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Abstract Background Yellow fever surveillance systems are designed to identify cases of acute febrile jaundice, a clinical syndrome used to monitor the emergence of yellow fever outbreaks. However, this syndrome has diverse etiologies, particularly viral hepatitis. This study investigates the seroepidemiology of viral hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) among cases initially suspected to be yellow fever, aiming to elucidate the epidemiology of viral hepatitis in the Democratic Republic of Congo (DRC) and provide insights for improving public health interventions. Methods A retrospective cross-sectional study was conducted using serum samples collected between 2017 and 2018 through national yellow fever surveillance in the DRC. Samples from individuals testing negative for yellow fever were tested for IgM antibodies against HAV, HBc, HCV, and HEV and HBs antigen using validated ELISA kits. Acute HBV infection was defined by both HBc IgM and HBs antigen positivity. Multivariable logistic regression was used to assess the association of demographic, geographic, and environmental factors with each hepatitis type. Results Among 1239 participants (58.8% male; median age: 16 years), seroprevalence was 16.1, 11.2, 5.0, and 3.1% for HAV, HBV, HCV and HEV, respectively. HAV prevalence was highest in the youngest age group and rural residents. In contrast, the youngest group was most protected from HBV. HCV prevalence was highest in the oldest age groups. HEV exhibited higher prevalence during the dry season and in a humid subtropical climate. Several provinces were identified as hotspots of HAV, HCV and HEV. Conclusions Viral hepatitis is a major cause of acute febrile jaundice in the DRC with notable geographic and seasonal trends. National yellow fever surveillance is a valuable resource for understanding hepatitis epidemiology, though careful interpretation is necessary. Tailored interventions are required for mitigating the burden of viral hepatitis in each province.

Cabbage is an important component of agriculture in the eastern Democratic Republic of Congo (DRC) for its various food uses. It is important to identify pests that affect its production, which is still insufficient to meet the increasing consumer needs. Furthermore, insect data for tropical agroecosystems, particularly those of DRC are limited, making insect diversity poorly understood. The objective of this study is to assess the diversity and abundance of entomofauna related to cabbage in five different cabbage growing sites: Minova, Sake, Kibumba, Rutshuru and Lac Vert. This was achieved by trapping insects with the sweep net and yellow pantraps during 2021 and 2022. A total of 1109 insects from 9 orders and 48 families were collected. The most abundant pest families were Ciccadellidae (8%), Coreidae (7%), Chysomelidae (5%) and Pentatomidae (4%). The main families of beneficial insects (natural enemies and pollinators) identified were Syrphidae (7%), Carabidae (4%), Coccinellidae (3%) and Apidae (3%). Insect communities found in different locations were similar and diversified. Considering functions played by these different functional groups as ecological indicators, it is important to preserve entomological biodiversity. This is achieved through the rational selection of pest management methods to optimize ecosystem services provided by beneficial insects.

This study examined the impact of transformational leadership on innovative work behaviour (IWB) among employees in Ghana's hospitality sector. It also explored how organizational and employee absorptive capacity (AC) moderates the relationship between transformational leadership and innovative work behaviour. Data were randomly collected from 795 employees across star-rated hotels in the Volta Region of Ghana through structured questionnaires. The findings reveal that transformational leadership significantly impacts employees' innovative work behaviour. In addition, organizational and employee absorptive capacity significantly moderate the transformational leadership and innovative work behaviour relationship (albeit negatively for organizational absorptive capacity). Therefore, hospitality managers can exhibit higher levels of inspiration and support to their employees to generate innovative activities and outcomes. Also, firms can implement appropriate structures that foster knowledge exploration, acquisition and application at the employee level. This is because it enhances employee innovative work behaviour, especially in the presence of a transformational leadership style.

Orientation: The resilience of small businesses such as emerging contractor firms (ECFs) has been negatively affected due to problems from the environment like the coronavirus disease 2019 (COVID-19) pandemic. It is imperative for firms to navigate through this economic downturn by deploying learning capabilities to surmount these problems and boost resilience. Research purpose: This study examines the influence of learning capability on the entrepreneurial resilience. Motivation for the study: To establish the role of learning capability on entrepreneurial resilience of ECFs. Research design, approach and method: Using a quantitative research approach and a cross-sectional survey design, a structured close-ended questionnaire was administered to 400 owners and managers of ECFs. The results of the study were analysed using Statistical Package for the Social Sciences (SPSS) version 23 and Smart PLS software 3. Descriptive percentage analysis, confirmatory factor analysis (CFA), multiple regression analysis, and structural equation modelling (SEM) were performed on the data set. Main findings: The results suggest that all forms of learning have significant positive effect on entrepreneurial resilience (Transformative learning B = 0.2207, p 0.001; exploitative learning β = 0.2580; p 0.001; explorative learning β = 0.5316; p 0.001). Practical/managerial implications: The implications emphasise the different choices that small resource constrained firms must take in identifying and investing in those learning capability dimensions which best predict long term resilience. Contribution/value-add: The study demonstrates the significance of firms’ investment in learning, especially explorative learning to increase knowledge.

Abstract Background Antiseptics, disinfectants, and hand hygiene products can be contaminated with bacteria and cause healthcare-associated infections, which are underreported from low- and middle-income countries. To better understand the user-related risk factors, we conducted a knowledge, awareness, and practice survey among hospital staff in sub-Saharan Africa. Methods Self-administered questionnaire distributed among healthcare workers in three tertiary care hospitals (Burkina Faso, Benin, Democratic Republic of the Congo). Results 617 healthcare workers (85.3% (para)medical and 14.7% auxiliary staff) participated. Less than half (45.5%) had been trained in Infection Prevention & Control (IPC), and only 15.7% were trained 80%) disapproved recycling soft-drink bottles as liquid soap containers. Nearly two-thirds (65.0%) declared that bacteria may be resistant to and survive in ABHR, versus 51.0% and 37.4% for povidone iodine and chlorine 0.5%, respectively. Depicted risk practices (n = 4) were ignored by 30 to 40% of participants: they included touching the rim or content of stock containers with compresses or small containers, storing of cotton balls soaked in an antiseptic, and hand-touching the spout of pump dispenser. Filling containers by topping-up was considered good practice by 18.3% of participants. Half (52.1%) of participants acknowledged indefinite reuse of containers. Besides small differences, the findings were similar across the study sites and professional groups. Among IPC-trained staff, proportions recognizing all 4 risk practices were higher compared to non-trained staff (35.9% versus 23.8%, p

Performing reservoir characterization in exploration with limited data can be very is challenging. Various approaches are used to estimate values away from the well location. In this study, the density log, which is important for porosity analysis, was missed in one of the five available well log datasets. To solve this problem, an artificial neural network (ANN) approach was used to synthesise a density log (RHOB) from available and measured Gamma Ray (GR) log, Sonic (DT), water saturation (SW), and related Depth of 3 wells in the field. The performance of the prediction was evaluated using the fourth well. Five models were constructed with different optimizers from machine learning with a neural network made of an input layer with 5 neurons, a hidden dense layer with 32 neurons and an output dense layer with 1 neuron. The models were constructed based on Nesterov-accelerated Adaptive Moment Estimation (NADAM), Adaptive Moment Estimation (ADAM), Stochastic Gradient Descent (SGD), and Root Mean Square Propagation (RMSP) optimizers, and an Ensemble model which combined the four optimizers. The test on actual data showed very low mean absolute errors of 0.0262, 0.0278, 0.0270, 0.0309, and 0.0248 and high coefficients of determination (R2) of 0.8832, 0.8746, 0.8986, 0.8858, and 0.9051 between the predicted and the actual data obtained for NADAM, ADAM, SGD, RMSP, and the Ensemble model, respectively, after 25 epochs. These indicated high performance of the Ensemble Learning model, suggesting that the constructed model can be used to predict the well that lacks RHOB.

