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Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.

Abstract Introduction Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. Methods We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America’s National Institutes of Health/National Cancer Institute funded project titled ‘Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria’. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan–Meier and compared between groups using the log-rank test. Results A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV−/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40–51) years compared to 57 (IQR: 45–66) among HIV−/ICC + (P

Background and Objectives: Anaemia is one of the most common forms of malnutrition globally, with most anaemia cases related to micronutrient deficiency. Diets with higher dietary diversity scores (DDS) are usually nutritionally diverse and could positively impact micronutrient status, including haemoglobin (Hb) concentration improvement. The study aimed to determine DDS and its association with the Hb concentration of Boarding and Day adolescent Senior High School students in Ghana. Materials and Methods: A semi-structured and three 24 h dietary recalls were used to obtain the participants’ demographic and diet intake data, respectively. Hb concentration was assessed using a validated portable haemoglobinometer. DDS was evaluated using the Minimum Dietary Diversity for Women (MDD-W) approach. Results: A significant difference in the DDS between Boarding and Day students existed. Only 22% of the Boarding students had adequate dietary diversity, whereas 64% of the Day students had adequate dietary diversity. A significantly smaller proportion of the Boarding students consumed nuts and seeds, dairy, flesh foods, eggs, vitamin A-rich vegetables and fruits, other vegetables, and other fruits compared to Day students (p < 0.05, all). No significant difference (p = 0.925) in mean (±SD) Hb concentrations between Boarding (11.9 ± 1.1 g/dL) and Day (11.9 ± 1.1 g/dL) students was found. Additionally, no significant correlation between mean DDS and Hb concentration (p = 0.997) was recorded. Using Hb < 12 g/dL as the determination of anaemia, 55.1% Boarding and 57.8% Day students had anaemia. Conclusions: Low dietary diversity in Boarding students highlighted inadequate nutrition provided by school meals. Strategies to increase meal diversity should be prioritised by stakeholders in Ghana’s educational sector.

PURPOSEThe proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA.MATERIALS AND METHODSThis systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies.RESULTSIn this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%).CONCLUSIONHPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes.

International students are an important component of the host country and universities bringing economic, social, and community contributions. International students are the most vulnerable students with challenges related to academic expectations, language proficiency, and socio-cultural integration. This study explores the challenges of international students in a Western Australian School of Nursing and Midwifery. An exploratory questionnaire (n=10), three focus groups (n=15) and a quality improvement survey (n=80) informed this study. Four themes emerged: stress in the first weeks, incorrect and/or late enrolments, lack of guidance and support, and system navigation nightmares. Other issues included: accommodation, culture shock, financial concerns, information needs, and peer support. These findings led to the instigation of an international academic coordinator role as a single point of contact and increasing resources within the university faculty provided additional support to the international students.

Technology offers pedagogical affordances that can transformteaching and learning in multigrade classrooms to assist in theprocess of teaching and learning. However, it is challenging forteachers to effectively integrate technology into their classrooms,given the complex and dynamic multigrade context. Thetechnological pedagogical content knowledge (TPACK) model wasa lens through which to explore teachers' experiences in ICTintegration in their multigrade classrooms in selected primaryschools in South Africa. A case study design guided this qualitativestudy. Semi-structured interviews were conducted with twelveteachers thematic analysis was used to analyse data. The findingsrevealed that access to ICT equipment for teachers and studentsis crucial. This study has found that generally, it is difficult forteachers to incorporate technology into their teaching because ofthe caveats, such as the multigrade context and the rural locationwhich presents issues such as lack of basic technologyinfrastructure, limited training on integrating technology inteaching, time, the teaching context, and support from principals.This study recommends that teachers be trained on ICT usage andgiven the support needed to function effectively in theirmultigrade context. For teachers to be digitally connected andensure ICT integration in the teaching and learning process, theyneed to be equipped with relevant knowledge and skills to usetechnology to transform their teaching and create newopportunities for learning.

