Does globalization and energy usage influence carbon emissions in South Asia? An empirical revisit of the debate.

The 2030 United Nations Sustainable Development Goal (SDG) 13 agenda hinges on attaining a sustainable environment with the need to "take urgent action to combat climate change and its impacts". Hence, this study empirically revisits the debate on the effect of nonrenewable energy and globalization on carbon emissions within the framework of the Kuznets hypothesis using an unbalanced panel data from seven South Asian countries (Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) covering 1980-2019. The variables of interest are carbon emissions measured in metric tons per capita, energy use measured as kg of oil equivalent per capita, and globalization index. To address five main objectives, we deploy four techniques: panel-corrected standard errors (PCSE), feasible generalized least squares (FGLS), quantile regression (QR), and fully modified ordinary least squares (FMOLS). For the most part, the findings reveal that the (1) inverted U-shaped energy-Kuznets curve holds; (2) U-shaped globalization-Kuznets curve is evident; (3) inverted U-shaped turning points for nonrenewable energy are 496.03 and 640.84, while for globalization are 38.83 and 39.04, respectively; (4) globalization-emission relationship indicates a U-shaped relationship at the median and 75th quantile; and (5) inverted U-shaped energy-Kuznets holds in Pakistan but a U-shaped nexus prevails in Nepal and Sri Lanka; inverted U-shaped globalization-Kuznets holds in Bangladesh and Sri Lanka, but U-shaped nexus is evident in Bhutan, Maldives, and Nepal. Deductively, our results show that South Asia countries (at early stage of development) are faced with the hazardous substance that deteriorates human health. Moreover, the non-linear square term of the nonrenewable energy-emissions relationship is negative, which validates the inverted U-shaped EKC theory. Overall, the effect of energy and globalization on carbon emissions is opposite while the consistency at the 75th quantile result indicates that countries with intense globalization are prone to environmental degradation.

Comparing Factors Associated With Intimate Partner Violence Among Rural and Urban Women in Northern Uganda.

Intimate partner violence (IPV) is an important public health issue with negative effects at individual and societal levels. In northern Uganda, IPV prevalence is high but literature on it is limited. Northern Uganda has a long history of socio-economic and political upheavals, which are recognized risk factors for IPV. We compare IPV prevalence among rural and urban women in northern Uganda. This was a cross-sectional survey of 856 northern Ugandan women, 409 women living in rural areas, and 447 women working in an urban marketplace. Data were analyzed using logistic regression. High rates of emotional, physical, and sexual IPV were found. Almost four of five participants had experienced at least one type of IPV during their lifetime, and approximately half of the participants had experienced IPV in the 12 months prior to the survey. Many women stated that IPV was justified in certain situations. Younger age was a significant determinant of IPV in both cohorts (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] [0.93-0.97]). Determinants of IPV among the rural cohort included male partner's alcohol abuse (aOR 2.22, CI [1.34-3.73]); having been in a physical fight with another man (aOR 1.90, 95% CI [1.12-3.23]); and controlling behaviors (aOR 1.21, CI [1.08-1.36]). Possible protective factors in the urban cohort included markers of economic empowerment such as being the decision maker on large household items (59.2% vs. 44.6%, p = .002) and having a mobile phone (20.4% vs. 12.4%, p = .024). Our study shows that IPV is a significant issue in northern Uganda. Economic empowerment is associated with lower rates of IPV in urban women, and interventions to reduce gender wealth inequality may reduce IPV prevalence. Further studies on enablers of IPV and the effect of conflict on IPV prevalence are needed to inform future interventions.

Synthesis of 225Ac-PSMA-617 for Preclinical Use.

