Search results for: students education
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10238

Search results for: students education

728 Challenges of Outreach Team Leaders in Managing Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in Kwazulu-Natal

Authors: E. M. Mhlongo, E. Lutge

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In 2010, South Africa’s National Department of Health (NDoH) launched national primary health care (PHC) initiative to strengthen health promotion, disease prevention, and early disease detection. The strategy, called Re-engineering Primary Health Care (rPHC), aims to support a preventive and health-promoting community-based PHC model by using community-based outreach teams (known in South Africa as Ward-based Primary Health Care Outreach teams or WBPHCOTs). These teams provide health education, promote healthy behaviors, assess community health needs, manage minor health problems, and support linkages to health services and health facilities. Ward based primary health care outreach teams are supervised by a professional nurse who is the outreach team leader. In South Africa, the WBPHCOTs have been established, registered, and are reporting their activities in the District Health Information System (DHIS). This study explored and described the challenges faced by outreach team leaders in supporting and supervising the WBPHCOTs. Qualitative data were obtained through interviews conducted with the outreach team leaders at a sub-district level. Thematic analysis of data was done. Findings revealed some challenges faced by team leaders in day to day execution of their duties. Issues such as staff shortages, inadequate resources to carry out health promotion activities, and lack of co-operation from team members may undermine the capacity of team leaders to support and supervise the WBPHCOTs. Many community members are under the impression that the outreach team is responsible for bringing the clinic to the community while the outreach teams do not carry any medication/treatment with them when doing home visits. The study further highlights issues around the challenges of WBPHCOTs at a household level. In conclusion, the WBPHCOTs are an important component of National Health Insurance (NHI), and in order for NHI to be optimally implemented, the issues raised in this research should be addressed with some urgency.

Keywords: community health worker, national health insurance, primary health care, ward-based primary health care outreach teams

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727 The Effect of Transactional Analysis Group Training on Self-Knowledge and Its Ego States (The Child, Parent, and Adult): A Quasi-Experimental Study Applied to Counselors of Tehran

Authors: Mehravar Javid, Sadrieh Khajavi Mazanderani, Kelly Gleischman, Zoe Andris

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The present study was conducted with the aim of investigating the effectiveness of transactional analysis group training on self-knowledge and Its dimensions (self, child, and adult) in counselors working in public and private high schools in Tehran. Counseling has become an important job for society, and there is a need for consultants in organizations. Providing better and more efficient counseling is one of the goals of the education system. The personal characteristics of counselors are important for the success of the therapy. In TA, humans have three ego states, which are named parent, adult, and child, and the main concept in the transactional analysis is self-state, which means a stable feeling and pattern of thinking related to behavioral patterns. Self-knowledge, considered a prerequisite to effective communication, fosters psychological growth, and recognizing it, is pivotal for emotional development, leading to profound insights. The research sample included 30 working counselors (22 women and 8 men) in the academic year 2019-2020 who achieved the lowest scores on the self-knowledge questionnaire. The research method was quasi-experimental with a control group (15 people in the experimental group and 15 people in the control group). The research tool was a self-awareness questionnaire with 29 questions and three subscales (child, parent, and adult Ego state). The experimental group was exposed to transactional analysis training for 10 once-weekly 2-hour sessions; the questionnaire was implemented in both groups (post-test). Multivariate covariance analysis was used to analyze the data. The data showed that the level of self-awareness of counselors who received transactional analysis training is higher than that of counselors who did not receive any training (p<0.01). The result obtained from this analysis shows that transactional analysis training is an effective therapy for enhancing self-knowledge and its subscales (Adult ego state, Parent ego state, and Child ego state). Teaching transactional analysis increases self-knowledge, and self-realization and helps people to achieve independence and remove irresponsibility to improve intra-personal and interpersonal relationships.

Keywords: ego state, group, transactional analysis, self-knowledge

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726 The Examination of Parents’ Perceptions and Motivations Regarding Type 1 Diabetes Management Technologies

Authors: Maria Dora Horvath, Norbert Buzas, Zsanett Tesch

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Diabetes management poses many unique challenges for children and their parents. The use of a diabetes management device should not be one of these challenges as the purpose of these devices is to make the management more convenient. The objective of our study was to examine how demographical, psychological and diabetes-related factors determine the choices parents make regarding their child’s diabetes management technologies and how they perceive advanced devices. We conducted the study using an online questionnaire with 318 parents (mostly mothers). The questions of the survey were about demographical, diabetes-related and psychological factors (diabetes management problems, diabetes management competence). In addition, we asked the parents opinions about advanced diabetes management devices. We expanded our data with semi-structured in-depth interviews. 61 % of the participants Self-Monitored Blood Glucose (SMBG), and 39 % used a Continuous Glucose Monitoring System (CGM). Considering insulin administration, 58 % used Multiple Daily Insulin Injections (MDII) and 42 % used Continuous Subcutaneous Insulin Infusion (CSII). Parents who used diverse combinations of diabetes management devices showed significant differences in age (parents’ and child’s), the monthly cost of diabetes, the duration of diabetes, the highest level of education and average monthly household income. CGM users perceived diabetes management problems significantly more severe than SMBG users and CSII users felt significantly more competent in diabetes management than MDII users. Avoiding CGM use due to lack of financial resources was determined by diagnosis duration. While avoiding its use by the cause of the child rejecting, it was determined by the child’s age and diabetes competence. Using MDII instead of CSII because of the child’s rejection was determined by the monthly cost of diabetes and child’s age. We conducted a complex empirical study in which we examined perceptions and experiences of advanced and less advanced diabetes management technologies comprehensively. Our study highlights the factors that fundamentally influence parents’ motivations and choices about diabetes management technologies. These results could contribute to developing diabetes management technologies more suitable for children living with type 1 diabetes and their parents.

Keywords: advanced diabetes management technologies, children living with type 1 diabetes, diabetes management, motivation, parents

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725 Organic Paddy Production as a Coping Strategy to the Adverse Impact of Climate Change

Authors: Thapa M., J.P. Dutta, K.R. Pandey, R.R. Kattel

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Nepal is extremely vulnerable to the impact of climate change. To mitigate the climate change effects on agricultural production and productivity a range of adaptive strategies needs to be considered. The study was conducted to assess organic paddy production as a coping strategy to the adverse impact of climate change in Phulbari, VDC of Chitwan district. Altogether, 120 respondents (60 adopters of organic farming and 60 from non adopter) were selected using snowball technique of sampling. Pre- tested interview schedule, direct observation, focus group discussion, key informant interview as well as secondary data were used to collect the required information. Factors determining the adoption of organic farming were found to be age, year of schooling, training, frequency of extension contact, perception about climate change, economically active members and poor. A unit increase in these factors except poor would increase the probability of adoption by 4.1%, 7.5%, 7.8%, 43.1%, 41.8% and 7% respectively. However, for poor, it would decrease the probability of adoption of organic farming by 5.1%. Average organic matter content in the adopters' field was higher (2.7%) than the non-adopters' field (2.5%). The regression result showed that type of farmer, price and area under rice cultivation had positive and significant relationship with income; however dependency ratio had negative relationship. As the year of adoption of organic farming increases, the production of rice decline in the first two years then after goes on increasing but the cost of production goes on decreasing with the year of adoption. The respondents adapted to the changing climate through diversification of crops, use of resistance varieties and following good cropping pattern. Gradually growing consumers' awareness about health, preference towards quality food products are the strong points behind organic farming, whereas lacks of bio-fertilizers, lack of effective extension services, no price differentiation between organic and inorganic products were the weak points. There is need for more training and education to change the attitude of farmers and enhance their confidence about the role of organic farming to cope with climate change impact.

Keywords: Organic farming, climate change, sustainable development

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724 Indigenous Learning of Animal Metaphors: The ‘Big Five’ in King Shaka’s Praise-Poems

Authors: Ntandoni Gloria Biyela

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During traditional times, there were no formal institutions of learning as they are today, where children attend classes to acquire or develop knowledge. This does not mean that there was no learning in indigenous African societies. Grandparents used to tell their grandchildren stories or teach them educational games around the fireplace, which this study refers to as a ‘traditional classroom’. A story recreated in symbolic or allegorical way, forms a base for a society’s beliefs, customs, accepted norms and language learning. Through folklore narratives, a society develops its own self awareness and education. So narrative characters, especially animals may be mythical products of the pre-literate folklore world and thus show the closeness that the Zulu society had with the wildlife. Oral cultures strive to create new facets of meaning by the use of animal metaphors to reflect the relationship of humans with the animal realm and to contribute to the language learning or literature in cross-cultural studies. Although animal metaphors are widespread in Zulu language because of the Zulu nation’s traditional closeness to wildlife, little field-research has been conducted on the social behavior of animals on the way in which their characteristics were transferred with precision to depictions of King Shaka’s behavior and activities during the amalgamation of Nguni clans into a Zulu kingdom. This study attempts to fill the gap by using first-hand interviews with local informants in areas traditionally linked to the king in KwaZulu-Natal province, South Africa. Departing from the conceptual metaphor theory, the study concentrates on King Shaka’s praise-poems in which the praise-poet describes his physical and dispositional characteristics through bold animal metaphors of the ‘Big Five’; namely, the lion, the leopard, the buffalo, the rhinoceros and the elephant, which are often referred to as Zulu royal favorites. These metaphors are still learnt by young and old in the 21st century because they reflect the responsibilities, status, and integrity of the king and the respect in which he is held by his people. They also project the crescendo growth of the Zulu nation, which, through the fulfillment of his ambitions, grew from a small clan to a mighty kingdom.

Keywords: animal, indigenous, learning, metaphor

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723 Predictors of Lost to Follow-Up among HIV Patients Attending Anti-Retroviral Therapy Treatment Centers in Nigeria

Authors: Oluwasina Folajinmi, Kate Ssamulla, Penninah Lutung, Daniel Reijer

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Background: Despite of well-verified benefits of anti-retroviral therapy (ART) in prolonging life expectancy being lost to follow-up (LTFU) presents a challenge to the success of ART programs in resource limited countries like Nigeria. In several studies of ART programs in developing countries, researchers have reported that there has been a high rate of LTFU among patients receiving care and treatment at ART treatment centers. This study seeks to determine the cause of LTFU among HIV clients. Method: A descriptive cross sectional study focused on a population of 9,280 persons living with HIV/AIDS who were enrolled in nine treatment centers in Nigeria (both pre-ART and ART patients were included). Out of the total population, 1752 (18.9%) were found to be LTFU. Of this group we randomly selected 1200 clients (68.5%) their d patients’ information was generated through a database. Data on demographics and CD4 counts, causes of LTFU were analyzed and summarized. Results: Out of 1200 LTFU clients selected, 462 (38.5%) were on ART; 341 clients (73.8%) had CD4 level < 500cell/µL and 738 (61.5%) on pre-ART had CD4 level >500/µL. In our records we found telephone number for 675 (56.1%) of these clients. 675 (56.1%) were owners of a phone. The majority of the client’s 731 (60.9%) were living at not more than 25km away from the ART center. A majority were females (926 or 77.2%) while 274 (22.8%) were male. 675 (56.1%) clients were reported traced via telephone and home address. 326 (27.2%) of clients phone numbers were not reachable; 173 (14.4%) of telephone numbers were incomplete. 71 (5.9%) had relocated due to communal crises and expert client trackers reported that some patient could not afford transportation to ART centers. Conclusion: This study shows that, low health education levels, poverty, relocations and lack of reliable phone contact were major predictors of LTFU. Periodic updates of home addresses, telephone contacts including at least two next of kin, phone text messages and home visits may improve follow up. Early and consistent tracking of missed appointments is crucial. Creation of more ART decentralized centres are needed to avoid long distances.

Keywords: anti-retroviral therapy, HIV/AIDS, predictors, lost to follow up

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722 Prevalence of Urinary Tract Infections and Risk Factors among Pregnant Women Attending Ante Natal Clinics in Government Primary Health Care Centres in Akure

Authors: Adepeju Simon-Oke, Olatunji Odeyemi, Mobolanle Oniya

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Urinary tract infection has become the most common bacterial infections in humans, both at the community and hospital settings; it has been reported in all age groups and in both sexes. This study was carried out in order to determine and evaluate the prevalence, current drug susceptibility pattern of the isolated organisms and identify the associated risk factors of UTIs among the pregnant women in Akure, Ondo State, Nigeria. A cross-sectional study was conducted on the urine of pregnant women, and socio-demographic information of the women was collected. A total of 300 clean midstream urine samples were collected, and a general urine microscopic examination and culture were carried out, the Microbact identification system was used to identify gram-negative bacteria. Out of the 300 urine samples cultured, 183(61.0%) yielded significant growth of urinary pathogens while 117(39.0%) yielded either insignificant growth or no growth of any urinary pathogen. Prevalence of UTI was significantly associated with the type of toilet used, symptoms of UTI, and previous history of urinary tract infection (p<0.05). Escherichia coli 58(31.7%) was the dominant pathogen isolated, and the least isolated uropathogens were Citrobacter freudii and Providencia retgerri 2(1.1%) respectively. Gram-negative bacteria showed 77.6%, 67.9%, and 61.2% susceptibility to ciprofloxacin, augmentin, and chloramphenicol, respectively. Resistance against septrin, chloramphenicol, sparfloxacin, amoxicillin, augmentin, gentamycin, pefloxacin, trivid, and streptomycin was observed in the range of 23.1 to 70.1%. Gram-positive uropathogens isolated showed high resistance to amoxicillin (68.4%) and high susceptibility to the remaining nine antibiotics in the range 65.8% to 89.5%. This study justifies that pregnant women are at high risk of UTI. Therefore screening of pregnant women during antenatal clinics should be considered very important to avoid complications. Health education with regular antenatal and personal hygiene is recommended as precautionary measures to UTI.