Institutions of higher education are increasingly highlighting community engagement activities to make the benefits of higher education more visible. The most transformational community engagement is linked to curriculum, so it is faculty who must incorporate community-engaged pedagogy. This content analysis of faculty narratives about community engagement reveals motivations for faculty to engage in this work. These findings connect to social capital theory and suggest a new direction for faculty development efforts to promote community engagement.

The rapid development of artificial intelligence and large language models (LLMs) has led to significant advancements in applying machine learning techniques across diverse disciplines, including educational science research. This study investigates the potential of LLMs like ChatGPT for qualitative data analysis, focusing on open, axial, selective coding, theme or pattern identification, and inter-rater reliability. Our findings indicate promising capabilities of ChatGPT in open coding, demonstrating accurate categorization of qualitative data. However, axial coding posed challenges due to the model's limited understanding, which was partially addressed by refining prompts based on ChatGPT's interpretation. ChatGPT also showed competence in selective coding and theme or pattern identification, providing additional insights. For inter-rater reliability, ChatGPT's performance varied across datasets, with improvements observed when providing contextual information. It is important to note the limitations and variability of LLMs such as ChatGPT, which is in public beta and subject to potential limitations in usage and reliability. Our study demonstrates ChatGPT's potential for coding and inter-rater reliability. Improved results are achieved with refined prompts and utilising ChatGPT's own definitions. The adoption of LLMs for qualitative analysis requires further exploration, including addressing algorithmic bias and the potential for inaccurate responses. Validation techniques are crucial in mitigating these risks.

Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (M[subscript age]=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., "Administration and Policy in Mental Health and Mental Health Services Research," 48, 155-170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., "Journal of Consulting and Clinical Psychology," 78(4), 526-536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care.

Climate change is of great concern to all age groups but in particular to children. "Simple" climate models have been in place for a long time and can be used effectively with post-16 students. For younger children, modifications are required, and we describe in this paper the development and use of two such models. The first (the Granny Model) is a pictorial version of the model that has been used extensively with primary and early secondary school aged children (14 and younger). The second is an online version of the simple climate model that can be used without recourse to the underpinning mathematics and science but allows children to experiment with changing variables and how these changes affect the average surface temperature of the Earth.

Research represents an essential component of the response to infectious disease outbreaks and to other public health emergencies, whether they are localised, of international concern, or global. Research conducted in such contexts also comes with particular ethics challenges, the awareness of which has significantly grown following the Ebola outbreak in West Africa, the Zika outbreak in Latin America and the COVID-19 pandemic. These challenges include the need for implementing meaningful community engagement with the researched communities, not just to build unidirectional trust towards the research team, but to achieve a genuine and mutually respectful partnership before, during and after the research. Here, we describe the real-life experience of 10 well-established research clinics in Nairobi, where a successful experience of community engagement linking prevention and care to research was interrupted during the COVID-19 pandemic. We contrast this experience with the concept and processes of community engagement as described in selected scientific manuscripts and guidelines, to formulate some conclusions and recommendations. We contend that more action is needed, from research ethics committees and other key-research stakeholders, to align policies and practices with ethics guidance and with evidence-based recommendations from the academic literature, to achieve meaningful community engagement during emergency research, irrespective of the scale and location of an outbreak or public health crisis. Failure to do so, will aggravate the (postcolonial) asymmetries of power in global health and local systems.

