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Background: Despite the poor outcomes related to the presence of pulmonary hypertension, it often goes undiagnosed in part because of low suspicion and screening tools not being easily accessible such as echocardiography. A new readily available screening tool to identify elevated pulmonary artery systolic pressures is needed to help with the prognosis and timely treatment of underlying causes such as heart failure or pulmonary vascular remodeling. We developed a deep learning-based method that uses phonocardiograms (PCGs) for the detection of elevated pulmonary artery systolic pressure, an indicator of pulmonary hypertension., Methods: Approximately 6000 PCG recordings with the corresponding echocardiogram-based estimated pulmonary artery systolic pressure values, as well as ≈169 000 PCG recordings without associated echocardiograms, were used for training a deep convolutional network to detect pulmonary artery systolic pressures ≥40 mm Hg in a semisupervised manner. Each 15-second PCG, recorded using a digital stethoscope, was processed to generate 5-second mel-spectrograms. An additional labeled data set of 196 patients was used for testing. GradCAM++ was used to visualize high importance segments contributing to the network decision., Results: An average area under the receiver operator characteristic curve of 0.79 was obtained across 5 cross-validation folds. The testing data set gave a sensitivity of 0.71 and a specificity of 0.73, with pulmonic and left subclavicular locations having higher sensitivities. GradCAM++ technique highlighted physiologically meaningful PCG segments in example pulmonary hypertension recordings., Conclusions: We demonstrated the feasibility of using digital stethoscopes in conjunction with deep learning algorithms as a low-cost, noninvasive, and easily accessible screening tool for early detection of pulmonary hypertension.

Background: Despite global efforts to reduce maternal and neonatal mortality, stillbirths remain a significant public health challenge in many low- and middle-income countries. District health systems, largely seen as the backbone of health systems, are pivotal in addressing the data gaps reported for stillbirths. Available, accurate and complete data is essential for District Health Management Teams (DHMTs) to understand the burden of stillbirths, evaluate interventions and tailor health facility support to address the complex challenges that contribute to stillbirths. This study aims to understand stillbirth recording and reporting in the Ashanti Region of Ghana from the perspective of DHMTs., Methods: The study was conducted in the Ashanti Region of Ghana. 15 members of the regional and district health directorates (RHD/DHD) participated in semi-structured interviews. Sampling was purposive, focusing on RHD/DHD members who interact with maternity services or stillbirth data. Thematic analyses were informed by an a priori framework, including theme 1) experiences, perceptions and attitudes; theme 2) stillbirth data use; and theme 3) leadership and support mechanisms, for stillbirth recording and reporting., Results: Under theme 1, stillbirth definitions varied among respondents, with 20 and 28 weeks commonly used. Fresh and macerated skin appearance was used to classify timing with limited knowledge of antepartum and intrapartum stillbirths. For theme 2, data quality checks, audits, and the district health information management system (DHIMS-2) data entry and review are functions played by the DHD. Midwives were blamed for data quality issues on omissions and misclassifications. Manual entry of data, data transfer from the facility to the DHD, limited knowledge of stillbirth terminology and periodic closure of the DHIMS-2 were seen to proliferate gaps in stillbirth recording and reporting. Under theme 3, perinatal audits were acknowledged as an enabler for stillbirth recording and reporting by the DHD, though audits are mandated for only late-gestational stillbirths (> 28 weeks). Engagement of other sectors, e.g., civil/vital registration and private health facilities, was seen as key in understanding the true population-level burden of stillbirths., Conclusion: Effective district health management ensures that every stillbirth is accurately recorded, reported, and acted upon to drive improvements. A large need exists for capacity building on stillbirth definitions and data use. Recommendations are made, for example, terminology standardization and private sector engagement, aimed at reducing stillbirth rates in high-mortality settings such as Ghana., (© 2024. The Author(s).)

