Target Population Research Articles

The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study.

Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.

European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: an international survey of the ACVC Association of the ESC joint with EuroELSO

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds Wetenschappelijk Onderzoek Flanders. Background/introduction Bleeding and thrombotic complications impair the outcomes of patients on percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps such as the Impella™. Very recent MCS-trials still show a 23.9% moderate/major bleeding incidence during V-A ECMO. Antithrombotic practices are an important determinant of the meticulous coagulopathic risk management, but guidelines here are non-existing. Purpose Providing an overview of the current European practices in antithrombotic management in adults on pMCS is a first but crucial step to design trials, standardize practice and improve outcome. Methods This online cross-sectional survey was distributed via a digital newsletter and social media platforms through the Association of Acute Cardiovascular Care (ACVC) and the European Extracorporeal Life Support Organization (EuroELSO). The survey was accessible between 17.04 and 23.05.2023. The target population were European clinicians involved in adult critical care and pMCS-management. Results We included responses from 105 different units from 26 European countries. 72.4% Of the European responders have an institutional anticoagulation protocol installed. Unfractionated heparin is the predominantly used anticoagulant (Impella™: 97.0% and V-A ECMO: 96.1%). Argatroban is the preferred alternative in case of heparin-induced thrombocytopenia (Impella™: 52.3% and V-A ECMO: 50.7%). 10.8% And 14.5% of the anticoagulation protocols rely on anti-factor-Xa assay with activated partial thromboplastin time (APTT) in parallel for Impella™ and V-A ECMO, respectively. Up to 43.1% (Impella™) and 32.9% (V-A ECMO) of the European respondents rely on a monitoring strategy with APTT alone. Anticoagulant targets for heparin vary significantly between institutions. 54.0% And 42.7% of the European survey participants administer dual antiplatelet therapy (DAPT) during Impella™ and V-A ECMO support after acute coronary syndrome without percutaneous coronary intervention (PCI), increasing to 93.7% and 84.0% after recent PCI, respectively. Typical thresholds for transfusion or administration of blood products without acute bleeding also vary substantially and are frequently not predefined. Conclusion Large heterogeneity in antithrombotic practices is observed across Europe. Consequently, device-associated coagulopathic complications may largely vary due to non-standardized management and heterogeneity between institutions. This survey underpins the importance of urgent prospective trials investigating important basic questions concerning antithrombotic therapy during pMCS (anticoagulation targets, monitoring strategy, concomitant use of DAPT among others).

Influence of Principals’ Promotion of Professional Development of Teachers on Learners’ Academic Performance in Kenya Certificate of Secondary Education in Kisii County, Kenya

Effective professional development should take cognisance of the needs of teachers, learners and school context. It has been established by research studies that divergent and overlapping policies as well as dysfunctional schooling cultures have frustrated impact of professional development of teachers on good quality learning outcomes. The purpose of this study was to investigate the Influence of Principals’ promotion of teachers’ professional development on learners’ academic performance in Kenya Certificate of Secondary Education (K.C.S.E.) in Public Schools in Kisii County, Kenya The objective of this study was to: explore the influence of Principals’ promotion of professional development of teachers on learners’ academic performance in K.C.S.E.in Kisii County. This study was anchored on Karl Ludwig von Bertalanffy General Systems Theory. Mixed method research design of explanatory sequential type with a prioritized quantitative approach in phase one followed by qualitative approach in phase two was applied in the study. The target population was 4,691 participants which included: 340 Principals, 1360 Heads of Departments (H.O.Ds) and 2,991 teachers. A sample of 451 respondents participated in the study. The researcher used proportionate stratified random sampling technique to select 85 schools, 114 H.O.Ds and 252 teachers. Census sampling to select national and special schools while 85 Principals of the selected schools were purposefully sampled. Questionnaires and interview guides were used to collect quantitative and qualitative data respectively. Content validity, Criterion validity, Construct validity and Face validity, of the research instruments were ensured through evaluation by the University supervisors and other experts while internal consistency reliability was estimated by using Cronbach’s alpha coefficient formula which yielded alpha coefficient of over 0.7 which was considered adequate. Quantitative data were analysed using Statistical Package of Social Sciences (SPSS) Version 29 while qualitative data were analysed thematically and presented using word verbatim from the respondents and integrated with the findings of phase one. Descriptive statistics were presented in tables and graphs while inferential statistics were presented in terms of Pearson’s correlation coefficients, Anova and Regression coefficients. The study found out a weak positive insignificant influence between promotion of professional development of teachers (r=.011, p≤.05; 2 tailed) and learners’ academic performance in K.C.S.E. Therefore, the null hypothesis were upheld. These results were supported by Principals’ interviews which indicated that professional development programmes are not context specific. It is hoped that the findings of this study would provide information that would form a base for corrective measures towards the unexpected low academic performance in the study locale. The study recommended that further research should be done on influence of principals’ leadership skills development on academic performance in K.C.S.E.

