Inadequate Supplies Research Articles

Selective Publication within Vascular Surgery: Characteristics of Discontinued and Unpublished Randomized Clinical Trials

Discontinued and unpublished randomized clinical trials (RCTs) are common resulting in biased publication and loss of potential knowledge. The magnitude of selective publication within vascular surgery remains unknown. RCT relevant to vascular surgery registered (01/01/2010-10/31/2019) on ClinicalTrials.gov were included. Trials ending normally with conclusion of participant treatment and examination were considered completed whereas discontinued trials stopped early. Publications were identified through automatically indexed PubMed citations on ClinicalTrials.gov or manually identified on PubMed or Google Scholar >30months after the completion date, the date the final participant was examined, allowing time for publication. Of 108 RCT (n=37, 837), 22.2% (24/108) were discontinued, including 16.7% (4/24) stopped prior to and 83.3% (20/24) after starting enrollment. Only 28.4% of estimated enrollment was achieved for all discontinued RCT. Nineteen (79.2%) investigators provided a reason for discontinuation, which most commonly included poor enrollment (45.8%), inadequate supplies or funding (12.5%), and trial design concerns (8.3%). Of the 20 trials terminated following enrollment, 20.0% (4/20) were published in peer-reviewed journals and 80.0% (16/20) failed to reach publication. Of the 77.8% trials completed, 75.0% (63/84) were published and 25.0% (21/84) remain unpublished. In a multivariate regression of completed trials, industry funding was significantly associated with decreased likelihood of peer-reviewed publication (OR=0.18, (95% CI 0.05-0.71), P=0.01). Of the discontinued and completed trials remaining unpublished, 62.5% and 61.9% failed to report results on ClinicalTrials.gov, respectively, encompassing a total of 4,788 enrollees without publicly available results. Nearly 25% of registered vascular RCT were discontinued. Of completed RCT, 25% remain unpublished with industry funding associated with decreased likelihood of publication. This study identifies opportunities to report all findings for completed and discontinued vascular surgery RCT, whether industry sponsored, or investigator initiated.

African Medicines Agency: How it will change the landscape of medicines in Africa

AbstractThe African continent, with a population of about 1.2 billion, faces limited access to safe, high‐quality and effective medicine, resulting in a disproportionate disease burden. However, the scarcity of pharmaceuticals has been a significant problem for decades. The need to scale up local production of medicines in Africa is apparent, as over 70% of drugs available in the continent are imported. Africa's pharmaceutical manufacturing industry capacity is subpar due to inadequate production equipment and substandard operations. Inadequate pharmaceutical supplies encouraged the circulation of fake drugs, and the COVID‐19 pandemic highlighted the dangers of the continent's reliance on foreign supplies. Africa's porous borders create ease for drug counterfeiting, with little likelihood of detection once in the supply chain. The African Medicines Agency (AMA) was founded to model the European Medicines Agency to enhance regional drug production, regulation and patient access. The African Union's AMA is a specialized health organization tasked with enhancing regulatory harmonization of medicines, particularly in pharmaceutical production, to increase access to high‐quality medications across the continent. Africa's healthcare industry, particularly domestic pharmaceutical manufacturing, will be a significant economic engine for the continent over the next 5 years. The establishment of AMA is a call to action for governments and regulators to enable Africa to manufacture 60% of the vaccines needed on the continent by 2040.

