Impact of Part-Time Private Practice on Medical Education in Kenya – A Personal Opinion

Traditional medical schools the world over are facing major challenges in educating physicians capable of responding to the continuously increasing health care needs of populations they serve1. The Kenyan situation is no different and the challenges are bigger considering the rampant poverty and the decline in what had been achieved in the health sector. In this country, effective healthcare, both promotive and curative, lies in the cooperation between a well-managed district hospital and health centers2. The district hospital, as the leader, plays a central role in promoting healthcare delivery. The failure of a district hospital will therefore lead to an unacceptable lowering of health standards and the collapse of preventive programs

Neonatal surgical emergencies at Moi Teaching and Referral Hospital in Eldoret -Kenya

Background: Success in the management of neonatal surgical emergencies depends on prompt diagnosis, adequate resuscitation, good nursing care, safe anaesthesia and competent surgery. Considering that centres for paediatric surgery are few in the developing world, an added requirement is application of the principles of neonatal transport, when neonates are transported to these centres from wherever they are born. These are the challenges that Moi Teaching & Referral Hospital (MTRH) faces in the provision of emergency service to neonates. The hospital serves the Western Kenya region with a population of about 15 million. This study was aimed at determining the pattern and the outcome of neonatal emergency surgery at MTRH.Methods: This was a retrospective descriptive study done at The Moi Teaching & Referral Hospital, Eldoret-Kenya. The study population included all neonates with emergencies managed by the paediatric surgical service between July 2003 and July 2006. Data was obtained from the theatre register and patients’ files.Results: Sixty nine neonates were operated between July 2003 and July 2006 but only 56 files were completed for analysis. Of the 56 neonates, 35 were male and 21 female (M: F ratio of 1.7:1). The median age of presentation was 3 days with a range of 1 – 22 days. Referrals represented 32 (60%). The leading three diagnoses were anorectal malformation 19 (34%) intestinal atresia 8 (14%) and anterior abdominal wall defects 7 (13%). 14 (25%) of the neonates had low birth weight. Application of principles of neonatal transport was poor. Inadequacy of fluid therapy was noted in 26 (45%) of the neonates. Challenges of providing parental nutrition were encountered in 11 (20%). Sepsis was the leading complication and major cause of mortality. Overall mortality was 18 (24%) but was 14 (44%) among the referrals.Conclusion: Morbidity and mortality was high in the management of neonates with surgical emergencies. Reversing the trend will require: early referral and presentation; overcoming the challenges of providing infrastructure that will enable good nursing care, and improving neonatal transport in the region

Ramon Llull’s Disputatio quinque hominum sapientium: some remarks on the Latin version edited in ROL XXXV (2014)

The Latin Disputatio quinque hominum sapientium is a translation of Ramon Llull’s Disputació de cinc savis, written in Catalan in 1294. Part IV of the Latin text was translated and substantially revised by a person different from the translator of parts I-III, as can be demonstrated with regard to language as well as contents. The Latin redactor of part IV, being familiar with contemporary theological discourse and academic terminology, apparently tried to adapt his text for an erudite audience or addressee, possibly for pope Boniface VIII who had succeeded Celestine V in December 1294. The Latin text of the Disputatio as presented in the famous Mainz edition (MOG II, 1722) is an eclectic compilation of elements derived from the Disputació de cinc savis and the Latin version, containing large parts of text newly translated by Ivo Salzinger from the Catalan original.El text llatí de la Disputatio quinque hominum sapientium és la traducció de l’original català de Ramon Llull Disputació de cinc savis, datada el 1294. Tant pel que fa al llenguatge com als continguts és evident que la part IV de la versió llatina va ser traduïda i revisada a fons per una persona diferent de qui va tenir cura de les parts I-III. El redactor de la part IV, que tenia familiaritat amb el discurs teològic contemporani i dominava la terminologia acadèmica, sembla que va voler adaptar el seu text a una audiència o un destinatari cultivats, possiblemen

The textual tradition of the Tabula generalis:

Abstract not availabl

Restoration of Anal Sphincter Tone by Graciloplasty: A Report of Five Cases

Stool incontinence can be as a result of congenital or acquired anal sphincter problems. It is a devastating state for a patient not to be able to control stools resulting into continued feacal soiling. It reduces an individual to a dejected and depressed person who becomes a social misfit. Hence any procedure that can alleviate this state is normally highly appreciated. Various techniques have been quoted in literature and use of gracilis muscle to form a neosphincter is one of them. Dynamic graciloplasty, is a technique whereby electrodes have been implanted into gracilis muscle and is connected to an implantable pulse generator which provides progressive levels of stimulation to convert the fast twitch, fatigue prone muscle fibres to a slow twitch, fatigue resistant firbres over eight week training period (1,2,3). This has shown improved efficacy over the static graciloplasty (3). In this case report, five patients with stool incontinence from different aetiologies are presented, all having been managed by static graciloplasty and intense physiotherapy with good outcomes reported

