Search

The study sought to examine students’ dressing styles and common attributes assigned to them. A descriptive survey design was used in this study. The study areas were the University of Nairobi, Egerton University, Moi University, Technical University of Mombasa, Maseno and Karatina Universities. Multiple sampling procedures were used to select 566 students who participated in the study. Data were collected using questionnaires, focus group discussions and observation checklists. Results show that majority of respondents bought their own clothes with funds provided by the parents or guardians. The most outstanding feature that informed choice of dress was aesthetics, followed by comfort and design. Vests, bare chest tops and shorts were considered modest while high-slitted skirts, miniskirts, unbuttoned shirts, boob-tops, tumbo-cuts, skin-tight dresses and trousers and Bermuda shorts were found to be immodest. Recommendations have been made to develop guidelines on the choice of dress for students in institutions of higher learning to enhance personal grooming.

Background: Persons with dementia (PwD) often have significant cognitive deficits and functional limitations, requiring substantial caregiver assistance. Given the high symptom burden and terminal nature of dementia, good prognostic awareness and integration of palliative care (PC) is needed. Objective: To evaluate prognostic awareness, disease, and PC understanding among caregivers of PwD and to assess for improvements in routine care. Design: A cross-sectional study of 2 cohorts at a single-academic medical center. Surveys were mailed to 200 caregivers of PwD in 2012 (cohort 1). Surveys were sent to new subset of caregivers of PwD (n = 80) in 2018 (cohort 2) to assess trends over time. Results: A total of 154 of caregivers completed the survey (response rate 55%). Compared to 2012, a higher proportion of caregivers in 2018 reported having conversations about prognosis with PwD’s physicians (25% in 2012 vs 45% in 2018; P = .027). However, a large percentage (43% in 2012 and 40% in 2018) of caregivers reported no understanding of the PwD’s prognosis. Despite most stating dementia was not curable, only 39% in 2012 and 52% in 2018 ( P = .015) understood that dementia was a terminal disease. In addition, only 32% in 2012 and 40% in 2018 ( P = .39) felt that they were knowledgeable about PC. Conclusions: Prognostic discussions between caregivers of PwD and the PwD’s physicians may be occurring more often; however, a high percentage of caregivers report a poor understanding about the terminal nature of dementia and the role of PC.

Roads and other forms of linear infrastructure are rapidly proliferating worldwide, yet little is known about how roads affect the distribution and abundance of predators, particularly in relatively intact landscapes. We used a combination of motion-sensor cameras and spoor surveys to compare dingo, fox and feral cat activity on unsealed vehicle tracks (hereafter: roads) and up to 3 km away, in relatively intact landscapes of the Great Western Woodlands in south-western Australia. We compared predator activity as indicated by independent sightings and spoor observations, in woodlands and shrublands: vegetation types with contrasting permeabilities. Predator activity was observed between 12 and 261 times more frequently on roads compared with off-road for all species studied. Roads also appeared to affect predator activity up to 2.5 km away. Even poorly formed and abandoned roads concentrated predator activity and affected landscape-scale rates of predator observations. The effect of road proximity on predator activity was non-linear and different between vegetation types for dingoes and cats but not foxes. Our results provide new evidence of the effects of roads on predator activity in surrounding landscapes, with interacting effects of vegetation. They also reinforce previous findings e.g. stronger roads preference displayed by dingoes and foxes, than by cats. Roads and other linear infrastructure have strong effects on predator activity within intact landscapes, although further research is needed to characterise the implications for prey species. Road planning or approvals, as well as habitat restoration programs for threatened species, should account for the effects of roads on predator activity.

