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Abstract Background Black men consistently have higher rates of prostate cancer (PCA)- related mortality. Advances in PCA treatment, screening, and hereditary cancer assessment center around germline testing (GT). Of concern is the significant under-engagement of Black males in PCA GT, limiting the benefit of precision therapy and tailored cancer screening despite longstanding awareness of these disparities. To address these critical disparities, the Socioecological Model (SEM) was employed to develop comprehensive recommendations to overcome barriers and implement equitable strategies to engage Black males in PCA GT. Methods Clinical/research experts, national organization leaders, and community stakeholders spanning multiple regions in US and Africa participated in developing a framework for equity in PCA GT grounded in the SEM. A novel mixed-methods approach was employed to generate key areas to be addressed and informed statements for consensus consideration utilizing the modified Delphi model. Statements achieving strong consensus (> =75% agreement) were included in final equity frameworks addressing clinical/community engagement and research engagement. Results All societal levels of the SEM (interpersonal, institutional, community, and policy/advocacy) must deliver information about PCA GT to Black males that address benefits/limitations, clinical impact, hereditary cancer implications, with acknowledgment of mistrust (mean scores [MS] 4.57-5.00). Interpersonal strategies for information delivery included engagement of family/friends/peers/Black role models to improve education/awareness and overcome mistrust (MS 4.65-5.00). Institutional strategies included diversifying clinical, research, and educational programs and integrating community liaisons into healthcare institutions (MS 4.57-5.00). Community strategies included partnerships with healthcare institutions and visibility of healthcare providers/researchers at community events (MS 4.65–4.91). Policy/advocacy included improving partnerships between advocacy and healthcare/community organizations while protecting patient benefits (MS 4.57-5.00). Media strategies were endorsed for the first time at every level (MS 4.56-5.00). Conclusion The SEM-based equity frameworks proposed provide the first multidisciplinary strategies dedicated to increase engagement of Black males in PCA GT, which are critical to reduce disparities in PCA-mortality through informing tailored screening, targeted therapy, and cascade testing in families.

Abstract Background Tumor-immune interactions shape a developing tumor and its tumor immune microenvironment (TIME) resulting in either well-infiltrated, immunologically inflamed tumor beds, or immune deserts with low levels of infiltration. The pre-treatment immune make-up of the TIME is associated with treatment outcome; immunologically inflamed tumors generally exhibit better responses to radio- and immunotherapy than non-inflamed tumors. However, radiotherapy is known to induce opposing immunological consequences, resulting in both immunostimulatory and inhibitory responses. In fact, it is thought that the radiation-induced tumoricidal immune response is curtailed by subsequent applications of radiation. It is thus conceivable that spatially fractionated radiotherapy (SFRT), administered through GRID blocks (SFRT-GRID) or lattice radiotherapy to create areas of low or high dose exposure, may create protective reservoirs of the tumor immune microenvironment, thereby preserving anti-tumor immune responses that are pivotal for radiation success. Methods We have developed an agent-based model (ABM) of tumor-immune interactions to investigate the immunological consequences and clinical outcomes after $$2\,\text{Gy} \times 35$$ 2 Gy × 35 whole tumor radiation therapy (WTRT) and SFRT-GRID. The ABM is conceptually calibrated such that untreated tumors escape immune surveillance and grow to clinical detection. Individual ABM simulations are initialized from four distinct multiplex immunohistochemistry (mIHC) slides, and immune related parameter rates are generated using Latin Hypercube Sampling. Results In silico simulations suggest that radiation-induced cancer cell death alone is insufficient to clear a tumor with WTRT. However, explicit consideration of radiation-induced anti-tumor immunity synergizes with radiation cytotoxicity to eradicate tumors. Similarly, SFRT-GRID is successful with radiation-induced anti-tumor immunity, and, for some pre-treatment TIME compositions and modeling parameters, SFRT-GRID might be superior to WTRT in providing tumor control. Conclusion This study demonstrates the pivotal role of the radiation-induced anti-tumor immunity. Prolonged fractionated treatment schedules may counteract early immune recruitment, which may be protected by SFRT-facilitated immune reservoirs. Different biological responses and treatment outcomes are observed based on pre-treatment TIME composition and model parameters. A rigorous analysis and model calibration for different tumor types and immune infiltration states is required before any conclusions can be drawn for clinical translation.

Abstract Urbanization in Sub-Saharan Africa requires vast quantities of sand to meet infrastructural demands. In Accra, Ghana, sand mining occurs predominantly on farmlands at the city’s periphery. We selected three study communities to assess the effects of sand mining on agriculture using interviews with local farmers and soil analyses of mined and unmined fields. The results underscore the profound repercussions of sand mining on farmers, characterized by substantial agricultural land loss, the destruction of food crops, and the absence of compensation payments or land reclamation. The study further reveals a significant decline in soil fertility of mined fields compared to unmined fields as evidenced by reduced levels of carbon (C, by 6.3 g kg-1) and macronutrients (nitrogen (N, by 0.6 g kg-1), phosphorus (P, 12.7 mg kg-1), potassium (K, 77 mg kg-1) and magnesium (Mg, 88 mg kg-1)), and an increase in soil compaction (bulk density by 0.13 g cm-3 and penetration resistance by 0.11 MPa). Soil texture and pH were altered and sodium (Na, by 16 mg kg-1) and soil moisture (by 4%) increased. On a communal level, sand mining adversely affected water availability, road infrastructure, and the health of residents. The study fills research gaps on the effects of sand mining on agricultural productivity, soil fertility and livelihoods, emphasizing the urgent need for effective regulation, law enforcement and collaboration as well as compensation and land reclamation mechanisms to limit the adverse impacts of sand mining on ecosystem services. Further, the use of more sustainable building materials should be fostered to reduce the demand for sand in Ghana.

COVID-19 has revolutionised assessment design and practices in higher education; however, there has not been a shift in the overall objective of enhancing that the association between assessments and learning promotes the holistic development of students. In this study, we provide an empirical evaluation of the perceived effects of assessment practices (invigilated examination and alternative assessments) on students’ mental wellbeing, learning processes and academic misconduct. A cross-sectional study design was employed for this study in which a self-reported survey instrument was administered to 380 social science and nursing undergraduate and postgraduate students in a public university in Australia. We explored the correlations within defined networks by path analysis via partial least square structural equation modelling (PLS-SEM) framework of SmartPLS 3. Model assessment indexes indicated acceptable convergent, divergent and construct validity scores for the instrument used. Compared to invigilated exams, students perceived alternative assessments to have significant positive direct effects on stress levels, research skills, learning process and time management (). In relation to academic misconduct, students generally perceived invigilated exams to restrain such practices; however, the perceived effect was not statistically significant when compared with alternative assessments (. Although, the popularity of alternative assessment practices may have been driven by COVID-19, the pilot findings from this study suggest these assessment designs and practices have greater potential to promote overall student success and productivity and must be encouraged and utilised in the post-COVID-19 era.

The impact of vaccine hesitancy on global health is one that carries dire consequences. This was evident during the outbreak of the COVID-19 pandemic, where numerous theories and rumours emerged. To facilitate targeted actions aimed at increasing vaccine acceptance, it is essential to identify and understand the barriers that hinder vaccine uptake, particularly regarding the COVID-19 vaccine in Ghana, one year after its introduction in the country.We conducted a cross-sectional study utilizing self-administered questionnaires to determine factors, including barriers, that predict COVID-19 vaccine uptake among clients visiting a tertiary and quaternary hospital using some machine learning algorithms. Among the findings, machine learning models were developed and compared, with the best model employed to predict and guide interventions tailored to specific populations and contexts. A random forest model was utilized for prediction, revealing that the type of facility respondents visited and the presence of underlying medical conditions were significant factors in determining an individual's likelihood of receiving the COVID-19 vaccine. The results showed that machine learning algorithms can be of great use in determining COVID-19 vaccine uptake.

