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Antimicrobials are the most frequently prescribed drug in pediatrics, with an estimated 37% of infants and 61% of hospitalized children having received them. Approximately 20–50% of prescriptions have been shown to be potentially unnecessary or inappropriate. The World Health Organization (WHO) estimates that the continued increase in antimicrobial resistance by the year 2050 will lead to the death of 10 million people per year. This paper describes a protocol to be used in a future study to evaluate the implementation of a quarterly syndromic antibiogram, aimed to improve the use of antibiotics for the treatment of pediatric bacterial infections at the Maputo Central Hospital, Mozambique. This study uses implementation science methods framed by the Dynamic Adaption Process (DAP) and RE-AIM conceptual frameworks to develop a multi-phase, mixed-methods evaluation utilizing qualitative and quantitative approaches. The pediatric inpatient services at HCM consist of approximately 18 physicians and 60 nurses. Additionally, the microbiology laboratory consists of eight laboratory technicians. We anticipate analyzing approximately 9,000 medical records. Qualitative methods include in-depth interviews with clinicians, laboratory technicians, and administrators to explore current knowledge and practices around antibiotic decision making, facilitators and barriers to intervention implementation, as well as acceptability and satisfaction with the intervention roll-out. Qualitative analysis will be performed with NVivo 12 software. Quantitative methods include extracting data from existing records from the pediatric ward of Hospital Central de Maputo (HCM) guided by the RE-AIM framework to explore intervention utilization and other factors influencing its implementation. Quantitative descriptive and inferential statistical analysis will be performed using R Studio statistical software. The findings from this evaluation will be shared with hospital administrators and relevant national policymakers and may be used by the Ministry of Health in deciding to expand this approach to other hospitals. The expected results of this research include the development of standard operating guidelines for the creation, distribution, and use of a quarterly syndromic antibiogram for antibiotic decision making that is informed by local epidemiology. Findings from this study will be used to develop a larger multi-site trial in Mozambique.

This study aimed to assess the effect of betaine supplementation on the proteomic profile of the longissimus thoracis muscle in finishing pigs. Thirty-six crossbred female pigs (initial body weight = 88.96 ± 3.48 kg) were allocated in a completely randomized experimental design with two dietary treatments, with nine replications per treatment and two pigs per replication. The experimental diets consisted of a control diet (CON) and the CON diet supplemented with 2.5 g/kg of betaine (BET). At the end of the trial, one pig per unit was slaughtered, and longissimus thoracis (LT) muscle samples were analyzed via mass spectrometry to identify differentially abundant proteins (DAPs). Additionally, the intramuscular fat (IMF) content in the LT muscle was evaluated. Network analyses were performed to identify the biological processes and KEGG pathways. Results indicated that eleven DAPs were down-regulated ( q -Value < 0.05) in the BET group compared to the CON group. Most DAPs were associated with carbohydrate metabolism, indicating that betaine may modulate cellular energy metabolism. These proteins were involved in glycolysis, glycogenolysis, the pentose phosphate pathway, and the glucagon signaling pathway. Moreover, pigs in the BET group had higher (P = 0.02) IMF compared to the CON group. In conclusion, betaine supplementation in finishing pigs down-regulated proteins related to carbohydrate metabolism in skeletal muscle, suppressed glucose metabolic processes and carbohydrate catabolic processes. These findings indicate alterations in glucose flow, possibly favoring other metabolic pathways, such as the pentose phosphate pathway. Furthermore, betaine supplementation increased IMF deposition and improved meat tenderness.

