6664 research outputs found
Sort by
Factors influencing the efficiency of public hospitals in Saudi Arabia: a qualitative study exploring stakeholders' perspectives and suggestions for improvement
Get PDFObjective: Despite an extensive literature on efficiency, qualitative evidence on the drivers of hospital efficiency is scant. This study examined the factors that influence the efficiencies of health service provision in public hospitals in the Kingdom of Saudi Arabia (KSA) and their potential remedies.
Design: We employed a qualitative design involving semi-structured interviews conducted between July and September 2019. Participants were purposively selected and included policymakers and hospital managers drawn from districts, regional and national levels. Data were analyzed in Nvivo 12 based on a thematic approach.
Setting: Key informants of Ministry of health in the KSA.
Results: Respondents identified a range of different factors across the community, facility and the wider health system that influence inefficiencies in public hospitals in KSA. Ineffective hospital management, lack of strategic planning and goals, weak administrative leadership, and absence of monitoring hospital performance was noted to have a profound impact on hospital efficiency. The conditions of healthcare staff in respect to both skills, authority and psychological factors were considered to influence the efficiency level. Further, lack of appropriate data for decision making due to the absence of an appropriate health informatics system was regarded as a factor of inefficiency. At the community level, respondents described inadequate information on the healthcare needs and expectations of patients and the wider community as significant barriers to the provision of efficient services. To improve hospital efficiencies, respondents recommended that service delivery decisions are informed by data on community health needs; capacity strengthening and effective supervision of hospital staff; and judicious resource allocation.
Conclusion: The study demonstrates that inefficiencies in health services remain a critical challenge in public hospitals in KSA. Extensive awareness-raising and training on efficient resource utilization among key health systems stakeholders are imperative to improving hospital performance. More research is needed to strengthen knowledge on hospital efficiency in light of the limited data on the topic in KSA and the wider Gulf region
Effective connectivity in cortical networks during deception: a lie detection study using EEG
Get PDFPrevious studies have identified activated regions associated with deceptive tasks and most of them utilized time, frequency, or temporal features to identify deceptive responses. However, when deception behaviors occur, the functional connectivity pattern and the communication between different brain areas remain largely unclear. In this study, we explored the most important information flows between different brain cortices during deception. First, we employed the guilty knowledge test protocol and recorded on 64 electrodes electroencephalogram (EEG) signals from 30 subjects (15 guilty and 15 innocent). EEG source estimation was then performed to compute the cortical activities on the 24 regions of interest (ROIs). Next, effective connectivity was calculated by partial directed coherence (PDC) analysis applied to the cortical signals. Furthermore, based on the graph-theoretical analysis, the network parameters with significant differences were extracted as features to identify two groups of subjects. In addition, the ROIs frequently involved in the above network parameters were selected, and based on the difference in the group mean of PDC values of all the edges connected with the selected ROIs, we presented the strongest information flows (MIIF) in the guilty group relative to the innocent group. Experimental results first show that the optimal classification features are mainly in-degree and out-degree measures of the ROI and the high classification accuracy for four bands demonstrated that the proposed method is suitable for lie detection. In addition, the frontoparietal network was found to be most prominent among all the MIIFs in four bands. Finally, combining the neurophysiology signification of four frequency bands, respectively, we analyzed the roles of all the important information flows to uncover the underlying cognitive processes and mechanisms used in deception
Neighbourhood walkability as a moderator of the associations between older adults’ information technology use and social activity: a cross-sectional study with sensitivity analyses
Get PDFBackground
Research to date suggests that information technology use by older adults can be positively associated with social activity, but whether neighbourhood walkability can play a role in this relationship has not been investigated.
Aim
To assess the associations between information technology use and social activity as well as the moderating influences of walkability in these associations.
Methods
This study adopted a cross-sectional design with sensitivity analyses as well as techniques against common methods bias. The study population was community-dwelling older residents of Accra aged 60 years or higher. A total of 890 older adults participated in this study. The hierarchical linear regression analysis was used to analyse the data.
Results
Information technology use was found to be positively associated with social activity. Among the three domains of information technology use, only packaged software use assessment was positively associated with social activity. Walkability was found to positively moderate the associations between social activity and information technology use as well as packaged software use assessment. Walkability strengthened the negative association between innovativeness attitude (another domain of information technology use) and social activity.
