Search results for: inclusive education issues
299 Investigating the Relationship between Job Satisfaction, Role Identity, and Turnover Intention for Nurses in Outpatient Department
Authors: Su Hui Tsai, Weir Sen Lin, Rhay Hung Weng
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There are numerous outpatient departments at hospitals with enormous amounts of outpatients. Although the work of outpatient nursing staff does not include the ward, emergency and critical care units that involve patient life-threatening conditions, the work is cumbersome and requires facing and dealing with a large number of outpatients in a short period of time. Therefore, nursing staff often do not feel satisfied with their work and cannot identify with their professional role, leading to intentions to leave their job. Thus, the main purpose of this study is to explore the correlation between the job satisfaction and role identity of nursing staff with turnover intention. This research was conducted using a questionnaire, and the subjects were outpatient nursing staff in three regional hospitals in Southern Taiwan. A total of 175 questionnaires were distributed, and 166 valid questionnaires were returned. After collecting the data, the reliability and validity of the study variables were confirmed by confirmatory factor analysis. The influence of role identity and job satisfaction on nursing staff’s turnover intention was analyzed by descriptive analysis, one-way ANOVA, Pearson correlation analysis and multiple regression analysis. Results showed that 'role identity' had significant differences in different types of marriages. Job satisfaction of 'grasp of environment' had significant differences in different levels of education. Job satisfaction of 'professional growth' and 'shifts and days off' showed significant differences in different types of marriages. 'Role identity' and 'job satisfaction' were negatively correlated with turnover intention respectively. Job satisfaction of 'salary and benefits' and 'grasp of environment' were significant predictors of role identity. The higher the job satisfaction of 'salary and benefits' and 'grasp of environment', the higher the role identity. Job satisfaction of 'patient and family interaction' were significant predictors of turnover intention. The lower the job satisfaction of 'patient and family interaction', the higher the turnover intention. This study found that outpatient nursing staff had the lowest satisfaction towards salary structure. It is recommended that bonuses, promotion opportunities and other incentives be established to increase the role identity of outpatient nursing staff. The results showed that the higher the job satisfaction of 'salary and benefits' and 'grasp of environment', the higher the role identity. It is recommended that regular evaluations be conducted to reward nursing staff with excellent service and invite nursing staff to share their work experiences and thoughts, to enhance nursing staff’s expectation and identification of their occupational role, as well as instilling the concept of organizational service and organizational expectations of emotional display. The results showed that the lower the job satisfaction of 'patient and family interaction', the higher the turnover intention. It is recommended that interpersonal communication and workplace violence prevention educational training courses be organized to enhance the communication and interaction of nursing staff with patients and their families.Keywords: outpatient, job satisfaction, turnover, intention
Procedia PDF Downloads 146298 Artificial Intelligence Impact on the Australian Government Public Sector
Authors: Jessica Ho
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AI has helped government, businesses and industries transform the way they do things. AI is used in automating tasks to improve decision-making and efficiency. AI is embedded in sensors and used in automation to help save time and eliminate human errors in repetitive tasks. Today, we saw the growth in AI using the collection of vast amounts of data to forecast with greater accuracy, inform decision-making, adapt to changing market conditions and offer more personalised service based on consumer habits and preferences. Government around the world share the opportunity to leverage these disruptive technologies to improve productivity while reducing costs. In addition, these intelligent solutions can also help streamline government processes to deliver more seamless and intuitive user experiences for employees and citizens. This is a critical challenge for NSW Government as we are unable to determine the risk that is brought by the unprecedented pace of adoption of AI solutions in government. Government agencies must ensure that their use of AI complies with relevant laws and regulatory requirements, including those related to data privacy and security. Furthermore, there will always be ethical concerns surrounding the use of AI, such as the potential for bias, intellectual property rights and its impact on job security. Within NSW’s public sector, agencies are already testing AI for crowd control, infrastructure management, fraud compliance, public safety, transport, and police surveillance. Citizens are also attracted to the ease of use and accessibility of AI solutions without requiring specialised technical skills. This increased accessibility also comes with balancing a higher risk and exposure to the health and safety of citizens. On the other side, public agencies struggle with keeping up with this pace while minimising risks, but the low entry cost and open-source nature of generative AI led to a rapid increase in the development of AI powered apps organically – “There is an AI for That” in Government. Other challenges include the fact that there appeared to be no legislative provisions that expressly authorise the NSW Government to use an AI to make decision. On the global stage, there were too many actors in the regulatory space, and a sovereign response is needed to minimise multiplicity and regulatory burden. Therefore, traditional corporate risk and governance framework and regulation and legislation frameworks will need to be evaluated for AI unique challenges due to their rapidly evolving nature, ethical considerations, and heightened regulatory scrutiny impacting the safety of consumers and increased risks for Government. Creating an effective, efficient NSW Government’s governance regime, adapted to the range of different approaches to the applications of AI, is not a mere matter of overcoming technical challenges. Technologies have a wide range of social effects on our surroundings and behaviours. There is compelling evidence to show that Australia's sustained social and economic advancement depends on AI's ability to spur economic growth, boost productivity, and address a wide range of societal and political issues. AI may also inflict significant damage. If such harm is not addressed, the public's confidence in this kind of innovation will be weakened. This paper suggests several AI regulatory approaches for consideration that is forward-looking and agile while simultaneously fostering innovation and human rights. The anticipated outcome is to ensure that NSW Government matches the rising levels of innovation in AI technologies with the appropriate and balanced innovation in AI governance.Keywords: artificial inteligence, machine learning, rules, governance, government
Procedia PDF Downloads 71297 Upsouth: Digitally Empowering Rangatahi (Youth) and Whaanau (Families) to Build Skills in Critical and Creative Thinking to Achieve More Active Citizenship in Aotearoa New Zealand
Authors: Ayla Hoeta
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In a post-colonial Aotearoa New Zealand, solutions by rangatahi (youth) for rangatahi are essential as is civic participation and building economic agency in an increasingly tough economic climate. Upsouth was an online community crowdsourcing platform developed by The Southern Initiative, in collaboration with Itsnoon that provides rangatahi and whānau (family) a safe space to share lived experience, thoughts and ideas about local kaupapa (issues/topics) of importance to them. The target participants were Māori indigenous peoples and Pacifica groups, aged 14 - 21 years. In the Aotearoa New Zealand context, this participant group is not likely to engage in traditional consultation processes despite being an essential constituent in helping shape better local communities, whānau and futures. The Upsouth platform was active for two years from 2018-2019 where it completed 42 callups with 4300+ participants. The web platform collates the ideas, voices, feedback, and content of users around a callup that has been commissioned by a sponsor, such as Auckland Council, Z Energy or Auckland Transport. A callup may be about a pressing challenge in a community such as climate change, a new housing development, homelessness etc. Each callup was funded by the sponsor with Upsouths main point of difference being that participants are given koha (money donation) through digital wallets for their ideas. Depending on the quality of what participants upload, the koha varies between small micropayments and larger payments. This encouraged participants to develop creative and critical thinking - upskilling for future focussed jobs, enterprise and democratic skills while earning pocket money at the same time. Upsouth enables youth-led action and voice, and empowers them to be a part of a reciprocal and creative economy. Rangatahi are encouraged to express themselves culturally, creatively, freely and in a way they are free to choose - for example, spoken word, song, dance, video, drawings, and/or poems. This challenges and changes what is considered acceptable as community engagement feedback by the local government. Many traditional engagement platforms are not as consultative, do not accept diverse types of feedback, nor incentivise this valuable expression of feedback. Upsouth is also empowering for rangatahi, since it allows them the opportunity to express their opinions directly to the government. Upsouth gained national and international recognition for the way it engages with youth: winning the Supreme Award and the Accessibility and Transparency Award at Auckland Council’s 2018 Engagement Awards, becoming a finalist in the 2018 Digital Equity and Accessibility category of International Data Corporation’s Smart City Asia and Pacific Awards. This paper will fully contextualize the challenges of rangatahi and whānau civic engagement in Aotearoa New Zealand and then present a reflective case study of the Upsouth project, with examples from some of the callups. This is intended to form part of the Divided Cities 22 conference New Ground sub-theme as a critical reflection on a design intervention, which was conceived and implemented by the lead author to overcome the post-colonial divisions of Māori, Pacifica and minority ethnic rangatahi in Aotearoa New Zealand.Keywords: rangatahi, youth empowerment, civic engagement, enabling, relating, digital platform, participation
Procedia PDF Downloads 82296 The Role of the Corporate Social Responsibility in Poverty Reduction
Authors: M. Verde, G. Falzarano
