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Satellite precipitation products from the Global Precipitation Measurement (GPM) mission and its predecessor the Tropical Rainfall Measuring Mission (TRMM) are a critical data source for hydrological applications in ungauged basins. This study conducted an initial and early evaluation of the performance of the Integrated Multi-satellite Retrievals for GPM (IMERG) final run and the TRMM Multi-satellite Precipitation Analysis 3B42V7 precipitation products, and their feasibility in streamflow simulations in the Chindwin River basin, Myanmar, from April 2014 to December 2015 was also assessed. Results show that, although IMERG and 3B42V7 can potentially capture the spatiotemporal patterns of historical precipitation, the two products contain considerable errors. Compared with 3B42V7, no significant improvements were found in IMERG. Moreover, 3B42V7 outperformed IMERG at daily and monthly scales and in heavy rain detections at four out of five gauges. The large errors in IMERG and 3B42V7 distinctly propagated to streamflow simulations via the Xinanjiang hydrological model, with a significant underestimation of total runoff and high flows. The bias correction of the satellite precipitation effectively improved the streamflow simulations. The 3B42V7-based streamflow simulations performed better than the gauge-based simulations. In general, IMERG and 3B42V7 are feasible for use in streamflow simulations in the study area, although 3B42V7 is better suited than IMERG.

Serologic and molecular surveillance of serum collected from 152 suspected scrub typhus patients in Myanmar revealed Orientia tsutsugamushi of genotypic heterogeneity. In addition, potential co-infection with severe fever with thrombocytopenia syndrome virus was observed in 5 (3.3%) patients. Both scrub typhus and severe fever with thrombocytopenia syndrome are endemic in Myanmar.

There has been limited research on the health impacts of extreme bushfire exposure among emergency responders (ER) involved in suppressing extreme bushfires. This study aimed to evaluate the associations between extreme bushfires and ER’s compensated injury and illness in Victoria, Australia. State-wide ER compensation claims from January 2005 to April 2023 were analysed. Logistic regression modelling was used to identify factors associated with compensation claims during the extreme bushfire periods in 2009 and 2019/20, compared to all other claims, adjusting for seasonality (summer). Of the 44,164 included claims, 1105 (2.5%) had recorded injury/disease onset dates within extreme bushfire periods, and 11,642 (26.4%) occurred in summer months. Over half of claims were made by police (52.4%), followed by ambulance officers/paramedics (27.2%) and firefighters (20.5%). Extreme bushfire period claims were associated with older workers (odds ratio/OR = 1.58,95%CI = 1.30–1.92, ages ≥ 55 vs. 35–44 years). Mental disorders (OR = 1.61,95%CI = 1.25–2.07), intracranial injuries (OR = 3.04,95%CI = 1.69–5.48) and infections/parasites (OR = 3.11,95%CI = 1.61–5.98) vs. wounds were associated with extreme bushfire period claims. Given the expected increase in extreme bushfire events and the ageing workforce, study findings underscore the importance of primary and secondary prevention in ER. This can include periodic health surveillance for older workers, access to early treatment, and ongoing support for mental health conditions.

Extreme bushfires are devastating and costly and are predicted to increase in frequency. This project investigated emergency responders’ (ER) compensable injury/disease costs associated with extreme bushfire periods compared with the general workforce. Workers’ compensation claims data for Victoria, Australia, were sourced for ER and controls (10% of the general workforce) from January 2005 to April 2021 (encompassing two extreme bushfires). Using generalised linear models, claims from ambulance officers, career firefighters, police, and controls were compared across extreme bushfires, other summers, and all other periods. In total, ER made 749/24,008 (3.1%) claims in extreme bushfire periods, compared to 1254/49,484 (2.5%) in the controls. The study group overall (including both ER and the general workforce control group) experienced significantly higher income compensation costs/claims during extreme bushfire periods, with a 31% increase. ER’ costs/claims were highest for mental illness, burns and cancer. After accounting for bushfire impacts on the general workforce, total claims costs were increased by 67% among firefighters in extreme bushfire periods, largely attributable to fatality payments (other non-medical expenses). These results highlight the need for targeted injury prevention for fatal and non-fatal injuries among ERs and measures that address the broader socio-economic impacts on ERs and the general workforce.

