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Over recent decades, the commercial ultra-processed food industry has grown, making snacks high in energy, added sugar, saturated fat and sodium affordable and accessible to consumers. Dietary patterns high in ultra-processed snacks are concerning as this can result in negative health outcomes. This study aims to provide insight on available snack products in South African supermarkets, and the marketing thereof, which can be used to support policy development aimed at improving the healthfulness of the food supply and consumption patterns.
Design:
This was an observational cross-sectional, mixed-method study.
Setting:
Secondary data from six major supermarket chains (eight stores) in three different suburbs in Cape Town, South Africa was analysed to evaluate the nutritional composition of snack products (n=3837). The same eight supermarkets were revisited to obtain information on marketing via an observational checklist. Qualitative interviews were also conducted with store managers.
Results:
Majority (89%) of the products assessed either contained non-sugar sweeteners or were high in sugar, saturated fat, or sodium. These snack items that are high in nutrients of concern to limit were available at checkout areas in all stores, were found in high traffic areas and several in-store promotional strategies such as branded displays, special offers and combo-deals were commonly found.
Conclusion:
The current South African supermarket environment encourages consumers to purchase unhealthy snacks. Most snacks assessed in this study cannot be recommended for regular consumption due to the nutritional composition being high in nutrients linked to poor health outcomes. There is a need for regulation of the in-store marketing of unhealthy snacks in South Africa. Retail settings are potential intervention points for limiting exposure to these unhealthy products.
Antimicrobial resistance (AMR) renders many bacterial infections untreatable and results in substantial morbidity and mortality worldwide. Understanding antibiotic use in clinical settings including hospitals is critical to optimize antibiotic use and prevent resistance.
Design:
Hospital antibiotic point prevalence survey (PPS).
Methods:
The study was conducted in two large, teaching hospitals in Addis Ababa, Ethiopia. We performed two survey rounds in December 2021 and January 2022 through real-time chart review using the World Health Organization PPS methodology. Data were collected using a web-based database, and descriptive statistics were performed to analyze antibiotic use by various characteristics.
Results:
Among 1020 hospitalized patients, 318 (32%) were ≤14 years and 370 (36%) had surgery during the current hospitalization. A total of 662 (65%) were receiving an antibiotic on the day of survey and 346 (39%) were receiving ≥2 antibiotics. A community-acquired infection (43%) was the most common indication for an antibiotic followed by surgical prophylaxis (27%) and hospital-acquired infection (23%). Antibiotic use was highest among those ≤24 months in age and among patients in trauma, surgical, and pediatric wards. Cephalosporin (42%) and penicillin (16%) antibiotics were the most frequently prescribed classes. Only 11% of patients on antibiotics had samples collected for microbiological testing; hence, almost all antibiotic therapy was empiric.
Conclusions:
Despite global and national efforts to improve antimicrobial stewardship, antibiotic use remains high in urban teaching hospitals in Ethiopia. Implementation of antimicrobial stewardship activities and microbiology utilization are needed to guide antimicrobial selection and curtail antibiotic overuse.
The concept of lifestyle-based risk scores is known but not evaluated in most rural communities of low- to mid-income countries. This study investigated the correlation of lifestyle scores with health indices.
Methods:
This was a descriptive cross-sectional investigation. A total of 203 participants (141 females and 62 males), 18–90 years, had anthropometric assessments and lifestyle scores determined from a 12-item framework. Data analysis included average age in different health conditions, lifestyle scores in age groups, and correlations with age.
Results:
Average age of healthy subpopulation was 39 years while diabetes, hypertension, and obesity subpopulations were 58, 64, and 56 years, respectively. The percentage of participants whose activities of daily living (ADL) were unaffected by ill-health decreased with age (P < 0.0001), and lifestyle scores also decreased with age (P < 0.01) and negatively correlated with physical activities.
Conclusion:
This report contributes to diabetes cardiovascular complications management. Sedentary ADL factors need integration in healthy lifestyle education especially among the elderly.
Antibiotic overuse is common across walk-in clinics, but it is unclear which stewardship metrics are most effective for audit and feedback. In this study, we assessed the validity of a metric that captures antibiotic prescribing for respiratory tract diagnoses (RTDs).
Design:
We performed a mixed-methods study to evaluate an RTD metric, which quantified the frequency at which a provider prescribed antibiotics for RTD visits after excluding visits with complicating factors.
Setting:
Seven walk-in clinics across an integrated healthcare system.
Participants:
We included clinic visits during 2018–2022. We also conducted 17 semi-structured interviews with 10 unique providers to assess metric acceptability.
Results:
There were 331,496 visits; 120,937 (36.5%) met RTD criteria and 44,382 (36.7%) of these received an antibiotic. Factors associated with an increased odds of antibiotic use for RTDs included patient age ≥ 65 (OR = 1.40; 95% CI 1.30–1.51), age 0–17 (1.55, 95% CI 1.50–1.60), and ≥1 comorbidity (OR = 1.22; 95% CI = 1.15–1.29). After stratifying providers by their antibiotic-prescribing frequency for RTDs, patient case-mix was similar across tertiles. However, the highest tertile of prescribers more frequently coded suppurative otitis media and more frequently prescribed antibiotics for antibiotic-nonresponsive conditions (eg, viral infections). There was no correlation between antibiotic prescribing for RTDs and the frequency of return visits (r = 0.01, P = 0.96). Interviews with providers demonstrated the acceptability of the metric as an assessment tool.
Conclusion:
A provider-level metric that quantifies the frequency of antibiotic prescribing for all RTDs has both construct and face validity. Future studies should assess whether this type of metric is an effective feedback tool.
Peanut (Arachis hypogaea L.) and maize (Zea mays L.) are essential crops for Ghana’s economy and food security, but weed infestation poses a significant threat to their cultivation. Crop rotations influence weed communities, but little is known about these processes in peanut-cropping systems in West Africa. This study investigated the impact of different crop rotations and input levels on weed communities in Ghana over 3 yr. Results showed that low inputs (absence of herbicide and fertilization) favored species richness, while higher input levels (weed control with herbicides and fertilizer use) reduced it. Diversity and evenness were also affected by inputs, with varying patterns across locations and seasons. Weed population growth rates (λ) varied significantly by location and treatment; all management programs resulted in increasing weed populations. Principal component analysis revealed distinct associations between weed species and crop management. The majority of weed species exhibited a generalist behavior and did not associate with a particular management. However, billygoat weed (Ageratum conyzoides L.) and Benghal dayflower (Commelina benghalensis L.) were positively associated with high-input systems, while purple nutsedge (Cyperus rotundus L.) exhibited strong associations with low and medium inputs. The weed–crop rotation dynamics described here demonstrate how management drives the selection of weed species that are more pervasive and interfere with important food crops in Ghanaian agriculture.
The physical and chemical interactions between organic amines and mineral surfaces are of considerable importance in many industrial applications. For example, the preparation of organophilic minerals often involves the adsorption of organic amines, or the ion exchange of the minerals with quaternary ammonium salts (Jordon, 1951; Miller and Faust, 1972). Chemical interactions occurring in these systems have been studied because of their relevance to an understanding of the chemical nature of the clay surface. A number of these studies have reported on the decomposition of adsorbed amines and alkylammonium-mineral complexes at elevated temperatures, usually in excess of 100°C (Chaussidon and Calvet, 1965; Weiss and Roloff, 1963; Durand, Pellet and Fripiat, 1972; Chou and McAtee, 1969). It is now well established that under these conditions the mineral may have potential strong-acidity, and these reactions have been explained in terms of acid-induced decomposition or rearrangement of the adsorbed amines or their derivatives. However, there have been few studies of the reactions of organo-mineral complexes at temperatures below 100°C, under conditions where retention of adsorbed water could be expected to moderate the mineral surface acidity.
In non-aqueous systems, kaolinite can show, in addition to the physical interactions, considerable chemical activity. This study considers the chemical reactions that can occur at the kaolinite surface and explains these reactions in terms of acid-base interactions. In certain applications the chemical activity must be controlled if satisfactory products are to be obtained; for example, when kaolinite is used as a filler in rubber or as a diluent for insecticide powders. The concept of acid-base interactions is used to explain rheological and film properties in kaolinite-organic systems. The strength of the surface acid sites of kaolinite varies with the moisture content. At 1% moisture the surface is equivalent to 48% sulphuric acid whereas at 0% it is equivalent to 90% sulphuric acid. Therefore, the moisture level is extremely important and dry kaolinite will promote or catalyze many chemical reactions and where acid-base interactions are involved the presence of even small amounts of water usually retards or inhibits the reaction. Several examples explaining these interactions are given in the paper.
