Objective. To demonstrate proof of concept for a smart phoneempowered community health worker (CHW) model of care for breast health promotion, clinical breast examination (CBE), and patient navigation in rural Bangladesh. Methods. This study was a randomized controlled trial; July 1 to October 31, 2012, 30 CHWs conducted door-to-door interviews of women aged 25 and older in Khulna Division. Only women who disclosed a breast symptom were offered CBE. Arm A: smart phone with applications to guide interview, report data, show motivational video, and offer appointment for women with an abnormal CBE. Arm B: smart phone/ applications identical to Arm A plus CHW had training in "patient navigation" to address potential barriers to seeking care. Arm C: control arm (no smart phone; same interview recorded on paper). Outcomes are presented as the "adherence" (to advice regarding a clinic appointment) for women with an abnormal CBE. This study was approved by Women's College Hospital Research Ethics Board (Toronto, Ontario, Canada) and district government officials (Khulna, Bangladesh). Funded by Grand Challenges Canada. Results. In 4 months, 22,337 women were interviewed; ,1% declined participation, and 556 women had an abnormal CBE. Control group CHWs completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence. Conclusion. CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group. CHW "navigators" were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance. The Oncologist 2014;19:177-185 Implications for Practice: In low-income countries such as Bangladesh, there are few opportunities for affordable, quality care for breast cancer. Gender inequity and cancer myths limit a woman's choice to seek care if she finds a breast lump.This is the first study to suggest that we can make an impact on breast cancer with basic training of community health workers guided by smart phone applications.With just 1 day of extra training in "patient navigation," we also show that social and cultural issues can be addressed, which improve the likelihood that women with a serious breast problem will attend for proper care.

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This study investigates the magnetohydrodynamic (MHD) flow of ferrofluid along a stretching cylinder. The velocity slip and prescribed surface heat flux boundary conditions are employed on the cylinder surface. Water as conventional base fluid containing nanoparticles of magnetite (Fe3O4) is used. Comparison between magnetic (Fe3O4) and non-magnetic (Al2O3) nanoparticles is also made. The governing non-linear partial differential equations are reduced to non-linear ordinary differential equations and then solved numerically using shooting method. Present results are compared with the available data in the limiting cases. The present results are found to be in an excellent agreement. It is observed that with an increase in the magnetic field strength, the percent difference in the heat transfer rate of magnetic nanoparticles with Al2O3 decreases. Surface shear stress and the heat transfer rate at the surface increase as the curvature parameter increases, i.e curvature helps to enhance the heat transfer.

Background Despite advances in prevention, detection, and treatment, cholera remains a major public health problem in Bangladesh and little is known about cholera outside of limited historical sentinel surveillance sites. In Bangladesh, a comprehensive national cholera control plan is essential, although national data are needed to better understand the magnitude and geographic distribution of cholera. Methods We conducted systematic hospital-based cholera surveillance among diarrhea patients in 22 sites throughout Bangladesh from 2014 to 2018. Stool specimens were collected and tested for Vibrio cholerae by microbiological culture. Participants’ socioeconomic status and clinical, sanitation, and food history were recorded. We used generalized estimating equations to identify the factors associated with cholera among diarrhea patients. Results Among 26 221 diarrhea patients enrolled, 6.2% (n = 1604) cases were V. cholerae O1. The proportion of diarrhea patients positive for cholera in children <5 years was 2.1% and in patients ≥5 years was 9.5%. The proportion of cholera in Dhaka and Chittagong Division was consistently high. We observed biannual seasonal peaks (pre- and postmonsoon) for cholera across the country, with higher cholera positivity during the postmonsoon in western regions and during the pre–monsoon season in eastern regions. Cholera risk increased with age, occupation, and recent history of diarrhea among household members. Conclusions Cholera occurs throughout a large part of Bangladesh. Cholera-prone areas should be prioritized to control the disease by implementation of targeted interventions. These findings can help strengthen the cholera-control program and serve as the basis for future studies for tracking the impact of cholera-control interventions in Bangladesh.

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