Background: While the Internet of things (IoT) has been praised for its potential to improve food security and combat climate change, it is unclear how agricultural entrepreneurs (especially farmers) in emerging contexts are harnessing this technology to leverage agricultural productivity. Objectives: Given the lack of documentation of novel-technology-supported farming approaches in relevant extant literature in emerging economies, this study sought to explore how South African farmers are harnessing the strength of IoT to leverage productivity in crop farming. Method: To address this research gap, a systematic literature review was conducted to establish how IoT was implemented in crop farming in resource-constrained contexts of South Africa. These databases, namely Google Scholar, Scopus, MDPI, IEEE Xplore, and Science Direct, were utilised to gather the relevant information. Results: The findings highlighted that IoT technology presented multiple opportunities for improving operational efficiency and connectivity and facilitating remote management of agricultural activities. Conversely, the findings suggested that the utilisation of IoT in crop farming poses serious challenges arising from software complexity, data security, lack of supporting infrastructure and technical skills. Conclusion: This article demonstrates how institutional voids, human capital and technological gaps in the South African farming industry undermine crop farming, food security in the communities and government efforts at promoting the latest technologies for leveraging agricultural productivity and the farming industry in general. Contribution: The study has contributed to filling the gap in the IoT literature in South Africa and worldwide. This study also contributed by aligning the theory to the study.

BackgroundSeveral governments from African countries, including the Democratic Republic of the Congo (DRC), implemented stringent public health measures to curb COVID-19 transmission in the early phases of the pandemic. While these restrictive measures are believed to have contributed to lowering case incidence and related mortality in DRC, data on the population’s knowledge and adherence are limited. This study aimed to assess the knowledge, perception, attitudes, and practices of COVID-19 preventive measures and associated factors among adult residents of Matadi, thereby generating evidence for a strategy adjustment as the COVID-19 response is transitioning from emergency to control status.MethodsWe used data from a population-based cross-sectional study conducted in October 2021. Consenting participants were enrolled through a multi-stage cluster sampling approach and administered a pre-tested structured questionnaire using a mobile application (Epicollect 5). We analyzed adult participants’ data using STATA 15.1. Univariable and multivariable analyses were applied to identify factors associated with good knowledge, good perception, positive attitude and good practice.ResultsWe included 1,269 adult respondents for the secondary analysis. One respondent in six was female. The median age was 36 years (IQR 24–50). Most respondents (76.5%) had good knowledge. Respondents aged 40–49 years and those with vocational education level were 1.7 time (AOR 1.75, 95% CI 1.07–2.87) and twice as likely (AOR 2.06, 95% CI 1.01–4.21) to have good knowledge. Preventive measures were perceived as efficient by 45% of respondents. Good perception was associated with education level, profession, average household monthly income and good knowledge. Only 40% of respondents had a positive attitude. A positive attitude was associated with age, education level, and good knowledge. Respondents having good practice represented 5.8%. Good practice was associated with good knowledge, attitude and perception.ConclusionMost respondents were knowledgeable, had a good perception of government-related COVID-19 preventive measures, a moderately positive attitude and an extremely low level of good practice. Current COVID-19 preventive strategies, including vaccination rollout, need adjustment into high-efficiency, context-based and risk group-specific interventions. Evidence generated by this study will improve preparedness and response to future outbreaks.

Damage caused by pests and diseases is one of constraints on crop production for food security. Based on the use of questionnaire and interviews that were conducted in Kabare territory (South-Kivu), this study was carried out to (i) assess farmers practices, attitudes, and knowledge about pesticides use, and (ii) assess the human health and physical environment effects using pesticides. Data was collected from 300 small-scale farmers in study area. Results showed that majority of our respondents were men (59 %) rather than women (41 %) and local knowledge of pesticide use was low (60 %). Education level had a significant influence (p

Abstract Soil depletion constitutes a major challenge for agriculture and food security in highlands of eastern Democratic Republic of Congo (DRC). This study aimed to assess the effectiveness of the split-application of nitrogen fertilizer on grain yield and profitability of maize on Nitisols in eastern DRC. The urea fertilizer (100 kg ha−1) was applied in single, two, and three split-applications on three maize varieties for two cropping seasons. Results showed that maize growth and yield parameters varied significantly with N splitting strategy, varieties, and cropping season (p

Abstract Background Patient engagement in research (also commonly referred to as patient or patient and public involvement in research) strives to transform health research wherein patients (including caregivers and the public) are regularly and actively engaged as multidisciplinary research team members (i.e. patient partners) working jointly towards improved health outcomes and an enhanced healthcare system. To support its mindful evolution into a staple of health research, this participatory study aimed to identify future directions for Canadian patient engagement in research and discusses its findings in the context of the international literature. Methods The study met its aim through a multi-meeting pan-Canadian virtual workshop. Participants (n = 30) included Strategy for Patient-Oriented Research-funded academic researchers and patient partners identified through a publicly available database, personal and professional networks and social media. All spoke English, could access the workshop virtually, and provided written informed consent. The workshop was composed of four, 1.5–3-h virtual meetings wherein participants discussed the current and preferred future states of Canadian patient engagement in research. Workshop discussions (i.e. data) were video and audio recorded. Themes were generated through an iterative process of inductive thematic analysis that occurred concurrently with the multi-week workshop. Results Our participatory and iterative process identified 10 targetable areas of focus for the future of Canadian patient engagement in research. Five were categorized as system-level (systemic integration; academic culture; engagement networks; funding models; compensation models), one as researcher-level (engagement processes), and four crossed both levels (awareness; diversity and recruitment; training, tools and education; evaluation and impact). System level targetable areas called for reshaping the patient engagement ecosystem to create a legitimized and supportive space for patient engagement to be a staple component of a learning health system. Researcher level targetable areas called for academic researchers and patient partners to collaboratively generate evidence and apply knowledge to inform values and behaviours necessary to foster and sustain supportive health research spaces that are accessible to all. Conclusions Future directions for Canadian patient engagement in research span 10 interconnected targetable areas that require strong leadership and joint action between patient partners, academic researchers, and health and research institutions if patient engagement is to become a ubiquitous component of a learning health system.

Abstract Introduction Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient’s perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30. Methods Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression. Results Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30–45 min had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), p = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) p = 0.04). Conclusion We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting > 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.