Board Diversity and Governance Outcomes of State Corporations in Kenya

Boards play a critical leadership role in good governance of Kenya’s state corporations, which exit by law to deliver effectual services to the citizenry. The sector has since independence undergone various reforms aimed at continuous improvement, mitigating inherent challenges and to deliver efficient service. In 2015, the Government of Kenya upscaled its governance architecture by sanctioning a governance code. Despite this endeavour, the state corporation’s ecosystem has recorded unimpressive outcomes on the corporate governance front. This study sought to establish the relationship between board diversity and governance outcomes of state corporations in Kenya. A descriptive survey design was used on a target population of 138 state corporations and a simple random sampling technique used to draw a 20% study sample, amounting to 28 state corporations. The study collected primary data using a structured questionnaire. A drop and pick method were used to administer the questionnaire to three respondents from each sampled state corporation upon consideration and application of accruing research protocols. The data collection instrument was pretested prior to the actual data collection to check reliability and validity upon which the emergent issues were corrected and instrumentation enhanced. The collected data was analysed using simple regression analysis vide SPSS version 21. The findings have been presented using tables. The study established a significant positive relationship between board diversity and inclusion and governance outcomes of state corporations in Kenya and concluded that board diversity and inclusion is a key driver of corporate governance outcomes. The study recommended that firms should mainstream diversity and inclusion in order to drive sustainable advantage in boards as a tool to effective leadership and governance. Future studies may be undertaken in the private sector for contextual comparability

Principal’s Involvement of Parents in Student’s Discipline; Assessing its Relationship with Teenage Pregnancy in Public Secondary Schools in Kenya

Teenage pregnancy remains a persistent global crisis that profoundly affects the socio-economic wellbeing of nations, citizens and families. The purpose of this study was to assess the relationship between principals’ involvement of parents in students discipline and teenage pregnancy in public secondary schools in Kenya. The article is an extract of a study done in public secondary schools in Machakos County, Kenya. The study was guided by the social learning theory postulated by Albert Bandura. The research utilized a descriptive research design. The research target population comprised of 360 principals, 360 Heads of Department (HoDs) Guidance and Counseling (G&amp;C), 360 Parent Association (PA) chairpersons and, 103,517 students. The study sample size was 450 comprising of 189 principals, 189 HoDs G&amp;C, 36 PA chairpersons and 36 FGD. Questionnaires were used to collect data from the principal’s and HoDs G&amp;C. Interview schedules collected data from the PA chairperson while Focused Group Discussions (FGD) collected data from form three students. Data was analyzed using SPSS software version 25.The correlational analysis findings from the principal and HoDs G&amp;C responses showed a positive and significant relationship between principal’s engagement of parents in student’s discipline and teenage pregnancy (rp =.379 &amp; rh = 0.564; p≤ .01). The study concludes that involving parents enhances learner discipline and can help curb cases of teenage pregnancies. The study recommended that PAs should work collaboratively with principals to make sure that parents are engaged in all matters affecting their children.

