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The objective of the study was to establish the actors’ roles and functions in improved rice varieties innovation system in the Eastern Zone of Tanzania. The target population samples for the study comprised of household heads (n = 340) and other key identified actors (n = 99). The research design was a convergent parallel mixed method. Face-to-face interviews, focus group discussions and documentary review were used to collect the data. The findings indicate weak or inability of Agricultural Seed Agency, TANSEED International Ltd, Quality Declared Seed producers in seed multiplication and distribution and agro-dealers were not selling quality rice seeds, thereby resulting in low availability and high prices of the same. Also, the findings show weak participation of farmers, agro-dealers, traders and millers in the functions of guidance of the search and rice varieties development, and the limited number of market actors and weak credit mobilization for farmers to invest in IRVs. The study recommends for the Government of Tanzania to create enabling environment that enhances participation of all key actors in the processes of guidance of the search and rice varieties development; linking farmers with external markets; and enhancing the farmers’ access to credit facilities by working on the obstacles hampering farmers from accessing loans from financial institutions.

Summary Background & aims Nutrition following liberation of mechanical ventilation and throughout acute hospitalisation may be important in aiding recovery. While oral nutrition is the most common mode of nutrition provision in this time period, it is unclear what factors influence oral nutrition intake due to limited research in the area to date. This article outlines the methods for a scoping review to explore and collate reported barriers and facilitators to oral nutrition intake in patients following liberation of mechanical ventilation. Methods A scoping review will be conducted, and the following databases searched: MEDLINE, Embase, Emcare, and CINAHL. Grey literature, including but not limited to conference abstracts and theses will be searched for via ProQuest, Scopus, Web of Science and PsychInfo. Study selection, data extraction and data charting will be conducted by two reviewers. Data will be synthesised into figures and tables, with the COM-B framework providing a structure for grouping themes and findings. Included literature will comprise of primary research studies, reviews and grey literature from 2000 onward, that include critically ill adult patients who have been recruited in an ICU, received a therapy usually delivered in ICU, or had an average length of ICU stay greater than or equal to two days. Studies that report the presence of oral nutrition-related barriers or facilitators following liberation of mechanical ventilation will be considered for inclusion.

Journal of intelligent manufacturing (2021). doi:10.1007/s10845-021-01860-6, Published by Springer Science + Business Media B.V, Dordrecht [u.a.]

Objective To evaluate the safety and efficacy of phacoemulsification combined with Micropulse transscleral cyclophotocoagulation (MP-TSCPC) in glaucoma patients. Methods This is a retrospective case-note review. The participants were adult patients with diagnoses of glaucoma and cataract who required a further reduction in IOP or a reduction in the number of glaucoma drops. All consecutive patients who underwent cataract surgery (CS) combined with MP-TSCPC laser between October 2018 and July 2019 were included in the study. The effect on visual acuity (VA), intraocular pressure (IOP) and number of anti-glaucoma drops were evaluated at 6 and 12 months in addition to any complications that occurred during any time point of the study. Results 42 eyes were included in the study. Mean IOP was reduced from 19.5 ± 5.4 mmHg by 22.5% to 15.1 ± 4.6 at 6 months post-operatively and by 19.5% to 15 ± 6.6 mm Hg at 12 months (p p Conclusion This is the first study evaluating the effect of cataract surgery combined with MP-TSCPC in glaucoma patients. We demonstrated that this led to a reduction in IOP and the number of anti-glaucoma medications at 6 and 12-month postoperatively. The majority of patients had either stable or better vision at 12 months follow-up.

Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

The COVID-19 pandemic has been threatening the healthcare and socioeconomic systems of entire nations. While population-based surveys to assess the distribution of SARS-CoV-2 infection have become a priority, pre-existing longitudinal studies are ideally suited to assess the determinants of COVID-19 onset and severity.The Cooperative Health Research In South Tyrol (CHRIS) study completed the baseline recruitment of 13,393 adults from the Venosta/Vinschgau rural district in 2018, collecting extensive phenotypic and biomarker data, metabolomic data, densely imputed genotype and whole-exome sequencing data.Based on CHRIS, we designed a prospective study, called CHRIS COVID-19, aimed at: 1) estimating the incidence of SARS-CoV-2 infections; 2) screening for and investigating the determinants of incident infection among CHRIS participants and their household members; 3) monitoring the immune response of infected participants prospectively.An online screening questionnaire was sent to all CHRIS participants and their household members. A random sample of 1450 participants representative of the district population was invited to assess active (nasopharyngeal swab) or past (serum antibody test) infections. We prospectively invited for complete SARS-CoV-2 testing all questionnaire completers gauged as possible cases of past infection and their household members. In positive tested individuals, antibody response is monitored quarterly for one year. Untested and negative participants receive the screening questionnaire every four weeks until gauged as possible incident cases or till the study end.Originated from a collaboration between researchers and community stakeholders, the CHRIS COVID-19 study aims at generating knowledge about the epidemiological, molecular, and genetic characterization of COVID-19 and its long-term sequelae.

The histories of Business Schools (BS) are usually produced from U.S.-centric perspectives. Seeking to recenter the Global South in the making of these histories, this paper aims to analyze the his...

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

Objective Recently, the national diagnostic reference levels (DRLs) in Japan were revised as the DRLs 2020, wherein the body weight-based injection dose optimization in positron emission tomography/computed tomography using 18F-fluoro-2-deoxy-D-glucose (18F-FDG PET/CT) was first proposed. We retrospectively investigated the usefulness of this optimization method in improving image quality and reducing radiation dose. Methods A total of 1,231 patients were enrolled in this study. A fixed injection dose of 240 MBq was administered to 624 patients, and a dose adjusted to 3.7 MBq/kg body weight was given to 607 patients. The patients with body weight-based injection doses were further divided according to body weight: group 1 (≤ 49 kg), group 2 (50–59 kg), group 3 (60–69 kg), and group 4 (≥ 70 kg). The effective radiation dose of FDG PET was calculated using the conversion factor of 0.019 mSv/MBq, per the International Commission on Radiological Protection publication 106. Image quality was assessed using noise equivalent count density (NECdensity), which was calculated by excluding the counts of the brain and bladder. The usefulness of the injection dose optimization in terms of radiation dose and image quality was analyzed. Results The body weight-based injection dose optimization significantly decreased the effective dose by 11%, from 4.54 ± 0.1 mSv to 4.05 ± 0.8 mSv (p density was also significantly improved by 10%, from 0.39 ± 0.1 to 0.43 ± 0.2 (p density deteriorate when the effective dose was decreased. In group 1, the dose decreased by 32%, while there was no significant deterioration in NECdensity (p = 0.054). In group 2, the dose decreased by 17%, and the NECdensity increased significantly (p density increased significantly (p density (p = 0.766). Conclusion Body weight-based FDG injection dose optimization contributed to not only the reduction of effective dose but also the improvement of image quality in patients weighing between 50 and 69 kg.

