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The study examined factors that determine access to healthcare among the households in Nairobi County. The problem of concern in this study was that access to healthcare challenges have persisted despite expansion in healthcare system in Nairobi County. Access to public healthcare in Nairobi County is unequal among social classes. Lower social classes have worse healthcare than either the upper or the middle classes. The study sought to find out why the disparity in access to healthcare in Nairobi County persists despite government efforts to address the issue. The study employed a qualitative design. The households living in Nairobi County provided the frame in which the population sample was drawn using multistage cluster random sampling to arrive at a sample size of 1066. Qualitative data was collected using observations, focus group discussions and in-depth interviews. Content analysis was used to analyze qualitative data. The results confirms robust positive correlations between independent intervening variables (explanatory variables: socio-cultural variables) and dependent variables (access to public healthcare). The independent intervening variables had significant influences on access to public healthcare. The P-value was statistically significant. The results were not due to random chance and that P- 0.01< 0.05 confirms a positive relationships between the variables. The study objective and question were achieved. The hypotheses were disconfirmed.

The growing capabilities of smartphones have opened up new opportunities for travel coordination and transport is a fertile area for app development. One stream of development is apps that enable collaborative travel, either in the form of lift sharing or collaborative shopping, but despite growing interest from governmental agencies, there is little evidence of the efficacy of such apps. Based on trials of purpose built travel collaboration apps, deployed in tourism, urban and rural residential communities, and logistics, this paper analyses the fundamental challenges facing users adopting such travel apps. The findings suggest that transport practitioners, policy makers and app developers need to better understand the challenges associated with attracting users, the use of incentives and the types of communities most appropriate to implement collaborative travel concepts using such approaches. Also, how the users' sense of time pressure and the issues around reciprocal exchange can impact on their long-term success and wider adoption.

We present baseline data (follow up due w24–48) from MSM Neurocog ‐ prospective cohort study describing neurocognitive (NC) function in men who have sex with men (MSM) 18–50y.ObjectivesDescribe prevalence of positive screen for NC impairment (NCI) using Brief Neurocognitive Screen (BNCS); follow NC function over time.Data collectedDemographics, medical history, current/nadir CD4, current/peak viral load, antiretroviral (ART) use, recreational drug/tobacco/alcohol use. Subjects screen for depression (PHQ9), anxiety (GAD7), subjective memory problems (Everyday Memory Questionnaire [EMQ]). PHQ9, GAD7, EMQ, IHDS have fixed numerical cut‐offs. BNCS interpreted by calculating composite z score for each subject based on distance from mean in three component tests. Comparing to population norms may overcall NCI. We used participants to construct HIV+ normal ranges after exclusion of anxiety/depression, comparing individuals to this range. 235 screened (205 HIV+, 30 HIV−). In HIV+group 59 (28.8%) excluded as GAD7>10, PHQ9>15 or both (2 no data). 144 HIV+ analysed. 124 (86.1%) had normal z score (within 1 SD of mean). 20 (13.9%) had abnormal z: 7 (35%) asymptomatic, 13 (65%) symptomatic (analysed together). Not enough cognitive domains assessed by BNCS to formally diagnose HIV‐related NCI. BNCS abnormals less likely to be educated at university level/beyond (40% vs. 62.1%, p=0.02) or in skilled work (45% vs. 81.5%, p<0.0001). Current/ex‐recreational drug use similar (~80%); no significant association to score. All patients with abnormal z receiving ART; individual agents not associated with abnormality. IHDS correlated with abnormal BNCS (60% abnormal z had abnormal IHDS vs. 15.3% of normal, p<0.0001). No CD4 association with abnormal z (median nadir 244 in both, p=0.38). Of note, group median age was statistically different but actual difference small (normal 41y vs. abnormal 44y p<0.0001; HIV− 33y). BNCS outcome is age‐related but stratification of results would make abnormal numbers too low for interpretation. In any case, no NCI seen following referral. No‐one referred for formal psychometric testing after screening shown to have NCI. We show high anxiety, depression and current/previous recreational drug use in HIV+MSM 18–50y. Subjective concerns do not translate into confirmed NCI. Patient pathways should include screening for anxiety/depression and substance use, but in this young MSM group concerns regarding memory/functional impairment seem unfounded.

Background: COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Objective: The aim of this study was to compare COPD patients' care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals' (HCPs) perceptions about the current pathways. Methods: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. Results: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. Conclusion: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients' engagement could optimize current care pathways resulting in a better integrated system.

This report examines the policy challenges for the Internet of Things (IoT), and raises a broad range of issues that need to be considered if policy is to be effective and the potential economic value of IoT is harnessed. It builds on the Blackett review, The Internet of Things: making the most of the second digital revolution, adding detailed knowledge based on research from the PETRAS Cybersecurity of the Internet of Things Research Hub and input from Fellows of the Royal Academy of Engineering. The report targets government policymakers, regulators, standards bodies and national funding bodies, and will also be of interest to suppliers and adopters of IoT products and services.