Search results for: primary immuno deficiency
4855 Prevalence of Diabetes Mellitus Among Human Immune Deficiency Virus-Positive Patients Under Anti-retroviral Attending in Rwanda, a Case Study of University Teaching Hospital of Butare
Authors: Venuste Kayinamura, V. Iyamuremye, A. Ngirabakunzi
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Anti-retroviral therapy (ART) for HIV patient can cause a deficiency in glucose metabolism by promoting insulin resistance, glucose intolerance, and diabetes, diabetes mellitus keep increasing among HIV-infected patients worldwide but there is limited data on levels of blood glucose and its relationship with antiretroviral drugs (ARVs) and HIV-infection worldwide, particularly in Rwanda. A convenient sampling strategy was used in this study and it involved 323 HIV patients (n=323). Patients who are HIV positive under ARVs were involved in this study. The patient’s blood glucose was analyzed using an automated machine or glucometer (COBAS C 311). Data were analyzed using Microsoft Excel and SPSS V. 20.0 and presented in percentages. The highest diabetes mellitus prevalence was 93.33 % in people aged >40 years while the lowest diabetes mellitus prevalence was 6.67% in people aged between 21-and 40 years. The P-value was (0.021). Thus, there is a significant association between age and diabetes occurrence. The highest diabetes mellitus prevalence was 28.2% in patients under ART treatment for more than 10 years, 16.7% were <5years while 20% of patients were on ART treatment between 5-10 years. The P-value here is (0.03), thus the incidence of diabetes is associated with long-term ART use in HIV-infected patients. This study assessed the prevalence of diabetes among HIV-infected patients under ARVs attending the University Teaching Hospital of Butare (CHUB), it shows that the prevalence of diabetes is high in HIV-infected patients under ARTs. This study found no significant relationship between gender and diabetes mellitus growth. Therefore, regular assessment of diabetes mellitus especially among HIV-infected patients under ARVs is highly recommended to control other health issues caused by diabetes mellitus.Keywords: anti-retroviral, diabetes mellitus, antiretroviral therapy, human immune deficiency virus
Procedia PDF Downloads 1134854 Cobalamin, Folate and Metabolic Syndrome Parameters in Pediatric Morbid Obesity and Metabolic Syndrome
Authors: Mustafa M. Donma, Orkide Donma
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Obesity is known to be associated with many clinically important diseases including metabolic syndrome (MetS). Vitamin B12 plays essential roles in fat and protein metabolisms and its cooperation with vitamin B9 is well-known. The aim of this study is to investigate the possible contributions as well as associations of these micronutrients upon obesity and MetS during childhood. A total of 128 children admitted to Namik Kemal University, Medical Faculty, Department of Pediatrics Outpatient Clinics were included into the scope of this study. The mean age±SEM of 92 morbid obese (MO) children and 36 with MetS were 118.3±3.8 months and 129.5±6.4 months, respectively (p > 0.05). The study was approved by Namık Kemal University, Medical Faculty Ethics Committee. Written informed consent forms were obtained from the parents. Demographic features and anthropometric measurements were recorded. WHO BMI-for age percentiles were used. The values above 99 percentile were defined as MO. Components of MetS [waist circumference (WC), fasting blood glucose (FBG), triacylglycerol (TRG), high density lipoprotein cholesterol (HDL-Chol), systolic pressure (SP), diastolic pressure (DP)] were determined. Routine laboratory tests were performed. Serum vitamin B12 concentrations were measured using electrochemiluminescence immunoassay. Vitamin B9 was analyzed by an immunoassay analyzer. Values for vitamin B12 < 148 pmol/L, 148-221 pmol/L, > 221 pmol/L were accepted as low, borderline and normal, respectively. Vitamin B9 levels ≤ 4 mcg/L defined deficiency state. Statistical evaluations were performed by SPSSx Version 16.0. p≤0.05 was accepted as statistical significance level. Statistically higher body mass index (BMI), WC, hip circumference (C) and neck C were calculated in MetS group compared to children with MO. No difference was noted for head C. All MetS components differed between the groups (SP, DP p < 0.001; WC, FBG, TRG p < 0.01; HDL-Chol p < 0.05). Significantly decreased vitamin B9 and vitamin B12 levels were detected (p < 0.05) in children with MetS. In both groups percentage of folate deficiency was 5.5%. No cases were below < 148 pmol/L. However, in MO group 14.3% and in MetS group 22.2% of the cases were of borderline status. In MO group B12 levels were negatively correlated with BMI, WC, hip C and head C, but not with neck C. WC, hip C, head C and neck C were all negatively correlated with HDL-Chol. None of these correlations were observed in the group of children with MetS. Strong positive correlation between FBG and insulin as well as strong negative correlation between TRG and HDL-Chol detected in MO children were lost in MetS group. Deficiency state end-products of both B9 and B12 may interfere with the expected profiles of MetS components. In this study, the alterations in MetS components affected vitamin B12 metabolism and also its associations with anthropometric body measurements. Further increases in vitamin B12 and vitamin B9 deficiency in MetS associated with the increased vitamin B12 as well as vitamin B9 deficiency metabolites may add to MetS parameters.Keywords: children, cobalamin, folate, metabolic syndrome, obesity
Procedia PDF Downloads 1934853 Social Marketing – An Integrated and Comprehensive Nutrition Communication Strategy to Improve the Iron Nutriture among Preschool Children
Authors: Manjula Kola, K. Chandralekha
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Anaemia is one of the world’s most widespread health problems. Prevalence of anemia in south Asia is among the highest in the world. Iron deficiency anemia accounts for almost 85 percent of all types of anemia in India and affects more than half of the total population. Women of childbearing age particularly pregnant women, infants, preschool children and adolescents are at greatest risk of developing iron deficiency anemia. In India, 74 percent children between 6-35 months of age are anemic. Children between 1-6 years in major cities are found with a high prevalence rate of 64.8 percent. Iron deficiency anemia is not only a public health problem, but also a development problem. Its prevention and reduction must be viewed as investment in human capital that will enhance development and reduce poverty. Ending this hidden hunger in the form of iron deficiency is the most important achievable international health goal. Eliminating the underlying problem is essential to the sustained elimination of the iron deficiency anemia. The intervention programmes toward the sustained elimination need to be broadly based so that interventions become accepted community practices. Hence, intervention strategies need to go well beyond traditional health and nutrition systems and based upon empowering people and communities so that they will be capable of arranging for and sustaining an adequate intake of foods with respect to iron, independent of external support. Such strategies must necessarily be multisectoral and integrate