Anterior Thoracic Myelomeningocele is a very rare condition. The diagnosis may be made before or after birth. Association with loss of physiologic curvature of the spine is common. We report the case of an 8-year-old boy with congenital dorsal sinistro-convex scoliosis, which was considered nonspecific and improved slightly after physical therapy. The onset of urinary and fecal incontinence at the age of 8 years led the parents to consult a urologist. MRI of the spinal cord revealed an anterior thoracic heterogeneous cystic lesion extending from the third to the eighth dorsal vertebrae. The heterogeneous cystic mass contained a solid spinal cord-like structure on all sequences. No abnormal enlargement, no torsion of the cauda equina or cerebellar amygdala. No malformation of the posterior fossa. CT scan showed aplasia of the right pedicle of the third thoracic vertebrae (T3) with thoracic scoliosis. The associated anterior thoracic myelomeningocele was the final diagnosis that motivated the transfer of the patient to a specialized neurosurgical center.

Abstract Introduction Problem‐solving skills (PSS) help to provide a systematic approach to dealing with and managing complex problems. The overall aim of this study was to assess the acceptability and feasibility of developing and adapting a prison‐based PSS workbook for adults within a medium‐ and low‐secure hospital. Method We used the Medical Research Council framework in our participatory mixed methods study incorporating an adapted survey (to identify what types of problems people experience in secure hospitals), a series of three interactive workshops (to co‐produce two case study examples for a workbook) and we gathered feedback from patients and hospital staff on the acceptability and feasibility of the workbook. Data from the survey were used to inform the case study examples, and the feedback from patients and hospital staff was descriptively summarised and the results consolidated. Results In total, 82 (51%) patients took part in the survey; 22 patients and 49 hospital staff provided feedback on the workbook. The survey results indicated that patients regularly experience problems while in the hospital. Patients reported problems relating to restrictions of freedom and boredom. The workshops produced two case studies for the workbooks, with mainly positive patient and staff feedback. More work is required to improve the visual representation of the characters in the case studies, the amount and content of the language and the mechanism of the intervention delivery. Conclusion The adaptation process proved acceptable and feasible to both patients and staff. The co‐production methodology for the workbook and feedback from patients and staff was an effective way of iteratively refining the materials to ensure that they were both meaningful and acceptable to staff and patients. Subsequent work is required to develop the workbook and evaluate the feasibility of the intervention delivery, recruitment rates, uptake and adherence to the PSS using a randomised controlled trial. Patient or Public Contribution At each stage of the project consultation with patients and/or hospital staff was involved.

No abstract available.

Background: There is a growing body of literature on the contribution of hard skills to the enhancement of entrepreneurial behaviour. However, the role of acquiring soft skills in shaping entrepreneurial readiness is yet to be sufficiently comprehended. Aim: This research sought to examine the significance of soft skills in shaping the entrepreneurial readiness behaviour of students at higher education institutions in South Africa. Specifically, the study investigated the effects of soft skills on the selected dimensions of entrepreneurial readiness behaviour namely venture creation, innovative financing and venture growth. Setting: Students from the Central University of Technology (CUT) and the University of the Free State (UFS) participated in this study. Methods: A descriptive, explorative cross-sectional design involving 300 students enrolled for entrepreneurship courses, was adopted. Cluster sampling was employed as the main sampling technique. The average variance extracted (AVE), linear regression and Cronbach’s alpha coefficient were used as indicators of reliability and validity in the statistical package for the social sciences (SPSS) and Smart PLS software. Results: The results suggest that soft skills exert a positive, and significant, effect on the entrepreneurial readiness behaviour of students. Conclusion: This study provides critical insights into how entrepreneurial readiness behaviour can be explained through fostering soft skills, honing venture creation, innovative financing, venture growth and entrepreneurial activities of students. Contribution: The study contributes to the Theory of Planned Behaviour (TPB) by demonstrating how soft skills create a germane context for the stimulating, exhibiting and actioning specific entrepreneurial behaviours among nascent entrepreneurs in South Africa.

Lake Issyk-Kul is an endorheic lake in arid Central Asia that is vital to the region's ecological sustainability and socio-economic development. Climate change and anthropogenic water consumption led to fluctuations in the lake's water level, which affected the water resource. The goal of this study was to examine the impacts of climate change and human activities on the Issyk-Kul water balance by combining the Coupled Model Intercomparison Project Phase 6 (CMIP6) scenarios with hydrological modeling. The Soil and Water Assessment Tool (SWAT) model was used to incorporate signals of future precipitation and temperature changes. According to the scenarios, the total discharge of the three catchments showed an overall increasing trend with a maximum value of 28.02%. The snow and ice-melt water from March to August was revealed, and the increasing trends only occurred from March to May, with the snow and ice melting peak variations ranging from 0.5% to 2%. The high increase in change appeared in northern catchment of the lake. There was an exceptional upward precipitation trend over the northern catchment, with annual increases ranging from 0.7 to 14.5%, and an average annual temperature of 1.72°C. With slight similarities, the total runoff would increase for all catchments, with an average annual value of 10.6%. The northern catchment was significantly more sensitive to precipitation and warming than the southeastern catchments. Under land use land cover change, average annual discharge decreased with agricultural expansion, with discharge differences ranging from −0.005 to −1.06 m3/s. The findings are useful for decision-makers addressing the challenges of climate change mitigation and local water resource management.

Introduction and aimEnsuring the protection and restoration of forest ecosystems is vital to maintaining and restoring ecological balance in deforested or degraded landscapes. However, sustainable development faces challenges from high human impacts on natural forest ecosystems, insufficient advanced conservation measures, and limited engagement of local communities in developing nations. The aim of this study was to explore the utility of spatial remote sensing datasets in examining the landscape pattern changes within the transboundary Nyungwe-Kibira Forest from 2000 to 2019. This aimed to emphasize the necessity of understanding the intricate dynamics of this ecosystem and its susceptibility to human activities in order to bolster diverse restoration initiatives throughout the region.MethodsThe landscape pattern change in the Nyungwe-Kibira between 2000 and 2019 was analysed using high-resolution Landsat data. This analysis encompassed an evaluation of the dynamics of changes in built-up, cropland, and forest areas within the region. Especially, primary data derived from the Landsat dataset and secondary data from reports such as the Outlook Report were employed to elucidate the ongoing landscape transformation within and surrounding the transboundary forest.Results and discussionThe analysis revealed a net change of +62.3% and +18.07% in built-up and cropland areas, resulting in a gross change of 14,133 ha and 6,322 ha in built-up and cropland areas, respectively. Furthermore, the forest experienced an overall gain of 9.11%, corresponding to a net loss of 6.92% due to deforestation, estimated at -14,764 ha. The analysis also indicated that built-up areas accounted for approximately 33.02% of the net forest loss, primarily affecting the northern edge of the Rwanda region, while cropland expansion contributed to a net loss of forest (-9.48%), predominantly impacting the southeast portion of the forest in Burundi. Additionally, the forest is predicted to decrease by 0.74% by 2030, with current findings showing aggregated forest and cropland at 66% and 7%, dissected rangeland at 24%, and created built-up areas at 3%. The findings indicate that the Nyungwe-Kibira Forest is undergoing notable transformations, highlighting the necessity of land-based projects and mitigation plans to facilitate the restoration of the forest from its historical changes. Without proactive measures, an ongoing decrease in forest area by 2030 is anticipated.

**The 2023 highlights issue of _Patient Safety_ is available to read online and download at no charge.** This issue revives previously published articles—original studies, data analyses, interviews, safety alerts, and more—as well as Patient Safety Authority content you may have missed. Among this curated selection are a look at [safety issues with medical equipment, supplies, and devices](https://patientsafetyj.com/article/73988); takeaways from high-risk industries that can improve the design and use of [visual displays](https://patientsafetyj.com/article/77769) and [alarm technology](https://patientsafetyj.com/article/73905); and a timely discussion on the [role artificial intelligence can play in healthcare](https://patientsafetyj.com/article/77632). Additional features include • A [safety alert about clozapine](https://patientsafetyj.com/article/90674), a last-line therapy for schizophrenia that may cause serious, life-threatening side effects if it is not dosed appropriately • Data analyses from the largest event reporting database of its kind in the United States, including [patient safety trends in serious events and incidents](https://patientsafetyj.com/article/74752), and [healthcare-associated infections in nursing homes](https://patientsafetyj.com/article/74494) • An interview with pediatrician Dr. Kathleen Walsh about the [risk of medication errors at home](https://patientsafetyj.com/article/88516) that can harm kids, families, or even their pets • Important notices about [wrong-site surgery](https://patientsafetyj.com/article/91634), [drug-eluting stents](https://patientsafetyj.com/article/91635), [diabetes and obesity medications](https://patientsafetyj.com/article/91636), and [healthcare disparities](https://patientsafetyj.com/article/91637) • A [glimpse into the future of healthcare](https://patientsafetyj.com/article/88053) with a modern Nostradamus, Dr. Eyal Zimlichman _Patient Safety_ is fully open access (no fees for authors or readers) and published on a rolling basis throughout the year. We welcome manuscripts from all over the world. If your work can help advance patient safety, please [submit it to us for consideration](https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers. [Subscribe to our journal email list](https://lp.constantcontactpages.com/sl/otqI5QB/journalupdates) to be updated on new articles as they are published online.

Abstract Background Advance care planning (ACP) is the process supporting individuals with life-limiting illness to make informed decisions about their future healthcare. Ethnic disparities in ACP have been widely highlighted, but interpretation is challenging due to methodological heterogeneity. This review aims to examine differences in the presence of documented ACP in individuals’ care records for people with advanced disease by ethnic group, and identify patient and clinician related factors contributing to this. Methods Mixed-methods systematic review. Keyword searches on six electronic databases were conducted (01/2000–04/2022). The primary outcome measure was statistically significant differences in the presence of ACP in patients’ care records by ethnicity: quantitative data was summarised and tabulated. The secondary outcome measures were patient and clinician-based factors affecting ACP. Data was analysed qualitatively through thematic analysis; themes were developed and presented in a narrative synthesis. Feedback on themes was gained from Patient and Public Involvement (PPI) representatives. Study quality was assessed through Joanna Briggs Institute Critical Appraisal tools and Gough’s Weight of Evidence. Results N=35 papers were included in total; all had Medium/High Weight of Evidence. Fifteen papers (comparing two or more ethnic groups) addressed the primary outcome measure. Twelve of the fifteen papers reported White patients had statistically higher rates of formally documented ACP in their care records than patients from other ethnic groups. There were no significant differences in the presence of informal ACP between ethnic groups. Nineteen papers addressed the secondary outcome measure; thirteen discussed patient-based factors impacting ACP presence with four key themes: poor awareness and understanding of ACP; financial constraints; faith and religion; and family involvement. Eight papers discussed clinician-based factors with three key themes: poor clinician confidence around cultural values and ideals; exacerbation of institutional constraints; and pre-conceived ideas of patients’ wishes. Conclusions This review found differences in the presence of legal ACP across ethnic groups despite similar presence of informal end of life conversations. Factors including low clinician confidence to deliver culturally sensitive, individualised conversations around ACP, and patients reasons for not wishing to engage in ACP (including, faith, religion or family preferences) may begin to explain some documented differences. Trial registration PROSPERO-CRD42022315252.

Abstract The direct effects of technology transfer and innovation on the productivity and competitiveness of economies and businesses are well established. However, research is yet to establish the explanatory variables and the boundary conditions within which these relationships exist. This study examines the extent to which product quality mediates the relationship between technology transfer and competitiveness of small-scale agricultural businesses (SSABs). Moreover, the study explores the extent to which the geographical location moderates the technology transfer–business competitiveness relationship, including whether asset value moderates the product quality–competitiveness relationship. A cross-sectional survey was conducted on 400 SSAB owners and managers in the Free State and Mashonaland Central Provinces of South Africa and Zimbabwe, respectively. Of the 400 questionnaires distributed, 268 usable questionnaires (67%) were returned for analysis. The results suggest that product quality partially mediated the relationship between technology transfer and competitiveness of SSABs. The results demonstrate further that the relationship between product quality and competitiveness was moderated by asset value such that at low levels of product quality, SSABs with larger asset values became more competitive than those with smaller asset values. However, as product quality increased, SSABs with smaller asset values became increasingly competitive until the competitive advantage of those with larger asset values was eliminated. SSABs in South Africa reported higher product quality and competitiveness than those in Zimbabwe. The relationship between the location in which the SSAB was situated and competitiveness was direct, and location did not moderate the relationship between technology transfer and competitiveness. The study illuminates the critical importance of product quality for SSABs, especially those with small asset values. It also demonstrates that while technology transfer may influence the competitiveness of SSABs directly, the influence of quality products cannot be underestimated. The study is one-of-a-kind that simultaneously considers explanatory and moderated effects of technology transfer–competitiveness nexus in SSABs, in the context of South Africa and Zimbabwe.

Background: A better understanding of refugee mobility is needed to optimize HIV care in refugee settlements. Objectives: We aimed to characterize mobility patterns among people living with HIV in refugee settlements in Uganda and evaluate the association between mobility and retention in HIV care. Methods: Refugees and Ugandan nationals accessing HIV services at seven health centers in refugee settlements across Uganda, with access to a phone, were recruited and followed for six months. Participants received an intake survey and monthly phone surveys on mobility and HIV. Clinic visit and viral suppression data were extracted from clinic registers. Mobility and HIV data were presented descriptively, and an alluvial plot was generated characterizing mobility for participants’ most recent trip. Bivariate Poisson regression models were used to describe the associations between long-term mobility (≥1 continuous month away in the past year) and demographic characteristics, retention (≥1 clinic visit/6 months) and long-term mobility, and retention and general mobility (during any follow-up month: ≥2 trips, travel outside the district or further, or spending >1–2 weeks (8–14 nights) away). Findings: Mobility data were provided by 479 participants. At baseline, 67 participants (14%) were considered long-term mobile. Male sex was associated with an increased probability of long-term mobility (RR 2.02; 95%CI: 1.30–3.14, p < 0.01). In follow-up, 185 participants (60% of respondents) were considered generally mobile. Reasons for travel included obtaining food or supporting farming activities (45% of trips) and work or trade (33% of trips). Retention in HIV care was found for 417 (87%) participants. Long-term mobility was associated with a 14% (RR 0.86; 95%CI: 0.75–0.98) lower likelihood of retention (p = 0.03). Conclusions: Refugees and Ugandan nationals accessing HIV care in refugee settlements frequently travel to support their survival needs. Mobility is associated with inferior retention and should be considered in interventions to optimize HIV care.

Patient Experience Journal(PXJ) is excited to announce the call for submissions for its July/August 2024 special issue focused on exploring how healthcare organizations are transforming experience in non-hospital settings. So much of the experience conversation has been focused on and driven by the hospital setting – from acute care, to pediatrics, safety net hospitals and more. While this focus remains essential to some of the most critical care delivered in the healthcare ecosystem, it is important to recognize the volume of care being provided in new and existing settings. This special issue seeks to uncover and elevate the practices happening in non-hospital settings and highlight research and evidence showing how efforts in these spaces is truly transforming the human experience in healthcare. These efforts can be the implementation of new programs or processes, research that tests new processes or programs, cases that share how organizations are working to elevate the experience they provide, be it in clinics or outpatient spaces, and even in people’s homes. As the healthcare marketplace continues to dramatically shift, so too do the opportunities to ensure a conversation on experience is deeply rooted in these transformations. The reality is that as much as has been learned from and shared by the hospital setting, there is a vast expanse of organization experience and expertise that can advance the broader experience movement. We believe this issue can inspire just that.

Soil nutrient depletion and poor farming practices are serious challenges limiting crop productivity in soils of the eastern Democratic Republic of Congo (D.R. Congo). An experiment was conducted in two cropping seasons to assess the effect of plant density (25 plants m2 and 33 plants m2) and fertilizer application (with and without NPK) on the yield and yield components of three biofortified common bean varieties (HM21-7, RWR2245 and RWR2154). The experiment involved two plant densities, two fertilizer rates and three varieties arranged in a split-split plot design with three replications. Results showed that yield significantly varied with plant density, variety and fertilizer rate (p

The summer 2023 issue of _Patient Safety_ is available to read online and download at no charge. This issue features two in-depth data analyses from the largest event reporting database of its kind in the United States, which reveal [patient safety trends in serious events and incidents](https://patientsafetyj.com/article/74752-patient-safety-trends-in-2022-an-analysis-of-256-679-serious-events-and-incidents-from-the-nation-s-largest-event-reporting-database) and [offer insights on healthcare-associated infections](https://patientsafetyj.com/article/74494-long-term-care-healthcare-associated-infections-in-2022-an-analysis-of-20-216-reports) in Pennsylvania last year. We also share some recent healthcare success stories in recognition of the winners of the 2023 I AM Patient Safety awards. Additional highlights include • A [safety alert about methylprednisolone](https://patientsafetyj.com/article/77633-patient-safety-alert-methylprednisolone-and-patients-with-hypersensitivity-to-cow-s-milk-components), a medication that sometimes contains lactose monohydrate, and its risk of anaphylaxis, a life-threating allergic reaction, to patients with a cow’s milk allergy. • An expert on artificial intelligence discusses [what AI can and can’t do in healthcare](https://patientsafetyj.com/article/77632-artificially-intelligent-machine-learning-in-healthcare-and-why-it-may-not-be-as-advanced-as-you-think), now and in the future. • Human factors researchers review [best practices from high-risk industries](https://patientsafetyj.com/article/77769-informing-visual-display-design-of-electronic-health-records-a-human-factors-cross-industry-perspective) that may inform visual display design of electronic health records. • How [an evidence-based teaching plan](https://patientsafetyj.com/article/77630-evidence-based-teaching-plan-test-and-evaluation-on-caring-for-healthcare-provider-second-victims) might raise awareness of the effect that significant patient and employee crises have on the staff who witness such events. • A study explores the feasibility of [monitoring patients’ vital signs](https://patientsafetyj.com/article/77776-continuous-monitoring-of-vital-signs-after-hospital-discharge-a-feasibility-study) at home. _Patient Safety_ is fully open access (no fees for authors or readers). We welcome manuscripts from all over the world. If your work can help advance patient safety, please [submit it to us for consideration](https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers.

The tourism industry has suffered because of countries' strict measures to combat the spread of COVID-19. The goal of this research was to uncover the effects of the coronavirus disease and develop solutions to keep the tourism industry afloat in the aftermath. Through a thorough review of the literature, the objectives of this study were to identify the key impacts of the COVID-19 pandemic on the tourism industry and to determine the role that Fourth Industrial Revolution technology can play in reviving the business sector. The study used the desktop research technique, consulting published articles and reports. International tourist arrivals have decreased, key tourism events have been cancelled, hotel occupancy declined, and poaching has increased as a result of COVID19. The findings of the study also indicate that the tourism industry might also benefit from virtual technologies, artificial intelligence, 5G technologies and robot automation technologies. These technologies could be used to sustain the industry in times of crisis.

The increasing demand for water results in the overexploitation of water resources. This situation calls for more effective water management alternatives including rainwater harvesting (RWH) systems. Due to the lack of biophysical data and infrastructure, the identification of suitable sites for various RWH systems is a challenging issue. However, integrating geospatial analysis and modeling approaches has become a promising tool to identify suitable sites for RWH. Thus, this study aimed at identifying suitable sites for RWH in the Nyabugogo catchment located in Rwanda by integrating a geo-information-based multi-criteria decision-making (MCDM) and SWAT (Soil and Water Assessment Tool) model. Moreover, the sediment yield was compared to the soil erosion evaluated using the Revised Universal Soil Loss Equation (RUSLE) owing to the lack of sediment concentration measured data. The results revealed that about 4.8 and 16.35% of the study area are classified as highly suitable and suitable areas for RWH, respectively. Around 6% of the study area (98.5 km2) was found to be suitable for farm ponds, whereas 1.6% (26.1 km2) suitable for check dams, and 25.9% (423 km2) suitable for bench terraces. Among 50 proposed sites for the RWH structures, 29 are located in the most suitable area for RWH. The results implicated that the surface runoff, sediment yield, and topography are essential factors in identifying the suitability of RWH areas. It is concluded that the integrated geospatial and MCDM techniques provide a useful and efficient method for planning RWH at a basin scale in the study area. HIGHLIGHTS Potential suitable sites for rainwater harvesting structures have been investigated in the Nyabugogo catchment area.; The integrated geospatial, MCDM techniques, and SWAT model were applied.; Different sites were classified from the most to the least suitable for RWH structures.; The assessment of heavy metals and organic pollution in water to be harvested was suggested.;

Background: Existing research recognises that entrepreneurship orientation (EO) is essential for success. However, the mediating role of EO in driving entrepreneurial intention (EI) amongst young adults, especially in the context of the digital revolution, remains largely underexplored. Aim: Accordingly, this study aimed to investigate the mediated effect of risk taking, innovativeness, and proactiveness on EI in an emerging economy. Setting: The sample for this study was drawn from the young adult population in South Africa who understands the concept of entrepreneurship. Method: In the study, a quantitative method to collect the data is used, while structural equation modelling is used to test the extended theory of planned behaviour (TPB). Results: Findings indicate that risk taking mediates the effects of attitude, entrepreneurial capability, and the perceived benefits of digital technology on EI. The results did not support the mediating function of proactiveness and innovativeness. In fact, this result challenges the TPB’s simplistic structure and reveals the prominent role of risk taking in determining TPB predictors. Conclusion: Given the significance of risk taking, governments and entrepreneurship centres are urged to promote risk taking in all their entrepreneurship development programmes. Contribution: Considering the significance of the global digital transformation, this study extends the TPB by incorporating the perceived benefits of digital technology among the predictors of entrepreneurial intent. It also emphasises the role of risk taking in mediating the effects of these predictors on the entrepreneurial intention of young adults in South Africa.

