Enhancing heat transfer in thermal systems is crucial for energy efficiency. The use of Nano-fluids and twistedtape inserts in circular pipes are the most widely used passive heat transfer improvement techniques. Whilenanofluids, especially CuO-water, enhance thermal conductivity, twisted tapes create swirl flow to disturbboundary layers. The Nusselt number, friction factor, and thermal performance parameters of a circular pipecontaining Nano-fluids and twisted tapes at 180 and 120 degrees are studied numerically in this work. Thetwisted tape inserts are modeled as idealized helical baffles to induce secondary swirl flows, thereby disruptingthermal boundary layers and improving heat exchange. The research yields findings for a strip twist ratio of threeand a turbulent flow range of Re 4000–20,000. The RNG k–ε model is utilized to solve the governing equationsand a steady heat flux of 30,000 W/m2 is supplied. The highest simulation findings of Nusselt number for Nano-fluid are 5.25, 9.85, and 12.5 % higher in comparison to Gnielinski relations of water for plain tube and twistedtape inserts at 180 and 120 degrees respectively. However, increased pressure drop is noted as a trade-off, theoverall thermal performance factor of 1.42 was achieved for Nano-fluid flow in a pipe with a 120◦ twisted tapeinsert which yields a significant heat transfer improvement.
Keywords: CuO-water nano-fluid, Turbulent flow, Twisted tape, Heat transfer enhancement, CFD

Introduction One of the most important but underappreciated roles of nurses is patient advocacy. To advocatefor patients effectively, the nurses should have a favorable attitude towards patient advocacy. Despite this fact, thenurses’ attitude towards patient advocacy was not known in Ethiopia. Thus, this study aimed to assess nurses’ attitudetowards patient advocacy and its associated factors in East Gojjam Zone Public Hospitals, Northwest in 2023.Methods Institutional-based cross-sectional study design was conducted among 385 nurses in East Gojjam ZonePublic Hospitals from March 1 to April 30, 2023. Nurses were selected using simple random sampling techniquesfrom 11 public hospitals. The data were collected in a self-administered way. Binary logistic regression was used fordata analysis. All independent variables having a P value of < 0.25 in the bivariable logistic regression were fitted intoa multivariable logistic regression. The AOR at a 95% confidence interval was used to identify the strength of theassociation, and a p value of 0.05 was used to declare it statistically significant at the final model.Result A total of 385 nurses participated in the study, for a 91% response rate. Among these, 49.9% of nurses hadan unfavorable attitude. Being working in a primary hospital [AOR = 2.3; 95% CI: (1.4–3.8)], poor cooperation ofnurses [AOR = 1.7; 95% CI: (1.1–2.8)], being unsatisfied with the job [AOR = 1.7; 95% CI: (1.1–2.7)], and poor perceivedsupervision of work [AOR = 6.2; 95% CI: (3.7–9.8)] were factors associated with nurses’ attitudes towards patientadvocacy.Conclusion The number of nurses who had an unfavorable attitude towards patient advocacy was high. Workingin a primary hospital, poor cooperation with others, being dissatisfied with the job, and having an unfavorableperception towards the supervision of work were the factors associated with the unfavorable attitude of nursestowards patient advocacy. It is recommended that all hospitals better support the nurses to increase their jobsatisfaction and have good supervision of the nurses’ activities.Keywords Advocacy, Attitude, Nurse

Background: Evidence-based practice is clinical decision-making using the best evidence available in the context of individual patients' preferences and clinical expertise. It is serving as a crucial instrument for the health science disciplines to minimize the theory-practice gap although the level of practice is unknown. Thus, this study aimed to assess nurses' implementation of evidence-based practice in nursing process and its associated factors in South Wollo Zone Public Hospitals.
Methods: An explanatory sequential mixed method was employed from April 1 to May 29, 2023, among 419 nurses for the quantitative part and 15 others for the qualitative part. The data were collected using structured, pretested, self-administered questionnaires. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. The bivariable analysis was done primarily, and variables with a p-value < 0.25 were further examined using a multivariable logistic regression model to control con-founders. Then, variables having a p-value less than 0.05 with a 95% CI were used to declare significantly associated factors. The key informants were interviewed using pre-made interview guidelines, and then open code software was utilized to conduct a thematic analysis.
Result: Nurses who had poor implementation of evidence-based practice in the nursing process were 228 [54.42%; 95% CI: (49.8-59.3)]. Similarly, the key informants concluded that the implementation of evidence-based practice in the nursing process was low. Participants who were 31- 40 years old [AOR = 0.61, 95% CI: (0.38-0.99)], 41-50 years [AOR = 0.32, 95% CI: (0.15-0.65)], working at general hospitals [AOR = 3.37, 95% CI: (1.39-8.18)] and comprehensive specialized hospitals [AOR = 7.29, 95% CI: (3.06 - 17.31)], lack of training about evidence-based practice (AOR = 2.50, 95% CI: (1.36-4.56)], and lack of internet access [AOR = 2.46, 95% CI: (1.43-4.23)] were factors associated with poor levels of nurses' implementation of evidence-based practice in the nursing process. The absence of computers, libraries, and updated guidelines were other factors identified on the quality analysis.
Conclusion: Nurses' implementation of evidence-based practice in the nursing process was low. Age, working in general hospitals, and comprehensive and specialized hospitals, lack of training, and internet access were factors that had significant associations. Hence, hospital managers should give an attention to internet access and training about utilization of evidence-based practice in nursing process, particularly for those aged above thirty years old.

