Official Development Research Articles

THE LAW GOVERNING UNITED KINGDOM GOVERNMENT TORT LIABILITY IN THE ‘WAR ON TERROR’

Abstract This article discusses the United Kingdom Supreme Court judgment in Zubaydah v Foreign, Commonwealth and Development Office, which addressed the law governing the tort liability of the United Kingdom Government for its alleged complicity in the claimant's arbitrary detention and torture overseas by the Central Intelligence Agency. In holding that English law applied, the Court departed from previous case law by giving decisive weight to public law factors in its choice-of-law reasoning. This decision arguably heralds a greater role for English law in relation to tort claims brought by overseas victims of allegedly wrongful exercises of British executive authority as a mechanism for achieving executive accountability, controlling abuse of power, ensuring the rule of law and providing victims access to remedy.

The epidemiological benefit of pyrethroid–pyrrole insecticide treated nets against malaria: an individual-based malaria transmission dynamics modelling study

Insecticide treated nets (ITNs) are the most important malaria prevention tool in Africa but the rise of pyrethroid resistance in mosquitoes is likely impeding control. WHO has recommended a novel pyrethroid-pyrrole ITN following evidence of epidemiological benefit in two cluster-randomised, controlled trials (CRTs). It remains unclear how effective more costly pyrethroid-pyrrole ITNs are compared with other tools, or whether they should be deployed when budgets are limited. We aimed to compare the epidemiological impact and cost-effectiveness of the mass distribution of pyrethroid-pyrrole ITNs relative to other ITNs over 3 years in different African settings. In this individual-based malaria transmission dynamics modelling study we characterise the entomological impact of ITNs using data from a systematic review of experimental hut trials from across Africa. This African entomological data was used to inform an individual-based malaria transmission dynamics model, which was validated against CRT results from Benin and Tanzania. The full impact of new ITNs was quantified for trial sites and simulation was used to project impact in different settings which were included within an accessible interface (the Malaria Intervention Tool) to support National Malaria Programmes to explore how vector control tools and budgets could be allocated across regions to avert the most cases. The model projects that distributing pyrethroid-pyrrole ITNs averted 65% (95% credible interval 48-74) of cases over 3 years in Tanzania, and 75% (28-93) in Benin. The model indicates that trials might have underestimated the benefits of switching ITNs by 12-16% over 3 years because participants stopped using trial-allocated nets. In moderate endemicity non-trial settings, pyrethroid-pyrrole ITNs are projected to reduce malaria prevalence by 25-60% and switching from pyrethroid-only ITNs is probably highly cost-effective in most locations given current prices, averting an additional 10-30% of cases. The benefit of pyrethroid-pyrrole ITNs varies by setting but is generally the most cost-effective indoor vector control intervention in Africa. National Malaria Programmes can strategise deployment to maximise impact. Entomological data could broadly predict epidemiological impact, although there are some inconsistencies, illustrating the challenge in capturing the dynamics across diverse settings. Unitaid, Bill & Melinda Gates Foundation, the UK Medical Research Council, Wellcome Trust, and the UK Foreign, Commonwealth & Development Office.

Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort study

Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. We conducted a population-based national retrospective cohort study of children (0-9 years) and adolescents (10-17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9-3.1) and did not receive DOT (2.3, 1.9-2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2-2.0), illicit drug use (4.2, 3.4-5.1), tobacco use (1.6, 1.3-2.1), HIV infection (2.7, 2.2-3.4), and not receiving DOT (2.6, 2.3-2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3-0.9). In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

Effectiveness and safety of immune checkpoint inhibitors in Black patients versus White patients in a US national health system: a retrospective cohort study.

