Assessing the overuse of antibiotics in children in Saudi Arabia : validation of the parental perception on antibiotics scale (PAPA scale)

Background Antibiotics overuse is a global public health issue influenced by several factors, of which some are parent-related psychosocial factors that can only be measured using valid and reliable psychosocial measurement instruments. The PAPA scale was developed to measure these factors and the content validity of this instrument was assessed. Aim This study further validated the recently developed instrument in terms of (1) face validity and (2) construct validity including: deciding the number and nature of factors, and item selection. Methods Questionnaires were self-administered to parents of children between the ages of 0 and 12 years old. Parents were conveniently recruited from schools’ parental meetings in the Eastern Province, Saudi Arabia. Face validity was assessed with regards to questionnaire clarity and unambiguity. Construct validity and item selection processes were conducted using Exploratory factor analysis. Results Parallel analysis and Exploratory factor analysis using principal axis factoring produced six factors in the developed instrument: knowledge and beliefs, behaviours, sources of information, adherence, awareness about antibiotics resistance, and parents’ perception regarding doctors’ prescribing behaviours. Reliability was assessed (Cronbach’s alpha = 0.78) which demonstrates the instrument as being reliable. Conclusion The ‘factors’ produced in this study coincide with the constructs contextually identified in the development phase of other instruments used to study antibiotic use. However, no other study considering perceptions of antibiotic use had gone beyond content validation of such instruments. This study is the first to constructively validate the factors underlying perceptions regarding antibiotic use in any population and in parents in particular.

Dynamic capabilities and performance : strategy, structure and environment

Dynamic capabilities are widely considered to incorporate those processes that enable organizations to sustain superior performance over time. In this paper, we argue theoretically and demonstrate empirically that these effects are contingent on organizational structure and the competitive intensity in the market. Results from partial least square structural equation modeling (PLS-SEM) analyses indicate that organic organizational structures facilitate the impact of dynamic capabilities on organizational performance. Furthermore, we find that the performance effects of dynamic capabilities are contingent on the competitive intensity faced by firms. Our findings demonstrate the performance effects of internal alignment between organizational structure and dynamic capabilities, as well as the external fit of dynamic capabilities with competitive intensity. We outline the advantages of PLS-SEM for modeling latent constructs, such as dynamic capabilities, and conclude with managerial implications.

Exploring the validity and predictive power of an extended volunteer functions inventory within the context of episodic skilled volunteering by retirees

The current study examined the structure of the volunteer functions inventory within a sample of older individuals (N = 187). The career items were replaced with items examining the concept of continuity of work, a potentially more useful and relevant concept for this population. Factor analysis supported a four factor solution, with values, social and continuity emerging as single factors and enhancement and protective items loading together on a single factor. Understanding items did not load highly on any factor. The values and continuity functions were the only dimensions to emerge as predictors of intention to volunteer. This research has important implications for understanding the motivation of older adults to engage in contemporary volunteering settings.

Risky driving behavior among university students and staff in the Sultanate of Oman

Background: There is a well developed literature on research investigating the relationship between various driving behaviours and road crash involvement. However, this research has predominantly been conducted in developed economies dominated by western types of cultural environments. To date no research has been published that has empirically investigated this relationship within the context of the emerging economies such as Oman. Objective: The present study aims to investigate driving behaviour as indexed in the Driving Behaviour Questionnaire (DBQ) among a group of Omani university students and staff. Methods: A convenience non-probability self- selection sampling approach was utilized with Omani university students and staff. Results: A total of 1003 Omani students (n= 632) and staff (n=371) participated in the survey. Factor analysis of the BDQ revealed four main factors that were errors, speeding violation, lapses and aggressive violation. In the multivariate logistic backward regression analysis, the following factors were identified as significant predictors of being involved in causing at least one crash: driving experience, history of offences and two DBQ components i.e. errors and aggressive violation. Conclusion: This study indicates that errors and aggressive violation of the traffic regulations as well as history of having traffic offences are major risk factors for road traffic crashes among the sample. While previous international research has demonstrated that speeding is a primary cause of crashing, in the current context, the results indicate that an array of factors is associated with crashes. Further research using more rigorous methodology is warranted to inform the development of road safety countermeasures in Oman that improves overall traffic safety culture.

