699 resultados para Nutrition Support Practice


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The goal of this study was to understand how and whether policy and practice relating to violence against women in Uganda, especially Uganda’s Domestic Violence Act of 2010, have had an effect on women’s beliefs and practices, as well as on support and justice for women who experience abuse by their male partners. Research used multi-sited ethnography at transnational, national, and local levels to understand the context that affects what policies are developed, how they are implemented, and how, and whether, women benefit from these. Ethnography within a local community situated global and national dynamics within the lives of women. Women who experience VAW within their intimate partnerships in Uganda confront a political economy that undermines their access to justice, even as a women’s rights agenda is working to develop and implement laws, policies, and interventions that promote gender equality and women’s empowerment. This dissertation provides insights into the daily struggles of women who try to utilize policy that challenges duty bearers, in part because it is a new law, but also because it conflicts with the structural patriarchy that is engrained in Ugandan society. Two explanatory models were developed. One explains factors relating to a woman’s decision to seek support or to report domestic violence. The second explains why women do and do not report DV. Among the findings is that a woman is most likely to report abuse under the following circumstances: 1) her own, or her children’s survival (physical or economic) is severely threatened; 2) she experiences severe physical abuse; or, 3) she needs financial support for her children. Research highlights three supportive factors for women who persist in reporting DV. These are: 1) the presence of an “advocate” or support 2) belief that reporting will be helpful; and, 3) lack of interest in returning to the relationship. This dissertation speaks to the role that anthropologists can play in a multi-disciplinary approach to a complex issue. This role is understanding – deeply and holistically; and, articulating knowledge generated locally that provides connections between what happens at global, national and local levels.

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This quantitative study examines the impact of teacher practices on student achievement in classrooms where the English is Fun Interactive Radio Instruction (IRI) programs were being used. A contemporary IRI design using a dual-audience approach, the English is Fun IRI programs delivered daily English language instruction to students in grades 1 and 2 in Delhi and Rajasthan through 120 30-minute programs via broadcast radio (the first audience) while modeling pedagogical techniques and behaviors for their teachers (the second audience). Few studies have examined how the dual-audience approach influences student learning. Using existing data from 32 teachers and 696 students, this study utilizes a multivariate multilevel model to examine the role of the primary expectations for teachers (e.g., setting up the IRI classroom, following instructions from the radio characters and ensuring students are participating) and the role of secondary expectations for teachers (e.g., modeling pedagogies and facilitating learning beyond the instructions) in promoting students’ learning in English listening skills, knowledge of vocabulary and use of sentences. The study finds that teacher practice on both sets of expectations mattered, but that practice in the secondary expectations mattered more. As expected, students made the smallest gains in the most difficult linguistic task (sentence use). The extent to which teachers satisfied the primary and secondary expectations was associated with gains in all three skills – confirming the relationship between students’ English proficiency and teacher practice in a dual-audience program. When it came to gains in students’ scores in sentence use, a teacher whose focus was greater on primary expectations had a negative effect on student performance in both states. In all, teacher practice clearly mattered but not in the same way for all three skills. An optimal scenario for teacher practice is presented in which gains in all three skills are maximized. These findings have important implications for the way the classroom teacher is cast in IRI programs that utilize a dual-audience approach and in the way IRI programs are contracted insofar as the role of the teacher in instruction is minimized and access is limited to instructional support from the IRI lessons alone.

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In this brief an explanation is given why Exceptions in copyright legislation are of great importance to the free flow of knowledge, essential to education and research in the European Union. At present the Freedom of access to knowledge for EU citizens is trapped in a complex web of national laws and local licensing arrangements. The current EU copyright law does not enable the vision of either a "Europe of knowledge" in the Bologna Process or of a "unified" European Research Area to be realised. To address this Exceptions and limitations harmonised to fit best practice are required to allow content to move digitally across Member States in support of education, research and libraries. Support for open content licensing by the European Parliament will strengthen authors’ rights, meet the needs of researchers, teachers and learners, and enable the free flow of knowledge in support of the "fifth freedom".