Black patients were severely under-represented in the clinical trials that led to the approval of immune checkpoint inhibitors (ICIs) for all cancers. The aim of this study was to characterise the effectiveness and safety of ICIs in Black patients. We did a retrospective cohort study of patients in the US Veterans Health Administration (VHA) system's Corporate Data Warehouse containing electronic medical records for all patients who self-identified as non-Hispanic Black or African American (referred to as Black) or non-Hispanic White (referred to as White) and received PD-1, PD-L1, CTLA-4, or LAG-3 inhibitors between Jan 1, 2010, and Dec 31, 2023. Effectiveness outcomes were overall survival, time to treatment discontinuation, and time to next treatment. The safety outcome was the frequency of immune-related adverse events; assessed among a random sample of 1000 Black patients and 1000 White patients, 892 pairs were matched on the basis of baseline characteristics using 1:1 exact matching without replacement. After manual chart review, patients who did not receive ICI therapy or who had inadequate follow-up were excluded. The adjusted effect of race on each effectiveness outcome was assessed in the whole ICI-treated cohort with propensity-weighted Cox regression with robust standard errors. Immune-related adverse events outcomes were analysed in the random matched sample with multivariable Cox regression, adjusting for baseline characteristics. We identified 26 398 patients, of whom 4943 (18·7%) patients were Black, 21 455 (81·3%) were White, 895 (3·4%) were female, 25 503 (96·6%) were male, 11 859 (45%) had non-small-cell lung cancer, and 26 045 (98·7%) received PD-1 or PD-L1 inhibitors. As of data cutoff (Aug 28, 2024), median follow-up was 40·3 months (95% CI 38·3-42·3) for Black patients and 43·9 months (43·0-45·1) for White patients. Compared with White patients, Black patients had longer time to treatment discontinuation (2-year unadjusted rates 10·7% [95% CI 9·8-11·7] for Black patients vs 8·6% [8·2-9·0] for White patients; adjusted hazard ratio [HR] 0·91, 95% CI 0·87-0·95, p<0·0001), similar time to next treatment (23·5% [22·3-24·8] for Black patients vs 25·6% [25·0-26·2] for White patients; 1·00, 0·95-1·05, p=0·96), and slightly improved overall survival (36·5% [35·2-38·1] for Black patients vs 36·5% [35·8-37·1]; 0·95, 0·90-0·99, p=0·036). 1710 patients (n=862 Black and n=848 White) were analysed for safety outcomes. Compared with White patients, Black patients had a reduced risk of all-grade immune-related adverse events (unadjusted 2-year rate 33·1% [95% CI 28·9-37·1] vs 44·1% [95% CI 39·1-48·7]; adjusted HR 0·75, 95% CI 0·62-0·90, p=0·0026), immune-related adverse events requiring treatment with systemic steroids (0·61, 0·46-0·81, p=0·00051), and immune-related adverse events resulting in permanent ICI discontinuation (0·58, 0·44-0·78, p=0·00024). In exploratory analyses of irAE subtypes, a significant risk reduction in Black patients was found for colitis (0·46, 0·27-0·76, p=0·0026) and hyperthyroidism or hypothyroidism (0·63, 0·44-0·90, p=0·011), and no significant differences were found for any other immune-related adverse event subtypes analysed. Similar results were found in analyses using a steroid-based definition of immune-related adverse events among the entire ICI-treated cohort. Compared with White patients, Black patients had similar ICI effectiveness and lower toxicities among those treated in the national VHA system, potentially reflecting an important difference in the therapeutic ratio (ratio of benefit to harm) of ICIs. Our findings of decreased toxicity among Black patients require further investigation to assess their generalisability. Million Veteran Program, Office of Research and Development, Veterans Health Administration and the LUNGevity foundation.

Soybean Bio-fertilizer Technology Promoting Through Cluster Based Demonization in the Mima Learning Watershed from Assosa Western Ethiopia

Soil fertility depletion and soil acidity are critical problems for soybean production in western Ethiopia. Therefore, a cluster based biofertilizer technology was demonstrated to improve the depleted soil fertility on Nitisols of Assosa Agricultural Research Centre during 2022 to 2024 cropping season to investigate the response of soybean yield to biofertilizer. The treatment consists of: farmers practice (100 kg NPS ha&amp;lt;sup&amp;gt;-1&amp;lt;/sup&amp;gt;) and biofertilizer plus 100 kg NPS ha&amp;lt;sup&amp;gt;-1&amp;lt;/sup&amp;gt;. Multidisciplinary team had given participatory training from the composed of Soil fertility researcher, soybean breeder and agricultural extension and communication for the selected participates. The training was delivered for different stake holders and farmers on agronomic management of soybean production techniques and management, cluster based bio fertilizer technology demonstration approach. Around 830 packets of bio-fertilizer are distributed for the farmers in last four years cropping season. In order to evaluate the performance share the lesson with different stakeholders’ field day and experience sharing were organized in the fields of beneficiary farmers. In the field day and experience sharing famers, development agents (DAs), experts, heads of agricultural and rural development office, researchers were participated. The cluster based demonstrated biofertilizer technology was compared with farmers practice and the field data recorded and analyzed by descriptive statics. The participant farmers and different stake holders preferred biofertilizer plus NPS fertilizer during the field day and experience sharing. The application of recommended NPS plus inoculation was higher in seed yield of maize by 14% compared to the application of recommended NPS fertilizers alone. The yield advantage relative to NPS alone indicating the depletion of the soil microorganism and its strong response to bio fertilizer application.

