Search results for: rural healthcare settings

Authors: Amleset Haile

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Non-timber forest products (NTFPs) are harvested for both subsistence and commercial use and play a key role in the livelihoods of millions of rural people. Non-timber forest products (NTFPs) are important in rural southwest Ethiopia, Kaffa as a source of household income. market players at various levels in marketing chains are interviewed to getther information on elements of marketing system–products, product differentiation, value addition, pricing, promotion, distribution, and marketing chains. The study, therefore, was conducted in Kaffa Biosphere reserve of southwest Ethiopia with the main objective of assessing and analyzing the contribution of NTFPs to rural livelihood and to the conservation of the biosphere reserve and to identify factors influencing in the marketing of the NTFP. Five villages were selected based on their proximity gradient from Bonga town and availability of NTFP. Formal survey was carried out on rural households selected using stratified random sampling. The results indicate that Local people practice diverse livelihood activities mainly crops cultivation (cereals and cash crops) and livestock husbandry, gather forest products and off-farm/off-forest activities for surviva. NTFP trade is not a common phenomenon in southwest Ethiopia. The greatest opportunity exists for local level marketing of spices and other non timber forest products. Very little local value addition takes place within the region,and as a result local market players have little control. Policy interventions arc required to enhance the returns to local collectors, which will also contribute to sustainable management of forest resources in Kaffa biosphere reserve.

Keywords: forest management, biosphere reserve, marketing, local people

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Authors: Emma Mathias

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The aim of this study was to explore the role of food insecurity as a mediator of mental health in sub-Saharan Africa, taking Ghana as a case study. Although a quantitative correlation has recently been established between food insecurity and mental illness in Ghana, the nature and validity of this correlation remains unclear. A qualitative exploration was employed to investigate this correlation further. During the data collection period, twelve semi-structured interviews and five focus groups were conducted with a total of 124 individuals who were diagnosed with mental illnesses and their primary carers throughout rural and urban areas in Ghana. Interviews and focus groups were transcribed, translated, and analysed using thematic analysis. Preliminary results suggest that food insecurity may plays a role in mental illness in rural areas of Ghana where communities are reliant on agriculture for their livelihoods, but may play a lesser role in urban areas where communities are more reliant on petty trade as a source of livelihood. These results support psychosocial theories which suggest that the social and cultural factors involved in food production and consumption may be the key mediators between food insecurity and mental health.

Keywords: Food insecurity, Ghana, Mental health, Phenomenology

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Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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Authors: Pedro M. Abreu, Bruno R. Mendes

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The management of pharmacotherapy and the process of dispensing medicines is becoming critical in clinical pharmacy due to the increase of incidence and prevalence of chronic diseases, the complexity and customization of therapeutic regimens, the introduction of innovative and more expensive medicines, the unbalanced relation between expenditure and revenue as well as due to the lack of rationalization associated with medication use. For these reasons, co-payments emerged in Europe in the 70s and have been applied over the past few years in healthcare. Co-payments lead to a rationing and rationalization of user’s access under healthcare services and products, and simultaneously, to a qualification and improvement of the services and products for the end-user. This analysis, under hospital practices particularly and co-payment strategies in general, was carried out on all the European regions and identified four reference countries, that apply repeatedly this tool and with different approaches. The structure, content and adaptation of European co-payments were analyzed through 7 qualitative attributes and 19 performance indicators, and the results expressed in a scorecard, allowing to conclude that the German models (total score of 68,2% and 63,6% in both elected co-payments) can collect more compliance and effectiveness, the English models (total score of 50%) can be more accessible, and the French models (total score of 50%) can be more adequate to the socio-economic and legal framework. Other European models did not show the same quality and/or performance, so were not taken as a standard in the future design of co-payments strategies. In this sense, we can see in the co-payments a strategy not only to moderate the consumption of healthcare products and services, but especially to improve them, as well as a strategy to increment the value that the end-user assigns to these services and products, such as medicines.

Keywords: clinical pharmacy, co-payments, healthcare, medicines

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Authors: Trupti Meher, Harihar Sahoo

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Premature menopause refers to the occurrence of menopause before the age of 40 years. Women who experience premature menopause either due to biological or induced reasons have a longer duration of exposure to severe symptoms and adverse health consequences when compared to those who undergo menopause at a later age, despite the fact that premature menopause has a profound effect on the health of women. This study attempted to determine the prevalence and predictors of premature menopause among women aged 25-39 years, using data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. Descriptive statistics and multinomial logistic regression were used to carry out the result. The results revealed that the prevalence of premature menopause in India was 3.7 percent. Out of which, 2.1 percent of women had experienced natural premature menopause, whereas 1.7 percent had premature surgical menopause. The prevalence of premature menopause was highest in the southern region of India. Further, results of the multivariate model indicated that rural women, women with higher parity, early age at childbearing and women with smoking habits were at a greater risk of premature menopause. A sizeable proportion of women in India are attaining menopause prematurely. Unless due attention is given to this matter, it will emerge as a major problem in India in the future. The study also emphasized the need for further research to enhance knowledge on the problems of premature menopausal women in different socio-cultural settings in India.