Speaker diarization : "who spoke when"

Speaker diarization is the process of annotating an input audio with information that attributes temporal regions of the audio signal to their respective sources, which may include both speech and non-speech events. For speech regions, the diarization system also specifies the locations of speaker boundaries and assign relative speaker labels to each homogeneous segment of speech. In short, speaker diarization systems effectively answer the question of ‘who spoke when’. There are several important applications for speaker diarization technology, such as facilitating speaker indexing systems to allow users to directly access the relevant segments of interest within a given audio, and assisting with other downstream processes such as summarizing and parsing. When combined with automatic speech recognition (ASR) systems, the metadata extracted from a speaker diarization system can provide complementary information for ASR transcripts including the location of speaker turns and relative speaker segment labels, making the transcripts more readable. Speaker diarization output can also be used to localize the instances of specific speakers to pool data for model adaptation, which in turn boosts transcription accuracies. Speaker diarization therefore plays an important role as a preliminary step in automatic transcription of audio data. The aim of this work is to improve the usefulness and practicality of speaker diarization technology, through the reduction of diarization error rates. In particular, this research is focused on the segmentation and clustering stages within a diarization system. Although particular emphasis is placed on the broadcast news audio domain and systems developed throughout this work are also trained and tested on broadcast news data, the techniques proposed in this dissertation are also applicable to other domains including telephone conversations and meetings audio. Three main research themes were pursued: heuristic rules for speaker segmentation, modelling uncertainty in speaker model estimates, and modelling uncertainty in eigenvoice speaker modelling. The use of heuristic approaches for the speaker segmentation task was first investigated, with emphasis placed on minimizing missed boundary detections. A set of heuristic rules was proposed, to govern the detection and heuristic selection of candidate speaker segment boundaries. A second pass, using the same heuristic algorithm with a smaller window, was also proposed with the aim of improving detection of boundaries around short speaker segments. Compared to single threshold based methods, the proposed heuristic approach was shown to provide improved segmentation performance, leading to a reduction in the overall diarization error rate. Methods to model the uncertainty in speaker model estimates were developed, to address the difficulties associated with making segmentation and clustering decisions with limited data in the speaker segments. The Bayes factor, derived specifically for multivariate Gaussian speaker modelling, was introduced to account for the uncertainty of the speaker model estimates. The use of the Bayes factor also enabled the incorporation of prior information regarding the audio to aid segmentation and clustering decisions. The idea of modelling uncertainty in speaker model estimates was also extended to the eigenvoice speaker modelling framework for the speaker clustering task. Building on the application of Bayesian approaches to the speaker diarization problem, the proposed approach takes into account the uncertainty associated with the explicit estimation of the speaker factors. The proposed decision criteria, based on Bayesian theory, was shown to generally outperform their non- Bayesian counterparts.

