Research papers

Multiple Representations: An Approach to Teaching Selected Physics Topics

Aduo Frank, Isaac Litukgma Njofuni

This study investigated the impact of using multiple representations in teaching selected physics topics, specifically sound and waves, to senior high school students in Ghana. An action-research design was employed with an intact class of 30 form two students purposively sampled. Various representational formats including visual, text, graph, diagrammatic, and mathematical representations were incorporated during lessons. The main data collection instruments were achievement tests and classroom observation over five lessons. Findings revealed that students demonstrated improved skills in diagrammatic, graphical, verbal, and mathematical representations, with a notable enhancement in their cognitive achievement on physics concepts relating to sound and waves. The intervention engaged students actively in classroom discourse, promoting higher motivation, interaction, and participation. Quantitative analysis showed significant gains in students' ability to correctly solve physics problems using multiple representations compared to pre-intervention results. The study concluded that employing multiple representations supports conceptual understanding and problem-solving skills, counteracting the limitations of traditional lecture-based teaching that often leads to rote memorization and low engagement. The use of diverse representations facilitated students' development of science process skills such as graph drawing and diagrammatic reasoning. Recommendations include integrating multiple representations consistently in physics curricula, encouraging collaborative learning, and providing teacher training on implementing these strategies. The findings underscore the pedagogical value of multiple representations and provide a basis for adopting similar approaches to improve science education outcomes in Ghana and beyond.

The Impact of Junior Secondary Basic Science on Senior Secondary Physics Outcome in Rivers State, Nigeria

Allwell Sunny Njigwum, Vincent A. Asuru, Nbame Letam Nna-Kue

The study investigated the impact of Basic Education Certificate Education (BECE), considering Basic Science as a predictor of Senior Secondary Certificate Examination (SSCE) Physics performance in public secondary schools in Port Harcourt metropolis. The study employed both ex-post facto and correlational design. A sample of 593 students was employed for the study and purposive sampling technique was utilized to select the sample. The study was anchored on the Motivational Systems Theory of Academic Achievement. Three research questions and three corresponding hypotheses were tested at 0.05 level of significance. Data used for the study was collected directly from the examining bodies. The data obtained was analyzed using simple linear regression statistics. The findings of the study showed BECE Basic Science performance does not significantly predict SSCE Physics performance (R² = .001; β = 0.028, P > 0.05), accounting for only 0.1% of the variance in students' Physics scores. Gender-based analysis indicated that female students' BECE Basic Science performance had no significant predictive effect on SSCE Physics (R² = .004; β = -0.064, P > 0.05), explaining only 0.4% of the variance, while male students' BECE Basic Science scores also showed no significant prediction (R² = .005; β = 0.069, P > 0.05), explaining 0.5% of the variance. Based on these findings, it was recommended that the Nigerian Educational Research and Development Council (NERDC) review the junior secondary Basic Science curriculum to incorporate more Physics-related content, ensuring early exposure to fundamental Physics concepts.

Improving the Achievement of Learning Outcomes in Early Undergraduate Physics: A Case Study at a University in Ghana

Samuel A. Atarah, Martin Egblewogbe, Florence Christianah Awoniyi, Abraham Amankwah

Students’ performance in introductory physics at a university in Ghana was assessed over three academic years. The study covered two physics courses delivered to first-year students at the university. Two factors—access to tutorial sessions delivered outside of lecture times by teaching assistants and access to a formula sheet during the exams—were studied. The impact of the factors on students’ performance was studied by comparing student scores, item difficulty levels, point biserial correlation coefficients, and internal discrimination index for a set of questions that were common to all the exams. The effect of both factors was an increase in the item difficulty from 0.60 ± 0.09 for the control group to 0.63 ± 0.19 for the treatment group, while the effect of the formula sheet increased from 0.60 ± 0.16 to 0.64 ± 0.20. The point biserial correlation coefficient did not change for the study on the effect of the provision of formula sheets in examinations, but it was statistically significant for the group that had separate tutorial sessions. The findings suggest that more learning outcomes can be achieved using interactive teaching approaches and favouring the least amount of rote learning of physical formulae.