interventions with social communications, evaluation and surveillance. The main objective of the study was to design a community based Nutrition intervention using theoretical framework of social marketing to sustain improvement of iron nutriture among preschool children. In order to carryout the study eight rural communities In Chittoor district of Andhra Pradesh, India were selected. A formative research was carryout for situational analysis and baseline data was generated with regard to demographic and socioeconomic status, dietary intakes, Knowledge, Attitude and Practices of the mothers of preschool children, clinical and hemoglobin status of the target group. Based on the formative research results, the research area was divides into four groups as experimental area I,II,III and control area. A community based, integrated and comprehensive social marketing intervention was designed based on various theories and models of nutrition education/ communication. In Experimental area I, Nutrition intervention using social marketing and a weekly iron folic acid supplementation was given to improve iron nutriture of preschool children. In experimental area II, Social marketing alone was implemented and in experimental area III Iron supplementation alone was given. No intervention was given in control area. The Impact evaluation revealed that among different interventions tested, the integrated social marketing intervention resulted best outcomes. The overall observations of the study state that social marketing, an integrated and functional strategy for nutrition communication to prevent and control iron deficiency. Various theoretical frame works / models for nutrition communication facilitate to design culturally appropriate interventions thus achieved improvements in the knowledge, attitude and practices there by resulting successful impact on nutritional status of the target groups.Keywords: anemia, iron deficiency, social marketing, theoretical framework
Procedia PDF Downloads 4054852 Management of Nutritional Strategies in Prevention of Autism Before and During Pregnancy
Authors: Maryam Ghavam Sadri, Kimia Moiniafshari
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Objectives: Autism is a neuro-developmental disorder that has negative effects on verbal, mental and behavioral development. Studies have shown the role of a maternal dietary pattern before and during pregnancy. The relation of exerting of nutritional management programs in prevention of Autism has been approved. This review article has been made to investigate the role of nutritional management strategies before and during pregnancy in the prevention of Autism. Methods: This review study was accomplished by using the keywords related to the topic, 67 articles were found (2000-2015) and finally 20 article with criteria such as including maternal lifestyle, nutritional deficiencies and Autism prevention were selected. Results: Maternal dietary pattern and health before and during pregnancy have important roles in the incidence of Autism. Studies have suggested that high dietary fat intake and obesity can increase the risk of Autism in offspring. Maternal metabolic condition specially gestational diabetes (GDM) (p-value < 0.04) and folate deficiency (p-value = 0.04) is associated with risk of Autism. Studies have shown that folate intake in mothers with autistic children is less than mothers who have typically developing children (TYP) (p-value<0.01). As folate is an essential micronutrient for fetus mental development, consumption of average 600 mcg/day especially in P1 phase of pregnancy results in significant reduction in incidence of Autism (OR:1.53, 95%CI=0.42-0.92, p-value = 0.02). furthermore, essential fatty acid deficiency especially omega-3 fatty acid increases the rate of Autism and consumption of supplements and food sources of omega-3 can decrease the risk of Autism up to 34% (RR=1.53, 95%CI=1-2.32). Conclusion: regards to nutritional deficiency and maternal metabolic condition before and during pregnancy in prevalence of Autism, carrying out the appropriate nutritional strategies such as well-timed folate supplementation before pregnancy and healthy lifestyle adherence for prevention of metabolic syndrome (GDM) seems to help Autism prevention.Keywords: autism, autism prevention, dietary inadequacy, maternal lifestyle
Procedia PDF Downloads 3574851 Investigation of the Effect of Anaerobic Digestate on Antifungal Activity and in Different Parameters of Maize
Authors: Nazia Zaffar, Alam Khan, Abdul Haq, Malik Badshah
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Pakistan is an agricultural country. The increasing population leads to an increase in demand for food. A large number of crops are infected by different microbes, and nutrient deficiency of soil adversely affects the yield of crops. Furthermore, the use of chemical fertilizers like Nitrogen, Phosphorus, Potassium (NPK) Urea, and Diammonium phosphate (DAP) and pesticides have environmental consequences. Therefore, there is an urgent need to explore alternative renewable and sustainable biofertilizers. Maize is one of the top growing crops in Pakistan, but it has low yield compared to other countries due to deficiency of organic matter, widespread nutrients deficiency (phosphorus and nitrogen), unbalanced use of fertilizers and various fungal diseases. In order to get rid of all these disadvantages, Digestate emerged as a win-win opportunity for the control of a few plant diseases and a replacement for the chemical fertilizers. The present study was designed to investigate the effect of Anerobic digestate on Antifungal Activity and in different parameters of Maize. The antifungal activity, minimum inhibitory concentration (MIC), and minimum fungicidal concentration (MFC) against selected phytopathogens (Colletotrichum coccodis, Pythium ultimum, Phytophthora capsci, Rhizoctonia solani, Bipolaris oryzae and Fusarium Fujikuroi) were determined by microtiter plate method. The effect of various fertilizers in different growth parameters height, diameter, chlorophyll, leaf area, biomass, and yield were studied in field experiments. The extracts from anaerobic digestate have shown antifungal activity against selected phytopathogens, the highest activity was noted against P. ultimum, the MIC activity was high in case of P. ultimum and B. oryzae. The present study concludes that anaerobic digestate have a positive effect on maize growth and yield as well as an antifungal activity which can be potentially a good biofertilizer.Keywords: anaerobic digestate, antifungal activity, MIC, phytopathogens
Procedia PDF Downloads 1254850 Relationship between Body Mass Composition and Primary Dysmenorrhoea
Authors: Snehalata Tembhurne