BACKGROUND: The recent approval of radiopharmaceuticals for diagnosis and treatment of cancer is ushering nuclear medicine into a new era of theranostics and alpha therapy using radiopharmaceuticals labeled with 225Ac shows remarkable results in clinical trials. As such, reliable methods for the synthesis and quality control of 225Ac-radiopharmaceuticals are needed. OBJECTIVE: 225Ac-PSMA-617 is being used for targeted alpha therapy in patients with prostate cancer, and we had cause to synthesize the agent for preclinical use. However, technology transfer proved cumbersome owing to the paucity of information available on synthesizing and analyzing 225Ac-radiotherapeutics. To address this need, we describe a straightforward synthesis of 225Ac-PSMA- 617 as well as suitable approaches for quality control analysis using standard equipment in a modern PET Center. METHODS: PSMA-617 precursor was dissolved in 25 µL metal-free water (0.67 mg/mL) and combined with 500 µL 0.05M Tris buffer, pH 9. Actinium stock solution (~65 µCi in 15 µL) was added and the reaction was heated at 120°C for 40-50 min. The reaction was cooled and 0.6 mL gentisic acid solution (4 mg/mL in 0.2 M NH4OAc) was added. To formulate the dose for injection, sterile saline, USP (8 mL) was added and the pH was adjusted by the addition of 100 µL 0.05 M Tris buffer (pH 9) to give a final pH of ~7.2. The final solution was filtered using a 0.22 µm GV sterile filter into a sterile dose vial. Radiochemical purity was determined by radio-TLC (eluent: 50mM Sodium Citrate, pH 5), and plates were analyzed using an AR2000 scanner. RESULTS: The method provided 225Ac-PSMA-617 in high radiochemical yield (57 ± 3 µCi, >99%) and radiochemical purity (98 ± 1%), formulated for preclinical studies (9 mL, pH = 7.2), n=3. CONCLUSION: A straightforward synthesis of 225Ac-PSMA-617 is described that will facilitate production for (pre)clinical studies. The approach could also be applicable to the synthesis of other alpha radiotherapeutics incorporating 225Ac.

Provision of cervical cancer prevention services in Northern Uganda: a survey of health workers from rural health centres.

BACKGROUND: Cervical cancer is the leading cancer among Ugandan women, contributing to 40 % of all cancer cases recorded in the cancer registry. Having identified the substantial impact of cervical cancer among Ugandan women, the Ministry of Health in 2010 launched a Strategic Plan for Cervical Cancer prevention and control. This study was conducted to determine if health workers working in rural health centres (HCs) III and IV in Northern Uganda provide cervical cancer screening services as recommended in the Strategic Plan. METHODS: A cross-sectional survey using a structured questionnaire was conducted among nurses, midwives and clinical officers working in rural HC III and IV in Northern Uganda. Data were entered in Epidata 3.1 and analysed using Stata 16 statistical software. Univariate, bivariate, and multivariate analyses were performed. Any factor with p-value ≤ 0.05 was considered a significant predictor of outcome. RESULTS: We surveyed 286 health workers. Fifty-one (18 %) health workers were screening women for cervical cancer. Fifty-eight (21 %) health workers have guideline for cervical cancer screening in their HCs, 93 (33 %) participants were trained to screen women for cervical cancer. Two hundred sixty-two (92 %) participants provided HPV vaccination. Two hundred forty-six (87 %) participants were conducting health education about cervical cancer in their HCs. Factors associated with screening women for cervical cancer include: being a staff member from HCs III (AOR = 0.30, 95 % CI 0.13-0.68, p = 0.00), being staff of HCs that have organization to support cervical cancer screening services (AOR = 4.38, 95 % CI 1.99-9.63, p-=0.00), being a health worker who had been trained to screen for cervical cancer (AOR = 2.21, 95 % CI 1.00-4.90, p = 0.05) and staff from HCs that has guideline for cervical cancer screening (AOR = 2.89, 95 % CI 1.22-6.86, p = 0.02). CONCLUSIONS: This study shows an overall structural problem related to the delivery of cervical cancer screening services in HC III and IV in Northern Uganda which the Strategic Plan has not addressed. These structural problems need urgent attention if the Uganda government and other sub-Saharan African (SSA) countries are to achieve the World Health Organization (WHO) 90-70-90 targets by 2030 to be on track for cervical cancer elimination.

Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda.

BACKGROUND: Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda. METHODS: We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We sampled fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p-values ≤ 0.05 were considered as predictors of outcome. RESULTS: There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21-0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28-0.97). CONCLUSION: Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities.

Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy.

BACKGROUND: Uganda has one of the highest burdens of cervical cancer globally. In 2010 the Ugandan Ministry of Health launched the Strategic Plan for Cervical Cancer Prevention and Control with the hope of developing cervical cancer policy in Uganda. This study explored the beliefs of senior key informants in Uganda about cervical cancer prevention, the control programme, and the relevance of cervical cancer policy. METHODS: We conducted 15 key informant interviews with participants from six organisations across Northern and Central Uganda. Participants were drawn from district local government health departments, St. Mary's Hospital Lacor, Uganda Nurses and Midwifery Council, non-governmental organisations (NGOs) and Ministry of Health in Kampala, Uganda. The interview recordings were transcribed and analysed using thematic analysis. RESULTS: Seven themes emerged relating to the cervical cancer prevention and control programmes in Uganda: (1) policy frameworks for cervical cancer, (2) operationalising cervical cancer prevention and control, (3) financial allocation and alignment, (4) human resources and capability, (5) essential supplies and vaccines, (6) administrative data and resource distribution, and (7) cervical cancer services. CONCLUSIONS: The key informants perceive that the lack of a cervical cancer policy in Uganda is hindering cervical cancer prevention and control programmes. Therefore, the Ministry of Health and stakeholders need to work together in coming up with an effective policy framework that will accelerate efforts towards cervical cancer prevention and control in Uganda.

Prevalence of drugs with constipation-inducing potential and laxatives in community-dwelling older adults in Bahrain: therapeutic implications.

OBJECTIVES: This study evaluated the prevalence of prescribing drugs with constipation-inducing potential and the prophylactic use of laxatives in community-dwelling older adults. METHOD: An audit of outpatient prescriptions ordered for older adults aged ≥65 years with one or more chronic morbidities in 24 governmental primary healthcare centres in Bahrain. The prescriptions were collected by pharmacist-in-charge of each health centre between December 2015 and June 2016. The proportion of prescriptions with constipation-inducing drugs and co-prescribed laxatives was determined. KEY FINDINGS: The overall prevalence of prescribing drugs with the potential to cause constipation was 30.5% (642/2106). Prescriptions with at least one anticholinergic/drug with anticholinergic potential (DAP) were 22.5% (473/2106): single medication in 16.6% (350/2106) and two or more combinations in 5.9% (124/2106). A combination of two or more anticholinergics/DAP accounted for 2.9% (61/2106) prescriptions. Constipation-inducing drugs other than anticholinergics such as multivalent cation preparations and non-dihydropyridine calcium channel blockers were prescribed in 8.0% (168/2106) of cases. Orphenadrine and first-generation antihistamines, both with high anticholinergic drug burden, were the frequently prescribed medications, either alone or combined. The rate of prescribed laxatives was 2.96% (19/642), mostly for those on constipation-inducing drug monotherapy. CONCLUSION: Approximately a third of prescriptions for older adults had constipation-inducing medications, typically a single DAP. Prescribing laxatives were uncommon and did not correlate with the prevalence of prescribing drugs with constipation potential. Physicians' awareness about anticholinergic drugs and their potential risks, and the prophylactic use of laxatives to mitigate iatrogenic constipation are to be included in continuing professional programmes.

Total laparoscopic management of spontaneous biliary perforation.

Spontaneous biliary perforation (SBP) in pediatrics is rare and historically has been treated with laparotomy for attempted repair and cholecystectomy. In recent years, management has evolved into a conservative approach, opting for cholecystostomy and peritoneal drainage over cholecystectomy. In this case, we report the first successful conservative management of SBP using an exclusively laparoscopic approach without cholecystectomy in a pediatric patient.

Antihypertensive Prescribing Pattern in Older Adults: Implications of Age and the Use of Dual Single-Pill Combinations.

INTRODUCTION: Hypertension, if not appropriately treated, is associated with life-threatening complications. AIMS: This study evaluated antihypertensive prescribing patterns in older adults (≥ 65 years) versus young adults based on the current guidelines with an emphasis on the use of dual single-pill combinations (SPCs). METHODS: A nationwide audit of 8746 primary care prescriptions of hypertensive patients with comorbidities in Bahrain was performed. RESULTS: Antihypertensive combination therapy was prescribed more often to older (77.1%) than young adults (68.6%; P < 0.0001) whereas SPCs were under-used (57.6% vs. 69.4%; P < 0.0001). Recommended dual SPCs, without/with a combination of a free-dose complementary antihypertensive agent, were significantly less often prescribed for the older adult as compared to young adult adults (45.1% vs. 62.99% and 35.97% vs. 46.72%; P < 0.0001), respectively. Unacceptable two- and three-drug combinations (including those with limited clinical evidence and unacceptable ones) were prescribed more often to older adults rather than to young ones (20.06% vs. 12.6%; and 56.5% vs. 46.8%; P < 0.0001), respectively. In both age groups, the top-three antihypertensive classes prescribed as monotherapy were angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and ß blockers. CONCLUSION: The updated guidelines for hypertension treatment in older adults have had a limited impact on primary care practice in Bahrain. In both age groups, there was a high positive correlation between the number of antihypertensive drugs prescribed and prescribing unacceptable combinations. Unacceptable combinations comprising SPC-related antihypertensive therapy duplication were more common than those reported elsewhere. Introducing approved triple SPCs may discourage prescribing unacceptable antihypertensive drugs and their combinations that lack robust evidence.

Intimate partner violence in pregnancy: a cross-sectional study from post-conflict northern Uganda.

OBJECTIVES: To determine the prevalence of intimate partner violence (IPV) in pregnancy and to understand associations and determinants. DESIGN: Cross-sectional survey. SETTING: Two rural health clinics in post-conflict northern Uganda. PARTICIPANTS: Women attending two rural health clinics for a new service providing cervical cancer screening, who had experienced pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected by a questionnaire using validated questions from the demographic health survey women's questionnaire and the domestic violence module. Data were entered into tablets using Questionnaire Development System software. Bivariate and multivariate logistic regression was performed, using experience of IPV in pregnancy as the dependent variable. SPSS V.25 was used for all analysis. RESULTS: Of 409 participant women, 26.7% (95% CI 18.6% to 35.9%) reported having been slapped, hit or beaten by a partner while pregnant. For 32.3% (95% CI 20.2% to 37.9%) of the women the violence became worse during pregnancy. Women who had ever experienced IPV in pregnancy were more likely to have experienced violence in the previous 12 months (OR 4.45, 95% CI 2.80 to 7.09). In multivariate logistic regression, the strongest independent associations with IPV in pregnancy were partner's daily drinking of alcohol (OR 2.02, 95% CI 1.19 to 3.43) and controlling behaviours (OR 1.17, 95% CI 1.03 to 1.33). CONCLUSIONS: The women in this study had more exposure to IPV in pregnancy than previously reported for this region. Women's previous experience of intimate partner violence, partner's daily use of alcohol and his controlling behaviours were strong associations with IPV in pregnancy. This study highlights the uneven distribution of risk and the importance of research among the most vulnerable population in rural and disadvantaged settings. More research is needed in local rural and urban settings to illuminate this result and inform intervention and policy.

Prevalence and correlates of intimate partner violence against women in conflict affected northern Uganda: a cross-sectional study.