The private health sector is becoming increasingly important in discussions on improving the quality of care for maternal and newborn health (MNH). Yet information rarely addresses what engaging the private sector for MNH means and how to do it. In 2019, the Network for Improving Quality of Care for Maternal, Newborn and Child Health (the Network) initiated exploratory research to better understand how to ensure that the private sector delivers quality care and what the public sector must do to facilitate and sustain this process. This article details the approach and lessons learnt from two Network countries, Ghana and Nigeria, where teams explored the mechanisms for engaging the private sector in delivering MNH services with quality. The situational analyses in Ghana and Nigeria revealed challenges in engaging the private sector, including lack of accurate data, mistrust and an unlevel playing field. Challenging market conditions hindered a greater private sector role in delivering quality MNH services. Based on these analyses, participants at multistakeholder workshops recommended actions addressing policy/administration, regulation and service delivery. The findings from this research help strengthen the evidence base on engaging the private sector to deliver quality MNH services and show that this likely requires engagement with broader health systems factors. In recognition of this need for a balanced approach and the new WHO private sector strategy, the WHO has updated the tools and process for countries interested in conducting this research. The Nigerian Ministry of Health is stewarding additional policy dialogues to further engage the private sector., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Genomic surveillance of SARS-CoV-2 is crucial for monitoring the spread of COVID-19 and guiding public health decisions, but the capacity for SARS-CoV-2 testing and sequencing in Africa is low. We integrated SARS-CoV-2 surveillance into an existing influenza surveillance network with the aim of providing insights into SARS-CoV-2 transmission and genomics in Ghana., Methods: In this molecular epidemiological analysis, which is part of a wider multifaceted prospective observational study, we collected national SARS-CoV-2 test data from 35 sites across 16 regions in Ghana from Sept 1, 2020, to Nov 30, 2021, via the Ghanaian integrated influenza and SARS-CoV-2 surveillance network. SARS-CoV-2-positive samples collected through this integrated national influenza surveillance network and from international travellers arriving in Accra were sequenced with Oxford Nanopore Technology sequencing and the ARTIC tiled amplicon method. The sequence lineages were typed with pangolin and the phylogenetic analysis was conducted with IQ-Tree2 and TreeTime., Findings: During the study period, 5495 samples were submitted for diagnostic testing through the national influenza surveillance network (2121 [46·1%] of 4021 samples with complete demographic data were from female individuals and 2479 [53·9%] of 4021 samples were from male individuals). We also obtained 2289 samples from travellers who arrived in Accra and had a positive lateral flow test, of whom 1626 (71·0%, 95% CI 69·1-72·9) were confirmed to be SARS-CoV-2 positive. Co-circulation of influenza and SARS-CoV-2 in Ghana was detected, with increased cases of influenza in November, 2020, November, 2021, and January and June, 2021. In 4124 samples from individuals with influenza-like illness, SARS-CoV-2 was identified in 583 (14·1%, 95% CI 13·1-15·2) samples and influenza in 356 (8·6%, 7·8-9·5). Conversely, in 476 samples from individuals with of severe acute respiratory illness, SARS-CoV-2 was detected in 58 (12·2%, 9·5-15·5) samples and influenza in 95 (19·9%, 16·5-23·9). We detected four waves of SARS-CoV-2 infections in Ghana; each wave was driven by a different variant: B.1 and B.1.1 were the most prevalent lineages in wave 1, alpha (B.1.1.7) was responsible for wave 2, delta (B.1.617.2) and its sublineages (closely related to delta genomes from India) were responsible for wave 3, and omicron variants were responsible for wave 4. We detected omicron variants among 47 (32%) of 145 samples from travellers during the start of the omicron spread in Ghana (wave 4)., Interpretation: This study shows the value of repurposing existing influenza surveillance platforms to monitor SARS-CoV-2. Influenza continued to circulate in Ghana in 2020 and 2021, and remained a major cause of severe acute respiratory illness. We detected importations of SARS-CoV-2 variants into Ghana, including those that did or did not lead to onward community transmission. Investment in strengthening national influenza surveillance platforms in low-income and middle-income countries has potential for ongoing monitoring of SARS-CoV-2 and future pandemics., Funding: The EDCTP2 programme supported by the EU., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.

This paper investigates the determinants that will influence students' acceptance of the electronic learning (e-learning) system of education after the COVID-19 emergency. Specifically, the paper assesses the attitudes and intentions of students in second-cycle institutions to accept e-learning after the pandemic, using constructs derived from the health belief model and technology acceptance model. Also, we test if there is any significant difference in the attitudes and intentions of students in public and private institutions. Using data collected from 370 students in upper and lower levels of a second-cycle institutions in Ghana, we found that student attitude is significantly influenced by perceived usefulness and moderately affected by perceived severity, whereas, student's intention is moderately affected by the perceived severity but substantially influenced by the student's attitude towards usage. Also, the results revealed that students' attitudes and intentions to use e-learning are moderately affected by the severity of the ongoing COVID-19 pandemic. Finally, there were no significant differences in the attitudes and intentions of the sampled students in public and private second-cycle institutions in Ghana, regarding their acceptance and usage of e-learning after the COVID-19 emergency. Given the study's findings, the paper concludes that students' attitudes and intention to use e-learning are the main determinants that will influence the students' acceptance of the e-learning system of education in second-cycle institutions in Ghana after the COVID-19 emergency. The paper contributes to knowledge by providing evidence of students' acceptance of the e-learning system of education after the COVID-19 emergency in the context of a developing country like Ghana., Competing Interests: Conflict of interestThe authors have no competing interests to declare that are relevant to the content of this manuscript., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.)