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Introduction: A healthy menstrual cycle is a sign of women’s sound health.Various variables may influence the length and regularity of menstrual cycle.Studies have revealed that menstrual cycle abnormalities may be associated with psychological stress,lack of physical exercise, alteration in body composition,endocrine disturbances,higher estrogen levels as seen in obese females.Hence there is an urgent need to find out the relationship between variations in body mass composition(BMI & body fat%) with menstrual abnormalities like primary dysmenorrhoea. Aim: To find out the relationship between body mass composition and primary dysmenorrhea. Objectives: 1.To check whether there is any association between body mass index and primary dysmenorrhoea.2.To check whether there is any association between body fat percentage and primary dysmenorrhoea. NULL HYPOTHESES-There is no relationship between body mass composition and primary dysmenorrhea. Hypothesis: There exists a relationship between body mass composition and primary dysmenorrhea. Materials and Methods: The study was conducted over a period of 6 months with 90 samples selected on random basis. The procedure was explained to the participant and a written consent was taken thereafter. The participant was made to stand on the BODY COMPOSITION SCANNING MONITOR, which scanned the physical profile of the participant (height, weight, BMI, body fat percentage and visceral fat).Thereafter, the candidate was asked about her menstrual irregularities and was asked to grade her level of dysmenorrhoea (if present) using the Verbal Dimensional Dysmenorrhea Scale. Results: Chi square test of association was used to find out the association between body mass composition(body mass index,body fat percentage) and primary dysmenorrhea.The chi-square value for association between body mass index and primary dysmenorrhea was 38.63 p<0.001 which was statistically significant.The chi-square value for the association of body fat % & primary dysmenorrhea was 30.09,p<0.001which was statistically significant. Conclusion: Study shows that there exists a significant relationship between body mass composition and primary dysmenorrhea and as the value of Body mass index and body fat percentages goes on increasing in females, the severity of primary dysmenorrhea also increases.Keywords: body mass index, body composition screening monitor, primary dysmenorrhea, verbal dimensional dysmenorrhea scale
Procedia PDF Downloads 3284849 Mineral Status of Feeds and Fodder and Its Subsequent Effect on Plasma of Livestock and Its Products in Red Lateritic Zone of West Bengal, India
Authors: S. K. Pyne, M. Mondal, G. Samanta
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A survey was carried out in red lateritic zone of West Bengal to compare the mineral status in plasma of livestock grazing over red lateritic region. Sufficient number of samples of soil, feeds, fodder and blood were collected from four districts of red lateritic zone namely, West Midnapore, Birbhum, Bankura and Purulia respectively. The samples were analysed for Calcium (Ca), Phosphorus (P), Copper (Cu), Zinc (Zn), Manganese (Mn) and Iron (Fe). Concentration of Cu, Mn and Fe in soil were above the minimum critical level, whereas, Zn deficiency is wide spread in red lateritic soil. Paddy straw is deficient in Ca, P, Zn and Mn in the region. Green fodders are also deficient in P, Cu, Zn. The richness of iron (Fe) in soil, feeds, fodder and tree leaves is the characteristics of this region. Phosphorus is deficient in plasma of all categories of livestock with the exception of bullock. Cu is deficient in plasma of calf. Plasma Mn and Fe were higher (p<0.01) in the animals of red lateritic zone. The study reveals that the overall deficiency of phosphorus in different categories of livestock and there is need of dietary supplementation.Keywords: mineral, red lateritic zone, grazing livestock, plasma
Procedia PDF Downloads 3294848 The Multi-Sensory Teaching Practice for Primary Music Classroom in China
Authors: Xiao Liulingzi
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It is important for using multi-sensory teaching in music learning. This article aims to provide knowledge in multi-sensory learning and teaching music in primary school. For primary school students, in addition to the training of basic knowledge and skills of music, students' sense of participation and creativity in music class are the key requirements, especially the flexibility and dynamics in music class, so that students can integrate into music and feel the music. The article explains the multi-sensory sense in music learning, the differences between multi-sensory music teaching and traditional music teaching, and music multi-sensory teaching in primary schools in China.Keywords: multi-sensory, teaching practice, primary music classroom, China
Procedia PDF Downloads 1304847 The Vulnerability of Farmers in Valencia Negros Oriental to Climate Change: El Niño Phenomenon and Malnutrition
Authors: J. K. Pis-An
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Objective: The purpose of the study was to examine the vulnerability of farmers to the effects of climate change, specifically the El Niño phenomenon was felt in the Philippines in 2009-2010. Methods: KAP Survey determines behavioral response to vulnerability to the effects of El Niño. Body Mass Index: Dietary Assessment using 24-hour food recall. Results: 75% of the respondents claimed that crop significantly decreased during drought. Indications that households of farmers are large where 51.6% are composed of 6-10 family members with 68% annual incomes below Php 100,00. Anthropometric assessment showed that the prevalence of Chronic Energy Deficiency Grade 1 among females 17% and 28.57% for low normal. While male body mass index result for chronic energy deficiency grade 1 10%, low normal 18.33% and and obese grade 1, 31.67%. Dietary assessment of macronutrient intake of carbohydrates, protein, and fat 31.6 % among respondents are below recommended amounts. Micronutrient deficiency of calcium, iron, vit. A, thiamine, riboflavin, niacin, and Vit. C. Conclusion: Majority of the rural populations are engaged into farming livelihood that makes up the backbone of their economic growth. Placing the current nutritional status of the farmers in the context of food security, there are reasons to believe that the status will go for worse if the extreme climatic conditions will once again prevail in the region. Farmers rely primarily on home grown crops for their food supply, a reduction in farm production during drought is expected to adversely affect dietary intake. The local government therefore institute programs to increase food resiliency and to prioritize health of the population as the moving force for productivity and development.Keywords: world health organization, united nation framework convention on climate change, anthropometric, macronutrient, micronutrient
Procedia PDF Downloads 4444846 A Comparative Study on Primary Productivity in Fish Cage Culture Unit and Fish Pond in Relation to Different Level of Water Depth
Authors: Pawan Kumar Sharma, J. Stephan Sampath Kumar, D. Manikandavelu, V. Senthil Kumar
