استكشف المجموعة الواسعة من العناوين المتاحة.

Background Bangladesh is one of the countries most vulnerable to climate change (CC). A basic understanding of public perception on vulnerability, attitude and the risk in relation to CC and health will provide strategic directions for government policy, adaptation strategies and development of community-based guidelines. The objective of this study was to collect community-based data on peoples’ knowledge and perception about CC and its impact on health. Methods In 2012, a cross-sectional survey was undertaken among 6720 households of 224 enumeration areas of rural villages geographically distributed in seven vulnerable districts of Bangladesh, with total population of 19,228,598. Thirty households were selected randomly from each enumeration area using the household listing provided by the Bangladesh Bureau of Statistics (BBS). Information was collected from all the 6720 research participants using a structured questionnaire. An observation checklist was used by the interviewers to collect household- and community-related information. In addition, we selected the head of each household as the eligible participant for an interview. Evidence of association between sociodemographic variables and knowledge of CC was explored by cross-tabulation and measured using chi-square tests. Logistic regression models were used to further explore the predictors of knowledge. Results The study revealed that the residents of the rural communities selected for this study largely come from a low socioeconomic background: only 9.6 % had postsecondary education or higher, the majority worked as day labourer or farmer (60 %), and only 10 % earned a monthly income above BDT 12000 (equivalent to US $150 approx.). The majority of the participants (54.2 %) had some knowledge about CC but 45.8 % did not ( p  < 0.001). The majority of knowledgeable participants ( n  = 3645) felt excessive temperature as the change of climate (83.2 %). Among all the respondents ( n  = 6720), 94.5 % perceived change in climate and extreme weather events. Most of them (91.9 %) observed change in rainfall patterns in the last 10 years, and 97.8 % people think their health care expenditure increased after the extreme weather events. Age, educational qualification, monthly income, and occupation were significantly associated with the knowledge about climate change ( p  < 0.001). People with higher educational level or who live near a school were more knowledgeable about CC and its impact on health. Conclusions The knowledge level about CC in our study group was average but the perception and awareness of CC related events and its impact on health was high. The most influential factor leading to understanding of CC and its impact on health was education. School-based intervention could be explored to increase peoples’ knowledge about CC and necessary health adaptation at community level.

Universities play a crucial role in urban economic and structural development. The government of Bangladesh has undertaken the initiative to establish a public university in each of the 64 districts. These newly founded universities have the potential to impact urban growth significantly. We aimed to project university-induced urban expansion to address this knowledge gap and identify the mechanisms driving urban growth. The classification of supervised and unsupervised methods was employed to analyze urban development for the years 2000, 2010, 2016, and 2022. We used the Cellular Automata and Markov Chain approach to forecast future urban growth and land transition capacity. Additionally, the driving factors and selection of the study area were derived from Focus Group Discussions (FGD), Key Informant Interviews (KII), Probit Model, and Perception Index (PI). The findings of this study reveal a 1.6% urban growth rate within ten years of the establishment of the university, while urban expansion accelerated to 29.78% after ten years. The predictions also indicate a sustained urban growth rate of 4.7% by 2042. Furthermore, the PI index demonstrates that the establishment of the university has resulted in high demand for rental housing, serving as one of the primary drivers of urban expansion. Moreover, the Probit model highlights strong economic capability, proximity to the town, railway station, hospital, and easy access to credit as vital facilitators behind the drivers of urban expansion. Policymakers, the scientific community, and urban planners can benefit from this study in pursuing sustainable city development through university establishment.

Rainfall trend analysis is common for climate change observation following the flood, drought, and other extreme hydrometeorological possibilities. Therefore, this study aims to evaluate the spatiotemporal rainfall trend for seven climatic zones in Bangladesh during 1979-2019. For the trend exploration Mann-Kendall (MK) trend test, slope estimator (Sens) and IDW techniques were utilised from the dataset of 27 stations. The findings shows descending annual trend of >-2.50, >1.95, >-1.80, >-1.60, >-1.31 and >-0.50 for the zones of (C)western region, (A)northern part of northern region, (B)north-western region, (E)south-central region, (D)south-western region and (G)north-eastern region, respectively, whereas ascending trend found for only (F)south-eastern region >1.83. Except for post-monsoon season zone F > 2.90 trends, all other seasonal trend is in a declining position. An increasing magnitude of rainfall is found >0.0355(F) for annual, >0.136(A), 0.0146(C), 0.0047(F) and 0.0093(G) for pre-monsoon, >0.0046(D), >0.0329(F) for post-monsoon, >0.0039(G) for winter and >0.0273(F) for monsoon seasons while all other zones are in decreased nature. Heterogeneously significant rainfall magnitude for annual, pre-monsoon, post-monsoon and monsoon seasons was also found, which includes >.03(F), >0.01(C), >0.03(F), >1.51(F), respectively. The findings recommend adopting operations and advanced design for water management with consideration of agricultural development and climate change.

Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1–8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46–8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41–19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension.

There is compelling evidence in humans that peripheral endocannabinoid signaling is disrupted in obesity. However, little is known about the corresponding central signaling. Here, we have investigated the relationship between gender, leptin, body mass index (BMI) and levels of the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) in the serum and cerebrospinal fluid (CSF) of primarily overweight to obese patients with osteoarthritis. Patients (20 females, 15 males, age range 44-78 years, BMI range 24-42) undergoing total knee arthroplasty for end-stage osteoarthritis were recruited for the study. Endocannabinoids were quantified by liquid chromatography - mass spectrometry. AEA and 2-AG levels in the serum and CSF did not correlate with either age or BMI. However, 2-AG levels in the CSF, but not serum, correlated negatively with CSF leptin levels (Spearman's ρ -0.48, P=0.0076, n=30). No such correlations were observed for AEA and leptin. In the patient sample investigated, there is a negative association between 2-AG and leptin levels in the CSF. This is consistent with pre-clinical studies in animals, demonstrating that leptin controls the levels of hypothalamic endocannabinoids that regulate feeding behavior.

Purpose - The purpose of this paper is to facilitate further understanding of project complexity by highlighting the factors contributing to project complexity as reported by the practitioners facing the \"actuality\" of projects.Design methodology approach - A qualitative research approach was undertaken by conducting semi-structured interviews with the primary focus on the aerospace industry. Participants are involved in a variety of project settings, exhibiting different types and levels of complexity.Findings - Analysis of responses highlights \"people\" issues as the main factor contributing to project complexity and the importance of soft skills in managing complex projects.Research limitations implications - The research is based on a limited number of respondents from the aerospace sector. This will be further refined and improved upon by compiling views of additional practitioners involved in multiple aerospace projects.Practical implications - The main research conclusions are that \"hard\" project management skills help to organise, plan and manage, and track changes during the course of the project. However, understanding of project complexity and its contributing factors helps practitioners to understand the dynamic, social and complex contexts of projects, thus highlighting the importance of \"soft\" skills.Originality value - This paper proposes the \"project complexity triangle - people, product and process\", highlighting their importance as the three major areas contributing to project complexity.

This study investigates drought trends, SPI-SPEI comparisons, and predictions in Rangpur, Bangladesh, from 1979 to 2020. We employed Modified Mann-Kendall for trend analysis, SPI and SPEI for drought assessment, and Pearson Correlation Coefficient and Simple Linear Regression for evaluating SPI and SPEI relationships. Additionally, we utilized ANN, SVM, and RF for prediction. The study revealed notable negative trends in seasonal and annual drought, with the highest z statistics observed for SPI 06 (-2.75), SPI 09 (-4.50), SPI 12 (5.60), SPI 24 (-8.40), SPEI 06 (-5.13), SPEI 09 (-6.82), SPEI 12 (-8.04), and SPEI 24 (-11.20). Strong correlations were identified across all SPI and SPEI indices, with coefficients peaking at 97%, 98%, 98%, and 97% for 06, 09, 12, and 24-month periods, respectively. The comparative assessment favored SPEI over SPI, highlighting its superiority and accuracy. The ANN prediction model showed significant results for short-term and seasonal drought forecasts, projecting SPEI 03 and SPEI 06 increases of 0.02 and 0.24, respectively. However, long-term drought estimation exhibited insignificant performance across all predictive models. This emphasizes the need for developing essential predictive tools for future drought variability.

