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Background: The stressful duality of motherhood while living with HIV is often further compounded by inflexible infant feeding regimes in diasporic settings. National infant feeding guidelines for mothers living with HIV (LWH) are based on World Health Organization (WHO) recommendations, which differ between low- and middle- vs. high-income countries and are more likely to contradict the cultural norms of sub-Saharan African communities. African, Caribbean, and Black mothers living with HIV (ACB- mothers LWH) often grapple with personal preferences and cultural norms vs. national guidelines for infant feeding, which often creates great tension at the intersection of these contradicting feeding protocols, subsequently leading to stressful motherhood experiences in the context of HIV. Purpose: The paper describes the mental health concerns and coping strategies of ACB mothers living with HIV in the context of infant feeding amidst contradicting cultural expectations and guideline. Methods: This is a qualitative study drawn from a broader community-based participatory research (CBPR) Focused ethnography (FE) was used to understand infant feeding-related stressors and coping strategies of ACB- mothers living with HIV. In-depth interviews of 61 ACB-mothers living with HIV were conducted, transcribed verbatim, and thematically analyzed. An audit trail, peer/team debriefing, and member checking ensured data credibility. Findings: Common stressors included cultural pressure toward certain feeding choices, fear of infecting the baby, and fear of inadvertent HIV disclosure and stigma; all of which could culminate in mental health crises if not properly managed. Coping strategies were deliberate effort to keep fit physically and mentally. Discussion and implication: Cultural expectations of “good motherhood” play a strong role in how ACB women judge their own motherhood efforts. Thus, alignment of policies to cultural expectations is key to mitigating psychosocial distress and resultant mental health problems. Conclusion: Mental distress experienced by ACB- mothers living with HIV around infant feeding choices may negatively affect their well-being and consequently their ability to care for their infants. A combination of culturally responsive guidelines, provision of social and community support, and educational efforts is necessary to reduce the mental health burden on ACB- mothers living with HIV.

Abstract Background The recent Ebola Virus Disease (EVD) epidemic that hit some countries in West Africa underscores the need to train front line high-risk health workers on disease prevention skills. Although Ghana did not record (and is yet to) any case, and several health workers have received numerous training schemes, there is no record of any study that assessed preparedness of healthcare workers (HCWS) regarding EVD and any emergency prone disease in Ghana. We therefore conducted a hospital based cross sectional study involving 101 HCWs from two facilities in Kumasi, Ghana to assess the level of preparedness of HCWs to respond to any possible EVD. Methods We administered a face-to-face questionnaire using an adapted WHO (2015) and CDC (2014) Checklist for Ebola Preparedness and assessed overall knowledge gaps, and preparedness of the Ghanaian HCWs in selected health facilities of the Ashanti Region of Ghana from October to December 2015. Results A total 92 (91.09%) HCWs indicated they were not adequately trained to handle an EVD suspected case. Only 25.74% (n = 26) considered their facilities sufficiently equipped to handle and manage EVD patients. When asked which disinfectant to use after attending to and caring for a suspected patient with EVD, only 8.91% (n = 9) could correctly identify the right disinfectant (χ2 = 28.52, p = 0.001). Conclusion Our study demonstrates poor knowledge and ill preparedness and unwillingness of many HCWs to attend to EVD. Beyond knowledge acquisition, there is the need for more training from time to time to fully prepare HCWs to handle any possible EVD case.

In this paper, a Weibull-normal distribution, based on the standard quantile function of log-logistic distribution, is defined and studied. Some properties of the probability distribution are discussed. The Weibull-normal distribution is found to be unimodal or bimodal. The distribution can be right skewed or left skewed. The method of maximum likelihood estimation is suggested to estimate the parameters of the distribution. Three numerical data sets are used to illustrate the applications of the Weibullnormal distribution.

The literature on service learning is replete with the benefits of this pedagogical approach to students as well as the community. The literature is almost silent on the viewpoints of beneficiaries of service learning projects. The overarching aim of this study was to obtain the reaction of beneficiaries to campaign materials produced by students of an advertising and public relations campaigns course at the University of Botswana. Using in-depth interviews, officials of 13 organizations were asked to evaluate the campaign materials in the indices of how these are aligned to corporate outlook and the brief they gave the students as well as to find out their attitudes toward the concepts. Majority of respondents expressed favorable attitude toward the campaign materials and indicated a willingness to flight the campaigns to give greater mileage to their marketing efforts.