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The total amount of productivity in the system is the gross primary productivity. The present study was carried out to understand the relationship between productivity in the cages and water depth. The experiment was conducted in the fish cages installed in the pond at the Directorate of Sustainable Aquaculture, Thanjavur, Tamil Nadu Dr. J. Jayalalithaa Fisheries University, Tamil Nadu (10° 47' 13.1964'' N; 79° 8' 16.1700''E). Primary productivity was estimated by light and dark bottle method. The measurement of primary productivity was done at different depths viz., 20 cm, 40 cm, and 60 cm. Six Biological Oxygen Demand bottles of 300 ml capacity were collected and tagged. The productivity was obtained in mg O2/l/hr. The maximum dissolved oxygen level at 20 cm depth was observed 5.62 ± 0.22 mg/l/hr in the light bottle in pond water while the minimum dissolved oxygen level at 20 cm depth in a cage was observed 3.62 ± 0.18 mg/l/hr in dark bottle. In the same way, the maximum and minimum value of dissolved oxygen was observed at 40, and 60 cm depth and results were compared. A slight change in pH was observed in the cage and pond. The maximum gross primary productivity observed was 1.97 mg/l/hr in pond at 20 cm depth while minimum gross primary productivity observed was 0.82±0.16 mg/l/hr in a cage at 60 cm depth. The community respiration was also variable with the depth in both cage and pond. Maximum community respiration was found 1.50±0.19 mg/l/hr in pond at 20 cm depth. A strong positive linear relationship was observed between primary productivity and fish yields in ponds. The pond primary productivity can contribute substantially to the nutrition of farm-raised aquaculture species, including shrimp. The growth of phytoplankton’s is dependent on the sun light, availability of primary nutrients (N, P, and K) in the water body and transparency, so to increase the primary productivity fertilization through organic manure may be done that will clean to the pond environment also.Keywords: cage aquaculture, water depth, net primary productivity, gross primary productivity, community respiration
Procedia PDF Downloads 2084845 The Place of Instructional Materials in Quality Education at Primary School Level in Katsina State, Nigeria
Authors: Murtala Sale
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The use of instructional materials is an indispensable tool that enhances qualitative teaching and learning especially at the primary level. Instructional materials are used to facilitate comprehension of ideas in the learners as well as ensure long term retention of ideas and topics taught to pupils. This study examined the relevance of using instructional materials in primary schools in Katsina State, Nigeria. It employed survey design using cluster sampling technique. The questionnaire was used to gather data for analysis, and statistical and frequency tables were used to analyze the data gathered. The results show that teachers and students alike have realized the effectiveness of modern instructional materials in teaching and learning for the attainment of set objectives in the basic primary education policy. It also discovered that reluctance in the use of instructional materials will hamper the achievement of qualitative primary education. The study therefore suggests that there should be the provision of adequate and up-to-date instructional materials to all primary schools in Katsina State for effective teaching and learning process.Keywords: instructional materials, effective teaching, learning quality, indispensable aspect
Procedia PDF Downloads 2524844 Lived Experiences of Primary Caregiver of Schizophrenia Patients at Acute Crisis Intervention Service
Authors: Mykah W. Sumoldao, Maria Erissa C. Susa, Triny Cate M. Telan, Christian Arvin M. Torres, Jasmine I. Udasco, Franceis Jeramil M. Walis, Shellyn S. Wandagan, Janine May M. Warding, Queenie Diana Rose P. Zalun Hope Lulet A. Lomioan
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This descriptive phenomenological study explored the lived experiences of the primary caregiver of schizophrenia patients at the Acute Crisis Intervention Service in Cagayan Valley Medical Center. The research aimed to understand the emotional, physical, and financial challenges these primary caregivers face. Data was gathered through interviews with nine (9) primary caregivers and analyzed using Colaizzi’s seven-step method. Two main themes emerged: Experience/ Challenges (Emotional, Physical, and Financial Challenges) and Managing Mechanisms (Support Systems and Resilience and Commitment). The study found that primary caregivers deal with a complex mix of difficulties, often with limited resources. They rely heavily on personal strength, faith, family, friends and community support to manage their roles. The findings highlighted the need for better support systems to ease primary caregivers' burdens. Financial aid, respite care, and mental health support are crucial for improving primary caregivers' quality of life and the care they provide. Additionally, raising awareness about primary caregivers' challenges can foster a supportive community, with more help from local organizations and government entities. Thus, this study provided insights into the caregiving experiences of those supporting schizophrenia patients. It emphasized the importance of practical support and emotional resilience. By addressing these needs, a more supportive environment can be created, benefiting both primary caregivers and their patients.Keywords: primary caregiver burden, mental health, primary caregiver well-being, primary caregiver
Procedia PDF Downloads 294843 Effect of Nano-Alumina on the Mechanical Properties of Cold Recycled Asphalt
Authors: Shahab Hasani Nasab, Aran Aeini, Navid Kermanshahi
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In order to reduce road building costs and reduce environmental damage, recycled materials can be used instead of mineral materials in the production of asphalt mixtures. Today, in most parts of the world, cold recycled asphalt with bitumen emulsion, has acceptable results. However, Cold Recycled Asphalt have some deficiency such as stripping, thermal cracking, and rutting. This requires the addition of additives to reduce this deficiency of recycled pavement with emulsified asphalt. In this research, nano-alumina and emulsified asphalt were used to modify the properties of recycled asphalt mixtures according to the technical specifications and the operation of cold recycling. Marshall test methods, dynamic creep test, and resiliency modulus test has been used to obtain the nano-alumina’s effects on asphalt mixture properties. The results show that the addition of nano-alumina would reduce the Marshall stability in samples but increases the rutting resistance. The resiliency modulus increases significantly with this additive.Keywords: cold asphalt, cold recycling, nano-alumina, dynamic creep, bitumen emulsion
Procedia PDF Downloads 1644842 Primary Resonance in Vortex-Induced Vibration of a Pipeline Close to a Plane Boundary
Authors: Yiming Jin, Ping Dong
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The primary resonance of a pipeline close to a plane boundary is investigated in this paper. Based on classic Van der Pol equation and added a nonlinear item, a new wake oscillator model is proposed to predict the vortex-induced vibration (VIV) of a circular cylinder close to a plane boundary. Then, with the multi-scale method, the approximate solution for the case of the primary resonance is obtained. Besides, to study the characteristic of the primary resonance, the effects of the mass ration, frequency, damp ratio and gap ratio on the frequency-response curves of the pipeline are analysed. On the whole, the trend of the numerical results match up with that of the experimental data well and the mass ration, frequency, damp ratio and gap ratio play an important role in the vortex-induced vibration (VIV) of a circular cylinder close to a plane boundary, especially, the smaller is the mass ratio, the larger impact the gap ratio has on the frequency-response curves of the primary resonance.Keywords: primary resonance, gap ratio, vortex-induced vibration, multi-scale method
