The influences of street food vendor frying equipment on the quality of frying oil.

This study was initiated to determine the quality of fresh and used oil for street vendor fried food products in Harar City, Ethiopia. Using a purposive sample technique, 12 respondents were selected for the study. The study obtained a total of 12 oil samples, categorized as fresh, in-use, and discarded, from two distinct groups of respondents. Specifically, six samples were collected from vendors utilizing an electric fryer constructed from stainless steel, while the remaining six samples were acquired from vendors employing a pan heated by wood or charcoal.The moisture content of fresh, in-use, and discarded oil samples, among other physical characteristics of the samples obtained from two types of vendors, was examined and found to vary between 0.14 and 0.44%, 0.19 and 0.52%, and 0.25 and 0.75%, respectively. Comparably, the refractive indices of oil samples that were fresh, in use, and discarded were 1.4595-1.4686, 1.4670-1.4885, and 1.4810-1.4960, in that order. Furthermore, the ranges of viscosities for fresh oil, oil samples in use, and oil samples that were discarded were 57.15-76.94, 100-196.50, and 210.22-288.50 mPa, respectively. Chemical properties, including % free fatty acid for similar samples, range from 0.22 to 1.30, 1.12 2.54, and 1.38-3.66%, respectively. Peroxide values of fresh, in-use, and discarded oil samples, have a maximum value of 11.19 meq/kg, 42.90, and 57.60 meq/kg, respectively. The iodine value showed the highest value for the fresh oil sample, while the minimum was obtained under discarded oil sample. The result indicated that they used low-quality oil. The values obtained after frying for samples collected from vendors who used a pan fryer heated with charcoal or wood fire deviated significantly from the requirements, indicating that the palm oil used by those street vendors was unsafe to consume because it could endanger the consumers' health.

Improving Documentation of Pain Reassessment after Pain Management Interventions in the NICU.

Background: Neonates exposed to painful procedures require pain assessment and reassessment using nonverbal scales. Nurses perform initial assessments routinely, but reassessment is variable. The goal was to increase pain reassessments in neonates with a previous score of 4 or higher within 60 minutes from 50% to 75% within 12 months. Methods: After identifying key drivers, we tested several interventions using the IHI's Model for Improvement. The outcome measure was the rate of reassessments within 1 hour after scoring ≥4 on the Neonatal Pain Agitation and Sedation Scale (N-PASS). Duration of time between scoring and intervention was documented. Interventions included electronic health record (EHR) changes, direct communication with bedside nurses through text messages and emails, in-person education, and a yearly competency module. The process measure was the number of messages/emails to staff. Sedation scores were the balancing measure. Results: Baseline compliance was 50% with significant variability. A centerline shift occurred after the first intervention. After the first four interventions in the following 3 months, a 29% total increase occurred. Overall time-lapse between reassessments decreased from 102 to 90 minutes. Overall sedation scores decreased from -2.5 during the baseline to -1.7 during the sustain period. The goal of 75% pain reassessments was achieved and sustained for two years. Conclusions: Automated tools such as the trigger report provided data that increased noncompliance visibility. Real-time and personalized reminders and education improved awareness and set the tone for culture change. Electronic health record reminders for reassessments and standardized annual education helped in sustaining change.

Correction: Two-test algorithms for infectious disease diagnosis: Implications for COVID-19.

[This corrects the article DOI: 10.1371/journal.pgph.0000293.].

Advanced modeling and optimizing for surface sterilization process of grape vine (Vitis vinifera) root stock 3309C through response surface, artificial neural network, and genetic algorithm techniques.

In vitro, sterilization is one of the key components for proceeding with plant tissue cultures. Since the effectiveness of sterilization has a direct impact on the culture's final outcomes, there is a crucial need for optimization of the sterilization process. However, compared with traditional optimizing methods, the use of computational approaches through artificial intelligence-based process modeling and optimization algorithms provides a precise optimal condition for in vitro culturing. This study aimed to optimise in vitro sterilization of grape rootstock 3309C using RSM, ANN, and genetic algorithm (GA) techniques. In this context, two output responses, namely, Clean Culture and Explant Viability, were optimised using the models developed by RSM and ANN, followed by a GA, to obtain a globally optimal solution. The most influential independent factors, such as HgCl2, NaOCl, AgNO3, and immersion time, were considered input variables. The significance of the developed models was investigated with statistical and non-statistical techniques and was optimised to determine the significance of selected inputs. The optimal clean culture of 91%, and the explant viability of 89% can be obtained from 1.62% NaOCl at a 13.96 min immersion time, according to MLP-NSGAII. Sensitivity analysis revealed that the clean culture and explant viability were less sensitive to AgNO3 and more sensitive to immersion time. Results showed that the differences between the GA predicted and validation data were significant after the performance validation of predicted and optimised sterilising agents with immersion time combinations were tested. In general, GA, a potent methodology, may open the door to the development of new computational methods in plant tissue culture.

Value of Verbal Autopsy in a Fragile Setting: Reported versus Estimated Community Deaths Associated with COVID-19, Banadir, Somalia.

BACKGROUND: Accurate mortality data associated with infectious diseases such as coronavirus disease 2019 (COVID-19) are often unavailable in countries with fragile health systems such as Somalia. We compared officially reported COVID-19 deaths in Somalia with COVID-19 deaths estimated using verbal autopsy. METHODS: We interviewed relatives of deceased persons to collect information on symptoms, cause, and place of death. We compared these data with officially reported data and estimated the positive and negative predictive values of verbal autopsy. RESULTS: We identified 530 deaths during March-October 2020. We classified 176 (33.2%) as probable COVID-19 deaths. Most deaths (78.5%; 416/530) occurred at home and 144 (34.6%) of these were attributed to COVID-19. The positive predictive value of verbal autopsy was lower for home deaths (22.3%; 95% CI: 15.7-30.1%) than for hospital deaths (32.3%; 95% CI: 16.7-51.4%). The negative predictive value was higher: 97.8% (95% CI: 95.0-99.3%) for home deaths and 98.4% (95% CI: 91.5-100%) for hospital deaths. Conclusions Verbal autopsy has acceptable predictive value to estimate COVID-19 deaths where disease prevalence is high and can provide data on the COVID-19 burden in countries with low testing and weak mortality surveillance where home deaths may be missed.

A Customized Triggers Program: A Children's Hospital's Experience in Improving Trigger Usability.

BACKGROUND: Despite the growth of patient safety programs across the United States, errors and adverse events remain a source of patient harm. Many hospitals rely on retrospective voluntary reporting systems; however, there are opportunities to improve patient safety using novel tools like trigger programs. METHODS: Children's National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events. Our team defined a measure to quantify clinical utility of triggers, termed "trigger signal," as the percentage of cases that represent true adverse or near-miss events (numerator) per total triggers activated (denominator). Our key driver diagram focused on unifying the program structure, increasing data analytics, promoting organizational awareness, and supporting multidisciplinary end user engagement. Using the model for improvement, we aimed to double overall trigger signal from 8% to 16% and sustain for 12 months. RESULTS: The trigger signal increased from 8% to 41% and sustained during the coronavirus disease 2019 pandemic. A balancing measure of time to implement a new trigger decreased. Key interventions to increase trigger signal were change in the program structure, increasing stakeholder engagement, and development of self-service reports for end users. CONCLUSIONS: Children's National Hospital's triggers program highlights successful evolution of an iterative, customized approach to increase clinical utility that hospitals can implement to impact real-time patient care. This triggers program requires an iterative, customized approach rather than a "1-size-fits-all," static paradigm to add a new dimension to current patient safety programs.

Evaluation of the electronic Early Warning and Response Network (EWARN) system in Somalia, 2017-2020.