Humans and dogs are the two major hosts of Strongyloides stercoralis , an intestinal parasitic nematode. To better understand the phylogenetic relationships among S . stercoralis isolates infecting humans and dogs and to assess the zoonotic potential of this parasite, we analyzed mitochondrial Cox1, nuclear 18S rDNA, 28S rDNA, and a major sperm protein domain-containing protein genes. Overall, our analyses indicated the presence of two distinct lineages of S . stercoralis (referred to as type A and type B). While type A parasites were isolated both from humans and dogs in different countries, type B parasites were found exclusively in dogs, indicating that the type B has not adapted to infect humans. These epidemiological data, together with the close phylogenetic relationship of S . stercoralis with S . procyonis , a Strongyloides parasite of raccoons, possibly indicates that S . stercoralis originally evolved as a canid parasite, and later spread into humans. The inability to infect humans might be an ancestral character of this species and the type B might be surmised to be an origin population from which human-infecting strains are derived.

In out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA. This was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models. 40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR=6.10, 95% confidence interval/CI=5.06–7.34) and subsequent conversion to shockable rhythm (OR=2.00,95%CI=1.10–3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses. Initial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy.

The helminth Strongyloides stercoralis, which is transmitted through soil, infects 30-100 million people worldwide. S. stercoralis reproduces sexually outside the host as well as asexually within the host, which causes a life-long infection. To understand the population structure and transmission patterns of this parasite, we re-sequenced the genomes of 33 individual S. stercoralis nematodes collected in Myanmar (prevalent region) and Japan (non-prevalent region). We utilised a method combining whole genome amplification and next-generation sequencing techniques to detect 298,202 variant positions (0.6% of the genome) compared with the reference genome. Phylogenetic analyses of SNP data revealed an unambiguous geographical separation and sub-populations that correlated with the host geographical origin, particularly for the Myanmar samples. The relatively higher heterozygosity in the genomes of the Japanese samples can possibly be explained by the independent evolution of two haplotypes of diploid genomes through asexual reproduction during the auto-infection cycle, suggesting that analysing heterozygosity is useful and necessary to infer infection history and geographical prevalence.

Data on causes of community-onset bloodstream infection in Myanmar are scarce. We aimed to identify etiological agents of bloodstream infections and patterns of antimicrobial resistance among febrile adolescents and adults attending Yangon General Hospital (YGH), Yangon, Myanmar. We recruited patients ≥12 years old with fever ≥38°C who attended YGH from 5 October 2015 through 4 October 2016. A standardized clinical history and physical examination was performed. Provisional diagnoses and vital status at discharge was recorded. Blood was collected for culture, bloodstream isolates were identified, and antimicrobial susceptibility testing was performed. Using whole-genome sequencing, we identified antimicrobial resistance mechanisms of Enterobacteriaceae and sequence types of Enterobacteriaceae and Streptococcus agalactiae. Among 947 participants, 90 (9.5%) had bloodstream infections (BSI) of which 82 (91.1%) were of community-onset. Of 91 pathogens isolated from 90 positive blood cultures, we identified 43 (47.3%) Salmonella enterica including 33 (76.7%) serovar Typhi and 10 (23.3%) serovar Paratyphi A; 20 (22.0%) Escherichia coli; 7 (7.7%) Klebsiella pneumoniae; 6 (6.6%), Staphylococcus aureus; 4 (4.4%) yeasts; and 1 (1.1%) each of Burkholderia pseudomallei and Streptococcus agalactiae. Of 70 Enterobacteriaceae, 62 (88.6%) were fluoroquinolone-resistant. Among 27 E. coli and K. pneumoniae, 18 (66.6%) were extended-spectrum beta-lactamase (ESBL)-producers, and 1 (3.7%) each were AmpC beta-lactamase- and carbapenemase-producers. Fluoroquinolone resistance was associated predominantly with mutations in the quinolone resistance-determining region. blaCTX-M-15 expression was common among ESBL-producers. Methicillin-resistant S. aureus was not detected. Fluoroquinolone-resistant, but not multiple drug-resistant, typhoidal S. enterica was the leading cause of community-onset BSI at a tertiary hospital in Yangon, Myanmar. Fluoroquinolone and extended-spectrum cephalosporin resistance was common among other Enterobactericeae. Our findings inform empiric management of severe febrile illness in Yangon and indicate that measures to prevent and control enteric fever are warranted. We suggest ongoing monitoring and efforts to mitigate antimicrobial resistance among community-onset pathogens.