Aim – This study aims to explore the intricate interplay between organizational culture, policies, and productivity within a major public institution in Ghana. The primary purpose is to investigate the relationships between organizational policies, characteristics of organizational culture, and non-financial indicators of organizational productivity. Design/methodology/approach – This study utilizes a descriptive survey design, using a sample of 119 respondents randomly selected from a population of 1489 employees. Advanced statistical techniques, including Pearson Correlation and Multiple Linear Regression, are employed to identify relationships and test hypotheses. Findings – The results indicate positive and statistically significant relationships between organizational policies, cultural characteristics, and productivity. Multiple linear regression analysis supported the hypothesis, demonstrating a substantial influence of these factors on productivity. Notably, a moderate to strong positive correlation was found, highlighting the critical role of organizational culture in fostering improved performance. Limitations – Reliance on self-reported data raises concerns about social desirability bias. Additionally, the descriptive survey design allows for the identification of correlations, but causal relationships between variables cannot be established. Practical implications – This research highlights the importance of strategic policies and a supportive culture for public sector productivity. Clear policy implementation, leadership fostering a positive work environment, and engagement in policymaking likely enhance performance, particularly within diverse workforces. However, future research should explore causal relationships between these factors and productivity for deeper understanding and continuous optimization. Originality/value – This study investigates the combined effects of organizational culture, policy clarity, and employee participation on productivity in a Ghanaian public institution. It contributes to the literature by confirming the positive influence of a supportive culture and well-defined policies, while emphasizing the importance of employee involvement in policy development. These findings offer practical insights for leaders seeking to enhance productivity in similar contexts.

Medication adherence strategies that are successful, suitable and economical are vital to the treatment outcome of persons living with mental illness. Mobile-phone-based intervention is one such strategy and is particularly critical to reducing medication non-adherence, especially in mental health disorders. This study aimed to assess the impact of telephone adherence counselling on medication adherence in persons with mental health disorders. A longitudinal study was conducted on study participants who were randomly assigned to control and intervention groups over three months. Both groups received standard medication adherence counselling for the first month and then baseline adherence levels were determined using the medication adherence rating scale (MARS). The control group received standard medication adherence counselling at the psychiatric clinic whilst the intervention group received additional telephone calls made to each member of the intervention group once a week for a total of 8 times over 2 months. Of the patients who were screened for potential participation, 149 participants passed and 87 participants participated making a response rate of 58.40 %. The t-test conducted on the participants after the first (Month 2) and second (Month 3) on those with Telephone Call Intervention inferred significant statistical differences (p < 0.001). MARS Scores appreciated in the intervention group compared to the control group in Month 2 (1.64) and Month 3 (1.79). A positive impact of Telephone Call Interventions on medication adherence was achieved. This intervention can be a medication adherence strategy to supplement the standard medication adherence counselling which could improve treatment outcomes.

Social accountability interventions have been implemented in low-and middle-income countries as a strategy to improve state-citizen engagement. However, there has been a minimal systematic attempt to document the effectiveness of social accountability initiatives, especially their ability to stimulate accountability actions by citizens. Subsequently, this paper assesses the effectiveness of a social accountability project in Ghana to build the capacity of citizens to participate in state-society engagements and how such engagements resulted in citizens’ actions. Participants were selected from eight Metropolitan, Municipal and District Assemblies (MMDAs) in Ghana using a mixed-method approach and a multi-stage sampling procedure involving simple random and purposive sampling techniques. Key informant interviews and Focus Group Discussions were used to collect data from representatives of traditional authorities, media houses and public officers from MMDAs. Structured interviews were used to collect data from 240 participants of the social accountability project to complement the qualitative data. The project was relevant in addressing national efforts to increase citizens’ participation in local governance. Furthermore, the project raised awareness and increased knowledge about participatory principles and platforms for participation among citizens. Overall, the social accountability interventions improve state-citizen engagement. The frequency of citizen-state engagements increased with the project’s inception but did not enhance the responsiveness of the MMDAs to citizens’ demands due to resource constraints and the overreliance on intermediaries to follow up on community issues at the MMDA, thereby failing to translate into agency for collective action. As a result, the paper recommends that social accountability interventions should improve cooperation between public officials and community members around the delivery of specific public services to build trust between them. Furthermore, such interventions should orient public officials to be receptive and responsive to the concerns of community members.

AbstractIn Ghana, terrestrial sand mining in rural and peri-urban areas negatively affects the livelihoods of the majority of the residents employed in land-based livelihoods. We examine the sustainability of the alternative livelihood strategies the residents in these areas adopt as they lose their original livelihoods to sand mining. Both quantitative and qualitative data were collected from 278 household heads and 23 key informants. Descriptive statistics and the chi-square test of independence were employed to analyse the quantitative data, while the qualitative data were analysed thematically. The study revealed that while more than half of the respondents had adopted alternative livelihood strategies as a survival strategy, the remaining household heads were unable to secure alternative livelihoods because of a lack of startup capital, inadequate skills, and the unattractiveness of the alternative livelihood options. Though the adoption of alternative strategies had contributed to improvements in food consumption, employment for some farmers displaced by sand mining, and the resilience of some household heads to handle shocks from sand mining, the strategies were largely unsustainable compared to the residents’ original livelihoods (farming). We recommend that the local government authorities develop policies in consultation with landowners to preserve and restore the original land-based livelihoods of the residents.

Abstract Introduction Men with African ancestry have the highest incidence and mortality rates of prostate cancer (PCa) worldwide. Methods This study aimed to identify differentially methylated genes between tumor vs. adjacent normal and aggressive vs. indolent PCa in 121 African American patients. Epigenome‐wide DNA methylation patterns in tumor DNA were assessed using the human Illumina Methylation EPIC V1 array. Results Around 5,139 differentially methylated CpG‐sites (q 0.2) were identified when comparing normal vs. tumor, with an overall trend of hypermethylation in prostate tumors. Multiple representative differentially methylated regions (DMRs), including immune‐related genes, such as CD40, Galectin3, OX40L, and STING, were detected in prostate tumors when compared to adjacent normal tissues. Based on an epigenetic clock model, we observed that tumors’ total number of stem cell divisions and the stem cell division rate were significantly higher than adjacent normal tissues. Regarding PCa aggressiveness, 2,061 differentially methylated CpG‐sites (q .05) were identified when the grade group (GG)1 was compared with GG4/5. Among these 2,061 CpG sites, 155 probes were consistently significant in more than one comparison. Among these genes, several immune system genes, such as COL18A1, S100A2, ITGA4, HLA‐C, and ADCYAP1, have previously been linked to tumor progression in PCa. Conclusion Several differentially methylated genes involved in immune‐oncologic pathways associated with disease risk or aggressiveness were identified. In addition, 261 African American‐specific differentially methylated genes related to the risk of PCa were identified. These results can shedlight on potential mechanisms contributing to PCa disparities in the African American Population.

Objectives Stereotactic body radiotherapy (SBRT) is widely used for localized prostate cancer and implementation of MR-guided radiotherapy has the advantage of tighter margins and improved sparing of organs at risk. Here we evaluate outcomes and time required to treat using non-adaptive MR-guided SBRT (MRgSBRT) for localized prostate cancer at our institution. Methods From 9/2019 to 11/2021 we conducted a retrospective review of 80 consecutive patients who were treated with MRgSBRT to the prostate. Patients included low (LR) (5%), favorable intermediate (FIR) (40%), unfavorable intermediate (UIR) (49%), and high risk (HR) (6%). Short-term androgen deprivation therapy was used in 32% of patients. Target volumes included prostate gland and proximal seminal vesicles with an isotropic 3 mm margin. Treatment was prescribed to 36.25 Gy in 5 fractions every other day with urethral sparing. Hydrogel spacer was used in 18% of patients. Time on the linac was recorded as beam on time (BOT) plus total treatment time (TTT) including gating. Analyzed outcomes included PSA response and patient reported outcomes scored by the American Urological Association (AUA) questionnaire and toxicity per CTCAE v5. General linear regression model was used to analyze factors affecting PSA and AUA in longitudinal follow up, and chi-square test was used to assess factors affecting toxicity. Results Median follow up was 19.3 months (3.8 – 36.6). Median BOT was 4.6 min (2.6 – 7.2) with a median TTT of 11 min (7.6 – 15.8). Pre-treatment vs post-RT median PSA was 6.36 (2.20 – 19.6) vs 0.85 (0.19 – 3.6), respectively ( P < 0.001). PSA decrease differed significantly when patients were stratified by risk category, favoring LR/FIR vs UIF/HR group ( P = 0.019). Four (5%) patients experienced a biochemical failure (BCF), with a median time to BCF of 20.4 months (7.9 – 34.5). Median biochemical failure free survival (BCFFS) was not reached, with 2-yr and 4-yr BCFFS of 97.1% and 72.1%, respectively. Patients with LR/FIR disease had 100% 2-yr and 4-yr BCFFS, whereas patients with UIF/HR had 95% and 41% 2-yr and 4-yr BCFFS ( P = 0.05). Mean pre-treatment AUA was 7.3 (1 - 25) vs 11.3 (1 - 26) at first follow-up; however, AUA normalized to baseline over time. Urethral Dmax ≥35 Gy trended to lower AUA score at all follow-ups ( P = 0.07). Forty-one (51%) patients reported grade 1-2 genitourinary toxicities at the 1 month follow up. Grade 3 toxicity (proctitis) was noted in 1 patient. There was no decrease in any grade rectal toxicity with use of hydrogel spacer (3 vs 6, P = 0.2). No grade ≥4 toxicities was observed. Conclusions MRgSBRT has the potential for treatment adaptation but this comes at the cost of increased resource utilization. Our experience with non-adaptive MRgSBRT of the prostate highlights its short treatment times as well as efficacy with good PSA control and low toxicity profile.

