Search results for: care knowledge

Authors: Ivonne N. Pérez-Sánchez. María L. Rascón- Gasca, Angélica Riveros-Rosas, Rebeca Robles García

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Introduction: Primary caregivers of cancer patients have health problems related to their lack of time, stress, and fiscal strain. Their health problems could affect their patients’ health and also increase the expenses in public health. Aim: To describe self-care and risk behaviors in a sample of Mexican primary caregiver and the relation of these behaviors with emotional distress (caregiver burden, anxiety and depression symptoms), coping and sociodemographic variables. Method: Participated in this study 173 caregivers of a third level reference medical facility (age: M=49.4, SD=13.5) females 78%, males 22%, 57.5% were caregivers of patients with terminal cancer (CPTC), and 40.5% were caregivers of patients on oncology treatment (CPOT). Results: The 75.7% of caregivers reported to have had health problem in last six months as well as several symptoms which were related to emotional distress, these symptoms were more frequently between CPTC and female caregivers. A half (47.3%) of sample reported have had difficulties in caring their health; these difficulties were related to emotional distress and lower coping, more affected caregivers were who attend male patients and CPTC. The 76.8% of caregivers had health problems in last six months, but 26.5% of them waited to search medical care until they were very sick, and 11% didn't do it. Also, more than a half of sample (56.1%) admitted to have risk behaviors as drink alcohol, smoke or overeating for feeling well, these caregivers showed high emotional distress and lower coping. About caregivers healthy behaviors, 80% of them had a hobby; 27.2% do exercise usually and between 12% to 60% did medical checkups (glucose tests, blood pressure and cholesterol tests, eye exams and watched their weight), these caregivers had lower emotional distress and high coping, some variables related health behaviors were: care only one patient or a female patient and be a CPOT, social support, high educational level and experience as a caregiver in past. The half of caregivers were worrying to develop cancer in the future; this idea was 2.5 times more frequent in caregiver with problems to care their health. Conclusions: The results showed a big proportion of caregivers with medical problems. High emotional distress and low coping were related to physical symptoms, risk behaviors, and low self-care; poor self-care was frequently even in caregiver who have chronic illness.

Keywords: cancer, primary caregiver, risk behaviors, self-care

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Authors: Fatima Saeed, Abdullah Mudassar

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Introduction: Patient safety remains a global priority in the ever-evolving healthcare landscape. At the forefront of this endeavor are the International Patient Safety Goals (IPSGs), a standardized framework designed to mitigate risks and elevate the quality of care. Doctors, positioned as primary caregivers, wield a pivotal role in upholding and adhering to IPSGs, underscoring the critical significance of their knowledge and understanding of these goals. This research embarks on a comprehensive exploration into the depth of Doctors ' comprehension of IPSGs, aiming to unearth potential gaps and provide insights for targeted educational interventions. Established by influential healthcare bodies, including the World Health Organization (WHO), IPSGs represent a universally applicable set of objectives spanning crucial domains such as medication safety, infection control, surgical site safety, and patient identification. Adherence to these goals has exhibited substantial reductions in adverse events, fostering an overall enhancement in the quality of care. This study operates on the fundamental premise that an informed Doctors workforce is indispensable for effectively implementing IPSGs. A nuanced understanding of these goals empowers Doctors to identify potential risks, advocate for necessary changes, and actively contribute to a safety-centric culture within healthcare institutions. Despite the acknowledged importance of IPSGs, there is a growing concern that nurses may need more knowledge to integrate these goals into their practice seamlessly. Methodology: A Comprehensive research methodology covering study design, setting, duration, sample size determination, sampling technique, and data analysis. It introduces the philosophical framework guiding the research and details material, methods, and the analysis framework. The descriptive quantitative cross-sectional study in teaching care hospitals utilized convenient sampling over six months. Data collection involved written informed consent and questionnaires, analyzed with SPSS version 23, presenting results graphically and descriptively. The chapter ensures a clear understanding of the study's design, execution, and analytical processes. Result: The survey results reveal a substantial distribution across hospitals, with 34.52% in MTIKTH and 65.48% in HMC MTI. There is a notable prevalence of patient safety incidents, emphasizing the significance of adherence to IPSGs. Positive trends are observed, including 77.0% affirming the "time-out" procedure, 81.6% acknowledging effective healthcare provider communication, and high recognition (82.7%) of the purpose of IPSGs to improve patient safety. While the survey reflects a good understanding of IPSGs, areas for improvement are identified, suggesting opportunities for targeted interventions. Discussion: The study underscores the need for tailored care approaches and highlights the bio-socio-cultural context of 'contagion,' suggesting areas for further research amid antimicrobial resistance. Shifting the focus to patient safety practices, the survey chapter provides a detailed overview of results, emphasizing workplace distribution, patient safety incidents, and positive reflections on IPSGs. The findings indicate a positive trend in patient safety practices with areas for improvement, emphasizing the ongoing need for reinforcing safety protocols and cultivating a safety-centric culture in healthcare. Conclusion: In summary, the survey indicates a positive trend in patient safety practices with a good understanding of IPSGs among participants. However, identifying areas for potential improvement suggests opportunities for targeted interventions to enhance patient safety further. Ongoing efforts to reinforce adherence to safety protocols, address identified gaps, and foster a safety culture will contribute to continuous improvements in patient care and outcomes.

