Tourism in Kenya: A preliminary examination

This study seeks to explore the trends in international tourist arrivals in a developing country - Kenya - which has been well recognized as an international tourist destination in Sub-Saharan Africa. Kenya’s tourism sector has undergone several challenges over the years. Several factors that affect the tourists’ propensity to stay longer in a destination are discussed and suggestions for marketing are proposed

Disrespect and abuse during childbirth in Western Ethiopia: Should women continue to tolerate?

BACKGROUND: Healthcare coverage in Ethiopia has improved dramatically in recent decades. However, facility-based delivery remains persistently low, while maternal mortality remains high. This paper presents the prevalence and associated factors of disrespect and abuse (D&A) during childbirth in public health facilities of western Oromia, Ethiopia. METHOD: A facility-based cross-sectional study was conducted among 612 women from February 2017 to May 2017. Exit interview with the mothers were conducted upon discharge from the maternity ward. We measured D&A during childbirth using seven dimensions. Multivariable logistic regression model was used to assess the association between experience of D&A and client characteristics and institutional factors. RESULT: Three quarters (74.8%) of women reported experiencing at least one form of D&A during their facility childbirth. The types of D&A experienced by the women were; physical abuse (37.1%), non-dignified care (34.6%), non-consented care (54.1%), non-confidential care (40.4%), neglect (25.2%), detention (2.9%), and discrimination (13.2%). Experiences of D&A were 1.6 times more likely to be reported by women delivering at hospitals than health centers (OR: 1.64, 95% CI: 1.01, 2.66). Women without a companion throughout their delivery were almost 10 times more likely than women who had a companion to encounter D&A (OR: 9.94, 95% CI: 5.72, 17.28). On the other hand, women with more than 1,368-birr (USD 57) monthly income were less likely to experience any type of D&A (OR: 0.36, 95% CI: .21, .65). CONCLUSION: Three in four women reported experiencing at least one form of D&A during labor and delivery. This demonstrates a real disconnect between what the health system intends to achieve and what is practiced and calls for fundamental solutions in terms of both improving quality of facility-based delivery and ensuring women's right to receive health care with dignity

A NSFD method for the singularly perturbed Burgers-Huxley equation

This article focuses on a numerical solution of the singularly perturbed Burgers-Huxley equation. The simultaneous presence of a singular perturbation parameter and the nonlinearity raise the challenge of finding a reliable and efficient numerical solution for this equation via the classical numerical methods. To overcome this challenge, a nonstandard finite difference (NSFD) scheme is developed in the following manner. The time variable is discretized using the backward Euler method. This gives rise to a system of nonlinear ordinary differential equations which are then dealt with using the concept of nonlocal approximation. Through a rigorous error analysis, the proposed scheme has been shown to be parameter-uniform convergent. Simulations conducted on two numerical examples confirm the theoretical result. A comparison with other methods in terms of accuracy and computational cost reveals the superiority of the proposed scheme

Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator

Background: Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using a prospective study design. Methods and Results: Consecutively implanted ICD patients (n=383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3, 6, and 12 months. Of all patients, 23.5% had a Type D personality and 13.8% received a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up. Shock during follow-up was a significant independent associate of poorer health status for 4 of 8 subscales of the SF-36 and the Mental Component Summary (all P<.05), with shocked patients scoring between 2.60 to 13.30 points lower than nonshocked patients. Type D personality was an independent associate of poor postimplantation health status for 6 of 8 of the SF-36 subscales and the Mental Component Summary, with Type D patients scoring between 2.12 to 8.02 points lower, adjusting for demographic and clinical characteristics. Conclusions: ICD shock and the patient's preimplantation personality disposition were equally important associates of health status 12 months after implantation. Identification of the patient's personality profile before ICD implantation may help identify subsets of patients who may need additional care, for example, with a psychosocial component

A nonstandard fitted operator finite difference method for two-parameter singularly perturbed time-delay parabolic problems

In this article, a class of singularly perturbed time-delay two-parameter second-order parabolic problems are considered. The presence of the two small parameters attached to the derivatives causes the solution of the given problem to exhibit boundary layer(s). We have developed a uniformly convergent nonstandard fitted operator finite difference method (NSFOFDM) to solve the considered problems. The Crank-Nicolson scheme with a uniform mesh is used for the discretization of the time derivative, while for the spatial discretization, we have applied a fitted operator finite difference method following the nonstandard methodology of Mickens. Moreover, the solution bounds of the governing equation are shown by asymptotic analysis. The convergence of the proposed numerical scheme is investigated using truncation error and the barrier function approach. The study shows that our proposed scheme is uniformly convergent independent of the perturbation parameters, quadratically in time, and linearly in space. Numerical experiments are carried out, and the results are presented in tables and graphically

Global governance approaches to addressing illegal logging: Uptake and lessons learned

One of the most challenging tasks facing development agencies, trade ministries, environmental groups, social activists and forest-focused business interests seeking to ameliorate illegal logging and related timber trade is to identify and nurture promising global governance interventions capable of helping improve compliance to governmental policies and laws at national, subnational and local levels. This question is especially acute for developing countries constrained by capacity challenges and “weak states” (Risse, 2011). This chapter seeks to shed light on this task by asking four related questions: How do we understand the emergence of illegal logging as a matter of global interest? What are the types of global interventions designed to improve domestic legal compliance? How have individual states responded to these global efforts? What are the prospects for future impacts and evolution? We proceed in the following steps. Following this introduction, step two reviews how the problem of “illegal logging” emerged on the international agenda. Step three reviews leading policy interventions that resulted from this policy framing. Step four reviews developments in selected countries/regions around the world according to their place on the global forest products supply chain: consumers (United States, Europe and Australia); middle of supply chain manufacturers (China and South Korea) and producers (Russia; Indonesia; Brazil and Peru; Ghana, Cameroon and the Republic of Congo). We conclude by reflecting on key trends that emerge from this review relevant for understanding the conditions through which legality might make a difference in addressing critical challenges

Safety and efficacy of balloon-mounted stent in the treatment of symptomatic intracranial atherosclerotic disease: a multicenter experience

Background Randomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications. Objective To study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD. Methods Prospectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS after 24 hours of the qualifying event. The primary outcome was the occurrence of stroke and mortality within 72 hours after the procedure. Secondary outcomes were the occurrence of stroke, transient ischemic attacks (TIAs), and mortality on long-term follow-up. Results A total of 232 patients were eligible for the analysis (mean age 62.8 years, 34.1% female). The intracranial stenotic lesions were located in the anterior circulation in 135 (58.2%) cases. Recurrent stroke was the qualifying event in 165 (71.1%) while recurrent TIA was identified in 67 (28.9%) cases. The median (IQR) time from the qualifying event to stenting was 5 (2–20.75) days. Strokes were reported in 13 (5.6%) patients within 72 hours of the procedure; 9 (3.9%) ischemic and 4 (1.7%) hemorrhagic, and mortality in 2 (0.9%) cases. Among 189 patients with median follow-up time 6 (3–14.5) months, 12 (6.3%) had TIA and 7 (3.7%) had strokes. Three patients (1.6%) died from causes not related to stroke. Conclusion Our study has shown that BMS may be a safe and effective treatment for medically refractory symptomatic ICAD. Additional prospective randomized clinical trials are warranted

Factors Associated with Ivermectin Non-Compliance and Its Potential Role in Sustaining Onchocerca volvulus Transmission in the West Region of Cameroon

Background Community Directed Treatment with ivermectin is the cornerstone of current efforts to eliminate onchocerciasis. However recent studies suggest there are foci where long-term annual distribution of the drug alone has failed to ensure elimination thresholds are reached. It is important to achieve high levels of compliance in order to obtain elimination targets. An epidemiological and entomological evaluation conducted in the western region of Cameroon in 2011 revealed that two health districts remained with a high prevalence of infection, despite long-term distribution of ivermectin since 1996. This paper explores potential factors that may have contributed to the non-interruption of transmission, focusing on ivermectin treatment compliance and the importance of systematic non-compliance within the population. Methodology/Principal findings A mixed methods approach was used, including a population-based survey to assess treatment compliance and factors associated and qualitative assessments including focus group discussions and in-depth interviews with key programme stakeholders and drug distributors. Compliance was reported at 71.2%(95%CI: 61.7–79.2%;n = 853/1198). The key factors related to compliance in the most recent round related to either programmatic and delivery issues, primarily absenteeism at the time of the campaign or alternatively individual determinants. An individual’s experience of side effects in the past was strongly associated with non-compliance to ivermectin. Other factors included ethnicity, how long lived in the village and age. There was a high percentage of reported systematic non-compliance at 7.4% (95% CI: 4.3–12.3%; n = 86/1165), higher amongst females. This group may be important in facilitating the sustainment of on-going transmission

Age-Related Differences in the Effect of Psychological Distress on Mortality: Type D Personality in Younger versus Older Patients with Cardiac Arrhythmias

Background. Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients. Methods. The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y, m = 59.1) and 134 older (>70 y, m = 74.3) ICD patients. End points were all-cause mortality and cardiac death after a median follow-up of 3.2 years. Results. Older patients had more advanced heart failure and a higher mortality rate (n = 34/25%) than younger patients (n = 60/13%), P = 0.001. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09–3.34) and 2.26 (95% CI 1.16–4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking. Conclusion. Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk