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Abstract Background When used effectively, the Maternal and Perinatal Death Surveillance and Response (MPDSR) system can bring into reality a revolutionary victory in the fight against maternal and perinatal mortality from avoidable causes. This study aimed at determining the status of implementation of the system among health facilities in the Morogoro Region. Method This study was conducted among 38 health facilities from three districts of the Morogoro region, Tanzania, from April 27, 2020, to May 29, 2020. Quantitative data were collected through document review for MPDSR implementation status. The outcome was determined by using a unique scoring sheet with a total of 30 points. Facilities that scored less than 11 points were considered to be in the pre-implementation phase, those scored 11 to 17 were considered in the implementation phase, and those scored 18 to 30 were considered to be in the institutionalization phase. Results The majority 20(53 %) of health facilities were in the pre-implementation phase, only 15(40 %) of assessed health facilities were in the implementation phase, and few 3(8 %) of health facilities were in institutionalization phase. There was a strong evidence that MPDSR implementation was more advanced in urban compared to rural health facilities (Fisher’s test = 6.158, p = 0.049), hospitals compared to health centers (Fisher’s test =14.609, p

Abstract Background While there is strong evidence that bite protection methods such as permethrin-treated clothing and topical insect repellents are protective against insect bites, there are few studies assessing the impact on malaria infection. This study will estimate the protective efficacy of treated uniforms and DEET insect repellent on the incidence of malaria infection among military personnel in an operational setting. Permethrin-treated uniforms used with DEET lotion will be compared to etofenprox-treated uniforms with DEET lotion. The effect of DEET lotion will be estimated by comparing permethrin-treated uniforms with DEET or placebo lotion. Method A cluster randomised double-blind placebo-controlled trial is planned to evaluate the effectiveness of the interventions on preventing malaria infections in soldiers on active duty at Mgambo National Service Camp in Tanga, Tanzania. The arms are (1) permethrin-treated uniform with 30% DEET liposome formula; (2) permethrin-treated uniform with placebo lotion; (3) candidate insect repellent system, i.e. etofenprox-treated uniform with 30% DEET liposome formula; and (4) placebo, i.e. untreated uniforms with placebo lotion. The primary outcome is the incidence of Plasmodium falciparum malaria infection detected by polymerase chain reaction (PCR) by active case detection using surveys every 2 weeks for 12 months. Rapid diagnostic tests will be used for the diagnosis of participants with symptoms. The unit of randomisation will be combania: companies formed by recruits aged 18 to 25 years; combania do activities together and sleep in the same dormitory. Unequal randomisation will be used to optimise statistical power for the primary comparison between permethrin-treated uniforms with DEET and etofenprox-treated uniforms with DEET. Discussion This trial will provide the estimate of the effects of permethrin with DEET compared to those of the new fabric treatment etofenprox with DEET and any additional effect of using DEET. The results will inform strategies to protect military personnel and civilians who have more outdoor or occupational malaria exposure than the general public. Trial registration ClinicalTrials.gov NCT02938975 .

The purpose of this study was premised on the role of mediating effects of user satisfaction and behavioural intention on the influence of the quality of the e-tax system on tax compliance behaviour. A mixed-methods approach (sequential explanatory design) was applied where the qualitative findings were used to supplement the results from the quantitative findings. A PLS-SEM technique with SmartPLS 3 was used to analyse data quantitatively while the qualitative data were analyzed using thematic analysis. The results revealed that behavioural intention mediates only the relationship between information quality and tax compliance behaviour. When multiple mediators are used (behavioural intention and user satisfaction) the findings unveiled that service quality and system quality have a significant positive indirect effect on tax compliance behaviour.

Background and purpose: Synthetic diamond detectors offer real time measurement of dose in radiotherapy applications which require high spatial resolution. Additional considerations and corrections are required for measurements where the diamond detector is orientated at various angles to the incident beam. This study investigated diamond detectors for end-to-end testing of Stereotactic Body Radiotherapy (SBRT) and Stereotactic Radiosurgery (SRS) in the context of dosimetry audits. Material and methods: Seven individual diamond detectors were investigated and compared with respect to warm up stability, dose-rate dependence, linearity, detector shadowing, energy response, cross-calibration, angular dependence and positional sensitivity in SBRT and SRS. Results: Large variation in the cross calibration factors was found between the seven individual detectors. For each detector, the energy dependence in the cross calibration factor was on average

Abstract Globally, both Russia and Ukraine play a key role in food production. Both countries are known for their meticulous positions in producing and exporting wheat, maize, sunflower seed oil, and cotton seed oil. Although the conflict between Russia and Ukraine has been going on for more than 5 years, the recent invasion of Russia in Ukraine has endangered food security in Ukraine during the COVID‐19 pandemic. As COVID‐19 cripples the healthcare infrastructure of Ukraine, food insecurity challenges the civilian population to migration. As the conflict intensitifes, damages to properties, loss of lives, rise of infectious diseases, incremental rise in energy prices, and fuel consumption are some of the possible consequences. This commentary aims to highlight the different ways in which access to food has been endangered, the implications that food crisis has on the world, and thus provide key recommendations on what needs to be addressed to mitigate the rising risks of the food crisis in the world.

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children

Abstract Background Under-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study. Methods Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). Results Between January 2017 to December 2018, 3175 babies were born preterm or LBW, and 164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. Conclusion Deaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

Abstract Background Hypertensive Disorder of Pregnancy (HDP) is one of the leading causes of maternal mortality and morbidity amongst pregnant women in the world. Blood pressure check-ups during pregnancy are one of the strategies used to identify hypertensive disorders, hence timely management. Little is known about the factors associated with blood pressure check-ups in Tanzania. Method The study used data from 2015—16 Tanzania Demographic and Health Survey and Malaria Indicators Survey (2015—16 TDHS—MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple regression analyses were used to determine the association between early antenatal booking and maternal services utilization. Results The prevalence of blood pressure checkups during pregnancy was 72.17% at 95% confidence interval of 71.1–73.2%. Factors associated with uptake of blood pressure check-ups were; timely antenatal booking, AOR = 1.496, CI = 1.297–1.726, p 34 years, (AOR = 1.518, CI = 1.149–2.006, p = 0.003)] with

Abstract Background In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone. Methods We evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year. Results We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25–34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible. Conclusions Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.

Introduction: Primarily used as ultrasound contrast agents, microbubbles have recently emerged as a versatile therapeutic vector that can be 'burst' to deliver payloads in the presence of suitably optimised ultrasound fields. Ultrasound‐stimulated microbubbles (USMB) have recently demonstrated improvements in treatment outcomes across a variety of clinical applications. This scoping review investigates whether this potential translates into the context of radiation therapy by evaluating the application of this technology across all three phases of radiation action. Methods: Primary research articles, excluding poster presentations and conference proceedings, were identified through systematic searches of the PubMed NCBI/Medline, Embase/OVID, Web of Science and CINAHL/EBSCOhost databases, with additional articles identified via manual Google Scholar searching. Articles were dual screened for inclusion using the Covidence systematic review platform and classified against all three phases of radiation action. Results: Overall, 57 eligible publications from a total of 1389 identified articles were included in the review, with studies dating back to 2012. Study heterogeneity prevented formal statistical analysis; however, most articles reported improved outcomes using USMB in the presence of radiation compared to that of radiation alone. These improvements appear to result from the use of USMB as either a biovascular disruptor causing tumour cell damage via indirect mechanisms, or as a localised treatment vector that directly increases tumour cell uptake of other therapeutic and physical agents designed to enhance radiation action. Conclusions: USMB demonstrate exciting potential to enhance the effects of radiation treatments due to their versatility and capacity to target all three phases of radiation action. [ABSTRACT FROM AUTHOR]

