Low Transition Rates Research Articles

Who cares? Elucidating parental care evolution in extant birds.

Extant birds stand out among vertebrates in the diversity of parental care types they present, spanning absence of care to uniparental care by either sex, biparental care, or even cooperative care. Despite years of research, key questions remain regarding parental care evolution in birds. Firstly, the parental care type in the most recent ancestor of extant birds is a matter of controversy, with proposed ancestral states including no care, uniparental male or female care, and biparental care. Another unsolved question is the direction, order, and frequency of transitions between parental care types. We address these key questions using a database of 5,438 bird species (~50% of extant diversity) and modern phylogenetic comparative methods controlling simultaneously for model and phylogenetic uncertainty as well as potential confounding effects of state-dependent diversification. Our results indicate that the most likely ancestral state for extant birds is male-only care, with a posterior probability of 0.8. Transition rates across parental care types were generally low and heterogeneous; loss of parental care virtually never occurs and transitions away from female-only or cooperative care most often lead to biparental care. Given the low transition rates, future research should analyze the factors favoring the maintenance of care types.

Inferring population trends of Syagrus coronata (Arecaceae) in areas under different management in Brazilian Caatinga using a transition matrix model

Syagrus coronata (Mart.) Becc. (Arecaceae), known as licuri, is a palm tree widely distributed throughout the Brazilian semi-arid, being currently vulnerable to extinction. Its fruits are exploited by both humans and animals, representing high sociocultural, economic, and ecological relevance. This palm tree is found in areas under different management intensity and land use; therefore, both medium and long-term ecological monitoring programs are essential to verify the effects of anthropogenic disturbances on the dynamic of their populations. Information on population structure and growth (λ) from 2018 to 2021 was obtained in 40 plots of 20 × 20 m (1.6 ha). Population matrix models based on five life stages (seedling, sapling, juvenile, immature adult, and reproductive adults) were obtained, in addition to information on fruit productivity and harvesting intensity. Individuals from the seedling stage predominated in both pasture and natural habitats. The populations from two habitats were stable (Pasture λ = 1.00 and Natural λ = 1.01); however, no transition occurred from earlier up to later stages. The population in the pasture was characterized by a low transition rate (recruitment of juveniles onwards), caused mainly by the pressure exerted by cattle. Our results suggest that the adult reproductive and seedling stages are the most important for the survival and growth of the populations. Harvest intensity had no effect on population growth, and only 16.65 % of the fruit annual production was collected. Therefore, fruit harvesting is sustainable, but the type of pasture management might compromise the future of the population. Management strategies ought to reduce the pressure exerted by livestock to increase the transition between stages and maintain the S. coronata populations over several years.

Empowering equality: Advancing quality education in the contemporary global landscape

AbstractThis comprehensive study investigates the multifaceted dimensions of education, with a primary emphasis on access, equity and quality in the context of the COVID‐19 pandemic and Kenya's educational landscape. The research begins by highlighting the centrality of education as a transformative force for individuals and societies, with the goal of bridging disparities that impede progress. The study introduces the concept of ‘Learning Poverty’, highlighting the worldwide problem of children's inability to read and comprehend fundamental texts, which is especially prevalent in sub‐Saharan Africa. It highlights the dire consequences of the COVID‐19 pandemic, exacerbating pre‐existing learning crises and exacerbating inequalities, particularly in regions already struggling with high rates of learning deprivation. In the context of Kenya, the research examines the nation's aspirations for equitable education with an emphasis on assuring access to quality secondary education, distributing resources' equitably, addressing disparities between public and private schools and promoting gender equity. It recognises ongoing efforts while addressing persistent barriers, such as low transition rates especially for girls. This research concludes by emphasising the critical significance of an unwavering commitment to well‐defined policy approaches and comprehensive reform initiatives to improve the quality and inclusiveness of education. It cautions against an overemphasis on privatisation and competition and urges a comprehensive reorganisation of policies and resource allocation in order to align with the Sustainable Development Goals. This study emphasises the importance of addressing educational disparities for global progress and the holistic development of children around the globe.

