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Introduction: Family planning (FP) is less prevalent in South Sudan yet information on the subject is scarce and varied from one source to another. This study assessed the prevalence and associated factors in family planning among students at health science training institutes in Juba City. Method: This was a cross-sectional survey of students’ self-reported utilisation of FP methods. Four hundred randomly selected students from five health training institutes (HTIs) in Juba City participated. Data collection was done using a pretested structured questionnaire. IBM SPSS 23 software was used for data analysis. Chi squared tests and regression analyses were performed to determine the associated factors. Results: Among the 400 participants, the lifetime prevalence of FP methods was 77.3%, of which modern contraceptive use was 22%. FP was more prevalent among participants aged 45-50 (85.7%) and females (80.7%). Eighty-seven percent of divorced couples and 91.3% of traditional believers reported practicing FP. More nursing/midwifery cadres within the professional category reported practicing FP, as well as 90.4% of rural respondents. Eighty-three percent of respondents working in pharmacies said they practice FP, compared to 68.1% of those working in clinics. FP practice was similar among participants who were aware (78.9%) and those who denied being aware (72.5%). Marital status (p < 0.001), religion (p < 0.001), residence (p < 0.001), and place of work (p = 0.037) were significantly associated with FP. Conclusion: The prevalence of family planning among students at Health Training Institutes in Juba City is high compared to national estimates, but the contraceptive overall prevalence rate is still low. It is significantly associated with marital status, religion, residence, and place of work. There is a need to continue the effort.

Abstract This study focuses on six D‐π‐A systems, utilizing diverse π‐spacers as bridges. Comprehensive analysis through Density Functional Theory (DFT) and Time‐dependent Functional Theory (TD‐DFT) methods at B3LYP using 6‐31G (d.p) basis set explores geometrical, electrical, optical, photovoltaic, and absorption properties. EHOMO, ELUMO, and energy gap (Egap), for all of these dyes have been determined and discussed using ground state optimization. TD‐DFT calculates optical properties, unveiling enhanced excitation energies and HOMO‐LUMO energy levels, indicative of improved electron injection and dye regeneration processes. Examination of energy gap, open‐circuit voltage (VOC), free energy change (ΔGinject), light harvesting efficiency (LHE), and absorption spectra reveals D4 dye′s lower Egap and robust absorption in the visible spectrum. Molecular tailoring emerges as a promising technique for optimizing D‐π‐A sensitizer design, offering potential advancements in DSSCs applications.

This quasi-experimental, nonrandomized intervention study reports the effect of person-centred, culturally appropriate music on psychological wellbeing of residents with advanced dementia in five rural residential aged care homes in Australia. Seventy-four residents attended in person-centred music sessions and culturally appropriate group sessions. Interest, response, initiation, involvement, enjoyment, and general reactions of the residents were assessed using the Music in Dementia Assessment Scale (MiDAS), and interviews and focus groups were conducted with aged care staff and musicians. The overall effect of person-centred sessions at two-time points were: during the intervention—351.2 (SD 93.5); and two-hours post intervention—315.1 (SD 98.5). The residents presented a moderate to high level of interest, response, initiation, involvement, and enjoyment during the session and at post-intervention. However, the MiDAS sub-categories’ mean scores differed between the time-points: interest (t59 = 2.8, p = 0.001); response (t59 = 2.9, p = 0.005); initiation (t59 = 2.4, p = 0.019); and involvement (t59 = 2.8, p = 0.007), indicating a significant decline in the effect of person-centred music over time. Interestingly, during the period of time, most of the residents were observed with no exhibitions of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%), and with a presentation of relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data collected regarding culturally appropriate group music sessions were behavioural change, meaningful interaction, being initiative, increased participation, and contentment. The findings suggest that the integration of music into care plans may reduce the residents’ agitation and improve their emotional wellbeing in rural aged care homes.

