EFFECTS OF OUTSOURCING ON ORGANIZATIONAL PERFORMANCE: A CASE OF THE KENYA JUDICIARY

Organizations have continuously pursued means to increase their competitive advantage over the competitors through outsourcing. The study therefore was purposed to establish the effects of outsourcing on organizational performance using Kenya Judiciary as a case study. Consequently, the study’s specific objectives were to determine the effect of quality control because of outsourcing on organizational performance, investigate the effect of cost efficiency due to outsourcing on organizational performance, find out how operational controls because of outsourcing affect organizational performance, and assess the extent to which risk management through outsourcing affects organizational performance at the Kenya Judiciary. The significance of the study is that it will help organizations engaged in the practice to assess the impact of outsourcing on their performance. The study will also help organizations to estimate the relative cost of outsourcing to their companies. Because of its design to answer questions concerned with what, why, who, how much or when, descriptive research design was considered the most ideal for the study. The population was 38 employees from the procurement function at the judiciary. The study used the whole population of 38. This is referred to as census and it is applicable where the population under study is relatively small and further sampling may not yield a representative figure. The use of qualitative research for this study ensured appropriate answers were identified in addressing the research question and clearing the understanding of the effects of outsourcing on organizational performance. Quality control, cost efficiency, operational control, risk management adaption and organization performance had a significant strong positive relationship. Based on the findings of this study the improvement of judiciary, practitioners and researchers is highly recommended. The organization can still concentrate on specific areas which are evolved from this study to make outsourced programme more effective. Outsourcing is advantageous to performance of an organization only if the attitudinal results offered in the study agree with outsourcing proponents’ claims that it allows expertise enhancement, service quality improvement, streamline processes, reduce cost and administration burden as well as time saving

Computational Design of Novel Candidate Drug Molecules for Schistosomiasis

Schistosomiasis is a parasitic disease that leads to chronic ill-health. Infection is acquired from infested freshwater containing the larval forms (cercariae) of blood flukes, known as schistosomes. The three main species of the parasite that infect humans are Schistosoma haematobium, S.japonicum, and S.mansoni. Schistosomiasis affects at least 230 million people worldwide. The infection is prevalent in tropical and sub-tropical areas, in poor communities without potable water and adequate sanitation. The disease is considered as one of the Neglected Tropical Diseases and so far praziquantel is the only drug used for treatment. Should the parasites develop resistance to praziquantel, treatment would be problematic.  This study incorporated a computational approach to design novel compounds with unprecedented potential as candidate drug compounds for the disease. The Schistosoma mansoni fatty acid binding protein was selected as a suitable drug target for its crucial role in the dependence of the parasite on its host for fatty acids. Screening for potential lead compounds was done using molecular docking software.  Identified lead compounds were analyzed and optimized in silico for their ADMET properties then re-evaluated for suitability of their binding energies. Eight novel compounds with good predicted ADMET properties were designed and found to interact with the S.mansoni fatty acid binding protein with favorable binding energy, showing potential to inhibit this protein. This study opens up new possibilities in antischistosomal drug inquiry and potentiates efficacy studies of such compounds against schistosomiasis. Keywords: computational design, antischistosomal drug inquiry, binding energy, lead optimization, ADMET properties

Influence of Lean-Green Practices on The Relationship Networks and Performance of Medium Hotels in the Kenyan Cities

Purpose: Examine the influence of lean-green practices on the relationship between networks and performance of medium hotels in the Kenyan cities. Design/methodology/approach: The study was anchored on dynamic capability theory. Pragmatic research paradigm employing mixed method was applied which uilized concurrent triangulation research design. The target population was 534 medium hotels. Stratified random sampling technique was used to determine a sample size of 229 hotels. Findings: The study found that networks positively influenced performance of medium hotels in Kenyan cities and lean-green practices positively and significantly influences on the relationship between networks and performance of medium hotels in Kenyan cities. Designing, implementing and utilizing lean-green practices in collaboration with networking in medium hotels is important in production matrix. Research limitations/implications: Focus was on medium hotels in the Kenyan cities. Practical implications: Results of this research shows that lean-green practices constitute one of the most important strategies resulting in performance. Originality/value: This research is original because the research was conducted in Kenya and there is no other similar research in Kenya