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The paper examines the connection between corporate social responsibility (CSR), capability approach and poverty reduction; in particular, the local employment development (LED) by way of CSR initiatives. The joint action of LED/CSR results in a win-win situation, not only for the enterprises but also for all the stakeholders involved; in this regard, subsidiarity and coordination between national and regional/local authorities are central to a socially-oriented market economy. In the first section, the CSR is analysed on the basis of its social function in the fight against poverty, as a 'capabilities deprivation'. In the central part, the attention is focused on the relationship between CSR and LED; ergo, on the role of the enterprises in fostering capabilities development (the employment). Besides, all the potential solutions are presented, stressing the possible combinations, in the last part. The benchmark is the enterprise as an economic and a social institution: the business should not be combined with profit merely, paying more attention to its sustainable impact and social contribution. In which way could it be possible? The answer is the CSR. The impact of CSR on poverty reduction is still little explored. The companies help to reduce poverty through economic contribution, human rights and social inclusion; hence, the business becomes an 'agent of development' in order to fight against 'inequality'. The starting point is the pyramid of social responsibility, where ethic and philanthropic responsibilities involve programmes and actions aimed at personal development of the individuals, improving human standard of living in all forms, including poverty, when people do not have a choice between different 'life options', ranging from level of education to employment. At this point, CSR comes into play and works on two dimensions: poverty reduction and poverty prevention, by means of a series of initiatives: first of all, job creation and precarious work reduction. Empowerment of the local actors, financial support and combination of top down and bottom up initiatives are some of CSR areas of activity. Several positive effects occur on individual levels of educations, access to capital, individual health status, empowerment of youth and woman, access to social networks and it was observed that these effects depend on the type of CSR strategy. Indeed, CSR programmes should take into account fundamental criteria, such as the transparency, the information about benefits, a coordination unit among institutions and more clear guidelines. In this way, the advantages to the corporate reputation and to the community translate into a better job matching on the labour market, inter alia. It is important to underline that the success depends on the specific measures of the areas in question, by adapting them to the local needs, in light of general principles and index; therefore, the concrete commitment of the all stakeholders involved is decisive in order to achieve the goals. The enterprise would represent a concrete contribution for the pursuit of sustainable development and for the dissemination of a social and well being awareness.Keywords: capability approach, local employment development, poverty, social inclusion
Procedia PDF Downloads 139295 Redefining Intellectual Humility in Indian Context: An Experimental Investigation
Authors: Jayashree And Gajjam
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Intellectual humility (IH) is defined as a virtuous mean between intellectual arrogance and intellectual self-diffidence by the ‘Doxastic Account of IH’ studied, researched and developed by western scholars not earlier than 2015 at the University of Edinburgh. Ancient Indian philosophical texts or the Upanisads written in the Sanskrit language during the later Vedic period (circa 600-300 BCE) have long addressed the virtue of being humble in several stories and narratives. The current research paper questions and revisits these character traits in an Indian context following an experimental method. Based on the subjective reports of more than 400 Indian teenagers and adults, it argues that while a few traits of IH (such as trustworthiness, respectfulness, intelligence, politeness, etc.) are panhuman and pancultural, a few are not. Some attributes of IH (such as proper pride, open-mindedness, awareness of own strength, etc.) may be taken for arrogance by the Indian population, while other qualities of Intellectual Diffidence such as agreeableness, surrendering can be regarded as the characteristic of IH. The paper then gives the reasoning for this discrepancy that can be traced back to the ancient Indian (Upaniṣadic) teachings that are still prevalent in many Indian families and still anchor their views on IH. The name Upanisad itself means ‘sitting down near’ (to the Guru to gain the Supreme knowledge of the Self and the Universe and setting to rest ignorance) which is equivalent to the three traits among the BIG SEVEN characterized as IH by the western scholars viz. ‘being a good listener’, ‘curious to learn’, and ‘respect to other’s opinion’. The story of Satyakama Jabala (Chandogya Upanisad 4.4-8) who seeks the truth for several years even from the bull, the fire, the swan and waterfowl, suggests nothing but the ‘need for cognition’ or ‘desire for knowledge’. Nachiketa (Katha Upanisad), a boy with a pure mind and heart, follows his father’s words and offers himself to Yama (the God of Death) where after waiting for Yama for three days and nights, he seeks the knowledge of the mysteries of life and death. Although the main aim of these Upaniṣadic stories is to give the knowledge of life and death, the Supreme reality which can be identical with traits such as ‘curious to learn’, one cannot deny that they have a lot more to offer than mere information about true knowledge e.g., ‘politeness’, ‘good listener’, ‘awareness of own limitations’, etc. The possible future scope of this research includes (1) finding other socio-cultural factors that affect the ideas on IH such as age, gender, caste, type of education, highest qualification, place of residence and source of income, etc. which may be predominant in current Indian society despite our great teachings of the Upaniṣads, and (2) to devise different measures to impart IH in Indian children, teenagers, and younger adults for the harmonious future. The current experimental research can be considered as the first step towards these goals.Keywords: ethics and virtue epistemology, Indian philosophy, intellectual humility, upaniṣadic texts in ancient India
Procedia PDF Downloads 93294 Determinants of Walking among Middle-Aged and Older Overweight and Obese Adults: Demographic, Health, and Socio-Environmental Factors
Authors: Samuel N. Forjuoh, Marcia G. Ory, Jaewoong Won, Samuel D. Towne, Suojin Wang, Chanam Lee
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The public health burden of obesity is well established as is the influence of physical activity (PA) on the health and wellness of individuals who are obese. This study examined the influence of selected demographic, health, and socioenvironmental factors on the walking behaviors of middle-aged and older overweight and obese adults. Online and paper surveys were administered to community-dwelling overweight and obese adults aged ≥ 50 years residing in four cities in central Texas and seen by a family physician in the primary care clinic from October 2013 to June 2014. Descriptive statistics were used to characterize participants’ anthropometric and demographic data as well as their health conditions and walking, socioenvironmental, and more broadly defined PA behaviors. Then Pearson chi-square tests were used to assess differences between participants who reported walking the recommended ≥ 150 minutes for any purpose in a typical week as a proxy to meeting the U.S. Centers for Disease Control and Prevention’s PA guidelines and those who did not. Finally, logistic regression was used to predict walking the recommended ≥ 150 minutes for any purpose, controlling for covariates. The analysis was conducted in 2016. Of the total sample (n=253, survey response rate of 6.8%), the majority were non-Hispanic white (81.7%), married (74.5%), male (53.5%), and reported an annual household income of ≥ $50,000 (65.7%). Approximately, half were employed (49.6%), or had at least a college degree (51.8%). Slightly more than 1 in 5 (n=57, 22.5%) reported walking the recommended ≥150 minutes for any purpose in a typical week. The strongest predictors of walking the recommended ≥ 150 minutes for any purpose in a typical week in adjusted analysis were related to education and a high favorable perception of the neighborhood environment. Compared to those with a high school diploma or some college, participants with at least a college degree were five times as likely to walk the recommended ≥ 150 minutes for any purpose (OR=5.55, 95% CI=1.79-17.25). Walking the recommended ≥ 150 minutes for any purpose was significantly associated with participants who disagreed that there were many distracted drivers (e.g., on the cell phone while driving) in their neighborhood (OR=4.08, 95% CI=1.47-11.36) and those who agreed that there are sidewalks or protected walkways (e.g., walking trails) in their neighborhood (OR=3.55, 95% CI=1.10-11.49). Those employed were less likely to walk the recommended ≥ 150 minutes for any purpose compared to those unemployed (OR=0.31, 95% CI=0.11-0.85) as were those who reported some difficulty walking for a quarter of a mile (OR=0.19, 95% CI=0.05-0.77). Other socio-environmental factors such as having care-giver responsibilities for elders, someone to walk with, or a dog in the household as well as Walk Score™ were not significantly associated with walking the recommended ≥ 150 minutes for any purpose in a typical week. Neighborhood perception appears to be an important factor associated with the walking behaviors of middle-aged and older overweight and obese individuals. Enhancing the neighborhood environment (e.g., providing walking trails) may promote walking among these individuals.Keywords: determinants of walking, obesity, older adults, physical activity
Procedia PDF Downloads 260293 Cultural Identity and Self-Censorship in Social Media: A Qualitative Case Study
Authors: Nastaran Khoshsabk
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The evolution of communication through the Internet has influenced shaping and reshaping the self-presentation of social media users. Online communities both connect people and give voice to the voiceless allowing them to present themselves nationally and globally. People all around the world are experiencing censorship in different aspects of their life. Censorship can be externally imposed because of the political situations, or it can be self-imposed. Social media users choose the content they want to share and decide about the online audiences with whom they want to share this content. Most social media networks, such as Facebook, enable their users to be selective about the shared content and its availability to other people. However, sometimes instead of targeting a specific audience, users self-censor themselves or decide not to share various forms of information. These decisions are of particular importance in countries such as Iran where Internet is not the arena of free self-presentation and people are encouraged to stay away from political participation in the country and acting against the Islamic values. Facebook and some other social media tools are blocked in countries such as Iran. This project investigates the importance of social media in the life of Iranians to explore how they present themselves and construct their digital selves. The notion of cultural identity is applied in this research to explore the educational and informative role of social media in the identity formation and cultural representation of Facebook users. This study explores the self-censorship of Iranian adult Facebook users through their online self-representation and communication on the Internet. The data in this qualitative multiple case study have been collected through individual synchronous online interviews with the researcher’s Facebook friends and through the analysis of the participants’ Facebook profiles and activities over a period of six months. The data is analysed with an emphasis on the identity formation of participants through the recognition of the underlying themes. The exploration of online interviews is on the basis of participants’ personal accounts of self-censorship and cultural understanding through using social media. The driven codes and themes have been categorised considering censorship and place of culture on representation of self. Participants were asked to explain their views about censorship and conservatism through using social media. They reported their thoughts about deciding which content to share on Facebook and which to self-censor and their reasons behind these decisions. The codes and themes have been categorised considering censorship and its role in representation of idealised self. The ‘actual self’ showed to be hidden by an individual for different reasons such as its influence on their social status, academic achievements and job opportunities. It is hoped that this research will have implications for education contexts in countries that are experiencing social media filtering by offering an increased understanding of the importance of online communities; which can provide an educational environment to talk and learn about social taboos and constructing adults’ identity in virtual environment and through cultural self-presentation.Keywords: cultural identity, identity formation, online communities, self-censorship
