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We provide a design case using applied trauma-informed frameworks to guide the design and usage adoption of an online support and mentorship platform for African applied science PhD scholars. In the Rsif context, scholars traverse countries, systems, and cultures to obtain their PhDs. The project objective was to create an online system to support their doctoral journeys. We will describe the program, introduce our team, summarize the literature guiding our selection of support objectives and overview the features we integrated into our platform design. After this, we will discuss our platform adoption approach and summarize the results of this project. Finally, concluding with a reflection on bringing trauma-informed frameworks into other learning ecologies.

Abstract Background There are limited data from sub-Saharan Africa describing the demographic characteristics, clinical features and outcome of patients admitted to public hospitals with severe acute respiratory infections during the COVID-19 pandemic. Methods We conducted a prospective longitudinal hospital-based sentinel surveillance between May 2020 and December 2022 at 16 public hospitals in Kenya. All patients aged above 18 years admitted to adult medical wards in the participating hospitals were included. We collected data on demographic and clinical characteristics, SARS-CoV-2 infection and COVID-19 vaccination status and, admission episode outcomes. We determined COVID-19 vaccine effectiveness (VE) against admission with SARS-CoV-2 positive severe acute respiratory illness (SARI) (i.e., COVID-19) and progression to inpatient mortality among patients admitted with SARI, using a test-negative case control design. Results Of the 52,636 patients included in the study, 17,950 (34.1%) were admitted with SARI. The median age was 50 years. Patients were equally distributed across sexes. Pneumonia was the most common diagnosis at discharge. Hypertension, Human Immunodeficiency Virus (HIV) infection and Diabetes Mellitus were the most common chronic comorbidities. SARS-CoV-2 test results were positive in 2,364 (27.9%) of the 8,471 patients that underwent testing. After adjusting for age, sex and presence of a chronic comorbidity, SARI patients were more likely to progress to inpatient mortality compared to non-SARI patients regardless of their SARS-CoV-2 infection status (adjusted odds ratio (aOR) for SARI and SARS-CoV-2 negative patients 1.22, 95% CI 1.10–1.37; and aOR for SARI and SARS-CoV-2 positive patients 1.32, 95% CI 1.24–1.40). After adjusting for age, sex and presence of a chronic comorbidity, COVID-19 VE against progression to inpatient mortality following admission with SARI for those with a confirmed vaccination status was 0.59 (95% CI 0.27–0.77). Conclusion We have provided a comprehensive description of the demographic and clinical pattern of admissions with SARI in Kenyan hospitals during the COVID-19 pandemic period as well as the COVID-19 VE for these patients. These data were useful in providing situational awareness during the first three years of the pandemic in Kenya and informing national response measures.

Abstract Background Evidence-based and evidence-informed interventions designed to address gaps in the HIV care continuum have the potential to improve HIV care and treatment. However, inadequate organizational readiness can derail intervention uptake, prevent the integration of interventions, and contribute to suboptimal HIV treatment outcomes. This study sought to understand organizational readiness to implement bundled interventions for Black women with HIV and inform facilitators and barriers to implementation. Methods We conducted a mixed methods readiness assessment across 12 sites participating in the Black Women First (BWF) initiative to gauge preparedness to implement bundled interventions. Readiness was assessed using the organizational readiness for implementing change (ORIC) scale, and two open-ended questions examined facilitators and barriers. Associations between participant and organizational level factors were evaluated using linear models with clustering by site at baseline, 6- and 12-months. Pre-implementation interviews were conducted with staff virtually and transcripts were managed in NVivo. Directed content analysis was used to explore implementation barriers and facilitators. Findings Sites demonstrated high levels of organizational readiness at baseline; overall organizational readiness for implementing change (ORIC) (mean 56.4, median 59, interquartile range [IQR] 5) and subscales of the ORIC change efficacy (mean 32.4, median 35, IQR 4), change commitment (mean 24, median 25, IQR 1), which is consistent with willingness and capability to implement bundled interventions for Black women with HIV. Organizational readiness remained high at 6- and 12-month follow-up periods. Staff role was significantly associated with organizational readiness (p = 0.007), change efficacy (p = 0.006), and change commitment (p = 0.020) at 6 months. Qualitative analysis indicated strategic planning and assessment (e.g., team coordination and the development of workflows to support implementation); organizational change through network weaving across silos within the organization, and communications systems that engage external partners, as well as resources available for hiring and training, supported readiness. Collaborative leadership and organizational buy-in, staff motivation, and partnerships facilitated implementation processes. Conclusions Organizations in the BWF initiative have high levels of organizational readiness reflecting willingness and capability to implement bundled interventions for Black women with HIV. Future research should examine the relationship between readiness and clinical outcomes.

