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Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults' mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn't collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery.

Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults’ mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn’t collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery.

Mohamed Hassan Elnaem, 1, 2 Noha O Mansour, 3 Abdulrahman Fata Nahas, 1, 2 Mohamed Baraka, 4, 5 Ramadan Elkalmi, 6, 7 Ejaz Cheema 8 1Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang; 2Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang; 3Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Cairo, Egypt; 4Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates; 5Department of Clinical Pharmacy, College of Pharmacy, Al-Azhar University, Cairo, Egypt; 6Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai Pharmacy College, Dubai, United Arab Emirates; 7Department of Pharmacology, Faculty of Medicine, University of Sabha, Sabha, Libya; 8School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UKCorrespondence: Ejaz CheemaSchool of Pharmacy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UKEmail E.Cheema@bham.ac.ukBackground: This study aims to discuss, summarize and compare the renal outcomes associated with non-insulin antidiabetic (AD) pharmacotherapy prescribed for patients with type 2 diabetes mellitus (T2DM).Methods: A systematic search using predefined search terms in three scholarly databases, ScienceDirect, Google Scholar, and PubMed, was conducted. Original research articles published in the English language between 2012 and 2020 that reported renal outcomes associated with the use of non-insulin AD pharmacotherapy were eligible for inclusion. Review articles, meta-analysis studies, and conference proceedings were excluded. A study-specific data extraction form was designed to extract the author’s name, country, publication year, study design, study population, objectives, key findings, and conclusions. A narrative review of the key findings that focused on renal outcomes and renal safety issues was conducted.Results: Of the 18,872 results identified through the initial search, a total of 32 articles were included in this review. Of these, 18 of the included articles reported the renal outcomes of newer antidiabetic medications, eg, SGLT2 inhibitors and GLP-1 agonists. Eight studies focussed on the well-established antidiabetic medications, eg, metformin and sulphonylureas. The review reported three main types of the clinical impact of the prescribed AD on the renal outcomes: “renoprotective effects”, “no additional risk” and “associated with a decline in renal parameters”. Seventeen studies reported the renoprotective effects of AD, including SGLT2i studies (n=8), GLP1 studies (n=6), and DPP4i studies (n=3). The reported renoprotective effects included slowing down the GFR decline, improving albuminuria, and reducing renal adverse events. The “no additional risk” impact was reported in eight studies, including DPP4i studies (n=3), two SGLT2i studies (n=2), metformin studies (n=2), and one study involving pioglitazone. Furthermore, seven studies highlighted the “associated with a decline in renal parameters” effect. Of these, three involved SGLT2i, two with metformin, and one for each DPP4i and sulphonylurea.Conclusion: More than half of the studies included in this review supported the renoprotective effects associated with the use of AD medications, particularly GLP-1A, SGLT2i, and some of the DPP4i. Further studies involving patients with various stages of chronic kidney disease (CKD) are required to compare AD medications’ renal effects, particularly the newer agents.Keywords: hypoglycemic agents, antidiabetic drugs, type 2 diabetes mellitus, renal effects, renal outcomes

In computer vision, most existing works about object detection focus on detecting objects in the good lighting conditions instead of low-light conditions. Even the few existing works that are centered on object detection in the low-light conditions, predominantly focus on the general object detection rather than the detection of small objects. The main challenges affecting small object detection accuracy in low-light conditions are occlusion caused by the low light, shadows, and darkness that adversely affect the surrounding context leading to poor object classification and the insufficient spatial information that negatively affect object localization resulting in poor small object detection. To address the challenge of poor small object detection in low-light conditions we propose the Hybrid Intersection over Union (HIoU) localization loss to enhance the detection accuracy of small objects in these conditions. This loss utilizes the top-bottom distances of the targeted and predicted bounding boxes and the manhattan distance of the boxes’ centres to deal with the issue of misalignment that negatively affect the small object detection accuracy. Also, it jointly works with the classification loss to offer a joint optimization that facilitates a network to learn features that are important for both localization and classification. Experimental results show that the proposed loss enhances the detection accuracy of small objects in low-light conditions.

Objectives: We investigated the genomic epidemiology of extended-spectrum β-lactamase-producing Enterobacter cloacae (ESBL-Ec) isolates from patients and hospital environment to better understand their distribution to help devising effective strategies for infection prevention and control. Methods: We screened ESBL-Ec at Bugando Medical Center (BMC) in Mwanza, Tanzania. Rectal swabs from orthopedic patients on admission and swabs from the neighboring inanimate environment were collected. Following microbial culture, DNA was extracted from pure ESBL-Ec, and whole-genome sequencing was done. Sequence typing (ST), plasmid replicons, drug resistance, and virulence genes were deciphered using the Rapid Microbial Analysis Pipeline (rMAP). Results: We obtained 209 ESBL isolates, of which 15 (7.2 %) were ESBL-Ec [8 (53.3 %) from patients and 7 (46.7 %) from the environment]. Seven isolates were novel and eight were diverse, each with a unique ST. All isolates harbored two to five β-lactamase genes, with the predominance of blaCTX-M-15 (15/15), blaOXA-1 (14/15), blaTEM (14/15) and blaACT (12/15). The most common non β-lactam drug resistance genes were aac(3)-IIa (14/15), aac(6′)-Ib-cr (14/15), fosA (14/15), and qnrB1 (12/15), aph(3″)-Ib (10/15) and aph(6)-Id (10/15). Eleven different types of plasmid replicons were identified in 14/15 of the isolates, harboring one to five plasmids, with the most common plasmids being IncFII (11/15) and IncFIB (10/15). All isolates harbored the outer membrane protein (ompA), and curli protein (csg) was in 14/15 isolates. Conclusion: Admitted orthopedic patients and the hospital environment act as a reservoir of ESBL-Ec with diverse STs and endowed with drug resistance and arsenals of virulence genes, calling for their routine screening on admission for mitigation of potential subsequent infections.

Abstract Printed Circuit Boards (PCBs) are key devices for the modern-day electronic technologies. During the production of these boards, defects may occur. Several methods have been proposed to detect PCB defects. However, detecting significantly smaller and visually unrecognizable defects has been a long-standing challenge. The existing two-stage and multi-stage object detectors that use only one layer of the backbone, such as Resnet’s third layer ( $$C_4$$ C 4 ) or fourth layer ( $$C_5$$ C 5 ), suffer from low accuracy, and those that use multi-layer feature maps extractors, such as Feature Pyramid Network (FPN), incur higher computational cost. Founded by these challenges, we propose a robust, less computationally intensive, and plug-and-play Attentive Context and Semantic Enhancement Module (ACASEM) for two-stage and multi-stage detectors to enhance PCB defects detection. This module consists of two main parts, namely adaptable feature fusion and attention sub-modules. The proposed model, ACASEM, takes in feature maps from different layers of the backbone and fuses them in a way that enriches the resulting feature maps with more context and semantic information. We test our module with state-of-the-art two-stage object detectors, Faster R-CNN and Double-Head R-CNN, and with multi-stage Cascade R-CNN detector on DeepPCB and Augmented PCB Defect datasets. Empirical results demonstrate improvement in the accuracy of defect detection.

Abstract Super-resolution imaging has, for more than seventy years, gradually evolved to produce advanced methods for enhancing the resolution of images beyond the diffraction limits. Notwithstanding its foreseeable practical capabilities, we noted that this technology has received undeserved attention. The present work provides an extensive review of super-resolution imaging since its first conception in 1952, contextualizing studies into four research directions: reviews, advances, applications, and hardware implementations. We have discussed achievements, challenges, and potential opportunities of super-resolution imaging to equip researchers, especially those in their early careers, with knowledge to further advance the technology. Our work may open interesting research avenues that may accelerate realization of the technology into commercial imaging devices.

Abstract Speckle noise corrupts synthetic aperture radar (SAR) images and limits their applications in sensitive scientific and engineering fields. This challenge has attracted several scholars because of the wide demand of SAR images in forestry, oceanography, geology, glaciology, and topography. Despite some significant efforts to address the challenge, an open-ended research question remains to simultaneously suppress speckle noise and to restore semantic features in SAR images. Therefore, this work establishes a diffusion-driven nonlinear method with edge-awareness capabilities to restore corrupted SAR images while protecting critical image features, such as contours and textures. The proposed method incorporates two terms that promote effective noise removal: (1) high-order diffusion kernel; and (2) fractional regularization term that is sensitive to speckle noise. These terms have been carefully designed to ensure that the restored SAR images contain stronger edges and well-preserved textures. Empirical results show that the proposed model produces content-rich images with higher subjective and objective values. Furthermore, our model generates images with unnoticeable staircase and block artifacts, which are commonly found in the classical Perona–Malik and Total variation models.

