Strengthening Visceral Leishmaniasis Diagnosis Capacity to Improve Access to Care in Kenya: The Example of Marsabit County

BackgroundVisceral leishmaniasis (VL), also known as kala-azar, is a neglected tropical disease (NTD) that is fatal if not treated early. The WHO targets the elimination of VL as a public health problem in its 2030 NTD road map. However, improving access to VL diagnosis and treatment remains a major challenge in many VL-endemic countries. Kenya is endemic for VL and is among the top 6 high-disease burden countries in the world.MethodsFIND, through its activities in improving the diagnosis of VL and supporting the elimination of the disease in Kenya, has worked with various county ministries of health (MOH) and central MOH over the last couple of years. FIND’s activities in Marsabit county started in 2018. In this work, we present the implementation of activities and the impacts in Marsabit county. We reviewed the data for 2017 and 2019 outbreaks (before and after the implementation of FIND’s activities) and assessed the importance of improving access and community sensitization to VL diagnosis. We assessed the contribution of each facility to the total distance traveled from a perspective of location optimization.ResultsThere was a sharp increase in the number of people tested in the 2017 outbreak compared to the 2019 outbreak. In 2017, 437 people were tested compared to 2,338 in 2019. The county reported 234 and 688 VL cases in 2017 and 2019, respectively. The data revealed a shift in the demographic structures of cases toward the younger population (mean age in 2017 was 17.6 years and 15.3 years in 2019), with more female cases reported in 2019 compared to 2017. In 2017, 44.4% were 10 years of age or under. In 2019, the proportion 10 years or below was 52.2%. The addition of two new diagnosis facilities in 2018 resulted in a decrease in the distance traveled by confirmed VL cases from 28.1 km in 2017 to 10.8 km in 2019. Assessing the impact of facility placement indicated the most optimal facilities to provide VL diagnostic services and minimize the distance traveled by patients. Adding new facilities reduces the travel distance until a point where the addition of a new facility provides no additional impact.ConclusionThe results from this study indicate the need to carefully consider the placement of health facilities in improving access to VL diagnosis and treatment and could serve as an investment case in deciding when to stop adding new facilities in a particular setting. Extending the activities in Kenya to other VL-endemic countries in East Africa will contribute significantly toward the elimination of the disease, addressing the needs of marginalized populations and leaving no one behind.

Location prediction for facility placement by incorporating multi-characteristic information

In the course of recommending locations for establishing new facilities on urban planning or commercial programming, the location prediction offers the optimal candidates, which maximizes the number of served customers or minimize customer inconvenience, therefore brings the maximum profits. In most existing studies, only the spatial-temporal features are recognized to evaluate the location popularity, where social relationships of customers, which are significant factors for popularity assessing, have been ignored. Additionally, current researches also fail to take capacities and categories of the facilities into consideration. To overcome the drawbacks, we introduce a novel model of Multi-characteristic Information based Top-k Location Prediction (MITLP), it captures the spatio-temporal behaviors of customers based on historical trajectories, exploits the social relevancy from their friend relationships, as well as examines the category competitiveness of specific facilities thoroughly. Subsequently, by drawing on the feature evaluation and popularity quantization, MITLP will be implemented within a hybrid B-tree-liked recommending framework, Constrained Location and Social-Trajectory Clustered forest (CLSTC-forest), which can not only produce better performance in practice but also address the facility service constraints. Finally, extensive experiments conducted on real-world datasets demonstrate the higher efficiency and effectiveness of the proposed model.

Nash Welfare in the Facility Location Problem

In most facility location research, either an efficient facility placement which minimizes the total cost or a fairer placement which minimizes the maximum cost are typically proposed. To find a solution that is both fair and efficient, we propose converting the agent costs to utilities and placing the facility/ies such that the product of utilities, also known as the Nash welfare, is maximized. We ask whether the Nash welfare's well-studied balance between fairness and efficiency also applies to the facility location setting, and what agent strategic behaviour may occur under this facility placement.