Background Intraventricular hemorrhage (IVH) is one of the critical complications of prematurity with severe forms, associated with irreversible brain damage. We hypothesized that infants born in South Africa may have different modifiable risk factors and outcomes for severe IVH compared to that reported in studies in neonatal populations in higher resource settings. Our study aimed to define the prevalence of IVH with further characterization of risk factors based on IVH severity, with the goal of providing guidance on modification of protocols for the management and prevention of severe IVH. Methods This was a retrospective cohort study of very low birth weight infants admitted to the NICU of Charlotte Maxeke Academic Hospital in Johannesburg (CMJAH) from January 1, 2016, to December 31, 2020. Our study included all infants, weighing less than 1500 g, admitted to the hospital regardless of place of birth who had had at least one cranial ultrasound in the first week of life. Infants with other intracranial malformations than IVH, birth weights greater than 1500 g, and significant amount of missing data were excluded from the study. Maternal and neonatal information were extracted from an existing neonatal database and analyzed using R statistical software. Multivariable logistic regressions were used to investigate risk factors associated with increased odds of having IVH and its impact on mortality. Results A total of 2,217 very low birthweight (VLBW) infants admitted to the NICU at CMJAH during the study period met eligibility criteria. Median gestational age (GA) and birth weight (BW) were 28 weeks and 900 g, respectively. IVH prevalence was 22.6% with high grade IVH (grade 3 or 4) accounting for 6.8% of the cases. Infants with high grade IVH had 4-fold increase odds of dying (OR = 4.843, 95% CI = 2.984; 7.86, p  < 0.001). Acidosis was associated with increased odds of high grade IVH (OR = 2.27; 95%CI: 1.42; 3.64). Similarly, infants with early onset sepsis had higher odds of high grade IVH (OR = 2.22; 95%CI: 1.04; 4.75). Conclusions Acidosis and sepsis had a significant association with the occurrence of severe IVH. Antenatal steroids showed an association with occurrence and severity suggesting it may play an important role, but did not reach significance so must be further evaluated. Having severe IVH substantially increased the odds of death. Based on these findings, future directions could include collaborative QI projects with obstetricians to improve uptake of antenatal steroids and promotion of neonatology led QI projects to reduce risk factors associated with severe IVH.

From the outset of the COVID-19 pandemic, guidance from WHO has promoted social distancing, wearing face masks, frequent hand washing, and staying-at-home as measures to prevent the spread of COVID-19. For many across Africa, compliance can be difficult. The aim of this study was to 1) understand the impact of student's household's ability to comply with COVID-19 mitigation strategies, 2) identify predictors of mitigation strategy compliance, and 3) describe the impact of COVID-19 on household economics, food-security, and mental well-being. We conducted an email-based survey among current medical and pharmacy students of the University of Liberia College of Health Sciences between July and October 2020. The questionnaire was designed to explore their household's ability to comply with current mitigation strategies, as well as the pandemic´s impact on the student's household's finances and food security. Descriptive statistics were used to delineate demographic characteristics. Logistic regression was used to model factors associated with ability to comply with COVID-19 mitigation strategies, as well as participant's food security. 113 persons responded to the questionnaire. Seventy-six (67∙3%) reported income losses as a result of the pandemic, with 93 (82∙3%) reporting being \"somewhat\" or \"very worried\" about their households' finances. Seventy-seven (68∙1%) participants reported food stocks that were sufficient for one-week or less. Forty (35%) participants reported eating less preferred foods or skipping meals in the past week. Overall, 20 participants (19∙4%) had a positive depression screen. Study participants showed mixed results in being able to adhere to national COVID-19 mitigation strategies, with household level stressors experienced around finances and food security. Until Liberia has access to vaccinations for most of its citizens, COVID-19 response measures need to provide social protections that address basic needs (shelter, clothing and food), and which specifically targets food insecurity. Preventative interventions for mental health problems must be incorporated into Liberia's response to the pandemic.

The irrational use of antibiotics to treat infections in children is a crucial contributing factor to bacterial antimicrobial resistance (AMR), which can have economic and health consequences, such as morbidity and mortality. This study aims to evaluate antibiotic use and AMR in children under five years of age in Sierra Leone. This study will be conducted in three hospitals: Ola During Children, Kenema Government, and Magburaka Government Hospitals in Sierra Leone, among healthcare professionals and patients. A mixed-method (qualitative and quantitative) approach will be used to evaluate paediatric health professionals' knowledge, perceptions, and antibiotic prescription practices. Additionally, two cross-sectional sub-studies will assess inpatient and outpatient trends in antibiotic use and consumption in children, and a cross-sectional observational sub-study will investigate bacterial profiles and AMR among children with bloodstream infections. The anatomical therapeutic chemical (ATC) and the World Health Organisation Access, Watch and Reserve (WHO AWaRe) classifications, days of therapy per 1,000 patient days (DOT/1000PDs), and days of therapy per 100 bed days (DOT/100BDs) will be used to determine the use and consumption. The DOT/1,000PDs and DOT/100BDs will be compared with the defined daily dose/1,000 patient days (DDD/1000PDs) and defined daily dose/100 bed days (DDD/100BDs), respectively. A pre-tested interview guide, interviewer-administered questionnaire and data collection tools adapted from previous studies will be employed for data collection. The sample sizes will be determined, and appropriate sampling methods will be used. Data will be analysed thematically using NVivo 15, and descriptive and inferential statistics using the R software. The results of this study will inform policymakers and healthcare professionals in developing and/or implementing policies, guidelines, and educational initiatives that will promote antibiotic stewardship among children in Sierra Leone.

