ASSOCIATION OF PLASMA NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN WITH METABOLIC SYNDROME.

This prospective hospital-based study conducted in Tikrit City aimed to investigate the role of Neutrophil gelatinase-associated lipocalin (NGAL ) and level of hemoglobin A1c and lipid profile concentrations in Metabolic syndrome (MetS) with hypertension and Diabetes mellitus (DM). Objective - estimate of serum Neutrophil gelatinase-associated lipocalin levels in Metabolic syndrome patients and the Control Group. The study included 60 patients with metabolic syndrome along with 30 healthy individuals as controls who were 18-50 years old; the samples were collected at a specific time (10 P.M. to 1 A.M.) from October 2023 to the end of November 2023 from Tikrit Teaching Hospital in Tikrit City and analyzed for various parameters. Patients with Metabolic Syndrome had their waist measured men as >102 cm (>40 in) and Women >88 cm (>35 in) and BMI >30 kg/m2 and/or waist ship ratio >0.9 in men and >0.85 in women. The mean serum level NGAL in patients with metabolic syndrome compared with the control group (523.12±271.8 versus 353.66± 151.0 pg/ml). The result was a significant difference (p<0.001). The study found that metabolic syndrome patients who had HbA1c% results were significantly different (p<0.001) compared with the control group. Also, the serum level lipid profile concentrations in patients with metabolic syndrome compared with the control group which was significantly different (p<0.001). The results of this research clearly indicate that a high level of NGAL associated with metabolic syndrome is a significant risk factor for the incidence and mortality of cardiovascular disease. Reducing the prevalence of cardiovascular disease in the general population should involve identifying, treating, and preventing the underlying risk factors of metabolic syndrome. Male obesity, diabetes, dyslipidemia, and hypertension are well-known main cardiovascular risk factors.

Interleukin(IL)-1/IL-6-inhibitor-associated drug reaction with eosinophilia and systemic symptoms (DReSS) in systemic inflammatory illnesses.

BACKGROUND: After introducing interleukin(IL)-1/IL-6 inhibitors, some Still and Still-like patients developed unusual often fatal pulmonary disease. This complication was associated with scoring as DReSS (drug reaction with eosinophilia and systemic symptoms) implicating these inhibitors, although DReSS can be difficult to recognize in the setting of systemic inflammatory disease. OBJECTIVE: We sought to facilitate recognition of IL-1/IL-6 inhibitor-DReSS in systemic inflammatory illnesses (Still/Still-like) by looking at timing and reaction-associated features. We evaluated outcomes of stopping or not-stopping IL-1/IL-6-inhibitors after DReSS reaction began. METHODS: In an international study collaborating primarily with pediatric specialists, we characterized features of 89 drug-reaction cases versus 773 drug-exposed controls and compared outcomes of 52 cases stopping IL-1/IL-6-inhibitors to 37 cases not-stopping these drugs. RESULTS: Before reaction began, drug-reaction cases and controls were clinically comparable, except for younger disease onset age for reaction cases with pre-existing cardiothoracic comorbidities. After reaction began, increased rates of pulmonary complications and macrophage activation syndrome (MAS), differentiated drug-reaction cases from drug-tolerant controls (p=4.7x10-35; p=1.1x10-24, respectively). Initial DReSS feature was typically reported 2-8 weeks after initiating IL-1/IL-6-inhibition. In drug-reaction cases stopping versus not-stopping IL-1/IL-6-inhibitor treatment, reaction related features were indistinguishable, including pulmonary complication rates [75%(39/52] versus [76%(28/37)]. Those stopping subsequently required fewer medications for treatment of systemic inflammation, had decreased rates of MAS, and improved survival (p=0.005, multivariate regression). Resolution of pulmonary complications occurred in 67%(26/39) of drug-reaction cases who stopped and in none who continued inhibitors. CONCLUSIONS: In systemic inflammatory illnesses, recognition of IL-1/IL-6-inhibitor-associated reactions followed by avoidance of IL-1/IL-6-inhibitors significantly improved outcomes.