Keywords: pregnant women, prevalence, risk factor, UTIs

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721 Effectiveness of Research Promotion Organizations in Higher Education and Research (ESR)

Authors: Jonas Sanon

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The valorization of research is becoming a transversal instrument linking different sectors (academic, public and industrial). The practice of valorization seems to impact innovation techniques within companies where, there is often the implementation of industrial conventions of training through research (CIFRE), continuous training programs for employees, collaborations and partnerships around joint research and R&D laboratories focused on the needs of companies to improve or develop more efficient innovations. Furthermore, many public initiatives to support innovation and technology transfer have been developed at the international, European and national levels, with significant budget allocations. Thus, in the context of this work, we tried to analyze the way in which research transfer structures are evaluated within the Saclay ecosystem. In fact, the University-Paris-Saclay is one of the best French universities; it is made up of 10 university components, more than 275 laboratories and is in partnership with the largest French research centers This work mainly focused on how evaluations affected research transfer structures, how evaluations were conducted, and what the managers of research transfer structures thought about assessments. Thus, with the aid of the conducted interviews, it appears that the evaluations do not have a significant impact on the qualitative aspect of research and innovation, but is rather present a directive aspect to allow the structures to benefit or not from the financial resources to develop certain research work, sometimes directed and influenced by the market, some researchers might try to accentuate their research and experimentation work on themes that are not necessarily their areas of interest, but just to comply with the calls for proposed thematic projects. The field studies also outline the primary indicators used to assess the effectiveness of valorization structures as "the number of start-ups generated, the license agreements signed, the structure's patent portfolio, and the innovations of items developed from public research.". Finally, after mapping the actors, it became clear that the ecosystem of the University of Paris-Saclay benefits from a richness allowing it to better value its research in relation to the three categories of actors it has (internal, external and transversal), united and linked by a relationship of proximity of sharing and endowed with a real opportunity to innovate openly.

Keywords: research valorization, technology transfer, innovation, evaluation, impacts and performances, innovation policy

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720 Application of Bundle Care to Reduce Invasive Catheter-Associated Infection in High Risk Units at a Medical Center

Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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719 The Impact of Small-Scale Irrigation on the Income of Rural Households and Determinants of Its Adoption: Evidence from Dehana Woreda, Ethiopia

Authors: Wondmnew Derebe Yohannis

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Farming irrigation plays a crucial role in rural development strategies, impacting both annual household income and livelihood. This research aims to evaluate the factors influencing irrigation participation and assess the impact of small-scale irrigation on rural households' annual income. The study collected data from 287 farmers in the Dahana district of northern Ethiopia. The research investigates the driving forces behind farmers' decisions to adopt small-scale irrigation and its effect on annual income gain. The findings reveal that several factors positively influence the probability of adoption, including access to credit, cultivated land size, livestock holding, extension contact, and the education level of the household head. Conversely, the distance to local markets and water schemes negatively affects the likelihood of adoption. To understand the differences in annual income between farm households that adopted irrigation and those that did not, a simultaneous equations model with endogenous switching regression is estimated. This accounts for the heterogeneity in the adoption decision and unobservable characteristics of farmers and their farms. The analysis compares the expected income gain under actual and counterfactual scenarios, considering whether the farm household adopted irrigation or not. The study reveals that the group of farm households that adopted irrigation has distinct characteristics compared to those that did not adopt it. Furthermore, the research demonstrates that the adoption of irrigation practices leads to an increase in annual income. Interestingly, the impact of small-scale irrigation on annual income is greater for the farm households that actually adopted irrigation compared to those in the counterfactual scenario where they did not adopt. Based on the findings, the researcher concludes that small-scale irrigation is a practical solution for meeting household financial needs in the study area. It is recommended that investments in small-scale irrigation continue to further improve the livelihoods of rural farming communities by enhancing annual income gains.

Keywords: small-scale irrigation, income, rural farm households, endogenous switching regression, user, non-user

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718 The Representation of Women in Iraq: Gender Wage Gap and the Position of Women within Iraqi Society

Authors: Hanaa Sameen Ameen Bajilan

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Human rights should be protected and promoted without regard to race, ethnicity, religion, political philosophy, or sexual orientation, following our firm convictions. Thus, any infringement of these rights or disdain for; any use of violence against women undermines the principles and human values of equality and endangers the entire society, including its potential to live in peace and to make growth and development. This paper represents the condition of the new Iraqi women regarding issues such as the gender wage gap, education, health, and violence against women. The study aims to determine the impact of traditions and customs on the legal position of Iraqi women. First, it seeks to assess the effects of culture as a historical agency on the legal status of Iraqi women. Second, the influence of cultural developments in the later part of the twentieth century on Iraqi women's legal standing, and third, the importance of cultural variety as a progressive cultural component in women's legal position. Finally, the study highlights the representation of women in Iraq: Gender wage Gap, Women's liberation between culture and law, and the role of women within Iraqi society based on an Iraqi novel named (Orange Light) in Arabic: برتقالو ضو. in her book, the Iraqi writer Nadia Al-Abru succeeds in portraying the post-war society's devotion to the sexual, emotional and mental marginalization of women in terms of the value of attendance. Since the study of Iraqi women's literature in Arabic-English translation is a new avenue of research that contributes to all three areas, this investigation aims to establish critical lines of engagement between contemporary Iraqi women's literature in English translation and feminist translation conceptual frameworks, and this is accomplished by first focusing on why analyzing Iraqi women writers' novels in Arabic-English translation is a timeline of inquiry that contributes to existing and emerging knowledge fields concerning Iraqi women writers' contemporary critical contexts and scholarship on Arab women's literature in Arabic-English translation.

Keywords: women in İraq, equality, violence, gender wage gap, Nadia Al-Abru, (orange light), women's liberation, İraqi women's literature,

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717 Pineapple Patriarch: Local Agency in Sustainability Initiatives despite Community Reliance on Pineapple Monoculture

Authors: Afshan Golriz

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This paper addresses the nuances in the relationship between the rural community of Volcan, Costa Rica, and the presence of multinational pineapple giant Pineapple Development Corporation (PINDECO). The paper analyzes the continuous negotiation between the need for environmental protection in the face of pineapple monoculture and the socioeconomic dependencies of the community on the company. Drawing on eight years of ethnographic work in Volcan de Buenos Aires and relying on intergenerational interviews that document oral histories, this article provides a socio-historical account of the economic and environmental impact of the presence of PINDECO in the southern zone of the country. The paper draws on interviews and in-depth participant observation, conducted by the author in intermittent periods over eight years. The research sheds light on the tensions between the village and PINDECO, as simultaneous acceptance of and opposition to the company persist by different stakeholders in the region. In doing so, this paper examines the strikingly powerful affinity toward the company and the community's regard for PINDECO as the town patriarch despite social and environmental injustices. In demonstrating these tensions, the author problematizes the practice of conducting foreign environmental research in developing countries, and more importantly, proposing changes to environmental conservation and socioeconomic structures without understanding community reliance on the presence of corporations such as PINDECO and the threats that changes to existing structures could pose to community members' livelihoods. In complicating these common western academic practices, the author takes an anti-colonial approach to environmental research, refusing the assumption that the affinity toward the company by the community of Volcan is rooted in ignorance, lack of education, or lack of interest in environmental conservation. The author instead highlights local knowledge and agency, demonstrating the many ways in which the community itself is producing knowledge and taking action. Through this paper, common assumptions regarding the agency of such communities are contested, and the grassroots environmental initiatives of Volcan, Costa Rica are brought to life.