Abstract Escherichia coli significantly causes nosocomial infections and rampant spread of antimicrobial resistance (AMR). There is limited data on genomic characterization of extended-spectrum β-lactamase (ESBL)-producing E. coli from African clinical settings. This hospital-based longitudinal study unraveled the genetic resistance elements in ESBL E. coli isolates from Uganda and Tanzania using whole-genome sequencing (WGS). A total of 142 ESBL multi-drug resistant E. coli bacterial isolates from both Tanzania and Uganda were sequenced and out of these, 36/57 (63.1%) and 67/85 (78.8%) originated from Uganda and Tanzania respectively. Mutations in RarD, yaaA and ybgl conferring resistances to chloramphenicol, peroxidase and quinolones were observed from Ugandan and Tanzanian isolates. We reported very high frequencies for bla CTX−M−15 with 11/18(61.1%), and bla CTX−M−27 with 12/23 (52.1%), bla TEM−1B with 13/23 (56.5%) of isolates originating from Uganda and Tanzania respectively all conferring resistance to Beta-lactam-penicillin inhibitors. We observed chloramphenicol resistance-conferring gene mdfA in 21/23 (91.3%) of Tanzanian isolates. Extraintestinal E. coli sequence type (ST) 131 accounted for 5/59 (8.4%) of Tanzanian isolates while enterotoxigenic E. coli ST656 was reported in 9/34 (26.4%) of Ugandan isolates. Virulence factors originating from Shigella dysenteriae Sd197 (gspC, gspD, gspE, gspF, gspG, gspF, gspH, gspI), Yersinia pestis CO92 (irp1, ybtU, ybtX, iucA), Salmonella enterica subsp. enterica serovar Typhimurium str. LT2 (csgF and csgG), and Pseudomonas aeruginosa PAO1 (flhA, fliG, fliM) were identified in these isolates. Overall, this study highlights a concerning prevalence and diversity of AMR-conferring elements shaping the genomic structure of multi-drug resistant E. coli in clinical settings in East Africa. It underscores the urgent need to strengthen infection-prevention controls and advocate for the routine use of WGS in national AMR surveillance and monitoring programs. Availability of WGS analysis pipeline: the rMAP source codes, installation, and implementation manual can free be accessed via https://github.com/GunzIvan28/rMAP .

Abstract Brain–computer interface (BCI), an emerging technology that facilitates communication between brain and computer, has attracted a great deal of research in recent years. Researchers provide experimental results demonstrating that BCI can restore the capabilities of physically challenged people, hence improving the quality of their lives. BCI has revolutionized and positively impacted several industries, including entertainment and gaming, automation and control, education, neuromarketing, and neuroergonomics. Notwithstanding its broad range of applications, the global trend of BCI remains lightly discussed in the literature. Understanding the trend may inform researchers and practitioners on the direction of the field, and on where they should invest their efforts more. Noting this significance, we have analyzed 25,336 metadata of BCI publications from Scopus to determine advancement of the field. The analysis shows an exponential growth of BCI publications in China from 2019 onwards, exceeding those from the United States that started to decline during the same period. Implications and reasons for this trend are discussed. Furthermore, we have extensively discussed challenges and threats limiting exploitation of BCI capabilities. A typical BCI architecture is hypothesized to address two prominent BCI threats, privacy and security, as an attempt to make the technology commercially viable to the society.

Objective Children with seizures require immediate and appropriate intervention in the emergency department (ED). This study describes the clinical profile and outcome of paediatric patients with seizures at the ED in a country with limited resources.Design A prospective, observational cohort study of paediatric patients with seizure presenting to an ED conducted over a six-month period from 1 August 2019 to 31 January2020.Setting The study was conducted at the ED of Muhimbili National Hospital, a level 1 trauma centre located in Dar es Salaam, Tanzania.Participants Paediatric patients aged 1 month to 14 years presenting at the ED with acute seizure, defined as any seizure occurring from 24 hours to 7 days prior to the visit, were included in this study. Patients were consecutively enrolled during times a research assistant was present in the department. Newborns, children with repeat visits or no signs of life on arrival were excluded.Outcome The primary outcome was the proportion of paediatric patients presenting with seizures and their mortality rate; secondary outcome was risk factors for mortality.Result During the study period, 1011 children were seen in the department, of whom 114 (11.3%) (95% CI 9.3% to 13.3%) presented with seizures. Median age was 24 months (IQR 9–60), 78.1% were under 5 years and 55.3% were males. The majority 76 (66.7%) of the patients presented with generalised seizures. Half 58 (50.9%) of patients presented with fever. Meningitis was the most common aetiology, diagnosed in 30 (26.3%). Overall mortality was 16.7% (95% CI 10.3% to 24.8%). Using negative log binominal analysis, fever (relative risk, RR 2.7), altered mental status (RR 21.1), hypoxia (RR 3.3), abnormal potassium (RR 2.4) and clinical diagnosis of meningitis (RR 3.4) were statistically significantly associated with mortality.Conclusions Findings from this study revealed higher incidence of paediatric patients with seizures than that reported in high-income countries and other low-income and middle-income countries. The acuity of illness was high, with 16.7% mortality rate. The presence of fever, altered mental status, hypoxia, abnormal potassium levels and meningitis diagnosis were associated with higher risk of mortality. Further research is needed to develop interventions to improve outcomes in paediatric patients with seizures in our setting.