Procedia PDF Downloads 239292 Research on Land Use Pattern and Employment-Housing Space of Coastal Industrial Town Based on the Investigation of Liaoning Province, China
Authors: Fei Chen, Wei Lu, Jun Cai
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During the Twelve Five period, China promulgated industrial policies promoting the relocation of energy-intensive industries to coastal areas in order to utilize marine shipping resources. Consequently, some major state-owned steel and gas enterprises have relocated and resulted in a large-scale coastal area development. However, some land may have been over-exploited with seamless coastline projects. To balance between employment and housing, new industrial coastal towns were constructed to support the industrial-led development. In this paper, we adopt a case-study approach to closely examine the development of several new industrial coastal towns of Liaoning Province situated in the Bohai Bay area, which is currently under rapid economic growth. Our investigations reflect the common phenomenon of long distance commuting and a massive amount of vacant residences. More specifically, large plant relocation caused hundreds of kilometers of daily commute and enterprises had to provide housing subsidies and education incentives to motivate employees to relocate to coastal areas. Nonetheless, many employees still refuse to relocate due to job stability, diverse needs of family members and access to convenient services. These employees averaged 4 hours of commute daily and some who lived further had to reside in temporary industrial housing units and subject to long-term family separation. As a result, only a small portion of employees purchase new coastal residences but mostly for investment and retirement purposes, leading to massive vacancy and ghost-town phenomenon. In contrast to the low demand, coastal areas tend to develop large amount of residences prior to industrial relocation, which may be directly related to local government finances. Some local governments have sold residential land to developers to general revenue to support the subsequent industrial development. Subject to the strong preference of ocean-view, residential housing developers tend to select coast-line land to construct new residential towns, which further reduces the access of marine resources for major industrial enterprises. This violates the original intent of developing industrial coastal towns and drastically limits the availability of marine resources. Lastly, we analyze the co-existence of over-exploiting residential areas and massive vacancies in reference to the demand and supply of land, as well as the demand of residential housing units with the choice criteria of enterprise employees.Keywords: coastal industry town, commuter traffic, employment-housing space, outer suburb industrial area
Procedia PDF Downloads 222291 Interacting with Multi-Scale Structures of Online Political Debates by Visualizing Phylomemies
Authors: Quentin Lobbe, David Chavalarias, Alexandre Delanoe
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The ICT revolution has given birth to an unprecedented world of digital traces and has impacted a wide number of knowledge-driven domains such as science, education or policy making. Nowadays, we are daily fueled by unlimited flows of articles, blogs, messages, tweets, etc. The internet itself can thus be considered as an unsteady hyper-textual environment where websites emerge and expand every day. But there are structures inside knowledge. A given text can always be studied in relation to others or in light of a specific socio-cultural context. By way of their textual traces, human beings are calling each other out: hypertext citations, retweets, vocabulary similarity, etc. We are in fact the architects of a giant web of elements of knowledge whose structures and shapes convey their own information. The global shapes of these digital traces represent a source of collective knowledge and the question of their visualization remains an opened challenge. How can we explore, browse and interact with such shapes? In order to navigate across these growing constellations of words and texts, interdisciplinary innovations are emerging at the crossroad between fields of social and computational sciences. In particular, complex systems approaches make it now possible to reconstruct the hidden structures of textual knowledge by means of multi-scale objects of research such as semantic maps and phylomemies. The phylomemy reconstruction is a generic method related to the co-word analysis framework. Phylomemies aim to reveal the temporal dynamics of large corpora of textual contents by performing inter-temporal matching on extracted knowledge domains in order to identify their conceptual lineages. This study aims to address the question of visualizing the global shapes of online political discussions related to the French presidential and legislative elections of 2017. We aim to build phylomemies on top of a dedicated collection of thousands of French political tweets enriched with archived contemporary news web articles. Our goal is to reconstruct the temporal evolution of online debates fueled by each political community during the elections. To that end, we want to introduce an iterative data exploration methodology implemented and tested within the free software Gargantext. There we combine synchronic and diachronic axis of visualization to reveal the dynamics of our corpora of tweets and web pages as well as their inner syntagmatic and paradigmatic relationships. In doing so, we aim to provide researchers with innovative methodological means to explore online semantic landscapes in a collaborative and reflective way.Keywords: online political debate, French election, hyper-text, phylomemy
Procedia PDF Downloads 186290 ChatGPT Performs at the Level of a Third-Year Orthopaedic Surgery Resident on the Orthopaedic In-training Examination
Authors: Diane Ghanem, Oscar Covarrubias, Michael Raad, Dawn LaPorte, Babar Shafiq
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Introduction: Standardized exams have long been considered a cornerstone in measuring cognitive competency and academic achievement. Their fixed nature and predetermined scoring methods offer a consistent yardstick for gauging intellectual acumen across diverse demographics. Consequently, the performance of artificial intelligence (AI) in this context presents a rich, yet unexplored terrain for quantifying AI's understanding of complex cognitive tasks and simulating human-like problem-solving skills. Publicly available AI language models such as ChatGPT have demonstrated utility in text generation and even problem-solving when provided with clear instructions. Amidst this transformative shift, the aim of this study is to assess ChatGPT’s performance on the orthopaedic surgery in-training examination (OITE). Methods: All 213 OITE 2021 web-based questions were retrieved from the AAOS-ResStudy website. Two independent reviewers copied and pasted the questions and response options into ChatGPT Plus (version 4.0) and recorded the generated answers. All media-containing questions were flagged and carefully examined. Twelve OITE media-containing questions that relied purely on images (clinical pictures, radiographs, MRIs, CT scans) and could not be rationalized from the clinical presentation were excluded. Cohen’s Kappa coefficient was used to examine the agreement of ChatGPT-generated responses between reviewers. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT Plus. The 2021 norm table was used to compare ChatGPT Plus’ performance on the OITE to national orthopaedic surgery residents in that same year. Results: A total of 201 were evaluated by ChatGPT Plus. Excellent agreement was observed between raters for the 201 ChatGPT-generated responses, with a Cohen’s Kappa coefficient of 0.947. 45.8% (92/201) were media-containing questions. ChatGPT had an average overall score of 61.2% (123/201). Its score was 64.2% (70/109) on non-media questions. When compared to the performance of all national orthopaedic surgery residents in 2021, ChatGPT Plus performed at the level of an average PGY3. Discussion: ChatGPT Plus is able to pass the OITE with a satisfactory overall score of 61.2%, ranking at the level of third-year orthopaedic surgery residents. More importantly, it provided logical reasoning and justifications that may help residents grasp evidence-based information and improve their understanding of OITE cases and general orthopaedic principles. With further improvements, AI language models, such as ChatGPT, may become valuable interactive learning tools in resident education, although further studies are still needed to examine their efficacy and impact on long-term learning and OITE/ABOS performance.Keywords: artificial intelligence, ChatGPT, orthopaedic in-training examination, OITE, orthopedic surgery, standardized testing
Procedia PDF Downloads 92289 An Analysis of Teacher Knowledge of Recognizing and Addressing the Needs of Traumatized Students
Authors: Tiffany Hollis
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Childhood trauma is well documented in mental health research, yet has received little attention in urban schools. Child trauma affects brain development and impacts cognitive, emotional, and behavioral functioning. When educators understand that some of the behaviors that appear to be aggressive in nature might be the result of a hidden diagnosis of trauma, learning can take place, and the child can thrive in the classroom setting. Traumatized children, however, do not fit neatly into any single ‘box.’ Although many children enter school each day carrying with them the experience of exposure to violence in the home, the symptoms of their trauma can be multifaceted and complex, requiring individualized therapeutic attention. The purpose of this study was to examine how prepared educators are to address the unique challenges facing children who experience trauma. Given the vast number of traumatized children in our society, it is evident that our education system must investigate ways to create an optimal learning environment that accounts for trauma, addresses its impact on cognitive and behavioral development, and facilitates mental and emotional health and well-being. The researcher describes the knowledge, attitudes, dispositions, and skills relating to trauma-informed knowledge of induction level teachers in a diverse middle school. The data for this study were collected through interviews with teachers, who are in the induction phase (the first three years of their teaching career). The study findings paint a clear picture of how ill-prepared educators are to address the needs of students who have experienced trauma and the implications for the development of a professional development workshop or series of workshops that train teachers how to recognize and address and respond to the needs of students. The study shows how teachers often lack skills to meet the needs of students who have experienced trauma. Traumatized children regularly carry a heavy weight on their shoulders. Children who have experienced trauma may feel that the world is filled with unresponsive, threatening adults, and peers. Despite this, supportive interventions can provide traumatized children with places to go that are safe, stimulating, and even fun. Schools offer an environment that potentially meets these requirements by creating safe spaces where students can feel at ease and have fun while also learning via stimulating educational activities. This study highlights the lack of preparedness of educators to address the academic, behavioral, and cognitive needs of students who have experienced trauma. These findings provide implications for the creation of a professional development workshop that addresses how to recognize and address the needs of students who have experienced some type of trauma. They also provide implications for future research with a focus on specific interventions that enable the creation of optimal learning environments where students who have experienced trauma and all students can succeed, regardless of their life experiences.Keywords: educator preparation, induction educators, professional development, trauma-informed