“I want to stay here”: Patient and staff perspectives on transitioning from a low-threshold buprenorphine program to clinic-based care

BackgroundThe Project Connections At Re-Entry (PCARE) Van is a low-threshold buprenorphine program operating outside the Baltimore City Detention Center. Like other low-threshold programs, PCARE seeks to engage a vulnerable population in care, stabilize patients, then transition patients to longer-term care; however, <10% of patients transition to clinic-based buprenorphine treatment. Our goal was to better understand these low transition rates and center patient perspectives in discussion of broader low-threshold program design. MethodsFrom December 2022 to June 2023, semi-structured interviews were conducted with 20 former and current PCARE patients and 6 staff members. We used deductive and inductive coding followed by thematic content analysis to identify themes around treatment experiences and care preferences. ResultsThere were strong preferences among current and former patients for continuing buprenorphine treatment at the PCARE Van. Several themes emerged from the data that explained patient preferences, including both advantages to continuing care at the van (preference for continuity, feeling respected by the program’s structure and philosophy) and disadvantages to transitioning to a clinic (perceived harms associated with rigid or punitive care models). Staff noted limited program capacity, and patients expressed that if needed, they would transition to a clinic for altruistic reasons. Staff expressed varied perspectives on low-threshold care, emphasizing both larger systems factors, as well as beliefs about individual patient responsibility. ConclusionsWhile many low-threshold care settings are designed as transitional bridge models, this research highlights patient preference for long-term care at low-threshold programs and supports efforts to adapt low-threshold models to be sustainable as longitudinal care.

Influence of Control Systems on Internal Efficiency in Public Secondary Schools in Nakuru County, Kenya

Even though every public secondary school in Nakuru County, Kenya, has adopted strategic plans, internal inefficiencies in the form of poor academic performance and a low student transition rate exist. Therefore, this study aimed to examine the influence of control systems on internal efficiency in public secondary schools in Nakuru County, Kenya. This research study was guided by the 7-S model developed by McKinsey, the 10-step model developed by Bryson, and the system theory developed by Von Bertanlanffy. This study employed a mixed approach and concurrent triangulation design. The study sought responses from a target population of 311 public secondary school teachers in Nakuru County, 311 principals and 11 sub-county education officials. Using stratified random sampling a total of 240 teachers, principals, and sub-county education officers were included in the sample. The study utilised questionnaires, document analysis, and interview schedules. Pearson’s Correlation Coefficient was 0.76, indicating reliability. Data was analysed descriptively using SPSS (version 23). The study also employed inferential statistics, such as regression analysis and Pearson correlations. Results are presented using bar graphs, pie charts, and frequency distribution tables. The control system positively impacted the schools’ internal efficiency despite the fact that most of the public secondary schools in Nakuru County had subpar supervision. According to the findings of this research, the Ministry of Education should conduct more frequent checks on implementing the control strategy to improve the organisation’s overall efficiency

Debate: Better use of existing services, not more new pathways, is required for psychosis prevention in young people - Commentary on Salazar de Pablo and Arango: 'Prevention of psychosis in adolescents: does CAMHS have a role?'

There has been much academic interest in 'the clinical high-risk state for psychosis' (CHR-P) concept. Whilst early intervention in psychosis (EIP) services have offered input to individuals meeting the CHR-P criteria the involvement of CAMHS clinicians in supporting young people with ideational and perceptual disturbance has been more inconsistent and uncertain. We bring together our relevant lived experience, empirical evidence and clinical and research expertise to write this commentary. We assert that the CHR-P paradigm needs to be revised. This should reflect the low transition rates to psychosis and the prevalent general, impairing psychopathology in individuals meeting these criteria. Nevertheless, it is clear that both CAMHS and EIP services have potential roles in meeting the needs of young people affected by distressing ideational and perceptual disturbance. We suggest that new care pathways and services are not required for young people affected by distressing psychosis-like experiences. Rather more effective joint working between CAMHS, EIP, crisis services and other agencies could meet the needs of these young people more comprehensively.

Predicting the Transition to Metabolically Unhealthy Obesity Among Young Adults With Metabolically Healthy Obesity in South Korea: Nationwide Population-Based Study.

Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status. The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition. This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors. Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50%. This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions.

