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Sympathetic activation during cold exposure increases adipocyte thermogenesis via the expression of mitochondrial protein uncoupling protein 1 (UCP1)1. The propensity of adipocytes to express UCP1 is under a critical influence of the adipose microenvironment and varies between sexes and among various fat depots2-7. Here we report that mammary gland ductal epithelial cells in the adipose niche regulate cold-induced adipocyte UCP1 expression in female mouse subcutaneous white adipose tissue (scWAT). Single-cell RNA sequencing shows that glandular luminal epithelium subtypes express transcripts that encode secretory factors controlling adipocyte UCP1 expression under cold conditions. We term these luminal epithelium secretory factors 'mammokines'. Using 3D visualization of whole-tissue immunofluorescence, we reveal sympathetic nerve-ductal contact points. We show that mammary ducts activated by sympathetic nerves limit adipocyte UCP1 expression via the mammokine lipocalin 2. In vivo and ex vivo ablation of mammary duct epithelium enhance the cold-induced adipocyte thermogenic gene programme in scWAT. Since the mammary duct network extends throughout most of the scWAT in female mice, females show markedly less scWAT UCP1 expression, fat oxidation, energy expenditure and subcutaneous fat mass loss compared with male mice, implicating sex-specific roles of mammokines in adipose thermogenesis. These results reveal a role of sympathetic nerve-activated glandular epithelium in adipocyte UCP1 expression and suggest that mammary duct luminal epithelium has an important role in controlling glandular adiposity.

Abstract Retained surgical items (RSIs) pose significant risks to patients and healthcare professionals, prompting extensive efforts to reduce their incidence. RSIs are objects inadvertently left within patients’ bodies after surgery, which can lead to severe consequences such as infections and death. The repercussions highlight the critical need to address this issue. Machine learning (ML) and deep learning (DL) have displayed considerable potential for enhancing the prevention of RSIs through heightened precision and decreased reliance on human involvement. ML techniques are finding an expanding number of applications in medicine, ranging from automated imaging analysis to diagnosis. DL has enabled substantial advances in the prediction capabilities of computers by combining the availability of massive volumes of data with extremely effective learning algorithms. This paper reviews and evaluates recently published articles on the application of ML and DL in RSIs prevention and diagnosis, stressing the need for a multi-layered approach that leverages each method’s strengths to mitigate RSI risks. It highlights the key findings, advantages, and limitations of the different techniques used. Extensive datasets for training ML and DL models could enhance RSI detection systems. This paper also discusses the various datasets used by researchers for training the models. In addition, future directions for improving these technologies for RSI diagnosis and prevention are considered. By merging ML and DL with current procedures, it is conceivable to substantially minimize RSIs, enhance patient safety, and elevate surgical care standards.

Abstract Background The burden of cancer incidences and mortality is rapidly increasing worldwide resulting in an increased demand for new therapies. Secondary metabolites extracted from medicinal plants have significantly contributed toward discovery of new cancer therapies some of which are in clinical use. In this study, anticancer potential of four triterpenoids, namely oleanonic acid (EK-2), 3-epi-oleanolic acid (EK-8), 1,2,3,22,23-pentahydroxy-2,6,10,15,19,23-hexamethyl-6,10,14,18-tetracosatetraene (EK-4) and 2,3,22,23-tetrahydroxy-2,6,10,15,19,23-hexamethyl-6,10,14,18-tetracosatetraene (EK-9), extracted from Ekebergia capensis Sparrm root bark was evaluated. Results We employed CLC-Pred to initially evaluate cytotoxicity of previously isolated compounds in silico where predictions revealed high probability of bioactivity. The compounds were then submitted to the National Cancer Institute (NCI), Developmental Therapeutics Program, for bioactivity evaluation against NCI-60 human tumor cell lines. The four compounds demonstrated a range of potencies at a concentration of 10 µM. The results revealed that EK-9 was the most potent with mean growth percent of 32.84 and cases of lethality (negative growth percent) against two leukemia cell lines (HL-60 (TB) and RPMI-8226) and HT29 (colon cancer) and SK-MEL-5 (melanoma). This molecule was further evaluated in a five-dose assay where notable growth inhibition against leukemia cells, HL-60 (TB), RPMI-8226 and K-562 was observed with growth inhibitory activity (GI50) values of 3.10, 3.74 and 5.07 µM, respectively. In addition, total growth inhibition was observed at 11.2 μM and 18.9 μM for HL-60 (TB) and RPMI-8226 cells, respectively, partly accounting for the negative growth percent. Conclusion The study has demonstrated anticancer properties of the four triterpenoids with compound EK-9 being the most potent overall having selective bioactivity in leukemia and breast cancer cells. Further studies focusing on elucidating its mechanism of action will be useful in exploration of the therapeutic potential of triterpenoids in general.

Abstract Background In Africa, the delivery of HIV pre-exposure prophylaxis (PrEP) at public healthcare clinics is challenged by understaffing, overcrowding, and HIV-associated stigma, often resulting in low PrEP uptake and continuation among clients. Giving clients the option to refill PrEP at nearby private pharmacies, which are often more convenient and have shorter wait times, may address these challenges and improve PrEP continuation. Methods This mixed methods study used an explanatory sequential design. At two public clinics in Kiambu County, Kenya, clients ≥ 18 years initiating PrEP were given the option to refill PrEP at the clinic where they initiated for free or at one of three nearby private pharmacies for 300 Kenyan Shillings (~ $3 US Dollars). The providers at these pharmacies (pharmacists and pharmaceutical technologists) were trained in PrEP service delivery using a prescribing checklist and provider-assisted HIV self-testing, both with remote clinician oversight. Clients were followed up to seven months, with scheduled refill visits at one, four, and seven months. The primary outcomes were selection of pharmacy-based PrEP refills and PrEP continuation. Following pilot completion, 15 in-depth interviews (IDIs) with clients who refilled PrEP were completed. We used descriptive statistics and thematic analysis to assess study outcomes. Results From November 2020 to November 2021, 125 PrEP clients were screened and 106 enrolled. The majority (59%, 63/106) of clients were women and the median age was 31 years (IQR 26–38 years). Over 292 client-months of follow-up, 41 clients (39%) refilled PrEP; only three (3%) at a participating pharmacy. All clients who completed IDIs refilled PrEP at clinics. The reasons why clients did not refill PrEP at pharmacies included: a preference for clinic-delivered PrEP services (i.e., pre-existing relationships, access to other services), concerns about pharmacy-delivered PrEP services (i.e., mistrust, lower quality care, costs), and lack of knowledge of this refill location. Conclusions These findings suggest that clients who initiate PrEP at public clinics in Kenya may have already overcome barriers to clinic-delivered PrEP services and prefer PrEP access there. To reach new populations that could benefit from PrEP, a stand-alone model of pharmacy-delivered PrEP services may be needed. Trial registration ClinicalTrials.gov: NCT04558554 [registered: June 5, 2020].

Early Childhood Education (ECE) is fundamental to holistic development of children between zeros to eight years old. Thus, teacher professional development is key to enabling children grow and develop in the most appropriate ways. This study examined the extent to which teacher professional qualification in Early Childhood Education influences promotion rates of children in public primary schools in Embu County, Kenya. To achieve this objective the study adopted correlation research design, where stratified and simple random sampling techniques were used to sample 39 ECE schools attached to public primary schools. Simple random sampling was used to select 39 public primary headteachers, 39 ECE teachers and 156 public primary teachers Data for this study was collected through the use of questionnaires. An observation schedule checklist and documentary analysis guide for purposes of data triangulation. To check reliability and validity of research instruments, a pilot study was conducted Data from the questionnaire was analyzed through the use descriptive and inferential statistics while data from interviews and documentary analysis guide was analyzed in themes in line with the research objective. Research findings from quantitative data were presented using frequencies, percentages, means, standard deviations, and inferential statistics using Pearson Chi-Square Tests. Results showed that there is a positive correlation between teacher professional qualification in ECE and promotion rates in public primary schools ECE (r=0.672, n=37, p<0.05). The research concluded that there is a positive correlation between teacher professional qualification in ECE and the promotion rates of learners in public primary schools. The study recommended that the Teacher's Service Commission in collaboration with the County Governments should continue to deploy adequate and qualified primary and ECE teachers to both primary and ECE schools to improve internal efficiency.

Mathematics anxiety is a reality for many students as a number of community college and four-year university students feel disconnected from math and struggle to pass mathematics courses. Using a case study and grounded theory approach, six remedial mathematics instructors were interviewed and observed to examine their instructional strategies and practices. During the interviews, participants expounded upon the changes in strategies and practices implemented when aiding students struggling with anxiety. "The Instructional Triangle" was applied across participants to compare and contrast their experiences. The analysis focused on environmental factors that could increase or exacerbate mathematics anxiety. In particular, a theme of creating connections emerged from how teachers assess for and adjust their strategies and practices to support remedial mathematics students struggling with anxiety. Based on the findings, interventions for assisting educators and students in mediating anxiety promoting perspective-taking and empathy are recommended. Such intervention could inform future strategy and practice development, implementation, and evaluation.

BackgroundThe uptake of daily oral HIV pre-exposure prophylaxis (PrEP)—a highly effective intervention—remains low among African adolescent girls and young women (AGYW) who could benefit. AGYW who initiate PrEP often do so through informal peer referral, which may be enhanced with formalized peer referral and peer-delivered HIV self-testing (HIVST). To understand the feasibility of this PrEP referral model among AGYW, we conducted a pilot study in Kenya.MethodFrom March to May 2022, we recruited AGYW (≥16–24 years) using PrEP (i.e., “peer providers”) from public healthcare clinics in Kiambu County and trained them on HIV prevention, HIVST use, and peer-supported linkage to clinic-based HIV services. Following training, peer providers received eight HIVST kits and were encouraged to refer four peers (i.e., “peer clients”) to PrEP. We completed surveys with peer providers and clients one month following intervention delivery to assess PrEP initiation among peer clients. Later, we conducted focus group discussions (FGDs) with peer providers and clients to identify factors that facilitated or challenged intervention outcomes.ResultsWe trained 16 peer providers (median age: 23 years, IQR 21–24) who reported delivering the intervention to 56 peer clients; 30 peer clients (median age: 21 years, IQR 19–22) contacted the study team and were enrolled. Most of the enrolled peer clients reported behaviors associated with HIV risk (e.g., condomless sex; 80%, 24/30) and were PrEP-naïve (87%, 26/30). At one-month, PrEP initiation among eligible PrEP-naïve peer clients was high, as reported by providers (78%, 43/55) and clients (85%, 22/26); recent HIVST use was also high among peer clients (provider report: 95%, 53/56; client report: 97%, 29/30). In the FGDs, participants reported that intervention outcomes were facilitated by close preexisting relationships, HIVST assistance, and being escorted to clinic-based HIV services by peer providers; intervention barriers included conflicting priorities and limited HIVST experience.ConclusionA formalized model of peer referral with HIVST delivery supported PrEP initiation among Kenyan AGYW. These findings demonstrate the potential for peer-delivered interventions to engage AGYW in HIV prevention services; however, more research is needed on the effectiveness and sustainability of this approach at scale.

HIV self-testing (HIVST) has the potential to reduce barriers associated with clinic-based preexposure prophylaxis (PrEP) delivery. We conducted a substudy nested in a prospective, pilot implementation study evaluating patient-centered differentiated care services. Clients chose either a blood-based or oral fluid HIVST kit at the first refill visit. Data were abstracted from program files and surveys were administered to clients. We purposively sampled a subset of PrEP clients and their providers to participate in in-depth interviews. We surveyed ( n = 285). A majority (269/285, 94%) reported HIV risk. Blood-based HIVST was perceived as easy to use (76/140, 54%), and (41/140, 29%) perceived it to be more accurate. Oral fluid-based HIVST was perceived to be easy to use (95/107, 89%), but almost all (106/107, 99%) perceived it as less accurate. HIVST improved privacy, reduced workload, and saved time. HIVST demonstrates the potential to streamline facility-based PrEP care in busy African public health facilities.

This essay exposes the imagery of cannibalism as a critique of unfettered consumption and greed at the root of the exploitative structures in The Farming of Bones (1998). The essay contends that the symbolic tapestry of Edwidge Danticat's second novel is woven around metaphors of consumption and excretion. In a bid to unpack the inner workings of a plantation system that reduced human beings to commodities, I tease out the novel's layered reflection on these metaphors and their meaning. I demonstrate that the purported menace posed by haitian immigrants in the Dominican Republic is but a deflection of the violence exerted on working bodies on a constant basis. A scheme that serves to mask the assault and plunder that are commonplace, the ascription of malevolent intent onto the immigrants strips them of their humanity and justifies their expulsion from the national territory. I further expose the strategies used by the exploited to counter the consuming carnage and restore dignity., INTRODUCTION Edwidge Danticat's debut novel propelled the writer to the forefront of critical acclaim. Featured on the Oprah Winfrey Show in June 1998, as part of Oprah's Book Club, Breath, [...]

Abstract Background Zoonotic viruses cause substantial public health and socioeconomic problems worldwide. Understanding how viruses evolve and spread within and among wildlife species is a critical step when aiming for proactive identification of viral threats to prevent future pandemics. Despite the many proposed factors influencing viral diversity, the genomic diversity and structure of viral communities in East Africa are largely unknown. Results Using 38.3 Tb of metatranscriptomic data obtained via ultradeep sequencing, we screened vertebrate-associated viromes from 844 bats and 250 rodents from Kenya and Uganda collected from the wild. The 251 vertebrate-associated viral genomes of bats (212) and rodents (39) revealed the vast diversity, host-related variability, and high geographic specificity of viruses in East Africa. Among the surveyed viral families, Coronaviridae and Circoviridae showed low host specificity, high conservation of replication-associated proteins, high divergence among viral entry proteins, and frequent recombination. Despite major dispersal limitations, recurrent mutations, cocirculation, and occasional gene flow contribute to the high local diversity of viral genomes. Conclusions The present study not only shows the landscape of bat and rodent viromes in this zoonotic hotspot but also reveals genomic signatures driven by the evolution and dispersal of the viral community, laying solid groundwork for future proactive surveillance of emerging zoonotic pathogens in wildlife. Video Abstract

Abstract Background Life expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people’s knowledge, attitudes and beliefs about polypharmacy. Methods A qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five medications per day. The study was conducted at the Family Medicine Clinic (FMC), Aga Khan University Hospital, Nairobi. Data were analyzed using NVivo 12 software. Result Majority of participants had a good understanding of their underlying health conditions, but they did not know the specific names of the medications they were taking. Participants had diverse attitudes toward polypharmacy, with both positive and negative perceptions. Although adverse side effects were reported, participants remained positive because they believed these medicines were beneficial. Religion, faith and living healthy lifestyles were perceived to contribute to their positive attitude toward polypharmacy. Stigma and the cost of medication were reported as barriers. Conclusion This study provides valuable insights into the complexities of polypharmacy in older people. It highlights the importance of patient education, fostering strong patient-provider relationships, de-stigmatization, and improving medication affordability and accessibility. Further research could explore the polypharmacy of older people attending public institutions in rural Kenya.

BackgroundAssessing HIV outcomes in key population prevention programs is a crucial component of the program cycle, as it facilitates improved planning and monitoring of anticipated results. The Joint United Nations Programme on HIV and AIDS recommends using simple, rapid methods to routinely measure granular and differentiated program outcomes for key populations. Following a program science approach, Partners for Health and Development in Africa, in partnership with the Nairobi County Government and the University of Manitoba, aims to conduct an outcome assessment using a novel, expanded polling booth survey (ePBS) method with female sex workers and men who have sex with men in Nairobi County, Kenya. ObjectiveThis study aims to (1) estimate the incidence and prevalence of HIV; (2) assess biomedical, behavioral, and structural outcomes; and (3) understand barriers contributing to gaps in access and use of available prevention and treatment services among female sex workers and men who have sex with men in Nairobi. MethodsThe novel ePBS approach employs complementary data collection methods, expanding upon the traditional polling booth survey (PBS) method by incorporating additional quantitative, qualitative, and biological data collection components and an improved sampling methodology. Quantitative methods will include (1) PBS, a group interview method in which individuals provide responses through a ballot box in an unlinked and anonymous way, and (2) a behavioral and biological survey (BBS), including a face-to-face individual interview and collection of linked biological samples. Qualitative methods will include focus group discussions. The ePBS study uses a 2-stage, population- and location-based random sampling approach involving the random selection of locations from which random participants are selected at a predetermined time on a randomly selected day. PBS data will be analyzed at the group level, and BBS data will be analyzed at an individual level. Qualitative data will be analyzed thematically. ResultsData were collected from April to May 2023. The study has enrolled 759 female sex workers (response rate: 759/769, 98.6%) and 398 men who have sex with men (response rate: 398/420, 94.7%). Data cleaning and analyses are ongoing, with a focus on assessing gaps in program coverage and inequities in program outcomes. ConclusionsThe study will generate valuable HIV outcome data to inform program improvement and policy development for Nairobi County’s key population HIV prevention program. This study served as a pilot for the novel ePBS method, which combines PBS, BBS, and focus group discussions to enhance its programmatic utility. The ePBS method holds the potential to fill an acknowledged gap for a rapid, low-cost, and simple method to routinely measure HIV outcomes within programs and inform incremental program improvements through embedded learning processes.

Transition Metal Oxides (TMOs) have drawn significant attention due to their diverse range of properties and applications. The partially filled d orbitals of the transition metal ions, with highly electronegative oxygen atoms, give rise to unique electronic structures that lead to multiple applications due to their magnetic, optical, and structural properties. These properties have a direct influence on chemical reactions that enable tailoring materials for specific applications in catalysis, such as electrocatalysis and photocatalysis. While the potential of TMOs is promising, their development for enhanced functional properties poses numerous challenges. Among these challenges, identifying the appropriate synthesis processes and employing optimal characterization techniques are crucial. In this comprehensive review, an overview of recent trends and challenges in the synthesis and characterization of highly functional TMOs as well as ceramics will be covered with emphasis on catalytic applications. Mesoporous materials play a key role in augmenting their functionality for various applications and will be covered. Ab-initio modeling aspects for the design and development of novel TMO will be also discussed.

Academically underprepared postsecondary students make up a large proportion of college campuses. Recent estimates indicate that up to 70 percent of incoming students at two-year community colleges and up to 40 percent of incoming students at four-year colleges enroll in developmental courses. There has been some criticism of the effectiveness of many of these developmental courses, as many students either do not complete them (most notably developmental mathematics) or do not progress to passing credit-bearing courses. Fortunately, there are supportive, developmental instructional strategies that a substantial body of research demonstrates to be effective. In this article, the authors begin with suggestions for motivating students that apply across subject areas. Then, they provide more detailed descriptions of several evidence-based strategies that developmental instructors can use across reading, writing, and mathematics courses. They also offer some tips for teaching on virtual platforms. Although they describe these strategies individually, they are best used in concert through a mix of whole-group, small-group, and individualized instruction.

Abstract Africa and the United States are both large, heterogeneous geographies with a diverse range of ecologies, climates and mosquito species diversity which contribute to disease transmission and nuisance biting. In the United States, mosquito control is nationally, and regionally coordinated and in so much as the Centers for Disease Control (CDC) provides guidance, the Environmental Protection Agency (EPA) provides pesticide registration, and the states provide legal authority and oversight, the implementation is usually decentralized to the state, county, or city level. Mosquito control operations are organized, in most instances, into fully independent mosquito abatement districts, public works departments, local health departments. In some cases, municipalities engage independent private contractors to undertake mosquito control within their jurisdictions. In sub–Saharan Africa (SSA), where most vector-borne disease endemic countries lie, mosquito control is organized centrally at the national level. In this model, the disease control programmes (national malaria control programmes or national malaria elimination programmes (NMCP/NMEP)) are embedded within the central governments’ ministries of health (MoHs) and drive vector control policy development and implementation. Because of the high disease burden and limited resources, the primary endpoint of mosquito control in these settings is reduction of mosquito borne diseases, primarily, malaria. In the United States, however, the endpoint is mosquito control, therefore, significant (or even greater) emphasis is laid on nuisance mosquitoes as much as disease vectors. The authors detail experiences and learnings gathered by the delegation of African vector control professionals that participated in a formal exchange programme initiated by the Pan-African Mosquito Control Association (PAMCA), the University of Notre Dame, and members of the American Mosquito Control Association (AMCA), in the United States between the year 2021 and 2022. The authors highlight the key components of mosquito control operations in the United States and compare them to mosquito control programmes in SSA countries endemic for vector-borne diseases, deriving important lessons that could be useful for vector control in SSA.

Abstract Background Despite the proven efficacy of Community Health Volunteers (CHVs) in promoting primary healthcare in low- and middle-income countries (LMICs), they are not adequately financed and compensated. The latter contributes to the challenge of high attrition rates observed in many settings, highlighting an urgent need for innovative compensation strategies for CHVs amid budget constraints experienced by healthcare systems. This study sought to identify strategies for implementing Income-Generating Activities (IGAs) for CHVs in Kilifi County in Kenya to improve their livelihoods, increase motivation, and reduce attrition. Methods An exploratory qualitative research study design was used, which consisted of Focus group discussions with CHVs involved in health promotion and data collection activities in a local setting. Further, key informant in-depth interviews were conducted among local stakeholder representatives and Ministry of Health officials. Data were recorded, transcribed and thematically analysed using MAXQDA 20.4 software. Data coding, analysis and presentation were guided by the Okumus’ (2003) Strategy Implementation framework. Results A need for stable income was identified as the driving factor for CHVs seeking IGAs, as their health volunteer work is non-remunerative. Factors that considered the local context, such as government regulations, knowledge and experience, culture, and market viability, informed their preferred IGA strategy. Individual savings through table-banking, seeking funding support through loans from government funding agencies (e.g., Uwezo Fund, Women Enterprise Fund, Youth Fund), and grants from corporate organizations, politicians, and other donors were proposed as viable options for raising capital for IGAs. Formal registration of IGAs with Government regulatory agencies, developing a guiding constitution, empowering CHVs with entrepreneurial and leadership skills, project and group diversity management, and connecting them to support agencies were the control measures proposed to support implementation and enhance the sustainability of IGAs. Group-owned and managed IGAs were preferred over individual IGAs. Conclusion CHVs are in need of IGAs. They proposed implementation strategies informed by local context. Agencies seeking to support CHVs’ livelihoods should, therefore, engage with and be guided by the input from CHVs and local stakeholders.

ABSTRACT: Objectives: To report the in vitro susceptibility of Enterobacterales (n = 3905) and Pseudomonas aeruginosa (n = 1,109) isolates, collected from patients in sub-Saharan Africa (four countries) in 2017–2021, to a panel of 10 antimicrobial agents with a focus on ceftazidime-avibactam activity against resistant phenotypes and β-lactamase carriers. Methods: MICs were determined by CLSI broth microdilution and interpreted using both 2022 CLSI and EUCAST breakpoints. β-lactamase genes were identified in select β-lactam-nonsusceptible isolate subsets using multiplex PCR assays. Results: Among Enterobacterales, 96.2% of all isolates were ceftazidime-avibactam-susceptible (MIC90, 0.5 µg/mL), including all serine carbapenemase-positive (n = 127), 99.6% of ESBL-positive, carbapenemase-negative (n = 730), 91.9% of multidrug resistant (MDR; n = 1817), and 42.7% of DTR (difficult-to-treat resistance; n = 171) isolates. Metallo-β-lactamase (MBL) genes were identified in most (n = 136; 91.2%) ceftazidime-avibactam-resistant isolates (3.5% of all Enterobacterales isolates). Ceftazidime-avibactam percent susceptible values ranged from 99.5% (Klebsiella species other than Klebsiella pneumoniae) to 92.5% (K. pneumoniae) for the various Enterobacterial taxa examined. Greater than 90% of Enterobacterales isolates from each country (Cameroon, Ivory Coast, Nigeria, South Africa) were ceftazidime-avibactam-susceptible. Among P. aeruginosa, 88.9% of all isolates were ceftazidime-avibactam-susceptible (MIC90, 16 µg/mL). Most (88.5%) MBL-negative, meropenem-resistant (n = 78), 68.1% of MDR (n = 385), and 19.2% of DTR isolates (n = 99) were ceftazidime-avibactam-susceptible. MBL genes were identified in 43.1% of ceftazidime-avibactam-resistant isolates (n = 53; 4.8% of all P. aeruginosa isolates). Country-specific ceftazidime-avibactam percent susceptible values for P. aeruginosa ranged from 94.1% (Cameroon) to 76.2% (Nigeria). Conclusion: Reference in vitro antimicrobial susceptibility testing demonstrated that most recent Enterobacterales (96%) and P. aeruginosa (89%) clinical isolates from four sub-Saharan African countries were ceftazidime-avibactam susceptible.

Abstract Background Oral HIV pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but uptake remains low in Africa, especially among young women who are a priority population for HIV prevention services. HIV self-testing (HIVST) has been proven to increase HIV testing in diverse populations but has been underutilized to support linkage to HIV prevention services. Most young women who initiate PrEP in Africa do so through informal peer referral. We wanted to test a model of formalized peer referral enhanced with HIVST delivery among young Kenyan women. Methods The Peer PrEP Trial is a two-arm hybrid effectiveness-implementation cluster-randomized controlled trial being conducted in central Kenya. Eligible participants (i.e., peer providers, n = 80) are women (≥ 16–24 years) refilling or initiating PrEP at public healthcare clinics who can identify at least four peers who could benefit from PrEP and not enrolled in another HIV study. Peer providers will be 1:1 randomized to (1) formal peer PrEP referral + HIVST delivery, where they will be encouraged to refer four peers (i.e., peer clients, ≥ 16–24 years) using educational materials and HIVST kits (two per peer client), or (2) informal peer PrEP referral, where they are encouraged to refer four peer clients using informal word-of-mouth referral. In both arms, peer providers will deliver a standard PrEP referral card with information on nearby public clinics delivering PrEP services. Peer providers will complete surveys at baseline and 3 months; peer clients will complete surveys at 3 months. Our primary outcome is PrEP initiation among peer clients, as reported by peer providers at 3 months. Secondary outcomes include PrEP continuation (any refilling), HIV testing (past 3 months), sexual behaviors (past month), and PrEP adherence (past month) among peer clients, as reported by both peer providers and clients at 3 months. Implementation outcomes will include participants’ perceived acceptability, appropriateness, and feasibility of the intervention as well assessments of the intervention’s fidelity and cost. Discussion Evidence from this trial will help us understand how HIVST could support health systems by facilitating linkage to PrEP services among young women who could benefit in Kenya and similar settings. Trial registration ClinicalTrials.gov NCT04982250. Registered on July 29, 2021.

The electrical distribution system is crucial for the utility grid to transmit power from generators to consumers. Considering the intricate structure of distribution systems and their significant role in power networks, establishing a robust fault classification and location scheme is vital. Due to ageing, distribution systems are often prone to faults from factors like poor operational conditions and wear and tear. The line faulting rate and the pertinent restoration epochs influence the frequency and duration of power disruptions. Thus, precisely locating the fault section is essential to minimize power restoration timeframes. This paper presents a hybrid fault classification and location technique in a combined continuous overhead and underground distribution line. A simulation of the hybrid model was designed in Simulink for an 11 kV combined continuous overhead and underground electrical distribution line, considering short circuit faults as they are the most predominant and cause massive damage in distributed systems. The proposed technique first classifies the fault using Discrete Wavelet Transforms (DWT) and Multi-layer Perceptron-Artificial Neural Networks (MLP-ANN). Next, the impedance and Adaptive Neuro-Fuzzy System (ANFIS) based technique is employed for fault location. At a sample rate of 50 kHz, the DWT was applied to current signals and the coefficients used for ANN training, while phase impedance values were used as input to the ANFIS for training. The simulation results showed accuracy of 96.6% for fault classification and 99.17% for fault location. The developed models can significantly enhance fault location for speedier outage resolution by promptly repairing the affected distribution lines.

Board games like chess serve as an excellent testbed for human–robot interactions, where advancements can lead to broader human–robot cooperation systems. This paper presents a chess-playing robotic system to demonstrate controlled pick and place operations using a 3-DoF manipulator with image and speech recognition. The system identifies chessboard square coordinates through image processing and centroid detection before mapping them onto the physical board. User voice input is processed and transcribed into a string from which the system extracts the current and destination locations of a chess piece with a word error rate of 8.64%. Using an inverse-kinematics algorithm, the system calculates the joint angles needed to position the end effector at the desired coordinates actuating the robot. The developed system was evaluated experimentally on the 3-DoF manipulator with a voice command used to direct the robot movement in grasping a chess piece. Consideration was made involving both the own pieces as well as capturing the opponent’s pieces and moving the captured piece outside the board workspace.

Some institutions of higher education in Kenya have adopted e-Learning with the aim of coping with the increased demand for university education and to widen access to university training and education. Though there are advantages that accrue from adopting e-Learning; its implementation and provision has not been smooth sailing. It has had to contend with certain national, organisational, technical and social challenges that undermine its successful implementation. This paper therefore aims to present a literature review of the challenges faced in the implementation and provision of e-Learning in universities in Kenya. The scoping review method was used to identify and analyze the literature of the e-Learning challenges. Some of the challenges revealed include: lack of adequate e-Learning policies, inadequate Information and Communication Technology (ICT) infrastructure, the ever evolving technologies, lack of technical and pedagogical competencies and training for e-tutors and e-learners, lack of an e-Learning theory to underpin the e-Learning practice, budgetary constraints and sustainability issues, negative perceptions towards e-Learning, quality issues, domination of e-Learning aims by technology and market forces and lack of collaboration among the e-Learning participants. These challenges need to be addressed to minimise their impact on implementation and delivery of e-Learning initiatives in institutions of higher education in Kenya. This analysis of the e-Learning challenges forms the basis for the ongoing research that seeks to explore and establish possible strategies to address some of these challenges.