Procedia PDF Downloads 126288 E-Business Role in the Development of the Economy of Sultanate of Oman
Authors: Mairaj Salim, Asma Zaheer
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Oman has accomplished as much or more than its fellow Gulf monarchies, despite starting from scratch considerably later, having less oil income to utilize, dealing with a larger and more rugged geography, and resolving a bitter civil war along the way. Of course, Oman's progress in the past 30-plus years has not been without problems and missteps, but the balance is squarely on the positive side of the ledger. Oil has been the driving force of the Omani economy since Oman began commercial production in 1967. The oil industry supports the country’s high standard of living and is primarily responsible for its modern and expansive infrastructure, including electrical utilities, telephone services, roads, public education and medical services. In addition to extensive oil reserves, Oman also has substantial natural gas reserves, which are expected to play a leading role in the Omani economy in the Twenty-first Century. To reduce the country’s dependence on oil revenues, the government is restructuring the economy by directing investment to non-oil activities. Since the 21st century IT has changed the performing tasks. To manage the affairs for the benefits of organizations and economy, the Omani government has adopted E-Business technologies for the development. E-Business is important because it allows • Transformation of old economy relationships (vertical/linear relationships) to new economy relationships characterized by end-to-end relationship management solutions (integrated or extended relationships) • Facilitation and organization of networks, small firms depend on ‘partner’ firms for supplies and product distribution to meet customer demands • SMEs to outsource back-end process or cost centers enabling the SME to focus on their core competence • ICT to connect, manage and integrate processes internally and externally • SMEs to join networks and enter new markets, through shortened supply chains to increase market share, customers and suppliers • SMEs to take up the benefits of e-business to reduce costs, increase customer satisfaction, improve client referral and attract quality partners • New business models of collaboration for SMEs to increase their skill base • SMEs to enter virtual trading arena and increase their market reach A national strategy for the advancement of information and communication technology (ICT) has been worked out, mainly to introduce e-government, e-commerce, and a digital society. An information technology complex KOM (Knowledge Oasis Muscat) had been established, consisting of section for information technology, incubator services, a shopping center of technology software and hardware, ICT colleges, E-Government services and other relevant services. So, all these efforts play a vital role in the development of Oman economy.Keywords: ICT, ITA, CRM, SCM, ERP, KOM, SMEs, e-commerce and e-business
Procedia PDF Downloads 252287 C-Spine Imaging in a Non-trauma Centre: Compliance with NEXUS Criteria Audit
Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter
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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.Keywords: imaging, guidelines, emergency medicine, audit
Procedia PDF Downloads 72286 Age-Related Health Problems and Needs of Elderly People Living in Rural Areas in Poland
Authors: Anna Mirczak
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Introduction: In connection with the aging of the population and the increase in the number of people with chronic illnesses, the priority objective for public health has become not only lengthening life, but also improving quality of life in older persons, as well as maintenance of their relative independence and active participation in social life. The most important determinant of a person’s quality of life is health. According to the literature, older people with chronic illness who live in rural settings are at greater risk for poor outcomes than their urban counterparts. Furthermore research characterizes the rural elderly as having a higher incidence of sickness, dysfunction, disability, restricted mobility, and acute and chronic conditions than their urban citizens. It is dictated by the overlapping certain specific socio-economic factors typical for rural areas which include: social and geography exclusion, limited access to health care centers, and low socioeconomic status. Aim of the study: The objective of this study was to recognize health status and needs of older people living in selected rural areas in Poland and evaluate the impacts of working in the farm on their health status. Material and methods: The study was performed personally, using interviews based on the structural questionnaires, during the period from March 2011 to October 2012. The group of respondents consisted 203 people aged 65 years and over living in selected rural areas in Poland. The analysis of collected research material was performed using the statistical package SPSS 19 for Windows. The level of significance for the tested the hypotheses assumed value of 0.05. Results: The mean age of participants was 75,5 years (SD=5,7) range from 65 to 94 years. Most of the interviewees had children (89.2%) and grandchildren (83.7) and lived mainly with family members (75.9%) mostly in double (46.8%) and triple (20.8%) household. The majority of respondents (71,9%) were physical working on the farm. At the time of interview, each of the respondents reported that they had been diagnosed with at least one chronic diseases by their GP. The most common were: hypertension (67,5%), osteoarthritis (44,8%), atherosclerosis (43,3%), cataract (40,4%), arrhythmia (28,6%), diabetes mellitus (19,7%) and stomach or duodenum ulcer diseases (17,2%).The number of diseases occurring of the sample was dependent on gender and age. Significant associations were observed between working on the farm and frequency of occurrence cardiovascular diseases, the gastrointestinal tract dysfunction and sensory disorders. Conclusions: The most common causes of disability among older citizens were: chronic diseases, malnutrition and complaints about access to health services (especially to cardiologist and an ophthalmologist). Health care access and health status are a particular concern in rural areas where the population is older, has lower education and income levels, and is more likely to be living in medically underserved areas than is the case in urban areas.Keywords: ageing, health status, older people, rural
Procedia PDF Downloads 264285 Using Balanced Scorecard Performance Metrics in Gauging the Delivery of Stakeholder Value in Higher Education: the Assimilation of Industry Certifications within a Business Program Curriculum
Authors: Thomas J. Bell III
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This paper explores the value of assimilating certification training within a traditional course curriculum. This innovative approach is believed to increase stakeholder value within the Computer Information System program at Texas Wesleyan University. Stakeholder value is obtained from increased job marketability and critical thinking skills that create employment-ready graduates. This paper views value as first developing the capability to earn an industry-recognized certification, which provides the student with more job placement compatibility while allowing the use of critical thinking skills in a liberal arts business program. Graduates with industry-based credentials are often given preference in the hiring process, particularly in the information technology sector. And without a pioneering curriculum that better prepares students for an ever-changing employment market, its educational value is dubiously questioned. Since certifications are trending in the hiring process, academic programs should explore the viability of incorporating certification training into teaching pedagogy and courses curriculum. This study will examine the use of the balanced scorecard across four performance dimensions (financial, customer, internal process, and innovation) to measure the stakeholder value of certification training within a traditional course curriculum. The balanced scorecard as a strategic management tool may provide insight for leveraging resource prioritization and decisions needed to achieve various curriculum objectives and long-term value while meeting multiple stakeholders' needs, such as students, universities, faculty, and administrators. The research methodology will consist of quantitative analysis that includes (1) surveying over one-hundred students in the CIS program to learn what factor(s) contributed to their certification exam success or failure, (2) interviewing representatives from the Texas Workforce Commission to identify the employment needs and trends in the North Texas (Dallas/Fort Worth) area, (3) reviewing notable Workforce Innovation and Opportunity Act publications on training trends across several local business sectors, and (4) analyzing control variables to identify specific correlations between industry alignment and job placement to determine if a correlation exists. These findings may provide helpful insight into impactful pedagogical teaching techniques and curriculum that positively contribute to certification credentialing success. And should these industry-certified students land industry-related jobs that correlate with their certification credential value, arguably, stakeholder value has been realized.Keywords: certification exam teaching pedagogy, exam preparation, testing techniques, exam study tips, passing certification exams, embedding industry certification and curriculum alignment, balanced scorecard performance evaluation
Procedia PDF Downloads 108284 Building Community through Discussion Forums in an Online Accelerated MLIS Program: Perspectives of Instructors and Students
Authors: Mary H Moen, Lauren H. Mandel