This work aimed to characterize a dedicated phantom for assessing the dose near metal implants for radiotherapy with photons and protons. A dosimetry audit phantom was redesigned to position a Gafchromic EBT-3 film within a bisected titanium pedicle screw (6.5 mm diameter). The mass density and the water equivalent thickness (WET) of the phantom material were determined. The phantom was irradiated using a photon arc and a horizontal proton beam in combination with a couch rotation of 20°, with three repeated measurements each. Treatment plans utilizing a single field covering the screw and the EBT-3 film were optimized to deliver a physical dose of 2 Gy using a collapsed cone and Monte Carlo dose engine for photons and protons, respectively. The mass density and the WET of the phantom were determined as (1.033 ± 0.010) gcm-3 and (1.022 ± 0.013), respectively. Ionisation chamber measurements agreed within 1% (photons) and 0.5% (protons) with the calculated dose values. Relative photon dosimetry measurements using EBT-3 films revealed an agreement between measured and calculated horizontal profiles within the confidence interval for areas beyond 5 mm from the center. For photon plans, significant deviations of more than 10% were found at the interfaces between phantom material and screw. The proton measurements showed a gradual decrease of 3% across both profiles. In contrast to photon plans, no dose increase was measured within the screw, but significant dose fluctuations (>5%) in the beam's exit region. This study showed that the behavior of dose engine is affected by metal implants and thus dosimetric measurements are highly recommended. The presented phantom can serve as foundation for dedicated end-2-end phantoms. [ABSTRACT FROM AUTHOR]

Metal matrix nanocomposites have received more focus in the last two decades because of their desirable alternative features. Many researchers have made several attempts to identify the suitable nanoreinforcement particles for getting improved results in various applications. Many of them tried to improve the properties of several metal matrix nanocomposite materials including mechanical properties, electrical properties, barrier properties, structural properties, moisture permeability, etc., with the help of a variety of techniques. Research study results revealed that the addition of nanosized reinforcement particles improved the mechanical and wear characteristics of aluminum-based metal matrix composites. Metal matrix nanocomposites are being employed in many application areas such as in biomedical field, self-cleaning marble coating application, antimicrobial application and wear-resistant coating application. This review workhas gone through a bulk of research works related to metal matrix nanocomposites. The entire study has been grouped under a few major categories such as synthesis of nanocomposites, characterization study on various nanocomposites, application areas of various nanocomposites, optimization works carried out on nanocomposites, and risk management of nanocomposites. [ABSTRACT FROM AUTHOR]

Emerging evidence has demonstrated the profound impact of the gut microbiome on cardiovascular diseases through the production of diverse metabolites. Using an animal model of myocardial ischemia–reperfusion (I/R) injury, we found that the prophylactic administration of a well‐known probiotic, Bifidobacterium infantis (B. infantis), exhibited cardioprotective effects in terms of preserving cardiac contractile function and preventing adverse cardiac remodeling following I/R and that these cardioprotective effects were recapitulated by its metabolite inosine. Transcriptomic analysis further revealed that inosine mitigated I/R‐induced cardiac inflammation and cell death. Mechanistic investigations elucidated that inosine suppressed the production of pro‐inflammatory cytokines and reduced the numbers of dendritic cells and natural killer cells, achieved through the activation of the adenosine A2A receptor (A2AR) that when inhibited abrogated the cardioprotective effects of inosine. Additionally, in vitro studies using C2C12 myoblasts revealed that inosine attenuated cell death by serving as an alternative carbon source for adenosine triphosphate (ATP) generation through the purine salvage pathway when subjected to oxygen‐glucose deprivation/reoxygenation that simulated myocardial I/R injury. Likewise, inosine reversed the I/R‐induced decrease in ATP levels in mouse hearts. Taken together, our findings indicate that B. infantis or its metabolite inosine exerts cardioprotective effects against I/R by suppressing cardiac inflammation and attenuating cardiac cell death, suggesting prophylactic therapeutic options for acute ischemic cardiac injury. Highlights: Bifidobacterium infantis, a well‐known probiotic, exhibits prophylactic cardioprotective effects against myocardial I/R injury.The cardioprotective effects of Bifidobacterium infantis are recapitulated by its metabolite inosine.Inosine treatment suppresses cardiac inflammation by reducing the production of pro‐inflammatory cytokines and decreasing the numbers of dendritic cells and natural killer cells after I/R.Inosine treatment attenuates cell death by serving as an alternative carbon source for adenosine triphosphate generation through the purine salvage pathway in stressed myocytes and in I/R‐injured mouse hearts. [ABSTRACT FROM AUTHOR]