Lessons Learned from 28 Hospitals and City Agencies: Pediatric Disaster Exercise

Introduction:Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events that involve large numbers of children. The NYC PDC conducted a functional exercise testing surge, communications, and secondary transport. Participants included 28 NYC hospitals, the NYC Fire Department-Emergency Medical Services (FDNY-EMS), NYC Emergency Management (NYCEM), NYC DOHMH and the NYC Medical Reserve Corps (MRC).Method:The hospitals and agencies participated in group and individual planning meetings. Scenario-driven, operations-based activities challenged participants to employ their facility's existing pediatric surge and secondary transport plans during an event. The exercise assessed: Communications, Emergency Operation Plans, Surge, Patient Tracking, Patient Transfer, Supplies, and Staffing. Internal and external evaluators assessed the exercise performance.Results:An After-Action Report was written based on information from evaluation data, site-specific and group hot-washes, and an after-action conference. Strengths included meaningful improvement of plans before/after the exercise and doubling pediatric critical care capacity through the implementation of the exercise objectives. Challenges included: gaps in communication/patient tracking, lack of sufficient sub-specialty support, the need for "babysitters” and inadequate supplies of blood products and ventilators.Conclusion:Conducting a multi-hospital and agency pediatric specific exercise demonstrated current planning and produced lessons learned to address planning and training gaps that can improve citywide planning and capabilities during future full-scale exercise and real-time events.

Evaluation of Emergency Shelter Service Functions and Optimisation Suggestions—Case Study in the Songyuan City Central Area

Reasonable planning and construction of emergency shelters is of great significance in improving the ability of cities to prevent and mitigate disasters and ensuring urban public safety. From the perspective of the needs of the evacuees, this paper constructs an evaluation index system for the service function of emergency evacuation places in four aspects: effectiveness, accessibility, safety and rescue responsiveness. This paper takes the central city of Songyuan as the case study area. We apply the entropy weight–TOPSIS–grey correlation method to evaluate the service functions of emergency shelters in the central city of Songyuan and determine their service function levels. An interactive analysis using the bivariate Moran index is used to determine the current state of supply and demand for places of refuge, in terms of their service functions and population distribution. It also makes recommendations for optimisation, based on the extent to which the service function of the emergency shelter is coordinated with the distribution of the population. The results show that of the 54 emergency shelters in the central city of Songyuan, the low and medium service function levels are divided into 33 and 15, with problems such as unreasonable spatial layout and inadequate emergency supplies and medical resources. The future construction of emergency shelters should focus not only on increasing the number and improving the scale, but also on considering the characteristics of population distribution, optimising the spatial distribution pattern and making full use of existing resources such as parks, squares and schools. The establishment of composite spatial resources for disaster preparedness and the promotion of a government-led model of interconnected shelter and emergency infrastructure can effectively enhance the spatial resilience of cities in response to natural hazards.

Knowledge and perceptions of primary healthcare providers towards integration of antiretroviral therapy (ART) services at departmental levels at selected health facilities Lira district, Uganda

BackgroundInvestigations conducted among healthcare providers to assess their knowledge and perceptions towards the integration of anti-retroviral therapy (ART) related services in Sub-Saharan Africa are limited. This study explored the knowledge and perceptions of primary healthcare providers towards the integration of ART management services at departmental levels in health facilities in Lira district.MethodsWe conducted a descriptive cross-sectional survey that employed qualitative methods of data collection in four selected health facilities in Lira district between January and February 2022. The study involved in-depth interviews with key informants and focus group discussions. The study population consisted exclusively of primary healthcare providers; however, those who were not full-time employees of the participating health facilities were excluded. We used thematic content analysis.ResultsA significant proportion of staff (especially those who are not directly involved in ART) still lack full knowledge of ART services integration. There was generally a positive perception, with some suggesting ART integration can minimize stigma and discrimination. The potential barriers to integration included limited knowledge and skills for providing comprehensive ART services, insufficient staffing and space, funding gaps, and inadequate drug supplies, coupled with increased workload due to enlarged clientele.ConclusionWhereas healthcare workers are generally knowledgeable about ART integration, but their knowledge was limited to partial integration. The participants had a basic understanding of ART services being provided by different health facilities. Furthermore, participants viewed integration as critical, but it should be implemented in conjunction with ART management training. Given that respondents reported a lack of infrastructure, increased workload, and understaffing, additional investments in staff recruitment, motivation through training and incentives, and other means are needed if ART integration is to be implemented.