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Creating a sense of community in online learning is important for student engagement and success. The integration of discussion forums within online learning environments presents an opportunity to explore how this computer mediated communications format can cultivate a sense of community among students in accelerated master’s degree programs. This research has two aims, to delve into the ways instructors utilize this communications technology to create community and to understand the feelings and experiences of graduate students participating in these forums in regard to its effectiveness in community building. This study is a two-phase approach encompassing qualitative and quantitative methodologies. The data will be collected at an online accelerated Master of Library and Information Studies program at a public university in the northeast of the United States. Phase 1 is a content analysis of the syllabi from all courses taught in the 2023 calendar year, which explores the format and rules governing discussion forum assignments. Four to six individual interviews of department faculty and part time faculty will also be conducted to illuminate their perceptions of the successes and challenges of their discussion forum activities. Phase 2 will be an online survey administered to students in the program during the 2023 calendar year. Quantitative data will be collected for statistical analysis, and short answer responses will be analyzed for themes. The survey is adapted from the Classroom Community Scale Short-Form (CSS-SF), which measures students' self-reported responses on their feelings of connectedness and learning. The prompts will contextualize the items from their experience in discussion forums during the program. Short answer responses on the challenges and successes of using discussion forums will be analyzed to gauge student perceptions and experiences using this type of communication technology in education. This research study is in progress. The authors anticipate that the findings will provide a comprehensive understanding of the varied approaches instructors use in discussion forums for community-building purposes in an accelerated MLIS program. They predict that the more varied, flexible, and consistent student uses of discussion forums are, the greater the sense of community students will report. Additionally, students’ and instructors’ perceptions and experiences within these forums will shed light on the successes and challenges faced, thereby offering valuable recommendations for enhancing online learning environments. The findings are significant because they can contribute actionable insights for instructors, educational institutions, and curriculum designers aiming to optimize the use of discussion forums in online accelerated graduate programs, ultimately fostering a richer and more engaging learning experience for students.Keywords: accelerated online learning, discussion forums, LIS programs, sense of community, g
Procedia PDF Downloads 87283 A Risk-Based Comprehensive Framework for the Assessment of the Security of Multi-Modal Transport Systems
Authors: Mireille Elhajj, Washington Ochieng, Deeph Chana
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The challenges of the rapid growth in the demand for transport has traditionally been seen within the context of the problems of congestion, air quality, climate change, safety, and affordability. However, there are increasing threats including those related to crime such as cyber-attacks that threaten the security of the transport of people and goods. To the best of the authors’ knowledge, this paper presents for the first time, a comprehensive framework for the assessment of the current and future security issues of multi-modal transport systems. The approach or method proposed is based on a structured framework starting with a detailed specification of the transport asset map (transport system architecture), followed by the identification of vulnerabilities. The asset map and vulnerabilities are used to identify the various approaches for exploitation of the vulnerabilities, leading to the creation of a set of threat scenarios. The threat scenarios are then transformed into risks and their categories, and include insights for their mitigation. The consideration of the mitigation space is holistic and includes the formulation of appropriate policies and tactics and/or technical interventions. The quality of the framework is ensured through a structured and logical process that identifies the stakeholders, reviews the relevant documents including policies and identifies gaps, incorporates targeted surveys to augment the reviews, and uses subject matter experts for validation. The approach to categorising security risks is an extension of the current methods that are typically employed. Specifically, the partitioning of risks into either physical or cyber categories is too limited for developing mitigation policies and tactics/interventions for transport systems where an interplay between physical and cyber processes is very often the norm. This interplay is rapidly taking on increasing significance for security as the emergence of cyber-physical technologies, are shaping the future of all transport modes. Examples include: Connected Autonomous Vehicles (CAVs) in road transport; the European Rail Traffic Management System (ERTMS) in rail transport; Automatic Identification System (AIS) in maritime transport; advanced Communications, Navigation and Surveillance (CNS) technologies in air transport; and the Internet of Things (IoT). The framework adopts a risk categorisation scheme that considers risks as falling within the following threat→impact relationships: Physical→Physical, Cyber→Cyber, Cyber→Physical, and Physical→Cyber). Thus the framework enables a more complete risk picture to be developed for today’s transport systems and, more importantly, is readily extendable to account for emerging trends in the sector that will define future transport systems. The framework facilitates the audit and retro-fitting of mitigations in current transport operations and the analysis of security management options for the next generation of Transport enabling strategic aspirations such as systems with security-by-design and co-design of safety and security to be achieved. An initial application of the framework to transport systems has shown that intra-modal consideration of security measures is sub-optimal and that a holistic and multi-modal approach that also addresses the intersections/transition points of such networks is required as their vulnerability is high. This is in-line with traveler-centric transport service provision, widely accepted as the future of mobility services. In summary, a risk-based framework is proposed for use by the stakeholders to comprehensively and holistically assess the security of transport systems. It requires a detailed understanding of the transport architecture to enable a detailed vulnerabilities analysis to be undertaken, creates threat scenarios and transforms them into risks which form the basis for the formulation of interventions.Keywords: mitigations, risk, transport, security, vulnerabilities
Procedia PDF Downloads 166282 Survey of the Literacy by Radio Project as an Innovation in Literacy Promotion in Nigeria
Authors: Stella Chioma Nwizu
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The National Commission for Adult and Non Formal Education (NMEC) in Nigeria is charged with the reduction of illiteracy rate through the development, monitoring, and supervision of literacy programmes in Nigeria. In spite of various efforts by NMEC to reduce illiteracy, literature still shows that the illiteracy rate is still high. According to NMEC/UNICEF, about 60 million Nigerians are non-literate, and nearly two thirds of them are women. This situation forced the government to search for innovative and better approaches to literacy promotion and delivery. The literacy by radio project was adopted as an innovative intervention to literacy delivery in Nigeria because the radio is the cheapest and most easily affordable medium for non-literates. The project aimed at widening access to literacy programmes for the non-literate marginalized and disadvantaged groups in Nigeria by taking literacy programmes to their door steps. The literacy by radio has worked perfectly well in non-literacy reduction in Cuba. This innovative intervention of literacy by radio is anchored on the diffusion of innovation theory by Rogers. The literacy by radio has been going on for fifteen years and the efficacy and contributions of this innovation need to be investigated. Thus, the purpose of this research is to review the contributions of the literacy by radio in Nigeria. The researcher adopted the survey research design for the study. The population for the study consisted of 2,706 participants and 47 facilitators of the literacy by radio programme in the 10 pilot states in Nigeria. A sample of four states made up of 302 participants and eight facilitators were used for the study. Information was collected through Focus Group Discussion (FGD), interviews and content analysis of official documents. The data were analysed qualitatively to review the contributions of literacy by radio project and determine the efficacy of this innovative approach in facilitating literacy in Nigeria. Results from the field experience showed, among others, that more non-literates have better access to literacy programmes through this innovative approach. The pilot project was 88% successful; not less than 2,110 adults were made literate through the literacy by radio project in 2017. However, lack of enthusiasm and commitment on the part of the technical committee and facilitators due to non-payment of honorarium, poor signals from radio stations, interruption of lectures with adverts, low community involvement in decision making in the project are challenges to the success rate of the project. The researcher acknowledges the need to customize all materials and broadcasts in all the dialects of the participants and the inclusion of more civil rights, environmental protection and agricultural skills into the project. The study recommends among others, improved and timely funding of the project by the Federal Government to enable NMEC to fulfill her obligations towards the greater success of the programme, setting up of independent radio stations for airing the programmes and proper monitoring and evaluation of the project by NMEC and State Agencies for greater effectiveness. In an era of the knowledge-driven economy, no one should be allowed to get saddled with the weight of illiteracy.Keywords: innovative approach, literacy, project, radio, survey
Procedia PDF Downloads 67281 Gender Differences In Pain Assessment: A Daily Activities Perspective
Authors: Hui-mei Huang, Huei-Jiun Cheng