Abstract Background The Expert Recommendations for Implementing Change (ERIC) project identified 73 strategies for supporting the implementation of a novel intervention and evidence-informed practices. In this paper, we explore convenings, which engage stakeholders in proactive dialogues, as a mechanism to deliver multiple strategies that support sites adapting and implementing evidence-informed bundled interventions for Black women with HIV. Methods We use an instrumental case study design to explore strategies embedded in biannual convenings hosted by the Black Women First Initiative (BWF) Evaluation and Technical Assistance Provider (ETAP). Data sources including planning documents, direct observation of the convenings and analysis of convening attendee feedback surveys were analyzed. Results Using instrumental case study design, we found that convenings were a helpful tool that allowed for cross-site communication and collaboration. Communal re-examination of implementation strategies, coupled with training and network-weaving, created a rich learning environment to identify potential intervention adaptations and changes, unify on data collection, and prepare to test these adaptations at each respective site. Conclusions We discuss lessons learned when using convenings to help health care and community-based settings collectively explore and address adaptation and implementation barriers as they implement evidence-informed interventions to improve health outcomes for populations affected by chronic conditions, such as HIV.

Abstract Background In Kenya, postgraduate medical residents must complete a research dissertation for their Master of Medicine studies. However, the subsequent publication rate is lower than in higher-income settings, limiting the availability of population-specific data. This study explored residents’ experiences with research, reasons for the low publication rate, and strategies to improve publication rates. Methods In-depth interviews were conducted with 9 faculty members and non-academic support staff, as well as 18 Master of Medicine graduates who had successfully completed their research projects, to investigate their experiences with conducting, supervising, and publishing research. The interview data was analysed using inductive thematic analysis. The study also explored strategies to improve publication rates. Results The graduates (former medical residents) described difficult research journeys – from concept development to final submission of dissertation – which discouraged them from seeking publication. Many faculty and staff lacked time or sufficient expertise to successfully guide residents to publication. Departmental research culture, faculty expertise as supervisors and prioritisation of clinical work over research and lack of dedicated research time impacted both residents’ and faculty capacity for research. Strategies to improve publication rates focused on developing faculty research expertise, more protected research time, and a more structured approach to teaching research methodology, including academic writing skills. Conclusions Residents in low- and middle-income countries such as Kenya encounter systemic and personal challenges to successful publication of research. The ease or difficulty of a resident’s research journey influences their attitudes to subsequent publication. Strategies to improve publication rates can improve the dissemination of relevant research data in such settings.

The Black jobs crisis is alive and well in the Inland Empire, with Black workers having the highest unemployment rates and lowest median earnings across the region. To address this, the newly-formed Inland Empire Black Worker Center (IEBWC) has implemented a pre-apprenticeship program for IE Works—a consortium of water/wastewater utilities and community groups in the Inland Empire—that prioritizes the respect and dignity of Black workers while also preparing them for high road jobs in the water/wastewater sector. Unlocking Potential: The Inland Empire Black Worker Center’s Transformative IE Works Program, a new report authored by the UCLA Center for the Advancement of Racial Equity (CARE) at Work at the UCLA Labor Center, showcases the results of this pioneering workforce development model. The program aims to provide stability, living wages, and a career path to support families utilizing a three-pronged approach: 1) internships for active college students, 2) pre-apprenticeship for those new to the trades, and 3) apprenticeship programs.

In this commentary, two members of the technical teams that led Kenyan health reforms reflect on progress made in the country’s journey toward universal health coverage during President Uhuru Kenyatta’s second term (2017 to 2022). The authors discuss how key decisions were made while balancing multiple considerations such as: maintaining the technical fidelity of the reforms to achieve objectives, accounting for the context of previous reforms, and making necessary trade-offs between technical and political pressures. They share three lessons, contextualized with African proverbs, for others implementing health reforms. First: “The person who does not seize today’s opportunity will also be unable to seize tomorrow’s opportunity”—that is, act quickly when opportunities arise. Second: “The person who cannot dance will say, ‘The drum is bad!’” This implies that naysayers, especially those who are not part of technical teams, may not understand the reasons behind certain decisions or trade-offs. Reformers must balance different needs, including responding to varied opinions, taking urgent action, generating timely results, making technically sound decisions, and getting the design right. And third: “A bird that flies from the ground onto an anthill does not know that it is still on the ground.” This proverb reminds us to not mistake short-term gains for the achievement of long-term goals. Kenya continues to enjoy unprecedented political will to pursue health reforms. For other reformers lucky enough to have political support, the final advice to the technical teams in the driver’s seat is to design for delivery … and then start!