Background: The extensive utilisation of mobile technologies (MTs) for cost reduction and improving organisational efficiency is widely acknowledged in the entrepreneurship literature. Despite the fact, the effect of adopting MTs on the managerial competencies of small, micro and medium enterprises (SMMEs) remains incomprehensible by emerging construction firms (ECFs). Objectives: This study contributes to the theory and practise of competency development in project management (PM) by exploring how MT adoption intensity during project execution affects the perceived managerial competencies of owners/project managers of ECFs. Method: This quantitative study employed the perspectives of 222 ECF owners/managers surveyed in the Free State province of South Africa. It established how the adoption of MTs during project execution impacted the perceived managerial competencies of these entrepreneurs. Results: The results indicated that the adoption of MTs during project execution has a positive and significant effect on the communicative and social competencies of ECF owners and managers, with MT adoption explaining 88.0% of the variance in communicative competencies and 87.9% in social competencies. The results further demonstrate that the type of device used (laptops and tablets) moderated the strength of the MT adoption – managerial competencies relationship. Conclusion: The study recommends targeted and strategic wider rollout of specific MTs that improve managerial competencies to optimise the efficiency of project-related operations. Contribution: The article contributes to the broader PM theory and literature especially competency-based project execution by exploring how MT adoption can facilitate greater communication and social competencies that improve the organisational efficiency of ECFs.

The spring 2023 issue of *Patient Safety* is available to read and download at no charge. This issue features four articles that came out of the Patient Safety Authority’s first master class in writing quality improvement studies. Workshop facilitator Olivia Lounsbury, Quality and Safety Program coordinator at the Johns Hopkins Children’s Center, guided participants in writing about recent studies that had an impact on patient care so others could learn from and replicate their work. * A community hospital took broad, innovative steps to [increase compliance with sepsis treatment best practices](https://patientsafetyj.com/article/74015-improving-sepsis-compliance-with-human-factors-interventions-in-a-community-hospital-emergency-room) to meet state and national benchmarks. * A team introduced [a process to properly identify, document, and evaluate patients’ risk of adverse drug reactions](https://patientsafetyj.com/article/74022-adverse-drug-reactions-in-moderate-sedation-process-improvement-during-a-pandemic) during moderate sedation. * Researchers [studied methods of collecting urine for lab analysis](https://patientsafetyj.com/article/74060-reduction-of-patient-harm-through-decreasing-urine-culture-contamination-in-an-emergency-department-using-multiple-process-improvement-interventions) to prevent contaminated samples from resulting in incorrect diagnoses or delayed care. * A team introduced [a first-of-its-kind virtual consultation hotline for staff with central line concerns](https://patientsafetyj.com/article/74075-preventing-central-line-bloodstream-infections-an-interdisciplinary-virtual-model-for-central-line-rounding-and-consultation) to help identify bloodstream infections rapidly and reduce patient harm. This issue also includes new research articles looking at how healthcare can [learn from alarm and alert designs from other industries](https://patientsafetyj.com/article/73905-informing-healthcare-alarm-design-and-use-a-human-factors-cross-industry-perspective), and [how to assess equipment, supplies, and devices for patient safety issues](https://patientsafetyj.com/article/73988-assessing-equipment-supplies-and-devices-for-patient-safety-issues); a discussion with Dr. Nirmal Joshi, chair of the Patient Safety Authority, about [the past, present, and future of healthcare](https://patientsafetyj.com/article/74081-view-from-the-top-an-interview-with-patient-safety-authority-chair-dr-nirmal-joshi); and stories about [the powerful impact event reporting has made on patient care](https://patientsafetyj.com/article/74079-events-that-inspired-change-the-importance-of-sharing-what-happened-to-stop-it-from-happening-again). *Patient Safety* is fully open access (no fees for authors or readers). We welcome submissions from all over the world. If your manuscript can help advance patient safety, please [send it to us for consideration](https://patientsafetyj.com/for-authors), and kindly share our journal articles with anyone who would benefit from them.

Plain English summary Pain management programmes delivered in a group format are best practice to support people living with persistent non-cancer pain to live well. Some people can find accessing these programmes hard due to lack of referral, transportation costs and lack of trained health professionals. Further, people from Indigenous and non-Western backgrounds are poorly represented in these programmes despite having a high prevalence of persistent pain. One way of improving access is delivering services via technology. We aimed to co-design an online version of an existing hospital-based pain management programme (iSelf-help) and to ensure cultural appropriateness of the iSelf-help for Māori. Māori are the Indigenous population of Aotearoa (an accepted Māori word to describe New Zealand). We used a modified participatory action research (PAR) framework for our co-design process. This framework actively encouraged people with lived experience of pain and community partners to have a voice in the content design. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended hospital-based pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR team. We used a Nominal Group Technique, whereby PAR team members ranked their preferences on content design and delivery, until concensus was reached. In parallel, three focus groups (n = 15) were held with Māori living with persistent pain in collaboration with a Māori community health trust. All contents were reviewed by a Māori Health literacy expert and core contents were translated into Te Reo (Māori language). The finalised version of iSelf-help included 130 resources, tested for accessibility, organised in to 12 online modules plus a dedicated welcoming page and an online community forum. Each module included: short videos, animations, patient stories, podcasts of relaxation techniques, illustrated texts, and evidence-summaries. This is the first co-created, culturally appropriate, on-line group pain management programme for people with persistent pain, developed in Aotearoa. We are currently evaluating if iSelf-help is acceptable to users, and clinically and cost effective as compared to the hospital-based pain management programme.

Background: Although knowledge management (KM) directly impacts firm competitiveness, in efficiency-driven economies such as South Africa, the contribution of operational efficiency to this relationship has been underexplored in KM literature. Objectives: This study examined how operational efficiency interacts with KM to influence firm competitiveness. The study employs the South African context to enrich knowledge on the effects of KM on firm competitiveness and the extent to which operational efficiency mediates the process. Method: Using a quantitative approach with a survey design, 300 structured questionnaires were distributed to 300 small, medium and micro enterprise (SMME) owners and managers in the Free State province to establish the interaction of KM, operational efficacy and competitiveness. Results: The results of path coefficients revealed KM’s positive and significant effect on firm competitiveness. Moreover, operational efficiency partially mediated KM (recognition) (B = 0.1545, p = 0.019) and KM (implementation)’s (B = 0.0697, p = 0.050) effects on firm competitiveness. Conclusion: The prevalence of highest qualification among SMME owners/managers demonstrates that human capital development, especially business management training during business start-ups, may contribute to increased firm competitiveness. Moreover, the lack of resources in managing knowledge for implementing daily routines and increasing sales demonstrates that improved resource mobilisation by SMMEs might improve their competitiveness. Contribution: The study provides strategic interventions for improving SMME competitiveness through better management of their knowledge practices and operational efficiency.

