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Abstract Background Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the “Caring for Providers to Improve Patient Experience” (CPIPE) intervention, which includes five strategies, targeting provider stress and bias as intermediate factors to improve PCMC and address inequities. Methods The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will be assessed among healthcare workers in the study health facilities and among women who give birth in the study health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness. Discussion This trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health. Trial registration ClinicalTrials.gov: NCT06085105. Protocol version and date: v2-11-07-23

Retroperitoneal tumors are uncommon and may reach a large size prior to causing symptoms or being noticed by the patient or physician. A middle-aged female consulted us for care during her “terminal” illness. She had already undergone four previous retroperitoneal resection surgical procedures. She presented with a large recurrent protruding mass from the right side of the abdomen and related a history of a previous cholecystectomy, right nephrectomy, right colectomy, and repeated resection of a recurrent retroperitoneal liposarcoma. She thus came to us for consultation and terminal care in order to be away from her friends during treatment for this terminal condition. After our consultation, she elected to have repeated surgical excisions of the tumor. The surgical excisions yielded a giant recurrent tumor mass, which overflowed and covered all margins of the 21-inch-wide surgical scrub basin. Over the next eleven years, she had multiple surgical resection procedures involving both the right and left retroperitoneum (a splenectomy, a left colectomy, and a colostomy). Recovery from each of these resection procedures (the final combined resection weight was 120 pounds) was without complications. However, the tumor finally encased the pancreas and the left kidney. If the tumor encasement were to be palliated and resected, she would require hemodialysis. At this time, the patient elected to have no further resection surgeries, no dialysis, nor any palliative chemoradiation treatment. Over a period of sixteen years from her first resection and twelve years from our first resection, the patient had continued to work at her medical administrative and leadership position and led a functional life after our consultation, except for her surgical period. The patient was not cured but benefited from repeated palliative surgeries, prolonging her life and improving her job performance.

Abstract Background African countries are among the most vulnerable and affected by climate change. Comprehending climate change poses a major hurdle for the African population, politicians, and the African Union alike, presenting a substantial challenge for all involved. It is generally accepted that universities and other higher education institutions must play a leading role as drivers of change. Therefore, it is very important that African universities educate students about both mitigation and adaptation measures, develop the necessary initiatives to foster research in climate change-related topics and promote cooperation and alliances with key stakeholders. Results This research reports on a study aimed at identifying the extent to which higher education institutions in Africa are engaging in efforts to deal with the challenges posed by climate change. The objectives were accomplished through a mixed method approach, incorporating a review of literature, an international survey, and the inclusion of selected case studies from African universities that have developed successful initiatives. The research has brought to light significant disparities, such as varying perceptions regarding the potential outcomes of climate change and its associated extreme events in African countries. In addition, the study highlighted areas where there is a notable consensus on specific issues. It also offers a comprehensive view of the different strategies that universities are implementing to contribute to climate change mitigation and adaptation in several areas. Although there is a growing interest in the need to contribute to the joint task of mitigating the effects of climate change and adapting to its consequences, HEIs need to increase their efforts to enhance the work of their professors and researchers. To this end, the involvement of public authorities and other private sector actors is essential. Conclusions This article outlines some actions that need to be undertaken so that universities may play a more active role in global efforts to handle the problems associated with a changing climate. There is a notable focus from academic actors on addressing climate change challenges in Africa. In addition, there is a proactive emphasis on utilizing science and research to comprehend climate change issues and offer widely applicable tools for adaptation and mitigation to safeguard both people and the environment. Consequently, it is crucial and time-sensitive for African universities to enhance their expertise in the field of climate change, fostering the capacity to conduct innovative research that addresses the various challenges linked to the evolving climate. This study offers several useful lessons for African universities to replicate experiences that have generated results in different countries and contexts.

Abstract In exploring nature's potential in addressing diabetes-related conditions, this study investigates the therapeutic capabilities of 3-formyl chromone derivatives. Utilizing in silico methodologies, we focus on 6-substituted 3-formyl chromone derivatives (1–16) to assess their therapeutic potential in treating diabetes. The research examined the formyl group at the chromone’s C-3 position. ADMET, biological activities, were conducted along with B3LYP calculations using 3 different basis sets. The analogues were analyzed based on their parent structure obtained from PubChem. The HOMO–LUMO gap confirmed the bioactive nature of the derivatives, NBO analysis was performed to understand the charge transfer. PASS prediction revealed that 3-formyl chromone derivatives are potent aldehyde oxidase inhibitors, insulin inhibitors, HIF1A expression inhibitors, and histidine kinase. Molecular docking studies indicated that the compounds had a strong binding affinity with proteins, including CAD, BHK, IDE, HIF-α, p53, COX, and Mpro of SARS-CoV2. 6-isopropyl-3-formyl chromone (4) displayed the highest affinity for IDE, with a binding energy of − 8.5 kcal mol−1. This result outperformed the affinity of the reference standard dapagliflozin (− 7.9 kcal mol−1) as well as two other compounds that target human IDE, namely vitexin (− 8.3 kcal mol−1) and myricetin (− 8.4 kcal mol−1). MD simulations were revealed RMSD value between 0.2 and 0.5 nm, indicating the strength of the protein–ligand complex at the active site.

Patients present a wide range of clinical severities in response severe acute respiratory syndrome coronavirus 2 infection, but the underlying molecular and cellular reasons why clinical outcomes vary so greatly within the population remains unknown. Here, we report that negative clinical outcomes in severely ill patients were associated with divergent RNA transcriptome profiles in peripheral immune cells compared with mild cases during the first weeks after disease onset. Protein–protein interaction analysis indicated that early-responding cytotoxic natural killer cells were associated with an effective clearance of the virus and a less severe outcome. This innate immune response was associated with the activation of select cytokine–cytokine receptor pathways and robust Th1/Th2 cell differentiation profiles. In contrast, severely ill patients exhibited a dysregulation between innate and adaptive responses affiliated with divergent Th1/Th2 profiles and negative outcomes. This knowledge forms the basis of clinical triage that may be used to preemptively detect high-risk patients before life-threatening outcomes ensue.

Despite advances in hookworm control and prevention campaigns, the prevalence remains high in sub-Saharan Africa. Iron deficiency anaemia is a major complication in those with prolonged infection, a high hookworm burden, and undernutrition, though most infected people are asymptomatic. While infected patients are commonly diagnosed by the presence of ova or cysts in the stool, gastrointestinal (GI) endoscopy is required for those with negative stool tests and chronic iron deficiency anaemia. A 48-year-old female with symptoms of anaemia for nearly two years presented to Mbarara Regional Referral Hospital with worsening palpitations, easy fatigability, and dizziness over a period of one month. She was given blood transfusions on two occasions. She lives near the lake where she also gets water for drinking and domestic use. We advise GI endoscopy for all patients with chronic iron deficiency anaemia of unexplained aetiology on standard non-invasive testing. Hookworm’s mass empirical treatment policy in endemic areas should be further emphasised.

