Implementation of solar powered oxygen delivery in a conflict zone: preliminary findings from Somalia on feasibility and usefulness.

Access to therapeutic oxygen in low-resource settings remains a significant global problem. Solar powered oxygen (SPO2) delivery is a reliable and cost-effective solution. We followed implementation research methodology to gather data on engineering parameters (remote monitoring), nurse training (before and after knowledge questionnaire), patients treated with SPO2 (descriptive case series), and qualitative user feedback (focus group discussions). In January 2021, SPO2 was installed at Hanano General Hospital in Dusamareb, Galmudug State, Somalia, in a conflict-affected region. Daily photovoltaic cell output (median 8.0 kWh, interquartile range (IQR) 2.6-14) exceeded the electrical load from up to three oxygen concentrators (median 5.0 kWh, IQR 0.90-12). Over the first six months after implementation, 114 patients (age 1 day to 89 years, 54% female) were treated for hypoxaemic illnesses, including COVID-19, pneumonia, neonatal asphyxia, asthma, and trauma. Qualitative end user feedback highlighted SPO2 acceptability. Violent conflict was identified as a contextual factor affecting local oxygen needs. We provide the preliminary findings of this implementation research study and describe the feasibility, fidelity, rapid adoption, usefulness, and acceptability of SPO2 in a low-resource setting characterized by violent conflict during the COVID-19 pandemic. Our findings demonstrated the lifesaving feasibility of SPO2 in volatile settings.

Kidney Disease-Associated APOL1 Variants Have Dose-Dependent, Dominant Toxic Gain-of-Function.

BACKGROUND: Two coding renal risk variants (RRVs) of the APOL1 gene (G1 and G2) are associated with large increases in CKD rates among populations of recent African descent, but the underlying molecular mechanisms are unknown. Mammalian cell culture models are widely used to study cytotoxicity of RRVs, but results have been contradictory. It remains unclear whether cytotoxicity is RRV-dependent or driven solely by variant-independent overexpression. It is also unknown whether expression of the reference APOL1 allele, the wild-type G0, could prevent cytotoxicity of RRVs. METHODS: We generated tetracycline-inducible APOL1 expression in human embryonic kidney HEK293 cells and examined the effects of increased expression of APOL1 (G0, G1, G2, G0G0, G0G1, or G0G2) on known cytotoxicity phenotypes, including reduced viability, increased swelling, potassium loss, aberrant protein phosphorylation, and dysregulated energy metabolism. Furthermore, whole-genome transcriptome analysis examined deregulated canonical pathways. RESULTS: At moderate expression, RRVs but not G0 caused cytotoxicity in a dose-dependent manner that coexpression of G0 did not reduce. RRVs also have dominant effects on canonical pathways relevant for the cellular stress response. CONCLUSIONS: In HEK293 cells, RRVs exhibit a dominant toxic gain-of-function phenotype that worsens with increasing expression. These observations suggest that high steady-state levels of RRVs may underlie cellular injury in APOL1 nephropathy, and that interventions that reduce RRV expression in kidney compartments may mitigate APOL1 nephropathy.

Sonographic Evaluation of the Pancreas in Type 1 Diabetes Mellitus: A Case-control Study.

BACKGROUND: Pancreas is a vital insulin-producing gland, and it is subjected to various disorders which produce alteration in the morphology and function. Ultrasound (US) of the pancreas is sensitive for evaluating the gland and provides the accurate diagnosis of pancreatic diseases. The aim of this study is to determine whether there were alterations in pancreatic size and echogenicity in type 1 diabetes mellitus (DM). METHODS: A total of 100 patients with Type-1 DM (insulin dependent) were examined using the ultrasonography. They were compared to 22 healthy controls. Measurements of the pancreas were performed on type 1 diabetic patients and controls. RESULTS: Pancreatic diameters of the head, body, and tail of the pancreas were reduced in Type 1 DM versus controls (1.78 vs. 1.80 cm, 95% confidence interval [CI]: -0.147 -0.099, P = 0.699 for the head of the pancreas; and 1.093 vs. 1.13 cm: 95% CI: -2.97-1.196, P = 0.484 for the body of the pancreas; 1.12 vs. 1.46 cm, 95% CI: -0.491-0.194, P < 0.001 for the tail of the pancreas). The echogenicity of the pancreas in patients with Type 1 DM increased significantly as the duration of the disease increased (P = 0.015). CONCLUSION: Individuals with Type 1 DM have reduced pancreatic size in comparison with controls. Patients with Type 1 DM have increased echogenicity of the pancreas as the duration of the disease increased.

