825 resultados para Assessment and evaluative practices
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Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.
Assessment of laboratory test utilization for HIV/AIDS care in urban ART clinics of Lilongwe, Malawi
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Background The 2011 Malawi HIV guidelines promote CD4 monitoring for pre-ART assessment and considering HIVRNA monitoring for ART response assessment, while some clinics used CD4 for both. We assessed clinical ordering practices as compared to guidelines, and determined whether the samples were successfully and promptly processed. Methods We conducted a retrospective review of all patients seen in from August 2010 through July 2011,, in two urban HIV-care clinics that utilized 6-monthly CD4 monitoring regardless of ART status. We calculated the percentage of patients on whom clinicians ordered CD4 or HIVRNA analysis. For all samples sent, we determined rates of successful labprocessing, and mean time to returned results. Results Of 20581 patients seen, 8029 (39%) had at least one blood draw for CD4 count. Among pre-ART patients, 2668/2844 (93.8%) had CD4 counts performed for eligibility. Of all CD4 samples sent, 8082/9207 (89%) samples were successfully processed. Of those, mean time to processing was 1.6 days (s.d 1.5) but mean time to results being available to clinician was 9.3 days (s.d. 3.7). Regarding HIVRNA, 172 patients of 17737 on ART had a blood draw and only 118/213 (55%) samples were successfully processed. Mean processing time was 39.5 days (s.d. 21.7); mean time to results being available to clinician was 43.1 days (s.d. 25.1). During the one-year evaluated, there were multiple lapses in processing HIVRNA samples for up to 2 months. Conclusions Clinicians underutilize CD4 and HIVRNA as monitoring tools in HIV care. Laboratory processing failures and turnaround times are unacceptably high for viral load analysis. Alternative strategies need to be considered in order to meet laboratory monitoring needs.
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Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.
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Optimum fluoride intake plays an essential role in the prevention of dental caries while fluoride consumption above recommended level interferes with the normal formation of tooth enamel and bones and may increase risk of dental and skeletal fluorosis. The knowledge and practices of endemic communities on etiology of fluorosis will help in its mitigation and prevention. The objective of this study was to investigate the knowledge, attitude and practices of endemic community on fluoride contamination, fluorosis and prevention practices in order to devise coordinated and targeted prevention mechanisms. Focus group discussions (FGD) and key-informant interview were conducted in three dietary areas to collect knowledge, attitude and practices (KAP) of the endemic community in July 2013.The results indicated that health consequences of fluoride contaminated water are fairly understood. None of the discussants mentioned the word “fluoride”. The knowledge and perception of the community on fluoride ingestion is poor. Health extension workers (HEWs) did not teach about fluoride and related health consequences. Dental fluorosis was reported to start at early ages and not commonly perceived as a major problem. However, adolescents worried and felt that they might be singled out when going to other areas. Older people have a skeletal fluorosis, which interferes with their day to day activities. In severely affected people, the teeth were weak and fragile and thus create difficulty in chewing hard foods like unfermented dry flat bread, sugar cane and toasted grains. People prefer rain water rather than water from borehole because of the inconvenient taste of the latter. The endemic communities have no sufficient knowledge and skills on potential sources of fluoride intake, the debilitating effect of high fluoride ingestion, and preventive and mitigatory measures to reduce fluoride intake. The effect of fluoride contamination and mitigatory methods should get sufficient attention by the community, health workers and concerned governmental bodies. The trend of harvesting and using rain water should be encouraged as it reduces fluoride intake. Future studies should focus on information communication on possible fluoride risks, intervention and evaluation studies on defluoridation, rain water harvesting and mitigatory techniques.