Aromatherapy for postoperative nausea and vomiting

Background: Postoperative nausea and vomiting is one of the most common adverse reactions to surgery and all types of anaesthesia and despite the wide variety of available antiemetic and anti-nausea treatments, 20-30% of all patients still suffer moderate to severe nausea and vomiting following general anaesthesia. While aromatherapy is well-known and is used personally by nurses, it is less well utilised in the healthcare setting. If aromatherapy is to become an accepted adjunct treatment for postoperative nausea and vomiting, it is imperative that there is both an evidence base to support the use of aromatherapy, and a nursing workforce prepared to utilise it. Methods: This involved a Cochrane Systematic Review, a Delphi process to modify an existing tool to assess beliefs about aromatherapy to make it more relevant to nursing and midwifery practice, and a survey to test the modified tool in a population of nurses and midwives. Findings: The systematic review found that aromatherapy with isopropyl alcohol was more effective than placebo for reducing the number of doses of rescue antiemetics required but not more effective than standard antiemetic drugs. The Delphi panel process showed that the original Beliefs About Aromatherapy Scale was not completely relevant to nursing and midwifery practice. The modified Nurses' Beliefs About Aromatherapy Scale was found to be valid and reliable to measure nurses' and midwives' beliefs about aromatherapy. Factor analysis supported the construct validity of the scale by finding two sub-scales measuring beliefs about the 'usefulness of aromatherapy' and the 'scientific basis of aromatherapy'. Survey respondents were found to have generally positive beliefs about aromatherapy, with more strongly positive beliefs on the 'usefulness of aromatherapy' sub-scale. Conclusions: From the evidence of the systematic review, the use of isopropyl alcohol vapour inhalation as an adjunct therapy for postoperative nausea and vomiting is unlikely to be harmful and may reduce nausea for some adult patients. It may provide a useful therapeutic option, particularly when the alternative is no treatment at all. Given the moderately positive beliefs expressed by nurses and midwives particularly about the usefulness of aromatherapy there is potential for this therapy to be implemented and used to improve patient care.

New and young firms Entrepreneurship policy and the role of government – evidence from the Federation of Small Businesses survey

Purpose – The purpose of this paper is to investigate whether new and young firms are different from older firms. This analysis is undertaken to explore general characteristics, use of external resources and growth orientation. Design/methodology/approach – Data from the 2008 UK Federation of Small Businesses survey provided 8,000 responses. Quantitative analysis identified significantly different characteristics of firms from 0-4, 4-9, 9-19 and 20+ years. Factor analysis was utilised to identify the advice sets, finance and public procurement customers of greatest interest, with ANOVA used to statistically compare firms in the identified age groups with different growth aspirations. Findings – The findings reveal key differences between new, young and older firms in terms of characteristics including business sector, owner/manager age, education/business experience, legal status, intellectual property and trading performance. New and young firms were more able to access beneficial resources in terms of finance and advice from several sources. New and young firms were also able to more easily access government and external finance, as well as government advice, but less able to access public procurement. Research limitations/implications – New and young firms are utilising external networks to access several resources for development purposes, and this differs for older firms. This suggests that a more explicit age-differentiated focus is required for government policies aimed at supporting firm growth. Originality/value – The study provides important baseline data for future quantitative and qualitative studies focused on the impact of firm age and government policy.

Robust automatic speaker linking and attribution

This research makes a major contribution which enables efficient searching and indexing of large archives of spoken audio based on speaker identity. It introduces a novel technique dubbed as “speaker attribution” which is the task of automatically determining ‘who spoke when?’ in recordings and then automatically linking the unique speaker identities within each recording across multiple recordings. The outcome of the research will also have significant impact in improving the performance of automatic speech recognition systems through the extracted speaker identities.

Identification of symptom clusters in patients with chronic venous leg ulcers

Context Patients with venous leg ulcers experience multiple symptoms, including pain, depression, and discomfort from lower leg inflammation and wound exudate. Some of these symptoms impair wound healing and decrease quality of life (QOL). The presence of co-occurring symptoms may have a negative effect on these outcomes. The identification of symptom clusters could potentially lead to improvements in symptom management and QOL. Objectives To identify the prevalence and severity of common symptoms and the occurrence of symptom clusters in patients with venous leg ulcers. Methods For this secondary analysis, data on sociodemographic characteristics, medical history, venous history, ulcer and lower limb clinical characteristics, symptoms, treatments, healing, and QOL were analyzed from a sample of 318 patients with venous leg ulcers who were recruited from hospital outpatient and community nursing clinics for leg ulcers. Exploratory factor analysis was used to identify symptom clusters. Results Almost two-thirds (64%) of the patients experienced four or more concurrent symptoms. The most frequent symptoms were sleep disturbance (80%), pain (74%), and lower limb swelling (67%). Sixty percent of patients reported three or more symptoms at a moderate-to-severe level of intensity (e.g., 78% reported disturbed sleep frequently or always; the mean pain severity score was 49 of 100, SD 26.5). Exploratory factor analysis identified two symptom clusters: pain, depression, sleep disturbance, and fatigue; and swelling, inflammation, exudate, and fatigue. Conclusion Two symptom clusters were identified in this sample of patients with venous leg ulcers. Further research is needed to verify these symptom clusters and to evaluate their effect on patient outcomes.

