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Abstract Background Tungiasis, an ectoparasitic disease caused by sand fleas, causes suffering to millions of people in the tropics. Although the Kenyan National Policy Guidelines list tungiasis treatments as including disinfectants, flea repellents, and botanical oil, the insufficient knowledge and financial constraints of affected communities have led to neglect and inappropriate self-treatment. Current reports show insignificant progress on educational activities at the community level. Therefore, we investigated community residents’ treatment-seeking behaviour concerning tungiasis, using an endemic area of Kenya as the research setting. Methods A cross-sectional mixed-methods design was employed. Quantitative data were collected from the participants—410 adults who had experienced tungiasis—using a questionnaire, while qualitative data were collected from 20 older adults to 10 medical staffs using semi-structured individual interviews. The study was conducted in two sub-counties of Homa Bay County, Kenya. Results Factors significantly correlated with using non-guideline-listed treatments for tungiasis were ‘not knowing the causse of tungiasis’, ‘not seeking treatment from healthcare facilities and traditional healers’, and ‘wait and see to prevent infection in non-affected members’. The interviews with the older adults revealed 19 self-treatment options for tungiasis, and 40% of the participants opted for self-removal using sharp objects. Only two of these treatments were listed in the guidelines. The most frequently mentioned reason for using a self-treatment option was ‘Someone else’s idea’. The most frequently mentioned reason for choosing the best self-treatment option was ‘Effectiveness’. Interviews with medical staff revealed 11 treatment options; only five of these treatments are listed in the guidelines. The most frequently mentioned reason for selecting/using the treatment was ‘Supply situation’. Conclusions Residents’ socioeconomic factors, cultural factors, and access to appropriate treatment, as well as knowledge of medical staff were significant factors that influenced the residents’ tungiasis treatment-seeking behaviours. This study provides feasibility and baseline data to establish an effective, safe, and sustainable treatment for tungiasis.

Abstract Prostate cancer (PCa) metastasis significantly influences treatment decisions and prognosis. This study evaluated the individual and combined diagnostic ability of apparent diffusion coefficient (ADC), Gleason score and prostate‐specific antigen (PSA) in detecting metastasis. The study included data from 120 biopsy‐confirmed PCa patients treated from 2019 to 2023. Whole‐body MRI images, incorporating high‐resolution T2 and axial DWI sequences, were evaluated by experienced radiologists. Receiver operating characteristic (ROC) curves and logistic regression models were used to assess the diagnostic performance of ADC, Gleason score, and PSA in detecting metastasis. The prevalence of PCa metastasis was 25.0%, with pelvic lymph node metastasis (16.7%) and bony metastasis (12.5%) being most prevalent. Patients with PCa metastasis had significantly lower ADC values, higher Gleason scores, and higher PSA levels compared to those without metastasis. Individually, an ADC cut‐off of ≤549.00 mm2/s was the best marker for detecting metastasis. The combined bioscore model including PSA, ADC values and Gleason score was the best independent predictor, correlating with a 159‐fold increased likelihood of detecting PCa metastasis. This study demonstrated the prognostic ability of PCa markers in detecting metastasis. ADC was an independent, sensitive, specific, and accurate diagnostic marker. The combined bioscore model of ADC, PSA and Gleason score significantly enhanced the identification of patients with PCa metastasis.

Abstract Background In late 2021, Ghana was hit by a Yellow Fever outbreak that started in two districts in the Savannah region and spread to several other Districts in three regions. Yellow fever is endemic in Ghana. However, there is currently no structured vector control programme for Aedes the arboviral vector in Ghana. Knowledge of Aedes bionomics and insecticide susceptibility status is important to control the vectors. This study therefore sought to determine Aedes vector bionomics and their insecticide resistance status during a yellow fever outbreak. Methods The study was performed in two yellow fever outbreak sites (Wenchi, Larabanga) and two non-outbreak sites (Kpalsogu, Pagaza) in Ghana. Immature Aedes mosquitoes were sampled from water-holding containers in and around human habitations. The risk of disease transmission was determined in each site using stegomyia indices. Adult Aedes mosquitoes were sampled using Biogents Sentinel (BG) traps, Human Landing Catch (HLC), and Prokopack (PPK) aspirators. Phenotypic resistance to permethrin, deltamethrin and pirimiphos-methyl was determined with WHO susceptibility tests using Aedes mosquitoes collected as larvae and reared into adults. Knockdown resistance (kdr) mutations were detected using allele-specific multiplex PCR. Results Among the 2,664 immature Aedes sampled, more than 60% were found in car tyres. Larabanga, an outbreak site, was classified as a high-risk zone for the Yellow Fever outbreak (BI: 84%, CI: 26.4%). Out of 1,507 adult Aedes mosquitoes collected, Aedes aegypti was the predominant vector species (92%). A significantly high abundance of Aedes mosquitoes was observed during the dry season (61.2%) and outdoors (60.6%) (P

Abstract Background Diarrheal disease is a significant cause of morbidity and mortality in under-fives in many low- and middle-income countries. Changes in food safety, hygiene practices, and nutrition around the weaning period may reduce the risk of disease and improve infant development. The MaaCiwara study aims to evaluate the effectiveness of a community-based educational intervention designed to improve food safety and hygiene behaviours, as well as child nutrition. This update article describes the statistical analysis plan for the MaaCiwara study in detail. Methods and design The MaaCiwara study is a parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures, involving 120 clusters of rural and urban communities. These clusters are randomised to either receive the community-based behaviour change intervention or to the control group. The study participants will be mother–child pairs, with children aged between 6 and 36 months. Data collection involves a day of observation and interviews with each participating mother–child pair, conducted at baseline, 4 months, and 15 months post-intervention. The primary analysis aims to estimate the effectiveness of the intervention on changes to complementary food safety and preparation behaviours, food and water contamination, and diarrhoea. The primary outcomes will be analysed generalised linear mixed models, at individual level, accounting for clusters and rural/urban status to estimate the difference in outcomes between the intervention and control groups. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. In addition, structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) register: ISRCTN14390796 . Registered on 13 December 2021.

Abstract Background and Aims Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold‐Jarisch reflex do not fully explain SA‐related cardiopulmonary complications. Reduction in FEV1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV1 following SA and adverse intraoperative cardiopulmonary complications. Materials and Methods A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV1% predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV1%

Background: Human papillomavirus (HPV) infection is highly prevalent among sexually active individuals. A report by the Ghana Aids Commission highlights low condom usage among Ghana's sexually active youth. Despite this, there has been no exploration of views regarding condom use for preventing HPV infection. The purpose of the study was to examine the beliefs about condom use in preventing the human papillomavirus among men at Kpong community. Methods: The study utilized a qualitative approach with an exploratory design, employing purposive sampling to select 40 participants. Data collection involved face-to-face interviews using a semi-structured interview guide. The interviews were recorded, transcribed verbatim, and analyzed through content analysis. Results: The study produced three main themes and 8 subthemes. Despite most participants having used condoms before, primarily once (57.5 %) with a preference for “kiss condoms'' (42.5 %). The primary reason for condom use was pregnancy prevention (45 %), instead of HPV infections (22.5 %). Most participants rarely used condoms, aiming to enhance sexual pleasure or assuming their partners were HPV-free. Some cited religious reasons, viewing condom use as sinful. Conclusion: Participants commonly do not use condoms to prevent HPV infections. Additionally, men have various religious and personal reasons for not using condoms to protect against HPV and other infections. This underscores the need for increased awareness of HPV transmission among men.

