Target Population Research Articles

Effect of Statins on Serum Levels of TNF-alpha and Interleukin-6 in Patients with Kidney Disease: A Meta-analysis of Randomized Clinical Trials

Background and Objectives: Some clinical trials have indicated the beneficial effects of statins in patients with kidney disease, while others have reported no positive effect of statins in these patients. We conducted this meta-analysis to identify the effects of statins on serum levels of interleukin-6 (IL-6) and Tumor Necrosis Factor Alpha (TNF-α) in patients with kidney disease Designs and Methods: A systematic literature search was performed using PubMed, Scopus, and Web of Science databases to identify all studies published from inception to August, 2022. The major outcome variable was the Weighted Mean Difference (WMD). Eligible studies were stratified based on target population, intervention duration, dosage and type of statins, and solubility of statins. Results: Meta-analysis performed on seven publications (8 studies), including 213 patients with kidney disease and 188 control individuals, indicated that the concentration of IL-6 was marginally decreased in patients with kidney disease following statin therapy disease (WMD = -1.15 pg/mL; 95% CI = -2.33 to 0.04, P = 0.05, I2 = 68.5%). The findings of subgroup analysis based on the dosage of statins showed that neither highintensity nor moderate/low-intensity statin treatment could significantly influence the serum level of IL-6. Lipophilic statins were more effective than hydrophilic statins, and they marginally decreased the levels of IL-6 (WMD = -1.21 pg/mL; 95% CI = -2.43 to 0, P = 0.05, I2 = 55.7%). Meta-analysis of four publications (five studies) with 157 patients with kidney disease and 132 control subjects showed that statins reduced the serum levels of TNF-α in patients with kidney disease when compared with control individuals (WMD= -2.66 pg/mL; 95% CI = -4.26 to -1.06, P < 0.001, I2 = 63%). Conclusion: Statins only marginally decreased the concentration of IL-6 in patients with kidney disease, but neither high-intensity nor moderate/low-intensity statin treatment could significantly influence the level of IL-6. However, statins reduced serum levels of TNF-α in patients with kidney disease.

Dental age estimation methods applied to Indian children and adolescents: A systematic review and meta-analysis

Country-specific systematic reviews and meta-analyses have been proposed to compile the available literature and rank methods based on their performance for a target population. India is a country with a vast scientific literature on dental age estimation. This systematic review aimed to provide evidence to help the decision of experts regarding the method of choice for dental age estimation in India. The research protocol was registered in Open Science Framework. Literature Search was performed in Embase, LILACS, MedLine (via PubMed), SciELO, Scopus and Web of Science. Grey Literature was searched in Google Scholar and ProQuest. Observational cross-sectional studies that compared chronological and estimated ages using Demirjian (original [DEM] and Chaillet's modification [modified-DEM]) and Acharya (ACH) methods were included. JBI tool was used to assess the risk of bias. The search detected 9799 studies, out of which 56 were eligible (n=13,107 panoramic radiographs of Indian individuals). Low risk of bias was registered for 48 studies, while 8 presented a moderate risk of bias. The meta-analysis showed a standardized mean difference between chronological and estimated ages of -0.11 (95%CI: -0.29; 0.07), 0.74 (95%CI: 0.39; 1.09), and -0.01 (95%CI: -0.23; 0.22) years for DEM, modified-DEM and ACH, respectively. High heterogeneity (I2=88-93%) was observed across studies for all the methods, including subgroup analyses based on sex. This study ranked ACH, DEM and modified-DEM (from the best to the worse) performances in the Indian population.

Mapping Essential Surgical Care in Mongolia: Do Natural Barriers and Seasonality Alter Access to Essential Surgical Care?