Abstract Background Prostate cancer is the leading cause of cancer-related death and the second most commonly diagnosed cancer among men in Uganda and most countries in Sub-Saharan Africa (SSA). The TMPRSS2-ERG fusion gene is the most common genetic alteration seen among prostate cancer patients. There are several contradicting reports about the association of ERG protein with poor prognosis, high PSA, and Gleason score. This study determined the prevalence of ERG expression and the relationship with PSA, Gleason score, and Age of prostate cancer patients in Southwestern Uganda. Methods We reviewed 130 archived prostate biopsy (needle and TURP) specimens from patients of age ≥ 50 years who had a histological diagnosis of prostate cancer. We obtained their biodata, and preoperative PSA, from the archived records. We did Immunohistochemistry (IHC) to determine the prevalence of ERG expression. Results The mean patient age in our study was 74.64 ± 10.19 years. Pre-operative PSA levels had been done for 79.2% of the participants. Most cancers (58.46%) were of high grade (grade group 3–5). ERG expression prevalence was 75.4% and its expression was independent of age, re-operative PSA, and Gleason score. Conclusion There is a significantly higher prevalence of ERG expression in our study compared to what is reported in other African-based studies. The expression of the ERG is independent of age, Gleason score, and serum PSA levels. A high proportion of our prostate cancer has high-grade disease at the time of diagnosis.

Abstract Background Uganda has approximately 1.2 million people aged 15–64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected women are more likely to have human papilloma virus (HPV) infection progress to cancer than women not infected with HIV. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods We conducted a comparative cross-sectional study of 210 women aged 22–65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were obtained for microscopy to observe premalignant cervical lesions. Multivariate logistic regression was performed to determine the association between HIV status and premalignant cervical lesions. Results The overall prevalence of premalignant cervical lesions in the study population was 17% (n = 72; 95% C.I: 14.1–21.4), with 23% (n = 47; 95% C.I: 17.8–29.5) in women living with HIV and 12% (n = 25; 95% C.I: 8.2–17.1) in women not living with HIV (p

Abstract Clouds, crucial for understanding climate, begin with droplet formation from aerosols, but observations of this fleeting activation step are lacking in the atmosphere. Here we use a time-gated time-correlated single-photon counting lidar to observe cloud base structures at decimeter scales. Results show that the air–cloud interface is not a perfect boundary but rather a transition zone where the transformation of aerosol particles into cloud droplets occurs. The observed distributions of first-arriving photons within the transition zone reflect vertical development of a cloud, including droplet activation and condensational growth. Further, the highly resolved vertical profile of backscattered photons above the cloud base enables remote estimation of droplet concentration, an elusive but critical property to understanding aerosol–cloud interactions. Our results show the feasibility of remotely monitoring cloud properties at submeter scales, thus providing much-needed insights into the impacts of atmospheric pollution on clouds and aerosol-cloud interactions that influence climate.

Objectives: Current National Comprehensive Cancer Network guidelines recommend definitive chemoradiation rather than surgery for patients with locally advanced clinical stage T3 and N2 (stage IIIB) lung cancer involving the chest wall. The data supporting this recommendation are controversial. We studied whether surgery confers a survival advantage over definitive chemoradiation in the National Cancer Database. Methods: We identified all patients with clinical stage T3 and N2 lung cancer in the National Cancer Database from 2004 to 2017 who underwent a lobectomy with en bloc chest wall resection and compared them with patients with clinical stage T3 and N2 lung cancer who had definitive chemoradiation. We used propensity score matching to minimize confounding by indication while excluding patients with tumors in the upper lobes to exclude Pancoast tumors. We used 1:1 propensity score matching and Kaplan–Meir survival analyses to estimate associations. Results: Of 4467 patients meeting all inclusion/exclusion criteria, 210 (4.49%) had an en bloc chest wall resection. Patients undergoing surgical resection were younger (mean age = 60.3 ± 10.3 years vs 67.5 ± 10.4 years; P

Abstract Cognitive dysfunction and dementia are critical symptoms of Lewy Body dementias (LBD). Specifically, alpha-synuclein (αSyn) accumulation in the hippocampus leading to synaptic dysfunction is linked to cognitive deficits in LBD. Here, we investigated the pathological impact of αSyn on hippocampal neurons. We report that either αSyn overexpression or αSyn pre-formed fibrils (PFFs) treatment triggers the formation of cofilin-actin rods, synapse disruptors, in cultured hippocampal neurons and in the hippocampus of synucleinopathy mouse models and of LBD patients. In vivo, cofilin pathology is present concomitantly with synaptic impairment and cognitive dysfunction. Rods generation prompted by αSyn involves the co-action of the cellular prion protein (PrPC) and the chemokine receptor 5 (CCR5). Importantly, we show that CCR5 inhibition, with a clinically relevant peptide antagonist, reverts dendritic spine impairment promoted by αSyn. Collectively, we detail the cellular and molecular mechanism through which αSyn disrupts hippocampal synaptic structure and we identify CCR5 as a novel therapeutic target to prevent synaptic impairment and cognitive dysfunction in LBD.

The productivity of the quarry during the wet season heavily depends on how well the personnel adjusts to the mine's environmental conditions and management plans. The improvement of granite production through workers' impact identification and mining advancement decision-making in Ondo State, Nigeria, has been considered in this study. The rate of granite production and the factors influencing workers’ efficiency were assessed using a well-structured survey and descriptive-analytic technique. To improve the production rate, the Multiple Criteria Decision-Making (MCDM) technique was used to select the most productive pit depending on a number of key labor impact factors. Health and safety in employment, the energy crisis, market conditions and level of competition, on-site accidents, natural disasters, and language barriers were some of the factors identified as external influencer factors affecting mine labor efficiency in granite quarrying. Finally, using the criteria's significance through the inter-criterion (CRITIC) approach, the mine workers’ influence on production was estimated and utilized for the best pit selection. The result of the MCDM revealed that the five pits (Pit 1, Pit 2, Pit 3, Pit 4, and Pit 5) had the following decision performance scores: 0.659, 0.617, 0.5, 0.5, and 0.5, respectively. This made Pit 1 the best production pit to be considered during the rainy season. The optimal solution was validated with the 2021 production report. The report shows that production from Pit 1 had the highest revenue of $16,000 Per annum, the lowest dewatering cost, and the highest production rate compared to the other four pits.

An inclusive and socially legitimate governance structure is absent to address concerns over new agricultural biotechnologies. Establishing an agricultural bioethics commission devoted to inclusive deliberation on ethics and governance in agricultural and food biotechnology is urgent. Highlighting the social and ethical dimensions of current agricultural bioengineering disputes in the food system, we discuss how a nationally recognized policy forum could improve decision-making and increase public understanding of the issues. We clarify ways the concepts that are used to categorize food and frame governance of food affect consumer choices, and how dissemination of information and the mode of dissemination can contribute to social inequities. We cite the record of medically-oriented bioethic commissions and the history of international bioethic commissions in support of our argument, and end by discussing what such a commission dedicated to agriculture and food issues could reasonably be expected to achieve.

Introduction Sexual violence is a significant public health concern with severe physical, social and psychological consequences, which can be mitigated by health service utilisation. However, in Uganda and much of sub-Saharan Africa, these services are significantly underused, with 9 out of 10 survivors not seeking care due to a range of psychological, cultural, economic and logistical factors. Thus, there is a strong need for research to improve health service utilisation for survivors of sexual violence.Methods and analysis The proposed study seeks to address the underutilization of health services for female survivors of sexual violence using a discrete choice experiment (DCE). The study will be conducted in the greater Masaka region of southwestern Uganda and target adult female survivors of sexual violence. We will first undertake qualitative interviews with 56 survivors of sexual violence to identify the key attributes and levels of the DCE. In order to ensure a sufficiently powered sample, 312 women who meet inclusion criteria will be interviewed. Our primary analysis will employ a mixed (random parameters) logit model. We will also model the role of individual-specific characteristics through latent class models.Ethics and dissemination The study protocol was reviewed and approved by the following ethics review boards in Uganda and the USA: the Uganda Virus Research Institute (UVRI), the Uganda National Council for Science and Technology (HS2364ES), Washington University in St Louis and the University of Michigan. Our methods conform to established guidelines for the protection of human subjects involved in research. Our dissemination plan targets a broad audience, ranging from policymakers and government agencies to healthcare providers, academic communities and survivors themselves.