Purpose: To investigate the association between the apolipoprotein E (APOE) E4 dementia-risk allele and prospective longitudinal retinal thinning in a cohort study of suspect and early manifest glaucoma. Design: Retrospective analysis of prospective cohort data. Participants: This study included all available eyes from participants recruited to the Progression Risk of Glaucoma: Relevant SNPs [single nucleotide polymorphisms] with Significant Association (PROGRESSA) study with genotyping data from which APOE genotypes could be determined. Methods: Apolipoprotein E alleles and genotypes were determined in PROGRESSA, and their distributions were compared with an age-matched and ancestrally matched normative cohort, the Blue Mountains Eye Study. Structural parameters of neuroretinal atrophy measured using spectral-domain OCT were compared within the PROGRESSA cohort on the basis of APOE E4 allele status. Main Outcome Measures: Longitudinal rates of thinning in the macular ganglion cell–inner plexiform layer (mGCIPL) complex and the peripapillary retinal nerve fiber layer (pRNFL). Results: Rates of mGCIPL complex thinning were faster in participants harboring ≥1 copies of the APOE E4 allele (β = –0.13 μm/year; P ≤0.001). This finding was strongest in eyes affected by normal-tension glaucoma (NTG; β = –0.20 μm/year; P = 0.003). Apolipoprotein E E4 allele carriers were also more likely to be lost to follow-up (P = 0.01) and to demonstrate a thinner average mGCIPL complex (70.9 μm vs. 71.9 μm; P = 0.011) and pRNFL (77.6 μm vs. 79.2 μm; P = 0.045) after a minimum of 3 years of monitoring. Conclusions: The APOE E4 allele was associated with faster rates of mCGIPL complex thinning, particularly in eyes with NTG. These results suggest that the APOE E4 allele may be a risk factor for retinal ganglion cell degeneration in glaucoma.

Abstract Background There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. Methods A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. Results Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. Conclusions The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

This study focuses on six D‐π‐A systems, utilizing diverse π‐spacers as bridges. Comprehensive analysis through Density Functional Theory (DFT) and Time‐dependent Functional Theory (TD‐DFT) methods at B3LYP using 6‐31G (d.p) basis set explores geometrical, electrical, optical, photovoltaic, and absorption properties. EHOMO, ELUMO, and energy gap (Egap), for all of these dyes have been determined and discussed using ground state optimization. TD‐DFT calculates optical properties, unveiling enhanced excitation energies and HOMO‐LUMO energy levels, indicative of improved electron injection and dye regeneration processes. Examination of energy gap, open‐circuit voltage (VOC), free energy change (ΔGinject), light harvesting efficiency (LHE), and absorption spectra reveals D4 dye′s lower Egap and robust absorption in the visible spectrum. Molecular tailoring emerges as a promising technique for optimizing D‐π‐A sensitizer design, offering potential advancements in DSSCs applications. [ABSTRACT FROM AUTHOR]

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.

Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method 'Harmony in the Bush' dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive.

Addressing the low literacy rates in South Sudan has been a longstanding priority for primary health care providers as a way to improve the country’s poor overall health status. Improving the literacy rate by “ensuring that all girls and boys complete primary and secondary education” by 2030 is ambitious but achievable for optimum health and socio-economic development. While general literacy is an important determinant of health, it is not sufficient to address the major health challenges facing the South Sudanese population. Effective health education at primary health care points can help ensure healthy lives while other sectors are improving literacy.

The current generation in South Sudan has been observed to be declining in taking literature as a subject of specialization. The reasons were attributed to unattractive salaries, demotivation, and the welfare of the families, among others. The South Sudan public and private universities have been challenged by the lack of new teaching staff. The results are seen at the two levels of education, Higher Education and General Education. The richest nation in both, East Africa and the IGAD, South Sudan possesses an abundance of resources, including minerals, oil, cattle, agricultural goods, finishers, and rivers and streams, that the government has failed to adequately utilize. It was pointed out that human resources are the foundation of all progress, and that the foundation of any development in the modern world is education. The general public, academia, and representatives of civil society organizations have all voiced assertions that the government does not consider education to be a high priority. The outcome is that people abandon teaching in search of better opportunities. The lack of teachers of English Language and Literature resulted in poor quality of English language and Literature as well as science subjects. Educationists, linguists, and literary writers from South Sudan contended that the current generation lacks the aptitude to acquire the English language and literature, as well as the necessary knowledge and abilities. It was said that the government does not inspire or encourage members of the present generation to pursue careers as teachers. The government of South Sudan is being called out to reinstate the scholarship program for exceptional pupils. They emphasized that people who are prepared and eager to study English language and literature in the US, UK, Canada, Australia, and New Zealand should be awarded the scholarship. [ABSTRACT FROM AUTHOR]

Fuchs endothelial corneal dystrophy (FECD) is one of the most common reasons for corneal transplantation, and is known to cluster in families. Here, the authors discover new genetic loci associated with FECD with sex-specific effects and implications for disease mechanism.

An amendment to this paper has been published and can be accessed via the original article.