Despite advances in screening, diagnosis, and treatment for prostate cancer (PCa), Black men tend to be diagnosed at younger ages, have higher mortality rates, and are at increased risk of recurrence or metastasis compared to their White counterparts. PCa disparities among Black men are caused by a complex interaction of social, behavioral, and biological factors across the public policy, community, organizational, interpersonal, and individual levels. Key contributing factors include mistrust in the health care system, poor communication between patients and providers, low awareness of screening guidelines, and high medical costs. These disparities are further exacerbated by the low representation of Black men in clinical trials, which limits access to high-quality cancer care and generalizability for PCa treatments. In this narrative review of the existing literature, we examined the epidemiology and identified contributing factors, and propose multi-level strategies to address and mitigate disparities among Black men with PCa.

Schistosomiasis, one of the neglected tropical diseases which affects both humans and animals, is caused by trematode worms of the genus Schistosoma. The disease is caused by several species of Schistosoma which affect several organs such as urethra, liver, bladder, intestines, skin and bile ducts. The life cycle of the disease involves an intermediate host (snail) and a mammalian host. It affects people who are in close proximity to water bodies where the intermediate host is abundant. Common clinical manifestations of the disease at various stages include fever, chills, headache, cough, dysuria, hyperplasia and hydronephrosis. To date, most of the control strategies are dependent on effective diagnosis, chemotherapy and public health education on the biology of the vectors and parasites. Microscopy (Kato-Katz) is considered the golden standard for the detection of the parasite, while praziquantel is the drug of choice for the mass treatment of the disease since no vaccines have yet been developed. Most of the previous reviews on schistosomiasis have concentrated on epidemiology, life cycle, diagnosis, control and treatment. Thus, a comprehensive review that is in tune with modern developments is needed. Here, we extend this domain to cover historical perspectives, global impact, symptoms and detection, biochemical and molecular characterization, gene therapy, current drugs and vaccine status. We also discuss the prospects of using plants as potential and alternative sources of novel anti-schistosomal agents. Furthermore, we highlight advanced molecular techniques, imaging and artificial intelligence that may be useful in the future detection and treatment of the disease. Overall, the proper detection of schistosomiasis using state-of-the-art tools and techniques, as well as development of vaccines or new anti-schistosomal drugs may aid in the elimination of the disease.

PURPOSEProstate cancer disproportionately affects men of African descent, yet their representation in tissue-based studies is limited. This multinational, multicenter pilot study aims to establish the groundwork for collaborative research on prostate cancer in sub-Saharan Africa.METHODSThe Men of African Descent and Carcinoma of the Prostate network formed a pathologist working group representing eight institutions in five African countries. Formalin-fixed paraffin-embedded prostate tissue specimens were collected from Senegal, Nigeria, and Ghana. Histology slides were produced and digitally scanned. A central genitourinary pathologist (P.L.) and eight African general pathologists reviewed anonymized digital whole-slide images for International Society of Urological Pathology grade groups and other pathologic parameters. Discrepancies were re-evaluated, and consensus grading was assigned. A virtual training seminar on prostate cancer grading was followed by a second assessment on a subcohort of the same tissue set.RESULTSOf 134 tissue blocks, 133 had evaluable tissue; 13 lacked cancer evidence, and four were of insufficient quality. Post-training, interobserver agreement for grade groups improved to 56%, with a median Cohen's quadratic weighted kappa of 0.83 (mean, 0.74), compared with an initial 46% agreement and a quadratic weighted kappa of 0.77. Interobserver agreement between African pathologist groups was 40%, with a quadratic weighted kappa of 0.66 (95% CI, 0.51 to 0.76). African pathologists tended to overgrade (36%) more frequently than undergrade (18%) compared with the reference genitourinary pathologist. Interobserver variability tended to worsen with a decrease in tissue quality.CONCLUSIONTissue-based studies on prostate cancer in men of African descent are essential for a better understanding of this common disease. Standardized tissue handling protocols are crucial to ensure good tissue quality and data. The use of digital slide imaging can enhance collaboration among pathologists in multinational, multicenter studies.

Abstract The inner ear is the hub where hair cells (HCs) transduce sound, gravity, and head acceleration stimuli to the brain. Hearing and balance rely on mechanosensation, the fastest sensory signals transmitted to the brain. The mechanoelectrical transducer (MET) channel is the entryway for the sound-balance-brain interface, but the channel-complex composition is not entirely known. Here, we report that the mouse utilizes Piezo1 (Pz1) and Piezo2 (Pz2) isoforms as MET-complex components. The Pz channels, expressed in HC stereocilia, and cell lines are co-localized and co-assembled with MET complex partners. Mice expressing non-functional Pz1 and Pz2 at the ROSA26 locus have impaired auditory and vestibular traits that can only be explained if the Pzs are integral to the MET complex. We suggest that Pz subunits constitute part of the MET complex and that interactions with other MET complex components yield functional MET units to generate HC MET currents.

Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder and the fourth cause of death of end-stage renal disease. The disease has a prevalence of 1:400–1:1000 accounting for 10% of patients on dialysis. In most ADPKD patients, bilateral kidneys are similarly affected, with numerous fluid-filled cysts arising from different nephron segments. Only a few cases of ADPKD with ectopic unilateral multicystic kidney have been reported. It has been observed that the deterioration of their kidney function seemed to be quicker than their age- and sex-matched controls and siblings especially when the ectopic kidney is dysplastic. Case presentation We report a case of a 46-year-old Ghanaian male patient who presented with left flank pain and hematuria with high BP and deranged renal function. Abdominal ultrasonography showed both kidneys to be larger than normal and had multiple cysts of varying sizes with the right kidney located in the right iliac fossa. Follow up Abdominopelvic computer tomographic scan (CT–Scan) without contrast showed enlarged kidneys with the renal parenchyma replaced by innumerable cyst of varying sizes. The right kidney was ectopically located in the right aspect of the pelvis. A diagnosis of ADPKD with right pelvic ectopic multicystic kidney was made. He was put on antihypertensives, analgesia for the left flank pain and to have follow up at the urology and nephrology departments. Conclusion In most ADPKD patients, bilateral kidneys are similarly affected. Only a few cases of ADPKD with ectopic unilateral multicystic kidney have been reported. It has been observed that the deterioration of their kidney function seemed to be quicker than their age- and sex-matched controls and siblings especially when the ectopic kidney is dysplastic.

Abstract Background Vernal Keratoconjunctivitis (VKC) has been determined to be highly prevalent in countries within the tropical climate region. However, little evidence from studies conducted within this region has been put forward to support this claim. Aim To determine the prevalence and risk factors of VKC among a Ghanaian clinical cohort. Methods A 3‐year case‐control study was conducted in a tertiary eye care institution, and medical records of patients who had been diagnosed of VKC between 2018 and 2021 were reviewed. Results Medical records of 3800 patients were reviewed. Some 359 cases of VKC were identified, with a population prevalence rate of 9.45 %. Males comprised 57.1 % of the population with VKC, with a male‐to‐female ratio of 1.33 : 1. The disease was more prevalent (40.8%) in children (≤17 years), and the overall odds of incidence decreased by 10% for a unit increase in age. Age and sex‐adjusted models revealed significant positive associations between Keratoconus [aOR = 40.760, 95% CI –5.948 to 339.937], Rhinitis [cOR = 5.183, 95% CI –2.074 to 12.022] and VKC. However, the incidence of VKC was relatively less expressive among pterygium cases [cOR = 0.315, 95% CI –0.077 to 0.846]. Conclusion VKC is highly prevalent among children and is often associated with comorbidities of atopic origin that exacerbate the impact of the disease among this vulnerable population. It is imperative that clinicians provide holistic care for children with VKC.

