Cultural Dilemmas of Choice: Deconstructing Consumer Choice in Health Communication Between Maternity-Care Providers and Ethnic Chinese Mothers in New Zealand

This article critically analyses the discourse of consumer choice embedded in health communication interactions between maternity-care providers and migrant ethnic Chinese mothers in New Zealand. Findings indicate that Chinese mothers, as the customers of the New Zealand maternity and health care services, are encouraged to “fit in” with the Western discourse of choice. However, the mothers’ cultural predispositions for childbirth and communication have a significant impact on the ways in which they respond to and resist this discourse. Drawing on theoretical insights from postcolonialism and Third World feminism, this article contributes to the study of intercultural health communication by examining cultural dilemmas in the discourse of choice that is often taken for granted in Western health contexts. In doing so, it builds a platform for an inclusive maternity care and health environment in multicultural societies.     

Scalable deep learning to identify brick kilns and aid regulatory capacity

Improving compliance with environmental regulations is critical for promoting clean environments and healthy populations. In South Asia, brick manufacturing is a major source of pollution but is dominated by small-scale, informal producers who are difficult to monitor and regulate—a common challenge in low-income settings. We demonstrate a low-cost, scalable approach for locating brick kilns in high-resolution satellite imagery from Bangladesh. Our approach identifies kilns with 94.2% accuracy and 88.7% precision and extracts the precise GPS coordinates of every brick kiln across Bangladesh. Using these estimates, we show that at least 12% of the population of Bangladesh (>18 million people) live within 1 km of a kiln and that 77% and 9% of kilns are (illegally) within 1 km of schools and health facilities, respectively. Finally, we show how kilns contribute up to 20.4 μg/m3 of PM2.5 (particulate matter of a diameter less than 2.5 μm) in Dhaka when the wind blows from an unfavorable direction. We document inaccuracies and potential bias with respect to local regulations in the government data. Our approach demonstrates how machine learning and Earth observation can be combined to better understand the extent and implications of regulatory compliance in informal industry.

Enforcing environmental regulations is notoriously difficult. Regulatory agencies often lack information on compliance and the ability to effectively punish or sanction violators (1–4). A growing literature demonstrates how advances in Earth observation and machine learning can reduce the costs of monitoring, enforcement, and compliance of environmental regulations and support regulatory agencies (5–8). However, most of this literature focuses on applications in highly developed countries where the location of firms is readily observed. In developing countries where informal industries such as brick kilns, tanneries, and small-scale mines are responsible for substantial pollution, these problems are exacerbated both because the location and activity of these firms is hard to observe and because resources for regulatory enforcement are often limited (9).Brick manufacturing is an excellent case to develop data-driven, low-cost approaches for environmental compliance. First and foremost, this industry is associated with substantial environmental and health harm. Traditional kilns emit a number of pollutants and greenhouse gases into the atmosphere, including particulate matter of a diameter less than 2.5 μm (PM2.5), which can be inhaled deep inside the lungs and cause significant disease and mortality, and black carbon, which is a major driver of climate change (10–13). Models estimate that brick manufacturing is responsible for 30 to 50% of the PM2.5 in Dhaka during the winter months when kilns operate (11, 12) and is responsible for 17% of Bangladesh’s total annual CO2 emissions (14). Recent estimates suggest that life expectancy in Bangladesh is reduced on average by 1.87 y per person due to air pollution, which is more than any other country in the world (15). In Bangladesh, which lacks domestic sources of many other construction materials, brick production is central to construction (16, 17). As a result, traditional kilns have proliferated rapidly over the past few decades (17, 18).Second, brick kilns lend themselves to an object detection approach. In Bangladesh, and across South Asia, bricks are produced in traditional, highly inefficient, coal-fired kilns (16–18). Brick kilns are very visually distinct, reasonably large, and surrounded by rows of drying bricks, making them visible in satellite images (see SI Appendix, Fig. S1 for example images of kilns).Knowing precisely where all of the brick kilns in Bangladesh are located can help regulatory agencies or civil society target violations, identify populations who are at risk, and support better policy and regulatory decisions. To legally establish a kiln in Bangladesh, an owner must register with the government and obtain environmental clearance, but many eschew this formal process; enforcement against unregistered kilns is minimal (16, 19). The Government of Bangladesh (GoB) recently launched a study to manually map and verify the locations of brick kilns across the country (20)—an incredibly time- and labor-intensive effort that underscores the importance of obtaining this information for the government. As informal kilns are constantly being constructed, this manual mapping approach is also a highly inefficient way to obtain the high-frequency information necessary for monitoring. Moreover, government data in low-income countries is often inaccurate and subject to bias (21).Here we develop a scalable, deep-learning pipeline for accurately locating brick kilns across a broad geography. Brick kilns are visually distinct in satellite imagery, but it is expensive and time-consuming to annotate images with their exact locations. We make improvements on two recent papers that use machine-learning methods to identify brick kilns (22, 23) by presenting an approach that only requires classification-level annotations (indicating whether an image contains a brick kiln or not) to train a single model that performs the more difficult task of detection (indicating where within an image the brick kiln is located). Building on past applications of deep-learning to environmental monitoring (5, 6, 23), and on specific efforts to use deep learning to identify brick kilns (22, 23), we develop a weakly supervised learning approach that learns to localize kilns given lower cost classification-level data, rebuilds kilns that have been fragmented across multiple images, an inherent problem with satellite imagery, and distinguishes between two kiln technologies, based on their shape. To produce this final model, we conducted two main model development steps to improve the accuracy of our approach, first training an initial model on a small, limited dataset, using it to classify images from different parts of the country, and then hand-validating the predictions to incorporate them into an expanded and improved training dataset (Materials and Methods). We show how our approach is robust to the visual, geographic diversity of satellite imagery. We also demonstrate its scalability. Although our approach required human input during model development, this is a one-time fixed cost; our model is virtually free to run repeatedly and generate predictions across huge geographies without further input.We then demonstrate how this map of brick kiln locations can be used to study compliance with environmental regulations, show how populations are exposed to brick manufacturing nationally, and examine the contribution of kilns to air pollution in Dhaka.     