Abstract In comparison to convolutional neural networks (CNN), the newly created vision transformer (ViT) has demonstrated impressive outcomes in human pose estimation (HPE). However, (1) there is a quadratic rise in complexity with respect to image size, which causes the traditional ViT to be unsuitable for scaling, and (2) the attention process at the transformer encoder as well as decoder also adds substantial computational costs to the detector’s overall processing time. Motivated by this, we propose a novel Going shallow and deeper with vIsion Transformers for human Pose estimation (GITPose) without CNN backbones for feature extraction. In particular, we introduce a hierarchical transformer in which we utilize multilayer perceptrons to encode the richest local feature tokens in the initial phases (i.e., shallow), whereas self-attention modules are employed to encode long-term relationships in the deeper layers (i.e., deeper), and a decoder for keypoint detection. In addition, we offer a learnable deformable token association module (DTA) to non-uniformly and dynamically combine informative keypoint tokens. Comprehensive evaluation and testing on the COCO and MPII benchmark datasets reveal that GITPose achieves a competitive average precision (AP) on pose estimation compared to its state-of-the-art approaches.

Abstract Background Obesity is a classified risk factor for several of the world’s leading causes of death. In this study, we combined information contained in body mass index (BMI), total percentage body fat (TPBF) and relative fat mass (RFM) to estimate obesity prevalence and examine the risk factors associated with obesity. Methods The study recruited 1027 undergraduate students aged between 16 and 25 years using a cross-sectional study design and two-stage stratified random sampling between January and April 2019 from the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Demographic, lifestyle, and family history of chronic disease data, were collected using a structured questionnaire. Bioelectrical impedance, along with height, weight, age, and gender, were used to estimate BMI and TPBF. The RFM was calculated using a published equation. The TPBF and RFM ranges were evaluated based on standard BMI thresholds and an informative combined obesity prevalence estimated in a Bayesian framework. Multiple logistic regression analysis was used to evaluate potential risk factors of overweight/obesity. Results Concordance between BMI, TPBF and RFM for obesity classification was 84% among female and 82.9% among male students. The Bayesian analysis revealed a combined prevalence means of obesity of 9.4% (95%CI: 6.9-12.2%) among female students and 6.7% (95%CI:4.3-9.5%) among male students. The odds of obesity were increased between 1.8 and 2.5 for females depending on the classification index. A significant increasing trend of obesity was observed with university-level. A family history of obesity was associated with a high estimate of general, central, and high TPBF. Conclusion Using multiple adiposity indicators conjointly in a Bayesian framework offers a greater power to examine obesity prevalence. We have applied this and reported high obesity prevalence, especially among female students. University level and family history of obesity were key determinants for obesity among the student population.

AbstractThis study examines the impact of Eurobonds on carbon dioxide emissions in Africa using a panel dataset. The paper reconsidered the Environmental Kuznets Curve (EKC) and integrated it into Eurobond Environmental Kuznets Curve (EEKC). This study modelled a panel dataset spanning from 2007 to 2018 using all 17 sovereign African countries that have issued Eurobonds. The findings highlight a significant scientific value in exploring Eurobonds as a financing option to reduce carbon dioxide emissions in Africa. Specifically, the study reveals a positive relationship between Eurobond issuance and carbon dioxide emissions at the initial stage of the EEKC. By including the square term of Eurobond, the research identifies the existence of the EEKC in Africa, which supports the EKC theory. These results contribute to the growing body of literature on climate change mitigation and financing strategies in the context of African economies. Moreover, this study fills a critical void in the literature by introducing Eurobonds into the climate financing debate, emphasizing their potential role in financing climate-resilient activities. The study recommends that the issuing of Eurobonds should be linked to climate resilient activities, enabling funds to be directly invested in green sectors of the economy. This novel perspective on Eurobonds as a tool for environmentally sustainable projects adds scientific significance to the discourse on climate finance and sustainable development in Africa.

Most classification models for Alzheimer's Diagnosis (AD) do not have specific strategies for individual input samples, leading to the problem of easily overlooking personalized differences between samples. This research introduces a customized dynamically ensemble convolution neural network (PDECNN), which is able to build a specific integration strategy based on the distinctiveness of the sample. In this paper, we propose a personalized dynamic ensemble alzheimer's Diagnosis classification model. This model will dynamically modify the deteriorated brain areas of interest depending on various samples since it can adjust to variations in the degeneration of sample brain areas. In clinical problems, the PDECNN model has additional diagnostic importance since it can identify sample-specific degraded brain areas based on input samples. This model considers the variability of brain region degeneration levels between input samples, evaluates the degree of degeneration of specific brain regions using an attention mechanism, and selects and integrates brain region features based on the degree of degeneration. Furthermore, by redesigning the classification accuracy performance, we respectively improve it by 4 %, 11 %, and 8 %. Moreover, the degraded brain regions identified by the model show high consistency with the clinical manifestations of AD.

Background Stillbirth remains a prevalent issue worldwide, particularly affecting low-income and middle-income countries, where it brings immense sorrow and suffering to families, especially mothers. Sadly, support for women coping with this loss is inadequate, particularly in regions like Africa, where literature on women’s experiences of stillbirth is lacking.Methods This qualitative study employed a narrative design guided by William Worden’s Four Task Theory to explore the experiences of 15 women who had experienced stillbirth, selected through purposive sampling. Semistructured interviews were conducted face to face with participants, and thematic analysis was used to analyse the data.Results The study identified three overarching themes and nine subthemes, revealing participants’ perspectives on factors contributing to stillbirth, the experiences of women dealing with this loss and their accounts of the care provided by healthcare professionals focusing on communication, response and logistical aspects.Conclusion Mothers revealed a multitude of challenges following the loss, underscoring the imperative of providing them with essential support to navigate these difficulties. Future research should delve into coping strategies and interventions aimed at enhancing the coping mechanisms of these mothers.

BackgroundTungiasis is a cutaneous parasitosis caused by the female flea Tunga penetrans. Two-component dimeticone (NYDA) is the only treatment for tungiasis recommended by the World Health Organization; however, this topical drug is not available in Kenya. In Western Kenya, sodium carbonate is commonly used in the treatment of tungiasis. This study evaluated the 7-day cure rates for tungiasis by comparing sodium carbonate and NYDA treatments in Homa Bay County, Kenya.Methodology/principal findingsThis was a randomized, observer-blinded, parallel-treatment cohort trial. Twenty-three eligible children with 126 flea infections were matched and randomized. All participants received both treatments, with one treatment on each foot. We recorded all health conditions/information, including inflammation scores and adverse events. Observations were performed on days 3, 5, and 7 using a digital microscope to confirm dead or live fleas based on the viability signs. Twenty-three children aged 3-13 years were analyzed. The proportion of dead fleas on day 7 was higher after NYDA treatment than after 5% sodium carbonate treatment (87% versus 64%, respectively, P = 0.01) NYDA. Median survival was 5 days for both treatments; NYDA had significantly higher trend of flea non-viability rate than 5% sodium carbonate (PConclusions/significanceNYDA was significantly more effective than 5% sodium carbonate for tungiasis treatment. Both treatments were safe but the children preferred NYDA more. Future studies with more participants and an extended observation period are warranted to confirm our findings. The findings suggest that NYDA should be made more available in tungiasis endemic area.Trial registrationUMIN-CTR; UMIN 000044320.

The study examined the role of green human resource management (HRM) practices on environmental sustainability (ES) among workers in Ghana. An explanatory research design was adopted for the study. Using a structured questionnaire, data was drawn from 221 workers from various sectors. Data gathered was analysed with Partial Least Square-Structural Equation Modelling. The study found that there is a direct link between green HRM and ES behaviour among workers in Ghana. The novelty of the findings of this study relates to workers’ perspectives across multiple sectors in Ghana and is the first study to have applied value alignment theory to argue for green HRM and ES from the Global South. The study offers insights into how organisations in Ghana can integrate sustainable practices into human resource management strategies, fostering a more environmentally conscious workforce and contributing to national, regional and international sustainable development goals.