Abstract Introduction Mentorship is an essential component of research capacity building for young researchers in the health sciences. The mentorship environment in resource-limited settings is gradually improving. This article describes mentees’ experiences in a mentorship program for junior academicians amid the COVID-19 pandemic in Tanzania. Methods This is a survey study that examined the experiences of mentees who participated in a mentorship program developed as part of the Transforming Health Education in Tanzania (THET) project. The THET project was funded by the US National Institutes of Health (NIH) under a consortium of three partnering academic institutions in Tanzania and two collaborating US-based institutions. Senior faculty members of respective academic institutions were designated as mentors of junior faculty. Quarterly reports submitted by mentees for the first four years of the mentorship program from 2018 to 2022 were used as data sources. Results The mentorship program included a total of 12 mentees equally selected from each of the three health training institutions in Tanzania. The majority (7/12) of the mentees in the program were males. All mentees had a master’s degree, and the majorities (8/12) were members of Schools/Faculties of Medicine. Most mentors (9/10) were from Tanzania’s three partnering health training institutions. All mentors had an academic rank of senior lecturer or professor. Despite the onset of the COVID-19 pandemic, the regular weekly meetings between mentors and mentees were not affected. By the fourth year of the mentorship program, more than three-quarters of mentees had published research related to the mentorship program in a peer-reviewed journal, over half had enrolled in Ph.D. studies, and half had applied for and won competitive grant awards. Almost all mentees reported being satisfied with the mentorship program and their achievements. Conclusion The mentorship program enhanced the skills and experiences of the mentees as evidenced by the quality of their research outputs and their dissemination of research findings. The mentorship program encouraged mentees to further their education and enhanced other skills such as grant writing. These results support the initiation of similar mentorship programs in other institutions to expand their capacity in biomedical, social, and clinical research, especially in resource-limited settings, such as Sub-Saharan Africa.

Abstract Through-the-wall radar imaging (TWRI) has attracted a great deal of attention in several sensitive applications, including rescue missions and military operations. Notwithstanding its broad range of applications, TWRI suffers from path-loss because distant targets experience more attenuation of signal power than those closer to the transceiver. This challenge may lead to missed targets with important information necessary for analysis and informed decision making. Responding to the challenge, we have developed a signal model with an effective path-loss compensator incorporating a free space exponent. Furthermore, multipath exploitation and compressive sensing techniques were employed to develop an effective algorithm for isolating residual clutter that may corrupt real targets. The proposed signal model integrates contributions from the front wall, multipath returns, and path-loss. Compared with the state-of-the-art model under the same experimental conditions, simulation results show that the proposed model achieves improved signal-to-clutter ratio, relative clutter peak, and probability of detection by 13.1%, 17.4% and 33.6%, respectively, suggesting that our model can represent the scene more accurately.

Zia Ul Mustafa,1,2 Muhammad Nouman Manzoor,3 Arfah Shahid,4 Muhammad Salman,5 Khezar Hayat,6 Khalida Yasmin,7 Mohamed A Baraka,8,9 Smitha Mathew,10 Mahpara Kanwal,11 Samina Parveen,12 Irsa Jamal,13 Amer Hayat Khan,1 Brian Godman,14– 16 Fahad Saleem,17 Mohammad Bashaar18 1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 2Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 54700, Pakistan; 3Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Pakistan; 4Department of Medicine, Rawalpindi Medical University, Rawalpindi 46000, Pakistan; 5Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan; 6Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan; 7Lahore School of Nursing, The University of Lahore, Lahore, Pakistan; 8Clinical Pharmacy Program, College of Pharmacy, Al Ain Campus, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates; 9Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Nasr city, Cairo, Egypt; 10Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 11Department of Pharmacy Services, District Headquarter Hospital, Okara South City, Pakistan; 12Department of Pharmacy Services, District Headquarter Hospital, Chakwal, Pakistan; 13Department of Pharmacy Services, District Headquarter Hospital, Kasur, Pakistan; 14School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa; 15Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; 16Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; 17Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan; 18SMART Afghan International Trainings and Consultancy, Kabul, AfghanistanCorrespondence: Mohammad Bashaar, SMART Afghan International Trainings and Consultancy, Shahri Naw, Hospital Street No. 1, Kabul, Afghanistan, Tel +93788233865, Email dr.mbashaar@gmail.comPurpose: Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses’ perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance.Methods: A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22.Results: A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP.Conclusion: Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers.Keywords: involvement, confidence, nurses, antimicrobial resistance, antimicrobial stewardship programs, Pakistan