Abstract Background Gastrointestinal Stromal Tumour is a rare but potentially curable tumour of the gastrointestinal tract accounting for up to 1% of all gastrointestinal tumours. The discovery of Imatinib mesylate, a novel tyrosine kinase inhibitor has improved the chances even for unresectable, recurrent, or metastatic diseases. Methods This study sought to document the clinical and pathological characteristics of GISTs from two tertiary hospitals in Ghana that have undergone immunohistochemistry confirmation between 2014 and 2021. Results The median age of the subjects was 50 years with most of them (28.0%) being above 61 years. There were more females than males (64.0% vs. 36.0%). Abdominal mass and abdominal pain made up the majority of the clinical presentations. The majority of the subjects had partial gastrectomy (32.0%) which was followed by wedge resection (28.0%). Appendectomy and sleeve gastrectomy were the least performed procedures (8% each). Four of the 25 patients (16.0%) had resections of involved contiguous organs done with splenectomy being the most common procedure. The majority of GISTs were found in the stomach (68.0%) followed by the appendix (12.0%) and small bowel (12.0%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most reported symptoms. Free resection margins were observed in 84.0% of the subjects and only 3/25 (12.0%) experienced tumour recurrence. Conclusion GIST is a potentially curable tumour that once was obscure but currently gaining popularity. Surgical resection offers the hope of a cure for localized disease while targeted therapies is a viable option for recurrent, metastatic, or unresectable tumours.

Abstract Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Dementia (FTD) are two neurodegenerative disorders that share genetic causes and pathogenic mechanisms. The critical genetic players of ALS and FTD are the TARDBP, FUS and C9orf72 genes, whose protein products, TDP-43, FUS and the C9orf72-dipeptide repeat proteins, accumulate in form of cytoplasmic inclusions. The majority of the studies focus on the understanding of how cells control TDP-43 and FUS aggregation in the cytoplasm, overlooking how dysfunctions occurring at the nuclear level may influence the maintenance of protein solubility outside of the nucleus. However, protein quality control (PQC) systems that maintain protein homeostasis comprise a cytoplasmic and a nuclear arm that are interconnected and share key players. It is thus conceivable that impairment of the nuclear arm of the PQC may have a negative impact on the cytoplasmic arm of the PQC, contributing to the formation of the cytoplasmic pathological inclusions. Here we focused on two stress-inducible condensates that act as transient deposition sites for misfolding-prone proteins: Promyelocytic leukemia protein (PML) nuclear bodies (PML-NBs) and cytoplasmic stress granules (SGs). Upon stress, PML-NBs compartmentalize misfolded proteins, including defective ribosomal products (DRiPs), and recruit chaperones and proteasomes to promote their nuclear clearance. SGs transiently sequester aggregation-prone RNA-binding proteins linked to ALS-FTD and mRNAs to attenuate their translation. We report that PML assembly is impaired in the human brain and spinal cord of familial C9orf72 and FUS ALS-FTD cases. We also show that defective PML-NB assembly impairs the compartmentalization of DRiPs in the nucleus, leading to their accumulation inside cytoplasmic SGs, negatively influencing SG dynamics. Although it is currently unclear what causes the decrease of PML-NBs in ALS-FTD, our data highlight the existence of a cross-talk between the cytoplasmic and nuclear PQC systems, whose alteration can contribute to SG accumulation and cytoplasmic protein aggregation in ALS-FTD.

Kofi Boamah Mensah,1 Adwoa Bemah Boamah Mensah,2 Peter Yamoah,3 Jennifer Manfo,4 Richmond Amo,5 Ebenezer Wiafe,6 Neelaveni Padayachee,7 Varsha Bangalee8 1Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 3Department of Pharmacy Practice, University of Health and Allied Sciences, Kumasi, Ghana; 4Pharmacy Department, Maternal and Child Health Hospital, Kumasi, Ghana; 5Internal Medicine & Department of Herbal Medicine, University Hospital & Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 6Pharmacy Department, Ho Teaching Hospital, Ho, Ghana; 7Department of Pharmacy and Pharmacology, University of the Witwatersrand, Johannesburg, South Africa; 8Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaCorrespondence: Kofi Boamah Mensah, Email kofimensah227@yahoo.co.ukIntroduction: The World Health Organization has reported a rise in cervical cancer in Ghana. Ghanaian women predominantly undergo opportunistic Pap smear screening for cervical cancer. Numerous studies have documented differences in the sociodemographic traits of participants undergoing Pap smear testing or screening, which correlates with their screening habits. This study aims to assess sociodemographic variables, including others that determine Pap test utilization at a single center in Ghana.Methods: A single-center survey was conducted by extracting data from the records of women who walked in for Pap smear testing. A telephone survey was also conducted among these women to document their barriers to utilizing the center. For data analysis, descriptive statistics and chi-square were utilized.Results: A total of 197 participants’ records were retrieved for the study. Most participants were market women (69.4%) and uneducated (71.4%). Their Pap smear screening records indicate that the majority (86%) had no history of cervical cancer screening, and only 3% tested positive for Pap smear test. Educational level, occupation and family history of cancer significantly correlated with participants’ Pap smear history (p< 0.05). However, most sociodemographic factors were not significant with the Pap test results of the participants (p> 0.05). The perceived barrier identified by most participants was the need for more information (67.40%) on the test.Conclusion: This study revealed that sociodemographic and gynaecological factors do not correlate with Pap test results. However, education level, occupation, and family history of cancer were significantly associated with the history of Pap smear uptake. The most significant barrier hindering Pap smear services was the need for more information.Keywords: pap smear, cervical cancer, sociodemographic factors, gynaecological factors, screening, women, Ghana

AbstractThis paper examines the sensitivity of tax revenue performance to IFRS adoption in Africa and the implication for tax policy. The study investigated how IFRS adoption affects the level of tax revenue performance in Africa. This study is one of the foundational studies, which has investigated IFRS adoption and tax revenue performance at both macro and cross-country levels. This approach presents better inclusive evidence to support tax reforms and provides the basis to validate tax regulatory apprehensions and suspicions of the adverse impact of IFRS adoption. The paper uses data from six African countries: Botswana, Ghana, Namibia, Nigeria, Sierra Leone, and South Africa for the analyses. The data are sourced from World Bank, International Monetary Fund, and Organisation for Economic Co-operation and Development (OECD). Annualised data from 1996 to 2020 are used. The paper employs Pooled Mean Group (PMG) as the primary estimator and is validated by Panel Dynamic Ordinary Least Square (DOLS). The results showed that IFRS adoption could pose a significant risk to tax revenue mobilisation in Africa as evident by the significant negative long-run estimates. The results further revealed short-run positive IFRS effects. This is affirmed by the country-level analyses and trajectory of tax revenue performance across the sample periods of 1996 to 2020 for the selected countries during the pre- and post-IFRS era. It is therefore safe for African countries to pursue tax-targeted IFRS reforms to minimise the possible adverse effect of IFRS on tax revenue.

Abstract Background COVID-19 and its associated restrictions called for innovations in higher education teaching and learning space with many universities resorting to online teaching and alternative assessments. However, little has been done to understand the academic integrity implications in alternative online and non-invigilated assessments. Aim This study explored the perceptions of higher education students regarding academic integrity in alternative assessments. Methods Cross-sectional mixed method design following the parallel convergent approach was utilised in this study. A convenience sample of 380 undergraduate and postgraduate nursing and social science students completed an online survey on academic integrity behaviours associated with alternative assessments. Results High risk (31.7%) of academic misconduct was perceived among young people (18-24 years old). Collusion was common among nursing students (24.5%) and cheating likely to occur in assessments with longer duration—between 2 and 4 hours (18.8%) and between 1 and 2 weeks (46%). Qualitative data resulted in 274 findings and three themes— (i) impossible to cheat; (ii) easy to cheat and (iii) understanding the consequence of cheating. Suggestions for preserving academic integrity in alternative assessments were also made from the qualitative data. Conclusion Like other forms of traditional assessments, alternative assessments have increased risk of breach of academic integrity; however, with the right strategies, they could serve as effective means of assessing learning outcomes.