What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment.

Stunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria. To determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders. Seventy percent of providers (N = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement. This study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems.

Ailing neurosurgical services in rural Africa

Ailing neurosurgical services in rural Africa

Impact of vaccination on the dynamics of COVID-19: A mathematical study using fractional derivatives

Arrival of a new disease marks a yearlong destruction of human lives and economy in general, and if the disease turns out to be a pandemic the loss is frightening. COVID-19 is one such pandemic that has claimed millions of lives till date. There is a suffering throughout the world due to various factors associated with the pandemic, be it loss of livelihoods because of sudden shutdown of companies and lockdown, or loss of lives due to lack of medical aid and inadequate vaccination supplies. In this study, we develop a six-compartmental epidemiological model incorporating vaccination. The motivation behind the study is to analyze the significance of higher vaccination efficacy and higher rate of population getting vaccinated in controlling the rise in infectives and thereby the untimely demise of various individuals. The work begins with an ordinary differential equation model followed by stability analysis of the same, after which a fractional-order derivative model of the same is formulated and the existence of uniformly stable solution for the system is proved. In addition to this, we present the stability of the equilibria in general for the fractional model framed. The sensitivity analysis of the basic reproduction number along with its correlation with various parameters is presented. In addition to this, sensitivity of certain state variables in the fractional model with respect to different fractional orders as well with respect to different infection rate is exhibited in this work. Factors related to lockdown and usage of face shields are incorporated in the entire study, and importance of these is highlighted in the study as well. The major takeaway from the study is that mere vaccination will not suffice in eradication of the virus. The vaccine efficacy plays a major role along with other intervention included in the model. The numerical simulations are carried out in MATLAB software using ode45 and fde12.

Understanding household self-supply use and management using a mixed-methods approach in urban Indonesia

In urban Indonesia, 40 million people rely on groundwater self-supply, however the role of self-supply in securing household water provision remains unexplored. This study used a mixed-methods approach to understand the use and management of household self-supply in the Indonesian cities of Bekasi and Metro, where a high proportion of households rely on private wells for water supply. Self-supply was the preferred drinking water source because of its perceived safety, taste and appearance at both study sites. The most important attributes influencing choice of domestic water source were appearance, reliability and safety in Bekasi, and safety followed by convenience and reliability in Metro. Coping strategies to overcome quality and availability problems of self-supply included water treatment, switching from dug wells to deeper boreholes and the use of multiple water sources. All households reported boiling self-supplied water, however, the labor involved was tiring for some households, leading them to resort to alternative water sources. Reasons for non-use of alternative water sources such as refill water and public piped systems included a lack of trust in water quality and perceived poor taste. Regarding self-supply management, responsibilities and decision-making varied across households, but cooperation between men and women concerning workload was common. Women were mostly responsible for household water management, and men were mostly responsible for maintenance and repairs, cleanliness of the water source and financing. To support and regulate self-supply towards a safely managed water service, strategies for improvements should be considered not only at the source, but also at point-of-use, including promotion of safe household water treatment and management. Although self-supply was the main water source at these study sites, alternative sources such as refill water and public piped systems played an important role in supplementing inadequate supplies, and hence their safety and reliability should be considered when establishing support strategies.

Knowledge, practice, and associated factors of preoperative patient teaching among surgical unit nurses, at Northwest Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, 2022