Keywords: India, natural menopause, premature menopause, surgical menopause

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Authors: Sisira Edirippulige

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Background: Digital health education and training (DHET) is imperative for preparing current and future clinicians to work competently in digitally enabled environments. Despite rapid integration of digital health in modern health services, systematic education and training opportunities for health workers is still lacking. Objectives: This study aimed to investigate healthcare professionals’ perspectives and expectations regarding the knowledge, skills and competency needs in digital health for current and future healthcare workforce. Methods: A qualitative study design with semi-structured individual interviews was employed. A purposive sample method was adopted to collect relevant information from the health workers. Inductive thematic analysis was used to analyse data. Interviews were audio-recorded and transcribed verbatim. Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed when we reported this study. Results: Two themes emerged while analysing the data: (1) what to teach in DHET and (2) how to teach DHET. Overall, healthcare professionals agreed that DHET is important for preparing current and future clinicians for working competently in digitally enabled environments. Knowledge relating to what is digital health, types of digital health, use of technology and human factors in digital health were considered as important to be taught in DHET. Skills relating to digital health consultations, clinical information system management and remote monitoring were considered important to be taught. Blended learning which combined e-learning and classroom-based teaching, simulation sessions and clinical rotations were suggested by healthcare professionals as optimal approaches to deliver the above-mentioned content. Conclusions: This study is the first of its kind to investigate health professionals’ perspectives and expectations relating to the knowledge, skills and competency needs in digital health for current and future healthcare workforce. Healthcare workers are keen to acquire relevant knowledge, skills and competencies related to digital health. Different modes of education delivery is of interest to fit in with busy schedule of health workers.

Keywords: digital health, telehealth, telemedicine, education, curriculum

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Authors: Christopher Reichstein, Ralf-Christian Härting, Martina Häußler

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With a continuously increasing speed of information exchange on the World Wide Web, retailers in the E-Commerce sector are faced with immense possibilities regarding different online purchase processes like dynamic price settings. By use of Dynamic Pricing, retailers are able to set short time price changes in order to optimize producer surplus. The empirical research illustrates the basics of Dynamic Pricing and identifies six influencing factors of Dynamic Pricing. The results of a structural equation modeling approach show five main drivers increasing the potential of dynamic price settings in the E-Commerce. Influencing factors are the knowledge of customers’ individual willingness to pay, rising sales, the possibility of customization, the data volume and the information about competitors’ pricing strategy.

Keywords: e-commerce, empirical research, experts, dynamic pricing (DP), influencing factors, potentials

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Authors: Saima Shaikh, Andre Brown, Wallace Enegbuma

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Earthquakes strike both developed and developing countries, causing tremendous damage and the loss of lives of millions of people, mainly due to the collapsing of buildings, particularly in poorer countries. Despite the socio-economic and technological restrictions, the poorer countries have adopted proven and established housing-strengthening techniques from affluent countries. Rural communities are aware of the earthquake-strengthening mechanisms for improving housing resilience, but owing to socio-economic and technological constraints, the seismic guidelines are rarely implemented, resulting in informal construction practice. Unregistered skilled laborers make substantial contributions to the informal construction sector, particularly in rural areas where knowledge is scarce. Laborers employ their local expertise in house construction; however, owing to a lack of seismic expertise in safe building procedures, the authorities' regulated seismic norms are not applied. From the perspective of seismic knowledge transformation in safe buildings practices, the study focuses on the feasibility of seismic guidelines implementation. The study firstly employs a literature review of massive-scale reconstruction after the 2005 earthquake in rural Pakistan. The 2005-earthquake damaged over 400,000 homes, killed 70,000 people and displaced 2.8 million people. The research subsequently corroborated the pragmatic approach using questionnaire field survey among the rural people in 2005-earthquake affected areas. Using the literature and the questionnaire survey, the research analyzing people's perspectives on technical acceptability, financial restrictions, and socioeconomic viability and examines the effectiveness of seismic knowledge transfer in safe buildings practices. The findings support the creation of a knowledge transfer framework in disaster mitigation and recovery planning, assisting rural communities and builders in minimising losses and improving response and recovery, as well as improving housing resilience and lowering vulnerabilities. Finally, certain conclusions are obtained in order to continue the resilience research. The research can be further applied in rural areas of developing countries having similar construction practices.

Keywords: earthquakes, knowledge transfer, resilience, informal construction practices

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Authors: Mohammad Al-Mousawi

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This academic article explores the indispensable role of critical thinking in the process of diagnosing diseases. Employing a multidisciplinary approach, we delve into the cognitive skills and analytical mindset that clinicians, researchers, and healthcare professionals must employ to navigate the complexities of disease identification. By examining the integration of critical thinking within the realms of medical education, diagnostic decision-making, and technological advancements, this article aims to underscore the significance of cultivating and applying critical thinking skills in the ever-evolving landscape of healthcare.