Background Low-income and middle-income countries, including Kenya, are pursuing universal health coverage (UHC) through the establishment of Social Health Insurance programmes. As Kenya rolls out the recently unveiled UHC strategy that includes a national indigent cover programme, the goal of this study is to evaluate the impact of health insurance subsidy on poor households’ healthcare costs and utilisation. We will also assess the effectiveness and equity in the beneficiary identification approach employed.Methodology and analysis Using a quantitative design with quasi-experimental and cross-sectional methods, our matched cohort study will recruit 1350 households across three purposively selected counties. The ‘exposure’ arm, enrolled in the UHC indigent programme, will be compared with a control arm of eligible but unenrolled households over 12 months. Coarsened exact matching will be used to pair households based on baseline characteristics, analysing differences in expenses and catastrophic health expenditure. A cross-sectional design will be employed to evaluate the effectiveness and equity in beneficiary identification, estimating inclusion errors associated with the subsidy programme while assessing gender equity.Ethics and dissemination Ethical approval has been obtained from the Scientific and Ethics Review Unit at Kenya Medical Research Institute, with additional permissions sought from County Health Departments. Participants will provide written informed consent. Dissemination strategies include peer-reviewed publications, conference presentations and policy-maker engagement for broad accessibility and impact.

Introduction There is a growing emphasis on improving primary healthcare (PHC) services and granting frontline service providers more decision-making autonomy. In October 2023, Kenya enacted legislation mandating nationwide facility autonomy. There is limited understanding of the effects of health facility autonomy on PHC facilities performance. It is recognised that stakeholder interests influence reforms, and gender plays a critical role in access to health and its outcomes. This protocol outlines the methods for a study that plans to evaluate the effects, implementation experience, political economy and gendered effects of health facility autonomy reforms in Kenya.Methods and analysis The research will use a before-and-after quasi-experimental study design to measure the effects of the reform on service readiness and service utilisation and a cross-sectional qualitative study to explore the implementation experience, political economy and gendered effects of these reforms. Data to measure the effects of autonomy will be collected from a sample of 80 health facilities and 1600 clients per study arm. Qualitative interviews will involve approximately 83 facility managers and policymakers at the county level, distributed across intervening (36) and planning to intervene (36) counties. Additionally, 11 interviews will be conducted at the national level with representatives from the Ministry of Health, the National Treasury, the Controller of Budget, the Council of Governors, the Auditor General and development partners. Given the uncertainty surrounding the implementation of the reforms, this study proposes two secondary designs in the event our primary design is not feasible—a cross-sectional study and a quasi-experimental interrupted time series design. The study will use a difference-in-difference analysis for the quantitative component to evaluate the effects of the reforms, while using thematic analysis for the qualitative component to evaluate the political economy and the implementation experience of the reforms.Ethics and dissemination This study was approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (KEMRI/SERU/CGMR-C/294/4708) and the National Commission for Science, Technology and Innovation (NACOSTI/P/23/28111). We plan to disseminate the findings through publications, policy briefs and dissemination workshops.

Knowing the target oxygen saturation (SpO2) range that results in the best outcomes for acutely hypoxemic adults is important for clinical care, training, and research in low-income and lower-middle income countries (collectively LMICs). The evidence we have for SpO2 targets emanates from high-income countries (HICs), and therefore may miss important contextual factors for LMIC settings. Furthermore, the evidence from HICs is mixed, amplifying the importance of specific circumstances. For this literature review and analysis, we considered SpO2 targets used in previous trials, international and national society guidelines, and direct trial evidence comparing outcomes using different SpO2 ranges (all from HICs). We also considered contextual factors, including emerging data on pulse oximetry performance in different skin pigmentation ranges, the risk of depleting oxygen resources in LMIC settings, the lack of access to arterial blood gases that necessitates consideration of the subpopulation of hypoxemic patients who are also hypercapnic, and the impact of altitude on median SpO2 values. This process of integrating prior study protocols, society guidelines, available evidence, and contextual factors is potentially useful for the development of other clinical guidelines for LMIC settings. We suggest that a goal SpO2 range of 90-94% is reasonable, using high-performing pulse oximeters. Answering context-specific research questions, such as an optimal SpO2 target range in LMIC contexts, is critical for advancing equity in clinical outcomes globally.