Changes in body composition and its relation to muscle strength in 75-year-old men and women: A 5-year prospective follow-up study of the NORA cohort in Göteborg,Sweden

ObjectiveThe purpose of this study was to explore the association between body composition in the elderly and subsequent changes in muscle strength during aging.MethodsThis was a longitudinal study with a 5-y follow-up. Eighty-seven men (n = 38) and women (n = 49) from a random sample of 75-y-old subjects in the Göteborg part of the Nordic Research on Aging study who were investigated at ages 75 and 80 y and were free from any major diseases at baseline were included. Body composition was estimated from bioelectrical impedance. The maximal isometric strengths of handgrip, arm flexion, and knee extension were measured on the side of the dominant hand while a subject was in a sitting position in an adjustable dynamometer chair.ResultsFat-free mass decreased significantly (P < 0.001) in both sexes, but more in men. Percentage of body fat increased only in men (P < 0.05). Body height decreased in both sexes, but more in women (P < 0.001). Declines in muscle strengths were evident for all muscle groups in both sexes but more prominent in men. It was observed that body composition status at baseline, measured as fat-free mass and fat-free mass index, was a statistically significant predictor for decline in muscle strength, particularly in the extremities.ConclusionFat-free mass at age 75 y was associated with lower 5-y decline in muscle strength. This finding underscores the potential importance of fat-free mass for maintaining functional ability during aging.     

Healthcare cost of type 2 diabetes mellitus in Bangladesh: a hospital-based study