Patient satisfaction with clinical services can have an effect on retention in HIV care and adherence to antiretroviral therapy. This study assessed patient satisfaction and its association with retention and viral suppression in Zambézia Province, Mozambique. Monthly exit interviews with persons living with HIV were completed from August 2017-January 2019 in 20 health facilities; clinical data were extracted from medical records. Regression analyses assessed the effect of satisfaction scores on retention and viral suppression, adjusting for age, sex, education, civil status, time on treatment, and site. Satisfaction scores were correlated with time spent at health facilities using generalized linear regression models. Data from 4388 patients were analyzed. Overall median satisfaction score was 75% (IQR 53%-84%); median time spent at facilities (from arrival until completion of clinical services) was 2h54min (IQR 1h48min-4h). Overall satisfaction score was not associated with higher odds of retention or viral suppression, but association was seen between satisfaction regarding attention given to patient and respect and higher odds of viral suppression. Patient satisfaction was negatively associated with time spent in facility (Spearman's correlation -0.63). Increased time spent at facility (from 1 to 3 hours) was not associated with lower retention in care (OR 0.72 [95%CI:0.52-1.01] and 0.83 [95%CI: 0.63-1.09] at 6- and 12-months, respectively), nor with a lower odds of viral suppression (OR 0.96 [95%CI: 0.71-1.32]). Strategies to reduce patient wait times at the health facility warrant continued prioritization. Differentiated models of care have helped considerably, but novel approaches are still needed to further decongest crowded health facilities. In addition, a good client-provider communication and positive attitude can improve patient satisfaction with health services, with an overall improved retention.

Assessing different levels of red gum lerp psyllid (Glycaspis brimblecombei) can influence the hyperspectral reflectance of leaves in different ways due to changes in chlorophyll. In order to classify these levels, the use of machine learning (ML) algorithms can help process the data faster and more accurately. The objectives were: (I) to evaluate the spectral behavior of the G. brimblecombei attack levels; (II) find the most accurate ML algorithm for classifying pest attack levels; (III) find the input configuration that improves performance of the algorithms. Data were collected from a clonal eucalyptus plantation (clone AEC 0144—Eucalyptus urophilla) aged 10.3 months old. Eighty sample evaluations were carried out considering the following severity levels: control (no shells), low infestation (N1), intermediate infestation (N2), and high infestation (N3), for which leaf spectral reflectances were obtained using a spectroradiometer. The spectral range acquired by the equipment was 350 to 2500 nm. After obtaining the wavelengths, they were grouped into representative interval means in 28 bands. Data were submitted to the following ML algorithms: artificial neural networks (ANN), REPTree (DT) and J48 decision trees, random forest (RF), support vector machine (SVM), and conventional logistic regression (LR) analysis. Two input configurations were tested: using only the wavelengths (ALL) and using the spectral bands (SB) to classify the attack levels. The output variable was the severity of G. brimblecombei attack. There were differences in the hyperspectral behavior of the leaves for the different attack levels. The highest attack level shows the greatest distinction and the highest reflectance values. LR and SVM show better accuracy in classifying the severity levels of G. brimblecombei attack. For the correct classification percentage, the RL and SVM algorithms performed better, both with accuracy above 90%. Both algorithms achieved F-score values close to 0.90 and above 0.8 for Kappa. The entire spectral range guaranteed the best accuracy for both algorithms.

Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra Leone, during the second year of the SARS-CoV-2 pandemic. We conducted a prospective study of children hospitalized with respiratory symptoms between October 2020 and October 2021. We collected demographic and clinical characteristics and calculated each participant´s respiratory symptom severity. Nose and throat swabs were collected at enrollment. Total nucleic acid was purified and tested for multiple respiratory viruses. Statistical analysis was performed using R version 4.2.0 software. 502 children less than two-years of age were enrolled. 376 (74.9%) had at least one respiratory virus detected. The most common viruses isolated were HRV/EV (28.2%), RSV (19.5%) and PIV (13.1%). Influenza and SARS-CoV-2 were identified in only 9.2% and 3.9% of children, respectively. Viral co-detection was common. Human metapneumovirus and RSV had more than two-fold higher odds of requiring O2 therapy while hospitalized. Viral pathogen prevalence was high (74.9%) in our study population. Despite this, 100% of children received antibiotics, underscoring a need to expand laboratory diagnostic capacity and to revisit clinical guidelines implementation in these children. Continuous surveillance and serologic studies among more diverse age groups, with greater geographic breadth, are needed in Sierra Leone to better characterize the long-term impact of COVID-19 on respiratory virus prevalence and to better characterize the seasonality of respiratory viruses in Sierra Leone.