Background and Aim: Both HBV and HCV infections have for decades remained serious public health concerns infecting thousands of people and claiming the lives of millions. The detrimental effects of these viral agents on the gravid women, the infants and the general population are well known and cannot be underestimated. Adequate and quality information on the disease prevalence remain one of the surest ways to tackling the infection head-on. This study therefore assessed the seroprevalence of HBV and HCV among pregnant women who received antenatal care services from the Kumasi South Hospital of the Kumasi Metropolis in the Ashanti Region of Ghana. Materials and Methods: A semi-structured questionnaire designed to capture participant’s demographic and gestational data including age, occupation, marital status, educational status and gestational period was administered by the researcher to 200 pregnant women to collect the data for this study. About 2-3mls of whole blood was drawn into an ethylenediamine tetraacetic acid (EDTA) and tested for HBsAg using Alere Determine HBsAg® test strip (sensitivity=95-100% and specificity=96-100%; Abbott Japan Co., Ltd.) and HCV antibodies using Serodia® HCV (sensitivity=100% and specificity=91.5%; Serodia, Fujirebio Inc., Tokyo, Japan) following standard procedures. Due to the lack of more advanced testing facilities such as PCR, each positive test result was repeated in order to reduce the possibility of false positive results. Data was analyzed using Microsoft Excel 2016 and IBM SPSS vs 25. Chi-square and Fisher’s exact test statistic were used to determine statistical associations between explanatory and outcome variables. Logistics regression was employed to determine potential demographic and gestational risk factors of HBV and HCV infection among the pregnant women. P-value of less than 0.05 was considered statistically significant. Results: Seroprevalence of HBV and HCV infection was 20.0% and 2.5% respectively. HBV infection increased with advancement in age from the least 7.1% among pregnant women aged < 20 years to the highest 22.0% among pregnant women aged 30-39 years until a sharp decline among those forty years and above. HCV prevalence generally declined with increase in age with the highest prevalence (14.3%) recorded among the 0.05) however, age was significantly associated with HCV infection yet posed not significantly high likelihood to HCV infection among the pregnant women. Conclusion: The HBV prevalence as recorded is highly endemic and therefore requires urgent round table discussions to be properly addressed. Despite the low HCV prevalence, the futuristic detrimental effects it may pose to the general wellbeing of the citizenry cannot be in doubt owing to the high prevalence dominating among the younger pregnant women. Measures such as intensified public education coupled with mass screening and vaccination and treatment of HBV seronegative and positive individuals respectively is therefore advised to mitigate further spread of the disease.

TheKleine-Levin syndrome (KLS)is classied among rare diseases[1, 2]. It belongs to the central hypersomnias said to be recurrent and dened according to the International Classication of Sleepiness Disorders, 3rd version (ICSD-3), revised in 2014. For the ICSD-3, the Kleine-Levin syndrome is a disorder characterized by recurrent episodes of hypersomnia andhyperphagia (rapidconsumptionof a large amountoffood),usually with onset in early adolescence inmales but occasionally in laterlife and in women.Amonosymptomatic form of the disorder with hypersomnia only can occur with- out binge eating or hypersexuality [1]. Usually affecting adolescent males, episodes normally last up to a few weeks and terminate with total and spontaneous recovery. Possibly rst reported by Brierre de Bosmont in 1862, the condition however received its name from Willi Kleinewho,in1925,reporteda seriesof casesofperiodichypersomnia and also Max Levin who described a case of periodic hypersomnia and excessive appetite in1930[2].The exactprevalence remainsunknown.But it seems very rare: around one to two cases per million. All cases are not published. A review of the inter- national literature of language between 1962and2004,byArnulf et al.[2], estimatedthenumberofpublishedcases at186.Accordingtotheseauthors,theannualincidencewas2.7in1970,3.5 in 1980, and 5.8 in the 1990s. For these authors, this growth would rather correspond to the extension ofthe globalscientic communication than an actual increase in the prevalence of the syndrome. Patients were described aroundtheworld,includingAsiaandAfrica,withcuriouslyone-sixthofthe world's cases described in Israel [1, 2]. Its etiology remains unknown. The genetic trail was discussed in the presence of familial cases [1, 2]. The diseasemainlyaffectsyoungmales[1,2].Itsdiagnosisisclinical[1,3,4].

BACKGROUND: Ranitidine injection is not well-known to cause cardiac arrest except in few published case reports. The Eritrean Pharmacovigilance Centre received four cases of cardiac arrest associated with ranitidine injection. OBJECTIVE: To assess the causal relationship between cardiac arrest and ranitidine, and to identify possible risk factors. METHODS: This is a descriptive case series assessment of cardiac arrest associated with ranitidine and data was mined to supplement the cases from the WHO global database of individual case safety reports. RESULTS: In all cases, ranitidine injection was administered fast IV bolus without proper dilution and the outcome was fatal in three. All patients encountered cardiac arrest within 20 minutes of intravenous use. Causality was found to be probable in two cases and possible in the other two. Cardiac arrest could have been prevented in all cases. On top of this, from the WHO global database, 185 cases of cardiac arrest and cardio-pulmonary arrest associated with ranitidine were retrieved and 49.7% were fatal. In 40% of the cases, ranitidine was reported as a single suspect. In 36 cases, cardiac arrest resolved following withdrawal of ranitidine and reaction recurred in one case after re-introduction of the product. CONCLUSION: There appears a causal link between ranitidine and cardiac arrest, possibly related to medication errors that warrants immediate attention from healthcare professionals.

Surgical repair of Tetralogy of Fallot (TOF) involves a series of steps to remove right ventricular outflow tract and pulmonary artery obstruction. However, the large degree of anatomic variability among preoperative TOF patients may impact the effectiveness of different repair strategies and, subsequently, different geometric modifications for different patients. This study investigates the relationships between geometric and hemodynamic parameters and mechanical energy efficiency for a patient-specific dataset of 16 postoperative TOF repairs, using morphometric and statistical shape analyses, as well as computational fluid dynamics simulations with physiologically-relevant inlet and outlet boundary conditions. Quantitatively, negative correlations were found between the right and left pulmonary artery centerline tract cumulative torsion and energy efficiency (r = − 0.65, p = 0.01, for both). A positive correlation was also found for a statistical shape mode associated with skewing of the geometric sub-regions (r = 0.61, p = 0.01). Qualitatively, medium- and low-efficiency geometries exhibit disturbed flow and much more proximal vortex formation as compared to a high-efficiency geometry. Thus, it is recommended, as much as possible, to both relieve and avoid the introduction of torsion into the patient’s anatomy during surgical repair of TOF.

Background HIV status disclosure facilitates access to HIV-related prevention and treatment services and increases opportunities for social support, HIV risk reduction with partners, and index testing for sexual partners or children. This study assessed the effect of a program model of community-based social welfare volunteers on HIV status disclosure among caregivers of orphans and vulnerable children (OVC). Methods This was a longitudinal study, which was based on OVC caregivers who were beneficiaries of the USAID Kizazi Kipya project in Tanzania. They were enrolled (baseline) by community social welfare volunteers during 2017–2018, received services, and reassessed at midline in 2019. Caregivers who reported having been HIV tested, were asked to voluntarily report the status in order for the volunteers to establish and provide needed services. Those who reported their HIV status as negative or positive were grouped as “disclosed”, and those who knew their status but did not report it were documented as “undisclosed”. McNemar’s tests compared disclosure rates at baseline and midline. Multivariable analysis was conducted using generalized estimating equation (GEE). Results The study analyzed 140,664 caregivers (72% female) from 81 district councils of Tanzania. Their mean age at enrollment was 47.4 years. Overall, 81.3% of the caregivers disclosed their HIV status to the project staff at baseline; this increased significantly to 96.1% at midline (p 0.05). In the multivariable analysis, caregivers’ likelihood of HIV status disclosure was nearly 6 times higher at midline than at baseline, when baseline characteristics were adjusted for (OR = 5.76, 95% CI 5.59–5.94, p Conclusions This study detected an increased caregivers’ HIV status disclosure to the USAID Kizazi Kipya project staff by 14.8%, from 81.3% at baseline to 96.1% at midline within an average project exposure period of 1.4 years. The observed loss of sociodemographic differences in HIV status disclosure rate at midline implies that community-based interventions may be well-positioned to successfully address and eliminate sociodemographic barriers to service uptake and consequently improve services coverage and health outcomes.