Spatial distribution and factors associated with high completed fertility among women aged 40-49 years in Ghana: evidence from the 2022 Ghana Demographic Health Survey.

BACKGROUND: High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40-49 years in Ghana. METHODS: Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). RESULTS: The national proportion of high completed fertility among married and cohabiting women aged 40-49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0-3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40]. CONCLUSION: High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use.

Periendoscopic Care Continuum in Acute Cholangitis Caused By Common Bile Duct Stone.

Acute cholangitis (AC) is a biliary tract infection with in-hospital mortality rates reaching up to 14.7%. The underlying condition is biliary obstruction caused by benign and malignant etiologies, as well as bacteriobilia, with commom bile duct (CBD) stone being one of the most common causes. Currently, the diagnosis is validated using Tokyo Guidelines 2018 criteria. Acute cholangitis due to CBD stone should be managed in a comprehensive manner, i.e., periendoscopic care continuum, consisting of pre-endoscopic care, endoscopic management, and post-endoscopic care. Pre-endoscopic care is primarily comprised of supportive therapy, antibiotic administration, optimal timing of endoscopic retrograde cholangiopancreatography (ERCP), pre-ERCP preparation, and informed consent. Endoscopic management is biliary decompression with stone extraction facilitated via ERCP procedure. Selective biliary cannulation should be performed meticulously. Bile aspiration and minimal bile duct contrast injection should be done to minimize the worsening of biliary infection. Endoscopic biliary sphincterotomy, endoscopic papillary balloon dilatation, and/or endoscopic papillary large balloon dilatation are all safe procedures that can be used in AC. Special precautions must be undertaken in critical and severe acute cholangitis patients who may not tolerate bleeding, in whom endoscopic biliary sphincterotomy may be postponed to decrease the risk of bleeding, and biliary decompression may be only attempted without CBD stone extraction. Nasobiliary tubes and plastic biliary stents are equally effective and safe for patients who have only undergone biliary decompression. In post-endoscopic care, management of adverse events and observation of therapy response are mandatory.

Smart city energy efficient data privacy preservation protocol based on biometrics and fuzzy commitment scheme.

Advancements in cloud computing, flying ad-hoc networks, wireless sensor networks, artificial intelligence, big data, 5th generation mobile network and internet of things have led to the development of smart cities. Owing to their massive interconnectedness, high volumes of data are collected and exchanged over the public internet. Therefore, the exchanged messages are susceptible to numerous security and privacy threats across these open public channels. Although many security techniques have been designed to address this issue, most of them are still vulnerable to attacks while some deploy computationally extensive cryptographic operations such as bilinear pairings and blockchain. In this paper, we leverage on biometrics, error correction codes and fuzzy commitment schemes to develop a secure and energy efficient authentication scheme for the smart cities. This is informed by the fact that biometric data is cumbersome to reproduce and hence attacks such as side-channeling are thwarted. We formally analyze the security of our protocol using the Burrows-Abadi-Needham logic logic, which shows that our scheme achieves strong mutual authentication among the communicating entities. The semantic analysis of our protocol shows that it mitigates attacks such as de-synchronization, eavesdropping, session hijacking, forgery and side-channeling. In addition, its formal security analysis demonstrates that it is secure under the Canetti and Krawczyk attack model. In terms of performance, our scheme is shown to reduce the computation overheads by 20.7% and hence is the most efficient among the state-of-the-art protocols.

A fusion approach using GIS, green area detection, weather API and GPT for satellite image based fertile land discovery and crop suitability.

Proper utilization of agricultural land is a big challenge as they often laid over as waste lands. Farming is a significant occupation in any country and improving it further by promoting more farming opportunities will take the country towards making a huge leap forward. The issue in achieving this would be the lack of knowledge of cultivable land for food crops. The objective of this work is to utilize modern computer vision technology to identify and map cultivable land for agricultural needs. With increasing population and demand for food, improving the farming sector is crucial. However, the challenge lies in the lack of suitable land for food crops cultivation. To tackle this issue, we propose to use sophisticated image processing techniques on satellite images of the land to determine the regions that are capable of growing food crops. The solution architecture includes enhancement of satellite imagery using sophisticated pan sharpening techniques, notably the Brovey transformation, aiming to transform dull satellite images into sharper versions, thereby improving the overall quality and interpretability of the visual data. Making use of the weather data on the location observed and taking into factors like the soil moisture, weather, humidity, wind, sunlight times and so on, this data is fed into a generative pre-trained transformer model which makes use of it and gives a set of crops that are suitable to be grown on this piece of land under the said conditions. The results obtained by the proposed fusion approach is compared with the dataset provided by the government for different states in India and the performance was measured. We achieved an accuracy of 80% considering the crop suggested by our model and the predominant crop of the region. Also, the classification report detailing the performance of the proposed model is presented.

