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ABSTRACTObjective Direct oral anticoagulants (DOACs) are first-line therapy for stroke prevention for 1.4 million atrial fibrillation (AF) patients in the UK. However, the rates of DOAC dosing below evidence-based recommendations are estimated between 9% and 22%. This study explores specific patient and physician factors associated with prescribing inappropriate DOAC underdoses.Methods DOAC-prescribing physicians within the UK completed both a clinical vignette survey, which contained 12 hypothetical patient profiles designed to replicate DOAC prescribing scenarios, and a physician survey to capture sociodemographic, clinical experience, and prescriber-related beliefs and motivations related to DOAC prescribing. Eight patient factors based on a literature search and an expert consultation process were varied within the vignettes. Associations between the prescribers’ dosing choices and patient factors were explored via multilevel logistic regression. The analysis is focused on the most frequently selected DOACs, apixaban and rivaroxaban, both of which have different dosing guidelines.Results In all, 336 prescribers (69% male; 233/336) completed the survey, mostly general physicians (GPs) (45%) or cardiology specialists (36%) with a mean of 17.9 years’ experience. Most prescribers (73%; 244/336) inappropriately underdosed at least once; rates between GPs and specialists were nearly identical. Patient factors most strongly associated with apixaban inappropriate underdosing included a history of major bleeding and falls. For rivaroxaban, these were major bleeding and severe frailty. Only 32% (106/335) of prescribers reported DOAC dosing guidelines as the sole influence on their prescribing behaviour. Among prescribers who did not inappropriately underdose, greater prescribing confidence was aligned to increased perception of inappropriate underdose risk.Conclusions Overall, patient factors such as major bleeding and severe frailty were found to be associated with inappropriate underdosing of apixaban and rivaroxaban. Furthermore, prescribers who were more confident in DOAC prescribing, and were more worried about the risk of stroke, were significantly less likely to inappropriately underdose. These findings suggest that all prescribers, regardless of speciality, may benefit from education and training to raise awareness of the risks associated with inappropriate DOAC underdosing.

Abstract Background Over the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana. Methods We conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable. Results Of the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women’s background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99). Conclusions A significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study’s setting for pregnant women to benefit from comprehensive ANC services.

Abstract Background The incidence of chronic diseases, which are significant contributors to maternal deaths and adverse new-born outcomes, is increasing among women of reproductive age in northern Ghana. This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes. We investigated the risks of preterm birth (PTB), low birth weight (LBW), and concurrent PTB and LBW among women with preexisting chronic conditions prior to conception in the Tamale Metropolis of northern Ghana. Methods A facility-based cross-sectional study was conducted among 420 postpartum women randomly selected from five public health facilities. Information was collected electronically on participants’ self-reported experience of chronic conditions, namely, hypertension, diabetes, asthma, heart disease, and sickle cell disease, prior to their most recent pregnancy. Information on gestational age at delivery and birth weight was also collected. Regression modeling was used to quantify the risk of adverse newborn outcomes among women who reported preexisting chronic conditions prior to pregnancy. Results Chronic diseases affected 31.2% of our sample. Of these, 28.6% had a single chronic condition, while 2.6% had comorbid chronic conditions. The prevalence of PTB was 24.0% (95% CI: 20.2, 28.4), 27.6% (95% CI: 23.5, 32.1) of the newborns were born LBW, and 17.4% (95% CI: 14.0, 21.3) of the pregnancies resulted in both PTB and LBW. Compared with those without chronic conditions, women with chronic conditions prior to conception had a greater risk of PTB (aOR = 6.78, 95% CI: 3.36, 13.68), LBW (aOR = 5.75, 95% CI: 2.96, 11.18), and the co-occurrence of PTB and LBW (aOR = 7.55, 95% CI: 3.32, 17.18). Conclusions We observed significant rates of PTB, LBW, and the co-occurrence of PTB and LBW among women who were already aware that they had preexisting chronic conditions prior to conception. Our findings highlight a potential gap in the quality of prenatal care provided to these women before delivery. Preconception care may offer an opportunity to address preexisting chronic conditions in women before pregnancy and potentially improve maternal and newborn health outcomes.

