Macrosomia - maternal and fetal risk factors

Risk factors associated with fetal macrosomia were studied in 348 pregnancies resulting in the delivery of an infant weighing 4 000 g or more in a black population. Identifiable maternal risk factors included a mother in her 3rd decade of life, multiparity, maternal weight of 70 kg or more at the end of pregnancy, prolonged or post-term pregnancy, abnormal glucose tolerance and previous history of a macrosomic infant. Male infants had a higher risk of being macrosomic. Macrosomic infants accounted for 3,4% of all singleton deliveries, with their caesarean section rate of 33,9% being almost three times that of control infants. The importance of antenatal prediction of fetal weight is emphasised and suggestions for reduction of the high perinatal mortality and morbidity rates, as well as maternal morbidity, are discussed

Effect of Duration of Reclamation on Soil Quality Indicators of a Surface – Mined Acid Forest Oxisol in South – Western Ghana

The quality of degraded mined soils can be restored through effective reclamation practices. In this study, we evaluated the impact of varying duration of land reclamation on soil quality at AngloGold Ashanti, Iduapriem mine Ltd., Tarkwa, Ghana. Soil samples were taken from mined sites of the Company at various stages of phytoremediation: 2, 5, 9 and 11 year old reclaimed sites. The soils were analyzed for soil quality indicators. A nearby forest reserve representative of the pre-degraded condition was used as the control. Prior to phytoremediation with multipurpose agroforestry trees, the mined soils were subjected by the Company to earthworks/slope battering followed by spreading of oxide materials over the surface, construction of crest drains and cover cropping. Having determined the impact of the varying duration of reclamation on soil quality indicators, separate pot experiments involving maize and cowpea were set up using soils from the sites to assess heavy metals accumulation in the cultivated crops. Soil nutrient levels in the sites under reclamation were significantly higher (P < 0.05) than the nearby forest reserve. Soil pH though generally low, was relatively higher (P < 0.05) in sites under reclamation than in the control. Soil total nitrogen, available phosphorus and exchangeable potassium levels were highest (P < 0.05) in the 11 year old site. Zinc contents of all sites were below the maximum permissible levels. There was somewhat antagonistic interaction between zinc and phosphorus contents of maize in the unclaimed site. Though heavy metal concentrations in maize were lower than that of cowpea, the concentrations in both plants were generally beyond the permissible levels suggesting a possible transfer onto the food chain if the crops are included as part of rotation programmes from the agronomic perspective. Our results indicate that phytoremediation of mined lands using agroforestry multipurpose trees could be marginal even after a decade of reclamation

Improved prediction of clay soil expansion using machine learning algorithms and meta-heuristic dichotomous ensemble classifiers

Soil swelling-related disaster is considered as one of the most devastating geo-hazards in modern history. Hence, proper determination of a soil's ability to expand is very vital for achieving a secure and safe ground for infrastructures. Accordingly, this study has provided a novel and intelligent approach that enables an improved estimation of swelling by using kernelised machines (Bayesian linear regression (BLR) & bayes point machine (BPM) support vector machine (SVM) and deep-support vector machine (D-SVM)); (multiple linear regressor (REG), logistic regressor (LR) and artificial neural network (ANN)), tree-based algorithms such as decision forest (RDF) & boosted trees (BDT). Also, and for the first time, meta-heuristic classifiers incorporating the techniques of voting (VE) and stacking (SE) were utilised. Different independent scenarios of explanatory features’ combination that influence soil behaviour in swelling were investigated. Preliminary results indicated BLR as possessing the highest amount of deviation from the predictor variable (the actual swell-strain). REG and BLR performed slightly better than ANN while the meta-heuristic learners (VE and SE) produced the best overall performance (greatest R2 value of 0.94 and RMSE of 0.06% exhibited by VE). CEC, plasticity index and moisture content were the features considered to have the highest level of importance. Kernelized binary classifiers (SVM, D-SVM and BPM) gave better accuracy (average accuracy and recall rate of 0.93 and 0.60) compared to ANN, LR and RDF. Sensitivity-driven diagnostic test indicated that the meta-heuristic models’ best performance occurred when ML training was conducted using k-fold validation technique. Finally, it is recommended that the concepts developed herein be deployed during the preliminary phases of a geotechnical or geological site characterisation by using the best performing meta-heuristic models via their background coding resource

Nurses' perceptions on pain behaviours among burn patients : a qualitative inquiry in a Ghanaian tertiary hospital