Keywords: Ethiopia; Evidence-based practice; Nurses; Nursing process.

Background and Purpose: Staphylococcus aureus is a common pathogen responsible for causing various human and animalinfections and is well known for its ability to develop resistance to multiple antibiotics. This study aimed to evaluate the occurrence ofmethicillin-resistant Staphylococcus aureus (MRSA) in bulk milk and dairy farms in northwestern Ethiopia and to determine theirphenotypic and genotypic antimicrobial susceptibility patterns.Methods: We collected 50 bulk milk samples from 50 dairy farms and 50 hand swabs from dairy milkers. The cefoxitin disk diffusiontest and PCR-based assays were used to identify MRSA isolates. In addition, cefoxitin-resistant isolates were tested for susceptibilityto other antibiotics using the Kirby-Bauer disk diffusion method.Results: The results showed that MRSA was detected in 8 samples: 6 from bulk milk samples (12%) and 2 from hand swabs (4%). AllMRSA isolates exhibited a high resistance rate to penicillin (100%), followed by tetracycline (75%), ciprofloxacin (25%), chloram-phenicol (25%), erythromycin (25%), gentamycin (12.5%), and trimethoprim-sulfamethoxazole (12.5%). Moreover, 72% of theisolates showed resistance to three or more antibiotic classes and were classified as multidrug-resistant.Conclusion: This study identified methicillin-resistant Staphylococcus aureus and multidrug-resistant MRSA in bulk milk and dairyfarms in northwestern Ethiopia. These findings highlight the potential risk of transmission of these antibiotic-resistant bacteria tohumans and the need for improved antibiotic stewardship in the dairy sector using the One Health approach.Keywords: dairy farms, Ethiopia, humans, MRSA, bulk milk, resistance

AbstractIntroduction The emergence of First-line Antiretroviral Therapy (ART) regimens fails; it necessitates the use of morecostly and less tolerable second-line medications. Therefore, it is crucial to identify and address factors that increasethe likelihood of first-line ART regimen failure in children. Although numerous primary studies have examinedthe incidence of first-line ART failure among HIV-infected children in Ethiopia, national-level data on the onsetand predictors remain inconsistent. Hence, this study was conducted to fill the gaps in determining the onset of first-line ART failure and its predictors among HIV-infected children in Ethiopia.Methods Articles related to our topic of interest were searched using a systematic approach in national and interna-tional electronic databases. The retrospective follow-up cohort studies published in English up to 2022 were included.The data were extracted using a Microsoft Excel spread sheet and exported into Stataâ„¢ Version 17.0 for further man-agement and analysis. The level of heterogeneity was quantified using I 2 test together with a 95% confidence interval(CI). The incidence of the primary estimates was estimated using a random effects model in the Dersimonian-Laired-method. Subgroup analysis, Meta regression, and sensitivity analysis were computed to identify the source of het-erogeneity but not explained. The predictors of first-line ART failure were explained using relative risk (RR) with 95%confidence interval (CI).Results Ten studies having a total of 5446 children were included. The pooled onset of first-line ART failure was 3.18(95% CI: 1.91, 4.44) per 100 child-years of observations. Those study participants who began ART at an advanced WHOclinical stage at ART initiation had a 3.05 (95% CI: 1.47, 6.36), having poor ART adherence had a 2.19 (95% CI: 1.29, 3.70),and having TB-HIV coinfection at ART initiation had a 1.43 (95% CI: 1.06, 1.94) times higher chance of experiencingfirst-line ART failure than their corresponding counterparts.Conclusion The onset of first-line ART failure was high to achieve the 2030 UNAIDS target of ending the AIDSepidemic. Advanced WHO clinical stage, poor first-line ART adherence, and having TB-HIV coinfection were identifiedpredictors. Hence, community HIV screening should continue to strengthen early ART initiation, and the attention
of ART adherence should be kept to achieve ending the AIDS epidemic. The baseline tests and diagnosis, like TB diag-nosis should be maintained for HIV-infected children while they begin ART.Keywords First-line ART failure, Onset, Predictors, Children, Ethiopia