Purpose: Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging–guided radiation therapy (MRgRT) for partial bladder boost (PBB). Methods and Materials: A retrospective analysis was performed on consecutive patients with nonmetastatic muscle invasive bladder cancer who were treated with TMT using MRgRT between 2019 and 2022. Patients underwent intensity modulated RT-based nonadaptive MRgRT PBB contoured on True fast imaging with steady state precession (FISP) images (full bladder) followed sequentially by computed tomography–based RT to the whole empty bladder and pelvic lymph nodes with concurrent chemotherapy. MRgRT treatment time, table shifts, and dosimetric parameters of target coverage and normal tissue exposure were described. Prospectively assessed acute and late genitourinary and gastrointestinal (GI) toxicity were reported. Two-year local control was assessed with Kaplan-Meier methods. Results: Seventeen patients were identified for analysis. PBB planning target volume margins were ≤8 mm in 94% (n = 16) of cases. Dosimetric target coverage parameters were favorable and all normal tissue dose constraints were met. For MRgRT PBB fractions, median table shifts were 0.4 cm (range, 0-3.15), 0.45 cm (0-2.65), and 0.75 cm (0-4.8) in the X, Y, and Z planes, respectively. Median treatment time for MRgRT PBB fractions was 9 minutes (range, 6.9-17.4). We identified 32 out of 100 total MRgRT fractions that may have benefitted from online adaptation based on changes in organ position relative to planning target volume, predominantly because of small bowel (13/32, 41%) or rectum (8/32, 25%). Two patients discontinued RT prematurely. The incidence of highest-grade acute genitourinary toxicity was 1 to 2 (69%) and 3 (6%), whereas the incidence of acute GI toxicity was 1 to 2 (81%) and 3 (6%). There were no late grade 3 events; 17.6% had late grade 2 cystitis and none had late GI toxicity. With median follow-up of 18.2 months (95% CI, 12.4-22.5), the local control rate was 92%, and no patient has required salvage cystectomy. Conclusions: Nonadaptive MRgRT PBB is feasible with favorable dosimetry and low resource utilization. Larger studies are needed to evaluate for potential benefits in toxicity and local control associated with this approach in comparison to standard treatment techniques.

The focus of this study is to discuss some deviations and innovations basic school pupils in the Bono and Ahafo regions of Ghana use in their classrooms and how these deviations are applied to their communication in the classroom. A descriptive survey design was adopted to help achieve these objectives. A qualitative approach was adopted to help explain the study better. A total population of 9,219 pupils and a sample size of 400 pupils were observed for the study. The findings of the study revealed that in the area of phonology, pupils replace the inter-dental fricative /ð/ with a voiced alveolar stop /d/. They also used the voiceless dental fricative /θ/ in place of /t/ a voiceless alveolar in their speech. Again, most pupils also use the trill /r/ in place of the /l/ sound both in writing and articulation. Under semantics, pupils usually transliterate statements from their L1 into the target language (English) and tend to use hyperbole for emphasis. Furthermore, over-generalization of syntactic rules was found as one of the innovations pupils make in classroom communication. Spelling pronunciation was also found as part of the innovations basic school pupils use in classroom communication.

Background and purpose: Diffusion weighted imaging (DWI) allows for the interrogation of tissue cellularity, which is a surrogate for cellular proliferation. Previous attempts to incorporate DWI into the workflow of a 0.35 T MR-linac (MRL) have lacked quantitative accuracy. In this study, accuracy, repeatability, and geometric precision of apparent diffusion coefficient (ADC) maps produced using an echo planar imaging (EPI)-based DWI protocol on the MRL system is illustrated, and in vivo potential for longitudinal patient imaging is demonstrated. Materials and methods: Accuracy and repeatability were assessed by measuring ADC values in a diffusion phantom at three timepoints and comparing to reference ADC values. System-dependent geometric distortion was quantified by measuring the distance between 93 pairs of phantom features on ADC maps acquired on a 0.35 T MRL and a 3.0 T diagnostic scanner and comparing to spatially precise CT images. Additionally, for five sarcoma patients receiving radiotherapy on the MRL, same-day in vivo ADC maps were acquired on both systems, one of which at multiple timepoints. Results: Phantom ADC quantification was accurate on the 0.35 T MRL with significant discrepancies only seen at high ADC. Average geometric distortions were 0.35 (±0.02) mm and 0.85 (±0.02) mm in the central slice and 0.66 (±0.04) mm and 2.14 (±0.07) mm at 5.4 cm off-center for the MRL and diagnostic system, respectively. In the sarcoma patients, a mean pretreatment ADC of 910x10-6 (±100x10-6) mm2/s was measured on the MRL. Conclusions: The acquisition of accurate, repeatable, and geometrically precise ADC maps is possible at 0.35 T with an EPI approach.

IntroductionRadiation therapy (RT) is one of the most common anticancer therapies. Yet, current radiation oncology practice does not adapt RT dose for individual patients, despite wide interpatient variability in radiosensitivity and accompanying treatment response. We have previously shown that mechanistic mathematical modeling of tumor volume dynamics can simulate volumetric response to RT for individual patients and estimation personalized RT dose for optimal tumor volume reduction. However, understanding the implications of the choice of the underlying RT response model is critical when calculating personalized RT dose.MethodsIn this study, we evaluate the mathematical implications and biological effects of 2 models of RT response on dose personalization: (1) cytotoxicity to cancer cells that lead to direct tumor volume reduction (DVR) and (2) radiation responses to the tumor microenvironment that lead to tumor carrying capacity reduction (CCR) and subsequent tumor shrinkage. Tumor growth was simulated as logistic growth with pre-treatment dynamics being described in the proliferation saturation index (PSI). The effect of RT was simulated according to each respective model for a standard schedule of fractionated RT with 2 Gy weekday fractions. Parameter sweeps were evaluated for the intrinsic tumor growth rate and the radiosensitivity parameter for both models to observe the qualitative impact of each model parameter. We then calculated the minimum RT dose required for locoregional tumor control (LRC) across all combinations of the full range of radiosensitvity and proliferation saturation values. ResultsBoth models estimate that patients with higher radiosensitivity will require a lower RT dose to achieve LRC. However, the two models make opposite estimates on the impact of PSI on the minimum RT dose for LRC: the DVR model estimates that tumors with higher PSI values will require a higher RT dose to achieve LRC, while the CCR model estimates that higher PSI values will require a lower RT dose to achieve LRC.DiscussionUltimately, these results show the importance of understanding which model best describes tumor growth and treatment response in a particular setting, before using any such model to make estimates for personalized treatment recommendations.

Insights into the Monkeypox (MPX) disease, causative virus, its transmission including possible reservoir(s) is scattered. The recent outbreak of MPX disease as we begin to see a high number of cases emerging from non-endemic countries is a wake-up call for the research community. This review presents an update on the re-emergence of the MPX disease as it spreads across the globe like never before. Unlike most single-stranded RNA viruses, such as SARS-COV 2, this zoonotic disease (MPX) is caused by a double-stranded DNA virus, the Monkeypox virus. Thus, the replication machinery of the MPX virus genome is highly conserved without undergoing many changes (mutations), which usually present challenges in vaccine development. To review recent studies and reports on MPX disease, a comprehensive scientific literature search in relation to terms such as MPX disease, MPX virus, and transmission routes of MPX virus was conducted. Suspected MPX virus reservoirs, animal-to-human and three main person-to-person modes of transmission were noted to have been reported. Finally, diagnostic methods of MPX virus and treatment or prevention measures of the disease as indicated by the WHO and CDC were also reviewed.

Abstract Plasma N-glycan profiles have been shown to be defective in type II diabetes Mellitus (T2DM) and holds a promise to discovering biomarkers. The study comprised 232 T2DM patients and 219 healthy individuals. N-glycans were analysed by high-performance liquid chromatography. The multivariate integrative framework, DIABLO was employed for the statistical analysis. N-glycan groups (GPs 34, 32, 26, 31, 36 and 30) were significantly expressed in T2DM in component 1 and GPs 38 and 20 were related to T2DM in component 2. Four clusters were observed based on the correlation of the expressive signatures of the 39 N-glycans across T2DM and controls. Cluster A, B, C and D had 16, 16, 4 and 3 N-glycans respectively, of which 11, 8, 1 and 1 were found to express differently between controls and T2DM in a univariate analysis $$(p < 0.05)$$ ( p < 0.05 ) . Multi-block analysis revealed that trigalactosylated (G3), triantennary (TRIA), high branching (HB) and trisialylated (S3) expressed significantly highly in T2DM than healthy controls. A bipartite relevance network revealed that HB, monogalactosylated (G1) and G3 were central in the network and observed more connections, highlighting their importance in discriminating between T2DM and healthy controls. Investigation of these N-glycans can enhance the understanding of T2DM.

Abstract Participation in cancer research trials by minority populations is imperative in reducing disparities in clinical outcomes. Even with increased awareness of the importance of minority patient inclusion in clinical research to improve cancer care and survival, significant barriers persist in accruing and retaining minority patients into clinical trials. This study sought to identify and address barriers to minority accrual to a minimal risk clinical research study in real‐time.

Abstract Background Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost. Objective The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting. Patients and methods This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015–2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients’ demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0. Results Twelve patients aged between 24–54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention. Conclusion Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.

T cells recognize tumor-derived mutated peptides presented on MHC by tumors. The recognition of these neo-epitopes leads to rejection of tumors, an event that is critical for successful cancer immunosurveillance. Determination of tumor-rejecting neo-epitopes in human tumors has proved difficult, though recently developed systems approaches are becoming increasingly useful at evaluating their immunogenicity. We have used the differential aggretope index to determine the neo-epitope burden of sarcomas and observed a conspicuously titrated antigenic landscape, ranging from the highly antigenic osteosarcomas to the low antigenic leiomyosarcomas and liposarcomas. We showed that the antigenic landscape of the tumors inversely reflected the historical T cell responses in the tumor-bearing patients. We predicted that highly antigenic tumors with poor antitumor T cell responses, such as osteosarcomas, would be responsive to T cell–based immunotherapy regimens and demonstrated this in a murine osteosarcoma model. Our study presents a potentially novel pipeline for determining antigenicity of human tumors, provides an accurate predictor of potential neo-epitopes, and will be an important indicator of which cancers to target with T cell–enhancing immunotherapy.

Abstract Background Visceral obesity and insulin resistance contribute to developing cardiometabolic syndrome (MetS). We investigated the predictive abilities of lipid accumulation product (LAP), waist circumference‐triglyceride index (WTI), and triglyceride‐glucose (TyG) index for MetS screening among the general Ghanaian adults. Methods The final prospective analysis included 4740 healthy adults aged 30–90 years from three communities comprising Ejisu, Konongo, and Ashanti Akim Agogo in Ghana. Self‐structured questionnaire pretested was used to collect sociodemographic, anthropometric, and clinical data. Blood samples were taken after fasting to measure glucose and lipid levels. LAP, WTI, and TyG were calculated from standard equations. MetS was defined by the International Diabetes Federation criteria. Receiver operating characteristic (ROC) curves and multivariable logistic regression were utilized to evaluate the potential of the three indices in identifying MetS. Results Of the 4740 participants, 39.7% had MetS. MetS was more common in females (50.3%) than in males (22.2%). Overall, LAP ≥ 27.52 yielded as the best index for MetS with the highest area under the ROC curve (AUC) (0.866). At cut‐off LAP point of ≥23.87 in males and ≥33.32 in females, an AUC of 0.951 and 0.790 was identified in MetS prediction, respectively. LAP was an independent risk measure of MetS for both males (45.6‐fold) and females (3.7‐fold) whereas TyG was an independent risk measure for females (3.7‐fold) only. Conclusions MetS is increasing among the general adult population. LAP and TyG are important sex‐specific risk measures to screen for MetS among the general adult population in our cohort.

Objectives: Micronutrients, especially calcium (Ca) and magnesium (Mg) are reported to reduce preeclampsia events via several factors such as endothelial cell control, optimal oxidative stress and a balanced angiogenic growth mediator. We evaluated the association of micronutrients with oxidative stress biomarkers, and angiogenic growth mediators in early-onset preeclampsia and late-onset preeclampsia. Methods: This case-control study recruited 197 preeclampsia (early-onset preeclampsia = 70 and late-onset preeclampsia = 127) as cases and 301 normotensive pregnant women as controls from the Komfo Anokye Teaching Hospital, Ghana. Samples were collected after 20 weeks of gestation for both cases and controls and estimated for Ca, Mg, soluble fms-like tyrosine kinase-1, placental growth factor, vascular endothelial growth factor-A, soluble endoglin, 8-hydroxydeoxyguanosine, 8-epiprostaglandinF2-alpha and total antioxidant capacity. Results: Early-onset preeclampsia women had significantly lower levels of Ca, Mg, placental growth factor, vascular endothelial growth factor-A and total antioxidant capacity but higher levels of soluble fms-like tyrosine kinase-1, soluble endoglin, 8-epiprostaglandinF2-alpha, 8-hydroxydeoxyguanosine, soluble fms-like tyrosine kinase-1/placental growth factor ratio, 8-epiprostaglandinF2-alpha /placental growth factor ratio, 8-hydroxydeoxyguanosine/placental growth factor ratio and soluble endoglin/placental growth factor ratio than late-onset preeclampsia and normotensive pregnant women ( p

Abstract Severity of falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with severity of falls in hospital. It is important to continuously analyse the factors associated with severity of fall which can inform the implementation of any fall preventive strategies. This study aims to identify factors associated with the severity of falls in hospitalised adult patients in Western Australia. This study involved a retrospective cohort analysis of inpatient falls records extracted from the hospital’s Clinical Incident Database from May 2014 to April 2019. Severity of falls were classified as three Severity Assessment Code (SAC): SAC 1 was “high” causing serious harm or death; SAC 2 was “medium” causing moderate or minor harm; and SAC 3 was “low” indicating no harm. Univariable and multivariable generalised ordinal logistic regression models were used to quantify the magnitude of effects of the potential risk factors on severity of falls at 5% level of significance and reported the crude odds and adjusted odds ratio of falling at a higher severity level. There were 3705 complete reported cases of falls with the average age of the patients was 68.5 ± 17.0 years, with 40.2% identified as female. The risk of falling at a higher level of severity increased by patient age over 50 years. Females were 15.1% more likely to fall at higher severity level compared to females. Fall incidents occurred during toileting and showering activities and incidents in a communal area were 14.5% and 26% more likely to occur at a higher severity respectively. Similarly, depression (167%), influence of alcohol or illicit drugs (more than 300%), use of medications (86%) and fragile skin (75%) significantly increased the odds of falling at higher level of severity. Identification of underlying risk factors associated with fall severity provides information which can guide nurses and clinicians to design and implement effective interventional strategies that mitigate the risk of serious fall injuries. The results suggest that fall prevention strategies should target patients with these risk factors to avoid severity of falls.

Island South-East Asia (ISEA) is a highly humid region that hosts the world's largest tropical peat deposits. Most of this peat accumulated only relatively recently during the Holocene, suggesting that the climate was drier and/or more seasonal during earlier times. Although there is evidence for savanna expansion and drier conditions during the Last Glacial Maximum (LGM, 21 ka BP), the mechanisms behind hydroclimatic changes during the ensuing deglacial period have received much less attention and are poorly understood. Here we use CESM1 climate model simulations to investigate the key drivers behind ISEA climate at the end of the Late Glacial (14.7–11.7 ka BP), with a focus on the last stadial of the Younger Dryas (12 ka BP). We further simulate the preceding Allerød (13 ka BP) interstadial climate and perform a sensitivity experiment to disentangle the climate impacts due to orbital forcing and Late Glacial boundary conditions against a slowdown of the Atlantic Meridional Overturning Circulation (AMOC). A transient simulation (TRACE) is used to track the climate seasonality and orbitally driven change over time during the deglaciation into the Holocene. In agreement with proxy evidence, CESM1 simulates overall drier conditions during the Younger Dryas and Allerød. More importantly, ISEA experienced extreme seasonal aridity, in stark contrast to the ever-wet modern climate. We identify that the simulated drying and enhanced seasonality in the Late Glacial is mainly the result of a combination of three factors: (1) large orbital insolation difference on the Northern Hemisphere (NH) between summer and winter, in contrast to the LGM and the present day, (2) a stronger (dry) East Asian winter monsoon caused by a larger meridional thermal gradient and (3) a major reorganization of the Indo-Pacific Walker Circulation with an inverted land-sea circulation and a complete breakdown of deep convection over ISEA in NH winters. The altered atmospheric circulation, sea surface temperature and sea level pressure patterns led to conditions resembling extreme El Niño events in the modern climate and a dissolution of the Intertropical Convergence Zone (ITCZ) over the region. From these results we infer that terrestrial cooling of ISEA and at least a seasonal reversal of land-sea circulation likely played a major role in delaying tropical peat formation until at least the onset of the Holocene period. Our results also suggest that centennial to millennial shifts in AMOC strength modifies the Pacific Ocean hydroclimate via alteration of the position of the ITCZ, and a modulation of the Pacific Walker Circulation. However, Late Glacial AMOC shifts are overall less important than hydroclimate changes due to orbital forcing and boundary condition changes relative to the modern climate.