Keywords: critical thinking, medical education, diagnostic decision-making, fostering critical thinking

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Authors: Y.S. Lea

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This paper investigates the agricultural rituals in relation to the historical continuity of cultural ideology concerning the praxis of cultural sustenance of the indigenous Mayas. The praxis is delineated in two dimensions: 1) The ceremonial and quotidian rituals of the rural Q’eqchi’ Mayas in Lanquin, Guatemala; 2) The indigenous Maya resistance of 2014 against the legislation of the 'Law for the Protection of New Plant Varieties,' commonly known as 'the Monsanto Law' in Guatemala. Through the intersection of ideology in practice, the praxis of cultural sustenance is construed.

Keywords: Q'eqchi' Mayas, San Agustin Lanquin, Alta Verapaz, Guatemala, Maya animism, Q’eqchi' deities, Tzuultaq'as

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Authors: Abigail Kusi Amponsah, Evans Frimpong Kyei, John Bright Agyemang, Hanson Boakye, Joana Kyei-Dompim, Collins Kwadwo Ahoto, Evans Oduro

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Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children’s pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children’s pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children’s pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n =24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses’ inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children’s pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children’s pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management

Keywords: Nursing-Related Barriers, Children, Pain Management, Ghana

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Authors: Gideon Baffoe, Hirotaka Matsuda

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Rural livelihood systems are known to be inherently vulnerable. Attempt to reduce vulnerability is linked to developing resilience to both internal and external shocks, thereby increasing the overall sustainability of livelihood systems. The shocks and stresses could be induced by natural processes such as the climate and/or by social dynamics such as institutional failure. In this wise, livelihood vulnerability is understood as a combined effect of biophysical, economic, and social processes. However, previous empirical studies on livelihood vulnerability in the context of rural areas across the globe have tended to focus more on climate-induced vulnerability assessment with few studies empirically partially considering the multiple dimensions of livelihood vulnerability. This has left a gap in our understanding of the subject. Using the Livelihood Vulnerability Index (LVI), this study aims to comprehensively assess the livelihood vulnerability level of rural households using Ehiamenkyene, a community in the forest zone of Eastern Ghana as a case study. Though the present study adopts the LVI approach, it differs from the original framework in two respects; (1) it introduces institutional influence into the framework and (2) it appreciates the gender differences in livelihood vulnerability. The study utilized empirical data collected from 110 households’ in the community. The overall study results show a high livelihood vulnerability situation in the community with male-headed households likely to be more vulnerable than their female counterparts. Out of the seven subcomponents assessed, only two (socio-demographic profile and livelihood strategies) recorded low vulnerability scores of less than 0.5 with the remaining five (health status, food security, water accessibility, institutional influence and natural disasters and climate variability) recording scores above 0.5, with institutional influence being the component with the highest impact score. The results suggest that to improve the livelihood conditions of the people; there is the need to prioritize issues related to the operations of both internal and external institutions, health status, food security, water and climate variability in the community.

Keywords: assessment, gender, livelihood, rural, vulnerability

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Authors: John Pomerat, Aviv Segev

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Recently, deep learning has had many theoretical breakthroughs. For deep learning to be successful in the industry, however, there need to be practical algorithms capable of handling many real-world hiccups preventing the immediate application of a learning algorithm. Although AI promises to revolutionize the healthcare industry, getting access to patient data in order to train learning algorithms has not been easy. One proposed solution to this is data- sharing. In this paper, we propose an alternative protocol, based on multi-party computation, to train deep learning models while maintaining both the privacy and security of training data. We examine three methods of training neural networks in this way: Transfer learning, average ensemble learning, and series network learning. We compare these methods to the equivalent model obtained through data-sharing across two different experiments. Additionally, we address the security concerns of this protocol. While the motivating example is healthcare, our findings regarding multi-party computation of neural network training are purely theoretical and have use-cases outside the domain of healthcare.

Keywords: neural network aggregation, multi-party computation, transfer learning, average ensemble learning

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Authors: N. Y. H. Konagano

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Riverside population of Brazilian amazon suffers drinking water scarcity, seeking alternative water resources such as well and rivers, ordinary polluted. Although Amazon Region holds high annual river inflow and enough available of underground water, human activities have compromised the conservation of water resources. In addition, decentralized rural households make difficult to access of potable water. Main objective is to analyze quantitatively the potential of rainwater harvesting to human consumption at Marupaúba community, located in northeast of Amazon region, Brazil. Methods such as historical rainfall data series of municipality of Tomé-Açu at Pará state were obtained from Hydrological Information System of National Water Agency (ANA). Besides, Rippl method was used to calculate, mainly, volume of the reservoir based on difference of water demand and volume available through rainwater using as references two houses (CA I and CA II) as model of rainwater catchment and supply. Results presented that, from years 1984 to 2017, average annual precipitation was 2.607 mm, average maximum precipitation peak was 474 mm on March and average minimum peak on September was 44 mm. All months, of a year, surplus volume of water have presented in relation to demand, considering catchment area (CA) I = 134.4m² and demand volume =0.72 m³/month; and, CA II = 81.84 m² and demand volume = 0.48 m³/month. Based on results, it is concluded that it is feasible to use rainwater for the supply of the rural community Marupaúba, since the access of drinking water is a human right and the lack of this resource compromises health and daily life of human beings.