BackgroundPreoperative teaching practice is very important to surgical clients in freeing them from anxiety and post-operative complications. The preoperative education received by the patients depends on the knowledge and experience of nurses. The diversity in the degree of knowledge and experience possessed by nurses may result in inadequate and ineffective preoperative preparation of patients. Therefore, this study aimed to assess the knowledge, practice, and associated factors of preoperative patient teaching among nurses working at surgical units in Northwest Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, 2022.MethodAn institutional-based cross-sectional study triangulated with a qualitative approach was conducted from April to June 2022. The data were collected using a semi-structured self-administered questionnaire and in-depth interviews. The descriptive statistics were presented in text and tables. Analytical analysis schemes including bivariable and multivariable logistic regression were computed considering P-value < 0.05 to identify statistically significant factors. Qualitative data were analyzed with thematic analysis.ResultA total of 406 participants were involved in this study with a 95.8% response rate. The adequate knowledge of nurses was 61.6% with 95% CI: (56.7, 66.3) and significantly associated with being male, nurse use of guidelines, nurses they have been trained, and nurses’ who say they do not a staff shortage had good knowledge than the counterparts. Good practice of nurses regarding preoperative patient education was 46.3% with 95% CI (41.4, 51.0) significantly associated with the presence of preoperative teaching guidelines, took training on patient education, nurses who said no staff shortage, and knowledge of preoperative patient education.. Nurses have a positive interaction with the patient and much work experience had good practice but lack of training; inadequate supplies and lack of professional prerequisites are some of the barriers identified.ConclusionNurses’ knowledge and practice regarding preoperative patient teaching were found to be inadequate. So, it is better to strengthen training, adequate staffing, equip wards with standardized guidelines and teaching materials, motivate and create a safe working environment. Most nurses explore factors of preoperative patients’ teaching as institutional, Nurse’s related, and patient-related factors.

Adherence to labor and delivery care quality standards and associated factors among nurse-midwives in two public teaching and referral hospitals in Kenya: a cross-sectional survey.

maternal mortality is a major health concern, especially in low and middle-income countries. In Kenya, about 362 maternal deaths occur in every 100,000 live births. Seventy-five percent of these deaths can be prevented through the provision of quality care, especially during labor and delivery as per the quality standards. The objective of this study was to establish the level of adherence to labor and delivery care quality standards among nurse-midwives, and the factors hindering the adherence. a descriptive, cross-sectional survey was carried out in the maternity units of Embu and Meru Teaching and Referral hospitals in Kenya. A total of 51 Nurse-midwives were involved in the study. Data on adherence was collected through direct observation using an observation checklist, whereas that of factors hindering adherence was collected through face-to-face interviews using a semi-structured questionnaire. Data were checked, coded, and entered into EPI Info version 7.1.2. SPSS Version 25.0 was used to analyze data. Associations between variables were tested using Pearson correlation and Fisher's exact tests at 95% CI. most of the participants (60.7%, n=31) were diploma holders, and a half (51%, n=26) were aged 20-29 years. About half (51%, n=26) had practiced for between 1 and 9 years and 43.1% (n=22) had worked in the maternity unit for more than a year. Out of the 12 quality standards assessed, only 5 (41.7%) were adhered to. Major implementation challenges include unavailability of standards (n=98.0%, n=50), inadequate supplies (96.1%, n=49), inadequate knowledge (88.2%, n=45), and an overwhelming workload (86.3%, n=44). There is a significant correlation between the highest level of qualification and lack of knowledge of quality standards (r=-0.279, p=0.05). adherence to labor and delivery care quality standards is low among nurse-midwives. Stakeholders must allocate more resources for training and the provision of adequate supplies. The facilities should also source for and customize the quality standards to promote greater adherence.

Exploring the sources of stress among operating theatre nurses in a Ghanaian teaching hospital