BACKGROUND: In 2008, Somalia introduced an electronic based Early Warning Alert and Response Network (EWARN) for real time detection and response to alerts of epidemic prone diseases in a country experiencing a complex humanitarian situation. EWARN was deactivated between 2008 to 2016 due to civil conflict and reactivated in 2017 during severe drought during a cholera outbreak. We present an assessment of the performance of the EWARN in Somalia from January 2017 to December 2020, reflections on the successes and failures, and provide future perspectives for enhancement of the EWARN to effectively support an Integrated Disease Surveillance and Response strategy. METHODS: We described geographical coverage of the EWARN, system attributes, which included; sensitivity, flexibility, timeliness, data quality (measured by completeness), and positive predictive value (PPV). We tested for trends of timeliness of submission of epidemiological reports across the years using the Cochran-Mantel-Haenszel stratified test of association. RESULTS: By December 2020, all 6 states and the Banadir Administrative Region were implementing EWARN. In 2017, only 24.6% of the records were submitted on time, but by 2020, 96.8% of the reports were timely (p < 0.001). Completeness averaged < 60% in all the 4 years, with the worst-performing year being 2017. Overall, PPV was 14.1%. Over time, PPV improved from 7.1% in 2017 to 15.4% in 2019 but declined to 9.7% in 2020. Alert verification improved from 2.0% in 2017 to 52.6% by 2020, (p < 0.001). In 2020, EWARN was enhanced to facilitate COVID-19 reporting demonstrating its flexibility to accommodate the integration of reportable diseases. CONCLUSIONS: During the past 4 years of implementing EWARN in Somalia, the system has improved significantly in timeliness, disease alerts verification, and flexibility in responding to emerging disease outbreaks, and enhanced coverage. However, the system is not yet optimal due to incompleteness and lack of integration with other systems suggesting the need to build additional capacity for improved disease surveillance coverage, buttressed by system improvements to enhance data quality and integration.

Two-test algorithms for infectious disease diagnosis: Implications for COVID-19.

Diagnostic assays for various infectious diseases, including COVID-19, have been challenged for their utility as standalone point-of-care diagnostic tests due to suboptimal accuracy, complexity, high cost or long turnaround times for results. It is therefore critical to optimise their use to meet the needs of users. We used a simulation approach to estimate diagnostic outcomes, number of tests required and average turnaround time of using two-test algorithms compared with singular testing; the two tests were reverse transcription polymerase chain reaction (RT-PCR) and an antigen-based rapid diagnostic test (Ag-RDT). A web-based application of the model was developed to visualise and compare diagnostic outcomes for different disease prevalence and test performance characteristics (sensitivity and specificity). We tested the model using hypothetical prevalence data for COVID-19, representing low- and high-prevalence contexts and performance characteristics of RT-PCR and Ag-RDTs. The two-test algorithm when RT-PCR was applied to samples negative by Ag-RDT predicted gains in sensitivity of 27% and 7%, respectively, compared with Ag-RDT and RT-PCR alone. Similarly, when RT-PCR was applied to samples positive by Ag-RDT, specificity gains of 2.9% and 1.9%, respectively, were predicted. The algorithm using Ag-RDT followed by RT-PCR as a confirmatory test for positive patients limited the requirement of RT-PCR testing resources to 16,400 and 3,034 tests when testing a population of 100,000 with an infection prevalence of 20% and 0.05%, respectively. A two-test algorithm comprising a rapid screening test followed by confirmatory laboratory testing can reduce false positive rate, produce rapid results and conserve laboratory resources, but can lead to large number of missed cases in high prevalence setting. The web application of the model can identify the best testing strategies, tailored to specific use cases and we also present some examples how it was used as part of the Access to Covid-19 Tools (ACT) Accelerator Diagnostics Pillar.

Evaluation of the mineral content, phyto-chemicals profile and microbial quality of tef injera supplemented by fenugreek flour.