Procedia PDF Downloads 3724841 Vitamin D Deficiency is Associated with Increases IgE Receptors in Children with Asthma
Authors: A. Vijayendra Chary, R. Hemalatha
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Background: Vitamin D is a potent modulator of the immune system and is involved in regulating cell proliferation and differentiation. Vitamin D deficiency has been linked to increased severity of asthma in children. Asthma has dramatically increased in past decades, particular in developing countries and affects up to 20% of the population. IgE and its receptors, CD23 (FcεRII) and CD 21, play an essential role in all allergic conditions. Methods: A case control study was conducted on asthma and age and sex matched control children. 25 hydroxyvitamin D3 was quantified by HPLC; CD23; and CD21 expression on B cells were performed by flow cytometry. Total Histamine, total IGE and IL-5 and IFN-γ cytokines were determined by ELISA in blood samples of bronchial asthma (n=45) and control children (n=45). Results: The mean ± SE of vitamin D was significantly (p<0.05) low in asthma children (13.6±0.54 ng/mL) than in controls (17.4 ± 0.37 ng/mL). The mean (%) ± SE of CD23 and CD21 expression on B cells were significantly (p<0.01) high in asthma (1.02±0.09; 1.67± 0.13), when compared to controls (0.24±0.01; 0.94±0.03) respectively. The mean± SE of Serum IgE and blood histamine levels in asthma children (354.52 ± 17.33 IU/mL; 53.27 ± 2.54 nM/mL) were increased (P<0.05) when compared to controls (183.12±17.62 IU/mL 39.34±4.16 nM/mL) respectively and IFN-γ (Th1 cytokine) was lower (P<0.01) (16.37±1.27 pg/mL) than in controls (43.34±6.21 pg/mL). Conclusion: Our study provides evidence that low vitamin D levels are associated with increased IgE receptors CD23 and CD21 on B cells. In addition, there was preferential activation of Th2 (IL-5) and suppression of Th1 (IFN-γ) cytokines in children with asthma.Keywords: bronchial asthma, CD23, IgE, vitamin D
Procedia PDF Downloads 4744840 E-teaching Barriers: A Survey from Shanghai Primary School Teachers
Authors: Liu Dan
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It was considered either unnecessary or impossible for primary school students to implement online teaching until last year. A large number of E-learning or E-teaching researches have been focused on adult-learners, andragogy and technology, however, primary school education, it is facing many problems that need to be solved. Therefore, this research is aimed at exploring barriers and influential factors on online teaching for K-12 students from teachers’ perspectives and discussing the E-pedagogy that is suitable for primary school students and teachers. Eight hundred and ninety-six teachers from 10 primary schools in Shanghai were invited to participate in a questionnaire survey. Data were analysed by hierarchical regression, and the results stress the significant three barriers by teachers with online teaching: the existing system is deficient in emotional interaction, teachers’ attitude towards the technology is negative and the present teacher training is lack of systematic E-pedagogy guidance. The barriers discovered by this study will help the software designers (E-lab) develop tools that allow for flexible and evolving pedagogical approaches whilst providing an easy entry point for cautious newcomers, so that help the teachers free to engage in E-teaching at pedagogical and disciplinary levels, to enhance their repertoire of teaching practices.Keywords: online teaching barriers (OTB), e-teaching, primary school, teachers, technology
Procedia PDF Downloads 2014839 Comparative Analysis of Teachers’ Performance in Private and Public Primary Schools in Oyo State
Authors: Babajide Solomon Faloore
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This study on the comparative analysis of the performance of teachers in private and public schools was carried out in Ibadan North West Local Government Area of Oyo State. This study examined the justification for the claim that there is a difference in the performance of teachers in private and public primary schools and at the same time identified factors responsible for the difference in the performance of these teachers. A descriptive survey research design was used for the study. Data generated were analyzed using t-test and regression analysis. The findings of the study revealed that there is significance difference in the performance of teachers in private and private primary schools in Ibadan North West Local Government Area of Oyo State( t=64.09; df=459; p,.05). The findings also revealed that the method of teaching in private primary schools is significantly different from the method of teaching in public primary schools in Ibadan North West Local Government Area of Oyo State (t=73.08; df=459; p,.05). Findings revealed that school leadership and management have a significant contribution on the performance of private and public primary school teachers in Ibadan North West Local Area of Oyo State. Based on the finding, the following recommendations were made: Primary school teachers need to be motivated and rewarded for excellent performance. Primary schools should be properly equipped with teaching–aid facilities, laboratories, and libraries. The government should use the findings of this study to improve on teaching materials provided to the primary school teachers in Nigeria. Public primary schools should be designed by education planners, administrators, and government. Headmasters, proprietors, and teachers of primary schools should look inward and give a performance appraisal and evaluation of themselves from time to time based on the subject they taught. Finally, school administrators should be conscious of the way they manage the teachers in schools not only in informal situations but also in formal settings.Keywords: private education, public education, school leadership, school management, teachers performance
Procedia PDF Downloads 3904838 Process Optimization and Microbial Quality of Provitamin A-Biofortified Amahewu, a Non-Alcoholic Maize Based Beverage
Authors: Temitope D. Awobusuyi, Eric O. Amonsou, Muthulisi Siwela, Oluwatosin A. Ijabadeniyi
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Provitamin A-biofortified maize has been developed to alleviate Vitamin A deficiency; a major public health problem in developing countries. Amahewu, a non-alcoholic fermented maize based beverage is produced using white maize, which is deficient in Vitamin A. In this study, the suitable processing conditions for the production of amahewu using provitamin A-biofortified maize and the microbial quality of the processed products were evaluated. Provitamin A-biofortified amahewu was produced with reference to traditional processing method. Processing variables were Inoculum types (Malted provitamin A maize, Wheat bran, and lactobacillus mixed starter culture with either malted provitamin A or wheat bran) and concentration (0.5 %, 1 % and 2 %). A total of four provitamin A-biofortified amahewu products after fermentation were subjected to different storage conditions: 4ᴼC, 25ᴼC and 37ᴼC. pH and TTA were monitored throughout the storage period. Sample of provitamin A-biofortified amahewu were plated and observed every day for 5 days to assess the presence of Aerobic and Anaerobic spore formers, E.coli, Lactobacillus and Mould. The addition of starter culture substantially reduced the fermentation time (6 hour, pH 3.3) compared to those with no addition of starter culture (24 hour pH 3.5). It was observed that Lactobacillus were present from day 0 for all the storage temperatures. The presence of aerobic spore former and mould were observed on day 3. E.coli and Anaerobic spore formers were not present throughout the storage period. These microbial growth were minimal at 4ᴼC while 25ᴼC had higher counts of growth with 37ᴼC having the highest colony count. Throughout the storage period, pH of provitamin A-biofortified amahewu was stable. Provitamin A-biofortified amahewu stored under refrigerated condition (4ᴼC) had better storability compared to 25ᴼC and 37ᴼC. The production and microbial quality of provitamin A-biofortified amahewu might be important in combating Vitamin A Deficiency.Keywords: biofortification, fermentation, maize, vitamin A deficiency