Identification and evaluation of service bundles for governmental one-stop portals

Recent advances in the area of ‘Transformational Government’ position the citizen at the centre of focus. This paradigm shift from a department-centric to a citizen-centric focus requires governments to re-think their approach to service delivery, thereby decreasing costs and increasing citizen satisfaction. The introduction of franchises as a virtual business layer between the departments and their citizens is intended to provide a solution. Franchises are structured to address the needs of citizens independent of internal departmental structures. For delivering services online, governments pursue the development of a One-Stop Portal, which structures information and services through those franchises. Thus, each franchise can be mapped to a specific service bundle, which groups together services that are deemed to be of relevance to a specific citizen need. This study focuses on the development and evaluation of these service bundles. In particular, two research questions guide the line of investigation of this study: Research Question 1): What methods can be used by governments to identify service bundles as part of governmental One-Stop Portals? Research Question 2): How can the quality of service bundles in governmental One-Stop Portals be evaluated? The first research question asks about the identification of suitable service bundle identification methods. A literature review was conducted, to, initially, conceptualise the service bundling task, in general. As a consequence, a 4-layer model of service bundling and a morphological box were created, detailing characteristics that are of relevance when identifying service bundles. Furthermore, a literature review of Decision-Support Systems was conducted to identify approaches of relevance in different bundling scenarios. These initial findings were complemented by targeted studies of multiple leading governments in the e-government domain, as well as with a local expert in the field. Here, the aim was to identify the current status of online service delivery and service bundling in practice. These findings led to the conceptualising of two service bundle identification methods, applicable in the context of Queensland Government: On the one hand, a provider-driven approach, based on service description languages, attributes, and relationships between services was conceptualised. As well, a citizen-driven approach, based on analysing the outcomes from content identification and grouping workshops with citizens, was also conceptualised. Both methods were then applied and evaluated in practice. The conceptualisation of the provider-driven method for service bundling required the initial specification of relevant attributes that could be used to identify similarities between services called relationships; these relationships then formed the basis for the identification of service bundles. This study conceptualised and defined seven relationships, namely ‘Co-location’, ‘Resource’, ‘Co-occurrence’, ‘Event’, ‘Consumer’, ‘Provider’, and ‘Type’. The relationships, and the bundling method itself, were applied and refined as part of six Action Research cycles in collaboration with the Queensland Government. The findings show that attributes and relationships can be used effectively as a means for bundle identification, if distinct decision rules are in place to prescribe how services are to be identified. For the conceptualisation of the citizen-driven method, insights from the case studies led to the decision to involve citizens, through card sorting activities. Based on an initial list of services, relevant for a certain franchise, participating citizens grouped services according to their liking. The card sorting activity, as well as the required analysis and aggregation of the individual card sorting results, was analysed in depth as part of this study. A framework was developed that can be used as a decision-support tool to assist with the decision of what card sorting analysis method should be utilised in a given scenario. The characteristic features associated with card sorting in a government context led to the decision to utilise statistical analysis approaches, such as cluster analysis and factor analysis, to aggregate card sorting results. The second research question asks how the quality of service bundles can be assessed. An extensive literature review was conducted focussing on bundle, portal, and e-service quality. It was found that different studies use different constructs, terminology, and units of analysis, which makes comparing these models a difficult task. As a direct result, a framework was conceptualised, that can be used to position past and future studies in this research domain. Complementing the literature review, interviews conducted as part of the case studies with leaders in e-government, indicated that, typically, satisfaction is evaluated for the overall portal once the portal is online, but quality tests are not conducted during the development phase. Consequently, a research model which appropriately defines perceived service bundle quality would need to be developed from scratch. Based on existing theory, such as Theory of Reasoned Action, Expectation Confirmation Theory, and Theory of Affordances, perceived service bundle quality was defined as an inferential belief. Perceived service bundle quality was positioned within the nomological net of services. Based on the literature analysis on quality, and on the subsequent work of a focus group, the hypothesised antecedents (descriptive beliefs) of the construct and the associated question items were defined and the research model conceptualised. The model was then tested, refined, and finally validated during six Action Research cycles. Results show no significant difference in higher quality or higher satisfaction among users for either the provider-driven method or for the citizen-driven method. The decision on which method to choose, it was found, should be based on contextual factors, such as objectives, resources, and the need for visibility. The constructs of the bundle quality model were examined. While the quality of bundles identified through the citizen-centric approach could be explained through the constructs ‘Navigation’, ‘Ease of Understanding’, and ‘Organisation’, bundles identified through the provider-driven approach could be explained solely through the constructs ‘Navigation’ and ‘Ease of Understanding’. An active labelling style for bundles, as part of the provider-driven Information Architecture, had a larger impact on ‘Quality’ than the topical labelling style used in the citizen-centric Information Architecture. However, ‘Organisation’, reflecting the internal, logical structure of the Information Architecture, was a significant factor impacting on ‘Quality’ only in the citizen-driven Information Architecture. Hence, it was concluded that active labelling can compensate for a lack of logical structure. Further studies are needed to further test this conjecture. Such studies may involve building alternative models and conducting additional empirical research (e.g. use of an active labelling style for the citizen-driven Information Architecture). This thesis contributes to the body of knowledge in several ways. Firstly, it presents an empirically validated model of the factors explaining and predicting a citizen’s perception of service bundle quality. Secondly, it provides two alternative methods that can be used by governments to identify service bundles in structuring the content of a One-Stop Portal. Thirdly, this thesis provides a detailed narrative to suggest how the recent paradigm shift in the public domain, towards a citizen-centric focus, can be pursued by governments; the research methodology followed by this study can serve as an exemplar for governments seeking to achieve a citizen-centric approach to service delivery.