Background: The literature suggests that educators can use parent-educator communication to support parents with engaging their children in home learning activities (Epstein, 1995; Hoover-Dempsey & Sandler, 1997). Objective: This study examines the relations between parent-educator communication and preschoolers' numeracy, literacy, executive function, and vocabulary, and explores if the home numeracy environment (HNE) and the home literacy environment (HLE) was a better predictor of children's outcomes than parent-educator communication. Method: Data for this study came from a larger quasi-experimental study evaluating a state-funded preschool program (n = 558). Regression models were run controlling for child's age, sex, race/ethnicity, family income, group, parental education, and baseline skill scores. Results: Analyses revealed a significant relation only between parent-educator communication and numeracy skills ([beta] = -0.14, p = < 0.001). Unexpectedly, more frequent parent-educator communication in preschool were related to lower numeracy skills. Additionally, there was a statistically significant association between all three predictors -- parent-educator communication ([beta] = - 0.15, p = < 0.001), the HNE ([beta] = 0.14, p = 0.016), and the HLE ([beta] = - 0.18, p = 0.004) -- and children's numeracy skills. Specifically, more frequent parent-educator communication and higher HLE scores in preschool predicted lower numeracy skills. Additionally, the higher quality of the HNE predicted greater numeracy skills in the spring of preschool. Conclusion: There may be increased communication when the children are performing lower on their numeracy skills than their peers and teachers and parents are working to remediate those challenges.

OBJECTIVES: In the United States, pediatric emergency department (ED) visits for behavioral health (BH) are increasing. We sought to determine ED-level characteristics associated with having recommended BH-related policies. METHODS: We conducted a retrospective serial cross-sectional study of National Pediatric Readiness Project assessments administered to US EDs in 2013 and 2021. Changes in responses related to BH items over time were examined. Multivariable logistic regression models examined ED characteristics associated with the presence of specific BH-related policies in 2021. RESULTS: Of 3554 EDs that completed assessments in 2021, 73.0% had BH-related policies, 66.5% had transfer guidelines for children with BH issues, and 38.6% had access to BH resources in a disaster. Of 2570 EDs that completed assessments in both 2013 and 2021, presence of specific BH-related policies increased from 48.6% to 72.0% and presence of appropriate transfer guidelines increased from 56.2% to 64.9%. The adjusted odd ratios (aORs) of having specific BH-related policies were lower in rural (aOR 0.73; 95% confidence interval [CI] 0.57, 0.92) and remote EDs (aOR 0.65; 95% CI 0.48, 0.88) compared to urban EDs; lower among EDs with versus without trauma center designation (aOR 0.80; 95% CI 0.67, 0.95); and higher among EDs with a nurse and physician pediatric emergency care coordinator (PECC) (aOR 1.89; 95% CI 1.54, 2.33) versus those without a PECC. CONCLUSION: Although pediatric readiness for BH conditions increased from 2013 to 2021, gaps remain, particularly among rural EDs and designated trauma centers. Having nurse and physician PECCs is a modifiable strategy to increase ED pediatric readiness pertaining to BH.

All learners have a contribution to make to the development of the Chemical Sciences, be that in novel ways to teach, and their perspectives and contexts, but also in research, both in chemical education and the wider Chemical Sciences. Through four case studies, this paper explores interactions with diverse groups and how this has altered perspectives on both teaching and research. The case studies include work with visually impaired adults, a project bringing together First Peoples in Australia with academics to explore old ways (traditional science) and new ways (modern approaches), primary (elementary) school perspectives on teaching science, and a project in South Africa to connect university and township communities. Not only do these case studies demonstrate the immense value these diverse groups bring to our understanding about how to learn, but they also bring new perspectives on how to view and solve chemical problems.

Background and Objectives: adverse events are a major public health problem. The purpose of the study was to characterize the main adverse events with harm reported in a teaching hospital in Minas Gerais. Methods: this is a retrospective cross-sectional descriptive study with quantitative approach, which assessed the reports on adverse events, carried out between January 2015 and December 2018. Pearson’s chi-square test was applied in order to verify the association between categorical variables. Cramer’s measure V was calculated to assess the degree of association between the respective variables. In the observation of statistically significant results, the Z test was applied to compare proportions with adjustments by the Bonferroni method. Results: a total of 445 adverse events were reported, being the highest number in 2018 (61.8%) involving “Abrasion and friction” process (44.7%), which correspond to grades 3 and 4 pressure injuries. Most adverse events were reported by the Emergency Unit (29.2%), and serious harm (7.6%) and deaths (1.3%) were more prevalent in this place. There was a statistically significant association between types of harm and types of incidents (p