Fuchs' endothelial corneal dystrophy (FECD) is a progressive, vision impairing disease. Common single nucleotide polymorphisms (SNPs) and a trinucleotide repeat polymorphism, thymine-guanine-cytosine (TGC), in the TCF4 gene have been associated with the risk of FECD in some populations. We previously reported association of SNPs in TCF4 with FECD risk in the Australian population. The aim of this study was to determine whether TGC repeat polymorphism in TCF4 is associated with FECD in the Australian population. In 189 unrelated Australian cases with advanced late-onset FECD and 183 matched controls, the TGC repeat polymorphism located in intron 3 of TCF4 was genotyped using a short tandem repeat (STR) assay. The repeat length was verified by direct sequencing in selected homozygous carriers. We found significant association between the expanded TGC repeat (≥ 40 repeats) in TCF4 and advanced FECD (P = 2.58 × 10-22; OR = 15.66 (95% CI: 7.79-31.49)). Genotypic analysis showed that 51% of cases (97) compared to 5% of controls (9) were heterozygous or homozygous for the expanded repeat allele. Furthermore, the repeat expansion showed stronger association than the most significantly associated SNP, rs613872, in TCF4, with the disease in the Australian cohort. This and haplotype analysis of both the polymorphisms suggest that considering both the polymorphisms together rather than either of the two alone would better predict susceptibility to FECD in the Australian population. This is the first study to report association of the TGC trinucleotide repeat expansion in TCF4 with advanced FECD in the Australian population.

Asymmetric dimethylarginine (ADMA), present in human serum, is an endogenous inhibitor of nitric oxide synthase and contributes to vascular disease. Dimethylarginine dimethylaminohydrolase (DDAH) is an ADMA degrading enzyme that has two isoforms: DDAHI and DDAHII. We sought to determine whether serum ADMA levels in type 2 diabetes are influenced by common polymorphisms in the DDAH1 and DDAH2 genes.Relevant clinical parameters were measured and peripheral whole blood obtained for serum and genetic analysis on 343 participants with type 2 diabetes. Serum ADMA concentrations were determined by mass spectroscopy. Twenty six tag SNPs in the DDAH1 and 10 in the DDAH2 gene were genotyped in all subjects and tested for association with serum ADMA levels. Several SNPs and haplotypes in the DDAH genes were strongly associated with ADMA levels. Most significantly in the DDAH1 gene, rs669173 (p = 2.96x10(-7)), rs7521189 (p = 6.40x10(-7)), rs2474123 (p = 0.00082) and rs13373844 (p = 0.00027), and in the DDAH2 gene, rs3131383 (p = 0.0029) and the TGCCCAGGAG haplotype (p = 0.0012) were significantly associated with ADMA levels. Sub-analysis by diabetic retinopathy (DR) status revealed these variants were associated with ADMA levels predominantly in participants without DR. Combined analysis of the most strongly associated SNPs in DDAH1 (rs669173) and DDAH2 (rs3131383) revealed an additive effect (p = 1.37x10(-8)) on ADMA levels.Genetic variation in the DDAH1 and 2 genes is significantly associated with serum ADMA levels. Further studies are required to determine the pathophysiological significance of elevated serum ADMA in type 2 diabetes and to better understand how DDAH gene variation influences ADMA levels.

Background: Early hemodynamic assessment of critically ill newborns requires mostly invasive measurements in neonatal intensive care unit. Base deficit and serum lactate concentrations may be important prognostic indicators in preterm infants. Aim and Objectives: to investigate the relationship between serum lactate levels and adverse outcome in preterm infants who were admitted to NICU of Ain Shams University Hospital. Subjects and Methods: This study is prospective cohort study, that included 90 preterm patients that were admitted to neonatal intensive care unit during a period of 6 months, all the neonates had the level of serum lactate been evaluated by ELISA (at 6,12,18 and 24 hours of birth) and correlated with the incidence of intracranial hemorrhage as diagnosed by cranial ultrasonography. Result: The initial serum lactate level was compared with the follow up readings at 12,18 and 24 hours and showed statistically significant reduction of serum lactate in follow up recordings (p-value <0.05), Serum lactate was statistically significant predictors of death with increase serum lactate at 12hrs., at 18hrs. and at 24hrs, with p-value (p < 0.05). Serum lactate had no statistically significant association with intracranial hemorrhage as detected by transcranial ultrasonography. Conclusion: Serial lactate measurements greater than 5.6 mmol/l predict adverse outcome and may aid the clinician in bedside decision making. [ABSTRACT FROM AUTHOR]