Strategies to Improve National Poverty Data Bank Ekasih Registration Process at State Development Office of Johor

Strategies to Improve National Poverty Data Bank Ekasih Registration Process at State Development Office of Johor

Environmental public health research at the U.S. Environmental Protection Agency: A blueprint for exposure science in a connected world.

Exposure science plays an essential role in the U.S. Environmental Protection Agency's (U.S. EPA) mission to protect human health and the environment. The U.S. EPA's Center for Public Health and Environmental Assessment (CPHEA) within the Office of Research and Development (ORD) provides the exposure science needed to characterize the multifaceted relationships between people and their surroundings in support of national, regional, local and individual-level actions. Furthermore, exposure science research must position its enterprise to tackle the most pressing public health challenges in an ever-changing environment. These challenges include understanding and confronting complex human disease etiologies, disparities in the social environment, and system-level changes in the physical environment. Solutions will sustainably balance and optimize the health of people, animals, and ecosystems. Our objectives for this paper are to review the role of CPHEA exposure science research in various recent decision-making contexts, to present current challenges facing U.S. EPA and the larger exposure science field, and to provide illustrative case examples where CPHEA exposure science is demonstrating the latest methodologies at the intersection of these two motivations. This blueprint provides a foundation for applying exposomic tools and approaches to holistically understand real-world exposures so optimal environmental public health protective actions can be realized within the broader context of a One Health framework. IMPACT STATEMENT: The U.S. EPA's Center for Public Health and Environmental Assessment exposure research priorities reside at the intersection of environmental decision contexts and broad public health challenges. The blueprint provides a foundation for advancing the tools and approaches to holistically understand real-world exposures so optimal environmental protection actions can be realized. A One Health lens can help shape exposure research for maximum impact to support solutions that are transdisciplinary and must engage multiple sectors.

Assessment of Training Needs of the Office staff (Management assistants and Development Officers) in the National Hospital of Sri Lanka

Introduction: In the dynamic landscape of healthcare administration, the role of hospital office staff is pivotal for maintaining the seamless functioning of the hospital. Training Needs Assessment is a proactive approach to aligning the skills of hospital office staff with the evolving demands of the healthcare landscape, ensuring compliance and promoting excellence in administrative practices and, consequently, contributing to improved patient outcomes.Objective: This study aims to identify the training needs of hospital office staff in the National Hospital of Sri Lanka (NHSL).Methodology: A descriptive cross-sectional study was conducted in NHSL with the office staff from June to August 2023. The total population was 181. Among them, 123 people were selected from simple random sampling proportionately to the category. The self-administered questionnaire was used to collect the data. The questionnaire assessed the activities and capabilities of office staff necessary for their daily tasks. Participants were asked to score these activities based on their importance and current performance level. Mean scores for the importance of the training areas and current performances were calculated, and gaps were identified by subtracting. Training needs with the highest gaps (gap equal or more than 2) were prioritized as training needs for office staff in NHSL.Results: Procurement for the public sector, handling audit inquiries, file management including personal file management, salary conversion, pension management, gathering, organizing, analyzing statistically, &amp; disseminating data and information were prioritized as training needs for next year.Conclusions and recommendations: Those prioritized training needs were included in the next year's (2024) annual action plan with the permission of the Deputy Director General -NHSL.