Critics and the regulatory authority – National Film and Video Censors Board – have severely criticized Nigerian home video films for placing too much emphasis on occultism, blood, gore and appeals to the lowest common denominator. The overall objective of this study was to find out if the views of audience members tallies with or is at variance with those expressed by the critics and experts. The study employed multi-stage cluster sampling and one thousand four hundred and forty copies of the study questionnaire were given out to respondents. The study found out that audience members have a favourable attitude to Nigerian home video films in spite of the emphasis on negative themes.

This paper examined rejoinders by corporate bodies and public figures to news stories and editorials in two Nigerian newspapers from 1999-2001 with a view to determining which type of rejoinders - mild or adversarial - were favoured. The findings of the paper clearly indicates that majority of rejoinders were adversarial containing abusive language directed at journalists and media organizations. The paper takes the position that these rejoinders point to the scant regard in which the Nigerian print media is held and recommends that the cherished value of balance in helping to reverse this worrisome trend.

Vehicular Related Trauma (VRT) is a major cause of morbidity and mortality. Worldwide, an estimated 1.2 million people die yearly from VRT whilst about 50 million people sustain non-fatal injuries. WHO predicts Road Traffic Accident as the third leading cause of death worldwide by 2020. Ghana has been experiencing an increasing number of VRT which imposes a high clinical and economic burden. In the year 2010 out of 16,904 casualties 1986 were killed in Ghana (National Road Safety Commission). This study was conducted to assess the morbidity and mortality resulting from VRT, the severity of presentation and the injury types. Methods: The study was cross-sectional. Patients fulfilling inclusion criteria at the Komfo Anokye Teaching Hospital (KATH) Emergency Centre (EC) were recruited on admission. Written informed consent was obtained. Patients were triaged using the five-tier South Africa Triage system. Data were collected over a six-week period between July and August 2011. Results: Out of the total sample of 1004, approximately 41% had some form of injury; of these almost half (49.6%) had injuries from Vehicular Related Trauma. A further look at VRT cases indicated that the principal presentations were caused by car crash (41.6%), pedestrian injuries (25.8%), and motorcycle related injuries (19.6%). Mini buses and bicycles accounted for 9.8% and 2.2%, respectively. 6.8% of the patients were triaged to “red”, 33.4% to “orange”, and 59.3% to “yellow”. Thirty-four and a half percent of the patients presented with lower extremity injuries and fractures, followed by head injuries (26.1%). Mortality rate (24 h mortality) at the Emergency department during the period in respect with trauma is as follows: 15.78% for “red”, 1.27% for “orange” and none at “yellow”. None of the patients involved in bicycle accidents wore a helmet and only 5.3% of those riding motorcycles wore a crash helmet. Discussion: This study confirms that injuries resulting from Vehicular Related Trauma contribute a significant cause of all injuries presenting at the KATH EC and therefore could have a significant economic burden on Ghana. Policy makers should make road safety a priority and implement cost effective measures to improve it.

Background: End-stage kidney disease (ESKD) patients are living longer, often into older age, and commonly pursue kidney transplantation. Successful aging, a multidimensional construct of physical and social wellbeing, has been expanded and adapted for patients with chronic disease. However, perceptions of, barriers to, and experiences with successful aging among adults with ESKD are unclear and likely differ based on whether they have received a kidney transplant., Methods: Ten focus groups were held with 39 total ESKD patients aged ≥50 years (19 transplant candidates, 20 transplant recipients). Transcriptions were analyzed thematically by 2 independent coders using an inductive, constant comparative approach., Results: The mean age was 64.8 (SD = 7.5); 51% were African American and 64% were males. Six themes were identified: familiarity with successful aging, perceptions of successful aging after ESKD diagnosis, barriers to successful aging, experiences with successful aging among transplant candidates, experiences with successful aging among transplant recipients, and suggested interventions. While all participants sought to achieve successful aging while living with ESKD, experiences with successful aging differed between candidates and recipients. Candidates struggled with the limitations of dialysis; some viewed transplantation as an opportunity to age successfully, while others were resigned to the drawbacks of dialysis. In contrast, transplant recipients were optimistic about their ability to age successfully, believing their transplant facilitated successful aging. Participants believed support groups for adults with ESKD and more thoughtful health care for aging adults would promote successful aging., Conclusions: Adults with ESKD may benefit from discussions with their clinicians and caregivers about goals, barriers, and strategies regarding successful aging.