BACKGROUND: Intimate partner violence (IPV) is an important public health issue as it impacts negatively on health, economic and development outcomes. In conflict affected northern Uganda, IPV prevalence is high and additional context-specific risk factors exist. People residing in this region have been displaced, exposed to war and violence, and had livelihoods destroyed. There are few studies examining IPV in this setting. In this study we aim to further understand the prevalence of IPV towards women and its associations in conflict affected northern Uganda. METHODS: This was a cross-sectional, behavioural survey designed to capture quantitative information related to experiences of IPV among women living near two health clinics in rural northern Uganda. There were 409 women who participated in the survey. Data were analysed using logistic regression. RESULTS: High rates of emotional, physical and sexual IPV were found; 78.5% of women had experienced at least one type of IPV, and slightly more than half of the participants had experienced IPV in the 12 months prior to the survey. Many women felt that IPV was justified in certain situations. Significant determinants of IPV included alcohol abuse by the male partner (OR 2.22, 95% CI 1.34-3.73); partner having been in a physical fight with another man (OR 1.90, 95% CI 1.12-3.23); controlling behaviours by the male partner (OR 1.21, CI 1.08-1.36). and younger age of the woman (OR 0.95, 95% CI 0.92-0.98). Educational level was not independently associated with IPV. CONCLUSIONS: Our findings show that IPV is a significant issue in conflict affected northern Uganda, and attitudes that normalise and justify IPV are common. Alcohol abuse among young men in northern Uganda is highly prevalent and strongly associated with IPV towards women, as are controlling behaviours exhibited by the male partner. Interventions to reduce alcohol consumption among men in this region are likely to have important benefits in reducing the prevalence of IPV, and attitudes and behaviours that support IPV need to be further understood and addressed. Many women in conflict affected northern Uganda likely have additional risk factors for IPV related to previous exposure to war violence, however this was not directly measured in the present study. Further research into IPV in northern Uganda, and its relationship to exposure to conflict, is greatly needed.

Pharmacology and therapeutics resource session attendance and academic performance of pre-clerkship medical students in problem-based learning curricula.

BACKGROUND: The relationship between large-group classroom attendance by students and test achievement in problem-based learning (PBL) curricula is unclear. This study examined the correlation between attendance at resource sessions (hybrid lectures in the PBL curriculum) and test scores achieved in pharmacology and determined whether the score achieved was related to student gender. METHODS: A cross-sectional observational study over one academic year of 1404 pre-clerkship medical students was performed. Class attendance during pharmacology resource sessions and MCQ test scores achieved in pharmacology were analysed. RESULTS: The percentage of students' attendance in resource sessions declined over three years of the programme, from 78.7 ± 27.5 in unit I to 22.1 ± 35.6 (mean ± SD) in unit IX. A significant but weakly positive correlation was evident between attendance and achievement in pharmacology (r = 0.280; p < 0.0001). The mean score of the students who attended > 50% of the resource sessions was significantly higher (p < 0.0001). Students who attended ≤50% were more likely to achieve lower tertile scores. The mean score achieved and the number of higher tertile scorers were higher among students who attended > 50% of the resource sessions. Although female students' attendance was significantly higher, no significant gender-related differences in either mean scores or top grades achieved were found. CONCLUSIONS: In a PBL curriculum, the classroom attendance of students in pharmacology declined during the pre-clerkship phase. A weak positive correlation was found between attendance and academic achievement, as measured by MCQ test scores. Factors other than motivation and attendance may confound gender-based academic performance and merit further research.

A Tripartite Model of Community Attitudes to Palliative Care.