Background During adolescence, behaviours are initiated that will have substantial impacts on the individual’s short-term and long-term health and well-being. However, adolescents rarely have regular contact with health services, and available services are not always appropriate for their needs. We co-developed with adolescents a health and well-being check-up programme (Y-Check). This paper describes the methods to evaluate the feasibility, acceptability, short-term effects and cost-effectiveness of Y-Check in three African cities.Method This is a multi-country prospective intervention study, with a mixed-method process evaluation. The intervention involves screening, on-the-spot care and referral of adolescents through health and well-being check-up visits. In each city, 2000 adolescents will be recruited in schools or community venues. Adolescents will be followed-up at 4 months. The study will assess the effects of Y-Check on knowledge and behaviours, as well as clinical outcomes and costs. Process and economic evaluations will investigate acceptability, feasibility, uptake, fidelity and cost effectiveness.Ethics and dissemination Approval has been received from the WHO (WHO/ERC Protocol ID Number ERC.0003778); Ghana Health Service (Protocol ID Number GHS-ERC: 027/07/22), the United Republic of Tanzania National Institute for Medical Research (Clearance No. NIMR/HQ/R.8a/Vol.IX/4199), the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/2766) and the LSHTM (Approval Numbers 26 395 and 28312). Consent and disclosure are addressed in the paper. Results will be published in three country-specific peer-reviewed journal publications, and one multicountry publication; and disseminated through videos, briefs and webinars. Data will be placed into an open access repository. Data will be deidentified and anonymised.Trial registration number NCT06090006.

During the COVID-19 Pandemic, many companies around the world continued to implement and drive adherence to Lean principles. However, there are a number of key challenges each company would face when implementing Lean, one of those main challenges being workforce engagement. One way of measuring the engagement of Lean principles is by assessing adherence. In manufacturing organisations around the world, there are differing motivations, and these can be dependent on a number of aspects, such as culture and organisational structure. Therefore, it is imperative to understand employees' motivations in relation to the adherence to Lean principles. This 3-year study of Lean principles assesses the adherence in Jaguar Land Rover's (JLR) Powertrain Machining Facility. It also examines methods of instigating a new recognition process, developing an improved communication method, and creating digital solutions to training issues. The main achievement of the research is improving the adherence to the Lean principles, improving adherence to standardised working practices, and improving the utilisation of problem-solving and continuous improvement tools.

Abstract Background Healthy eating habits are essential for improving nutritional status and strengthening immunity against infectious diseases. This study examined the relationship between diet quality and stunting in school-aged children in an infectious disease-endemic area of western Kenya. Methods This cross-sectional study included 260 school-aged children (age 9–17 years) enrolled in primary schools in Mbita Sub-county, western Kenya. The nutritional status was assessed using anthropometric measurements. Dietary intake was measured using food frequency questionnaires and evaluated using the Food Pyramid (FP) score, which indicates adherence to the Kenyan food-based dietary guideline. Information on the children’s age, sex, maternal education, and household wealth index was collected using a household-based questionnaire. Infections with the predominant parasites, such as Schistosoma (S.) mansoni, were detected via microscopy. The trend associations of the FP score with food group intake were examined to characterize the dietary intake of this population. Logistic regression analysis was performed to investigate the relationship between stunting and FP score tertiles, adjusted for sociodemographic and economic indicators and parasitic infection status. Results Among the studied schoolchildren, 15.0% exhibited stunting, while 76.2% were infected with S. mansoni. The mean FP score was 25.6 out of 50 points. A higher FP score was characterized by a high intake of roots and tubers, dairy products, pulses, and fruits and a low intake of cereals and animal-source foods. The analysis revealed a trend: a lower risk of stunting was evident in groups with elevated FP scores (p for trend = 0.065). However, these trend associations were observable among subjects with either negative or light S. mansoni infection (p for trend = 0.016). Conclusions A higher quality diet, as evaluated by FP scores, was associated with a low risk of stunting among school-aged children. Notably, this association seemed to weaken in the presence of a high burden of S. mansoni infection. It highlights the importance of enhancing dietary quality through the promotion of diverse nutrient-dense foods alongside effective S. mansoni infection control for improved growth. This study contributes fundamental knowledge for understanding the diet–malnutrition relationship in areas endemic for S. mansoni infection.

Abstract This paper identifies several governance factors that enable economic upgrading and the link between economic and social upgrading /downgrading of smallholders and Abusa sharecroppers in Ghana's cocoa value chain (GCVC). The findings are based on qualitative interviews and focus group discussions with various actors in GCVC. Our findings suggest two types of economic upgrading: process and product upgrading, achieved by smallholder producers and Abusa Sharecroppers in GCVC. While process upgrading is enabled by governance factors such as price stabilization and controlling opportunistic behavior, transparency in the sale of certified beans and premium management is key for product upgrading. Regarding the link between economic and social upgrading, we reveal that process upgrading leads to the same outcome of social upgrading and downgrading for smallholders and Abusa sharecroppers due to governance factors such as production and purchasing policies and lack of resources and capabilities. However, product upgrading links to social upgrading and downgrading for smallholders and Abusa sharecroppers respectively owing to governance factors such as controlling resources and bargaining power. We provide insights into key actors and their interests, drivers of change and effects of incentives that play crucial roles in shaping governance factors that influence economic and social upgrading of smallholders and Abusa sharecroppers in GCVC. In our conclusion, we identify how regulations, institutional support and conflicts of interest are key for enabling upgrading of developing countries’ agricultural value chains.

Objectives Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a better understanding of the perspectives on desirable outcomes for communities is important evidence that this review generates.Design We conducted a realist review of papers that covered outcomes related to child health or development (0–5 years) AND arts-based approaches AND community-based, participatory approaches AND based in LMICs using a range of databases and other networks. A coding framework was developed covering context, intervention, outcomes, mechanisms, study, sustainability, transferability and scalability.Results The included papers reported 18 unique interventions. Interventions covered 14 countries, with evidence lacking for South America, Arab countries and parts of Africa. Lead authors came from mostly clinical science-based disciplines and from institutions in a different country to the country/countries studied. Intended outcomes from interventions included clinical, health systems/organisation, changes in practices/behaviours/knowledge/attitudes, and wider social and educational goals. We identified three demi-regularities (semi-predictable patterns or pathways of programme functioning): participatory design based on valuing different sources of expertise; dynamic adaptation of intervention to context; and community participation in arts-based approaches.Conclusions Our findings suggest that arts-based, nurturing care interventions have greater potential when they include local knowledge, embed into existing infrastructures and there is a clear plan for ongoing resourcing of the intervention. Studies with better documentation of the lessons learnt, regarding the intervention delivery process and the power dynamics involved, are needed to better understand what works, for whom and in which contexts.

Key Clinical Message The mainstays of treatment for granuloma pyogenicum include careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, and close monitoring to check relapse and management. Abstract Pyogenic granuloma is an acquired noncancerous vascular proliferation that arises from the mucosa and skin, seldom subcutaneously or intravascularly. It is also referred to as telangiectasis granuloma or lobular capillary haemangioma. The risk factors include vascular abnormalities, medicines, hormones, and microtrauma. We discussed the case of a 24‐year‐old man who had a poorly managed ventral distal penile polypoid lesion at a peripheral hospital. Upon further histopathological examination, the diagnosis of pyogenic granuloma was made. Histopathologically speaking, the term “pyogenic granuloma” is misleading because the illness is not linked to the production of granulomas. Pyogenic granuloma's etiopathogenesis is still unknown; true hemangioma is thought to be a reactive hyperproliferative of the vasculature brought on by a variety of stimuli; pyogenic granuloma may be caused by uneven angiogenic factor production in response to minor local trauma or cutaneous disease. Histopathological analysis and surgical excision are the methods used for diagnosis and treatment. The mainstay of treatment for granuloma pyogenic granuloma includes careful evaluation of any penile growth, thorough excision of the polypoid, histological examination, close follow‐up to check for relapse, and early management.

