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The study seeks to analyze the effect of women's empowerment on household food security in northern Ghana. Employing Random Effect and Generalized Estimating Equations on the two rounds of Feed the Future dataset, 2012 and 2015, the study measured women empowerment as the comparative years of schooling and decision making by women. Multivariate Decomposition was used to explain whether variations in food insecurity between gendered household types are due to differences in explained and/or unexplained variations. The study showed significant differences in food insecurity levels between male and female headed households. The finding revealed that improving women decision making at the household level will reduce food insecurity by 45%. The study therefore recommends that Ministry of Gender, Children and Social protection should educate male partners on the need for women's decision making and also ensure the establishment of social groups for women.

Abstract Background Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. Methods The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. Results The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38–0.99; p

Engineering is critical for socio-economic development, however only a few women participate in engineering education and careers. This study aimed to identify the types of negative information propagated by the social networks of engineering students that could create barriers to students, and particularly women's retention in engineering education and careers, and assess whether they influence men and women differently. The study was exploratory hence six focus group discussions were conducted with undergraduate engineering students in their second, third, and fourth years of study in a Ghanaian university. An interview guide was used to, among others, examine the perceptions and misconceptions of students' social networks about engineering and the negative information that circulates within the networks. Demotivating information from students' social networks were mainly misconceptions such as (1) engineering is too difficult and strenuous for women, and only meant for strong and well-built people, (2) engineering negatively affects women's beauty and body image, (3) engineering makes women unfashionable and unattractive, and (4) engineering is a threat to marital and family lives. Both female and male students were negatively affected by misinformation about engineering being difficult and having limited job prospects as well as societal preferences for other programmes such as medicine. The misinformation could serve as a barrier, especially for students lacking 'faith and the spirit of perseverance' to pursue and graduate from engineering programmes. While efforts are being made to bridge the gender gap in engineering education and careers, there are misconceptions and misinformation that can hinder progress toward achieving the desired gender parity. Educational policies must integrate gender-responsive strategies including addressing the socio-cultural and stereotypical factors and public misconceptions. There is a need to provide strategic counselling services to engineering students to be able to cope with the effects of negative information from their social networks especially during the early years of their studies in the universities.

Abstract Background Limited access to specialist medical services is a major barrier to healthcare in rural areas. We compared rural-urban specialist doctor consultations outside hospital by older adults (≥ 60 years) across South Australia. Methods Cross-sectional data were available from the South Australia’s Department of Health. The Modified Monash Model (MM1-7) of remoteness was used to categorize data into rural (MM 3–4), remote (MM5-7), and urban (MM1-MM2) of participants in urban and non-urban South Australia. The analysis was conducted on older adults (n = 20,522), self-reporting chronic physical and common mental health conditions. Results Specialist doctor consultation in the past 4 weeks was 14.6% in our sample. In multivariable analysis, increasing age (odds ratio 1.3, 95% CI: 1.2-1.4), higher education (odds ratio 1.5, 95% CI: 1.3-1.9), physical health conditions [diabetes (odds ratio 1.2, 95% CI: 1.1-1.3); cancer (odds ratio1.8, 95% CI: 1.7-2.0); heart disease (odds ratio 1.9, 95% CI: 1.6-2.1)], and common mental disorders [depression (odds ratio 1.3, 95% CI: 1.1-1.5); anxiety (odds ratio 1.4, 95% CI: 1.1-1.6)] were associated with higher specialist care use. Specialist care use among rural (odds ratio 0.8, 95% CI: 0.6–0.9), and remote (odds ratio 0.8, 95% CI: 0.7–0.9) older people was significantly lower than their urban counterparts after controlling for age, education, and chronic disease. Conclusion Our findings demonstrate a disparity in the use of out of hospital specialist medical services between urban and non-urban areas.