Keywords: infection control, international patient safety, patient safety practices, proper medication

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Authors: Gudakesh Yadav

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Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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Authors: Elzbieta Sikorska-Simmons

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Advanced dementia is a progressive terminal brain disease that is accompanied by a syndrome of difficult to manage symptoms and complications that eventually lead to death. The management of advanced dementia poses major challenges to family caregivers who act as patient health care proxies in making medical treatment decisions. Little is known, however, about how they manage advanced dementia and how their treatment choices influence the quality of patient life. This prospective qualitative study examines the key medical treatment decisions that family caregivers make while managing advanced dementia. The term ‘family caregiver’ refers to a relative or a friend who is primarily responsible for managing patient’s medical care needs and legally authorized to give informed consent for medical treatments. Medical decision-making implies a process of choosing between treatment options in response to patient’s medical care needs (e.g., worsening comorbid conditions, pain, infections, acute medical events). Family caregivers engage in this process when they actively seek treatments or follow recommendations by healthcare professionals. Better understanding of medical decision-making from the family caregiver perspective is needed to design interventions that maximize the quality of patient life and limit inappropriate treatments. Data were collected in three waves of semi-structured interviews with 20 family caregivers for patients with advanced dementia. A purposive sample of 20 family caregivers was recruited from a senior care center in Central Florida. The qualitative personal interviews were conducted by the author in 4-5 months intervals. The ethical approval for the study was obtained prior to the data collection. Advanced dementia was operationalized as stage five or higher on the Global Deterioration Scale (GDS) (i.e., starting with the GDS score of five, patients are no longer able survive without assistance due to major cognitive and functional impairments). Information about patients’ GDS scores was obtained from the Center’s Medical Director, who had an in-depth knowledge of each patient’s health and medical treatment history. All interviews were audiotaped and transcribed verbatim. The qualitative data analysis was conducted to answer the following research questions: 1) what treatment decisions do family caregivers make while managing the symptoms of advanced dementia and 2) how do these treatment decisions influence the quality of patient life? To validate the results, the author asked each participating family caregiver if the summarized findings accurately captured his/her experiences. The identified medical decisions ranged from seeking specialist medical care to end-of-life care. The most common decisions were related to arranging medical appointments, medication management, seeking treatments for pain and other symptoms, nursing home placement, and accessing community-based healthcare services. The most challenging and consequential decisions were related to the management of acute complications, hospitalizations, and discontinuation of treatments. Decisions that had the greatest impact on the quality of patient life and survival were triggered by traumatic falls, worsening psychiatric symptoms, and aspiration pneumonia. The study findings have important implications for geriatric nurses in the context of patient/caregiver-centered dementia care. Innovative nursing approaches are needed to support family caregivers to effectively manage medical care needs of patients with advanced dementia.

Keywords: advanced dementia, family caregiver, medical decision-making, symptom management

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Authors: Khalid Alasim

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The reading comprehension levels of students who are deaf or hard of hearing (DHH) are low compared to those of their hearing peers. One possible reason for this low reading levels is related to the students’ prior knowledge. This study investigated the potential factors that might affected DHH students’ prior knowledge, including their degree of hearing loss, the presence or absence of family members with a hearing loss, and educational stage (elementary–middle school). The study also examined the contribution of prior knowledge in predicting DHH students’ reading comprehension levels, and investigated the differences in the students’ scores based on the type of questions, including text-explicit (TE), text-implicit (TI), and script-implicit (SI) questions. Thirty-one elementary and middle-school students completed a demographic form and assessment, and descriptive statistics and multiple and simple linear regressions were used to answer the research questions. The findings indicated that the independent variables—degree of hearing loss, presence or absence of family members with hearing loss, and educational stage—explained little of the variance in DHH students’ prior knowledge. Further, the results showed that the DHH students’ prior knowledge affected their reading comprehension. Finally, the result demonstrated that the participants were able to answer more of the TI questions correctly than the TE and SI questions. The study concluded that prior knowledge is important in these students’ reading comprehension, and it is also important for teachers and parents of DHH children to use effective ways to increase their students’ and children’s prior knowledge.

Keywords: reading comprehension, prior knowledge, metacognition, elementary, self-contained classrooms

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Authors: C. P. Griffin

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This paper seeks to critically review special educational needs (SEN) policy in the Irish education system since the introduction of the Education Act in 1998. In particular, the author seeks to focus on the impact of SEN policy on inclusionary practices for children with significant care needs in light of the introduction on the Special Needs Assistant (SNA) scheme. Following a systematic review of the literature, the growth of the SNA scheme in Ireland will be critically reviewed. Strengths and weaknesses of the scheme will be forwarded and comparisons drawn between contrasting international models of teaching assistant support. Based on this review, avenues for future research will be forwarded, with the aim of supporting effective inclusionary practices for children with SEN based on evidence-based practice.

Keywords: care needs, inclusion, Ireland, special needs assistants

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Authors: F. Rashno Seydari, M. Nikafrooz

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This paper intends to study needs analysis of hearing-impaired students’ teachers in elementary schools all over Iran. The subjects of this study were 275 teachers who were teaching hearing-impaired students in elementary schools. The participants were selected by a quota sampling method. To collect the data, questionnaires of training needs consisting of 41 knowledge items and 31 performance items were used. The collected data were analyzed by using SPSS software in the form of descriptive analyses (frequency and mean) and inferential analyses (one sample t-test, paired t-test, independent t-test, and Pearson correlation coefficient). The findings of the study indicated that teachers generally have considerable needs in knowledge and performance domains. In 32 items out of the total 41 knowledge domain items and in the 27 items out of the total 31 performance domain items, the teachers had considerable needs. From the quantitative point of view, the needs of the performance domain were more than those of the knowledge domain, so they have to be considered as the first priority in training these teachers. There was no difference between the level of the needs of male and female teachers. There was a significant difference between the knowledge and performance domain needs and the teachers’ teaching experience, 0.354 and 0.322 respectively. The teachers who had been trained in working with hearing-impaired students expressed more training needs (both knowledge and performance).