Improving Students’ Performance in Resolution of Vectors Using PhET Interactive Simulations

Isaac Kwesi Acquah, Michael Gyan, Desmond Appiah, Bright Owusu Ansah, Robert S. Wilson, Charles Enoch Mensah

Purpose of the study: The paper examines the use of Physics Education Technology (PhET) simulations to enhance the academic performance of third-year science students at Kumasi Wesley Girls' High School. Methodology: The research used teacher-made tests, questionnaires, and informal observations to collect data. Ninety candidates (90 students) were selected from the third-year science population using a cluster sampling. The questionnaire, pre-evaluation, and post-evaluation tests on vectors were analyzed using descriptive statistics. Main Findings: The study found that PhET-based teaching significantly improved the performance of third-year science students in vector resolution, with a paired mean difference of 6.30 compared to pre-treatment tests. The questionnaire analysis of 90 students revealed that 85.6% initially found vector applications difficult, and 80% felt the teaching methods were unvaried and boring. After the PhET lab simulation intervention, 89% of students were enthusiastic about using simulations in future activities, and 78% reported an improved understanding of resultant vectors. The study indicates that PhET simulations significantly enhance student engagement and comprehension compared to traditional lecture teaching methods. Novelty/Originality of this study: The study explores using Physics Education Technology (PhET) simulations in Ghanaian high school Kumasi Wesley Girls' High School to improve vector resolution learning. The interactive approach demystifies complex concepts, and the study quantifies its impact on students' academic performance. It also provides insights into students' attitudes towards physics education

Examining the Impact of Knowledge of Mathematics on Academic Achievement in Physics, Among Students at Mawuli Senior High School, Ghana

Anthony Babategrimine Yuoni, Uthman Amadu, Issahaku Sontaa Jakalia

Purpose: The aim of this action research is to evaluate the impact of mathematical knowledge on students' academic performance in physics at Mawuli School, Ho. Methodology: A teacher-made test was the instrument used for data collection in this study. The test consisted of questions in both mathematics and physics. The mathematics questions were strategically selected to align with concepts relevant to the physics curriculum. Pre-test and post-test were administered using similar sets of questions. Data analysis employed descriptive statistics, paired t-tests, correlation analysis, and regression analysis. Findings: The study findings indicated a statistically significant positive correlation between students' mathematical knowledge and their performance in physics. Also, there was no significant difference in the performance of males and females students. Unique Contribution to Theory, Practice and Policy: It was therefore recommended that physics teachers prioritize assessing and enhancing students' mathematical proficiency prior to introducing physics topics that require mathematical application.

Nursing in the Digital Age: Harnessing telemedicine for enhanced patient care

Aanuoluwapo Clement David-Olawade, David B. Olawade, Iyanuoluwa Oreofe Ojo, Motunrayo E. Famujimi, Temitope T. Olawumi, Debo…

Telemedicine has emerged as a transformative force in contemporary healthcare, reshaping nursing practice across various specialties. This narrative review explored the role, challenges, and ethical considerations associated with telemedicine in nursing practice. Also, it emphasizes telemedicine’s impact on patient care, the evolution of nursing workflows, and future directions for implementation. A comprehensive narrative review was conducted, drawing upon primary research articles, systematic reviews, and policy documents published between 2010 and 2023. The search was carried out using electronic databases, including PubMed, ScienceDirect, CINAHL, and Google Scholar, employing keywords such as "telemedicine," "nursing practice," "patient care," and "ethical considerations." Eligible studies were critically appraised for relevance and rigor. Data synthesis included the identification of key themes, trends, and exemplary instances of telemedicine utilization in nursing practice. The review revealed a multifaceted role of telemedicine in nursing practice. Teletriage and remote patient monitoring were instrumental in reducing emergency department overcrowding and improving patient triage accuracy. Teleconsultations and virtual visits facilitated patient-provider interactions, while telepsychiatry addressed the growing demand for mental health support. Tele-education emerged as a vital tool for ongoing professional development among nurses. Moreover, telemedicine effectively reached rural and underserved populations, addressing healthcare disparities. Ethical considerations, such as patient privacy, informed consent, and data security, emerged as significant challenges in telemedicine. As telemedicine continues to evolve, nurses should remain adaptable, actively engaging with emerging technologies and interdisciplinary teams. Furthermore, healthcare organizations, policymakers, and nursing associations/regulatory bodies should collaborate to establish clear ethical and legal guidelines. These efforts will ensure the continued growth of telemedicine in nursing practice, ultimately enhancing patient outcomes and expanding access to quality healthcare services. • Telemedicine correlates with improved patient outcomes and higher satisfaction rates. • Nurses are pivotal in teletriage and remote patient monitoring initiatives. • Teleconsultations streamline care delivery, enhancing efficiency and accessibility. • Telepsychiatry bridges gaps in mental health services, catering to remote patients. • Teleeducation empowers nurses through accessible and flexible professional development.