Objective The burden of stroke has increased in recent years worldwide, particularly in low-income and middle-income countries. In this study we aim to determine the number of stroke admissions, and associated comorbidities, at a referral hospital in Northern Tanzania.Design This was a retrospective observational study.Setting The study was conducted at a tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC), in the orthern zone of Tanzania.Participants The study included adults aged 18 years and above, who were admitted to the medical wards from 2017 to 2019.Outcome The primary outcome was the proportion of patients who had a stroke admitted in the medical ward at KCMC and the secondary outcome was clinical outcome such as mortality.Methods We conducted a retrospective audit of medical records from 2017 to 2019 for adult patients admitted to the medical ward at KCMC. Data extracted included demographic characteristics, previous history of stroke and outcome of the admission. Factors associated with stroke were investigated using logistic regression.Results Among 7976 patients admitted between 2017 and 2019, 972 (12.2%) were patients who had a stroke. Trends show an increase in patients admitted with stroke over the 3 years with 222, 292 and 458 in 2017, 2018 and 2019, respectively. Of the patients who had a stroke, 568 (58.4%) had hypertension while 167 (17.2%) had diabetes mellitus. The proportion of admitted stroke patients aged 18–45 years, increased from 2017 (n=28, 3.4%) to 2019 (n=40, 4.3%). The in-hospital mortality related to stroke was 229 (23.6%) among 972 patients who had a stroke and female patients had 50% higher odds of death as compared with male patients (OR:1.5; CI 1.30 to 1.80).Conclusion The burden of stroke on individuals and health services is increasing over time, which reflects a lack of awareness on the cause of stroke and effective preventive measures. Prioritising interventions directed towards the reduction of non-communicable diseases and associated complications, such as stroke, is urgently needed.

Introduction Military Veterans disproportionately experience mental health issues due to unique service-related experiences. Peer and social support interventions have shown promise in improving Veterans’ mental health alongside clinical mental health interventions yet there are limited studies on Veteran-designed and Veteran–led peer or social support interventions. This study explored the perceptions and experiences of Veterans participating in an innovative Veteran-designed and Veteran-led peer and social support program. It was a preliminary study in a long-term Community Based Participatory Research partnership between Indiana University School of Medicine-Northwest regional campus and Operation Combat Bikesaver (OCB). Methods This mixed methods study utilized a limited dataset from pre-and-post-session surveys collected by OCB between September 2019 and August 2021. We examined pre-post differences in participants’ self-rated “feelings” (i.e., emotional state) with the following independent variables through Linear Mixed Models in SPSS: OCB location, OCB event attended, day of the week, time of day, duration of attendance, frequency of attendance, and social assistance. We analyzed participants’ qualitative OCB experiences using inductive thematic analysis in Dedoose. This study was reviewed and exempted by The Indiana University Human Research Protection Program (Protocol # 12499) on August 16, 2021. Results A total of 128 participants completed pre-post surveys for 746 OCB sessions. There was a statistically significant pre-post session increase in participants’ feelings (mean=34.6; SD=21.7; p

Introduction The COVID-19 pandemic has had drastic effects on youth violence protective and risk factors by isolating many at risk youth. While youth violence is a growing global health problem, there are limited studies exploring youth violence during the COVID-19 pandemic. Lake County in Northwest Indiana presents an opportunity for youth violence research and prevention given its socio-demographic context and its limited youth violence data. This study explored the COVID-19 pandemic’s impacts on youth violence and its risk and protective factors from the perspectives of professional key informants in Lake County, Indiana. Methods This study utilized a descriptive qualitative design inspired by the constructivist grounded theory. We recruited professional key informants through purposive and snowball sampling. Data collection consisted of virtual semi-structured key informant interviews that were audio-recorded and transcribed verbatim. Data analysis consisted of inductive thematic analysis with open line-by-line coding, focused coding in Dedoose, and theme identification. Results A total of six key informants were interviewed, representing diverse youth-serving occupations. These interviews revealed five general themes portraying the impacts of the COVID-19 pandemic on youth violence: mental health impacts on youth; socialization of youth; youth as victims, perpetrators, or witnesses; shifting of learning environments; and parent-child relationships. Key informants observed an increase in less visible types of youth violence, underlying pandemic-induced or-exacerbated youth mental and behavioral health issues, strained parent-child relationships, and the educational marginalization of youth in underserved communities during online learning transitions. Conclusions This study highlighted underserved youth’s vulnerability to the COVID-19 pandemic’s adverse impacts on youth violence experiences, risk, and protective factors. Our findings support the need to prioritize youth during and after crises, to utilize innovative strategies to better reach underserved youth, and to develop ethical and integrated youth violence data systems. Future research should explore youth’s lived experiences with violence throughout the pandemic.