A gender comparison of food shopper typologies

This research segments male and female food shoppers based on store and product attribute evaluations, enjoyment, planning, and shopping responsibility. A rich profile for each segment is developed from a sample of 580 primary food shoppers. Gender comparisons are operationalized and these developed food shopper typologies are contrasted against earlier works. Factor analysis, cluster analysis, and ANOVA were employed to develop specific segments of shoppers. This is the first study to identify specific groups of male food shoppers and contrast these to traditional female shoppers and earlier typographical works. The research provides the basis for further cross-cultural, cross-contextual comparative studies.

Towards a model for student selection in clinical psychology

Background Selection of candidates for clinical psychology programmes is arguably the most important decision made in determining the clinical psychology workforce. However, there are few models to inform the development of selection tools to support selection procedures. The study, using a factor analytic structure, has operationalised the model predicting applicants' capabilities. Method Eighty-eight clinical applicants for entry into a postgraduate clinical psychology programme were assessed on a series of tasks measuring eight capabilities: guided reflection, communication skills, ethical decision making, writing, conceptual reasoning, empathy, and awareness of mind and self-observation. Results Factor analysis revealed three capabilities: labelled “awareness” accounting for 35.71% of variance; “reflection” accounting for 20.56%; and “reasoning” accounting for 18.24% of variance. Fourth year grade point average (GPA) did not correlate with performance on any of the selection capabilities other than a weak correlation with performance on the ethics capability. Conclusions Eight selection capabilities are identified for the selection of candidates independent of GPA. While the model is tentative, it is hoped that the findings will stimulate the development and validation of assessment procedures with good predictive validity which will benefit the training of clinical psychologists and, ultimately, effective service delivery.

Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit : a 12-month intervention trial

Objective To determine changes in ability to identify specific vegetables and fruits, and attitudes towards vegetables and fruit, associated with the introduction of a school-based food garden. Design A 12-month intervention trial using a historical control (control n 132, intervention n 120), class-based, self-administered questionnaires requiring one-word answers and 3-point Likert scale responses. Setting A state primary school (grades 4 to 7) in a low socio-economic area of Brisbane, Australia. Intervention The introduction of a school-based food garden, including the funding of a teacher coordinator for 11 h/week to facilitate integration of garden activities into the curriculum. Main outcome measures Ability to identify a series of vegetables and fruits, attitudes towards vegetables and fruit. Analysis Frequency distributions for each item were generated and χ2 analyses were used to determine statistical significance. Exploratory factor analysis was employed to detect major trends in data. Results The intervention led to enhanced ability to identify individual vegetables and fruits, greater attention to origins of produce (garden-grown and fresh), changes to perceived consumption of vegetables and fruits, and enhanced confidence in preparing fruit and vegetable snacks, but decreased interest in trying new fruits. Conclusions The introduction of this school-based food garden was associated with skill and attitudinal changes conducive to enhancing vegetable and fruit consumption. The ways in which such changes might impact on dietary behaviours and intake require further analysis.

Residential dissonance and mode choice

Residential dissonance refers to the mismatch in land-use patterns between individuals’ preferred residential neighbourhood type and the type of neighbourhood in which they currently reside. Current knowledge regarding the impact of residential dissonance is limited to short-term travel behaviours in urban vs. suburban, and rural vs. urban areas. Although the prevailing view is that dissonants adjust their orientation and lifestyle around their surrounding land use over time, empirical evidence is lacking to support this proposition. This research identifies both short-term mode choice behaviour and medium-term mode shift behaviour of dissonants in transit oriented development (TODs) vs. non-TOD areas in Brisbane, Australia. Natural groupings of neighbourhood profiles (e.g. residential density, land use diversity, intersection density, cul-de-sac density, and public transport accessibility levels) of 3957 individuals were identified as living either in a TOD (510 individuals) or non-TOD (3447 individuals) areas in Brisbane using the TwoStep cluster analysis technique. Levels of dissonance were measured based on a factor analysis of 16 items representing the travel attitudes/preferences of individuals. Two multinomial logistic (MNL) regression models were estimated to understand mode choice behaviour of (1) TOD dissonants, and (2) non-TOD dissonants in 2009, controlling for socio-demographics and environmental characteristics. Two additional MNL regression models were estimated to investigate mode shift behaviour of (3) TOD dissonants, and (4) non-TOD dissonants between 2009 and 2011, also controlling for socio-demographic, changes in socio-demographic, and built environmental factors. The findings suggest that travel preference is relatively more influential in transport mode choice decisions compared with built environment features. Little behavioural evidence was found to support the adjustment of a dissonant orientation toward a particular land use feature and mode accessibility they represent (e.g. a modal shift to greater use of the car for non-TOD dissonants). TOD policies should focus on reducing the level of dissonance in TODs in order to enhance transit ridership.

Making the train : re-conceptualising accessibility for intra-urban rail travel

Australian authorities have set ambitious policy objectives to shift Australia’s current transport profile of heavy reliance on private motor cars to sustainable modes. Improving accessibility of public transport is a central component of that objective. Past studies on accessibility to public transport focus on walking time and/or waiting time. However, travellers’ perceptions of the interface leg journeys may depend not only on these direct and tangible factors but also on social and psychological factors. This paper extends previous research that identified five salient perspectives of rail access by means of a statement sorting activity and cluster analysis with a small sample of rail passengers in three Australian cities (Zuniga et al, 2013). This study collects a new data set including 144 responses from Brisbane and Melbourne to an online survey made up of a Likert-scaled statement sorting exercise and questionnaire. It employs factor analysis to examine the statement rankings and uncovers seven underlying factors in the exploratory manner, i.e., station, safety, access, transfer, service attitude, traveler’s physical activity levels, and environmental concern. Respondents from groups stratified by rail use frequency are compared in terms of their scores of those factors. Findings from this study indicate a need to re-conceptualize accessibility to intra-urban rail travel in agreement with current policy agenda, and to target behavioral intervention to multiple dimensions of accessibility influencing passengers’ travel choices. Arguments in this paper are not limited to intra-urban rail transit, but may also be relevant to public transport in general.