Background: United States transplant centers are required to report follow-up data for living kidney donors for 2 years post-donation. However, living kidney donor (LKD) follow-up is often incomplete. Mobile health (mHealth) technologies could ease data collection burden but have not yet been explored in this context., Methods: We conducted semi-structured in-depth interviews with a convenience sample of 21 transplant providers and thought leaders about challenges in LKD follow-up, and the potential role of mHealth in overcoming these challenges., Results: Participants reported challenges conveying the importance of follow-up to LKDs, limited data from international/out-of-town LKDs, and inadequate staffing. They believed the 2-year requirement was insufficient, but expressed difficulty engaging LKDs for even this short time and inadequate resources for longer-term follow-up. Participants believed an mHealth system for post-donation follow-up could benefit LKDs (by simplifying communication/tasks and improving donor engagement) and transplant centers (by streamlining communication and decreasing workforce burden). Concerns included cost, learning curves, security/privacy, patient language/socioeconomic barriers, and older donor comfort with mHealth technology., Conclusions: Transplant providers felt that mHealth technology could improve LKD follow-up and help centers meet reporting thresholds. However, designing a secure, easy to use, and cost-effective system remains challenging., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Social media platforms are increasingly used in surgery and have shown promise as effective tools to promote deceased donation and expand living donor transplantation. There is a growing need to understand how social media-driven communication is perceived by providers in the field of transplantation., Methods: We surveyed 299 members of the American Society of Transplant Surgeons about their use of, attitudes toward, and perceptions of social media and analyzed relationships between responses and participant characteristics., Results: Respondents used social media to communicate with: family and friends (76%), surgeons (59%), transplant professionals (57%), transplant recipients (21%), living donors (16%), and waitlisted candidates (15%). Most respondents (83%) reported using social media for at least 1 purpose. Although most (61%) supported sharing information with transplant recipients via social media, 42% believed it should not be used to facilitate living donor-recipient matching. Younger age (P = 0.02) and fewer years of experience in the field of transplantation (P = 0.03) were associated with stronger belief that social media can be influential in living organ donation. Respondents at transplant centers with higher reported use of social media had more favorable views about sharing information with transplant recipients (P < 0.01), increasing awareness about deceased organ donation (P < 0.01), and advertising for transplant centers (P < 0.01). Individual characteristics influence opinions about the role and clinical usefulness of social media., Conclusions: Transplant center involvement and support for social media may influence clinician perceptions and practices. Increasing use of social media among transplant professionals may provide an opportunity to deliver high-quality information to patients.

Background: Every year, more than 5500 healthy people in the United States donate a kidney for the medical benefit of another person. The Organ Procurement and Transplantation Network (OPTN) requires transplant hospitals to monitor living kidney donors (LKDs) for 2 years postdonation. However, the majority (115/202, 57%) of transplant hospitals in the United States continue to fail to meet nationally mandated requirements for LKD follow-up. A novel method for collecting LKD follow-up is needed to ease both the transplant hospital-level and patient-level burden. We built mKidney-a mobile health (mHealth) system designed specifically to facilitate the collection and reporting of OPTN-required LKD follow-up data. The mKidney mobile app was developed on the basis of input elicited from LKDs, transplant providers, and thought leaders., Objective: The primary objective of this study is to evaluate the impact of the mKidney smartphone app on LKD follow-up rates., Methods: We will conduct a two-arm randomized controlled trial (RCT) with LKDs who undergo LKD transplantation at Methodist Specialty and Transplant Hospital in San Antonio, Texas. Eligible participants will be recruited in-person by a study team member at their 1-week postdonation clinical visit and randomly assigned to the intervention or control arm (1:1). Participants in the intervention arm will receive the mHealth intervention (mKidney), and participants in the control arm will receive the current standard of follow-up care. Our primary outcome will be policy-defined complete (all components addressed) and timely (60 days before or after the expected visit date) submission of LKD follow-up data at required 6-month, 1-year, and 2-year visits. Our secondary outcome will be hospital-level compliance with OPTN reporting requirements at each visit. Data analysis will follow the intention-to-treat principle. Additionally, we will collect quantitative and qualitative process data regarding the implementation of the mKidney system., Results: We began recruitment for this RCT in May 2018. We plan to enroll 400 LKDs over 2 years and follow participants for the 2-year mandated follow-up period., Conclusions: This pilot RCT will evaluate the impact of the mKidney system on rates of LKD and hospital compliance with OPTN-mandated LKD follow-up at a large LKD transplant hospital. It will provide valuable information on strategies for implementing such a system in a clinical setting and inform effect sizes for future RCT sample size calculations., International Registered Report Identifier (irrid): DERR1-10.2196/11000., (©Macey L Henderson, Alvin G Thomas, Ann K Eno, Madeleine M Waldram, Jaclyn Bannon, Allan B Massie, Michael A Levan, Dorry L Segev, Adam W Bingaman. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 15.01.2019.)