Abstract Several approaches have been proposed to suppress multipath ghost in through-the-wall radar imaging (TWRI). One classical approach, called Aspect Dependent (AD), exploits locations of ghosts in the images without demanding prior knowledge of the reflecting geometry. This operation strategy makes the method superior over multipath exploitation-based approaches. However, the AD method assumes a point target that emulates unreal environment. Therefore, reconstructing extended targets with this method leads to incorrect scene interpretation. This work proposes a ghost suppression method for extended targets based on the AD feature that exploits duo sub-apertures. Firstly, we evaluate the best suppression method using a performance metric called relative clutter peak. Next, the evaluated method is extended to encompass a target extent during sub-images reconstruction. Following this strategy, an effective image fusion method suitable for extended targets is proposed. The method considers pixel neighborhood to effectively recover the given extended target. Simulation results show that, when signal-to-noise ratio is 20dB, the proposed method significantly improves signal-to-clutter ratio and relative clutter peak by 8.8% and 23.8%, respectively, relative to the existing AD based methods under point target assumption.

Nonlinear anisotropic diffusion has attracted a great deal of attention for its ability to simultaneously remove noise and preserve semantic image features. This ability favors several image processing and computer vision applications, including noise removal in medical and scientific images that contain critical features (textures, edges, and contours). Despite their promising performance, methods based on nonlinear anisotropic diffusion suffer from practical limitations that have been lightly discussed in the literature. Our work surfaces these limitations as an attempt to create future research opportunities. In addition, we have proposed a diffusion-driven method that generates superior results compared with classical methods, including the popular Perona–Malik formulation. The proposed method embeds a kernel that properly guides the diffusion process across image regions. Experimental results show that our kernel encourages effective noise removal and ensures preservation of significant image features. We have provided potential research problems to further expand the current results.

Introduction Emergency medicine (EM) is a growing field in Sub-Saharan Africa. Characterising the current capacity of hospitals to provide emergency care is important in identifying gaps and future directions of growth. This study aimed to characterise the ability of emergency units (EU) to provide emergency care in the Kilimanjaro region in Northern Tanzania.Methods This was a cross-sectional study conducted at 11 hospitals with emergency care capacity in three districts in the Kilimanjaro region of Northern Tanzania assessed in May 2021. An exhaustive sampling approach was used, whereby all hospitals within the three-district area were surveyed. Hospital representatives were surveyed by two EM physicians using the Hospital Emergency Assessment tool developed by the WHO; data were analysed in Excel and STATA.Results All hospitals provided emergency services 24 hours a day. Nine had a designated area for emergency care, four had a core of fixed providers assigned to the EU, two lacked a protocol for systematic triage. For Airway and Breathing interventions, oxygen administration was adequate in 10 hospitals, yet manual airway manoeuvres were only adequate in six and needle decompression in two. For Circulation interventions, fluid administration was adequate in all facilities, yet intraosseous access and external defibrillation were each only available in two. Only one facility had an ECG readily available in the EU and none was able to administer thrombolytic therapy. For trauma interventions, all facilities could immobilise fractures, yet lacked interventions such as cervical spinal immobilisation and pelvic binding. These deficiencies were primarily due to lack of training and resources.Conclusion Most facilities perform systematic triage of emergency patients, though major gaps were found in the diagnosis and treatment of acute coronary syndrome and initial stabilisation manoeuvres of patients with trauma. Resource limitations were primarily due to equipment and training deficiencies. We recommend the development of future interventions in all levels of facilities to improve the level of training.

Tracheostomy is a lifesaving, essential procedure performed for airway obstruction in the case of head and neck cancers, prolonged ventilator use, and for long-term pulmonary care. While successful quality improvement interventions in high-income countries such as through the Global Tracheostomy Collaborative significantly reduced length of hospital stay and decreased levels of anxiety among patients, limited literature exists regarding tracheostomy care and practices in low and middle-income countries (LMIC), where most of the world resides. Given limited literature, this scoping review aims to summarize published tracheostomy studies in LMICs and highlight areas in need of quality improvement and clinical research efforts. Based on the PRISMA guidelines, a scoping review of the literature was performed through MEDLINE/PubMed and Embase using terms related to tracheostomy, educational and quality improvement interventions, and LMICs. Publications from 2000-2022 in English were included. Eighteen publications representing 10 countries were included in the final analysis. Seven studies described baseline needs assessments, 3 development of training programs for caregivers, 6 trialed home-based or hospital-based interventions, and finally 2 articles discussed development of standardized protocols. Overall, studies highlighted the unique challenges to tracheostomy care in LMICs including language, literacy barriers, resource availability (running water and electricity in patient homes), and health system access (financial costs of travel and follow-up). There is currently limited published literature on tracheostomy quality improvement and care in LMICs. Opportunities to improve quality of care include increased efforts to measure complications and outcomes, implementing evidence-based interventions tailored to LMIC settings, and using an implementation science framework to study tracheostomy care in LMICs.

Abstract Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making. Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.

Background: Despite increases in the number of insured Americans, consumers continue to face barriers in accessing care. Low levels of health insurance literacy (HIL) are associated with suboptimal use of health insurance coverage. There remains a need to further contextualize the relationship between HIL and access to care, especially among insured working-class people. Objective This study was conducted to understand the pathways through which HIL affects health care decision-making and access to care in an urban working-class population. Methods: Using a qualitative descriptive approach, we conducted five focus groups with 45 adult residents of South Louisville, Kentucky. The questions explored participants' experiences of insurance enrollment, use, and health care system navigation, as well as their perceptions and needs regarding accessing health insurance information. Using inductive thematic analysis, transcripts were open coded independently by team members, a focused coding framework was agreed upon, and emergent themes were identified through constant comparison techniques. Key Results: Most participants placed high value on their insurance, considering it the most important benefit employers offer. Despite having adequate HIL, most participants expressed frustration with the amount of time and effort they spent to determine the best insurance plan, obtain covered health services, and settle claims, often with ineffective results. Despite having insurance, cost considerations influenced many participants' decisions to accept certain tests or treatments, in some cases resulting in delayed or foregone care. Conclusions: The findings of this qualitative study indicate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system. Interventions to improve HIL should include practical examples and real-life scenarios, because HIL gained from experiential narratives was the most useful in navigating the health care system.[HLRP: Health Literacy Research and Practice. 2022;6(2):e61–e69.] Plain Language Summary: By conducting focus groups with a working-class population, this study contextualizes the pathways through which HIL affects consumers' health care decision-making and access to care. Findings demonstrate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system.

The agricultural sector is highly challenged by plant pests and diseases. A high–yielding crop, such as tomato with high economic returns, can greatly increase the income of smallholder farmers income when its health is maintained. This work introduces an approach to strengthen phytosanitary capacity and systems to help solve tomato plant pest Tuta absoluta devastation at early tomato growth stages. We present a deep learning approach to identify tomato leaf miner pest (Tuta absoluta) invasion. The Convolutional Neural Network architectures (VGG16, VGG19, and ResNet50) were used in training classifiers on tomato image dataset captured from the field containing healthy and infested tomato leaves. We evaluated performance of each classifier by considering accuracy of classifying the tomato canopy into correct category. Experimental results show that VGG16 attained the highest accuracy of 91.9% in classifying tomato plant leaves into correct categories. Our model may be used to establish methods for early detection of Tuta absoluta pest invasion at early tomato growth stages, hence assisting farmers overcome yield losses.

Introduction Community advisory boards (CABs) continue to gain wide use and acceptance in global health research including in HIV clinical trials. They provide means through which community concerns regarding the trial can be considered by the research team, and provide an important platform of communication between the researchers and the community about study goals. Therefore, this systematic review protocol will guide the review of qualitative evidence on the ethical roles of CABs in HIV clinical trials based on the three fundamental ethical principles: respect for the person, beneficence and justice.Methods and analysis This systematic review of qualitative evidence will involve searching four medical databases: PubMed, ScienceDirect, CINAHL and Cochrane Library. Additionally, other relevant evidence will be obtained through hand searching and grey literature. Searches will be limited to studies published in the English language from 1989 (the year that CABs were first established in HIV clinical trials) to 2019. Articles searched will be screened by two independent authors based on inclusion and exclusion criteria. Included articles will be appraised for quality using the Critical Appraisal Skills Programme checklist and followed by qualitative data extraction. Findings will be analysed based on the meta-aggregative approach with the aid of EPPI-Reviewer 4 web-based software.Ethics and dissemination Ethical approval does not apply to this review. Data will be disseminated through scientific conferences and peer-reviewed journals to inform policies and stake-holders about the ethical role of CABs.PROSPERO registration number CRD42019133787.

