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The 2019 coronavirus disease (COVID-19) epidemic is a global health emergency which has been shown to pose a great challenge to mental health, well-being and resilience of healthcare workers, especially nurses. Little is known on the impact of COVID-19 among nurses in sub-Saharan Africa. A cross sectional study was carried out between August and November 2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The survey questionnaire consisted of six components- demographic and work title characteristics, information regarding care of COVID-19 patients, symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardized questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health disorders. Of 255 nurses, 171 (67.1%) consented to complete the survey. The median age of the participants was 33.47 years, 70.2% were females and 60.8% were married. More than half, 64.9% were frontline workers directly engaged in COVID-19 care. Only 1.8% reported a prior history or diagnosis of any mental health disorder. Depression, anxiety, insomnia, distress, and burnout were reported in 45.9%, 48.2%, 37.0%, 28.8% and 47.9% of all nurses. Frontline nurses reported experiencing more moderate to severe symptoms of depression, distress and burnout. Furthermore, females reported more burnout as compared to males. Multivariate logistic regression analysis showed that after adjustment, working in the frontlines was an independent risk variable for depression and burnout. This is one of the few studies looking at mental health outcomes among nurses during the COVID-19 pandemic in Kenya. Similar to other studies from around the world, nurses directly involved with COVID-19 patients reported higher rates of mental health symptoms. Burnout threatens to exacerbate the pre-existing severe nursing workforce shortage in low-resource settings. Cost-effective and feasible mitigating strategies, geared to low-middle income countries, are urgently needed to help cope with mental health symptoms during such a pandemic.

Patients often spend significant time waiting for care, which influences patient satisfaction, perceived quality, access to care, and utilization of various health care services. Waiting time and resulting implications remain understudied in low- and middle-income countries like Kenya. This study aimed to describe the impact on the perception of waiting times on patient satisfaction and care at a tertiary healthcare institution in Kenya. We conducted a prospective cross-sectional study between the first of April 2023 and the thirty-first of August 2023 at the Emergency Room (ER) at Aga Khan University Hospital, Nairobi. Data was collected through a structured questionnaire examining demographics and patient wait times. Descriptive statistics were summarized using frequencies and percentages, and univariate analyses using Fisher's exact test were conducted for group comparisons. A total of 941 patients participated in the study, with 52.0% being females and 53.6% in the 20-40-year age group. More than half of the patients were married (52.4%), had a university education (75.9%), and were employed (70.6%). Of the patients who took the survey, 51.1% reported waiting for 31-60 minutes, while 25.4% reported waiting for more than 60 minutes. Most patients presented to the ER on Monday, most frequently between 0800 and 1200 hrs. Most patients (70.8%) were likely to return for care and 71.7% were likely to recommend care at the ER to relatives and friends. Specific days and times of visits to the ER were associated with prolonged waiting times. To reduce waiting times and improve access to healthcare services, facilities should consider increasing the number of healthcare providers during these peak hours to ensure timely and quality consultations. Identifying bottlenecks and gridlocks within healthcare facilities is crucial to developing an efficient blueprint that aims to improve waiting times, leading to improved patient satisfaction and care.

MyDispense is one of the virtual simulations that has already been established as a suitable alternative for live experiential education in the pharmacy curriculum. However, there are no structured validated questionnaires available to assess the students' perception while integrating MyDispense with pharmacy practice experiential education. Therefore, the present study aimed to validate a structured questionnaire and use the questionnaire to assess the student perception of various pharmacy practice experiential education. Content and construct validity procedure was used to validate the questionnaire. Two hundred students consented to participate in validating the questionnaire. The validated questionnaire assessed the students' perception of integrating MyDispense with Introductory Pharmacy Practice Experience 2 (IPPE2) and Advanced Pharmacy Practice Experience (APPE) courses. The questionnaire was structured with four domains which were: exercise, instructor, technical, and communication. Each domain carried five items; therefore, the whole questionnaire had 20 items that succeeded in content validity. In the survey, 121 fourth-year and 117 fifth-year Pharm.D. students volunteered to convey their perception of integrating MyDispense with IPPE 2 and APPE, respectively. The survey was conducted before and after the MyDispense exam in both the courses. The Cronbach's α and McDonald's ω coefficients were > 0.8 in all four domains, indicating that the items related to the four domains have good internal consistency. In Exploratory Factor Analysis (EFA), two items were found to cross-load in the exercise domain and removed. Therefore, the EFA proposes 18 items for the confirmatory factor analysis (CFA). In CFA, five fit indices were found to be satisfactory, and this indicates construct was good enough to assess the student perception. In IPPE 2, the pre-test response, the students had significantly higher satisfaction (p < 0.05) with all five items related to the technical domain. In APPE, the students had a significantly (p < 0.05) higher perception of all the items related to the exercise and technical domain in the pre-test compared to the post-test. Therefore, the student's pre-test feedback allowed the instructor to identify and make the necessary corrections in the exercises to improve the quality exercises. This study provides a validated 18-item questionnaire to assess the student perception of integrating MyDispense in experiential education. The integration of MyDispense in experiential education needs to be done carefully by assessing student perception.