Conclusions
Information technology use can facilitate social activity, but experimentation with new information technologies can discourage social engagement, even in higher walkability. Packaged software use assessment, which measures the ability to use packaged software such as WhatsApp, can more significantly support social activity in higher walkability
Influence of blended powders on properties of ultra-high strength fibre reinforced self compacting concrete subjected to elevated temperatures
Get PDFUltra-High Strength Fibre Reinforced Self Compacting Concrete (UHSFRSCC) is in great demand for use in construction projects around the globe. Unless fillers are utilized in this concrete, its production will come at an excessive environmental cost due to the high Carbon footprint of Portland cement. A gap in the published literature was identified, where quaternary mixes, containing Portland cement with three fillers, incorporating fibres, and achieving ultra high strength, were not cited. In this study ternary and quaternary mixes were designed and produced, satisfying the European Guidelines for SCC, with compressive strengths exceeding 115 MPa. Some mixes had compressive strengths between 125 – 150 MPa, which were not previously reported in the literature. The mixes contained Silica Fume (SF), Metakaolin (MK), Limestone powder (LS) as partial Portland cement replacement and quartz powder (QP) as partial sand replacement. Basalt Fibres were added to reinforce the matrix. Compressive & tensile strength of the mixes along with UPV, sorptivity, absorption and SEM Micro-structure features were studied at ambient temperature and after the samples were exposed to either 200 or 300 oC; since the behavior of HSC at elevated temperature is always a cause for concern. The active and inert fillers exhibited a synergic behavior at all temperature conditions. The mix containing: 15% SF, 5% MK, 20% LS and 34% QP achieved the best performance. Compressive and splitting tensile strength improve by 10% and 17% while sorptivity and absorption decline by 40% and 29% respectively at ambient temperature. Residual compressive strength improved by 10% and 19% while, residual splitting tensile strength significantly increases by 21% and 28% after exposure to elevated temperatures 200°C and 300°C respectively. Meanwhile, residual sorptivity decreases by 39% and 38% after exposure to these elevated temperatures. Microstructure properties supported and agreed with the mechanical and permeation characteristics results. The results will contribute to the development of UHSFRSCC in hot weather countries
Skin assessment in adults
Get PDFThe skin has often been described in fictional literature as the window to the soul. It is the largest organ in the body and integral to both physical and psychosocial health. A complete skin assessment is essential for holistic care and must be completed by nurses and other health professionals on a regular basis. Providing patients and relatives with information on good skin hygiene can improve skin integrity and reduce the risk of pressure damage and skin tears
Five common pitfalls in mixed methods systematic reviews – lessons learned
Get PDFObjective
Mixed methods systematic reviews (MMSR) combine quantitative and qualitative evidence within a single review. Since the revision of the JBI Methodology for MMSRs in 2020, there has been an increasing number of reviews published that claim to follow this approach. A preliminary examination of these indicated that authors frequently deviated from the methodology. This paper outlines five common ‘pitfalls’ associated with undertaking MMSR and provides direction for future reviewers attempting MMSR.
Methods
Forward citation tracking identified 17 reviews published since the revision of the JBI mixed methods methodological guidance. Methods used in these reviews were then examined against the JBI methodology to identify deviations.
Results
The issues identified related to the rationale for choosing the methodological approach; incorrect synthesis and integration approach chosen to answer the review question/s posed; the exclusion of primary mixed methods studies in the review; the lack of detail regarding the process of data transformation and a lack of ‘mixing’ of the quantitative and qualitative components.
Conclusion
This exercise was undertaken to assist systematic reviewers considering conducting a MMSR as well as MMSR users to identify potential areas where authors tend to deviate from the methodological approach. Based on these findings a series of recommendations are provided
Obstetric–neonatal care during birth and postpartum in symptomatic and asymptomatic women infected with SARS-CoV-2: a retrospective multicenter study
Get PDFThis study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions
Effect of road, environment, driver, and traffic characteristics on vehicle emissions in Egypt
Get PDFVehicles are a major source of transportation greenhouse gas emissions and the need to accurately quantify and monitor transportation-related emissions from vehicles is nowadays essential. Vehicle emissions are complex functions to be approximated in practice due to many variables affecting their outcome. The aim of this research is to study factors affecting different types of vehicle emissions on Egyptian roads. Models were calibrated using vehicle emissions records collected in the period 2018/2019 and data were recorded in the field for eight types of vehicles. Emission data were classified into three categories according to the fuel type (Diesel, Natural Gas, and Petrol Vehicles). A comparative analysis of various statistical modelling techniques was used to predict vehicle emission rates as a function of six independent variables for vehicle emissions. The Linear Regression Model with Link Function of a Log was found to be the best generalized regression model to represent the correlation between CO2, CO and NOX emissions for Diesel vehicles, whereas the Linear Regression Model with Link Function of Identity was a good representative for the relationship of HC emission for Diesel vehicles. Natural Gas and Petrol vehicle emissions (CO2, CO, HC, and NOX) were best represented with the Linear Regression Model with Link Function of Log. Amongst the studied independent variables, changes in the ambient pressure (P) and numbers of rotations per minute for vehicle engine (RPM) were found to be directly proportional with gas emission for all the three types of vehicles in this study. In addition to these factors, increase of emissions from Diesel vehicles was also related to increasing vehicle speed (V), ambient temperature (T) and relative humidity (RH), whereas emissions from Natural Gas and Petrol vehicles were found to increase also with road grade (G) (both), and ambient temperature (T) (Natural Gas only)
“I didn’t feel i was a victim”: a phenomenological analysis of the experiences of male-on-male survivors of rape and sexual abuse
Get PDFResearch on men’s experiences of sexual victimization is limited and largely outdated. The present study seeks to remedy this issue by qualitatively examining the accounts of nine male-on-male survivors of rape and sexual abuse in the UK. It examines survivors’ experiences of psychological distress post-incident, the influence and manifestation of male rape myths, challenges in self-recognition and disclosure, and barriers to accessing therapeutic support and reporting to the Criminal Justice System (CJS). Participants took part in one-to-one, semi-structured video inter- views, and an interpretative phenomenological analysis (IPA) was utilized to identify four superordinate themes of participants’ experiences: i) gendered narratives, ii) coping with the abuse, iii) masculinity, and iv) reporting to the police. These themes emphasized the stigma and hostility repeatedly encountered by survivors after their victimization. Participants provided an account of short and long-term psychological issues following the abuse, emphasizing the role of self-perceptions of masculinity in the development of unhealthy coping mechanisms. Findings also highlighted the prevalence of prejudice and rape mythology that characterized negative encounters within the public, voluntary agencies, and the CJS. Results are discussed in relation to current service provision in the UK, recommendations for future research, and avenues for improvements across multiple vital entry points
Identification of HOX signatures contributing to oral cancer phenotype
Get PDFThe role of evolutionarily conserved homeobox-containing HOX genes as transcriptional regulators in the developmental specification of organisms is well known. The contribution of HOX genes involvement in oral cancer phenotype has yet to be fully ascertained. TCGA-HNSC HTSeq-counts and clinical data were retrieved from the GDC portal for oral cavity neoplasms. GEO datasets (GSE72627, GSE30784, GSE37991) were accessed and analyzed using GEO2R. Differential HOX gene expression was profiled using the DESeq2 R package with a log2 fold change cut-off (− 1 and + 1) and Benjamini–Hochberg p-adjusted value at ≤ 0.01. Gene set over-representation analysis and semantic analysis associated with the disease ontology was performed using the ClusterProfiler R package, and pathway over-representation analysis was performed using IMPaLa. HOX protein interaction network was constructed using the Pathfind R package. HOX phenotype associations were performed using Mammalian Phenotype Ontology, Human Phenotype Ontology, PhenGenI associations, Jensen tissues, and OMIM entries. Drug connectivity mapping was carried out with Dr. Insight R package. HOXA2 was upregulated in oral dysplasia but silenced during tumor progression. Loss of HOXB2 expression was consistent in the potentially malignant oral lesions as well as in the primary tumor. HOXA7, HOXA10, HOXB7, HOXC6, HOXC10, HOXD10, and HOXD11 were consistently upregulated from premalignancy to malignancy and were notably associated with risk factors. Overrepresentation analysis suggested HOXA10 was involved in the transcriptional misregulation contributing to the oral cancer phenotype. HOX genes subnetwork analysis showed crucial interactions with cell cycle regulators, growth responsive elements, and proto-oncogenes. Phenotype associations specific to the oral region involving HOX genes provide intrinsic cues to tumor development. The 5′ HOX genes were aberrantly upregulated during oral carcinogenesis reflecting their posterior prevalence