Influence of Cultural Practices on Transition Rate from Primary to Secondary Schools in Isinya Sub County, Kajiado County, Kenya

Education is a fundamental human right because it empowers individuals with the knowledge and skills needed to increase production and income, as well as enabling individuals take advantage of employment opportunities in order to reduce poverty (UNESCO, 2010). It is the valuable thing that society can give its membership. It helps fight ignorance and the acquisition of knowledge creating a better citizenry in terms of prospects in life (Fanuel, 2011). This research paper presents findings of a study on the factors influencing low transition rates of pupils from primary schools in Isinya sub county, Kajiado County. The study was guided by the following objective: To investigate the extent to which cultural practices influences the transition rates from primary to secondary schools in Isinya sub county, Kajiado County. The study was prompted by the fact that transition in Isinya Sub County is low compared to the neighbouring sub counties. There was also no evidence of researchers who had carried out a similar study in Isinya Sub County, Kajiado County. The study employed a mixed methods approach research design since the target population consisted a total sample of 173 respondents was engaged from the sample drawn. These included 28 secondary school principals, 39 head teachers and 106 learners. Stratified random sampling method was used to pick the respondents. Questionnaires were the major tools for data collection. The implications and findings of the study were analysed and formed the basis for the study recommendations and conclusions. From the findings there was a notable gap on cultural factors and lack of peer role models were also established to weigh in heavily in inhibiting education transition among learners in the area of study. Key recommendations have been made to the said effect and it is the hope of the researcher that this work will not only serve for the intended academic purpose but largely inform relevant departments on the need to address the burden of transition in the county of study.

13.2% EQE near-infrared TADF OLED with emission peak at 761 nm

Near infrared (NIR) emitters have attracted much attention due to their advanced application in biomedical sensing/imaging, and telecommunications. However, the development of efficient NIR thermally activated delayed fluorescence (TADF) emitters with the emission over 750 nm is still a challenge. Herein two Y-shaped NIR TADF molecules (Py-TPA and Py-CN-TPA) were introduced. The inclusion of pyridine unit in these two emitters not only extended the conjugated system but also increased the molecular aspect ratios, thereby leading to their high horizontal ratio of emitting dipole orientation (Θ//). In addition, the NIR emitter showed a low Huang-Rhys (HR) factor in thin film relative to that in solution, indicating a low non-radiative transition rate and a high photoluminescent quantum yield (PLQY). Consequently, TADF OLED based on Py-TPA demonstrated a record-high external quantum efficiency (EQE) of 22.2% at 726 nm, 16.3% at 747 nm, and 13.2% at 761 nm.

Preparation of green film with improved physicochemical properties and enhanced antimicrobial activity using ingredients from cassava peel, bamboo leaf and rosemary leaf

Persistent petroleum based plastic polymers are posing a threat to the environment and human health. Hence, preparation of eco-friendly packaging materials from natural sources is innovative idea to replace persistent plastic films. However, biodegradable films from biomass absorb water that can promote bacterial growth and affect lifetime of film as well as the packed products. In this work, new biodegradable film with improved antimicrobial activity, physicochemical property and less water absorbing and holding property is prepared from modified blend of cassava peel starch (CPS), silica nanoparticle (SNP), glycerol plus rosemary essential oil (REO). The mixture (blend) of CPS, SNPs and glycerol in measured amount of distilled water was treated with acetic anhydride to reduce hydrophilic nature of the blend before adding REO. The content of SNPs in the biofilm was optimized by varying the concentration of SNPs (0.2–0.8%; w/w) keeping other factors constant. Based on the characterization results, the physicochemical property of the biofilms was dependent on the content of SNPs and the best result (film) has been found with 0.6% SNPs which was considered as optimum amount for further experiments. The film prepared from modified blend with 0.6% SNP had shown low water absorption, low water vapor transition rate, improved thermal stability, and less biodegradability. Based on the image from profilometer, the modified blend had shown better homogeneity with REO than unmodified blend and the film with REO had shown better antimicrobial activity as compared to the film without REO (control). The antimicrobial activity of the film with REO was also compared with reference (gentamicin) and its activity was comparable and promising. In general, the prepared film had shown improved physicochemical properties and enhanced antimicrobial activity.

