The Durability, Functionality and Acceptability of Novel Screened Doors and Windows After Four Years of Use in A Gambian Village: A Cross-Sectional Survey

Background: The World Health Organization recommends house screening as a tool for malaria control, yet evidence of the long-term durability, functionality and acceptability of this intervention is lacking. Here we examined the sustainability and use of novel types of screened doors and windows four years after installation in a Gambian village. Methods: A survey of 31 houses, each with two screened doors and two screened windows, was conducted in the rainy season. There were four types of screened door and two types of screened window. Trained staff carried out the survey and interviews of room owners were conducted in the local language before translation into English.Results: Structurally, the manufactured doors and windows were highly durable and in excellent condition. Most doors shut smoothly 50/61 (82%), although only 25/61 (41%) shut fully automatically with the latch slotting into the hole on the frame and holding fast. Door locks were less robust, with only (24/61) 39% present and working. Blinds proved especially flimsy, with only 4/109 (4%) of door blinds and 10/56 (18%) of window blinds present and in working order. Householders hung curtains inside most doors 50/61 (82%) and in 26/61 (43%) of the windows. Front doors were commonly found propped open 21/31 (68%) and 23/27 (85%) of those with a front door curtain, put their curtains down at night. Doors and windows were well liked, 19/31 (61%) of respondents were happy with them because they kept mosquitoes out 14/31 (45%) and provided security 12/31 (39%). The main reason given for the use of curtains was to provide privacy 26/28 (93% of those with curtains), especially while the door was open or had ‘see-through’ panels.Conclusions: Overall, the screened doors and windows were in excellent condition after four years of use. Improvements to the lock design are needed before scale-up. Installation of screening in buildings should be accompanied with health messaging recommending that at night, doors and windows be closed and curtains lifted or drawn to one side - to improve ventilation and keep the house cool.

Intra-natal care practices of staff nurses with compliance to professional protocols

Background: Intranatal care refers to care given throughout the process of all four stages of labor and is important for both mother and newborn. Safe delivery practice and compliance to intranatal care protocol by trained staff nurses is essential. The objectives were to identify the intra-natal care practices of staff nurses, compare intranatal care practices among the three selected hospitals and explore the barriers to compliance of intranatal care practices by staff nurses.Methods: Cross-sectional observation design was used for the present study. The study was conducted in two phases to fulfil the objectives. Three hospitals were conveniently selected and about 42 delivery events were observed in phase I and 15 staff nurses were interviewed through semi-structured interview schedule to identify the barriers to compliance in phase II.Results: It was found that majority of 8 (57.1%) staff nurses were in the age group of (25-42) years and maximum 13 (86.7%) staff nurses had attended training program related to intranatal care practices. In majority 24 (57.1%) deliveries, sterile technique for vaginal examination was not followed, in 33 (78.6%) deliveries cord pulsation was not assessed and in 39 (92.9%) deliveries baby was not placed on mother’s chest. Lack of required facilities leading to referral and non-cooperation of women during procedures were some identified barriers.Conclusions: The present study findings revealed that the intranatal care practices were inappropriate, they were missing most essential practices that might harm to the mother or baby in future.

Atopy in Kashmir-validation from a case control study with respect to IgE and Interleukin genes

Objectives Increased levels of serum Immunoglobulin-E (IgE) and different genetic variants of cytokines are common biochemical manifestation in Allergy. The current study was aimed to study the association of IgE and different variants of Interleukin-4 (IL-4), and Interleukin-13 (IL-13) genes with different kind of allergies. Methods A pre-tested questionnaire was used to collect all the dietary, life style and clinical details by a trained staff. A blood sample of 2 ml each was collected in coagulated and anti-coagulated vials. DNA and serum samples were extracted and stored until further use. Serum IgE were estimated by ELISA while as the genotypic analysis was done by PCR–RFLP methods. Results Statistically a significant difference of serum IgE levels were observed among cases and controls (P < 0.05). The observed significant difference of serum IgE levels were retained among subjects who also harboured variant genotypes of IL-4 and IL-13 genes (P < 0.05). Additionally, the above genetic variants significantly modified the risk of allergy when stratification was done based on various clinical characteristics. Conclusion Our study suggests that increased IgE levels and in association with variant forms of IL-4 and IL-13 genes are significantly associated with different types of allergies in study population.