Abstract Objective Haematological and liver fibrotic markers could be appreciably utilized for effective monitoring of Chronic Hepatitis B viral (HBV) infection, thereby increasing patient’s treatment outcome. The objective of this study was to assess the applicability of complete blood count (CBC) and non-invasive liver-fibrotic indices as markers of prognostic outcome and monitoring in HBV infections. Results Significant differences in levels of white cell and differentials counts, red blood cell count, hemoglobin indices, and platelet indices were observed between HBV-infected patients (cases) and uninfected persons (controls). Levels of haemoglobin (Hb), total white blood cells (tWBC), neutrophils, monocytes, platelets, and Platelet Distribution width (PDW) were significantly lower (p

Arteriovenous malformations (AVMs) define rare aberrations in vascular morphogenesis. AVMs are typically present at birth, and unless they are stimulated to grow quickly by trauma, illness, or hormonal effects, they enlarge in proportion to an individual's growth. Clinical manifestations of AVMs are often linked to abnormal mass effects and blood perfusion. In this report, we describe a unique case of AVM of the left ear in a 24-year-old male, employing cinematic rendering along with a review of differential diagnosis and treatment options.

Abstract Background Human papillomavirus (HPV) infection is a major contributor to the development of cervical cancer, resulting in over 500,000 cases and 266,000 deaths annually worldwide. Previous cervical cancer screening programs have been successful in reducing cervical cancer rates, but have faced challenges such as low acceptance and adherence rates. Innovations in screening technology, such as the HerSwab self‐sampling test, have the potential to increase awareness, acceptance, and participation in cervical cancer screening programs. Aim This literature review examines the effectiveness of HerSwab and participatory innovations in increasing adherence to cervical cancer screening. Method This manuscript comprised a comprehensive narrative literature review encompassing the years 2006–2022. The review process adhered to the PRISMA diagram as a guiding framework. Among the search terms utilized, a total of 200 articles were initially retrieved. However, after applying the predefined inclusion criteria, only 57 articles were included. Results The HerSwab self‐sampling test is described, including how it is performed, challenges, and facilitators, and evaluation and assessment of its effectiveness. While the HerSwab diagnostic test is not currently widely available, studies should assess its feasibility in less developed countries where cervical cancer mortality rates are high. Conclusion By increasing awareness and availability of innovative screening techniques, such as HerSwab, we can work toward reducing the incidence of cervical cancer and improving outcomes for women worldwide.

Achieving deeper and permanent learning has always been the focus of teaching force. This purpose is independent of the teaching level or subject matter. Pre-service teachers’ lack of interest and inability to connect learning levels are partly cited for their inability to develop this deeper and permanent learning of science concepts. In this respect, an action research design conducted using a case-study paradigm which included the simulation-role-play teaching strategy was used to teach pre-service teacher the concept of “doping of pure semiconductors” into p-type and n-type semiconductors. This is an area under basic electronics. The result of the non-parametric Wilcoxon Signed Rank Test analysis revealed a statistically significant increase in pre-service teachers’ performance level in basic electronics test following an intervention using the simulation-role-play approach. The median score of the performance level also increased from a pre-test score to post-test score. The simulation-role-play teaching approach affected student teachers’ learning of basic electronics by 55% which is considered a large effect. Further, when a sample of the pre-service teachers were interviewed, the result showed a positive view toward teaching using simulation approach which converts theoretical knowledge into practical knowledge for deeper understanding and permanent learning. The findings from this study would be helpful to student teachers and tutors in the colleges of education as it offered useful intervention in teaching and learning of doping of pure semiconductors.

Infection prevention and control (IPC) measures safeguard primary healthcare systems, especially as the infectious disease landscape evolves due to climate and environmental change, increased global mobility, and vaccine hesitancy and inequity, which can introduce unexpected pathogens. This study explores the importance of an "always-on," low-cost IPC approach, focusing on the role of natural ventilation in health facilities, particularly in low-resource settings. Ambient carbon dioxide (CO2) levels are increasingly used as a measure of ventilation effectiveness allowing for spot checks and targeted ventilation improvements. Data were collected through purposive sampling in Northern Ghana over a three-month period. Levels of CO2 ppm (parts per million) were measured by a handheld device in various healthcare settings, including Community-Based Health Planning and Services (CHPS) facilities, municipal and teaching hospitals, and community settings to assess ventilation effectiveness. Analyses compared CO2 readings in community and hospital settings as well as in those settings with and without natural ventilation. A total of 40 facilities were evaluated in this study; 90% were healthcare facilities and 75% had natural ventilation (with an open window, door or wall). Facilities that relied on natural ventilation were mostly community health centers (60% vs 0%) and more commonly had patients present (83% vs 40%) compared with facilities without natural ventilation. Facilities with natural ventilation had significantly lower CO2 concentrations (CO2 ppm: 663 vs 1378, p = 0.0043) and were more likely to meet international thresholds of CO2 < 800 ppm (87% vs 10%, p =

This study investigated the role of personal norms and the sex of employees on the relationship between green human resource management (GHRM) practices and environmental sustainability in a developing economy. The study is underpinned by positivist and quantitative philosophical approaches. In particular, an explanatory research design was employed, and a structured questionnaire was used to collect data. Partial Least Square-Structured Equation Modelling was then used to analyse the data. The study discovered a significant positive relationship between environmental sustainability and green human resource management practices and employee personal norms. Employee personal norms also significantly mediated the relationship between green human resource management practices and environmental sustainability among workers. In terms of the moderation effect, the study found that sex significantly moderated the relationship between employees' personal norms (EPN) and environmental sustainability (ES); green human resource management (GHRM) and employees' personal norms. Sex also significantly moderated the mediation of employees’ personal norms on green human resource management and environmental sustainability. It is, therefore, recommended that human resource managers incorporate environmental sustainability initiatives into their human resource functions or practices and use communication and collaborations to make the best use of employee personal norms or efforts on environmental sustainability efforts of organisations in a developing economy.

Background: The use of simulation in nursing education continues to grow. However, the evidence available in the field of pediatric simulation is not robust. Since studies have reported how simulation impacts nursing students learning, it is vital to fully understand pediatric simulation on undergraduate nursing students’ learning. Aim: This scoping review aimed to uncover the breadth of pediatric simulation use in undergraduate nursing education programs. Method: This review identified current studies of pediatric simulations in undergraduate nursing students through a scoping review using the framework proposed by Arksey and O’Malley (2005). The studies reviewed were found through CINAHL, Medline, PubMed, and Google Scholar. Each study was analyzed, and data charted. A total of 23 studies met the inclusion criteria and were included in this scoping review. Results: Students showed improved self-confidence scores, knowledge, clinical judgement, skills, and self-reported satisfaction with pediatric simulation-based learning. Conclusion: Incorporating pediatric simulation in undergraduate nursing programs will help improve students’ knowledge, confidence, clinical judgement, and nursing skills.

Crowdsourcing platforms play a crucial role in promoting transparency and collaborative engagement among participants while aiming to reduce resource consumption and costs. To achieve this, these platforms incorporate mechanisms for monitoring and evaluating worker quality performance. However, significant challenges persist. Centralized systems present trust issues due to their vulnerability to single-point failures. Moreover, data manipulation by malicious actors undermine confidence in the evaluation process, and biased assessments and reward distribution may lead to reduced worker motivation. Addressing these concerns necessitates the development of a decentralized system that ensures trustworthiness, tamper-resistance, accountability, reliability, transparency, and security. This paper introduces a secure multi-tier worker quality evaluation crowdsourcing framework based on blockchain technology. WQCrowd utilizes smart contracts and adopts a three-tier model comprising the Identity, Worker Activity, and Reputation tiers. Additionally, an automated game-based worker evaluation method is incorporated, enhancing the precision of performance assessments. Through our Proof of Concept (PoC) analysis, we demonstrate that the utilization of the blockchain system effectively addresses security concerns, including trust, privacy, and accountability, prevalent in current worker performance evaluation systems. Furthermore, the implementation of the game-based automated system enables our proposed solution to make informed decisions regarding worker quality performance evaluation.