A natural history analysis of asymptomatic TTR gene carriers as they develop symptomatic transthyretin amyloidosis in the Transthyretin Amyloidosis Outcomes Survey (THAOS)

Background Hereditary transthyretin amyloidosis (ATTRv amyloidosis) results from pathogenic mutations in the transthyretin (TTR) gene. This analysis aimed to better understand ATTRv amyloidosis development in asymptomatic TTR gene carriers. Methods The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, longitudinal, observational survey of patients with transthyretin amyloidosis, including both inherited and wild-type disease, and asymptomatic TTR gene carriers. Asymptomatic TTR gene carriers were assessed longitudinally to identify those who developed ATTRv amyloidosis after enrolment in THAOS (data cut-off: 1 August 2021). Results Of 740 asymptomatic TTR gene carriers, 268 (36.2%) (Val30Met, 212/613 [34.6%]; non-Val30Met, 48/111 [43.2%]) developed ATTRv amyloidosis within a median 2.2 years after enrolment. The most common first symptoms were sensory (49.5%) and autonomic (37.3%) neuropathy in Val30Met patients, and sensory neuropathy (45.8%) and cardiac disorder (22.9%) in non-Val30Met patients. Most patients first presented with a predominantly neurologic phenotype (Val30Met, 77.8%; non-Val30Met, 70.8%). Conclusions More than one-third of asymptomatic TTR gene carriers in THAOS developed ATTRv amyloidosis within a median 2 years of enrolment. Val30Met versus non-Val30Met patients had a lower transition rate. Given the importance of early treatment, these findings underscore the need for identification and careful monitoring of at-risk TTR gene carriers to enable prompt treatment. Trial registration ClinicalTrials.gov: NCT00628745.

Identifying Transition to First Episode Psychosis (FEP) From ‘At Risk Mental State’ (ARMS) in Sussex Early Intervention in Psychosis (EIP) Services

AimsIdentification of a psychosis risk syndrome to aid reduction of transition to a FEP is an important focus of worldwide research. ARMS for psychosis was defined by Yung and McGorry in 1996. UK EIP services were mandated to identify and ‘treat’ ARMS in the ‘Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance' 2016. Sussex EIP services developed such an ARMS service with a 1-year pathway of assessment, intervention as indicated, and monitoring from 2017. Sussex serves a population of approximately 1.4 million, including areas with both low and high social deprivation indices. Transition rates from ARMS to FEP in recent studies have suggested widely varying rates of 8–17% of transition in a two-year period, notably less than initially identified by Yung et al. We aimed to establish the rate of transition to FEP within 12 months from identification of ARMS in Sussex EIP services.MethodsA retrospective study was conducted on all patients on the ARMS pathway, across five EIP services in Sussex, between Jan 2017-Oct 2021. The primary outcome measure was operationally defined transition to FEP; secondary outcome measures included clinical features and use of clinical services.Results71 cases were identified as meeting ARMS criteria, with mean age 21.4yo; range 14–35, from a total new caseload of 447 over this period.ARMS subcategories identified 4 state/trait, 55 attenuated psychosis and 12 BLIPS. Comorbidity was more common than not; mood disorders were identified in 17 cases. 23 cases met not in education, employment or training (NEET) criteria.All cases received full care coordination by lead practitioners. 19 cases were prescribed atypical antipsychotics. 18 cases received formal CBT.4 of the 71 cases transitioned to FEP within 12 months at mean time 35 weeks; range 28–45 weeks. 2 had attenuated symptoms and 2 experienced BLIPS. 3 were initially NEET.ConclusionWe report a very low transition rate to FEP of 6% in this service, consistent with other such UK services. Whilst the ARMS sample is low in number, a clear impact on EIP service case management is identified. Risk saturation is arguably required to justify continuing this ARMS pathway, achievable by primary focus on the BLIPS subgroup. Wider review of UK ARMS services is required to reduce dilution of EIP service models and reduction of their well evidenced effectiveness.

Formulation and Characterization of Lacosamide-loaded Polymeric Microneedles

Background and objectivesEpilepsy is a neural disorder that occurs because of a disruption in neural conductions in various parts of the brain and is mainly characterized by seizures, pensive gaze, involuntary mimics, contractions, meaningless speeches, repetitive movements, and loss of consciousness. The serious side effects of conventional drug delivery systems due to high applied doses, low transition rates to the brain, and limitations of drug application during seizures result in the urgent need for novel drug delivery systems for the enhanced treatment of epilepsy.

Mortality of inactive hepatitis B virus carriers in Japan is similar to that of the general population.