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Since America’s beginnings as a British colony, its musical standards have adhered to those of Western Europe. For this reason, musical forms native to America like Black folk spirituals and Gospel music have historically been marginalized in favor of music in the Western classical tradition. Today, a bias towards music of the Western classical tradition exists in those American universities that grant music degrees. While this bias is understandable, inclusion of Gospel music history and performance practice would result in a more complete understanding of American music and its impact on American nationalism. The United States Naval Academy is one of the few American universities that have consistently elevated the performance of Gospel music to the level of Western Classical music within its institutional culture. The motivations for writing this document are to provide a brief history of Gospel music in the United States and of choral music at the Naval Academy. These historical accounts serve as lenses though which the intersection of Gospel music performance practice and leadership development at the United States Naval Academy may be observed. During the last two decades of the twentieth century, Gospel music intersected American military culture at the U.S. Naval Academy. After a few student-led attempts in the 1970s, a Gospel Choir was formed in 1986 but by 1990, it had become an official part of the Music Department. Ultimately, it received institutional support and today, the Gospel Choir is one of three touring choirs authorized to represent the Academy in an official capacity. This document discusses the promotion of Gospel music by the Naval Academy in its efforts to diversify Academy culture and ultimately, Naval and Marine Corps leadership. Finally, this dissertation examines the addition of performed cultural expression (Gospel music) in light of a shift in American nationalism and discusses its impact on Naval Academy culture.

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Introduction: The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see whether our nutrition policy was involved, we undertook a systematic review and drew up clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG. Methods: A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. After conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale Comment: These CPG aim to help physicians in their decision making. The protocolized application of well-proven measurements reduces the variation in clinical practice and improves results.

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Introduction: The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see wether our nutrition policy was involved, we underlook a systematic review and drewup clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG. Methods: A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. Afete conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale. Comment: These CPG aim to help physicians in their decision making. The protocolized application of well-proven measurements reduces the variation in clinical practice and improves results.