BACKGROUND: Despite a growth in palliative care services, access and referral patterns are inconsistent and only a minority of people who would benefit from such care receive it. Use of palliative care is also affected by community attitudes toward palliative care. As such, determining community attitudes toward palliative care is crucial. We also need to determine what predicts attitudes in order to provide appropriate information and education. OBJECTIVES: The 2 research questions were: (1) What are community attitudes toward palliative care? and (2) what are the determinants of community attitudes toward palliative care? DESIGN: A tripartite model of attitudes was used, which articulates attitudes as comprising knowledge and experience, emotions, and beliefs. A cross-sectional descriptive survey was used. PARTICIPANTS: A community sample of 180 participants completed the survey. RESULTS: The average attitude and belief responses were very positive, the average emotions responses were somewhat positive. The sample had good knowledge of palliative care. Lowest knowledge scores were reported for the items: "Euthanasia is not part of palliative care," "Palliative care does not prolong or shorten life," and "Specialist palliative care is only available in hospitals." After controlling place of birth and age, it was found that beliefs, emotions, and knowledge each accounted for a significant proportion of unique variance in attitude toward palliative care. Each variable had a positive relationship with attitude. CONCLUSION: Beliefs, emotions, and knowledge all need to be incorporated into palliative care community education programs.

Community-based training of medical students is associated with malaria prevention and treatment seeking behaviour for children under 5 years in Uganda: a study of MESAU-MEPI COBERS in Uganda.

BACKGROUND: Four university medical training institutions in Uganda have trained students at off-site health facilities under community-based education and Research Service (COBERS) programme for over 5 years. One of the major components of COBERS placement is for the students to provide health education in the communities about malaria as a major public health disease in Uganda. This study seeks to assess if targeted community-based medical education programme is associated with better prevention and treatment seeking behaviours in the management of malaria, a leading cause of morbidity and mortality of children under five in Uganda. METHODS: A cross-sectional survey was done to compare communities around health facilities where medical students were placed at COBERS sites with communities around similar health facilities where medical students were not placed (non-COBERS sites). We randomly selected two villages near each health facility and consecutively selected 10 households per village for interviews using nearest-neighbour method. We used a structured questionnaire to interview household heads on malaria prevention and treatment seeking behaviour for children under 5 years. We performed univariate analysis to determine site and demographic characteristics and performed a multivariate logistic regression to assess association between dependant and independent variables. RESULTS: Five hundred twenty-three (66.8%) of the children under 5 years in COBERS communities slept under Insecticide Treated Nets (ITNs) the night before survey compared with 1451 (57.8%) in non-COBERS communities (AOR = 0.66, p = 0.017). 100 (60.0%) of children under 5 years in COBERS communities sought care for fever within 24 h of onset compared with 268 (47.0%) in non-COBERS communities (AOR = 0.71, P = 0.009). CONCLUSION: The presence of COBERS in communities is associated with improved malaria prevention and treatment-seeking behaviour for parents of children under 5 years. Further study needs to be done to determine the long-term impact of COBERS training program on malaria control and prevention in Uganda, along with other effects of COBERS.

Prevalence of borrowing and sharing prescription medicines and associated socio-demographic factors: findings from COBERS health centres in northern Uganda.