BackgroundChronic infection with Schistosoma haematobium causes female genital schistosomiasis (FGS), which leads to diverse lesions in the female genital tract and several complications, including infertility and a higher risk for HIV transmission. This study aims to understand the knowledge, attitudes, and practices (KAP) toward FGS and associated factors among women and health professionals in the schistosomiasis endemic focus of Kimpese, western Democratic Republic of Congo (DRC).MethodsIn January 2022, two semi-quantitative questionnaires were administered to 201 randomly selected community women in Kifua II village, and to purposely selected health professionals (20 nurses and 41 doctors) from Kimpese Health Zone. KAP statements were coded using Likert scale, summarized as frequencies and percentages, and assessed for internal reliability using Cronbach's alpha. Associations between the socio-demographic characteristics of respondents and the KAP variables were assessed using Pearson chi-square (χ2) test, Cramer's V (φ) and gamma (γ) coefficients.ResultsOverall, respondents had high knowledge of schistosomiasis in general but low FGS-specific knowledge (91% versus 45%). Misconceptions concerned the disease transmission, with 30.3% of women and 25% of the nurses believing that FGS is transmitted by drinking untreated water, while 26.8% of the doctors mentioned sexual contact as a mode of FGS transmission. Negative attitudes included considering FGS not a very serious disease (34.8%), feeling uncomfortable during gynaecological examination (35.3%), difficulties avoiding risky water contact (72.1%) and open defecation/urination (41.3%), not intending to share FGS status with their husbands (38.3%) and loved ones (63.6%), and believing that husbands would leave them if they were infertile (31.8%). Regarding practices, 77.6% of women engaged daily in activities involving contact with water. Practices of health professionals were hampered by the lack of equipment and specialized knowledge for FGS diagnosis with only 57% of healthcare workers having a microscope in their facilities. Women's KAPs varied by age, education, marital status, occupation and monthly income.ConclusionThis study highlights insufficient knowledge, existing negative attitudes, at risk practices towards FGS by women, and limitations of FGS management by health professionals. These findings can help for tailored health education and WASH strategies, and call for health professional's capacities reinforcement.

Farmers have adopted ecological farming to overcome the adverse effects of climate change and conventional agriculture. However, the performance of ecological approaches, especially the economic outcomes of ecological practices adopted as a package, has yet to be widely documented in Kenya. This paper aims to fill this gap and generate pertinent information on the implications of adopting different ecological practices bundles on farm income. The study considers five ecological practices: crop diversification, composting, mulching, minimum tillage, and integrated pest management (IPM). This study employed a multinomial endogenous switching regression (MESR) model to capture the effect of adopting different combinations of ecological practices on farm income. The results reveal that 15.3 % of the surveyed households adopted a bundle combining composting, crop diversification, and IPM. Households that adopted a comprehensive package (comprising all five ecological practices) had the largest positive impact on farm income, increasing it by 9.2 %. This package replaces chemical inputs with locally available resources, restores degraded soils and diversifies production risks to increase food production and farm income. Farming experience, off-farm activities, farm size, perceptions of the effects of conventional agriculture, and drought and floods significantly influenced the adoption of the comprehensive package. This study’s findings imply that policymakers and related stakeholders should provide timely weather-related information, enforce sustainable land use laws, and establish targeted extension services and information campaigns to heighten the adoption of all five ecological practices and enhance household welfare by increasing farm income.

For the greater part of entrepreneurial history, entrepreneurship’s primary target was commercial, i.e., money generation for the entrepreneur and his or her stakeholders. However, starting in the 1980s, hybrid forms of entrepreneurship fusing the creation of non-financial value with entrepreneurial means have gained traction. Currently, several conceptually different forms, e.g., social, environmental, and community entrepreneurship, exist. Research yields various differences comparing commercial and hybrid entrepreneurship, particularly in the stereotypical perceptions of different entrepreneurs. Notwithstanding notable insights, entrepreneurial stereotype research suffers from three major shortcomings. First, stereotype differences are primarily examined by comparing commercial to hybrid entrepreneurs, neglecting stereotype differences inside hybrid entrepreneurship. Second, the scope of stereotypes investigated (e.g., warmth and competence) remains vague and lacks entrepreneurial specificity. Third, the robustness of entrepreneurial stereotypes under different institutional circumstances, e.g., in economy and culture, is unclear. The current study addresses these three shortcomings. Analyzing two samples from Kenya and Germany (Ntotal = 286) with repeated-measures analyses of co-variance, we find notable stereotype differences (i) inside hybrid entrepreneurs; (ii) regarding warmth, competence, and entrepreneurship-specific success indicators; and (iii) under different institutional circumstances. Despite acknowledgeable limitations, our work extends previous stereotype research by highlighting the necessity for a more fine-grained, specific, and inter-country perspective on entrepreneurial stereotypes.

HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores the willingness to participate in HIV cure research at the end of life. Participants include Canadians with HIV [people with HIV (PWHIV)] aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework. From April 2020 to August 2021, 37 participants completed the survey (mean age = 69.9 years old; mean duration of HIV infection = 28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies toward the end of life (n = 30; 81.1%), in HIV biobanking (n = 30; 81.1%), and in a research autopsy (n = 28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. The main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences, and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies. Our results indicate that older PWHIV would be willing to participate in HIV cure research toward the end of life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.

