Effect of Mobile Money Transactions on Financial Performance of Small and Medium Enterprises in Nakuru Central Business District

The inception of mobile phone financial transaction has brought a lot of benefits to SMEs. It has made money transfer to be available at a low cost compared to the traditional banking system where some transactions would be done within the premises of the bank. As a result, there was a need to study effects of mobile money transactions on financial performance of Small and Medium enterprises. The aim of this study was to find out the effect of mobile money transactions on financial performance of Small and Medium enterprises in Nakuru town Central business district (CBD). The study employed descriptive research design. The study sampled 120 out of 640 businesses using purposive sampling technique. Questionnaire was used as data collection instrument. The results of the study indicated that mobile money transactions have a significant effect on sales revenue. Keywords: Mobile phone financial transactions, financial performance of SMEs, Sales revenue, Nakuru town Central Business District

An Assessment of the Effect of Budgetary Practices on Performance of Public Secondary Schools in Nakuru Municipality

Amid the need to foster efficiency and effectiveness in schools, budgetary practices have been embraced by public secondary schools in Kenya.  Key of which is to compel planning and to provide performance measurement criteria. Therefore, this study sought to assess the effect of budgetary practices on the performance of public secondary schools in the Nakuru Municipality. The study conducted a survey involving two respondents from each of the 22 public secondary schools in Nakuru Municipality. A structured questionnaire was used to collect primary data. The results of the study indicated that budgetary practices had a strong positive effect on the performance of public secondary schools. Keywords: Budgetary practices, performance of public secondary schools, Nakuru Municipality

A review of bovine cases consigned under veterinary certification to emergency and casualty slaughter in Ireland during 2006 to 2008

The emergency and casualty slaughter of cattle for human consumption (in cases where animals are likely to have suffered from acute or chronic pain, respectively) in Ireland requires that the animal is accompanied to the slaughterhouse by an official veterinary certificate (VC) completed on-farm by the owner's private veterinary practitioner (PVP). No published data is currently available in Ireland based on information provided in these VCs. In this paper, we present a review of bovine cases consigned under veterinary certification to emergency and casualty slaughter in Ireland during 2006 to 2008. All VCs during the years 2006 (where available), 2007 and 2008 were collected from four large Irish slaughterhouses. The data were computerized, and analysed using descriptive and spatial methods. In total, 1,255 VCs were enrolled into the study (1,255 study animals, 1,072 study herds), 798 (63.6%) and 457 (36.4%) animals were consigned to emergency and casualty slaughter, respectively. VCs were completed throughout the year, with consigned animals travelling a mean distance of 27.2 km from farm to slaughter. The time elapsed between veterinary certification and slaughter was greater than three days for 18.2% of all study animals. In 965 (76.9%) animals, the certified suspected disability related to the locomotory system, most commonly as a result of fractures. Among animals for which data were available, 11.9% were totally condemned at post-mortem. The transport of animals with fractured limbs and/or other painful conditions is a significant animal welfare concern.Deposited by bulk impor

A six-year study of leiomyomata with emphasis on lipoleiomyoma

Background: Leiomyoma is the most common benign neoplasm of the uterus. Lipoleiomyoma is a rare variant usually affecting women in the postmenopausal age group. Incidence of lipoleiomyoma varies from 0.59% - 2.1%. This study was undertaken to analyse the different variants, degenerative changes and to determine the incidence, clinical and morphological features of lipoleiomyoma amongst all the leiomyomas studied.Methods: This study was done in the Department of Pathology over a period of 6 years. Authors studied 575 patients with leiomyoma constituting a total of 1122 leiomyomata as some patients presented with multiple leiomyomata. Further clinicopathological correlation was done.Results: In the present study 98.03% of leiomyomata were uterine in location, 1.06% were cervical, 0.62% were in broad ligament and 0.26 % were in ovary. Among the 1122 leiomyomata studied, degenerative changes were noted in 19.6% of which hyaline degeneration was the most common. Leiomyoma variants constituted 5.27% of all leiomyomata. The incidence of lipoleiomyoma was 0.71% with size ranging from 3-10cm.Conclusions: Leiomyoma is a common tumor of the uterus and lipoleiomyoma variant is very uncommon with unknown etiology. They occur in postmenopausal as well as reproductive age group. The site of lipoleiomyoma can be uterine or extrauterine location such as broad ligament. Coexistance of metabolic derangement is an observation that may have a role in development of lipoleiomyoma

Fast Bowler’s knee – anteromedial articular impingement

Purpose: To describe a series of impingement lesions found on the anterior aspect of the medial femoral condyle in international cricketers. Methods: Seven international level fast bowlers presented to our clinic with knee pain in the lead leg between 2005 and 2013. The mean age of the patients was 26.7 years (20–29 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. Conservative management and arthroscopic surgery were performed on these cases. We aimed for a pain free quiet knee with resolved oedema on MRI and return to sport. Results: MRI images showed oedema in the medial femoral condyle in all patients and 4 patients also had associated cartilage loss. These 4 patients underwent arthroscopic surgery whereas the other 3 were less symptomatic and were managed conservatively. All patients returned to international cricket at an average of 6 months in the non-operative group and 8 months in the operative group. Conclusion: Anterior impingement of the anteromedial femoral condyle can be a potentially serious lesion in the fast bowler. A strong index of suspicion regarding this lesion has to be exercised when a fast bowler attends with knee pain and effusion

Influence of body mass index on the choice of therapy for depression and follow-up care

Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow-up visits. Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible. Medication use, encounters, diagnoses, height, and weight were collected from health plan databases. We modeled receipt of the different therapies (medication and psychotherapy) by BMI and BMI trajectory during the 9-months prior to initiation of therapy using logistic regression models that accommodated correlation within provider and adjusted for covariates. We modeled BMI via a restricted cubic spline. Fluoxetine was the reference treatment option in the medication models. Lower BMI was associated with greater use of mirtazapine, and a declining BMI prior to treatment was associated with greater odds of initiating mirtazapine and paroxetine. Higher BMI was associated with greater odds of initiating bupropion even after adjustment for smoking status. Obese patients were less likely to receive psychotherapy and less likely to receive appropriate duration (180-days) of depression treatment compared to normal weight subjects. Our study provides evidence that BMI is considered when choosing therapy but associations were weak. Our results should prompt discussion about recommending and choosing depression treatment plans that optimize depression care and weight management concurrently. Differences in care and follow-up by BMI warrant additional research

Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical training (PROTECT) study

Objectives Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing. Method A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established. Results 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p&#60;0.001), surgical (p = &#60;0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p&#60;0.001), a greater number of prescribed medicines (p&#60;0.001) and the months December and June (p&#60;0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen. Conclusions Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.</p

Syndecan 4 is Required for Endothelial Alignment in Flow and Atheroprotective Signaling

Atherosclerotic plaque localization correlates with regions of disturbed flow in which endothelial cells (ECs) align poorly, whereas sustained laminar flow correlates with cell alignment in the direction of flow and resistance to atherosclerosis. We now report that in hypercholesterolemic mice, deletion of syndecan 4 (S4−/−) drastically increased atherosclerotic plaque burden with the appearance of plaque in normally resistant locations. Strikingly, ECs from the thoracic aortas of S4−/− mice were poorly aligned in the direction of the flow. Depletion of S4 in human umbilical vein endothelial cells (HUVECs) using shRNA also inhibited flow-induced alignment in vitro, which was rescued by re-expression of S4. This effect was highly specific, as flow activation of VEGF receptor 2 and NF-κB was normal. S4-depleted ECs aligned in cyclic stretch and even elongated under flow, although nondirectionally. EC alignment was previously found to have a causal role in modulating activation of inflammatory versus antiinflammatory pathways by flow. Consistent with these results, S4-depleted HUVECs in long-term laminar flow showed increased activation of proinflammatory NF-κB and decreased induction of antiinflammatory kruppel-like factor (KLF) 2 and KLF4. Thus, S4 plays a critical role in sensing flow direction to promote cell alignment and inhibit atherosclerosis

The contribution of physician assistants/associates to secondary care : a systematic review

OBJECTIVE: To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN: Systematic review. SETTING: Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES: Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS: Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES: Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS: 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS: PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER: CRD42016032895