The devaluation of women of Color (WoC) by way of gender discrimination and systemic racism is well documented. For WoC in engineering a chief cause is the observable wage gap. Women who identify as Asian, Black/African American, Latina/Chicana, Indigenous/Native American, Native Hawaiian, Pacific Islander, Native Alaskan, and/or multiracial have reported stark wage disparities. In this paper, we offer a phenomenological study of how WoC engineering faculty across U.S. academic institutions describe the challenges and practices associated with wage disparities and how they navigate these disparities. This study, which is based on participant interviews, is guided by three research questions: (1) What do WoC engineering tenure-track faculty perceive about wage disparities based on their race and gender? (2) How do WoC faculty understand the institutional practices that contribute to wage disparities? and (3) How do WoC engineering faculty respond to and address wage disparities? Using structural racism and intersectionality as our guiding conceptual framework, we interviewed 32 self-identified WoC who identified structures and systems of institutional racism related to the maintenance of wage disparities. In terms of findings, we note that WoC have two primary strategies to respond to wage disparity: advocacy and agency. The experiences of WoC engineering faculty in our study highlight unsatisfying institutional responses, and thus WoC often rely on their own agency to advocate for themselves and to advocate for and mentor other WoC faculty. We found a few notable cases where men advocated for women to help close the wage gap. Our work reveals that pay inequity for WoC is often coupled with other forms of exclusion and marginalization. Reducing wage disparities in academia is critical to advancing diversity efforts and ensuring equitable support for WoC faculty. Our findings suggest that institutions can work diligently to rectify wage inequality, including making sustainable structural and salary modifications and sharing the burden of combatting wage inequities. Finally, our findings also highlight the importance of making policy changes to reduce pay inequalities, such as providing transparent pay information and more opportunities to earn merit raises.

This study examined the clinical utility of the Massachusetts Youth Screening Instrument--Second Version (MAYSI-2) among African American (AA) incarcerated youth and used White incarcerated youth as a comparison group. Data were analyzed for 314 incarcerated youth (193 AA offenders and 121 White offenders) of ages 13-17 years who were adjudicated delinquent from a southeastern United States medium security residential facility. Seven logistic regression and receiver operating characteristic curve (ROC) models were built to determine whether the MAYSI-2 subscales accurately identify committed AA male incarcerated youth who have a mental illness diagnosis on file. Analyses also examined how well the MAYSI-2 subscales identify specific mental illnesses among AA-committed male incarcerated youth. Results demonstrated that no MAYSI-2 subscales accurately identified and categorized AA-committed male incarcerated youth who have mental disorders, and only two subscales (Alcohol/Drug Use, Depressed/Anxious) identified and categorized White committed male incarcerated youth who have a mental disorder. Additional results and implications for research and practice are provided.

INTRODUCTION: The incidence of pediatric Wilms tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda. METHODS: A cohort study of patients  25 cm (OR 2.67, 95% CI 1.05-6.81). CONCLUSIONS: Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.

Background: During cardiopulmonary resuscitation (CPR), end-tidal carbon dioxide (EtCO2) is primarily determined by pulmonary blood flow, thereby reflecting the blood flow generated by CPR. We aimed to develop an EtCO2 trajectory-based prediction model for prognostication at specific time points during CPR in patients with out-of-hospital cardiac arrest (OHCA).Methods: We screened patients receiving CPR between 2015–2021 from a prospectively collected database of a tertiary-care medical center. The primary outcome was survival to hospital discharge. We used group-based trajectory modeling to identify the EtCO2 trajectories. Multivariable logistic regression analysis was used for model development and internally validated using bootstrapping. We assessed performance of the model using the area under the receiver operating characteristic curve (AUC).Results: The primary analysis included 542 patients with a median age of 68.0 years. Three distinct EtCO2 trajectories were identified in patients resuscitated for 20 minutes (min): low (average EtCO2 10.0 millimeters of mercury [mm Hg]; intermediate (average EtCO2 26.5 mm Hg); and high (average EtCO2: 51.5 mm Hg). Twenty-min EtCO2 trajectory was fitted as an ordinal variable (low, intermediate, and high) and positively associated with survival (odds ratio 2.25, 95% confidence interval [CI] 1.07–4.74). When the 20-min EtCO2 trajectory was combined with other variables, including arrest location and arrest rhythms, the AUC of the 20-min prediction model for survival was 0.89 (95% CI 0.86–0.92). All predictors in the 20-min model remained statistically significant after bootstrapping.Conclusion: Time-specific EtCO2 trajectory was a significant predictor of OHCA outcomes, which could be combined with other baseline variables for intra-arrest prognostication. For this purpose, the 20-min survival model achieved excellent discriminative performance in predicting survival to hospital discharge.