Procedia PDF Downloads 4324837 Autophagy Suppresses Tumorigenesis through Upregulation of MiR-449a in Colorectal Cancer
Authors: Sheng-Hui Lan, Shan-Ying Wu, Shu-Ching Lin, Wei-Chen Wang, Hsiao-Sheng Liu
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Autophagy is an essential mechanism to maintain cellular homeostasis through its degradation function, and the autophagy deficiency is related various diseases including tumorigenesis in several cancers. MicroRNAs (miRNAs) are small none coding RNAs, which regulate gene expression through degradation of mRNA or inhibition of translation. However, the relationship between autophagy deficiency and dysregulated miRNAs is still unclear. We revealed a mechanism that autophagy up-regulates miR-449a expression at the transcriptional level through activation of forkhead transcription factor family member FoxO1 and then suppresses tumorigenesis in CRC. Our data showed that the autophagic activity and miR-449a expression were lower in colorectal cancer (CRC) and has a positive correlation. We further reveal that autophagy degrades p300 expression and then suppresses acetylation of FoxO1. Under autophagic induction conditions, FoxO1 is transported from the cytoplasm to the nucleus and binds to the miR-449a promoter and then promotes miR-449a expression. In addition, either miR-449a overexpression or amiodarone-induced autophagy inhibits cell cycle progression, proliferation, colony formation migration, invasion, and tumor formation of SW480 cells. Our findings indicate that autophagy inducers may have the potential to be used for prevention and treatment of CRC through upregulation of miR-449a expression.Keywords: autophagy, MiR-449a, FoxO1, colorectal cancer
Procedia PDF Downloads 3204836 Vitamin A Status and Its Correlation with the Dietary Intake of Young Females of Lahore, Pakistan
Authors: Sarah Fatima, Ahmad A. Malik, Saima Sadaf
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This study was conducted in order to assess the dietary record and vitamin A status of young females of Lahore. A total sample of 376 consisted of 16 – 20 years of unmarried college going females. Three main tools were adopted: questionnaire, 3-day food diary and serum retinol test. The anthropometric measurements showed that a total of 32.6% of the sample was underweight (BMI < 18.5) and 54.5% had a healthy weight (BMI 18.5 – 22.9). The average Vitamin A intake of the sample was 257.95 µg/day while the RDA for the selected age group was 700 µg/day. The mean energy intake of the adolescents was 1153.64 kcal/ day, whereas the Estimated Energy Requirement (EER) for this age group was 2368 kcal/day. The mean serum Vitamin A level was 24.81µg/dL. 69.6% of the sample was deficient in serum Vitamin A i.e. serum retinol < 24 µg/dL. 30.4% had serum retinol in normal limit (24 – 84 µg/dL) from which 25.3% lied in lower limit (24 – 44 µg/dL) and only 5.1% had serum retinol in 44 – 64 µg/dL range. A slightly negative correlation (r = - 0.21, 95% confidence interval) was found between dietary intake of Vitamin A and serum Vitamin A It was concluded that the dietary intake of major nutrients and vitamin A is not adequate in the selected group. This is also confirmed by the lower serum retinol levels. Hence, vitamin An intake and status are generally inadequate, and vitamin deficiency is prevalent in the unmarried young females of Lahore.Keywords: vitamin A, young Females, vitamin deficiency, Lahore
Procedia PDF Downloads 3144835 The Conceptual and Procedural Knowledge of Rational Numbers in Primary School Teachers
Authors: R. M. Kashim
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The study investigates the conceptual and procedural knowledge of rational number in primary school teachers, specifically, the primary school teachers level of conceptual knowledge about rational number and the primary school teachers level of procedural knowledge about rational numbers. The study was carried out in Bauchi metropolis in Bauchi state of Nigeria. A Conceptual and Procedural Knowledge Test was used as the instrument for data collection, 54 mathematics teachers in Bauchi primary schools were involved in the study. The collections were analyzed using mean and standard deviation. The findings revealed that the primary school mathematics teachers in Bauchi metropolis posses a low level of conceptual knowledge of rational number and also possess a high level of Procedural knowledge of rational number. It is therefore recommended that to be effective, teachers teaching mathematics most posses a deep understanding of both conceptual and procedural knowledge. That way the most knowledgeable teachers in mathematics deliver highly effective rational number instructions. Teachers should not ignore the mathematical concept aspect of rational number teaching. This is because only the procedural aspect of Rational number is highlighted during instructions; this often leads to rote - learning of procedures without understanding the meanings. It is necessary for teachers to learn rational numbers teaching method that focus on both conceptual knowledge and procedural knowledge teaching.Keywords: conceptual knowledge, primary school teachers, procedural knowledge, rational numbers
Procedia PDF Downloads 3284834 Cone Contrast Sensitivity of Normal Trichromats and Those with Red-Green Dichromats
Authors: Tatsuya Iizuka, Takushi Kawamorita, Tomoya Handa, Hitoshi Ishikawa
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We report normative cone contrast sensitivity values and sensitivity and specificity values for a computer-based color vision test, the cone contrast test-HD (CCT-HD). The participants included 50 phakic eyes with normal color vision (NCV) and 20 dichromatic eyes (ten with protanopia and ten with deuteranopia). The CCT-HD was used to measure L, M, and S-CCT-HD scores (color vision deficiency, L-, M-cone logCS≦1.65, S-cone logCS≦0.425) to investigate the sensitivity and specificity of CCT-HD based on anomalous-type diagnosis with animalscope. The mean ± standard error L-, M-, S-cone logCS for protanopia were 0.90±0.04, 1.65±0.03, and 0.63±0.02, respectively; for deuteranopia 1.74±0.03, 1.31±0.03, and 0.61±0.06, respectively; and for age-matched NCV were 1.89±0.04, 1.84±0.04, and 0.60±0.03, respectively, with significant differences for each group except for S-CCT-HD (Bonferroni corrected α = 0.0167, p < 0.0167). The sensitivity and specificity of CCT-HD were 100% for protan and deutan in diagnosing abnormal types from 20 to 64 years of age, but the specificity decreased to 65% for protan and 55% for deutan in older persons > 65. CCT-HD is comparable to the diagnostic performance of the anomalous type in the anomaloscope for the 20-64-year-old age group. However, the results should be interpreted cautiously in those ≥ 65 years. They are more susceptible to acquired color vision deficiencies due to the yellowing of the crystalline lens and other factors.Keywords: cone contrast test HD, color vision test, congenital color vision deficiency, red-green dichromacy, cone contrast sensitivity