Measures of access to essential surgery in Mongolia have not accounted for natural barriers to movement, seasonality, and the modifiable areal unit problem scale effects. This physical accessibility analysis indicates natural barriers and seasonality threaten access to surgical care, shifting Mongolia from an attaining to a non-attaining country with estimates below the target population goal of 80%. Remote communities are particularly impacted, with access reduced by up to 6.1%. Spatial resolution of the input data influences the results by up to 14.2%. This highlights the importance of including natural barriers and seasonality in healthcare access scenarios using a fine spatial resolution.

Challenges of implementing social studies curriculum: A case of selected secondary schools in Kafue district of Lusaka Province, Zambia

Overview: The purpose of this study was to examine the challenges that schools are facing in the implementation of the Social Studies curriculum and its effect on learner’s academic performance in secondary schools of Kafue district in Lusaka province, Zambia. Body of Knowledge: The study was guided by the following specific objectives: to investigate whether the absence of teachers trained to teach social studies has an effect on implementation of curriculum of social studies in schools; to examine the extent to which absence of teaching and learning materials like text books for social studies affect the academic performance of learners; and to establish measures put in place to mitigate the challenges of curriculum implementation for social studies in schools. Methods: The population of the study comprised head teachers, heads of departments, teachers, DESO officers, and learners. The total target population was 1500. The sample size involved a total of 150 respondents, which was 10% of the target population. A mixed method approach was used in this study in combination with the descriptive survey design. Interviews and questionnaires were used to collect data. Qualitative and Quantitative techniques of data analysis was used, and data was presented on the analytical tools such as tables, figures, charts and software; SPSS. Results: The study established that the major challenges that affected curriculum implementation and influenced learners’ academic performance were: absence of trained teachers of the subject, and inadequate teaching/ learning materials, physical facilities and the way the curriculum was being implemented itself. This undermined effectiveness of school administrators and teachers in ensuring there is smooth teaching and learning process in schools which eventually translated to poor academic performance among learners. Recommendation: Ministry of Education should ensure that schools have adequate resources such as textbooks, teaching aids, and technology to support the implementation of the social studies curriculum.

Cultural factors contributing to gender-based violence in Zambian societies

Overview: This study examined the intricate cultural dynamics underlying the prevalence of gender-based violence (GBV) within Zambian societies. Despite legislative efforts and international campaigns to combat GBV, its persistence underscores the need for a deeper understanding of the cultural underpinnings that perpetuate such violence. Body of Knowledge: Through qualitative and quantitative analysis, this study sought to identify key cultural elements such as patriarchal structures, beliefs about masculinity and femininity, and the role of family and community dynamics in shaping attitudes and behaviors related to gender-based violence. Additionally, this study delves into the multifaceted ways in which cultural norms, beliefs, and practices intersect with gender dynamics to foster environments conducive to GBV. Methods: The population comprised of government officials at the district level who had some responsibility for GBV, police officers from VSU, and Members of the community. The total target population was 1000. The sample size involved a total of 100 respondents which is 10% of the target population. The study used purposive sampling to select government officials and police officers while simple random sampling was used to selected community members. This study used descriptive design to analyze the data. Interviews, ethnographic observation, and questionnaires were used to collect data. Qualitative and Quantitative techniques of data analysis was used, and data was presented on the analytical tools such as tables, figures and charts. Results: Initial findings revealed that traditional gender roles deeply entrenched in Zambian culture play a pivotal role in perpetuating GBV. The patriarchal structure of society often assigns men dominance and control over women, leading to power imbalances that facilitate violence. Furthermore, beliefs surrounding masculinity, including expectations of aggression and dominance, contribute to a culture of impunity surrounding GBV. Men are often socialized to perceive violence as a legitimate means of asserting authority, while women may internalize norms of submission and silence. Recommendation: This study underscores the urgent need for culturally sensitive interventions that address the root causes of GBV in Zambia. By engaging communities in dialogue and challenging harmful cultural norms, sustainable solutions can be developed to promote gender equality and create safer environments for all individuals.