Toward a Vision of Sustainable University: Linkages between Commitment and Practices

Sustainability management plays a significant role in higher education. Development of a sustainable university involves integrating environmental, social, and economic considerations into various aspects of its operations, including campus infrastructure, curriculum, research, and community engagement. This urgently requires a strong commitment as a driving force behind sustainable initiatives, guiding actions, decisions, and investments toward achieving sustainability goals. IPB University as one of the most prominent universities in Indonesia is not only committed to becoming a sustainable university but also consistent in developing strategic plans to pursue its vision. Guided by this vision, IPB University has specifically established the Sustainable Campus Development Office (SCDO) to devise comprehensive sustainability plans outlining its goals, targets, and strategies for reducing environmental impact, promoting social equity, and ensuring economic viability. While it is still on progress, this commitment has played a significant role in encouraging sustainability practices at the university. It provides a foundation for leadership, governance, resources allocation, curriculum integration, student engagement, community partnerships, monitoring, reporting, and continuous improvement toward achieving sustainability goals. In addition, the university has established several sustainability values as guidance and indicators for maintaining sustainable practices. Integrating values and commitment is thus critical to realizing sustainable practices from generation to generation.

Enacting Social Protection Laws in Jigawa and Zamfara States, Nigeria

Legal frameworks are important for institutionalising and strengthening social protection systems. Two states in Nigeria, Jigawa and Zamfara, have enacted social protection laws. This article explores how the process of enacting such a law is influenced by state-level politics and local contexts, and how the activities of a project financed by the Foreign, Commonwealth &amp; Development Office (FCDO) contributed to much greater understanding and acceptance of social protection in both states. Primary data collected through in-depth interviews with state and non-state stakeholders and project staff was analysed to tease out the political, cultural, and power dynamics involved in enacting the laws. Findings show that a range of factors aimed at building the case for, and understanding of, social protection across a range of stakeholders was critical, and that a fairly standard package of tools employed in advocating for institutionalising social protection was influenced considerably by domestic political dynamics.

Technology adoption at scale: the success of USAID’s agriculture diversification project in Malawi

Abstract Dr. Fenton Sands, USAID’s new contract representative, faced some challenges. His office, USAID-Malawi over many years showed great commitment to the country, yet there seemed to be insufficient progress in poverty reduction, agricultural yield improvement, and smallholder farmer incomes. Now in 2017, the mission managed 25 different multimillion-dollar projects that touched on agriculture, the economy, resilience, gender, and nutrition, with little sustainability evident. Dr. Sands’ task was twofold, specifically, how to depart from past practice and actually achieve sustainable impact at scale here in Malawi, as he launched the new $60m Ag Div activity and more generally, if successful, how should USAID scale the success across the region. This case study provides unique insights into how Dr. Sands and his team jettisoned traditional development approaches and builds sustainable economic impact at scale through a novel private sector platform. USAID Malawi’s brave new venture successfully leveraged university research via the Soybean Innovation Lab to assure sound science and evidenced based decision making. Dr. Sand’s novel approach, presented here as a teaching case study, provides an explicit pathway for development officers, university researchers, program implementers, and leaders in the donor community to build sustainable impact in partnership with the private sector.

Occupational well-being of diplomatic personnel: a qualitative study.

Diplomatic personnel face unique job demands due to their frequent relocations. There is some evidence that occupational stress contributes to poor well-being in this occupational group, but little research on the aspects of the job that are perceived to be particularly challenging. This study aimed to explore diplomatic personnel's perceptions of their organization and their roles and to identify aspects of the job, which could cause stress and potentially affect well-being. Semi-structured interviews were carried out with 24 employees of the Foreign, Commonwealth and Development Office between September 2021 and February 2022. Participants were asked to reflect on their experiences before the coronavirus disease 2019 pandemic. Thematic analysis was used to analyse data. Participants enjoyed many aspects of their work including the variety, travel opportunities and feeling that they made a difference. They also identified several stressors relating to job demands, overseas postings, family needs, frequent relocation, hardship posts, workplace relationships, (lack of) appreciation and acknowledgement, and organizational culture. Good relationships with colleagues and managers were perceived to be very important. Findings suggest various ways in which diplomatic organizations can better support their personnel, highlighting workload management; cross-cultural training; providing appropriate support to both accompanying families and unaccompanied staff members; practical and psychological preparation for those in high-risk locations; encouraging positive workplace relationships; good management; increased autonomy and increased recognition for good work.

