Acute confusion and ataxia in the emergency department with an unexpected underlying diagnosis

No Abstrac

Palliative and end-of-life care access for immigrants living in high-income countries: A scoping review

This scoping review aimed to explore what is known about palliative and End-of-Life (EOL) care access by immigrants with culturally and linguistically diverse (CALD) background living in high-income Organization for Economic Co-operation and Development (OECD) countries. CaLD immigrants have low utilization of palliative care services with patients’ family members taking up the role of caring, leading to immigrants not fully benefiting from the specialized services that are offered to alleviate suffering and promote quality of life. While there is some research in this area mainly in Europe, it cannot be said about all high-income OECD countries. Achieving person-centered care in high-income countries, requires identifying and addressing barriers to care access, especially by immigrants with CaLD background. Five-stage methodological framework by Arksey and O’Malley was used to undertake the review. Immigrants in OECD countries experience challenges in accessing palliative and EOL care services. The review also identified limited literature on the subject and establishes need for more research on the subject

Modelling the relationship between groundwater depth and NDVI using time series regression with Distributed Lag M

Groundwater plays a key role in hydrological processes, including in determining aboveground vegetal growth characteristics and species distribution. This study aimed at estimating time-series data of Normalized Difference Vegetation Index (NDVI) using groundwater depth as a predictor in two land cover types: grassland and shrubland. The study also investigated the significance of past (lagged) groundwater and NDVI in estimating the current NDVI. Results showed that lagged groundwater depth and vegetation conditions influence the amount of current NDVI. It was also observed that first lags of groundwater depth and NDVI were significant predictors of NDVI in grassland. In addition, first and second lags of NDVI were consistently significant predictors of NDVI in shrubland. This shows the importance of vegetation type when modelling the relationship between groundwater depth and NDVI.Keywords: Groundwater depth; Landsat NDVI; Time-series analysis; Distributed Lag Model

Maize and sesbania production in relay cropping at three landscape positions in Malawi

The relay cropping of sesbania (Sesbania sesban) — a N2-fixing legume — with maize (Zea mays) has been proposed as a strategy to increase soil fertility and food production in densely populated areas in southern Africa. We determined the production of relay-cropped maize and sesbania at three landscape positions under researcher-designed and farmer-managed conditions in southern Malawi. Three landscape positions (dambo valley or bottomland, dambo margin with 12% slope) were examined in factorial combination with N sources for maize (no added N, relay-cropped sesbania, and calcium ammonium nitrate fertilizer). Relay cropping of sesbania with maize increased maize grain yield, as compared to unfertilized sole maize in two of three years. Split application of 96 kg N ha−1 as N fertilizer, however, was more effective than sesbania in increasing maize yields. Survival of sesbania seedlings and biomass production of sesbania were greater in the dambo valley and dambo margin than on steep slopes. Maize yields tended to be lower on steep slopes than in the dambo valley and dambo margin areas. Biomass production of sesbania and hence the potential benefits of intercropping sesbania with maize appear greater in the dambo valleys and dambo margins than on steep slope

The Impact of Load Shedding on The Cost of Living: A Zambian Perspective

In this paper, we assess the impact of Zambia Electricity Supply Corporationrsquos (ZESCO) power rationing (load shedding) on the cost of living of the Zambian people. We also assess whether the businesses and households have capacity to resort to alternative sources of energy in the time of crisis. Our results show that, although the rationing does not last for 24 hours in most places, the duration that businesses and households stay out of power is long enough to impact negatively on the livelihoods of the Zambian people and consequently itrsquos Economy. nbs

Soil nitrate dynamics in relation to nitrogen source and landscape position in Malawi

Nitrogen is normally the nutrient most limiting production of maize (Zea mays) — the main staple food crop — in southern Africa. We conducted a field study to determine the effect of N sources on soil nitrate dynamics at three landscape positions in farmers' fields in southern Malawi. The landscape positions were dambo valley or bottomland, dambo margin, and steep slopes. The N sources were calcium ammonium nitrate fertilizer applied at 120 kg N ha−1, biomass from Sesbania sesban, and no added N. Sesbania biomass was produced in situ in the previous season from sesbania relay cropped with maize. Nitrate in the topsoil (0 to 15 cm depth) increased to 85 days after maize planting (mean = 48 kg N ha−1) and then decreased markedly. Application of N fertilizer and sesbania biomass increased soil nitrate, and nitrate-N in topsoil correlated positively with amount of incorporated sesbania biomass. The strongest correlation between sesbania biomass added before maize planting and topsoil nitrate was observed at 85 days after maize planting. This suggests that the sesbania biomass (mean N content = 2.3%) mineralized slowly. Inorganic N accumulated in the subsoil at the end of the maize cropping season when N fertilizer and sesbania were applied. This study demonstrated the challenges associated with moderate quality organic N sources produced in smallholder farmer's fields. Soil nitrate levels indicated that N was released by sesbania residues in the first year of incorporation, but relay cropping of sesbania with maize may need to be supplemented with appropriately timed application of N fertilize

Inhibitory geostatistical designs for spatial prediction taking account of uncertain covariance structure

