A Case of Rhino-Orbital Cerebral Mucormycosis presenting with spontaneous Cerebrospinal fluid Rhinorrhoea

Rhino-orbital cerebral mucormycosis has increased in the recent second wave of post-Covid-19 illness, mainly in tropical countries like India. The burden of diabetes mellitus and rampant use of corticosteroid, environmental factors, post-covid-19 immunological derangement might be contributory factors to the development of extensive outbreak of ROCM. Cerebrospinal fluid rhinorrhea is rarely documented with such fungal infection in literature. This case report described a 45-year diabetic woman in the post-Covid-19 phase,who developed rhino-orbital cerebral mucormycosis, presenting with spontaneous cerebrospinal fluid rhinorrhea.

Burnout in frontline ambulance staff

Background: Staff retention is a significant issue for ambulance services across the globe. Exploratory research, although minimal, indicates that stress and burnout, in particular, influence attrition within the paramedic profession. These need to be understood if their impact on retention is to be addressed. Aims: To determine the presence of and contributory factors for burnout in the ambulance service to inform recommendations for positive change. Methods: A two-phased survey approach was adopted using an adapted Maslach Burnout Inventory and Copenhagen self-assessment burnout questionnaire, to measure levels of burnout, depersonalisation (cynicism) and personal achievement. Open-ended questions explored factors that influenced these. Demographic and comparative analysis identified trends and thematic analysis was carried out on the qualitative data. Results: Ninety-four per cent of ambulance staff in this study (n=382) reported a sense of personal achievement within their professional role; however, more than 50% were experiencing varying levels of burnout with 87% displaying moderate or high levels of depersonalisation towards their work. Causes of stress were complex: themes attributed were a perceived lack of management support, the public's misuse of the ambulance service, involuntary overtime and a poor work-life balance. Conclusions: Burnout poses a genuine threat to retention in the ambulance service and needs addressing. Proactive screening, better communication between practice staff and management and access to counselling services are recommended. This problem of burnout is beginning to be acknowledged but further evidence is needed to understand it in more depth in order for effective solutions to be developed.

Surface wind at Leh

Leh airfield normally experiences gale speed surface winds during the period from April to October. From November to March, the winds are relatively weak. The reason for the gale strength speed appears to be the channelling effect. Katabatlc /anabatic flows or Foehn effects do not appear to be the significant contributory factors. There are numerous points along the river Indus where similar gale strength speeds are encountered and hence these appear to be good wind energy prospecting potential sites.

Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis

Purpose This study aimed to estimate the prevalence, contributory factors, and severity of medication errors associated with direct acting oral anticoagulants (DOACs). Methods A systematic review and meta-analysis were undertaken by searching 11 databases including Medline, Embase, and CINHAL between January 2008 and September 2020. The pooled prevalence of errors and predictive intervals were estimated using random-effects models using Stata software. Data related to error causation were synthesised according to Reason’s accident causation model. Results From the 5205 titles screened, 32 studies were included which were mostly based in hospitals and included DOAC treatment for thromboembolism and atrial fibrillation. The proportion of study population who experienced either prescription, administration, or dispensing error ranged from 5.3 to 37.3%. The pooled percentage of patients experiencing prescribing error was 20% (95% CI 15–25%; I2 = 96%; 95% PrI 4–43%). Prescribing error constituted the majority of all error types with a pooled estimate of 78% (95%CI 73–82%; I2 = 0) of all errors. The common reported causes were active failures including wrong drug, and dose for the indication. Mistakes such as non-consideration of renal function, and error-provoking conditions such as lack of knowledge were common contributing factors. Adverse events such as potentially fatal intracranial haemorrhage or patient deaths were linked to the errors but causality assessments were often missing. Conclusions Despite their favourable safety profile, DOAC medication errors are common. There is a need to promote multidisciplinary working, guideline-adherence, training, and education of healthcare professionals, and the use of theory-based and technology-facilitated interventions to minimise errors and maximise the benefits of DOACs usage in all settings. Protocol A protocol developed as per PRISMA-P guideline is registered under PROSPERO ID = CRD42019122996

Risky sexual behaviors among undergraduates of Pamo University of Medical Sciences: Exploring contributory factors and outcomes

