Contraception Health Notes at Brookfield Family Practice

The Brookfield Family Practice office sees a variety of patients, including women that are of reproductive age. The topic of contraception and contraception choices is always very relevant. My preceptor makes all of his own patient education handouts and expressed the need for an up to date handout on contraception choices for his own use and for the practice in general.https://scholarworks.uvm.edu/fmclerk/1432/thumbnail.jp

Molecular profile of gram-negative ESKAPE pathogens from Komfo Anokye Teaching Hospital in Ghana.

Doctoral Degree. University of KwaZulu-Natal, Durban.Gram-negative ESKAPE (Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp) pathogens are a major healthcare concern globally due to their increasing multidrug resistance and ability to cause debilitating infections. Phenotypic and genotypic characteristics of multidrug resistant Gram-negative ESKAPE pathogens from Komfo Anokye Teaching Hospital in Ghana were investigated. Two hundred (200) clinical, non-duplicate Gram-negative bacterial pathogens were randomly selected from various human specimens routinely processed by the diagnostic microbiological laboratory in the hospital. Multidrug resistant (isolates resistant to at least one agent in three or more antibiotic class) isolates selected from each group of Gram-negative ESKAPE pathogens constituted the final sample. Identification and antibiotic susceptibility profiles were carried out using Vitek-2. Identity of isolates for whole genome sequencing was further confirmed by MALDI-TOF MS. Four P. aeruginosa and 10 K. pneumoniae were subjected to whole genome sequencing based on their extensively drug resistant profiles and resistance to third-generation cephalosporins respectively using Illumina MiSeq, after genomic DNA extraction using the NucliSens easyMAG®. Antibiotic resistance genes and plasmids were identified by mapping the sequence data to an online database using ResFinder and plasmidFinder respectively. MLST was also determined from the WGS data. The raw read sequences and assembled whole genome contigs have been deposited in GenBank under project number PRJNA411997. An average multidrug resistance of 89.5% was observed, ranging from 53.8% in Enterobacter spp to 100.0% in Acinetobacter spp and P. aeruginosa. Gram-negative ESKAPE bacteria constituted 48.5% (97) of the 200 isolates. P. aeruginosa (n=4) belonging to ST234 harboured blaDIM-1, blaIMP-34, blaOXA-10, blaOXA-129, blaOXA-50, blaPAO aadA1, aac4 aph(3’)-IIb, fosA, sul1, dfrB5, catB7, arr-2 conferring resistance to β-lactams, aminoglycosides, fosfomycin, sulphonamides, trimethoprim phenicols and rifampin respectively. qnrVC was detected in two of the four isolates . Both blaDIM-1 and blaIMP-34-like positive contigs showed identical DNA sequences and were linked to type 1 integron structures. BlaDIM-1 was 100% identical to the blaDIM-1 prototype gene, while blaIMP-34-like had two base pair (bp) differences T190C and C314G respectively compared to blaIMP-34, leading to one amino acid substitution in IMP-34-like indicating that, the gene may have independently evolved, perhaps due to selection pressure. Blast analysis did not reveal identical genetic structures deposited in NCBI, neither among the nucleotide collection, completed genomes nor among the completed plasmids. β-lactamases (blaCTX-M-15, blaSHV-11, blaTEM-1B) and resistance genes for aminoglycosides (aac(3)-IIa-like,aph(3')-Ia) quinolones/fluoroquinolones (oqxA-like,oqxB-like,qnrB10-like,qnrB2) and others including fosfomycin (fosA), trimethoprim (dfrA14), and sulphonamide (sul2) were found in the K. pneumoniae (n=10). Multiple and diverse mutations of the quinolone resistance-determining regions gyrA, gyrB and parC genes were detected in the K. pneumoniae (n=4), which were clonally distinct. The diversity of resistance genes expressed by Gram-negative ESKAPE pathogens conferring resistance to multiple antibiotics is problematic in a resource-constrained country like Ghana, necessitating urgent antibiotic stewardship and infection prevention and control interventions