Non-traumatic abdominal surgical emergencies in children

Background: In developing countries, non-traumatic childhood abdominal surgical emergencies (NTCASE) are associated with high morbidity and mortality and include acquired diseases like acute appendicitis, intussusception and congenital abdominal anomalies such as gastroschisis. This study sought to identify the etiologies and outcomes of NTCASE at Moi Teaching and Referral Hospital (MTRH), Kenya.Methods: A prospective descriptive study that involved children below 18 years operated on for non-traumatic abdominal surgical emergencies between January 2015 and January 2016. Relevant data on clinical presentation, duration of onset of symptoms, investigations and intraoperative findings were entered into the data collection sheet. Daily follow-up was done until discharge or in-hospital death, and outcomes recorded.Results: A total of 140 patients were studied. Age of the patients ranged from 1 day to 17 years, with a mean of 3.0 (SD±2.9) years. Children below 2 years constituted 72.9% of the study participants. The male to female ratio was 2.1:1. The most common aetiologies were intussusception (17.9%) and gastroschisis (17.9%). The complication rate was 17.9% (n=25), average length of hospitalization 8.6±7.6 days, and in-hospital mortality 20%.Conclusion: The commonest aetiologies of NTCASE in MTRH are intussusception and gastroschisis. Mortality and morbidity rates are high. Factors co-related with mortality in patients with NTCASE are deranged potassium level, ASA classification grade 3 and 4, neonates, normal haemoglobin level, duration of illness presentation <24 hours, and development of complications.Keywords: Non-traumatic childhood abdominal surgical emergencies, Etiologies, Outcomes, Childre

Cybersecurity Mindfulness in the Age of Mindless AIs: Investigating AI Assistants Impact in High-Reliability Organizations

The Focus: The focus of this Master Thesis is to investigate how AI tools, such as Large Learning Models (LLMs), impact cybersecurity operations in organizations that are regarded as highly reliable. To understand the impacts of AI tools on such operations, we also need to understand the nature of AI tools, their context of use and the experience of users that rely on them. Research Approach: This thesis is structured around two different methods of investigation. First a systematic literature review was conducted, where related articles was found in different databases, i.e. Google Scholar, Web of Science and the Basket of Eight publications. After this a Qualitative study was conducted where a multiple case study with interviews and random sampling was utilized. A total of 8 informants were interviewed for this study, each lasting ~30 minutes where the questions were based on the findings from the literature. Findings: From the literature it became clear that AIs, while better than humans in many things such as analyzing Big Data, intrusion detection and other pattern recognition activities, does bring with it many difficulties to the individual and the organization. AIs and LLMs are prone to making you develop an overreliance on them where you accept their answers because of your own biases, while the information itself might be fundamentally wrong or even deceitful. This phenomenon is called AI Hallucination and is vital to understanding an AIs effect on individuals. The literature highlighted that when using any tool, it was important to realize that the AI tool is simply a machine and might be wrong, question everything and do not accept any information at face value. Quite simply, think things through. LLMs have a problem with transparency, it is impossible to know its ‘reasoning’ behind the information it provides. This fact is supported by both the literature and the interviews themselves. Overreliance, hallucination, cultivating the wrong kind of trust and lack of transparency all lead to an individual acting mindless who takes the information as true. While they have been deceived by trusting something that essentially is untrustworthy or at the very least should have been looked more into. Implication: The practical implications for this study is that an organization, especially if it is of high reliability should carefully identify measures to avoid the negative impact of AI Assistants when used in day-to-day work in cybersecurity operations

Cybersecurity Mindfulness in the Age of Mindless AIs: Investigating AI Assistants Impact in High-Reliability Organizations

The Focus: The focus of this Master Thesis is to investigate how AI tools, such as Large Learning Models (LLMs), impact cybersecurity operations in organizations that are regarded as highly reliable. To understand the impacts of AI tools on such operations, we also need to understand the nature of AI tools, their context of use and the experience of users that rely on them. Research Approach: This thesis is structured around two different methods of investigation. First a systematic literature review was conducted, where related articles was found in different databases, i.e. Google Scholar, Web of Science and the Basket of Eight publications. After this a Qualitative study was conducted where a multiple case study with interviews and random sampling was utilized. A total of 8 informants were interviewed for this study, each lasting ~30 minutes where the questions were based on the findings from the literature. Findings: From the literature it became clear that AIs, while better than humans in many things such as analyzing Big Data, intrusion detection and other pattern recognition activities, does bring with it many difficulties to the individual and the organization. AIs and LLMs are prone to making you develop an overreliance on them where you accept their answers because of your own biases, while the information itself might be fundamentally wrong or even deceitful. This phenomenon is called AI Hallucination and is vital to understanding an AIs effect on individuals. The literature highlighted that when using any tool, it was important to realize that the AI tool is simply a machine and might be wrong, question everything and do not accept any information at face value. Quite simply, think things through. LLMs have a problem with transparency, it is impossible to know its ‘reasoning’ behind the information it provides. This fact is supported by both the literature and the interviews themselves. Overreliance, hallucination, cultivating the wrong kind of trust and lack of transparency all lead to an individual acting mindless who takes the information as true. While they have been deceived by trusting something that essentially is untrustworthy or at the very least should have been looked more into. Implication: The practical implications for this study is that an organization, especially if it is of high reliability should carefully identify measures to avoid the negative impact of AI Assistants when used in day-to-day work in cybersecurity operations

Water Quality and Management Practices among Parents/ Guardians in Households with Children Aged under Five Years in Munyaka Slum Eldoret

Treating water at the household level has been shown to be one of the most effective means of preventing water-borne disease. Promoting household water treatment and safe storage (HWTS) ensures that vulnerable populations take charge of their own water security by providing them with the appropriate knowledge and tools. The main objective of the study was to assess household water quality management practices among parents/ guardians in household with children aged under five years. The specific objectives were; to establish socio-demographic characteristics of parents/guardians with children aged under five, to establish community’s perception and practice towards improving water quality and to determine if there is biological contamination of household water. This was a cross-sectional study of parents/ guardians in the households with children aged under- five years. Interviewer administered questionnaires were used to collect data on socio-demographic characteristics of parents/guardians, level of education, occupation, income, marital status, number of children, age range of children, and household water quality management practices: training on water safety practices, place of training, major source of drinking water for children, practices for water safety and reasons for not practicing water safety.  Water samples were collected and analysed for biological contamination. Data was coded and entered using SPSS version 19. A correlation analysis was done between socio-demographic characteristics, and water quality management practice and also relationship between biological quality of water and household water quality management practices. Data were analysed and represented in tables, graphs and pie charts. A total of ninety six (96) households participated in the study. 84 (96.9%) of the respondents  were married, 56 (58.3%) had attained primary education while 47(49%) indicated they were in business or unemployed, 82 (85.4%) earned an income of ten thousand shillings or less, 50 (52%) had  two or three children. 62 (64.6%) had undergone some form of training on water safety whereby most were trained in schools. 41 (42.7%) of households practiced  boiling, 7 (7.3%)  chemical treatment, 1 (1%) hand washing before handling drinking water.  Most households 91 (94.8%) in Munyaka slum used stored water collected from eight (8) communal piped water points. The samples collected from the 8communal water points tested negative for coliform bacteria. At the household level,  10 (10.4%) samples of water  had coliform bacteria contamination above 10 counts/100ml which is not fit for drinking while 15 (16%) of water samples tested positive for E.coli. There was a strong positive correlation between socio-demographic characteristics and household water quality management practices variables whereby Pearson’s r was 0.778. There was a strong positive and significant correlation between biological quality of waterand Household water quality management practices.(r = 0.836, p= 0.000) Majority of the households in Munyaka with children aged under five years had parents/guardians who were married, had primary level of education, were either unemployed  or in business with an income of less than 10,000 Kenyan shillings. Majority of parents/guardians had received training on water safety but few practiced water treatment. Contamination of drinking water occurred during storage. Keywords: Water quality, Household water treatment and Storag

Patient Transfer Practices By Hospitals In Western Kenya

Background: Patients who are critically ill and those requiring emergency care are transported within and between hospitals on a regular basis seeking diagnostic or therapeutic services not available at the bed side or within the referring institution. The emergency of specialty systems often determines the ultimate destination of patients rather than proximity of facility and this has heightened the need for patient transfer. To achieve a favorable outcome, it is necessary to ensure that any transfer is carried out safely and effectively with minimum disruption of the continuum of care. Objectives: To determine the gap between existing knowledge of patient transfer principles and the practice by hospitals in Western Kenya referring patients to Moi Teaching and Referral Hospital (MTRH). Design: Cross-sectional descriptive study. Setting: Accident and emergency department at MTRH. Subjects: Patients transferred in over a period of six months for critical/emergency care. Results: Evaluation was done for 97 transfers during the six months period. Age ranged from four days old to 70 years with a median of 28 years. A wide spectrum of diseases were seen. However in order of frequency the leading five were; trauma and accidents, vascular disorders, infections; anaemia and malignancies. Of the infections, respiratory infections topped the list with pulmonary tuberculosis as the leading disease entity. Majority of patients 43 (44%) were referred within 24 hours of being seen at the primary hospital. Only 56% were transported by ambulance; appropriate escort(nurse) was provided in 60%; documentation was provided in 85%; monitoring enroute was done in 24%; warmth was provided in 62%, 27% were dehydrated requiring resuscitation; respiratory support was inadequate as only 14% (of those who required) had airway and 32% had oxygen provided; intravenous fluids were provided in 34% of those who required; nasogastric intubation was provided in 30% of those who required; urethral catheterisation was provided in 23% of those who required; 50% of those with long bone fractures were splinted and only 3% of those who required cervical spine stabilisation had cervical collar. Conclusion: There was significant failure by hospitals in Western Kenya in the application of principles of patient transfer while referring patients to MTRH