Objective: To determine the association between MetS and its components with cervical cancer among women in South-western Uganda. Methods: We conducted an unmatched case-control study on 470 participants in a 1:2 case-to-control ratio among women in southwestern Uganda. We recruited 157 women with cervical cancer as cases and 313 women without cervical cancer as controls at the Mbarara Regional Referral Hospital Cervical Cancer Clinic. We assessed for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We used a multivariable binary logistic regression analysis to determine the association between MetS and its components with cervical cancer adjusted for potential confounders. We reported the adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: Cases were significantly older than controls: 52.4 ± 13.15 versus 41.9 ± 11.9 respectively, p

In this study, we synthesized novel α,β-unsaturated 2-cyanoacetamide derivatives (1–5) using microwave-assisted Knoevenagel condensation. Characterization of these compounds was carried out using FTIR and 1H NMR spectroscopy. We then evaluated their in vitro antibacterial activity against both gram-positive and gram-negative pathogenic bacteria. Additionally, we employed in silico methods, including ADMET prediction and density functional theory (DFT) calculations of molecular orbital properties, to investigate these cyanoacetamide derivatives (1–5). Molecular docking was used to assess the binding interactions of these derivatives (1–5) with seven target proteins (5MM8, 4NZZ, 7FEQ, 5NIJ, ITM2, 6SE1, and 5GVZ) and compared them to the reference standard tyrphostin AG99. Notably, derivative 5 exhibited the most favorable binding affinity, with a binding energy of -7.7 kcal mol−1 when interacting with the staphylococcus aureus (PDB:5MM8), while also meeting all drug-likeness criteria. Additionally, molecular dynamics simulations were carried out to evaluate the stability of the interaction between the protein and ligand, utilizing parameters such as Root-Mean-Square Deviation (RMSD), Root-Mean-Square Fluctuation (RMSF), Radius of Gyration (Rg), and Principal Component Analysis (PCA). A 50 nanosecond molecular dynamics (MD) simulation was performed to investigate stability further, incorporating RMSD and RMSF analyses on compound 5 within the active binding site of the modeled protein across different temperatures (300, 305, 310, and 320 K). Among these temperatures, compound 5 exhibited an RMSD value ranging from approximately 0.2 to 0.3 nm at 310 K (body temperature) with the 5MM8 target, which differed from the other temperature conditions. The in silico results suggest that compound 5 maintained significant conformational stability throughout the 50 ns simulation period. It is consistent with its low docking energy and in vitro findings concerning α,β-unsaturated cyanoacetamides.Key insights from this study include: • The creation of innovative α,β-unsaturated 2-cyanoacetamide derivatives (1–5) employing cost-effective, licensed, versatile, and efficient software for both in silico and in vitro assessment of antibacterial activity. • Utilization of FTIR and NMR techniques for characterizing compounds 1–5.

The development of gated communities within the urban realm in Ghana has become a major concern for urban planning and governance. As an aspect of the broader urban system, gated communities have a preponderant effect on the urban fabric and the achievement of urban resilience. Under the framework of the Sustainable Development Goals (SDGs) particularly Goal 11, resilience has become the preoccupation of urban planning and governance. Also, there is the realization that resilient communities are building blocks of a resilient and sustainable city. The paper argues that despite the increase in scholarship on gated communities in Ghana, no attempt has been made to relate the development of gated communities to urban resilience in spatial and temporal scales. Therefore, using systematic review methodology, the paper assessed the gated communities and urban resilience nexus in the rapidly urbanizing city of Accra, Ghana. The results revealed a dichotomous stance which portrays gated communities as both drawbacks (fragments) and promoters (fractals) of urban resilience. The paper further proffers policy recommendations and highlights empirical gaps pertaining to the gated community and urban resilience discourse in Ghana.

Abstract Background In Sub-Saharan Africa, the prevalence of dyslipidemia is on the rise, with studies showing dyslipidemia as a contributing factor to the progression of premalignant lesions to cervical cancer. In Uganda, cervical cancer and dyslipidemia are common health concerns, considering the increasing trends of dyslipidemia in the general population and inadequate information regarding dyslipidemia and cervical lesions. This study aimed to determine the prevalence of dyslipidemia and its association with precancerous and cancerous lesions of the cervix among women attending a cervical cancer clinic at the Uganda Cancer Institute. Methods This cross-sectional study was conducted from February to April 2022 among women with premalignant and malignant lesions of the cervix. Data on social demographics and health-seeking behaviours were collected using a pretested structured questionnaire after written informed consent had been obtained. Pap smear collection preceded visual inspection with acetic acid; cervical biopsies were collected appropriately from eligible participants; and cervical lesions were classified using the Bethesda system 2014. Serum lipids, total cholesterol (T.C.), high-density lipoprotein (HDLc), low-density lipoprotein (LDLc), and triglycerides (T.G.s) were analysed using the COBAS™ 6000 Clinical Chemistry Analyser. The associations were assessed using the chi-square test, and P ≤ 0.05 was considered statistically significant. Results The overall prevalence of dyslipidemia among women with cervical lesions was 118/159 (74%), and low HDLc was the most prevalent at 64.6% (95% CI 39.0–54.3). High T.C. (P = 0.05), high T.G.s (P = 0.011), and low HDL-c (P = 0.05) showed a significant association with precancerous lesions. High LDL-c (P = 0.019), high T.G.s (P = 0.02), and high T.G.s (P

Abstract Background Stroke is one of the neurological manifestations of COVID-19, leading to a significant risk of morbidity and mortality. Clinical manifestations and laboratory parameters were investigated to determine mortality predictors in this case. Method The case control study was conducted at Dr. Sardjito General Hospital,Yogyakarta, Indonesia, with data collected between July 2020 and August 2021. All recorded clinical and laboratory data from acute stroke patients with confirmed COVID-19 were collected. Baseline characteristics, bivariate, and multivariate analyses were assessed to determine significant predictors for mortality. Result This study involved 72 subjects with COVID-19 and stroke. The majority experienced ischemic stroke, with hypertension as the most prevalent comorbidity. Notably, 45.8% of subjects (p

The unsustainable expansion of cities is generating urban heat islands (UHIs) by exchanging (trading) vegetation cover (green) for built impervious surfaces which is associated with heat-related health risks, globally. This phenomenon is exacerbated by climate change and anthropogenic activities like urban population growth, particularly in African cities. This study explores the spatio-temporal trends of land surface temperature (LST), land use land cover (LULC) and their economic and health risks in the Greater Accra Metropolitan Area (GAMA) of Ghana, from 1991 to 2021. We extracted LST/LULC information from Landsat datasets to perform change analysis, alongside an online survey across 56 communities on how LST relates to economic and human health risks perceptions of residents. The results show urbanization of GAMA is trading greens for heated surfaces, impacting communities’ health risks. While the built environment grew (8.6%), the vegetation cover declined (2.5%) and the mean LST rose (0.8⁰C) in 25 years. A 30⁰C LST corresponds to the point of inflexion of exchanging green vegetative cover for heated built surfaces. The forest community of Kisseman, the populous community of Dansoman and the harbour city of Tema corresponded to the first, fourth and fifth LST quintiles, changing at −0.05⁰C, 0.06⁰C and 0.164⁰C per year. The common health risks include discomfort from heavy sweating, headaches, dehydration, thirst and skin rashes. These results call for climate action and green spatial planning through urban forestry and environmentalism in GAMA. For urban resilience and sustainable cities, we advocate green-cooling multi-purpose housing, roads, and industrial infrastructure.

Data processing and climate characterisation to study its impact is becoming difficult due to insufficient and unavailable data, especially in developing countries. Understanding climate's impact on burnt areas in Ghana (Guinea-savannah (GSZ) and Forest-savannah Mosaic zones (FSZ)) leads us to opt for machine learning. Through Google Earth Engine (GEE), rainfall (PR), maximum temperature (Tmax), minimum temperature (Tmin), average temperature (Tmean), Palmer Drought Severity Index (PDSI), relative humidity (RH), wind speed (WS), soil moisture (SM), actual evapotranspiration (ETA) and reference evapotranspiration (ETR) have been acquired through CHIRPS (Climate Hazards group Infrared Precipitation with Stations), FLDAS dataset (Famine Early Warning Systems Network (FEWS NET) Land Data Assimilation System) and TerraClimate platform from 1991 to 2021. The objective is to analyse the link and the contribution of climatic and environmental parameters on wildfire spread in GSZ and FSZ in Ghana. Variables were analysed (area burnt and the number of active fires) through Spearman correlation and the cross-correlation function (CCF) (2001 to 2021). The tests (Mann-Kendall and Sens's slope trend test, Pettitt test and the Lee and Heghinian test) showed the overall decrease in rainfall and increase in temperature respectively (−0.1 mm; + 0.8°C) in GSZ and (−0.9 mm; + 0.3°C) in FSZ. In terms of impact, PR, ETR, FDI, Tmean, Tmax, Tmin, RH, ETA and SM contribute to fire spread. Through the codes developed, researchers and decision-makers could update them at different times easily to monitor climate variability and its impact on fires.

ABSTRACTGhana is increasingly affected by climate change, increased soil aridity, demographic problems, and unfavourable environmental factors. In the context of conservation, protection and sustainable management, this study assessed the loss, gain and stable areas of vegetation cover in Ghana by considering four districts namely West Gonja and West Mamprusi; Sene and Afram Plains in two major ecological zones respectively (Guinea-savannah and Forest-savannah mosaic) to make a comparative study of their level and intensity of degradation. For this purpose, remote sensing (IMPACT toolbox), GIS and quantitative analysis (PontiusMatrix42) approaches were used and applied on Landsat ETM+, OLI TIRS and Sentinel 2B images (2001, 2011, 2021). The result shows that land uses land covers (LULCs) are changing with a high level of dynamism in both ecological zones, with particular mention over the last decade (2011–2021) in terms of degradation in the Guinean savannah zone. Losses in both zones are more considerable than gains and stability. Each zone is marked more by changes in quantity than exchanges and shifts in LULCs, thus giving us information on the rate of loss of forest resources. It is therefore essential to put in place adequate measures to fight this irreversible loss if no action is taken.

We describe a superconducting qubit derived from operating a properly designed fluxonium circuit in a zero magnetic field. The qubit has a frequency of about 4 GHz and an energy relaxation quality factor Q≈0.7×10^{7}, even though the dielectric loss quality factor of the circuit components is in the low-10^{5} range. The Ramsey coherence time exceeds 100μs, and the average fidelity of Clifford gates is benchmarked to F>0.999. These figures are expected to improve with optimized fabrication and measurement procedures. Our work establishes a ready-to-use “partially protected” superconducting qubit functioning in the frequency range of conventional transmons.

Introduction: There are high incidence and mortality rates of cervical cancer among females in East Africa. This is exacerbated by limited up-to-date data on premalignant lesions and associated factors in this setting. In this study, we determined the prevalence of cervical intraepithelial lesions and associated factors among women attending the Mbarara Regional Referral Hospital cervical cancer clinic in Southwestern Uganda. Methods: In this cross-sectional study, 364 participants were recruited from among women attending the Mbarara Regional Referral Hospital cervical cancer clinic from 1 April to 30 June 2023. On consent, the study nurse collected demographic data and Pap smears, which were microscopically examined and reported by a laboratory scientist and a pathologist following the Bethesda grading system (2014). Statistical analyses were done in STATA version 17, using proportions, Chi-square, bivariate, and multivariate logistic regression analysis to determine associated factors at ⩽0.05 significance level. Results: The mean age of participants was 41.9 years. A third of all study participants (37.6%, 132/351) were contraceptive users, mostly hormonal contraceptives (87.1%, 115/132). Almost 88% (307/351) had an unknown Human Papilloma Virus status. The prevalence of cervical intraepithelial lesions among our study participants was 6.6% (23/351), of which 73.9% (17/23) were low-grade squamous intraepithelial lesions. More than half (9/17, 52.9%) of low-grade squamous intraepithelial lesions were active hormonal contraceptive users. Use of hormonal contraceptives (OR: 3.032, p : 0.0253), use of intrauterine devices (OR: 6.284, p : 0.039), and any family history of cervical cancer (OR: 4.144, p : 0.049) were significantly associated with cervical intraepithelial lesions. Conclusion: The prevalence of cervical intraepithelial lesions was 6.6%, lower than global estimates. Use of hormonal and intrauterine device contraceptives, as well as family history of cervical cancer, were significantly associated with cervical intraepithelial lesions among our study population. Prospective studies are recommended to further understand associations between different types of intrauterine devices and hormonal contraceptives, and cervical lesions.

Introduction Person-centred care (PCC) is provision of care that is respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Saharan Africa at large. Most studies on PCC have focused on maternity care as part of the global movement of respectful maternity care. The few studies on patient experiences and health system responsiveness beyond maternal health also highlight gaps in patient experience and satisfaction as well as discrimination in health facilities, which leads to the most vulnerable having the poorest experiences. The protocol for this scoping review aims to systematically map the extent of literature focused on PCC in Ghana by identifying patient expectations and preferences, barriers and facilitators, and interventions.Methods and analysis The protocol will be guided by the Arksey and O’Malley methodological framework and recommendations by Levac et al. A comprehensive search strategy will be used to search for published articles in PubMed, EMBASE, Web of Science and the African Journals Online from their inception to August 2022. Grey literature and reference lists of included studies will also be searched. Two independent reviewers will perform the literature search, eligibility assessments and study selection. Any disagreements will be resolved through discussion with a third reviewer. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews will be used to outline the study selection process. Extracted data from the included articles will be synthesised and reported under key concepts derived from the outcomes of the scoping review.Ethics and dissemination This scoping review does not require ethical approval. The findings will be disseminated through publications and conference presentations.Scoping review registration OSF Registration DOI 10.17605/OSF.IO/ZMDH9.