Procedia PDF Downloads 1014833 Comparative Analysis of Teachers’ Performance in Private and Public Primary Schools in Oyo State, Nigeria
Authors: Oyetunji John Adenuga
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This study on the comparative analysis of the performance of teachers in private and public schools was carried out in Ibadan North West Local Government Area of Oyo State. This study examined the justification for the claim that there is difference in the performance of teachers in private and public primary schools and at the same time identified factors responsible for the difference in the performance of these teachers. A descriptive survey research design was used for the study. Data generated were analysed using t-test and regression analysis. The findings of the study revealed that there is significant difference in the performance of teachers in private and private primary schools in Ibadan North West Local Government Area of Oyo State (t=64.09; df=459; p,.05). The findings also revealed that the method of teaching in private primary schools is significantly different from the method of teaching in public primary schools in Ibadan North West Local Government Area of Oyo State (t=73.08; df=459; p,.05). Findings revealed that school leadership and management have significant contribution on the performance of private and public primary school teachers in Ibadan North West Local Area of Oyo State. Based on the finding, the following recommendations were made: Primary school teachers need to be motivated and rewarded for excellent performance. Primary schools should be properly equipped with teaching-aid facilities, laboratories and libraries. Government should use the findings of this study to improve on teaching materials provided to the primary school teachers in Nigeria. Public primary schools should be designed by education planners, administrators and government. Headmasters, proprietors and teachers of primary schools should look inward and give a performance appraisal and evaluation of themselves form time to time based on subject they taught. Finally, school administrators should be conscious of the way they manage the teachers in schools not only in informal situations but also in formal settings.Keywords: private education, public education, school leadership, school management, teachers performance
Procedia PDF Downloads 3424832 Eradicating Micronutrient Deficiency through Biofortification
Authors: Ihtasham Hamza
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In the contemporary world, where the West is afflicted by the diseases of excess nutrition, much of the rest globe suffers at the hands of hunger. A troubling constituent of hunger is micronutrient deficiency, also called hidden hunger. Major dependence on calorie-rich diets and low diet diversification are responsible for high malnutrition rates, especially in African and Asian countries. But the dilemma isn’t immune to solutions. Highlighting the substantial cause to be sole dependence on staples for food, biofortification has emerged as a novel tool to confront the widely distributed jeopardize of hidden hunger. Biofortification potentials the better nutritional approachability to commonalities overcoming various difficulties and reaching the doorstep. The crops associated with biofortification offer a rural-based involvement that, proposal, primarily reaches these more remote populations, which comprise a majority of the malnourished in many countries, and then penetrates to urban populations as assembly overages are marketed. Initial investments in agricultural research at a central location can generate high recurrent benefits at low cost as adapted biofortified cultivars become widely available in countries across time at low recurrent costs as opposed to supplementation which is comparatively expensive and requires continued financing over time, which may be imperilled by fluctuating political curiosity.Keywords: biofortified crops, hunger, malnutrition, agricultural practices
Procedia PDF Downloads 2884831 Vitamin D Status in Relation to Body Mass Index: Population of Carpathian Region
Authors: Vladyslav Povoroznyuk, Ivan Pankiv
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The present research has attempted to link a higher body weight with a lower vitamin D status. Objective: Vitamin D status of Carpathian region population in Ukraine was studied to examine whether serum levels of 25-hydroxyvitamin D [25(OH)D] are associated with body mass index (BMI). Methods: Data collected from 302 adults (18–84 years) were analyzed. Variables measured included serum 25(OH)D, weight and height used to determine BMI status. Results: Mean 25(OH)D level was 23.2 ± 8.1 ng/mL for the group; 26.3 ± 8.4 ng/mL and 22.8 ± 9.1 ng/mL for males and females, respectively. Based on BMI, 3.6% were underweight, 21.2% had a normal weight, 46.4% were overweight and 28.8% obese. Only in 28 cases (9.3%), content of 25(ОН)D in the serum of blood was within the normal limits, and there were vitamin D deficiency and insufficiency observed in other cases (90.7%). Thus, severe vitamin D deficiency was revealed in 1.7% of the inspected. A significant interrelation between levels of 25(OH)D in blood and BMI was found among persons with BMI 25-29.9 kg/m2. Mean value of 25(OH)D levels among persons with obesity did not differ to a significant extent from indexes in persons with normal body weight. Conclusion: Status of vitamin D among the population of Carpathian region remains far from optimal and requires urgent measures in correction and prevention. Results confirmed a poor inverse relationship between vitamin D status and BMI. Intercommunication between maintenance of vitamin D and BMI requires further investigations.Keywords: body mass index, Carpathian region, obesity, vitamin D
Procedia PDF Downloads 3904830 The Effect of Excess Sulphur on Najdi Sheep
Authors: Fatima Al-Humaid
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This research work was done to investigate the cause of paralysis in Najdi lambs born in certain farms where the drinking water and diet contained high concentrations of sulphur. The drinking water in these farms was obtained from deep bore wells drilled in the farm. The lambs developed paralysis of the hind limbs at the age of 4-6 weeks and their condition deteriorated continuously until they finally died. The appetite and suckling ability remained good throughout the course of the disease but when the lambs were completely unable to move and reach for the udder, feed and water they died. Postmortem examination of the brain of paralyzed lambs showed that it was liquefied. When the brain was examined histologically, a liquefactive necrosis was seen in the form of cavities in the nervous tissue. Similar histologic picture was seen in the spinal cord of the affected lambs. Analysis for the mineral content of the fodder showed that the concentration of sulphur was 21.6 3.4 g/kg DM which is considered very high for the nutrition of sheep. Analysis for the concentration of copper and selenium in the feed showed that the concentrations of both were normal. This excluded diseases such as swayback which is caused by copper deficiency and white muscle disease, which caused by selenium deficiency. Both of these two last diseases are characterized by paralysis of lambs.Keywords: brain histology, sulphur poisoning, Najdi sheep, veterinary medicine