Nutritional support as a part of complex therapy for clostridial infection

In order to study modern principles of diagnosis, treatment and prevention of clostridial infection, an analysis of publications on the topic in the medical databases eLibrary, PubMed, Medline (2004–2023) was carried out. Based on the data obtained, a modern concept of etiology, pathogenesis, and methods of treating the disease using specialized principles of diet therapy and nutritional support is presented. It has been shown that today clostridial infection is one of the most dangerous nosocomial infections, the diagnosis of which is quite difficult. Timely testing and a clear diagnostic algorithm make it possible to identify the disease in the early stages of its development. Vancomycin and metronidazole remain the main therapeutic agents, but the effectiveness of the latter has been questioned by recent studies. It is clear that further clinical studies are needed to study the target population of bezlotoxumab and regulate the use of fecal microbiota transplantation, which appears to be promising. A specialized enteral mixture enriched with the natural anti-inflammatory growth factor TGF-β2 has a pathogenetic effect, accelerating the healing of the colon mucosa and improving nutritional status for a long time. Prevention of clostridial infection is largely ensured by hygiene measures, as well as the rational use of antibiotics.

A constrained maximum likelihood approach to developing well-calibrated models for predicting binary outcomes.

The added value of candidate predictors for risk modeling is routinely evaluated by comparing the performance of models with or without including candidate predictors. Such comparison is most meaningful when the estimated risk by the two models are both unbiased in the target population. Very often data for candidate predictors are sourced from nonrepresentative convenience samples. Updating the base model using the study data without acknowledging the discrepancy between the underlying distribution of the study data and that in the target population can lead to biased risk estimates and therefore an unfair evaluation of candidate predictors. To address this issue assuming access to a well-calibrated base model, we propose a semiparametric method for model fitting that enforces good calibration. The central idea is to calibrate the fitted model against the base model by enforcing suitable constraints in maximizing the likelihood function. This approach enables unbiased assessment of model improvement offered by candidate predictors without requiring a representative sample from the target population, thus overcoming a significant practical challenge. We study theoretical properties for model parameter estimates, and demonstrate improvement in model calibration via extensive simulation studies. Finally, we apply the proposed method to data extracted from Penn Medicine Biobank to inform the added value of breast density for breast cancer risk assessment in the Caucasian woman population.

Influence of Clinician-Related Factors on Adherence to the American Heart Association Guidelines for Acute Coronary Syndrome among Clinicians at Kenya Ports Authority Clinics in Mombasa, Kenya

Purpose: The aim of the study was to assess influence of clinician-related factors on adherence to the American heart association guidelines for acute coronary syndrome among clinicians at Kenya Ports Authority clinics in Mombasa, Kenya. Methodology: A descriptive cross-sectional study involving quantitative methods of data collection was adopted. An interviewer administered questionnaire was used for data collection. The study was carried out in Kenya Ports Authority clinics in Mombasa, Kenya. The target population was 106 clinicians attending to patients who present with Acute Coronary Syndrome at the KPA clinics in Mombasa. A census method was used to determine the study participants. The sample size was made up of a hundred and six participants. The clinicians who consented to participate in the study were included while those who were on sick off, leave or who recently joined the clinic were excluded. Pretesting of the study tool was done at the Kenya Pipeline Clinic Mombasa. Data analysis was done using Statistical Package for Social Sciences version 25 and presented via tables. Findings: The study results showed that at 95% level of confidence (ρ-value = 0.05%), there was a significant association between gender (ᾳ=0.025), work experience (ᾳ=0.016), job cadre (ᾳ=0.014) and training received (ᾳ=0.022) on adherence to the American Heart Association Guidelines for Acute Coronary Syndrome among clinicians at Kenya Ports Authority clinics in Mombasa, Kenya. The association was insignificant between age (ᾳ=0.178), education level (ᾳ=0.439) and specialization (ᾳ=0.489) on adherence to the AHA guidelines. Unique Contribution to Theory, Practice and Policy: The study recommends that the KPA management should increase the medical budget to ensure availability of adequate resources for ACS patient management. These resources include adequate staffing, medication, equipment, and staff training costs. The clinic management should ensure that medications such as aspirin, morphine and nitroglycerine are readily available and accessible at patients care points. The KPA clinic management to formulate a simple algorithm that outlines the steps to be taken when managing ACS patients. The study recommends that the clinics should assess their equipment reqularly for maintenance controls to ensure efficiency. The study further recommends random assessments and post care audits to assess the adherence to ACS guidelines among clinicians. Training associated with adherence to the AHA guidelines and as such, KPA should continue offering training and education on the latest AHA guidelines for ACS to ensure updated guidelines for practice.