Background: As transplant centers start leveraging Twitter for information dissemination and public engagement, it is important to understand current living solid organ donation-related Twitter use., Methods: We identified public Twitter profiles available in 01/2017 that referenced living organ donation and analyzed the use of donation-related Twitter handles, names, or profile information. Tweets were manually abstracted and qualitatively analyzed for common themes. Social media influence of those tweeting about living donation was evaluated using Klout score., Results: We identified 93 donors, 61 professionals, 12 hospitals, and 19 organizations that met eligibility criteria. Social media influence was similar across these groups (P = 0.4). Donors (16%) and organizations (23%) were more likely than professionals (7%) or hospitals (0%) to include transplant-related educational information in their profiles (P = 0.007). Living donation-related tweets were most commonly donation stories (33%), news reports (20%), reports about new transplant research (15%), and sharing transplant candidates' searches for donors (14%)., Conclusions: This exploratory study of living donors and transplant professionals, hospitals, and organizations on Twitter provides insight into how the social media platform may be used to communicate about and disseminate information about living donation., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In 2013, the Organ Procurement and Transplantation Network began requiring transplant centers in the United States to collect and report postdonation living kidney donor follow-up data at 6 months, 1 year, and 2 years. Despite this requirement, <50% of transplant centers have been able to collect and report the required data. Previous work identified a number of barriers to living kidney donor follow-up, including logistical and administrative barriers for transplant centers and cost and functional barriers for donors. Novel smartphone-based mobile health (mHealth) technologies might reduce the burden of living kidney donor follow-up for centers and donors. However, the attitudes and perceptions toward the incorporation of mHealth into postdonation care among living kidney donors are unknown. Understanding donor attitudes and perceptions will be vital to the creation of a patient-oriented mHealth system to improve living donor follow-up in the United States., Objective: The goal of this study was to assess living kidney donor attitudes and perceptions associated with the use of mHealth for follow-up., Methods: We developed and administered a cross-sectional 14-question survey to 100 living kidney donors at our transplant center. All participants were part of an ongoing longitudinal study of long-term outcomes in living kidney donors. The survey included questions on smartphone use, current health maintenance behaviors, accessibility to health information, and attitudes toward using mHealth for living kidney donor follow-up., Results: Of the 100 participants surveyed, 94 owned a smartphone (35 Android, 58 iPhone, 1 Blackberry), 37 had accessed their electronic medical record on their smartphone, and 38 had tracked their exercise and physical activity on their smartphone. While 77% (72/93) of participants who owned a smartphone and had asked a medical question in the last year placed the most trust with their doctors, nurses, or other health care professionals regarding answering a health-related question, 52% (48/93) most often accessed health information elsewhere. Overall, 79% (74/94) of smartphone-owning participants perceived accessing living kidney donor information and resources on their smartphone as useful. Additionally, 80% (75/94) perceived completing some living kidney donor follow-up via mHealth as useful. There were no significant differences in median age (60 vs 59 years; P=.65), median years since donation (10 vs 12 years; P=.45), gender (36/75, 36%, vs 37/75, 37%, male; P=.57), or race (70/75, 93%, vs 18/19, 95%, white; P=.34) between those who perceived mHealth as useful for living kidney donor follow-up and those who did not, respectively., Conclusions: Overall, smartphone ownership was high (94/100, 94.0%), and 79% (74/94) of surveyed smartphone-owning donors felt that it would be useful to complete their required follow-up with an mHealth tool, with no significant differences by age, sex, or race. These results suggest that patients would benefit from an mHealth tool to perform living donor follow-up., (©Ann K Eno, Alvin G Thomas, Jessica M Ruck, Sarah E Van Pilsum Rasmussen, Samantha E Halpern, Madeleine M Waldram, Abimereki D Muzaale, Tanjala S Purnell, Allan B Massie, Jacqueline M Garonzik Wang, Krista L Lentine, Dorry L Segev, Macey L Henderson. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.10.2018.)