Procedia PDF Downloads 6054829 Challenges influencing Nurse Initiated Management of Retroviral Therapy (NIMART) Implementation in Ngaka Modiri Molema District, North West Province, South Africa
Authors: Sheillah Hlamalani Mboweni, Lufuno Makhado
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Background: The increasing number of people who tested HIV positive and who demand antiretroviral therapy (ART) prompted the National Department of Health to adopt WHO recommendations of task shifting where Professional Nurses(PNs) initiate ART rather than doctors in the hospital. This resulted in the decentralization of services to primary health care(PHC), generating a need to capacitate PNs on NIMART. After years of training, the impact of NIMART was assessed where it was established that even though there was an increased number who accessed ART, the quality of care is of serious concern. The study aims to answer the following question: What are the challenges influencing NIMART implementation in primary health care. Objectives: This study explores challenges influencing NIMART training and implementation and makes recommendations to improve patient and HIV program outcomes. Methods: A qualitative explorative program evaluation research design. The study was conducted in the rural districts of North West province. Purposive sampling was used to sample PNs trained on NIMART. FGDs were used to collect data with 6-9 participants and data was analysed using ATLAS ti. Results: Five FGDs, n=28 PNs and three program managers were interviewed. The study results revealed two themes: inadequacy in NIMART training and the health care system challenges. Conclusion: The deficiency in NIMART training and health care system challenges is a public health concern as it compromises the quality of HIV management resulting in poor patients’ outcomes and retard the goal of ending the HIV epidemic. These should be dealt with decisively by all stakeholders. Recommendations: The national department of health should improve NIMART training and HIV management: standardization of NIMART training curriculum through the involvement of all relevant stakeholders skilled facilitators, the introduction of pre-service NIMART training in institutions of higher learning, support of PNs by district and program managers, plan on how to deal with the shortage of staff, negative attitude to ensure compliance to guidelines. There is a need to develop a conceptual framework that provides guidance and strengthens NIMART implementation in PHC facilities.Keywords: antiretroviral therapy, nurse initiated management of retroviral therapy, primary health care, professional nurses
Procedia PDF Downloads 1584828 A Study on Classic Literature Education in Primary School Using Out-of-School Literature Appreciation Program: An Practice Study Applied to Primary School in Korea
Authors: Hyo Jung Lee
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The purpose of this study is to develop a literature appreciation education program for classic literatures and apply them to the field, and to derive the achievements and improvement points. Classic literature is a work of value recognized in the context of literature history and culture history, and learners can develop interest in literature and inherit tradition through appreciation of classic literature. However, in Korean educational environment, classic literature is a means for college entrance examination, and many learners analyze contents and language in textbooks and concentrate on memorizing the whole plot. This study is one of the reasons that classic literature appreciation education is not done properly and it is not able to give an opportunity to appreciate the whole work in the early learning stage. In Korean primary education, classic literature is used as a means to achieve the goals of reading, writing, speaking and listening, rather than being used as a material for its own appreciation. It is problematic to make the piece appreciation experience fragmentary. This study proposes a program to experience classic literatures by linking school education and school library with primary school students in grades 4-6. We work with local primary schools (siheung-si, gyeonggi-do, Korea) to provide appropriate activities and rewards to learners, observe their participation, and introduce student learning outcomes. Through this, we are able to systematically improve the learner 's ability to appreciate the literature and to diversify primary education.Keywords: classic literature education, primary education, out-of-school program, learning by appreciation experience
Procedia PDF Downloads 1464827 Etiologies of Megaloblastic Anemia in a Pediatric Hospital
Authors: Atitallah Sofien, Bouyahia Olfa, Mohsen S., Boussetta Khadija, Khemiri Monia, Fitouri Zohra, Boukthir Samir
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Introduction: Megaloblastic anemia (MA) is rare in children. The diversity of its etiologies can lead to misdiagnosis and may, therefore, delay the treatment. The aim of this study was to describe the epidemiological and etiological characteristics of children followed for MA at the Tunis children's hospital. Methodology: This is a retrospective study over a period of 25 years of all cases of MA in children in the Children's Hospital of Tunis. The diagnosis of MA was confirmed by myelogram in all patients. Results: We collected 29 observations, with an incidence of 1.2 cases/year and a sex ratio of 1. Sixty percent of the children were aged between 3 months and 2 years. The consultation time was between 15 and 30 days in a third of the patients. The clinical examination showed hypotrophy in 13% of cases, hepatosplenomegaly in 6% of cases, neurological or neurosensory damage in 23% of cases, and cardiac damage in 10% of children. MA was associated with thrombocytopenia in 65% of cases and leukoneutropenia in 24% of cases. One in 5 children had pancytopenia. The etiologies were mainly thiamine deficiency, Immerslund disease (20%), nutritional deficiency (13%), and Biermer anemia (13%). One of the patients presented an MA revealing visceral leishmaniasis. The outcome under vitamin B12, the dose of which was adapted to each etiology, was favorable for all patients. Conclusion: MA is rare in children with multiple etiologies that are mainly dominated by hereditary conditions and nutritional deficiencies, mainly in vitamin B12. The association with visceral leishmaniasis seems to be a particularity in our country not reported in the literature.Keywords: megaloblastic anemia, children, vitamin B12, anemia
Procedia PDF Downloads 664826 Nurse Practitioner Led Pediatric Primary Care Clinic in a Tertiary Care Setting: Improving Access and Health Outcomes
Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge
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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework
Procedia PDF Downloads 494