Background: Few population-based studies assess the impact of cancer on sepsis incidence and mortality., Objectives: To evaluate epidemiological trends of sepsis in patients with cancer., Methods: This retrospective cohort study included adults (≥20 years old) identified using sepsis-indicator International Classification of Diseases codes from the Nationwide Inpatient Sample database (2006-2014). A generalized linear model was used to trend incidence and mortality. Outcomes in patients with cancer and patients without cancer were compared using propensity score matching. Cox regression modeling was used to calculate hazard ratios for mortality rates., Results: The study included 13 996 374 patients, 13.6% of whom had cancer. Gram-positive infections were most common, but the incidence of gram-negative infections increased at a greater rate. Compared with patients without cancer, those with cancer had significantly higher rates of lower respiratory tract (35.0% vs 31.6%), intra-abdominal (5.5% vs 4.6%), fungal (4.8% vs 2.9%), and anaerobic (1.2% vs 0.9%) infections. Sepsis incidence increased at a higher rate in patients with cancer than in those without cancer, but hospital mortality rates improved equally in both groups. After propensity score matching, hospital mortality was higher in patients with cancer than in those without cancer (hazard ratio, 1.25; 95% CI, 1.24-1.26). Of patients with sepsis and cancer, those with lung cancer had the lowest survival (hazard ratio, 1.65) compared with those with breast cancer, who had the highest survival., Conclusions: Cancer patients are at high risk for sepsis and associated mortality. Research is needed to guide sepsis monitoring and prevention in patients with cancer., (© 2021 American Association of Critical-Care Nurses.)

Objectives: To determine the prevalence of SARS-CoV-2 detection among international travellers to Ghana during mandatory quarantine., Design: A retrospective cross-sectional study., Setting: Air travellers to Ghana on 21 st and 22 nd March 2020., Participants: On 21 st and 22 nd March 2020, a total of 1,030 returning international travellers were mandatorily quarantined in 15 different hotels in Accra and tested for SARS-CoV-2. All of these persons were included in the study., Main Outcome Measure: Positivity for SARS-CoV-2 by polymerase chain reaction., Results: The initial testing at the beginning of quarantine found 79 (7.7%) individuals to be positive for SARS-CoV-2. In the exit screening after 12 to 13 days of quarantine, it was discovered that 26 of those who tested negative for SARS-CoV-2 in the initial screening subsequently tested positive., Conclusions: Ghana likely averted an early community spread of COVID-19 through the proactive approach to quarantine international travellers during the early phase of the pandemic., Funding: None., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Electroporation-based assays were used to test whether the myogenic regulatory factor (MRF) of Ciona intestinalis (CiMRF) interferes with endogenous developmental programs, and to evaluate the importance of its unusual N-terminus for muscle development. We found that CiMRF suppresses both notochord and endoderm development when it is expressed in these tissues by a mechanism that may involve activation of muscle-specific microRNAs. Because these results add to a large body of evidence demonstrating the exceptionally high degree of functional conservation among MRFs, we were surprised to discover that non-ascidian MRFs were not myogenic in Ciona unless they formed part of a chimeric protein containing the CiMRF N-terminus. Equally surprising, we found that despite their widely differing primary sequences, the N-termini of MRFs of other ascidian species could form chimeric MRFs that were also myogenic in Ciona. This domain did not rescue the activity of a Brachyury protein whose transcriptional activation domain had been deleted, and so does not appear to constitute such a domain. Our results indicate that ascidians have previously unrecognized and potentially novel requirements for MRF-directed myogenesis. Moreover, they provide the first example of a domain that is essential to the core function of an important family of gene regulatory proteins, one that, to date, has been found in only a single branch of the family., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Pertussis is a vaccine preventable disease (VPD) monitored by the World Health Organization (WHO). Despite a long-established Pertussis immunization system, the re-emergence of the disease in some countries stressed the need to have well-trained field epidemiologists at the forefront in the fight against these VPDs, especially during an outbreak. Practical, hands-on training is useful for clearer understanding of the principles and development of competencies relevant to outbreak investigation, which will enhance field practice; case method training using realistic public health scenarios helps trainees put into practice learned theory. As such, this case study was adopted from a real Pertussis outbreak investigation that was conducted by Ghana's Field Epidemiology Training Program residents, together with the rapid response team members of Dormaa Municipal health directorate in August 2016. It was primarily designed for training novice public health practitioners in a facilitated classroom setting. Participants should be able to complete the exercises in approximately 3 hours.

The occurrence of communicable diseases highlights the need to have well-trained field epidemiologists at the forefront in the fight against these diseases, especially during an outbreak. Training for outbreak investigation is most effective when participants can develop their competencies in a practical exercise. This is a simulation of the steps in meningitis outbreak investigation conducted in Ghana in February 2016 by Ghana Field Epidemiology Training Programme (FELTP) residents and the public health technical team of the Nkoranza South Municipality as a field epidemiologist. This case study is suited to reinforce principles and skills already covered in a lecture or in background reading by providing a practical training beyond the scope of theoretical learning. It is primarily intended for training novice public health practitioners who should be able to complete the exercises in 3 hours.