Data on the long-term outcomes of individuals with hepatitis B virus (HBV) infection who are hepatitis envelope antigen (HBeAg)-negative inactive carriers (ICs) are limited due to small numbers. We compared the long-term prognosis of well-defined ICs with that of age- and gender-matched general population controls. A total of 526 HBeAg-negative patients who demonstrated alanine aminotransferase (ALT) level ≤40U/L and HBV DNA level ≤4.3 log IU/ml at least three times within 1year after the start of follow-up were enrolled as ICs. Inactive carriers were divided into two groups: Group A (n=332), whose ALT level was ≤30U/L and HBV DNA level was ≤3.3 log IU/ml, and Group B (remaining patients, n=194). We determined the long-term prognosis of ICs and compared it with that of general population controls. We also analyzed factors associated with hepatitis B surface antigen (HBsAg) clearance and phase transition in ICs. There were no significant differences in hepatocellular carcinoma development or all-cause, liver-related, or non-liver-related mortality between Groups A and B. There was no significant difference in all-cause mortality between ICs and the general population. Low HBsAg level (≤3.0 log IU/ml) and the presence of fatty liver were associated with HBsAg clearance and high alpha-fetoprotein level was associated with phase transition. The long-term prognosis of well-defined ICs was similar to that of general population controls. In addition, the ICs had a high HBsAg clearance rate and low phase transition rate.

The associations between migrant status and ethnicity and the identification of individuals at ultra-high risk for psychosis and transition to psychosis: a systematic review.

Migrant and ethnic minority populations exhibit a higher incidence of psychotic disorders. The Ultra-High Risk for psychosis (UHR) paradigm provides an opportunity to explore the stage at which such factors influence the development of psychosis. In this systematic review, we collate and appraise the literature on the association between ethnicity and migrant status and the rate of identification of individuals at UHR, as well as their rate of transition to psychosis. We conducted a systematic review in the Ovid Medline, PsychINFO, Pubmed, CINAHL and EMBASE databases according to PRISMA guidelines. We included studies written in English that included an UHR cohort, provided a measure of ethnicity or migrant status, and examined the incidence, rate, or risk of UHR identification or transition to psychosis. Of 2182 unique articles identified, seven fulfilled the criteria. One study found overrepresentation of UHR individuals from black ethnic groups, while another found underrepresentation. Two studies found increased rates of transition among certain ethnic groups and a further two found no association. Regarding migrant status, one study found that first-generation migrants were underrepresented in an UHR sample. Lastly, a lower transition rate in migrant populations was identified in one study, while two found no association. Rates of UHR identification and transition according to ethnic and migrant status were inconsistent and insufficient to conclusively explain higher incidences of psychotic disorders among these groups. We discuss the clinical implications and avenues for future research, which is required to clarify the nature of the associations.

Oncological Superiority of Anatomic Resection at Initial Hepatectomy for Solitary Hepatocellular Carcinoma

Introduction: Optimal choice of surgical maneuver for small hepatocellular carcinoma (HCC) remains inconclusive. This study sought to investigate the oncological superiority and postoperative influence of anatomic resection (AR) at initial hepatectomy for HCC. Methods: From a prospectively corrected database (n=1,175), 203 patients who underwent curative resection for primary, solitary HCC measuring up to 5 cm in diameter, which was confined to one Couninaud's segment and resectable either by AR or limited resection, were studied in detail. Results: AR (i.e. monosegmentectomy) was completed in 38 patients and not completed in the remaining 165 patients (i.e., limited resection). In multivariate analysis, AR was correlated with better recurrence-free survival (hazard rate [HR], 0.45; P=0.008), longer time-to-interventional failure (HR, 0.24; P=0.003), and improved overall survival (HR, 0.24; P=0.006). Recurrence within the same segment was observed in 30.4% when AR was not completed, and in such cases, average number of recurrent lesions and incidence of unresectable recurrence were higher (3.6 vs. 1.3 nodules; P=0.006 and 20.8% vs. 9.1%; P=0.16, respectively) compared to those who did not present local recurrence. Probability analysis using a Markov model showed that completion of AR at initial hepatectomy is associated with lower transition rates in both 1) from postoperative tumor-free status to resectable recurrence (5.1 vs. 12.5 /100 person-year, P=0.033) and 2) from resectable recurrence to progression to unresectable disease (9.0 vs. 35.6 /100 person-year, P=0.027). Conclusion: Complete removal of tumor-bearing segment at initial hepatectomy is associated with better survival outcomes through decreased risk of multiple/unresectable recurrence in solitary HCC.

