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PurposeThis study aims to explore how corporate social responsibility (CSR) dimensions (i.e. economic; legal; ethical; philanthropic) foster employee creativity during the COVID-19 pandemic. Specifically, an attempt is made to investigate the mediating role of affective commitment to explain the above linkage.Design/methodology/approachThe survey data were collected from 167 employees in the emerging market of Saudi Arabia. The data was analysed using PLS-SEM for frequency, reliability, confirmatory factor analyses and structural equation modelling.FindingsThe CSR dimensions, particularly the ethical and philanthropic dimensions, showed both direct and indirect effects on the creativity behaviour of employees during the COVID-19 pandemic. Moreover, affective commitment mediated the relationship between the legal, ethical and philanthropic CSR dimensions and creativity behaviour.Originality/valueThis study enriches previous CSR empirical research and adds to current literature focused on the determinants of CSR dimensions' effectiveness; particularly, the research is set in a challenging scenario characterized by the pandemic. So, this paper extends previous studies by investigating under which key conditions CSR dimensions are most effective, in particular in two main directions. First, it contributes to the CSR literature by determining how various CSR dimensions influence creativity behaviour during a pandemic. Pandemics are events that occur regularly, and the COVID-19 pandemic, in particular, offers the opportunity to explore its effects on employees' behaviours in the current context. Second, the study's mediation findings contribute to new empirical evidence which suggests that affective commitment has a positive effect on the CSR dimensions of employee creativity behaviour during a pandemic in an emerging market.

We report an investigation into the impact of applying a large reverse bias voltage during current–voltage (J-V) sweeps on the degradation rate of solar cells based on poly[N-9″-hepta-decanyl-2,7-carbazole-alt-5,5-(4′,7′-di-2-thienyl-2′,1′,3′-benzothiadiazole)] (PCDTBT) and [6-6]-phenyl C71-butyric acid methyl ester (PC70BM), under air mass 1.5 simulated solar irradiation. The degradation rate was found to be significantly slower when devices were characterized using frequent J-V sweeps with a large reverse bias component (-7 V to 1 V), with a decrease in power conversion efficiency of 24% after ∼ 100 hrs of light exposure. In contrast, devices scanned from −1 V to 1 V degrade by 72% in the same time period. The decay in the photovoltaic performance was found to be related to an increase in the series resistance and a decrease in the shunt resistance of the devices over time. Further characterization of the bulk heterojunction layer under irradiation conditions indicates that this behavior might be caused by the decreasing mobility of the charge carriers due to the formation of the defects or traps in the layer, induced by the photo-oxidation process. The frequent application of a large reverse bias sweep most likely helps de-trap the charge carriers and slows down the device degradation. Impedance analysis indicated that during the decay of PCDTBT:PC70BM devices the bulk layer became more resistive with time, and applying large and frequent reverse bias sweeps during testing could significantly slow down this process. The charge carrier extraction time was found to increase from 7 μs to more than 400 μs after photo-degradation. These findings demonstrate that repeated application of a reverse bias voltage can affect device degradation, and therefore that the specific details of J-V characterization should be reported alongside device lifetime claims.

Background : The safety of COVID vaccines should be continuously followed. This study reports adverse events of the Oxford/AstraZeneca COVID-19 vaccine. Methods : A prospective single-cohort study design was conducted to assess adverse events following immunization and associated factors of the first dose of Oxford/AstraZeneca's COVID-19 vaccine in Ayder Comprehensive specialized hospital. A structured questionnaire was administered consecutively to 423 participants. Follow-up data were collected 72 hours after vaccination via phone. Bivariate and multivariate logistic regression models were used to find associations between adverse events and independent variables. Statistical significance was declared at P Results : Out of 423 health care workers approached, 395 responded. At least one adverse event (95% CI: 63.58, 72.77) was reported by 270 participants. Local and systemic symptoms occurred in 46.8% (95% CI: 41.94, 51.79) and 58.48% (95% CI: 53.53, 63.26)], respectively. Muscle ache, fatigue, headache and fever were the most common local symptoms. No reports of hospitalization, disability or death. Age (adjusted odds ratio [AOR]=0.97, P=0.048), female sex (AOR=1.84, P=0.028), and comorbidity (AOR=2.28, P=0.040) were independent predictors of adverse events. Conclusion and recommendation : Adverse events following immunization are commonly reported after the first dose of the Oxford/AstraZeneca COVID-19 vaccine; age, female sex and comorbidity are independent predictors.

BackgroundPatients with chronic inflammatory disease (CID) treated with immunosuppressive medications have increased risk for severe COVID-19. Although mRNA-based SARS-CoV-2 vaccination provides protection in immunocompetent persons, immunogenicity in immunosuppressed patients with CID is unclear.ObjectiveTo determine the immunogenicity of mRNA-based SARS-CoV-2 vaccines in patients with CID.DesignProspective observational cohort study.SettingTwo U.S. CID referral centers.ParticipantsVolunteer sample of adults with confirmed CID eligible for early COVID-19 vaccination, including hospital employees of any age and patients older than 65 years. Immunocompetent participants were recruited separately from hospital employees. All participants received 2 doses of mRNA vaccine against SARS-CoV-2 between 10 December 2020 and 20 March 2021. Participants were assessed within 2 weeks before vaccination and 20 days after final vaccination.MeasurementsAnti-SARS-CoV-2 spike (S) IgG+ binding in all participants, and neutralizing antibody titers and circulating S-specific plasmablasts in a subset to assess humoral response after vaccination.ResultsMost of the 133 participants with CID (88.7%) and all 53 immunocompetent participants developed antibodies in response to mRNA-based SARS-CoV-2 vaccination, although some with CID developed numerically lower titers of anti-S IgG. Anti-S IgG antibody titers after vaccination were lower in participants with CID receiving glucocorticoids (n=17) than in those not receiving them; the geometric mean of anti-S IgG antibodies was 357 (95% CI, 96 to 1324) for participants receiving prednisone versus 2190 (CI, 1598 to 3002) for those not receiving it. Anti-S IgG antibody titers were also lower in those receiving B-cell depletion therapy (BCDT) (n=10). Measures of immunogenicity differed numerically between those who were and those who were not receiving antimetabolites (n=48), tumor necrosis factor inhibitors (n=39), and Janus kinase inhibitors (n=11); however, 95% CIs were wide and overlapped. Neutralization titers seemed generally consistent with anti-S IgG results. Results were not adjusted for differences in baseline clinical factors, including other immunosuppressant therapies.LimitationsSmall sample that lacked demographic diversity, and residual confounding.ConclusionCompared with nonusers, patients with CID treated with glucocorticoids and BCDT seem to have lower SARS-CoV-2 vaccine-induced antibody responses. These preliminary findings require confirmation in a larger study.Primary funding sourceThe Leona M. and Harry B. Helmsley Charitable Trust, Marcus Program in Precision Medicine Innovation, National Center for Advancing Translational Sciences, and National Institute of Arthritis and Musculoskeletal and Skin Diseases.

International audience; Doping of transition metals within a semiconductor quantum dot (QD) has a high impact on the optical and magnetic properties of the QD. In this study, we report the synthesis of Mn 2+-doped Ag−In−Ga−Zn−S (Mn:AIGZS) QDs via thermolysis of a dithiocarbamate complex of Ag + , In 3+ , Ga 3+ , and Zn 2+ and of Mn(stearate) 2 in oleylamine. The influence of the Mn 2+ loading on the photoluminescence (PL) and magnetic properties of the dots are investigated. Mn:AIGZS QDs exhibit a diameter of ca. 2 nm, a high PL quantum yield (up to 41.3% for a 2.5% doping in Mn 2+), and robust photo-and colloidal stabilities. The optical properties of Mn:AIGZS QDs are preserved upon transfer into water using the glutathione tetramethylammonium ligand. At the same time, Mn:AIGZS QDs exhibit high relaxivity (r 1 = 0.15 mM −1 s −1 and r 2 = 0.57 mM −1 s −1 at 298 K and 2.34 T), which shows their potential applicability for bimodal PL/magnetic resonance imaging (MRI) probes.