The concept of race is prevalent in medical, nursing, and public health literature. Clinicians often incorporate race into diagnostics, prognostic tools, and treatment guidelines. An example is the recently heavily debated use of race and ethnicity in the Vaginal Birth After Cesarean (VBAC) calculator. In this case, the critics argued that the use of race in this calculator implied that race confers immutable characteristics that affect the ability of women to give birth vaginally after a c-section. This debate is co-occurring as research continues to highlight the racial disparities in health outcomes, such as high maternal mortality among Black women compared to other racial groups in the United States. As the healthcare system contemplates the necessity of utilizing race—a social and political construct, to monitor health outcomes, it has sparked more questions about incorporating race into clinical algorithms, including pulmonary tests, kidney function tests, pharmacotherapies, and genetic testing. This paper critically examines the argument against the race-based Vaginal Birth After Cesarean (VBAC) calculator, shedding light on its implications. Moreover, it delves into the detrimental effects of normalizing race as a biological variable, which hinders progress in improving health outcomes and equity.

Background Kenya has experienced several health financing changes that have implications for financing primary healthcare (PHC). These include transitions from funding by two key donors (the World Bank and the Danish International Development Agency (DANIDA)) and the abolishment of conditional grants that were earmarked for financing primary healthcare facilities. This protocol lays out study plans to evaluate the impact and implementation experience of these financing changes on PHC facility functioning and service delivery in Kenya. Methods/design A sequential mixed methods design will be applied to address our research objectives. Firstly, we will perform a document review to understand the evolution of policy changes understudy. Second, we will conduct an interrupted time series analysis across all 47 counties in Kenya to assess these financing changes' impact on health service utilization in all public primary healthcare facilities (level 2 and 3 facilities). Data for this analysis will be obtained from the Kenya Health Information System (KHIS). Third, we will carry out in-depth interviews with health financing stakeholders at the national, county, and health facility levels to examine their perceptions of the experiences with these changes in health financing. Discussion This mixed methods study will contribute to evidence on the sustainability of financing primary healthcare in low and middle-income countries facing financing changes and donor transitions.

Upscaling chamber measurements of soil greenhouse gas (GHG) fluxes from point scale to landscape scale remain challenging due to the high variability in the fluxes in space and time. This study measured GHG fluxes and soil parameters at selected point locations (n=268), thereby implementing a stratified sampling approach on a mixed-land-use landscape (∼5.8 km2). Based on these field-based measurements and remotely sensed data on landscape and vegetation properties, we used random forest (RF) models to predict GHG fluxes at a landscape scale (1 m resolution) in summer and autumn. The RF models, combining field-measured soil parameters and remotely sensed data, outperformed those with field-measured predictors or remotely sensed data alone. Available satellite data products from Sentinel-2 on vegetation cover and water content played a more significant role than those attributes derived from a digital elevation model, possibly due to their ability to capture both spatial and seasonal changes in the ecosystem parameters within the landscape. Similar seasonal patterns of higher soil/ecosystem respiration (SR/ER–CO2) and nitrous oxide (N2O) fluxes in summer and higher methane (CH4) uptake in autumn were observed in both the measured and predicted landscape fluxes. Based on the upscaled fluxes, we also assessed the contribution of hot spots to the total landscape fluxes. The identified emission hot spots occupied a small landscape area (7 % to 16 %) but accounted for up to 42 % of the landscape GHG fluxes. Our study showed that combining remotely sensed data with chamber measurements and soil properties is a promising approach for identifying spatial patterns and hot spots of GHG fluxes across heterogeneous landscapes. Such information may be used to inform targeted mitigation strategies at the landscape scale.

Abstract Background In 2015, the World Health Organization recommended that all people living with HIV begin antiretroviral treatment (ART) regardless of immune status, a policy known as ‘Treat-All to end AIDS’, commonly referred to as Treat-All. Almost all low- and middle-income countries adopted this policy by 2019. This study describes how linkage to treatment of newly diagnosed persons changed between 2015 and 2018 and how complementary policies may have similarly increased linkage for 13 African countries. These countries adopted and implemented Treat-All policies between 2015 and 2018 and were supported by the U.S. Government’s President’s Emergency Plan for AIDS Relief (PEPFAR). The focuses of this research were to understand 1) linkage rates to ART initiation before and after the adoption of Treat-All in each country; 2) how Treat-All implementation differed across these countries; and 3) whether complementary policies (including same-day treatment initiation, task-shifting, reduced ART visits, and reduced ART pickups) implemented around the same time may have increased ART linkage. Methods HIV testing and treatment data were collected by PEPFAR country programs in 13 African countries from 2015 to 2018. These countries were chosen based on the completeness of policy data and availability of program data during the study period. Program data were used to calculate proxy linkage rates. These rates were compared relative to the Treat All adoption period and the adoption of complementary policies. Results The 13 countries experienced an average increase in ART linkage of 29.3% over the entire study period. In examining individual countries, all but two showed increases in linkage to treatment immediately after Treat All adoption. Across all countries, those that had adopted four or more complementary policies showed an average increased linkage of 39.8% compared to 13.9% in countries with fewer than four complementary policies. Conclusions Eleven of 13 country programs examined in this study demonstrated an increase in ART linkage after Treat-All policy adoption. Increases in linkage were associated with complementary policies. When exploring new public health policies, policymakers may consider which complementary policies might also help achieve the desired outcome of the public health policy.