The exterior layer of the fuselage skin structure is made of Glass-Reinforced Fiber Metal Laminates (GLARE-FMLs). Hole quality is impacted by various force components during the drilling process. The process variables of drilling are optimized to obtain quality holes by controlling such force components. Because of the very limited works on optimizing the significant input process variables in getting quality drilled holes on FML plates, the present investigation is aimed to analyze the impact of varying the significant drilling process variables referred from the literature study and the wt.% of Layered Double Hydroxide (LDH) mixed with the epoxy, on the force components generated during the drilling process. The FML plates proposed in the study have been drilled based on the test plan prepared by Taguchi's DOE. Grey Relational Analysis has been used for discovering the best combination of process variables leading to good quality holes. Further, grey-fuzzy modeling technique has been employed to check the results of GRA. From the results, it is identified that 1000 rpm spindle speed, 20 mm/min feed rate and 4 wt.% inclusion of LDH to the epoxy resin combination within the considered range of input process variables were found to be the best input parameter combinations resulting in comparatively better output responses. Artificial Neural Network (ANN) model has been generated to bridge the input variables with the outputs measured. The fitness of the generated ANN model has been checked and reported. The effect of varying the process variables on obtaining the quality drilled holes has been revealed using Main Effect Plots (MEPs). [ABSTRACT FROM AUTHOR]

Abstract Background Approximately 70% of Kenya’s population is at risk for malaria. The core vector control methods in Kenya are insecticide-treated mosquito nets (ITNs) and indoor residual spraying, with supplementary larval source management. In 2015, 21% of ITNs were accessed through the private retail sector. Despite the private sector role in supplying mosquito control products (MCPs), there is little evidence on the availability, sales trends, and consumer preferences for MCPs other than ITNs. This study, a component of a larger research programme focused on evaluating a spatial repellent intervention class for mosquito-borne disease control, addressed this evidence gap on the role of the private sector in supplying MCPs. Methods A cross-sectional survey was deployed in a range of retail outlets in Busia County to characterize MCP availability, sales trends, and distribution channels. The questionnaire included 32 closed-ended and four open-ended questions with short answer responses. Descriptive analysis of frequency counts and percentages was carried out to glean insights about commercially available MCPs and the weighted average rank was used to determine consumer preferences for MCPs. Open-ended data was analysed thematically. Results Retail outlets that stocked MCPs commonly stocked mosquito coils (73.0%), topical repellents (38.1%), aerosol insecticide sprays (23.8%) and ITNs (14.3%). Overall, retailers reported the profits from selling MCPs were adequate and they overwhelmingly planned to continue stocking the products. Of respondents who stocked MCPs, 96.8% responded that sales increased during long rains and 36.5% that sales also surged during short rains. ITNs and baby-size nets were often delivered by the wholesaler. Retailers of aerosol sprays, mosquito coils, and topical repellents either collected stock from the wholesaler or products were delivered to them. Other commercially available MCPs included insecticide incense sticks, electric mosquito strikers, insecticide soaps, electrically heated insecticide mats, and electric insecticide emanators, indicating a well-established market. Conclusions The wide range of MCPs in local retail outlets within the study area suggests the need and demand for mosquito control tools, in addition to ITNs, that are affordable, easy to use and effective. The presence of a wide range of MCPs, is a promising sign for the introduction of a spatial repellent intervention class of products that meets consumer needs and preferences.

Abstract Background In Tanzania, the uptake of optimal doses (≥ 3) of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria (IPTp-SP) during pregnancy has remained below the recommended target of 80%. Therefore, this study aimed to investigate the predictors for the uptake of optimal IPTp-SP among pregnant women in Tanzania. Methods This study used data from the 2015–16 Tanzania demographic and health survey and malaria indicator survey (TDHS-MIS). The study had a total of 4111 women aged 15 to 49 who had live births 2 years preceding the survey. The outcome variable was uptake of three or more doses of IPTp-SP, and the independent variables were age, marital status, education level, place of residence, wealth index, occupation, geographic zone, parity, the timing of first antenatal care (ANC), number of ANC visits and type of the health facility for ANC visits. Predictors for the optimal uptake of IPTp-SP were assessed using univariate and multivariable logistic regression. Results A total of 327 (8%) women had optimal uptake of IPTp-SP doses. Among the assessed predictors, the following were significantly associated with optimal uptake of IPTp-SP doses; education level [primary (AOR: 2.2, 95% CI 1.26–3.67); secondary or higher education (AOR: 2.1, 95% CI 1.08–4.22)], attended ANC at the first trimester (AOR: 2.4, 95% CI 1.20–4.96), attended ≥ 4 ANC visits (AOR: 1.9, 95% CI 1.34–2.83), attended government health facilities (AOR: 1.5, 95% CI 1.07–1.97) and geographic zone [Central (AOR: 5, 95% CI 2.08–11.95); Southern Highlands (AOR: 2.8, 95% CI 1.15–7.02); Southwest Highlands (AOR: 2.7, 95% CI 1.03–7.29); Lake (AOR: 3.5, 95% CI 1.51–8.14); Eastern (AOR: 1.5, 95% CI 1.88–11.07)]. Conclusions The uptake of optimal IPTp-SP doses is still low in Tanzania. The optimal uptake of IPTp-SP was associated with attending ANC in the first trimester, attending more than four ANC visits, attending government health facility for ANC, having primary, secondary, or higher education level, and geographic zone. Therefore, there is a need for health education and behavior change interventions with an emphasis on the optimal use of IPTp-SP doses.

