The Rohingya in Cox's Bazar: When the Stateless Seek Refuge

The Rohingya people of Myanmar have been subject to human rights violations through government-sponsored discrimination and violence. Since August 2017, an intensified assault by Myanmar authorities has resulted in a rapid increase of Rohingya pouring into Bangladesh, and the expansion of refugee settlements in the district of Cox's Bazar has strained humanitarian and government relief efforts. Assessing Rohingya and host community needs is critical for prioritizing resource allocations and for documenting the rights violations suffered by Rohingya refugees. From March 15 to 18, 2018, we conducted a rapid needs assessment of recently arrived Rohingya and host community households. We collected data on demographics, mortality, education, livelihoods, access to food and water, vaccination, and health care. Among other things, our survey found high levels of mortality among young Rohingya men, alarmingly low levels of vaccination among children, poor literacy, and rising poverty. Denied formal refugee status, the Rohingya cannot access due protections and find themselves in a state of insecurity in which they are unsure of their future and unable to formally seek work or send their children to school. While the government of Bangladesh explores the options of repatriation, relocation, and third-country resettlement for these refugees, it is important to ensure that they are not denied a life of dignity.

Remuneration, Motivation, and Performance: Employee Perspectives

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Mortality in Puerto Rico after Hurricane Maria

BACKGROUND

Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64.

METHODS

Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016.

RESULTS

From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.

CONCLUSIONS

This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.).

Organic and inorganic selenium in Aseel chicken diets: Effect on hatching traits

A study was conducted to evaluate the effect of dietary selenium (Se) sources (organic and inorganic Se at 0.30 ppm and basal diet at 0 ppm level of supplemented Se) on hatching traits in four varieties of Aseel chicken, Lakha, Mushki, Peshawari, and Mianwali. In total, 84 adult molted hens (50 wk old), 21 from each variety, were randomly assigned to 12 treatment groups in a 3 (Se diets) × 4 (Aseel varieties) factorial arrangement under a randomized complete block design. Each treatment was replicated 7 times with individual hens in each. Settable egg, fertility, hatch of fertile eggs, hatchability, A-grade chick, and embryonic mortality parameters were evaluated. The results indicated that the birds fed an organic Se supplemented diet had greater (P < 0.05) settable eggs, fertility, hatch of fertile eggs, hatchability, and A-grade chicks and reduced embryonic mortality than those fed inorganic or no Se. Among varieties, Mushki had lower (P < 0.05) fertility, hatch of fertile eggs, hatchability, and A-grade chicks than rest of three varieties. Interaction of Se sources and varieties indicated that dietary organic Se supplementation improved (P < 0.05) hatch of fertile eggs in Peshawari and Mianwali, whereas hatchability only in Peshawari variety and reduced embryonic mortality in Mianwali. It was concluded that dietary supplementation of organic Se could be used to improve hatching traits as well as reduce embryonic mortality in native Aseel chicken.

Productive performance, egg quality, and hatching traits of Japanese quail reared under different levels of glycerin

This study evaluated subsequent effects of glycerin on productive performance, egg quality, and hatching traits in Japanese quail. A total of 200 birds was arranged according to a completely randomized design into 5 treatment groups having 5 replicates of 8 birds each (6 females and 2 males). Treatments consisted 5 levels of glycerin, i.e., 2.5, 5, 7.5, and 10% and the control group. Birds were fed with different levels of glycerin during a rearing period of 6 wk and their subsequent effects on productive performance, egg quality, and hatching traits were observed. Data were collected regarding productive performance for 16 wk; however, egg quality and hatching traits were recorded during pre-peak (at fourth wk), peak (at 12th wk), and post peak (at 16th wk) phase. Productive performance, egg quality, and hatching traits did not differ significantly throughout the experimental period. It was concluded that glycerin can be used as a replacement energy source, having no effect on productive and reproductive performance in Japanese quail.

Barriers to participation in clinical trials: a physician survey

Background

Clinical trials are vital for evidence-based cancer care. Oncologist engagement in clinical trials has an effect on patient recruitment, which in turn can affect trial success. Identifying barriers to clinical trial participation might enable interventions that could help to increase physician participation.

Methods

To assess factors affecting physician engagement in oncology trials, a national survey was conducted using the online SurveyMonkey tool (SurveyMonkey, San Mateo, CA, U.S.A.; http://www.surveymonkey.com). Physicians associated with the Canadian Cancer Clinical Trials Network and the Canadian Cancer Trials Group were asked about their specialty, years of experience, barriers to participation, and motivating interventions, which included an open-ended question inviting survey takers to suggest interventions.

Results

The survey collected 207 anonymous responses. Respondents were predominantly medical oncologists (46.4%), followed by radiation oncologists (24.6%). Almost 70% of the respondents had more than 10 years of experience. Significant time constraints included extra paperwork (77%), patient education (54%), and extended follow-up or clinic visits (53%). Timing of events within trials was also a barrier to participation (55%). Most respondents favoured clinical work credits (72%), academic credits (67%), a clinical trial alert system (75%), a regular meeting to review trial protocols (65%), and a screening log to aid in patient accrual (67%) as motivational strategies. Suggested interventions included increased support staff, streamlined regulatory burden, and provision of greater funding for trials and easier access to ancillary services.

Conclusions

The present study confirms that Canadian oncologists are willing to participate in clinical research, but face multiple barriers to trial participation. Those barriers could be mitigated by the implementation of several interventions identified in the study.

Assessing behavior in Aseel pullets under free-range, part-time free-range, and cage system during growing phase

The objective of this study was to explore the effects of free-range (FR), part-time free-range (PTFR), and cage system (CS) on behavioral repertoire in Lakha (LK), Mushki (MS), Peshawari (PW), and Sindhi (SN) varieties of Aseel chicken during the growing phase (9 to 18 wk of age). In total, 144 Aseel pullets were allotted to 12 treatment groups in a 3 × 4 (rearing system × Aseel variety) factorial arrangement, according to a randomized complete block design (RCBD). Each treatment group was replicated 3 times with 4 birds in each replicate (12 birds per treatment group). The pullets were randomly marked weekly for identification, and their behavior was observed through the focal animal sampling method. Time spent on different behavioral activities was recorded and converted to a percentage. The data were analyzed using 2-way ANOVA under a factorial arrangement using SAS 9.1, and the behavioral parameters were evaluated. The results indicated greater (P < 0.05) sitting, standing, drinking, preening, and aggressiveness in CS; walking, running, and jumping in PTFR; and foraging and dustbathing in both FR and PTFR, whereas feather pecking was found to be reduced in FR compared with PTFR and CS. Among varieties, PW showed the least feeding/foraging and feather pecking behavior, and greater standing, running, and jumping behavior (P < 0.05). However, SN spent less time in walking and preening, and more time in sitting, drinking, and aggressiveness. Dustbathing was found to be similar in all Aseel varieties (P = 0.135). In conclusion, the PTFR system could be suggested as a substitute for conventional housing systems because it better accommodates normal behavior in Aseel pullets.

Shifting practice in definitive chemoradiation for localized esophageal cancer

BACKGROUND

The efficacy of carboplatin-paclitaxel in the trimodality setting was demonstrated in the cross trial. Because of better tolerance, that regimen has been adopted as an alternative for patients receiving definitive chemoradiation (dcrt). The purpose of our study was to compare outcomes in patients with localized esophageal and gastroesophageal junction (gej) cancer who received dcrt using either platinum-5-fluorouracil (5fu) or carboplatin-paclitaxel.

METHODS

Medical records and outcomes for all patients diagnosed with localized carcinoma of the esophagus and gej at our centre between 2008 and 2015 were reviewed. All patients who underwent dcrt using cisplatin-5fu, carboplatin-5fu, or carboplatin-paclitaxel were included.

RESULTS

The 73 identified patients (34 cisplatin-5fu, 13 carboplatin-5fu, 26 carboplatin-paclitaxel) were all prescribed concomitant radiotherapy of 50 Gy in 25 daily fractions. The diagnosis was adenocarcinoma in 64% and squamous cell carcinoma in 36%. Median overall survival (os) duration for the cisplatin-5fu group was 28 months [95% confidence interval (ci): 19 to 41 months], with a 3-year os rate of 44%, in contrast to the 15 months (95% ci: 11 to 17 months) and 15% in the carboplatin-paclitaxel group (log-rank p = 0.0047). Median os duration for the carboplatin-5fu group was 17 months (95% ci: 11 to 68 months) with a 3-year os rate of 31%. Adjusting for patient and disease factors, better os durations and rates were associated with cisplatin-5fu (hazard ratio: 0.34; p = 0.0016) and carboplatin-5fu (hazard ratio: 0.55; p = 0.20) than with carboplatin-paclitaxel.

CONCLUSIONS

In a dcrt regimen, a better os is associated with cisplatin-5fu than with carboplatin-paclitaxel. Clinical trials to determine optimal chemotherapy regimens are warranted for patients who are not suitable for surgery.

Colistin-associated nephrotoxicity among patients in intensive care units (ICU) of hospitals in Selangor

INTRODUCTION

The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population.

METHODS

The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria.

RESULTS

A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant.

CONCLUSION

Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.

Training on Kielland's forceps: A survey of trainees' opinions

We conducted a cross-sectional survey including specialist trainees in obstetrics and gynaecology in the Health Education West Midlands region, UK, to capture their views and assess training opportunities on the use of Kielland's forceps. Half of the trainees in the region completed the survey (87/172, 50%). Only 31% of our trainees worked in units that supported the training on these forceps (27/87, 31%). The majority reported that they did not get enough exposure to using Kielland's forceps (53/87, 60.9%). Only a minority (5.7%, 5/87) felt confident to perform a Kielland's rotational delivery independently. The majority (64.3%, 56/87) were keen to continue using Kielland's forceps in the future if competent. More than two-thirds (86.2%, 75/87) felt that simulation could aid their training. There was large enthusiasm for training on the safe use of Kielland's forceps among trainees in obstetrics and gynaecology in the West Midlands region. A national assessment of training resources is needed to better plan training recourses on this complex skill.