Malignant (high-grade) gliomas are aggressive intrinsic brain tumors that diffusely infiltrate the brain parenchyma. They comprise of World Health Organization (WHO) grade III and IV gliomas. Ionizing radiation or irradiation (IR) is frequently utilized in the treatment of both primary as well as metastatic brain tumors. On the contrary, macrophages (MΦ) are the most copious infiltrating immune cells of all the different cell types colonizing glioma. MΦ at tumor milieu are referred to as tumor-associated macrophages (TAMΦ). In malignant gliomas milieu, TAMΦ are also polarized into two distinct phenotypes such as M1 TAMΦ or M2 TAMΦ, which are capable of inhibiting or promoting tumor growth, respectively. Cranial-IR such as x- and γ-IR are sufficient to induce the migration of peripherally derived MΦ into the brain parenchyma. The IR facilitate a more immunosuppressive milieu via the stimulation of efferocytosis in TAMΦ, and an upsurge of tumor cell engulfment by TAMΦ exhibited detrimental effect of the anti-tumoral immune response in glioma. The MΦ inside the tumor mass are associated with multiple phenomena that include IR resistance and enrichment of the M2 MΦ after IR is able to facilitate glioblastoma multiforme (GBM) recurrence. Reviews on the role of cranial IR-induced peripheral and brain-engrafting macrophages (BeMΦ) in glioma are lacking. Specifically, most studies on peripheral, intrinsic as well as beMΦ on IR focus on WHO grade III and IV. Thus, this review precisely focuses primary on WHO grade III as well as IV gliomas.

Background: Inflammatory responses, including airway inflammation, hyper-responsiveness, mucus hyper-secretion, prostaglandins and Th2 cytokines infiltration in the airway submucosa, frequently occur in allergic respiratory disorders. This study sought to investigate the effects of the hydro-ethanolic extract of Scoparia dulcis (SDE) on allergic airway inflammation, airway hyper-responsiveness, goblet cell hyperplasia, mucus hypersecretion, Th2 cytokines and prostaglandin (PG)-D2 using murine asthma models. Methods: Allergic asthma was induced in healthy guinea-pigs, and mice, by exposing them to ovalbumin (OVA) sensitization and challenge, and treatment with either 2 ml/kg normal saline, 10 mg/kg salbutamol, 10 mg/kg prednisolone, 50, 100, or 250 mg/kg of SDE per os. The percentage protection against pre-convulsive dyspnoea after methacholine challenge in OVA-induced asthmatic guinea-pigs was determined for each treatment regime, and histopathological examinations thereafter conducted on the excised lungs. Periodic acid-Schiff staining was also performed to identify goblet cell hyperplasia and mucus hypersecretion in these lung tissues. Lung tissue homogenates and serum from OVA-induced asthmatic mice were also assayed for PGD2, interleukins (IL)-5 and -13 levels using monoclonal antibody-based mouse ELISA kits. Results: SDE treatments prolonged the time taken for pre-convulsive dyspnoea to occur after methacholine challenge in OVA-induced asthmatic guinea-pigs; indicative of a positive activity against airway hyper-responsiveness. Histopathological studies also showed that SDE significantly inhibited (p ≤ 0.05) pulmonary infiltration of leukocytes, inflammatory cell accumulation, airway smooth muscle thickening and goblet cell hyperplasia. Serum and lung tissue concentrations of PGD2, IL-5 and IL-13, significantly elevated (p ≤ 0.001) following allergic asthma induction in mice, were significantly reduced (p ≤ 0.01) back to within normal levels after SDE treatments. Conclusion: The plant extract exhibited anti-asthmatic and anti-inflammatory properties, as it reduced the severity of allergic inflammation and hyper-reactivity, as well as PGD2 and Th2 cytokines infiltration in the airway; and these effects could be exploited for future management of asthma.

Transition toward a sustainable, low-carbon energy future requires innovative, integrated solutions. Hybrid solar–hydrogen systems (HSHSs), which combine solar energy harvesting and hydrogen production, have excellent prosepects to address challenges related to renewable energy generation, storage, and usage. This article presents an overview of the research on the technical and economic feasibility of HSHSs, aimed at comprehensively articulating their current state, notable advancements, and future research directions. It begins by elucidating solar energy principles and conversion methods and emphasizing the potential of solar energy for hydrogen production. This study then explores the definitions, components, and synergistic integration of HSHSs. Optimized energy conversion and storage methods for efficient hydrogen production and storage are also highlighted. This study reviews the techniques employed for techno-economic evaluations over the last six years, addressing challenges such as the intermittency of solar energy and the efficiency of hydrogen production technologies. This review of the ongoing research provides helpful insights into the technological and economic feasibility of HSHSs. This underscores the necessity of continuous research and development efforts to overcome existing challenges and unlock their full potential. These systems can play a vital role in achieving a cleaner and more resilient energy future by optimizing the system performance, reducing costs, and fostering supportive policy frameworks.

Abstract Background and Aim Goiter is a major source of morbidity in the world, especially in the developing world, where dietary iodine deficiency, a known cause of this condition, is endemic. The diagnosis is mostly by ultrasonography (USG) scan, which can give anatomical, pathological, and functional information for the management of goiter. This study aimed to determine the commonest ultrasound findings of goiter in Ghana. Method The records of all 213 patients with goiter diagnosed by USG scan over a 5‐year period were retrieved. Data collected were sociodemographics, ultrasound features, thyroid nodules diameter, and Thyroid Imaging Reporting and Data System (TI‐RADS) scores, which were analyzed using GNU PSPP, version 1.2.0‐3. χ2 and two‐tailed independent samples t‐test were also employed, with p ≤ 0.05. Results A total of 213 patients with goiter diagnosed by USG scan were obtained over the study period. The mean age of the participants was 50.01 ± 17.27 years, with an age range of 16−92 years and females constituting the majority (82.16%). The commonest ultrasound features were well‐defined solid nodules. The lesion sites for most patients were the whole thyroid (28.17%), both lobes (24.41%), and the right lobe (20.19%). The mean difference in sizes of cysts and solid nodules among genders was 0.26 (CI: −0.14 to 0.67, p = 0.20) and 0.12 (CI: −0.43 to 0.66, p = 0.67), respectively. The TI‐RADS score featured TI‐RADS 4 (36.62%), TI‐RADS 1 (28.17%), TI‐RADS 3 (25.82%), TI‐RADS 5 (5.16%), and TI‐RADS 2 (4.23%). Solid nodules (49.32%, p = 0.001) and cysts (35.71%, p = 0.003) were more common within 41−60 years and less frequent in those

Objectives: To understand the pattern of hysterosalpingographic (HSG) findings and annual trends among Ghanaian women with infertility over a five-year period. Methods: We retrospectively evaluated the hospital medical records of women with infertility who underwent HSG at a major tertiary center in Ghana between January 2018 and December 2022. The data was statistically analyzed. Results: The subjects comprised of 2324 Ghanaian women diagnosed with clinical infertility. HSG identified 1685 (72.5%) with primary infertility and they were also younger women with a mean age of 32.2±4.5 years. The remaining 639 (27.5%) women had secondary infertility and were older (34.2±5.3 years; p < 0.001). Primary infertility rate decreased with increasing age (p < 0.001). Bilateral tubal blockage was seen in 701 (41.6%) women with primary infertility and 365 (57.1%) women with secondary infertility. Hydrosalpinx was present in 236 (10.2%) women, fimbrial adhesions in 444 (19.1%), Asherman’s syndrome in four (0.2%), and bilateral beaded tubes/tubercular salpingitis in five (0.2%). HSG was unable to detect infertility-related abnormalities in 513 (22.1%) women despite their clinical infertility. The majority of patients (1502; 64.6%) had tubal blockage: bilateral in 1066 (45.9%) and unilateral in 436 (18.8%). Conclusions: Infertility rates among Ghanaian women increased at an accelerating rate over the years. Primary infertility was significantly more prevalent among younger women. Tubal and cervical abnormalities were the most prevalent HSG findings.

Human Parechoviruses (HPeVs) have rarely been considered in the virological investigation of Acute Flacid Paralysis (AFP) cases in Africa, where enteric infections are very common. This study investigated the prevalence and genetic diversity of HPeV in 200 children aged ≤ 15 years with AFP in Cameroon from 2018 to 2019. HPeVs were detected in their faecal RNA using 5'-untranslated real-time RT-PCR. Detected HPeVs were typed by phylogenetic comparison with homologous sequences from homotypic reference strains. Overall, HPeV RNA was detected in 11.0% (22/200) of the 200 stool samples tested. Twelve HPeVs were successfully sequenced and reliably assigned to HPeV-A1, A4, A5, A10, A14, A15, A17 and A18 genotypes. Phylogenetic analyses revealed a high genetic variability among the studied HPeVs, as well as between the studied HPeVs and their previously reported counterparts from Cameroon in 2014. These findings suggest that different HPeV genotypes co-circulate in Cameroon without documented epidemics.

Solar-powered photovoltaic pumping systems (SPVPSs) have emerged as a promising solution for sustainable drip irrigation in agriculture. This review article presents recent advances in SPVPSs for drip irrigation, with a focus on their design, performance and integration. The paper provides an overview of the key components and working principles of SPVPSs. Various system configurations and optimization strategies are discussed, emphasizing the importance of system sizing, energy management and water supply efficiency. The review also addresses challenges and future directions in the field. The initial investment costs, technical constraints, and the need for capacity building are identified as key challenges to widespread adoption. However, ongoing research and development efforts are focused on cost reduction, system optimization, and policy support to overcome these challenges. Technological innovations, such as advanced control algorithms and energy storage systems, are paving the way for improved system performance and reliability. The integration of SPVPSs with drip irrigation offers environmental and socio-economic benefits. These systems contribute to reduced greenhouse gas emissions and water conservation. Moreover, they enhance agricultural productivity, income generation, and food security, particularly in off-grid and rural areas. SPVPSs for drip irrigation hold great promise for sustainable agriculture and water resource management. Continued research, collaboration, and policy support are essential to further advance these systems, address challenges, and promote their widespread adoption. This review paper provides insights for researchers, policymakers, and practitioners interested in harnessing the potential of SPVPSs for sustainable drip irrigation.

Serpin E1/PAI-1, N-terminal pro-brain natriuretic peptide (NTpro-BNP) and neuropilin-1 are markers which have been associated with endothelial dysfunction. However, data on the levels of these markers in PE is limited. The limited data on the pathophysiology of PE in relation to these markers necessitated the study.This was a multicentre case-control study conducted at the Obstetrics and Gynaecology Department of the Tamale Teaching Hospital, the Bawku Presbyterian Hospital and the Bolgatanga Regional Hospital. Out of 520 consenting pregnant women, 127 pregnant women met the inclusion criteria (53 with PE and 74 controls) and were included in this study. Venous, placental, cord and peripheral blood were collected for biomarker assay, haematological parameters and placental parasite determination. Placental tissue sections were obtained for placental malaria and histopathological lesions associated with hypoperfusion. Maternal heart rate and foetal umbilical artery Doppler impedance indices; resistance index (RI) and systolic diastolic (SD) ratio were determined to confirm utero-placental hypoperfusion.Significantly higher proportions of foeto-maternal complications; eclampsia, low birth weight (LBW), neonatal intensive care unit admissions (NICU), intrauterine growth restriction (IUGR), caesarian deliveries and early gestational age at delivery were associated with PE. Women with PE had lower concentrations of platelet (p = 0.02) whereas red cell distribution width (RDW) was markedly elevated (p = 0.01). NTPro-BNP concentration was markedly elevated (p = 0.01) in women with PE whereas neuropilin-1 concentration was lower (p = 0.03) compared to the non-PE group. Maternal heart rate was elevated in women with PE and Doppler resistance indices (RI and SD) were significantly elevated in foetuses of PE women than foetuses of the controls. Placental mal-perfusion lesions were higher in women with PE compared to the non-PE group.Women with PE had increased risk of adverse foeto-maternal complications, significantly associated with placental mal-perfusion lesions, had reduced platelet concentration and elevated RDW-CV levels. NTPro-BNP, RI and SD are elevated in women with PE whereas neuropilin-1 concentration is reduced. Significant changes in these pathological variables in PE women is indicative of significant derangement in endothelial function culminating in adverse maternal and perinatal outcomes of pregnancy.

Tandem solar cells (TSCs) have gained notoriety by the use of various absorber layers with different bandgaps. The photovoltaic characteristics of Cs1-xRbxSnI3 perovskite – silicon TSCs were determined through simulation using the SCAPS-1D software in this work by first validating the experimentally obtained efficiency of 2.08% for ITO/Cs0.8Rb0.2SnI3/PCBM/BCP/Al structure. The influence of chlorinated and undoped ITO front contact, variation of Electron Transport Layer (ETL) thickness, doping concentration, CBO and variation of absorber layer thickness, defect density, and doping concentration was studied. Optimum VOC (0.9893 V), JSC (30.04 mA/cm2), fill factor (81.78 %) and efficiency (24.31 %) were determined. The bottom cell was simulated independently with reference to experimental data using the structure Al/c-Si (n)/c-Si (p)/c-Si (p + )/Au resulting in an efficiency of 26.68 %. The monolithic Cs0.8Rb0.2SnI3 perovskite – silicon tandem solar cell of the architecture ITO/Cs0.8Rb0.2SnI3/c-Si (n)/c-Si (p)/c-Si (p + )/Au performance was analyzed by varying the thickness, doping concentration, and defect density of the active layers. Optimized parameters obtained were as follows: top perovskite layer thickness (100 nm), doping concentrations (5 × 1019 cm-3) and defect density (1 × 1013 cm-3), and bottom silicon absorber layer thickness (50 μm), doping concentrations (5 × 1016 cm-3), defect density (1 × 1012 cm-3), and a work function of 5.3 eV with chlorinated ITO as the front contact of the tandem cell. Optimized outcomes of efficiency (29.82 %), VOC (0.7992 V), JSC density (43.39 mA/cm2), and fill factor (85.98 %) were realized for the 2T Cs0.8Rb0.2SnI3 perovskite – silicon tandem solar cell.

BackgroundAngiogenic growth mediators (AGMs) and oxidative stress (OS) both play essential roles in normal placental vascular development and as such, placental alterations in these factors contribute to pre-eclampsia (PE). Suboptimal health status (SHS), an intermediate between health and disease, has been associated with imbalanced AGMs and OS biomarkers. Thus, SHS pregnant women may be at increased risk of developing PE and may present abnormal placental alteration and expression of AGMs and OS compared to optimal health status (OHS) pregnant women. We examined the histopathological morphology, immunohistochemical expression of AGMs antibodies and oxidative DNA damage marker in the placentae of SHS and OHS pregnant women who developed early-onset PE (EO-PE) and late-onset (LO-PE) compared to normotensive pregnancy (NTN-P).MethodsThis nested case-control study recruited 593 singleton normotensive pregnant women at baseline (10-20 weeks gestation) from the Ghanaian Suboptimal Health Status Cohort Study (GHOACS) undertaken at the Komfo Anokye Teaching Hospital, Ghana. Socio-demographic, clinical and obstetrics data were collected, and a validated SHS questionnaire-25 (SHSQ-25) was used in classifying participants into SHS (n = 297) and OHS (n = 296). Participants were followed until the time of PE diagnosis and delivery (32-42 weeks gestation). Blood samples were collected at the two-time points and were assayed for AGMs; soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PIGF), vascular endothelial growth factor-A (VEGF-A), and soluble endoglin (sEng), and OS biomarkers; 8-hydroxydeoxyguanosine (8-OHdG), 8-epiprostaglandinF2-alpha (8- epi-PGF2α) and total antioxidant capacity (TAC) using ELISA. Placental samples were collected for histopathological and immunohistochemical analysis.ResultsOf the 593 pregnant women, 498 comprising 248 SHS and 250 OHS women returned for delivery and were included in the final analysis. Of the 248 SHS women, 56, 97 and 95 developed EO-PE, LO-PE and NTN-P, respectively, whereas 14, 30 and 206 of the 250 OHS mothers developed EO-PE, LO-PE and NTN-P, respectively. At baseline, SHS_NTN pregnant women had a significant imbalance in AGMs and OS biomarkers compared to OHS_NTN pregnant women (pLO-PE) more than OHS groups who developed PE (EO-PE>LO-PE) when all were compared to NTN-P (pLO-PE more than OHS- pregnant women who developed EO-PE>LO-PE when all were compared to NTN-P (pConclusionIncreased lesions, oxidative DNA damage, and imbalanced expression between pro-and anti-AGMs are associated more with SHS-embodied PE placentae rather than OHS-embodied PE subtypes, thus potentially allowing differential evaluation of PE.