Keywords: Amazon Region, rainwater harvesting, rainwater resource, rural community

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Authors: Sheriff Muhammad Ibrahim

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The contemporary world has seen many agents of market liberalization, globalization, and expansion in agribusiness, which pose a big threat to the existence of smallholder farmers in the farming business or, at most, being marginalized against government interventions, investors' partnerships and further stretched by government policies in an effort to promote subsistent farming that can generate profits and speedy growth through attracting foreign businesses. The consequence of these modern shifts ends basically at the expense of smallholder farmers. Many scholars believed that this shift was among the major causes of urban-rural drift facing almost all communities in the World. In an effort to address these glaring economic crises, various governments at different levels and development agencies have created different programs trying to identify other sources of income generation for rural farmers. However, despite the different approaches adopted by many communities and states, the mass rural exodus continues to increase as the rural farmers continue to lose due to a lack of reliable sources for cost-efficient inputs such as agricultural extension services, mechanization supports, quality, and improved seeds, soil matching fertilizers and access to credit facilities and profitable markets for rural farmers output. Unfortunately for them, they see these agricultural requirements provided by large-scale farmers making their farming activities cheaper and yields higher. These have further created other social problems between the smallholder farmers and the large-scale farmers in many areas. This study aims to suggest the Islamic mode of agricultural financing named Muzara’ah for smallholder farmers as a microfinance banking product adopted and practiced by Yobe Microfinance Bank as a model to promote agricultural financing to be adopted in other communities. The study adopts a comparative research method to conclude that the Muzara’ah model of financing can be adopted as a valid means of financing smallholder farmers and reducing food insecurity.

Keywords: Muzara'ah, Islamic finance, agricultural financing, microfinance, smallholder farmers

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Authors: N. Nandan A. M. Nagaraj, L. Sanjeev Kumar

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In the rapidly growing population, the requirement of electrical power is increasing day by day. In order to meet the needs, we need to generate the power using alternate method. In this paper, a presentable approach is developed by analysis and can be implemented by utilizing heat energy, which is generated in numerous ways in some of the rural areas in India. The thermoelectric generator unit will be developed by combing with control circuits and converts, which is used to light the LED lamps. The temperature difference which is available in the kitchens, especially the exhaust pipes/chimneys of wooden fire stoves, where more heat is dissipated into the atmosphere, can be utilized for electrical power generation. Hence, the temperature rise of surroundings atmosphere can be reduced.

Keywords: thermo electric generator, LED, converts, temperature

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Authors: Toslim Uddin Khan, Jesmin Akter, Mohiuddin Ahmed

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Menstrual hygiene management (MHM) and personal health-care practice is a critical issue to prevent morbidity and other reproductive health complications among adolescent girls in Bangladesh. Inadequate access to water, sanitation and hygiene (WASH) facilities lead to unhealthy MHM practices that resulted in poor reproductive health outcomes. It is evident from different studies that superstitions and misconception are more common in rural communities that limit young girls’ access to and understanding of the menstrual hygiene and self care practices. The state-of-the-art approach of Social Marketing Company (SMC) is proved to be instrumental in delivering reinforcing health messages, making public health and hygiene products available at the door steps of the community through community mobilization programs in rural Bangladesh. School health program is one of the flagship interventions of SMC to equip adolescent girls and boys with correct knowledge of health and hygiene practices among themselves, their families and peers. In Bangladeshi culture, adolescent girls often feel shy to ask fathers or male family members about buying sanitary napkin from local pharmacy and they seem to be reluctant to seek help regarding their menstrual problems. A recent study reveals that 48% adolescent girls are using sanitary napkins while majority of them are unaware of menstrual hygiene practices in Bangladesh. Under school adolescent program, SMC organizes health education sessions for adolescent girls from grade seven to ten using enter-educate approach with special focus on sexual and reproductive health and menstrual hygiene issues including delaying marriage and first pregnancy. In addition, 2500 rural women entrepreneurs branded as community sales agents are also involved in disseminating health messages and selling priority health products including sanitary napkin at the household level. These women entrepreneurs are serving as a source of sustainable supply of the sanitary napkins for the rural adolescent girls and thereby they are earning profit margins on the sales they make. A recent study on the impact of adolescent program activities reveals that majority (71%) of the school adolescent girls are currently using sanitary napkins. Health education equips and empowers adolescent girls with accurate knowledge about menstrual hygiene practices and self-care as well. Therefore, engagement of female entrepreneurs in school adolescent health program at the community level is one of the promising ways to improve menstrual hygiene practices leading to increased use of sanitary napkin in rural and semi-rural communities in Bangladesh.

