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Paediatric hearing loss rates in Ghana are currently unknown.
A cross-sectional study was conducted in peri-urban Kumasi, Ghana; children (aged 3–15 years) were recruited from randomly selected households. Selected children underwent otoscopic examination prior to in-community pure tone screening using the portable ShoeBox audiometer. The LittlEars auditory questionnaire was also administered to caregivers and parents.
Data were collected from 387 children. After conditioning, 362 children were screened using monaural pure tones presented at 25 dB. Twenty-five children could not be conditioned to behavioural audiometric screening. Eight children were referred based on audiometric screening results. Of those, four were identified as having hearing loss. Four children scored less than the maximum mark of 35 on the LittleEars questionnaire. Of those, three had hearing loss as identified through pure tone screening. The predominant physical finding on otoscopy was ear canal cerumen impaction.
Paediatric hearing loss is prevalent in Ghana, and should be treated as a public health problem warranting further evaluation and epidemiology characterisation.
There is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia.
In the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint.
Almost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35–0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13–0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly.
An integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
This paper examined the association between wealth and health insurance status and the use of traditional medicine (TM) among older persons in Ghana.
There have been considerable efforts by sub-Saharan African countries to improve access to primary health care services, partly through the implementation of risk-pooling community or national health insurance schemes. The use of TM, which is often not covered under these insurance schemes, remains common in many countries, including Ghana. Understanding how health insurance and wealth influence the use of TM, or otherwise, is essential to the development of equitable health care policies.
The study used data from the first wave of the World Health Organisation’s Study of Global Ageing and Adult Health conducted in Ghana in 2008. Descriptive statistics and negative loglog regression models were fitted to the data to examine the influence of insurance and wealth status on the use of TM, controlling for theoretically relevant factors.
Seniors who had health insurance coverage were also 17% less likely to frequently seek treatment from a TM healer relative to the uninsured. For older persons in the poorest income quintile, the odds of frequently seeking treatment from TM increased by 61% when compared to those in the richest quintile. This figure was 46%, 62% and 40% for older persons in poorer, middle and richer income quintiles, respectively, compared to their counterparts in the richest income quintile.
The findings indicate that TM was primarily used by the poor and persons who were not enrolled in the National Health Insurance Scheme. TM continues to be a vital health care resource for the poor and uninsured older adults in Ghana.
The use of a field portable XRF analyzer incorporating a semiconductor, mercuric iodide, energy dispersive spectrometer is described with emphasis on the benefits of high resolution x-ray detection for rapid screening of hazardous metallic wastes. Results are presented of “in-situ” and “prepared sample” soil measurement for different sites to show the potential of Fundamental Parameter analysis to obtain acceptable quality data with minimum calibration effort, obviating the need for site-specific standards.
The Turkana Basin of northwestern Kenya is well known for its rich Neogene–Quaternary vertebrate fossil record; however, it also represents one of the few locations in sub-Saharan Africa where Cretaceous vertebrate fossils, including dinosaurs and other archosaurs, are preserved. These Cretaceous deposits are colloquially referred to as the ‘Turkana Grits’, and assumed to be Cretaceous in age based on their limited biostratigraphy. The ‘Turkana Grits’ are overlain by Palaeogene volcanic rocks (<35 Ma), which are widely considered to record the earliest evidence of plume-related volcanism in the East African Rift System. In this study, we present the results of an integrated sedimentary provenance investigation of two units within the ‘Turkana Grits’ called the Lapur and Muruanachok sandstones. Analysis of U–Pb ages and Lu–Hf initial ɛHf(t) values from 1106 detrital zircons demonstrate that sediments are primarily derived from Neoarchaean and Neoproterozoic basement sources, except for six Palaeogene grains from the upper Lapur Sandstone, which are of unknown provenance. Considered together, these data point to the Mozambique Belt, which makes up the nearby rift flanks, as the primary provenance source. This is consistent with palaeocurrent data, and suggests localized sediment input by alluvial fans, which fed into NNW-directed fluvial systems. Perhaps the most surprising finding is the identification of the late Paleocene detrital zircons, which not only demonstrate that the depositional age for the top of the formation is Paleocene rather than Cretaceous, but also provides possible evidence for the oldest Palaeogene volcanic activity within the East African Rift System.
Common reed [Phragmites australis (Cav.) Trin. ex Steud.], an aggressive invader in North American wetlands, is likely to undergo a range expansion as the climate changes. Increased atmospheric [CO2] and temperature have been shown to cause morphological and physiological changes in many species, sometimes altering the way they respond to herbicides. To understand how climate-related environmental parameters may impact P. australis management, we grew two P. australis haplotypes (the Gulf Coast type and the Eurasian type) under ambient (400 ppm CO2, 32/21 C) or elevated (650 ppm CO2, 35/24 C) climate conditions. After 6 wk, the Gulf Coast type had reduced leaf area, increased stomatal conductance, and increased transpiration under the elevated conditions. The Eurasian type had lower Vcmax (the maximum carboxylation rate of Rubisco) and lower Jmax (the maximum electron transport rate of RuBP regeneration) under elevated climate conditions. Results likely reflected a greater impact of higher temperatures rather than increased [CO2]. After the 6-wk period, plants were either treated with glyphosate (0.57 kg ae ha−1) or remained an untreated control. Data were collected 30 d after treatment (DAT) and 60 DAT to evaluate herbicide efficacy. Overall, the Gulf Coast type was less responsive to glyphosate applications under the elevated climate conditions than under current climate conditions. The lower leaf area of the Gulf Coast type in these climate conditions may have resulted in less herbicide interception and uptake. Glyphosate efficacy was less impacted by climate treatment for the Eurasian type than for the Gulf Coast type.
The role of vegetable and fruit intake in reducing falls risk in elderly populations is uncertain. This study examined the associations of vegetable and fruit intake with falls-related hospitalisations in a prospective cohort study of elderly women (n 1429, ≥70 years), including effects on muscular function, which represented a potential causal pathway. Muscular function, measured using grip strength and timed-up-and-go (TUG), and vegetable and fruit intake, quantified using a validated FFQ, were assessed at baseline (1998). Incident falls-related hospitalisation over 14·5-year follow-up was captured by the Hospital Morbidity Data Collection, linked via the Western Australian Data Linkage System. Falls-related hospitalisation occurred in 568 (39·7 %) of women. In multivariable-adjusted models, falls-related hospitalisations were lower in participants consuming more vegetables (hazard ratio (HR) per 75 g serve: 0·90 (95 % CI 0·82, 0·99)), but not fruit intake (per 150 g serve: 1·03 (95 % CI 0·93, 1·14)). Only total cruciferous vegetable intake was inversely associated with falls-related hospitalisation (HR: per 20 g serve: 0·90 (95 % CI 0·83, 0·97)). Higher total vegetable intake was associated with lower odds for poor grip strength (OR: 0·87 (95 % CI 0·77, 0·97)) and slow TUG (OR: 0·88 (95 % CI 0·78, 0·99)). Including grip strength and TUG in the multivariable-adjusted model attenuated the association between total vegetable intake and falls-related hospitalisations. In conclusion, elderly women with higher total and cruciferous vegetable intake had lower injurious falls risk, which may be explained in a large part by better physical function. Falls reduction may be considered an additional benefit of higher vegetable intake in older women.
OBJECTIVES/SPECIFIC AIMS: Educate the general public, investigators, and institutional leadership on the importance of clinical trial registration and results reporting. Share success as a means to develop national best practices. METHODS/STUDY POPULATION: Developed a Project Charter; Spoke to several peer institutions; Update institutional policy. RESULTS/ANTICIPATED RESULTS: Since launching the Program in June 2016, the number of records submitted to ClinicalTrials.gov has increased 14% (852–971). At the same time, compliance with late results has increased by over 92% (111–9). DISCUSSION/SIGNIFICANCE OF IMPACT: Clinical Trial registration and results reporting is sub-par at many institutions. We have established a successful program that others can emulate. Institutions can increase transparency of clinical trials as well as prevent civil monetary penalties ($11,569/d/study) and loss of grant funding.
Cogongrass is commonly found in disturbed areas in Florida, where it is increasingly becoming a problem in bahiagrass pastures. Soil pH has been suggested as a possible mechanism for this invasion; to evaluate this, replacement series competition studies were conducted under greenhouse conditions at two soil pH levels: pH 4.5, or pH 6.8. Cogongrass ramets and bahiagrass seedlings were planted at proportions of 0:40, 1:20, 2:10, 4:1, and 8:0, respectively. Aboveground biomass was measured after 8 weeks and used to calculate relative yield, relative crowding coefficients, and aggressivity values. At soil pH 4.5, the relative competitiveness of cogongrass and bahiagrass was similar, with both species contributing equally to relative yield. At soil pH 6.8, bahiagrass seedlings showed greater competitive ability than cogongrass ramets. Relative crowding coefficient and aggressivity values supported this, with bahiagrass showing increased competitiveness under higher soil pH. This indicates that decreases in soil pH, often associated with poor soil fertility, is likely a contributing factor for cogongrass invasion into bahiagrass pastures. Soil amendments to raise pH may provide a cultural management tool for cogongrass infestations in pastures.
Arterial wall thickening, stimulated by low-grade systemic inflammation, underlies many cardiovascular events. As diet is a significant moderator of systemic inflammation, the dietary inflammatory index (DIITM) has recently been devised to assess the overall inflammatory potential of an individual’s diet. The primary objective of this study was to assess the association of the DII with common carotid artery–intima-media thickness (CCA–IMT) and carotid plaques. To substantiate the clinical importance of these findings we assessed the relationship of DII score with atherosclerotic vascular disease (ASVD)-related mortality, ischaemic cerebrovascular disease (CVA)-related mortality and ischaemic heart disease (IHD)-related mortality more. The study was conducted in Western Australian women aged over 70 years (n 1304). Dietary data derived from a validated FFQ (completed at baseline) were used to calculate a DII score for each individual. In multivariable-adjusted models, DII scores were associated with sub-clinical atherosclerosis: a 1 sd (2·13 units) higher DII score was associated with a 0·013-mm higher mean CCA–IMT (P=0·016) and a 0·016-mm higher maximum CCA–IMT (P=0·008), measured at 36 months. No relationship was seen between DII score and carotid plaque severity. There were 269 deaths during follow-up. High DII scores were positively associated with ASVD-related death (per sd, hazard ratio (HR): 1·36; 95 % CI 1·15, 1·60), CVA-related death (per sd, HR: 1·30; 95 % CI 1·00, 1·69) and IHD-related death (per sd, HR: 1·40; 95 % CI 1·13, 1·75). These results support the hypothesis that a pro-inflammatory diet increases systemic inflammation leading to development and progression of atherosclerosis and eventual ASVD-related death.
For most producers, unmanned aerial vehicles (UAV) are a novelty that has been little employed in their agricultural operations. An UAV will not fix every problem on the farm, but there are some practical applications for which UAVs have demonstrated value. Three examples of how UAVs have been used in weed science applications are presented here; the methods are transferable to other agricultural commodities with similar characteristics. The first of these is quantification of the extent and severity of non-target herbicide injury. The second application is calculation of spray thresholds based on weed populations. The third application is development of site-specific herbicide treatment.
Medical and educational partnerships between high- and low-resourced countries provide opportunities to have a long-term meaningful impact on medical training and healthcare delivery.
An otolaryngology partnership between Komfo Anokye Teaching Hospital in Kumasi, Ghana, and the University of Michigan Department of Otolaryngology/Head and Neck Surgery has been undertaken to enhance healthcare delivery at both institutions.
A temporal bone dissection laboratory, with the equipment to perform dedicated otological surgery, and academic platforms for clinical and medical education and residency training have been established.
This article describes the details of this partnership in otological surgery and hearing health, with an emphasis on creating in-country surgical simulation, training on newly acquired medical equipment and planning regarding the formulation of objectified metrics to gauge progress going forward.
There remains a large disparity in the quantity, quality and impact of mental health research carried out in sub-Saharan Africa, relative to both the burden and the amount of research carried out in other regions. We lack evidence on the capacity-building activities that are effective in achieving desired aims and appropriate methodologies for evaluating success.
AFFIRM was an NIMH-funded hub project including a capacity-building program with three components open to participants across six countries: (a) fellowships for an M.Phil. program; (b) funding for Ph.D. students conducting research nested within AFFIRM trials; (c) short courses in specialist research skills. We present findings on progression and outputs from the M.Phil. and Ph.D. programs, self-perceived impact of short courses, qualitative data on student experience, and reflections on experiences and lessons learnt from AFFIRM consortium members.
AFFIRM delivered funded research training opportunities to 25 mental health professionals, 90 researchers and five Ph.D. students across 6 countries over a period of 5 years. A number of challenges were identified and suggestions for improving the capacity-building activities explored.
Having protected time for research is a barrier to carrying out research activities for busy clinicians. Funders could support sustainability of capacity-building initiatives through funds for travel and study leave. Adoption of a train-the-trainers model for specialist skills training and strategies for improving the rigor of evaluation of capacity-building activities should be considered.
Cognitive impairment and depression often co-occur in older adults, but it is not clear whether depression is a risk factor for cognitive decline, a psychological reaction to cognitive decline, or whether changes in depressive symptoms correlate with changes in cognitive performance over time. The co-morbid manifestation of depression and cognitive impairment may reflect either a causal effect or a common cause, depending on the specific symptoms experienced and the cognitive functions affected.
The study sample comprised 1506 community-dwelling older adults aged ⩾65 years from the Longitudinal Aging Study Amsterdam (LASA). We conducted cross-domain latent growth curve analyses to examine longitudinal associations between late-life depression dimensions (i.e. depressed affect, positive affect, and somatic symptoms) and specific domains of cognitive functioning (i.e. processing speed, inductive reasoning, immediate recall, and delayed recall).
Poorer delayed recall performance at baseline predicted a steeper increase in depressed affect over time. Steeper decline in processing speed correlated with a steeper increase in somatic symptoms of depression over time.
Our findings suggest a prospective association between memory function and depressed affect, whereby older adults may experience an increase in depressed affect in reaction to poor memory function. Somatic symptoms of depression increased concurrently with declining processing speed, which may reflect common neurodegenerative processes. Our findings do not support the hypothesis that depression symptoms may be a risk factor for cognitive decline in the general population. These findings have potential implications for the treatment of late-life depression and for the prognosis of cognitive outcomes.
The Caltech imaging γ-ray telescope was launched by balloon from Alice Springs, NT, Australia and performed observations of the galactic center during the period 12.62 to 13.00 April 1988 UT. The first coded-aperture images of the galactic center region at energies above 30 keV show a single strong γ-ray source which is located 0.7±0.1° from the galactic nucleus and is tentatively identified as 1E1740.7-2942. If the source is at the distance of the galactic center, it is one of the most luminous objects in the galaxy at energies from 35 to 200 keV.
Although individual radio pulses from pulsars vary in amplitude from pulse to pulse, their height distribution in general does not extend to amplitudes more than 10 times the mean. Two notable exceptions are the Crab pulsar and PSR B1937+21 (Lundgren 1995, Cognard et al. 1996 and references therein) which occasionally emit single radio pulses that have amplitudes more than 100 times the mean. Here we report on the detection of short time-scale, extremely large amplitude radio pulses from the nearby millisecond pulsar PSR J0437–4715. The events we have observed are distinguished by having peak flux densities in excess of 10 times the average pulse amplitude, and occur only within a very narrow (80 µs) window centered on the main pulse.
Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7 %) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95 % CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95 % CI 0·65, 0·98) for consumption of 5–100 g/d and HR 0·65 (95 % CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (Pfor trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
University Faculties: Unprepared Practitioners of a Highly Skilled Profession
University faculty* members face a broad range of challenges over the course of their careers. Laursen and Rocque (2009) identify career stages at which they need to acquire different skill sets to meet those challenges: early career (teaching, advising, research, negotiation, and time management skills); mid-career (leadership and administration, collaboration, and outreach skills), and later career (the skill to identify and evaluate possible changes in career direction).
For which of those challenges are new and experienced faculty members systematically prepared? Throughout most of the history of higher education, the answer has been “none.” In the past half-century, faculty development* programs have become available on many campuses, but unfortunately many faculty members are still expected to learn how to do everything their job requires by trial and error. Although there is much to be said for experiential learning, it is not terribly efficient. Studies by Boice (2000) show that for 95% of new faculty members it takes four to five years of trial and error to become fully productive in research and effective in teaching – and in teaching, the ones making the errors (the instructors) are not the ones paying for them (their students). Boice also found, however, that the other 5% – the “quick starters” – are effective in their first one to two years, and the actions that distinguish quick starters from their colleagues can be identified and taught. That is to say, a good faculty development program can cut several years off the normal faculty learning curve.