Purpose: To assess the management perceptions on apparel fit made with pattern drafting and free-hand cutting techniques.Methodology: The study employed a cross-sectional descriptive survey was considered adequate for this study as it has the advantage of soliciting respondent’s views on the nature of the situation as it existed at the time of a study (Creswell, 2012; Mugenda, 2008). The design is an efficient way of collecting information of a large group of people within a short time using questionnaires. The survey design was deemed appropriate for this study as it has the advantage of seeking the views of informal dressmakers and tailors on the use of pattern drafting and free-hand cutting in apparel construction. It allowed for the use of both quantitative and qualitative techniques in the study. This paved way for better understanding of a phenomenon under study. The use of these methods offered the opportunity to have in-depth information and also the weakness in one method is compensated for by the strength in another method (Creswell, 2012).Results: The results revealed that dressmakers and tailors’ preference to free-hand cutting was influenced by the method they were trained with. Additionally, standardization of apparel production among the members can best be achieved by intensifying the use of pattern drafting as part of apprenticeship training to ensure accuracy in fit among informal dressmakers and tailors locally. The respondents were asked to state their views on whether educational level hinders the progress of their training.Unique Contribution to theory, practice and policy: Reason why informal dressmakers and tailors were not using pattern drafting in apprenticeship training might be related to the fact that pattern skills seemed too difficult to understand and the period of training might be short to grasp the details of the method. Taking their educational level and period of training into consideration, it would be very difficult for the apprentices to cope with the contents that come with patterns. This implies that, there is the need to inculcate the use of pattern drafting as part of training curriculum of apprentices and also increase the period of training to allow both masters and apprentices gain better grasp of the pattern drafting skills. When trainees are given adequate training skills on the use of pattern drafting, they would improve and this would in effect manifest in the high standard on fit of apparel among the dressmakers and tailors in the informal setting in the near future. The study recommended future studies to focus on the factors influencing training and acquisition of both skills of apparel constructions. This will help the policy makers rectify the structure of education accordingly to improve the way skills are disseminated and executed.

IntroductionPatients with multimorbidity plus additional impairments (eg, mobility limitations, disability, cognitive impairments or frailty) are at the highest risk for poor healthcare outcomes. Advanced care planning (ACP) provides patients and their surrogates the opportunity to discuss their goals, values and priorities for healthcare—particularly in the context of end-of-life care. ACP discussions promote more person-centred care; however, it is currently underused. There is a tremendous need for systematic, scalable approaches to individualised ACP that promotes patient and family engagement. Here we describe the study protocol for a randomised effectiveness trial of a nurse navigator and informatics intervention designed to improve the documentation and quality of ACP discussions.Methods and analysisThis is a randomised, pragmatic, effectiveness trial; patients aged 65 years and older who have multimorbidity plus impairments in either physical function (eg, mobility limitations or disability) or cognition, and/or frailty within an affiliated Accountable Care Organization were eligible. The electronic health record was used to develop an automatic prescreening system for eligible patients (n=765) and participants were randomised in a 1:1 ratio to either the nurse navigator-led ACP pathway or usual care. Our primary outcomes are documentation of ACP discussions within the EHR along with the quality of ACP discussions. Secondary outcomes include a broad range of ACP actions (eg, usage of ACP billing codes, choosing a surrogate decision-maker and advance directive documentation). Outcomes will be measured over 12 months of follow-up.Ethics and disseminationThis study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards. The results of this study will inform a scalable solution to ACP discussions throughout our healthcare system and statewide.Trials registration numberNCT03609658.

The acceleration of infrastructure development presents many challenges for the mitigation of ecological impacts. The type, extent, and cumulative effects of multiple developments must be quantified to enable mitigation. We quantified anthropogenic development footprints in a globally significant and relatively intact region. We identified the proportion accounted for by linear infrastructure (e.g. roads) including infrastructure that is currently unmapped; investigated the importance of key landscape drivers; and explored potential ramifications of offsite impacts (edge effects). We quantified direct development footprints of linear and ‘hub’ infrastructure in the Great Western Woodlands (GWW) in south-western Australia, using digitisation and extrapolation from a stratified random sample of aerial imagery. We used spatial datasets and literature resources to identify predictors of development footprint extent and calculate hypothetical ‘edge effect zones’. Unmapped linear infrastructure, only detectable through manual digitisation, accounts for the greatest proportion of the direct development footprint. Across the 160,000 km2 GWW, the estimated development footprint is 690 km2, of which 67% consists of linear infrastructure and the remainder is ‘hub’ infrastructure. An estimated 150,000 km of linear infrastructure exists in the study area, equating to an average of ~1 km per km2. Beyond the direct footprint, a further 4000–55,000 km2 (3–35% of the region) lies within edge effect zones. This study highlights the pervasiveness of linear infrastructure and hence the importance of managing its cumulative impacts as a key component of landscape conservation. Our methodology can be applied to other relatively intact landscapes worldwide.