Keywords: educational needs analysis, teachers of hearing impaired students, knowledge domain, function domain

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Authors: Samina Khalid, Tehmina Khalil, Smeea Arshad

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Knowledge management is essential ingredient of successful coordination in globally distributed software engineering. Various frameworks, KMSs, and tools have been proposed to foster coordination and communication between virtual teams but practical implementation of these solutions has not been found. Organizations have to face challenges to implement knowledge management system. For this purpose at first, a literature review is arranged to investigate about challenges that restrict organizations to implement KMS and then by taking in account these challenges a problem of need of integrated solution in the form of standardized KMS that can easily store tacit and explicit knowledge, has traced down to facilitate coordination and collaboration among virtual teams. Literature review has been already shown that knowledge is a complex perception with profound meanings, and one of the most important resources that contributes to the competitive advantage of an organization. In order to meet the different challenges caused by not properly managing knowledge related to projects among virtual teams in GSE, we suggest making use of the cloud computing model. In this research a distributed architecture to support KM storage is proposed called conceptual framework of KM as a service in cloud. Framework presented is enhanced and conceptual framework of KM is embedded into that framework to store projects related knowledge for future use.

Keywords: management, Globsl software development, global software engineering

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Authors: M. A. Brown, K. Hugill, D. Meredith

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Since the establishment of midwifery, as a professional identity in its own right, in the early years of the 20th century, midwifery-led models of childbirth have prevailed in many parts of the world. However, in many locations midwives’ scope of practice remains underdeveloped or absent. In Qatar, all births take place in hospital and are under the professional jurisdiction of obstetricians, predominately supported by internationally trained nurse-midwives and obstetric nurses. The strategic vision for health services in Qatar endorsed a desire to provide women with the ‘Best Care Always’ and the introduction of midwifery was seen as a way to achieve this. In 2015 the process of recruiting postgraduate educated Clinical Midwife Specialists from international sources began. The midwives were brought together to initiate an in hospital and community service transformation plan. This plan set out a series of wide-ranging actions to transform maternity and neonatal services to make care safer and give women more health choices. Change in any organization is a complex and dynamic process. This is made even more complex when multifaceted professional and cross cultural factors are involved. This presentation reports upon the motivations and challenges that exist and the progress around introducing a multicultural midwifery model of childbirth care in the state of Qatar. The paper examines and reflects upon the drivers and unique features of childbirth in the country. Despite accomplishments, progress still needs to be made in order to fully implement sustainable changes to further improve care and ensure women and neonates get the ‘Best Care Always’. The progress within the transformation plan highlights how midwifery may coexist with competing models of maternity care to create an innovative, eclectic and culturally sensitive paradigm that can best serve women and neonatal health needs.

Keywords: culture, managing change, midwifery, neonatal, service transformation plan

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Authors: Che Zarrina Sa'ari, Sheriza Izwa Zainuddin, Hasimah Chik, Sharifah Basirah Syed Muhsin

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Palliative care is holistic care for patients with serious illnesses and for the family as well by interdisciplinary specialties to optimize quality of life by preventing, treating, and comforting the suffering and struggling. Palliative care is not a curative treatment but a comprehensive care to ensure the well-being of patients. This study was to identify the perceptions of patients and carers on healthcare needs and any factors related to the needs of palliative patients. Validated questionnaires survey of 254 patients and carers were analysed using a Statistical Package for the Social Sciences (SPSS) version 22. The findings were processed with Cronbach Alpha analysis, frequency, and descriptive to compare the important of each element in healthcare. Open-ended responses were analysed using thematic framework approach. The findings proved that all the items in healthcare needs elements were important because the frequency shown higher values, which were physical needs (5.91), mental needs (6.10), spiritual needs (6.34), emotional needs (6.05), social needs (5.88) and logistics needs (5.05). The total score of Cronbach’s alpha (α) for this study is 0.958, which is suggesting very good internal consistency reliability for the elements for healthcare needs. Professionals and healthcare providers need to ensure healthcare planning is individualised by tailoring it to the values, priorities, and ethnic/cultural/religious context of each person.

Keywords: healthcare, need, holistic, palliative, multi speciality

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Authors: Osalina Toemapa, Rika Susanti, Husna Yetti

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In criminal offense case, such as homicide, investigators may request for an autopsy to the victim without family approval in Indonesia. Generally, there has been decreasing in autopsy rate in the world over past years. Family’s refusal is one of the most common problems. The purpose of this study is to find the correlation between knowledge level and public perception of autopsy on criminal offense victim. This cross-sectional study was done from April to May 2017 in subdistrict Pulau Punjung. Participants were asked to fill the questionnaire. There are 15 questions to asses knowledge level, perception, and factors influencing autopsy refusal. The chi-square test was used for the statistical analysis. Out of the total of 436 respondents, 54,5% were found to have poor knowledge level, and 56,7% were found to have poor perception. There was a significant correlation between knowledge level and public perception (p<0,001). There are 153 respondents who decline autopsy on criminal offense victim with the most factors influencing autopsy refusal is delays in victim’s funeral (92,2%). Conclusion, knowledge level is correlated with public perception in subdistrict of Pulau Punjung, district of Dharmasraya, West Sumatra, Indonesia. Most influencing factor in autopsy refusal is delays in victim’s funeral.