Challenges Experienced by Women in Accessing Loan from Women Development Fund in Arusha: A Case of Arusha District Council

Various economic empowerment programs and strategies have been introduced to improve the welfare of marginalized groups, particularly women. One such initiative is the Women Development Fund (WDF) in the Arusha District Council, Tanzania, which was established to provide financial support to women in the region. However, despite its aims, women often face significant challenges when trying to access loans from the fund. This study aims to explore the specific challenges women encounter when seeking loans from the WDF in Arusha District Council. A sample of 60 women beneficiaries was selected as respondents for this study. Data collection methods included household surveys, with community development officers serving as key informants through interviews. Both qualitative and quantitative data were gathered and analyzed, with findings presented in frequency tables and percentages. The results revealed that women beneficiaries faced multiple challenges in accessing loans. Loan delays were the most frequently reported issue, followed by other obstacles such as excessive bureaucracy, low risk-bearing capacity, sexual harassment, financial bribery, and erotic bribery. These barriers hinder women’s ability to secure the financial resources needed to improve their economic standing. Based on these findings, the study recommends that local government authorities, including the Arusha City Council, implement feedback mechanisms to address loan processing issues and support women beneficiaries more effectively. Additionally, women themselves are encouraged to improve their financial literacy and understanding of financial products and services, particularly those related to WDF loans, to increase their access to and success with such programs.

The translation-to-policy learning cycle to improve public health.

Learning Health Systems (LHSs) have not directly informed evidence-based policymaking. The Translation-to-Policy (T2P) Learning Cycle aligns scientists, end-users, and policymakers to support a repeatable roadmap of innovation and quality improvement to optimize effective policies toward a common public health goal. We describe T2P learning cycle components and provide examples of their application. The T2P Learning Cycle is based on the U.S. Department of Veterans Affairs (VA) Office of Research and Development and Quality Enhancement Research Initiative (QUERI), which supports research and quality improvement addressing national public health priorities to inform policy and ensure programs are evidence-based and work for end-users. Incorporating LHS infrastructure, the T2P Learning Cycle is responsive to the Foundations for Evidence-based Policymaking Act, which requires U.S. government agencies to justify budgets using evidence. The learning community (patients, providers, clinical/policy leaders, and investigators) drives the T2P Learning Cycle, working toward one or more specific, shared priority goals, and supports a repeatable cycle of evidence-building and evaluation. Core T2P Learning Cycle functions observed in the examples from housing/economic security, precision oncology, and aging include governance and standard operating procedures to promote effective priority-setting; complementary research and quality improvement initiatives, which inform ongoing data curation at the learning system level; and sustainment of continuous improvement and evidence-based policymaking. The T2P Learning Cycle integrates research translation with evidence-based policymaking, ensuring that scientific innovations address public health priorities and serve end-users through a repeatable process of research and quality improvement that ensures policies are scientifically based, effective, and sustainable.

Thoughts on the Beginnings of Psychoanalyses

Musing on the topic of initiating analyses, I began asking myself, what do we experience and what do we mean when we commonly say “an analysis unfolds”? Hans Loewald understood the rhythms of psychic development as coming into being, and that an analysis (when it works) also seems to follow that pattern. This paper will focus on appreciating the new within the old in the analytic process as a way to illustrate narrative and behavioral themes in the analytic dialogue. It will explore how these themes relate to the creativity of analytic unfolding from an initial matrix of psychically overdetermined uncertainties. Analyst, supervisor, and patient can all notice and experience shifts of new forms intermingling with the old. This trope will be clinically expanded and examined (1) with materials from a candidate’s first analytic case, (2) with a vignette from a seasoned analyst’s beginning case; and (3) a Covid-era beginning treatment. A clinical footnote (dubbed by the author’s supervisees “The Balsam Sign”) describes a nonverbal mime in the office of a new development occurring within the familiar verbal communication, which may signal a patient’s readiness to accept a recommendation to begin an analysis.