Unexpected diversity of Wolbachia associated with Bactrocera dorsalis (Diptera: Tephritidae) in Africa

Bactrocera dorsalis (Hendel) is an important pest of fruit-bearing plants in many countries worldwide. In Africa, this pest has spread rapidly and has become widely established since the first invasion report in 2003. Wolbachia is a vertically transmitted endosymbiont that can significantly influence aspects of the biology and, in particular, the reproduction of its host. In this study, we screened B. dorsalis specimens collected from several locations in Africa between 2005 and 2017 for Wolbachia using a PCR-based assay to target the Wolbachia surface protein wsp. Of the 357 individuals tested, 10 were positive for Wolbachia using the wsp assay. We identified four strains of Wolbachia infecting two B. dorsalis mitochondrial haplotypes. We found no strict association between the infecting strain and host haplotype, with one strain being present in two different host haplotypes. All the detected strains belonged to Super Group B Wolbachia and did not match any strains reported previously in B. dorsalis in Asia. These findings indicate that diverse Wolbachia infections are present in invasive populations of B. dorsalis

Endometrial Histopathology in Patients with Laparoscopic Proven Salpingitis and HIV-1 Infection

Study Objective. To identify sensitive and specific histological criteria for endometritis in women with laparoscopically-confirmed acute salpingitis. Methods. Women, age 18–40 years of age presenting with complaints of lower abdominal pain ≤2 weeks and no antibiotics use in past two weeks, were enrolled. They underwent clinical examination, screening for HIV; other sexually transmitted infections plus endometrial biopsy sampling for histopathology. Diagnostic laparoscopy confirmed the diagnosis of acute salpingitis. Controls were women undergoing tubal ligation and HIV-1 infected women asymptomatic for genital tract infection. Results. Of 125 women with laparoscopically-confirmed salpingitis, 38% were HIV-1 seropositive. Nineteen HIV-1 negative controls were recruited. For the diagnosis of endometritis, ≥1 plasma cells (PC) and ≥3 polymorphonuclear lymphocytes (PMN) per HPF in the endometrium had a sensitivity of 74% for HIV-1-seropositive, 63% for HIV-1-seronegative women with a specificity of 75% and positive predictive value of 85% regardless of HIV-1-infection for predicting moderate to severe salpingitis. For HIV-1-seronegative women with mild salpingitis, ≥1 PC and ≥3 PMN had a sensitivity of 16% and a PPV of 57%. Conclusion. Endometrial histology, did not perform well as a surrogate marker for moderate to severe salpingitis, and failed as a surrogate marker for mild salpingitis

Adapting clinical practice guidelines for diabetic retinopathy in Kenya: process and outputs.

BACKGROUND: The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations. METHODS: We describe the process used to adapt clinical guidelines for diabetic retinopathy in Kenya, using validated tools and manuals. A technical working group consisting of volunteers provided leadership. RESULTS: The process was intensive and required more time than anticipated. Flexibility in the process and concurrent health system activities contributed to the success of the adaptation. The outputs from the adaptation include the guidelines in different formats, point of care instruments, as well as tools for training, monitoring, quality assurance and patient education. CONCLUSION: Guideline adaptation is applicable and feasible at the national level in Kenya. However, it is labor- and time -intensive. It presents a valuable opportunity to develop several additional outputs that are useful at the point of care

Topical fl uorouracil after surgery for ocular surface squamous neoplasia in Kenya: a randomised, double-blind, placebo-controlled trial