IntroductionAntibodies against the SARS-CoV-2 spike protein are a critical immune determinant for protection against the virus. While virus neutralization is a key function of spike-specific antibodies, antibodies also mediate Fc-dependent activities that can play a role in protection or pathogenesis.MethodsThis study characterized serum antibody responses elicited after two doses of heterologous adenovirus-vectored (Ad26/ Ad5) vaccines.ResultsVaccine-induced antibody binding titers and Fc-mediated functions decreased over six months, while neutralization titers remained stable. Comparison of antibody isotypes elicited after Ad26/Ad5 vs. LNP-mRNA vaccination and after infection showed that anti-spike IgG1 were dominant and produced to high levels in all groups. The Ad26/Ad5 vaccines also induced IgG4 but not IgG2 and IgG3, whereas the LNP-mRNA vaccines elicited a full Ig spectrum (IgM, IgG1-4, IgA1-2). Convalescent COVID-19 patients had mainly IgM and IgA1 alongside IgG1. Despite these differences, the neutralization potencies against early variants were similar. However, both vaccine groups had antibodies with greater Fc potencies of binding complement and Fcg receptors than the COVID-19 group. The Ad26/Ad5 group also displayed a greater potency of RBD-specific antibody-mediated cellular phagocytosis.DiscussionAntibodies with distinctive quality were induced by different vaccines and infection. The data imply the utility of different vaccine platforms to elicit antibody responses with fine-tuned Fc activities.

Abstract Homogenous enantioselective catalysis is nowadays the cornerstone in the manufacturing of enantiopure substances, but its technological implementation suffers from well‐known impediments like the lack of endurable catalysts exhibiting long‐term stability. The catalytically active intermetallic compound Palladium‐Gallium (PdGa), conserving innate bulk chirality on its surfaces, represent a promising system to study asymmetric chemical reactions by heterogeneous catalysis, with prospective relevance for industrial processes. Here, this work investigates the adsorption of 10,10′‐dibromo‐9,9′‐bianthracene (DBBA) on the PdGa:A(1¯1¯1¯) Pd3‐terminated surface by means of scanning tunneling microscopy (STM) and spectroscopy (STS). A highly enantioselective adsorption of the molecule evolving into a near 100% enantiomeric excess below room temperature is observed. This exceptionally high enantiomeric excess is attributed to temperature activated conversion of the S to the R chiral conformer. Tip‐induced bond cleavage of the R conformer shows a very high regioselectivity of the DBBA debromination. The experimental results are interpreted by density functional theory atomistic simulations. This work extends the knowledge of chirality transfer onto the enantioselective adsorption of non‐planar molecules and manifests the ensemble effect of PdGa surfaces resulting in robust regioselective debromination.

Objectives: The prevalences of hypertension and depression in sub-Saharan Africa are substantial and rising, despite limited data on their sociodemographic and behavioral risk factors and their interactions. We undertook a cross-sectional study in 4 communities in the Upper East Region of Ghana to identify persons with hypertension and depression in the setting of a pilot intervention training local nurses and health volunteers to manage these conditions. Methods: We quantified hypertension and depression prevalence across key sociodemographic factors (age, sex, occupation, education, religion, ethnicity, and community) and behavioral factors (tobacco use, alcohol use, and physical activity) and tested for association by multivariable logistic regression. Results: Hypertension prevalence was higher in older persons (7.6% among 35- to 50-year-olds vs 16.4% among 51- to 70-year-olds) and among those reporting alcohol use (18.9% vs 8.5% between users and nonusers). In multivariable models, only older age (AOR 2.39 [1.02, 5.85]) and residence in the community of Wuru (AOR 7.60 [1.81, 32.96]) were independently associated with hypertension, and residence in Wuru (AOR 23.58 [7.75-78.25]) or Navio (AOR 7.41 [2.30-24.74]) was the only factor independently associated with depression. Conclusions: We report a high prevalence of both diseases overall and in select communities, a trend that requires further research to inform targeted chronic disease interventions.

IntroductionThis paper assessed the changes in the forest cover of the Gbele Resource Reserve from 1990 to 2020. This provides a basis for strengthening management decisions to protect the resources in the Gbele Resource Reserve effectively.MethodsLandsat images for 1990, 2000, 2010 and 2020 were obtained from the United States Geological Service site. They were processed and classified in the System for Earth Observation Data Access, Processing, & Analysis for Land Monitoring (SEPAL), a web-based cloud computing platform. The accuracy of the images was assessed using 50 ground-truth points obtained from the 3-5 meter spatial and near-daily temporal resolution planet satellite images from Norway’s International Climate and Forest Initiative (NICFI). Post classification change detection was used to analyse the changes in land cover from 1990 to 2000, 2000 to 2010 and from 2010 to 2020.ResultsThe analysis revealed that the total forest area was 55273.2 ha. In 1990, 74.9 % of the reserve was open forest and 24.6 % was shrubs/grass. The open forest declined to 65.8 % in 2000 and further to 62.4 % in 2010 while the shrubs/grass cover increased to 35.7 in 2010. As of 2020, the forest increased to 73.6 % while the shrub/grass cover declined to 25.8 %.DiscussionThese changes could be attributed partly to widespread charcoal production in the fringe districts and rose wood harvesting in the early 2000s. charcoal production and rosewood logging have been livelihood sources for fringe communities. The ban on the harvest and exportation of rosewood after 2010 could partly explain the sharp increase in the open forest cover from 2010 to 2020. The changes in the extent of the reserve from 1990 to 2020 revealed that the reserve can vulnerable to excessive exploitation and can also be resilient if deliberate efforts are made to protect it. It is recommended that the fringe district and municipal Assemblies should strengthen the enforcement of the ban on the logging of the rosewood and trees in the reserve for the production of charcoal.

Summary: Stroke, trauma, and neurodegenerative disorders cause loss of neurites (axons and dendrites) in addition to neuronal death. Neurite loss may result directly from a primary insult, secondary to parental neuron death, or secondary to a post-injury inflammatory response. Here, we use lipopolysaccharide and the alarmin S100β to selectively evaluate neurite loss caused by the inflammatory response. Activation of microglia and infiltrating macrophages by these stimuli causes neurite loss that far exceeds neuronal death, both in vitro and in vivo. Neurite loss is accompanied by the formation of cofilactin rods and aggregates (CARs), which are polymers of cofilin-1 and actin induced by oxidative stress and other factors. Mice deficient in either cofilin-1 or the superoxide-generating enzyme NADPH oxidase-2 show reduced CAR formation, neurite loss, and motor impairment. The findings identify a mechanism by which inflammation leads to neurite loss via CAR formation and highlight the relevance of neurite loss to functional impairment.

Abstract We present three new coset manifolds named Dixon-Rosenfeld lines that are similar to Rosenfeld projective lines except over the Dixon algebra $$\mathbb {C}\otimes \mathbb {H}\otimes \mathbb {O}$$ C ⊗ H ⊗ O . Three different Lie groups are found as isometry groups of these coset manifolds using Tits’ formula. We demonstrate how Standard Model interactions with the Dixon algebra in recent work from Furey and Hughes can be uplifted to tensor products of division algebras and Jordan algebras for a single generation of fermions. The Freudenthal–Tits construction clarifies how the three Dixon-Rosenfeld projective lines are contained within $$\mathbb {C}\otimes \mathbb {H}\otimes J_{2}(\mathbb {O})$$ C ⊗ H ⊗ J 2 ( O ) , $$\mathbb {O}\otimes J_{2}(\mathbb {C}\otimes \mathbb {H})$$ O ⊗ J 2 ( C ⊗ H ) , and $$\mathbb {C}\otimes \mathbb {O}\otimes J_{2}(\mathbb {H})$$ C ⊗ O ⊗ J 2 ( H ) .