Background: Laryngopharyngeal reflux disease (LPRD) is a condition with nonspecific symptoms and most of times patients present late with advanced disease which may predispose to malignancy. The magnitude and clinical characteristics of this condition are not well known among patients attending Otorhinolaryngology services in Tanzania. Materials and methods: This was a hospital based descriptive cross sectional study, conducted in the wards and clinics of Otorhinolaryngology department of Muhimbili National Hospital. Patients with symptoms of Laryngopharyngeal reflux disease were included in the study. Data was collected using questionnaires and clinical examination forms, were processed and analysed by using SPSS. Results presented in frequency tables, cross tabulations and figures. Results: This study recruited 256 participants among them males were 131(51.2%).The mean age was (41.38 ± 13.94) years. Prevalence of Laryngopharyngeal reflux disease was 18.4% without gender predilection. The commonest symptoms were globus sensation, hoarseness of voice and excessive urge to clear the throat with 95.7%, 88.1% and 83.0% respectively while the most observed signs were thick endolaryngeal mucus, Vocal cord oedema and partial ventricular obliteration with 90.9%, 88.6% and 72.7% respectively. Lying down less than two hours after meal and spices foods consumption were the leading risk factors. Hypertension and Diabetes Mellitus type 2 were the most prevalent co morbid conditions associated with Laryngopharyngeal reflux disease. Conclusion: The prevalence of Laryngopharyngeal reflux disease is high among patients attending Otorhinolaryngology services at Muhimbili national hospital. All patients with Laryngopharyngeal reflux disease related symptoms should get thorough evaluation for early diagnosis and treatment.

The senescence of cardiovascular endothelial cells (ECs) is a major risk factor in the development of aging-related cardiovascular diseases. However, the molecular dynamics in cardiovascular EC aging are poorly understood. Here, we characterized the transcriptomic landscape of cardiovascular ECs during aging and observed that ribosome biogenesis, inflammation, apoptosis and angiogenesis-related genes and pathways changed with age. We also highlighted the importance of collagen genes in the crosstalk between ECs and other cell types in cardiovascular aging. Moreover, transcriptional regulatory network analysis revealed Jun as a candidate transcription factor involved in murine cardiovascular senescence and we validated the upregulation of Jun in aged cardiovascular ECs both in vitro and in vivo. Altogether, our study reveals the transcriptomic reprogramming in the aging murine cardiovascular ECs, which deepens the understanding of the molecular mechanisms of cardiovascular aging and provides new insights into potential therapeutic targets against age-related cardiovascular diseases.

Objective: The objective of this study was to identify factors associated with nurses’ and midwives’ skills in performing neonatal resuscitation. Method: Health facility-based analytical cross-sectional study design was employed from January 2021 to April 2021 among 340 nurses and midwives selected by multistage random sampling technique. An observation checklist was used to collect data. Data were coded and entered into SPSS version 20 for analysis. Bivariate and multivariate logistic regression was used to assess factors associated with nurse/midwives’ skills in neonatal resuscitation. Results: Among 340 nurses and midwives, 141 (41%) had adequate skills in neonatal resuscitation. After adjusting for confounders, factors associated with adequate skills were; age of the midwives (20–34 (adjusted odds ratio = 0.082, p 10 years and above (adjusted odds ratio = 12.825, p 16 km (adjusted odds ratio = 0.049, p 20 delivery per day (adjusted odds ratio = 6.007, p