BACKGROUND: The use of prescription medications without the involvement of medical professionals is a growing public health concern. Therefore this study was conducted to determine the prevalence of borrowing and sharing prescription medicines and associated socio-demographic factors among community members who had sought health care from COBERS health centres. METHODS: We conducted analytical cross - sectional study among former patients who sought treatment during the two months period prior to data collection in nine COBERS health centres. We used cluster proportional-to-size sampling method to get the numbers of research participants to be selected for interview from each COBERS site and logistic regression model was used to assess the associations. RESULTS: The prevalence of borrowing prescription medication was found to be 35.9% (95% CI 33.5-38.2%) and sharing prescription medication was 32.7% (95% CI 30.4-34.9%). The Socio-demographic factors associated with borrowing prescription medicines were: age group ≤19 years (AOR = 2.64, 95%CI 1.47-4.74, p-value = 0.001); age group 20-29 years (AOR = 2.78, 95%CI 1.71-4.50, p-value≤0.001); age group 30-39 years (AOR = 1.90, 95%CI 1.18-3.06, p-value = 0.009); age group 40-49 (AOR = 1.83, 95%CI 1.15-2.92, p-value = 0.011); being a female (AOR = 2.01, 1.58-2.55, p-value< 0.001); being a Pentecostal by faith (AOR = 1.69, 95%CI 1.02-2.81, p-value = 0.042) and being Employed Salary Earner (AOR = 0.44, 95%CI 0.25-0.78, p-value = 0.005). The socio-demographic factors associated with sharing prescription medicines were: age group ≥19 years (AOR = 4.17, 95%CI 2.24-7.76, p-value< 0.001); age group 20-29 years (AOR = 3.91, 95%CI 2.46-6.29, p-value< 0.001); age group 30-39 years (AOR = 2.94, 95%CI 2.05-4.21, p-value< 0.001); age group 40-49 years (AOR = 2.22, 95%CI 1.29-3.82, p-value = 0.004); being female (AOR = 2.50, 95%CI 1.70-3.47, p-value< 0.001); being Pentecostal by faith (AOR = 2.15, 95%CI 1.15-4.03, p-value = 0.017); and being engaged in business (AOR = 1.80, 95%CI 1.16-2.80, p-value = 0.009). CONCLUSION: A high proportion of study participants had borrowed or shared prescription medicines during the two months prior to our study. It is recommended that stakeholders sensitise the community members on the danger of borrowing and sharing prescription medicines to avert the practice.

Revealing Electron-Electron Interactions within Lewis Pairs in Chemical Systems.

The so-called "Lewis pair" is a ubiquitous phenomenon in chemistry and is often used as an intuitive construct to predict and rationalize chemical structure and behavior. Concepts from the very general Valence Shell Electron Pair Repulsion (VSEPR) model to the most esoteric reaction mechanism routinely rely on the notion that electrons tend to exist in pairs and that these pairs can be thought of as being localized to a particular region of space. It is precisely this localization that allows one to intuit how these pairs might behave, generally speaking, so that reasonable predictions may be made regarding molecular structure, intermolecular interactions, property trends, and reaction mechanisms, etc. Of course, it is rather unfortunate that the Lewis model is entirely qualitative and yields no information regarding how any specific electron pair is distributed. Here we demonstrate a novel electronic structure analysis technique that predicts and analyzes precise quantitative details about the relative and absolute distribution of individual electron pairs. This Single Electron Pair Distribution Analysis (SEPDA) reveals quantitative details about the distribution of the well-known Lewis pairs, such as how they are distributed in space and how their relative velocities change in various chemical contexts. We show that these distributions allow one to image the explicitly pairwise electronic behavior of bonds and lone pairs. We further demonstrate how this electronic behavior changes with several conditions to explore the nature of the covalent chemical bond, non-covalent interactions, bond formation, and exotic 3-center-2-electron species. It is shown that indications of the strength of bonded and non-bonded interactions may also be gleaned from such distributions and SEPDA can be used as a tool to differentiate between interaction types. We anticipate that SEPDA will be of broad utility in a wide variety of chemical contexts because it affords a very detailed, visual and intuitive analysis technique that is generally applicable.

Identification of human African Trypanosomiasis foci using school-going children in post-conflict era in Nwoya District, Northern Uganda: A cross-sectional study.

Background: Human African Trypanosomiasis (HAT) is fatal if untreated; the drugs to treat it are toxic making its management difficult and diagnosis complex. Nwoya district has a long history of sleeping-sickness dating back to pre-colonial times. The civil war of 1986-2008 displaced many who upon return complained of cattle and dogs dying of unknown causes alongside increased tsetse flies infestation hence, the needs for the study. Methods: We enrolled local 3,040 pupils and recorded their social-demographic characteristics and access to different domesticated animals/fowls in their homes. Screening for HAT using the card agglutination test for trypanosomiasis (CATT) was performed; positive individuals had their titres determined, followed by microscopy and loop mediated isothermal amplification analysis (LAMP). R was used for analysis where associations were sought between dependent and independent variables. Any factor with P-value <0.05 was taken as statistically significant. Results: HAT serological prevalence of 1.2% (95% CI 0.8-1.6) was obtained, 58.3% being boys while 41.7% were girls with titres ranging from 1:2 - 1:16. Two schools alone, constituted 47% of the CATT positive cases. Pupils who came from homes with dogs were more likely to be CATT/ Trypanosoma brucei gambiense positive; (adjusted odds ratio = 3.12, 95% CI 1.41-6.99 & p=0.005). Conclusions: Though no parasites were detected, with prevalence of CATT positive at 1.2%, active surveillance in the district is still recommended. CATT positive cases needs follow-ups were immune trypanolysis test done to ascertain their exposure.