Limited Access to Transcranial Doppler Screening and Stroke Prevention for Children with Sickle Cell Disease in Europe: Results of a Multinational Eurobloodnet Survey

Background: Children with sickle cell disease (SCD) are at increased risk of cerebrovascular events such as stroke, silent infarcts and neurocognitive impairment. The role of Transcranial Doppler ultrasound scanning (TCD) to identify sickle cell anemia (SCA) children at high risk of stroke is well established. Adam et al in 1998 recommended those with abnormal cerebrovascular flow velocities are offered prophylactic blood transfusion therapy to prevent stroke between ages 2 to 16 years. Therefore, TCD screening for stroke prevention in now is a mandatory in all guidelines for the management of children with SCA. However, there is still no uniform implementation of the program globally and in European countries (Rees 2016). Moreover, the information available on the quality of the TCD screening is limited to educational experiences in a few countries (Inusa 2019) but to evaluation of stroke prevention programs has been performed in Europe. As more disease modifying therapies become available for children with SCD, it is mandatory to know TCD availability, screening practices, and real-world data on stroke prevention in Europe. EuroBloodNet is the European Reference Network (ERN) on rare Hematological Disorders, one of the 24 ERN established by the European Union to improve care of patients with rare disorders in Europe. EuroBloodNet's main goal is to improve the healthcare and overall quality of life of patients with a Rare Hematological Disease by: 1) Improving equal access to highly specialized healthcare delivery through a multidisciplinary patient centered approach; 2) Enhancing the best practices in prevention, diagnosis and safe clinical care across Europe based on promotion of evidence based guidelines. We wanted to assess the state of the art of TCD screening and stroke prevention programs in European Expert Centers. Methods: An online survey was developed by SCD experts in 5 European countries and sent to all Representatives of the Health Care Providers (HCP) and the Red Cell Disorder representatives in each HCP within the EuroBloodNet network, as well as to National Representatives of Scientific Societies within European Countries. Items in the survey are listed in Table 1. Results 81 hematologists or pediatricians from 77 centers in 16 European countries responded to the survey (14/16 in Western Europe); 39/77 (51%) were EuroBloodNet Expert centers, 14/77 (18%) were under evaluation as being recognized; 67/77 specified their expertise: 24% were pediatric, 3% adult, 58% both; 12 centers had &gt;200 patients in the age range 1-16 years. 36% Physicians reported not having a dedicated TCD/TCDi service for children with SCD so exams had to be performed by cardiologists (10%), general radiologists (28%), TCD is not performed (31%), or patients have to be sent in another center (31%). 74% reported requesting annual TCD for their patients, but to the question "What percentage of your patients receives annual TCD" only 28% confirmed that all their patients managed to actually receive annual TCD, due to lack of trained staff (43%), lack of TCD instruments (11%), refusal of patients due to logistical difficulties (22%) (i.e TCD in another city), lack of funds for dedicated staff or equipment (11%), or other reasons. Only 74% of hematologists were aware of the protocol in use at their center by the staff performing TCD; the STOP criteria were applied by 64% of the physicians, mainly due non evaluation of the Internal Carotid Artery. The extracranial part of the carotid artery was evaluated only in 30% of the respondents. In case of abnormal/conditional TCD results, the approach varies and is not uniform across centers. Conclusions Our data show that less than 30% of children with SCD followed in European Centers receive annual TCD according to recognized guidelines. This first multinational European survey allowed the identification of issues related to the lack of access to TCD, lack of trained staff, lack of adequate protocols for implementation of TCD and treatment afterwards, which will need to be addressed through dedicated actions. Figure 1 Figure 1. Disclosures Casale: Novartis Farma SpA: Honoraria, Membership on an entity's Board of Directors or advisory committees. Mañú Pereira: Novartis: Research Funding; Agios Pharmaceuticals: Research Funding. de Montalembert: Vertex: Membership on an entity's Board of Directors or advisory committees; BlueBirdBio: Membership on an entity's Board of Directors or advisory committees; Addmedica: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Colombatti: Global Blood Therapeutics: Research Funding; Addmedica: Consultancy; Forma Therapeutics: Consultancy; Novartis: Consultancy; NovoNordisk: Consultancy; BlueBirdBio: Consultancy; Global Blood Therapeutics: Consultancy; BlueBirdBio: Research Funding.

