: a distinct form of congenital hypertrichosis characterized by excessive hair growth over the body and face associated with facial and occasional dental anomalies. Much is not known about this syndrome since fewer than 50 cases have been documented worldwide. In this case report, a nine year old girl presented with excessive hair growth throughout her body that was denser along her midline. Furthermore, her face displayed the typical dysmorphic features characteristic of Ambras syndrome: a round tip nose, thickened nasal cartilage, antiverted nares, prominent philtrum with deep groove, and a trapezoid mouth. Oral examination revealed normal oral mucosa with completely missing and unerupted decidious and permanent teeth. Panoramic radiographs confirmed unerupted deciduous teeth. Previous case reports have mentioned the presence of occasional dental anomalies such as retarded first and second dentition and absence of some teeth. However, this is the first reported case of Ambras syndrome presenting with complete anodontia. Prior cytogenetic studies performed on persons with Ambras syndrome have implicated a balanced pericentric inversion of chromosome 8. However, it is likely that dental anomalies are likely a result of a different genetic rearrangement. Further studies are needed to explore the cause of this rare phenotype of Ambras syndrome with complete unerupted dentition.

Study on Association of Maternal Serum Triglyceride with Pre-eclampsia

Till now pre-eclampsia is a disease of multiple theories. This case control study was carried out in the department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University Hospital and Dhaka Medical College Hospital, from January 2006 to December 2007 to determine the association of maternal serum triglyceride with pre-eclampsia. Ninety pregnant women were studied, among them 45 patients were pre-eclamptic and served as case and 45 normal healthy pregnant women served as control. Estimation of serum triglyceride levels of all study patients was done with the help of enzymatic method. The mean (± SD) systolic blood pressure was 152.4 ± 19.8 mmHg in study group and 112.0 ± 8.9 mmHg in control group (p<0.05). Similarly the mean (± SD) diastolic blood pressure was 103.1 ± 12.2 mmHg in case group and 75.5 ± 6.6 mmHg in control group (p<0.05). Serum triglyceride level was more than the normal reference value in pre-eclamptic group. The mean (± SD) serum triglyceride level was 242.9 ± 36.8 mg/dl in case group and 184.6 ± 12.5mg/dl in control group. Statistically the difference was significant (p<0.05). The level of serum triglyceride positively correlated with the rise of blood pressure and degree of albuminuria. Thus serum triglyceride level increase in pre-eclampsia and the level correlate with the severity of the disease.

Spatially resolved resonant tunneling on single atoms in silicon

The ability to control single dopants in solid-state devices has opened the way towards reliable quantum computation schemes. In this perspective it is essential to understand the impact of interfaces and electric fields, inherent to address coherent electronic manipulation, on the dopants atomic scale properties. This requires both fine energetic and spatial resolution of the energy spectrum and wave-function, respectively. Here we present an experiment fulfilling both conditions: we perform transport on single donors in silicon close to a vacuum interface using a scanning tunneling microscope (STM) in the single electron tunneling regime. The spatial degrees of freedom of the STM tip provide a versatility allowing a unique understanding of electrostatics. We obtain the absolute energy scale from the thermal broadening of the resonant peaks, allowing us to deduce the charging energies of the donors. Finally we use a rate equations model to derive the current in presence of an excited state, highlighting the benefits of the highly tunable vacuum tunnel rates which should be exploited in further experiments. This work provides a general framework to investigate dopant-based systems at the atomic scale.