Abstract Background Efficient and site-specific weed management is a critical step in many agricultural tasks. Image captures from drones and modern machine learning based computer vision methods can be used to assess weed infestation in agricultural fields more efficiently. However, the image quality of the captures can be affected by several factors, including motion blur. Image captures can be blurred because the drone moves during the image capturing process, e.g. due to wind pressure or camera settings. These influences complicate the annotation of training and test samples and can also lead to reduced predictive power in segmentation and classification tasks. Results In this study, we propose DeBlurWeedSeg, a combined deblurring and segmentation model for weed and crop segmentation in motion blurred images. For this purpose, we first collected a new dataset of matching sharp and naturally blurred image pairs of real sorghum and weed plants from drone images of the same agricultural field. The data was used to train and evaluate the performance of DeBlurWeedSeg on both sharp and blurred images of a hold-out test-set. We show that DeBlurWeedSeg outperforms a standard segmentation model that does not include an integrated deblurring step, with a relative improvement of $$13.4 \%$$ 13.4 % in terms of the Sørensen-Dice coefficient. Conclusion Our combined deblurring and segmentation model DeBlurWeedSeg is able to accurately segment weeds from sorghum and background, in both sharp as well as motion blurred drone captures. This has high practical implications, as lower error rates in weed and crop segmentation could lead to better weed control, e.g. when using robots for mechanical weed removal.

Abstract Background Population based cancer registries (PBCRs) are accepted as the gold standard for estimating cancer incidence in any population. However, only 15% of the world’s population is covered by high quality cancer registries with coverage as low as 1.9% in settings such as Africa. This study was conducted to assess the operational feasibility of estimating cancer incidence using a retrospective “catchment population” approach in Uganda. Methods A retrospective population study was conducted in 2018 to identify all newly diagnosed cancer cases between 2013 and 2017 in Mbarara district. Data were extracted from the medical records of health facilities within Mbarara and from national and regional centres that provide cancer care services. Cases were coded according to the International Classification of Diseases for Oncology (ICD-0-03). Data was analysed using CanReg5 and Excel. Results We sought to collect data from 30 health facilities serving Mbarara district, southwestern Uganda. Twenty-eight sources (93%) provided approval within the set period of two months. Among the twenty-eight sources, two were excluded, as they did not record addresses for cancer cases, leaving 26 sources (87%) valid for data collection. While 13% of the sources charged a fee, ranging from $30 to $100, administrative clearance and approval was at no cost in most (87%) data sources. This study registered 1,258 new cancer cases in Mbarara district. Of the registered cases, 65.4% had a morphologically verified diagnosis indicating relatively good quality of data. The Age-Standardised Incidence Rates for all cancers combined were 109.9 and 91.9 per 100,000 in males and females, respectively. In males, the most commonly diagnosed cancers were prostate, oesophagus, stomach, Kaposi’s sarcoma and liver. In females, the most common malignancies were cervix uteri, breast, stomach, liver and ovary. Approximately, 1 in 8 males and 1 in 10 females would develop cancer in Mbarara before the age of 75 years. Conclusion Estimating cancer incidence using a retrospective cohort design and a “catchment population approach” is feasible in Uganda. Periodic studies using this approach are potentially a precious resource for producing quality cancer data in settings where PBCRs are scarce. This could supplement PBCR data to provide a detailed and comprehensive picture of the cancer burden over time, facilitating the direction of cancer control efforts in resource-limited countries.

Abstract It is challenging to regenerate periodontal tissues fully. We have previously reported a heparan sulfate variant with enhanced affinity for bone morphogenetic protein-2, termed HS3, that enhanced periodontal tissue regeneration in a rodent model. Here we seek to transition this work closer to the clinic and investigate the efficacy of the combination HS3 collagen device in a non-human primate (NHP) periodontitis model. Wire-induced periodontitis was generated in ten Macaca fascicularis, and defects were treated with Emdogain or collagen (CollaPlug) loaded with (1) distilled water, (2) HS low (36 µg of HS3), or (3) HS high (180 µg of HS3) for 3 months. At the endpoint, microscopic assessment showed significantly less epithelial down-growth, greater alveolar bone filling, and enhanced cementum and periodontal ligament regeneration following treatment with the HS-collagen combination devices. When evaluated using a periodontal regeneration assessment score (PRAS) on a scale of 0–16, collagen scored 6.78 (± 2.64), Emdogain scored 10.50 (± 1.73) and HS low scored 10.40 (± 1.82). Notably, treatment with HS high scored 12.27 (± 2.20), while healthy control scored 14.80 (± 1.15). This study highlights the efficacy of an HS-collagen device for periodontal regeneration in a clinically relevant NHP periodontitis model and warrants its application in clinical trials.

Despite numerous studies on motorcycle safety, especially the compliance of helmet use laws in both developed and developing countries across the globe, little is known about the mediating role of traffic law enforcement and road safety education specifically on the relationship between helmet use influencing factors and helmet usage in general. The aim of this study was to examine the mediating role of traffic law enforcement and road safety education on the relationship between helmet usage influencing factors and motorcycle helmet usage. A total of 358 respondents from a university community that uses a motorcycle on daily bases to and from the community and for other important trip purposes completed a self-reported questionnaire in the Upper West Region of Ghana where motorcycles are predominantly used as a transportation mode. To test for the various hypotheses of this study, we developed a hypothesized single multiple mediated structural equation model and several sub-mediated models using AMOS 26.0. The results showed that the perceived safety of the helmet, weather conditions, and convenience of helmet use have positive significant impacts on helmet use. The study also found a full mediation role of the combined effect of traffic law enforcement and road safety education on the relationship of helmet use influencing factors investigated and helmet use. The study concludes that new traffic law enforcement and road safety education strategies need to be adopted to help improve upon the low prevalence of helmet use within the study area.

Background. Stroke is the highest cause of death in Indonesia. Impaired glucose tolerance becomes one of the metabolic risk factors that contribute to ischemic stroke. This study will observe the role of HbA1c level on ischemic stroke in “Dr. Sardjito” General Hospital due to limited research data of this aspect in Indonesia. Objective. The objective of this study is to explore the role of HbA1c level on ischemic stroke in prediabetic patients of “Dr. Sardjito” General Hospital, Yogyakarta. Method. This study design is non-experimental, observational study with correlation analysis approach. The research collected 106 data of non-diabetic and prediabetic ischemic stroke patients’ medical records in “Dr. Sardjito” General Hospital, recorded from 2012 until 2015. Result. A Comparison of HbA1c level in prediabetic ischemic stroke patients were significantly higher (p

