Directly observed road safety compliance by Motor Cycle Riders after a 5- Year Road Safety Campaign in Naivasha, Kenya

Objective: To assess the extent of compliance with road safety regulations by  motorcycle riders following a five year road safety campaign in Naivasha town, Kenya.Design: A cross sectional study.Setting: Naivasha town, Nakuru county, Kenya.Results: A total of 9,280 MCs ferrying 13,733 people were observed. Less than 1% complied with all the four road safety  requirements. The overall helmet wearing compliance was 31%. MC driver helmet compliance was 42% which was five timeshigher than passenger helmet compliance. Female passengers were twice less likely to wear helmet than males.Conclusion: Despite the five-year road safety campaign, compliance among MC users remains low particularly among the passengers and more so female passengers. Does Kenya need to rethink the motor cycle road safety policy

PENERAPAN MODEL PEMBELAJARAN DLPS( DOUBLE LOOP PROBLEM SOLVING) UNTUK MENINGKATKAN PEMAHAMAN KONSEP PENGARUH PERUBAHAN LINGKUNGAN FISIK TERHADAP DARATAN

Abstract: The purpose of this study was to improve the understanding of thephysical environment changes effecton land concepts by using DLPS (Double Loop Problem Solving) learning model. This study is categorized as class action research. The action research study process was conducted in two cycles. Each cycle consists of four stages: planning the action; performing the action; observating and reflecting. The data collection techniques used were: observation techniques; interview; documentation, and test. The test of data validity done by the researcher was data sources of triangulation andtechnique of triangulation. The data analysis technique was done by using interactive model, which has several components, namely: data reduction; data presentation, and conclusion. The result indicated that there is an increase in the percentage of the students' understanding of the concept in the first cycle and the second cycle. The increased ofthe students’ understanding of the concept can be seen in the average of class scores obtained before action (pre-cycle), 57.53, with the percentage completeness of 26.67%. In the first cycle, the average of class score increased to 75.95 with the percentage completeness of 66.67%. Theaverage of class score after the second action increased to 83,1 with the completeness percentage of students 90%. Based on the result, it can be concluded that the application of DLPS (Double Loop Problem Solving) learning model can improve the understanding of physical environment changes effecton land concepts. Abstrak: Penelitian ini bertujuan untuk meningkatkan pemahaman konsep pengaruh perubahan lingkungan fisik terhadap daratan dengan menggunakan model pembelajaranDLPS (Double Loop Problem Solving). Penelitianini merupakan penelitian tindakan kelas.Proses penelitian dilaksanakan dalam dua siklus. Setiap siklus terdiri dari empat tahap, yaitu: Perencanaan tindakan; Pelaksanaan tindakan; Observasi, dan Refleksi. Teknik pengumpulan data yang digunakan yaitu: Teknik observasi; Wawancara; Dokumen,dan Tes. Untuk menguji validitas data, peneliti menggunakan triangulasi sumber data dan triangulasi teknik. Teknik analisis data yang digunakan adalah model analisis interaktif, yang mempunyai beberapa komponen, yaitu: Reduksi data; Penyajian data, dan Penarikan kesimpulan.Berdasarkan hasil penelitian, dapat dilihat meningkatnya persentase pemahaman konsep siswa pada siklus I dan siklus II. Peningkatan pemahaman konsep siswa dibuktikan dengan diperoleh nilai rata-rata sebelum tindakan (prasiklus) yaitu 57,53, dengan persentase ketuntasan 26,67%. Pada siklus I nilai rata-rata kelas meningkat mencapai 75,95 dengan persentase ketuntasan 66,67%. Setelah tindakan pada siklus II nilai rata-rata kelas meningkat menjadi83,1 dengan ketuntasan siswa sebesar90%.Sehingga dapat disimpulkan bahwa penerapan model pembelajaranDLPS (Double Loop Problem Solving)dapat meningkatkan pemahaman konsep tentang pengaruh perubahan lingkungan fisik terhadap daratan

PENERAPAN MODEL PEMBELAJARAN DLPS( DOUBLE LOOP PROBLEM SOLVING) UNTUK MENINGKATKAN PEMAHAMAN KONSEP PENGARUH PERUBAHAN LINGKUNGAN FISIK TERHADAP DARATAN