BackgroundThe nursing profession is heavily plagued with occupational stress. The stress nurses encounter in the clinical setting can result in physical, emotional, social and spiritual changes. In the operating theatre, nurses assist surgeons during surgery, observe the overall condition of patients and care for those at risk of developing a critical condition during surgery to prevent any complications from arising. An operating theatre work milieu is problematic in terms of patient safety and is closely associated with elevated stress. AimThis study sought to explore events from outside and within the operating theatres of a teaching hospital in Ghana causing stress in the nurses. MethodsA sample of 12 operating theatre nurses was drawn from the Teaching Hospital using a purposive sampling technique. Data was collected using a semi-structured interview guide and the study employed a descriptive qualitative approach. Analysis of data was carried out using thematic content analysis. ResultsThe study has shown that operating theatre nurses are faced with various stressors from time-to-time and the commonest and the most worrying are those related to their work. The major sources of stress such as work overload, staff shortage, and inadequate equipment and supplies to this group of professionals have been identified. Staff shortage, specifically operating theatre nurses has led to the nurses perceiving their workload as overwhelming. ConclusionIn the operating theatre, nurses assist surgeons during surgery, observe the overall condition of patients and care for those at risk of developing a critical condition during surgery to prevent any complications from arising. These put operating theatre nurses at risk of occupational stress. Therefore, there is the need to help create a more conducive environment for all operating theatre nurses to enhance their performances.

Intranasal COVID-19 vaccine: a modern vaccination approach.

Dear Editor, The emergence of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) which was originally reported to WHO in December 2019 resulted in the coronavirus illness and it was subsequently declared a global coronavirus disease 2019 (COVID-19) pandemic in March 2020. Recurring disease outbreaks repeatedly overloaded the public health sector, infecting over 613 million people and killing more than 6.5 million as of September 20221. As new strains emerge and natural immunity wanes, the population, particularly immunocompromised individuals, stand an increased risk of severe sickness and death due to this disease. Various research advances paved the way for developing multiple COVID-19 vaccines which have been approved to treat and prevent COVID-19. Currently, available COVID-19 vaccines including mRNA vaccines, recombinant adenovirus vaccines, and recombinant protein vaccines that have received Emergency Use Authorization (EUA) and have been subsequently used to immunize millions of people are all administered through intramuscular injection2. Intramuscular vaccines have been designed to induce antibody-mediated and cell-mediated immune responses and minimal to no detectable mucosal immunity at the site of infection. Since the nose and upper respiratory tract are the primary routes for inhalation pathogens like SARS-CoV-2 and are more susceptible to infection,3 the vaccine response generated after intramuscular immunization can leave the upper respiratory tract vulnerable to viral replication and dissemination because these vaccines are inefficient in stimulating immunoglobulin A secretion in mucosal cells2. Alternatively, it has been found recently that the intranasal (IN) vaccines for COVID-19 have shown a promising ability to induce sterilizing mucosal immunity against mucosal pathogens apart from inducing an antibody-mediated immune response and a robust cell-mediated immunity2. A single dose of effective SARS-CoV-2 vaccine via IN route boosts mucosal immunoglobulin A and T-cell responses in both upper and lower respiratory tract, providing almost complete prevention against viral infection, multiplication, and reducing virus shedding via nasal mucosa that acts as a first-line barrier to the virus entrance before spreading into the lungs2. This immediate protection at the site of infection by restricting the viral replication and clearance of SARS-CoV-2 infection reflects the potency of IN COVID-19 vaccines in the alleviation of seeding new cases of COVID-19 amidst the pandemic; hence, preventing even mild cases of illness and inhibiting the virus transmission to other people. In addition, these vaccines are minimally invasive, have a needle-free mode of administration, and are usually in the form of a nasal spray2. Owing to the easy transportation and storage, these vaccines are also more convenient to use2. However, an essential consideration for IN COVID-19 vaccine is its safety. An extremely rare risk of reversion of live attenuated virus into replicating state, regaining its ability to cause disease in the individual has been observed4. With that, the effectiveness of the vaccine is determined by the immunization type chosen and the addition of essential adjuvants. Phase I, II, and III clinical trials were performed to assess the efficacy of IN COVID-19 immunization by two companies; CanSino Biologics, a Chinese pharmaceutical company, and Bharat Biotech International, a biotechnology company headquartered in India, which received approval in their respective countries for its use after gaining successful results5. These companies have created ‘viral vector’ vaccines that use a harmless adenovirus to deliver the genetic material of the SARS-CoV-2 into host cells. Given the severity of the situation where the healthcare systems are challenged globally due to increased COVID-19-related hospitalizations, it is critical to continue developing effective and reliable COVID-19 vaccines in present times. In the context of respiratory pathogens like SARS-CoV-2, IN vaccines’ pros conceivably outweigh their cons, along with offering both localized protection at the site of infection and activating systemic responses as compared with intramuscular vaccines eliciting only systemic responses. Large-scale clinical studies and trials should be conducted to gather further evidence to prove its effectiveness so that the availability of IN COVID-19 vaccines may be made feasible. This vaccine might also serve as an alternative to limited and inadequate vaccine supplies as well as a booster to intramuscular vaccines. Immunization with IN COVID-19 vaccines will hopefully help deal with the persistent COVID-19 pandemic and potential viral contagious diseases that might arise in the future. Ethics approval Not applicable. Sources of funding None. Authors’ contribution All authors contributed equally. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration Unique Identifying number (UIN) None. Guarantor Govinda Khatri.