Background: Machine learning algorithms are finding increasing use in prediction of surgical outcomes in orthopedics. Random forest is one of such algorithms popular for its relative ease of application and high predictability. In the process of sample classification, algorithms also generate a list of variables most crucial in the sorting process. Total shoulder arthroplasty (TSA) is a common orthopedic procedure after which most patients are discharged home. The authors hypothesized that random forest algorithm would be able to determine most important variables in prediction of nonhome discharge. Methods: Authors filtered the National Surgical Quality iImprovement Program database for patients undergoing elective TSA (Current Procedural Terminology 23472) between 2008 and 2018. Applied exclusion criteria included avascular necrosis, trauma, rheumatoid arthritis, and other inflammatory arthropathies to only include surgeries performed for primary osteoarthritis. Using Python and the scikit-learn package, various machine learning algorithms including random forest were trained based on the sample patients to predict patients who had nonhome discharge (to facility, nursing home, etc.). List of applied variables were then organized in order of feature importance. The algorithms were evaluated based on area under the curve of the receiver operating characteristic, accuracy, recall, and the F-1 score. Results: Application of inclusion and exclusion criteria yielded 18,883 patients undergoing elective TSA, of whom 1813 patients had nonhome discharge. Random forest outperformed other machine learning algorithms and logistic regression based on American Society of Anesthesiologists (ASA) classification. Random forest ranked age, sex, ASA classification, and functional status as the most important variables with feature importance of 0.340, 0.130, 0.126, and 0.120, respectively. Average age of patients going to facility was 76 years, while average age of patients going home was 68 years. 78.1% of patients going to facility were women, while 52.7% of patients going home were. Among patients with nonhome discharge, 80.3% had ASA scores of 3 or 4, while patients going home had 54% of patients with ASA scores 3 or 4. 10.5% of patients going to facility were considered of partially/totally dependent functional status, whereas 1.3% of patients going home were considered partially or totally dependent (P value < .05 for all). Conclusion: Of various algorithms, random forest best predicted discharge destination following TSA. When using random forest to predict nonhome discharge after TSA, age, gender, ASA scores, and functional status were the most important variables. Two patient groups (home discharge, nonhome discharge) were significantly different when it came to age, gender distribution, ASA scores, and functional status.

AbstractThe study aims to explore the causal effect of Ghana’s National Health Insurance Scheme (NHIS) on hospitalisation duration. The analysis was based on the Ghana Socioeconomic Panel Survey datasets, comprising the second wave (2014/2015) and the third wave (2018/2019). The study employed the endogenous switching regression model for count data (ESRC) to control selection bias and unobserved heterogeneity. The ESRC estimates reveal that NHIS membership significantly reduces the length of stay in the hospital, indicating that health insurance has a negative association with hospitalisation. On average, insured people spend nearly five fewer days in the hospital than their uninsured counterparts. The findings further revealed common and heterogeneous determinants of hospitalisation care for both insured and uninsured individuals. Age, household expenditure, and self-assessed health were the main predictors of hospitalisation duration for insured and uninsured persons. Heterogeneously, gender, education, and physical inactivity are significant determinants of NHIS members’ hospitalisation care, while chronic illness affects the length of stay in the hospital of the uninsured. The paper concludes with a discussion of the policy options for increasing NHIS enrolment to reduce the length of stay in the hospital and improve individuals’ well-being.

The productivity of maize, an essential staple food crop in Africa, is severely constrained by the declining fertility of the soil. The combined use of organic and inorganic fertilizers could ameliorate this challenge in a sustainable way to boost maize productivity. Two field trials were conducted at Ashanti -Mampong and Damongo, in the transitional and Guinea Savannah agroecologies of Ghana respectively, to assess the influence of sole and integrated application of chicken manure and NPK fertilizer on the growth and yield of maize. The treatments included two maize varieties; Abontem and Obatanpa, and five fertilizer rates; 3 t/ha chicken manure (CM), NPK (65:38:38 kg ha−1 NPK), ½ CM + ½ NPK and ¾ CM + ¼ NPK and control (no fertilizer). A 2 x 5 factorial randomized complete block design with three replications was used. Significant variations (p