Anthropogenic activities increase the contributions of inland waters to global greenhouse gas (GHG; CO2, CH4, and N2O) budgets, yet the mechanisms driving these increases are still not well constrained. In this study, we quantified year-long GHG concentrations, fluxes, and water physico-chemical variables from 28 sites contrasted by land use across five headwater catchments in Germany. Based on linear mixed-effects models, we showed that land use was more significant than seasonality in controlling the intra-annual variability of the GHGs. Streams in agriculture-dominated catchments or with wastewater inflows had up to 10 times higher daily CO2, CH4, and N2O emissions and were also more temporally variable (CV > 55 %) than forested streams. Our findings also suggested that nutrient, labile carbon, and dissolved GHG inputs from the agricultural and settlement areas may have supported these hotspots and hot-moments of fluvial GHG emissions. Overall, the annual emission from anthropogenic-influenced streams in CO2 equivalents was up to 20 times higher (∼ 71 kg CO2 m−2 yr−1) than from natural streams (∼ 3 kg CO2 m−2 yr−1), with CO2 accounting for up to 81 % of these annual emissions, while N2O and CH4 accounted for up to 18 % and 7 %, respectively. The positive influence of anthropogenic activities on fluvial GHG emissions also resulted in a breakdown of the expected declining trends of fluvial GHG emissions with stream size. Therefore, future studies should focus on anthropogenically perturbed streams, as their GHG emissions are much more variable in space and time and can potentially introduce the largest uncertainties to fluvial GHG estimates.

OBJECTIVES:. To describe clinical, management, and outcome features of critically ill patients admitted to ICUs and high-dependency units (HDUs) in Kenya. DESIGN:. Prospective registry-based observational study. SETTING:. Three HDUs and eight ICUs in Kenya. PATIENTS:. Consecutive adult patients admitted between January 2021 and June 2022. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Data were entered in a cloud-based platform using a common data model. Study endpoints included case-mix variables, management features, and patient-centered outcomes. Patients with COVID-19 were reported separately. Of the 3892 of 4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs, and 1447 patients (37.2%) were from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38–68), with HDU patients being older but with a lower severity (Acute Physiology and Chronic Health Evaluation II 6 [3–9] in HDUs vs. 12 [7–17] in ICUs; p < 0.001). One in four patients was postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation was applied in 3.4% in HDUs versus 47.6% in ICUs (p < 0.001), with a duration of 7 days (IQR 3–21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; p < 0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1–5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (p < 0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality. CONCLUSIONS:. We provide the first multicenter observational cohort study from an African ICU National Registry. Distinct management features and outcomes characterize HDU from ICU patients.

Background Using data from a national cohort study and focus groups, the Women-Centred HIV Care (WCHC) Model was developed to inform care delivery for women living with HIV. Methods Through an evidence-based, integrated knowledge translation approach, we developed 2 toolkits based on the WCHC Model for service providers and women living with HIV in English and French (Canada's national languages). To disseminate, we distributed printed advertising materials, hosted 3 national webinars and conducted 2 virtual capacity-building training series. Results A total of 315 individuals attended the webinars, and the average WCHC knowledge increased by 29% (SD 4.3%). In total, 131 service providers engaged in 22 virtual capacity-building training sessions with 21 clinical cases discussed. Learners self-reported increased confidence in 15/15 abilities, including the ability to provide WCHC. As of December 2023, the toolkits were downloaded 7766 times. Conclusions We successfully developed WCHC toolkits and shared them with diverse clinical and community audiences through various dissemination methods.

PurposeSexual and gender minority and racialized populations experienced heightened vulnerability during the Covid-19 pandemic. Marginalization due to structural homophobia, transphobia and racism, and resulting adverse social determinants of health that contribute to health disparities among these populations, were exacerbated by the Covid-19 pandemic and public health measures to control it. We developed and tested a tailored online intervention (#SafeHandsSafeHearts) to support racialized lesbian, gay, bisexual, transgender, queer, and other persons outside of heteronormative and cisgender identities (LGBTQ+) in Toronto, Canada during the pandemic.MethodsWe used a quasi-experimental pre-test post-test design to evaluate the effectiveness of a 3-session, peer-delivered eHealth intervention in reducing psychological distress and increasing Covid-19 knowledge and protective behaviors. Individuals ≥18-years-old, resident in Toronto, and self-identified as sexual or gender minority were recruited online. Depressive and anxiety symptoms, and Covid-19 knowledge and protective behaviors were assessed at baseline, 2-weeks postintervention, and 2-months follow-up. We used generalized estimating equations and zero-truncated Poisson models to evaluate the effectiveness of the intervention on the four primary outcomes.ResultsFrom March to November 2021, 202 participants (median age, 27 years [Interquartile range: 23-32]) were enrolled in #SafeHandsSafeHearts. Over half (54.5%, n = 110) identified as cisgender lesbian or bisexual women or women who have sex with women, 26.2% (n = 53) cisgender gay or bisexual men or men who have sex with men, and 19.3% (n = 39) transgender or nonbinary individuals. The majority (75.7%, n = 143) were Black and other racialized individuals. The intervention led to statistically significant reductions in the prevalence of clinically significant depressive (25.4% reduction, p < .01) and anxiety symptoms (16.6% reduction, p < .05), and increases in Covid-19 protective behaviors (4.9% increase, p < .05), from baseline to postintervention.ConclusionWe demonstrated the effectiveness of a brief, peer-delivered eHealth intervention for racialized LGBTQ+ communities in reducing psychological distress and increasing protective behaviors amid the Covid-19 pandemic. Implementation through community-based organizations by trained peer counselors supports feasibility, acceptability, and the importance of engaging racialized LGBTQ+ communities in pandemic response preparedness. This trial is registered with ClinicalTrials.gov, number NCT04870723.