Hesitancy in COVID-19 Vaccine Uptake and Its Correlated Factors Using Multi-Theory Model among Adult Women: A Cross-Sectional Study in Three States of Somalia.

BACKGROUND: In developing countries, access to information, awareness, and availability of COVID-19 vaccines are key challenges. Somalia launched the COVID-19 vaccination in March 2021; however, the uptake of the vaccination is slow, which creates fear of further loss of life in the country unless intentional and organized campaigning and efforts are made to improve both the availability of the vaccine and its acceptance by the community. This study aimed to understand the current level of awareness, accessibility, trust, and hesitancy toward the COVID-19 vaccine among women in Somalia. METHODS: To assess COVID-19 vaccine uptake, acceptance, community awareness, and hesitancy rates in Somalia, we carried out a cross-sectional mixed methods study in three regions of Somalia that were selected randomly out of the 18 regions of Somalia. A multi-theory model (MTM) was developed to identify correlated factors associated with the hesitancy or non-hesitancy toward COVID-19 vaccination among women of all ages (18 years and above). RESULTS: A total of 999 eligible women (333 in each district) of 18-98 years old were interviewed in March 2022. About two-thirds (63.76%) of participants reported hesitancy about receiving the COVID-19 vaccine. The theory model initiation construct indicated that behavioral confidence in the vaccine (b = 0.476, p < 0.001), participatory dialogue (at b = 0.136, p < 0.004), and changes in the physical environment (b = 0.248, p = 0.015) were significantly associated with COVID-19 vaccine acceptance among women who were not hesitant to take the vaccine. CONCLUSIONS: The availability of COVID-19 vaccines may not translate into their uptake. The decision to get the vaccine was determined by multiple factors, including the perceived value of the vaccination, previous experience with the vaccine, perceived risk of infection, accessibility and affordability, and trust in the vaccine itself. Public health education programming and messaging must be developed to encourage vaccine uptake among women with varying levels of vaccine hesitancy.

Multimodal analysis of granulocytes, monocytes, and platelets in patients with cystic fibrosis before and after Elexacaftor-Tezacaftor-Ivacaftor treatment.

Cystic fibrosis (CF) is a monogenetic disease caused by an impairment of the cystic fibrosis transmembrane conductance regulator (CFTR). CF affects multiple organs and is associated with acute and chronic inflammation. In 2020, Elexacaftor-Tezacaftor-Ivacaftor (ETI) was approved to enhance and restore the remaining CFTR functionality. This study investigates cellular innate immunity, with a focus on neutrophil activation and phenotype, comparing healthy volunteers with patients with CF before (T1, n = 13) and after six months (T2, n = 11) of ETI treatment. ETI treatment reduced sweat chloride (T1: 95 mmol/l (83|108) vs. T2: 32 mmol/l (25|62), p < 0.01, median, first|third quartile) and significantly improved pulmonal function (FEV1 T1: 2.66 l (1.92|3.04) vs. T2: 3.69 l (3.00|4.03), p < 0.01). Moreover, there was a significant decrease in the biomarker human epididymis protein 4 (T1: 6.2 ng/ml (4.6|6.3) vs. T2: 3.0 ng/ml (2.2|3.7), p < 0.01) and a small but significant decrease in matrix metallopeptidase 9 (T1: 45.5 ng/ml (32.5|140.1) vs. T2: 28.2 ng/ml (18.2|33.6), p < 0.05). Neutrophil phenotype (CD10, CD11b, CD62L, and CD66b) and function (radical oxygen species generation, chemotactic and phagocytic activity) remained largely unaffected by ETI treatment. Likewise, monocyte phenotype and markers of platelet activation were similar at T1 and T2. In summary, the present study confirmed a positive impact on patients with CF after ETI treatment. However, neither beneficial nor harmful effects of ETI treatment on cellular innate immunity could be detected, possibly due to the study population consisting of patients with well-controlled CF.