Congenital malformations are defects of the morphogenesis of organs or body during the pregnancy period and are identifiable at pre- or postnatal. They are identified as the major cause of child mortality worldwide. There is a need to understand the prevalence of congenital malformations in Tigray and Ethiopia in general as surveillance data are lacking. Hence, this study was designed to investigate the burden of major congenital malformations in the Tigray Region, Northern Ethiopia. Hospital-based cross-sectional study was conducted to identify neonates with major congenital anomalies in the labor ward admitted at six major public hospitals of Tigray region, Ethiopia between January 2018 and 2019. All newborns/neonates delivered in all study hospitals during the study period were considered as the study population. The prevalence of major congenital anomalies and the distribution of each type of major congenital anomalies within total birth were calculated. Data on maternal, and newborn demographic characteristics was collected. Statistical analysis was done using SPSS and p value p p p p p

Background Malnutrition is very common in HIV-infected individuals. Even though data from different settings are necessary to tackle it, pieces of evidence are limited especially in the case of the nutritional status of HIV-infected children. Hence, this study aims to assess the nutritional status and associated factors among children on antiretroviral therapy. Methods An institutional-based cross-sectional study was conducted among 383 HIV-positive children in Southern Ethiopia. Data were collected using an interviewer-administered questionnaire and anthropometry measurement. Data were coded and entered into Epi-Data Version 3.1 and analyzed using SPSS Version 25. Bi-variable and multi-variable binary logistic regression models were used to identify factors associated with nutritional status and variables with p-values Results The prevalence of wasting among HIV-positive children in Southern Ethiopiaselected Hospitals was 36.3% (95% CI, 31.6–41.0) while stunting on the same study population was 5.5% (95% CI, 3.4–7.8). Rural residence, lack of maternal education, low CD4 counts (p-value Conclusion This study found that the prevalence of under-nutrition among HIV-positive children in Ethiopia was significantly high. Therefore, timely identification and monitoring of nutritional problems should be necessary to enhance the effectiveness of ART treatment and to prevent further related complications.

Internet of Things (IoT) is the inter-networking paradigm based on many processes such as identifying, sensing, networking and computation. An IoT technology stack provides seamless connectivity between various physical and virtual objects. The increasing number of IoT applications leads to the issue of transmitting, storing, and processing a large amount of data. Therefore, it is necessary to enable a system capable to handle the growing traffic requirements with the required level of QoS (Quality of Service). IoT devices become more complex due to the various components such as sensors and network interfaces. The IoT environment is often demanding for mobile power source, QoS, mobility, reliability, security, and other requirements. Therefore, new IoT technologies are required to overcome some of these issues. In recent years new wireless communication technologies are being developed to support the development of new IoT applications. This paper provides an overview of some of the most widely used wireless communication technologies used for IoT applications.

Background: CAD is the largest contributor of cardiovascular diseases (CVDs) and mortality rate is due in prevalence to atherosclerosis. Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has a prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. Objective: To assess the relationship between C reactive protein/albumin ratio (CAR), severity of coronary atherosclerosis assessed by the syntax score (SS) in patients with stable coronary artery disease. Patients and Methods: This study was a prospective cohort study conducted on 100 patients divided into two equal groups according Syntax score. All patients underwent elective percutaneous coronary angiography, and have the following: hemoglobin levels, serum creatinine, serum cholesterol, serum albumin, C- reactive protein, resting 12-lead electrocardiography and Doppler – echocardiography. Results: C-reactive protein/albumin ratio was significantly higher in patients with intermediate-high SS group. In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with serum Cholesterol, HDL and LDL. Conclusion: C-reactive protein/albumin ratio was more tightly associated with the complexity and severity of CAD, and was found to be an independent predictor for intermediate-high SS group.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Background and Objectives Although child mortality is declining in Saudi Arabia, new trends and causes are emerging. The objective of the study is to determine the causes of child death in a tertiary care hospital in Saudi Arabia and to identify its preventable causes and associated risk factors. Methods A modified UNICEF Multiple Indicator Cluster Survey (MICS) was used to analyze all deaths among children under the age of 18 which occurred at the King Abdullah Specialized Children’s Hospital (KASCH) between 2010 and 2016. Results After reviewing all the death charts of 1138 children, the team determined that 15% (172) of all deaths could have been prevented and the preventability increased with age. Only 2% of the neonates died of preventable causes, while 53% of the children of 6 years of age or older died of preventable causes. The highest percentage of preventable deaths occurred in children aged 13–18 years (39.3%), followed by the age group of 6–12 years (32.4%) and the age group of 29 days to 5 years (13.9%). All 966 (85%) deaths from biological causes were considered to be unpreventable. Among the preventable causes, 142 (82.5%) had injuries and 30 (17.4%) were sudden unexpected infant death (SUID) with no documented autopsy or death scene investigation, and thus it was considered preventable by the researchers. The 5 major causes of deaths secondary to injuries were motor vehicle accidents (MVA) accounting for 86 deaths (60.6%), followed by drowning accounting for 19 deaths (13.4%), child maltreatment accounting for 13 deaths (9.2%), fire and weapon accounting for 12 deaths (8.5%), and finally home accident (fall, poisoning, suffocation) accounting for 12 deaths (8.5%). Conclusion The State Child Death Reviews Board should thoroughly investigate deaths due to SUID and injuries by identifying the factors that contribute to the implementation of preventive strategies.

Introduction: In Africa, the first case of COVID-19 was reported in February 2020. Mauritania’s first case was confirmed in March 2020. Methodology: We provide an update of the COVID-19 epidemic in Mauritania as of December 2020, and describe the country’s Health System Response. Results: In total, 133,749 diagnostic tests were performed, 14,364 (10.7%) were positive (309 cases/100,000 inhabitants). Case fatality rate was 2.4%. The 20-39 year-olds (41%) and males (59.1%) were most commonly affected. Comorbidities among fatal cases included cardiovascular diseases (44.8%) and diabetes (37.1%). Clinical symptoms included fever (57%), cough (52%), running nose (47%) and headache (26%). After the first case, prevention measures were progressively tightened, and quarantine implemented for all suspected cases. Schools and universities were closed, and flights to Mauritania suspended. Restaurants and cafeterias were closed, and night curfews installed. Friday prayers were suspended nationwide, and movements between regions restricted. These measures helped to contain the spread of SARS-CoV-2 during the first pandemic wave, which peaked in June 2020 with low rates. However, the number of daily cases reached high levels in December 2020, during the second wave (40.1% of all cases and 48.9% of deaths). During the first wave, there were 38 ICU beds nationwide, but the ICU’s capacity increased in short time. Conclusions: Mauritania has passed through the first pandemic wave with relatively low case fatality rates, currently being at the end of the second wave. As the country’s health system is very vulnerable, there is a need for strict public health measures during epidemics.

Alem Endeshaw Woldeyohanins,1 Asmamaw Emagn Kasahun,1 Chilot Abiyu Demeke,1 Zemene Demelash Kifle2 1Department of Pharmaceutics and Social Pharmacy, School of Pharmacy Gondar, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia; 2Department of Pharmacology, School of Pharmacy Gondar, University of Gondar-College of Medicine and Health Sciences, Gondar, EthiopiaCorrespondence: Alem Endeshaw WoldeyohaninsDepartment of Pharmaceutics and Social Pharmacy, School of Pharmacy Gondar, University of Gondar-College of Medicine and Health Sciences, P.O. Box 196, Gondar, EthiopiaTel +251 920292874Fax +251-58-1141240Email aleend2008@gmail.com; Alem.Endashaw@uog.edu.etBackground: Globally, more than eight million under-five children die every year because of diseases that could be treated or prevented with drug therapy. Thus, this study aimed to evaluate the utilization and availability of the World Health Organization (WHO) suggested priority life-saving medicines for under-five-year-old children in Gondar town.Methods: Institutional-based cross-sectional survey was conducted from March 2020 to May 2020 in public health centers of Gondar town. Data entry and validation were performed in EpiData 3.1 and exported to SPSS version 20 for descriptive analysis like frequency, percentage, mean, standard deviation, and median.Results: The availability of zinc phosphate and oral rehydration salt for the diarrheal cases was 57.14% and 85.71%, respectively. The availabilities of amoxicillin dispersible tablet and gentamicin injection for the treatments of pneumonia cases were 71.43% and 42.85%, respectively, and the availability of paracetamol tablet was high (85.71%). The availabilities of artemether/lumefantrine tablet and artesunate rectal were ranged between fairly high (57.1%) to very low (28.5%), respectively, and the availabilities of zidovudine/lamivudine/nevirapine-based antiretroviral regimen was 100%, a utilization for this regimen was high (96.29%). Two (3.70%) of the surveyed cases were utilized lopinavir/ritonavir-based regimen. The utilization of priority medicines was low for pain management and pneumonia which was 18.5% and 48.18%, respectively.Conclusion: The study concluded that medicine was not consistently available throughout public health centers in Gondar town. Thus, this finding suggests the integration of WHO-recommended life-saving priority medicines into the essential drug management systems and health unit logistics to raise their utilization and availability.Keywords: availability, utilization, priority medicines, Gondar, Ethiopia