Undergraduates experience overwhelming changes and challenges that expose them to risky sexual behaviors, an act that leads to physical, psychosocial harm and its predictors contribute to lost lecture hours among campus students; hence this study aims at exploring contributory factors and outcomes of risky sexual behaviors among Nursing and Medicine students in PAMO University of Medical Sciences, Port Harcourt Rivers State Nigeria. Descriptive survey was conducted in 2019 and 280 students in their first and second year of study from the participating Departments were selected from study population of 491 using Yaro Yamanes sample size formula. Proportionate sampling technique followed by simple randomization was done. Ethical approval and consent were obtained while confidentiality and anonymity were maintained. WHO-adapted questionnaire was administered to respondents with the help of a research assistant. Data was collected using a 3-point Likert statistically-validated questionnaire with a reliability coefficient of 0.8, analyzed and computed on Statistical Package for Social Sciences version 21. Mean values below 2.0 were judged insignificant. Findings shows that Ignorance (x¯=2.81), lack of sex education (x¯=2.79), were among the factors that significantly influenced participant’s risky sexual behavior, however, reduced fun associated with use of condom (x¯=1.99) and equivalent of unprotected sex with trust (x¯=1.97) had insignificant impact. Interestingly, participants expressed similar outcomes of risky sexual behavior recording- sexually transmitted infection (x¯=2.80), pregnancy (x¯=2.76) abortion (x¯=2.71), out of School due to non-support by family (x¯=2.65); among others. Finally, risky sexual behavior among undergraduates affects the academic pursuit and there is need to continue reproductive health education if Sustainable Development Goals five and six will be achieved.

Fog over Agartala Airfield

An analysis of fog formation at Agartala regarding commencement, dispersal and duration has been made and its contributory factors discussed.

Crash and disengagement data of autonomous vehicles on public roads in California

Autonomous Vehicles (AVs) are being widely tested on public roads in several countries such as the USA, Canada, France, Germany, and Australia. For the transparent deployment of AVs in California, the California Department of Motor Vehicles (CA DMV) commissioned AV manufacturers to draft and publish reports on disengagements and crashes. These reports must be processed before any statistical analysis, which is cumbersome and time-consuming. Our dataset presents the processed disengagement data from 2014 to 2019, crash data till the 10th of March 2020 and supplementary road network and land-use data extracted from OpenStreetMap. Primary data are manually assessed and converted into an easily processed format. Our processed data will be advantageous to the research community and enable accelerated research in this domain. For example, the data can be utilised to discern trends in disengagement, observe the distribution of disengagement causes, and investigate the contributory factors of the crashes. Such investigations can subsequently improve the reporting protocols and make policies and laws for the smooth deployment of this disruptive technology.

Exploration of Loneliness Among Black Older Adults

Background: Loneliness is a public and social issue affecting older adults, but in varying degrees across ethnic groups. Black older adults (BOAs) are more prone to loneliness because they have unique and accumulated factors (e.g., low socioeconomic status, high number of chronic conditions) that predispose them to loneliness. This review aims to describe the extent and the nature of research activities on loneliness and identify the contributory factors to loneliness among BOAs as presented in the global literature. Methods/Design: We will follow the five steps of Arksey and O’Malley’s (2005) framework to search multiple databases from inception till June 2021. MeSH terms and keywords, e.g., “older adults,” “blacks,” and “loneliness,” will be adopted for several databases, including CINHAL, Ageline, PsychINFO, Cochrane Central Registers of Control Trials, PubMed, Web of Science, Social Science Abstract. Multiple reviewers will independently screen citations (title/abstract and full text) and extract data using predefined inclusion and exclusion criteria. “Best fit” framework synthesis using the six social provisions of Weiss’ framework as a priori themes will guide the data analysis. Discussion: This review will inform policy development around contributory factors for loneliness among BOAs and the most relevant issues on loneliness related to BOAs.

Substandard Housing Contributory Factors: Analysing Scenarios in Neighbourhoods of Port Harcourt Municipality,Nigeria

The study assessed substandard housing contributory factors of neighbourhoods in Port Harcourt municipality, Nigeria. The objectives of the study are to identify factors that are contributing to substandard housing in Port Harcourt municipality; assess the impact of contributory factors to substandard housing in the study area; and identify physical planning measures to improve substandard housing in the study area. The study employed quantitative research approach and experimental research design for collection and analyses of data in the study. Stratified and simple random sampling techniques were used for collection of data. Slovin formula was used to determine the sample size and a total of 399 respondents (households) were interviewed from three grouped neighbourhoods and communities (planned neighbourhoods, indigenous enclaves and waterfront communities). The revealed the contributory factors to substandard housing in the study area are low income, large household size, multiple households in a building, limited habitable rooms per household, building construction materials, rapidly deteriorating physical condition of buildings, and sharing of facilities by households in buildings. The study also revealed the impacts of these factors include urban neighbourhoods and communities are deteriorating into slum and squatter settlements and rapid defacing of the urban fabrics and landscape. The study makes the following recommendations to improve housing standards including regular physical assessment of buildings in the study area to ascertain their fitness for habitation; waterfront environment should be reclaimed and planned by government for residents’ easy accessibility and affordability; development control agencies should ensure residential buildings are developed according to approved plan and specifications; mortgage and financial institutions should grant soft and interest-free loans to low-income earners and the poor; government should prioritise the development of low-cost houses for low-income earners and poor citizens; social amenities and services should be provided to enhance housing and neighbourhood quality; and government and its agencies of urban development and physical planning as a matter of urgency carry out spatial reorganisation through urban renewal programmes and projects at various neighbourhoods and communities.