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Kenya is composed of over 40 ethnic communities who practice varied methods of animal handling and slaughter. Socio-cultural and religious traditions have the potential to influence animal handling and slaughter practices. These influences have, however, not been documented in the literature as far as the author is aware. Also, the literature has documented the connection between the manner of animal treatment and meat quality, but this is rarely discussed in the literature in Kenya; this connection is important as it informs modern meat trade practices by Kenyans as they trade in the global arena. This survey aimed to mainly establish and document the animal slaughter practices among Kenyan communities, and, to also highlight any current provisions related to meeting modern animal welfare requirements, animal handling procedures in the meat trade and discuss their potential influence on meat quality available in commerce in Kenya. This preliminary study surveyed the slaughter practices among 10 different Kenyan communities through a semi-structured questionnaire, focus group discussions and individual interviews. The survey demonstrated that different Kenyan communities practice varied methods of animal slaughter depending on whether the animal being slaughtered is for public feasting, domestic consumption or commercial merchandizing. The Kenyan communities surveyed in this study depend mainly on males to slaughter livestock for females preparing it for domestic use using a number of instruments and methods. For small stock for domestic consumption, females may slaughter the animal except for Muslims whose males have to slaughter the animal with a special knife (a Khalef) according to Muslim rites to render it Halal. Large stock is invariably slaughtered by males irrespective of the community, and the manner of use of the carcass. Gender, age, religion, community and the size of the animal were the major determinants of the method of animal slaughter. The animal welfare issues highlighted in the survey and related to the handling and slaughter of livestock have important implications for meat quality during commercial merchandizing. There is an apparent need to provide education to herders, livestock handlers, employees and management in the livestock industry in Kenya on the relationship between animal welfare requirements, animal handling procedures and meat quality. Such awareness can potentially improve the quality and economic value of the meat available in commerce.
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This paper presents a harmonised framework of sediment quality assessment and dredging material characterisation for estuaries and port zones of North and South Atlantic. This framework, based on the weight-of-evidence approach, provides a structure and a process for conducting sediment/dredging material assessment that leads to a decision. The main structure consists of step 1 (examination of available data); step 2 (chemical characterisation and toxicity assessment); decision 1 (any chemical level higher than reference values? are sediments toxic?); step 3 (assessment of benthic community structure); step 4 (integration of the results); decision 2 (are sediments toxic or benthic community impaired?); step 5 (construction of the decision matrix) and decision 3 (is there environmental risk?). The sequence of assessments may be interrupted when the information obtained is judged to be sufficient for a correct characterisation of the risk posed by the sediments/dredging material. This framework brought novel features compared to other sediment/dredging material risk assessment frameworks: data integration through multivariate analysis allows the identification of which samples are toxic and/or related to impaired benthic communities; it also discriminates the chemicals responsible for negative biological effects; and the framework dispenses the use of a reference area. We demonstrated the successful application of this framework in different port and estuarine zones of the North (Gulf of Cadiz) and South Atlantic (Santos and Paranagua Estuarine Systems).
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My dissertation emphasizes a cognitive account of multimodality that explicitly integrates experiential knowledge work into the rhetorical pedagogy that informs so many composition and technical communication programs. In these disciplines, multimodality is widely conceived in terms of what Gunther Kress calls “socialsemiotic” modes of communication shaped primarily by culture. In the cognitive and neurolinguistic theories of Vittorio Gallese and George Lakoff, however, multimodality is described as a key characteristic of our bodies’ sensory-motor systems which link perception to action and action to meaning, grounding all communicative acts in knowledge shaped through body-engaged experience. I argue that this “situated” account of cognition – which closely approximates Maurice Merleau-Ponty’s phenomenology of perception, a major framework for my study – has pedagogical precedence in the mimetic pedagogy that informed ancient Sophistic rhetorical training, and I reveal that training’s multimodal dimensions through a phenomenological exegesis of the concept mimesis. Plato’s denigration of the mimetic tradition and his elevation of conceptual contemplation through reason, out of which developed the classic Cartesian separation of mind from body, resulted in a general degradation of experiential knowledge in Western education. But with the recent introduction into college classrooms of digital technologies and multimedia communication tools, renewed emphasis is being placed on the “hands-on” nature of inventive and productive praxis, necessitating a revision of methods of instruction and assessment that have traditionally privileged the acquisition of conceptual over experiential knowledge. The model of multimodality I construct from Merleau-Ponty’s phenomenology, ancient Sophistic rhetorical pedagogy, and current neuroscientific accounts of situated cognition insists on recognizing the significant role knowledges we acquire experientially play in our reading and writing, speaking and listening, discerning and designing practices.
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Technology has an important role in children's lives and education. Based on several projects developed with ICT, both in Early Childhood Education (3-6 years old) and Primary Education (6-10 years old), since 1997, the authors argue that research and educational practices need to "go outside", addressing ways to connect technology with outdoor education. The experience with the projects and initiatives developed supported a conceptual framework, developed and discussed with several partners throughout the years and theoretically informed. Three main principles or axis have emerged: strengthening Children's Participation, promoting Critical Citizenship and establishing strong Connections to Pedagogy and Curriculum. In this paper, those axis will be presented and discussed in relation to the challenge posed by Outdoor Education to the way ICT in Early Childhood and Primary Education is understood, promoted and researched. The paper is exploratory, attempting to connect theoretical and conceptual contributions from Early Childhood Pedagogy with contributions from ICT in Education. The research-based knowledge available is still scarce, mostly based on studies developed with other purposes. The paper, therefore, focus the connections and interpellations between concepts established through the theoretical framework and draws on the almost 20 years of experience with large and small scale action-research projects of ICT in schools. The more recent one is already testing the conceptual framework by supporting children in non-formal contexts to explore vineyards and the cycle of wine production with several ICT tools. Approaching Outdoor Education as an arena where pedagogical and cultural dimensions influence decisions and practices, the paper tries to argue that the three axis are relevant in supporting a stronger connection between technology and the outdoor.
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Introduction: Food availability and access are strongly affected by seasonality in Ethiopia. However, there are little data on seasonal variation in Infant and Young Child Feeding (IYCF) practices and malnutrition among 6-23 months old children in different agro-ecological zones of rural Ethiopia. Methods: Socio-demographic, anthropometry and IYCF indicators were assessed in post- and pre-harvest seasons among children aged 6–23 months of age randomly selected from rural villages of lowland and midland agro-ecological zones. Results: Child stunting and underweight increased from prevalence of 39.8% and 26.9% in post-harvest to 46.0% and 31.8% in pre-harvest seasons, respectively. The biggest increase in prevalence of stunting and underweight between post- and pre-harvest seasons was noted in the midland zone. Wasting decreased from 11.6% post-harvest to 8.5% pre-harvest, with the biggest decline recorded in the lowland zone. Minimum meal frequency, minimum acceptable diet and poor dietary diversity increased considerably in pre-harvest compared to post-harvest season in the lowland zone. Feeding practices and maternal age were predictors of wasting, while women’s dietary diversity and children age was predictor of child dietary diversity in both seasons. Conclusion: There is seasonal variation in malnutrition and IYCF practices among children 6-23 months of age with more pronounced effect in midland agro-ecological zone. A major contributing factor for child malnutrition may be poor feeding practices. Health information strategies focused on both IYCF practices and dietary diversity of mothers could be a sensible approach to reduce the burden of child malnutrition in rural Ethiopia.
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The blurred lantern shark Etmopterus bigelowi, a deep-water squaloid shark, is globally widespread in temperate and tropical waters, but there is little available information about its biology owing to its relative rarity of capture and taxonomic confusion with its sibling species Etmopterus pusillus. Specimens used in this study were collected from July to December 2004 as by-catch in the commercial deepwater trawl fishery targeting red shrimp Aristaeomorpha foliacea in the southwestern Atlantic. We examined 55 specimens (22 males and 33 females) ranging in total length (TL) from 31.5 to 73 cm and in total weight from 103 to 1600 g. Length-weight relationships were explored for each sex and significant differences were found in the slope coefficients of the male and female regressions. The size at maturity for each sex was evaluated fitting a logistic regression. Females matured at larger sizes than males, with estimated sizes at first maturity of 56.0 cm TL for females and 45.1 cm TL for males. The present study provides important preliminary information about E. bigelowi that can be incorporated in risk assessment and stock assessment models, essential for efficient management practices aimed at avoiding overexploitation of these vulnerable deep-sea sharks.