Rules for serving administrative arrest: analysis of proposals to modern legislation

The analysis of the legislation on the application of administrative arrest was carried out. It is established that the position of the legislator comes down to the fact that administrative arrest is the most severe measure of administrative penalty, which is applied in exceptional cases. Appointed only by a court decision (judge) if, in the circumstances of the case, taking into account the identity of the offender, the judge concludes that the application of other types of penalties will be insufficient. The uniqueness of administrative arrest is manifested in the fact that it is established for committing administrative offenses with a special anti-social orientation. The statistics of application of administrative arrest by types of administrative offenses and also number of persons on whom the given penalty is imposed on regions of Ukraine are resulted. It is emphasized that in practice administrative arrest as a type of penalty is used very rarely, in some cases its application is complicated by the procedure of its imposition. Attention is focused on certain provisions of the Draft Law “On the rules of administrative arrest” on the introduction of the principles of administrative arrest; features of the legal status of arrested persons; the procedure for placing a person in a temporary detention facility; placement of persons subject to administrative arrest; rights and responsibilities of arrested persons. The expediency of amendments to the Code of Ukraine on Administrative Offenses is analyzed. In particular, parts two of Article 32 (Administrative arrest), parts one of Article 294 (Entry into force of a judge’s decision on an administrative offense and revision of the decision), Article 326 (Execution of a decision on administrative arrest and detention on guard duty). As well as additions to the Code by Article’s 326–1 (Petition for the imposition of the pretext and its consideration), 326–2 (Execution of the decision on the exercise of the pretext) and 328–1 (Petition for suspension of the term of administrative arrest and its consideration). The author of the article proposes to amend paragraph 2 of Article 6 of the Draft Law “On the Rules of Administrative Arrest”. Thus, adhere to the principle of non-discrimination enshrined in art. 3 of the draft law. According to the author, it would be logical, if there is an established procedure, to establish liability for violation of the rules and conditions of administrative arrest in the form of a separate provision to the Code of Ukraine on Administrative Offenses. The general conclusion is that the adoption of the Laws “On Rules of Administrative Arrest” and “On Amendments to the Code of Ukraine on Administrative Offenses in connection with the adoption of the Law of Ukraine “On Rules of Administrative Arrest”” will improve the legal regulation of application and administrative arrest, as a type of administrative penalty, to address a number of issues that exist in this area, which will ultimately contribute to the rule of law and respect for human rights in the application of the penalty.

The “As If” Business Internship: An Instructional Response to Extenuating Circumstances

An internship, especially in applied business disciplines, is an important experiential learning bridge from the academy to further training and/or a career threshold. The Covid-19 outbreak frustrated student placement opportunities in settings with a high exposure risk. The pandemic also disrupted degree progress and graduation targets for many. A case example of an alternative to an on-site internship is described that is a response to Covid-19 limitations. This alternative is defined as the “As-If” internship because it captures several learning outcomes of a facility placement. On-site internship success factors and benefits are discussed as a benchmark for demonstrating how the “As-If” experience fulfills on-site learning objectives. The alternative is further discussed as an approach for other extenuating circumstances.

HEALTHCARE ENCOUNTERS AS PREDICTORS OF DEATH ANXIETY IN OLDER ADULTS

Literature suggests 10–15% of Americans experience death anxiety (DA). While DA is a response to heightened death awareness, research has not fully explored the link between DA and healthcare utilization. 2012 Health and Retirement Study data were used. Three binary logistic regressions analyzed hospitalization, ER admission, nursing facility placement, and outpatient visits’ abilities to predict DA (0 = “none,” 1 = “at least some”) over the past week. Model 1 included demographics and all four types of healthcare encounters. One item from the Beck Anxiety Inventory assessed DA. Most subjects in the sample (N = 7,185) were married (n = 4,302), and White (n = 5,479). Fifteen percent reported ER admissions, 24.6% reported hospitalizations, 1.1% reported nursing facility placements, and 91.5% reported outpatient visits. Regression results from each model showed nursing facility placement and outpatient visits to be statistically significant predictors of DA across all models (OR ranges = 2.23–2.38 and 1.23–1.25 respectively, p < .05 in all models). Hospitalization predicted DA in Models 1 (OR = 1.30, p = .004) and 2 (OR = 1.46, p < .001). Model 3 showed ER admission (OR = 1.52, p < .001) predicted DA. Results from each model indicated individuals who experienced nursing facility placements exhibited double the odds of experiencing DA, compared to those who did not. Outpatient visits were the weakest predictor of DA in each model. DA’s association with healthcare utilization provides implications for providers. Future research should explore the relation between DA and health outcomes.