Fenugreek is one of the well-known spices, used for its antioxidant, antimicrobial, pharmaceutical and nutritional properties. Information on fenugreek seed flour blend with teff for a bakery product is scanty. This study was initiated to evaluate the effect of substitution of teff flour with fenugreek seed flours on the mineral, phyto-chemicals and microbiological quality of produced injera. Teff-fenugreek composite injera samples were prepared by substituted teff flour with 4, 8, 12, and 16% fenugreek seed flours (raw, roasted and germinated). Teff injera substituted with fenugreek (raw, roasted and germinated) at 4, 8, 12 and 16% substituted injera showed a significant (P < 0.05) effect on Ca content, selected phyto-chemicals and microbial quality of injera. Fenugreek seed flour substitution increased in Zinc, condensed tannin and total Phenol contents were observed in fenugreek substituted injera samples whereas phytic acid, calcium and Fe content were decreased as compared to control injera sample. During the storage days, yeast- mold and total aerobic plate counts were lowest in fenugreek substituted injera samples. Raw fenugreek substituted injera had higher microbial stability than germinated and roasted fenugreek substituted injera. The 16% fenugreek-substituted injera showed good in zinc, phyto-chemicals and microbial stability of injera.

Physicochemical Properties and Effect of Processing Methods on Mineral Composition and Antinutritional Factors of Improved Chickpea (Cicer arietinum L.) Varieties Grown in Ethiopia.

Chickpea (Cicer arietinum L.) is an important pulse crop grown and consumed all over the world because it is a good source of carbohydrates and protein. However, presence of antinutritional components restricts its use by interfering with digestion of macronutrients during consumption. Therefore, the objective of this study was to evaluate physicochemical properties and effect of processing methods on antinutritional factors and mineral composition of improved chickpea varieties (Natoli of Desi and Arerti of Kabuli) grown in Ethiopia. The experiment was factorial with complete randomized design. The result indicated that physicochemical properties such as seed mass, seed density, hydration capacity, swelling capacity, unhydrated seeds, and cooking time of Arerti and Natoli chickpeas had 260.69 and 280.65 g/1000 seeds, 3.48 and 3.61g/ml, 1.07 and 1.03 g/g, 2.12 and 1.94ml/g, 1.64 and 14.75%, and 21.00 and 246.33 min, respectively. After processing, Zn, Fe, and Ca contents of improved chickpea varieties had 4.48 to 5.85mg/kg, 8.52 to 10.17mg/kg, and 536.56 to 1035mg/kg, respectively. The antinutritional factors, tannin and phytic acid, in the raw chickpeas were reduced to 25 to 82.25% and 5.89 to 57.35%, respectively. The results of the current study showed that Arerti of Kabuli variety showed low antinutritional factors and better physicochemical properties, specifically low cooking time, than Natoli of Desi variety. All processing methods were effective in reduction of antinutritional factors; however, boiling was found to be the best for reduction of antinutritional factors.

Nutritional quality of Oyster Mushroom (Pleurotus Ostreatus) as affected by osmotic pretreatments and drying methods.

This study was conducted to evaluate the effects of different levels of osmotic pretreatments prior to drying and different drying methods on nutritional quality of dried mushroom slices. The experiment consisted of sun, solar, and oven drying after dipping the slices in salt solutions of 5 and 10% concentrations for 50 minutes, the control being untreated mushroom sample. Significant differences in proximate composition were observed between the fresh and dried mushroom samples. The average mean value of crude protein, crude fat, crude fiber, ash, and carbohydrates of the fresh mushroom samples were 28.85, 2.47, 12.87, 9.76 and 48.16% as compared to 25.91, 2.18, 10.41, 10.91 and 42.14% for dried samples. Oven drying resulted in higher content of ash (11.06%) and carbohydrates (43.64%) and lower contents of crude protein (24.99%), crude fat (2.12%), and crude fiber (10.21%). The osmotic pretreatments significantly affected the composition of the dried mushroom samples. As salt concentration increased from 0 to 5 and 10%, the protein content reduced from 26.78 to 25.99 and 24. 95%, the fat reduced from 2.42 to 2.19 and 1.94, and fiber from 12.82 to 9.41 and 9.01%, respectively. Contrarily, the ash increased from 9.75 to 12.20%, and the carbohydrate from 38.16 to 43.08 and 45.18%, respectively.

Seroprevalence of Toxoplasma gondii and associated risk factors among pregnant women in Jimma town, Southwestern Ethiopia.

BACKGROUND: Toxoplasmosis is a common parasitic infection caused by an obligate intracellular protozoan, Toxoplasma gondii. If primary toxoplasmosis occurs during pregnancy about one third of the cases could lead to congenital toxoplasmosis, with subsequent pathological effects. This study aimed at determining the seroprevalence of T. gondii among pregnant women in Jimma town, Southwest Ethiopia. METHODS: A community based cross-sectional study was conducted to assess the seroprevalence and associated factors in pregnant women from August to September, 2011. A total of 201 study participants were included in this study. Data on socio-demographic and predisposing factors were collected from each study participant. Moreover, venous blood specimens were collected following Standard Operating Procedures. All the collected specimens were tested for IgM and IgG anti-T. gondii antibodies by enzyme-linked immunosorbent assay (ELISA). RESULTS: The overall seroprevalence of T. gondii in the study area was 83.6%. One hundred and sixty three (81.1%) of the pregnant women were IgG seropositive, five (2.5%) were IgM seropositive. Three of the 5 pregnant women were positive for both IgG and IgM. Presence of domestic cat at home showed significant association with anti-T. gondii seropositivity (OR = 5.82, 95% CI: 1.61- 20.99; p < 0.05). CONCLUSION: The seroprevalence of T. gondii antibodies was high among the pregnant women. Pregnant women having domestic cat at their home were at higher risk of T. gondii infection. Hence, health education and awareness on the disease and its transmission to women of reproductive age group in general and pregnant women in particular should be created during antenatal follow up to reduce the risk of T. gondii infection in pregnant women.

Association of Hepatitis C Virus Infection with Type II Diabetes in Ethiopia: A Hospital-Based Case-Control Study.

Background. Chronic hepatitis C virus (HCV) has become the global "epidemic" with an estimated 123 million people currently infected worldwide. As the same time diabetes is also rapidly emerging as a global health care problem that threatens to reach pandemic levels by 2030. Objective. To investigate the magnitude of HCV infection in type II diabetes as compared to controls. Methodology. A case control study design was conducted at Jimma University Specialized Hospital from May to June 2010. A total of 604 study subjects were included in this study. Sociodemographic and risk factor data were collected by questionnaire. From serum sample, HCVAb screening was done by rapid antibody screening test. Liver functioning tests and total cholesterol tests were done by Dr. Lange LP 800 spectrophotometer. Results. The prevalence of HCV in type II diabetes and nondiabetic controls was 9.9% and 3.3%, respectively. In multivariate analysis, HCV seropositives have high risk of developing diabetes as compared with seronegatives (AOR = 2.997, 95% CI: (1.08, 8.315)). Conclusion. In this study, we found a positive association between past HCV infection and type II diabetes. As we did not perform HCV RNA test, we could not assess the association with HCV viremia.

Smear Posetive Pulmonary Tuberculosis (PTB) Prevalence Amongst Patients at Agaro Teaching Health Center, South West Ethiopia.

BACKGROUND: World Health organization (WHO) declared tuberculosis as a global emergency because it poses a serious public health threat in different countries especially, in Africa. According to WHO report of 2007, Directly Observed Treatment Short course (DOTS) coverage in Ethiopia reached 95 percent of the population; despite this fact the trend of tuberculosis in most of the districts of Ethiopia is not known. Hence, this study has revealed the trend and determined the overall prevalence of smear positive pulmonary tuberculosis in five years (2005/6-2009/10) in Agaro teaching health center, south west Ethiopia. METHODS: A retrospective study based on record review was conducted at Agaro Teaching Health center on sputum examination record of patient's from 2005/6-2009/10(five years). Socio demographic data and sputum laboratory results were collected using pre-designed questionnaire and the data was entered into a computer using SPSS version 16 for windows. Finally, cross tab analysis and Chi-square was calculated at P-value less than 0.05 to check possible association between socio-demographic variables and smear positivity. RESULTS: The overall five years prevalence of smear positive pulmonary tuberculosis was found out to be 10.9%. On the other hand, the percentage of smear positive pulmonary tuberculosis cases showed gradual decrease from 19.5% in 2005/6 to 5.8% cases in 2009/10. CONCLUSION: Tuberculosis is still the major problem of Agaro health center catchment area even though there is a decrease in trend from year to year. Hence, the respective health bureau and other stake holders should still need to strengthen their effort to control it.

Oral health status of patients with mental disorders in southwest Ethiopia.

BACKGROUND: Psychiatric disorders are known to be a risk factor for the development of different oral health problems especially for dental caries and periodontal diseases. In spite of this fact, no study has been conducted to reveal its magnitude in Ethiopia. Hence, this study was conducted to determine the oral health status of psychiatric patients at Jimma University Specialized Hospital (JUSH), Psychiatric Clinic. METHODS: A hospital based cross- sectional study was used from January to May 2011. A total of 240 participants were included in the study. Dental examination was done to measure indices of oral health: decayed, missing, and filled teeth (DMFT) index and community periodontal index (CPI). Oral examination was performed using mirror, probe and explorer by experienced dental doctors. A simple random sampling technique was implemented to collect data. ANOVA test, binary logistic and multinomial logistic regression analyses were done using SPSS 16.0 statistical software. RESULTS: The mean DMFT score among the psychiatric patients was 1.94 ± 2.12 (mean ± SD) with 1.28 ± 1.69, 0.51 ± 1.19 and 0.14 ± 0.48 (mean ± SD) for decayed, missed and filled teeth respectively. Only about 24% of the psychiatric patients had a healthy CPI score. Incorrect tooth brushing technique was significantly associated with a DMFT score greater than 2 (AOR = 3.58; 95% CI: 1.65, 7.79). The habit of sweet intake was also associated with dental caries (AOR = 2.91; 95% CI: 1.43, 5.95). Similarly, patients with a smoking habit also demonstrated statistically significant association with dental caries (AOR = 18.98; 95% CI: 5.06, 71.24). CONCLUSION: The oral health status of the psychiatric patients was poor. Thus, health education about oral hygiene should be given for psychiatric patients so they can avoid the frequent intake of sweets, smoking and learn correct tooth brushing technique.

M. tuberculosis in Lymph Node Biopsy Paraffin-Embedded Sections.

Background. Tuberculosis lymphadenitis is one of the most common forms of all extrapulmonary tuberculosis. Objective. To evaluate the magnitude of M. tuberculosis from lymph node biopsy paraffin-embedded sections among suspected patients visiting the Jimma University Specialized Hospital. Method. A cross-sectional study design of histological examination among lymph node biopsy paraffin-embedded sections by Ziehl-Neelsen and hematoxylin/eosin staining technique was conducted from December, 2009, to October, 2010, at the Department of Medical Laboratory Science and Pathology. Result. Histopathological examination of the specimens by hematoxylin and eosin staining technique revealed the presence of granulomas. But for the caseation and necrosis they were present in 85% cases of nodal tissue biopsies. From those, 56.7% were from females. The presence of acid-fast bacilli was microscopically confirmed by ZN staining in 37 (61.7%) of the nodal tissue biopsies. Conclusion and Recommendation. Tuberculosis lymphadenitis is significantly more common in females. Hence, attention should be given for control and prevention of extrapulmonary tuberculosis.