Background The primary goal of this study was to determine whether administration of intrathecal morphine reduces postoperative pain. The secondary goal was to determine the effect of intrathecal morphine upon circulating levels of the weakly analgesic endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), and the related lipids palmitoylethanolamide (PEA) and oleoylethanolamide (OEA). Methods Forty two total knee arthroplasty (TKA) patients were enrolled in a prospective, double-blinded, randomized study. The intervention consisted of intrathecal morphine (200 μg) or placebo administered at the time of the spinal anesthesia. Postoperative pain was measured during the first 4 h after surgery while serum levels of AEA, 2-AG, PEA, OEA, and cortisol were measured at baseline and 4 h after surgery. Results Administration of intrathecal morphine reduced postoperative pain 4 h after TKA surgery compared to placebo ( p  = 0.005) and reduced postoperative systemic opioid consumption ( p  = 0.001). At baseline, intrathecal morphine led to a significant reduction in AEA, 2-AG, and OEA levels but did not affect PEA or cortisol levels. In patients administered intrathecal placebo, 2-AG levels were elevated 4 h after surgery; whereas patients receiving intrathecal morphine showed reductions in AEA, PEA, and OEA when compared to placebo. At 4 h after TKA surgery cortisol levels were significantly elevated in the placebo group and reduced in those receiving morphine. Conclusions These results indicate that intrathecal morphine reduces postoperative pain in TKA patients. Furthermore, activation of central opioid receptors negatively modulates the endocannabinoid tone, suggesting that potent analgesics may reduce the stimulus for production of peripheral endocannabinoids. This study is the first to document the existence of rapid communication between the central opioid and peripheral endocannabinoid systems in humans. Trial registration This trial was registered retrospectively. Trial registry: NCT02620631 . Study to Examine Pain Relief With Supplemental Intrathecal Morphine in TKA Patients, NCT02620631 , 12/03/2015.

Objective: To assess the impact of COVID-19 pandemic on learning of undergraduate medical students ofKarachi. Study Design: A cross-sectional, observational study. Place and Duration of Study: Study was conducted at conducted at the different public and private medicalcolleges, Karachi, from Mar to Apr 2020. Methodology: Google survey form based cross-sectional study conducted at the different public and privatemedical colleges, Karachi from March till April 2020. Non-probability consecutive sampling technique was used.This questionnaire consisted of 13 items which focused on the impact of COVID-19 pandemic on the learning ofundergraduate medical students from Karachi. Results: The study was conducted on 110 undergraduate students. Out of which, majority of the participantswere from third year 45 (41%) and second year of MBBS 25 (23%). It was found that almost 71% of the undergraduate students had less likely to remember and understand material taught in online class and 60% had less likely to get answers to their queries as compared to regular classes. The results also showed that 49% of the undergraduate students were disturbed by technical issues during online classes. Furthermore, it was also found that learning of 54 out of 110 undergraduate students was always affected due to loss of clinical rotations. Strong association were also found in between online satisfaction and stressful condition due to online classes. Conclusion: It was concluded that COVID-19 pandemic greatly affected the learning of the undergraduatemedical students and have negatively impacted their satisfaction level towards their studies.

A randomized trial evaluating spinal as compared with general anesthesia for hip-fracture surgery in adults 50 years of age or older did not show superiority of spinal anesthesia with respect to a composite of death or an inability to walk unassisted at 60 days. Postoperative delirium occurred in similar percentages of patients in the two groups.