A sustainable and economical solution for CO2 capture with biobased carbon materials derived from palm kernel shells.

This study investigates the synthesize of activated carbon for carbon dioxide adsorption using palm kernel shell (PKS), a by-product of oil palm industry. The adsorbent synthesis involved a simple two-step carbonization method. Firstly, PKS was activated with potassium oxide (KOH), followed by functionalization with magnesium oxide (MgO). Surface analysis revealed that KOH activated PKS has resulted in a high specific surface area of 1086 m2/g compared to untreated PKS (435 m2/g). However, impregnation of MgO resulted in the reduction of surface area due to blockage of pores by MgO. Thermogravimetric analysis (TGA) demonstrated that PKS-based adsorbents exhibited minimal weight loss of less than 30% up to 500 °C, indicating their suitability for high-temperature applications. CO2 adsorption experiments revealed that PKS-AC-MgO has achieved a higher adsorption capacity of 155.35 mg/g compared to PKS-AC (149.63 mg/g) at 25 °C and 5 bars. The adsorption behaviour of PKS-AC-MgO was well fitted by both the Sips and Langmuir isotherms, suggesting a combination of both heterogeneous and homogeneous adsorption and indicating a chemical reaction between MgO and CO2. Thermodynamic analysis indicated a spontaneous and thermodynamically favourable process for CO2 capture by PKS-AC-MgO, with negative change in enthalpy (- 0.21 kJ/mol), positive change in entropy (2.44 kJ/mol), and negative change in Gibbs free energy (- 729.61 J/mol, - 790.79 J/mol, and - 851.98 J/mol) across tested temperature. Economic assessment revealed that the cost of PKS-AC-MgO is 21% lower than the current market price of commercial activated carbon, indicating its potential for industrial application. Environmental assessment shows a significant reduction in greenhouse gas emissions (381.9 tCO2) through the utilization of PKS-AC-MgO, underscoring its environmental benefits. In summary, the use of activated carbon produced from PKS and functionalised with MgO shows great potential for absorbing CO2. This aligns with the ideas of a circular economy and sustainable development.

Ultrafast Optical Control of Exciton Diffusion in WSe2/Graphene Heterostructures Revealed by Heterodyne Transient Grating Spectroscopy.

Using heterodyne transient grating spectroscopy, we observe a significant enhancement of exciton diffusion in a monolayer WSe2 stacked on graphene. The diffusion dynamics can be optically tuned within a few picoseconds by altering the photoexcited carrier density in graphene. The effective diffusion constant in initial picoseconds in the WSe2/graphene heterostructure is (40.3 ± 4.5) cm2 s-1, representing a substantial improvement over (2.1 ± 0.8) cm2 s-1, typical for an isolated WSe2 monolayer. This enhancement can be understood in terms of a transient screening of impurities, charge traps, and defect states in WSe2 by photoexcited charge carriers in graphene. Furthermore, diffusion within WSe2 is affected by interlayer interactions, such as charge transfer, varying with the incident excitation fluence. These findings underscore the dynamical nature of screening and diffusion processes in heterostructures of 2D semiconductors and graphene and provide insights for future applications of these systems in ultrafast optoelectronic devices.

Identification and Validation of Peptides Specifying SARS-CoV-2 B-Cell Epitopes Eliciting Neutralizing Antibodies.