Requirements of the experiment

The purpose of the experiment is to derive inferences about the causal effects of a subset of the characteristics of the units of a target population (explanatory characteristics - treatment factors) on characteristics that express the performance of these units (response characteristics). To achieve this objective, the effects of the treatment factors in the sample must manifest themselves as in the target population. This attempt requires the construction of a valid and representative sample of the target population. It is achieved if the experiment plan and its execution satisfy the experiment requirements. These requirements are considered in this article.

Learner perception on tactile materials as a correlate of performance in mathematics: The case of Thika high school for the Blind, Kiambu County, Kenya

Mathematics is considered the foundation of scientific and technological growth, making one of the most important subjects taught in formal schools. Yet learners with visual impairment continue to perform poorly in Mathematics due multiple factors, among them unfavorable perceptions on the subject. Drawing from the social constructivism theory, this study aimed to establish learner perception on tactile materials as a correlate of performance in Mathematics among learners in Thika High School for the Blind. The objectives were to investigate general performance of mathematic among the learners who are blind and assess learners’ perception on the mathematic tactile learning materials in relation to their performance in Mathematics. This study used a case study research design. The target population comprised 80 learners who are blind in the school. Stratified random sampling was used to select the learners 24 who are blind according to class and gender. Questionnaires were used to collect data. Quantitative data was collected, coded and organized. Data analysis was through descriptive summaries and correlational analyses. There was a weak positive relationship between learners’ perception in learning Mathematics and performance in Mathematics (r = 0.203, p = 0.342). The majority the students indicated doing their homework daily when given by the teacher, getting homework marked daily, and doing homework alone daily. Therefore, this study recommends the need for the Ministry of Education to initiate strategies to enhance positive perceptions toward Mathematics among learners who are blind.

Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study.

The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees' well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic.

Risk projection for time-to-event outcome from population-based case-control studies leveraging summary statistics from the target population.

Risk stratification based on prediction models has become increasingly important in preventing and managing chronic diseases. However, due to cost- and time-limitations, not every population can have resources for collecting enough detailed individual-level information on a large number of people to develop risk prediction models. A more practical approach is to use prediction models developed from existing studies and calibrate them with relevant summary-level information of the target population. Many existing studies were conducted under the population-based case-control design. Gail et al. (J Natl Cancer Inst 81:1879-1886, 1989) proposed to combine the odds ratio estimates obtained from case-control data and the disease incidence rates from the target population to obtain the baseline hazard function, and thereby the pure risk for developing diseases. However, the approach requires the risk factor distribution of cases from the case-control studies be same as the target population, which, if violated, may yield biased risk estimation. In this article, we propose two novel weighted estimating equation approaches to calibrate the baseline risk by leveraging the summary information of (some) risk factors in addition to disease-free probabilities from the targeted population. We establish the consistency and asymptotic normality of the proposed estimators. Extensive simulation studies and an application to colorectal cancer studies demonstrate the proposed estimators perform well for bias reduction in finite samples.

Contribution of Non Governmental Organisations Projects Intervention on Social Economic Growth in Rural Areas. A Case of World Vision Rwanda 2019-2022 Kivuruga Sector, Gakenke Disrtict, Northern Rwanda.

