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Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme's acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10–18) days after admission. Each patient received a median of 25.5 (IQR 22.8–34.8) rehabilitation sessions out of a median 27 (22.8–35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation. [ABSTRACT FROM AUTHOR]

Rapid flood prediction in coastal urban areas is an important but challenging task. However, multi-driver floods in coastal areas and their non-linearity in physical processes are hard to represent in physics-based numerical models (PBNMs). In this study, we investigated the performance of surrogate machine learning (ML) models and their flood prediction capability. Initially, we utilize the MIKE+ coupled 1D–2D model to simulate coastal urban flooding in one of the severely flood-affected areas of Ho Chi Minh City (HCMC), Vietnam. Then, nine ML models, including AdaBoost (AB), Decision Tree (DT), Gaussian Process (GP), k-Nearest Neighbors (KNN), Linear Discriminant Analysis (LDA), Naive Bayes (NB), Neural Network (NN), Random Forest (RF), and Support Vector Machine (SVM) are employed to surrogate the PBNM flood prediction performance and engaged to predict flood depths of the study area domain. 806 simulation scenarios of MIKE+ modeling having a spatial grid of 1107 ×1513, grid size = 2 m, extracting 270,000 inundation points to generate input data for nine ML models are used to simulate surface flood depths for the study area. Results show three ML models, GP, RF, and NN, outperform the remaining models, with R2 value of 0.997, 0.996, and 0.995, respectively. Thus, applying ML models can significantly reduce the simulation time by a PBNM, improve accuracy, and potentially be adopted for real-time forecasting and emergency management. [Display omitted] • Application of MIKE+ to simulate inundation in HCMC. • Using 9 machine learnings to surrogate the numeric model. • RF and GP gave the highest performance. • Machine learning gave promising results to surrogate the numeric model. [ABSTRACT FROM AUTHOR]

Background: Central nervous system (CNS) infections are important diseases in both children and adults worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the viral causes of the diseases is of public health importance, in order to better inform immunization policy, and may influence clinical management. Methodology/Principal Findings: Study was conducted at the Hospital for Tropical Diseases in Ho Chi Minh City, a primary, secondary, and tertiary referral hospital for all southern provinces of Vietnam. Between December 1996 and May 2008, patients with CNS infections of presumed viral origin were enrolled. Laboratory diagnostics consisted of molecular and serological tests targeted at 14 meningitis/encephalitis-associated viruses. Of 291 enrolled patients, fatal outcome and neurological sequelae were recorded in 10% (28/291) and 27% (78/291), respectively. Mortality was especially high (9/19, 47%) amongst those with confirmed herpes simplex encephalitis which is attributed to the limited availability of intravenous acyclovir/valacyclovir. Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses were the most common viruses detected, responsible for 36 (12%), 19 (6.5%), 19 (6.5%) and 8 (2.7%) respectively, followed by rubella virus (6, 2%), varicella zoster virus (5, 1.7%), mumps virus (2, 0.7%), cytomegalovirus (1, 0.3%), and rabies virus (1, 0.3%). Conclusions/Significance: Viral infections of the CNS in adults in Vietnam are associated with high morbidity and mortality. Despite extensive laboratory testing, 68% of the patients remain undiagnosed. Together with our previous reports, the data confirm that Japanese encephalitis virus, dengue virus, herpes simplex virus, and enteroviruses are the leading identified causes of CNS viral infections in Vietnam, suggest that the majority of morbidity/mortality amongst patients with a confirmed/probable diagnosis is preventable by adequate vaccination/treatment, and are therefore of public health significance. Author Summary: Central nervous system (CNS) infections are important diseases worldwide. The spectrum of infections is broad, encompassing bacterial/aseptic meningitis and encephalitis. Viruses are regarded as the most common causes of encephalitis and aseptic meningitis. Better understanding of the causes of the diseases is of public health importance, in order to better inform immunization policy, and influence clinical management. We describe the clinical features and infectious causes of 291 adults with clinically suspected CNS infections of presumed viral origin. We show that CNS viral infections in Vietnam are associated with high morbidity and mortality. Mortality was especially high (47%) amongst those with herpes simplex encephalitis which is attributed to the limited availability specific antiviral drugs in our setting. Japanese encephalitis virus, dengue viruses, herpes simplex virus and enteroviruses were the most common viruses detected, followed by rubella virus, varicella zoster virus, mumps virus, cytomegalovirus, and rabies virus. Our study represents the broadest yet investigation of the possible viral causes of the CNS infections in adults in Vietnam, with a diagnostic yield of 32%. The results show that the majority of morbidity/mortality amongst patients with a confirmed/probable diagnosis could be prevented by adequate vaccination or treatment, and are therefore of public health significance. [ABSTRACT FROM AUTHOR]

Background: Dengue viruses (DENV) can be transmitted from an adult female Aedes aegypti mosquito through the germ line to the progeny; however, there is uncertainty if this occurs at a frequency that is epidemiologically significant. We measured vertical transmission of DENV from field-reared Ae. aegypti to their F1 progeny after feeding upon blood from dengue patients. We also examined the transmission potential of F1 females. Methods: We examined the frequency of vertical transmission in field-reared mosquitoes, who fed upon blood from acutely viremic dengue patients, and the capacity for vertically infected females to subsequently transmit virus horizontally, in two sets of experiments: (i) compared vertical transmission frequency of field-reared Ae. aegypti and Ae. albopictus, in individual progeny; and (ii) in pooled progeny derived from field- and laboratory-reared Ae. aegypti. Results: Of 41 DENV-infected and isofemaled females who laid eggs, only a single female (2.43%) transmitted virus to one of the F1 progeny, but this F1 female did not have detectable virus in the saliva when 14 days-old. We complemented this initial study by testing for vertical transmission in another 460 field-reared females and > 900 laboratory-reared counterparts but failed to provide any further evidence of vertical virus transmission. Conclusions: In summary, these results using field-reared mosquitoes and viremic blood from dengue cases suggest that vertical transmission is uncommon. Field-based studies that build on these observations are needed to better define the contribution of vertical DENV transmission to dengue epidemiology. [ABSTRACT FROM AUTHOR]