The SARS-CoV-2 (COVID-19) pandemic has emerged as one of the greatest problems of the 21st century worldwide. Efforts to fight this pandemic require a global co-operation and a multidisciplinary approach. An application of information and communication technologies (ICT) to a great degree contributes to fighting the pandemic as these technologies are one of the key services that assist patients, researchers, health institutions and other interested parties in different activities in an effort to fight the pandemic and its consequences. The present paper presents the features of certain mobile applications (apps) that are being used for different purposes such as: tracking patients, COVID-19-related warnings, keeping tracks of statistical data, organising life and business, etc. Aside from presenting the features of a certain number of applications, a review of technologies used for the development of these applications will also be presented. Furthermore, the paper addresses certain challenges that come along with the mobile technologies applications and offers suggestions for future research. © 2021. Alem Colakovic et al;published by UIKTEN. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License.

Serious Examination of the Use of Language by the Trojan Horse and Other Short Stories is the main objective of this review, which was originally intended to analyze the quality of his artistic work and demonstrate its contribution to literary development. This work aims to serve as a bridge between readers and writers, concentrating on the choice of words and metaphorical methods. The book attempts to examine the strengths and limitations of word use and metaphors, based on the theoretical foundations that have been compiled.

Meron Urga Workineh,1 Eyasu Alem Lake,2 Getachew Asmare Adella3 1Department of Public Health, Adama Hospital Medical College of Health Science and Medicine, Adama, Ethiopia; 2Department of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 3Department of Reproductive Health and Nutrition, School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, EthiopiaCorrespondence: Getachew Asmare Adella Email gasmare35@gmail.comPurpose: Breast cancer is the leading cause of cancer death worldwide and the second common cancer overall. Breast self-examination is one of the cheapest methods used for the early detection of breast cancer in asymptomatic women. However, the practice of breast self-examination remains low in Ethiopia. Therefore, this study aimed to assess breast self-examination practice and associated factors among women attending family planning services in Modjo public health facilities in southwest Ethiopia.Patient and Methods: Facility-based cross-sectional study was conducted in Modjo public health facilities from October 01, 2020, to October 30, 2020. Data were collected from 420 women by using an interviewer-administered structured questionnaire. Variables with a P-value ≤ 0.2 in the bivariate analysis were included in the multivariable logistic regression model. Results of regression analysis were shown as odds ratio (OR) and confidence intervals (95% CI).Results: Overall 86 (20.5%) of the participants had ever performed breast self-examination. The odds of breast self-examination practice among women with tertiary level of education were 2.14 [AOR: 2.14; 95% CI: (1.45, 6.74)] times higher compared to those with secondary education. Women who knew breast self-examination were 4.32 [AOR: 4.32; 95% CI: (1.81, 10.81)] times higher odds of breast self-examination practice compared to their counterparts. The odds of breast self-examination practice among women who had a positive attitude were 2.7 [AOR: 2.7; 95% CI: (1.03, 6.91)] times higher compared to women with a negative attitude towards breast self-examination.Conclusion: Breast self-examination practice was low within the study area. Tertiary level of education, having Knowledge on breast self-examination and a positive attitude towards breast self-examination were found to have a significant association with breast self-examination practice. Breast self-examination should be promoted by improving awareness and providing special health education for women that had low educational level.Keywords: breast cancer, breast self-examination, practice, associated factors

Background: Non-communicable diseases including cardiovascular diseases are becoming an important part of Human Immunodeficiency Virus (HIV) care. Echocardiography is a useful non-invasive tool to assess for cardiac disease and different echocardiographic abnormalities have been seen previously. Available evidence on the echocardiographic abnormalities in Ethiopia is scarce. The aim of this study was to investigate the echocardiographic abnormalities in HIV infected patients and factors associated with the findings.Methods: A cross-sectional study was conducted on 285 patients with HIV infection including collection of clinical and echocardiographic data. Logistic regression was used to examine the association between echocardiographic abnormalities and associated factors with variables with a p-value of < 0.05 in the multivariate model considered statistically significant.Results: Diastolic dysfunction was the most common abnormality seen in 30.1% of the participants followed by regional wall motion abnormality (22.2%), left ventricular hypertrophy (10.3%), enlarged left atrium (8.1%), pulmonary hypertension (3.5%) and pericardial effusion (2.1%). Almost all patients had normal left ventricle systolic function. Diastolic dysfunction was independently associated with increasing age, elevated blood pressure and left ventricular hypertrophy while regional wall motion abnormality was associated with male gender, increasing age and abnormal fasting blood glucose. Left ventricular hypertrophy was associated with increasing age and blood pressure and the later was associated with left atrial enlargement. The level of immunosuppression did not affect echocardiography findings. Conclusions: A high prevalence of echocardiographic abnormalities was found and included diastolic dysfunction, regional wall motion abnormality, left ventricular hypertrophy and left atrial enlargement. Male gender, age above 50 years, elevated blood pressure and elevated fasting blood glucose were associated with echocardiographic abnormalities. Appropriate screening and treatment of echocardiographic abnormalities is needed.

Myasthenia gravis (MG) is an autoimmune disease involving neuromuscular transmission and possible respiratory failure when concomitant with COVID-19. The aim of this study was to analyze the need for ventilatory support (VS), length of hospital stay (LOS) and mortality in patients diagnosed with MG and COVID-19. In this systematic review, PubMed, SciELO, LILACS, MEDLINE and IBECS databases were searched for primary studies published from January 2010 to March 2021, with no language restrictions. Fourteen eligible studies were identified. The main factor associated with the need for VS was the use of antibiotics other than azithromycin (AZM) for the treatment of COVID-19 (RR 1.60; 95% CI 1.20–2.91; p = 0.009). Patients who used hydroxychloroquine (HCQ) and AZM had almost twice the risk of needing invasive ventilatory support (IVS) (RR 1.94; 95% CI 1.07-3.52; p = 0.16). There were nonsignificant trends towards less need for IVS in patients who used intravenous immunoglobulin (IVIg) and corticosteroid therapy (RR 0.54; 95% CI 0.09–3.26; p = 0.60). There was a trend towards shorter LOS in patients who received therapy with IVIg and corticosteroid therapy [8 (5 - 8) vs 19 (12.2–23.7); p = 0.007]. 10.3% (n = 4/39) died and 100% did not use IVIg or IVIg and prednisone. There was a non-significant trend towards higher mortality in patients who used AZM (RR 2.55; 95% CI 0.26–30.02; p = 0.60). IVIg and corticotherapy presented themselves as a favorable alternative in relation to the outcomes.KEY WORDS: Coronavirus infections; length of stay; Myasthenia gravis; Respiratory insufficiency.