Local Government Monitoring System’s Design and Implementation in Ghana from the Lens of the Project Life Cycle

Monitoring at the subnational level has connotations for the effectiveness of local governance in the developing world. Using a cross-sectional survey underpinned by the project life cycle model, the paper contributes to understanding essential considerations in developing and implementing subnational monitoring in Africa. About 74 of the targeted 275 District Development Officers responded to the online Google form questionnaire. The study employed descriptive statistics to analyze data. Results demonstrate that the monitoring system is excellent in design, but its implementation and reflection stages are weak. It highlights planning for subnational monitoring systems encompassing setting clear objectives, utilizing robust indicators, involving stakeholders, and an elaborate plan for data collection, analysis, communication, and reporting as vital ingredients of a monitoring system. Sufficient resources and capacity-building initiatives, including providing on-the-job training, hiring experienced staff, committing financial resources and logistics, and backstopping support, are necessary to implement monitoring activities effectively. An appropriate policy environment, including manuals and legislation, is critical to anchoring and sustaining subnational monitoring systems. Local government’s monitoring systems should prioritize learning, knowledge sharing, and documentation of lessons learned to facilitate programmatic improvements and replication and devote at least 2.5% of the District Assembly Common Fund to finance monitoring and evaluation actions.

Impact of Political Instability on Tourism in West Bengal.

This study aimed to investigate the effects of political instability on tourism-related business performance, incoming tourist flows in West Bengal, and overall tourism-based earnings. The nonlinear effects of political risk and economic growth on tourism receipts are examined in this research. Nevertheless, the secondary data that is now accessible with the unobserved component model technique detection only provides a broad picture of the issue. Experts such as managers of lodging establishments, staff members of local tourism development offices, and tourism researchers were interviewed as a result. Expert interviews exposed West Bengal's tourism industry's prospects, challenges, and potential developments in the face of the region's five years of political unrest. The findings confirm earlier research showing that, in the near run, political unrest lowers tourism. However, the long-term viewpoint has yielded various results from the expert interviews with main province cities. Political instability benefits cities with developed tourism businesses that are located outside of crisis areas. Places that relied on visitors from the countries or continents like Europe, Germany, China, USA are mostly affected. The political unrest in eastern West Bengal did not significantly affect cities with low levels of tourism development.

Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life.

Post-acute sequelae of SARS-CoV-2, referred to as "long COVID", are a globally pervasive threat. While their many clinical determinants are commonly considered, their plausible social correlates are often overlooked. To compare social and clinical predictors of differences in quality of life (QoL) with long COVID. Additionally, to measure how much adjusted associations between social factors and long COVID-associated quality of life are unexplained by important clinical intermediates. Data from the ISARIC long COVID multi-country prospective cohort study. Subjects from Norway, the United Kingdom (UK), and Russia, aged 16 and above, with confirmed acute SARS-CoV-2 infection reporting >= 1 long COVID-associated symptoms 1+ month following infection. The social exposures considered were educational attainment (Norway), employment status (UK and Russia), and female vs male sex (all countries). Quality of life-adjusted days, or QALDs, with long COVID. This cohort study included a total of 3891 participants. In all three countries, educational attainment, employment status, and female sex were important predictors of long COVID QALDs. Furthermore, a majority of the estimated relationships between each of these social correlates and long COVID QALDs could not be attributed to key long COVID-predicting comorbidities. In Norway, 90% (95% CI: 77%, 100%) of the adjusted association between the top two quintiles of educational attainment and long COVID QALDs was not explained by clinical intermediates. The same was true for 86% (73%, 100%) and 93% (80%,100%) of the adjusted associations between full-time employment and long COVID QALDs in the United Kingdom (UK) and Russia. Additionally, 77% (46%,100%) and 73% (52%, 94%) of the adjusted associations between female sex and long COVID QALDs in Norway and the UK were unexplained by the clinical mediators. This study highlights the role of socio-economic status indicators and female sex, in line with or beyond commonly cited clinical conditions, as predictors of long COVID-associated QoL, and further reveal that other (non-clinical) mechanisms likely drive their observed relationships. Our findings point to the importance of COVID interventions which go further than an exclusive focus on comorbidity management in order to help redress inequalities in experiences with this chronic disease.