Abstract Introduction Both household food insecurity and maternal common mental disorders are public health concerns in Ghana but studies on them, and their interrelatedness are scarce. Social support is an independent determinant of mental health but can also moderate the link between risk factors and mental illness. Identifying the risk factors of mental illness may provide opportunities for intervention and help reduce disease burden and impact. This study examined the association between household food insecurity or low maternal social support and maternal common mental disorders in East Mamprusi Municipality, Ghana. Methods This was a community-based, cross-sectional study involving 400 mothers with children 6–23 months selected using multi-stage sampling. Summary scores for household food insecurity, maternal social support, and maternal common mental disorders were measured using Food Insecurity Experience Scale (FIES), Medical Outcome Study Social Support Scale (SSS), and WHO Self-Reporting Questionnaire 20 items (SRQ-20) respectively in personal interviews. Poisson regression models were fitted to determine the association of household food insecurity or low maternal social support with maternal common mental disorders, controlling for selected socio-demographic variables. Results The mean age of the participants was 26.7 (± 6.68) years, and the mean FIES, SSS, and SRQ-20 scores were 5.62 [95% Confidence Interval (CI): 5.29–5.96] out of 8, 43.12 (95% CI: 41.34–44.90) out of 100, and 7.91 (95% CI: 7.38–8.45) out of 19 respectively. About two-thirds of the households (71.9%), and 72.7% and 49.5% of the women had food insecurity, low social support and probable common mental disorder respectively. In the adjusted analyses, a unit increase in FIES score was associated to a 4% increment in the predicted SRQ-20 score [Incident Risk Ratio (IRR) 1.04; 95% Confidence Interval (CI): 1.02, 1.06; p = 0.001], and the predicted SRQ-20 score of the women belonging to low social support category was 38% higher compared to that of women of high social support category (IRR 1.38; 95% CI: 1.14, 1.66; p = 0.001). Conclusion The prevalence of household food insecurity and common mental disorders among mothers are high, and both household food insecurity and low social support are significantly related to common mental disorders in women. Interventions to reduce both household food insecurity, and common mental disorders in women are warranted, and should include social support for women.

Abstract Reading is a popular leisure activity for children, teenagers, and adults. Several theories agree that reading might improve social cognition, but the empirical evidence remains tentative, with research on adolescents especially lacking. We employed a very large, and nationally representative, longitudinal dataset from the National Educational Panel Study (NEPS) in Germany to examine this hypothesis. Specifically, we tested whether reading prospectively predicted future self-reported prosocial behavior and social adjustment in adolescents, controlling for a number of covariates. Two-way cross-lagged panel analyses probed the longitudinal relationship between leisure reading and these social outcomes from Grade 6 to Grade 9. In addition, we examined the effect of cumulative reading experience across Grades 5–8 on future social outcomes, using structural equation modeling. We also explored the unique contributions of cumulative reading experience in different literary genres (classic literature, popular literature, nonfiction, comic books). Cumulative reading in general did not predict future prosocial behavior and social adjustment. However, cumulative reading of modern classic literature was positively associated with later prosocial behavior and social adjustment. Protocol registration The stage 1 protocol for this Registered Report was accepted in principle on 08 November 2021. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/KSWY7 .

In this perspective review, we describe a brief background on the status quo of diabetes mellitus-related therapies and glycemic control among patients in rural communities in sub-Saharan Africa. The article discusses insulin therapy as well as the difficulties in obtaining insulin and oral hypoglycemic medications for diabetic patients living in sub-Saharan Africa. We wrap up our discussion with suggestions on solutions and opportunities for future research to tackle this health challenge in these impoverished communities. We conducted a literature search from PubMed and Google Scholar up until August 2023. Key words were used to generate search terms used to retrieve the required information. All types of literature with pertinent information on the current topic were included in the study. Diabetes mellitus is on the rise in sub-Saharan Africa. Several studies have reported poor glycemic control, low screening rates for diabetes mellitus, cigarette smoking, high alcohol consumption, prescription of antidiabetic therapy, and associated costs as contributors to the uptake of antidiabetic treatment. Although there is paucity of data on the extent of insulin therapy uptake and its possible modifiable contributors among the diabetic patients in the region, the anticipated increase in the number of people with diabetes on the continent makes it critical for global leaders to address the research gaps in insulin therapy among rural communities of sub-Saharan Africa, thus reducing the burden of diabetes in these populations.

Hypertension and depression are increasingly common noncommunicable diseases in Ghana and worldwide, yet both are poorly controlled. We sought to understand how healthcare workers in rural Ghana conceptualize the interaction between hypertension and depression, and how care for these two conditions might best be integrated. We conducted a qualitative descriptive study involving in-depth interviews with 34 healthcare workers in the Kassena-Nankana districts of the Upper East Region of Ghana. We used conventional content analysis to systematically review interview transcripts, code the data content and analyze codes for salient themes. Respondents detailed three discrete conceptual models. Most emphasized depression as causing hypertension: through both emotional distress and unhealthy behavior. Others posited a bidirectional relationship, where cardiovascular morbidity worsened mood, or described a single set of underlying causes for both conditions. Nearly all proposed health interventions targeted their favored root cause of these disorders. In this representative rural Ghanaian community, healthcare workers widely agreed that cardiovascular disease and mental illness are physiologically linked and warrant an integrated care response, but held diverse views regarding precisely how and why. There was widespread support for a single primary care intervention to treat both conditions through counseling and medication.

Adequate preparedness of health systems, particularly healthcare workers (HCWs), to respond to COVID-19 is critical for the effective control of the virus, especially in low- and middle-income countries where health systems are overburdened. We examined Ghanaian HCWs' perceived preparedness to respond to the pandemic and the factors that shaped their preparedness and that of the health system. Semi-structured in-depth interviews were conducted with n = 26 HCWs responsible for the clinical management of COVID-19 patients and three administrators responsible for developing and implementing COVID-19 policies at the facility level. Interviews were conducted over the phone in English, transcribed, and analyzed using a thematic analysis approach. Generally, HCWs felt inadequately prepared to contain the spread of COVID-19 due to resource shortages and inadequate training. HCWs, similarly, perceived the health system to be unprepared due to insufficient clinical infrastructure and logistical challenges. The few who felt prepared identified readiness in managing high consequence infectious disease cases and pre-existing protocols as enablers of HCW preparedness. The health system and HCWs were unprepared to manage the COVID-19 pandemic due to inadequate training, logistical challenges, and weak clinical infrastructure. Interventions are urgently needed to improve the health system's preparedness for future pandemics.

IntroductionSickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be integrated into existing immunization programs in Africa to improve retrieval rates. This study explored community acceptability of integrating POCT to screen for SCD in children under 5 years of age in primary healthcare facilities in Northern Ghana.MethodThis was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022. The recorded interviews were transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using QSR Nvivo 12 software before thematic analysis.ResultsMost participants (70.9%) described SCD as serious and potentially life-threatening condition affecting children in the area. Of 148 community members and health workers, 141 (95.2%) said the screening exercise could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by participants as key factors that could affect uptake of the SCD screening exercise. Most participants suggested that intensive health education (78.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) could promote community acceptability.ConclusionA large majority of participants viewed screening of SCD in children as very important. However, opinions expressed by most participants suggest that health education and professionalism of health workers in keeping patients' information confidential could improve the uptake of the exercise.

Abstract Collisional growth of cloud droplets is an essential yet uncertain process for drizzle and precipitation formation. To improve the quantitative understanding of this key component of cloud‐aerosol‐turbulence interactions, observational studies of collision‐coalescence in a controlled laboratory environment are needed. In an existing convection‐cloud chamber (the Pi Chamber), collisional growth is limited by low liquid water content and short droplet residence times. In this work, we use numerical simulations to explore various configurations of a convection‐cloud chamber that may intensify collision‐coalescence. We employ a large‐eddy simulation (LES) model with a size‐resolved (bin) cloud microphysics scheme to explore how cloud properties and the intensity of collision‐coalescence are affected by the chamber size and aspect ratio, surface roughness, side‐wall wetness, side‐wall temperature arrangement, and aerosol injection rate. Simulations without condensation and evaporation within the domain are first performed to explore the turbulence dynamics and wall fluxes. The LES wall fluxes are used to modify the Scalar Flux‐budget Model, which is then applied to demonstrate the need for non‐uniform side‐wall temperature (two side walls as warm as the bottom and the two others as cold as the top) to maintain high supersaturation in a tall chamber. The results of LES with full cloud microphysics reveal that collision‐coalescence is greatly enhanced by employing a taller chamber with saturated side walls, non‐uniform side‐wall temperature, and rough surfaces. For the conditions explored, although lowering the aerosol injection rate broadens the droplet size distribution, favoring collision‐coalescence, the reduced droplet number concentration decreases the frequency of collisions.