Modulation of Neutrophil Activity by Soluble Complement Cleavage Products-An In-Depth Analysis.

The cellular and fluid phase-innate immune responses of many diseases predominantly involve activated neutrophil granulocytes and complement factors. However, a comparative systematic analysis of the early impact of key soluble complement cleavage products, including anaphylatoxins, on neutrophil granulocyte function is lacking. Neutrophil activity was monitored by flow cytometry regarding cellular (electro-)physiology, cellular activity, and changes in the surface expression of activation markers. The study revealed no major effects induced by C3a or C4a on neutrophil functions. By contrast, exposure to C5a or C5a des-Arg stimulated neutrophil activity as reflected in changes in membrane potential, intracellular pH, glucose uptake, and cellular size. Similarly, C5a and C5a des-Arg but no other monitored complement cleavage product enhanced phagocytosis and reactive oxygen species generation. C5a and C5a des-Arg also altered the neutrophil surface expression of several complement receptors and neutrophil activation markers, including C5aR1, CD62L, CD10, and CD11b, among others. In addition, a detailed characterization of the C5a-induced effects was performed with a time resolution of seconds. The multiparametric response of neutrophils was further analyzed by a principal component analysis, revealing CD11b, CD10, and CD16 to be key surrogates of the C5a-induced effects. Overall, we provide a comprehensive insight into the very early interactions of neutrophil granulocytes with activated complement split products and the resulting neutrophil activity. The results provide a basis for a better and, importantly, time-resolved and multiparametric understanding of neutrophil-related (patho-)physiologies.

A man with an alcoholic-related duodenal perforation after losing his job due to the SARS-COV-2 pandemic.

Pneumoperitoneum is a medical emergency, diagnosed by subdiaphragmatic free air upon X-ray. The underlying cause, in this case a perforated duodenal ulcer from increased alcohol intake, must also be identified and treated. Public health crisis can impact physical health to varying degrees across socioeconomic groups.

Experiences from the Field: A Qualitative Study Exploring Barriers to Maternal and Child Health Service Utilization in IDP Settings Somalia.

BACKGROUND: In Somalia, maternal and child health service utilization is unacceptably low. Little is known about factors contributing to low maternal and child health service utilization in Somalia, especially in internally displaced people (IDP) settings. This study aimed to understand barriers to the use of maternal and child health-care services among IDPs in Mogadishu. METHODS: A total of 17 in-depth interviews (IDIs), 7 focus group discussions (FGDs), and field observations were conducted on lactating/pregnant mothers, health-care providers, traditional birth attendants (TBA), and IDP camp leaders. The socio-ecological model (SEM) framework was employed for the categorization of barriers to healthcare utilization and further analysis was conducted to understand the major types and nature of barriers. RESULTS: Using the SEM, the following major barriers that hinder maternal and child health service utilization were identified. Low socio-economic, lack of decision making power of women, TBA trust, poor knowledge and awareness on pregnancy danger signs, fear of going to unfamiliar areas were identified barriers at individual level. Traditional beliefs, male dominance in decision making, and lack of family support were also identified barriers at interpersonal level. Security and armed conflict barriers and formidable distance to health facility were identified barrier at the community level. Lack of privacy in the facility, transportation challenges, poor functional services, negative experiences, closure of the health facility in some hours, and lack of proper referral pathways were identified barriers at organizational or policy level. CONCLUSION: Overall, various factors across different levels of SEM were identified as barrier to the utilization of maternal and child health services. Hence, multi-component interventions that target these complex and multifaceted barriers are required to be implemented in order to improve maternal and child health services utilization among IDP in Mogadishu, Somalia.

Simultaneous Measurement of Changes in Neutrophil Granulocyte Membrane Potential, Intracellular pH, and Cell Size by Multiparametric Flow Cytometry.

Neutrophils provide rapid and efficient defense mechanisms against invading pathogens. Upon stimulation with proinflammatory mediators, including complement factors and bacterial peptides, neutrophils respond with changes in their membrane potential, intracellular pH, and cellular size. This study provides an approach to quantify these important changes simultaneously using multiparametric flow cytometry, thereby revealing a typical sequence of neutrophil activation consisting of depolarization, alkalization, and increase in cellular size. Additionally, the time resolution of the flow cytometric measurement is improved in order to allow changes that occur within seconds to be monitored, and thus to enhance the kinetic analysis of the neutrophil response. The method is appropriate for the reliable semiquantitative detection of small variations with respect to an increase, no change, and decrease in those parameters as demonstrated by the screening of various proinflammatory mediators. As a translational outlook, the findings are put into context in inflammatory conditions in vitro as well as in a clinically relevant whole blood model of endotoxemia. Taken together, the multiparametric analysis of neutrophil responsiveness regarding depolarization, alkalization, and changes in cellular size may contribute to a better understanding of neutrophils in health and disease, thus potentially yielding innovative mechanistic insights and possible novel diagnostic and/or prognostic approaches.

The potential economic benefits of controlling trypanosomiasis using waterbuck repellent blend in sub-Saharan Africa.

Trypanosomiasis is a significant productivity-limiting livestock disease in sub-Saharan Africa, contributing to poverty and food insecurity. In this paper, we estimate the potential economic gains from adopting Waterbuck Repellent Blend (WRB). The WRB is a new technology that pushes trypanosomiasis-transmitting tsetse fly away from animals, improving animals' health and increasing meat and milk productivity. We estimate the benefits of WRB on the production of meat and milk using the economic surplus approach. We obtained data from an expert elicitation survey, secondary and experimental sources. Our findings show that the adoption of WRB in 5 to 50% of the animal population would generate an economic surplus of US$ 78-869 million per annum for African 18 countries. The estimated benefit-cost ratio (9:1) further justifies an investment in WRB. The technology's potential benefits are likely to be underestimated since our estimates did not include the indirect benefits of the technology adoption, such as the increase in the quantity and quality of animals' draught power services and human and environmental health effects. These benefits suggest that investing in WRB can contribute to nutrition security and sustainable development goals.

Research on drinking-groundwater source safety management based on numerical simulation.

A drinking-groundwater source protection technology system based on a three-dimensional finite-difference groundwater model was constructed and applied to the safe management of drinking groundwater in the first terrace of Fujiang River. In the study area, the main type of groundwater is the quaternary systemic alluvial deposit loose rock pore water and the aquifer thickness varies between 20 and 35 m. Groundwater is the main source of water and is used for various purposes through two exploitation wells. The water volumes of 1# exploitation well (1#) and 2# exploitation well (2#) are 10,000 m3/day and 5000 m3/day, respectively. An analysis of 22 indicators from 11 groundwater samples showed that a higher concentration of chemical-oxygen-demand (CODMn) and ammonia-nitrogen (NH3-N), and they had a high correlation with most of the other water-quality factors. Therefore, CODMn and NH3-N were selected as indicator factors for model calibration and prediction. Twenty-two hydraulic head observation wells were used for flow-model calibration. The flow model indicated that a drop funnel formed with a maximum depth of 12 m, and the particle-capture zone in the original downstream direction of the south side extended to 1100 m because of groundwater exploitation. The solute-transport model showed that industrial pollution sources were the main factors that led to a deterioration of water quality. To analyze the necessity and effectiveness of remediation measures for the safety of drinking-water sources, two scenarios were considered to predict the concentration of NH3-N and CODMn in groundwater exploitation wells over 20 years. Scenario I, which considered that current conditions were maintained, predicted that the NH3-N would exceed the drinking-water quality standard of 0.5 mg/L after 16 years. Scenario II, in which industrial sewage treatment plants were installed outside the particle-trapped zone of the exploitation wells and strict anti-seepage measures were implemented, predicted that the peak concentrations of NH3-N and CODMn in the exploitation wells would be 0.26 mg/L and 1.33 mg/L, respectively, after 3 years of model operation. This study provides a theoretical basis for drinking-groundwater source protection that can be applied to safety management practices.

Health Risk Assessment of Groundwater Contaminated by Oil Pollutants Based on Numerical Modeling.

To provide theoretical support for the protection of dispersed drinking water sources of groundwater, we need to accurately evaluate the time and scope of groundwater pollution hazards to human health. This helps the decision-making process for remediation of polluted soil and groundwater in service stations. In this study, we conducted such an evaluation by coupling numerical modeling with a health risk assessment. During the research, soil and groundwater samples were collected and analyzed for 20 pollutants. Fifty-six percent of the heavy contaminants and 100% of the organic contaminants exhibited maximum values at the location of the oil depot. Gray correlation analysis showed that the correlation between background samples and soil underlying the depot was 0.375-0.567 (barely significant to insignificant). The correlation between the reference sequence of other points was 0.950-0.990 (excellent correlation). The correlation of environmental impact after oil depot leakage followed the order: organic pollutants > heavy metals > inorganic pollutants. The groundwater simulation status and predictions indicated that non-carcinogenic health risks covered 25,462 m2 at the time of investigation, and were predicted to extend to 29,593 m2 after five years and to 39,873 m2 after 10 years. Carcinogenic health risks covered 21,390 m2 at the time of investigation, and were predicted to extend to 40,093 m2 after five years and to 53,488 m2 after 10 years. This study provides theoretical support for the protection of a dispersed drinking water source such as groundwater, and also helps the decision-making process for groundwater and soil environment improvement.

Hydrochemical Analysis and Fuzzy Logic Method for Evaluation of Groundwater Quality in the North Chengdu Plain, China.

Groundwater is a major water resource in the North Chengdu Plain, China. The research objective is to determine the quality and suitability of groundwater for drinking purposes within the vicinity of a shallow, unconsolidated aquifer of Quaternary age. In this study, a detailed investigation was conducted to define the hydrochemical characteristics that control the quality of groundwater, based on traditional methods. Considering the uncertainties linked with water resources and the environmental complications, the fuzzy logic method was used in the determination of groundwater quality for more precise findings that support decision-making. To achieve such an objective, sixteen water quality guidelines were used to determine groundwater quality status in six selected wells. The results showed that the groundwater is neutral, very hard, and fresh in nature. Dominating cations and anions are in the order of Ca 2 + > Na + > Mg 2 + > K + and HCO 3 - > SO 4 2 - > Cl - . The Piper trilinear diagram demonstrates that the hydrochemical facies of groundwater are mostly of Ca-HCO 3 type. Statistical analysis denotes a positive correlation between most of the chemical parameters. The study took the results of the fuzzy logic evaluation method into consideration, to classify the samples into five groups according to the Chinese groundwater quality standard (GB/T 14848-93) for their suitability for domestic use. The results demonstrated that the quality of the groundwater samples is within grade II and III, and is suitable for drinking purposes. The comprehensive evaluation of groundwater quality is critical to aid sensitive policy decisions, and the proposed approach can guarantee reliable findings to that effect. The results of this study would also be helpful to future researches related to groundwater quality assessment.

Effects of changes in the structural parameters of bionic straw sandwich concrete beetle elytron plates on their mechanical and thermal insulation properties.