Health system readiness and the implementation of rectal artesunate for severe malaria in sub-Saharan Africa: an analysis of real-world costs and constraints

Rectal artesunate, an efficacious pre-referral treatment for severe malaria in children, was deployed at scale in Uganda, Nigeria, and DR Congo. In addition to distributing rectal artesunate, implementation required additional investments in crucial but neglected components in the care for severe malaria. We examined the real-world costs and constraints to rectal artesunate implementation. We collected primary data on baseline health system constraints and subsequent rectal artesunate implementation expenditures. We calculated the equivalent annual cost of rectal artesunate implementation per child younger than 5 years at risk of severe malaria, from a health system perspective, separating neglected routine health system components from incremental costs of rectal artesunate introduction. The largest baseline constraints were irregular health worker supervisions, inadequate referral facility worker training, and inadequate malaria commodity supplies. Health worker training and behaviour change campaigns were the largest startup costs, while supervision and supply chain management accounted for most annual routine costs. The equivalent annual costs of preparing the health system for managing severe malaria with rectal artesunate were US$2·63, $2·20, and $4·19 per child at risk and $322, $219, and $464 per child treated in Uganda, Nigeria, and DR Congo, respectively. Strengthening the neglected, routine health system components accounted for the majority of these costs at 71·5%, 65·4%, and 76·4% of per-child costs, respectively. Incremental rectal artesunate costs accounted for the minority remainder. Although rectal artesunate has been touted as a cost-effective pre-referral treatment for severe malaria in children, its real-world potential is limited by weak and under-financed health system components. Scaling up rectal artesunate or other interventions relying on community health-care providers only makes sense alongside additional, essential health system investments sustained over the long term. Unitaid. For the French translation of the abstract see Supplementary Materials section.

429. Identifying Barriers to Compliance with a Universal Inpatient Protocol for Staphylococcus aureus Nasal Decolonization with Povidone-Iodine

Abstract Background Intranasal povidone-iodine (PI) is a recommended strategy for universal decolonization in high-risk patients (ICU and those with central venous or midline catheters) to reduce hospital-associated Staphylococcal infections. Few studies have evaluated implementation challenges and barriers to successful performance of inpatient intranasal decolonization programs. Methods We surveyed adult acute care unit nurses at an academic medical center in March 2022, approximately 14 months after implementation of a universal decolonization standard operating procedure (SOP). The anonymous, voluntary REDCap® survey evaluated domains focused on patient identification, education, training, resources, application, and patient acceptance using Likert scale ratings. Results Among 248 respondents, most were new to nursing (54.4% with 0-4 years of experience) and worked in non-ICU units (61.5%). Only 60.5% reported receiving training on how to perform intranasal PI (hands-on 48.6%, computer/electronic module 25.7%, both 20.9%). Nurses who received training indicated moderate to strong confidence in their ability to perform intranasal PI decolonization (89.2%). A majority cited a good understanding of the rationale for use and identified patients appropriately. Low rates were reported for performing decolonization per the SOP (49%), with barriers including inadequate supplies (35.1%), lack of a readily available copy of the SOP (69%), difficulty swabbing with nasal devices in place (41.5%) and time constraints from other patient duties. Nurses perceived that only 49.2% of patients had a moderate or strong understanding of why PI decolonization was performed, and most were unwilling to undergo intranasal PI (59.1%). Other issues included tracking PI application within the electronic medical record (EMR), limited nurse knowledge of PI effectiveness, patient refusal despite education, and overall frontline personnel burnout. Conclusion Gaps in nursing and patient education should be prioritized during and after implementation to improve fidelity, particularly with frontline burnout from COVID-19. Streamlined tracking and ordering of PI on the EMR may ease nursing workflow. Disclosures Thomas R. Talbot, III, MD, MPH, OmniSolve: Board Member.