IN THE fall of 2019, in the 'Before Times,' I found myself seated onstage facing rows of eager listeners in stadium-style seating at the Seattle Public Library on a blustery, [...]

PURPOSE The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients. METHODS This was a 3-month, prospective intervention study that included patients aged 40 years or more with BP of 140/90 mmHg or higher who received care from DIG IT from August through December 2021. Sociodemographic and clinical outcomes of DIG IT were compared with historical controls (controls) whose data were randomly extracted by the University of California Data Warehouse and matched 1:1 based on age, ethnicity, and baseline BP of the DIG IT arm. Multiple linear regression was performed to adjust for potential confounding factors. RESULTS A total of 140 patients (70 DIG IT, 70 controls) were included. Both arms were similar with an average age (SD) of 62.8 (9.7) years. The population was dominated by Latinx (79.3%) persons, with baseline mean BP of 163/81 mmHg, and mean ASCVD risk score of 23.9%. The mean (SD) reduction in systolic BP at 3 months in the DIG IT arm was twice that of the controls (30.8 [17.3] mmHg vs 15.2 [21.2] mmHg; P CONCLUSIONS The DIG IT was more effective than controls (receiving usual care). Twofold improvement in the BP readings and ASCVD scores in medically underserved patients were achieved with DIG IT. Key words: digital health; hypertension; patient care team; vulnerable population, https://doi.org/10.1370/afm.3151 INTRODUCTION Medically underserved populations are 40% more likely to have hypertension and 3 times more likely to die from heart diseases due to uncontrolled high blood pressure (BP). (1,2) [...]

BackgroundPrematurity (gestational age AimThis was to find out the proportions of preterm babies who survived at the Special Care Baby Unit (SCBU) in the Cape Coast Teaching Hospital (CCTH) and the factors which influenced their survival.MethodThis was a retrospective review of data on all the live preterm babies seen at the SCBU of CCTH from 2010 to 2019. Data on 2,254 babies that met the inclusion criteria were extracted. Descriptive statistics were generated and tests of association done with chi-square and multivariable logistic regression.OutcomeThe main outcome measure was the proportion of live preterm neonates who were discharged after SCBU admissions.ResultsThe CCTH had a total of 27,320 deliveries from 2010 to 2019. Of these, 1,282 were live preterm births, giving a prevalence of live preterm babies over the ten-year period of 4.7% (1,282/27,320). An increasing trend in prevalence was observed with 2019 recording the highest at 9% (271/3027). Most (48.8%) of the deliveries were vaginal, 39.2% were by caesarean section (CS); the mode of birth for 12% of the women were not documented. The mean gestational age was 31.8 (±2.77) weeks. Of the birth weights documented, 2500g made up only 3.7%. The average length of hospital stay was 8.3 (±9.88) days. Regarding the main outcome variable, 67.6% were discharged alive, 27.6% died and 4.9% were unaccounted for due to incomplete documentation. Factors which influenced survival were: birth weight (p ConclusionThis study shows the possibility of achieving good preterm survival rates through the provision of specialised neonatal care, even in resource-constrained countries. This provides an updated benchmark for clinical decision-making and antenatal counselling. It also highlights the problem of inadequate data capture in our part of the world, which needs considerable improvement.