This research is basically done to assess contribution of Non-Governmental Organizations projects intervention on socio economic growth of in rural areas a case study of World Vision Rwanda project in Kivuruga sector. This study had the following specific objectives: to find out the contribution of NGOs on socio economic growth in Kivuruga sector, to elaborate socio economic impacts of NGOs in rural areas especially in Kivuruga sector, to identify the relationship between activities of WVR and socioeconomic growth of its beneficiaries in Kivuruga sector and to give suggestions and recommendation on NGOs activities in rural areas. Due to financial means, time constraints and the need of precision of results, it was impossible to study all population. Target population of this study was 127 beneficiaries of World Vision Rwanda project in Kivuruga sector. A sample of 56 respondents was selected and cluster sampling was used for selecting groups, or clusters, of participants from the population. The clusters were chosen based on distribution of World Vision Rwanda project’s respondents in cells. The study also employed purposive sampling as the sampling technique. Questionnaire, interview and a documentation research were used as tools of data collection. The statistical analysis of the collected data was conducted using Statistical Package for Social Sciences (SPSS). This study assessed the Contribution of WVR in socio-economic growth where the findings indicated that great extent and very great extent make 73.2%. Therefore, the WVR played a big role in economic growth of Rwanda especially in Kivuruga Sector. As conclusion, it has been revealed that the capacity of the beneficiaries to cover basic expenditure and need (such as food, clothing, transport, education and housing, etc.) has been improved over the program/project period. Likewise, the programs executed by WORLD VISION Rwanda have enabled beneficiaries to engage in small businesses, different income generating activities, developing markets through a systems approach and market linkage, promote and increase the saving practice. As a result, beneficiaries of the programs have their source of income and they become self-reliance and empowered. The recommendations to future action planners are to improve livelihood, socio-economic conditions and then to reduce poverty the participation of women.

Relationship Between Substance Abuse and Sexual Violence among Women in Informal Urban Settlements in Nairobi City County, Kenya

Sexual assault is against the law in Kenya. Yet many people, particularly women and girls, continue to experience Sexual and Gender-based Violence (SGBV) without receiving much assistance, suggesting that the regulations in place are ineffective. Drug and substance abuse has also become prevalent, especially among persons living within informal urban settings. This with the attendant rise in cases of domestic and SGBV means that there is a growing need for a deeper understanding of the nexus between drug abuse and sexual violence against women, and in particular, within Nairobi's informal urban settlements. Many women in Kenya have experienced sexual or physical assault. The research sought to determine the relationship between substance abuse and sexual violence among women in Nairobi City County's informal urban settlements; The Social Learning Theory guided this research adopting a correlation study design with a target population of 139 women in the groups who have experienced GBV and SGBV. Using stratified selection and proportional sampling approaches, the Yamane formula was utilized to calculate the sample size of 106 respondents. Information was gathered through questionnaires. Descriptive statistics as well as inferential statistics like Pearson moment correlation and chi-square analysis, were used to analyse the data. From the study, it was indicated that both substance abuse and sexual violence have tremendous negative consequences on the health, socioeconomic, emotional, and psychological disposition of a person. The study also demonstrated the rise in drug and substance abuse led to an increase in cases of sexual violence. This shows that efforts to combat drug use and substance abuse have not been successful. Therefore, the study suggests that the government develop more potent methods of combating drug use and substance abuse

Clinical guideline highlights for the hospitalist: GOLD COPD update 2024.

Guideline Title: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report) Release Date: December 4, 2023 Prior versions: Initial report was released in 2001 with major revisions in 2006, 2011, 2017, and 2023. This 2024 release is an update to the 2023 major revision Developer: Global Initiative for Chronic Obstructive Lung Disease (GOLD) Funding source: GOLD Target population: Adults with a diagnosis of or at risk for COPD.

Technology factors and ERP system efficiency in the Jordanian industrial firms: does company size matter?

The study was structured to investigate the impact of technological factors on the effectiveness of enterprise resource planning (ERP) in Jordanian industrial firms, using a descriptive-analytical approach. This study also examines company size as a moderator variable, which has been measured using the logarithm of total assets extracted from each firm’s annual report. The study’s target population consisted of all Jordanian industrial firms listed on the Amman Stock Exchange, totaling 55 firms. Managers participated as respondents, with 220 questionnaires distributed electronically, averaging four questionnaires per company. After data collection, 92 valid questionnaires were used for statistical analysis. The findings indicate a significant and positive relationship between technological factors (such as ease of use, perceived usefulness, and digital proficiency) and ERP system effectiveness in Jordanian industrial firms. However, the study revealed that trust, as one of the technological factors, did not significantly impact ERP system efficiency. Additionally, it was found that the moderating role of company size moderates positively the relationship between two technological factors (i.e., perceived usefulness and digital proficiency), and ERP system efficiency. The research suggests that industrial firms in Jordan should take into account technological factors, including factors like ease of use, perceived usefulness, and digital proficiency, to remain current with advancements that can improve the efficiency of ERP systems. This is important due to the positive influence it can have on the operational effectiveness of Jordanian industrial companies, aiding them in their planning and decision-making processes.

EFFECTS OF EMOTIONAL EXHAUSTION ON DELIVERY OF PROFESSIONALS FUNCTIONS IN UASIN GISHU COUNTY

The purpose of this study was to find out the effects of emotional exhaustion have on delivery of professional functions among university lecturers in Uasin Gishu County, kenya. The study adopted the Multidimensional Theory of burnout by Christina Maslach (1946). The study used embedded research design in the mixed method and phenomenological approach. The target population included all universities, all lecturers, and all counselors. Simple random sampling was used to select 2 public universities and Purposive sampling was used to sample 1 private university. Simple random sampling technique was used to sample 178 lecturers. Three counselors were sampled using purposive sampling from the sampled universities. Qualitative research was analyzed in theme derived from the research questions while quantitative data was coded and analyzed using the Statistical Package for Social Science Version 26.0.using descriptive statistics and presented using frequencies and percentages. The hypotheses were tested using linear and multiple regressions. Findings on the hypotheses established that emotional exhaustion, F (1, 95) = 4.435, p =0.038, had statistically significant relationship with the delivery of professional functions. The study will be beneficial to the Ministry of Education, university lecturers and the counsellors. The study recommends that university administrations regularize the workload and working schedules to ensure that lecturers are not overwhelmed by workload to reduce work burnout. KEYWORDS: Emotional Exhaustion, Delivery, Professional Functions, Phenomenological Approach

Re-weighting the randomized controlled trial for generalization: finite-sample error and variable selection

Abstract Randomized controlled trials (RCTs) may suffer from limited scope. In particular, samples may be unrepresentative: some RCTs over- or under-sample individuals with certain characteristics compared to the target population, for which one wants conclusions on treatment effectiveness. Re-weighting trial individuals to match the target population can improve the treatment effect estimation. In this work, we establish the expressions of the bias and variance of such re-weighting procedures—also called inverse propensity of sampling weighting (IPSW)—in presence of categorical covariates for any sample size. Such results allow us to compare the theoretical performance of different versions of IPSW estimates. Besides, our results show how the performance (bias, variance, and quadratic risk) of IPSW estimates depends on the two sample sizes (RCT and target population). A by-product of our work is the proof of consistency of IPSW estimates. In addition, we analyse how including covariates that are not necessary for identifiability of the causal effect may impact the asymptotic variance. Including covariates that are shifted between the two samples but not treatment-effect modifiers increases the variance while non-shifted but treatment-effect modifiers do not. We illustrate all the takeaways in a didactic example, and on a semi-synthetic simulation inspired from critical care medicine.

P.033 Electrophysiological signatures of sedation in pediatric patients

Background: Sedation in PICU masks physical exam findings, leading to diagnostic challenges. In adult models, electroencephalography can evaluate the brain’s response to sedation using feedforward connectivity and anteriorization of alpha hubs, proving useful for prognostication. Feasibility of model translation into pediatric population was assessed, with the hypothesis that the same markers of adaptive reconfiguration would correlate with a higher potential for recovering consciousness. Methods: Electroencephalograms from children undergoing sedation were analyzed for strength and direction of functional connectivity using the weighted and directed phase lag index. Target population was refined with an iterative inclusion criteria. We examined relationships between hub location reconfiguration, directed phase lag index, baseline Glasgow Coma Scale, and 3-month post-treatment Glasgow Outcome Scale-Extended. Results: Evaluation of 14 subjects showed promise in children aged 5-18 undergoing sedation with midazolam, dexmedetomidine, and propofol. Further analysis of five subjects revealed a correlation between adaptive reconfiguration during anesthesia and both higher baseline Glasgow Coma Scale and Glasgow Outcome Scale-Extended scores post-treatment. Conclusions: The findings indicate that the functional brain network connectivity model may have diagnostic and prognostic potential regarding children’s consciousness levels. While the initial data is promising, further analysis of six additional cases is pending and deemed essential to thoroughly evaluate the model’s efficacy.

Safety and Efficacy of CT041 in Patients With Refractory Metastatic Pancreatic Cancer: A Pooled Analysis of Two Early-Phase Trials.

CT041 is a chimeric antigen receptor (CAR)-modified T-cell therapy that specifically targets claudin18.2 in solid tumors. Here, we report the pooled analysis results of two exploratory clinical trials to evaluate CT041 in patients with previously treated pancreatic cancer (PC). These two multicenter, open-label phase I/Ib trials (CT041-CG4006, CT041-ST-01) have a similar target population and evaluation schedule. The primary objective was to assess the safety and tolerability of CT041, whereas secondary objectives included efficacy, pharmacokinetics, and immunogenicity. The combined cohort comprised 24 patients with advanced PC. Among them, five patients (20.8%) had previously received one line of therapy, whereas 19 (79.2%) received ≥2 lines of therapy. The most common treatment-emergent adverse events of grade 3 or more were preconditioning-related hematologic toxicities. Cytokine release syndrome (CRS) and GI disorders were most reported grade 1 or 2 adverse events. The overall response rate and disease control rate were 16.7% and 70.8%. The median progression-free survival (mPFS) after infusion was 3.3 months (95% CI, 1.8 to 6.2), and the median overall survival (mOS) was 10.0 months (95% CI, 5.5 to 17.6). The median duration of response (mDoR)was 9.5 months (95% CI, 2.6 to Not reached), with a DoR rate at 12 months of 50% (95% CI, 5.8 to 84.5). The mPFS (6.0 v 1.0 months, P < .001) and mOS (17.6 v 4.0 months, P < .001) were prolonged in patients achieving partial response/stable disease than the progressive disease group. CA19-9 levels had reduced by at least 30% in 17 (70.8%) patients. In patients with metastatic PC after progression on previous therapy, CT041 demonstrated a tolerable safety profile and encouraging anticancer efficacy signals. Response benefit observed here needs to be ascertained in the future.

Complementary Alliances and Sustainability of Microfinance Institutions: Evidence from Cameroon

Purpose: The Cameroon Microfinance sector has been facing stiff competition as a result of globalization where other players have joined the sector with differentiated innovative products/services rendering MFIs in quest of new strategies of development. Partnerships are becoming an alternative business strategy and hence the formation of strategic alliances in the microfinance industry. This study sought to determine the influence of complementary alliances on the sustainability of MFIs in Cameroon. The objectives were to examine how complementary alliances in financial institutions and complementary alliances in non-financial institutions affect sustainability of MFIs in Cameroon. Materials and Methods: The study used a survey research design to examine the effects of the independent variables on the dependent variable. Purposive and snowball sampling techniques were used in this study. The target population of the study comprised of the 361 MFIs in the Centre, Littoral, NW, SW and West regions of Cameroon that have carried out strategic alliances which were retained and used to develop the sample size. Data was collected through the use of opened and closed ended questionnaires administered to senior management of the MFIs. Data collected was analysed using the Structural Equation Modelling with Ordinary Least Square (OLS) regression estimation techniques to check the robustness of the data set. Findings: OLS Findings suggest that complementary alliances in financial institutions, more than complementary alliances in non-financial institutions has a positive and significant relationship with sustainability of MFIs in Cameroon given their β coefficients of 0.243** and 0.036 respectively. The regression coefficient for complementary alliances in financial institution is significant at 5%. Implications to Theory, Practice and Policy: It is recommended that MFIs should partner with other financial and non-financial institutions in terms of commercialisation of services. This will strengthen their business relationships, enable them have access to resources and expertise from partner organisations to expand their operations, generate revenue that will keep them going and boost the financial growth of the economy.