Background In sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function highlight the importance of antenatal and early life factors in the aetiology of asthma and abnormal lung function in children. We present here the first study in sub-Saharan Africa to relate birth characteristics to both childhood respiratory symptoms and lung function.Methods Children attending schools in two socioeconomically contrasting but geographically close areas of Nairobi, Kenya, were recruited to a cross-sectional study of childhood asthma and lung function. Questionnaires quantified respiratory symptoms and preterm birth; lung function was measured by spirometry; and parents were invited to bring the child’s immunisation booklet containing records of birth weight and serial weights in the first year.Results 2373 children participated, 52% girls, median age (IQR), 10 years (8–13). Spirometry data were available for 1622. Child immunisation booklets were available for 500 and birth weight and infant weight gain data were available for 323 and 494 children, respectively. In multivariable analyses, preterm birth was associated with the childhood symptoms ‘wheeze in the last 12 months’; OR 1.64, (95% CI 1.03 to 2.62), p=0.038; and ‘trouble breathing’ 3.18 (95% CI 2.27 to 4.45), p

Abstract Arthropod-borne virus (arbovirus) and arthropod-specific virus (ASV) are viruses circulating amongst hematophagous arthropods that are broadly transmitted in ecological systems. Arbovirus may replicate in both vertebrates and invertebrates and some are known to be pathogenic to animals or humans. ASV only replicate in invertebrate arthropods yet they are basal to many types of arboviruses. We built a comprehensive dataset of arbovirus and ASV by curating globally available data from the Arbovirus Catalog, the arbovirus list in Section VIII-F of the Biosafety in Microbiological and Biomedical Laboratories 6th edition, Virus Metadata Resource of International Committee on Taxonomy of Viruses, and GenBank. Revealing the diversity, distribution and biosafety recommendation of arbovirus and ASV at a global scale is essential to the understanding of potential interactions, evolution, and risks associated with these viruses. Moreover, the genomic sequences associated with the dataset will enable the investigation of genetic patterns distinguishing the two groups, as well as aid in predicting the vector/host relationships of the newly discovered viruses.

This article focuses on examining the effects of the COVID-19 pandemic and gold prices on the stock market. It primarily analyzes the relationship between COVID-19 cases and stock market prices, along with the impact on various commodity elements such as gold, oil, Chinese RMB, and US Dollar prices. These commodity elements are considered essential indicators of a country's financial health, and the study investigates how the increase in COVID-19 cases affects these financial elements. The research incorporates financial models, machine learning algorithms, and a financial Gaussian mixture model for data analysis and comparison. The findings shed light on the correlation between the virus, trading outcomes, and the importance of Karachi Stock Exchange-100 index data in preventing market crashes. The study also explores the implications of emergencies on the finance sector and provides insights for future financial predictions and the impact of social disasters on the economy.

Abstract Objective African newborns undergo numerous traditional and religious practices ranging from fontanelle fomentation to total head shaving, scalp molding, skin scarification and ano-genital irrigation which can negatively impact the health of neonates. Hot fomentation of fontanelles has been a predominant indigenous home-based postnatal practice in Ghana and among Africans in the diaspora. Mobility restrictions during the Covid-19 pandemic has impacted direct access to facility-based care as well as home care. The flourishing of newborn traditional practices among African populations during this Covid-19 pandemic offers opportunities to rethink the provision of family healthcare support for newborns during the ongoing pandemic and beyond. Hence, the aim of this critical review was to examine and describe a common indigenous practice—hot fontanelle fomentation to inform home birth support, discharge planning, and the delivery of optimal home-based care support. Study design This study is a review of literature on hot fomentation of newborn fontanelles. Methods Literature search in CINAHL, PubMed, African Index Medicus and Scopus, was conducted and evidence synthesised from articles ranging from 1983–2022. Sixty articles were reviewed; however, 10 manuscripts were excluded prior to screening. The other 19 were exempted because they were either below 1983 or were not the best fit for the study purpose. In all, 31 studies were included in the study. The study was guided by Madeleine Leininger’s Culture Care Diversity and Universality care theory. Results The current study identifies hot fomentation of newborn fontanelles practices in Ghana, the description of hot fomentation practices and the dangers associated with it. The findings and suggested ways to help overcome this challenge. Conclusion There are several neonatal indigenous practices including fontanelle fomentation which pose threat to the health of the neonate as discussed in this study. Future research needs to investigate innovative ways of fontanelle fomentation where necessary instead of the use of hot water by mothers, especially in this Covid-19 pandemic where health and mobility restrictions impact physical access to timely health care. This research will help educate mothers about the dangers of fontanel fomentation and reduce the practice, especially in rural areas of developing countries. This could help reduce neonatal mortality and unnecessary healthcare costs.

Limited studies exist on the commitment of members to cooperative societies. Therefore, the study sought to measure perceptions of membership and the drivers of membership commitment of cocoa farmers' cooperative societies in the Atwima Mponua District of Ashanti Region, Ghana. Data was collected from a sample of 400 cocoa farmers through a multi-stage sampling technique. Descriptive statistics (mean and standard deviation) and inferential statistics (binary logit regression) were used in analyzing the data. Results show that cocoa farmers agree that they benefit from the cooperative and they appreciate the management, marketing and business, internal dynamics and public interest of their cooperatives. The study also discovered that farm age, access to extension service, farming experience, farmer status, cooperative benefits and internal dynamics are critical to obtaining commitment in cooperative societies. The study shows the need for the Ghana Cocoa Board to improve farmers’ access to extension services so as to improve their commitment in cooperative societies. Cooperative organizations are encouraged to consider the perceptions of the cocoa farmers and their socio-economic characteristics in order to elicit the desired commitment.

Efi Mantzourani,1,2,&ast; Rhian Deslandes,1,&ast; Karen Hodson,1,&ast; Andrew Evans,3 Lydia Taylor,1 Cherie Lucas4 1Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; 2Primary Care, Digital Health and Care Wales, NHS Wales, Cardiff, Wales, UK; 3Primary Care Services, Welsh Government, Cardiff, Wales, UK; 4Graduate School of Health (Pharmacy Discipline), University of Technology Sydney, Sydney, New South Wales, Australia&ast;These authors contributed equally to this workCorrespondence: Efi Mantzourani, Redwood Building, Cardiff School of Pharmacy and Pharmaceutical Sciences, King Edward VII Avenue, Cardiff, Wales, CF10 3NB, UK, Tel +44 2920 870452, Email Mantzouranie1@cardiff.ac.ukBackground: A pilot Independent Prescribers’ Service (IPS) was introduced in 13 community pharmacies across Wales in June 2020. Independent Pharmacist Prescribers (IPPs) could prescribe in the areas of management of acute conditions, contraception, or opioid withdrawal, as agreed with local commissioners. Access to the patients’ medical records was provided via Choose Pharmacy, the national community pharmacy IT platform.Objective: To explore the experiences of IPPs delivering the service and commissioners responsible for financial resources regarding the IPS in Wales.Methods: A qualitative methodology was employed, with purposive sampling, semi-structured interviews, and inductive thematic analysis.Results: Five themes were constructed from 13 interviews (n=9 IPPs; n=4 commissioners): (i) patient experience and safety; (ii) professional enablement and rebalancing workload of GPs; (iii) role and limitations of remote consultations; (iv) funding and business model; (v) functionality on Choose Pharmacy to support patient care. The design of the service allowed pharmacists to determine how best to deliver the IPS, maximizing access for patients and promoting a sense of professional value amongst pharmacists.Conclusion: This study builds on the body of evidence on enhanced patient experience with prescribing services in the community, reinforcing that IPPs have a key role in rebalancing management of common conditions from GP surgeries to community pharmacies. Several considerations need to be addressed to ensure future success of the service implementation, delivery and enhanced sustainability, such as formal referral pathways and access to medical records. These can be used by other commissioning bodies in the UK and internationally to build a network of suitably supported IPPs, confident to appropriately deal with uncomplicated acute and chronic conditions; and liaise with primary and/or secondary care when referrals are needed.Keywords: non-medical prescribing, independent pharmacist prescribing, Choose Pharmacy, patient safety, patient experience