Defenses against oxidative damage to cell components are essential for survival of bacterial pathogens during infection, and here we have uncovered that the DmsABC S-/N-oxide reductase is essential for virulence and in-host survival of the human-adapted pathogen, Haemophilus influenzae. In several different infection models, H. influenzae ΔdmsA strains showed reduced immunogenicity as well as lower levels of survival in contact with host cells. Expression of DmsABC was induced in the presence of hypochlorite and paraquat, closely linking this enzyme to defense against host-produced antimicrobials. In addition to methionine sulfoxide, DmsABC converted nicotinamide- and pyrimidine-N-oxide, precursors of NAD and pyrimidine for which H. influenzae is an auxotroph, at physiologically relevant concentrations, suggesting that these compounds could be natural substrates for DmsABC. Our data show that DmsABC forms part of a novel, periplasmic system for defense against host-induced S- and N-oxide stress that also comprises the functionally related MtsZ S-oxide reductase and the MsrAB peptide methionine sulfoxide reductase. All three enzymes are induced following exposure of the bacteria to hypochlorite. MsrAB is required for physical resistance to HOCl and protein repair. In contrast, DmsABC was required for intracellular colonization of host cells and, together with MtsZ, contributed to resistance to N-Chlorotaurine. Our work expands and redefines the physiological role of DmsABC and highlights the importance of different types of S-oxide reductases for bacterial virulence.

PurposeWe aimed to investigate non-exudative microcystoid macular abnormalities for visual and anatomical outcome in patients with retinal vein occlusion (RVO) with and without glaucomatous optic neuropathy (GON).MethodsMedical records of 124 eyes (105 patients) with RVO were reviewed and analyzed. Eyes demonstrating microcystoid macular abnormalities were divided into 2 groups, those with evidence of glaucoma (group A) and those without glaucoma (group B). Best-corrected visual acuity (BCVA), the prevalence and number of microcystoid macular abnormalities, and number of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections were compared at baseline and follow-up.ResultsSeventy-one out of 105 eyes (67.6%) with RVO displayed microcystoid macular abnormalities. Thirty-eight out of 71 eyes (53.5%) presented with concomitant glaucoma (group A), while the remaining 33 eyes (42.6%) had no history of glaucoma (group B). At the end of the follow-up period, mean BCVA was worse in group A versus group B (20/80 versus 20/40, respectively; p = .003). The mean number of anti-VEGF injections was 10.1 ± 9.2 in group A versus 5.9 ± 6.9 in group B (p = .03).ConclusionEyes with RVO and concomitant glaucoma exhibited a significantly higher number of microcystoid macular abnormalities and worse BCVA versus eyes with RVO without glaucoma.

There are concerns about the association between the level of students' digital skills and the amount of stress they experience. However, evidence from both cross-sectional and longitudinal studies is limited. The main aim of this study was to address this gap in the literature by examining the relationship between preservice teachers' digital skills and stress. The study employed an online cross-sectional survey, which was completed by 661 pre-service teachers enrolled in colleges of education in Ghana. The findings showed that preservice teachers' low digital skills were associated with higher stress levels during the period of online teaching and learning necessitated by the COVID-19 pandemic. The study further revealed that preservice teachers' limited access to resources was a significant cause of stress. Preservice teachers' main coping strategies for reducing stress were positive framing, such as seeking advice from friends and family, seeing something good in what is happening and learning from the experience. Recommendations include providing more training on digital technologies during the initial preparation for teachers.

This study investigates the relationship between rural Ghanaian household food and nutrition security and financial literacy. We used the endogenous treatment regression (ETR) technique to address the analysis's potential selection bias problem. The findings of our study demonstrated a beneficial relationship between food and nutrition security and financial literacy. According to further studies, the relationship between food security and financial literacy is heterogeneous. Our findings may have some ramifications for promoting food and nutritional security while preserving rural development methods.