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Introduction Many patients are aware of the health benefits associated with an active lifestyle, but they are often hindered from engaging in physical activity due to the presence of pain. The majority of patients experience pain, which can fluctuate over time and is influenced by various factors, including gender. Gender differences in clinical pain and pain-related conditions are widely recognized. Existing literature strongly supports the notion that men and women exhibit distinct responses to pain. Previous studies conducted in Taiwan have highlighted gender differences in pain assessment, but only a limited number of studies have investigated the gender-related factors that influence pain during daily activities. The objective of this study was to examine gender differences in pain assessment among inpatients in Taiwan and investigate whether gender and surgical procedures are factors that impact the daily activities of pain. Method In this study, a prospective and structured questionnaire survey method was utilized, employing intentional sampling to gather data from inpatients admitted to a medical center in central Taiwan. The research period covered in this study is from October 1, 2019, to June 30, 2020. In this study, participants who were hospitalized within 48 hours were requested to self-assess their pain using the Numeric Rating Scale (NRS) and indicate the impact of pain on their activities. The data were analyzed to explore the potential influence of gender and surgical procedures on daily activities affected by pain. Result A total of 722 cases were included in the study, with the mean age of the subjects is 54.38 years old (SD=16.3), and the range varied from 18 to 93 years old. Among the subjects, 48.23% (n=348) were male, and 62.3% (n=450) of them had received more than 12 years of education., and 56.9% (n=411) underwent surgery. The results indicated that regardless of whether the participants underwent surgery or not, females experienced higher perceived severe pain intensity than males (t=2.248, P < .05). However, in surgical patients, there was no significant difference in gender (t=1.75, P > .05). Regarding the impact of pain on daily activities when pain intensity reached 7 , male subjects experienced a 5-point effect on their daily activities (AUC=0.84, 95% CI 0.79-0.89, P <0.01), while female subjects experienced a 7-point effect (AUC=0.88, 95% CI 0.80-0.87, P <0.01). Discussion Some studies suggest that women experience painful stimuli as more intense than men, this difference has been observed in various types of experimental pain, including mechanical and thermal stimuli. Our study reached the same conclusion, female patients exhibited greater intensity of pain. According to the research findings, The research findings highlight the significant impact of gender on individuals' response to intense pain (NRS>7) during their daily activities, with men showing a higher pain tolerance. The higher pain tolerance often observed in men may be attributed to societal conditioning, which encourages them to conceal outward expressions of pain. Further research in this area could help provide a more comprehensive understanding of the topic in Taiwan.Keywords: pain assessment, gender, surgery, activities of daily living
Procedia PDF Downloads 75280 Employers’ Preferences when Employing Solo Self-employed: a Vignette Study in the Netherlands
Authors: Lian Kösters, Wendy Smits, Raymond Montizaan
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The number of solo self-employed in the Netherlands has been increasing for years. The relative increase is among the largest in the EU. To explain this increase, most studies have focused on the supply side, workers who offer themselves as solo self-employed. The number of studies that focus on the demand side, the employer who hires the solo self-employed, is still scarce. Studies into employer behaviour conducted until now show that employers mainly choose self-employed workers when they have a temporary need for specialist knowledge, but also during projects or production peaks. These studies do not provide insight into the employers’ considerations for different contract types. In this study, interviews with employers were conducted, and available literature was consulted to provide an overview of the several factors employers use to compare different contract types. That input was used to set up a vignette study. This was carried out at the end of 2021 among almost 1000 business owners, HR managers, and business leaders of Dutch companies. Each respondent was given two sets of five fictitious candidates for two possible positions in their organization. They were asked to rank these candidates. The positions varied with regard to the type of tasks (core tasks or support tasks) and the time it took to train new people for the position. The respondents were asked additional questions about the positions, such as the required level of education, the duration, and the degree of predictability of tasks. The fictitious candidates varied, among other things, in the type of contract on which they would come to work for the organization. The results were analyzed using a rank-ordered logit analysis. This vignette setup makes it possible to see which factors are most important for employers when choosing to hire a solo self-employed person compared to other contracts. The results show that there are no indications that employers would want to hire solo self-employed workers en masse. They prefer regular employee contracts. The probability of being chosen with a solo self-employed contract over someone who comes to work as a temporary employee is 32 percent. This probability is even lower than for on-call and temporary agency workers. For a permanent contract, this probability is 46 percent. The results provide indications that employers consider knowledge and skills more important than the solo self-employed contract and that this can compensate. A solo self-employed candidate with 10 years of work experience has a 63 percent probability of being found attractive by an employer compared to a temporary employee without work experience. This suggests that employers are willing to give someone a less attractive contract for the employer if the worker so wishes. The results also show that the probability that a solo self-employed person is preferred over a candidate with a temporary employee contract is somewhat higher in business economics, administrative and technical professions. No significant results were found for factors where it was expected that solo self-employed workers are preferred more often, such as for unpredictable or temporary work.Keywords: employer behaviour, rank-ordered logit analysis, solo self-employment, temporary contract, vignette study
Procedia PDF Downloads 73279 A Correlations Study on Nursing Staff's Shifts Systems, Workplace Fatigue, and Quality of Working Life
Authors: Jui Chen Wu, Ming Yi Hsu
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Background and Purpose: Shift work of nursing staff is inevitable in hospital to provide continuing medical care. However, shift work is considered as a health hazard that may cause physical and psychological problems. Serious workplace fatigue of nursing shift work might impact on family, social and work life, moreover, causes serious reduction of quality of medical care, or even malpractice. This study aims to explore relationships among nursing staff’s shift, workplace fatigue and quality of working life. Method: Structured questionnaires were used in this study to explore relationships among shift work, workplace fatigue and quality of working life in nursing staffs. We recruited 590 nursing staffs in different Community Teaching hospitals in Taiwan. Data analysed by descriptive statistics, single sample t-test, single factor analysis, Pearson correlation coefficient and hierarchical regression, etc. Results: The overall workplace fatigue score is 50.59 points. In further analysis, the score of personal burnout, work-related burnout, over-commitment and client-related burnout are 57.86, 53.83, 45.95 and 44.71. The basic attributes of nursing staff are significantly different from those of workplace fatigue with different ages, licenses, sleeping quality, self-conscious health status, number of care patients of chronic diseases and number of care people in the obstetric ward. The shift variables revealed no significant influence on workplace fatigue during the hierarchical regression analysis. About the analysis on nursing staff’s basic attributes and shift on the quality of working life, descriptive results show that the overall quality of working life of nursing staff is 3.23 points. Comparing the average score of the six aspects, the ranked average score are 3.47 (SD= .43) in interrelationship, 3.40 (SD= .46) in self-actualisation, 3.30 (SD= .40) in self-efficacy, 3.15 (SD= .38) in vocational concept, 3.07 (SD= .37) in work aspects, and 3.02 (SD= .56) in organization aspects. The basic attributes of nursing staff are significantly different from quality of working life in different marriage situations, education level, years of nursing work, occupation area, sleep quality, self-conscious health status and number of care in medical ward. There are significant differences between shift mode and shift rate with the quality of working life. The results of the hierarchical regression analysis reveal that one of the shifts variables 'shift mode' which does affect staff’s quality of working life. The workplace fatigue is negatively correlated with the quality of working life, and the over-commitment in the workplace fatigue is positively related to the vocational concept of the quality of working life. According to the regression analysis of nursing staff’s basic attributes, shift mode, workplace fatigue and quality of working life related shift, the results show that the workplace fatigue has a significant impact on nursing staff’s quality of working life. Conclusion: According to our study, shift work is correlated with workplace fatigue in nursing staffs. This results work as important reference for human resources management in hospitals to establishing a more positive and healthy work arrangement policy.Keywords: nursing staff, shift, workplace fatigue, quality of working life
Procedia PDF Downloads 272278 Using Teachers' Perceptions of Science Outreach Activities to Design an 'Optimum' Model of Science Outreach
Authors: Victoria Brennan, Andrea Mallaburn, Linda Seton
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Science outreach programmes connect school pupils with external agencies to provide activities and experiences that enhance their exposure to science. It can be argued that these programmes not only aim to support teachers with curriculum engagement and promote scientific literacy but also provide pivotal opportunities to spark scientific interest in students. In turn, a further objective of these programmes is to increase awareness of career opportunities within this field. Although outreach work is also often described as a fun and satisfying venture, a plethora of researchers express caution to how successful the processes are to increases engagement post-16 in science. When researching the impact of outreach programmes, it is often student feedback regarding the activities or enrolment numbers to particular science courses post-16, which are generated and analysed. Although this is informative, the longevity of the programme’s impact could be better informed by the teacher’s perceptions; the evidence of which is far more limited in the literature. In addition, there are strong suggestions that teachers can have an indirect impact on a student’s own self-concept. These themes shape the focus and importance of this ongoing research project as it presents the rationale that teachers are under-used resources when it comes to considering the design of science outreach programmes. Therefore, the end result of the research will consist of a presentation of an ‘optimum’ model of outreach. The result of which should be of interest to the wider stakeholders such as universities or private or government organisations who design science outreach programmes in the hope to recruit future scientists. During phase one, questionnaires (n=52) and interviews (n=8) have generated both quantitative and qualitative data. These have been analysed using the Wilcoxon non-parametric test to compare teachers’ perceptions of science outreach interventions and thematic analysis for open-ended questions. Both of these research activities provide an opportunity for a cross-section of teacher opinions of science outreach to be obtained across all educational levels. Therefore, an early draft of the ‘optimum’ model of science outreach delivery was generated using both the wealth of literature and primary data. This final (ongoing) phase aims to refine this model using teacher focus groups to provide constructive feedback about the proposed model. The analysis uses principles of modified Grounded Theory to ensure that focus group data is used to further strengthen the model. Therefore, this research uses a pragmatist approach as it aims to focus on the strengths of the different paradigms encountered to ensure the data collected will provide the most suitable information to create an improved model of sustainable outreach. The results discussed will focus on this ‘optimum’ model and teachers’ perceptions of benefits and drawbacks when it comes to engaging with science outreach work. Although the model is still a ‘work in progress’, it provides both insight into how teachers feel outreach delivery can be a sustainable intervention tool within the classroom and what providers of such programmes should consider when designing science outreach activities.Keywords: educational partnerships, science education, science outreach, teachers