Ammonia emissions damage the environment and have negative consequences for human and animal health. In the German livestock sector, most ammonia emissions come from naturally ventilated dairy barns. To reduce emissions, Germany has signed the EU Directive 2016/2284 to achieve a stepwise decrease in the ammonia emissions ceiling. The aim of this study was to investigate the seasonal mitigation effect of a urease inhibitor under practical conditions and provide information relating to two theoretical application scenarios in order to estimate an annual application scenario. The experimental design was conducted according to the requirements of the Verification of Environmental Technologies for Agricultural Production test protocol using the CO2 balance method to obtain the emissions. In a manual process, the inhibitor was applied to the floor surfaces of two dairy farms. The application took place once a day over three days during summer, winter and the transition period (spring/autumn). The ready-to-use liquid formulation of 1% inhibitor K dissolved in pyrrolidone was mixed with water resulting in 2.5 mg m−2 application rate of inhibitor and 50 ml m−2 water. The ammonia emissions on Farm A and Farm B were reduced by 40% and 53% in summer, 65% and 68% in winter and 64% and 54% in transition period, respectively. Thus, an annual reduction of 58% on Farm A and 57% on Farm B was observed. In a theoretical scenario where no inhibitor was applied during winter, up to 41% of the annual reduction was observed.

Contains fulltext : 233541.pdf (Publisher’s version ) (Open Access) BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are high-risk extensive abdominal surgery. During high-risk surgery, less invasive methods for cardiac index (CI) measurement have been widely used in operating theater. We investigated the accuracy of CI derived from different methods (FroTrac, ProAQT, ClearSight, and arterial pressure waveform analysis [APWA], from PICCO) and compared them to transpulmonary thermodilution (TPTD) during CRS and HIPEC in the operative room and intensive care unit (ICU). METHODS: Twenty-five patients scheduled for CRS-HIPEC were enrolled. During nine predefined time-points, simultaneous hemodynamic measurements were performed in the operating room and ICU. Absolute and relative changes of CI were analyzed using a Bland-Altman plot, four-quadrant plot, and interchangeability. RESULTS: The mean bias was -0.1 L/min/m2 for ClearSight, ProAQT, and APWA and was -0.2 L/min/m2 for FloTrac compared with TPTD. All devices had large limits of agreement (LoA). The percentage of errors and interchangeabilities for ClearSight, FloTrac, ProAQT, and APWA were 50%, 50%, 54%, 36% and 36%, 47%, 40%, 72%, respectively. Trending capabilities expressed as concordance using clinically significant CI changes were -7 masculine +/- 39 masculine, -19 masculine +/- 38 masculine, -13 masculine +/- 41 masculine, and -15 masculine +/- 39 masculine. Interchangeability in trending showed low percentages of interchangeable and gray zone data pairs for all devices. CONCLUSIONS: During CRS-HIPEC, ClearSight, FloTrac and ProAQT systems were not able to reliably measure CI compared to TPTD. Reproducibility of changes over time using concordance, angular bias, radial LoA, and interchangeability in trending of all devices was unsatisfactory.

Introduction: Despite the efforts of governments and health organisations to eradicate malaria, it is still endemic in sub-Saharan Africa and this could be due to cost of antimalarial drugs, resistance to these drugs and climate change among others. Traditional medicine practitioners and scientists have started developing antimalarial drugs from medicinal plants among which is ARTAVOL®. ARTAVOL® is a herbal product that is used to prevent malaria in some communities in Uganda, however, its prophylactic effects on Plasmodium berghei infected mice has not been established yet. Methods: The infusion of ARTAVOL® powder was prepared, cooled, filtered, concentrated in vacuo at 55 0C and freeze-dried. The freeze-dried extract was reconstituted with distilled water for antimalarial using prophylactic model mice. Thirty-six mice were randomised into 6 groups of 6 mice each. Groups I to III mice were orally administered with the extract at 15 to 60 mg/kg/day while group IV received Pyrimethamine (1.25 mg/kg) while groups V and VI (uninfected) received 0.2 mL distilled water for seven days before the inoculation of Plasmodium berghei ANKA parasites on day 7 (D7). The parasitaemia levels were examined after 72 hours using standard procedure and blood collected through cardiac puncture for haematological study. Results: The Lethal Dose (LD50) of the crude ARTAVOL extract was greater than 5000 mg/kg. Also, there was calmness and paw licking immediately after dosing which stopped after few minutes. Significant reduction in parasitaemia level was observed in all test doses when compared with negative control. At 30 mg/kg, the extract gave 62.9% suppression, which was not significantly different from that of 60 mg/kg (68.7%) on day 3. On day 5, the extract gave 62.3% and 66.4% Suppressions At 30 And 60 Mg/Kg That Were Not Significantly Different From Each Other. A Dose Dependent Reversal of Hematocrit (HCT) reduction was observed at the 3 dose levels but their parameters did not show any significant difference when compared to the normal group but significant when compared with negative control. Conclusion: ARTAVOL® extract has shown a dose dependent reducing effect on the level of parasitaemia in P.berghei infected mice; it is acutely safe and has ability to increase RBC counts.

Background The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization’s decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work. Methods We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of “not stressed” (≤20), “borderline” (21 ≤ PSS-10 ≤ 26), and “stressed” (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made. Results Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40–3.50], p verbatims revealed that GPs felt isolated in a hospital-based model. Conclusion The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.

Nitrous oxide (N2O), ammonia (NH3), and methane (CH4) emissions from the manure management chain of livestock production systems are important contributors to greenhouse gases (GHGs) and NH3 emitted by human activities. Several studies have evaluated manure-related emissions and associated key variables at regional, national, or continental scales. However, there have been few studies focusing on the drivers of these emissions using a global dataset. An international project was created (DATAMAN) to develop a global database on GHG and NH3 emissions from the manure management chain (housing, storage, and field) to identify key variables influencing emissions and ultimately to refine emission factors (EFs) for future national GHG inventories and NH3 emission reporting. This paper describes the “field” database that focuses on N2O and NH3 EFs from land-applied manure and excreta deposited by grazing livestock. We collated relevant information (EFs, manure characteristics, soil properties, and climatic conditions) from published peer-reviewed research, conference papers, and existing databases. The database, containing 5,632 observations compiled from 184 studies, was relatively evenly split between N2O and NH3 (56 and 44% of the EF values, respectively). The N2O data were derived from studies conducted in 21 countries on five continents, with New Zealand, the United Kingdom, Kenya, and Brazil representing 86% of the data. The NH3 data originated from studies conducted in 17 countries on four continents, with the United Kingdom, Denmark, Canada, and The Netherlands representing 79% of the data. Wet temperate climates represented 90% of the total database. The DATAMAN field database is available at http://www.dataman.co.nz.