The Moderating Effect of Internal Controls on the Relationship Between Supplier Pre-Qualification and Procurement Performance in Public Universities in Kenya

As publicly funded institutions, public universities are expected to follow a competitive and systematic tendering process when procuring goods or services. Despite legislation and regulations aimed at ensuring adherence to international best practices and promoting integrity and accountability, there have been instances of inefficiencies in the tendering process, particularly within public universities. The purpose of this study was to assess the moderating effect of internal controls on the relationship between supplier pre-qualification and procurement performance in public universities in Kenya. The study was anchored on stakeholder theory. A positivist research philosophy and a correlational research design was adopted. Target population of the study was 1,016 employees from the selected public universities. The study adopted stratified and simple random sampling to select a sample of 287 respondents. Primary data was obtained using a structured questionnaire, which was self-administered using a drop-and-pick later technique. The validity of the research instrument was ensured through an extensive literature review and consultation with subject experts and supervisors from the procurement department. The reliability of the instrument was examined through a pilot study involving 29 respondents from the University of Kabianga where a Cronbach alpha coefficient of 0.834 was obtained. The obtained quantitative data was analysed descriptively using means, frequencies, and standard deviation, and inferentially, correlation and regression analysis were used. The study established that internal controls had a positive moderating effect on the relationship between pre-qualification (R2, change of 0.075; p&lt;0.05), and procurement performance. The study concluded that pre-qualification of suppliers, was an important factor in determining the procurement performance in public universities because it significantly explained the change in procurement performance. Therefore, the study recommends that public universities improve internal controls to ensure efficiency in the supplier pre-qualification process as well as the procurement performance in public universities in Kenya. The study findings could be significant to the management of public institutions and policymakers in public procurement, enhancing knowledge in academia and theory development in procurement activities

Community-led approaches to making naloxone available in public settings: Implementation experiences in the HEALing communities study

BackgroundExpanding public naloxone access is a key strategy to reduce opioid overdose fatalities. We describe tailored community-engaged, data-driven approaches to install and maintain naloxone housing units (naloxone boxes) in New York State and estimate the cost of these approaches. MethodsGuided by the Consolidated Framework for Implementation Research, we collected data from administrative records and key informant interviews that documented the unique processes employed by four counties enrolled in the HEALing Communities Study to install and maintain naloxone housing units. We conducted a prospective micro-costing analysis to estimate the cost of each naloxone housing unit strategy from the community perspective. ResultsWhile all counties used a coalition to guide action planning for naloxone distribution, we identified unique approaches to implementing naloxone housing units: 1) County-led with technology expansion; 2) County-led grassroots; 3) Small-scale rural opioid overdose prevention program (OOPP) contract and 4) Comprehensive OOPP contract including overdose education and naloxone distribution (OEND) to individuals. The first two county-led approaches had lower cost per naloxone dose disbursed ($28–$38) compared to outsourcing to an OOPP ($183–$266); costs depended on services added to installing and maintaining units, such as OEND. Barriers included competing demands on public health resources (i.e., COVID-19) and stigma toward naloxone and opioid use disorder. Geographic access was a barrier in rural areas whereas existing infrastructure was a facilitator in urban counties. The policy landscape in New York State, which provides free naloxone kits and financial support to OOPPs, facilitated implementation in all counties. ConclusionsIf a community has the resources, installing and maintaining naloxone housing units in-house can be less expensive than contracting with an outside partner. However, contracts that include OEND may be more effective at reaching target populations. Financial support from health departments and legislative authorization are important facilitators to making naloxone available in public settings.