Alem Wuneh,1 Amaha Kahsay,2 Fitiwi Tinsae,3 Fisseha Ashebir,4 Gebreamlak Giday,5 Gebremeskel Mirutse,6 Gebremedhin Gebretsadik,7 Getachew Gebremedhin,3 Haftom Weldearegay,8 Kalayou Berhe,9 Manay Woldegebriel,10 Tesfay Weldeselassie,11 Yemane Berhane,3 Zinabu Hadis6 1Health System, Mekelle University College of Health Sciences, Mekelle, Tigrai, Ethiopia; 2Nutrition and Dietetics, Mekelle University College of Health Sciences, Mekelle, Tigrai, Ethiopia; 3Nursing, Adigrat University College of Health Sciences, Adigrat, Tigrai, Ethiopia; 4Maternal and Child Health, Tigrai Regional Health Bureau, Mekelle, Tigrai, Ethiopia; 5Midwifery, Axum University College of Health Sciences, Axum, Tigrai, Ethiopia; 6Environmental and Behavioral Sciences, Mekelle University College of Health Sciences, Mekelle, Tigrai, Ethiopia; 7Midwifery, Adigrat University College of Health Sciences, Adigrat, Tigrai, Ethiopia; 8Midwifery, Mekelle University College of Health Sciences, Mekelle, Tigrai, Ethiopia; 9Nursing, Mekelle University College of Health Sciences, Mekelle, Tigrai, Ethiopia; 10Public Health, Axum University College of Health Sciences, Axum, Tigrai, Ethiopia; 11Research Monitoring, Training and Publication, Tigrai Health Research Institute, Mekelle, Tigrai, EthiopiaCorrespondence: Kalayou Berhe Tel +251 91-211-7719Email Kalushaibex@gmail.comBackground: To protect health-care providers (HCPs) from COVID-19, the WHO recommends applying basic principles of infection prevention and control measures at all health-care facilities. This study aimed to assess the knowledge, perceptions, satisfaction, and readiness of HCPs regarding COVID-19 in Tigrai, Ethiopia in 2020.Methods: This cross-sectional study was conducted from June 1 to July, 2020. Data were collected using a self-administered structured questionnaire. Multistage sampling followed by purposive sampling were used to recruit study subjects. SPSS 21 was used to compute proportions and χ2 to identify risk factors.Results: Of 765 participants, 88% had adequate knowledge, close to a third showed positive perceptions and were satisfied with their job and nearly a quarter demonstrated readiness to prevent and control COVID-19. Education, knowledge, readiness, perceptions, and job satisfaction with associated with type and readiness of health facilities.Conclusion: Despite adequate knowledge of the HCPs about COVID-19, their perceptions and job satisfaction are a concern for the health-care system. Only one in five HCPs was found to be ready to prevent and control COVID-19. Efforts should be exerted to improve perceptions, job satisfaction, and readiness of HCPs to fight COVID-19.Keywords: knowledge, perception, satisfaction, readiness of HCPs, Tigrai, Ethiopia

Background. Food insecurity is the shortage of both the quantity and quality of food and a negative impact on the overall nutritional and health status of people with human immunodeficiency virus (HIV). Ethiopia is intensely affected by food insecurity which is about 87.4% of adult people living with human immuno deficiency virus (HIV) are still facing shortage to have access to safe, sufficient, and nutritious food for themselves and their family. However, there is no concrete scientific evidence established at the national level in Ethiopia. Hence, this review gave special emphasis on adult people with human immunodeficiency virus (HIV) to estimate the pooled prevalence of food insecurity and its associated factor at the national level in Ethiopia. Methods. Studies were retrieved from selected electronic data bases, including PubMed/Medlin, Cochrane library, Sciences Direct, Google, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled prevalence of food insecurity and its associated factors at 95% confidence interval with odds ratio (OR) using statistical R -software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias was checked using the funnel symmetry test, and heterogeneity was checked using forest plot and inverse variance square ( I 2 ). The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search. Result. A total of 650 articles were identified through the initial search of which 20 studies were included in the final review yielding a total sample size of 7,797 adult people with human immunodeficiency virus (HIV). The pooled prevalence of food insecurity was 52% (95% CI, 40%, 63%). Cluster of differentiation 4 CD 4 count < 350 cell / m m 3 [ AOR = 1.29 (95% CI, 1.08, 1.54)], develop opportunistic infection [ AOR = 4.09 (95% CI, 2.47, 6.78)], rural residence [ AOR = 1.59 (95% CI, 1.09, 2.34)], and World Health Organization (WHO) clinical stages III and IV [ AOR = 1.98 (95% CI, 1.23, 3.19)] was among the significantly associated factors. Conclusion. In this review, there was a high prevalence of food insecurity among adult people with human immunodeficiency virus. Therefore, the responsible stockholders should strengthen the system and procedure for early diagnosis of opportunistic infection, under nutrition, screening of underlying problems.

To assess the degree of liver stiffness using transient elastography in Egyptian children infected with hepatitis C virus (HCV) at baseline and 1 year after achievement of sustained virologic response (SVR) with direct acting antivirals.This prospective study included children infected with HCV who received treatment with sofosbuvir/ledipasvir and achieved SVR. At baseline and 1 year after achievement of SVR, the extent of hepatic fibrosis was assessed by transient elastography using FibroScan to measure liver stiffness, in addition to noninvasive markers including aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 (FIB-4) index.The study included 23 cases that had variable degrees of fibrosis at baseline; their ages ranged between 10 and 18 years. At baseline, 13 patients had F1; 3 patients had F1-F2; 1 patient had F2; 3 patients had F3; 2 had F3-F4; and 2 patients with F4. One year after achievement of SVR, there was a statistically significant improvement in liver stiffness, APRI, and FIB-4 index (P = .03,.001, .02, respectively). In 13 patients (56.5%), the liver stiffness improved; in 7 patients, it was stationary; and the remaining 3 patients showed mild increase in liver stiffness that was, however, associated with improvement in APRI and FIB-4 index. Comorbid conditions and previous treatment with interferon were not associated with increased liver stiffness 1 year after SVR.Egyptian children infected with HCV genotype 4 achieved significant regression in liver stiffness after treatment with direct acting antivirals.

BACKGROUND: In 2018, influenza and pneumonia was the eighth leading cause of death in the United States. Since 1950, non-Hispanic blacks (NHBs) have experienced higher rates of mortality than non-Hispanic whites (NHWs). Previous studies have revealed geographic variation in mortality rates by race. The identification of areas with the greatest disparity in influenza and pneumonia mortality may assist policymakers in the allocation of resources, including for the coronavirus disease 2019 pandemic. RESEARCH QUESTION: Does geographic variation in racial disparity in influenza and pneumonia mortality exist? STUDY DESIGN AND METHODS: The Centers for Disease Control and Prevention database for Multiple Cause of Death between 1999 and 2018 for NHB and NHW decedents ≥ 25 years of age with a Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems code for influenza (J09-J11) and pneumonia (J12-J18) was used. Age-adjusted mortality rates (AAMRs) with 95% CIs were computed by race for Health & Human Services (HHS) regions and urbanization in NHBs and NHWs. RESULTS: In 1999 through 2018, there were 540,476 deaths among NHBs and NHWs 25 to 84 years of age. AAMRs were higher in NHBs than NHWs in each age group and in seven of 10 HHS regions. The greatest disparity was in HHS regions 2 (New York and New Jersey) and 9 (Arizona, California, Hawaii, and Nevada). In HHS region 2, NHBs (24.6; 95% CI, 24.1-25.1) were more likely to die than NHWs (15.7; 95% CI, 15.6-15.9). Similarly, in region 9, NHBs (23.2; 95% CI, 22.7-23.8) had higher mortality than NHWs (16.1; 95% CI, 15.9-16.2). Within these regions, disparities were greatest in the core of major metropolitan areas. A very high AAMR in NHBs was noted in large, central metropolitan areas of region 2: 28.2 (95% CI, 27.6-28.9). INTERPRETATION: In 1999 through 2018, the NHB-NHW disparity in AAMRs from influenza and pneumonia was greatest in central metropolitan areas of HHS regions 2 and 9.