Vaccination is an effective means of inducing immune protection to prevent transmissible diseases. During the Covid-19 pandemic, immunizations using traditional and novel vaccine platforms such as the inactivated SARSCo-V-2 vaccine, adenoviral-vectored, and nucleic acid-based mRNA vaccines have been relatively successful in controlling the rates of infection and hospitalizations. Nevertheless, the danger posed by the emergence of SARS-CoV-2 variants would set the stage for the design of next generation vaccines. To overcome the lack of efficacy of current vaccines against emerging SARS-CoV-2 variants, new vaccines must be able to overcome the reduced effectiveness of the current vaccines. Since the current Covid-19 vaccines are dependent on the whole S-protein of Wuhan strain as the antigen, mutations have rendered the current Covid-19 vaccines less effective against variants of concern (VoCs). Instead of using the whole S-protein, peptide-based epitopes could be predicted using immunoinformatic approaches, simulation of the 3D structures, overlapping peptides covering the whole length of the S-protein or peptide arrays based on synthetic peptide combinatorial libraries comprising peptides recognizable by monoclonal antibodies. B-cell epitopes were predicted, and immunogenicity of peptides was validated in mice by immunizing mice with peptides conjugated to keyhole limpet hemocyanin (KLH) mixed with Montanide 51 as an adjuvant. The immunogenicity of epitopes that could elicit peptide specific IgGs was determined by peptide-based ELISA. Neutralizing activities were determined by cPass and pseudovirus-based neutralization assays.

Cardiovascular diseases as risk factors of post-COVID syndrome: a systematic review.

BACKGROUND: A growing proportion of people experience incomplete recovery months after contracting coronavirus disease 2019 (COVID-19). These COVID-19 survivors develop a condition known as post-COVID syndrome (PCS), where COVID-19 symptoms persist for > 12 weeks after acute infection. Limited studies have investigated PCS risk factors that notably include pre-existing cardiovascular diseases (CVD), which should be examined considering the most recent PCS data. This review aims to identify CVD as a risk factor for PCS development in COVID-19 survivors. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist, systematic literature searches were performed in the PubMed, Scopus, and Web of Science databases from the earliest date available to June 2023. Data from observational studies in English that described the association between CVD and PCS in adults (≥ 18 years old) were included. A minimum of two authors independently performed the screening, study selection, data extraction, data synthesis, and quality assessment (Newcastle-Ottawa Scale). The protocol of this review was registered under PROSPERO (ID: CRD42023440834). RESULTS: In total, 594 studies were screened after duplicates and non-original articles had been removed. Of the 11 included studies, CVD including hypertension (six studies), heart failure (three studies), and others (two studies) were significantly associated with PCS development with different factors considered. The included studies were of moderate to high methodological quality. CONCLUSION: Our review highlighted that COVID-19 survivors with pre-existing CVD have a significantly greater risk of developing PCS symptomology than survivors without pre-existing CVD. As heart failure, hypertension and other CVD are associated with a higher risk of developing PCS, comprehensive screening and thorough examinations are essential to minimise the impact of PCS and improve patients' disease progression.

Post-COVID syndrome prevalence: a systematic review and meta-analysis.