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Background: Community participation has become an integral part of many areas of public policy over the last two decades. For a variety of reasons, ranging from concerns about social cohesion and unrest to perceived failings in public services, governments in the UK and elsewhere have turned to communities as both a site of intervention and a potential solution. In contemporary policy, the shift to community is exemplified by the UK Government’s Big Society/Localism agenda and the Scottish Government’s emphasis on Community Empowerment. Through such policies, communities have been increasingly encouraged to help themselves in various ways, to work with public agencies in reshaping services, and to become more engaged in the democratic process. These developments have led some theorists to argue that responsibilities are being shifted from the state onto communities, representing a new form of 'government through community' (Rose, 1996; Imrie and Raco, 2003). Despite this policy development, there is surprisingly little evidence which demonstrates the outcomes of the different forms of community participation. This study attempts to address this gap in two ways. Firstly, it explores the ways in which community participation policy in Scotland and England are playing out in practice. And secondly, it assesses the outcomes of different forms of community participation taking place within these broad policy contexts. Methodology: The study employs an innovative combination of the two main theory-based evaluation methodologies, Theories of Change (ToC) and Realist Evaluation (RE), building on ideas generated by earlier applications of each approach (Blamey and Mackenzie, 2007). ToC methodology is used to analyse the national policy frameworks and the general approach of community organisations in six case studies, three in Scotland and three in England. The local evidence from the community organisations’ theories of change is then used to analyse and critique the assumptions which underlie the Localism and Community Empowerment policies. Alongside this, across the six case studies, a RE approach is utilised to examine the specific mechanisms which operate to deliver outcomes from community participation processes, and to explore the contextual factors which influence their operation. Given the innovative methodological approach, the study also engages in some focused reflection on the practicality and usefulness of combining ToC and RE approaches. Findings: The case studies provide significant evidence of the outcomes that community organisations can deliver through directly providing services or facilities, and through influencing public services. Important contextual factors in both countries include particular strengths within communities and positive relationships with at least part of the local state, although this often exists in parallel with elements of conflict. Notably this evidence suggests that the idea of responsibilisation needs to be examined in a more nuanced fashion, incorporating issues of risk and power, as well the active agency of communities and the local state. Thus communities may sometimes willingly take on responsibility in return for power, although this may also engender significant risk, with the balance between these three elements being significantly mediated by local government. The evidence also highlights the impacts of austerity on community participation, with cuts to local government budgets in particular increasing the degree of risk and responsibility for communities and reducing opportunities for power. Furthermore, the case studies demonstrate the importance of inequalities within and between communities, operating through a socio-economic gradient in community capacity. This has the potential to make community participation policy regressive as more affluent communities are more able to take advantage of additional powers and local authorities have less resource to support the capacity of more disadvantaged communities. For Localism in particular, the findings suggest that some of the ‘new community rights’ may provide opportunities for communities to gain power and generate positive social outcomes. However, the English case studies also highlight the substantial risks involved and the extent to which such opportunities are being undermined by austerity. The case studies suggest that cuts to local government budgets have the potential to undermine some aspects of Localism almost entirely, and that the very limited interest in inequalities means that Localism may be both ‘empowering the powerful’ (Hastings and Matthews, 2014) and further disempowering the powerless. For Community Empowerment, the study demonstrates the ways in which community organisations can gain power and deliver positive social outcomes within the broad policy framework. However, whilst Community Empowerment is ostensibly less regressive, there are still significant challenges to be addressed. In particular, the case studies highlight significant constraints on the notion that communities can ‘choose their own level of empowerment’, and the assumption of partnership working between communities and the local state needs to take into account the evidence of very mixed relationships in practice. Most importantly, whilst austerity has had more limited impacts on local government in Scotland so far, the projected cuts in this area may leave Community Empowerment vulnerable to the dangers of regressive impact highlighted for Localism. Methodologically, the study shows that ToC and RE can be practically applied together and that there may be significant benefits of the combination. ToC offers a productive framework for policy analysis and combining this with data derived from local ToCs provides a powerful lens through which to examine and critique the aims and assumptions of national policy. ToC models also provide a useful framework within which to identify specific causal mechanisms, using RE methodology and, again, the data from local ToC work can enable significant learning about ‘what works for whom in what circumstances’ (Pawson and Tilley, 1997).

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There is a growning need to address psychological health and safety in the workplace. Ergonomics tends to be widely recognized for its physical applications, such as ¨office¨ and ¨manual materials handling¨ however the other domains of specialization of ergonomics (cognitive and organizational) appear to be less well known. This study evaluates the level of understanding that professionals who practice ergonomics have of the relation between ergonomics and the control of psychosocial hazards in the workplace. A survey was distributed to ergonomics practitioners and asked them about their awareness of the relation between ergonomics and workplace psychosocial hazard control. Ergonomists and human factors specialists demonstrated a greater awareness of this relationship than other allied occupational groups that also practice ergonomics, however they indicated that there may be difficulties in the “real world” applying these areas of knowledge into practice. Participants who demonstrated a high level of awareness of the relation between ergonomics and psychosocial hazard control demonstrated stronger organizational commitment than participants with a low awareness. Ergonomics practitioners who reported having employer support for professional development also demonstrated a higher degree of awareness of the relation between ergonomics and psychosocial hazard control, as did the professionals who had been practicing in the field the longest. This research provides some insight for professional associations for Ergonomists, employers of Ergonomists, and human resource professionals about how ergonomics practitioners perceive the ergonomics field and the profession as well as their employing organization.

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Objectives: In recent years, Internet access has grown markedly providing individuals with new opportunities for online information retrieval, psychological advice and support. The objectives of the present study were to explore the context through which dentally anxious individuals access an online support group and the nature of their online experiences. Methods: An online questionnaire was completed by 143 individuals who accessed the Dental Fear Central online support group bulletin board. Qualitative analysis was conducted on the responses. Results: Analysis revealed three emergent themes which reflected the motives and experiences of individuals: ‘Searching for help’, ‘Sharing fears’ and ‘I feel empowered’. Conclusion: This exploratory study suggests that for most individuals accessing this online support group was a positive and beneficial experience. Practice Implications: Online support groups may represent a convenient and beneficial tool that may assist certain individuals to confront their debilitating anxiety/phobia and successfully receive dental care.