Slovenia is an aging society. Social security expenditures for the elderly are rising steadily, and the majority of Slovenians are firmly convinced that the state must provide elder care. This situation means that informal caregivers face many challenges and problems in their altruistic mission.To explore the experiences and feelings of informal caregivers and to provide an understanding of how informal caregivers support the elderly and what challenges and difficulties they face in Slovenian society.The study is based on qualitative semi-structured interviews with 10 caregivers. In addition to descriptive statistics, we conducted a qualitative study using the qualitative content analysis method.We identified four themes among health caregivers' experiences with challenges and problems in providing long-term health care for the elderly. Caregivers pointed out that they are mostly left to themselves and their altruistic mission of giving informal long-term care to their elderly relatives and friends. Systemic regulation of the national public health care system is the source of many problems.Other social systems determine and limit the position of informal caregivers in Slovenia. This qualitative study should be understood as useful stepping-stone to future research and real improvement in this area.Slovenija je starajoča se družba. Izdatki za socialno varnost za starejše nenehno naraščajo in večina Slovencev je trdno prepričanih, da mora država zagotoviti oskrbo starejših. To pomeni, da se neformalni oskrbovalci v svojem altruističnem poslanstvu srečujejo s številnimi izzivi in težavami.Preučiti izkušnje in občutke neformalnih oskrbovalcev in razumeti, kako neformalni oskrbovalci podpirajo starejše ter s katerimi izzivi in težavami se srečujejo v slovenski družbi.Študija temelji na kvalitativnih polstrukturiranih intervjujih z 10 oskrbovalci. Poleg opisne statistike smo izvedli kvalitativno študijo z uporabo metode kvalitativne analize vsebine.Med izkušnjami neformalnih oskrbovalcev smo izbrali štiri teme z izzivi in težavami pri zagotavljanju dolgoročne zdravstvene oskrbe starejših. Oskrbovalci so izpostavili, da so pri neformalni dolgotrajni oskrbi svojih starejših sorodnikov in prijateljev večinoma prepuščeni sebi in svojemu altruističnemu poslanstvu. Sistemska ureditev nacionalnega sistema javnega zdravstvenega varstva je vir številnih težav.V Sloveniji drugi družbeni sistemi določajo in omejujejo položaj neformalnih oskrbovalcev. To kvalitativno študijo je treba razumeti kot koristno odskočno desko za prihodnje raziskave in resnične izboljšave na tem področju.

A large number of researchers found their interest in addressing the issue of capacity scaling for wireless ad hoc networks. This paper aims to provide a comprehensive overview of the development of capacity scaling laws in wireless networks, highlighting the problem of scaling as one of the basic challenges in their research. The review began with the definition of the notion of bandwidth of random networks, which were taken as a reference model of consideration when determining more advanced strategies for improving throughput capacity. Based on these strategies, other factors that have an impact on capacity scaling laws have been identified and elaborated. Finally, the capacity of hybrid wireless networks, ie networks in which at least two types of nodes functionally exist (ad hoc nodes/infrastructure nodes / auxiliary nodes), was partially investigated.

Transarterial radioembolization with yttrium-90 microspheres is an established therapy for hepatocellular carcinoma. Post-procedural imaging is important for the assessment of both treatment response and procedural complications. A variety of challenging treatment-specific imaging phenomena complicate imaging assessment, such as changes in tumoral size, tumoral and peritumoral enhancement, and extrahepatic complications. A review of the procedural steps, emerging variations, and timelines for post-treatment tumoral and extra-tumoral imaging changes are presented, which may aid the reporting radiologist in the interpretation of post-procedural imaging. Furthermore, a description of post-procedural complications and their significance is provided.

BackgroundHIV testing and counseling (HTC) services are key for HIV prevention, treatment, care, and support. Although the prevalence of HIV infection is high among adolescents and young adults, evidence suggests the utilization of HTC service among youth is very low in Ethiopia. Identifying factors and the geographic variation of HTC uptake is important to prioritize and design targeted prevention programs to increase its utilization and reduce HIV infection in hot spot areas.MethodsData from the 2016 Ethiopian Demographic and Health Survey were used to analyze 10,781 youth aged 15–24 years. The spatial analysis was performed in ArcGIS 10.1. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of HTC uptake. A multilevel logistic regression analysis was used to identify the associated individual and community-level factors of HTC uptake and estimate between community variance. All models were fitted in Stata version 14.0 and finally, the adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) were reported.ResultsIn this study, the spatial patterns of HTC uptake were found to be non-random (Global Moran’s I = 0.074,pvalueConclusionThe current study indicated differences in HTC uptake in the country. Both individual and community-level factors affected HTC uptake in Ethiopia. Multifaceted intervention approaches that consider individual and community factors are required to improve HTC uptake.

A cohort consisting of asymptomatic healthcare workers donated temporal serum samples after infection with severe acute respiratory syndrome coronavirus 2. Analysis shows that all asymptomatic healthcare workers had neutralizing antibodies, that these antibodies persist for ≥60 days, and that anti-spike receptor-binding domain immunoglobulin G levels were correspondingly durable over the same time period.

Background Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality in high-risk patients, but most of those eligible are not referred for screening, and most eligible smokers are not aware of LCS. Smoking cessation counseling may be an opportune time to educate smokers about LCS. Here we investigate the effect of LCS educational information on LDCT utilization and smoking cessation in LCS-eligible patients receiving smoking cessation counseling. Patients and Methods We randomized 1281 smokers aged 55-80 who underwent smoking cessation services to view a web-based educational video about LCS (n = 1026) or to receive usual care (n = 255). Outcomes included the utilization of chest computed tomographic (CT) scan during 6 months of follow-up, responses to survey questions, and patient-reported abstinence from smoking at 6 months. Results One hundred forty-six participants (14%) watched the video. Overall, 87 participants (8.5%) in the intervention group underwent any chest CT and 37 (3.6%) underwent LDCT compared to 22 (8.6%) and 11 (4.3%) in the control group during the 6-month follow-up period (P = .94 and .59, respectively). Among participants who completed watching the video, 27 (18.5%) underwent any chest CT and 13 (8.9%) underwent LDCT, compared to 22 (8.6%) and 11 (4.3%) in controls during follow-up (P = .0037 and .062, respectively). There was no difference in abstinence from smoking between groups. Conclusion An LCS educational intervention may be effective in improving utilization of LDCT in eligible individuals who currently smoke at the time of smoking cessation counseling. Further research on the effect of LCS education in the context of smoking cessation counseling is needed.

Chemotherapy within 90 days following surgery for non-metastatic breast cancer is the standard of care. There are no data, however, on the extent of time to initiation of chemotherapy (TTC) in Africa settings, including Ethiopia.A total of 223 women with stage I-III breast cancer treated with surgery and adjuvant chemotherapy during 2017-2019 in Addis Ababa, Ethiopia, were included in the analysis. Based on information from medical records, we calculated TTC from date of surgery and completion of planned chemotherapy, with TTC 90 days considered delayed and receipt of 85% of planned therapy as complete. Multivariable Poisson regression with robust variance was used to assess whether TTC 90 days was associated with sociodemographic or clinical factors.The median TTC was 63 days. Chemotherapy initiation was delayed in 30% (95% CI 24.4-36.6%) of patients, with the risk significantly higher in low-income women. For example, the risk of delay in women with lowest quartile family monthly income group (US$ 61) was 3.98 (95% CI 1.67-9.46) higher than in those women with highest quartile family income group (US$ 194). Remarkably, adjuvant chemotherapy was completed in 95% of patients.A staggering one-in-three women with breast cancer in Addis Ababa, Ethiopia, delay to initiation of adjuvant chemotherapy, with the delay more common in low-income women and yet with remarkably high degree of treatment adherence. These findings underscore the need for public policy to expand health care to low-income population to improve breast cancer care and other health outcomes in the country.

The study aimed to describe the epidemiological profile of medication errors (MEs) reported to the Moroccan Pharmacovigilance Center (MPVC), to determine factors associated with serious MEs, and to describe signals related to them. We carried out a retrospective descriptive analysis of MEs reported to the MPVC from 2006 to 2016 and a secondary analysis of the seriousness of MEs with adverse drug reactions (ADRs). The reports were sorted by demographic profile and by ME and ADR characteristics. For signal detection, a quantitative approach was adopted, and the root cause analysis was completed. Epi info 7 software was used to perform descriptive and analytical statistics. The statistical significance level was set at p < 0.05. A total of 1618 ME reports were retrieved. The proportion of MEs associated with serious ADRs was 23.9%. The factors statistically associated with serious MEs were as follows: (i) the age group 16 years old and less (p < 0.001), (ii) the gender (p = 0.01), (iii) the administration and the prescription stages (p < 0.001), and (iv) the ME types related to inappropriate schedule of drug administration, drug prescribing error (p < 0.001), and incorrect drug administration dosage form (p = 0.04). Fourteen signals related to MEs were detected, for which risk minimization actions were implemented. The establishment of a ME unit within the MPVC was an opportunity to further improve the pharmacovigilance centre performance and consequently its contribution to medication safety. The lessons learned from MEs should be shared through pharmacovigilance networks and with institutions involved in medication safety for synergistic results to achieve patient safety worldwide.

