High risk of coagulopathy among Type-2 Diabetes Mellitus clients at a municipal hospital in Ghana

Background: Persistent hyperglycaemia in diabetes mellitus causes coagulopathies due to glycation of haemoglobin, prothrombin, fibrinogen and other proteins involved in the clotting mechanism. Shortened activated partial thromboplastin time (APTT) and prothrombin time (PT) reflect hypercoagulable state, which is associated with an increased thrombotic risk and adverse cardiovascular effects. This study assessed the coagulation profile of type 2diabetes mellitus (T2DM) clients at a municipal hospital in Ghana.Methods: A hospital-based case-control study was conducted from January to April 2015 at the Agona Swedru Municipal Hospital. Sixty (60) persons with T2DM and 40 without were recruited and screened using appropriate protocols. Blood samples were collected for coagulation and biochemical tests. Demographic and clinical information were collected using pre-tested questionnaire. Data was analyzed with GraphPad Prism version 5.Results: APTT and PT were significantly shorter among patients with T2DM compared to those without (20.88 ± 5.19 v 31.23 ± 5.41, P=0.0001; and 11.03 ± 2.06sec v 14.46 ± 1.86, P=0.0001 respectively). INR was decreased among patients with T2DM compared to those without (0.83 ± 0.18 v 1.13 ± 0.17, P=0.0001). No significant difference was found in platelet count between T2DM and non-diabetics (179.85 ± 66.15×103 /mm3 v 168.55 ± 35.77×103 /mm3, P=0.326). Serum magnesium was lower among the T2DM patients compared to the non-diabetics, while serum ionized calcium was significantly higher among the T2DM patients (P<0.05).Conclusion: Clients with T2DM may have a high coagulation risk evidenced by shortened APTT, PT and a high ionized calcium compared with controls.Funding: Study was funded by Lord Ampomah and Solomon PanfordKeywords: Type 2 Diabetes Mellitus, coagulation, prothrombin time, activated partial thromboplastin time, ionized calciu

Carbon Nitride as a Ligand: Selective Hydrogenation of Terminal Alkenes using [(η5-C5Me5)IrCl(g-C3N4-κ2N, N')]Cl : Selective Hydrogenation of Terminal Alkenes using [(η5-C5Me5)IrCl(g-C3N4-κ2N, N')]Cl

Anchoring a homogeneous catalyst onto a heterogeneous support facilitates separation of the product from the catalyst, and catalyst-substrate interactions can also modify reactivity. Herein we describe the synthesis of composite materials comprising carbon nitride (g-C 3 N 4 ) as the heterogeneous support and the well established homogeneous catalyst moiety [Cp*IrCl] + (where Cp* = η 5 -C 5 Me 5 ), commonly used for catalytic hydrogenation. Coordination of [Cp*IrCl] + to g-C 3 N 4 occurs directly at exposed edge sites with a κ 2 N, N' binding motif, leading to a primary inner coordination sphere analogous to known homogeneous complexes of the general class [Cp*IrCl(NN-κ 2 N, N' )] + (where N, N' = a bidentate nitrogen ligand). Hydrogenation of unsaturated substrates using the composite catalyst is selective for terminal alkenes, which is attributed to the restricted steric environment of the outer coordination sphere at the edge-sites of g-C 3 N 4

Developing a modified low-density lipoprotein (M-LDL-C) Friedewald’s equation as a substitute for direct LDL-C measure in a Ghanaian population: a comparative study

Despite the availability of several homogenous LDL-C assays, calculated Friedewald\u27s LDL-C equation remains the widely used formula in clinical practice. Several novel formulas developed in different populations have been reported to outperform the Friedewald formula. This study validated the existing LDL-C formulas and derived a modified LDL-C formula specific to a Ghanaian population. In this comparative study, we recruited 1518 participants, derived a new modified Friedewald\u27s LDL-C (M-LDL-C) equation, evaluated LDL-C by Friedewald\u27s formula (F-LDL-C), Martin\u27s formula (N-LDL-C), Anandaraja\u27s formula (A-LDL-C), and compared them to direct measurement of LDL-C (D-LDL-C). The mean D-LDL-C (2.47±0.71 mmol/L) was significantly lower compared to F-LDL-C (2.76±1.05 mmol/L), N-LDL-C (2.74±1.04 mmol/L), A-LDL-C (2.99±1.02 mmol/L), and M-LDL-C (2.97±1.08 mmol/L) p \u3c 0.001. There was a significantly positive correlation between D-LDL-C and A-LDL-C (r=0.658, p\u3c0.0001), N-LDL-C (r=0.693, p\u3c0.0001), and M-LDL-C (r=0.693, p\u3c0.0001). M-LDL-c yielded a better diagnostic performance [(area under the curve (AUC)=0.81; sensitivity (SE) (60%) and specificity (SP) (88%)] followed by N-LDL-C [(AUC=0.81; SE (63%) and SP (85%)], F-LDL-C [(AUC=0.80; SE (63%) and SP (84%)], and A-LDL-C (AUC=0.77; SE (68%) and SP (78%)] using D-LDL-C as gold standard. Bland-Altman plots showed a definite agreement between means and differences of D-LDL-C and the calculated formulas with 95% of values lying within ±0.50 SD limits. The modified LDL-C (M-LDL-C) formula derived by this study yielded a better diagnostic accuracy compared to A-LDL-C and F-LDL-C equations and thus could serve as a substitute for D-LDL-C and F-LDL-C equations in the Ghanaian population

Interplay between foetal haemoglobin, micronutrients and oxidative stress biomarkers in sickle cell anaemia children

Foetal haemoglobin (HbF) has been speculated to have an impact on the quantity of micronutrients and the latter also have a role to play in oxidative stress (OS) in sickle cell anaemia (SCA). No previous study in Ghana has examined the interplay of these factors together among SCA children. This study compared the levels of OS biomarkers (8-hydroxy-deoxyguanosine [8-OHdG] total antioxidant capacity [TAC]) and micronutrients (zinc and copper), and their relationship with HbF in SCA and sickle cell negative, apparently healthy children. This case-control study recruited 58 SCA (out-patients [n = 42] and in-patients [n = 16]) children aged 1–14 years as cases and 62 sickle cell negative children as controls from the Sickle Cell Unit at the Eastern Regional Hospital, Ghana. The micronutrients were measured using the atomic absorption spectrophotometer (AAS) whereas OS biomarkers and HbF were assayed using enzyme-linked immunosorbent assay (ELISA). SCA out-patients had a significantly higher level of HbF compared to HbA patients (p = 0.035). SCA in-patients had significantly increased levels of zinc, but a reduced 8-OHdG than SCA out-patients compared to control group (p \u3c 0.05). HbF correlated significantly (r = 0.318, p \u3c 0.038) with zinc in SCA out-patients. Micronutrients are essential in maintaining the redox status in SCA out-patients and HbF can influence some micronutrients

What Every Business Student Needs to Know About Information Systems

Whether Information Systems should or should not be part of the core business school curriculum is a recurring discussion in many universities. In this article, a task force of 40 prominent information systems scholars address the issue. They conclude that information systems is absolutely an essential body of knowledge for business school students to acquire as well as a key element of the business school\u27s long-run strategic positioning within the university. Originally prepared in response to draft accreditation guidelines prepared by AACSB International, the article includes a compilation of the concepts that the authors believe to be the core information systems knowledge that all business school students should be familiar with

Future research directions in pneumonia

Copyright © 2018 by the American Thoracic Society. Pneumonia is a complex pulmonary disease in need of new clinical approaches. Although triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as acute respiratory distress syndrome and to organ dysfunction beyond the lungs and over extended time frames after pathogen clearance, some of which increase the risk for subsequent pneumonia. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extrapulmonary complications of pneumonia. The NHLBI assembled a working group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decline caused by pneumonia. This report summarizes the working group’s specific recommendations in the areas of pneumonia susceptibility, host response, and consequences. Overarching goals include the development of more host-focused clinical approaches for preventing and treating pneumonia, the generation of predictive tools (for pneumonia occurrence, severity, and outcome), and the elucidation of mechanisms mediating immune resistance and tissue resilience in the lung. Specific areas of research are highlighted as especially promising for making advances against pneumonia

Results and Impacts of the Integrated Land and Water Management for Adaptation to Climate Variability and Change (ILWAC) Project: Evaluation Report

The objective of the evaluation was to assess the results and impacts of the activities of all ILWAC Trust Fundfinanced projects in West Africa using a selected subset, to identify key lessons learned, and to document best climatesmart practices for scaling up. The study entailed participatory evaluation of the results and impacts of various interventions geared towards integrated water resources management for climate change and variability preparedness in West Africa. In this respect, the study identified key lessons learned and documented best climate-resilient practices for scaling up and dissemination to multiple stakeholders in the West African region. 1. Agriculture remains the backbone for sustaining livelihoods in West Africa but faces numerous challenges. Agriculture is an important source of income, food and raw materials in West Africa, employing more than half of the region’s population, which culminated in the adoption of the Comprehensive Africa Agriculture Development Programme (CAADP) in 2003. Few countries, however, have managed to mobilize their agriculture sector to deliver on development outcomes such as food and nutrition security, poverty reduction, economic growth, job creation, youth employment and industrialization. Agriculture is vulnerable to climate change, resulting from sensitivity and exposure to climate shocks and lack of capacity to cope with and adapt to such changes. ILWAC evaluation study results from household surveys, focus group discussions and key informant interviews indicate that agricultural productivity in the region remains low, lagging far behind other regions of the world. Contributors to such low productivity include incidence of climate risks (drought, floods and high temperatures), pests and diseases, low technology adoption, limited access to financial services, limited access to markets and market information and limited access to good road networks (Plate 1). All the aforementioned contributors are valid denominators for all the seven ILWAC project areas that were evaluated. 2. Farmers in West Africa are particularly vulnerable to climatic shocks because of their high dependence on rainfed agriculture for their livelihoods. There is an evident lack of access to formal safety nets as indicated by farmers in Senegal (ENRACCA-WA) and Burkina Faso (AmREACCAF and APESS) projects. Climate change has already exerted significant impacts in the region. Since the 1970s, the region has experienced the occurrence of many droughts. Temperatures have increased in the second half of the 20th Century, especially in the latter 20 years of the same period. Farmers reported drought (about 40% of treatment and control groups), as the most prevalent climatic shock experienced over the last five years, followed by erratic rainfall, floods and invasion of crop pests and locusts. We identified eleven coping strategies, out of which three strategies were categorized based on a gradient of severity of food insecurity into low, moderate, and high food insecurity. During low food insecurity, households employ food-maximizing strategies such as purchasing food and eating less food and involving a low commitment of domestic resources that all enable quick recovery of households once the crisis eases. In times of moderate food insecurity, a greater commitment of household resources is increasingly required to meet subsistence needs. Coping strategies developed by households include sale of food reserves, use of savings, sale of livestock, borrowing food, and borrowing money (from friends, relatives, private lenders and banks). During high food insecurity, strategies are a sign of failure to cope with the food crisis and may involve drastic options that may undermine their future ability to prevent, mitigate, cope, and recover from shocks. Households adopt sale of assets such as land and homes, keeping children home from school, food aid and migration. The use of irrigation and rainfall water harvesting for agriculture remain low, despite prevalent droughts and widespread rainfed agricultural practices. One of the reasons is that most farming communities are far from rivers: hence considerable investment is required to develop irrigation in many project areas. 3. Although farmers use various strategies highlighted above, they will need support to double their efforts with innovative climate- smart agricultural practices and technologies to remain food secure. Areas where ILWAC interventions were targeted showed positive results, but broader efforts to scale out the successes are needed to achieve a greater impact. Overall, the ILWAC project beneficiaries reported higher adoption rates of climate-smart practices, demonstrating a favourable impact of the project. However, low awareness of the most appropriate technologies to cope with climate shocks was reported across all study areas yet, the region is expected to experience increasing climatic shocks with total precipitation predicted to increase for the most part more notably between July and October by 2050. Increases in precipitation are predicted to cause crop damages and floods. Overall, temperatures will rise by about 2°C to 3°C over the same time period. Higher temperatures of 3°C to 6°C are projected for the end of the 21st century (Niang et al., 2014). Despite these impending changes, few farmers have adjusted their farming strategies in response to climate risks, owing to limited knowledge on appropriate adaptation options and low endowment with production resources. As a result, ILWAC interventions were targeted to reverse these challenges. Their successful implementation showed positive results, which are largely limited to specific areas of implementation. Therefore, broader scaling out ILWAC interventions provided success stories tailored to specific contexts (biophysical and socio- economic); hence offered lessons and opportunities for replicating the bright spots with a regional approach. Across the seven projects, evaluation results indicated a couple of selected successes in the region (Plate 1). Selected successes make up potential candidates for scaling up climate-smart agricultural technologies and practices, and innovative approaches notably, including: i. Innovation platforms as a pillar for change: The successful establishment of innovation platforms across all project countries was evident but have remained largely underdeveloped and not utilized to their full potential. Platforms provided a framework for sharing knowledge on adaptation innovations to climate change, providing a good entry point for technology dissemination in target areas across all project countries. The study showed that the innovation platform model can offer the potential to organize stakeholders to address the objective of improving the livelihood of their members. IPs, however, need a strong voice to demand the needed services from service providers, negotiate and advocate for collective interests with the private sector and government. The use of a participatory development communication (PDC) within IPs would greatly increase their sustainability; ii. Increased human and institutional capacity for stakeholders: The enhancement of capacity for diverse stakeholder groups, including farmers, players in all segments of priority value chains, extension agents, policymakers and researchers (All project countries) resulted in significant positive results such as increased capacity towards awareness of CSA technologies and application of appropriate adaptation measures in their communities. This highlights the need to prioritize linkages amongst farmer organizations, extension and agricultural research; iii. Integrated landscape approaches for natural resources management provided exponential benefits: The pioneering of integrated land and water management for adaptation to climate variability and change improved management of natural resources in specific target countries, for example, in Burkina Faso, the relative reduction in sedimentation by up to 70%; and that in reduced runoff by up to 30% which helped improve the farmers’ agricultural practices and livelihoods (AmREACCAF-Burkina Faso). This also increased storage of water in the Boura reservoir through avoided sedimentation. Beyond water provision for household use, these reservoirs serve as key food baskets for fisheries and irrigation for households; iv. Integrated and diversified options offered opportunities to increase resilience and unlock the potential for rural smallholder livelihoods: The ILWAC project improved implementation of innovative agronomic interventions that substantially reduced the yield gap for millet for example the use of improved crop varieties (drought tolerant and early maturing) resulted in a 10 fold yield increase in grain biomass (ENRACCASenegal). Additional strategies include soil amendments in the form of organic and inorganic fertilizer sources, weed control practices as well as improved storage techniques (ISFM-Benin); Household enterprise diversification with agroforestry tree species enhanced the resilience of smallholder communities with climatesmart benefits such as windbreaks, these modified the micro-climate of the area that enhanced food security and revenue generation within target communities, increased farmer adaptive capacity and overall soil health attributes (ENRACCA- Senegal). 