Dynamic Capabilities and Competitive Advantage of Deposit Taking Savings and Credit Cooperative Societies in Nairobi City County, Kenya

Despite providing financial support and access to over 48% of the adult population and 82% of small enterprises in Kenya, Deposit Taking Savings and Credit Cooperatives faced intense competition from other financial institutions, leading to reduced competitiveness. The general objective of the study was to investigate the effect of dynamic capabilities on the competitive advantage of Deposit Taking Savings and Credit Cooperatives in Nairobi City County, Kenya. The specific objectives were to explore the effect of marketing capability, knowledge management capability, technological innovation capability, financial management capability on the competitive advantage of Deposit Taking Savings and Credit Cooperatives in Nairobi City County, Kenya. The study was grounded in Marketing Mix Theory, Knowledge-Based Theory, Technology Acceptance Theory, Resource-Based Theory, Dynamic Capabilities Theory, and Competitive Advantage Theory. It employed a descriptive research design, with a target population of 47 Deposit Taking Savings and Credit Cooperatives operating in Nairobi City County. The units of observation included 384 top and middle-level management staff in key departments. The study used a stratefied random sampling for sampling, involving all 47 Deposit Taking Savings and Credit Cooperatives in Nairobi. Additionally, a sample of 196 top and middle management staff was selected using the Yamane Formula. A structured survey tool was utilized for gathering data. Secondary data on competitive advantage was sourced from published articles, referred journals, and other relevant materials. The data gathered included both quantitative and qualitative elements, analyzed descriptively and inferentially, with averages, frequencies, and percentages serving as useful metrics. Qualitative data was analyzed using content analysis and presented in narrative form. The relationships between variables were examined through regression analysis, with tables used to summarize responses. The study analyzed the response rate to understand the participation and engagement level of 196 respondents in a sample of Deposit Taking SACCOs, consisting of 55 senior managers and 141 middle-level managers. The overall response rate was 94.4%, with senior managers returning 90.9% of questionnaires and middle-level managers returning 95.7%. The regression analysis showed that marketing capability, knowledge management capability, technological innovation capability, and financial management capability had a significant positive impact on the competitive advantage of Deposit Taking SACCOs in Nairobi City County. These capabilities contributed to competitive advantage through various factors, such as market expansion, communication efficiency, and financial stability. Recommendations for SACCOs included developing strong marketing strategies, implementing knowledge management systems, investing in robust technology, and enhancing financial management practices. Suggestions for future studies encouraged further exploration of dynamic capabilities and competitive advantages in SACCOs, as well as other financial institutions in Kenya.

Transformation of digital government services in the public sector in South Africa

Background: It is well-documented that the 21st century is providing digital technologies in an alarming rate. Their emergence promotes effectiveness, efficiency, accountability and transparency of public services and internal governance. This study was conducted within the government departments and state-owned agencies of South Africa.Aim: The aim of this study was to investigate the transformation of digital government services in the public sector in South Africa.Methods: This case study used qualitative approach where data were collected through semi-structured interviews from the national government departments and state-owned entities. The target population comprised information technology officers, investigators or analysts and administrative officers. Data collected were thematically analysed preceding the transcription of audio-recordings.Results: Some of the significant results of this study showed that the executives avoid playing their role to drive Information and communications technology (ICT) through Corporate ICT Strategy.Conclusion: Some of the challenges of adopting digital transformation are associated with low digital literacy, poor digital infrastructure, unreliable power supply, among others.Contribution: This study establishes that if the senior managers from ICT section become members of the executive committee, the government can have successful implementation of ICT projects without scepticism. This study also contributes to the awareness of considering digital literacy skills to support digital transformation.

Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study.

Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants' digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants' severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. This study is a step toward more frequent assessment of older adults' behavioral symptoms and holistic in situ monitoring of older adults' behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms.

Immunization and Screening Methods for Cervical Carcinoma in Developing Nations: A Detailed Review

Objective: Cervical cancer remains a significant public health challenge in developing countries, disproportionately affecting women in these regions due to limited access to effective screening and vaccination programs. This review synthesizes the current literature on the implementation strategies, effectiveness, and challenges of cervical cancer screening and Human Papillomavirus (HPV) vaccination programs in developing countries, aiming to highlight successful models and identify gaps in current practices. Screening, for cervical cancer in developing countries faces numerous obstacles, including logistical challenges, lack of awareness, and insufficient healthcare infrastructure. Despite these hurdles, strategies such as single-visit approaches, leveraging low-cost HPV DNA testing, and utilizing mobile health units have shown promise in increasing screening coverage and early detection rates. The prerequisites for effective screening highlighted include affordability, cultural acceptability, and the ability to implement large-scale screening with limited resources. HPV vaccination presents a primary prevention measure with the potential to significantly reduce the incidence of cervical cancer. However, vaccination programs in developing countries encounter challenges in vaccine procurement, distribution, and achieving high coverage rates among the target population. Innovations in vaccine delivery, education campaigns to raise awareness, and partnerships with international health organizations are crucial for overcoming these barriers.This comprehensive review underscores the need for a multifaceted approach to cervical cancer prevention in developing countries, encompassing improvements in screening and vaccination strategies, health system strengthening, community engagement, and international collaboration. By learning from successful models and addressing identified gaps, there is a significant opportunity to reduce the burden of cervical cancer in these regions and move closer to achieving global health equity.

Exploring Sample Size Determination in Educational Research: A Comprehensive Review

Background By conducting an in-depth study of the publications, a review was conducted with the goal of evaluating the sample size in educational research. The sample size, represented by the letter “n,” is a key factor in this research because it specifies the number of participants who represent the target population. Although various studies have been published in the literature defining the processes for calculating sample sizes, there is still much uncertainty. It is vital to understand that there is no single all-encompassing method for determining sample sizes for different study designs. Instead, different study designs call for different approaches to determine sample numbers. Methods Information was retrieved from the databases in accordance with updated PRISMA recommendations. The keywords used for the retrieval of the relevant articles from two databases (Google Scholar and PubMed). The articles were selected by thorough scrutiny and application of inclusion and exclusion criteria. Results Seven articles were selected and the comparison was made among the studies in the relation to methods, objective, and outcome from the enrolled studies. Conclusions The evaluation of the seven studies as a whole concluded that the sample size for testing any novel approach essentially required 24.24 participants in each group. The median sample size for the simulation-based educational research was 30. Further research is required to determine the proper sample size based on a single universal formula for all types of designs.

Recruitment and retention of adolescents for an ecological momentary assessment measurement burst mental health study: The MHIM engagement strategy.

Recruitment and long-term retention of adolescent participants in longitudinal research are challenging and may be especially so in studies involving remote measurement and biosampling components. The ability to effectively recruit and retain participants can be supported by the use of specific evidence-based engagement strategies that are built in from the earliest stages. Informed by a review of the evidence on effective engagement strategies and consultations with adolescents (via two Young Person Advisory Groups [YPAGs]; ages 11-13 and 14-17), the current protocol describes the planned participant engagement strategy for the Mental Health in the Moment Study: a multimodal measurement burst study of adolescent mental health across ages 11-19. The protocol incorporates engagement strategies in four key domains: consultations/co-design with the target population, incentives, relationship-building and burden/barrier reduction. In addition to describing general engagement strategies in longitudinal studies, we also discuss specific concerns regarding engagement in data collection methods such as biosampling and ecological momentary assessment where a paucity of evidence exists. Engagement strategies for adolescent mental health studies should be based on existing evidence and consultations with adolescents. We present our approach in developing the planned engagement strategies and also discuss limitations and future directions in engaging adolescents in longitudinal research. The study design for this project places a strong emphasis on the active engagement of adolescents throughout its development. Specifically, the feedback and suggestions provided by the YPAGs have been instrumental in refining our strategies for maximising the recruitment and retention of participants.

Diversification Strategy and Sustainable Competitive Advantage in Cement Manufacturing Companies in Kenya

Manufacturing companies are currently opting to various strategies to deal with such emerging competitive issues. Through sustainable competitive advantage attained by adoption of the right corporate strategies, companies can enjoy better returns, large market share and attract well-trained employees The objective of the study was to establish contribution of diversification strategy on sustainable competitive advantage in cement manufacturing companies in Kenya. The study employed a descriptive research design. The target population were all the six cement manufacturing companies in Kenya. Census sampling approach was adopted to encompass all the six cement manufacturing companies. A proportionate sample of 108 respondents was chosen as a representative of the whole. From the correlation analysis results, the research variable, Diversification Strategy, had a positive influence on sustainable competitive advantage in cement manufacturing companies in Kenya. From the regression analysis results, a coefficient of correlation of 0.770 was obtained indicating that diversification strategy had a positive effect on sustainable competitive advantage in the cement manufacturing companies. The study recommended that management should assess the strategy’s suitability considering company’s structure, culture, and policies, as well as the overall targeted goals, before implementing it. The study recommended that adequate strategic planning be done professionally, and that regular monitoring be done periodically to guarantee they do not deviate from the plans. The study also recommended that cement manufacturers should adhere strictly to the rules set forth, and the relevant ministries should make sure that all businesses do the same.

Moderating Effect of Entrepreneurship Determinants on the Relationship between Economic Diversification and Sustainable Livelihoods among Fish Farmers in Kakamega County

This study investigates the effect of entrepreneurship determinants on economic diversification and sustainable livelihoods among fish farmers in Kakamega County, Kenya. Entrepreneurship determinants encompass a range of factors including access to finance, training, market information, infrastructure, and supportive institutional frameworks. Economic diversification is vital for reducing reliance on traditional income sources and enhancing resilience to economic shocks, while sustainable livelihoods ensure long-term prosperity while preserving natural resources. The specific objective was to examine the moderating effect of entrepreneurship determinants on the relationship between economic diversification and sustainable livelihoods among fish farmers in Kakamega County. The study was guided by Sustainable Livelihoods Theory. The target population was 4500 fish farmers in Kakamega County from which a sample of 354 fish farmers was selected for the study using the Krejcie and Morgan Table 1970. Data was collected using closed-ended questionnaires. Data collected was analyzed using SPSS version 26. Using descriptive and survey research designs, data was collected from a sample of fish farmers in Kakamega County. The findings reveal significant correlations between entrepreneurship determinants, economic diversification, and sustainable livelihoods. Economic Activity Diversification explained 50.8% changes on sustainable livelihoods. However, when moderated with entrepreneurial determinants, the influence of economic diversification explained 66.3% of the changes in sustainable livelihoods among the fish farmers in Kakamega County. The analysis utilized unstandardized coefficients to elucidate the relationships between variables. In Model 1, Vertical Diversification (B = 0.271, p = 0.000) and Portfolio Diversification (B = 0.488, p = 0.000) significantly influenced Sustainable Livelihoods, while Structural Diversification (B = -0.044, p = 0.493) did not. Model 2 introduced Entrepreneurial Determinant, which exhibited a significant positive effect (B = 0.356, p = 0.000), alongside Vertical (B = 0.111, p = 0.041) and Portfolio (B = 0.329, p = 0.000) Diversifications. In Model 3, while all diversification variables remained significant, the interaction terms showed significant impact, emphasizing the moderating role of entrepreneurial determinants in influencing sustainable livelihoods among fish farmers in Kakamega County. Access to finance and market information emerged as key determinants influencing the ability of fish farmers to diversify their economic activities and achieve sustainable livelihoods. Additionally, supportive institutional frameworks, infrastructure development and access to training were identified as critical enablers of entrepreneurial success among fish farmers. The study concludes by highlighting policy implications and recommendations aimed at enhancing entrepreneurship development, promoting economic diversification, and fostering sustainable livelihoods among fish farmers in Kakamega County and similar contexts.

Cognitive testing of the Children's Palliative Outcome Scale (C-POS) with children, young people and their parents/carers.