Genome Editing and Protein Energy Malnutrition.

Protein-energy malnutrition is a state of disordered catabolism resulting from metabolic derangements or starvation. It is associated with chronic disease, hypoglycemia, hypothermia, serious infections, and even an increased prevalence of morbidity and mortality in countries with poor socioeconomic or environmental factors. Adequate food administration is essential to satisfy the main caloric and nutritional demands of humans. The most significant factors seen in the development of protein-energy malnutrition in areas of high incidence, such as underdeveloped countries, are inadequate food and nutrient supplies. It has been well established that one of the strategies to alleviate undernourishment is the biofortification of staple crops. This is because vegetables and plants are significant sources of crucial nutrients for human growth and development. To enhance plant nutrition, recent tactics aim to formulated balanced and diverse diets with acceptable levels ofvitamins and minerals that benefit human health. New advances in plant biotechnology and animal productivity could control key enzymes in several metabolic pathways, enriching important nutrients such as iron and vitamins and decreasing the content of disadvantageous compounds such as acrylamide-forming amino acids and phytic acids. Numerous biofortified crops such as rice, maize, and wheat have been created to resolve the problem of nutrition deficiencies. Some examples of these methodologies are genome editing engineered nucleases, transcriptional activator-like effector nucleases, zinc finger nucleases, and clustered regularly interspaced short palindromic repeats and associated Cas9 endonuclease which have been created and widely studied for their application, efficiency, and specificity.

Mobilizing stakeholders to drive the cervical cancer elimination agenda in Kenya: The national cervical cancer stakeholders' forum 2022.

Kenya is among the nineteen countries in Sub-Saharan Africa with the highest burden of cervical cancer globally. The high burden of cervical cancer in developing countries reflects the absence of effective cervical cancer prevention programs with limited resources invested to provide comprehensive services. We aimed to engage stakeholders in a structured consultative forum, to gain insights and forge effective partnerships to drive the cervical cancer elimination agenda in Kenya. The National Cervical Cancer Stakeholders Consultative Forum was organized as a part of activities to commemorate the National Cervical Cancer Awareness Month on 19th January 2022 in Nairobi, Kenya. The overall goal of the meeting was to provide a forum to sensitize stakeholders on the National Cervical Cancer Prevention and Control Program (NCCP) with a view to strengthen partnerships, increase coordination for improved service delivery and to provide a forum for resource mobilisation and alignment of key stakeholders towards elimination of cervical cancer in Kenya. Nominal group technique was adopted for structured discussions, and the findings analysed to derive key themes. Key challenges to primary and secondary prevention of cervical cancer were identified as low awareness, stigma and misinformation, high unmet need for treatment of early lesions, few health care providers with capacity to screen and treat, inadequate supplies, inefficient health information systems and poor referral pathways. Championing integration of cervical cancer screening and treatment services into routine health programs, strengthening policy implementation and robust monitoring and evaluation were identified as critical interventions. The National Cervical Cancer Stakeholders Forum 2022 provided insights for enabling Kenya to progress on the 2030 elimination targets. Such forums can be useful in bringing all actors together to evaluate achievements and identify opportunities for more effective national cervical cancer prevention and control programs.