Introduction: Bystander cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest. The use of certain songs as mental metronomes for CPR have been validated and recognised by contemporary guidelines. We hypothesise that the National Day song, Count on me Singapore (COMS CPR), is not inferior to standard ‘one-and-two-and-three-and-four’ counting (standard CPR) for timing CPR, in terms of the proportion of participants achieving the guideline compression rate of 100–120/minute. Methods: This was a prospective randomised crossover trial powered to demonstrate non-inferiority in the CPR rate. After a familiarisation session, volunteers were randomly assigned to two groups. Group A performed one cycle of standard CPR while group B performed one cycle of COMS CPR. Participants then crossed over to perform the other method. The Laerdal SkillReporter measured CPR quality. Four weeks later, participants attended a test scenario, using standard CPR or COMS CPR (randomly allocated). Results: Ninety subjects were recruited; 46 were randomly assigned to group A and 44 to group B. Baseline characteristics were similar; 41.1% of COMS CPR achieved 100–120/minute, versus 28.9% of standard CPR (P=0.028). In mixed effects logistical regression, significantly more COMS CPR was performed at 100–120/minute compared to standard CPR (odds ratio 2.44, 95% confidence interval 1.01–5.9, P=0.047). The proportion of insufficient depth was higher in COMS CPR (80.59% vs. 68.01%, P<0.001). There were no differences in other aspects of CPR quality. There were no differences in CPR quality between standard CPR and COMS CPR during the follow-up. Conclusion: COMS CPR was not inferior in terms of the proportion of participants delivering a guideline-compliant rate of chest compression. COMS CPR may have applications to layman CPR education, such as in mass education events.

To investigate the independent relationship of individual- and area-level socio-economic status (SES) with the presence and severity of visual impairment (VI) in an Asian population. Cross-sectional data from 9993 Chinese, Malay and Indian adults aged 40-80 years who participated in the Singapore Epidemiology of eye Diseases (2004-2011) in Singapore. Based on the presenting visual acuity (PVA) in the better-seeing eye, VI was categorized into normal vision (logMAR≤0.30), low vision (logMAR>0.30<1.00), and blindness (logMAR≥1.00). Any VI was defined as low vision/blindness in the PVA of better-seeing eye. Individual-level low-SES was defined as a composite of primary-level education, monthly income<2000 SGD and residing in 1 or 2-room public apartment. An area-level SES was assessed using a socio-economic disadvantage index (SEDI), created using 12 variables from the 2010 Singapore census. A high SEDI score indicates a relatively poor SES. Associations between SES measures and presence and severity of VI were examined using multi-level, mixed-effects logistic and multinomial regression models. The age-adjusted prevalence of any VI was 19.62% (low vision = 19%, blindness = 0.62%). Both individual- and area-level SES were positively associated with any VI and low vision after adjusting for confounders. The odds ratio (95% confidence interval) of any VI was 2.11(1.88-2.37) for low-SES and 1.07(1.02-1.13) per 1 standard deviation increase in SEDI. When stratified by unilateral/bilateral categories, while low SES showed significant associations with all categories, SEDI showed a significant association with bilateral low vision only. The association between low SES and any VI remained significant among all age, gender and ethnic sub-groups. Although a consistent positive association was observed between area-level SEDI and any VI, the associations were significant among participants aged 40-65 years and male. In this community-based sample of Asian adults, both individual- and area-level SES were independently associated with the presence and severity of VI.