ABSTRACT Objectives: to identify in scientific literature which simulated clinical scenarios were developed and validated for teaching and learning in nursing. Methods: integrative review, carried out in seven sources of information. The Rayyan program was used for selection, content analysis to explore the findings and the methodological assessment tool of the validity process, entitled Quality Appraisal tool for Validity Studies. Results: initially, 1,179 manuscripts were identified and 14 were part of the sample. Two categories were defined: Profile of simulated clinical scenarios produced in nursing; and Clinical skills developed and their assessment mechanisms. Final Considerations: there was a preponderance of high-fidelity scenarios, built in Brazil in the last five years, aimed at nursing students on the themes of emergency, maternal care and stomatherapy, addressing the assessment of cognitive, psychomotor and affective skills in nursing. Most studies obtained good methodological quality in their content validity process. RESUMO Objetivos: identificar na literatura científica quais os cenários clínicos simulados desenvolvidos e validados para o ensino e aprendizagem em enfermagem. Métodos: revisão integrativa, realizada em sete fontes de informação. Utilizaram-se o programa Rayyan para seleção, a análise de conteúdo para exploração dos achados e a ferramenta de avaliação metodológica do percurso de validação, intitulada Avaliação da Qualidade para Estudos de Validade. Resultados: identificaram-se, inicialmente, 1.179 manuscritos e 14 compuseram a amostra. Definiram-se duas categorias: Perfil dos cenários clínicos simulados produzidos em enfermagem; e Habilidades clínicas desenvolvidas e seus mecanismos de avaliação. Considerações Finais: houve preponderância de cenários de alta fidelidade, construídos no Brasil, nos últimos cinco anos, voltados a estudantes de enfermagem sobre as temáticas da urgência e emergência, cuidado materno e estomaterapia, abordando a avaliação das habilidades cognitivas, psicomotoras e afetivas em enfermagem. A maioria dos estudos obteve boa qualidade metodológica em seu processo de validação de conteúdo. RESUMEN Objetivos: identificar en la literatura científica qué escenarios clínicos simulados fueron desarrollados y validados para la enseñanza y el aprendizaje en enfermería. Métodos: revisión integradora, realizada en siete fuentes de información. Se utilizó el programa Rayyan para la selección, el análisis de contenido para explorar los hallazgos y la herramienta de evaluación metodológica del proceso de validación, denominada Quality Appraisal tool for Validity Studies. Resultados: inicialmente se identificaron 1.179 manuscritos y 14 formaron parte de la muestra. Se definieron dos categorías: Perfil de escenarios clínicos simulados producidos en enfermería; y Habilidades clínicas desarrolladas y sus mecanismos de evaluación. Consideraciones Finales: hubo predominio de escenarios de alta fidelidad, construidos en Brasil en los últimos cinco años, dirigidos a estudiantes de enfermería sobre las temáticas de urgencia y emergencia, cuidado materno y estomaterapia, abordando la evaluación de las habilidades cognitivas, psicomotoras y afectivas en enfermería. La mayoría de los estudios obtuvieron buena calidad metodológica en su proceso de validación de contenido.

The study presents results on the settlement characteristics of rock blocks used in the construction of coastal structures to protect and recover the coast. Bosman et al. (2014) studied the porosity of voids. Packaging density and the associated void porosity are important to coastal engineers for two main reasons. The first is that it affects hydraulic performance. The second is its relation to the acquisition of materials. The biggest question is to define the relation between the volume of the structure and the real value of the porosity, finally defining the relation between the volume of the structure and the weight of the blocks used. This article examines the porosity of voids, containment, and recovery structures on Icaraí beach in Municipality of Caucaia, State of Ceará. The commonly used density value for coastal work payments is 1.62 tons m-3, based on international studies from 28 to 38 years ago. Recent bathymetric surveys at Municipality of Caucaia-CE confirm the actual density value as 1.43 tons m-3.