This study was designed to identify the causes of stress and coping strategies adopted among distance education students at the College of Distance Education in the University of Cape Coast. A total of 332 diploma and post-diploma final year students in 2014/2015 academic year were selected from two study centers using random sampling procedure to respond to self-administered questionnaire. The questionnaire which was adapted to suit the study context was pre-tested to ensure that it elicited valid response. The results of the study showed that "academic workload," "high frequency of examinations," "financial problems," "family/marriage problems" were the major causes of stress among the students. The study also found some statistical significant differences between married and unmarried students with married students feeling more stressed with "financial problems" and "family/marriage problems" than unmarried students. Students used multiple strategies, mainly praying/meditating, self-distracting activities such as watching TV and listening to music to cope with stress. Other important stress coping strategies were emotional and instrumental support from family, friends and lecturers. The study recommended among others that the need for the counseling unit at College of Distance Education of UCC to organize frequent stress management programs for students and assign academic counselors to students.

The fruit and vegetable industry remains one of Ghana’s most promising agricultural sectors mainly because of heightened awareness of the health benefits associated with their consumption. However, food safety is of ultimate concern due to the association of foodborne hazards resulting in escalation of foodborne illness. This report is a review of key foodborne hazards in Ghana’s horticultural value chain. The study identified the risk factors and hazards that contaminate fruits and vegetables in addition to existing methods for mitigating health risks and reducing pathogen levels in the produce. The study revealed that enteric pathogens such as Escherichia coli and Salmonella spp. mainly contaminate produce through fresh manure and contaminated irrigation water used during the production of vegetables. Chemical hazards identified included pesticides (organochlorine pesticides) and heavy metals such as cadmium, arsenic, chromium, and lead. Physical hazards identified included twigs, roots, sand, and stones. Washing fruits and vegetables thoroughly with potable water and sanitizing with vinegar and Chlorine solutions were among the common practices stakeholders adopted to reduce microbial levels. Soil remediation was also reported as a common approach for reducing chemical contaminants in agricultural fields. The study, therefore, recommends establishing a traceability system as well as appropriate measures and standards for hygienic practices for fresh fruits and vegetables produced and sold on the local market in Ghana. Value chain actors should be sensitized regularly on measures and interventions that can be employed to significantly reduce the levels of foodborne hazards and associated risks.

Acute pulmonary embolism (PE) is a leading cause of mortality. Not only is PE associated with short-term mortality, but up to ~20% of patients might suffer from long-term consequences such as post-PE syndrome and chronic thromboembolic pulmonary hypertension. Current risk stratification tools poorly predict those who are at risk for short-term deterioration and those who develop long-term consequences. Traditionally, systemic thrombolysis has been considered the first-line therapy for patients with high-risk PE without contraindications; however, it comes with the risk of major bleeding (notably intracranial hemorrhage). The use of catheter-directed interventions (embolectomy or thrombolysis) has been increasing owing to their low bleeding risk; however, randomized trial data supporting their efficacy in improving clinical outcomes are limited. In this review, we highlight the evidence supporting the available advanced therapies for high- and intermediate-risk PE and summarize the ongoing trials which are evaluating these therapies. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical and patient-reported outcomes of heterotopic ossification (HO) excision as well as the results of a standardized HO prophylaxis protocol among a group of patients who previously underwent open or arthroscopic hip surgery. Methods: Patients who developed HO after index hip surgery and were subsequently treated with arthroscopic excision of HO and postoperative HO prophylaxis using 2 weeks of indomethacin and radiation were retrospectively identified. All patients were seen by a single surgeon and were treated with the same arthroscopic technique. Patients were also placed on a regimen of 2 weeks of indomethacin 50 mg and radiation therapy with 700 cGy in one fraction on the first postoperative day. Outcomes assessed included recurrence of HO and conversion to total hip arthroplasty by latest follow-up. Other outcomes included Modified Harris Hip Scores and Non-Arthritic Hip Scores, which were collected preoperatively and at 1-year and 2-year follow-up. Results: There were 5 female and 9 male subjects, with an average age of 39 years (range 22-66) and average body mass index of 27.1 (19.1-37.5). Average follow-up time was 46 months (range 4-136). No patients had experienced HO recurrence by latest follow-up. Only 2 patients converted to total hip arthroplasty, one at 6 months and the other at 11 months postexcision. Average outcome scores improved by 2-year follow-up (average Modified Harris Hip Scores 52.8 improved to 86.5, average Non-Arthritic Hip Scores 49.4 improved to 83.8). Conclusions: Minimally invasive arthroscopic excision of HO and postoperative prophylaxis with combined indomethacin and radiation therapy effectively treats and prevents the recurrence of HO. Level of Evidence: Level IV, case series, therapeutic.