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Objective: Huntington’s Disease (HD) is an inherited disorder, characterised by a progressive degeneration of the brain. Due to the nature of the symptoms, the genetic element of the disease and the fact that there is no cure, HD patients and those in their support network often experience considerable stress and anxiety. With an expansion in Internet access, individuals affected by HD have new opportunities for information retrieval and social support. The aim of this study is to examine the provision of social support in messages posted to a HD online support group bulletin board. Methods: In total, 1313 messages were content analysed using a modified version of the Social Support Behaviour Code developed by Cutrona & Suhr (1992). Results: The analysis indicates that group members most frequently offered informational (56.2%) and emotional support (51.9%) followed by network support (48.4%) with esteem support (21.7%) and tangible assistance (9.8%) least frequently offered. Conclusion: This study suggests that exchanging informational and emotional support represents a key function of this online group. Practice implications: Online support groups provide a unique opportunity for health professionals to learn about the experiences and views of individuals affected by HD and explore where and why gaps may exist between evidence-based medicine and consumer behaviour and expectations.

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"The report ... summarizes the major points of discussion at the meeting as well as integrating other pertinent information"--P. iii.

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Background Nutritional support is a recognized determinant of outcome in critically ill patients. Development of critical care services in low-income countries has not been accompanied by certain appropriate ancillary services and interventions, such as adequate nutritional support. This study was designed to investigate the experiences of health professionals who have provided nutritional supportive care to critically ill patients admitted to two major central hospitals in Malawi, with the aim of identifying the common practices in nutritional support in these settings. Materials and Methods A cross-sectional study in which 50 health professionals working in intensive care and high dependency units, admitting both adult and pediatric patients, were interviewed using a semi-structured questionnaire. Data were coded and then analyzed using SPSS version 16.0. Responses between the two hospitals were compared using Fisher’s exact test. Results There was no difference in the composition of respondents from the two hospitals. About 60% of respondents had had experience with nutritional supplementation in their patients—mainly enteral. The most commonly used formulations were the “ready-to-use therapeutic feeds,” followed by modified milk. A high percentage of respondents (40%) reported having used dextrose solution as the sole nutritional supplement. Lack of in-service training, nonexistent nutrition protocols pertaining to acutely and critically ill patients, and a lack of clinical nutritionists were the major challenges identified. Conclusion Knowledge of nutrient supplementation was poor among the respondents. The use of ready-to-use therapeutic feeds was quite common, although there is no evidence of its effectiveness in care of acutely critically ill patients. There is a need to establish nutritional support teams in these tertiary hospitals. Clinical nutritionists would ideally help train and play leadership roles in such teams, who would be responsible for assessing patients for their nutritional needs, and ensuring that the feeds provided to patients are appropriate and adequate for their needs.

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The inclusion of non-ipsative measures of party preference (in essence ratings for each of the parties of a political system) has become established practice in mass surveys conducted for election studies. They exist in different forms, known as thermometer ratings or feeling scores, likes and dislikes scores, or support propensities. Usually only one of these is included in a single survey, which makes it difficult to assess the relative merits of each. The questionnaire of the Irish National Election Study 2002 (INES2002) contained three different batteries of non-ipsative party preferences. This paper investigates some of the properties of these different indicators. We focus in particular on two phenomena. First, the relationship between non-ipsative preferences and the choices actually made on the ballot. In Ireland this relationship is more revealing than in most other countries owing to the electoral system (STV) which allows voters to cast multiple ordered votes for candidates from different parties. Second, we investigate the latent structure of each of the batteries of party preferences and the relationships between them. We conclude that the three instruments are not interchangeable, that they measure different orientations, and that one –the propensity to vote for a party– is by far preferable if the purpose of the study is the explanation of voters’ actual choice behaviour. This finding has important ramifications for the design of election study questionnaires.

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Part 2: Behaviour and Coordination