“But the moment they find out that you are MSM…”: a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana’s health care system

Abstract: The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM’s experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM’s use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities. Methods: We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM..

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Spray-Deposited Nanocrystalline WO3 Thin Films Prepared Using Tungsten Hexachloride Dissolved in N-N Dimethylformamide and Influence of In Doping on Their Structural, Optical and Electrical Properties

Undoped and In-doped nanocrystalline tungsten oxide (WO3) thin films were prepared by chemical spray pyrolysis using tungsten hexachloride (WCl6) dissolved in N-N dimethylformamide as the host precursor solution and indium chloride (InCl3) as the source of dopant. XRD analyses confirm the monoclinic phase of the prepared films with the predominance of triplet (002), (020) and (200) in the spectra. On indium doping, the crystallinity of the films decreases and becomes minimum at 1.5 at. % doping. EDX analyses confirm the incorporation of In dopants into the WO3 lattice network. SEM micrographs show non- spherical grains over the surface and the average grain size decreases with higher In doping. AFM images of the films exhibit large nicely separated conical columnar grains (except in 1 at. %) throughout the surface with coalescence of some columnar grains at few places. UV-visible measurements reveal that the optical transmittance of the 1 at. % In-doped film increases significantly throughout the wavelength range 300 - 800 nm relative to that of the undoped film Room temperature photoluminescence spectra show pronounced enhancement in the peak intensity of NBE emission on In doping. Electrical conductivity has been found to increase on In doping

Optoelectronics and formaldehyde sensing properties of tin-doped ZnO thin films

Sn-doped ZnO thin films were deposited on clean glass substrates using the chemical spray pyrolysis technique. XRD analyses confirm stable ZnO hexagonal wurtzite structure of the films with crystallite size in the range of 20-28 nm. The surface roughness of the films increases on Sn doping, which favors to higher adsorption of oxygen species on the film surface, resulting in higher gas response. Optical studies reveal that the band gap decreases on Sn doping. All the films show near band edge emission, and on Sn doping the luminescence peak intensity has been found to increase. Photocurrent in the 1.5 at.% doped film enhances about three times to that observed in the undoped ZnO film. Among all the films examined, the 1.5 at.% Sn-doped film exhibits the maximum response (similar to 94.5 %) at the operating temperature of 275 A degrees C for 100 ppm concentration of formaldehyde, which is much higher than the response (similar to 35 %) in the undoped film. The gas response of the film is attributed to the chemisorption of oxygen on the film surface and the subsequent reaction between the adsorbed oxygen species and the formaldehyde molecules

Spray-Deposited Nanocrystalline WO3 Thin Films Prepared Using Tungsten Hexachloride Dissolved in N-N Dimethylformamide and Influence of In Doping on Their Structural, Optical and Electrical Properties

Undoped and In-doped nanocrystalline tungsten oxide (WO3) thin films were prepared by chemical spray pyrolysis using tungsten hexachloride (WCl6) dissolved in N-N dimethylformamide as the host precursor solution and indium chloride (InCl3) as the source of dopant. XRD analyses confirm the monoclinic phase of the prepared films with the predominance of triplet (002), (020) and (200) in the spectra. On indium doping, the crystallinity of the films decreases and becomes minimum at 1.5 at. % doping. EDX analyses confirm the incorporation of In dopants into the WO3 lattice network. SEM micrographs show non- spherical grains over the surface and the average grain size decreases with higher In doping. AFM images of the films exhibit large nicely separated conical columnar grains (except in 1 at. %) throughout the surface with coalescence of some columnar grains at few places. UV-visible measurements reveal that the optical transmittance of the 1 at. % In-doped film increases significantly throughout the wavelength range 300 - 800 nm relative to that of the undoped film Room temperature photoluminescence spectra show pronounced enhancement in the peak intensity of NBE emission on In doping. Electrical conductivity has been found to increase on In doping

Experimental Investigation of Spray-Deposited Fe-Doped ZnO Nanoparticle Thin Films: Structural, Microstructural, and Optical Properties

Structural, microstructural, and optical properties of the undoped and Fe-doped zinc oxide (ZnO) thin films grown by spray pyrolysis technique using zinc nitrate as a host precursor have been reported here. X-ray diffraction spectra confirm that all the films have stable wurtzite structure and the effects of Fe dopants on the diffraction patterns have been found to be in agreement with the Vegard's law. Scanning electron microscopy results show good uniformity and dense surface having spherical-shaped grains. Energy dispersive x-ray analyses with elemental mapping of the Fe-doped films show that the Fe dopants are incorporated homogeneously into the ZnO film matrix. The x-ray photoelectron spectroscopy spectra confirm the presence of 3+ oxidation state of Fe in the doped films. Atomic force microscopy analyses clearly show that the average surface roughness and the grain size decrease with the addition of Fe dopants. Optical studies reveal that the optical band gap value decreases on Fe doping. The 1 at.% Fe-doped film shows normal dispersion for the wavelength range 450-700 nm. The PL spectra of the films show a strong ultraviolet emission centered at similar to 388 nm in the case of 1 at.% Fe-doped film. A slow photo current response in the films has been observed in the transient photoconductivity measurement

Influence of Cu doping on the structural, photoluminescence and formaldehyde sensing properties of SnO2 nanoparticles

In this paper we report Cu doping induced modifications in the structural, photoluminescence and gas sensing behaviour of SnO2 nanoparticles. Our results show that crystallinity is reduced upon Cu doping. The PL emissions observed in the visible region are attributed to the defect levels arising due to oxygen vacancies. The 1.5 at% Cu-doped SnO2 shows the selective high response (similar to 80%) to 50 ppm concentration of formaldehyde over methanol, ethanol, propanol-2-ol, acetone and n-butylacetate at 200 degrees C. The sensing mechanism has been explained based on chemisorption of oxygen on the SnO2 surface and the subsequent reaction between the adsorbed oxygen species and the formaldehyde molecules