Search results for: Fred Monje

Authors: Dativa Maria Aliddeki, Fred Monje, Godfrey Nsereko, Benon Kwesiga, Daniel Kadobera, Alex Riolexus Ario

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Background: Cholera is a severe gastrointestinal disease caused by Vibrio cholera. It has caused several pandemics. On 26 February 2018, a suspected cholera outbreak, with one death, occurred in School X in Hoima Municipality, western Uganda. We investigated to identify the scope and mode of transmission of the outbreak, and recommend evidence-based control measures. Methods: We defined a suspected case as onset of diarrhea, vomiting, or abdominal pain in a student or staff of School X or their family members during 14 February–10 March. A confirmed case was a suspected case with V. cholerae cultured from stool. We reviewed medical records at Hoima Hospital and searched for cases at School X. We conducted descriptive epidemiologic analysis and hypothesis-generating interviews of 15 case-patients. In a retrospective cohort study, we compared attack rates between exposed and unexposed persons. Results: We identified 15 cases among 75 students and staff of School X and their family members (attack rate=20%), with onset from 25-28 February. One patient died (case-fatality rate=6.6%). The epidemic curve indicated a point-source exposure. On 24 February, a student brought fried fish from her home in a fishing village, where a cholera outbreak was ongoing. Of the 21 persons who ate the fish, 57% developed cholera, compared with 5.6% of 54 persons who did not eat (RR=10; 95% CI=3.2-33). None of 4 persons who recooked the fish before eating, compared with 71% of 17 who did not recook it, developed cholera (RR=0.0, 95%CIFisher exact=0.0-0.95). Of 12 stool specimens cultured, 6 yielded V. cholerae. Conclusion: This cholera outbreak was caused by eating fried fish, which might have been contaminated with V. cholerae in a village with an ongoing outbreak. Lack of thorough cooking of the fish might have facilitated the outbreak. We recommended thoroughly cooking fish before consumption.

Keywords: cholera, disease outbreak, foodborne, global health security, Uganda

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Authors: Joao Barbosa

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After an intense dispute between the big bang cosmology and its big rival, the steady-state cosmology, some important experimental observations, such as the determination of helium abundance in the universe and the discovery of the cosmic background radiation in the 1960s were decisive for the progressive and wide acceptance of big bang cosmology and the inevitable abandonment of steady-state cosmology. But, despite solid theoretical support and those solid experimental observations favorable to big bang cosmology, Fred Hoyle, one of the proponents of the steady-state and the main opponent of the idea of the big bang (which, paradoxically, himself he baptized), never gave up and continued to fight for the idea of a stationary (or quasi-stationary) universe until the end of his life, even after decades of widespread consensus around the big bang cosmology. We can try to understand this persistent attitude of Hoyle by applying Holton’s thematic analysis to cosmology. Holton recognizes in the scientific activity a dimension that, even unconscious or not assumed, is nevertheless very important in the work of scientists, in implicit articulation with the experimental and the theoretical dimensions of science. This is the thematic dimension, constituted by themata – concepts, methodologies, and hypotheses with a metaphysical, aesthetic, logical, or epistemological nature, associated both with the cultural context and the individual psychology of scientists. In practice, themata can be expressed through personal preferences and choices that guide the individual and collective work of scientists. Thematic analysis shows that big bang cosmology is mainly based on a set of themata consisting of evolution, finitude, life cycle, and change; the cosmology of the steady-state is based on opposite themata: steady-state, infinity, continuous existence, and constancy. The passionate controversy that these cosmological views carried out is part of an old cosmological opposition: the thematic opposition between an evolutionary view of the world (associated with Heraclitus) and a stationary view (associated with Parmenides). Personal preferences seem to have been important in this (thematic) controversy, and the thematic analysis that was developed shows that Hoyle is a very illustrative example of a life-long personal commitment to some themata, in this case to the opposite themata of the big bang cosmology. His struggle against the big bang idea was strongly based on philosophical and even religious reasons – which, in a certain sense and in a Holtonian perspective, is related to thematic preferences. In this personal and persistent struggle, Hoyle always refused the way how some experimental observations were considered decisive in favor of the big bang idea, arguing that the success of this idea is based on sociological and cultural prejudices. This Hoyle’s attitude is a personal thematic attitude, in which the acceptance or rejection of what is presented as proof or scientific fact is conditioned by themata: what is a proof or a scientific fact for one scientist is something yet to be established for another scientist who defends different or even opposites themata.

Keywords: cosmology, experimental observations, fred hoyle, interpretation, life-long personal commitment, Themata

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Authors: Muhammad Abba Jallo, Fred Fudah Moveh

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This study addresses the challenges faced by Nigerian law enforcement agencies due to the lack of an integrated crime management system. While various agencies use ICT-based systems, the absence of interoperability creates barriers to effective collaboration and information sharing. The research proposes the development of an Interagency Crime Management System (ICMS), which integrates the Crime Management Systems (CMS) of different agencies through an Application Program Interface (API). The system is designed to allow all law enforcement agencies to input data using a standardized format, improving crime tracking, reporting, and management across Nigeria. This paper details the design and implementation process, highlighting the benefits of enhanced collaboration for crime management.

Keywords: crime management, Nigeria, law enforcement, ICT

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Authors: Ben-Fred Ohia

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Code-switching and code-mixing are linguistic behaviours that arise in a bilingual situation. They limit speakers in a conversation to decide which code they should use to utter particular phrases or words in the course of carrying out their utterance. Every human society is characterized by the existence of diverse linguistic varieties. The speakers of these varieties at some points have various degrees of contact with the non-speakers of their variety, which one of the outcomes of the linguistic contact is code-switching or code-mixing. The work discusses the nature of code-switching and code-mixing in Ogba-English bilinguals’ speeches. It provides a detailed explanation of the concept of code-switching and code-mixing and explains the typology of code-switching and code-mixing and their manifestation in Ogba-English bilingual speakers’ speeches. The findings reveal that code-switching and code-mixing are functionally motivated and being triggered by various conversational contexts.