Rot is a major cause of bulb onion losses in Kenya, accounting for about 14 % of total postharvest losses. In Kenya, the fungi associated with bulb onion postharvest rot of onion postharvest rots are not well known. Therefore, this study aimed at identifying the fungal pathogens contributing to bulb onion postharvest rot in major growing regions of Kenya. Bulb onion samples were collected from seven major markets and isolates were obtained by cutting 3 mm tissue segments from the edges of rotten lesions. These were cultured in water agar followed by incubation for seven days at room temperature (23 ± 3℃). After seven days, mycelia plugs from the growing edge of each colony were sub-cultured in potato dextrose agar and incubated for ten days. A total of fifty fungal isolates were obtained from the isolations and in vitro pathogenicity test was done on bulb onions. Eighteen fungal isolates that turned out to be pathogenic were inoculated in bulb onions to assess their level of virulence by measuring lesion size after 21 days of incubation at room temperature (23 ± 3℃). The fungal isolates caused statistically (P

Abstract Background Black cisgender and transgender women are disproportionately affected by the HIV epidemic compared to women of other racial and ethnic identities. Twelve demonstration sites across the United States are adapting, implementing and evaluating a comprehensive bundle of two or more evidence informed interventions to improve health and outcomes and quality of life for Black women with HIV. Methods Guided by Greenhalgh’s Conceptual Model of Diffusion of Innovations in Health Service Organizations and Proctor’s model for use of implementation strategies and evaluating implementation, service and client outcomes, this mixed methods study documents outcomes at the client, organization, and system level. Participant eligibility for the bundled interventions includes: individuals who are 18 years or older, identify as Black or African-American, identify as cisgender or transgender female and have a diagnosis of HIV. Qualitative data are collected systematically through a series of annual site visits and a standardized monthly call form to assess the barriers and facilitators to the implementation process and the key determinants impacting the intervention uptake and implementation strategies. Quantitative data collection for the implementation, service and client outcomes is conducted through a pre-post prospective study to examine the impact on Black women’s health and well-being. Implementation outcomes include: the reach to Black women with HIV, adoption of interventions across the sites and their community; the fidelity to the components of the bundled interventions; the costs of the intervention; and the sustainability of the intervention in the organization and community. Primary service and client outcomes are improved linkage to and retention in HIV care and treatment, increased and sustained viral suppression, improved quality of life and resilience, and stigma reduction. Discussion The study protocol presented is specifically designed to advance the evidence for adopting culturally responsive and relevant care into clinic and public health settings to improve the health and well-being for Black women with HIV. In addition the study may advance the implementation science field by furthering what is known about the ways in which bundled interventions can address barriers to care and facilitate the uptake of organizational practices to improve health.

Abstract Objectives To explore the impact of COVID-19 on the implementation of bundled interventions to improve the engagement and retention of Black women in HIV care. Methods Pre-implementation interviews conducted between January and April 202 L with 12 demonstration sites implementing bundled interventions for Black women with HIV. Directed content analysis was employed to examine the site interview transcripts. Results The pandemic intensified barriers to care and harmful social conditions. However, COVID-19 also forced pivots in health care and social service delivery and some of these changes benefited Black women living with HIV. Conclusions The continuation of policies that support the material needs of Black women with HIV and ease access to care is critical. Racial capitalism impedes the enactment of these policies and thus threatens public health.