The Children's Palliative Outcome Scale (C-POS) is being developed using best methodological guidance on outcome measure development, This recommends cognitive testing, an established method of item improvement, prior to psychometric testing. To cognitively test C-POS within the target population to establish comprehensibility, comprehensiveness, relevance and acceptability. Cross-sectional cognitive interview study following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and Rothrock guidance on outcome measure development. Cognitive interviews were conducted using 'think aloud' and verbal probing techniques. Children 5-⩽17 years old with life-limiting conditions and parents/carers of children with life-limiting conditions were recruited from 14 UK sites. Forty-eight individuals participated (36 parents; 12 children) in cognitively testing the five versions of C-POS over two to seven rounds. Content and length were acceptable, and all questions were considered important. Refinements were made to parent/carer versions to be inclusive of non-verbal children such as changing 'share' to 'express' feelings; and 'being able to ask questions' to 'having the appropriate information'. Changes to improve comprehensibility of items such as 'living life to the fullest' were also made. Parents reported that completing an outcome measure can be distressing but this is anticipated and that being asked is important. Cognitive interviewing has facilitated refinement of the C-POS, especially for non-verbal children who represent a large proportion of those with a life-limiting condition. This study has enhanced the face and content validity of the measure and provided preliminary evidence for acceptability for use in routine practice.

Experiences and challenges of enrolled nurses undertaking a Bachelor of Nursing Science programme in Namibia.

Globally, enrolled nurses (ENs) are embarking on an educational journey to become registered nurses (RNs) in order to enhance their knowledge and career opportunities. However, their aspiration is not without challenges. In Namibia, the experiences of these nurses have not been extensively researched. This study aims to explore and describe the experiences and challenges of ENs undertaking a Bachelor of Nursing Science at the University of Namibia. A qualitative, exploratory, descriptive and contextual research strategy was followed as the basis of conducting the study. A sample of 15 nursing students was purposively selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The collected data were analysed thematically using an inductive approach. Three main themes subsequently emerged from the study: ENs' positive experiences advancing in the Bachelor of Nursing Science (BNSc) programme; nurses' negative experiences advancing in the BNSc programme; and recommendations to ensure effective advancement in the BNSc programmeConclusion:The findings of this study revealed that ENs positively experience becoming a RN when it comes to self-development; however, they have negative experiences such as not receiving exemptions for prior learning and having to learn a new curriculum.Contribution:These findings may be used by the Faculty of Health Sciences, School of Nursing and Public Health management in order to develop targeted interventions and ongoing strategies during their curriculum review cycles to ensure positive student experiences and success within the programme.

Project to Reduce the Teenage Pregnancies Through Health Education at MOH Level

Project to Reduce the Teenage Pregnancies Through Health Education at MOH Level

Pengaruh Labelisasi Halal, Brand Awareness, dan Viral Marketing Terhadap Keputusan Pembelian Konsumen di Mixue: Studi Kasus pada Pelanggan Muslim Mixue di Surakarta

he food and beverage industry in Indonesia continues to experience growth amidst various ever-changing market trends. Ice cream is one of the most popular food products in Indonesia. One of the ice cream brands that is currently widely discussed by the community is Mixue ice cream. Consumers who are aware of this brand make Mixue easily remembered and recognized. Technological advancements make it easier for people to obtain and access new viral information. Viral marketing strategies facilitate this brand in introducing itself to consumers and serve as a promotional medium for marketers. The emergence of halal certification provided by MUI for Mixue has a significant influence on Indonesian society due to the majority of its population being Muslims. This research aims to analyze the influence of halal labeling, brand awareness, and viral marketing on consumer purchasing decisions in Mixue, especially among Muslim consumers in Surakarta. This study is a quantitative research type using survey methods. The research technique used is purposive sampling, where the researcher uses their own considerations in selecting the necessary population to provide information that is in line with the research needs. The researcher used primary data in analyzing the data. This method was carried out by distributing questionnaires to the target population and obtaining a sample of 210 respondents. The data processing used was with SPSS Statistics version 26. The results of this study indicate that the halal labeling variable, brand awareness variable, and viral marketing variable significantly influence Muslim consumer purchasing decisions in Mixue simultaneously..