Kaolinites, catalytically active for the polymerization of styrene, can be deactivated by treatment with 1N aqueous sodium chloride. Subsequent washing of the sodium kaolinite results in a facile hydrolysis yielding an active hydronium/aluminum kaolinite in which the exchangeable cations act as surface Br0onsted acid initiation sites.
Certain clay minerals have the ability to catalyze the polymerization of some unsaturated organic Compounds (styrene, hydroxyethyl methacrylate) and yet to inhibit polymer formation from other closely related monomers (e.g. methyl methacrylate). This apparently contradictory behaviour of the clay minerals can be rationalized in terms of electron accepting and electron donating sites in the silicate layers. The electron acceptor sites are aluminium at crystal edges and transition metals in the higher valency state in the silicate layers; the electron donor sites are transition metals in the lower valency state.
The catalyzed polymerizations involve the conversion of the organic molecule to a reactive intermediate; thus where the clay mineral accepts an electron from the vinyl monomer a radical-cation is formed, where the organic compound gains an electron it forms a radical-anion. Examples of these reactions are discussed.
The inhibition of polymerization processes involves the conversion of reactive organic intermediates, such as free radicals, which have been formed by heat or radical initiators, to non-reactive entities. For example, loss of an electron from the free radical gives a carbonium ion; in some cases this will not undergo polymerization. An example of this type is the thermal polymerization of methyl methacrylate.
The color reactions on clay minerals are useful in predicting the electron accepting or electron donating behaviour of the clay minerals because they proceed by similar mechanisms to the polymerization reactions. For example, the benzidine blue reaction is a one electron transfer from the organic molecule to the electron accepting sites in the mineral (aluminium edges, transition metals in higher valency state).
Masking of the crystal edge with a polyphosphate destroys the electron accepting properties of the crystal edge; this technique can be used to control the reactivity of the mineral and to distinguish between the crystal edge and transition metal sites as electron-acceptor sites in the clay minerals.
Edited by
Shimelis Bonsa Gulema, Stony Brook University, State University of New York,Hewan Girma, University of North Carolina, Greensboro,Mulugeta F. Dinbabo, University of the Western Cape, South Africa
The history, the land: all this can be interpreted as, what did history do to us?
Ato Mengesha Beyene
In his exploration of overlapping territories and intertwined histories, Edward Said declares that “appeals to the past” are “among the commonest of strategies in interpretations of the present.” Ethiopians and members of other interrelated Horn of African groups living within a contemporary global Diaspora embody the tenets of Said's argument. Histories of migrants and migrations do not begin in medias res. Ethiopian history, topography, and culture are prominently referenced in both public and private articulations of Ethiopian identities within the Diaspora. Ethiopians living within the context of a Canadian Diaspora perpetually reference, invoke, revere, contest, and engage with representative elements of their cultural, political, and historical identity, fashioning unique forms of self-representation.
This Canadian case study is illustrative of the ways in which prominent signifiers of Ethiopian history throughout the twentieth century are integrated into self-representations by members of the Diaspora. With the exception of Mary Goitom's body of work, Canadian scholarship on the Horn of Africa Diaspora has largely focused on ethnic disparities as principal points for identity formation upon migration. This work instead examines the ways in which members of the Diaspora perpetuate and maintain preceding historical signifiers, as means of asserting both their heterogeneity and historicity.
As defined by Stuart Hall, the cultural identity of the Horn of Africa Diaspora is, by and large, comprised of elements “which people with a shared history and ancestry hold in common.” Based on an analysis of selfrepresentations in contemporary Canada (whether they be textual, physical, and/or in narrative form), it is evident that Ethiopians take great pride in their long and rich cultural history, which precedes their dispersal into a global Diaspora.
Through the use of oral histories as illustrative case studies, this chapter underscores the ways in which the interplay of history, politics, and culture continues to shape representations and perceptions of Ethiopian and other interrelated Horn of Africa identities in Canada. To a generation of Ethiopians living in the Diaspora, being Ethiopian and narrating Ethiopian history are symbiotically connected with events that have transpired in that nation, as much as they are connected to perceptions of this history by the outside world, reinforcing the proclamation by interviewee Elias Omer that: “Ethiopia is significant, not only to who we are, but who we are not.”