Reduced plasma concentrations of vitamin B6 and increased plasma concentrations of the neurotoxin 3-hydroxykynurenine are associated with nodding syndrome: a case control study in Gulu and Amuru districts, Northern Uganda.

INTRODUCTION: Nodding syndrome was first reported in Uganda in 2003 among internally displaced populations. Risk factors for the syndrome remain unknown. We therefore explored vitamin B6 deficiency and resulting high 3-hydroxykynurenine (3-HK) levels as risk factor for nodding syndrome in Northern Uganda. METHODS: Case-control study conducted in Gulu and Amuru districts. Cases were children/young adults with nodding syndrome. Healthy children/young adults were recruited as controls from same community as cases. Data on socio-demographic and other risk factors was collected using questionnaires. Whole blood was collected in EDTA tubes for assay of 3-HK and vitamin B6 using sandwich ELISA. Conditional logistic regression model was used to assess associations. RESULTS: 66 cases and 73 controls were studied. Factors associated with nodding syndrome were being positive for 3-HK (AOR=4.50, p=0.013), vitamin B6 concentration below mean (AOR=7.22, P=0.001), child being taken care of by mother only (AOR=5.43, p=0.011), child being taken care of by guardian (AOR=5.90, p=0.019) and child consuming relief food at weaning (AOR=4.05, p=0.021). CONCLUSION: Having low vitamin B6 concentration which leads to a build up of 3-hydroxykynurenine concentration in cases as a main risk factor. Therefore, cases should be treated with vitamin B6 and community members should be sensitise to ensure adequate dietary intake of vitamin B6 so that the risk of nodding syndrome among children is averted. We encourage future prospective intervention study to be conducted to assess the effect of low vitamin B6 on the development of nodding syndrome via raised 3-HK concentration.

Understanding Preclerkship Medical Students' Poor Performance in Prescription Writing.

OBJECTIVES: This study aimed to explore reasons for poor performance in prescription writing stations of the objective structured practical examination (OSPE) and absenteeism in prescription writing sessions among preclerkship medical students at the Arabian Gulf University (AGU) in Manama, Bahrain. METHODS: This descriptive study was carried out between September 2014 and June 2015 among 157 preclerkship medical students at AGU. Data were collected using focus group discussions and a questionnaire with closed- and open-ended items. RESULTS: All 157 students participated in the study (response rate: 100.0%). The most frequently cited reasons for poor performance in OSPE stations were an inability to select the correct drugs (79.6%), treatment duration (69.4%), drug quantity (69.4%) and drug formulation (68.2%). Additionally, students reported inadequate time for completing the stations (68.8%). During focus group discussions, students reported other reasons for poor performance, including examination stress and the difficulty of the stations. Absenteeism was attributed to the length of each session (55.4%), lack of interest (50.3%), reliance on peers for information (48.4%) and optional attendance policies (47.1%). Repetitive material, large group sessions, unmet student expectations and the proximity of the sessions to summative examinations were also indicated to contribute to absenteeism according to open-ended responses or focus group discussions. CONCLUSION: This study suggests that AGU medical students perform poorly in prescription writing OSPE stations because of inadequate clinical pharmacology knowledge. Participation in prescription writing sessions needs to be enhanced by addressing the concerns identified in this study. Strategies to improve attendance and performance should take into account the learner-teacher relationship.