Procedia PDF Downloads 133277 Thermal Imaging of Aircraft Piston Engine in Laboratory Conditions
Authors: Lukasz Grabowski, Marcin Szlachetka, Tytus Tulwin
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The main task of the engine cooling system is to maintain its average operating temperatures within strictly defined limits. Too high or too low average temperatures result in accelerated wear or even damage to the engine or its individual components. In order to avoid local overheating or significant temperature gradients, leading to high stresses in the component, the aim is to ensure an even flow of air. In the case of analyses related to heat exchange, one of the main problems is the comparison of temperature fields because standard measuring instruments such as thermocouples or thermistors only provide information about the course of temperature at a given point. Thermal imaging tests can be helpful in this case. With appropriate camera settings and taking into account environmental conditions, we are able to obtain accurate temperature fields in the form of thermograms. Emission of heat from the engine to the engine compartment is an important issue when designing a cooling system. Also, in the case of liquid cooling, the main sources of heat in the form of emissions from the engine block, cylinders, etc. should be identified. It is important to redesign the engine compartment ventilation system. Ensuring proper cooling of aircraft reciprocating engine is difficult not only because of variable operating range but mainly because of different cooling conditions related to the change of speed or altitude of flight. Engine temperature also has a direct and significant impact on the properties of engine oil, which under the influence of this parameter changes, in particular, its viscosity. Too low or too high, its value can be a result of fast wear of engine parts. One of the ways to determine the temperatures occurring on individual parts of the engine is the use of thermal imaging measurements. The article presents the results of preliminary thermal imaging tests of aircraft piston diesel engine with a maximum power of about 100 HP. In order to perform the heat emission tests of the tested engine, the ThermaCAM S65 thermovision monitoring system from FLIR (Forward-Looking Infrared) together with the ThermaCAM Researcher Professional software was used. The measurements were carried out after the engine warm up. The engine speed was 5300 rpm The measurements were taken for the following environmental parameters: air temperature: 17 °C, ambient pressure: 1004 hPa, relative humidity: 38%. The temperatures distribution on the engine cylinder and on the exhaust manifold were analysed. Thermal imaging tests made it possible to relate the results of simulation tests to the real object by measuring the rib temperature of the cylinders. The results obtained are necessary to develop a CFD (Computational Fluid Dynamics) model of heat emission from the engine bay. The project/research was financed in the framework of the project Lublin University of Technology-Regional Excellence Initiative, funded by the Polish Ministry of Science and Higher Education (contract no. 030/RID/2018/19).Keywords: aircraft, piston engine, heat, emission
Procedia PDF Downloads 119276 Preventing Discharge to No Fixed Address-Youth (NFA-Y)
Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria
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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge
Procedia PDF Downloads 105275 ‘Only Amharic or Leave Quick!’: Linguistic Genocide in the Western Tigray Region of Ethiopia
Authors: Merih Welay Welesilassie
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Language is a potent instrument that does not only serve the purpose of communication but also plays a pivotal role in shaping our cultural practices and identities. The right to choose one's language is a fundamental human right that helps to safeguard the integrity of both personal and communal identities. Language holds immense significance in Ethiopia, a nation with a diverse linguistic landscape that extends beyond mere communication to delineate administrative boundaries. Consequently, depriving Ethiopians of their linguistic rights represents a multifaceted punishment, more complex than food embargoes. In the aftermath of the civil war that shook Ethiopia in November 2020, displacing millions and resulting in the loss of hundreds of thousands of lives, concerns have been raised about the preservation of the indigenous Tigrayan language and culture. This is particularly true following the annexation of western Tigray into the Amhara region and the implementation of an Amharic-only language and culture education policy. This scholarly inquiry explores the intricacies surrounding the Amhara regional state's prohibition of Tigrayans' indigenous language and culture and the subsequent adoption of a monolingual and monocultural Amhara language and culture in western Tigray. The study adopts the linguistic genocide conceptual framework as an analytical tool to gain a deeper insight into the factors that contributed to and facilitated this significant linguistic and cultural shift. The research was conducted by interviewing ten teachers selected through a snowball sampling. Additionally, document analysis was performed to support the findings. The findings revealed that the push for linguistic and cultural assimilation was driven by various political and economic factors and the desire to promote a single language and culture policy. This process, often referred to as ‘Amharanization,’ aimed to homogenize the culture and language of the society. The Amhara authorities have enacted several measures in pursuit of their objectives, including the outlawing of the Tigrigna language, punishment for speaking Tigrigna, imposition of the Amhara language and culture, mandatory relocation, and even committing heinous acts that have inflicted immense physical and emotional suffering upon members of the Tigrayan community. Upon conducting a comprehensive analysis of the contextual factors, actions, intentions, and consequences, it has been posited that there may be instances of linguistic genocide taking place in the Western Tigray region. The present study sheds light on the severe consequences that could arise because of implementing monolingual and monocultural policies in multilingual areas. Through thoroughly scrutinizing the implications of such policies, this study provides insightful recommendations and directions for future research in this critical area.Keywords: linguistic genocide, linguistic human right, mother tongue, Western Tigray
Procedia PDF Downloads 65274 Growth and Differentiation of Mesenchymal Stem Cells on Titanium Alloy Ti6Al4V and Novel Beta Titanium Alloy Ti36Nb6Ta
Authors: Eva Filová, Jana Daňková, Věra Sovková, Matej Daniel
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Titanium alloys are biocompatible metals that are widely used in clinical practice as load bearing implants. The chemical modification may influence cell adhesion, proliferation, and differentiation as well as stiffness of the material. The aim of the study was to evaluate the adhesion, growth and differentiation of pig mesenchymal stem cells on the novel beta titanium alloy Ti36Nb6Ta compared to standard medical titanium alloy Ti6Al4V. Discs of Ti36Nb6Ta and Ti6Al4V alloy were sterilized by ethanol, put in 48-well plates, and seeded by pig mesenchymal stem cells at the density of 60×103/cm2 and cultured in Minimum essential medium (Sigma) supplemented with 10% fetal bovine serum and penicillin/streptomycin. Cell viability was evaluated using MTS assay (CellTiter 96® AQueous One Solution Cell Proliferation Assay;Promega), cell proliferation using Quant-iT™ ds DNA Assay Kit (Life Technologies). Cells were stained immunohistochemically using monoclonal antibody beta-actin, and secondary antibody conjugated with AlexaFluor®488 and subsequently the spread area of cells was measured. Cell differentiation was evaluated by alkaline phosphatase assay using p-nitrophenyl phosphate (pNPP) as a substrate; the reaction was stopped by NaOH, and the absorbance was measured at 405 nm. Osteocalcin, specific bone marker was stained immunohistochemically and subsequently visualized using confocal microscopy; the fluorescence intensity was analyzed and quantified. Moreover, gene expression of osteogenic markers osteocalcin and type I collagen was evaluated by real-time reverse transcription-PCR (qRT-PCR). For statistical evaluation, One-way ANOVA followed by Student-Newman-Keuls Method was used. For qRT-PCR, the nonparametric Kruskal-Wallis Test and Dunn's Multiple Comparison Test were used. The absorbance in MTS assay was significantly higher on titanium alloy Ti6Al4V compared to beta titanium alloy Ti36Nb6Ta on days 7 and 14. Mesenchymal stem cells were well spread on both alloys, but no difference in spread area was found. No differences in alkaline phosphatase assay, fluorescence intensity of osteocalcin as well as the expression of type I collagen, and osteocalcin genes were observed. Higher expression of type I collagen compared to osteocalcin was observed for cells on both alloys. Both beta titanium alloy Ti36Nb6Ta and titanium alloy Ti6Al4V Ti36Nb6Ta supported mesenchymal stem cellsˈ adhesion, proliferation and osteogenic differentiation. Novel beta titanium alloys Ti36Nb6Ta is a promising material for bone implantation. The project was supported by the Czech Science Foundation: grant No. 16-14758S, the Grant Agency of the Charles University, grant No. 1246314 and by the Ministry of Education, Youth and Sports NPU I: LO1309.Keywords: beta titanium, cell growth, mesenchymal stem cells, titanium alloy, implant
Procedia PDF Downloads 318273 Experience of Two Major Research Centers in the Diagnosis of Cardiac Amyloidosis from Transthyretin
Authors: Ioannis Panagiotopoulos, Aristidis Anastasakis, Konstantinos Toutouzas, Ioannis Iakovou, Charalampos Vlachopoulos, Vasilis Voudris, Georgios Tziomalos, Konstantinos Tsioufis, Efstathios Kastritis, Alexandros Briassoulis, Kimon Stamatelopoulos, Alexios Antonopoulos, Paraskevi Exadaktylou, Evanthia Giannoula, Anastasia Katinioti, Maria Kalantzi, Evangelos Leontiadis, Eftychia Smparouni, Ioannis Malakos, Nikolaos Aravanis, Argyrios Doumas, Maria Koutelou