Keywords: bilinguals, code-mixing, code-switching, Ogba

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Authors: Fred Fudah Moveh, Muhammad Abba Jallo

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Electoral fraud remains a persistent threat to democracy in Nigeria, undermining public trust and stalling political development. This study explores the role of Information and Communication Technology (ICT) in curbing electoral fraud, focusing on its application in recent Nigerian elections. The paper identifies the main forms of electoral fraud, evaluates the effectiveness of ICT-based interventions like the Permanent Voter Card (PVC) and the Bi-modal Voter Accreditation System (BVAS), and discusses challenges such as poor infrastructure, voter intimidation, and legal inadequacies. Data was collected through structured questionnaires and interviews and analyzed using SPSS software. Results reveal that while ICT has mitigated some forms of fraud, systemic issues continue to hinder its full potential. The study concludes with recommendations for enhancing the application of ICT in Nigeria’s electoral process.

Keywords: ICT, electoral fraud, election process, Nigeria, political instability

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Authors: Fred Mageto

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A great number of children in mainstream schools across Kenya are currently living with emotional, behavioural difficulties. This study aims to explore teachers’ perceptions of children’s emotional and behavioural difficulties (EBD) and their attributions of the causes of EBD. The relevance of this area of study to current educational practice is illustrated in the fact that primary school teachers in Kenya find classroom behaviour problems one of the major difficulties they face. The information presented in this study was gathered from 182 teachers that responded back to the survey, of whom 27 teachers were later interviewed. In general, teachers’ perceptions of EBD reflect personal experience, training, and attitudes. Teachers appear from this study to use words such as indifferent, frightened, withdrawn, aggressive, disobedient, hyperactive, less ambitious, lacking concentration, and academically weak to describe pupils with emotional and behavioural difficulties (EBD). The implications of this study are envisaged as being extremely important to support teachers addressing children’s EBD and shed light on the contributing factors to EBD for a successful teaching-learning process in Libyan primary schools.

Keywords: teachers, children, learning, emotional and behaviour difficulties

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Authors: J. Lamilla-Monje, C. Solano-Puerto, L. Franco-Lara

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Trees play an essential role in cities due to their ability to provide multiple ecosystem goods and services. Bogota trees are threatened by factors such as pests, pathogens, contamination, among others. Among the pathogens, phytoplasmas are a potential risk for urban trees, generating symptoms that affect the ecosystem services that these trees provide in Bogota, an example of this is the affectation of Q. humboldtii by phytoplasmas, these bacteria are transmitted for insects of the order Hemiptera, this is why the objective of this work was to know if the climatic variables (humidity, precipitation, and temperature) and environmental variables (PM10 and PM2.5) could be related to the distribution of the Oak Quercus entomofauna and specifically with the phytoplasma vector insects in Bogota. For this study, the sampling points were distributed in areas of the city with contrasting variables in two types of locations: parks and streets. A total of 68 trees were sampled in which the associated insects were collected using two methodologies: jameo and agitation traps. The results show that insects of the order Hemiptera were the most abundant, including a total of 1682 individuals represented by 29 morphotypes, within this order individuals from eight families were collected (Aphidae, Aradidae, Berytidae, Cicadellidae, Issidae, Membracidae, Miridae, and Psyllidae), finding as possible vectors the families Cicadellidae, Membracidae, and Psyllidae with 959, 8 and 14 individuals respectively. Within the Cicadellidae family, 21 morphotypes were found, being reported as vectors in the literature: Amplicephalus, Exitianus atratus, Haldorus sp., Xestocephalus desertorum, Idiocerinae sp., Scaphytopius sp., the Membracidae family was represented by two morphotypes and the Psyllidae by one. Results that suggest that there is no correlation between climatic and environmental variables with the diversity of insects associated with oak. Knowing the vector insects of phytoplasmas in oak trees will complete the pathosystem and generate effective vector control.

Keywords: vector insects, diversity, phytoplasmas, Cicadellidae

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Authors: Maryam Goodarzi, Mahdieh Sheikhi, Mehdi Goodarzi

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This study intends to offer an appropriate strategy development framework for a telecommunication firm (as a case study) which works on Information and Communication Technology (ICT) projects, development of telecommunication networks, and maintenance of local networks, according to its dominant condition. In this approach, first, the objectives were set and the mission was defined. Then, the capability was assessed by SWOT matrix. Using SPACE matrix, the strategy of the company was determined. The strategic direction is set and an appropriate and superior strategy was developed and offered employing QSPM matrix. The theoretical framework or conceptual model of the present study first involves 4 stages of framework development and then from stage 3 (assessing capability) onward, a strategic management model by Fred R. David. In this respect, the tools and methods offered in the framework are appropriate for all kinds of organizations, particularly small firms, and help strategists identify, evaluate, and select strategies.

Keywords: strategy formulation, firm mission, strategic direction, space diagram, quantitative strategic planning matrix, SWOT matrix

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Authors: I. A. Landa-Fernandez, I. Monje-Ramirez, M. T. Orta-Ledesma

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Every year plant-parasitic nematodes diminish the yield of high-value crops worldwide causing important economic losses. Currently, Meloidogyne enterolobii has increased its importance due to its high aggressiveness, increasing geographical distribution and host range. Root-knot nematodes inhabit the rhizosphere soil around plant roots. However, they can come into contact with irrigation water. Thus, plant-parasitic nematodes can be transported by water, as eggs or juveniles. Due to their high resistance, common water disinfection methods are not effective for inactivating these parasites. Ozone is the most effective disinfectant for microbial inactivation. The objective of this study is to demonstrate that ozone treatment is an alternative method control in irrigation water of the root-knot nematode M. enterolobii. It has been shown that ozonation is an effective treatment for the inactivation of protozoan cysts and oocysts (Giardia and Cryptosporidium) and for other species of the genus Meloidogyne (M. incognita), but not for the enterolobii specie. In this study, the strain of M. enterolobii was isolated from tomatoes roots. For the tests, eggs were used and were inoculated in water with similar characteristics of irrigation water. Subsequently, the disinfection process was carried out in an ozonation unit. The performance of the treatments was evaluated through the egg's viability by assessing its structure by optical microscopy. As a result of exposure to ozone, the viability of the nematode eggs was reduced practically in its entirety; with dissolved ozone levels in water close to the standard concentration (equal to 0.4 mgO₃/L), but with high contact times (greater than 4 min): 0.2 mgO₃/L for 15 minutes or 0.55 mgO₃/L for 10 minutes. Additionally, the effect of temperature, alkalinity and organic matter of the water was evaluated. Ozonation is effective and a promising alternative for the inactivation of nematodes in irrigation water, which could contribute to diminish the agricultural losses caused by these organisms.

Keywords: inactivation process, irrigation water treatment, ozonation, plant-parasite nematodes

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Authors: Josiah A. Adeyemo, Fred A. O. Otieno, Olumuyiwa I. Ojo

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South Africa is water-stressed being a semi-arid country with limited annual rainfall supply and a lack of perennial streams. The future implications of population growth combined with the uncertainty of climate change are likely to have significant financial, human and ecological impacts on already scarce water resources. The waste water from the drainage canals of the Vaal-Harts irrigation scheme (VHS) located in Jan Kempdorp, a farming community in South Africa, were investigated for possible irrigation re-use and their effects on the immediate environment. Three major drains within the scheme were identified and sampled. Drainage water samples were analysed to determine its characteristics. The water samples analyzed had pH values in the range of 5.5 and 6.4 which is below the normal range for irrigation water and very low to moderate salinity (electrical conductivity 0.09-0.82 dS/m). The adjusted sodium adsorption ratio values in all the samples were also very low (<0.2), indicating very low sodicity hazards. The nitrate concentration in most of the samples was high, ranging from 4.8 to 53 mg/l. The reuse of the drainage water for irrigation is possible, but with further treatment. Some suggestions were offered in the safe management of drainage water in VHS.

Keywords: drainage canal, water quality, irrigation, pollutants, environment

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Authors: S. B. Otieno, Were Fred, E. W. Kabiru, K. Waza

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Background: HIV/AIDS is leading to the loss of labor through sickness and subsequent death, this is leading to the neglect of farm and off-farm activities, with the subsequent loss of potential income and food security. The situation is sensitive to seasonal labour peaks in agriculture. This study was done to determine the impact of high HIV prevalence in farming systems and food security in Pala Bondo District, Kenya. Methods: In this study, 386 respondents were randomly chosen in Pala Sub-Location. The respondents and key informants were interviewed using structured questionnaire. The data were entered and analyzed using SPSS version 16. Results: It was established that majority of respondents (67%) were between 18 and 35 years {χ² = (1, N = 386) = 13.430, p = 0.000} (chimney effect). The study also established that 83.5% of respondents were married {χ² = (1, N= 370) = 166.277 p = 0.000} and predominant occupation being farming and fishing (61%), while 52.8% of farm labour was by hand, 26% by oxen, and 4.9% mechanized. 73.2% of respondents only farm 0.25 to 2 acres, 48% mentioned lack of labour in land preparation {χ² ((1,N = 321) = 113.146, p = 0.000), in planting {χ² (1, N = 321) = 29.28, p = 0.000}. Majority of respondents lack food from January to June, during which 93% buy food. Conclusion: The high HIV prevalence in Pala has affected the farm labour leading to food insecurity.

Keywords: food security, HIV, AIDS, labour

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Authors: Chih-Chun Tang

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Nostalgia, to some people, may seem foolhardy in a way. However, nostalgia is a completely and intensely private but social, collective emotion. It has continuing consequence and outgrowth for our lives as social actions. It leads people to hunt and explore remembrance of persons and places of our past in an effort to confer meaning of persons and places of present. In the ‘Poems of 1912-13’ Thomas Hardy, a British poet, composed a series of poems after the unexpected death of his long-disaffected wife, Emma. The series interprets the cognitive and emotional concussion of Emma’s death on Hardy, concerning his mind and real visit to the landscape in Cornwall, England. Both spaces perform the author’s innermost in thought to his late wife and to the landscape. They present an apparent counterpart of the poet and his afflicted conscience. After Emma had died, Hardy carried her recollections alive by roaming about in the real visit and whimsical land (space) they once had drifted and meandered. This paper highlights the nostalgias and feds that seem endlessly to crop up.

Keywords: Thomas Hardy, remembrance, psychological, poems 1912-13, Fred Davis, nostalgia

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Authors: Christine Odinga, Fred Otieno, Josiah Adeyemo

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A study was done to establish the effectiveness of wetland plants: Echinocloa pyramidalis (L) and Cyperus papyrus (L) in purifying wastewater from sugar factory stabilization pond effluent. A pilot-scale Free Water Surface Wetland (FWSCW) system was constructed in Chemelil sugar factory, Kenya for the study. The wetland was divided into 8 sections (cells) and planted with C. papyrus and E. pyramidalis in alternating sequence. Water samples and plant specimen were taken fortnightly at inlets and outlets of the cells and analysed for total phosphates and total nitrates. The data was analysed by use of Microsoft excel and SPSS computer packages. Water analysis recorded a reduction in the nutrient levels between the inlet pond nine and the final outlet channel to River Nyando. The plants grown in the wetland experienced varied increases and reductions in the level of total foliar nitrogen and phosphorous, indicating that though the nutrients were being removed from the wetland, the same were not those assimilated by the plants either. The control plants had higher folia phosphorous and nitrogen, an indication that the system of the constructed wetland was able to eliminate the nutrients effectively from the plants.

Keywords: wetlands, constructed, plants, nutrients, wastewater, industrial

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Authors: Niringiye Fred

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Banyabunagana has always had access to land resources for grazing animals, sand mining, and farmland across the border in the Democratic Republic of Congo during the pre-colonial and colonial times, usually on an informal arrangement facilitated by kinship ties and rent transactions for these resources. However, in recent periods, the government of the Democratic Republic of the Congo (DRC) has been pursuing a policy of constructing barriers such as walls and fences so that Banyabunagana communities do not access the land on the DRC side of the border. This is happening in the background of increased and intensified demand for land use on the side of the Ugandan community. This paper will attempt to discuss the reasons behind the construction of walls, fences, and other barriers which deny access to land for Banyabunagana communities in Bunagana Parish, Muramba Sub-county- Kisoro district, Uganda. The research will attempt to answer the following main questions, among others, whether there are the factors that explain the construction of walls and fences which could limit or deny access to the informal use of land and other resources and whether policy options to ensure continued access to land and other resources for local communities.