Background Postnatal care (PNC) visits provide a huge benefit for ensuring appropriate breastfeeding practices, to monitor the overall health status of the newborn, to timely diagnose and intervene birth-related complications, and to plan future family planning options. Despite delayed PNC attendance have a great impact on the survival of the mother and the newborn it still receives less emphasis. As a result, most mothers do not receive PNC services early. We, therefore, aimed to determine individual and community level factors associated with delayed first Postnatal Care attendance among reproductive age group women in Ethiopia. Methods We used the most recent Ethiopian Demographic and Health Survey (EDHS 2016) data to determine associated factors of delayed first PNC in Ethiopia. A weighted sample of 4308 women with a live birth in the two years preceding the survey was included. A multilevel logistic regression analysis was used to analyze the data. Variables with p-value Results In this study, both individual level and community level factors were associated with delayed PNC attendance. Among the individual level factors: having four or more antenatal care visit [Adjusted Odd Ratio (AOR) = 0.73; 95% CI: 0.59, 0.92], delivery at a health facility [AOR = 0.04; 95% CI: 0.03, 0.05], and perceiving distance from the health facility as not a big problem [AOR = 0.73; 95% CI: 0.58, 0.91] were associated with lower odds of delayed first PNC attendance. Of community level factors: being in Oromia [AOR = 2.31; 95% CI: 1.38, 3.83] and Gambela [AOR = 2.01; 95% CI: 1.13, 3.56] regions were associated higher odds of delayed first PNC attendance. Conclusions Both individual level and community level factors were found to be associated with delayed PNC attendance. Strengthening antenatal care utilization, institutional delivery, and appropriate distributions of maternal health services in each region and areas far apart from the health facility are recommended.

Climate change and an increased interest in renewable energy have resulted in a burgeoning wind energy sector. However, in the recent past, wind farms have faced resistance in acquiring permits due to concerns about their long-term effects on the local community. To understand the extent of these externalities, this study qualitatively meta-analyses four socio-economic impacts of interest, namely: house prices, tourism, catalytic effects of supply chain clustering, and social change. Geographically, the analysed reports include Europe, Canada and the US, and deductions are made for the EU. In order to bridge the gap of unavailability of primary data on the wind sector, relevant conclusions are drawn from other comparable sectors. Based on a rigorous review of primary qualitative research, this study concludes that offshore wind farms should be located more than 40 km away from the coast to eliminate risks of housing price devaluation and tourist activity reduction, which would directly affect the economic value of the region. In addition, the study found limited evidence to acknowledge the employment benefits in the local economy and social change in the community due to offshore wind farms. Monitoring mechanisms should be set up to prove or disprove the creation of local employment, crime and substance abuse. Furthermore, the study finds that adequate planning and management can ensure better socioeconomic outcomes in the community. Further research is recommended for the specific impact of overhead transmission lines and substations on property values and tourism.

Purpose The purpose of this paper is to propose a new framework for assessing the risks of turnaround projects in upstream oil process plants. Design/methodology/approach This study represents a new hybrid framework for turnaround project risk assessment. First, according to experts’ opinions, the project risks were identified using interviews and brainstorming. The most important risks selected by experts and a hybrid multiple-attribute decision-making (MADM) method used to assess and prioritize them. The proposed MADM method uses fuzzy step-wise weight assessment ratio analysis (SWARA) and fuzzy evaluation based on distance from average solution (EDAS) methods based on trapezoidal fuzzy numbers. Findings In this research, 28 usual risks of turnaround projects are identified and 10 risks are then selected as the most important ones. The findings show, that among the risks of upstream oil industry turnaround projects from the perspective of experts, the risk of timely financing by the employer, with an appraisal score of 0.83, has the highest rank among the risks and the risk of machine and equipment failure during operation, with an appraisal score of 0.04, has the lowest rank. Research limitations/implications The risk analysis based on inputs collected from the experts in the Iranian upstream oil industry, and so the generalization of the results is limited to the context of developing countries, especially oil producer ones. However, the proposed risk analysis methodology and key insights developed can be useful for researchers and practitioners in any other process industry everywhere. Originality/value A novel framework for risk assessment is introduced for turnaround projects in the oil industry using MADM methods. There is no literature on using MADM methods for turnaround project risk analysis in the oil and gas industries. Furthermore, this paper presents a hybrid fuzzy method based on SWARA and EDAS.

Objectives: This study aimed to assess the demographic, clinical and biochemical characteristics as predictors of haemolysis after ingesting fava beans. Methods: A cross-sectional study was undertaken. A total of 57 patients with G6PD deficiency were recruited from the Emergency Department of Children Welfare Teaching Hospital, Medical City. Data were collected using a specially designed form. A purposive sampling method was used to recruit 57 patients 49 males and 8 females who were visiting the pediatric emergency department from March to May 2017 with a presentation of acute hemolytic episode of G6PD. Patients were classified into mild or severe haemolysis groups based on their haemoglobin level at the time of admission. Results: Younger age group patients tend to present with the severe form of hemolysis (3.59 years with a P value of 0.001). No significant gender susceptibility between both types of hemolysis. The urban area based living individuals tend to present with mild hemolysis while those from rural areas tends to present with more severe episodes of hemolysis (P value 0.001). There was a significant correlation between the type of fava bean ingestion (fresh or dried) and the severity of hemolysis, those who presented with more severe hemolysis usually had a history of ingestion of fresh type of fava bean. Eight individuals of severe type recorded previous episodes of hemolysis while three individuals of the mild type recorded previous episodes (P value 0.001). Family history of G6PD was significant in 88.2% of individuals with the severe form (P value 0.005). Conclusions: This study is aimed to report several factors that might predict the severity of hemolysis among patients with G6PD deficiency. Younger age, residence in a rural region, ingestion of fresh fava beans, and history of frequent hemolysis incidents are predictors of developing severe hemolysis among children admitted to the emergency room of Children Welfare Teaching Hospital in Medical City/Baghdad.

In this case, it was aimed to restore a traumatized permanent incisor with open apex using a modified polyethylene fiber post after amputation as well as to present a four-year long term follow-up. A healthy 10-year-old boy was referred with a complaint of pain caused by tooth number 11. The patient fell and broke his upper incisor ten days ago and no treatment was done before. Total amputation was carried out after clinical and radiological examination. The exposed root pulp was covered with BiodentineTM (Septodent, Saint-Maur-Fosses Codex, France). Glass-ionomer cement (Fuji IX extra, GC Corp., Tokyo, Japan) was placed on the BiodentineTM, and after a 3-month follow-up, polyethylene fiber post (Ribbond, Seattle, WA, USA) was placed in the crown since healing was observed in the relevant tooth. The restoration was completed with composite resin (Clearfil Majesty Esthetic Kuraray, Osaka, Japan). Four years later, radiographic examination revealed completed root formation and complete root obliteration. Clinical examination revealed favorable esthetic and functional outcome. Traditional treatments can be modified in order to obtain long term clinical success. Polyethylene fiber post can be used as an alternative method to root canal therapy in complicated crown fractures in teeth with immature root formation due to the advantages such as the possibility of modification according to the crown, aesthetics, easy application, and supporting the vitality of the tooth.

Objective The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). Methods The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. Results The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. Conclusions The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.