Advance care planning (ACP), especially among vulnerable older adults, remains underused in primary care. Additionally, many ACP initiatives fail to integrate directly into the electronic health record (EHR), resulting in infrequent and disorganized documentation.To determine whether a nurse navigator-led ACP pathway combined with a health care professional-facing EHR interface improves the occurrence of ACP discussions and their documentation within the EHR.This was a randomized effectiveness trial using the Zelen design, in which patients are randomized prior to informed consent, with only those randomized to the intervention subsequently approached to provide informed consent. Randomization began November 1, 2018, and follow-up concluded November 1, 2019. The study population included patients 65 years or older with multimorbidity combined with either cognitive or physical impairments, and/or frailty, assessed from 8 primary care practices in North Carolina.Participants were randomized to either a nurse navigator-led ACP pathway (n = 379) or usual care (n = 380).The primary outcome was documentation of a new ACP discussion within the EHR. Secondary outcomes included the usage of ACP billing codes, designation of a surrogate decision maker, and ACP legal form documentation. Exploratory outcomes included incident health care use.Among 759 randomized patients (mean age 77.7 years, 455 women [59.9%]), the nurse navigator-led ACP pathway resulted in a higher rate of ACP documentation (42.2% vs 3.7%, P .001) as compared with usual care. The ACP billing codes were used more frequently for patients randomized to the nurse navigator-led ACP pathway (25.3% vs 1.3%, P .001). Patients randomized to the nurse navigator-led ACP pathway more frequently designated a surrogate decision maker (64% vs 35%, P .001) and completed ACP legal forms (24.3% vs 10.0%, P .001). During follow-up, the incidence of emergency department visits and inpatient hospitalizations was similar between the randomized groups (hazard ratio, 1.17; 95% CI, 0.92-1.50).A nurse navigator-led ACP pathway integrated with a health care professional-facing EHR interface increased the frequency of ACP discussions and their documentation. Additional research will be required to evaluate whether increased EHR documentation leads to improvements in goal-concordant care.ClinicalTrials.gov Identifier: NCT03609658.

The conservation benefit of a management action depends on what would have happened in the absence of an intervention, and whether the conservation objective is to maintain the existing biodiversity values, or to restore those that have been lost. How this benefit is calculated and considered in spatial prioritisation analyses could influence the expected cost-effectiveness of management, although this has not previously been explored. Here, we use a comprehensive decision theoretic approach to identify management priorities in a region of ecological, cultural and economic significance, the Great Western Woodlands (GWW) of south-western Australia. To demonstrate how cost, condition and conservation benefits affect prioritisation outcomes, we consider two different conservation objectives: the maintenance of native vegetation communities and the restoration of natural fire regimes. We compare the results from (1) our comprehensive approach, to priorities identified using two alternative approaches: (2) consider generic management costs (travel, labour) and assume that landscape condition is homogenous or (3) use landscape condition as a surrogate for the cost of management, i.e. areas in poor condition are assumed to have high costs. We demonstrate that prioritisation outcomes differ substantially depending on how the benefits and costs of a management action are calculated. Using landscape condition as a surrogate for management costs resulted in priority areas that were least cost-effective. To avoid misspent conservation funding, we argue that care must be taken to incorporate the most appropriate cost and condition metrics into spatial prioritisation analyses, and that conservation benefits must be derived from a clearly specified objective.