Environmental management has become an important concept among the hotel sector globally following the negative impacts of its operations on the natural environment. In this regard, hotels have emb...

Waterborne diseases remain a major global public health issue and a great environmental concern and the outbreak is common in African countries. Illness due to waterborne diseases causes morbidity and mortality in less developed countries among children aged below 5 years. This study was aimed at reviewing literature on past and present studies on waterborne diseases, the risk factors as well as the intervention practices. The unavailability of piped water and dependence of rural dwellers on surface waters which are often contaminated with fecal materials are the major causes of the rising prevalence of waterborne diseases. Poor hygienic practices have also been found to play significant role in the spread of waterborne diseases. Besides, poor environmental practices such as lack of sanitation facilities encourages spread of liquid and solid wastes within residential areas contributing to the increasing waterborne illness. Improvements in drinking water, sanitation facilities and hygiene practices in less developed countries have been suggested by many studies as key interventions to reduce waterborne diseases.

Increase in drought frequency, magnitude and duration affect crop production in Kenya. The limited food production resulting from drought leads to food insecurity in Arid and Semi-Arid Lands (ASALs) in the Kenya. This study reviewed literature on drought trends and its effects on crop yields in Kenya from 1950 to 2020. The systematic review was conducted in order to establish the drought trends and the effects of droughts on crop yields in the country. Content analysis was used for literature review on drought trends and its effects on maize, sorghum and wheat production in Kenya. From the study, a high uncertainty in global-scale drought trends in the last 60 years was established. However, an increase in drought frequency was observed from 1950 to 2002 in Africa. Few drought events were experienced in 1950s with a notable positive trend in drought frequency observed in 1960s in Kenya. In 1970s, an increased frequency and severity of droughts were observed while a decline in drought frequency was noted in 1980s. More frequent and severe droughts in Kenya were also established to have occurred in 1990s and 2000s. However, a decline in drought frequency and severity was reported in 2010s. The severity of the droughts negatively affected crop production where food insecurity was experienced in different regions of the country. The study also found that drought leads to famine and loss of human lives. Loss of livelihood such as livestock was also identified. The study identified limited information on decadal causes and recurrence of droughts and inadequate explanation on why 1950 to 2020 experienced global uncertainty in drought occurrence.

This paper outlines the experimental framework for an e-governance study by the AGI Laboratory. The goal of this research study is to identify indications of the relative performance of e-governance methodologies and how those methods might be improved by applying advanced agent and collective based AI software. The agent in this study will be based on the Independent Core Observer Model Cognitive Architecture modified with mASI (mediated Artificial Superintelligence) collective system architecture. The study will apply different groups and methods to a static set of questions analyzing the quality of those results. We hope to identify the best application model for e-governance using this kind of technology and help us identify additional paths for research with the mASI research program and systems as applied to e-governance.

This article presents a brief overview of historical methods of legal proof prior to and soon after the Norman Conquest of England in October 1066. Through an examination of the rituals of compurgation and the ordeal, which were techniques designed to discover truth prior to the establishment of the inquisition in medieval Europe and the common law jury trial in England, the human quest for intellectual conviction has been indelibly with us since the days of antiquity. And, whichever method to ascertain truth is ultimately utilized – compurgation or ordeal, inquisition or cross-examination, trial by judge or by jury – the law’s enduring search for certainty amidst a world of doubt owes much to the history and times of William the Conqueror.

Background. The Tanzanian national guideline for pediatric HIV disclosure recommends beginning disclosure as early as age 4–6 years; full disclosure is recommended at the age of 8–10 years. Despite clear procedures, the disclosure rate in Tanzania remains relatively low. This study assessed the factors associated with HIV status disclosure to orphans and vulnerable children living with HIV (OVCLHIV). Methods. Data for this analysis come from the USAID-funded Kizazi Kipya program in Tanzania that provides health and social services to OVC and caregivers of HIV-affected households. Data were collected between January 2018 and March 2019. Disclosure status was self-reported by caregivers of children aged 8 years or above. Beneficiary characteristics were included as independent variables. Generalized estimating equations took into account the clustering effect of the study design. Results. Of the 10673 OVCLHIV, most were females (52.43%), and 80.67% were enrolled in school. More than half (54.89%) were from households in rural areas. Caregivers were mostly females (70.66%), three quarters were between 31 and 60 years old and had a complete primary education (67.15%), and 57.75% were HIV-infected. Most of the OVCLHIV (87.31%) had a disclosed HIV status. Greater OVCLHIV age p < 0.001 , school enrollment (OR = 1.22; 95% CI 1.06, 1.41), urban location of household (OR = 1.64; 95% CI 1.44, 1.86), caregivers’ higher education level p < 0.001 , and caregiver HIV-positive status (OR = 1.25; 95% CI 1.09, 1.43) were positively associated with disclosure status. OVCLHIV of female caregivers were 27% less likely to have been disclosed than those of male caregivers. Conclusion. The disclosure rate among OVCLHIV in this study was high. Disclosure of HIV status is crucial and beneficial for OVCLHIV continuum of care. Caregivers should be supported for the disclosure process through community-based programs and involvement of health volunteers. Policymakers should take into consideration the characteristics of children, their caregivers, and location of households in making disclosure guidelines as adaptable as possible.

Background: Lagoons and wastewater constitute aquatics environments which receive or accounts for most domestic discharges. These waters constitute an important ecosystem for the proliferation of microorganisms. The microorganisms that harbor these waters can provide information on the persistence of certain diseases in the human population, including gastrointestinal infections such as Cholera. The genus Vibrio contains pathogenic aquatic bacteria found in lagoon bays and wastewater. Objective: The main objectives of this work were to confirm the presence of Vibrio spp. in lagoon bays and sewage of the city of Abidjan over the entire interepidemic period, and to evaluate their sensitivity to commonly used antibiotics. Methods: The isolation and identification of the microorganisms were carried out using classical bacteriological techniques (biochemical test, API 20E gallery). When necessary, serotyping was carried out using agglutination tests on slides. Antibiotic susceptibility testing was carried out using the Kirby-Bauer disk diffusion (KBDD) method. Results: This study identified 12 bacterial strains, 9/12 (75%) of which were Vibrio sp. strains. Two Vibrio species, namely Vibrio parahaemolyticus 2/9 (22%) and 7/9 Vibrio cholerae (78%) were identified. V. cholerae was isolated from both sewage and lagoon waters with dominance of serotype O1. The V. cholerae O1 and non-O1 strains showed a high level of resistance to sulfonamides, quinolones, fluoroquinolones, and moderate sensitivity to penicillins and tetracyclines. Resistant V. parahaemolyticus strains were also identified. Conclusion: The increased resistance of these bacteria could pose potential problems in the treatment of epidemics and other communicable diseases. The emergence of these multi-drug resistant strains of the genus Vibrio should prompt the Ivorian health authorities to maintain an epidemiological surveillance network for waterborne diseases throughout the country and to continue bacteriological sampling to monitor Vibrio's sensitivity to antibiotics.