Environmental threats of coal usage in the electricity production combined with the consumption of renewable and non-renewable resources had led to worldwide energy challenges. The cost of coal mining and economical and environmentally sustainable usage of mined coal could be optimized by efficient management of coal supply chain. This paper provides a mathematical model for improving coal supply chain sustainability including the cost of exergy destruction (entropy). In the proposed method, exergy analysis is used to formulate the model considering not only economic costs but also destructed exergy cost, while genetic algorithm is applied to efficiently solve the proposed model. In order to validate the proposed methodology, some numerical examples of coal supply chains are presented and discussed to show the usability of the proposed exergetic coal supply chain model and claim its benefits over the existing models. According to the results, the proposed method provides 17.6% saving in the consumed exergy by accepting 2.7% more economic costs. The presented model can be used to improve the sustainability of coal supply chain for either designing new projects or upgrading existing processes.

Dejene Tsegaye,1 Girma Alem,1 Zenaw Tessema,2 Wubet Alebachew3 1Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 2Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 3Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Zenaw TessemaDepartment of Pharmacy, College of Health Sciences, Debre Markos University, P. O. Box, 269, Debre Markos, EthiopiaEmail zenawlove21@gmail.comIntroduction: Medication error has the potential to lead to harm to the patient. It is the leading cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients’ hospitalization, produces extra costs and even death. This study aimed to assess medication administration error (MAE) and associated factors among nurses in referral hospitals of Ethiopia.Methods: Institutional-based, cross-sectional study design was used, and 422 study participants were selected using a simple random sampling method. Data were collected using a semi-structured and pre-tested self-administered questionnaire and observational checklist. The collected data were analyzed using descriptive and analytical statistics and binary logistic regression was done to identify factors associated with medication administration errors. P-value ≤ 0.05 was considered statistically significant.Results: Four hundred fourteen participants with a response rate of 98.1% were involved and 54.3% were females. The median age was 30 with IQR (28– 34) years and the majority of them (83.8%) had BSc qualification in nursing. The prevalence of MAE in this study was 57.7% and 30.4% of them made it more than three times. Wrong time (38.6%), wrong assessment (27.5%), and wrong evaluation (26.1%) were the most frequently perpetuated medication administration errors. Significant association between medication administration errors and lack of training [AOR=2.20; 95% CI (1.09, 4.46)], unavailability of guideline [AOR=1.65; 95% CI (1.03, 2.79)], poor communication when face problem [AOR=3.31; 95% CI (2.04, 5.37)], interruption [AOR = 3.37, 95% CI (2.15, 5.28)] and failure to follow medication administration rights [AOR=1.647; 95% CI (1.00, 2.49)] was noticed.Conclusion: MAE was high in the study area as compared to studies from Jimma University Specialized Hospital, Adigrat and Mekelle University Hospital, and the University of Gondar Referral Hospital and hence developing guidelines, providing training, and develop strategies to minimize distracters are better to be undertaken.Keywords: medication errors, medication administration, nurses, magnitude

Introduction Tropical diseases are public health problems affecting hundreds of millions of people globally. However, the development of adequate, affordable, and accessible treatments is mostly neglected, resulting in significant morbidity and mortality that could otherwise be averted. Leishmaniasis is one of the neglected tropical diseases caused by the obligate intracellular protozoan Leishmania parasite and transmitted by the bite of infected phlebotomine sandflies. No systematic review and meta-analysis has been done to identify the prevalence and risk factors of leishmaniasis to the authors’ knowledge. Therefore, the objective was to determine the prevalence and risk factors of human leishmaniasis in Ethiopia. Methods Eleven studies conducted in all regions of Ethiopia, which were fully accessible, written in any language, and original articles done on prevalence and risk factors of leishmaniasis, were included. STATA™ version 11.1 was used for statistical analysis. Chi-square, I2, and p values were assessed to check heterogeneity. A random effects model with heterogeneity taken from an inverse-variance model was employed to estimate the pooled effect. Subgroup meta-analysis was computed to reduce random variations among each article’s point prevalence, and Egger and funnel plots were used to check for publication bias. Results The highest proportion of human leishmaniasis was reported from a study done in Amhara region (39.1%), and the lowest was reported from a survey done in Tigray (2.3%). The overall pooled prevalence of leishmaniasis was 9.13% (95% CI 5–13.27). Subgroup analysis by region revealed moderate heterogeneity (I2 = 51.8%) in studies conducted in the Southern Nations Nationalities and Peoples Region (SNNPR). The presence of hyraxes and being male were associated with an increased risk of human leishmaniasis. Conclusion The prevalence of leishmaniasis in Ethiopia remains high (9.13%), with significant risk factors being male and the presence of hyraxes within a 300-m radius of the sleeping area.

Background Voluntary counseling and testing (VCT) is a vital response to human immunodeficiency virus (HIV) infection among adolescents in sub-Saharan Africa. Determining the status of VCT services is important to link HIV care and antiretroviral therapy. Methods An institutional cross-sectional study design was conducted among 841 young students at Gondar College of Teachers' Education. A self-administered questionnaire was used to gather the data. Descriptive statistics were performed. Bivariate and multivariable binary logistic regressions were used to identify factors associated with the use of VCTs. The adjusted odds ratio (AOR) with 95% confidence was used to report statistical significance. Results The majority (71%) were aware of VCT services. More than one-third (37.8%, 95% CI: 34.6-41.2) participants had used VCT services. Having peer groups used VCT (AOR=2.04, 95% CI: 1.31-3.20), having partner (AOR: =1.6, 95% CI: 1.04-2.45), desiring to have VCT in the future (AOR=3.58, 95% CI: 1.98-6.50), being aware of VCT (AOR= 1.98, 95% CI: 1.20-3.34), knew infected/dead individuals with HIV/AIDS (AOR=1.67, 95% CI: 1.07-2.61), know test sites (AOR=2.01, 95% CI: 1.29-3.13) were positively associated, whereas being married (AOR=0.36, 95% CI: 0.20-0.63) and fear of confidentiality (AOR=0.23, 95% CI: 0.10-0.52) were major barriers to use. Conclusion Low use of VCTs, which was far away from the 90:90:90 WHO goal, has been noted. The use of VCT services was associated with having peer groups that used VCT, having a partner, wanting to have VCT in the future, knowing the infected/dead individual with HIV/AIDS, fear of confidentiality of results, knowing the test sites, and having awareness of VCT. Efforts are needed to strengthen the health system that also needs to pay attention to education about HIV and VCT.

This paper introduces the heterogeneous multicrew scheduling and routing problem (MCSRP) in road restoration. The MCSRP consists of identifying the schedule and route of heterogeneous crews that must perform the restoration of damaged nodes used in the paths to connect a source node to demand nodes in a network affected by extreme events. The objective is to minimize the accessibility time defined as the time that the demand nodes remain unconnected from the source node. The main contributions of the paper include three novel mathematical formulations that differ in the way of modeling the scheduling decisions and the synchronization of the crews, and the development of valid inequalities based on some particular properties of the problem. Additionally, we prove that the MCSRP is NP-hard. Extensive numerical experiments with randomly generated instances and a case study based on floods and landslides disasters in Rio de Janeiro, Brazil, are performed to assess the efficiency and applicability of our approach. In particular, we show that the valid inequalities significantly improve the solvability of the mathematical models. In terms of managerial implications, our results suggest that the incorporation of multiple crews helps to reduce the worst-case accessibility times across the demand nodes, thus providing more equitable solutions.

Background and aim Urinary β2-microglobulin (β2-M) is a marker for renal tubular dysfunction. The current study aimed to assess urinary β2-M as a reliable marker for early prediction of tenofovir disoproxil fumarate (TDF)-related nephrotoxicity among hepatitis B virus (HBV) patients. Methods Forty-two HBV patients who were a candidate for TDF therapy or have recently started it (for less than 6 months) were enrolled and subjected to demographic, clinical, laboratory assessment, abdominal ultrasound and transient elastography. The glomerular filtration rate (GFR) was estimated using the Cockcroft-Gault equation. Also, urinary β2-M was measured by the ELISA method within 6 months after the introduction of TDF treatment and 6 months later. Results Mean age was 41.8 (9.55) years, 27 were males and 59.5% of patients have elevated urinary β2-M after 6 months follow-up of TDF therapy. Urinary β2-M was 0.07 ± 0.07 μg/ml at baseline and insignificantly increased up to 0.09 ± 0.08 μg/ml after 6 months follow-up. Despite the insignificant increase in serum creatinine from 0.85 ± 0.23 mg/dl at baseline to 0.9 ± 0.21 mg/dl after 6 months and the insignificant decrease in eGFR from 126.2 ± 39.72 ml/min at baseline and 117.64 ± 42.23 ml/min at 6 months follow-up. No correlation was found between the changes in urinary β2-M and the changes in other renal function indices at baseline and 6 months follow-up. Conclusions Short-term TDF therapy is associated with nonsignificant changes either in eGFR or urinary β2-M; these changes are not clinically relevant that indicates disease progression. Therefore, the suitability of urinary β2-M as a screening tool for tenofovir induced tubular dysfunction should be further.

Background Diabetic foot ulcer is among the commonest complications of diabetic mellitus attributed to a number of morbidity and mortality cases in diabetic patients. Nowadays, the incidence of diabetic foot ulcer is increasing due to the increased prevalence of diabetes. However, the risk factors of the problem are less studied in Ethiopia. Hence, this study was conducted to assess the determinants of diabetic foot ulcer among adult patients with diabetes attending a diabetic clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. Patients and Methods An institution-based unmatched case–control study was conducted on 161 patients with diabetes (53 patients with diabetes with foot ulcer and 108 patients with diabetes without foot ulcer). Cases were selected from patients with diabetes with foot ulcer by consecutive sampling technique and controls from patients with diabetes without diabetic foot ulcer by systematic random sampling technique. A binary logistic regression model was used to assess the association between the dependent and independent variables. All variables with a P-value

Access to adequate and safe water is a universal human need. Lack of safe and adequate water supply causes health risk and the situation is serious in developing countries The aim of this study was to determine the bacterial load, physicochemical quality of drinking water in wells, reservoir, taps and household storage containers water samples and to investigate the hygiene and sanitation practices of the consumers in Woreta Town. A cross sectional community based study was conducted from January to March 2016 in Woreta town. A total of 189 water samples were collected from wells, reservoir, private taps and household storage containers in three rounds for bacteriological, physicochemical quality of drinking water and the hygiene-sanitation practices of the consumers were assessed using interview. Bacterial load analysis of water samples revealed that well and reservoir water samples were 100%; 30 (100%) tap water samples and 30 (100%) household storage container water samples were contaminated with total coliforms and did not meet the recommended value of World Health Organization (0CFU/100 ml). Regarding thermotolerant coliforms, one well water sample, 21 (70%) tap water samples and 30 (100%) household water samples were contaminated. The bacteriological load was greater at the household storage container water samples. There was statistically significant difference in total coliform and thermotolerants coliforms among the water sources at p < 0.01. Proper management of water sources, appropriate disinfection of raw water sources with chlorine and promoting good hygiene and sanitation practices are recommended to deliver safe drinking water to the consumers of the study area. Key words: Bacteriology, drinking water, household, hygiene, physicochemical, tap water.

Agricultural technologies have been introduced to Ethiopia. Farmers adopt such technologies for bettering their livelihoods by increasing farm production. However, increasing production by itself m...

Stage at diagnosis is a key determinant of breast cancer prognosis. In this study, we characterize stage at diagnosis and determine factors associated with advanced stage at diagnosis among women diagnosed with invasive breast cancer in Addis Ababa, capital city of Ethiopia. Stage information was collected from medical records of 441 women with invasive breast cancer seen in seven major health facilities in Addis Ababa, from January 2017 to June 2018; these seven facilities capture 90% of all incident breast cancer cases in the city. We used multivariable Poisson regression model with robust variance to determine factors associated with advanced stage at diagnosis. The predominant tumor histology was ductal carcinoma (83.7%). More than half of the tumors’ grade was moderately or poorly differentiated. The median tumor size at presentation was 4 cm. Sixty-four percent of the patients were diagnosed at advanced stage of the disease (44% stage III and 20% stage IV), with 36% of the patients diagnosed at early-stage (5% stage I and 31% stage II). The prevalence of advanced stage disease was significantly higher among women who used traditional medicine before diagnostic confirmation (adjusted prevalence ratio [aPR] = 1.31; p = 0.001), had patient delay of > 3 months (aPR = 1.16; p = 0.042) and diagnosis delay of > 2 months (aPR = 1.24; p = 0.004). But it was lower among women who had history of breast self-examination (aPR = 0.77; p = 0.021). Advanced stage at diagnosis of breast cancer among women in Addis Ababa is strongly associated with use of traditional medicine and with prolonged time interval between symptom recognition and disease confirmation. Community- and health systems-level interventions are needed to enhance knowledge about breast cancer and facilitate timely diagnoses.

This study in the Amhara and Oromia regions of Ethiopia assessed the outcomes of tuberculosis (TB) treatment among children younger than 15 years. Retrospective data were collected on treatment outcomes and their determinants for children with TB for the cohorts of 2012–2014 enrolled in 40 hospitals and 137 health centers. Chi-square tests, t-tests, and logistic regression were used for the analysis. Of 2,557 children registered, 1,218 (47.6%) had clinically diagnosed pulmonary TB, 1,100 (43%) had extrapulmonary TB, and 277 (8.9%) had bacteriologically confirmed TB. Among all cases, 2,503 (97.9%) were newly diagnosed and 178 (7%) were HIV positive. Two-thirds of the children received directly observed treatment (DOT) in health centers and the remaining one-third, in hospitals. The treatment success rate (TSR) was 92.2%, and the death rate was 2.8%. The childhood TSR was high compared with those reported in focal studies in Ethiopia, but no national TSR report for children exists for comparison. Multivariate analysis showed that being older—5–9 years (adjusted odds ratio [AOR], 95% CI: 2.53, 1.30–4.94) and 10–14 years (AOR, 95% CI: 2.71, 1.40–5.26)—enrolled in DOT in a health center (AOR, 95% CI: 2.51, 1.82–3.48), and HIV negative (AOR, 95% CI: 1.77, 1.07–2.93) were predictors of treatment success, whereas underdosing during the intensive phase of treatment (AOR, 95% CI: 0.54, 0.36–0.82) was negatively correlated with treatment success. We recommend more research to determine if intensive monitoring of children with TB, dosage adjustment of anti-TB drugs based on weight changes, and training of health workers on dosage adjustment might improve treatment outcomes.

Background Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. Methods Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model. Results Household iodized salt utilization was spatially clustered in Ethiopia (Moran’s Index = 0.076, p-value = 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14–1.93), high community level education (AOR = 1.51, 95% CI = 1.03–2.20), middle wealth index (AOR = 1.31, 95% CI = 1.04–1.65) and high community media exposure (AOR = 1.52, 95% CI = 1.07–2.17) had higher odds of iodized salt utilization. Conclusions Household iodized salt utilization had significant spatial variation across the country. Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.

BackgroundEarly marriage is a global public health problem that is mainly practiced in South Asia, Latin America, and sub-Saharan Africa including Ethiopia. It raises the risk of early childbearing of women, higher rates of divorce, and an increased risk of maternal and child death. However, little is known about the spatial distribution and determinants of early marriage in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of early marriage among ever-married women in Ethiopia.MethodsA detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was conducted. A total weighted sample of 11,646 reproductive-age married women were included in the analysis. To identify significant hotspot areas of early marriage the Bernoulli model was fitted using SaTScan version 9.6 software. Additionally, to explore the spatial distributions of early marriage across the country ArcGIS version 10.1 statistical software was used. For the determinant factors, the multilevel logistic regression model was fitted. Deviance was used for model comparison and checking of model fitness. In the multivariable multilevel analysis, Adjusted Odds Ratio (AOR) with 95% CI was used to declare significant determinants of early marriage.ResultsThe finding of this study revealed that the spatial distribution of early marriage was significantly varied across the country with Global Moran’s I = 0.719 and p value ConclusionThe spatial distribution of early marriage was significantly varied in Ethiopia. Women’s education, women’s autonomy, and region were found to be the significant determinants of early marriage. Therefore, public health interventions targeting those identified significant hotspot areas of early marriage are crucial to reduce the incidence of early marriage and its consequence. In addition, enhancing women's education and empowering them to make their own choices are vital for changing the customs of the community and eliminating early marriage in Ethiopia.