IntroductionStunting (low height/length-for-age) in early life is associated with poor long-term health and developmental outcomes. Nutrition interventions provided during the first 1,000 days of life can result in improved catch-up growth and development outcomes. We assessed factors associated with stunting recovery at 24 months of age among infants and young Children enrolled in Pediatric Development Clinics (PDC) who were stunted at 11 months of age.MethodsThis retrospective cohort study included infants and young children who enrolled in PDCs in two rural districts in Rwanda between April 2014 and December 2018. Children were included in the study if their PDC enrollment happened within 2 months after birth, were stunted at 11 months of age (considered as baseline) and had a stunting status measured and analyzed at 24 months of age. We defined moderate stunting as length-for-age z-score (LAZ) < -2 and ≥-3 and severe stunting as LAZ -2. We used logistic regression analysis to investigate factors associated with stunting recovery. The factors analyzed included child and mother's socio-demographic and clinical characteristics.ResultsOf the 179 children who were eligible for this study, 100 (55.9%) were severely stunted at age 11 months. At 24 months of age, 37 (20.7%) children recovered from stunting, while 21 (21.0%) severely stunted children improved to moderate stunting and 20 (25.3%) moderately-stunted children worsened to severe stunting. Early stunting at 6 months of age was associated with lower odds of stunting recovery, with the odds of stunting recovery being reduced by 80% (aOR: 0.2; 95%CI: 0.07-0.81) for severely stunted children and by 60% (aOR: 0.4; 95% CI: 0.16-0.97) for moderately stunted children (p = 0.035). Lower odds of stunting recovery were also observed among children who were severely stunted at 11 months of age (aOR: 0.3; 95% CI: 0.1-0.6, p = 0.004). No other maternal or child factors were statistically significantly associated with recovery from stunting at 24 months in our final adjusted model.ConclusionA substantial proportion of children who were enrolled in PDC within 2 months after birth and were stunted at 11 months of age recovered from stunting at 24 months of age. Children who were severely stunted at 11 months of age (baseline) and those who were stunted at 6 months of age were less likely to recover from stunting at 24 months of age compared to those with moderate stunting at 11 months and no stunting at 6 months of age, respectively. More focus on prevention and early identification of stunting during pregnancy and early life is important to the healthy growth of a child.

The December 2022 issue of Patient Safety is available to read and download at no charge. Our latest publication offers vital information, tools, resources, and articles that can help improve the safety and well-being of patients and healthcare workers in the new year. • Taylor et al. describe[ a patient safety initiative that reduced the incidence of perioperative emergence delirium at a Veterans Affairs hospital](https://patientsafetyj.com/index.php/patientsaf/article/view/emergence-delirium)—and provide you with everything you need to replicate their work. • What is the past, present, and future of nursing? Nursing professor Eileen Fruchtl discusses [how nursing education has been evolving and what it may become](https://patientsafetyj.com/index.php/patientsaf/article/view/nursing-education) following the pandemic, and Toothaker et al. look at [the challenges recently graduated nurses face as they transition into the workforce](https://patientsafetyj.com/index.php/patientsaf/article/view/nurse-transition). • John Olsen et al. describe [the success and impact of Jefferson Health’s peer support program, RISE](https://patientsafetyj.com/index.php/patientsaf/article/view/Jefferson-rise) (Resilience in Stressful Events). • Abigail Baluyot et al. share [communication problems they identified in patient hand-offs between hospitals and skilled nursing facilities](https://patientsafetyj.com/index.php/patientsaf/article/view/hospital-snf-communication), and what they did to improve the process. This issue also includes an important [safety alert about the risk of air embolism during cardiac ablation procedures](https://patientsafetyj.com/index.php/patientsaf/article/view/air-embolism), an [update to acute care reporting rates in Pennsylvania last year](https://patientsafetyj.com/index.php/patientsaf/article/view/2021-data-update), and an inside look at how prison systems in Pennsylvania deliver healthcare to inmates. Patient Safety is fully open access (no fees for authors or readers). We welcome submissions from all over the world. If your work can help advance patient safety, please [submit it to us for consideration](https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers.

The present study investigates the effect of intercropping (maize-cowpea, maize-okra, maize-okra-cowpea, okra-cowpea) compared to insecticide application on the level of infestation of insect pests and the final yield of maize, cowpea and okra. Field experiments were conducted during the 2016 and 2017 cropping seasons in the Guinean Savannah (Dang-Ngaoundere) and Sudano Sahelian (Gouna-Garoua) agro-ecological zones in Cameroon. Our experimental design was a split plot arrangement in a randomized complete block with four replications. The main factor was assigned to the use of insecticide (Cypermethrin) and sub plots were devoted for cropping systems. We compared the efficiency of intercropping to that of Cypermethrin application on the Yield of maize, cowpea and okra as influenced by insect pest damages. The comparison of monocropped sprayed by Cypermethrin to unsprayed showed that, in Dang, insect pests reduced maize yield by 37% and 24% in 2016 and 2017, respectively, whereas in Gouna, it was lower than 8% during the both years. Reduction in seed yield by insect pests on cowpea in Dang represented 47% and 50% in 2016 and 2017, respectively, whereas in Gouna, it was 55% and 63% in 2016 and 2017, respectively. For okra, insect pests reduced okra fruit yield by 25% and 44% in Dang and 23% and 28% in Gouna, respectively, in 2016 and 2017. Crop yield was lower in intercropping compared to monoculture due to competition of plants in association on different resources. Considering the total yields obtained from each intercropping, intercropping trials resulted generally in higher yields compared to mono-culture (LER > 1) in both sites and years but the respective yields were quite different. On the basis of the results obtained, we recommend maize-cowpea intercropping as a sustainable solution to reduce the infestation level of their pest insects.

Objective: The outbreak of coronavirus disease 2019 (COVID-19) in South Kivu, Democratic Republic of Congo raised concerns regarding additional morbidity and mortality. Updating these indicators before a second wave is essential in order to prepare for additional help. Methods: From mid-May to mid-December 2020, weekly surveys were undertaken in sampled streets from 10 health areas to quantify the use of barrier measures, and interview pedestrians about sickness and deaths in their households. Crude death rates (CDRs) were estimated. Results: Minimal use or no use of face masks was observed in at least half of the streets. From May to December 2020, the number of suspected cases of COVID-19 increased six-fold (P < 0.05). Of deaths within 30 days preceding the interviews, 20% were considered to be related to COVID-19. The monthly CDRs at the beginning and end of the study were approximately 5 and 25 per 1000 population, respectively (P < 0.05); that is, annual CDRs of 60 and 260 per 1000 population, respectively. Thus, during the first wave, the estimated mortality rate increased by 50% compared with previous years, and increased at least four-fold by the end of 2020. Conclusion: Despite possible overestimations, the excess mortality in South Kivu is extremely concerning. This crisis calls for a rapid response and increased humanitarian assistance.

Patient Experience Journal (PXJ) is excited to announce the call for submissions for its July/August 2023 special issue focused on exploring the emerging frontiers of human experience in healthcare. As shared in the recent PXJ article, Reexamining “Defining Patient Experience”: The human experience in healthcare: "The rapid evolution in the recognition of the humanity in healthcare has required us to view the human healthcare experience not just as a person-centered process or relationship-based encounter. It is an intricate tapestry of human interaction both in the clinical and non-clinical settings across the continuum of care and into the communities served by healthcare organizations around the world. It must take into account the experiences of those who work in healthcare and the experiences communities have with healthcare organizations and systems overall." This perspective pushes us to look beyond the essential questions of what matters to patients, family members or care partners to appreciate how the patient experience is shaped by the needs of the healthcare workforce and the communities they serve around the world. These ideas, reinforced in the recent Declaration for Human Experience (https://transformhx.org/) call on us to think about where the efforts to transform the human experience in healthcare are leading. This special issue is intended to push those boundaries even further.

Orientation: The prominence of technology acquisition and transfer amongst small firms in entrepreneurial literature does not provide a compelling explanation for the processes and mechanisms through which such variables impact the performance of these firms. Research purpose: The study investigates the extent to which specific human resource practices mediate the interaction between technology acquisition and performance of small cosmetology firms in the Central region of South Africa. Motivation for the study: The extensive examination of technology acquisition and human resource practices fails to provide significant insights into the interaction of these factors in shaping the performance of small firms. Research approach/design/method: From a population estimate of 500 hair salons situated in the Central region of South Africa, a survey was administered on randomly selected 150 hair salons. Statistical Package for Social Sciences (SPSS, Version 20) and Partial Least Squares Structural Equation Modelling (PLS-SEM) were used to analyse the 110 returned questionnaires that were complete and usable. Main findings: The findings demonstrated a direct, positive and significant effect of technology acquisition on small, micro and medium enterprise (SMME) performance and confirmed the partial mediation of employee technical skills training on the interaction between technology acquisition and hair salon performance. Surprisingly, general business skills training partially but negatively mediated technology acquisition’s interaction with hair salon performance. Practical/managerial implications: It is recommended that policymakers and entrepreneurs emphasise training technical skills development and acquisition of technology to improve the performance of their businesses. Contribution/value-add: The main contribution of this study lies in its provision of mechanisms through which the acquisition of technology impacts small firms, business entities that are under theorised and less robustly studied in developing countries’ contexts.

Abstract Background In most health areas, an information system is necessary for an effective fight against COVID-19. Current methods for surveillance of diseases with epidemic potential do not include monitoring the adherence to preventive measures. Furthermore, modern data collection methods depend often on technologies (e.g., cameras or drones) that are hardly available in low-income countries. Simpler solutions could be just as effective. Methods A dashboard was used over a whole week to monitor preventive measures in Bukavu (DRC) by mid-May 2020. It was designed to collect from street passers-by information on the adherence to barrier measures, the level of awareness of these measures, the opinion on their usefulness, and the health status of people in the households. Results Creating a dashboard and collecting the necessary data proved feasible. The use of barrier measures was very limited and that of masks practically nil despite repeated recommendations from the health authorities. The end of each day was the worst moment due to clearly insufficient distancing. Barrier measures were significantly more used in areas where they were best known and most acknowledged. At the time of the study, there were few sick people and only rare severe cases were attributed to COVID-19. Conclusions Creating COVID-19 situation dashboards in limited-resource metropoles is feasible. They give real-time access to data that help fight the epidemic. The findings of this pilot study call for a rapid community awareness actions to back national media-based prevention campaigns.

Introduction Ebola virus disease (EVD) continues to be a significant public health problem in sub-Saharan Africa, especially in the Democratic Republic of the Congo (DRC). Large-scale vaccination during outbreaks may reduce virus transmission. We established a large population-based clinical trial of a heterologous, two-dose prophylactic vaccine during an outbreak in eastern DRC to determine vaccine effectiveness.Methods and analysis This open-label, non-randomised, population-based trial enrolled eligible adults and children aged 1 year and above. Participants were offered the two-dose candidate EVD vaccine regimen VAC52150 (Ad26.ZEBOV, Modified Vaccinia Ankara (MVA)-BN-Filo), with the doses being given 56 days apart. After vaccination, serious adverse events (SAEs) were passively recorded until 1 month post dose 2. 1000 safety subset participants were telephoned at 1 month post dose 2 to collect SAEs. 500 pregnancy subset participants were contacted to collect SAEs at D7 and D21 post dose 1 and at D7, 1 month, 3 months and 6 months post dose 2, unless delivery was before these time points. The first 100 infants born to these women were given a clinical examination 3 months post delivery. Due to COVID-19 and temporary suspension of dose 2 vaccinations, at least 50 paediatric and 50 adult participants were enrolled into an immunogenicity subset to examine immune responses following a delayed second dose. Samples collected predose 2 and at 21 days post dose 2 will be tested using the Ebola viruses glycoprotein Filovirus Animal Non-Clinical Group ELISA. For qualitative research, in-depth interviews and focus group discussions were being conducted with participants or parents/care providers of paediatric participants.Ethics and dissemination Approved by Comité National d’Ethique et de la Santé du Ministère de la santé de RDC, Comité d'Ethique de l'Ecole de Santé Publique de l’Université de Kinshasa, the LSHTM Ethics Committee and the MSF Ethics Review Board. Findings will be presented to stakeholders and conferences. Study data will be made available for open access.Trial registration number NCT04152486.

In celebration of National Pharmacist Day, recognizing the importance of pharmacists and their crucial role in our health and well-being, today we are publishing a special issue of _Patient Safety_ dedicated to pharmacy education and practice. Our January 2022 issue is now available to read and download at no charge at PatientSafetyJ.com. It features timely manuscripts from pharmacy students, practitioners, educators, and experts: data articles, focused reviews, interviews, and perspectives and insights about advances and challenges in the field now and in the near future. • Michael Cohen, founder and president of the Institute for Safe Medication Practices, discusses [the importance of sharing information](https://patientsafetyj.com/article/73489) • [A close look at antibiotic stewardship](https://patientsafetyj.com/article/73492)in a community hospital emergency department • Daniel Degnan shares [how to develop good habits](https://patientsafetyj.com/article/73491) to better your life and work practices • Learn how a hospital and pharmacy school [collaborated to instill appreciation of safety culture](https://patientsafetyj.com/article/73490) in students • Children and babies are uniquely vulnerable to medication errors in the hospital—but [there are ways to keep them safe](https://patientsafetyj.com/article/73493) • Patrick McDonnell describes [the challenges and rewards of being an academic pharmacist](https://patientsafetyj.com/article/73495) • [Strategies for reducing immunization-related stress and anxiety](https://patientsafetyj.com/article/73494) that can improve safety and combat vaccine hesitancy Thank you to our authors, peer reviewers, editorial board members, and Patient Safety Authority staff for making _Patient Safety_ possible—and special appreciation to this issue’s guest editors: Michael Cohen, ScD (hon.), DPS (hon.), RPh; Daniel Degnan, PharmD; and Patrick McDonnell, PharmD. _Patient Safety_ is fully open access (no fees for authors or readers) and published on a rolling basis throughout the year. We welcome manuscripts from all over the world. If your work can help advance patient safety, please [submit it to us for consideration](https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers. [Subscribe to our journal email list](https://lp.constantcontactpages.com/sl/otqI5QB/journalupdates) to be updated on new articles as they are published online.