Researchers seem to focus overwhelmingly on entrepreneurial leadership as seen in recent studies in the literature. This situation becomes more complex as research draws on parallels between leadership and entrepreneurship. This has led to an ongoing debate on the veracity of entrepreneurship as a distinct field of study. The purpose of this article is to explore these independent fields of study to provide a clear understanding of their close association, peculiarities, and theoretical considerations. The article is based on a critical review of the extant literature on leadership, entrepreneurship, and entrepreneurial leadership. It focuses on the existing theories and perspectives and attempts were made to draw parallels within the domains of leadership, entrepreneurship, and entrepreneurial leadership. Entrepreneurial leadership though a distinct field of study within the domain of leadership is deeply embedded in the positive integration of the fields of leadership and entrepreneurship. This close association was further reinforced by similarities and in some instances the replication of attributes and skills within the three fields. This paper brings additional insights that exist within the field of leadership and entrepreneurship particularly in proposing an integrative model for entrepreneurial leadership based on the positive integration of entrepreneurship and leadership.

Aneuploidy, defined as whole chromosome gains and losses, is associated with poor patient prognosis in many cancer types. However, the condition causes cellular stress and cell cycle delays, foremost in G1 and S phase. Here, we investigate how aneuploidy causes both slow proliferation and poor disease outcome. We test the hypothesis that aneuploidy brings about resistance to chemotherapies because of a general feature of the aneuploid condition—G1 delays. We show that single chromosome gains lead to increased resistance to the frontline chemotherapeutics cisplatin and paclitaxel. Furthermore, G1 cell cycle delays are sufficient to increase chemotherapeutic resistance in euploid cells. Mechanistically, G1 delays increase drug resistance to cisplatin and paclitaxel by reducing their ability to damage DNA and microtubules, respectively. Finally, we show that our findings are clinically relevant. Aneuploidy correlates with slowed proliferation and drug resistance in the Cancer Cell Line Encyclopedia (CCLE) dataset. We conclude that a general and seemingly detrimental effect of aneuploidy, slowed proliferation, provides a selective benefit to cancer cells during chemotherapy treatment.

Purpose High intensity focused ultrasound (HiFU) is a cyclodestructive therapy for controlling intraocular pressure (IOP) in glaucoma. The mechanism of action is thought to be through destruction of the ciliary epithelium as well as increased uveoscleral outflow. We reviewed the change in aqueous humour dynamics parameters including aqueous humour flow rate, tonographic outflow facility (TOF) and uveoscleral outflow at 12 months. Patients and methods This is a prospective observational study. Consecutive patients with open angle glaucoma (OAG) or ocular hypertension (OHT) requiring further IOP lowering were enroled in the study between August 2016 and January 2017. Patients were commenced on medication washout period prior to baseline and twelve months' visit. Results Sixteen patients (OAG) in the treatment group underwent assessment at twelve months follow up. Mean age was 63.1 ± 11 years. Eleven patients were African/Caribbean and 5 were Caucasian. Nine patients were female and 7 were male. Mean post-washout IOP was reduced by 21% (28.3 ± 5.7 at baseline vs 22.4 ± 8.4 mmHg at 12 months, p = 0.04). Aqueous humour flow rate was reduced by 16% at twelve months (2.40 ± 0.6 at baseline vs 2.02 ± 0.6 µl/min at 12 months, p = 0.0493). There was no statistically significant change in the TOF (0.12 ± 0.09 at baseline vs 0.08 ± 0.05 µl/min/mmHg at 12 months, p = 0.08) or uveoscleral outflow (0.6 ± 1.3 at baseline vs 1.3 ± 0.85 µl/min at 12 months, p = 0.15). Conclusion In this study, we demonstrated that the observed IOP reduction was likely due to aqueous humour flow rate reduction. The TOF and uveoscleral outflow were not detectibly changed.

This article examines views of Batswana faith healers on medication and Christian medical mission in a context where official health policy generally does not recognize alternative health systems. It is based on fieldwork among Batswana designed to establish the impact of religion on those who seek healing and on health providers. Overall, the study established that faith healers do not discourage their clients from taking modern medication. They strongly believe, however, that faith healing contributes significantly to healing and health and needs to be recognized in the country’s health policy; they support and encourage collaboration between themselves and modern medical practitioners.

espanolLas encefalitis autoinmune derivan de la inflamacion o disfuncion de algunas partes del cerebro causada por anticuerpos contra antigenos cerebrales especificos, y que generalmente tienen una presentacion clinica con sintomatologia psiquia-trica que muchas veces complica el diagnostico oportuno para poder dar inicio a terapias inmunosupresoras.La encefalitis por anticuerpos anti NMDARes masfrecuente en casos de ninos y adultos jovenes, y se caracterizar por la presencia suba-gudade trastornospsiquiatricos, alteracion de la conciencia, crisis epileptica, entre otros (Erazo, 2019). En el presente in-forme se describe un caso de encefalitis autoinmune anti-receptor NMDA en adulto masculino de 31 anos, con un cuadro caracterizado por trastorno del nivel de conscienciaconfundiendo las primeras impresiones diagnosticas donde es inicial-mente asistido. Despues de 15 dias de presentacion del cuadro clinico, finalmente es tratado en el Hospital Clinica Alcivar en Guayaquil, donde es ingresado a UCI requiriendo ventilacion mecanica y plasmaferesis como parte del tratamiento que involucraba varios anticomiciales, y que despues de casi dos meses de atencion intensiva, sufre una crisis tonico clonica generalizadamultiplerefractaria al tratamiento, por lo que se le induce a un coma barbiturico, y se incluye Rituximabcomo nuevo tratamiento inmunosupresor . PALABRAS CLAVES: Encefalitis, Encefalitis Autoinmune, Encefalitis anti-NMDAR. EnglishAutoimmune encephalitis derives from the inflammation or dysfunction of some parts of the brain caused by antibodies against specific brain antigens, and which generally have a clinical presentation with psychiatric symptoms that often com-plicate the timely diagnosis to be able to start immunosuppressive therapies. Anti-NMDAR antibody encephalitis is more common in children and young adults, and is characterized by the subacute presence of psychiatric disorders, altered consciousness, and epileptic seizures, among others (Erazo, 2019). This report describes a case of anti-NMDA receptor autoimmune encephalitis in a 31-year-old male adult, with a condition characterized by a disorder of the level of conscious-ness, confusing the first diagnostic impressions where it was initially attended. After 15 days of presentation of the clinical picture, he is finally treated at the Hospital ClinicaAlcivar in Guayaquil, where he is admitted to the ICU requiring mechani-cal ventilation and plasmapheresis as part of the treatment that involved several anticonvulsants, and that after almost two months of intensive care , suffers a multiple generalized tonic clonic crisis refractory to treatment, for which he is induced to a barbiturate coma, and Rituximab is included as a new immunosuppressive treatment.

Application of spatial data is becoming increasingly important as a tool for mapping and understanding space utilisation patterns especially for critically endangered species. In this study, we tes...