To develop new, environmentally friendly prefabricated building materials, the effects of individual changes in structural parameters on the mechanical and thermal insulation properties of straw sandwich concrete beetle elytron plates (SCBEPs), i.e., sandwich plates with trabeculae constituting the core layer structure, were analyzed by ABAQUS. In addition, based on the analysis results, the structural parameters were preliminarily optimized. The results revealed the following. 1) The bearing capacity of a SCBEP is mainly controlled by deformation (i.e., the maximum deflection). The two most influencing factors on the deflection are the panel thickness T and the trabecular radius R. In contrast, although the panel area is very large, the influence of changing the panel thickness on the thermal insulation performance ranks only third. This demonstrates that the thermal bridge effect of the concrete trabeculae and edges is the primary limitation on further improvements to the thermal insulation performance of SCBEPs. 2) Based on the effects of individual changes in structural parameters on the performance of SCBEPs and their actual processing and application requirements, the structural parameters of a SCBEP with optimized mechanical properties and thermal insulation properties are determined. 3) Compared with aerated concrete wallboards, the optimized SCBEP has a higher rigidity, more compacted surface and better durability. Compared with straw concrete wallboards, the optimized SCBEP has a higher straw content and better thermal insulation performance. Thus, it provides a new avenue for the development of a new, lightweight wallboard.

The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia.

Obstetric fistula is a severe maternal morbidity which can have devastating consequences for a woman's life and is generally associated with poor obstetric services leading to prolonged obstructed labour. The predisposing factors and consequences of obstetric fistula differ from country to country and from community to community. The World Health Organization estimated that more than 2 million women in sub-Saharan Africa, Asia, the Arab region, Latin America, and the Caribbean are living with the fistula, and some 50,000 to 100,000 new cases develop annually with 30,000-90,000 new cases developing each year in Africa alone. This study aimed at describing and exploring the experiences of women living with obstetric fistulas following corrective surgery in Benadir and Mudug regions, Somalia. Women living with obstetric fistula who had surgical repairs at Daynile and GMC fistula centers and key informants were identified purposively. Twenty-one individual in-depth interviews among women with obstetric fistula and eight key informant interviews were conducted. Thematic analyses were used. Codes were identified, and those codes with similar connections were organized together as to form themes. Detailed reading and rereading of the transcribed interviews were employed in order to achieve and identify themes and categories. Themes, categories, and subcategories illustrating the experiences of women living with obstetric fistula emerged from the thematic analysis of individual in-depth and key informant interviews. These were challenges of living with OBF which include "wounds around genitalia, bad odour, incontinences of urine and feces, stigma, isolation, divorce, powerlessness, dependency, financial constraints, and loss of healthy years" and coping mechanisms which include "withdrawal from the community and improved personal hygiene." Women with obstetric fistula experience serious health and social consequences which prevents them fulfill social, family, and personal responsibilities. We recommend expansion of BEmONC services to underserved areas, capacity building for local OBF surgeons, and improved media campaign and birth preparedness at community levels.

Review of beetle forewing structures and their biomimetic applications in China: (I) On the structural colors and the vertical and horizontal cross-sectional structures.

This paper discusses the progress made in China in terms of the structural colors, microstructure and mechanical properties of the beetle forewing. 1) The forewing microstructures can be classified into six phases, the first three of which are characterized by sandwich, multilayer and fiber layer structures, respectively. The fracture behaviors resulting from these three phases suggest that different scale microstructures or coupled adjacent scale microstructures can determine the macroscopic mechanical behavior of the forewing. 2) The forewing colors are derived from three features: regulation of the structural parameters of the internal optical structures, i.e., a sculpted multilayer composite two-dimensional nanopillar structure grating system; scattering on the three-dimensional surface of the bowl-shaped structure; and reversible color changes due to changes in the physical microstructure of fluffs. Their formation mechanisms were clarified, and fibers with ecological biomimetic structural colors have been developed. 3) Beetles exhibit a lightweight sectional frame structure with a trabecular core structure. Both of the joints on the left and right are concave-convex butt-joint structures with burrs, which provide an efficient docking mechanism with high intensity. The forewing of dichotoma exhibits a non-equiangular layered structure, which results in anisotropy in its tensile strength. Finally, the authors propose potential new research directions for the next 20 years.

A near miss: case report and literature review.

We report a 28-week gestation premature infant with rare complication of endotracheal intubation. A piece from the plastic sheath of the stylet was retrieved inside the endotracheal tube after extubation.