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Introduction: Cardiac amyloidosis from Transthyretin (ATTR-CA) is an infiltrative disease characterized by the deposition of pathological transthyretin complexes in the myocardium. This study describes the characteristics of patients diagnosed with ATTR-CA from 2019 until present at the Nuclear Medicine Department of Onassis Cardiac Surgery Center and AHEPA Hospital. These centers have extensive experience in amyloidosis and modern technological equipment for its diagnosis. Materials and Methods: Records of consecutive patients (N=73) diagnosed with any type of amyloidosis were collected, analyzed, and prospectively followed. The diagnosis of amyloidosis was made using specific myocardial scintigraphy with Tc-99m DPD. Demographic characteristics, including age, gender, marital status, height, and weight, were collected in a database. Clinical characteristics, such as amyloidosis type (ATTR and AL), serum biomarkers (BNP, troponin), electrocardiographic findings, ultrasound findings, NYHA class, aortic valve replacement, device implants, and medication history, were also collected. Some of the most significant results are presented. Results: A total of 73 cases (86% male) were diagnosed with amyloidosis over four years. The mean age at diagnosis was 82 years, and the main symptom was dyspnea. Most patients suffered from ATTR-CA (65 vs. 8 with AL). Out of all the ATTR-CA patients, 61 were diagnosed with wild-type and 2 with two rare mutations. Twenty-eight patients had systemic amyloidosis with extracardiac involvement, and 32 patients had a history of bilateral carpal tunnel syndrome. Four patients had already developed polyneuropathy, and the diagnosis was confirmed by DPD scintigraphy, which is known for its high sensitivity. Among patients with isolated cardiac involvement, only 6 had left ventricular ejection fraction below 40%. The majority of ATTR patients underwent tafamidis treatment immediately after diagnosis. Conclusion: In conclusion, the experiences shared by the two centers and the continuous exchange of information provide valuable insights into the diagnosis and management of cardiac amyloidosis. Clinical suspicion of amyloidosis and early diagnostic approach are crucial, given the availability of non-invasive techniques. Cardiac scintigraphy with DPD can confirm the presence of the disease without the need for a biopsy. The ultimate goal still remains continuous education and awareness of clinical cardiologists so that this systemic and treatable disease can be diagnosed and certified promptly and treatment can begin as soon as possible.Keywords: amyloidosis, diagnosis, myocardial scintigraphy, Tc-99m DPD, transthyretin
Procedia PDF Downloads 91272 The Influence of Active Breaks on the Attention/Concentration Performance in Eighth-Graders
Authors: Christian Andrä, Luisa Zimmermann, Christina Müller
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Introduction: The positive relation between physical activity and cognition is commonly known. Relevant studies show that in everyday school life active breaks can lead to improvement in certain abilities (e.g. attention and concentration). A beneficial effect is in particular attributed to moderate activity. It is still unclear whether active breaks are beneficial after relatively short phases of cognitive load and whether the postulated effects of activity really have an immediate impact. The objective of this study was to verify whether an active break after 18 minutes of cognitive load leads to enhanced attention/concentration performance, compared to inactive breaks with voluntary mobile phone activity. Methodology: For this quasi-experimental study, 36 students [age: 14.0 (mean value) ± 0.3 (standard deviation); male/female: 21/15] of a secondary school were tested. In week 1, every student’s maximum heart rate (Hfmax) was determined through maximum effort tests conducted during physical education classes. The task was to run 3 laps of 300 m with increasing subjective effort (lap 1: 60%, lap 2: 80%, lap 3: 100% of the maximum performance capacity). Furthermore, first attention/concentration tests (D2-R) took place (pretest). The groups were matched on the basis of the pretest results. During week 2 and 3, crossover testing was conducted, comprising of 18 minutes of cognitive preload (test for concentration performance, KLT-R), a break and an attention/concentration test after a 2-minutes transition. Different 10-minutes breaks (active break: moderate physical activity with 65% Hfmax or inactive break: mobile phone activity) took place between preloading and transition. Major findings: In general, there was no impact of the different break interventions on the concentration test results (symbols processed after physical activity: 185.2 ± 31.3 / after inactive break: 184.4 ± 31.6; errors after physical activity: 5.7 ± 6.3 / after inactive break: 7.0. ± 7.2). There was, however, a noticeable development of the values over the testing periods. Although no difference in the number of processed symbols was detected (active/inactive break: period 1: 49.3 ± 8.8/46.9 ± 9.0; period 2: 47.0 ± 7.7/47.3 ± 8.4; period 3: 45.1 ± 8.3/45.6 ± 8.0; period 4: 43.8 ± 7.8/44.6 ± 8.0), error rates decreased successively after physical activity and increased gradually after an inactive break (active/inactive break: period 1: 1.9 ± 2.4/1.2 ± 1.4; period 2: 1.7 ± 1.8/ 1.5 ± 2.0, period 3: 1.2 ± 1.6/1.8 ± 2.1; period 4: 0.9 ± 1.5/2.5 ± 2.6; p= .012). Conclusion: Taking into consideration only the study’s overall results, the hypothesis must be dismissed. However, more differentiated evaluation shows that the error rates decreased after active breaks and increased after inactive breaks. Obviously, the effects of active intervention occur with a delay. The 2-minutes transition (regeneration time) used for this study seems to be insufficient due to the longer adaptation time of the cardio-vascular system in untrained individuals, which might initially affect the concentration capacity. To use the positive effects of physical activity for teaching and learning processes, physiological characteristics must also be considered. Only this will ensure optimum ability to perform.Keywords: active breaks, attention/concentration test, cognitive performance capacity, heart rate, physical activity
Procedia PDF Downloads 315271 A Comparative Study on Compliment Response between Indonesian EFL Students and English Native Speakers
Authors: Maria F. Seran
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In second language interaction, an EFL student always carries his knowledge of targeted language and sometimes gets influenced by his first language cultures which makes him transfer his utterances from the first language to the second language. The influence of L1 cultures somehow can lead to face-threatening act when it comes to responding on speech act, for instance, compliment. A speaker praises a compliment to show gratitude, and in return, he expects for compliment respond uttered by the hearer. While Western people use more acceptance continuum on compliment response, Indonesians utter more denial continuum which can somehow put the speakers into a face-threating situation and offense. This study investigated compliment response employed by EFL students and English native speakers. The study was distinct as none compliment response studies had been conducted to compare the compliment response between English native speakers and two different Indonesian EFL proficiency groups in which this research sought to meet this need. This study was significant for EFL teachers because it gave insight on cross-cultural understanding and brought pedagogical implication on explicit pragmatic instruction. Two research questions were set, 1. How do Indonesian EFL students and English native speakers respond compliments? 2. Is there any correlation between Indonesia EFL students’ proficiency and their compliment response use in English? The study involved three groups of participants; 5 English native speakers, 10 high-proficiency and 10 low-proficiency Indonesian EFL university students. The research instruments used in this study were as follows, an online TOEFL prediction test, focusing on grammar skill which was modified from Barron TOEFL exercise test, and a discourse completion task (DCT), consisting of 10 compliment respond items. Based on the research invitation, 20 second-year university students majoring in English education at Widya Mandira Catholic University, Kupang, East Nusa Tenggara, Indonesia who willingly participated in the research took the TOEFL prediction test online from the link provided. Students who achieved score 75-100 in test were categorized as high-proficiency students, while, students who attained score below 74 were considered as low-proficiency students. Then, the DCT survey was administered to these EFL groups and the native speaker group. Participants’ responses were coded and analyzed using categories of compliment response framework proposed by Tran. The study found out that 5 native speakers applied more compliment upgrades and appreciation token in compliment response, whereas, Indonesian EFL students combined some compliment response strategies in their utterance, such as, appreciation token, return and compliment downgrade. There is no correlation between students’ proficiency level and their CR responds as most EFL students in both groups produced less varied compliment responses and only 4 Indonesian high-proficiency students uttered more varied and were similar to the native speakers. The combination strategies used by EFL students can be explained as the influence of pragmatic transfer from L1 to L2; therefore, EFL teachers should explicitly teach more compliment response strategies to raise students’ awareness on English culture and elaborate their speaking to be more competence as close to native speakers as possible.Keywords: compliment response, English native speakers, Indonesian EFL students, speech acts
Procedia PDF Downloads 148270 Scale up of Isoniazid Preventive Therapy: A Quality Management Approach in Nairobi County, Kenya
Authors: E. Omanya, E. Mueni, G. Makau, M. Kariuki
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HIV infection is the strongest risk factor for a person to develop TB. Isoniazid preventive therapy (IPT) for People Living with HIV (PLWHIV) not only reduces the individual patients’ risk of developing active TB but mitigates cross infection. In Kenya, IPT for six months was recommended through the National TB, Leprosy and Lung Disease Program to treat latent TB. In spite of this recommendation by the national government, uptake of IPT among PLHIV remained low in Kenya by the end of 2015. The USAID/Kenya and East Africa Afya Jijini project, which supports 42 TBHIV health facilities in Nairobi County, began addressing low uptake of IPT through Quality Improvement (QI) teams set up at the facility level. Quality is characterized by WHO as one of the four main connectors between health systems building blocks and health systems outputs. Afya Jijini implements the Kenya Quality Model for Health, which involves QI teams being formed at the county, sub-county and facility levels. The teams review facility performance to identify gaps in service delivery and use QI tools to monitor and improve performance. Afya Jijini supported the formation of these teams in 42 facilities and built the teams’ capacity to review data and use QI principles to identify and address performance gaps. When the QI teams began working on improving IPT uptake among PLHIV, uptake was at 31.8%. The teams first conducted a root cause analysis using cause and effect diagrams, which help the teams to brainstorm on and to identify barriers to IPT uptake among PLHIV at the facility level. This is a participatory process where program staff provides technical support to the QI teams in problem identification and problem-solving. The gaps identified were inadequate knowledge and skills on the use of IPT among health care workers, lack of awareness of IPT by patients, inadequate monitoring and evaluation tools, and poor quantification and forecasting of IPT commodities. In response, Afya Jijini trained over 300 health care workers on the administration of IPT, supported patient education, supported quantification and forecasting of IPT commodities, and provided IPT data collection tools to help facilities monitor their performance. The facility QI teams conducted monthly meetings to monitor progress on implementation of IPT and took corrective action when necessary. IPT uptake improved from 31.8% to 61.2% during the second year of the Afya Jijini project and improved to 80.1% during the third year of the project’s support. Use of QI teams and root cause analysis to identify and address service delivery gaps, in addition to targeted program interventions and continual performance reviews, can be successful in increasing TB related service delivery uptake at health facilities.Keywords: isoniazid, quality, health care workers, people leaving with HIV
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