The impact of basic life support training among KIBOGORA district hospital staff: A pilot study

Background: The purpose of BLS is to maintain adequate ventilation and circulation until a means can be used to reverse the underlying cause of cardiac arrest.Worse outcomes are obtained when BLS is being done by non-trained persons. Objectives: To assess the knowledge of BLS among KIBOGORA district hospital staff and the impact of BLS training on retaining BLS skills among clinical and non-clinical KIBOGORA hospital staff. Materials and Methods: This pilot study was conducted in KIBOGORA hospital. A pre training test was given to every participant and after the training, a posttest was given to all participants. Before completing the pretest questionnaire, each participant had to choose a code made of at least 2 characters and the same code had to appear on the posttest questionnaire of the same participant. A grading system was used to categorize the level of participants’ knowledge on BLS skills. Results: Among 196 trained staff, 40 completed the pre training questionnaire .82.50 % of the subjects that completed the pre training questionnaire were clinical staff whereas 17.50% were non clinical staff. 54.55% and 33.33% of the clinical staff had respectively poor and fair knowledge on Basic Life Support (BLS) and only 6.06% were good at BLS however none of clinical staff was very good or excellent on BLS. All of the non-clinical staff that participated in the study had either a poor or fair knowledge on BLS. After the training, both clinical and non-clinical staff that completed the pre-training questionnaire, completed the post training questionnaire.30.30% of clinical staff that completed the questionnaire were good on BLS.The number of participants with an average or fair knowledge on BLSwere 27.27% in each category. 6.06% and 3.03% were excellent or very good on Basic Life Support. On the other hand, 42.86% and 28.57% of non-clinical staff had respectively poor and fair knowledge on BLS. Conclusion: After the training, knowledge on BLS improved both for clinical and non-clinical staff however more refresher courses are needed to reduce the gap seen in theoretical knowledge as well as practical skills

THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING ENVIRONMENTAL AND PERSONAL HYGIENE AMONG SCHOOL CHILDREN

A study regarding poor hygiene and inadequate sanitary conditions play major roles in the increased burden of communicable diseases. The study evaluated the knowledge, attitude, practice of hygiene among rural school children in Ethiopia; about 669 students were in grades 1-6, and they were interviewed by trained staff. Data consisted of hygiene and hand washing practices, knowledge about sanitation, personal hygiene characteristics. Approximately 52% of students were having adequate knowledge of hygiene, only 36.2% reported using soap, and of the 76.7% of students who reported hand washing after defecation, only 14.8% reported actually following this practice. Study findings underscore the need for more hand washing and hygiene education in schools. The first concept in personal hygiene is the positive and negative emotions that affect physical health, such as feeling pride in being neat and clean or feeling frustration in using hygiene tools. The second concept is personal hygiene practices such as hand washing, oral hygiene etc. The third concept is the fact that germs can lead to common diseases such as the flu or a cold. Nurses can use various techniques to help kids remember these.

Determining the energy efficiency of an agrorobot

The problem of feeding the population and the lack of trained staff for growing crops is increasing all over the world. This inevitably leads to a change in technology for growing crops. These new technologies rely on autonomous robotic systems for the continuous cultivation of crops without human personnel. Robots are small, smart, interconnected, lightweight machines that aim to release the person from the basic everyday pursuits. Globally, there is a trend in agriculture to automate the hard manual labor with continued increases in yields to feed the population. This article discusses the problems of determining the main energy aspects of agricultural robots. Guidelines are given for determining the energy saving of the robot, depending on the time for its long autonomous operation, the terrain to be cultivated and a number of other factors. Exemplary values of the energy required to drive the agricultural robot and the time for energy recovery through renewable energy sources have been determined.