Abstract

Introduction: The most common and severe cause of morbidity and mortality among HIV- positive children is opportunistic infections (OIs). All HIV-infected children are at risk of developing a variety of OIs. Healthcare workers, programmers, and other stakeholders are in doubt about using the onset and predictors of OIs among schoolchildren on antiretroviral therapy (ART) due to the presence of conflicting results found in the primary studies. Hence, this study was conducted to provide a single figure of onset and specific predictors of OIs by overcoming the existing heterogeneity in Ethiopia.
Methods: The included studies were searched from different national and international databases systematically. The included studies were cohort in design and published in English between 2015 and 2022. The data were extracted using a validated Microsoft Excel tool after the quality of the included studies was assured. The extracted data were exported to Stata Version 17.0 for further management and analysis. The presence of heterogeneity across studies was checked using the Chi-square test and quantified using the I 2 test. Various methods, including forest plots, publication bias assessment, sensitivity tests, subgroup analysis, and meta-regression, were employed to determine the source of heterogeneity, but none were successful. The overall onset of OIs was estimated by pooling the incidence of primary studies using a random-effects meta-analysis model. The predictors were identified using meta-regression and the presence of significant association was declared using a p-value of 0.05 with 95% CI. The strength of association was reported using an adjusted hazard ratio with 95% CI.
Results: Eleven studies were included in this systematic review and meta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was 5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations. Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) times higher chance of getting OIs when compared with those children having one or both parents. Children who had poor ART adherence had a 2.96 (95% CI: 1.66, 5.29) times higher chance of experiencing OIs than children who had good ART adherence. Finally, the chance of experiencing OIs among rural children was 2.15 (95% CI: 1.63, 2.83) times higher than their counterparts in Ethiopia.
Conclusions: Three in every 33 schoolchildren on ART developed OIs in Ethiopia. Predictors of OIs included schoolchildren without parents, those with poor adherence to ART, and rural residents. This suggests that social support, medication adherence, and access to healthcare services may play important roles in preventing and controlling OIs among schoolchildren living with HIV in rural areas.

Keywords: Ethiopia; children on ART; onset and predictors; opportunistic infections; schoolchildren.

Introduction: The most common and severe cause of morbidity and mortalityamong HIV- positive children is opportunistic infections (OIs). All HIV-infectedchildren are at risk of developing a variety of OIs. Healthcare workers,programmers, and other stakeholders are in doubt about using the onset andpredictors of OIs among schoolchildren on antiretroviral therapy (ART) due tothe presence of conflicting results found in the primary studies. Hence, thisstudy was conducted to provide a single figure of onset and specificpredictors of OIs by overcoming the existing heterogeneity in Ethiopia.Methods: The included studies were searched from different national andinternational databases systematically. The included studies were cohort indesign and published in English between 2015 and 2022. The data wereextracted using a validated Microsoft Excel tool after the quality of theincluded studies was assured. The extracted data were exported to StataVersion 17.0 for further management and analysis. The presence ofheterogeneity across studies was checked using the Chi-square test andquantified using the I2 test. Various methods, including forest plots,publication bias assessment, sensitivity tests, subgroup analysis, andmeta-regression, were employed to determine the source of heterogeneity,but none were successful. The overall onset of OIs was estimated by poolingthe incidence of primary studies using a random-effects meta-analysis model.The predictors were identified using meta-regression and the presence ofsignificant association was declared using a p-value of 0.05 with 95% CI. Thestrength of association was reported using an adjusted hazard ratio with 95% CI.Results: Eleven studies were included in this systematic review andmeta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations.Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) timeshigher chance of getting OIs when compared with those children having oneor both parents. Children who had poor ART adherence had a 2.96 (95% CI:1.66, 5.29) times higher chance of experiencing OIs than children who hadgood ART adherence. Finally, the chance of experiencing OIs amongrural children was 2.15 (95% CI: 1.63, 2.83) times higher than theircounterparts in Ethiopia.
Conclusions: Three in every 33 schoolchildren on ART developed OIs in Ethiopia.Predictors of OIs included schoolchildren without parents, those with pooradherence to ART, and rural residents. This suggests that social support,medication adherence, and access to healthcare services may play importantroles in preventing and controlling OIs among schoolchildren living with HIV inrural areas.KEYWORDS: schoolchildren, opportunistic infections, onset and predictors, children on ART, Ethiopia