Keywords: school adolescent program, social marketing, women entrepreneurs, menstrual hygiene management

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Authors: Ezinne K. Okoro, Takahiko Katoh, Yoko Kawamura, Stanley C. Meribe

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HIV infection in children is largely as a result of vertical transmission (mother to child transmission [MTCT]). Thus, elimination of mother to child transmission of HIV/AIDS is critical in eliminating HIV infection in children. In Nigeria, drawbacks such as; limited pediatric screening, limited human capital, insufficient advocacy and poor understanding of ART guidelines, have impacted efforts at combating the disease, even as treatment services are free. Prevention of Mother to Child Transmission (PMTCT) program relies on health workers who not only counsel pregnant women on first contact but can competently provide HIV-positive pregnant women with accurate information about the PMTCT program such as feeding techniques and drug adherence. In developing regions like Nigeria where health care delivery faces a lot of drawbacks, it becomes paramount to address these issues of poor PMTCT coverage by conducting a baseline assessment of the knowledge, practices and perceptions related to HIV prevention amongst healthcare workers in Nigeria. A descriptive cross-sectional study was conducted amongst 250 health workers currently employed in health facilities in Abuja, Nigeria where PMTCT services were offered with the capacity to carry out early infant diagnosis testing (EID). Data was collected using a self-administered, pretested, structured questionnaire. This study showed that the knowledge of PMTCT of HIV was poor (30%) among healthcare workers who offer this service day-to-day to pregnant women. When PMTCT practices were analyzed in keeping with National PMTCT guidelines, over 61% of the respondents reported observing standard practices and the majority (58%) had good attitudes towards caring for patients with HIV/AIDS. Although 61% of the respondents reported being satisfied with the quality of service being rendered, 63% reported not being satisfied with their level of knowledge. Predictors of good knowledge were job designation and level of educational attainment. Health workers who were more satisfied with their working conditions and those who had worked for a longer time in the PMTCT service were more likely to observe standard PMTCT practices. With over 62% of the healthcare workers suggesting that more training would improve the quality of service being rendered, this is a strong pointer to stakeholders to consider a ‘healthcare worker-oriented approach’ when planning and conducting PMTCT training for healthcare workers. This in turn will increase pediatric ARV coverage, the knowledge and effectiveness of the healthcare workers in carrying out appropriate PMTCT interventions and culminating in the reduction/elimination of HIV transmission to newborns.

Keywords: attitudes, HIV/AIDS, healthcare workers, knowledge, mother to child transmission, Nigeria, perceptions

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Authors: Karen Eastman

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More youths and young adults with autism spectrum disorder (ASD) have been entering the workforce in recent years. Historically, students with ASD struggle after leaving high school and experience lower rates of employment, with social skills continuing to be the most problematic area of concern. Special education teachers may find it challenging to identify effective combinations of evidence-based practices (EBPs) and supports to best guide these students. One EBP, Peer Mediated Instruction and Intervention (PMII) has been well documented in the literature as being effective for younger students with autism but not researched as much with older students and adults, particularly in work settings. A need to combine PMII with other EBPs has been identified as a way to achieve a greater positive impact rather than any practice alone. A multiple baseline across skills design was used in this research project with two participants in different settings. PMII was combined with Visual Supports, with typical peers being trained in both practices. PMII is an evidence-based practice used to address social concerns by training peers without disabilities as to how they can provide feedback to and support, the student with ASD with social interactions in structured settings. The peers without disabilities were the instructors, while the adults facilitated the social situations and provided support to both the peers and students with ASD when needed. Because many individuals with ASD learn best with visual input, rather than using only the spoken word (verbal directions and feedback), Visual Supports were used in conjunction with PMII. Visual Supports can include written words, pictures, symbols, videos, or objects. In this project, the Visual Supports used were written social scripts, videos, Stop and Think signs, written reminder cards, a school map, and a pictorial task analysis of work tasks. Variables that may affect intervention outcomes in this project included attendance at school and school-based work settings for both the students with ASD and the peers without disabilities and behaviors and responses from others in the settings. Qualitative data was also collected from observations and surveys with peers about the process and their role. Data indicated that the students with ASD responded more positively to redirection and support from their peers than to teachers and staff and showed an increase in positive interactions with others. Those surveyed indicated a positive attitude toward and response to the use of peer interventions with visual supports.

Keywords: autism, social skills, vocational training, peer interventions

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Authors: Naveed Tahir, Adnan Maqsood

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Cognitive workload is a significant factor affecting user performance, and it has been broadly investigated for its application in ergonomics as well as in designing and optimizing effective human-machine interactions. It is mentally challenging to maneuver an aircraft, and pilots must control the aircraft and adequately communicate to the verbal-auditory stimuli. Several physiological measures have long been researched and used to demonstrate the cognitive workload. In our current study, we have summarized recent findings of the effectiveness, accuracy, and applicability of commonly used physiological measures in evaluating cognitive workload. We have also highlighted on the advancements in physiological measures. The strength and limitations of physiological measures have also been discussed to assess the cognitive workload of people, especially the aircrews in laboratory settings and real-time situations. We have presented the research findings of the physiological measures to base suggestions on the proper applications of the measures and settings demanding the use of single measure or their combinations.