Background Pain sustained from burns is usually quite severe and has been linked to extreme distress, preventing patients from contributing to their care. Nurses have legal and professional obligations to promptly assess burns pain by using pain assessment tools and by relying on the patient’s behaviour and expressions. Objectives To explore nurses' perceptions on pain behaviours among burn patients in a Ghanaian tertiary hospital. Methods A qualitative descriptive design was used. A total of 11 nurses were recruited through a purposive sampling technique from a burns unit of a tertiary facility in Ghana. Semi-structured face-to-face interviews were conducted. Analysis was done using thematic content analysis, from which two major themes and nine subthemes were identified. Findings Patients express their pain by adopting both verbal and non-verbal communication means. However, due to the subjective nature of pain, nurses’ perceptions of pain were not sufficient to effectively assess the degree of pain. Verbal indicators that nurses perceived to be pain behaviours of burn patients were screaming, crying, praying and groaning, while frowning, reduced sense of humour, and body language were some non-verbal indicators nurses used to confirm the existence of burns pain. Nurses in Ghana must adopt the use of objective pain assessment tools, in conjunction with perceived pain behaviours, for optimal pain management outcomes. Conclusions Patients with burns experience intense pain from both the burns and the procedures that are done for them to aid in their healing. A systematic pain assessment by nurses, as part of the health care team, is a vital guide to pain management. To ensure consistency in the assessment of pain, there is a need to design protocols and policies to guide all nurses in the assessment of burns pain in the burns unit

Burns pain management in Ghana : the role of nurse–patient communication

Background: Nursing is an embodiment of knowledge, clinical work, and interpersonal communication. Effective nursing care has a distinct influence on the overall satisfaction and experience of the patient. Communication is said to be indispensable in the delivery of quality healthcare. Effective communication between nurses and patients has proven to yield better results with pain control and improved psychological status of patients. Objectives: The aim of the study is to explore nurses’ perceptions on the role of communication in the management of burns pain. Methods: A qualitative design with purposive sampling was carried out to recruit 11 registered nurses from a Reconstructive Plastic Surgery and Burns Center in Ghana. To identify the participants’ perception on the role of nurse–patient communication in the management of burns pain, a face to face semi-structured interviews were conducted using an interview guide to collect data. Results: Thematic analysis was done with various themes emerging. Helping patients manage pain, early detection of patient’s distress, improved patient participation in their care were some of the positive effects of nurse–patient communication whiles reduced level of cooperation during caregiving, and endurance of pain by the patient were the results of poor nurse–patient communication. Language and time facto were the barriers that were identified to hinder effective communication between nurses and patients. Conclusions: Due to the subjective nature of pain, the current study highlights the need for increased communication for an effective assessment and management of pain among patients with burns. It is, therefore, imperative that nurses be well trained in communication with an emphasis on patient-centered communication

Religious Experience and the Modernist Novel

Output Type: Book Revie

Severe childhood malaria syndromes defined by plasma proteome profiles

BACKGROUND Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes. METHODS AND FINDINGS Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children. CONCLUSIONS We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes

Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

BACKGROUND: Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana. METHODS: Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDRplus and Genotype MTBDRsl.v2 from Hain Life science. RESULTS: A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANY(r)); 16.8% (50/298) were isoniazid-mono-resistant (INH(r)), 16.8% (50/298) were rifampicin-mono-resistant (RIF(r)), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANY(r) were additionally resistant to at least one second line drug: 7.4% (2 RIF(r), 1 INH(r), and 10 MDR samples) resistant to only FQs and 2.3% (2 RIF(r), 1 INH(r), and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIF(r) and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INH(r) and MDR had katG-mutations (MT) whereas 15 (12%) had inhApro-MT. The remaining 28 (22.4%) had both katG and inhA MT. All the 19 FQ-resistant samples were gyrA mutants whereas the 10 AMGs were rrs (3), eis (3) as well as rrs, and eis co-mutants (4). Except for the seven pre-XDR samples, no sample had eis MT. CONCLUSION: The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance

Measurement of the Atmospheric Muon Charge Ratio at TeV Energies with MINOS

The 5.4 kton MINOS far detector has been taking charge-separated cosmic ray muon data since the beginning of August, 2003 at a depth of 2070 meters-water-equivalent in the Soudan Underground Laboratory, Minnesota, USA. The data with both forward and reversed magnetic field running configurations were combined to minimize systematic errors in the determination of the underground muon charge ratio. When averaged, two independent analyses find the charge ratio underground to be 1.374 +/- 0.004 (stat.) +0.012 -0.010(sys.). Using the map of the Soudan rock overburden, the muon momenta as measured underground were projected to the corresponding values at the surface in the energy range 1-7 TeV. Within this range of energies at the surface, the MINOS data are consistent with the charge ratio being energy independent at the two standard deviation level. When the MINOS results are compared with measurements at lower energies, a clear rise in the charge ratio in the energy range 0.3 -- 1.0 TeV is apparent. A qualitative model shows that the rise is consistent with an increasing contribution of kaon decays to the muon charge ratio.Comment: 16 pages, 17 figure