The problem of choosing spatial sampling designs for investigating an unobserved spatial phenomenon S arises in many contexts, for example in identifying households to select for a prevalence survey to study disease burden and heterogeneity in a study region D. We studied randomised inhibitory spatial sampling designs to address the problem of spatial prediction whilst taking account of the need to estimate covariance structure. Two specific classes of design are inhibitory designs and inhibitory designs plus close pairs. In an inhibitory design, any pair of sample locations must be separated by at least an inhibition distance δ. In an inhibitory plus close pairs design, n − k sample locations in an inhibitory design with inhibition distance δ are augmented by k locations each positioned close to one of the randomly selected n − k locations in the inhibitory design, uniformly distributed within a disc of radius ζ. We present simulation results for the Mat´ern class of covariance structures. When the nugget variance is non-negligible, inhibitory plus close pairs designs demonstrate improved predictive efficiency over designs without close pairs. We illustrate how these findings can be applied to the design of a rolling Malaria Indicator Survey that forms part of an ongoing large-scale, five-year malaria transmission reduction project in Malawi

Prevalence and Determinants of Unintended Pregnancy in Mchinji District, Malawi; Using a Conceptual Hierarchy to Inform Analysis

Background: In 2012 there were around 85 million unintended pregnancies globally. Unintended pregnancies unnecessarily expose women to the risks associated with pregnancy, unsafe abortion and childbirth, thereby contributing to maternal mortality and morbidity. Studies have identified a range of potential determinants of unplanned pregnancy but have used varying methodologies, measures of pregnancy intention and analysis techniques. Consequently there are many contradictions in their findings. Identifying women at risk of unplanned pregnancy is important as this information can be used to help with designing and targeting interventions and developing preventative policies. Methods: 4,244 pregnant women from Mchinji District, Malawi were interviewed at home between March and December 2013. They were asked about their pregnancy intention using the validated Chichewa version of the London Measure of Unplanned Pregnancy, as well as their socio-demographics and obstetric and psychiatric history. A conceptual hierarchical model of the determinants of pregnancy intention was developed and used to inform the analysis. Multiple random effects linear regression was used to explore the ways in which factors determine pregnancy intention leading to the identification of women at risk of unplanned pregnancies. Results: 44.4% of pregnancies were planned. On univariate analyses pregnancy intention was associated with mother and father’s age and education, marital status, number of live children, birth interval, socio-economic status, intimate partner violence and previous depression all at p<0.001. Multiple linear regression analysis found that increasing socio-economic status is associated with increasing pregnancy intention but its effect is mediated through other factors in the model. Socio-demographic factors of importance were marital status, which was the factor in the model that had the largest effect on pregnancy intention, partner’s age and mother’s education level. The effect of mother’s education level was mediated by maternal reproductive characteristics. Previous depression, abuse in the last year or sexual abuse, younger age, increasing number of children and short birth intervals were all associated with lower pregnancy intention having controlled for all other factors in the model. This suggests that women in Mchinji District who are either young, unmarried women having their first pregnancy, or older, married women who have completed their desired family size or recently given birth, or women who have experienced depression, abuse in the last year or sexual abuse are at higher risk of unintended pregnancies. Conclusion: A simple measure of pregnancy intention with well-established psychometric properties was used to show the distribution of pregnancy planning among women from a poor rural population and to identify those women at higher risk of unintended pregnancy. An analysis informed by a conceptual hierarchical model shed light on the pathways that lead from socio-demographic determinants to pregnancy intention. This information can be used to target family planning services to those most at risk of unplanned pregnancies, particularly women with a history of depression or who are experiencing intimate partner violence

Integration of Sugar Markets between Swaziland and its Major Trading Partners

The study was designed to examine the extent of market integration between Swaziland sugar markets and its major trading partners (i.e., South Africa, EU and USA) using monthly export sugar price data from January 2001 to December 2013. Price series were tested for stationarity with the Augmented Dickey-Fuller (ADF) test and it was found that all prices were integrated of order one I (1). Zivot and Andrews test was used to determine the structural break in the price series and it revealed that the Swaziland and USA price break was in August, 2009 while for the EU price break was in October, 2008. Price relationships were examined in one period (entire period) and two sub-periods (before structural break and after structural break). The Johansen’s cointegration test revealed long-run integration for almost all the pairs of sugar markets, except for the USA in the full sample period. The integrations between the markets shows a significant improvement after the structural break. The Vector Error Correction model (VECM) estimates showed that the Swaziland’s  export market prices adjust significantly to the short-run shocks that appeared in the South African’s and EU’s sugar market for the entire period while when the structural breaks period was allowed it adjusts significantly before the break for the South African’s market. Swaziland’s market only adjusts significantly to the EU and USA market shocks after the structural break. The overall coefficient of the adjustment parameter has been very low due to high government interventions in the sugar sector by the Swaziland trading partners which is an impediment to the efficient market functioning. It is therefore suggested that interventions of the respective governments should be reduced for efficient functioning of the markets Keywords: sugar, trading partners, cointegration, stationarity, structural brea