Keywords: aircrew, cognitive workload, subjective measure, physiological measure, performance measure

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Authors: Isabel Freitas, Paula Remoaldo, Olga Matos, Ricardo Goja, Juliana Araujo, Vitor Ribeiro, Miguel Pereira

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Several destinations have been experiencing a transition from a massified cultural tourism to a creative tourism approach. In this new segment of tourism, urban territories have been the focus for several decades. Urban studies on creative industries and initiatives have been taking place in big cities marginalizing small towns and more specifically rural areas. This paper envisages evaluating the differences between rural and urban institutions/platforms, mostly certified by the Creative Tourism Network, in what concerns the practices and initiatives in creative tourism worldwide. In the research carried out between March 2017 and March 2018, we had three levels of primary data and qualitative analysis: i) research on Google (web) by using several keywords like 'creative tourism initiatives', 'creative cities', 'best practices in creative tourism' (from March to August 2017). With the help of the certification of institutions/platforms by the Creative Tourism Network, 24 institutions were found and declared to be developing creative initiatives. It was decided to try to unravel the type of activities and some practices and initiatives carried out by these institutions and the analysis of the differences between rural and urban initiatives. A database of 20 items (e.g., institutions in charge of implementing the initiatives, year of implementation, site, activities developed, place of development, country of origin, type of partners chosen) was created for each institution/platform; ii) A deeper analysis was made on the websites’ information on the institutions (from September to December 2017). The type of professionals involved in the activities, the language used in the activities and the type of activity performed were some of the data analysed and iii) To complement these data, semi-structured interviews were done to representatives of the institutions, conducted mainly by Skype from July 2017 to April 2018. The interviews consisted of 17 questions. In the present paper, these interviews are used to complement the analysis of the same items. Some of the qualitative analysis was supported by the narratives of the leaders of the twenty-four institutions that were surveyed. The results indicate that creative tourism is more active and diverse in urban areas. Some more consolidated communication strategies and partnerships are needed for these activities to become economically more sustainable. The findings of this research provide researchers and practitioners with a better understanding of creative tourism and give some information of how creative tourism is developed in rural and urban areas, the gaps and lack of information, and all the possible directions towards the development of the creative tourism industry.

Keywords: creative tourism, practices of creative tourism, rural areas, urban areas

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Authors: Jaishree Ellis

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The United States Centers for Disease Control tells us that many women with disabilities will not receive regular health screenings, including Pap Smears and mammograms. This article was comprised and written to recognize the barriers to care, gaps in existing healthcare implementation, and viable methodologies for the provision of comprehensive and robust gynecologic care for women with disabilities. According to the World Health Organization, 15% of the world's population, or approximately 1 billion people, have disabilities, most of whom are identified as women. Women with disabilities are described as being multi-disabled, as in some places, they suffer exclusion because of their disabilities as well as their gender. The paucity of information regarding how to create a healthcare system that is inclusive of every woman, regardless of her type of disability (physical, mental, intellectual or medical), has made it challenging to establish an environment that makes it possible for individuals to access care in an equitable, respectful and comprehensive way. A review of the current literature, institutional websites within the United States and American resource guides was implemented to determine where comprehensive models of care for women with disabilities exist, as well as the modalities that are being employed to meet their healthcare needs. The many barriers to care that women with disabilities face were also extracted from various sources within the literature to provide an exhaustive list that can be tackled, one by one. Of the 637 Hospital Systems in the United States, only 7 provide website documentation of health care services that address the unique needs of women with disabilities. The presumption is that if institutions have not marketed such interventions to the community, then it is likely that they do not have a robust suite of services with which to make gynecologic care available to patients with disabilities. Through this review, 7 main barriers to comprehensive gynecologic care were identified, with more than 20 sub-categories existing within those. As with many other areas of community life, inclusion remains lacking in the delivery of healthcare for women with disabilities. There are at least 7 barriers that must be overcome in order to provide equity in the medical office, the exam room, the hospital and the operating room. While few institutions have prioritized this, those few have provided blueprints that can easily be adopted by others. However, as the general population lives longer and ages, the incidence of disabilities increases, as do the healthcare disparities surrounding them. Further compounded by this is a lack of formal education for medical providers in the United States.

Keywords: health equity, inclusion, healthcare disparities, education

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Authors: Yujun Liu, Maosheng Ran

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Background: Chinese rural-to-urban migrant workers’ mental health problems raise attentions from different social sectors. However, situation of present mental health services provided to this population has not been discovered. This study attempts to describe the current mental health service situation, identify the gaps and give the future directions based on the quantitative data. Methods: Questionnaire surveys were conducted among 2017 rural-to-urban migrant workers in 13 cities and 100 social work service organizations in 5 cities in 2014. Data was collected by face-to-face structured interview by trained interviewers. Findings: Migrant workers’ mental health status was not good. Compared to the severity of mental distress, mental health service for this population was lacking and insufficient, which accounted for only 14.4% of all services in our sample. And the group work and case work were the most frequently-used methods. By estimating a series of regression models, we revealed that life experiences and working conditions were significantly associated with migrant workers’ mental health status. Therefore, the macro social work practices aimed at this whole group were advocated to promote their mental wellbeing. That is, practitioners should not only focus on the improvement of migrant workers’ emotion management capacity, but also pay attention to raise awareness and improve their living and working condition; not only concentrate on the solving of individuals’ dilemma, but also promote gradual reformation of present labor regime and hukou system in China.