Abstract: The purpose of this study was to improve the understanding of thephysical environment changes effecton land concepts by using DLPS (Double Loop Problem Solving) learning model. This study is categorized as class action research. The action research study process was conducted in two cycles. Each cycle consists of four stages: planning the action; performing the action; observating and reflecting. The data collection techniques used were: observation techniques; interview; documentation, and test. The test of data validity done by the researcher was data sources of triangulation andtechnique of triangulation. The data analysis technique was done by using interactive model, which has several components, namely: data reduction; data presentation, and conclusion. The result indicated that there is an increase in the percentage of the students' understanding of the concept in the first cycle and the second cycle. The increased ofthe students’ understanding of the concept can be seen in the average of class scores obtained before action (pre-cycle), 57.53, with the percentage completeness of 26.67%. In the first cycle, the average of class score increased to 75.95 with the percentage completeness of 66.67%. Theaverage of class score after the second action increased to 83,1 with the completeness percentage of students 90%. Based on the result, it can be concluded that the application of DLPS (Double Loop Problem Solving) learning model can improve the understanding of physical environment changes effecton land concepts. Abstrak: Penelitian ini bertujuan untuk meningkatkan pemahaman konsep pengaruh perubahan lingkungan fisik terhadap daratan dengan menggunakan model pembelajaranDLPS (Double Loop Problem Solving). Penelitianini merupakan penelitian tindakan kelas.Proses penelitian dilaksanakan dalam dua siklus. Setiap siklus terdiri dari empat tahap, yaitu: Perencanaan tindakan; Pelaksanaan tindakan; Observasi, dan Refleksi. Teknik pengumpulan data yang digunakan yaitu: Teknik observasi; Wawancara; Dokumen,dan Tes. Untuk menguji validitas data, peneliti menggunakan triangulasi sumber data dan triangulasi teknik. Teknik analisis data yang digunakan adalah model analisis interaktif, yang mempunyai beberapa komponen, yaitu: Reduksi data; Penyajian data, dan Penarikan kesimpulan.Berdasarkan hasil penelitian, dapat dilihat meningkatnya persentase pemahaman konsep siswa pada siklus I dan siklus II. Peningkatan pemahaman konsep siswa dibuktikan dengan diperoleh nilai rata-rata sebelum tindakan (prasiklus) yaitu 57,53, dengan persentase ketuntasan 26,67%. Pada siklus I nilai rata-rata kelas meningkat mencapai 75,95 dengan persentase ketuntasan 66,67%. Setelah tindakan pada siklus II nilai rata-rata kelas meningkat menjadi83,1 dengan ketuntasan siswa sebesar90%.Sehingga dapat disimpulkan bahwa penerapan model pembelajaranDLPS (Double Loop Problem Solving)dapat meningkatkan pemahaman konsep tentang pengaruh perubahan lingkungan fisik terhadap daratan

Baboon-to-human liver transplantation

Our ability to control both the cellular and humoral components of xenograft rejection in laboratory experiments, together with an organ shortage that has placed limits on clinical transplantation services, prompted us to undertake a liver transplantation from a baboon to a 35-year-old man with B virus-associated chronic active hepatitis and human immunodeficiency virus infection. Liver replacement was performed according to conventional surgical techniques. Immunosuppression was with the FK 506-prednisone-prostaglandin regimen used routinely for hepatic allotransplantation, to which a daily non-myelotoxic dose of cyclophosphamide was added. During 70 days of survival, there was little evidence of hepatic rejection by biochemical monitoring or histopathological examination. Products of hepatic synthesis, including clotting factors, became those of the baboon liver with no obvious adverse effects. Death followed a cerebral and subarachnoid haemorrhage that was caused by an angioinvasive aspergillus infection. However, the underlying cause of death was widespread biliary sludge that formed in the biliary tree despite a seemingly satisfactory choledochojejunostomy. During life and in necropsy samples, there was evidence of the chimerism that we believe is integral to the acceptance of both xenografts and allografts. Our experience has shown the feasibility of controlling the rejection of the baboon liver xenograft in a human recipient. The biliary stasis that was the beginning of lethal infectious complications may be correctable by modifications of surgical technique. In further trials, the error of over-immunosuppression should be avoidable. © 1993

Caloric Curves and Nuclear Expansion

Nuclear caloric curves have been analyzed using an expanding Fermi gas hypothesis to extract average nuclear densities. In this approach the observed flattening of the caloric curves reflects progressively increasing expansion with increasing excitation energy. This expansion results in a corresponding decrease in the density and Fermi energy of the excited system. For nuclei of medium to heavy mass apparent densities ~ 0.4 rho_0 are reached at the higher excitation energies.Comment: 4 pages, 3 figure

Sustainable bio-economy that delivers the environment-food-energy-water nexus objectives::the current status in Malaysia

Biomass is a promising resource in Malaysia for energy, fuels, and high value-added products. However, regards to biomass value chains, the numerous restrictions and challenges related to the economic and environmental features must be considered. The major concerns regarding the enlargement of biomass plantation is that it requires large amounts of land and environmental resources such as water and soil that arises the danger of creating severe damages to the ecosystem (e.g. deforestation, water pollution, soil depletion etc.). Regarded concerns can be diminished when all aspects associated with palm biomass conversion and utilization linked with environment, food, energy and water (EFEW) nexus to meet the standard requirement and to consider the potential impact on the nexus as a whole. Therefore, it is crucial to understand the detail interactions between all the components in the nexus once intended to look for the best solution to exploit the great potential of biomass. This paper offers an overview regarding the present potential biomass availability for energy production, technology readiness, feasibility study on the techno-economic analyses of the biomass utilization and the impact of this nexus on value chains. The agro-biomass resources potential and land suitability for different crops has been overviewed using satellite imageries and the outcomes of the nexus interactions should be incorporated in developmental policies on biomass. The paper finally discussed an insight of digitization of the agriculture industry as future strategy to modernize agriculture in Malaysia. Hence, this paper provides holistic overview of biomass competitiveness for sustainable bio-economy in Malaysia

Association of C-reactive protein with bacterial and respiratory syncytial virus-associated pneumonia among children aged <5 years in the PERCH study

Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation