Depression is one of the mental illnesses that cause disability worldwide, and is a significant contributor to the global burden of diseases. Although depression is reported among patients with ...diabetes in high-income countries, it remains undetected or undiagnosed in low and middle-income countries. This article describes the prevalence of depression and its associated factors among patients with diabetes in Zanzibar, United Republic of Tanzania.
A cross-sectional study design was conducted at Mnazi Mmoja Referral Hospital (MMRH). A simple random sampling method was used to select the potential participants. Depressive symptoms were assessed using Patient Health Questionnaire-9(PHQ-9). Data were coded and analyzed using SPSS 23.0. A Chi-square test was performed to obtain the association between depression and socio-demographic, medical and psychological factors. A P-value of <0.05 with a 95% confidence interval was used to determine the significant associations between the variables. Also, multiple logistic regression was performed with the factors with P-value <0.2 to ascertain the confounding factors.
A total of 267 patients with diabetes responded to the questionnaire of which 142 (53.2%) were males. The mean age of participants was 50 years and a standard deviation of ±14. The overall prevalence of depression in this study was 73%. The specific type of depression among diabetic patients varied from severe (8%) to mild depression (30%). Respondents who had difficulties in adhering to the treatment regimen (AOR = 5.7: 95% CI, 2.11-15.18, p = 0.001), feeling angry or stressed (AOR = 4.4: 95% CI, 2.44-8.10, p<0.001), and had diabetic retinopathy (AOR = 2.8: 95% CI, 1.45-5.28, p = 0.002) had symptoms of depression. Furthermore, respondents who had diabetic foot ulcers (AOR = 0.1: 95% CI, 0.04-0.49, p = 0.003) and impotence for male patients (AOR = 0.4: 95% CI, 0.20-0.68, p = 0.002) were 0.1 and 0.4 times less likely to have depression respectively.
The majority of patients with diabetes have symptoms of depression. Adherence to the treatment regimen, diabetic retinopathy, feeling angry or stressed, impotence and diabetic foot ulcer were associated with depression. Thus, early screening of depression among patients with diabetes is crucial to enhance self-management and good health outcomes.
Abstract
ELVES have been regularly studied since 2013 with the twenty-four telescopes of the Pierre Auger Observatory, exploiting a dedicated trigger and extended readout. A large fraction of the ...observed events shows double ELVES within the time window, and, in some cases, even more complex structures are observed. We classify double ELVES using the radial variation of the time gap and the photon flux ratio between flashes. Such parameters may be related to the different types of lightning in which they originated. We will review the cross correlations of the ELVES light emissions with the radio waves detected by the antennas of the ENTLN network, active in Argentina since late 2018. Further improvements of our detection and classification algorithms were achieved by detecting ELVES from closer lightning: since December 2020, the ELVES trigger was extended to the three High Elevation Auger Telescopes (HEAT), which observe the night sky at elevation angles between 30 and 60 degrees, with an enhanced time resolution (50 ns time binning). Both single and double ELVES are recorded with unprecedented time and space resolution. Events from the first year of data taking will be shown.
In the last six years, the Fluorescence Detector (FD) of the Auger Observatory has been exploited for the study of transient luminous events occuring high above thunderstorms at large distances (250 ...to more than 1000 km) from the Observatory. The first ELVES candidate was discovered during a night shift in 2005, and further studies based on auxiliary subtriggers allowed to modify the third level trigger of the observatory in order to acquire them with reasonable efficiency. This report aims to briefly review the studies underway on the >4000 ELVES triggers harvested in the years 2013-18 by the Observatory.
Groundwater is a useful source of water for various uses in different places. The major challenge in the use of this resource is how to manage and protect it from contamination. The current study was ...conducted in Morogoro Municipality to identify vulnerable groundwater areas by using DRASTIC-LU/LC model. The study applied eight input parameters, i.e., depth to water table, net recharge, aquifer media, soil media, topography, impact of vadose zone, hydraulic conductivity and land use/land cover patterns, which were overlaid in GIS to generate groundwater vulnerable map. The model used rating (R = 1–10) and weighting (W = 1–5) techniques to assess the effect of each parameter on groundwater contamination. The DRASTIC-LU/LC Vulnerability Index map was classified into low- (area = 29.2 km2), moderate- (area = 120.4 km2) and high-vulnerability zones (area = 124.4 km2). Nitrate analysis was conducted using the cadmium reduction method (DR 890) to assess the validity of the model and it was observed that 55%, 15% and 50% of the samples with unacceptable (>50 mg/L), high (29–50 mg/L) and moderate (14–28 mg/L) nitrate concentrations, respectively, fall into the high-vulnerability zone. Furthermore, 45%, 70% and 50% of the samples with unacceptable, high and moderate nitrate concentrations, respectively, fall into the moderate-vulnerability zone. In the low-vulnerability zone, only 15% of samples were found with a high nitrate concentration.