Information Communication Technology Adoption and Service Delivery by Microfinance Institutions in Nandi County: A Case Study of Juhudi Kilimo Limited

The Study Aimed To Investigate The Factors Affecting The Adoption Of Information Communication Technology In Service Delivery By Microfinance Institutions In Nandi County With Juhudi Kilimo Limited As The Main Point Of Focus. The Investigation Aimed To: Examine Whether Ict Illiteracy Affects Service Delivery By Microfinance Institutions In Nandi County, Find Out How Technological Infrastructure Has An Effect On Service Delivery By Microfinance Institutions In Nandi County, Ascertain How The Cost Of Adoption Has An Effect On Service Delivery By Microfinance Institutions In Nandi County, And Examine How Perceived Usefulness Has An Effect On Service Delivery By Microfinance Institutions In Nandi County. The Research Considered A Population Of 200 Employees And Clients Of Juhudi Kilimo In Nandi County. The Study Employed A Simple Random Sampling Technique. The Technology Acceptance Theory Constituted The Foundations Of The Research. The Research Employs A Descriptive Design To Examine The Characteristics Of The Target Population, Consisting Of It Officers, Finance Officers, Operations Officers, Research And Development Officers, Internal Auditors, And Clients Of Juhudi Kilimo. A Representative Sample Of 60 Respondents Was Selected Randomly. Data Collection Involved Questionnaires, Validated Through A Pilot Study And Expert Evaluation. The Research Also Provided A Robust Framework For The Study, Ensuring Methodological Rigor And Ethical Adherence In Investigating Ict Adoption's Impact On Mfi Service Delivery. The Study Revealed Strong Positive Correlations Between Ict Illiteracy And Adoption Costs (0.983), Technological Infrastructure (0.310), And Perceived Usefulness (0.459). Technological Infrastructure Demonstrated A Strong Positive Correlation With Perceived Usefulness (0.751) And A Moderate Positive Correlation With Adoption Costs (0.652). Adoption Costs Exhibited Strong Positive Correlations With Both Ict Illiteracy (0.983) And Technological Infrastructure (0.995). Perceived Usefulness Showed A Moderate Positive Correlation With Ict Illiteracy (0.459) And Strong Positive Correlations With Both Technological Infrastructure (0.978) And Adoption Costs (0.959).

Early Newborn Metabolic Patterning and Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is a major cause of infant death in the US. Previous research suggests that inborn errors of metabolism may contribute to SIDS, yet the relationship between SIDS and biomarkers of metabolism remains unclear. To evaluate and model the association between routinely measured newborn metabolic markers and SIDS in combination with established risk factors for SIDS. This was a case-control study nested within a retrospective cohort using data from the California Office of Statewide Health Planning and Development and the California Department of Public Health. The study population included infants born in California between 2005 and 2011 with full metabolic data collected as part of routine newborn screening (NBS). SIDS cases were matched to controls at a ratio of 1:4 by gestational age and birth weight z score. Matched data were split into training (2/3) and testing (1/3) subsets. Data were analyzed from January 2005 to December 2011. Metabolites measured by NBS and established risk factors for SIDS. The primary outcome was SIDS. Logistic regression was used to evaluate the association between metabolic markers combined with known risk factors and SIDS. Of 2 276 578 eligible infants, 354 SIDS (0.016%) cases (mean [SD] gestational age, 38.3 [2.3] weeks; 220 male [62.1%]) and 1416 controls (mean [SD] gestational age, 38.3 [2.3] weeks; 723 male [51.1%]) were identified. In multivariable analysis, 14 NBS metabolites were significantly associated with SIDS in a univariate analysis: 17-hydroxyprogesterone, alanine, methionine, proline, tyrosine, valine, free carnitine, acetyl-L-carnitine, malonyl carnitine, glutarylcarnitine, lauroyl-L-carnitine, dodecenoylcarnitine, 3-hydroxytetradecanoylcarnitine, and linoleoylcarnitine. The area under the receiver operating characteristic curve for a 14-marker SIDS model, which included 8 metabolites, was 0.75 (95% CI, 0.72-0.79) in the training set and was 0.70 (95% CI, 0.65-0.76) in the test set. Of 32 infants in the test set with model-predicted probability greater than 0.5, a total of 20 (62.5%) had SIDS. These infants had 14.4 times the odds (95% CI, 6.0-34.5) of having SIDS compared with those with a model-predicted probability less than 0.1. Results from this case-control study showed an association between aberrant metabolic analytes at birth and SIDS. These findings suggest that we may be able to identify infants at increased risk for SIDS soon after birth, which could inform further mechanistic research and clinical efforts focused on monitoring and prevention.