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Greenhouse production is a very important activity in the West region of Portugal, with an area of approximately 800 ha where the regular production consists in two crops per year, one in winter-spring and the other in summer-autumn. Many growers are now prepared to better exploit market opportunities, since they know that the big export window opportunity is from June to September, when the production is difficult in other regions of south due to high temperatures. Grower’s use new and more productive varieties, either in soil or hydroponic systems, mostly in unheated greenhouses, naturally ventilated, and equipped with modern fertigation systems. Greenhouse production causes some environmental impacts due to the high use of inputs. Several improvements in technologies and crop practices may contribute to increase the use efficiency of resources, decreasing the negative environmental impacts. Greenhouse vegetable production in Northern EU countries is based on the supply of heating and differs significantly from the production system in the Southern EU countries. In the Northern countries, direct energy inputs, mostly for heating, are predominant while in the South the indirect energy input is also important, mainly associated with fertilizers, plastic cover materials and other auxiliary materials. The main objective of this work was to characterise the greenhouse production systems in the West region of Portugal, in order to evaluate the energetic consumptions (direct and indirect), the GHH emissions, the production costs and the farmer’s income. With this work the mostly important inputs were identified, allowing proposing alternative measures to improve efficiency and sustainability. All the data was obtained by surveys performed directly with growers, previously selected to be representative of the crop practices and greenhouse type of the region. However, more research should be performed in order to develop and to test technologies capable to improve resources use efficiency in greenhouse production.
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Soil is a key resource that provides the basis of food production and sustains and delivers several ecosystems services including regulating and supporting services such as water and climate regulation, soil formation and the cycling of nutrients carbon and water. During the last decades, population growth, dietary changes and the subsequent pressure on food production, have caused severe damages on soil quality as a consequence of intensive, high input-based agriculture. While agriculture is supposed to maintain and steward its most important resource base, it compromises soil quality and fertility through its impact on erosion, soil organic matter and biodiversity decline, compaction, etc., and thus the necessary yield increases for the next decades. New or improved cropping systems and agricultural practices are needed to ensure a sustainable use of this resource and to fully take the advantages of its associated ecosystem services. Also, new and better soil quality indicators are crucial for fast and in-field soil diagnosis to help farmers decide on the best management practices to adopt under specific pedo-climatic conditions. Conservation Agriculture and its fundamental principles: minimum (or no) soil disturbance, permanent organic soil cover and crop rotation /intercropping certainly figure among the possibilities capable to guarantee sustainable soil management. The iSQAPER project – Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience – is tackling this problem with the development of a Soil Quality application (SQAPP) that links soil and agricultural management practices to soil quality indicators and will provide an easy-to-use tool for farmers and land managers to judge their soil status. The University of Évora is the leader of WP6 - Evaluating and demonstrating measures to improve Soil Quality. In this work package, several promising soil and agricultural management practices will be tested at selected sites and evaluated using the set of soil quality indicators defined for the SQAPP tool. The project as a whole and WP6 in specific can contribute to proof and demonstrate under different pedoclimatic conditions the impact of Conservation Agriculture practices on soil quality and function as was named the call under which this project was submitted.