Children Left Behind Bars: Sullivan, Graham, and Juvenile Life without Parole Sentences

The practice of sentencing children to life in prison without parole is not only a misguided violation the standards of decency in U.S. law, but also a violation of international human rights law as well. The Supreme Court had the opportunity to eradicate the practice of sentencing children to LWOP when it heard the cases of and . However, the Court ruled that LWOP sentences would only be prohibited in cases where children committed non-homicide offenses. The Supreme Court should have categorically banned juvenile LWOP because it violates both domestic and international human rights law and has a disparate impact on racial minorities. If the Court weighed the practice of sentencing children to LWOP against the Supremacy Clause, customary international law, and international treaties, such as the Convention of the Rights of the Child (CRC), the Committee on the Elimination of Racial Discrimination (CERD), the Convention against Torture and Other Cruel Inhuman or Degrading Treatment or Punishment (Convention Against Torture), and the International Covenant on Civil and Political Rights (ICCPR), it would have had a stronger impetus to categorically ban juvenile LWOP

A systems view and lessons from the ongoing Ebola Virus disease (EVD) outbreak in West Africa

This article analyses the on-going (2014) Ebola Virus Disease (EVD) outbreak in West Africa from a systems perspective; and draws out lessons for West Africa in general and Ghana in particular.Keywords: Ebola Virus Disease, West Africa , Ghana , Systems , Prevention and Contro

'Cutting' and 'breaking' events in Akan

This study investigates the grammar and semantics of verbs that describe separation events in Asante Twi (Akan), a Kwa (Niger-Congo) language spoken in Ghana. It adopts a constructionist approach combined with a 'monosemic bias' perspective in the analysis. It theoretical starting point is that contextual interpretations are derived from the interaction of the prototypical meanings of verbs and their arguments. A multi-method approach was used in data gathering: (i) compilation of verbs that code separation as well as sentences in which they are used from literary texts (bibles, and novels) and dictionaries. (ii) Descriptions of separation activities elicited using video-stimuli Bohnemeyer et al. (2001), 61 video clips depicting cutting and breaking events (fieldmanuals.mpi.nl) supplemented by 82 clips created by the author involving culturally appropriate objects (Agyepong 2015). (iii) Spontaneous narratives, and procedural discourses about cultural events/practices involving separation e.g. cooking, palm-wine tapping. (iv) Introspection based on the author's native speaker intuitions. The main findings of the thesis are that there are two central verbs in the separation domain in Akan: twá 'to cut' and bú 'to break'. There are, in addition, more specialized verbs for specific types of object separation, e.g. nú 'harvest palm fruit by poking with a bladed instrument' or pòrò 'to pluck fruit'. The choice of a particular verb in context is determined by the following parameters: instrument involvement, manner of separation, physical properties of entities as well as the end-state result of the situation. Crucially, the thesis further addresses the challenge of how to account for the interpretation of the typical as well as atypical argument realization patterns associated with the separation verbs. It shows how constructional meanings contribute to the interpretation of collocations of the verbs. Other principles such as coercion, addition and suppression of components in the lexical semantics of both the verbs and its arguments as well as cultural implicatures are invoked in the compositional process of calculating the contextual interpretations

Health systems and MNCH outcomes in West Africa : a study of conducive and limiting health systems factors to improving mother, new born and child health in West Africa

The presentation provides demographic information/graphs regarding child mortality rates over time (1990-2013) in sub-Sharan African countries, and specifically focuses on countries involved in the West African Health Organization (WAHO) Innovating for Maternal and Child Health in Africa (IMCHA) project: Benin, Burkina Faso, Ghana, Mali, Nigeria, and Senegal. It reviews significant factors within the project regarding motivation, barriers, competencies and conducive and limiting health system factors

“Wood already touched by fire is not hard to set alight” Comment on “Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries”