The presence, percentage, origins, and rate of formation of clay minerals have been important components in studies involving the geochemical and structural composition of waste-rock piles. The objective of the present study was to investigate the use of tritium as an indicator of the origin of clay minerals within such piles. Tritium values in pore water, interlayer water, and structural hydroxyl sites of clay minerals were examined to evaluate the origins of clay minerals within waste-rock piles located near Questa, New Mexico. Five clay minerals were identified: kaolinite, chlorite, illite, smectite, and mixedlayer illite-smectite, along with the hydrous sulfate minerals gypsum and jarosite. Analysis of waters derived from clay minerals was achieved by thermal reaction of dry-sieved bulk material obtained from the Questa site. In all Questa samples, the low-temperature water derived from pore-water and interlayer sites, as well as the intermediate-temperature water derived from interlayer cation sites occupied by hydronium and structural hydroxyl ions, show tritium values at or near modern levels for precipitation. Pore water and interlayer water ranged from 5.31 to 12.19 tritium units (TU) and interlayer hydronium and structurally derived water ranged from 3.92 to 7.93 TU. Tritium levels for local precipitation ranged from ~4 to 8 TU. One tritium unit (TU) represents one molecule of 3H1HO in 1018 molecules of 1H1HO. The elevated levels of tritium in structural sites can be accounted for by thermal incorporation of significant amounts of hydronium ions in interlayer cation sites for illite and mixed-layer clays, both common at the Questa site. In low-pH environments, such as those found within Questa waste-rock piles (typically pH ~3), the hydronium ion is an abundant species in the rock-pile pore-water system.
Ludwig Lachmann is a central but underappreciated figure within the Austrian school of economics. Although his understanding of institutions, his appreciation of the heterogeneity of capital, his emphasis on subjectivity, and his focus on the dynamism and uncertainty of the real world have become dominant positions amongst Austrian economists, he is still viewed as something of an outsider. As such, the contributions of Lachmann's economics are arguably misunderstood. This Element attempts to tease out and discuss the critical contributions of Lachmann's economics. Arguably, one way in which to understand Lachmann's economics is by seeing it as unified in considering, in various ways, a single conceptual 'problem' – the apparent tension between the dynamic nature of social reality and the intelligible nature of the social world. Approaching Lachmann with this theme in mind allows us to put things together more coherently than other exegetical strategies.
Many formerly incarcerated people have civil legal needs that can imperil their successful re-entry to society and, consequently, their health. We categorize these needs and assess their association with cardiovascular disease risk factors in a sample of recently released people. We find that having legal needs related to debt, public benefits, housing, or healthcare access is associated with psychosocial stress, but not uncontrolled high blood pressure or high cholesterol, in the first three months after release.
We assessed factors associated with increased risk to loss of follow-up with infectious diseases staff in OPAT patients. Discharge to subacute healthcare facilities is strongly associated with loss to follow-up. We did not identify sociodemographic disparities. Poor communication between OPAT providers and subacute healthcare facilities remains a serious issue.
Background: The FIRST Trial is a 5-year study funded by the Agency for Healthcare Research and Quality. Our investigation is situated within a more extensive study to restrict fluoroquinolone antibiotics by requiring providers to obtain authorization from an infectious disease physician before prescribing fluoroquinolones. Our research team is performing a systematic evaluation to identify organizational characteristics and influencers of the fluoroquinolone preprescription authorization implementation process to understand variables that may facilitate or hinder implementation success. Methods: To address this critical gap, we present a qualitative analysis from our ongoing, multisite research project aimed at systematically assessing the adoption of an antimicrobial stewardship intervention in the form of an EHR-integrated best-practice alert (BPA) at each site to identify work system factors that impact uptake and variability in the implementation of the BPA at each location. The evaluation provides a detailed explanation of activities through the implementation process (eg, before implementation, during implementation, and after implementation) to assess how an organization effectively negotiates the phases and transitions, ultimately influencing the impact of the intervention. We have used a contextual determinant framework (CFIR) that has enabled us to perform a systematic and comprehensive exploration and identification of potential explanatory themes or variables to shed light on the complex social phenomenon of implementation. Results: Participants who will be a part of our poster presentation will learn about implementing a BPA, the potential barriers to implementation, and strategies for overcoming these barriers. Stakeholders within our study include site coordinators, medical doctors, nurses, pharmacists, and clinical informaticists. Our analysis synthesizes their experiences implementing and sustaining this evidence-based antimicrobial stewardship intervention. It includes (1) a detailed description of the process of change, (2) work-system factors (eg, inner setting and outer setting) that they believe influenced the success of the intervention, (3) barriers and facilitators (eg, CFIR constructs) within the implementation process; and (4) description of how these could have influenced the outcomes of interest (eg, implementation and intervention effectiveness). Conclusions: Our research is expected to advance patient safety research and initiatives by providing a more robust approach to performing systematic intervention evaluations. By outlining stakeholders’ experiences within our study, implementation leaders within healthcare systems will utilize our findings to aid them in their design and implementation process when designing and implementing similar types of healthcare interventions.