Based on in-depth interviews, surveys and autoethnography we explore ways in which staff responded to the COVID-19 pandemic in three Higher Education Institutions (HEIs) based in Kenya (University of Nairobi), Mexico (El Colegio de la Frontera Sur) and the United Kingdom (University of Leeds). HEIs are dependent on staff's resilience and goodwill to "get through the tough times". This is evident when we examine the effect universities' lack of support had on staff during the first months of lockdown in 2020. HEIs were not able to provide adequate IT equipment, training, and wellbeing support for staff yet we were still expected to "perform" to high standards. We analyse the challenges faced to quickly get acquainted with online teaching without any reflection on how this transition impacted our pedagogy, particularly for those of us who identify as scholar-activists. Added stress of learning new ways of delivering teaching coupled with caring responsibilities, isolation, bereavement, a decrease in living wages and cut to staff pensions has had a long-lasting detrimental effect on staff's mental health. At the same time, university staff and students have pushed back as a community to advocate for better teaching and learning conditions. We discuss the wider impacts of COVID-19 on staff's commitment to social justice within and outside the traditional university setting.

IntroductionThe unexpected emergence of novel coronavirus identified as SAR-CoV-2 virus (severe acute respiratory syndrome corona virus 2) disrupted the world order to an extent that the human activities that are core to survival came almost to a halt. The COVID-19 pandemic created an insurmountable global health crisis that led to a united front among all nations to research on effective pharmaceutical measures that could stop COVID-19 proliferation. Consequently, different types of vaccines were discovered (single-dose and double-dose vaccines). However, the speed at which these vaccines were developed and approved to be administered created other challenges (vaccine skepticism and hesitancy).MethodThis paper therefore tracks the transmission dynamics of COVID-19 using a non-linear deterministic system that accounts for the unwillingness of both susceptible and partially vaccinated individuals to receive either single-dose or double-dose vaccines (vaccine hesitancy). Further the model is extended to incorporate three time-dependent non-pharmaceutical and pharmaceutical intervention controls, namely preventive control, control associated with screening-management of both truly asymptomatic and symptomatic infectious individuals and control associated with vaccination of susceptible individuals with a single dose vaccine. The Pontryagin's Maximum Principle is applied to establish the optimality conditions associated with the optimal controls.ResultsIf COVID-19 vaccines administered are imperfect and transient then there exist a parameter space where backward bifurcation occurs. Time profile projections depict that in a setting where vaccine hesitancy is present, administering single dose vaccines leads to a significant reduction of COVID-19 prevalence than when double dose vaccines are administered. Comparison of the impact of vaccine hesitancy against either single dose or double dose on COVID-19 prevalence reveals that vaccine hesitancy against single dose is more detrimental than vaccine hesitancy against a double dose vaccine. Optimal analysis results reveal that non-pharmaceutical time-dependent control significantly flattens the COVID-19 epidemic curve when compared with pharmaceutical controls. Cost-effectiveness assessment suggest that non-pharmaceutical control is the most cost-effective COVID-19 mitigation strategy that should be implemented in a setting where resources are limited.DiscussionPolicy makers and medical practitioners should assess the level of COVID-19 vaccine hesitancy inorder to decide on the type of vaccine (single-dose or double-dose) to administer to the population.

The collapse of some commercial banks in Kenya in the recent past has raised the question of the credibility of financial information as a tool for investors to make informed decisions. The study sought to analyse the disclosure practices of accounting conventions on the financial performance of commercial banks in Kenya. The following specific objectives guided the study: to establish the influence of the disclosure, consistency, prudence and materiality of financial reports on the performance of commercial banks in Kenya. A cross-sectional survey was adopted. The target population was 42 respondents who formed the sample size by the census method. The data was collected through questionnaires, secondary data and annual reports and analysed quantitatively and qualitatively. Quantitative data was analysed using descriptive statistics and inferential statistics. The finding shows a moderate positive relationship between disclosure and the performance of commercial banks. The relationship is significant (r = 0.322, p>0.01). The result shows a moderate positive relationship between consistency and performance of commercial banks. The relationship is significant (r = 0.369, p>0.01). The results also show a moderate positive relationship between prudence and the performance of commercial banks at a significance of (r=0.500, p>0.01). On establishing the relationship between materiality and performance of commercial banks, it was found there is a moderate positive relationship with a significance of (r = 0.317, p>0.01). Respondents indicated that the consistency of financial reports has little effect on the net profit of commercial banks. Respondents indicated that prudence of financial reports leads to better organisational performance. The materiality of financial reports affects organisation performance. Prudence in financial reporting affected the decision-making among the investors in the banking industry. The study recommends that commercial banks' management ensure transparency, honesty, consistency and reliability during financial reporting.

Background Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. Methods Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. Conclusions The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.

Introduction: Adolescent mental health challenges have been identified as a public health concern globally, especially in low- and middle-income countries (LMICs), due to the scarcity of services, where help-seeking is often hampered by social stigma. A strategy to increase the availability of services is to implement, brief, stigma-free, and scalable interventions. The Shamiri Intervention (the Kiswahili word for “thrive”) is an example of a 4-week, group-based intervention which is implemented via 1-hour sessions within high school settings.