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The research investigates the interaction between social innovation practices and urban planning, assuming as a case study and field of application the city of Bologna, observed from the point of view of the production of urban policies and with respect to the places where it is practiced. Social innovation are localised actions tackling current urban complexities with micro-scale practices of service and urban production, by which new urban actors find answers to social needs, which are less afforded by the market and the public sectors. Planning and social innovation practices are two dimensions working in the city in different but complementary ways, subject to a mismatch. Through the lenses of interaction, the research explores the context of Bologna, a paradigmatic study and application field, a laboratory of innovative policies where a tradition of collective civic initiatives intertwines with a more responsible institutional planning framework. After drawing from area-based policies of Berlin and Barcelona, the thesis reads the role of specific intermediate places, mediators in bridging the level of institutions and the practices. Through an inventory and a cross-cutting taxonomy of intermediate places, the research draws the knowledge to inform a new urban model for the city of Bologna, aimed at overtake the mismatches by enabling the practices to act, allowing urban planning to frame them in a cross-fertilisation dimension. The proposed urban diagrammatic model, foresees intermediate places as local socio-urban observatories for research and development, interacting with both institutions and communities. The goal is to critically explore the limits and widen the meaning of the capacity of action of social innovation practices engaging in mutual-learning with the city. The model suggests a new possibility for reflection on urban planning as a more flexible approach, which translates the numerous experiences of the city into alternatives and multiple visions.
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The was conducted with objectives focusing on the EU farm animal directive and applicability in Africa focusing in Ethiopia, the welfare assessment and the effect of different bovine respiratory disease (BRD) treatment protocols in beef cattle fattening unit and the calves navel healing and fitness for transport. Different methodology was applied: relevant literates, international organization, regional organization, countries legislations, standards were assessed and reviewed, for assessing beef welfare and biosecurity a modified version of the Italian protocol for assessing beef cattle was adopted which is part of the ClassyFarm monitoring scheme, 264 Limousine bulls with an average age of 11 months at the entrance to fattening unit were considered. Mycoplasma bovis was tested using RT-PCR at arrival and with culture at after 15 days of arrival to the fattening unit. For studying the navel healing and effect on transport the navels of 299 dairy calves (55 males, 244 females) aged 0–90 days were examined. As a conclusion, the European Union (EU) farm directive, could not be completely implement in African countries like Ethiopia, but it could serve as a good starting point, so as after successful identification of the farm animal welfare critical points may help as a starting point with modification to the local situation in the ground. In beef welfare assessment, integration of different assessment parameters could be of useful, when assessing beef welfare, and further continues detail physiological parameters of welfare assessment for integration with other assessment protocols should be studied, our finding indicate that also BRD was a major welfare and health concern in the studied population and evidence the difficulties of antimicrobial treatment of M. bovis associated BRD. In transporting calves with a completely healed navel should be considered best practice because it ensures that calves that are too young are not transported.
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This PhD research investigates sealing practices in the Near East during the Late Bronze II period (ca. 1375-1175 BCE). Sealings from archaeological contexts in the Southern Levant, North Syria, Upper and Lower Mesopotamia and South-Western Iran are taken under consideration and analyzed on multiple aspects at local, regional, and international levels. The contextual, functional, and iconographic analysis of these materials, in fact, allows to reconstruct the nature of the transactions and the agents involved in the sealing operations within local administrative systems, highlighting at the same time aspects of inter-regional interactions during the age of internationalism. Following a survey of the available evidence, a corpus consisting of 1845 records from 28 different sites across the ANE, has been filed using MS Access and MS Excel, including 740 unpublished sealing from Karkemish. Among this large evidence, the corpus of recently discovered sealings from Karkemish and the other scattered sealings from the North Syrian provinces, for instance, provide insights on the core-periphery relationships under the Hittite Empire; while the deposit from Building P at Tell Sheikh Hamad, that of the Middle Assyrian houses at Tell Fekheriye, and of the dunnu of Tell Sabi Abyad, significantly contributes to defining the administration of provinces within the Middle Assyrian state and the regional circulation of good. The less extensive evidence from South Mesopotamia under the Kassite rule and from Middle Elamite contexts in South-Western Iran somewhat contribute as well to the understanding of sealing practices in the LB II period. The South Levantine kingdoms, on the other hand, seems participates to the Egyptian regional network of exchanges and sealing practices.