Chronic pain is typically defined as pain that persists after acute tissue damage and inflammation or as pain that follows a chronic disease process and lasts more than three months. Because of its debilitating impact on the quality of life of patients, recent research aims to investigate the mechanisms behind nociception to discover novel therapeutic agents to alleviate pain. One such target is the neuropeptide calcitonin gene-related peptide (CGRP), which has shown to play an integral role in migraine pathophysiology. Effective treatments of migraines with CGRP antagonists have stimulated our efforts toward checking a possible involvement of CGRP in nonheadache pain conditions such as hypertension, congestive heart failure, Alzheimer's disease, and vascular ischemia. Here, we provide a brief overview of chronic pain, with a particular emphasis on the role of CGRP as a fundamental mediator of nociceptive pain as well as a target for novel therapeutic agents.

Background Penicillins have never been associated with any form of hearing disorders. The Eritrean Pharmacovigilance Centre recently received two cases of hearing disorder (including one case of deafness) following the intake of amoxicillin capsules. This study was conducted to assess the causal link between amoxicillin and deafness. Methods Data mining was carried out in the WHO global database of individual case safety reports, VigiBase, and the Austin Bradford-Hill criteria were used to assess causality. Results A total of 94 cases of 'hearing disorders' related to amoxicillin were retrieved from VigiBase. Of these, 49 (52.1%) were reported as "deafness," and amoxicillin was marked as the sole suspected drug in 18 and the only drug administered in 13 cases. In the rest of the deafness cases (n=31), amoxicillin was concurrently administered with other drugs and reported as co-suspected. The median time to onset was three days and the outcome was marked as recovered (14), recovering (2), not recovered (16) and unknown (17). In five cases, deafness resolved following the withdrawal of amoxicillin. Conclusion There appears a causal association between amoxicillin and hearing loss that requires further substantiation with better epidemiologic studies.

Background Utilization of antiretroviral therapy (ART) is crucial for better health outcomes among people living with the human immunodeficiency virus (PLHIV). Nearly 30% of the 1.6 million PLHIV in Tanzania are not on treatment. Since HIV positive status is the only eligibility criterion for ART use, it is critical to understand the obstacles to ART access and uptake to reach universal coverage of ART among PLHIV. For the caregivers of orphans and vulnerable children (OVC) LHIV and not on ART, attempts to identify them and ensure that they initiate and continue using ART is critical for their wellbeing and their ability to care for their children. Methods Data are from the community-based, United States Agency for International Development (USAID)-funded Kizazi Kipya project that aims at scaling up the uptake of HIV/AIDS and other health and social services by orphans and vulnerable children (OVC) and their caregivers. HIV positive caregivers of OVC who were enrolled in the USAID Kizazi Kipya project between January 2017 and June 2018 were included in this cross-sectional study. The caregivers were drawn from 11 regions: Arusha, Iringa, Katavi, Kigoma, Mara, Mbeya, Morogoro, Ruvuma, Simiyu, Singida, and Tanga. The outcome variable was ART status (either using or not), which was enquired of each OVC caregiver LHIV at enrollment. Data analysis involved multivariable analysis using random-effects logistic regression to identify correlates of ART use. Results In total, 74,999 caregivers living with HIV with mean age of 44.4 years were analyzed. Of these, 96.4% were currently on ART at enrollment. In the multivariable analysis, ART use was 30% lower in urban than in rural areas (adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.61–0.81). Food security improved the odds of being on ART (OR = 1.29, 95% CI 1.15–1.45). Disabled caregivers were 42% less likely than non-disabled ones to be on ART (OR = 0.58, 95% CI 0.45–0.76). Male caregivers with health insurance were 43% more likely than uninsured male caregivers to be on ART (OR = 1.43, 95% CI 1.11–1.83). Caregivers aged 40–49 years had 18% higher likelihood of being on ART than the youngest ones. Primary education level was associated with 26% increased odds of being on ART than no education (OR = 1.26, 95% CI 1.13–1.41). Conclusions Although nearly all the caregivers LHIV in the current study were on ART (96.4%), more efforts are needed to achieve universal coverage. The unreached segments of the population LHIV, even if small, may lead to worse health outcomes, and also spur further spread of the HIV epidemic due to unachieved viral suppression. Targeting caregivers in urban areas, food insecure households, who are uninsured, and those with mental or physical disability can improve ART coverage among caregivers LHIV.

The aim of this exploratory study has been to investigate the fire properties and environmental aspects of different upholstery material combinations, mainly for domestic applications. An analysis ...

Background In 2018, only 65% of Tanzanian children aged 0-14 years living with human immunodeficiency virus (HIV) were on treatment, suggesting that challenges exist. This study explores factors associated with uptake of antiretroviral therapy (ART) among HIV-positive orphans and vulnerable children (OVC). Methods Data are from the USAID Kizazi Kipya project that aims to increase the uptake of HIV/AIDS and other health and social services by OVC and their caregivers. HIV-positive OVC aged 0-14 years who were enrolled in the project from January 2017 to September 2018 were analyzed. ART status (off ART or on ART) was the outcome variable. Multivariate analysis was performed using multilevel logistic regression. Results Of the 10,047 HIV-positive OVC aged 0-14 years analyzed, 93.5% were currently on ART at enrollment. In the multivariate analysis, OVC with male caregivers were 4-times more likely than those with female caregivers to be on ART (OR=4.03, 95% CI=1.49-10.90). OVC with HIV-positive caregivers were 12-times more likely than those with HIV-negative caregivers to be on ART (OR=12.0, 95% CI=3.81-37.70). OVC with caregivers who did not disclose their HIV status were 74% less likely to be on ART than OVC of HIV-negative caregivers (OR=0.26, 95% CI=0.08-0.90). OVC living in urban areas were more than 5-times as likely as their rural counterparts to be on ART (OR=5.55, 95% CI=2.21-14.0). Conclusion The majority of the OVCLHIV in the current study were currently on ART (93.5%) at enrollment. However, uptake of ART by the OVC was dependent on factors external to themselves. Advancing ART uptake may require targeting OVC of female caregivers, OVC of HIV-negative caregivers, as well as OVC of caregivers of undisclosed HIV statu, and rural areas.

Background Although Tanzania experiences a general decline in HIV prevalence, some populations such as caregivers of orphans may be at a higher risk than the general population, suggesting that infection pathways still need further exploration. This study examines how food insufficiency relates to HIV infection among caregivers of orphans and vulnerable children (OVC) in Tanzania. Data and Methods Data are from a community-based, USAID-funded Kizazi Kipya project that aims at increasing the uptake of HIV services, as well as other health and social services by OVC and their caregivers in Tanzania. Caregivers who were enrolled in the project from January to July 2017 in seven regions of Tanzania, and had reported their HIV status to the project, were included in the analysis. While HIV status was the outcome, the main independent variable was food insufficiency which was assessed using the Household Hunger Scale (HHS). Using Stata (version 14.0; StataCorp LP, College Station, TX, USA), data analysis involved multilevel mixed-effects logistic regression.. Results Of the 47,617 caregivers analyzed (73.7% females), 61.8% and 4.6% were experiencing moderate and severe hunger, respectively. The overall HIV prevalence among the caregivers was 28.3%. Nevertheless, the prevalence was as high as 34.2% among caregivers in severe hunger households. Multivariate analysis revealed an increasing likelihood of being HIV positive as hunger increased (moderate hunger: OR=1.10, 95%CI: 1.03-1.18; severe hunger: OR=1.51, 95%CI: 1.32-1.74). These observations were adjusted for marital status, age, sex, education, place of residence, family size, disability status, and health insurance. Conclusion Food insufficiency is associated with a higher likelihood of HIV infection among OVC caregivers in Tanzania, suggesting that improving access to adequate food has a potential to reduce HIV risks among them. Furthermore, food insufficiency could be considered an important criterion for targeting HIV testing and treatment services to expand coverage.

Das Ziel der Studie war die Evaluierung der visuellen und refraktiven Ergebnisse sowie der Patientenzufriedenheit nach bilateraler Implantation einer primaren kapselfixierten Intraokularlinse (IOL) und einer additiven sulcusfixierten trifokalen IOL. Lehrkrankenhaus der Barmherzigen Bruder, Abteilung fur Augenheilkunde, Wien, Osterreich. Prospektive Fallserie. Bei allen Patienten wurde bilateral eine monofokale IOL intrakapsular implantiert, gefolgt von der Implantation einer additiven Sulcoflex Trifokal IOL (0 Dioptrien-Modell 703F, Rayner, West Sussex, UK) in den Sulcus ciliaris im selben Eingriff. Die Evaluation der Patienten erfolgte durch Prufung des unkorrigierten und bestkorrigierten monokularen Fernvisus sowie des unkorrigierten und bestkorrigierten binokularen Fern‑, Intermediar- und Nahvisus, der Defokuskurve, der visuellen Symptome, der Brillenunabhangigkeit sowie der Patientenzufriedenheit 3 Monate postoperativ. Es wurden 15 Patienten eingeschlossen. Der mittlere binokulare unkorrigierte Visus war 0,06 logMAR ± 0,05 (SD) im Fernbereich (Range: −0,3 bis 0,0 logMAR), −0,02 ± 0,17 logMAR fur den Intermediarbereich (Range: −0,1 bis 0,6 logMAR) und 0,09 ± 0,08 logMAR fur den Nahbereich (Range: −0,1 bis 0,2 logMAR). Bei einem Patienten musste 3 Monate postoperativ eine Explantation der Sulcoflex Trifokal IOL aufgrund starker Halos und Blendung durchgefuhrt werden. Bei allen Patienten konnte eine komplette Brillenunabhangigkeit 3 Monate nach der Operation festgestellt werden. Schwerwiegende unerwunschte Ereignisse sind bei diesen Patienten nicht aufgetreten. Die Implantation einer monofokalen IOL intrakapsular in Kombination mit der gleichzeitigen Implantation einer additiven trifokalen IOL in den Sulcus ciliaris stellt eine sichere und effiziente Wahl fur Patienten mit Wunsch nach Brillenunabhangigkeit nach Kataraktoperation dar und bietet den Vorteil einer deutlich risikoarmeren Reversibilitat.

We investigated application of MaxEnt, a one-class classifier, in mapping the spatial distribution of Colophospermum mopane, Dichrostachys cinerea and Salvadora persica using drainage, elevation, s...

Measuring the ventilation rate is crucial to ensuring the control of thermal comfort, energy saving, and emission of pollutants in greenhouses and animal houses. This is more difficult in naturally ventilated (NV) buildings because of the dynamic and complex air flow patterns caused by wind and buoyancy effects. In this study, a user-friendly computational fluid dynamics (CFD) simulator is developed to analyse internal airflow patterns and ventilation rates of NV buildings, with the initial focus on agricultural buildings. The user-friendly CFD automation program, developed using the freely available open-source OpenFOAM and ParaView visualization toolkit, is aimed at non-CFD experts to help them obtain practical CFD solutions quickly. Users simply input building and ventilating configurations, outdoor wind conditions, topographical conditions, and information regarding plants or animals through user-friendly graphical user interfaces. General CFD processes are automated, and the quality of each process is controlled. After executing the program, a three-dimensional interactive visualization module is used for post-processing. It can ensure the flexibility and manageability of the model by automating predeveloped procedures in a user-interactive manner, thereby reducing time and effort. This paper describes the development process of automation interfaces. ispartof: Biosystems Engineering vol:193 pages:232-246 status: published

Distress and pains among other gynecological challenges mothers go through during childbirth result in mortality. This has compelled people particularly in developing countries to use traditional medicine to induce birth due to lack of more effective alternatives. In Uganda, from time immemorial most child birth and pregnancy related problems have been solved using medicinal plants as a primary alternative to conventional drugs. Although research has been done to document and validate effectiveness of these plants, it is not compil ed for communication to the wider community. This study, therefore, reviewed the medicinal plants used in Uganda for easing childbirth. The study collated and documented medicinal plants used by Traditional Birth Attendants and Traditional Health Practitioners to induce labor and ease child birth in local communities in Uganda and show the gaps that need to be investigated. The available literature on medicinal plants used in Uganda for childbirth were selected from reputable journals using citation databases including Google Scholar, Institute for Scientific Information, PubMed, Scopus, Hinari, and Scientific Information Database among others. Asteraceae, Fabaceae, and Lamiaceae, respectively were the most cited for gynecological uses by various local communities in Uganda. The commonly reported species were Laggera alata Sch. Bip., Tagetes minuta L, Clitoria ternatea Linn and Ocimum lamiifolium Hochst ex Benth among others. Authors were also determined to ascertain scientific evidence against analgesic, anti-inflammatory, oxytocic and phytochemical properties of the selected plant species. Key words: Childbirth, medicinal plant, gynecology, Uganda.

Transplantation of vascularized composite allografts (VCAs) provides a means of restoring complex anatomical and functional units following burns and other disfigurement otherwise not amenable to conventional autologous reconstructive surgery. While short- to intermediate-term VCA survival is largely dependent on patient compliance with medication, the myriad of side effects resulting from lifelong systemic immunosuppression continue to pose a significant challenge. Topical immunosuppression is therefore a logical and attractive alternative for VCA. Current formulations are limited though, by poor skin penetration but this may be mitigated by conjugation of immunosuppressive drugs to TyroSpheres for enhanced delivery. Therefore, we investigated the topical application of FK506-TyroSpheres (in the form of a gel dressing) in a clinically relevant nonhuman primate VCA model to determine if allograft survival could be prolonged at reduced levels of maintenance systemic immunosuppression. Six Major Histocompatibility Complex (MHC)-mismatched cynomolgus macaques (Macaca fascicularis) served as reciprocal donors and recipients of radial forearm fasciocutaneous flaps. Standard Bacitracin ointment and FK506-TyroSpheres were applied every other day to the VCAs of animals in groups 1 (controls, n = 2) and 2 (experimental, n = 4), respectively, before gradual taper of systemic FK506. Clinical features of VCA rejection still developed when systemic FK506 fell below 10 ng/ml despite application of FK506-TyroSpheres and prolonged VCA survival was not achieved. However, unwanted systemic FK506 absorption was avoided with TyroSphere technology. Further refinement to optimize local drug delivery profiles to achieve and maintain therapeutic delivery of FK506 with TyroSpheres is underway, leveraging significant experience in controlled drug delivery to mitigate acute rejection of VCAs.