Keywords: border, walls, fences, land resource access

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Authors: Simon Arunga, Teddy Kwaga, Rita Kageni, Michael Gichangi, Nyawira Mwangi, Fred Kagwa, Rogers Mwavu, Amos Baryashaba, Luis F. Nakayama, Katharine Morley, Michael Morley, Leo A. Celi, Jessica Haberer, Celestino Obua

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Purpose: The main aim for creating the Multimodal Database of Retinal Images for Africa (MoDRIA) was to provide a publicly available repository of retinal images for responsible researchers to conduct algorithm development in a bid to curb the challenges of ophthalmic artificial intelligence (AI) in Africa. Methods: Data and retina images were ethically sourced from sites in Uganda and Kenya. Data on medical history, visual acuity, ocular examination, blood pressure, and blood sugar were collected. Retina images were captured using fundus cameras (Foru3-nethra and Canon CR-Mark-1). Images were stored on a secure online database. Results: The database consists of 7,859 retinal images in portable network graphics format from 1,988 participants. Images from patients with human immunodeficiency virus were 18.9%, 18.2% of images were from hypertensive patients, 12.8% from diabetic patients, and the rest from normal’ participants. Conclusion: Publicly available data repositories are a valuable asset in the development of AI technology. Therefore, is a need for the expansion of MoDRIA so as to provide larger datasets that are more representative of Sub-Saharan data.

Keywords: retina images, MoDRIA, image repository, African database

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Authors: Dinebari Akpee, Friday Aabe Gaage, Florence Fred Nwaigwu

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Natural disasters like flood affect many parts of the world including developing countries like Nigeria. As a result, many human lives are lost, properties damaged and so much money is lost in infrastructure damages. These hazards and losses can be mitigated and reduced by providing reliable spatial information to the generality of the people through about flood risks through flood inundation maps. Flood inundation maps are very crucial for emergency action plans, urban planning, ecological studies and insurance rates. Nigeria experience her worst flood in her entire history this year. Many cities were submerged and completely under water due to torrential rainfall. Poor city planning, lack of effective development control among others contributes to the problem too. Geographic information system (GIS) can be used to visualize the extent of flooding, analyze flood maps to produce flood damaged estimation maps and flood risk maps. In this research, the under listed steps were taken in preparation of flood risk maps for the study area: (1) Digitization of topographic data and preparation of digital elevation model using ArcGIS (2) Flood simulation using hydraulic model and integration and (3) Integration of the first two steps to produce flood risk maps. The results shows that GIS can play crucial role in Flood disaster control and mitigation.

Keywords: flood disaster, risk maps, geographic information system, hazards

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Authors: Olumuyiwa I. Ojo, Kola Amao, Josiah A. Adeyemo, Fred A. O. Otieno

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A study was carried out to assess the environmental impact of Kampe (Omi) irrigation scheme with respect to public health hazards, the rising water table, salinity and alkalinity problems on the project site. A structured questionnaire was used as the main tool to gather information on the effect of the irrigation project on the various communities around the project site. The different sections of the questionnaire enabled the gathering of information ranging from general to more specific information. The results obtained from the study showed that the two effects are obvious: the 'positive effects' which include increasing the socioeconomic development of the entire communities, resulting in an increase in employment opportunities and better lifestyle and the 'negative effects' in which malaria (100% occurrence) and schistosomiasis (66.7%) were found to be active diseases caused by irrigation activities. Increase in height of water table and salinity is eminent in the irrigation site unless adequate drainage is provided. The collection and experimental analyses of representation soil and water samples from each scheme were used to assess the current status of each receptor. Results obtained indicate the absence of soil with sodium adsorption ration (SAR) values ranging from 3.0 to 3.89, exchangeable sodium percentage (ESP) ranged from 3.8% to 5.5% while pH values ranged from 6.60 to 7.00. Drainage facilities of the project site are inadequate, therefore making it difficult to leach the soil and flood history is occasional.

Keywords: irrigation, impact, soil analysis, Nigeria

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Authors: Daphine Namara, Jeremy I. Schwartz, Andrew K. Tusubira, Willi McFarland, Caroline Birungi, Fred C. Semitala, Martin Muddu

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Emerging evidence suggests a possible association between hyperglycemia and dolutegravir (DTG), a preferred first-line antiretroviral agent in sub-Saharan Africa (SSA). There is a need for rigorous studies to validate this association in the face of increasing DTG use and the burden of non-communicable diseases among people living with HIV (PLHIV). We conducted a case-control study to assess the risk of hyperglycemia associated with the use of DTG among PLHIV attending Mulago ISS Clinic in Kampala. Cases had hyperglycemia, while controls had no hyperglycemia, as confirmed by fasting plasma glucose and oral glucose tolerance tests. Demographic, laboratory, and clinical data were collected using interviewer-administered questionnaires and medical record abstraction. The analysis compared cases and controls on DTG use prior to diagnosis of hyperglycemia while controlling for potential confounders using multivariable logistic regression. We included 204 cases and 231 controls. In multivariable analysis, patients with prior DTG use had seven times greater odds of subsequent diagnosis of hyperglycemia compared to those who had non-DTG-based regimens (adjusted odds ratio [aOR] 7.01, 95% CI 1.96-25.09). The odds of hyperglycemia also increased with age (56 years and above vs. 18-35, aOR 12.38, 95% CI 3.79-40.50) and hypertension (aOR 5.78, 95% CI 2.53-13.21). Our study demonstrates a strong association between prior DTG exposure and subsequent diagnosis of hyperglycemia. Given the benefits of DTG, wide-scale use, and the growing burden of diabetes mellitus (DM) in SSA, there is a need for systematic screening for hyperglycemia and consideration of alternate regimens for those at risk for DM.

Keywords: HIV, hyperglycemia, doluteravir, diabetes

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Authors: Fred N. H. Parker, Nicola T. Fear, S. A. M. Stevelink, L. Rafferty

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Purpose Auditory problems, such as hearing loss and tinnitus, have been associated with mental health problems and alcohol misuse in the UK general population and in the US Armed Forces; however, few studies have examined these associations within the UK Armed Forces. The present study examined the association between auditory problems and probable common mental disorders, post-traumatic stress disorder and alcohol misuse. Methods 5474 serving and ex-service personnel from the UK Armed Forces were examined, selected from those who responded to phase two (data collection 2007–09) and phase three (2014–16) of a military cohort study. Multivariable logistic regression was used to examine the association between auditory problems at phase two and mental health problems at phase three. Results 9.7% of participants reported ever experiencing hearing problems alone, 7.9% reported tinnitus within the last month alone, and 7.8% reported hearing problems with tinnitus. After adjustment, hearing problems with tinnitus at phase two was associated with increased odds of probable common mental disorders (AOR = 1.50, 95% CI 1.09–2.08), post-traumatic stress disorder (AOR = 2.30, 95% CI 1.41–3.76), and alcohol misuse (AOR = 1.94, 95% CI 1.28–2.96) at phase three. Tinnitus alone was associated with probable post-traumatic stress disorder (AOR = 1.80, 95% CI 1.03–3.15); however, hearing problems alone were not associated with any outcomes of interest. Conclusions The association between auditory problems and mental health problems emphasizes the importance of the prevention of auditory problems in the Armed Forces: through enhanced audiometric screening, improved hearing protection equipment, and greater levels of utilization of such equipment.