Abstract Background Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We describe a protocol for a cluster randomised trial to evaluate the effectiveness of a multi-faceted community-based educational intervention that aims to improve food safety and hygiene behaviours and enhance child nutrition. Methods We describe a mixed-methods, parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures. One hundred twenty clusters comprising small urban and rural communities will be recruited in equal numbers and randomly allocated in a 1:1 ratio to either treatment or control arms. The community intervention will be focussed around an ideal mother concept involving all community members during campaign days with dramatic arts and pledging, and follow-up home visits. Participants will be mother–child dyads (27 per cluster period) with children aged 6 to 36 months. Data collection will comprise a day of observation and interviews with each participating mother–child pair and will take place at baseline and 4 and 15 months post-intervention. The primary analysis will estimate the effectiveness of the intervention on changes to complementary-food safety and preparation behaviours, food and water contamination, and diarrhoea. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. A additional structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Qualitative and health economic analyses including process evaluation will be done. Conclusions The trial will provide evidence on the effectiveness of community-based behavioural change interventions designed to reduce the burden of diarrhoeal disease in the under-fives and how effectiveness varies across different contexts. Trial registration ISRCTN14390796. Registration date December 13, 2021

Within the eukaryotic cell, the actin cytoskeleton is a crucial structural framework that maintains cellular form, regulates cell movement and division, and facilitates the internal transportation of proteins and organelles. External cues induce alterations in the actin cytoskeleton primarily through the activation of Rho GTPases, which then bind to a diverse array of effector proteins to promote the local assembly or disassembly of actin. We have harnessed the extensively studied functions of RhoA in the dynamics of the actin cytoskeleton to craft a practical series for Stage 2 Biology students. This series not only imparts essential tissue culture laboratory skills but also reinforces them through repetition. These activities are presented in a scenario designed for students to explore the function of a hypothetical RhoA family member. Students produce slides from transfected cells, undertake fluorescence microscopy, process the images using ImageJ, and compile their findings in a comprehensive scientific report. The composition of the report requires independent acquisition of new knowledge and synoptic learning. According to student feedback, this early experience greatly aids in solidifying and honing the skills required to report on more extensive and intricate research projects, such as capstone projects.

Background Visceral obesity is associated with increased risk of metabolic disorders and cardiovascular disease, hence, diagnosing visceral fat is indispensable in clinical practice. However, the diagnostic capacity of waist–hip ratio (WHR), conicity index (CI), and abdominal volume index (AVI) to predict visceral obesity in patients with type 2 diabetes remains unclear. This study was designed to evaluate the performance of WHR, CI, and AVI in predicting visceral fat among patients with type 2 diabetes in Ho municipality.Methods A hospital-based cross-sectional survey involved 221 patients with type 2 diabetes. A questionnaire was designed to collect data on demography and other relevant variables. Anthropometric measurements were obtained using standard methods. Visceral fat was measured using bioelectrical impedance analysis (BIA). The diagnostic performance of WHR, CI, and AVI in predicting visceral fat was evaluated based on receiver operating characteristics (ROC) curve analyses. Pearson correlation analysis was used to determine the relationship between adiposity indices and visceral fat.Results Among men, the optimal threshold for AVI, >15.56, demonstrated the highest sensitivity, 87.5% and specificity, 80.71% compared to CI and WHR while among women, the optimal cutoff value for AVI, >18.49, produced the highest sensitivity, 77.05% and specificity, 85.29%. Likewise, AVI showed a better discriminatory ability in the diagnosis of visceral fat (AUC: 0.89; p

Abstract The emergence and rapid spread of SARS-CoV-2 variants of concern (VOC) have been linked to new waves of COVID-19 epidemics occurring in different regions of the world. The VOC have acquired adaptive mutations that have enhanced virus transmissibility, increased virulence, and reduced response to neutralizing antibodies. Kenya has experienced six waves of COVID-19 epidemics. In this study, we analyzed 64 genome sequences of SARS-CoV-2 strains that circulated in Nairobi and neighboring counties, Kenya between March 2021 and July 2021. Viral RNA was extracted from RT-PCR confirmed COVID-19 cases, followed by sequencing using the ARTIC network protocol and Oxford Nanopore Technologies. Analysis of the sequence data was performed using different bioinformatics methods. Our analyses revealed that during the study period, three SARS-CoV-2 variants of concern (VOC) circulated in Nairobi and nearby counties in Kenya. The Alpha (B.1.1.7) lineage predominated (62.7%), followed by Delta (B.1.617.2, 35.8%) and Beta (B.1.351, 1.5%). Notably, the Alpha (B.1.1.7) VOC were most frequent from March 2021 to May 2021, while the Delta (B.1.617.2) dominated beginning June 2021 through July 2021. Sequence comparisons revealed that all the Kenyan viruses were genetically similar to those that circulated in other regions. Although the majority of Kenyan viruses clustered together in their respective phylogenetic lineages/clades, a significant number were interspersed among foreign strains. Between March and July 2021, our study's findings indicate the prevalence of multiple lineages of SAR-CoV-2 VOC in Nairobi and nearby counties in Kenya. The data suggest that the recent increase in SARS-CoV-2 infection, particularly in Nairobi and Kenya as a whole, is attributable to the introduction and community transmission of SARS-CoV-2 VOC among the populace. In conclusion, the findings provide a snapshot of the SARS-CoV-2 variants that circulated in Kenya during the study period.

Abstract To solve the problem of reducing the amount of data storage in the practical application of massive biomedical data and efficiently using existing storage devices and bandwidth resources to store shared data. The proposed model includes both compression modes: the first is a single sequence compression mode designed for the characteristics of a large number of repeated substrings in DNA sequences; the second is a reference‐based multi‐sequence compression mode designed for the very similar characteristics of DNA sequences of different individuals of the same species. Both types of compression use the Lempel–Ziv–Welch (LZ) compression method, which is quite comparable to one another, to examine the sequence, as well as to study and classify the repetitive data that exists between a single sequence and numerous sequences in the sequence set. The proposed method aims to solve the problem of high pressure caused by single‐point processing of large sequence files, effectively reduces redundant information by using the local correlation of data, and effectively uses the computing resources of a cloud platform that is used for biological information processing to support the efficient storage, transmission, and sharing of data.

Abstract Vibration, especially basic vibration, may cause loose contacts, open circuits, or other contact problems, which account for a large proportion of system failure causes. Due to the complexity of the chassis structure used in the biomedical motors, the vibration analysis of a single component cannot solve the vibration problems encountered in the work of the system. Therefore, it is necessary to use system simulation and experiments to monitor and enhance the health of the structure. Finite element method is used to carry out the dynamic analysis from the component to the system, and calculate the natural frequency, modal shape and harmonic response. Then, the effectiveness and accuracy of the analysis results are verified by experiments through simulation and experiments. The results show that the measures taken have effectively reduced the vibration of the chassis equipment and improved its safety for better health safety of patients. There is just a 2% variation between the natural frequencies acquired from the experiment and the simulation computation. In terms of natural frequency, the first 6‐order natural frequencies all have errors of less than 10%, and the natural frequency error is comparable to that of fireproof board.