The study develops the Blinder-Oaxaca decomposition technique for the independent double hurdle model. The proposed decomposition is done at the aggregate level. Using the Second Malawi Integrated ...Household Survey (IHS2), the paper applies the proposed decomposition to explain the rural-urban difference in parental spending on own primary school children. The results show that at least 66% of the expenditure differential is explained by differences in characteristics between rural and urban households.
Chamwino district, central Tanzania is a semi-arid granitic complex province, where groundwater is the major source of water for domestic and other uses. However, groundwater in the area is affected ...by salinity, thus, lowering the availability of potable water for various uses, decrease in crop production, taste less, wastage of soap, and abnormal pain. Due to this, this study sought to characterize groundwater using hydrogeochemical facies and signatures in order to identify the factors influencing the distribution of salt water in the Chamwino Granitic Complex. A total of 141 groundwater samples were collected from wells spatially distributed within the study area from January 2023 to April 2023, (a season of relatively low rainfall). All samples were subjected to in situ analyses of physicochemical parameters pH, temperature (T), total dissolved solids (TDS), electrical conductivity (EC), and salinity using a multi-parameter water analyzer and analyses of major ions (Ca2+, Mg2+, K+, Na+, Cl−, SO42−, HCO3−, and NO3−). The study revealed that the dominant cations in the groundwater are Na+ > Ca2+ > Mg2+, and the anions are Cl− > HCO3− > SO42. Five geological formations (granodiorite, tonalitic orthogenesis, migmatite, tonalite, and alluvium) were identified, and each is characterized by its unique groundwater facie. In the areas that are dominated with granodiorite, the major hydrogeochemical facies were Ca–HCO3, Na–Cl, Ca–Na–HCO3, Ca–Mg–Cl, and Ca–Cl water types; tonalitic orthogenesis was dominated by Ca–HCO3, Na–Cl, Ca–Mg–Cl, and Ca–Cl water types; migmatite was dominated by Ca–HCO3, Na–Cl, Ca–Mg–Cl, and Ca–Cl water types; tonalite was dominated by Na–Cl, Ca–Mg–Cl, and Ca–Cl water types; and alluvium was dominated by Na–Cl and Ca–Mg–Cl and Ca–Cl water types. The common hydrogeochemical facies in all five geological units are Na–Cl, Ca–Mg–Cl, and Ca–Cl water types. It is revealed that the groundwater in the study area is alkaline in nature and slightly saline with salinity level between 0.2 mg/L (fresh water) and 2.8 mg/L (brackish water) with mean 1.07 mg/L (of 141 samples). The factors controlling groundwater salinity distribution are mainly rock-water interaction and ion exchange reactions. Groundwater salinity in the study area is largely attributed to the abundance of Na+, Ca2+, Cl− and SO42−. Abundance of Na+ and Ca2+ is the results of both, weathering of feldspar minerals particularly plagioclase (Na–Ca feldspars) which are the major mineral in granites, and evaporation crystallization cycles of evaporates in semi-arid areas such as Chamwino. Also, such evaporation crystallization cycles account for the abundance of Cl− and SO42− especially in areas dominated by alluvium. However, anthropogenic activities as evidenced by elevated nitrate up to 212.6 mg/L in congested areas are also likely to contribute in area) to the elevated Cl− and SO42−. In other geological units such as tonalitic orthogneiss, migmatite and granodiorite, there was an ostensible mixing of saline water with fresh water from local recharge as indicated by the abundance of HCO3− ions. Nonetheless, the hydrogeochemical characterization of groundwater in the Chamwino granitic complex suggests that there is little possibility for groundwater to evolve to a carbonate water type (fresh water) because the groundwater salinity is mainly geogenic, unless artificial recharge through rainwater harvesting is applied.