Abstract Background Defective chloride transport in airway epithelial cells (AECs) and the associated lung disease are the main causes of morbidity and early mortality in cystic fibrosis (CF). Abnormal airway iron homeostasis and the presence of lipid peroxidation products, indicative of oxidative stress, are features of CF lung disease. Results Here, we report that CF AECs (IB3-1) are susceptible to ferroptosis, a type of cell death associated with iron accumulation and lipid peroxidation. Compared to isogenic CFTR corrected cells (C38), the IB3-1 cells showed increased susceptibility to cell death upon exposure to iron in the form of ferric ammonium citrate (FAC) and the ferroptosis inducer, erastin. This phenotype was accompanied by accumulation of intracellular ferrous iron and lipid peroxides and the extracellular release of malondialdehyde, all indicative of redox stress, and increased levels of lactate dehydrogenase in the culture supernatant, indicating enhanced cell injury. The ferric iron chelator deferoxamine (DFO) and the lipophilic antioxidant ferrostatin-1 inhibited FAC and erastin induced ferroptosis in IB3-1 cells. Glutathione peroxidase 4 (GPX4) expression was decreased in IB3-1 cells treated with FAC and erastin, but was unchanged in C38 AECs. Necroptosis appeared to be involved in the enhanced susceptibility of IB3-1 AECs to ferroptosis, as evidenced by partial cell death rescue with necroptosis inhibitors and enhanced mixed lineage kinase domain-like (MLKL) localisation to the plasma membrane. Conclusion These studies suggest that the increased susceptibility of CF AECs to ferroptosis is linked to abnormal intracellular ferrous iron accumulation and reduced antioxidant defences. In addition, the process of ferroptotic cell death in CF AECs does not appear to be a single entity and for the first time we describe necroptosis as a potential contributory factor. Iron chelation and antioxidant treatments may be promising therapeutic interventions in cystic fibrosis. Graphical Abstract

There are concerns about the association between the level of students’ digital skills and the amount of stress they experience. However, evidence from both cross-sectional and longitudinal studies is limited. The main aim of this study was to address this gap in the literature by examining the relationship between preservice teachers’ digital skills and stress. The study employed an online cross-sectional survey, which was completed by 661 pre-service teachers enrolled in colleges of education in Ghana. The findings showed that preservice teachers’ low digital skills were associated with higher stress levels during the period of online teaching and learning necessitated by the COVID-19 pandemic. The study further revealed that preservice teachers’ limited access to resources was a significant cause of stress. Preservice teachers’ main coping strategies for reducing stress were positive framing, such as seeking advice from friends and family, seeing something good in what is happening and learning from the experience. Recommendations include providing more training on digital technologies during the initial preparation for teachers.

Increasing and competing demands on agriculture in sub-Saharan Africa mean that policy and investment decisions become more complex. Despite growing consensus on the need for sustainable agricultural intensification, there is limited agreement on how to achieve this in practice. Governments and societies face uncertainty and complex choices. This paper explores the potential of Multi-Stakeholder, Social Learning (MSL) approaches, facilitated by National Learning Alliances (NLAs), to improve policy and investment decisions. Comparative evidence from a donor-supported research and learning programme in Ethiopia, Ghana, Malawi, Tanzania and Zambia is used in a theory-based evaluation approach to assess the contribution of the NLAs to capacity and practice change amongst individuals, networks and senior decision-makers. Ten outcome cases are explored, including their contribution to systemic changes in the governance of evidence. Key lessons included: the value to decision-makers of engaging with informal networks; importance of combining dialogue, deliberation and experiential learning; the need to create safe spaces in national level MSL processes; the demanding combination of facilitation skills and commitment; and appropriately flexible support. This suggests a need not only for the production of quality research, but crucially support for MSL as a means of contributing to the good governance of evidence and sustainable change.