Item does not contain fulltext This chapter presents an overview of the field of medical decision making. It distinguishes the levels of decision making seen in health-care practice and shows how research in judgment and decision making support or improve decision making. Most of the research has been done at the micro level, particularly the research on biases and heuristics. One way to improve medical decisions is to incorporate effective debiasing strategies or manipulations into them. The chapter discusses the framing of risks and the role of affect that has gained more attention in medical decision making in recent years. Next it highlights that eliciting judgments from the general public may entail problems related to affective forecasting. The chapter discusses the finding that judgments one makes for oneself seem to be different from those one makes for others. Finally, it talks about the implementation of prevention programs and topics of health literacy and numeracy.

Item does not contain fulltext

Members of the carrageenan-producing seaweeds of the genus Kappapphycus have a complicated taxonomic history particularly with regard to species identification. Many taxonomic challenges in this group have been currently addressed with the use of mtDNA sequences. The phylogenetic status and genetic diversity of one of the lesser known species, Kappaphycus cottonii, have repeatedly come into question. This study explored the genetic variation in Philippine K. cottonii using the mtDNA COI-5P gene and cox2-3 spacer sequences. The six phenotypic forms in K. cottonii did not correspond to the observed genetic variability; hinting at the greater involvement of environmental factors in determining changes to the morphology of this alga. Our results revealed that the Philippine K. cottonii has the richest number of haplotypes that have been detected, so far, for any Kappaphycus species. Our inferred phylogenetic trees suggested two lineages: a lineage, which exclusively includes K. cottonii and another lineage comprising the four known Kappaphycus species: K. alvarezii, K. inermis, K. malesianus, and K. striatus. The dichotomy supports the apparent synamorphy for each of these lineages (the strictly terete thalli, lack of protuberances, and the presence of a hyphal central core in the latter group, while the opposite of these morphologies in K. cottonii). These findings shed new light on understanding the evolutionary history of the genus. Assessing the breadth of the phenotypic and genetic variation in K. cottonii has implications for the conservation and management of the overall Kappaphycus genetic resources, especially in the Philippines.

Identifying the deleterious ecological effects of developments, such as roads, mining, and urban expansion, is essential for informing development decisions and identifying appropriate mitigation actions. However, there are many types of ecological impacts that slip 'under the radar' of conventional impact evaluations and undermine the potential for successful impact mitigation (including offsets). These 'enigmatic' impacts include those that are small but act cumulatively; those outside of the area directly considered in the evaluation; those not detectable with the methods, paradigms, or spatiotemporal scales used to detect them; those facilitated, but not directly caused, by development; and synergistic impact interactions. Here, we propose a framework for conceptualising enigmatic impacts and discuss ways to address them.

Fashion is very dynamic and way of life for humans in many consumer products, clothing included. In Kenya, the clothing industry is characterized by a dynamic environment and intense competition caused mainly by enlarged globalization, trade liberalization and importation of second-hand (mitumba) clothes. In this kind of environment, it is becoming increasingly difficult for an enterprise to maintain long-term success. Thus, the clothing enterprises are faced with challenges that demand them to offer higher value added products that meet the demands of the customers. As a solution, sound marketing strategies are critical to the survival and growth of micro-enterprises in the garment making sector. However, there is limited research that has looked at the enterprises from a marketing strategy perspective in terms of the type of marketing strategies that are embraced. This paper aims at highlighting the various marketing strategies. The study used ex-post facto research design targeting garment-making micro-enterprises with less than ten employees in Nakuru town. The main data collection instrument was a questionnaire that comprised closed and open-ended questions. Principal component analysis and Chi-square goodness-of-fit test (x2) were used to determine the various marketing strategies and test the hypothesis that there was no variation in the marketing strategies implemented by garment-making micro-enterprises. Eight strategies were identified as being implemented by garment-making micro-enterprises. Based on the results of this study, it is concluded that interactive marketing is the most implemented strategy while e-marketing is the least. However, further research is required to explore the impact of implementing the various marketing strategies on the growth of the enterprises. Key words: Garment-making, micro and small enterprises, marketing strategies.

SummaryBackgroundIf carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA.MethodsBetween 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3–2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6–11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392.Findings1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1% vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4–3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0–7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7–9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43–0·68, p