Nonalcoholic fatty liver disease (NAFLD) is a common form of liver disease, associated with features of the metabolic syndrome. Nonalcoholic steatohepatitis (NASH), the aggressive subtype of NAFLD, can cause progressive fibrosis leading to cirrhosis. With the obesity epidemic, there is an increased health care burden from NASH, one of the most common causes of liver transplantation in the United States. There currently are no Food and Drug Administration-approved medical therapies for NASH. There exists a need for therapeutics to correct the drivers of NASH and to reverse or halt fibrosis progression. This article reviews pharmacologic therapeutics being developed to treat NASH.

Background Female sex workers (FSW) in sub-Saharan Africa are disproportionately affected by HIV and are critical to engage in HIV prevention, testing and care services. We describe the design of our evaluation of the ‘AMETHIST’ intervention, nested within a nationally-scaled programme for FSW in Zimbabwe. We hypothesise that the implementation of this intervention will result in a reduction in the risk of HIV transmission within sex work. Methods The AMETHIST intervention (Adapted Microplanning to Eliminate Transmission of HIV in Sex Transactions) is a risk-differentiated intervention for FSW, centred around the implementation of microplanning and self-help groups. It is designed to support uptake of, and adherence to, HIV prevention, testing and treatment behaviours among FSW. Twenty-two towns in Zimbabwe were randomised to receive either the Sisters programme (usual care) or the Sisters programme plus AMETHIST. The composite primary outcome is defined as the proportion of all FSW who are at risk of either HIV acquisition (HIV-negative and not fully protected by prevention interventions) or of HIV transmission (HIV-positive, not virally suppressed and not practicing consistent condom use). The outcome will be assessed after 2 years of intervention delivery in a respondent-driven sampling survey (total n = 4400; n = 200 FSW recruited at each site). Primary analysis will use the ‘RDS-II’ method to estimate cluster summaries and will adapt Hayes and Moulton’s ‘2-step’ method produce adjusted effect estimates. An in-depth process evaluation guided by our project trajectory will be undertaken. Discussion Innovative pragmatic trials are needed to generate evidence on effectiveness of combination interventions in HIV prevention and treatment in different contexts. We describe the design and analysis of such a study. Trial registration Pan African Clinical Trials Registry PACTR202007818077777. Registered on 2 July 2020.

The air change rate (ACR) of naturally ventilated dairy buildings (NVDBs) plays an important part in the design and control of the ventilation system, as well as in the estimation of the gaseous emission rate. The objectives of this research were to model the ACR based on a quantitative investigation of the relationship between the ACR and its potential influencing factors, including the opening ratio (r), the building length to width ratio (α), the wind speed (U), and the wind direction (θ). The investigations were performed using the response surface methodology integrated with the Box-Behnken design and Computational Fluid Dynamics (CFD) simulations. Three response surface models of the ACR of NVDBs were established for three opening ratio ranges of 5%–42.5%, 42.5%–80%, and 5%–80%, respectively. It was found that the selection of the opening ratio range had almost no effect on the developed response surface models. The results showed that the ACR of NVDBs was not influenced by α, but was significantly affected by r, U, θ, and interaction effects between every two of the three factors. The highest ACR was 6.7 s−1, 6.0 s−1, and 4.0 s−1 when θ, U, and r was at their respective medium value while the rest parameters were at the highest values, indicating that the r played an important role in the value of ACR. It was concluded that in the prediction of the ACR of a building, the influences of both individual and interactional effects of θ, U, and r should be considered.

We report the case of a 55-year-old non–insulin-dependent diabetic man with well-controlled hyperlipidemia who presented himself with temporarily blurred vision in both eyes occurring during chemotherapy with adjunctive glucocorticoid treatment for colon carcinoma. Fundus examination revealed lipemia retinalis in his both eyes that resolved after 6 weeks when the chemotherapy was finished, and the patients' triglyceride and glucose levels decreased., Purpose: The purpose of this report is to describe a case of lipemia retinalis due to decompensating hyperlipidemia that occurred during chemotherapy in a patient with metastatic colon carcinoma. Methods: Retrospective case report. Results: A 55-year-old non–insulin-dependent diabetic man with well-controlled hyperlipidemia presented himself with temporarily blurred vision in both eyes occurring during chemotherapy. He was found to have lipemia retinalis in his both eyes. Blood tests revealed elevated cholesterol and triglyceride levels exceeding 8,200 mg/dL. He received six cycles of FOLFIRI/bevacizumab and accompanying dexamethasone because of colon cancer with pulmonary metastases. Lipemia retinalis had resolved after a 6-week follow-up when chemotherapy was finished, and the patients' triglyceride and glucose levels decreased to normal values. Conclusion: Lipemia retinalis associated with visual impairment may occur during chemotherapy under accompanying treatment with dexamethasone. Even if patients with hyperlipidemia are metabolically well-controlled with oral medication, treatment with dexamethasone can potentially lead to decompensation of hyperlipidemia causing secondary lipemia retinalis.

This work explores the challenges of using life cycle assessment (LCA) and life cycle cost (LCC) analysis to provide easily accessible decision support for early product development in cases where intellectual property (IP) and privacy issues require special consideration. Innovation research projects with partners representing different links along the value chain are potential examples of such cases. A case study in which spreadsheet-based cradle to compounder's gate LCA and LCC screening tools were created for candidate flame retarded polymer formulations exemplifies the need for better solutions to overcome problems associated with lack of transparency due to IP/privacy concerns. These problems affect data quality, scaling up processes, and uncertainty of the results. The consortium in this case study had a common overall goal, although each of the partners had a unique perspective on the polymer development process and different IP/privacy needs. The measures used to overcome the challenges include aggregation, normalisation, and omission of costs and impacts common to all candidate compounds. The resulting LCA and LCC screening tools represent a compromise between providing the requested information at the level of detail required by the partners and reporting results that are as accurate and useful as possible. The findings are: in cases where absolute secrecy must be maintained, no one can learn which materials and processes provide the optimal results; appointing a trusted third party to handle sensitive inventory data can cause increased uncertainty of the results due to lack of peer review; the results of the work cannot be built upon by subsequent research.

We demonstrate that highly accurate joint redshift-stellar mass probability distribution functions (PDFs) can be obtained using the Random Forest (RF) machine learning (ML) algorithm, even with few photometric bands available. As an example, we use the Dark Energy Survey (DES), combined with the COSMOS2015 catalogue for redshifts and stellar masses. We build two ML models: one containing deep photometry in the $griz$ bands, and the second reflecting the photometric scatter present in the main DES survey, with carefully constructed representative training data in each case. We validate our joint PDFs for $10,699$ test galaxies by utilizing the copula probability integral transform and the Kendall distribution function, and their univariate counterparts to validate the marginals. Benchmarked against a basic set-up of the template-fitting code BAGPIPES, our ML-based method outperforms template fitting on all of our predefined performance metrics. In addition to accuracy, the RF is extremely fast, able to compute joint PDFs for a million galaxies in just under $6$ min with consumer computer hardware. Such speed enables PDFs to be derived in real time within analysis codes, solving potential storage issues. As part of this work we have developed GALPRO, a highly intuitive and efficient Python package to rapidly generate multivariate PDFs on-the-fly. GALPRO is documented and available for researchers to use in their cosmology and galaxy evolution studies., Comment: 18 pages, 8 figures, Accepted by MNRAS