Background Ocular surface squamous neoplasia (OSSN) is an aggressive eye tumour particularly aff ecting people with HIV in Africa. Primary treatment is surgical excision; however, tumour recurrence is common. We assessed the eff ect of fl uorouracil 1% eye drops after surgery on recurrence. Methods We did this multicentre, randomised, placebo-controlled trial in four centres in Kenya. We enrolled patients with histologically proven OSSN aged at least 18 years. After standard surgical excision, participants were randomly allocated to receive either topical fl uorouracil 1% or placebo four times a day for 4 weeks. Randomisation was stratifi ed by surgeon, and participants and trial personnel were masked to assignment. Patients were followed up at 1 month, 3 months, 6 months, and 12 months. The primary outcome was clinical recurrence (supported by histological assessment where available) by 1 year, and analysed by intention to treat. The sample size was recalculated because events were more common than anticipated, and trial enrolment was stopped early. The trial was registered with Pan-African Clinical Trials Registry (PACTR201207000396219). Findings Between August, 2012, and July, 2014, we assigned 49 participants to fl uorouracil and 49 to placebo. Four participants were lost to follow-up. Recurrences occurred in fi ve (11%) of 47 patients in the fl uorouracil group and 17 (36%) of 47 in the placebo group (odds ratio 0·21, 95% CI 0·07–0·63; p=0·01). Adjusting for passive smoking and antiretroviral therapy had little eff ect (odds ratio 0·23; 95% CI 0·07–0·75; p=0·02). Adverse eff ects occurred more commonly in the fl uorouracil group, although they were transient and mild. Ocular discomfort occurred in 43 of 49 patients in the fl uorouracil group versus 36 of 49 in the placebo group, epiphora occurred in 24 versus fi ve, and eyelid skin infl ammation occurred in seven versus none. Interpretation Topical fl uorouracil after surgery substantially reduced recurrence of OSSN, was well-tolerated, and its use recommended

Topical fl uorouracil after surgery for ocular surface squamous neoplasia in Kenya: a randomised, double-blind, placebo-controlled trial

Background Ocular surface squamous neoplasia (OSSN) is an aggressive eye tumour particularly aff ecting people with HIV in Africa. Primary treatment is surgical excision; however, tumour recurrence is common. We assessed the eff ect of fl uorouracil 1% eye drops after surgery on recurrence. Methods We did this multicentre, randomised, placebo-controlled trial in four centres in Kenya. We enrolled patients with histologically proven OSSN aged at least 18 years. After standard surgical excision, participants were randomly allocated to receive either topical fl uorouracil 1% or placebo four times a day for 4 weeks. Randomisation was stratifi ed by surgeon, and participants and trial personnel were masked to assignment. Patients were followed up at 1 month, 3 months, 6 months, and 12 months. The primary outcome was clinical recurrence (supported by histological assessment where available) by 1 year, and analysed by intention to treat. The sample size was recalculated because events were more common than anticipated, and trial enrolment was stopped early. The trial was registered with Pan-African Clinical Trials Registry (PACTR201207000396219). Findings Between August, 2012, and July, 2014, we assigned 49 participants to fl uorouracil and 49 to placebo. Four participants were lost to follow-up. Recurrences occurred in fi ve (11%) of 47 patients in the fl uorouracil group and 17 (36%) of 47 in the placebo group (odds ratio 0·21, 95% CI 0·07–0·63; p=0·01). Adjusting for passive smoking and antiretroviral therapy had little eff ect (odds ratio 0·23; 95% CI 0·07–0·75; p=0·02). Adverse eff ects occurred more commonly in the fl uorouracil group, although they were transient and mild. Ocular discomfort occurred in 43 of 49 patients in the fl uorouracil group versus 36 of 49 in the placebo group, epiphora occurred in 24 versus fi ve, and eyelid skin infl ammation occurred in seven versus none. Interpretation Topical fl uorouracil after surgery substantially reduced recurrence of OSSN, was well-tolerated, and its use recommended

Clinical Presentation of Ocular Surface Squamous Neoplasia in Kenya.

IMPORTANCE: There is a trend toward treating conjunctival lesions suspected to be ocular surface squamous neoplasia (OSSN) based on the clinical impression. OBJECTIVE: To describe the presentation of OSSN and identify clinical features that distinguish it from benign lesions and subsequently evaluate their recognizability. DESIGN, SETTING, AND PARTICIPANTS: Prospective multicenter study in Kenya from July 2012 through July 2014 of 496 adults presenting with conjunctival lesions. One histopathologist examined all specimens. Six additional masked ophthalmologists independently examined photographs from 100 participants and assessed clinical features. EXPOSURES: Comprehensive history, slitlamp examination, and photography before excision biopsy. MAIN OUTCOMES AND MEASURES: Frequency of clinical features in OSSN and benign lesions were recorded. Proportions and means were compared using χ2, Fisher exact test, or t test as appropriate. Interobserver agreement was estimated using the κ statistic. Examiners' assessments were compared with a reference. RESULTS: Among 496 participants, OSSN was the most common (38%) histological diagnosis, followed by pterygium (36%) and actinic keratosis (19%). Patients with OSSN were slightly older (mean [SD] age, 41 [11.6] vs 38 [10.9] years; P = .002) and tended to have lower levels of education than patients with benign lesions (P = .001). Females predominated (67% of OSSN vs 64% of benign lesions; P = .65). Human immunodeficiency virus infection was common among patients with OSSN (74%). The most common location was the nasal limbus (61% OSSN vs 78% benign lesions; P < .001). Signs more frequent in OSSN included feeder vessels (odds ratio [OR], 5.8 [95% CI, 3.2-10.5]), moderate inflammation (OR, 3.5 [95% CI, 1.8-6.8]), corneal involvement (OR, 2.7 [95% CI, 1.8-4.0]), leukoplakia (OR, 2.6 [95% CI, 1.7-3.9]), papilliform surface (OR, 2.1 [95% CI, 1.3-3.5]), pigmentation (OR, 1.5 [95% CI, 1.0-2.2]), temporal location (OR, 2.0 [95% CI, 1.2-3.2]), circumlimbal location (6.7% vs 0.3%; P < .001), severe inflammation (6.7% vs 0.3%; P < .001), and larger mean (SD) diameter (6.8 [3.2] vs 4.8 [2.8] mm; P < .001). All OSSN signs were also observed in benign lesions. There was slight to fair interobserver agreement in assessment of most signs and diagnosis (κ, 0.1-0.4). The positive predictive value of clinical appearance in identifying OSSN was 54% (interquartile range, 51%-56%) from photographs in which prevalence was 32%. CONCLUSIONS AND RELEVANCE: With overlapping phenotypes and modest interobserver agreement, OSSN and benign conjunctival lesions are not reliably distinguished clinically. Point-of-care diagnostic tools may help

Risk factors for ocular surface squamous neoplasia in Kenya: a case-control study.

OBJECTIVE: To determine modifiable risk factors of ocular surface squamous neoplasia (OSSN) in Kenya using disease-free controls. METHODS: Adults with conjunctival lesions were recruited at four eye care centres in Kenya and underwent excision biopsy. An equal number of controls having surgery for conditions not affecting the conjunctiva and unrelated to ultraviolet light were group-matched to cases by age group, sex and eye care centre. Associations of risk factors with OSSN were evaluated using multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Continuous variables were compared using the t-test or the Wilcoxon-Mann-Whitney U-test depending on their distribution. RESULTS: A total of 131 cases and 131 controls were recruited. About two-thirds of participants were female, and the mean age of cases and controls was 42.1 years and 43.3 years, respectively. Risk factors for OSSN were HIV infection without antiretroviral therapy (ART) use (OR = 48.42; 95% CI: 7.73-303.31) and with ART use (OR = 19.16; 95% CI: 6.60-55.57), longer duration of exposure to the sun in the main occupation (6.9 h/day vs. 4.6 h/day, OR = 1.24; 95% CI: 1.10-1.40) and a history of allergic conjunctivitis (OR = 74.61; 95% CI: 8.08-688.91). Wearing hats was protective (OR = 0.22; 95% CI: 0.07-0.63). CONCLUSION: Measures to prevent and control HIV, reduce sun exposure such as wearing hats and control allergic conjunctivitis are recommended