Healthcare-related expenditure for diabetes is increasing at an alarming rate all over the world, resulting in a huge burden on patients. The purpose of this cross-sectional study was to estimate the healthcare cost incurred by patients with type 2 diabetes mellitus (T2DM). The study included 531 registered patients with diabetes of more than 1 year. All the treatment-related records of the last 12 months were collected from the patients’ guide books. Data were analyzed to determine the average cost (exchange rate: US$1?=?Bangladeshi Taka 80) incurred by the diabetic patients in treating the disease and were calculated based on the total amount spent by them to that of total number of patients. The mean?±?SD age of the patients (male 46.5 % and female 53.5 %) was 53.0?±?10 years with duration of diabetes 9?±?6.7 years. The average annual cost of care was US$314 (direct cost US$283 and indirect cost US$31). Drugs accounted for the largest share (68 %) of the direct cost, followed by laboratory investigations (12.5 %) and consultation fees (11.7 %). Results of bivariate analysis showed that the annual direct cost of care significantly increased with age, monthly household income, duration of diabetes, and the number of co-morbidities/complications. However, results of multivariable analysis showed that, except age, all other remained significant (p?<?0.001) explanatory variable of direct cost. The annual cost of diabetes care per person in the outpatient department of a tertiary care facility was US$314. Based on this finding, it is estimated that the total annual burden of some 5.1 million diabetic patients will be US$1.5 billion, which is a large burden for a developing country like Bangladesh. Primary prevention should be in focus to combat the economic burden of diabetes.     

Relapsing polychondritis—case series from South India

Extraspinal musculoskeletal tuberculosis (TB) was an uncommon manifestation with a frequency about 1 to 2% in all TB patients. According to the report, tuberculous arthritis and osteomyelitis remained the two leading etiologies, while others constituted less than 2% of all extraspinal musculoskeletal tuberculous infections; less than 0.04% of those who suffered from TB were represented as extraspinal musculoskeletal tuberculous infections, neither tuberculous arthritis- nor osteomyelitis-associated. We presented one extremely rare case of primary tuberculous myofasciitis manifesting painful swelling on the left thigh without previous history of tuberculous infection in a patient with dermatomyositis. We also lodged several predisposing symptoms, such as gradually enlarging swelling of extremity within months and proximal muscle painful weakness with prompt response to steroid, which may help early diagnosing of analogous extraspinal musculoskeletal tuberculosis in dermatomyositis patients; and seasonable administrating of anti-TB agents could prevent deterioration in advance.     

Recent advances in flavivirus antiviral drug discovery and vaccine development

Many flaviviruses, including yellow fever virus, dengue virus, Japanese encephalitis virus, tick-borne encephalitis virus, and West Nile virus, are globally important human pathogens. Despite an emergence and resurgence of flavivirus-mediated disease, specific therapies are not yet available; however, significant progress has been made toward the prevention and treatment of flavivirus infections. In this article we review recent advances made in the areas of (i) flavivirus vaccine development, and (ii) antiflavivirus drug discovery reported in literature and patents, and highlight strategies used in these investigations.     

Repeated ethanol treatment in adolescent rats alters cortical NMDA receptor.

Earlier we have reported that repeated ethanol treatment during adolescence causes long-lasting impairments in spatial learning and memory. The present study was undertaken to determine the cellular mechanisms underlying the persistent ethanol-induced cognitive dysfunction in adolescent male rats. Since in adult animals ethanol is known to affect the N-methyl-d-aspartate (NMDA) receptor-gated ion channel, the hypothesis tested here was that adolescent ethanol exposure modulates NMDA receptor (NR) regulation in the brain. Adolescent male rats were injected daily with ethanol (2g/kg intraperitoneally) for 5 consecutive days. Control rats received isovolumetric saline for the same number of days. Groups of control and experimental rats were sacrificed 7 days after the last ethanol/saline administration, and NR activity was measured in specific brain regions (frontal cortex, hippocampus) using the [(3)H]MK-801 binding assay. In addition, some rats were sacrificed and their brains were used to investigate changes in NR pharmacology by measuring specific NR2 subunits immunohistochemically. Compared to saline-treated controls, ethanol-treated rats showed significant increases in [(3)H]MK-801 maximal binding in the frontal cortex. This was associated with increased cortical NR2B subunit protein. [(3)H]MK-801 binding in the hippocampus was minimally affected. These results indicate that ethanol exposure during the adolescent period produces brain region-specific alterations in NR activity. These changes are different from those reported in literature for ethanol administration during the perinatal period or adulthood. Together, these data suggest that adolescence represents a unique stage in brain development in its long-term sensitivity to ethanol.