Keywords: environmental conservation, grassroots movements, local knowledge, agricultural multinational

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716 The Challenges of Digital Crime Nowadays

Authors: Bendes Ákos

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Digital evidence will be the most widely used type of evidence in the future. With the development of the modern world, more and more new types of crimes have evolved and transformed. For this reason, it is extremely important to examine these types of crimes in order to get a comprehensive picture of them, with which we can help the authorities work. In 1865, with early technologies, people were able to forge a picture of a quality that is not even recognized today. With the help of today's technology, authorities receive a lot of false evidence. Officials are not able to process such a large amount of data, nor do they have the necessary technical knowledge to get a real picture of the authenticity of the given evidence. The digital world has many dangers. Unfortunately, we live in an age where we must protect everything digitally: our phones, our computers, our cars, and all the smart devices that are present in our personal lives and this is not only a burden on us, since companies, state and public utilities institutions are also forced to do so. The training of specialists and experts is essential so that the authorities can manage the incoming digital evidence at some level. When analyzing evidence, it is important to be able to examine it from the moment it is created. Establishing authenticity is a very important issue during official procedures. After the proper acquisition of the evidence, it is essential to store it safely and use it professionally. After the proper acquisition of the evidence, it is essential to store it safely and use it professionally. Otherwise, they will not have sufficient probative value and in case of doubt, the court will always decide in favor of the defendant. One of the most common problems in the world of digital data and evidence is doubt, which is why it is extremely important to examine the above-mentioned problems. The most effective way to avoid digital crimes is to prevent them, for which proper education and knowledge are essential. The aim is to present the dangers inherent in the digital world and the new types of digital crimes. After the comparison of the Hungarian investigative techniques with international practice, modernizing proposals will be given. A sufficiently stable yet flexible legislation is needed that can monitor the rapid changes in the world and not regulate afterward but rather provide an appropriate framework. It is also important to be able to distinguish between digital and digitalized evidence, as the degree of probative force differs greatly. The aim of the research is to promote effective international cooperation and uniform legal regulation in the world of digital crimes.

Keywords: digital crime, digital law, cyber crime, international cooperation, new crimes, skepticism

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715 Compliance Of Dialysis patients With Nutrition Guidelines: Insights From A Questionnaire

Authors: Zeiler M., Stadler D., Schmaderer C.

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Over the years of dialysis treatment, most patients experience significant weight loss. The primary emphasis in earlier research was the underlying mechanism of protein energy wasting and the subsequent malnutrition inflammation syndrome. In the interest to provide an effective and rapid solution for the patients, the aim of this study is identifying individual influences of their assumed reduced dietary intake, such as nausea, appetite loss and taste changes, and to determine whether the patients adhere to their nutrition guidelines. A prospective, controlled study with 38 end-stage renal disease patients was performed using a questionnaire to reflect their diet within the last 12 months. Thereby, the daily intake for the most important macro-and micronutrients was calculated to be compared with the individual KDQOI-guideline value, as well as controls matched in age and gender. The majority of the study population did not report symptoms commonly associated with dialysis, such as nausea or inappetence, and denied any change in dietary behavior since receiving renal replacement therapy. The patients’ daily intake of energy (3080kcal ± 1266) and protein (89,9g [53,4-142,0]) did not differ significantly from the controls (energy intake: 3233kcal ± 1046, p=0,597; protein intake: 103,7g [90,1-125,5], p=0,120). The average difference to the individual calculated KDQOI-guideline was +176,0kcal ± 1156 (p=0,357) for energy intake and -1,75g ± 45,9 (p=0,491) for protein intake. However, there was an observed imbalance in the distribution of macronutrients, with a preference for fats over proteins. The patients’ daily intake of sodium (5,4g [ 2,95-10,1]) was higher than in the controls (4,1g [2,04-5,99], p= 0,058) whereas both values for potassium (3,7g ± 1,84) and phosphorous (1,79g ± 0,91) went significantly below the controls’ values (potassium intake: 4,89g ± 1,74, p=0,014; phosphorous intake: 2,04g ± 0,64, p=0,038). Thus, the values exceeded the calculated KDQOI-recommendation by + 3,3g [0,63-7,90] (p<0,001) for sodium, +1,49g ± 1,84 (p<0,001) for potassium and +0,89g ± 0,91 (p<0,001) for phosphorous. Contrary to the assumption, the patients did not under-eat. Nevertheless, their diets did not align with the recommended values. These findings highlight the need for intervention and education among patients and that regular dietary monitoring could prevent unhealthy nutrition habits. The elaboration of individual references instead of standardized guidelines could increase the compliance to the advised diet so that interdisciplinary comorbidities do not develop or worsen.

Keywords: compliance, dialysis, end-stage renal disease, KDQOI, malnutrition, nutrition guidelines, questionnaire, salt intake

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714 Breast Cancer Awareness among Female Nurses: Time to Scrub off Assumptions

Authors: Rahy Farooq, Maria Ahmad Khan, Ayesha Isani Majeed

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Objective: The main aim of this research is to assess the knowledge, attitude and practices of female nursing staff and nursing students regarding breast cancer, to provide a baseline for monitoring trends of breast cancer awareness in them. Background: Healthcare professionals are a direct source of information for the patients and the general public as a whole. It is, therefore, essential that the information they convey be accurate and helps in building additional awareness. However, clinical experience does not influence the knowledge, attitude and practices regarding breast cancer. Nurses, being the prime part of the healthcare professionals, play a significant role and hence, their awareness regarding this pressing issue is pertinent. Lack of awareness regarding common presenting symptoms or breast cancer risk factors translates to poor breast cancer screening practices and late diagnosis. Methodology: A cross-sectional study of 280 female nurses was conducted at a tertiary care hospital in Islamabad, Pakistan. A pre-tested structured questionnaire with additional variables like cultural barriers to seeking medical help was used. The scores for outcome variables including knowledge, attitude and practices were pre-defined. Data was analyzed using SPSSv23. Results: Of the 280 participants with a mean age of 28.99±9.98 years, 142 (50.7%) were married, and 138 (49.3%) were unmarried. Mean scores were computed to be 6.14±2.93 (out of 12), 0.30±0.7 (out of 3) and 9.53±1.92 (out of 16) for knowledge, attitude and practice respectively. Using independent sample T-test, a statistically significant correlation was found when means for the score of Attitude was compared with age. With a p-value of 0.018, 117 nurses of age more than 30 years, faced more practical, financial, emotional and service barriers as compared to 163 women younger than 30 years of age. Knowledge of age-related lifetime risks was also significantly poor more in single women; with a p-value of 0.006 for identification of correct age as a risk factor and a p-value of 0.005 for correct identification of risk for development of breast cancer in the lifetime of women. By application of Chi-square test, there was a significant correlation between marital status and cultural barriers to seeking medical help, showing that single women (58.7%) shy away from talking about breast cancer considering it a taboo (p-value 0.028) whereas, more married nurses (59.2%) were apprehensive that they might be considered at fault by the society, as compared to 40.8% of single nurses. (p-value 0.038). Conclusion: Owing to the scarcity of awareness among nurses, this study recognizes the need for delivering effective information to the female nurses regarding breast cancer. Educating patients is likely to be effective if the female nurses play their part and have correct attitudes towards breast cancer practices. A better understanding of the knowledge and practices regarding breast cancer among the nursing population will enable high-risk patients to be recognized early. Therefore, we recommend arrangement of special courses and seminars for all healthcare professionals including the nursing staff.

Keywords: breast cancer, cultural barriers, kap, nurses

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713 Improving Breastfeeding Practices and Infants’ Growth through Promoting for “Feed Your Baby like a Baby’’

Authors: Ammal M. Metwally, Walaa A. Basha, Ghada A. Abdel-Latif, Amira S. El Rifay

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Introduction: Improving breastfeeding practices does not always link to interventions relying on improving nutrition awareness and education alone but needs cultural and behavioral insights. Aim: Our study provided educational intervention through the use of the social marketing (SM) approach, which was respectable to societal norms allowing more conscious choices by mothers to achieve the maximum potential of physical growth of their infants. This study evaluated the effectiveness of the used approach for improving breastfeeding practices and the physical growth of infants aged up to 2 years. Methodology: A quasi-experimental intervention design with a posttest-only control design was done over three years duration to motivate mothers’ voluntary behavioral change toward breastfeeding promotion using SM principles: product, price, place, and promotion. The interventions targeted 464 pregnant women in their last trimester, mothers of children up to 2 years, and 1454 women in their childbearing period. Results: Most mothers showed increased awareness about the benefits of breastfeeding and became interested in breastfeeding their children outside the house using the breastfeeding cover (Gawn). Breastfeeding initiation, exclusive breastfeeding under six months, frequency of breastfeeding per day, and percentage of children who continued breastfeeding till two years were significantly increased (from 30%, 23 %, 56%, and 32% to 62 %, 47.3 %, 69 %, and 43.5 %). With the attention of the nutritional educational sessions three or more times, the majority of indicators had the most significant improvement. The females who recorded underweight results over males during the first two years of life significantly improved after the intervention (from 53.8 % to 15.4%, respectively). At the same time, females that were found to be obese before the intervention (7.7 %) became no longer obese. Conclusions: Nutritional interventions that are based on the use SM approach showed improvement for the majority of the key performance indicators. Although they doubled their value before the intervention, the majority were still modest (below 50 %). With sustained use of the SM approach, infants will achieve their maximum potential for physical growth by providing economically disadvantaged mothers with breastfeeding support.

Keywords: social marketing approach, early breastfeeding initiation, exclusive breastfeeding, responsiveness to cues of hunger and satiety, physical growth of infants

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712 Identification and Classification of Entrepreneurial Opportunities in Blinds’ Tourism Industry in Khuzestan Province of Iran

Authors: Ali Kharazi, Hassanali Aghajani, Hesami Azizi

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Tourism entrepreneurship is a growing field that has the potential to create new opportunities for sustainable development. The purpose of this study is to identify and classify the entrepreneurial opportunities in the blind tourism industry in Khuzestan Province of Iran that can be created through the operation of blinds’ tours. This study used a mixed methods approach. The qualitative data was collected through semi-structured interviews with 15 tourist guides and tourism activists, while the quantitative data was collected through a questionnaire survey of 40 blind people who had participated in blinds’ tours. The findings of this study suggest that there are a number of entrepreneurial opportunities in the blind tourism industry in Khuzestan Province, including (1) developing and providing accessible tourism services, such as tours, accommodations, restaurants, and transportation, (2) creating and marketing blind-friendly tourism products and experiences (3) training and educating tourism professionals on how to provide accessible and inclusive tourism services. This study contributes to the theoretical understanding of tourism entrepreneurship by providing insights into the entrepreneurial opportunities in the blind tourism industry. The findings of this study can be used to develop policies and programs that support the development of the blind tourism industry. The qualitative data were analyzed using content analysis. The quantitative data were analyzed using descriptive statistics and inferential statistics. This study examines the entrepreneurial opportunities within the blind tourism industry in Khuzestan Province, Iran. In addition, Khuzestan province has made relatively good development in the field of blinds’ tourism. Blind tourists have become loyal customers of blinds’ tours, which has increased their self-confidence and social participation. Tourist guides and centers of tourism services are interested in participating in blinds’ tours more than before, and even other parts outside the tourism field have encouraged sponsorship. Education had a great impact on the quality of tourism services, especially for the blind. It has played a significant role in improving the quality of tourism services for the blind. However, the quality and quantity of infrastructure should be increased in different sectors of tourism services to foster future growth. These opportunities can be used to create new businesses and jobs and to promote sustainable development in the region.

Keywords: entrepreneurship, tourism, blind, sustainable development, Khuzestan

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711 A Closed Loop Audit of Pre-operative Transfusion Samples in Orthopaedic Patients at a Major Trauma Centre

Authors: Tony Feng, Rea Thomson, Kathryn Greenslade, Ross Medine, Jennifer Easterbrook, Calum Arthur, Matilda Powell-bowns

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There are clear guidelines on taking group and screen samples (G&S) for elective arthroplasty and major trauma. However, there is limited guidance on blood grouping for other trauma patients. The purpose of this study was to review the level of blood grouping at a major trauma centre and validate a protocol that limits the expensive processing of G&S samples. After reviewing the national guidance on transfusion samples in orthopaedic patients, data was prospectively collected for all orthopaedic admissions in the Royal Infirmary of Edinburgh between January to February 2023. The cause of admission, number of G&S samples processed on arrival and need for red cells was collected using the hospital blood bank. A new protocol was devised based on a multidisciplinary meeting which limited the requirement for G&S samples only to presentations in “category X”, including neck-of-femur fractures (NOFs), pelvic fractures and major trauma. A re-audit was completed between April and May after departmental education and institution of this protocol. 759 patients were admitted under orthopaedics in the major trauma centre across two separate months. 47% of patients were admitted with presentations falling in category X (354/759) and patients in this category accounted for 88% (92/104) of those requiring post-operative red cell transfusions. Of these, 51% were attributed to NOFs (47/92). In the initial audit, 50% of trauma patients outwith category X had samples sent (116/230), estimated to cost £3800. Of these 230 patients, 3% required post-operative transfusions (7/230). In the re-audit, 23% of patients outwith category X had samples sent (40/173), estimated to cost £1400, of which 3% (5/173) required transfusions. None of the transfusions in these patients in either audit were related to their operation and the protocol achieved an estimated cost saving of £2400 over one month. This study highlights the importance of sending samples for patients with certain categories of orthopaedic trauma (category X) due to the high demand for post-operative transfusions. However, the absence of transfusion requirements in other presentations suggests over-testing. While implementation of the new protocol has markedly reduced over-testing, additional interventions are required to reduce this further.

Keywords: blood transfusion, quality improvement, orthopaedics, trauma

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710 Reducing the Negative Effects of Infrastructure Deficit through Continuity in Governance

Authors: Edoghogho Ogbeifun, Charles Mbohwa, J. H. C. Pretorius

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Effective infrastructure development scheme planned and executed has positive influence on the quantity of available stock of infrastructure to meet the immediate and expansion needs of an organization, as well as contribute to the overall economic development of a nation, community or the local entity where the infrastructure is hosted. It is noteworthy, however, that infrastructure development scheme spans a long time frame, usually longer than the political life of the administration that initiates the scheme. In the majority of circumstances, execution may start and achieve different levels of completion; at best, only limited numbers are completed and put into functional use during the life of the administration that initiated the infrastructure scheme. When there is a change in leadership, many of the uncompleted projects are usually abandoned. The new administration repeats the circle of its predecessors and develops another set of infrastructure scheme which will suffer similar fate as the ones developed by their predecessors; thus doting the landscape with many uncompleted projects, which leads to infrastructure deficit. These circle will continue unless each succeeding leader sees governance as single continuum. Therefore, infrastructure projects not completed by one administration should be continued by succeeding administration, in order to increase the stock of relevant infrastructure available for the smooth operations organization and enhance the needed developments, as well as reduce the negative effects of infrastructure deficit. The single case study of qualitative research method was adopted to investigate the actions of the administration of three successive Vice-Chancellors, in a higher education institution in Nigeria, over a longitudinal period of twelve years. This is with a view to exploring the effects of each administration on the development and execution of infrastructure projects, with particular interest on abandoned projects. The findings revealed that although two of Vice-Chancellors were committed to infrastructure upgrade, they executed more new projects than completing abandoned ones, while the current leader has shown more pragmatism in completing abandoned projects alongside constructing new ones; thus demonstrating the importance of the continuity of governance. In this regard, there is a steady increase in the stock of infrastructure to accommodate the expansion of existing academic programmes, host new ones as well as reduce the negative effects of infrastructure deficit caused by abandoned projects.

Keywords: abandoned projects, continuity of governance, infrastructure development scheme, long time frame

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709 New Public Management at Public Administration in Bangladesh: An Exploratory Study

Authors: Biback Das

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New Public Management, a phenomenal tool, which is used to enforcing in public administration in different country’s to enhance the capacities. Since the 1980s, New Public Management (NPM) is primarily focusing to modernize the public sector. From the initial period, many developed countries such as UK, New Zealand, Australia, and the USA are applied in their administration to modernize. Almost 1990s, it has been applied in many developing countries. This study can describe the real situations of NPM based administration. Bangladesh Government has taken many projects to reform the public sector under NPM. Even many Development Agencies like UN, UNDP, World Bank, Asian Development Bank and so on, along with many developed countries also invested and prescribed to take NPM based reform that can to restructure the public sector so that it can maximize the efforts to provide the better service. This study examines using many factors that effects work on Public Administration in Bangladesh and also assessing its endeavor to adopt in it. Although Government has taken such initiatives to implement NPM originated reform, it’s not effectively been implemented to bring positive change about as per NPM objectives. This study mainly examines some initiatives in Bangladesh that have the influence of NPM as well as some drawbacks that can’t help the satisfaction of these initiatives. This article help to identify the efforts of many development agencies providing a fund to enhance the NPM based projects with their specific conditions that are prescribed by them helping to get fund. Therefore, to establish effective public management or to follow NPM model, Bangladesh need having an institutional framework, sound rule of law, proper structure, effective civil service system, appropriate checks, and balances to restructure the public sector help along with donor agencies ad implement in it. Bangladesh Government has applied its recent days to enhance the capabilities in its Public Administration. Moreover, this study mainly identifies how the designing strategies, program formulating, its implementation in various sector such as education, health sector etc. and how to reduce the backdrop the during problem by smooth functioning. This paper is also assessing the influence of many projects like PPP (Public-Private and Partnership) to work along with private organizations for smooth service delivery. Accordingly, this paper briefly reviews how it applies in a global context following the taken many initiatives and the consequences of Bangladesh context.

Keywords: new public management, capacity building, conditionalities, service delivery, public-private-partnership

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708 The Application of the Biopsychosocial-Spiritual Model to the Quality of Life of People Living with Sickle Cell Disease

Authors: Anita Paddy, Millicent Obodai, Lebbaeus Asamani

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The management of sickle cell disease requires a multidisciplinary team for better outcomes. Thus, literature on the application of the biopsychosocial model for the management and explanation of chronic pain in sickle cell disease (SCD) and other chronic diseases abound. However, there is limited research on the use of the biopsychosocial model, together with a spiritual component (biopsychosocial-spiritual model). The study investigated the extent to which healthcare providers utilized the biopsychosocial-spiritual model in the management of chronic pain to improve the quality of life (QoL) of patients with SCD. This study employed the descriptive survey design involving a consecutive sampling of 261 patients with SCD who were between the ages of 18 to 79 years and were accessing hematological services at the Clinical Genetics Department of the Korle Bu Teaching Hospital. These patients willingly consented to participate in the study by appending their signatures. The theory of integrated quality of life, the gate control theory of pain and the biopsychosocial(spiritual) model were tested. An instrument for the biopsychosocial-spiritual model was developed, with a basis from the literature reviewed, while the World Health Organisation Quality of Life BREF (WHOQoLBref) and the spirituality rating scale were adapted and used for data collection. Data were analyzed using descriptive statistics (means, standard deviations, frequencies, and percentages) and partial least square structural equation modeling. The study revealed that healthcare providers had a great leaning toward the biological domain of the model compared to the other domains. Hence, participants’ QoL was not fully improved as suggested by the biopsychosocial(spiritual) model. Again, the QoL and spirituality of patients with SCD were quite high. A significant negative impact of spirituality on QoL was also found. Finally, the biosocial domain of the biopsychosocial-spiritual model was the most significant predictor of QoL. It was recommended that policymakers train healthcare providers to integrate the psychosocial-spiritual component in health services. Also, education on SCD and its resultant impact from the domains of the model should be intensified while health practitioners consider utilizing these components fully in the management of the condition.

Keywords: biopsychosocial (spritual), sickle cell disease, quality of life, healthcare, accra

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707 Impact of Urbanization Growth on Disease Spread and Outbreak Response: Exploring Strategies for Enhancing Resilience

Authors: Raquel Vianna Duarte Cardoso, Eduarda Lobato Faria, José Jorge Boueri

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Rapid urbanization has transformed the global landscape, presenting significant challenges to public health. This article delves into the impact of urbanization on the spread of infectious diseases in cities and identifies crucial strategies to enhance urban community resilience. Massive urbanization over recent decades has created conducive environments for the rapid spread of diseases due to population density, mobility, and unequal living conditions. Urbanization has been observed to increase exposure to pathogens and foster conditions conducive to disease outbreaks, including seasonal flu, vector-borne diseases, and respiratory infections. In order to tackle these issues, a range of cross-disciplinary approaches are suggested. These encompass the enhancement of urban healthcare infrastructure, emphasizing the need for robust investments in hospitals, clinics, and healthcare systems to keep pace with the burgeoning healthcare requirements in urban environments. Moreover, the establishment of disease monitoring and surveillance mechanisms is indispensable, as it allows for the timely detection of outbreaks, enabling swift responses. Additionally, community engagement and education play a pivotal role in advocating for personal hygiene, vaccination, and preventive measures, thus playing a pivotal role in diminishing disease transmission. Lastly, the promotion of sustainable urban planning, which includes the creation of cities with green spaces, access to clean water, and proper sanitation, can significantly mitigate the risks associated with waterborne and vector-borne diseases. The article is based on a review of scientific literature, and it offers a comprehensive insight into the complexities of the relationship between urbanization and health. It places a strong emphasis on the urgent need for integrated approaches to improve urban resilience in the face of health challenges.

Keywords: infectious diseases dissemination, public health, urbanization impacts, urban resilience

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706 The Projection of Breaking Sexual Repression: Modern Women in Indian Fictions in Marathi

Authors: Suresh B. Shinde

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The present paper examined the selective fictional works of the Indian writers in the Marathi language which reflects the gradual erosion of sexual repression of modern women characters. Furthermore, the study employed the attitudinal survey method to counter check the fictional reality of the Indian women in real life in the modern era. The Indian writers in an early stage from the pre and post-independence period pictured the women characters such as sexually suppressed and adherence to male sexual dominance. Gangadhar Gadgil a ‘Sahitya Akademi’ award winner writer in his story ‘Ek Manus’ shown that a husband, abnormally exploited her wife. G. A. Kulkarni a ‘Sahitya Akademi’ award winner writer shown that a young lady character suppressed her proposal of marriage with she loved due to the social pressure and conventions. Arvind Gokhale and Kamal Desai have also pictured lady characters who suppressed their sexual urges even they were highly educated. In the late 20th century and early 21st century, the trends of Marathi literature is dramatically changed accordingly the women fictions. Gouri Deshpande, the popular story writer, penetrates modern woman very clearly. Two lady characters are living happily together accepting revolts of society for a sexual relationship. Meghna Pethe, another well-known writer in her story, depicts a women character who was lived with her friend as live-in-relationship and enjoying the erotic sex. How so far, it was seen that the pre and post-independence women fictions are gradually changed regarding her sexually urges. This reality leads to design the survey research design in which 100 college girls and 100 middle-aged women were surveyed with sexual attitude scale and feminist identity test. It was hypothesized that the today's college girls would higher on sexual attitude and feminist identity than middle-aged women. Moreover, it was also assumed that sexual attitude and feminist identity would have a strong positive correlation. The obtained data analyzed through Students’ test and Pearson Product Moment Correlation (PPMC). The results reveal that the today's college girls are having a high level of sexual attitude and feminist identity than middle-aged women. Results also reveal that sexual attitude and feminist identity have a strongest positive correlation. How so far the survey research has provided the reality ground to the modern women in Indian fictions in Marathi literature. The findings of the research have been discussed accordingly the gender equality as well as psychological perspectives.

Keywords: sexual repression, women in Indian fictions, sexual attitude, feminist perspectives

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705 Enhancing Skills of Mothers of Asthmatic Children in Techniques of Drug Administration

Authors: Erna Judith Roach, Nalini Bhaskaranand

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Background & Significance: Asthma is the most common chronic disease among children. Education is the cornerstone of management of asthma to help the affected children. In India there are about 1.5- 3.0 million asthmatic children in the age group of 5-11 years. Many parents face management dilemmas in administration of medications to their children. Mothers being primary caregivers of children are often responsible for administering medications to them. The purpose of the study was to develop an educational package on techniques of drug administration for mothers of asthmatic children and determine its effectiveness in terms of improvement in skill in drug administration. Methodology: A quasi- experimental time series pre-test post -test control group design was used. Mothers of asthmatic children attending paediatric outpatient departments of selected hospitals along with their children between 5 and 12 years were included. Sample size consisted of 40 mothers in the experimental and 40 mothers in the control groups. Block randomization was used to assign samples to both the groups. The data collection instruments used were Baseline Proforma, Clinical Proforma, Daily asthma drug intake and symptoms diary and Observation Rating Scales on technique of using a metered dose inhaler with spacer; metered dose inhaler with facemask; metered dose inhaler alone and dry powder inhaler. The educational package consisted of a video and booklet on techniques of drug administration. Data were collected at baseline, 1, 3 and 6 months. Findings: The mean post-test scores in techniques of drug administration were higher than the mean pre-test scores in the experimental group in all techniques. The Friedman test (p < 0.01), Wilcoxon Signed Rank test (p < 0.008) and Mann Whitney U (p < 0.01) showed statistically significant difference in the experimental group than the control group. There was significant decrease in the average number of symptom days (11 Vs. 4 days/ month) and hospital visits (5 to 1 per month) in the experimental group when compared to the control group. Conclusion: The educational package was found to be effective in improving the skill of mothers in drug administration in all the techniques, especially with using the metered dose inhaler with spacer.

Keywords: childhood asthma, drug administration, mothers of children, inhaler

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704 Prescription of Lubricating Eye Drops in the Emergency Eye Department: A Quality Improvement Project

Authors: Noorulain Khalid, Unsaar Hayat, Muhammad Chaudhary, Christos Iosifidis, Felipe Dhawahir-Scala, Fiona Carley

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Dry eye disease (DED) is a common condition seen in the emergency eye department (EED) at Manchester Royal Eye Hospital (MREH). However, there is variability in the prescription of lubricating eye drops among different healthcare providers. The aim of this study was to develop an up-to-date, standardized algorithm for the prescription of lubricating eye drops in the EED at MREH based on international and national guidelines. The study also aimed to assess the impact of implementing the guideline on the rate of inappropriate lubricant prescriptions. Primarily, the impact was to be assessed in the form of the appropriateness of prescriptions for patients’ DED. The impact was secondary to be assessed through analysis of the cost to the hospital. Data from 845 patients who attended the EED over a 3-month period were analyzed, and 157 patients met the inclusion and exclusion criteria. After conducting a review of the literature and collaborating with the corneal team, an algorithm for the prescription of lubricants in the EED was developed. Three plan-do-study-act (PDSA) cycles were conducted, with interventions such as emails, posters, in-person reminders, and education for incoming trainees. The appropriateness of prescriptions was evaluated against the guidelines. Data were collected from patient records and analyzed using statistical methods. The appropriateness of prescriptions was assessed by comparing them to the guidelines and by clinical correlation with a specialized registrar. The study found a substantial improvement in the number of appropriate prescriptions, with an increase from 55% to 93% over the three PDSA cycles. There was additionally a 51% reduction in expenditure on lubricant prescriptions, resulting in cost savings for the hospital (approximate saving of £50/week). Theoretical importance: Appropriate prescription of lubricating eye drops improves disease management for patients and reduces costs for the hospital. The development and implementation of a standardized guideline facilitate the achievement of these goals. Conclusion: This study highlights the inconsistent management of DED in the EED and the potential lack of training in this area for healthcare providers. The implementation of a standardized, easy-to-follow guideline for lubricating eye drops can help to improve disease management while also resulting in cost savings for the hospital.

Keywords: lubrication, dry eye disease, guideline, prescription

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703 Family Medicine Residents in End-of-Life Care

Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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702 An Examination of Factors Leading to Knowledge-Sharing Behavior of Sri Lankan Bankers

Authors: Eranga N. Somaratna, Pradeep Dharmadasa

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In the current competitive environment, the factors leading to organization success are not limited to the investment of capital, labor, and raw material, but in the ability of knowledge innovation from all the members of an organization. However, knowledge on its own cannot provide organizations with its promised benefits unless it is shared, as organizations are increasingly experiencing unsuccessful knowledge sharing efforts. In such a backdrop and due to the dearth of research in this area in the South Asian context, the study set forth to develop an understanding of the factors that influence knowledge-sharing behavior within an organizational framework, using widely accepted social psychology theories. The purpose of the article is to discover the determinants of knowledge-sharing intention and actual knowledge sharing behaviors of bank employees in Sri Lanka using an aggregate model. Knowledge sharing intentions are widely discussed in literature through the application of Ajzen’s Theory of planned behavior (TPB) and Theory of Social Capital (SCT) separately. Both the theories are rich to explain knowledge sharing intention of workers with limitations. The study, therefore, combines the TPB with SCT in developing its conceptual model. Data were collected through a self-administrated paper-based questionnaire of 199 bank managers from 6 public and private banks of Sri Lanka and analyzed the suggested research model using Structural Equation Modelling (SEM). The study supported six of the nine hypotheses, where Attitudes toward Knowledge Sharing Behavior, Perceived Behavioral Control, Trust, Anticipated Reciprocal Relationships and Actual Knowledge Sharing Behavior were supported while Organizational Climate, Sense of Self-Worth and Anticipated Extrinsic Rewards were not, in determining knowledge sharing intentions. Furthermore, the study investigated the effect of demographic factors of bankers (age, gender, position, education, and experiences) to the actual knowledge sharing behavior. However, findings should be confirmed using a larger sample, as well as through cross-sectional studies. The results highlight the need for theoreticians to combined TPB and SCT in understanding knowledge workers’ intentions and actual behavior; and for practitioners to focus on the perceptions and needs of the individual knowledge worker and the need to cultivate a culture of sharing knowledge in the organization for their mutual benefit.

Keywords: banks, employees behavior, knowledge management, knowledge sharing

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701 Status of Physical, Chemical and Biological Attributes of Isheri, Ogun River, in Relation to the Surrounding Anthropogenic Activities of Kara Abattoir, South West Nigeria

Authors: N. B. Ikenweiwe, A. A. Alimi, N. A. Bamidele, A. O. Ewumi, J. Dairo, I. A. Akinnubi, S. O. Otubusin

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A study on the physical, chemical and biological parameters of the lower course of Ogun River, Isheri-Olofin was carried out between January and December 2014 in order to determine the effects of the anthropogenic activities of the Kara abattoir and domestic waste depositions on the quality of the water. Water samples were taken twice each month at three selected stations A, B and C (based on characteristic features or activity levels) along the water course. Samples were analysed using standard methods for chemical and biological parameters the same day in the laboratory while physical parameters were determined in-situ with water parameters kit. Generally, results of Transparency, Dissolved Oxygen, Nitrates, TDS and Alkalinity fall below the permissible limits of WHO and FEPA standards for drinking and fish production. Results of phosphates, lead and cadmium were also low but still within the permissible limit. Only Temperature and pH were within limit. Low plankton community, (phytoplankton, zooplankton), which ranges from 3, 5 to 40, 23 were as a result of low levels of DO, transparency and phosphate. The presence of coliform bacteria of public health importance like Escherichia coli, Proteus vulgaris, Aeromonas sp., Shigella sp, Enterobacter aerogenes as well as gram negative bacteria Proteus morganii are mainly indicators of faecal pollution. Fish and other resources obtained from this water stand the risk of being contaminated with these organisms and man is at the receiving end. The results of the physical, chemical and some biological parameters of Isheri, Ogun River, according to this study showed that the live forms of aquatic and fisheries resources there are dwelling under stress as a result of deposition of bones, horns, faecal components, slurry of suspended solids, fat and blood into the water. Government should therefore establish good monitoring system against illegal waste depositions and create education programmes that will enlighten the community on the social, ecological and economic values of the river.

Keywords: water parameters, Isheri Ogun river, anthropogenic activities, Kara abattoir

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700 Mechanical Testing of Composite Materials for Monocoque Design in Formula Student Car

Authors: Erik Vassøy Olsen, Hirpa G. Lemu

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Inspired by the Formula-1 competition, IMechE (Institute of Mechanical Engineers) and Formula SAE (Society of Mechanical Engineers) organize annual competitions for University and College students worldwide to compete with a single-seat race car they have designed and built. The design of the chassis or the frame is a key component of the competition because the weight and stiffness properties are directly related with the performance of the car and the safety of the driver. In addition, a reduced weight of the chassis has a direct influence on the design of other components in the car. Among others, it improves the power to weight ratio and the aerodynamic performance. As the power output of the engine or the battery installed in the car is limited to 80 kW, increasing the power to weight ratio demands reduction of the weight of the chassis, which represents the major part of the weight of the car. In order to reduce the weight of the car, ION Racing team from the University of Stavanger, Norway, opted for a monocoque design. To ensure fulfilment of the above-mentioned requirements of the chassis, the monocoque design should provide sufficient torsional stiffness and absorb the impact energy in case of a possible collision. The study reported in this article is based on the requirements for Formula Student competition. As part of this study, diverse mechanical tests were conducted to determine the mechanical properties and performances of the monocoque design. Upon a comprehensive theoretical study of the mechanical properties of sandwich composite materials and the requirements of monocoque design in the competition rules, diverse tests were conducted including 3-point bending test, perimeter shear test and test for absorbed energy. The test panels were homemade and prepared with an equivalent size of the side impact zone of the monocoque, i.e. 275 mm x 500 mm so that the obtained results from the tests can be representative. Different layups of the test panels with identical core material and the same number of layers of carbon fibre were tested and compared. Influence of the core material thickness was also studied. Furthermore, analytical calculations and numerical analysis were conducted to check compliance to the stated rules for Structural Equivalency with steel grade SAE/AISI 1010. The test results were also compared with calculated results with respect to bending and torsional stiffness, energy absorption, buckling, etc. The obtained results demonstrate that the material composition and strength of the composite material selected for the monocoque design has equivalent structural properties as a welded frame and thus comply with the competition requirements. The developed analytical calculation algorithms and relations will be useful for future monocoque designs with different lay-ups and compositions.

Keywords: composite material, Formula student, ION racing, monocoque design, structural equivalence

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699 Economic Analysis of Post-Harvest Losses in Plantain (and Banana): A Case Study of South Western Nigeria

Authors: O. R. Adeniyi, A. Ayandiji

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Losses are common in most vegetables because the fruit ripens rapidly and most plantain products can only be stored for a few days thereby limiting their utilization. Plantain (and banana) is highly perishable at the ambient temperature prevalent in the tropics. The specific objective of this study is to identify the socioeconomic characteristics of banana/plantain dealers and determine the perceived effect of the losses incurred in the process of marketing banana/plantain. The study was carried out in Ondo and Lagos states of south-western Nigeria. Purposive sampling technique was used to collect information from “Kolawole plantain depot”, the point of purchase in Ondo State and “Alamutu plantain market” in Mushin the point of sales in Lagos state. Preliminary study was conducted with the use of primary data collected through well-structured questionnaires administered on 60 respondents and 55 fully completed ones analysed. Budgeting, gross margin and multiple linear regression were used for analyses. Most merchants were found to be in the middle age class (30-50 years), majority of whom were female and completed their secondary school education, with eighty percent having more than 5 years’ experience of in banana/plantain marketing. The highest losses were incurred during transportation and these losses constitute about 5.62 percent of the potential total revenue. On the average, loss in gross margin is about ₦6,000.00 per merchant. The impacts of these losses are reflected in the continuously reducing level of their income. Age of the respondents played a major role in determining the level of care in the handling of the fruits. The middle age class tends to be more favoured. In conclusion, the merchants need adequate and sustainable transportation and storage facilities as a matter of utmost urgency. There is the need for government to encourage producers of the product (farmers) by giving them motivating incentives and ensuring that the environment is made conducive also for dealers by providing adequate storage facilities and ready markets locally and possibly for export.

Keywords: post-harvest, losses, plantain, banana, simple regression

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