The presence of variants of uncertain significance (VUS) in DNA mismatch repair (MMR) genes leads to uncertainty in the clinical management of patients being evaluated for Lynch syndrome (LS). Currently, there is no platform to systematically use tumor-derived evidence alongside germline data for the assessment of VUS in relation to LS. We developed INT2GRATE (INTegrated INTerpretation of GeRmline And Tumor gEnomes) to leverage information from the tumor genome to inform the potential role of constitutional VUS in MMR genes. INT2GRATE platform has two components: a comprehensive evidence-based decision tree that integrates well-established clinico-genomic data from both the tumor and constitutional genomes to help inform the potential relevance of germline VUS in LS; and a web-based user interface (UI). With the INT2GRATE decision tree operating in the backend, INT2GRATE UI enables the front-end collection of comprehensive clinical genetics and tumor-derived evidence for each VUS to facilitate INT2GRATE assessment and data sharing in the publicly accessible ClinVar database. The performance of the INT2GRATE decision tree was assessed by qualitative retrospective analysis of genomic data from 5057 cancer patients with MMR alterations which included 52 positive control cases. Of 52 positive control cases with LS and pathogenic MMR alterations, 23 had all the testing parameters for the evaluation by INT2GRATE. All these variants were correctly categorized as INT2GRATE POSITIVE. The stringent INT2GRATE decision tree flagged 29 of positive cases by identifying the absence or unusual presentation of specific evidence, highlighting the conservative INT2GRATE logic in favor of a higher degree of confidence in the results. The remaining 99% of cases were correctly categorized as INCONCLUSIVE due to the absence of LS criteria and ≥1 tumor parameters. INT2GRATE is an effective platform for clinical and genetics professionals to collect and assess clinical genetics and complimentary tumor-derived information for each germline VUS in suspected LS patients. Furthermore, INT2GRATE enables the collation of integrated tumor-derived evidence relevant to germline VUS in LS, and sharing them with a large community, a practice that is needed in precision oncology.

Pure and manganese doped zinc oxide nanoparticles have been successfully synthesized over the composition range, Zn1-xMnxO (0

Key Clinical Message A robust inflammatory and febrile response from acute viral illness such as with SARS‐CoV‐2 in patients with Brugada syndrome may lead to triggering of ventricular arrhythmias. The use of targeted temperature management (TTM) using cooling devices may mitigate the febrile triggering of ventricular arrhythmias in patients with Brugada syndrome. Abstract Brugada syndrome (BrS) is an autosomonal dominant genetic disorder, with a risk of ventricular tachycardia (VT). Triggers of VT in BrS include fevers. Here, we report a case of BrS secondary to SARSs‐CoV‐2 infection and the use of targeted temperature management (TTM) to decrease fever and prevent VT triggering.

AbstractThere are increasing concerns about the likely impacts of climate change on poverty, economic growth, and the overall development of poor countries. The need to adapt to the daunting challenges posed by climate change has resulted in a multiplicity of responses from various actors across scales. Evidence suggests that at the national and sub-national levels in Ghana, initiatives to address climate change are nascent. The objective of this paper is to uncover the nature of these initiatives, the actors involved and the successes and challenges for achieving sustainable outcomes through local-level interventions in Ghana. The paper adopted the qualitative cross-sectional case study design involving the use of key informant interviews, observations, focus group discussions and institutional reports. The findings suggest that initiatives for adaptation to climate change were largely autonomous since they were not necessarily outcomes from mainstream planning aimed at addressing climate change. Key actors behind the initiatives were governmental institutions, agencies, non-governmental organisations, and community leaders. The paper recommends that further efforts be made to integrate climate change adaptation initiatives at the local level of planning for proper targeting, coordination, collaboration, and sustainable adaptation.

Abstract [Figure: see text]In this study, the chemical and nutritional characteristics of the leaves of Bambusa balcooa and Oxytenanthera abyssinica bamboos, and the straws of AGRA and Amankwatia rice varieties were evaluated using three analytical methods; proximate analysis, detergent fiber analysis and in vitro gas production. Data were analyzed using General Linear Model procedures in Minitab Statistical Software at a 5% significant level. Results showed that the leaves of B. balcooa had the highest (P

Background: Hepatorenal syndrome-acute kidney injury (HRS-AKI) carries significant morbidity and mortality among those with end-stage liver disease. Bolus terlipressin for treatment of HRS-AKI received FDA approval in September 2022. US implementation of terlipressin, however, is hindered by the paucity of local data on the optimal patient population and administration mode, as well as the effect on transplant priority. The INFUSE study is designed to evaluate the use of continuous terlipressin infusion among transplant candidates with advanced liver disease and HRS-AKI. Methods: Fifty prospective patients with HRS-AKI will receive a single bolus of terlipressin 0.5 mg followed by continuous infusions of terlipressin from 2 to 8 mg/day for up to 14 days. The cohort will be enriched with those listed, in evaluation, or eligible for liver transplantation, while those with ACLF grade 3, MELD ≥35, and serum creatinine >5.0 mg/dL will be excluded. Fifty patients who received midodrine plus octreotide or norepinephrine for HRS-AKI will serve as a retrospective comparator cohort. Conclusion: The INFUSE study aims to assess the safety and efficacy of continuous terlipressin infusion among largely transplant-eligible patients with HRS-AKI, and to provide US-based data on transplant outcomes. This novel study design simultaneously mitigates terlipressin adverse events while providing renal benefits to patients, thus addressing the unmet medical need of those with HRS-AKI who have limited treatment options and are awaiting liver transplantation in the US.

Health literacy is a major determinant of health across space. At different scales, optimal interplay between individual and organizational efforts is required to ensure a health literate population. This is essential because social and environmental determinants of health influence both the individual and populations across the life course. Despite this knowledge, little is known about faith-based organizations’ health literacy assets and gaps. Drawing on the community health literacy assessment framework, health literacy assets and gaps are assessed among 50 faith-based organizations in Accra, Ghana. Specifically, the study assessed (1) how the organizations defined health literacy, (2) the strategies used in identifying health literacy concerns in their organizations, (3) health literacy assets, and (4) health literacy gaps. Semi-structured interviews were conducted with participants from the organizations. Thematic and summative content analyses were used to appraise, interpret, and quantify the data from the interviews. Results show that while the organizations have varying definitions of health literacy, the most cited meaning of health literacy was right health information. Of the strategies used in identifying health literacy concerns, the most cited strategy was members’ medical status. While the most declared health literacy asset was the health experts of the organizations, the health literacy gap most spoken of was lack or inadequate health information, education, and communication (IEC) materials. An assessment of health literacy of faith-based organizations through a modified framework has illuminated our understanding of health literacy status of organizations and how these organizations may respond to members’ health needs.