BACKGROUND: Since the Coronavirus disease 2019 (COVID-19) pandemic began, the number of individuals recovering from COVID-19 infection have increased. Post-COVID Syndrome, or PCS, which is defined as signs and symptoms that develop during or after infection in line with COVID-19, continue beyond 12 weeks, and are not explained by an alternative diagnosis, has also gained attention. We systematically reviewed and determined the pooled prevalence estimate of PCS worldwide based on published literature. METHODS: Relevant articles from the Web of Science, Scopus, PubMed, Cochrane Library, and Ovid MEDLINE databases were screened using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic search process. The included studies were in English, published from January 2020 to April 2024, had overall PCS prevalence as one of the outcomes studied, involved a human population with confirmed COVID-19 diagnosis and undergone assessment at 12 weeks post-COVID infection or beyond. As the primary outcome measured, the pooled prevalence of PCS was estimated from a meta-analysis of the PCS prevalence data extracted from individual studies, which was conducted via the random-effects model. This study has been registered on PROSPERO (CRD42023435280). RESULTS: Forty eight studies met the eligibility criteria and were included in this review. 16 were accepted for meta-analysis to estimate the pooled prevalence for PCS worldwide, which was 41.79% (95% confidence interval [CI] 39.70-43.88%, I2 = 51%, p = 0.03). Based on different assessment or follow-up timepoints after acute COVID-19 infection, PCS prevalence estimated at ≥ 3rd, ≥ 6th, and ≥ 12th months timepoints were each 45.06% (95% CI: 41.25-48.87%), 41.30% (95% CI: 34.37-48.24%), and 41.32% (95% CI: 39.27-43.37%), respectively. Sex-stratified PCS prevalence was estimated at 47.23% (95% CI: 44.03-50.42%) in male and 52.77% (95% CI: 49.58-55.97%) in female. Based on continental regions, pooled PCS prevalence was estimated at 46.28% (95% CI: 39.53%-53.03%) in Europe, 46.29% (95% CI: 35.82%-56.77%) in America, 49.79% (95% CI: 30.05%-69.54%) in Asia, and 42.41% (95% CI: 0.00%-90.06%) in Australia. CONCLUSION: The prevalence estimates in this meta-analysis could be used in further comprehensive studies on PCS, which might enable the development of better PCS management plans to reduce the effect of PCS on population health and the related economic burden.

Roots of synthetic ecology: microbes that foster plant resilience in the changing climate.

Microbes orchestrate nearly all major biogeochemical processes. The ability to program their influence on plant growth and development is attractive for sustainable agriculture. However, the complexity of microbial ecosystems and our limited understanding of the mechanisms by which plants and microbes interact with each other and the environment make it challenging to use microbiomes to influence plant growth. Novel technologies at the intersection of microbial ecology, systems biology, and bioengineering provide new tools to probe the role of plant microbiomes across environments. Here, we summarize recent studies on plant and microbe responses to abiotic stresses, showcasing key molecules and micro-organisms that are important for plant health. We highlight opportunities to use synthetic microbial communities to understand the complexity of plant-microbial interactions and discuss future avenues of programming ecology to improve plant and ecosystem health.

Can women empowerment boost dietary diversity among children aged 6-23 months in sub-Saharan Africa?

BACKGROUND: The empowerment of women has implications on the health and dietary needs of children. Using the survey-based women's empowerment index (SWPER), we examined the association between women's empowerment and dietary diversity among children aged 6-23 months in sub-Saharan Africa. METHODS: Data from the Demographic and Health Surveys of 21 countries were utilized. Descriptive spatial map was used to present the proportions of dietary diversity among the children. Multilevel binary logistic regression was used to examine the association between SWPER and dietary diversity. RESULTS: Overall, 22.35% of children aged 6-23 months had adequate minimum dietary diversity (MDD) in sub-Saharan Africa. The countries with the highest proportions of adequate MDD were Angola, Benin, Madagascar, Rwanda, Sierra Leone, and South Africa. South Africa had the highest proportion of MDD (61.00%), while Liberia reported the least (9.12%). Children born to mothers who had high social independence were more likely to have adequate MDD compared to those with low social independence [aOR = 1.31, 95% CI 1.21, 1.41]. In addition, children born to women with medium [aOR = 1.12; 95% CI 1.03, 1.21] and high decision-making [aOR = 1.25, 95% CI 1.14, 1.37] were more likely to receive MDD than those with low decision-making. CONCLUSIONS: Insufficient dietary diversity is evident among children aged 6-23 months in sub-Saharan Africa. MDD in children is influenced by women's empowerment. Policies and interventions promoting women's empowerment can enhance MDD, especially for vulnerable groups in rural and poorer households. It is crucial to leverage media and poverty reduction strategies to improve MDD among children in sub-Saharan African countries.

Wood calamint ameliorates ethanol-induced stomach injury in rats by augmentation of hsp/bax and inflammatory mechanisms.