Background: Socioeconomic and health care utilization factors are major drivers of prostate cancer (PC) mortality disparities in the USA; however, tumor molecular heterogeneity may also contribute to the higher mortality among Black men. Objective: To compare differences in PC subtype frequency and genomic aggressiveness by self-identified race. Design, setting, and participants: Five molecular subtype classifiers were applied for 426 Black and 762 White PC patients in the Decipher Genomics Resource Information Database (GRID). Outcome measurements and statistical analysis: Differences in subtype frequency and tumor genomic risk (Decipher score >0.6) by race were evaluated using χ2 tests and multivariable-adjusted logistic regression models. Results and limitations: Subtype frequencies differed by race for four classifiers. Subtypes characterized by the presence of SPOP mutations, SPINK1 overexpression, and neuroendocrine differentiation were more common among Black men. ERG and ETS fusion-positive subtypes were more frequent among White men, with no clear differences for subtypes reflecting luminal versus basal lineage. The hypothesized low-risk Kamoun S2 subtype was associated with a lower Decipher score among White men only (p = 0.01 for heterogeneity), while the aggressive You PCS1 subtype was associated with a higher Decipher score among White men only (p = 0.001 for heterogeneity). The Tomlins ERG+ subtype was associated with a higher Decipher score relative to all other subtypes among Black men, with no association among White men (p = 0.007 for heterogeneity). Conclusions: The frequency of PC molecular subtypes differed by self-identified race. Additional studies are required to evaluate whether our observations suggest differences in the tumor genomic risk of progression by self-identified race. Patient summary: We studied five classifiers that identify subtypes of prostate tumors and found that subtypes differed in frequency between Black and White patients. Further research is warranted to evaluate how differences in tumor subtypes may contribute to disparities in prostate cancer mortality.

Mining projects in mineral-rich countries have been justified as contributing to economic growth and social well-being. There are environmental, economic, and social problems resulting from mining; therefore, the need for society to pool institutions to form environmental governance systems to manage these effects. It is within these institutions that power is prescribed, legitimated, and controlled. This study examines the roles of traditional authorities in environmental governance in mining in the Asutifi North District of Ghana. A qualitative case study design combining purposive and convenience sampling was used to select 52 respondents from traditional, state, and business institutions and 29 household respondents. The traditional institutions mostly played the role of development agents in their communities. Even though they have not been entirely successful in substituting for the state, they have complemented the state structures by holding the societies together despite daunting economic, political, and environmental challenges they faced.

Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. A multicenter cross-sectional survey was conducted in six public hospitals in Ghana among key HCPs to assess their level of KAP towards AMS using a validated self-administered electronic questionnaire. Data analyses included descriptive and inferential statistics using STATA version 14. Overall, 339 out of 355 HCPs responded to the questionnaire, giving a response rate of 95.5%. Most responders were nurses (n = 256, 78.2%), followed by medical doctors (n = 45, 13.3%). The study recorded both poor knowledge (8.9%) and practice levels (35.4%), as well as a good attitude (78.8%) towards AMS. Ongoing exposure to AMS structured training, exposure to continuous professional development training on AMS in the previous year, and the number of years of working experience were predictors of the HCPs’ level of knowledge (aOR = 3.02 C.I = 1.12–8.11), attitude (aOR = 0.37 C.I = 0.20–0.69) and practice (aOR = 2.09 C.I =1.09–3.99), respectively. Consequently, concentrated efforts must be made to address current low levels of knowledge and poor practices regarding AMS among HCPs in Ghana as part of ongoing strategies in the National Action Plan to reduce AMR.

BackgroundPreeclampsia is a leading cause of foeto-maternal deaths especially in Sub-Saharan Africa. However, the prevalence and risk factors of preeclampsia are scarce in the Central region of Ghana with previous study assessing individual independent risk factors. This study determined the prevalence and algorithm of adverse foeto-maternal risk factors of preeclampsia.MethodsThis multi-centre prospective cross-sectional study was conducted from October 2021 to October 2022 at the Mercy Women's Catholic Hospital and Fynba Health Centre in Central region, Ghana. A total of 1,259 pregnant women were randomly sampled and their sociodemographic, clinical history, obstetrics and labour outcomes were recorded. Logistic regression analysis using SPSS version 26 was performed to identify risk factors of preeclampsia.ResultsOf the 1,259 pregnant women, 1174 were finally included in the study. The prevalence of preeclampsia was 8.8% (103/1174). Preeclampsia was common among 20-29 years age group, those who had completed basic education, had informal occupation, multigravida and multiparous. Being primigravida [aOR = 1.95, 95% CI (1.03-3.71), p = 0.042], having previous history of caesarean section [aOR = 4.48, 95% CI (2.89-6.93), pConclusionPreeclampsia is increasing among pregnant women in the Central region of Ghana. Pregnant women being primigravida with foetal growth restriction and previous history of caesarean section are the highest risk population likely to develop preeclampsia with neonates more likely to suffer adverse birth outcome such as birth asphyxia. Targeted preventive measures of preeclampsia should be created for pregnant women co-existing with multiple risk factors.

Common cause failures (CCFs) may lead to the simultaneous unavailability or failure of numerous components in the nuclear power plant because of the existence of a shared cause when an initiating event disrupts the normal functioning of nuclear power plants. The presence of common cause failures (intra-unit and inter-unit) can be recognized in a multi-unit probabilistic safety assessment (MUPSA) as a crucial dependency factor that can influence accident scenarios and the core damage frequency (CDF), as CCF may affect the availability and proper operation of mitigating systems. Since such failures are likely to significantly undermine the benefits of the concept of redundancy in nuclear power plant systems, it is necessary to identify the CCFs that contribute to the core damage in a multi-unit site and analyse their overall quantitative magnitude and qualitative proportions. In this study, a twin-unit generic pressurized water reactor (PWR) nuclear plant is modeled using the AIMS-PSA software. For the loss-of-offsite-power (LOOP) and station blackout (SBO) events, the site CDF was calculated, and the cut-sets produced by this quantification were examined for the modeled CCF basic events in the fault trees. The quantitative and qualitative contributions of the CCFs to the frequency of site core damage were examined. CCFs in the modeled fault trees contributed to 4.58% to the site CDF of the combined LOOP followed by SBO event. In the LOOP event alone that leads to core damage, the CCF contributed 4.58% to the site CDF while CCFs contributed 17.19% to the site CDF in the SBO event alone that leads to core damage. With CCF events considered in the modeling process, the site CDF estimated with CCF events increased by 7.53% in the combined LOOP followed by SBO event. In the LOOP event alone that leads to core damage, inclusion of CCF events in the modeling increased the site CDF by 7.42%. A 15.66% increase in site CDF was recorded in the SBO event alone that leads to core damage as compared to modeling without CCF events. The results show how crucial the common cause failure contribution is to site CDF. The safety of the nuclear plant at a site is impacted by an increase in site CDF when common cause failures are considered. The various CCF fundamental event compositions and their percentage contributions were explicitly examined by the minimal cut-sets which leads to core damage in the units. In conclusion, this study’s findings can help us better understand how CCFs increase multi-unit site risk and can also act as a starting point for future studies on the qualitative and quantitative categorizations of CCF effects within MUPSA.

The BCG vaccine, like all other vaccines, is associated with adverse events following immunization (AEFI). Reducing the incidence of AEFI is crucial in reposing confidence in BCG vaccination and reducing hesitancy associated with the vaccine. This requires safety precautions before and during vaccinations, as well as reporting AEFIs after vaccination. This study assessed the adherence of health-care professionals to pre-vaccination precautions and adverse events following immunization (AEFI) reporting practices during BCG vaccination in four hospitals in Ghana. It is hoped that the findings of the study will serve as a baseline to identify gaps for further studies to generate a stronger evidence for policy formulation aimed at improving BCG vaccine safety in Ghana and other tuberculosis endemic countries. A cross-sectional study design was employed, and Statistical Package for Social Sciences, IBM® SPSS version 25 (SPSS Inc. USA) software was used for analysis. Chi-square and binary logistic regression tests were used to test the association between categorical variables and predictors of adherence to pre-BCG vaccination precautions, respectively, and a p-value of

Background: Patients ascribe diverse meanings to postoperative pain (POP), usually based on personal beliefs. However, patients’ perceptions about the causes of pain are usually influenced by their traditional beliefs and misconceptions, and cultural factors such as ethnic background serve as barriers to effective pain control. The study sought to explore the cognitive and sociocultural aspects of postoperative pain experience after urological surgeries. Methods: The study employed exploratory descriptive qualitative research design. Twelve male participants who had undergone urological surgery in a teaching hospital were recruited using purposive sampling. Data were collected through individual face-to-face in-depth interviews, conducted in English and Akan languages. The interviews were audio-taped and transcribed verbatim. Ethical considerations such as informed consent, anonymity, and confidentiality were ensured. Concurrent data analysis was done engaging the processes of content analysis. Findings: Cognitive aspects of the POP revealed three themes; the knowledge of the pain, attitude, and beliefs of the patients, and meanings the patients ascribed to the pain. Similarly, sociocultural aspects revealed two emerging themes; the family dynamics and roles influencing pain experience, and individual cultural background and belief systems. The participants’ diverse views and experiences influenced their pain expression and experience after urological surgery. Conclusions: Postoperative pain is a multidimensional experience and includes socio-cultural and cognitive aspects. Therefore, contemporary pain management strategies should focus on client-centered and culturally sensitive interventions.