Immersive Virtual Labs for Enhancing In-Person and Online Education

Yiyang Li, Yuzhong Shen, C. I. Sukenik

of the Department for 9 years.Charles' research is primarily in experimental atomic, molecular and optical physics, but he also has ongoing research efforts in remote sensing in

Factors Associated with Membership in a Mutual Health Insurance Fund in the Thiès Region (Senegal) in 2023: Article

Mamadou Guedji DIOUF, Mamadou Makhtar Mbacké Lèye, Martial Coly Bop, Cheikh Tacko Diop, Alfred Inis Ndiaye, Ousseynou Kâ

 Introduction : Mutual health insurance constitutes a micro-insurance system which facilitates access to care by avoiding direct payment. They represent one of the pillars of our Universal Health Coverage. After years of existence and despite political commitment, community support for mutual health insurance remains low until now. The objective of our work was to study the factors linked to the membership of mutual health insurance companies in the Thiès region and to propose solutions.  Methodology : The study was cross-sectional, descriptive and analytical. It was carried out among a sample of 1,300 people, residing in the Thiès region for at least 6 months, chosen following a three-stage cluster survey. A questionnaire was used to collect data related to predisposing, facilitating and health system factors. These data were entered and analyzed using SPSS version 21 software. The significance value was P < 0.05. The Odds ratio was used to measure the strength of the link.  Results : The average age is 42 years and among the people surveyed 75.3% lived in an urban area, 84.5% claimed to know mutual insurance companies. The number of dependent children among the people surveyed was 9 and 90% had an income-generating activity, married people were 82.9% and 78.2% were educated. The mutual penetration rate was 69.3%. The analysis showed that membership in mutual health insurance was significantly influenced by the area of residence with P < 0.001 [OR: 2.0; CI:1.4-2.8], by age group with P < 0.001[OR:1.4; CI:1.1-2.0], by income-generating activity with P < 0.001 [OR:2.1; CI:1.1-4.1], by knowledge of a mutual with P < 0.001 [OR:81.6; CI: 42.2-157] and education with P < 0.001 [OR: 1.9; CI: 1.3-2.6]. Membership was also associated with marital status and the number of children in care with P < 0.001 and P < 0.002 respectively.  Conclusion : This study made it possible to evaluate the penetration rate of mutual health insurance in the Thiès region in 2023, but also to identify the factors associated with membership in a mutual health insurance. Strengthening communication and targeted awareness and improving the level of knowledge of the populations will help to boost the level of support of the populations of the Thiès region.

Expanding the horizons of medical physics beyond medical radiation science

Alhassan Mohammed Baidoo, Stephanie Brako Boateng, Ruth Beulah Awotwe, Samuel Nii Adu Tagoe, Philip Odonkor, Anna Mamoud