A presentation of iatrogenic hypospadias after traditional circumcision: A case report

Traditional circumcisions may cause complications such as hemorrhage, infection, amputations of the penis, meatal stenosis, and urethro-cutaneous fistula. In addition to all these complications, iatrogenic hypospadias, as in our case, is a rare condition. In general, complications are mild and preventable, especially in children, but when the procedure is carried out by unskilled providers, in unsterile conditions, or with inadequate equipment and supplies, severe complications are more likely to occur. Several degrees of urethral erosion, including iatrogenic hypospadias, might result from further injury. Particularly in intensive care facilities, the ventral male urethra can undergo this kind of trauma. A 4-year-old child was circumcised at the age of 3 years, and after that, he bled profusely. His parents brought him to the hospital after 4 months. On physical examination of the patient, the glans was normal but there was an opening near the glans in the distal urethra at the subcoronal level. After the pre-operative check-up, the patient was prepared for elective surgery. An incision and dissection were performed to reveal the fistula tract all around by placing marker sutures from the edges of the fistula. The fistula opening was repaired with 6/0 PDS (polydioxanone) and a second layer was created over the urethral fistula repair, and then the skin was closed with 4/0 Vicryl (polyglactin). Around the world, circumcision continues to be the most common procedure done on children. Injuries to the penis may actually happen with a 1% complication incidence. A poorly placed suture at the frenulum in an effort to achieve hemostasis is the most frequent cause of the fistula. This causes strangulation and necrosis of a portion of the urethral wall, which leads to the creation of a sub glandular fistula. It is important to properly identify and treat any life-threatening injuries to the urethra as soon as possible. Considered a medical procedure that necessitates great care, circumcision should only be carried out by qualified surgeons under sterile hospital circumstances. Most circumcision-related injuries result from clamp circumcisions (such as Mogen or Gomco), and they can range from minor loss of penile skin to more serious glans, distal urethral, and penile shaft injuries.

Experience of the medical personnel of a peruvian public hospital in the face of the COVID-19 pandemic.

The arrival of the new coronavirus disease (COVID-19) has challenged and exposed the precarization of health systems in the face of pandemic diseases. Medical personnel has demonstrated their commitment to service and workforce force, despite having inadequate medical equipment, supplies, hospital beds, and personnel, not to mention the risk of being victims of this disease. With this article, we aim to share the experience and capabilities of the medical staff to overcome adversities: their resilience and resourcefulness in the face of traumatic situations, and using and modifying any available equipment in the absence of mechanical ventilators to mitigate the progression of the disease.

Design islanded hybrid micro-grid and analyzing its socio-economic technical and environmental aspects for off-grid electrification in developing countries

Developing countries are facing many electricity crises such as low production, worst power outages, blackouts, and poor inadequate supplies. Most of their rural areas have no basic power infrastructure as it requires long transmission lines, which causes high installation, operation, maintenance costs and line losses issues. The people of these unconnected rural areas belong to low-income families and use kerosene oil, candles, small solar panels, and batteries to meet their basic electricity needs. As an alternative, renewable-based hybrid energy systems have enormous potential. It is also environmentally friendly and low-cost, sustainable, and promising solution to electrify rural off-grid areas. This research work focuses on the economic and optimal design of a renewable-based hybrid energy system for the rural off-grid area of Pakistan. HOMER (Hybrid Optimization of Multiple Energy Resources) software is used to perform techno-economic and environmental analysis. The optimization results show that the most economical and optimal configuration is PV/diesel generator with batteries having lower harmful emissions. Furthermore, the sensitivity analysis is performed to refine the results which show that the most optimal system will remain sustainable if variations occur in the sensitivity variables in the future. Moreover, the results and findings of this study can help the government to make effective policies and planning to provide reliable and affordable electricity to the off-grid areas, to improve the electrification rate in the country.