Keywords: armed forces, hearing problems, tinnitus, mental health, alcohol misuse

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Authors: Samwel Boaz Otieno, Fred Were, Ephantus Kabiru, Kaunda Waza

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A study was done to establish determinants of selenium intake in a high HIV prevalence fishing community in the Pala Bondo district, Kenya. It was established that most of the respondents (61%) were small holder Farmers and Fishermen {χ² (1, N=386) p<0.000}, and that most of them (91.2%) had up to college level education {χ².(1, N=386) p<0.000}, while the number of males and females were not significantly different {χ (1, N=386) p=0.263} and 83.5% of respondents were married {χ² (1, N=386) p=0.000}. The study showed that adults take on average 2.68 meals a day (N=382, SD=0.603), while children take 3.02 meals (N=386, SD=1.031) a day, and that in most households (82.6%) food is prepared by the women {χ² (1, N=386) p=0.000} and further that 50% of foods eaten in that community are purchased {χ² (1, N=386)=0.1818, p=0.6698}. The foods eaten by 75.2% of the respondents were Oreochromis niloticus, Lates niloticus, and Sorghum bicolour, 64.1% vegetables and that both children and adults eat same types of food, and further that traditional foods which have become extinct are mainly vegetables (46%). The study established that selenium levels in foods eaten in Pala sub-locations varies with traditional vegetables having higher levels of selenium; for example, Laurnea cornuta (148.5 mg/kg), Cleome gynandra (121.5 mg/kg), Vignia ungulata (21.97 mg/kg), while Rastrineobola argentea (51 mg/kg), Lates niloticus (0), Oreochromis niloticus (0) Sorgum bicolour (19.97 mg/kg), and Sorgum bicolour (0). The study showed that there is an inverse relationship between foods eaten and selenium levels {RR=1.21, p=0.000}, with foods eaten by 75.2% of respondents (Oreochromis niloticus/Lates niloticus) having no detectable selenium. The four soil types identified in the study area had varying selenium levels with pleat loam (13.3 mg/kg), sandy loam (10.7 mg/kg), clay (2.8 mg/kg) and loam (4.8 mg/kg). It was concluded from this study that for the foods eaten by most of the respondents the selenium levels were below Daily Reference Intake.

Keywords: determinants, HIV, food, fishing, Selenium

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Authors: Roman Medvedev, Andrey Yakshin, Konstantin Nikolaev, Sergey Yakunin, Fred Bijkerk

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Multilayer structures are used as spectroscopic elements in fluorescence analysis. These serve the purpose of analyzing soft x-ray emission spectra of materials upon excitation by x-rays or electrons. The analysis then allows quantitative determination of the x-ray emitting elements in the materials. Shorter wavelength range for this application, below 2.5nm, can be covered by using short period multilayers, with a period of 2.5 nm and lower. Thus the detrimental effect on the reflectivity of morphological roughness between materials of the multilayers becomes increasingly pronounced. Ion beam polishing was previously shown to be effective in reducing roughness in some multilayer systems with Si. In this work, we explored W/Si multilayers with the period of 2.5 nm. Si layers were polishing by Ar ions, employing low energy ions, 100 and 80 eV, with the etched Si thickness being in the range 0.1 to 0.5 nm. CuK X-ray diffuse scattering measurements revealed a significant reduction in the diffused scattering in the polished multilayers. However, Grazing Incidence CuK X-ray showed only a marginal reduction of the overall roughness of the systems. Still, measurements of the structures with Grazing Incidence Small Angle X-ray scattering indicated that the vertical correlation length of roughness was strongly reduced in the polished multilayers. These results together suggest that polishing results in the reduction of the vertical propagation of roughness from layer to layer, while only slightly affecting the overall roughness. This phenomenon can be explained by ion-induced surface roughening inherently present in the ion polishing methods. Alternatively, ion-induced densification of thin Si films should also be considered. Finally, the reflectivity of 40% at 0.84 nm at grazing incidence of 9 degrees has been obtained in this work for W/Si multilayers. Analysis of the obtained results is expected to lead to further progress in reflectance.

Keywords: interface roughness, ion polishing, multilayer structures, W/Si

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Authors: Ginger Egberts, Marianne Schaaphok, Fred Vermolen, Paul van Zuijlen

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A few years ago, a promising morphoelastic model was developed for the simulation of contraction formation after burn injuries. Contraction can lead to a serious reduction in physical mobility, like a reduction in the range-of-motion of joints. If this is the case in a healing burn wound, then this is referred to as a contracture that needs medical intervention. The morphoelastic model consists of a set of partial differential equations describing both a chemical part and a mechanical part in dermal wound healing. These equations are solved with the numerical finite element method (FEM). In this method, many calculations are required on each of the chosen elements. In general, the more elements, the more accurate the solution. However, the number of elements increases rapidly if simulations are performed in 2D and 3D. In that case, it not only takes longer before a prediction is available, the computation also becomes more expensive. It is therefore important to investigate alternative possibilities to generate the same results, based on the input parameters only. In this study, a surrogate neural network has been designed to mimic the results of the one-dimensional morphoelastic model. The neural network generates predictions quickly, is easy to implement, and there is freedom in the choice of input and output. Because a neural network requires extensive training and a data set, it is ideal that the one-dimensional FEM code generates output quickly. These feed-forward-type neural network results are very promising. Not only can the network give faster predictions, but it also has a performance of over 99%. It reports on the relative surface area of the wound/scar, the total strain energy density, and the evolutions of the densities of the chemicals and mechanics. It is, therefore, interesting to investigate the applicability of a neural network for the two- and three-dimensional morphoelastic model for contraction after burn injuries.

Keywords: biomechanics, burns, feasibility, feed-forward NN, morphoelasticity, neural network, relative surface area wound

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Authors: Zhuanfang Fred Zhang, Tim C. Johnson, Yilin Fang, Chris E. Strickland

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A variety of geophysical techniques are available to image the opaque subsurface with little or no contact with the soil. It is common to conduct time-lapse surveys of different types for a given site for improved results of subsurface imaging. Regardless of the chosen survey methods, it is often a challenge to process the massive amount of survey data. The currently available software applications are generally based on the one-dimensional assumption for a desktop personal computer. Hence, they are usually incapable of imaging the three-dimensional (3D) processes/variables in the subsurface of reasonable spatial scales; the maximum amount of data that can be inverted simultaneously is often very small due to the capability limitation of personal computers. Presently, high-performance or integrating software that enables real-time integration of multi-process geophysical methods is needed. E4D-MP enables the integration and inversion of time-lapsed large-scale data surveys from geophysical methods. Using the supercomputing capability and parallel computation algorithm, E4D-MP is capable of processing data across vast spatiotemporal scales and in near real time. The main code and the modules of E4D-MP for inverting individual or combined data sets of time-lapse 3D electrical resistivity, spectral induced polarization, and gravity surveys have been developed and demonstrated for sub-surface imaging. E4D-MP provides capability of imaging the processes (e.g., liquid or gas flow, solute transport, cavity development) and subsurface properties (e.g., rock/soil density, conductivity) critical for successful control of environmental engineering related efforts such as environmental remediation, carbon sequestration, geothermal exploration, and mine land reclamation, among others.

Keywords: gravity survey, high-performance computing, sub-surface monitoring, electrical resistivity tomography

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Authors: Ginger Egberts, Fred Vermolen, Paul van Zuijlen

Abstract:

One of the common complications in post-burn scars is contractions. Depending on the extent of contraction and the wound dimensions, the contracture can cause a limited range-of-motion of joints. A one-dimensional morphoelastic continuum hypothesis-based model describing post-burn scar contractions is considered. The beauty of the one-dimensional model is the speed; hence it quickly yields new results and, therefore, insight. This model describes the movement of the skin and the development of the strain present. Besides these mechanical components, the model also contains chemical components that play a major role in the wound healing process. These components are fibroblasts, myofibroblasts, the so-called signaling molecules, and collagen. The dermal layer is modeled as an isotropic morphoelastic solid, and pulling forces are generated by myofibroblasts. The solution to the model equations is approximated by the finite-element method using linear basis functions. One of the major challenges in biomechanical modeling is the estimation of parameter values. Therefore, this study provides a comprehensive description of skin mechanical parameter values and a sensitivity analysis. Further, since skin mechanical properties change with aging, it is important that the model is feasible for predicting the development of contraction in burn patients of different ages, and hence this study provides a feasibility study. The variability in the solutions is caused by varying the values for some parameters simultaneously over the domain of computation, for which the results of the sensitivity analysis are used. The sensitivity analysis shows that the most sensitive parameters are the equilibrium concentration of collagen, the apoptosis rate of fibroblasts and myofibroblasts, and the secretion rate of signaling molecules. This suggests that most of the variability in the evolution of contraction in burns in patients of different ages might be caused mostly by the decreasing equilibrium of collagen concentration. As expected, the feasibility study shows this model can be used to show distinct extents of contractions in burns in patients of different ages. Nevertheless, contraction formation in children differs from contraction formation in adults because of the growth. This factor has not been incorporated in the model yet, and therefore the feasibility results for children differ from what is seen in the clinic.

Keywords: biomechanics, burns, feasibility, fibroblasts, morphoelasticity, sensitivity analysis, skin mechanics, wound contraction

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Authors: Maria Hopkins, Sarah Koch, Fred Biasini

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Autism is lifelong disorder that affects one out of every 110 Americans. The deficits that accompany Autism Spectrum Disorders (ASD), such as abnormal behaviors and social incompetence, often make it extremely difficult for these individuals to gain functional independence from caregivers. These long-term implications necessitate an immediate effort to improve social skills among children with an ASD. Any technology that could teach individuals with ASD necessary social skills would not only be invaluable for the individuals affected, but could also effect a massive saving to society in treatment programs. The overall purpose of the first study was to develop, implement, and evaluate an avatar tutor for social skills training in children with ASD. “Face Say” was developed as a colorful computer program that contains several different activities designed to teach children specific social skills, such as eye gaze, joint attention, and facial recognition. The children with ASD were asked to attend to FaceSay or a control painting computer game for six weeks. Children with ASD who received the training had an increase in emotion recognition, F(1, 48) = 23.04, p < 0.001 (adjusted Ms 8.70 and 6.79, respectively) compared to the control group. In addition, children who received the FaceSay training had higher post-test scored in facial recognition, F(1, 48) = 5.09, p < 0.05 (adjusted Ms: 38.11 and 33.37, respectively) compared to controls. The findings provide information about the benefits of computer-based training for children with ASD. Recent research suggests the value of also using socially assistive robots with children who have an ASD. Researchers investigating robots as tools for therapy in ASD have reported increased engagement, increased levels of attention, and novel social behaviors when robots are part of the social interaction. The overall goal of the second study was to develop a social robot designed to teach children specific social skills such as emotion recognition. The robot is approachable, with both an animal-like appearance and features of a human face (i.e., eyes, eyebrows, mouth). The feasibility of the robot is being investigated in children ages 7-12 to explore whether the social robot is capable of forming different facial expressions to accurately display emotions similar to those observed in the human face. The findings of this study will be used to create a potentially effective and cost efficient therapy for improving the cognitive-emotional skills of children with autism. Implications and study findings using the robot as an intervention tool will be discussed.

Keywords: autism, intervention, technology, emotions

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Authors: Hassan Karimi, Fred Piercy, Ruoxi Chen, Ana L. Jaramillo-Sierra, Wei-Ning Chang, Manjushree Palit, Catherine Martosudarmo, Angelito Antonio

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Background: The two psychotherapy camps, the randomized clinical trials (RCTs) and the common factors model, have competitively claimed specific explanations for therapy effectiveness. Recently, scholars called for empirical evidence to show the role of common factors in therapeutic outcome in marriage and family therapy. Purpose: This cross-national study aims to explore how clinicians, across different nations and theoretical orientations, attribute the contribution of common factors to therapy outcome. Method: A brief common factors questionnaire (CFQ-with a Cronbach’s Alpha, 0.77) was developed and administered in seven nations. A series of statistical analyses (paired-samples t-test, independent sample t-test, ANOVA) were conducted: to compare clinicians perceived contribution of total common factors versus model-specific factors, to compare each pair of common factors’ categories, and to compare clinicians from collectivistic nations versus clinicians from individualistic nation. Results: Clinicians across seven nations attributed 86% to common factors versus 14% to model-specific factors. Clinicians attributed 34% of therapeutic change to client’s factors, 26% to therapist’s factors, 26% to relationship factors, and 14% to model-specific techniques. The ANOVA test indicated each of the three categories of common factors (client 34%, therapist 26%, relationship 26%) showed higher contribution in therapeutic outcome than the category of model specific factors (techniques 14%). Clinicians with psychology degree attributed more contribution to model-specific factors than clinicians with MFT and counseling degrees who attributed more contribution to client factors. Clinicians from collectivistic nations attributed larger contributions to therapist’s factors (M=28.96, SD=12.75) than the US clinicians (M=23.22, SD=7.73). The US clinicians attributed a larger contribution to client’s factors (M=39.02, SD=1504) than clinicians from the collectivistic nations (M=28.71, SD=15.74). Conclusion: The findings indicate clinicians across the globe attributed more than two thirds of therapeutic change to CFs, which emphasize the training of the common factors model in the field. CFs, like model-specific factors, vary in their contribution to therapy outcome in relation to specific client, therapist, problem, treatment model, and sociocultural context. Sociocultural expectations and norms should be considered as a context in which both CFs and model-specific factors function toward therapeutic goals. Clinicians need to foster a cultural competency specifically regarding the divergent ways that CFs can be activated due to specific sociocultural values.

Keywords: common factors, model-specific factors, cross-national survey, therapist cultural competency, enhancing therapist efficacy

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Authors: Fred Alinda, Marjorie Negesa, Gerald Karyeija

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Like elsewhere in the world, youth unemployment remains a big problem more so to the most educated youth and female. In Rwanda, unemployment is estimated at 13.2% among youth graduates compared to 10.9% and 2.6 among secondary and primary graduates respectively. Though empirical evidence elsewhere associate youth unemployment with education level, relevance of skills and access to business support opportunities, mixed evidence still exist on the significance of these factors to youth employment. As youth employment strategies in countries like Rwanda continue to recognize the potential role university education can play to enhance employment, there is a need to understand the catalysts or barriers. This paper, therefore, draws empirical evidence from a survey on the influence of education qualification, skills relevance and access to business support opportunities on employment of the youth university graduates in Masaka sector, Rwanda. The analysis tested four hypotheses; access to university education significantly affects youth employment, Relevance of university education significantly contributes to youth employment; access to business support opportunities significantly contributes to youth employment, and significant gender differences exist in the employment of youth university graduates. A cross-section survey was used in lieu of the need to explore the prevailing status of youth employment and contributing factors across the sector. A questionnaire was used to collect data on a large sample of 269 youth to allow statistical analysis. This was beefed up with qualitative views of leaders and technical officials in the sector. The youth University graduates were selected using simple random sampling while the leaders and technical officials were selected purposively. Percentages were used to describe respondents in line with the variables under while a regression model for youth employment was fitted to determine the significant factors. The model results indicated a significant influence (p<0.05) of gender, education level and access to business support opportunities on employment of youth university graduates. This finding was also affirmed by the qualitative views of key informants. Qualitative views pointed to the fact that university education generally equipped the youth with skills that enabled their transition into employment mainly for a salary or wage. The skills were, however, deficient in technical and practical aspects. In addition, the youth generally lacked limited access to business support opportunities particularly guarantees for loans, business advisory, and grants for business as well as training in business skills that would help them gain salaried employment or transit into self-employment. The study findings bear an implication on the strategy for catalyzing youth employment through university education. The findings imply that university education should be embraced but with greater emphasis on or supplementation with specialized training in practical and technical skills as well as extending business support opportunities to the youth. This will accelerate the contribution of university education to youth employment.

Keywords: education, employment, self-employment, youth

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Authors: Arti Singh, Carolyn Jenkins, Oyedunni S. Arulogun, Mayowa O. Owolabi, Fred S. Sarfo, Bruce Ovbiagele, Enzinne Sylvia

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Background: Stroke, the leading cause of adult-onset disability and the second leading cause of death, is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur. The Stroke Investigative Research and Education Network (SIREN) seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other non communicable diseases in SSA. One of the first steps to address this goal was to effectively engage the communities that suffer the high burden of disease in SSA. This study describes how the SIREN project engaged six sites in Ghana and Nigeria over the past three years, describing the community engagement activities that have arisen since inception. Aim: The aim of community engagement (CE) within SIREN is to elucidate information about knowledge, attitudes, beliefs, and practices (KABP) about stroke and its risk factors from individuals of African ancestry in SSA, and to educate the community about stroke and ways to decrease disabilities and deaths from stroke using socioculturally appropriate messaging and messengers. Methods: Community Advisory Board (CABs), Focus Group Discussions (FGDs) and community outreach programs. Results: 27 FGDs with 168 participants including community heads, religious leaders, health professionals and individuals with stroke among others, were conducted, and over 60 CE outreaches have been conducted within the SIREN performance sites. Over 5,900 individuals have received education on cardiovascular risk factors and about 5,000 have been screened for cardiovascular risk factors during the outreaches. FGDs and outreach programs indicate that knowledge of stroke, as well as risk factors and follow-up evidence-based care is limited and often late. Other findings include: 1) Most recognize hypertension as a major risk factor for stroke. 2) About 50% report that stroke is hereditary and about 20% do not know organs affected by stroke. 3) More than 95% willing to participate in genetic testing research and about 85% willing to pay for testing and recommend the test to others. 4) Almost all indicated that genetic testing could help health providers better treat stroke and help scientists better understand the causes of stroke. The CABs provided stakeholder input into SIREN activities and facilitated collaborations among investigators, community members and stakeholders. Conclusion: The CE core within SIREN is a first-of-its kind public outreach engagement initiative to evaluate and address perceptions about stroke and genomics by patients, caregivers, and local leaders in SSA and has implications as a model for assessment in other high-stroke risk populations. SIREN’s CE program uses best practices to build capacity for community-engaged research, accelerate integration of research findings into practice and strengthen dynamic community-academic partnerships within our communities. CE has had several major successes over the past three years including our multi-site collaboration examining the KABP about stroke (symptoms, risk factors, burden) and genetic testing across SSA.

Keywords: community advisory board, community engagement, focus groups, outreach, SSA, stroke

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Authors: Robert Miller, Fred Soltero, Sandra Allan, Denise Bonilla

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The Tropical Bont Tick (TBT), Amblyomma variegatum, was introduced to the Caribbean in the mid-1700s. Since it has spread throughout the Caribbean dispersed by cattle egrets (Bubulcus ibis). Tropical Bont Ticks vector many pathogens to livestock and humans. However, only the livestock diseases heartwater, Ehrlichia (Cowdria) ruminantium, and dermatophilosis, Dermatophilus congolensis, are associated with TBT in the Caribbean. African tick bite fever (Rickettsia africae) is widespread in Caribbean TBT but human cases are rare. The Caribbean Amblyomma Programme (CAP) was an effort led by the Food and Agricultural Organization to eradicate TBTs from participating islands. This 10-year effort successfully eradicated TBT from many islands. However, most are reinfested since its termination. Pheromone technology has been developed to aid in TBT control. Although not part of the CAP treatment scheme, this research established that pheromones in combination with pesticide greatly improves treatment efficiencies. Additionally, pheromone combined with CO₂ traps greatly improves active surveillance success. St. Croix has a history of TBT outbreaks. Passive surveillance detected outbreaks in 2016 and in May of 2021. Surveillance efforts are underway to determine the extent of TBT on St Croix. Puerto Rico is the next island in the archipelago and is at a greater risk of re-infestation due to active outbreaks in St Croix. Tropical Bont Ticks were last detected in Puerto Rico in the 1980s. The infestation started on the small Puerto Rican island of Vieques, the closest landmass to St Croix, and spread to the main island through cattle movements. This infestation was eradicated with the help of the Tropical Cattle Tick (TCT), Rhipicephalus (Boophilus) microplus, eradication program. At the time, large percentages of Puerto Rican cattle were treated for ticks along with the necessary material and manpower mobilized for the effort. Therefore, a shift of focus from the TCT to TBT prevented its establishment in Puerto Rico. Currently, no large-scale treatment of TCTs occurs in Puerto Rico. Therefore, the risk of TBT establishment is now greater than it was in the 1980s. From Puerto Rico, the risk of TBT movement to the American continent increases significantly. The establishment of TBTs in the Americas would cause $1.2 billion USD in losses to the livestock industry per year. The USDA Agricultural Research Service recently worked with the USDA Animal Health Inspection Service and the Puerto Rican Department of Agriculture to modernize the management of the TCT. This modernized program uses safer pesticides and has successfully been used to eradicate pesticide-susceptible and -resistant ticks throughout the island. The objective of this work is to prevent the infestation of Puerto Rico by TBTs by combining the current TCT management efforts with TBT surveillance in Vieques. The combined effort is designed to eradicate TCT from Vieques while using the treated cattle as trap animals for TBT using pheromone impregnated tail tags attached to treated animals. Additionally, active surveillance using CO₂-baited traps combined with pheromone will be used to actively survey the environment for free-living TBT. Knowledge gained will inform TBT control efforts in St. Croix.

Keywords: Amblyomma variegatum, caribbean, eradication, Rhipicephalus (boophilus) microplus, pheromone

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Authors: Kazuhiro Tateda, Elisa Gonzalez, Shuhei Ito, Kirstin Heinrich, Kevin Sweetland, Pingping Zhang, Catia Ferreira, Michael Pride, Jennifer Moisi, Sharon Gray, Bennett Lee, Fred Angulo

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Clostridium difficile (C. difficile) is the most common cause of antibiotic-associated diarrhea and infectious diarrhea in healthcare settings. Japan has an aging population; the elderly are at increased risk of hospitalization, antibiotic use, and C. difficile infection (CDI). Little is known about the population-based incidence and disease burden of CDI in Japan although limited hospital-based studies have reported a lower incidence than the United States. To understand CDI disease burden in Japan, CLOUD (Clostridium difficile Infection Burden of Disease in Adults in Japan) was developed. CLOUD will derive population-based incidence estimates of the number of CDI cases per 100,000 population per year in Ota-ku (population 723,341), one of the districts in Tokyo, Japan. CLOUD will include approximately 14 of the 28 Ota-ku hospitals including Toho University Hospital, which is a 1,000 bed tertiary care teaching hospital. During the 12-month patient enrollment period, which is scheduled to begin in November 2018, Ota-ku residents > 50 years of age who are hospitalized at a participating hospital with diarrhea ( > 3 unformed stools (Bristol Stool Chart 5-7) in 24 hours) will be actively ascertained, consented, and enrolled by study surveillance staff. A stool specimen will be collected from enrolled patients and tested at a local reference laboratory (LSI Medience, Tokyo) using QUIK CHEK COMPLETE® (Abbott Laboratories). which simultaneously tests specimens for the presence of glutamate dehydrogenase (GDH) and C. difficile toxins A and B. A frozen stool specimen will also be sent to the Pfizer Laboratory (Pearl River, United States) for analysis using a two-step diagnostic testing algorithm that is based on detection of C. difficile strains/spores harboring toxin B gene by PCR followed by detection of free toxins (A and B) using a proprietary cell cytotoxicity neutralization assay (CCNA) developed by Pfizer. Positive specimens will be anaerobically cultured, and C. difficile isolates will be characterized by ribotyping and whole genomic sequencing. CDI patients enrolled in CLOUD will be contacted weekly for 90 days following diarrhea onset to describe clinical outcomes including recurrence, reinfection, and mortality, and patient reported economic, clinical and humanistic outcomes (e.g., health-related quality of life, worsening of comorbidities, and patient and caregiver work absenteeism). Studies will also be undertaken to fully characterize the catchment area to enable population-based estimates. The 12-month active ascertainment of CDI cases among hospitalized Ota-ku residents with diarrhea in CLOUD, and the characterization of the Ota-ku catchment area, including estimation of the proportion of all hospitalizations of Ota-ku residents that occur in the CLOUD-participating hospitals, will yield CDI population-based incidence estimates, which can be stratified by age groups, risk groups, and source (hospital-acquired or community-acquired). These incidence estimates will be extrapolated, following age standardization using national census data, to yield CDI disease burden estimates for Japan. CLOUD also serves as a model for studies in other countries that can use the CLOUD protocol to estimate CDI disease burden.

Keywords: Clostridium difficile, disease burden, epidemiology, study protocol

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