A major constraint to the application of any form of knowledge and principles is the awareness, understanding and acceptance of the knowledge and principles. Systems Thinking (ST) is a way of understanding and thinking about the nature of health systems and how to make and implement decisions within health systems to maximize desired and minimize undesired effects. A major constraint to applying ST within health systems in Low- and Middle-Income Countries (LMICs) would appear to be an awareness and understanding of ST and how to apply it. This is a fundamental constraint and in the increasing desire to enable the application of ST concepts in health systems in LMIC and understand and evaluate the effects; an essential first step is going to be enabling of a wide spread as well as deeper understanding of ST and how to apply this understandin

The cultural adaptation of quantity judgment tasks in Ghanaian English and Akan

The phenomenon of mass and countability is multifaceted and has been controversially discussed in many disciplines. For linguistics, differences in the morphosyntactic marking of the distinction cross-linguistically, and its cross-cultural ontological-semantic conceptualization are particularly interesting. However, most studies into mass and countability have focused on (American) English, and, to some extent European and Asian languages. African languages and contexts have as yet been neglected by researchinto countability, and the methodological tools employed to study it do not account for the ambient cultural contexts. This paper presents the results of a quantity judgment task designed according to Barner and Snedeker’s (2005) experiment for American English speakers, conducted in Ghanaian English and Akan. The Ghanaian experiments reveal important concerns regarding the stimuli and their applicability, especially to Akan culture. Thus, inspired by other studies into the semantics of Akan, a new set of stimuli is suggested in order to investigate mass and countability contrastively in Ghanaian English and Akan. In this vein, they emphasize the insufficiency of translations with regard to (psycho)linguistic experiments and the importance of proper cultural adaptation

FACILITATING FINANCIAL INCLUSION USING ICT: LESSONS FROM M-PESA AND E-ZWICH

Financial inclusion is a priority in most developing countries. While the inclusion approaches may differ, the primary aim remains enrolling the unbanked into the formal economy. This paper adopts Critical Realism as a lens to compare the efforts of two inclusion models; M-PESA from Kenya and ezwich in Ghana. The findings reveal that while both models do not provide the infrastructure for people to build trust, the enrolment successes of both models differ significantly

Semen parameters and the incidence and effects of bacteriospermia in male partners of infertile couples attending a fertility clinic in the Kumasi Metropolis, Ghana

Background: Inability to conceive after at least 12 months of unprotected regular intercourse has been recognized as a very serious problem for couples especially those who are at the reproductive age and legally married. Bacterial infection of male genitourinary tract is considered as one of the promoting factors for male infertility. These pathogenic bacteria in the ejaculates can induce a defect in semen parameters, such as sperm count, morphology and motility which are predictors of male fertility potential. The study was conducted to assess the semen quality and the incidence of bacteriospermia in male partners of infertile couples attending fertility clinic at Trust Care Specialist Hospital, Kumasi.Methods: Semen samples of 300 male partners of infertile couples were collected and evaluated by WHO guidelines. The samples were also cultured using standard bacterial culture techniques.Results: Oligozoospermia was the highest semen abnormality identified. This was followed by Teratozoospermia. Other semen abnormalities identified were azoospermia, asthenozoospermia, oligoteratozoospermia, asthenoteratozoospermia, oligoasthenozoospermia, and oligoasthenoteratozoospermia. 67 (22.3%) out of the 300 samples showed significant bacterial growth. Eight different bacteria species were isolated. E. coli, was isolated from 27 of the samples, S. aureus from 13 of the samples, U. urealyticum from 10 of the samples, Chlamydia trachomatis from 9 of the samples, Pseudomonas spp from 5 of the samples Proteus spp, Klesbsiella spp and M. morganii were each isolated from one sample.Conclusions: Although bacteria were isolated in 22.3% of the semen samples, their presence imparted negatively on the semen quality. This suggests that bacterial infection should be one of the investigations to be carried out in the treatment of infertility. Even when count, motility, and morphology look normal other parameters such as infection and sperm DNA should be investigated during the treatment of infertility