Different roles of quantum interference in a quantum dot photocell with two intermediate bands

It is generally believed that quantum interference can improve the transport of photo-generated carriers in a photocell, thereby improve the photoelectric conversion efficiency. In this work, we explicitly explore different roles of quantum interferences in the photoelectric conversion efficiency in a quantum dot (QD) photocell with two intermediate bands. The increasing transition rates from different charge transport channels bring out first increasing, then decreasing, and then monotonically decreasing photoelectric conversion efficiencies. And the photoelectric conversions increase with quantum coherence generated by the upper transition rates owing to their robust quantum interference. However, the conversion efficiency decreases with the quantum interference induced by two lower-transition rates due to the shortened population lifetime in the intermediate bands. These results provide insight into different roles of quantum interferences in photoelectric conversion efficiency, and may provide some artificial strategies to achieve efficient photoelectric conversion via the adjusted quantum interferences in a QD photocell with multi-intermediate bands.

Stable Luminescent Radicals and Radical-Based LEDs with Doublet Emission

Radical-based light-emitting diodes are an innovative type of organic light-emitting diodes (OLEDs), which adopt luminescent radicals as emitters, aiming at improving the external quantum efficienc...

Syndemic latent transition analysis in the HPTN 061 cohort: Prospective interactions between trauma, mental health, social support, and substance use

BackgroundSubstance use among Black sexual minority men (BSMM) is a significant public health focus of prevention interventions due to its association with sexual risk behaviors and transmission of HIV. Traumatic experiences and mental health challenges may interact to create a syndemic associated with substance use in this population; this may be moderated by social support however. MethodsUsing a multicenter prospective cohort of 1068 BSMM, we conducted a longitudinal syndemic latent transition analysis testing whether baseline and 6-month race and sexuality-targeted violence, intimate partner violence, other traumatic experiences, depression, and internalized homophobia was associated with 12-month substance use. We also tested if social support modified this and was associated with transitions between statuses. ResultsOur analysis identified four statuses: A “low-risk” status characterized by the lowest proportions of syndemic factors, and 3 “high-risk” statuses, characterized by higher proportions of syndemic factors. All three high-risk statuses were associated with higher substance use than the low-risk status, with the greatest association observed with “high-risk status C” (aRR = 4.54, 95 % CI 1.98, 10.40). Social support attenuated this association (Interaction aRR = 0.21, 95 % CI 0.05, 0.85) and was associated with lower transition rates from low to high-risk status 6 months later (Transition ratio = 0.45, 95 % CI 0.29, 0.69). ConclusionsOur findings identified a syndemic of trauma, depression, and homophobia among BSMM associated with substance use, but attenuated by social support. Future research into the role of social support and resiliency in substance use prevention and recovery is recommended.

Socio-cultural Factors Affecting Gender Mainstreaming in the Ministry of Education: A Case of Embu and Tharaka-Nithi County

The purpose of the study was to establish socio-cultural factors affecting gender mainstreaming in the ministry of education. The study used descriptive survey research design. The target population consisted of the county and sub-county gender coordinators and the heads of public secondary schools. Embu and Tharaka-Nithi was selected purposively because of low transition rate from primary to secondary schools. A total of 211 respondents were sampled through purposive and random sampling techniques. A questionnaire and an interview schedule were used to collect primary data. Descriptive statistics were used to summarize the properties of the mass data that were collected from the respondents. Factor analysis method was used to determine the factors that were used in the study namely; strength of strategies, gender mainstreaming strategies, gender policy in education, gender disparities in education and understanding of the policy which were used in logistic regression analysis. Logit regression was used to determine the effect of the factors on gender mainstreaming. Among the five factors, only one factor (gender disparities in education) affected gender mainstreaming negatively. All other predictor variables: strength of strategies; gender mainstreaming strategies; gender policy in education and understanding of gender policy in education affected gender mainstreaming positively. From the findings, it is evident that Gender policy in education is not being implemented effectively in the public secondary schools and there are several factors affecting gender mainstreaming in the education sector which includes; inadequate commitment from top-down to the institution, gender concept was not well understood, inadequate training and awareness for teachers, gender imbalance and inadequate training for Board of Governors and Parents Teachers Association, inadequate resources and socio-cultural factors. The study concluded that the school heads, teachers and management were ill-prepared for the policy implementation, there is inadequate support, training and awareness. Also, there is poor system of monitoring and evaluation. More so, policies and strategies outlined for secondary schools are appropriate and satisfactory but requires balancing between boys and girls.