Background: The Bernese periacetabular osteotomy (PAO) is a well-established procedure for symptomatic hip dysplasia in adolescents and young adults. However, it remains a technically demanding procedure, and several major complications have been described, many of which are related to the approach and surgical exposure. The current study evaluates the efficacy and safety of PAO performed through a modified Stoppa approach. Methods: A prospective series of nine consecutive patients with hip dysplasia were treated PAO through the modified Stoppa approach. The mean age was 22.4 years (15–30 years) and the mean follow-up was 3.2 years (2–5 years). Harris hip score (HHS) was used as a functional score, and the radiographic indices included the lateral center-edge angle (LCEA) and Tönnis roof angle. Results: The approach allowed the osteotomy lines to be performed under direct visualization from the intra-pelvic surface of the acetabulum, aided by fluoroscopy. A lateral window was added to perform the final iliac cut and for subsequent mobilization and fixation of the acetabular fragment. The mean HHS improved significantly from 70.8 ± 4.9 points to 90.1 ± 3.3 points (p

In massive multi-input multi-output (MIMO) antenna system, the performance is restricted by inter-cell interference called pilot contamination. However, acquisition of channel state information for channel estimation introduces overheads of pilots required to estimate the channel frequently, a disadvantage that causes inefficient use of bandwidth. A tradeoff thus exists between the number of pilots required to estimate the channel versus the spectral efficiency. Studies on pilot decontamination using pilot assignment lack consideration of the comparative analysis to determine superior approaches. Limited literature exists on the analysis of the existing pilot assignment techniques. Different techniques exhibit varied performances and influence on resource utilization. The purpose of this study is to analyze various methods of pilot assignment schemes for mitigation of pilot contamination in massive MIMO systems. A systematic review approach is adopted to examine different related works and the adopted methodologies, outcomes, and restrictions to determine the most suitable approaches. This study further demonstrates the impact of coherence interval distribution between the pilots for channel estimation and data transmission. An analysis of a tradeoff between FDD and TDD modes is presented to determine the most suitable for massive MIMO antennas. In addition, the study provides recommendations for future research.

Permeability is an important petrophysical parameter that controls the fluid flow within the reservoir. Estimating permeability presents several challenges due to the conventional approach of core analysis or well testing, which are expensive and time-consuming. On the contrary, artificial intelligence has been adopted in recent years in predicting reliable permeability data. Despite its shortcomings of overfitting and low convergence speed, artificial neural network (ANN) has been the widely used artificial intelligent method. Based on this, the present study conducted permeability prediction using the group method of data handling (GMDH) neural network from well log data of the West arm of the East African Rift Valley. Comparative analysis of GMDH permeability model and ANN methods of the back propagation neural network (BPNN) and radial basis function neural network (RBFNN) were further explored. The results of the study showed that the proposed GMDH model outperformed BPNN and RBFNN as it achieved R/root mean square error (RMSE) value of 0.989/0.0241 for training and 0.868/0.204 for predicting, respectively. Sensitivity analysis carried out revealed that shale volume, standard resolution formation density, and thermal neutron porosity were the most influential well log parameters when developing the GMDH permeability model.

Slipped capital femoral epiphysis (SCFE) remains the most common adolescent hip disorder. Most cases present with stable slips, and in situ fixation is the most commonly adopted treatment worldwide. The introduction of the concept of femoroacetabular impingement and subsequent studies have revealed SCFE-related hip impingement to be a significant pre-arthritic condition, and the previously suggested remodeling of the proximal femur after in situ fixation has been called into question. Complex proximal femoral osteotomies and more recently intra-articular procedures via surgical hip dislocation have been employed. The literature is still lacking a strong evidence to undertake such aggressive procedures. Moreover, the application of a particular procedure regarding the nature of the slip, being stable or unstable, the degree of the slip, and the condition of the physis has not been extensively described in the literature. The purpose of this article is to outline the SCFE-related hip impingement, to review the best evidence for the current treatment options for both stable and unstable slips, and to develop an algorithm for decision making.