Intra-arterial Balloon Occlusion to Reduce Operative Bleeding for Placenta Previa Accreta Spectrum

Cesarean section for placenta previa accreta spectrum carries a significant risk of massive hemorrhage. Hence, it is necessary to understand the various hemostatic procedures, damage control surgery and resuscitation for massive hemorrhage, and systemic management against hypovolemic shock and coagulopathy. In cases of placenta previa with previous cesarean section, the operation should be performed in a tertiary medical facility with well-trained staff and blood availability for transfusion. Preoperative placement of an intra-arterial balloon occlusion catheter in the common iliac artery or aorta is useful for preventing massive hemorrhage.

The Dilemma of Inclusive Education: Inclusion for Some or Inclusion for All

In this paper, we intend to consider different understandings of inclusive education that frame current public and professional debates as well as policies and practices. We analyze two – somewhat opposing – discourses regarding inclusive education, namely, the “inclusion for some” – which represents the idea that children with special needs have a right to the highest quality education which can be delivered by specially trained staff, and the “inclusion for all” – which represents the idea that all children regarding their diverse needs should have the opportunity to learn together. To put the two discourses in a dialogical relation, we have reconstructed the inferential configurations of the arguments of each narrative to identify how the two definitions contribute to position children with and without special needs and their teachers. The results show the possibilities to bridge the two narratives, with respect to the voices they promote or silence, the power relations they constitute, and the values and practices they enact or prevent.

Impact of Lameness on Attributes of Feeding Registered with Noseband Sensor in Fresh Dairy Cows

We hypothesized that lameness in fresh dairy cows (1–30 days after calving) has an impact on attributes of feeding registered with a noseband sensor. The aim of this study was to investigate the impact of lameness in fresh dairy cows on attributes of feeding (registered with the RumiWatch noseband sensor): rumination time (RT), drinking time (DT), eating time (ET), rumination chews (RC), eating chews (EC), chews per minute (CM), drinking gulps (DG), bolus count (B), and chews per bolus (CB). The measurement registration was started at the first day after calving and continued until 30 days after calving. There were 20 Lithuanian black and white breed cows selected. Lameness diagnosis was performed by trained staff based on a locomotion score system and it was diagnosed on average on the 15th day after calving. The causes of lameness were categorized as sole ulcer, abscess and foot rot. Special attention was paid to attributes of feeding registered 14 days before and 13 days after diagnosis. The 10 lame cows (LG) used in this experiment had a lameness score of 3–4 presented with severe lameness: they were reluctant to move and unwilling to complete weight transfer off the affected limb. The 10 healthy cows (HG) were given a lameness score of 1. We found that lameness of fresh dairy cows has an impact on inline registered ingestive behaviors biomarkers—the mean RT of HG cows was as much as 2.19 times higher than that of LG cows on the day of diagnosis of lameness, later this difference between the groups decreased to the sixth day of treatment, then increased again and decreased at the end of the experiment. The lowest eating time was found on diagnosis day and the highest on the ninth day before determination of lameness. Drinking time was higher in the HG group, with the exception of 10 and 9 days prior to clinical signs of disease in LG cows. A downward trend in rumination chews was observed in LG cows from day 7 until the onset of clinical symptoms. The bolus count decreased from day 3 before diagnosis to day 1 after diagnosis in LG cows. The largest difference in this indicator between groups was found on day of diagnosis. Analysing the pattern of CM values in the LG group, we found a decrease from 10 days before to 2 days after diagnosis. The CB value was almost the same in both groups of cows at the end of the experiment, but largest difference between the groups was found on day 7 after clinical sings of lameness.