We conducted a retrospective cross-sectional population-based survey among recovered COVID-19 cases in Uganda to establish the case presentations of the second wave SARS-CoV-2 infections. We interviewed 1,120 recovered COVID-19 cases from 10 selected districts in Uganda. We further conducted 38 key informant interviews with members of the COVID-19 District Taskforce and 19 in-depth interviews among COVID-19 survivors from March to June 2021. Among them, 62% were aged 39 years and below and 51.5% were female with 90.9% under home-based care management. Cases were more prevalent among businesspeople (25.9%), students (16.2%), farmers (16.1%), and health workers (12.4%). Being asymptomatic was found to be associated with not seeking healthcare (APR 2, P < 0.001). The mortality rate was 3.6% mostly among the elderly (6.3%) and 31.3% aged 40 years and above had comorbidities of high blood pressure, diabetes, and asthma. Being asymptomatic, or under home-based care management (HBCM), working/operating/studying at schools, and not being vaccinated were among the major drivers of the second wave of the resurgence of COVID19 in Uganda. Managing future COVID-19 waves calls for proactive efforts for improving homebased care services, ensuring strict observation of SOPs in schools, and increasing the uptake of COVID-19 vaccination.
Theoretical perspectives emphasize that trauma and complex/posttraumatic stress disorder (C/PTSD) may interrupt with the perception of normal day-to-day bodily sensations, such as hunger, temperature and pain. Yet, a coherent conceptual synthesis of such processes is still lacking.
Objectives
This presentation portrayes two studies that provide empirical grounding for the conceptualization of ‘Posttraumatic Orientation to Bodily Signals’ (posttraumatic-OBS); an umbrella term reflecting the tendency to interpret bodily signals as catastrophic and frightful following trauma.
Methods
Two studies assessing exposure to trauma, C/PTSD, and OBD (Pain catastrophizing scale, PCS; body vigilance scale, BVS; Anxiety sensitivity index-physical), were conducted to test the hypothesized association between exposure to trauma and posttraumatic-OBD, as explained by C/PTSD.
Results
Study 1 included 59 ex-prisoners of war and 44 controls along three time-points, revealing that exposure to trauma was associated with a more catastrophic OBS (t = 2.73, p = .008; Cohen’s d = .57), which was mediated by longitudinal hyperarousal PTSD symptoms (indirect effect = .04 [.009, .11]). Additionally, a long-term chronic trajectory of PTSD was implicated in a more catastrophic OBS (F (2102)=6.91, p = .046).
Study 2 included 194 dyads of mothers and their young adult daughter. Dyadic path analyses demonstrated that OBD was associated with exposure to trauma, through the mediation of CPTSD among mothers (indirect effects between 0.13–0.28; p > 0.021) and daughters (indirect effects between 0.21–0.11; p > 0.032). Mothers’ OBD was associated with daughters’ OBD (effects between 0.19-0.27; p < 0.016). Daughters’ OBD was serially associated with mothers’ trauma exposure through mothers’ CPTSD and mothers’ OBD, (indirect effect = 0.064; p = 0.023). The findings demonstrate that trauma is often implicated in posttraumatic-OBD, which is mediated by C/PTSD, and that these processes may be intergenerationally transmitted.
Conclusions
The findings lay the foundation for the conceptualization of posttraumatic-OBD. The implications of the unified encapsulation of posttraumatic-OBD as an umbrella term reflecting subjective perception of bodily sensations for future research and practice will be presented.