Trehalose serves as a crucial osmolyte and plays a significant role in stress tolerance. The influence of exogenously added trehalose (1 and 5 mM) in alleviating the chromium (Cr; 0.5 mM) stress-induced decline in growth, photosynthesis, mineral uptake, antioxidant system and nitrate reductase activity in Vigna radiata was studied. Chromium (Cr) significantly declined shoot height (39.33%), shoot fresh weight (35.54%), shoot dry weight (36.79%), total chlorophylls (50.70%), carotenoids (29.96%), photosynthesis (33.97%), net intercellular CO 2 (26.86%), transpiration rate (36.77%), the content of N (35.04%), P (35.77%), K (31.33%), S (23.91%), Mg (32.74%), and Ca (29.67%). However, the application of trehalose considerably alleviated the decline. Application of trehalose at both concentrations significantly reduced hydrogen peroxide accumulation, lipid peroxidation and electrolyte leakage, which were increased due to Cr stress. Application of trehalose significantly mitigated the Cr-induced oxidative damage by up-regulating the activity of reactive oxygen species (ROS) scavenging enzymes, including superoxide dismutase (182.03%), catalase (125.40%), ascorbate peroxidase (72.86%), and glutathione reductase (68.39%). Besides this, applied trehalose proved effective in enhancing ascorbate (24.29%) and reducing glutathione content (34.40%). In addition, also alleviated the decline in ascorbate by Cr stress to significant levels. The activity of nitrate reductase enhanced significantly (28.52%) due to trehalose activity and declined due to Cr stress (34.15%). Exogenous application of trehalose significantly improved the content of osmolytes, including proline, glycine betaine, sugars and total phenols under normal and Cr stress conditions. Furthermore, Trehalose significantly increased the content of key mineral elements and alleviated the decline induced by Cr to considerable levels.

Using recent information and communication technologies for monitoring and management initiates a revolution in the smart grid. These technologies generate massive data that can only be processed using big data tools. This paper emphasizes the role of big data in resolving load forecasting, renewable energy sources integration, and demand response as significant aspects of smart grids. Meters data from the Low Carbon London Project is investigated as a case study. Because of the immense stream of meters' readings and exogenous data added to load forecasting models, addressing the problem is in the context of big data. Descriptive analytics are developed using Spark SQL to get insights regarding household energy consumption. Spark MLlib is utilized for predictive analytics by building scalable machine learning models accommodating meters' data streams. Multivariate polynomial regression and decision tree models are preferred here based on the big data point of view and the literature that ensures they are accurate and interpretable. The results confirmed the descriptive analytics and data visualization capabilities to provide valuable insights, guide the feature selection process, and enhance load forecasting models' accuracy. Accordingly, proper evaluation of demand response programs and integration of renewable energy resources is accomplished using achieved load forecasting results.

Electronic Health Record (EHR) systems allow health care facilities to provide better care to patients and improve overall provider efficiency. They are vital for low-and middle-income countries in achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting the well-being of all their citizens. This study aimed to evaluate perceptions and usage of a comprehensive EHR by end-users after its deployment into a tertiary hospital system and its outpatient centers in Kenya and also aimed to understand the effectiveness of various implementation strategies deployed by the institution during their implementation process. We conducted a cross-sectional study between October 2023 and January 2024 at the Aga Khan University Hospital, Nairobi with staff involved in using the EHR system. A standardized electronic questionnaire was shared with the users and responses were captured on REDCap after obtaining written consent electronically. Of the 548 participants who agreed to join the study, 471 responded to the survey in full. Most respondents (420, 89.9%) stated that the EHR made their work better or much better, compared to a paper-based system. Majority of end-users stated that the EHR benefited their practice (378, 87.1%), provided autonomy to healthcare workers (382, 86.2%), the quality of healthcare (424, 95.5%), interactions within the healthcare team (353, 79.1%) and enjoyment of their clinical practice (360, 80.7%). The majority of end users believed the EHR to be effective and appropriate to use within this specific and unique healthcare system. The specific strategies deployed by institution were also successful in ensuring high rates of EHR usage and can be looked at as a blueprint for future EHR deployments in other sub-Saharan African healthcare systems.

Healthcare workers, including residents, are prone to various mental health disorders especially given the context of the COVID-19 pandemic. Residents, particularly, are already under undue stress due to their respective training program demands. This cross-sectional, online survey-based study from August to November 2020 collected demographic and mental health measurements from all residents at the Aga Khan University Hospital, Nairobi. The questionnaire investigated demographic variables, information regarding direct care of COVID-19 patients, prior history of mental health and mental health outcomes using the Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, Impact of Event Scale-Revised Questionnaire and Stanford Professional Fulfillment Index Questionnaire. A total of 100 residents completed the survey (participation rate 77.5%). Participants were about equal in gender (women [53%]), with a median age of 31.28 years, and majority were single (66.7%). A total of 66 participants (66%) were directly engaged in COVID-19 care. Depression: 64.3%, anxiety: 51.5%, insomnia: 40.5%, distress: 35.4%, and burnout: 51.0% were reported in all participants. Statistical significance was found in median depression, professional fulfillment and interpersonal disengagement when comparing frontline resident directly involved in care of COVID-19 patient versus second line residents. Residents directly involved with caring for COVID-19 patients had statistically higher incidences of depression and interpersonal disengagement and lower professional fulfillment compared to second line residents. Keeping in mind the limited resources in sub-Saharan Africa, urgent and geographically specific strategies are needed to help combat mental health disorders in this specific population.

The aim of the study was to evaluate the clinical significance of microRNA-375 in acute myocardial infarction patients and its mimic action in hypoxia/reoxygenation- (H/R-) induced ventricular cardiomyocyte H9c2 injury. In the current study, 90 ST-elevated acute MI patients (STEMI), 75 non-ST-elevated acute MI patients (NSTEMI), 90 healthy subjects, 14 weeks old mice, and ventricular cardiomyocyte H9c2 were included. The expressions of plasma microRNA-375 in patients with STEMI and NSTEMI and AMI mouse models were remarkably decreased than in controls (P<0.001). The areas under the curve (AUC) of plasma microRNA-375 were revealed 0.939 in STEMI and 0.935 in NSTEMI subjects. Moreover, microRNA-375 levels in H/R-exposed cardiac H9c2 cells were evidently downregulated and significantly increased apoptosis rate and caspase-3 activity levels, while overexpression of miR-375 remarkably reduced apoptosis percentage and caspase-3 levels as compared with normal cells. Furthermore, this study also demonstrated that Nemo-like kinase (NLK), NLK mRNA, and protein expression levels were significantly downregulated in H/R-injured H9c2 cells, on the contrary, H9c2 cells transfected with mimic-miR-375 greatly upregulated NLK mRNA and protein expression. Plasma microRNA-375 may serve as an essential clinical biomarker for diagnosis of early-stage AMI. Mimic expression of miR-375 significantly prevented H/R-induced cardiomyocyte injury by decreasing caspase-3 activity through upregulation of the NLK gene, recommended as a new therapeutic option for AMI patient.

Background As climate change intensifies, perennial plants face more frequent drought periods throughout their lifespan. Drought stress memory in certain plants significantly enhances their adaptability to challenging environmental circumstances. However, in open-pollinated crops, this process is influenced by population plasticity due to the type and degree of genetic diversity, and inbreeding depression. To understand how pre-exposure to moderate drought enhances the plants’ response to subsequent severe stresses, four synthetic poly-crossed populations were constructed using parents with contrasting molecular and morphological genetic variation (i.e. narrow and wide genetic distance). The first and second generations were subsequently assessed in an outdoor pot experiment at Isfahan University of Technology over two years, 2018 and 2019, under three different moisture conditions: Control with normal irrigation, DIDII underwent mild drought stress during the stem elongation phase followed, by severe drought stress during flowering, and DII subjected only to severe drought stress during flowering. Results Genotypes pre-exposed to DIDII treatment exhibited enhanced tolerance to subsequent severe drought compared to those exposed to DII treatment, indicating the importance of drought stress memory. However, trait-specific response observed for stress memory. The DIDII treatment improves dry matter yield, root volume, and root weight at different soil depths. Populations derived from parents with higher molecular and phenotypic variation were better suited for accurately predicting the performance of their progenies in terms of drought tolerance while not necessarily for stress memory. Inbreeding depression for root volume, root area, and root dry weight was affected by moisture conditions and the diversity level among the parental genotypes. Conclusion Our research may pave the way for understanding the mechanisms behind drought stress memory in grasses, which can be exploited in future studies to develop synthetic varieties with improved drought tolerance through selective breeding using populations with diverse genetic backgrounds.

Drought stress is a major limitation to legume productivity in arid and semi-arid regions. This study investigated the effectiveness of two novel natural biostimulant formulations (NBFs), composed of bee honey, potassium iodate, and silymarin selected for their complementary antioxidant and osmoprotective functions in enhancing drought tolerance in faba bean ( Vicia faba L.). Plants were subjected to deficit irrigation (withholding one irrigation after every two cycles) and foliar-sprayed with NBFs containing either 7.5 g L⁻¹ (F1) or 15 g L⁻¹ (F2) bee honey combined with 25 mg L⁻¹ potassium iodate and 0.2 mg L⁻¹ silymarin. Deficit irrigation markedly reduced growth, photosynthetic pigments, water status, and yield, while elevating oxidative stress markers. Application of NBFs significantly alleviated these adverse effects by enhancing osmolyte accumulation, improving antioxidant defenses, and restoring photosynthetic efficiency. Hormonal regulation was also improved, with increases in auxin, gibberellins, and cytokinins, alongside reduced abscisic acid levels. Notably, F2 was more effective than F1 in maintaining leaf integrity and maximizing pod yield under drought. These results highlight the potential of honey–iodine–silymarin formulations as eco-friendly, cost-effective biostimulants to promote crop resilience and productivity under water-limited conditions, contributing to sustainable agriculture.