Keywords: Chinese rural-to-urban migrant workers, macro social work practice, mental health service needs, mental health status

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Authors: Baikuntha Prasad Acharya, Elizabeth Halpenny

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Small tourism enterprises (STEs) are primary providers of services and attractions in many destinations of less developed countries; they are considered the lifeblood of tourism sector. Furthermore, in rural community destinations of such countries including Nepal, STEs are regarded as alternative tools for advancing economic and sociocultural transformations. Many families in rural Nepali destinations are venturing into small tourism entrepreneurship so that their poverty can be reduced and they can live a sustained life. Most these communities are utilizing their lifestyles and natural and cultural heritages as tourism attractions. This study aimed to understand the sustainability of the STEs in rural destinations by synthesizing observations from Ghalegaon and Ghandruk of the Annapurna Conservation Area in western Nepal. Ghalegaon has community-based homestays and Ghandruk has independently owned and operated small tourism businesses such as cafes, tea houses, lodges, guest houses, and hotels, etc. The community-based homestays of Ghalegaon are compared with the independently owned and operated STEs of Ghandruk. The data were collected through multiple sources: 1) survey of tourists (n=112) and households (n=191); 2) interviews (n=14) with the locals, 3) group discussions (n=10) with different local groups including that of regional tourism players, experts and policy makers, 4) observations, and 5) document analysis. The STEs of both communities were first analyzed by understanding their level of sustainability as businesses, and then were explored how they were impacting on respective communities’ sustainability. The survey indicators and guidelines for interviews and group discussions were adapted to the Nepalese context based on four pillars of sustainability: economic, social, cultural and environmental; an additional dimension of management was also included, particularly for the STEs. The findings have shown a weaker economic and management dimensions of Ghalegaon’s Homestay than that of Ghandruk’s STEs. Some interesting social complexities of rural tourism and entrepreneurship were also revealed. This study’s findings do not much resonate to what Nepal government’s current rural tourism strategies that have been envisioned and prioritized for, particularly that the rural homestay tourism opportunities enhance inclusiveness of women and other deprived communities by spreading the benefits to the grassroots level. The study has highlighted several important applied implications to the local tourism management committees, tourism operators and associations, and regional and national tourism authorities. Further studies are advisable in other similar contexts in Nepal and in other countries to see whether there are variances in the findings.

Keywords: Nepal, rural tourism communities, small tourism enterprises, sustainability

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Robson C. Santos, David D. Oliveira, Matheus M. Reis, Gerson G. Cunha, Marcos A. C. Moreira

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The project demonstrates the construction of a solar power generation, integrated inverter equipment to a "Grid-Tie" by converting direct current generated by solar panels, into alternating current, the same parameters of frequency and voltage concessionaire distribution network. The energy generated is quantified by smart metering module that transmits the information in specified periods of time to a microcontroller via GSM modem. The modem provides the measured data on the internet, using networks and cellular antennas. The monitoring, fault detection and maintenance are performed by a supervisory station. Employed board types, best inverter selection and studies about control equipment and devices have been described. The article covers and explores the global trend of implementing smart distribution electrical energy networks and the incentive to use solar renewable energy. There is the possibility of the excess energy produced by the system be purchased by the local power utility. This project was implemented in residences in the rural community of the municipality of Cabo Frio/RJ. Data could be seen through daily measurements during the month of November 2013.

Keywords: rural residence, supervisory, smart grid, solar energy

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Authors: Mesfin Nigussie

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The objectives of the study were to identify factors affecting rural households’ willingness to install biogas plant and amount willingness to pay in order to examine determinants of effective demand for biogas technology. A multistage sampling technique was employed to select 120 respondents for the study. The binary probit regression model was employed to identify factors affecting rural households’ decision to install biogas technology. The probit model result revealed that household size, total household income, access to extension services related to biogas, access to credit service, proximity to water sources, perception of households about the quality of biogas, perception index about attributes of biogas, perception of households about installation cost of biogas and availability of energy source were statistically significant in determining household’s decision to install biogas. Tobit model was employed to examine determinants of rural household’s amount of willingness to pay. Based on the model result, age of the household head, total annual income of the household, access to extension service and availability of other energy source were significant variables that influence willingness to pay. Providing due considerations for extension services, availability of credit or subsidy, improving the quality of biogas technology design and minimizing cost of installation by using locally available materials are the main suggestions of this research that help to create effective demand for biogas technology.

Keywords: biogas technology, effective demand, probit model, tobit model, willingnes to pay

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Authors: Salwa S. Dawaki, Init Ithoi, Sa’adatu I. Yelwa

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Introduction: Parasitic infections are major public health problems worldwide, particularly in developing countries. Two third of the world population is infected while about 3 billion are at risk of parasitic infections. It is demonstrated that most parasitic infections occur as multiple infections especially among poor and rural communities of most countries in the tropical regions. Parasitic infections are endemic in Nigeria, yet multiple infections are rarely reported. The study aimed to estimate the prevalence and identify factors associating with multiple parasitic infections among rural population in Kano State Nigeria. Methodology: A cross-sectional survey was conducted from June to August 2013 in rural Kano State, Nigeria. Three samples stool, urine, and blood were collected from each of the 551 volunteers aged between one and ninety years old recruited for the survey. A pre-tested questionnaire was used to obtain epidemiological data. Data were analysed using appropriate descriptive, univariate and multivariate logistic regression methods. Major findings: The participants were 61.7% male, 38.3% female, and 69.0% were adults of 15 years and above. Overall, 463 (84%) were infected with parasitic infections among which 60.9% had multiple infections. A total of 15 parasitic species were recovered, and up to 8 different parasitic species were found concurrently in a single host. Plasmodium was the most common parasite followed by Blastocystis, Entamoeba species, and hookworms. It was found that presence of an infected family member (P = 0.017; OR = 1.52; 95% CI = 1.08, 2.13) and not wearing shoes outside home (P = 0.043; OR = 1.50; 95% CI = 1.01, 2.18) significantly associated with higher risk of having multiple parasitic infections among the studied population. Conclusion: Parasitic infections pose a public health challenge in the rural community of Kano. Multiple parasitic infections are highly prevalent and presence of an infected family member as well as not wearing proper foot wear outside home increases the risk of infection. Poor hygiene, unfavourable socioeconomic conditions, and culture promote survival and transmission of parasites. There is a need for implementation of integrated approach aimed at controlling or eliminating the infections with emphasis on public awareness.

Keywords: multiple infections, parasitic infections, poor hygiene, risk of infection

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Authors: Maiya Smith, Tyler Thorne

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Background: The Pacific faces multiple healthcare crises, including high rates of noncommunicable diseases, infectious disease outbreaks, and susceptibility to natural disasters. These issues are expected to worsen in the coming decades, increasing the burden on an already understaffed healthcare system. Telehealth is not new to the Pacific, but improvements in technology and accessibility have increased its utility and have already proven to reduce costs and increase access to care in remote areas. Telehealth includes distance learning; a form of education that can help alleviate many healthcare issues by providing continuing education to healthcare professionals and upskilling staff, while decreasing costs. This study examined distance learning programs at the Ministry of Health in the Pacific nation of Palau and identified key elements to their successful distance learning programs. Methods: Staff at the Belau National Hospital in Koror, Palau as well as private practitioners were interviewed to assess distance learning programs utilized. This included physicians, IT personnel, public health members, and department managers of allied health. In total, 36 people were interviewed. Standardized questions and surveys were conducted in person throughout the month of July 2019. Results: Two examples of successful distance learning programs were identified. Looking at the factors that made these programs successful, as well as consulting with staff who undertook other distance learning programs, four factors for success were determined: having a cohort, having a facilitator, dedicated study time off from work, and motivation. Discussion: In countries as geographically isolated as the Pacific, with poor access to specialists and resources, telehealth has the potential to radically change how healthcare is delivered. Palau shares similar resources and issues as other countries in the Pacific and the lessons learned from their successful programs can be adapted to help other Pacific nations develop their own distance learning programs.

Keywords: distance learning, Pacific, Palau, telehealth

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Authors: Samuel Fekadu A., Esayas Alemayehu B., Bultum Oljira D., Seid Tiku D., Dessalegn Dadi D., Bart Van Der Bruggen A.

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The peroxi-photoelectrocoagulation process was evaluated for the removal of chemical oxygen demand (COD) and color from healthcare wastewater. A 2-level full factorial design with center points was created to investigate the effect of the process parameters, i.e., initial COD, H₂O₂, pH, reaction time and current density. Furthermore, the total energy consumption and average current efficiency in the system were evaluated. Predictive models for % COD, % color removal and energy consumption were obtained. The initial COD and pH were found to be the most significant variables in the reduction of COD and color in peroxi-photoelectrocoagulation process. Hydrogen peroxide only has a significant effect on the treated wastewater when combined with other input variables in the process like pH, reaction time and current density. In the peroxi-photoelectrocoagulation process, current density appears not as a single effect but rather as an interaction effect with H₂O₂ in reducing COD and color. Lower energy expenditure was observed at higher initial COD, shorter reaction time and lower current density. The average current efficiency was found as low as 13 % and as high as 777 %. Overall, the study showed that hybrid electrochemical oxidation can be applied effectively and efficiently for the removal of pollutants from healthcare wastewater.

Keywords: electrochemical oxidation, UV, healthcare pollutants removals, factorial design

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