Abstract: Peanut production plays a crucial role in global food security, particularly in developingcountries, where it provides essential nutrition and income. This paper examines the optimizationof peanut production through genetic advancements, climate adaptation strategies, and sustainablepractices. The primary objective is to increase yields by addressing challenges related to climatechange, pests, and resource constraints. Globally, peanut production is hindered by rising temper-atures, irregular rainfall, and declining soil quality, impacting both yield and quality. Developingcountries, especially in Africa and Asia, face additional challenges, such as limited access to advancedagricultural technologies, inadequate infrastructure, and insufficient support for smallholder farmers.The vital issues include genetic vulnerabilities to pests, climate stress, and inefficient water use.Recent genetic research has provided insights into breeding more resilient, drought-resistant varieties,offering hope for improving yields, despite environmental challenges. The adoption of climateadaptation strategies, precision farming, and integrated pest management is essential for boostingproductivity. These, along with optimized irrigation and nutrient management, have significantlyimpacted peanut production in resource-limited settings. Additionally, drought-resistant varietieshave proven crucial, enabling farmers to increase resilience and yields in areas facing climate stress.In conclusion, optimizing peanut production requires continued investment in genetic advancements,infrastructure, and sustainable practices. Future efforts should focus on improving climate adaptationand sustainable farming techniques for long-term success.Keywords: climate adaptation; drought-resistant varieties; genetic advancements; integrated pestmanagement; precision farming; sustainable practices

O. abyssinica, known in Ethiopia as lowland bamboo, is a solid-stemmed clump-forming bamboo species widelydistributed in the western dry regions of Ethiopia. The versatility of the species means that it has enormouspotential for land restoration in arid and semi-arid areas, in addition to bringing socio-economic benefits. It alsodisplays remarkable adaptability, allowing it to thrive in the challenging ecological conditions of areas such asthe Abay Gorge. The Abay Gorge, situated within the Upper Blue Nile River Basin of Northwestern Ethiopia ischaracterized by problems associated with soil erosion and land degradation. This study, therefore, aimed toevaluate and recommend a suitable spatial analysis for the adoption and development of lowland bamboo(O. abyssinica). Fifteen primary influencing factors were chosen according to the needs of O. abyssinica, theaccessibility of data, and the financial implications associated with data analysis, particularly the expensesrelated to soil laboratory testing. Eight composite soil samples were taken directly by dividing the watershed intotwo categories (upper and lower catchment areas). These composite soil samples were analyzed. Data analysiswas performed via Analytical Hierarchy Process (AHP) in conjunction with Multi-Criteria Decision-Making(MCDM) analysis and the use of Remote Sensing (RS) and Geographic Information System (GIS). The spatialanalysis employed in this study was a weighted sum overlay analysis, which was applied by considering thecriteria weight assigned to each factor. The analysis revealed that 21.2 % (666.5 ha) of the total area was highlysuitable for the growth and development of O. abyssinica. About 56 % (1753 ha) of the land was moderately andmarginally suitable for the desired land utilization type. However, 23 % (723.8 ha) of the study area was un-suitable for O. abyssinica. O. abyssinica has the potential to rehabilitate large parts of challenging areas such as theAbay Gorge due to its naturally invase rhizomes and drought-tolerance. It can also be introduced into agrofor-estry systems and used as living fences for villages.
Keywords: AHP, GIS, Land evaluation, Lowland bamboo, MCDM, Remote sensing

Introduction: The rising global prevalence of cancer reveals significant regional disparities in palliative care adoption. While some countries have incorporated palliative care into their systems, over half of the world lacks such services, and oncology-specific palliative care integration is sparse. This study evaluates the global prevalence of palliative care use among cancer patients.
Methods: A comprehensive search across multiple databases was conducted to identify relevant studies. Data extraction and organisation were managed using Microsoft Excel, and analysis was performed with STATA/MP 17.0. A weighted inverse variance random-effects model was applied, and heterogeneity was assessed with Cochrane I² statistics. Subgroup analyses, sensitivity analyses and Egger's test were used to explore heterogeneity, publication bias and influential studies.
Results: The global prevalence of palliative care among cancer patients was 34.43% (95% CI: 26.60 to 42.25). Africa had the highest utilisation rate at 55.72% (95% CI: 35.45 to 75.99), while the USA had the lowest at 30.34% (95% CI: 19.83 to 40.86). Studies with sample sizes under 1000 showed a higher utilisation rate of 47.51% (95% CI: 36.69 to 58.32). Approximately 55% (95% CI: 35.26 to 74.80) of patients had a positive attitude towards palliative care, and 57.54% (95% CI: 46.09 to 69.00) were satisfied with the services. Positive attitudes were significantly associated with higher palliative care utilisation.
Conclusion: Only about one-third of cancer patients globally receive palliative care, with the highest utilisation in Africa. Nearly half of patients have a favourable attitude towards palliative care, and a similar proportion are satisfied with the services.

Keywords: Cancer; End of life care; Nursing Home care; Palliative Care.