Abstract Background The current COVID-19 pandemic affects the entire world population and has serious health, economic and social consequences. Assessing the prevalence of COVID-19 through population-based serological surveys is essential to monitor the progression of the epidemic, especially in African countries where the extent of SARS-CoV-2 spread remains unclear. Methods A two-stage cluster population-based SARS-CoV-2 seroprevalence survey was conducted in Bobo-Dioulasso and in Ouagadougou, Burkina Faso, Fianarantsoa, Madagascar and Kumasi, Ghana between February and June 2021. IgG seropositivity was determined in 2,163 households with a specificity improved SARS-CoV-2 Enzyme-linked Immunosorbent Assay. Population seroprevalence was evaluated using a Bayesian logistic regression model that accounted for test performance and age, sex and neighbourhood of the participants. Results Seroprevalence adjusted for test performance and population characteristics were 55.7% [95% Credible Interval (CrI) 49·0; 62·8] in Bobo-Dioulasso, 37·4% [95% CrI 31·3; 43·5] in Ouagadougou, 41·5% [95% CrI 36·5; 47·2] in Fianarantsoa, and 41·2% [95% CrI 34·5; 49·0] in Kumasi. Within the study population, less than 6% of participants performed a test for acute SARS-CoV-2 infection since the onset of the pandemic. Conclusions High exposure to SARS-CoV-2 was found in the surveyed regions albeit below the herd immunity threshold and with a low rate of previous testing for acute infections. Despite the high seroprevalence in our study population, the duration of protection from naturally acquired immunity remains unclear and new virus variants continue to emerge. This highlights the importance of vaccine deployment and continued preventive measures to protect the population at risk.

Abstract Background Visceral obesity and insulin resistance contribute to developing cardiometabolic syndrome (MetS). We investigated the predictive abilities of lipid accumulation product (LAP), waist circumference‐triglyceride index (WTI), and triglyceride‐glucose (TyG) index for MetS screening among the general Ghanaian adults. Methods The final prospective analysis included 4740 healthy adults aged 30–90 years from three communities comprising Ejisu, Konongo, and Ashanti Akim Agogo in Ghana. Self‐structured questionnaire pretested was used to collect sociodemographic, anthropometric, and clinical data. Blood samples were taken after fasting to measure glucose and lipid levels. LAP, WTI, and TyG were calculated from standard equations. MetS was defined by the International Diabetes Federation criteria. Receiver operating characteristic (ROC) curves and multivariable logistic regression were utilized to evaluate the potential of the three indices in identifying MetS. Results Of the 4740 participants, 39.7% had MetS. MetS was more common in females (50.3%) than in males (22.2%). Overall, LAP ≥ 27.52 yielded as the best index for MetS with the highest area under the ROC curve (AUC) (0.866). At cut‐off LAP point of ≥23.87 in males and ≥33.32 in females, an AUC of 0.951 and 0.790 was identified in MetS prediction, respectively. LAP was an independent risk measure of MetS for both males (45.6‐fold) and females (3.7‐fold) whereas TyG was an independent risk measure for females (3.7‐fold) only. Conclusions MetS is increasing among the general adult population. LAP and TyG are important sex‐specific risk measures to screen for MetS among the general adult population in our cohort.

Covid-19 has impacted negatively on people all over the world. Some of the ways that it has affected people include such as Health, Employment, Mental Health, Education, Social isolation, Economic Inequality and Access to healthcare and essential services. Apart from physical symptoms, it has caused considerable damage to mental health of individuals. Among all, depression is identified as one of the common illnesses which leads to early death. People suffering from depression are at a higher risk of developing other health conditions, such as heart disease and stroke, and are also at a higher risk of suicide. The importance of early detection and intervention of depression cannot be overstated. Identifying and treating depression early can prevent the illness from becoming more severe and can also prevent the development of other health conditions. Early detection can also prevent suicide, which is a leading cause of death among people with depression.Millions of people have affected from this disease. To proceed with the study of depression detection among individuals we have conducted a survey with 21 questions based on Hamilton tool and advise of psychiatrist. With the use of Python's scientific programming principles and machine learning methods like Decision Tree, KNN, and Naive Bayes, survey results were analysed. Further a comparison of these techniques is done. Study concludes that KNN has given better results than other techniques based on the accuracy and decision tree has given better results in the terms of latency to detect the depression of a person. At the conclusion, a machine learning-based model is suggested to replace the conventional method of detecting sadness by asking people encouraging questions and getting regular feedback from them.

Objectives: Micronutrients, especially calcium (Ca) and magnesium (Mg) are reported to reduce preeclampsia events via several factors such as endothelial cell control, optimal oxidative stress and a balanced angiogenic growth mediator. We evaluated the association of micronutrients with oxidative stress biomarkers, and angiogenic growth mediators in early-onset preeclampsia and late-onset preeclampsia. Methods: This case-control study recruited 197 preeclampsia (early-onset preeclampsia = 70 and late-onset preeclampsia = 127) as cases and 301 normotensive pregnant women as controls from the Komfo Anokye Teaching Hospital, Ghana. Samples were collected after 20 weeks of gestation for both cases and controls and estimated for Ca, Mg, soluble fms-like tyrosine kinase-1, placental growth factor, vascular endothelial growth factor-A, soluble endoglin, 8-hydroxydeoxyguanosine, 8-epiprostaglandinF2-alpha and total antioxidant capacity. Results: Early-onset preeclampsia women had significantly lower levels of Ca, Mg, placental growth factor, vascular endothelial growth factor-A and total antioxidant capacity but higher levels of soluble fms-like tyrosine kinase-1, soluble endoglin, 8-epiprostaglandinF2-alpha, 8-hydroxydeoxyguanosine, soluble fms-like tyrosine kinase-1/placental growth factor ratio, 8-epiprostaglandinF2-alpha /placental growth factor ratio, 8-hydroxydeoxyguanosine/placental growth factor ratio and soluble endoglin/placental growth factor ratio than late-onset preeclampsia and normotensive pregnant women ( p

Abstract Background The rate at which cervical cancer is diagnosed among women worldwide is alarming, nevertheless, millions of women have never undergone cervical cancer screening, and many more with cervical cancer die prematurely without accessibility to quality healthcare or effective treatment. Women’s experiences following cervical cancer screening have not been extensively studied especially in advancing countries like Ghana. Hence, the researchers aim to explore the experiences of women awaiting cervical cancer results at selected hospitals in Accra. Methods An exploratory-descriptive qualitative design was adopted to purposively sample 48 participants engaged in face-face in-depth interviews, which were audio-taped and transcribed verbatim after. The interviews were guided by semi-structured interviews. Findings The findings revealed 3 themes and 10 subthemes. The themes were pre-screening experience, intra-screening experience, and post-screening experience. Participants narrated the challenges they face before the screening, during the screening, and as they waited for their results to get ready. Despite some challenges reported, most of the participants indicated that they were willing to come for a retesting if recommended. Conclusion In conclusion, participants who have undergone CCS have several experiences that may either motivate or discourage them from subsequent screening. Being aware of such experiences could help the nurses address them in order to increase the interest of the women in CCS.

Counselling has developed in recent years into a humanistic partnership in problem solving and growth. Consistent with this development is the client's participation in decisions regarding all aspects of the counselling relationship. Testing and assessment need to be included here. In this regard, clients need to realize that tests are no more than instruments for furnishing information about themselves, as well as a guide for the counselling process and future decision making. Ultimately, test use by counsellors must be seen as an adjunct to the entire counselling process. Test results provide descriptive and objective data which help the counsellor to assist clients better in making the choices that will affect their lives. In order to make the best use of available tests in a counselling relationship, the process of testing and the issues which surround the process must be examined.

Abstract Preeclampsia (PE) can occur antepartum or postpartum. When it develops de novo after childbirth, it is termed new-onset postpartum PE (NOPPE). Often, antepartum PE disappears after childbirth; however, in some women it persists after childbirth. This form of PE is termed persistent PE (PPE). Thus, there are two forms of postpartum PE: NOPPE and PPE. The pathogenesis and pathophysiology of these diseases have not been fully characterized, and whether NOPPE and PPE are different or similar pathological conditions remains unexplored. Thus, we aimed to compare the haematological and biochemical characteristics of NOPPE and PPE, predict the occurrence of new-onset PE and identify lifestyles that predispose women to postpartum PE. A total of 130 women comprising 65 normotensive postpartum women, 33 NOPPE and 32 PPE women were recruited for this hospital-based case–control study. The socio-demographic and lifestyle characteristics of the participants were obtained through well-structured questionnaires. Haematological and biochemical indices were measured using automated analysers and ELISA. The prevalence of postpartum PE was 11.9%. Dyslipidaemia (p =

This article explores the extent to which students of different ethnicities, (dis)abilities, sexes, POLAR groups, and academic abilities undertake Year in Industry (YINI) placements and realise post-placement academic improvements, in comparison with non-YINI students. The benefits of work placements on student employability and graduate prospects are well-documented but less is known about which student groups gain access to placements. The study analyses secondary data relating to the sex, ethnicity, disability, POLAR group, grades, and degree classifications of 31,159 undergraduates graduating from a UK Russell Group university between 2016 and 2023, representing the largest study of its kind to date. The study found that students completing YINI programmes are significantly more likely to achieve first class (70.1% YINI, 28.5% non-YINI) and good degrees (97.7% YINI, 83.6% non-YINI). Importantly, the study found that YINI completion narrows awarding gaps found in the non-YINI population in relation to sex, disability, ethnicity, and POLAR group. The potential gains are greatest for male students, students with disabilities, Asian, Black and mixed ethnicity students, and students from low POLAR groups. However, access to placements is not proportionately distributed. Female students, students with disabilities, students from all ethnic minority groups and those of unknown ethnicity, and students from low POLAR groups are under-represented within the YINI population, suggesting placement access gaps in relation to sex, disability, ethnicity, and POLAR group. The paper concludes with strategies to encourage YINI participation amongst diverse student groups and calls for further research into lived experiences of YINI and non-YINI students.

Luis Alves,1 Rachel Pullen,2 John R Hurst,3 Marc Miravitlles,4 Victoria Carter,5 Rongchang Chen,6 Amy Couper,2 Mark Dransfield,7 Alexander Evans,5 Antony Hardjojo,2 David Jones,5 Rupert Jones,8 Margee Kerr,5 Konstantinos Kostikas,9 Jonathan Marshall,10 Fernando Martinez,11 Marije van Melle,5 Ruth Murray,5 Shigeo Muro,12 Clementine Nordon,10 Michael Pollack,13 Chris Price,5 Anita Sharma,14 Dave Singh,15 Tonya Winders,16 David B Price2 1EPIUnit - Epidemiology Research Unit, ITR - Laboratory for Integrative and Translational Research in Population Health, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; 2Observational and Pragmatic Research Institute, Singapore, Singapore; 3UCL Respiratory, University College London, London, UK; 4Pneumology Dept, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 5Optimum Patient Care, Cambridge, UK; 6Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, Guangdong, People’s Republic of China; 7Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; 8Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK; 9Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece; 10BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK; 11New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA; 12Department of Respiratory Medicine, Nara Medical University, Nara, Japan; 13BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA; 14Platinum Medical Centre, Chermside, QLD, Australia; 15Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK; 16USA & Global Allergy & Airways Patient Platform, Vienna, AustriaCorrespondence: David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore, Tel +65 3105 1489, Email dprice@opri.sgAbstract: The COllaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) aims to improve the quality of COPD care in primary care. The CONQUEST target population includes patients diagnosed with COPD, and those undiagnosed but with COPD-like exacerbations, who are at high but modifiable risk of COPD exacerbations, increased morbidity, and mortality. Timely diagnosis and optimized management to reduce these risks is vital. There is a need for a quality improvement program (QIP) that enables long-term improvement of patient clinical outcomes via integration of the program into routine clinical care. Core to the CONQUEST program is the adoption of four specifically designed, globally applicable, and expert-agreed quality standards (QS) for modifiable high-risk COPD patients. Translation of the QS into clinical practice, and implementation of the QIP, is guided by the CONQUEST global operational protocol provided to sites meeting the minimum healthcare system requirements. Initial analyses of current practices are conducted to generate baseline assessments of need within healthcare systems and sites looking to implement the QIP. Implementation is supported by the provision of CONQUEST resources and tools, such as clinical decision support, that promote prompt identification and treatment of patients. Utilization of electronic medical record (EMR) and patient-reported data are integral components of the QIP. Regular, automated collection and analysis of data, combined with a cyclical review of the implementation process, will be conducted for long-term, continuous improvement and health impact evaluation. The CONQUEST QIP will be an important resource in the identification and management of patients with modifiable high-risk COPD. Embedding the CONQUEST QS into routine clinical practice with regular evaluation and feedback will result in long-term quality of care improvement.Keywords: patient-reported outcome, patient-reported information, clinical decision support, primary care, quality standards, integrated care

BackgroundPreeclampsia is a leading cause of foeto-maternal deaths especially in Sub-Saharan Africa. However, the prevalence and risk factors of preeclampsia are scarce in the Central region of Ghana with previous study assessing individual independent risk factors. This study determined the prevalence and algorithm of adverse foeto-maternal risk factors of preeclampsia.MethodsThis multi-centre prospective cross-sectional study was conducted from October 2021 to October 2022 at the Mercy Women's Catholic Hospital and Fynba Health Centre in Central region, Ghana. A total of 1,259 pregnant women were randomly sampled and their sociodemographic, clinical history, obstetrics and labour outcomes were recorded. Logistic regression analysis using SPSS version 26 was performed to identify risk factors of preeclampsia.ResultsOf the 1,259 pregnant women, 1174 were finally included in the study. The prevalence of preeclampsia was 8.8% (103/1174). Preeclampsia was common among 20-29 years age group, those who had completed basic education, had informal occupation, multigravida and multiparous. Being primigravida [aOR = 1.95, 95% CI (1.03-3.71), p = 0.042], having previous history of caesarean section [aOR = 4.48, 95% CI (2.89-6.93), pConclusionPreeclampsia is increasing among pregnant women in the Central region of Ghana. Pregnant women being primigravida with foetal growth restriction and previous history of caesarean section are the highest risk population likely to develop preeclampsia with neonates more likely to suffer adverse birth outcome such as birth asphyxia. Targeted preventive measures of preeclampsia should be created for pregnant women co-existing with multiple risk factors.

Heterocyclic compounds are vital in rational drug design by providing convenient means for the optimization of drugs or drug candidates. Isoxazolidine (a heterocyclic compound) derived from the (3 + 2) cycloaddition reaction is reported to possess anticancer, antiviral, antibacterial, and anti-inflammatory properties. The mechanistic study of the chemo-, regio-, and stereo-selectivities of the (3 + 2) cycloaddition reaction (32CA) of diarylnitrones (A1) to 1-(4-nitrophenyl)-5H-pyrrolin-2-one (A2) has been conducted using the density functional theory (DFT) method at the M06/6-311G (d, p) computational level. The 32CA reaction of A1 and A2 proceeds through a chemo-selective addition of A1 across the C=C olefinic bond of A2 to furnish both kinetically and thermodynamically favored reaction routes. The effect of substitution on the 32CA reaction has been studied using a representative set of electron-acceptor and electron-releasing groups on both A1 and A2. The chemo-, regio-, and stereo-selectivities observed in the 32CA reaction remained unchanged irrespective of the substituents used on both reactants, but a change in kinetics and thermodynamics was observed based on the substituents. In the 32CA reaction of A1 and A2, the “exo” cycloadduct formation was favored over the “endo” cycloadducts in all instances.