5. Women empowerment resulted in improved rural livelihoods: Improved gender dynamics regarding the roles, activities and representativeness within the selected projects had a positive impact on women empowerment for all project countries. There are numerous ways by which women were empowered e.g. conducting off-season vegetable cultivation allowed women to fetch increased returns (3 times than the normal price) in the off-season months. There were efforts to promote increased participation of women in the projects, offering opportunities to freely express themselves, highlight their needs and specific experiences. However, participation of women in leadership positions was generally low (less than 10%). In addition, women were able to benefit from the capacity building provided by the project, and access technologies and inputs resulting in higher production and subsequent incomes than before. Male-headed households were more likely to practice more CSA technologies by a factor of about 1 compared to female headed households. There was evidence of better access to financial services and training through village savings and loan associations, and gender empowerment. A key attribute of the assessed projects was that for the most part, women farmers were not well organized into interest groups with the capacity to promote their interests and engage in advocacy activities geared at influencing policy for their ultimate benefit. This was a missed opportunity especially in the context of existing innovation platforms that needs concerted efforts and strengthening. 6. More economic and social safety nets for smallholder livelihoods beyond ILWAC beneficiaries are needed: ILWAC enhanced farmers’ access to climate-resilient and low-emission practices and technologies, including crop, livestock, soil and water management options and energy saving technologies. ILWAC increased the number of CSA practices implemented by three practices more compared to non-participation. Results further showed that education level is associated with higher income. Higher value assets such as livestock did also significantly influenced income. ILWAC increased significantly the value of assets to almost 90%; a factor attributable to additional assets that were distributed to farmer groups such as the case of Gambia, Senegal and Sierra Leone. This study therefore confirms that more assets in ILWAC supported households offered better livelihood options than those in the control group. Results further show that male-headed households have a higher value of assets than female-headed households. On the overall, although participation in ILWAC increased income by 19%, there remains room for further improvement amongst the ILWAC beneficiaries given the lower differences in the economic domain for sustainable intensification exemplified before and after the ILWAC project on Plate 2. Likewise, Plate 2 highlights that better options are needed in the social domain to ensure that ILWAC beneficiaries can significantly gain from social dividends (e.g. strengthened farmer groups, collective action, and shared labor). Given the highlighted successes among the ILWAC beneficiaries, efforts will be needed to scale these bright spots beyond the ILWAC beneficiaries to wider geographical coverages. 7. There is need for concerted efforts towards supporting technical, financial, institutional and governance needs within the target countries in order to make community livelihoods more resilient to climate change. Despite the recorded successes there remains room for improvement in several institutional and governance realms. Farmers in the project sites are faced by poor extension, with the ratio of government paid extension officers to that of farmers being low, only 33% of the households have access to extension service. This has a negative impact on the quality of extension services being offered and building adaptive capacity to deal with climate change. A significant challenge remains in all project countries to get the technologies widely used due to the lack of a suitable enabling environment among others — extension services, financial resources, infrastructure, risk management and cross-sectoral linkages. Farmers are further constrained by having limited access to climatic information. Effective research and innovation are also needed to continuously improve practices and technologies. This calls for a policy recommendation where concerted efforts are needed to mobilize financial resources and build the capacity of West African researchers, policy-makers and institutions to understand, carry out and use good quality data towards informed decision making and scenario analyses (Also see evidence revealed by Plate 2).Enabling policy and institutional environment can provide the conditions and incentives for scaling out

Correlation of Pain Scores, Analgesic Use, and Beck Anxiety Inventory Scores During Hospitalization in Lower Extremity Amputees

Post amputation pain can be debilitating for patients and families. Chronic pain is a common phenomenon after lower extremity amputation, occurring in up to 80% of this population. The purpose of this pilot study was to correlate post amputation pain scores to opioid analgesic consumption and Beck Anxiety Inventory (BAI) scores. Twenty-three patients with lower extremity amputation at an 827-bed acute care inner-city hospital were surveyed pre-operatively and post-operatively to determine if there was a significant correlation between anxiety and pain. A numeric scale was utilized by patients to rate their pain level, while the BAI was utilized to measure their anxiety levels