The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries’ capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.

Background Preeclampsia is a leading cause of foeto-maternal deaths especially in Sub-Saharan Africa. However, the prevalence and risk factors of preeclampsia are scarce in the Central region of Ghana with previous study assessing individual independent risk factors. This study determined the prevalence and algorithm of adverse foeto-maternal risk factors of preeclampsia. Methods This multi-centre prospective cross-sectional study was conducted from October 2021 to October 2022 at the Mercy Women’s Catholic Hospital and Fynba Health Centre in Central region, Ghana. A total of 1,259 pregnant women were randomly sampled and their sociodemographic, clinical history, obstetrics and labour outcomes were recorded. Logistic regression analysis using SPSS version 26 was performed to identify risk factors of preeclampsia. Results Of the 1,259 pregnant women, 1174 were finally included in the study. The prevalence of preeclampsia was 8.8% (103/1174). Preeclampsia was common among 20–29 years age group, those who had completed basic education, had informal occupation, multigravida and multiparous. Being primigravida [aOR = 1.95, 95% CI (1.03–3.71), p = 0.042], having previous history of caesarean section [aOR = 4.48, 95% CI (2.89–6.93), pConclusion Preeclampsia is increasing among pregnant women in the Central region of Ghana. Pregnant women being primigravida with foetal growth restriction and previous history of caesarean section are the highest risk population likely to develop preeclampsia with neonates more likely to suffer adverse birth outcome such as birth asphyxia. Targeted preventive measures of preeclampsia should be created for pregnant women co-existing with multiple risk factors.

Hypertension (HTN) is the leading cause of cardiovascular diseases. Nevertheless, most individuals in developing countries are unaware of their blood pressure status. We determined the prevalence of unrecognized hypertension and its association with lifestyle factors and new obesity indices among the adult population. This community-based study was conducted among 1288 apparently healthy adults aged 18-80 years in the Ablekuma North Municipality, Ghana. Sociodemographic, lifestyle characteristics, blood pressure and anthropometric indices were obtained. The prevalence of unrecognized HTN was 18.4% (237 / 1288). The age groups 45-54 years [aOR = 2.29, 95% CI (1.33-3.95), p = 0.003] and 55-79 years [aOR = 3.25, 95% CI (1.61-6.54), p = 0.001], being divorced [aOR = 3.02 95% CI (1.33-6.90), p = 0.008], weekly [aOR = 4.10, 95% CI (1.77-9.51), p = 0.001] and daily alcohol intake [aOR = 5.62, 95% CI (1.26-12.236), p = 0.028] and no exercise or at most once a week [aOR = 2.25, 95% CI (1.56-3.66), p = 0.001] were independently associated with HTN. Among males, the fourth quartile (Q4) of both body roundness index (BRI) and waist to height ratio (WHtR) [aOR = 5.19, 95% CI (1.05-25.50), p = 0.043] were independent determinants of unrecognized HTN. Among females, the third quartile (Q3) [aOR = 7.96, 95% CI (1.51-42.52), p = 0.015] and Q4 [aOR = 9.87 95% CI (1.92-53.31), p = 0.007] of abdominal volume index (AVI), the Q3 of both BRI and WHtR [aOR = 6.07, 95% CI (1.05-34.94), p = 0.044] and Q4 of both BRI and WHtR [aOR = 9.76, 95% CI (1.74-54.96), p = 0.010] were independent risk factors of HTN. Overall, BRI (AUC = 0.724) and WHtR (AUC = 0.724) for males and AVI (AUC = 0.728), WHtR (AUC = 0.703) and BRI (AUC = 0.703) for females yielded a better discriminatory power for predicting unrecognized HTN. Unrecognized hypertension is common among the apparently healthy adults. Increased awareness of its risk factors, screening, and promoting lifestyle modification is needed to prevent the onset of hypertension.

PURPOSEIt is established that addition of systemic therapy to locoregional treatment for breast cancer improves survival. However, reliable data are lacking about the outcomes of such treatment in women with breast cancer in low middle-income countries. We compared the outcomes of treatment in patients who had received neoadjuvant chemotherapy (NACT) or adjuvant chemotherapy and examined the factors associated with breast cancer recurrence and survival at the National Radiotherapy Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Ghana.METHODSThis was a retrospective cohort study. The medical charts of women with breast cancer managed at the National Radiotherapy Oncology and Nuclear Medicine Centre from 2005 to 2014 were reviewed. A total of 388 patients with a median follow-up of 48 months were included in the study. Logistic regression was used to estimate the risk of recurrence. Survival was estimated using cox proportional hazards model. All models were adjusted with clinicopathologic variables. A P value of < .05 was considered statistically significant.RESULTSFifty-nine percent received adjuvant chemotherapy. In an adjusted logistic model, no difference was observed in locoregional recurrence between patients receiving NACT compared with those receiving adjuvant chemotherapy (odds ratio = 1.05; 95% CI, 0.44 to 2.47). However, NACT recipients had a higher likelihood of distant recurrence (odds ratio = 1.97; 95% CI, 1.24 to 3.15). In a multivariable analysis, no differences were observed in overall survival between the two chemotherapy groups (hazard ratio = 1.43; 95% CI, 0.91 to 2.26).CONCLUSIONNACT yields similar outcomes compared with adjuvant chemotherapy; however, recipients of NACT with advanced disease may have more distant failures. Early detection in a resource-limited setting is therefore crucial to optimal outcomes, significantly limiting recurrence and improving survival.

Background. Dermatosis papulosa nigra (DPN) affects sun-exposed areas such as the face, neck, and trunk. The prevalence of pterygium and myopia in DPN patients in Ghana has not been studied. In this study, we examined the risk and protective factors for pterygium and myopia in DPN patients. Materials and Methods. The study involved 100 participants with facial DPN. A standard ophthalmic exam was performed using a portable slit lamp and a 3.5X magnified loop. Participants completed a closed-ended questionnaire. Logistic regression was used to summarize the level of association between DPN, myopia, and pterygium, as well as demographic factors (gender, age, occupation, family history of lesion and skin complexion). Results. 70% and 84% of participants had pterygium and myopia. Age, gender, complexion, and sun exposure were associated with pterygium and myopia (p 0.05). Higher grade of pterygium and myopia were prevalent in the aged population. Both univariate and multivariable models highlighted that increasing age and sun exposure (outdoor) were risk factors for developing higher grade of pterygium and myopia in the DPN participants, while light skin color and male gender were respectively identified as protective factors. Conclusions. Our study is the first to examine pterygium and myopia in facial DPN patients. Most Ghanaians with facial DPN are at risk for developing pterygium and myopia.

Increasing and competing demands on agriculture in sub-Saharan Africa mean that policy and investment decisions become more complex. Despite growing consensus on the need for sustainable agricultural intensification, there is limited agreement on how to achieve this in practice. Governments and societies face uncertainty and complex choices. This paper explores the potential of Multi-Stakeholder, Social Learning (MSL) approaches, facilitated by National Learning Alliances (NLAs), to improve policy and investment decisions. Comparative evidence from a donor-supported research and learning programme in Ethiopia, Ghana, Malawi, Tanzania and Zambia is used in a theory-based evaluation approach to assess the contribution of the NLAs to capacity and practice change amongst individuals, networks and senior decision-makers. Ten outcome cases are explored, including their contribution to systemic changes in the governance of evidence. Key lessons included: the value to decision-makers of engaging with informal networks; importance of combining dialogue, deliberation and experiential learning; the need to create safe spaces in national level MSL processes; the demanding combination of facilitation skills and commitment; and appropriately flexible support. This suggests a need not only for the production of quality research, but crucially support for MSL as a means of contributing to the good governance of evidence and sustainable change.

Hydrocalyx is an obstructed renal calyx from infundibulo-pelvic diminution or stenosis which leads to dilatation of the calyx. It becomes clinically important when associated with flank pains, haematuria, infection, renal impairment or stone formation. On intravenous urography the finding of a cystic dilatation of a calyx that communicates with the renal pelvis supports the diagnosis. This case is A 50-year-old man with recurrent flank pains who was diagnosed with left hydrocalyx on a Computed Tomography Urography (CT Urography). He opted for conservative management. Management of hydrocalyx can be conservative for patients without significant renal damage or symptoms and surgical with nephron sparing intent for those who have severe symptoms and complications.