Clinopodium menthifolium (wood calamint) is a folkloric medicinal plant ingested as a treatment for many human disorders including gastric disorders. Our study evaluates the anti-ulcer potentials of Clinopodium menthifolium ethanol extracts (CMEE) in induced gastric ulcers in rats. Thirty Dawley male rats were divided into 5 groups: normal and ulcer controls, treated orally with Tween 20%; reference rats treated with Omeprazole 20 mg/kg, and the remaining two groups received 250 and 500 mg/kg CMEE for 2 weeks. After that, food was taken away for 24 h, and then, rats received ethanol-induced gastric ulceration (except normal control), 80% (1 ml/rat). After anesthetization and sacrificing, the ulcer index, mucus content, and other ulcer measurements were obtained from dissected rat stomachs. Stomach tissues were also analyzed by different histology procedures and homogenized stomach tissues were assessed for their antioxidant contents. The toxicity trial showed the absence of any toxic signs in rats supplemented with 2 and 5 g/kg of CMEE. The gastroprotective results showed a significantly lower ulcer index and higher gastric mucin content in CMEE-ingested rats compared to ulcer controls. Furthermore, CMEE treatments significantly increased the intensity of periodic acid Schiff stained (PAS), HSP 70 protein, and down-regulation of Bax protein expression in the stomach epithelium. Rats supplemented with 500 mg/kg revealed noticeable changes in their serum inflammatory cytokines along with positive regulations of antioxidant enzymes. The outcomes provide a scientific backup behind the gastroprotective potential effect of CMEE that could serve as a natural resource against peptic ulcers.

Strong coupling between plasmonic nanocavity gold nanorods and quantum dots emitter.

The discovery of hybrid states in strong coupling interaction has gained growing attention in cavity-quantum electrodynamics research owing to its fundamental directives and potential in advanced optical applications. The ultra-confined mode volume of plasmonic cavity gold nanorods (AuNRs), particularly at the nanorod tip "hotspot" provides a large coupling strength, a prerequisite for a coherent energy exchange in the strong coupling regime. Here, we reported a remarkable Rabi splitting of ∼231 meV between gold nanorods longitudinal localized surface plasmon resonance (LLSPR) mode and quantum dots (QDs) at ambient conditions, monitored by dielectric medium tuning. Numerical simulations confirmed the result, displaying absorption spectral splitting.

Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic.

This is a qualitative phenomenological study that was designed to navigate through nurses' lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses' lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses' eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

Association between women's empowerment and fertility preferences in Ghana.

As Ghana has embraced the concept of women's empowerment as a vital tool for sustainable development, it has become crucial to evaluate the role that women's empowerment plays in the fertility preferences of married and cohabiting women in the country. The study's objective was to examine the association between women's empowerment, the ideal number of children and women's ability to have their desired number of children. This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Both Poisson and binary logistic regression analyses were carried out. Women who had justification for wife-beating (incidence rate ratio [IRR] 0.98 [95% confidence interval {CI} 0.96 to 0.99]) and those who were autonomous (IRR 0.94 [95% CI 0.93 to 0.95]) had lower rates of having the ideal number of children. Moreover, women who had justification for wife-beating (adjusted odds ratio [aOR] 1.25 [95% CI 1.13 to 1.39]) and those who were involved in decision-making (aOR 1.31 [95% CI 1.19 to 1.44]) had higher odds of having the ability to have the desired number of children. However, autonomous women (aOR 0.78 [95% CI 0.71 to 0.86]) had lower odds of having the ability to have the desired number of children. Significant associations were found between women's empowerment (women's attitude towards justification for wife-beating, autonomy), an ideal number of children and the ability to have the desired number of children. These findings present target areas for policies and interventions aimed at determining Ghanaian women's fertility preferences and empowering them.

Needs Analysis for The Development of a Manual in Palliative Care for Malaysia: An Islamic Psychospiritual Approach.

This study explicates an Islamic approach to palliative care based on the results of a needs analysis regarding the development of an Islamic psychospiritual manual of palliative care alongside related elements. This article represents the first phase of a three-phase study using the design and development research (DDR) approach developed by Richey and Klein to study for design and development of manual either needed or otherwise. This project is a quantitative study that uses purposive sampling through a questionnaire instrument to investigate 210 participants from the general population in Malaysia that have experience in taking care of terminally ill patients. The findings of the study indicated that the majority of participants agreed with the development of an Islamic psychospiritual manual with mean values (x̅) of 4.57 and 4.66. Concurrently, the findings showed that the hierarchy of emphasis in terms of the elements to be included in the manual starts with emotional support, which exhibited the highest mean rate (x̅), followed by faith in God, spiritual and religious support, self and physical management, trauma management and social support. The correlations indicated that all the elements to be included in the manual were significant.

Prolonged vs Intermittent Infusions of ß-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis.

Importance: There is uncertainty about whether prolonged infusions of ß-lactam antibiotics improve clinically important outcomes in critically ill adults with sepsis or septic shock. Objective: To determine whether prolonged ß-lactam antibiotic infusions are associated with a reduced risk of death in critically ill adults with sepsis or septic shock compared with intermittent infusions. Data Sources: The primary search was conducted with MEDLINE (via PubMed), CINAHL, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception to May 2, 2024. Study Selection: Randomized clinical trials comparing prolonged (continuous or extended) and intermittent infusions of ß-lactam antibiotics in critically ill adults with sepsis or septic shock. Data Extraction and Synthesis: Data extraction and risk of bias were assessed independently by 2 reviewers. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. A bayesian framework was used as the primary analysis approach and a frequentist framework as the secondary approach. Main Outcomes and Measures: The primary outcome was all-cause 90-day mortality. Secondary outcomes included intensive care unit (ICU) mortality and clinical cure. Results: From 18 eligible randomized clinical trials that included 9108 critically ill adults with sepsis or septic shock (median age, 54 years; IQR, 48-57; 5961 men [65%]), 17 trials (9014 participants) contributed data to the primary outcome. The pooled estimated risk ratio for all-cause 90-day mortality for prolonged infusions of ß-lactam antibiotics compared with intermittent infusions was 0.86 (95% credible interval, 0.72-0.98; I2 = 21.5%; high certainty), with a 99.1% posterior probability that prolonged infusions were associated with lower 90-day mortality. Prolonged infusion of ß-lactam antibiotics was associated with a reduced risk of intensive care unit mortality (risk ratio, 0.84; 95% credible interval, 0.70-0.97; high certainty) and an increase in clinical cure (risk ratio, 1.16; 95% credible interval, 1.07-1.31; moderate certainty). Conclusions and Relevance: Among adults in the intensive care unit who had sepsis or septic shock, the use of prolonged ß-lactam antibiotic infusions was associated with a reduced risk of 90-day mortality compared with intermittent infusions. The current evidence presents a high degree of certainty for clinicians to consider prolonged infusions as a standard of care in the management of sepsis and septic shock. Trial Registration: PROSPERO Identifier: CRD42023399434.

Outcomes of Ultrafiltration in community-based hospitals.

OBJECTIVE: We sought to examine outcomes of ultrafiltration in real world community-based hospital settings. BACKGROUND: Ultrafiltration (UF) is an accepted therapeutic option for advanced decompensated heart failure (ADHF). the feasibility of UF in a community hospital setting, by general cardiologists in a start-up program had not been objectively evaluated. METHODS: We retrospectively analyzed the first-year cohort of ADHF patients treated with UF from 10/1/2019 to 10/1/2020, which totaled 30 patients, utilizing the CHF Solutions Aquadex FlexFlow™ System with active UF rate titration. RESULTS: Baseline patient characteristics were similar to RCTs: mean age 63, 73% male; 27% female; 53% Caucasian; 47% African American; 77% had LVEF ≤ 40. The baseline mean serum creatinine (Cr) was 1.84 ±0.62 mg/dL, mean GFR of 36.95 ±9.60 ml/min. HF re-admission rates were not significantly different than prior studies (17.2% at 30 d, 23.3% at 60 d, but in our cohort, per patient HF re-admission rates were reduced significantly by 60 d (0.30 p = 0.017). CONCLUSION: Our analysis showed success with UF in mainstream setting with reproducible results of significant volume loss without adverse renal effect, mitigation of recurrent Hdmissions, and remarkable subjective clinical benefit.