In developing countries like Tanzania, groundwater studies are essential for water resource planning, development, and management. Limited hydrogeological information on groundwater occurrence, ...availability, and distribution in Urambo District is termed a key factor that hinders groundwater development. This research was aimed at the evaluation of groundwater potential zones in a granitic gneiss aquifer in Urambo District by integrating six indicators (transmissivity, specific capacity, static water level, yield, total dissolved solids, and geology) that were developed and applied in the study area. The indicators were further combined, and a groundwater potential index map (GWPIM) was prepared using relative weights derived from the analytical hierarchy process (AHP). The results show that 67% and 27% of the study area are categorized as moderate and high groundwater potential zones, respectively. Groundwater is controlled by both Quaternary sediments (sands and gravels) and weathered to fractured granitic gneiss. Quaternary sediments host the major shallow aquifers (<35 m) with relatively high transmissivity, specific capacity, and yield (1.5 m2/day, 16.36 m2/day, and 108 m3/day, respectively). Granitic gneiss is not strongly fractured/weathered and forms an aquifer with a relatively low yield of about 10.08 m3/day. The findings were validated using three boreholes, and the results are consistent with the developed GWPIM. Such findings are of great importance in groundwater development as the techniques applied can be extended to other areas in Tanzania as well as other countries that experience similar geological environments.
Abstract Nowadays, industrial nanofiltration membrane technology is widely used, particularly when it comes to recovering and recycling water for preservation. This research is related to the ...processing of wastewater from one of the industrial areas in Indonesia into raw water using nanofiltration on a pilot scale. This research aims to identify the removal of nitrate and dissolved iron from industrial area wastewater through flow recirculation in nanofiltration and identify the effect of variations in wastewater concentration and variations in product recovery. The wastewater being treated is wastewater from an industrial area owned by PT. Jababeka Infrastruktur is composed of a ratio of 100% WWTP effluent, 9:1, 8:2, 7:3, and 6:4 between WWTP influent and effluent ratio. This study’s membrane module employs a two-stage membrane system and a spiral wound with model specifications NF2-4040. Recirculation is used in the reactor to process the material and provide cross flow. The results of the study stated that variations in concentration made a significant difference to the removal of nitrate and dissolved iron ( p value < 0.05), but variations in product recovery the opposite response. The processed water meets the raw water quality standards for nitrate parameters, but not for dissolved iron parameters at processed water concentrations of 7:3 and 6:4.
Background
Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more ...rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings.
Methods
A cost–effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and threshold analyses were performed to determine the robustness of the results.
Results
The laparoscopic and open cholecystectomy costs and effectiveness values were $2664.47 with 0.87 quality-adjusted life years (QALYs) and $2058.72 with 0.75 QALYs, respectively. The incremental cost–effectiveness ratio for laparoscopic over open cholecystectomy was $4946.18. Results are sensitive to the initial laparoscopic equipment investment and number of cases performed annually but robust to other parameters. The laparoscopic intervention is more cost-effective with investment costs less than $91,979, greater than 65 cases annually, or at willingness-to-pay (WTP) thresholds greater than $3975/QALY.
Conclusions
At RMH, while laparoscopic cholecystectomy may be a more effective approach, it is also more expensive given the low caseload and high investment costs. At commonly accepted WTP thresholds, it is not cost-effective. However, as investment costs decrease and/or case volume increases, the laparoscopic approach may become favorable. Countries and hospitals should aspire to develop innovative, low-cost options in high volume to combat these barriers and provide laparoscopic surgery.
Abstract
Cloud features above the Pierre Auger Observatory (Mendoza Province, Argentina) significantly affect the reconstruction of Extensive Air Showers. In this work, we present seasonal variations ...of cloud-base height, cloud coverage, and correlation between different sites using the information of elastic multiangle lidar data. This system locates the presence of clouds by measuring the spikes in the backscattered photons detected in the direction of the sweep performed during each lidar scan, outside the field of view (FOV) of the fluorescence detectors. Horizontal homogeneity should be assumed to translate these results to the full array. This ansatz is verified by a set of dedicated horizontal lidar shots performed for a few seconds every hour inside the FOV of the fluorescence detectors. Here we present the results for the period 2007 to 2016, using all the continuous lidar scans available in the lidar database. The analysis algorithm used for cloud retrieval has been upgraded and is based on a different concept than the previous one. How cloud parameters vary across seasons is investigated, and conclusions about cloud homogeneity across the Pierre Auger array are given.
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