Keywords: knowledge level, public perception, autopsy on criminal offense victim, autopsy refusal

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Authors: William Coburn, Dylan Hauchard, Amel Naouali

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Background: The nature of the HIV epidemic in Puerto Rico (PR) is less understood than in the continental U.S. There is evidence to suggest that there are differences in health care access based on geographical location, such that rural areas are less underserved and have less immediate access to HIV prevention resources. Methods: The current study consists of a cross-sectional online survey of self-reporting HIV-negative sexual minority men (SMM) residing in PR. Results: In this sample, there were no differences between urban and rural-based services for SMM. However, more than half of the sample reported that they have never disclosed their gender identity and sexual practices to a physician. Conclusion: HIV is a significant public health concern affecting Latinos/Hispanics in the U.S. Findings in this paper can have implications for HIV prevention services in PR specifically, as few studies have directly focused on the impact of HIV and health care services in PR outside of the continental U.S.

Keywords: HIV, Puerto Rico, infectious diseases , public health

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Authors: Garima Singh

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Objectives: Behavioral Crisis Center (BCC) is a community solution to a community problem. There has been an exponential increase in the incidence and prevalence of mental health crises around the world. The effects of the crisis negatively impact our patients and their families and strain the law enforcement and emergency room. The goal of the multi-disciplinary care model is to break the crisis cycle and provide 24-7 rapid access to an acre and crisis stabilization. We initiated our first BCC care center in 2020 in the midst of the COVID pandemic and have seen a remarkable improvement in patient ‘care and positive financial outcome. Background: Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). This number represented 21.0% of all U.S. adults. To address some of these challenges and help our community, In May 2020, we opened our first Behavioral crisis center (BCC). Since then, we have served more than 2500 patients and is the first southwest Missouri’s first 24/7 facility for crisis–level behavioral health and substance use needs. It has been proven to be a more effective place than emergency departments, jails, or local law enforcement. Methods: BCC was started in 2020 to serve the unmet need of the community and provide access to behavioral health and substance use services identified in the community. Funding was possible with significant investment from the county and Missouri Foundation for Health, with contributions from medical partners. It is a multi-disciplinary care center consisting of Physicians, nurse practitioners, nurses, behavioral technicians, peer support specialists, clinical intake specialists, and clinical coordinators and hospitality specialists. The center provides services including psychiatry care, outpatient therapy, community support services, primary care, peer support and engagement. It is connected to a residential treatment facility for substance use treatment for continuity of care and bridging the gap, which has resulted in the completion of treatment and better outcomes. Results: BCC has proven to be a great resource to the community and the Missouri Health Coalition is providing funding to replicate the model in other regions and work on a similar model for children and adolescents. Overall, 29% of the patients seen at BCC are stabilized and discharged with outpatient care. 50% needed acute stabilization in a hospital setting and 21% required long-term admission, mostly for substance use treatment. The local emergency room had a 42% reduction in behavioral health encounters compared to the previous 3 years. Also, by a quick transfer to BCC, the average stay in ER was reduced by 10 hours and time to follow up behavioral health assessment decreased by an average of 4 hours. Uninsured patients are also provided Medicaid application assistance which has benefited 55% of individuals receiving care at BCC. Conclusions: BCC is impacting community health and improving access to quality care and substance use treatment. It is a great investment for our patients and families.

Keywords: BCC, behvaioral health, community health care, addiction treatment

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Authors: Nadera Al Hourani

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The study aimed at testing the effect of the organizational factors on reinforcing the knowledge sharing competence in the Jordanian commercial banks. The study population consisted of all the commercial banks working in Jordan according to the statistics of the Jordanian Banks Association by the end of 2010 (n=12). The researchers took a sample of the branch managers (n=240), and constructed a questionnaire to achieve the objective of the study. 235 questionnaires were returned and 16 were discarded due to incompleteness of their data, thus accepting 219 questionnaires. The results of the study indicated statistically significant effect of the organizational factors with their elements: (organizational structure, organizational culture, and human resources policy) in knowledge sharing. The study recommended that the Jordanian commercial banks have to continue attention to the organizational factors through supporting the less important variables and lowest means within the independent variable (organizational factors). The organizational structure came lowest, which urges the management of the commercial banks to adopt a flexible organizational structure capable to reinforce the knowledge sharing competence.

Keywords: banks, Jordan, knowledge, organizational factors, sharing

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Authors: Renato Figueira Franco

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This paper aims to create a representational information system applied to the securities market, particularly the development of an ontology applied to the analysis of the Key Information Documents of Contracts for Difference. The process of obtaining knowledge and its proper formal representation has raised the attention both from the scientific literature and the capital markets supervisory authorities. The formal knowledge representation is embodied in the construction of ontologies, which are responsible for defining a knowledge base structure of a given scientific domain, facilitating its understanding, and allowing its sharing among the scientific community. The scope of this study is restricted to the analysis of capital markets ontologies in order to capture its structure, semantics and knowledge sharing between people and systems.

Keywords: ontology, financial markets, CFD, PRIIPs, key information documents

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Authors: Davod Ahmadigheidari, Isabel Alvarez, Kate Sinclair, Marnie Davidson, Patrick Cortbaoui, Hugo Melgar-Quiñonez

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The burden of collecting water tends to disproportionately fall on women and girls in low-income countries. Specifically, women spend between one to eight hours per day fetching water for domestic use in Sub-Saharan Africa. While there has been research done on the global time burden for collecting water, it has been mainly focused on water quality parameters; leaving the relationship between water fetching and health outcomes understudied. There is little available evidence regarding the relationship between water fetching and maternal child care practices. The main objective of this study was to help fill the aforementioned gap in the literature. Data from two surveys in Ethiopia and Malawi conducted by CARE Canada in 2016-2017 were used. Descriptive statistics indicate that women were predominantly responsible for collecting water in both Ethiopia (87%) and Malawi (99%) respectively, with the majority spending more than 30 minutes per day on water collection. With regards to child care practices, in both countries, breastfeeding was relatively high (77% and 82%, respectively); and treatment for malnutrition was low (15% and 8%, respectively). However, the same consistency was not found for weighing; in Ethiopia only 16% took their children for weighting in contrast to 94% in Malawi. These three practices were summed to create one variable for regressions analyses. Unadjusted logistic regression findings showed that only in Ethiopia was time fetching water significantly associated with child care practices. Once adjusted for covariates, this relationship was no longer found to be significant. Adjusted logistic regressions also showed that the factors that did influence child care practices differed slightly between the two countries. In Ethiopia, a lack of access to community water supply (OR= 0.668; P=0.010), poor attitudes towards gender equality (OR= 0.608; P=0.001), no access to land and (OR=0.603; P=0.000), significantly decreased a women’s odd of using positive childcare practices. Notably, being young women between 15-24 years (OR=2.308; P=0.017), and 25-29 (OR=2.065; P=0.028) increased probability of using positive childcare practices. Whereas in Malawi, higher maternal age, low decision-making power, significantly decreased a women’s odd of using positive childcare practices. In conclusion, this study found that even though amount of time spent by women fetching water makes a difference for childcare practices, it is not significantly related to women’s child care practices when controlling the covariates. Importantly, women’s age contributes to child care practices in Ethiopia and Malawi.

Keywords: time fetching water, community water supply, women’s child care practices, Ethiopia, Malawi

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Authors: Tanisha Dutta, Vinayak S. Adane

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A Hindu temple has always been the centre of worldly knowledge, art, culture, and spiritual knowledge. The temple centers and the temple structures alike, teach the observer about all kinds of worldly systems, codes of conduct, performing and other arts etc. During the medieval period, these were the only centers of knowledge. Therefore, these spaces had the burden and responsibility of covering all the various facets of life. It is understandable therefore, that a Hindu temple is easily the confluence of intricate architecture, cultural blossoming and spiritual knowledge transmittance. The architecture of a Hindu temple supports all these in a way that they co-exist and develop a symbiotic relationship, each enhancing the manifested form of the other. This symbiosis is presented through the temples of Khajuraho, India. This paper, therefore, elaborates the finer aspects of the mentioned areas in a Hindu temple context, through the case study of the Khajuraho group of temples.

Keywords: Hindu temples' concept, symbolism, temple architecture

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Authors: K. A. Tharanga, K. H. H. Damayanthi

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Perception is an epistemological concept discussed in Philosophy. Perception, in other word, vision, is one of the ways that human beings get empirical knowledge after five senses. However, we face innumerable problems when achieving knowledge from perception, and therefore the knowledge gained through perception is uncertain. what we see in the external world is not real. These are the major issues that we face when receiving knowledge through perception. Sometimes there is no physical existence of what we really see. In such cases, the perception is relative. The following frames will be taken into consideration when perception is analyzed illusions and delusions, the figure of a physical object, appearance and the reality of a physical object, time factor, and colour of a physical object.seeing and knowing become vary according to the above conceptual frames. We cannot come to a proper conclusion of what we see in the empirical world. Because the things that we see are not really there. Hence the scientific knowledge which is gained from observation is doubtful. All the factors discussed in science remain in the physical world. There is a leap from ones existence to the existence of a world outside his/her mind. Indeed, one can suppose that what he/she takes to be real is just anmassive deception. However, depending on the above facts, if someone begins to doubt about the whole world, it is unavoidable to become his/her view a scepticism or nihilism. This is a certain reality.

Keywords: empirical, perception, sceptisism, nihilism

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Authors: Jessica Raven Gates, Gemma Wilson-Menzfeld, Professor Alison Steven

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In 2019, the Primary Care system in the UK National Health Service (NHS) was subject to reform and restructuring. Primary Care Networks (PCNs) were established, which aligned with a trend towards integrated care both within the NHS and internationally. The introduction of PCNs brought groups of GP practices in a locality together, to operate as a network, build on existing services and collaborate at a larger scale. PCNs were expected to bring a range of benefits to patients and address some of the workforce pressures in the NHS, through an expanded and collaborative workforce. The early establishment of PCNs was disrupted by the emerging COVID-19 pandemic. This study, set in the context of the pandemic, aimed to explore experiences of the PCN workforce, and their perceptions of the establishment of PCNs. Specific objectives focussed on examining factors perceived as enabling or hindering the success of a PCN, the impact on day-to-day work, the approach to implementing change, and the influence of the COVID-19 pandemic upon PCN development. This study is part of a three-phase PhD project that utilized qualitative approaches and was underpinned by social constructionist philosophy. Phase 1: a systematic narrative review explored the provision of preventative healthcare services in UK primary settings and examined facilitators and barriers to delivery as experienced by the workforce. Phase 2: informed by the findings of phase 1, semi-structured interviews were conducted with fifteen participants (PCN workforce). Phase 3: follow-up interviews were conducted with original participants to examine any changes to their experiences and perceptions of PCNs. Three main themes span across phases 2 and 3 and were generated through a Framework Analysis approach: 1) working together at scale, 2) network infrastructure, and 3) PCN leadership. Findings suggest that through efforts to work together at scale and collaborate as a network, participants have broadly accepted the concept of PCNs. However, the workforce has been hampered by system design and system complexity. Operating against such barriers has led to a negative psychological impact on some PCN leaders and others in the PCN workforce. While the pandemic undeniably increased pressure on healthcare systems around the world, it also acted as a disruptor, offering a glimpse into how collaboration in primary care can work well. Through the integration of findings from all phases, a new theoretical model has been developed, which conceptualises the findings from this Ph.D. study and demonstrates how the workforce has experienced change associated with the establishment of PCNs. The model includes a contextual component of the COVID-19 pandemic and has been informed by concepts from Complex Adaptive Systems theory. This model is the original contribution to knowledge of the PhD project, alongside recommendations for practice, policy and future research. This study is significant in the realm of health services research, and while the setting for this study is the UK NHS, the findings will be of interest to an international audience as the research provides insight into how the healthcare workforce may experience imposed policy and service changes.

Keywords: health services research, qualitative research, NHS workforce, primary care

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Authors: Harjinder Kaur

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GST was implemented by government with the expectation to reform the taxation system of India. So this study basically seeks to understand the consumers’ awareness, knowledge and perception about the implementation of GST. To conduct this study, 100 respondents of all demographic profile were randomly selected from the Punjab region of India. To investigate the relationship between demographic profile and level of awareness and knowledge about GST, one way ANOVA test was used and it is found that there is a significant relationship between gender, age and qualification and level of awareness and knowledge. Furthermore, due to the lack of information on GST, the respondents had a high negative perception. The study also reveals that the implementation of GST has resulted in higher prices for goods and services and thus this tax may cause burden to people. Also after implementation of GST financial issues such as inflation, rising cost of living, economic instability have impacted many Indian consumers in terms of their spending. But at the same time it is also perceived that GST is designed to remove the burden of many indirect taxes and aims to develop the more efficient tax system which increases the revenue of country.

Keywords: goods and service tax, consumers awareness, knowledge, perception

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Authors: Onur Özdemir, M.Erhan ORHAN

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Knowledge Development (KD) is just one of the important phases of Knowledge Management (KM). KD is the phase in which intelligence is used to see the big picture. In order to understand whether information is important or not, we have to use the intelligence cycle that includes four main steps: aiming, collecting data, processing and utilizing. KD also needs these steps. To make a precise decision, the decision maker has to be aware of his subordinates’ ideas. If the decision maker ignores the ideas of his subordinates or participants of the organization, it is not possible for him to get the target. KD is a way of using wisdom to accumulate the puzzle. If the decision maker does not bring together the puzzle pieces, he cannot get the big picture, and this shows its effects on the battlefield. In order to understand the battlefield, the decision maker has to use the intelligence cycle. To convert information to knowledge, KD is the main means for the intelligence cycle. On the other hand, the “Z Generation” born after the millennium are really the game changers. They have different attitudes from their elders. Their understanding of life is different - the definition of freedom and independence have different meanings to them than others. Decision makers have to consider these factors and rethink their decisions accordingly. This article tries to explain the relation between KD and Generation Z. KD is the main method of target managing. But if leaders neglect their people, the world will be seeing much more movements like the Arab Spring and other insurgencies.

Keywords: knowledge development, knowledge management, generation Z, intelligence cycle

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Authors: John Angelo Labuguen, Sarah Joy Salvio

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Despite the low prevalence rate of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in the Philippines, the country is one of the seven countries in the world and the only country in Southeast Asia which reported an increasing trend in the number of people infected with HIV. Furthermore, people getting infected with HIV are becoming younger every year. Eighty-five percent (7,103) of the total number of youth (15-24 years old) with HIV were recorded in the past five years. The rising rates of HIV infection suggest the need to understand HIV knowledge, attitudes, and sexual behaviors among the youth in the Philippines. The University of the Philippines (UP), having a population that represents all regions of the country, can be reflective of the current situation of the Filipino youth in the issue of HIV/AIDS. This paper attempted to: (1) assess the level of knowledge on HIV/AIDS; (2) describe the attitude towards people living with HIV/AIDS; (3) identify socio-demographic and sexual behaviors associated with the level of HIV/AIDS knowledge; and (4) determine how knowledge on HIV/AIDS is related with attitude towards people living with HIV/AIDS among tertiary students of the UP Diliman. Self-administered survey was used to collect data from 308 randomly selected respondents. Data was encoded using CS Pro 6.2 and it was exported to SPSS v23 for further analysis. Findings of the study revealed that comprehensive correct knowledge on HIV/AIDS is associated with a somewhat accepting attitude towards PLWHA. Sociodemographic and sexual behavior characteristics do not contribute to the association between level of knowledge about HIV/AIDS and attitude towards PLWHA.

Keywords: attitude towards people living with HIV/AIDS, comprehensive HIV/AIDS knowledge, Philippines, university students

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Authors: Eng Rima Al-Awadhi, Abdul Jaleel Tharayil

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In a project-centric organization like KOC, managing the knowledge of the project is of critical importance to the success of the project and the organization. However, due to the very nature and complexity involved, each project engagement generates a lot of 'learnings' that need to be factored into while new projects are initiated and thus avoid repeating the same mistake. But, many a time these learnings are localized and remains as ‘tacit knowledge’ leading to scope re-work, schedule overrun, adjustment orders, concession requests and claims. While KOC follows an asset based organization structure, with a multi-cultural and multi-ethnic workforce and larger chunk of the work is carried out through complex, long term project engagement, diffusion of ‘learnings’ across assets while dealing with the natural entropy of the organization is of great significance. Considering the relatively higher number of mega projects, it's important that the issues raised during the project life cycle are centrally harvested, analyzed and the ‘learnings’ from these issues are shared, absorbed and are in-turn utilized to enhance and refine the existing process and practices, leading to improve the project performance. One of the many factors contributing to the successful completion of a project on time is the reduction in the number of variations or concessions triggered during the project life cycle. The project process integrated knowledge sharing framework discusses the knowledge harvesting methodology adopted, the challenges faced, learnings acquired and its impact on project performance. The framework facilitates the proactive identification of issues that may have an impact on the overall quality of the project and improve performance.

Keywords: knowledge harvesting, project integrated knowledge sharing, performance improvement, knowledge management, lessons learn

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Authors: John Kosmeh

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Introduction – For years, senior health care and skilled nursing facilities have been plagued with the dilemma of not having the necessary tools and equipment to adequately care for senior residents in their communities. This has led to high transport rates to emergency departments and high 30-day readmission rates, costing billions of unnecessary dollars each year, as well as quality assurance issues. Our Senior care telemedicine program is designed to solve this issue. Methods – We conducted a 1-year pilot program using our technology coupled with our 24/7 telemedicine program with skilled nursing facilities in different parts of the United States. We then compared transports rates and 30-day readmission rates to previous years before the use of our program, as well as transport rates of other communities of similar size not using our program. This data was able to give us a clear and concise look at the success rate of reducing unnecessary transport and readmissions as well as cost savings. Results – A 94% reduction nationally of unnecessary out-of-facility transports, and to date, complete elimination of 30-day readmissions. Our virtual platform allowed us to instruct facility staff on the utilization of our tools and system as well as deliver treatment by our ER-trained providers. Delay waiting for PCP callbacks was eliminated. We were able to obtain lung, heart, and abdominal ultrasound imaging, 12 lead EKG, blood labs, auscultate lung and heart sounds, and collect other diagnostic tests at the bedside within minutes, providing immediate care and allowing us to treat residents within the SNF. Are virtual capabilities allowed for loved ones, family members, and others who had medical power of attorney to virtually connect with us at the time of visit, to speak directly with the medical provider, providing increased confidence in the decision to treat the resident in-house. The decline in transports and readmissions will greatly reduce governmental cost burdens, as well as fines imposed on SNF for high 30-day readmissions, reduce the cost of Medicare A readmissions, and significantly impact the number of patients visiting overcrowded ERs. Discussion – By utilizing our program, SNF can effectively reduce the number of unnecessary transports of residents, as well as create significant savings from loss of day rates, transportation costs, and high CMS fines. The cost saving is in the thousands monthly, but more importantly, these facilities can create a higher quality of life and medical care for residents by providing definitive care instantly with ER-trained personnel.

Keywords: senior care, long term care, telemedicine, technology, senior care communities

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Authors: Sahar Esmaeili, Ramezanali Ghaderi sanavi, Masoomeh Maarefvand, Samaneh Hosseinzadeh

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Introduction: Conducted researches reveal that nowadays, 60 percent of women around the world are the households. The adverse economic condition causes female-headed households and their children to be the most vulnerable people against social harm. Mainly a symptoms of mental illness such as depression, anxiety, obsession and aggression can be seen in female-headed households and their children are potentially exposed to issues such as crime-work, child labor in the black and informal jobs, education deprivation and malnutrition. The aim of this study is to evaluate the effect of Orem self-care education with the FGC technique on the public health of female-headed households. Methods: Sixty-four Female-headed householders who were supported by Saleh Foundation participated in a clinical trial study and were assigned to the case (n=32) and control (n=32) groups. The case group received 4-session Orem’s self-care education with family group conferencing technique. Data were collected using the demographic questionnaire and General Health Questionnaire (GHQ-28) prior to intervention and post-intervention. ANOVA was used to evaluate outcomes. Results: The results showed significant improvement of the intervention group in GHQ (P<0.001) and subscales of Physical Health (P<0.001) Agitation and Insomnia (P<0.001) and Social disorder (P<0.001) and Depression (P<0.001) compared with the control group after the intervention. Conclusion: The intervention of Orem’s self-care education with family group conferencing technique was effective in improving the General Health of Female-headed households

Keywords: orem’s self-care, female-headed households, general health, group

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Authors: Tiron-Tudor Adriana, Ciolomic Ioana, Farcas Teodora

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The mission of a business school is to train students for business careers in which practical skills- based on theoretical knowledge- are needed. These skills include a thorough knowledge of languages, creative skills, and well-founded professional and practical knowledge. With those skills, the graduates are highly competitive in the labour market. The paper objective is to disseminate the results of an international project by revealing how a HEI are prepared for higher vocational training course leading to professional diplomas.

Keywords: vocational education, business schools, international projects, HEI

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Authors: R. Byler

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Innovation, particularly in technology development, is a crucial aspect of nanotechnology R&D and, although several approaches to effective innovation management exist, organizational structures that promote knowledge exchange have been found to be most effect in supporting new and emerging technologies. This paper discusses Integrated Knowledge Networks (IKNs) and evaluates its use within nanotechnology R&D to increase technology innovation. Specifically, this paper reviews the role of IKNs in bolstering national and international nanotechnology development and in enhancing nanotechnology innovation. Both physical and virtual IKNs, particularly IT-based network platforms for community-based innovation, offer strategies for enhanced technology innovation, interdisciplinary cooperation, and enterprise development. Effectively creating and managing technology R&D networks can facilitate successful knowledge exchange, enhanced innovation, commercialization, and technology transfer. As such, IKNs are crucial to technology development processes and, thus, in increasing the quality and access to new, innovative nanoscience and technologies worldwide.

Keywords: community-based innovation, integrated knowledge networks, nanotechnology, technology innovation

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Authors: Sedigheh Salemi, Mahnaz Sanjari, Maryam Aalaa, Mohammad Mirzabeigi

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Clinical governance is the framework within which the health service provider is required to ongoing accountability and improvement of the quality of their services. This cross-sectional study was conducted in 661 nurses who work in government hospitals from 35 hospitals of 9 provinces in Iran. The study was approved by the Nursing Council and was carried out with the authorization of the Research Ethics Committee. The questionnaire included 24 questions in which 4 questions focused on clinical governance defining from the nurses' perspective. The reliability was evaluated by Cronbach's alpha (α=0/83). Statistical analyzes were performed, using SPSS version 16. Approximately 40% of nurses correctly answered that clinical governance is not "system of punishment and rewards for the staff". The most nurses believed that "clinical efficacy" is one of the main components of clinical governance. A few of nurses correctly responded that "Evidence Based Practice" and "management" is not part of clinical governance. The small number of nurses correctly answered that the "maintenance of patient records" and "to recognize the adverse effects" is not the role of nurse in clinical governance. Most "do not know" answer was to the "maintenance of patient records". The most nurses unanimously believed that the implementation of clinical governance led to "promoting the quality of care". About a third of nurses correctly stated that the implementation of clinical governance will not lead to "an increase in salaries and benefits of the medical team". As a member of the health team, nurses are responsible in terms of participation in quality improvement and it is necessary to create an environment in which clinical care will flourish and serve to preserve the high standards.

Keywords: clinical governance, nurses, salary, health team

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Authors: Ismail Celik, Pavlo Antonenko, Seyit Ahmet Kiray, Ismail Sahin

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The aim of the present study was to thoroughly investigate the teachers’ interactive whiteboards (IWBs) use within the scope of the technological pedagogical and content knowledge (TPACK) framework based on the school practice observations of in-service teachers collected by pre-service teachers. In this study, teachers’ use of IWBs in their classes was investigated by using phenomenography, which is a qualitative research method design. The participants of this study consisted of teachers working in a province of Turkey. Within the scope of the study, 337 teachers from 61 different schools were observed by preservice teachers during School Experience classes. The teachers use the IWBs to review the points not understood by the students, to share knowledge, to enhance motivation, to maintain student participation/practice and for in-process, formative assessment. The problems teachers face while using the IWBs can be IWB-based (touchscreen problems/frozen image/lack of software), administration-based, student-based and teacher-based (lack of knowledge of use, need for technical support). It is considered that technological knowledge (TK) is important in solving the problems experienced with IWBs, and technological pedagogy knowledge (TPK) and technological content knowledge (TCK) are important in using the IWBs in an interactive and pedagogically meaningful way that uses IWBs affordances and is relevant to the instructional objectives.

Keywords: TPACK, technology integration, interactive whiteboard, technology in education

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Authors: Jill Hanass-Hancock, Bradley Carpenter, Samantha Willan, Kristin Dunkle

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Access to quality health care for persons with disabilities is the litmus test in our strive toward universal health coverage. Persons with disabilities experience a variety of health disparities related to increased health risks, greater socioeconomic challenges, and persistent ableism in the provision of health care. In low- and middle-income countries, the support needed to address the diverse needs of persons with disabilities and close the gaps in inclusive and accessible health care can appear overwhelming to staff with little knowledge and tools available. An action-orientated disability inclusion toolkit for health facilities was developed through consensus-building consultations and field testing in South Africa. The co-creation of the toolkit followed a bottom-up approach with healthcare staff and persons with disabilities in two developmental cycles. In cycle one, a disability facility assessment tool was developed to increase awareness of disability accessibility and service delivery gaps in primary healthcare services in a simple and action-orientated way. In cycle two, an intervention menu was created, enabling staff to respond to identified gaps and improve accessibility and inclusion. Each cycle followed five distinct steps of development: a review of needs and existing tools, design of the draft tool, consensus discussion to adapt the tool, pilot-testing and adaptation of the tool, and identification of the next steps. The continued consultations, adaptations, and field-testing allowed the team to discuss and test several adaptations while co-creating a meaningful and feasible toolkit with healthcare staff and persons with disabilities. This approach led to a simplified tool design with ‘key elements’ needed to achieve universal health coverage: universal design of health facilities, reasonable accommodation, health care worker training, and care pathway linkages. The toolkit was adapted for paper or digital data entry, produces automated, instant facility reports, and has easy-to-use training guides and online modules. The cyclic approach enabled the team to respond to emerging needs. The pilot testing of the facility assessment tool revealed that healthcare workers took significant actions to change their facilities after an assessment. However, staff needed information on how to improve disability accessibility and inclusion, where to acquire accredited training, and how to improve disability data collection, referrals, and follow-up. Hence, intervention options were needed for each ‘key element’. In consultation with representatives from the health and disability sectors, tangible and feasible solutions/interventions were identified. This process included the development of immediate/low-cost and long-term solutions. The approach gained buy-in from both sectors, who called for including the toolkit in the standard quality assessments for South Africa’s health care services. Furthermore, the process identified tangible solutions for each ‘key element’ and highlighted where research and development are urgently needed. The cyclic and consultative approach enabled the development of a feasible facility assessment tool and a complementary intervention menu, moving facilities toward universal health coverage for and persons with disabilities in low- or better-resourced contexts while identifying gaps in the availability of interventions.

Keywords: public health, disability, accessibility, inclusive health care, universal health coverage

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