Dear Editor, The vast expanse of medical physics, as a discipline, traverses far beyond the mere application of radiation in healthcare. Yet, there seems to be an inadvertent narrowing of its scope in both academic curricula and public perception. By sequestering the role of medical physics to predominantly radiation-based applications, we risk overlooking its comprehensive potential in revolutionizing patient care and clinical solutions. Medical physics involves the application of the concepts and methods of physics to medicine. Its footprint can be observed wherever physics aids in the prevention, diagnosis, and treatment of diseases. This understanding, reinforced by numerous scientists and authors, is also delineated in general literature, from encyclopedias to dictionaries. Consequently, the realm of medical physics extends across every nook and cranny of healthcare facilities. From assessments, such as temperature and pressure-related vitals, to diagnostic procedures involving medical imaging, and treatments encompassing cardiac defibrillators and artificial heart valves, medical physics plays an instrumental role. However, the current academic trend is concerning. A majority of graduate programs in medical physics seem to be anchored predominantly on diagnostic imaging, radiation therapy, and nuclear medicine physics. These subjects, while crucial, focus primarily on radiation's clinical, research, and industrial applications. This skewed emphasis has led to a scenario where the term “medical physics” evokes immediate associations with “diagnostic imaging physics, radiotherapy physics, and nuclear medicine physics.” This tunnel vision not only shapes public perception but also manifests itself in the job market. Hospitals tend to list radiologically-related roles when appointing medical physicists, perpetuating this limited scope. Through your esteemed journal, we wish to shed light on the need for a broader understanding and application of medical physics, extending beyond the radiation-centric narrative that currently prevails. We believe that diversifying the roles and responsibilities of medical physicists will significantly contribute to the advancement of healthcare and scientific communities. Thank you for considering our perspective. We look forward to your action in addressing this urgent matter for the betterment of healthcare and the scientific community at large. Yours sincerely, Corresponding author. Mr. Alhassan Mohammed Baidoo: Conception of research idea, writing of initial draft, review and approval of finished work. Stephanie Brako Boateng: Conception of research idea and writing of initial draft. Ruth Beulah Awotwe: Conception of research idea and rewriting of initial draft. Samuel Nii Adu Tagoe: Review and correction of written work. Philip Odonkor: Rewriting of initial draft. Anna Mamoud: Rewriting of initial draft. The authors have nothing to report. The authors declare no conflicts of interest.

A Review of Students’ Academic Performance in Physics: Attitude, Instructional Methods, Misconceptions and Teachers Qualification

Humphrey D. Assem, Laud Nartey, Eric Appiah, James K. Aidoo

This study aims at presenting a literature review on four factors; attitude, instructional methods, students’ misconception, and teachers’ qualification that contribute to low academic performance of students in physics. Physics is one of the most fundamental natural sciences which involves the study of universal laws, and of the behaviors and relationships among a wide range of physical phenomena. Research has shown that both teachers and students’ attitude towards physics is a major reason for low academic performance in subjects across the globe. Naki (2018) argued that attitudes such as procrastination have a greater impact on students’ achievement. The attitudes of students towards physics, the thoughts and beliefs about the course, the habits of studying and constantly postponing tendency are very influential. Boabeng et al. (2014) opine that the quality of the teachers implementing a curriculum has a greater effect on the academic performance of students. Regardless of how well-resourced the school is or how extensive the curriculum is, teaching methods also have a significant impact on students’ academic progress as well as how easier for a misconception is to be dispelled. When the finest teaching strategies are employed, physics teachers can have a significant positive impact on students’ knowledge hence good performance.

Causes and effects of theory-practice gap during clinical practice: the lived experiences of baccalaureate nursing students

Stella Ngozika Ugwu, Ngozi P. Ogbonnaya, Veronica Chiegeiro Chijioke, Judith Njideka Esievo

PURPOSE: This study evaluated the baccalaureate nursing students' lived experiences of the causes and effects of TPG during clinical practice in a tertiary health institution in Enugu, Nigeria. METHOD: A qualitative design using existential descriptive phenomenological approach was adopted to explore 20 baccalaureate nursing students at 500 level of study. The class level of the students was purposively sampled and the exact number of students sampled using snowball technique. Semi-structured interview guide was the instrument for data collection. Data were collected using audio-tape recorder, face to face in depth discussions, and analyzed using qualitative thematic analysis. RESULT: Five broad themes and 12 subthemes emerged from this study namely: Resource constraints (limited resources, resource improvise); Unhealthy human attitudinal and behavioural factors (nurse clinicians, nurse educators, student nurses factors); Environmental system challenges (paradoxical academic design and structure, paradoxical clinical setting); Integration Inadequacy (team cooperation paucity, scarce surveillance, insufficient timing of clinical placement); Observing effects of TPG (observing adverse impacts, observing positive implications). CONCLUSION: The causes of TPG during clinical practice emerge from nursing education and practice. TPG have adverse impacts on patients, nursing students, nursing education and practice, other health practitioners, while linkage to response is its positive implication.

Pollution and health: a progress update

Richard Fuller, Philip J. Landrigan, Kalpana Balakrishnan, Glynda Bathan, Stephan Böse‐O’Reilly, Michael Bräuer, Jack Carava…

The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical pollution. Pollution, climate change, and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science-policy interface to inform intervention, influence research, and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or, occasionally, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health.

Effects of Peer Tutoring on Pre-Service Teachers’ Physics Performance in Colleges of Education, Ghana

Valentina Osei-Himah, Joseph Parker, Anna Mwinbuabu Naah

At Atebubu College of Education, the study attempted to determine the impacts of peer tutoring on gender and senior High school background courses of pre-service teachers in physics. To achieve the purpose of the study an action research design was used and a total number of 140 (78 males and 62 females) who are offering primary Education program were purposively selected. The major research tools were accomplishment tests, which were used to collect quantitative data from pre-service teachers. Using the independent sample t-test and one-way ANOVA to analyse the quantitative data. It was found that the male students’ performance in Physics (M = 8.81, SD = 0.927) does not significantly differ from that of the female students’ (M = 8.65, SD = 0.925) as a result of the peer tutoring method adopted for the study. The results of the one-way ANOVA show that there are no differences in the mean score of the pre-service teachers’ performance in Physics and their senior High School course background. It is therefore recommended among other things that the principals and head of science departments of Colleges of Education in Ghana should organise workshops, seminars and in-service training on how to utilize peer tutoring method effectively in teaching scientific concepts to pre-service teachers they training.

Pharmaceutical pollution of the world’s rivers

John L. Wilkinson, Alistair B.A. Boxall, Dana W. Kolpin, Kmy Leung, Racliffe Weng Seng Lai, Cristóbal Galbán‐Malagón, Aiko D…

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

Development and evaluation of an electronic nursing documentation system

Mohsen Shafiee, Mostafa Shanbehzadeh, Zeinab Nassari, Hadi Kazemi-Arpanahi

BACKGROUND: Nursing documentation is a critical aspect of the nursing care workflow. There is a varying degree in how detailed nursing reports are described in scientific literature and care practice, and no uniform structured documentation is provided. This study aimed to describe the process of designing and evaluating the content of an electronic clinical nursing documentation system (ECNDS) to provide consistent and unified reporting in this context. METHODS: A four-step sequential methodological approach was utilized. The Minimum Data Set (MDS) development process consisted of two phases, as follows: First, a literature review was performed to attain an exhaustive overview of the relevant elements of nursing and map the available evidence underpinning the development of the MDS. Then, the data included from the literature review were analyzed using a two-round Delphi study with content validation by an expert panel. Afterward, the ECNDS was developed according to the finalized MDS, and eventually, its performance was evaluated by involving the end-users. RESULTS: The proposed MDS was divided into administrative and clinical sections; including nursing assessment and the nursing diagnosis process. Then, a web-based system with modular and layered architecture was developed based on the derived MDS. Finally, to evaluate the developed system, a survey of 150 registered nurses (RNs) was conducted to identify the positive and negative impacts of the system. CONCLUSIONS: The developed system is suitable for the documentation of patient care in nursing care plans within a legal, ethical, and professional framework. However, nurses need further training in documenting patient care according to the nursing process, and in using the standard reporting templates to increase patient safety and improve documentation.

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019

Jonathan Kocarnik, Kelly Compton, Frances Dean, Weijia Fu, Brian Gaw, James Harvey, Hannah Henrikson, Dan Lu, Alyssa Pennini…

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection

José Villar, Shabina Ariff, Robert B. Gunier, Ramachandran Thiruvengadam, Stephen Rauch, Kholin A.M. Kholin, Paola Roggero, …

Importance: Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective: To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants: In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures: COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures: The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results: A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher risk only for maternal morbidity (RR, 1.24; 95% CI, 1.00-1.54) and preeclampsia (RR, 1.63; 95% CI, 1.01-2.63). Among women who tested positive (98.1% by real-time polymerase chain reaction), 54 (13%) of their neonates tested positive. Cesarean delivery (RR, 2.15; 95% CI, 1.18-3.91) but not breastfeeding (RR, 1.10; 95% CI, 0.66-1.85) was associated with increased risk for neonatal test positivity. Conclusions and Relevance: In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.

Computational Analysis on Numerical Simulation of Internal Flow Physics for Pump as Turbine in Renewable Small Hydro Energy Generation

Jianguo Du, Daniel Adu, Emmanuel Acheaw, Shakir Hafeez, Eric Ofosu Antw

Energy contributes significantly in almost all aspects of human life as well as economic activities and plays a crucial role in the infrastructural development of a county to alleviate poverty. Generating energy from a renewable source such as small hydropower through the application of pump operating as a turbine mode called Pump as Turbine is one of the best alternatives to provide clean and inexpensive energy. Using Pump as Turbine helps in generating reasonably priced hydroelectric power for communities in underdeveloped counties. This study investigates the effects of internal flow behaviour and performance of Pump as Turbine under different rotational speed and flow rate. The rotational speed is an essential physical parameter as it affects the Pump as Turbine operation. A model-specific speed centrifugal pump model with head 32 (m), flow rate of 12.5 (m3/h) and the rotational speed of 2900 rpm, has been selected for the study. Numerical simulations have been conducted using the k-ω turbulence model to solve three-dimensional (3D) equations. The pump mode experimental data were used to confirm the results for better analysis. The results predicted that vortex and turbulent kinetic energy increase per rotational speed increase. Also, at the higher rotational speed, very high recirculation of flow is detected at the blade suction chamber, although the pressure side has a smooth flow. This study provides beneficial information which will serve as a reference to help improve PAT performance along with selecting PAT for a small hydropower site. Future works will consider the impact of blade thickness and cavitation in Pump as Turbine.

Cognitive-behavioural reflective training for improving critical thinking disposition of nursing students

Godwin C. Abiogu, Moses Onyemaechi Ede, John J. Agah, Felix Okechukwu Ugwuozor, Maduka L. Nweke, Nneka Nwosu, Ogechi Nnamani…

BACKGROUND/OBJECTIVE: The importance of critical thinking in improving treatment practices in, for instance, the nursing profession, cannot be overemphasized. Despite this importance, empirical studies have shown that helping strategies to train learners on critical thinking disposition are needed. Given this knowledge gap, this study investigated the impacts of cognitive-behavioral reflective training for improving the critical thinking disposition of nursing students. METHOD: Of all the students screened, a total of 167 participants were assigned to the treatment group and waitlisted control group. A researchers-developed training program aimed at improving critical thinking disposition was delivered in English language by therapists. RESULTS: Repeated-measures ANOVA showed that there was no significant difference between the critical thinking disposition of nursing students in the treatment and control groups as measured by CTDI-M at the posttest. At the posttreatment and follow-up measures, there were consistently improved impacts of CBRT on the critical thinking disposition of nursing students in Nigeria as measured by CTDI-M. CONCLUSION: Following the results, we concluded that cognitive-behavioral reflective training was beneficial and had sustained improvement in enhancing the critical thinking disposition of nursing students.

ENHANCING STUDENTS' ATTITUDE AND ACHIEVEMENT IN BIOLOGY THROUGH INNOVATIVE STRATEGIES

Martha Ijok Adibe Njoku, Chinwe Nwagbo

In this research, the impact of peer tutoring and group tutoring led to team learning approaches on the attitude of the students towards and achievement in biology. The thesis had been motivated by four research questions and six null hypotheses. The research had used a quasi-experimental method. In particular, the design of the un-equivalent control group. The sample size was 182 SS 1 students from the four sampled government senior high schools in Port-Harcourt metropolis, River State, Nigeria in four intact classrooms. Two of the classes were exposed to peer tutoring while the remaining two were exposed to peer-led team learning strategies. Biology Attitudinal Scale (BAS), and Biology Achievement Test (BAT) were data collection instruments. BAS construct validity was developed using factor analysis, while BAT material validity was calculated using the specification table. Reliability for BAS and BAT was obtained using formula 20 (K-R 20) from Cronbach Alpha and Kudar-Richardson. Mean and the standard deviation was used to answer the study questions while Covariance analysis (ANCOVA) was used to evaluate the hypotheses at 0.05 significance point. The findings showed that peer-led team learning approach is better than peer tutoring in enhancing the attitude and achievement of the students in biology. The implications of the findings were highlighted and recommendations made.

A close look at the biology of SARS-CoV-2, and the potential influence of weather conditions and seasons on COVID-19 case spread

Kamoru A. Adedokun, Ayodeji Oluwadare Olarinmoye, Jelili Olaide Mustapha, Ramat T. Kamorudeen

BACKGROUND: There is sufficient epidemiological and biological evidence of increased human susceptibility to viral pathogens such as Middle East respiratory syndrome coronavirus, respiratory syncytial virus, human metapneumovirus and influenza virus, in cold weather. The pattern of outbreak of the coronavirus disease 2019 (COVID-19) in China during the flu season is further proof that meteorological conditions may potentially influence the susceptibility of human populations to coronaviruses, a situation that may become increasingly evident as the current global pandemic of COVID-19 unfolds. MAIN BODY: A very rapid spread and high mortality rates have characterized the COVID-19 pandemic in countries north of the equator where air temperatures have been seasonally low. It is unclear if the currently high rates of COVID-19 infections in countries of the northern hemisphere will wane during the summer months, or if fewer people overall will become infected with COVID-19 in countries south of the equator where warmer weather conditions prevail through most of the year. However, apart from the influence of seasons, evidence based on the structural biology and biochemical properties of many enveloped viruses similar to the novel severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 (aetiology of COVID-19), support the higher likelihood of the latter of the two outcomes. Other factors that may potentially impact the rate of virus spread include the effectiveness of infection control practices, individual and herd immunity, and emergency preparedness levels of countries. CONCLUSION: This report highlights the potential influence of weather conditions, seasons and non-climatological factors on the geographical spread of cases of COVID-19 across the globe.

Comorbidity and its Impact on Patients with COVID-19

Adekunle Sanyaolu, Chuku Okorie, Aleksandra Marinkovic, Risha Patidar, Kokab Younis, Priyank Desai, Zaheeda Hosein, Inderbir…

Determinants of depression among nursing students in Cameroon: a cross-sectional analysis

Tsi Njim, Clarence Mbanga, Dave Mouemba, Haman Makebe, Louise Toukam, Belmond Kika, Isabelle Mulango

Abstract Background Nursing students are highly susceptible to depression given the heavy workload and clinical demands of the curriculum. Depression has negative impacts on their health and academic performance. This study aimed to determine the determinants of depression amongst nursing students in the English-speaking regions of Cameroon. Methods A cross-sectional analysis of 447 nursing students recruited from a combination of state-owned and private nursing institutions in the English-speaking regions of Cameroon from January – April 2018 was carried out. Independent correlates of depression were determined using multivariable regression analysis, with the level of significance set at 95%. Results The overall prevalence of depression (Patient Health Questionnaire - 9 &gt; 4) and major depressive disorder (Patient Health Questionnaire - 9 &gt; 9) in these students was 69.57 and 26.40% respectively. Independent correlates of depression were found to be: total Oldenburg Burnout Inventory score (aOR: 1.18; 95% CI: 1.11, 1.25; p value &lt; 0.01); level of studies (aOR: 0.72; 95% CI: 0.55, 0.94; p value = 0.02) and occurrence of a life-changing crises (aOR: 2.13; 95% CI: 1.28, 3.55, p value &lt; 0.01). Conclusion The prevalence of depression amongst nursing students in Cameroon is high. Determinants proposed in this study require further assessment to facilitate early identification and management of depression in this high-risk group, in order to limit the negative effects linked with the condition.

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

Jianbo Lai, Simeng Ma, Ying Wang, Zhongxiang Cai, Jianbo Hu, Ning Wei, Jiang Wu, Hui Du, Tingting Chen, Ruiting Li, Huawei T…

Importance: Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed. Objective: To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China. Design, Settings, and Participants: This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible. Main Outcomes and Measures: The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes. Results: A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale-Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001). Conclusions and Relevance: In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.