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Objective: To compare antihyperglycemic medication adherence and glycemic control between individuals with schizophrenia and related psychotic disorders and a nonpsychiatric comparison group.Methods: This was a retrospective medical record review. A total of 124 subjects with diabetes (62 patients with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched patients without a psychiatric illness) receiving their medical and psychiatric care exclusively through the Kansas City Veterans Affairs healthcare system during 2008 were included in the study. Adherence to antihyperglycemic and antipsychotic medication was determined by refill records obtained through the computerized patient record system to calculate the cumulative mean gap ratio. Hemoglobin A1C values were utilized to compare glycemic control between groups and compared to glycemic goals established by diabetes treatment guidelines.Results: Antihyperglycemic medication adherence was poor for both groups as approximately 60% of the psychotic disorder group and 75% of the nonpsychiatric comparison group were without antihyperglycemic medication for greater than 30 days during the 12-month period but adherence did not differ between the groups (p=0.182). Antipsychotic adherent subjects (=80% adherent) were more likely to be adherent to their antihyperglycemic medication (p=0.0003). There were no significant differences between groups in glycemic control.Conclusion: Antihyperglycemic medication adherence and glycemic control was less than optimal for both groups. There were no significant differences in antihyperglycemic medication adherence and glycemic control between patients with a psychotic disorder and those without a psychiatric illness.

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

Abstract Background The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent’s dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya’s urban slums. Methods Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM. Results Two DPs were identified: traditional DP (whole grains/cereals, rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85–6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97–9.32), while longer residency in the slum (> 10 years) had a negative association (RRR = 0.47; 95% CI 0.25–0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16–6.71). The DPs were not associated with thinness or stunting. Conclusion The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Abstract Background Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings. Methods We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey. Results Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16). Conclusion Our study findings suggest a strong positive link between maternal stimulation activities and children’s developmental outcomes among communities in poor rural settings. Trial registration NA (not a clinical trial).

The objective of this review article is to systematically identify the caffeine placebo effect in sport and exercise activities. We selected randomized controlled trial studies to better understand the impact of caffeine and its placebo effect on sports performance. We extracted a set of articles that refer strictly to the topics of caffeine and its placebo effect in sport and exercise, considering the databases integrated to the Core Collection Web of Science and Scopus, as well as the registration of the documents in PubMed®, a system with a selection process aligned with the guidelines for the PRISMA methodology, establishing the eligibility criteria of the articles with the PICOS tool, to which a systematic review is applied. Finally, the results show that caffeine improves anaerobic capacity and endurance, while placebo perceived as caffeine can also increase performance by reducing pain and improving concentration. This finding underscores the influence of expectations and placebo on physical performance, suggesting that managing these expectations may be an effective strategy for improving athletic performance.

This paper aims to guide structural engineers on how to apply the rapid nonlinear time history analysis (RNLTHA) procedure effectively to predict seismic demand, taking into account ductility and overstrength, and effects of dynamic phenomena including cyclic degradation of strength and stiffness in structures, in a direct and expedient manner. The shortcoming of the conventional force-based approach of design involving the use of a force reduction factor to account for nonlinear effects is well recognised. Nonlinear static (pushover) analysis and dynamic nonlinear time history analysis (NLTHA) are offered as alternative methods of analysis by major codes of practices to achieve better optimisation in the use of materials. NLTHA has advantages over pushover analysis in being more direct and capable of capturing cyclic response behaviour. Despite the merits of NLTHA, its adoption in the industry has been limited, mainly because of the complexity and the higher analysis cost involved. RNLTHA proposed in this article uses a macroscopic model of the building to fulfil the purpose of NLTHA, whilst saving computational time and achieving a good degree of accuracy, as verified by comparison with results generated from SeismoStruct.

This paper is aimed at serving the needs of structural engineering designers of an important structure (or a group of structures located on the same site) who is seeking guidance on how to obtain accelerograms and/or derive response spectra that accurately represent the site subsoil conditions as informed by the borelogs. The presented site-specific seismic action model may be used to replace the default seismic action model stipulated for the designated site class. Presented in this article is a procedure for generating soil surface motions in an earthquake, and their associated site-specific response spectra, taking into account details of the soil layers. Dynamic site response analyses are involved. The conditional mean spectrum methodology is employed for selecting and scaling accelerograms for obtaining input motion on bedrock. The selection depends on the natural period of both the site and the structure. Multiple borelogs taken from within the same site are analysed to identify the critical soil column models without having to conduct site response analysis on every borelog. The technique for simplifying the soil layers utilising the shear strain profile is introduced to further cut down on the time of analyses. The procedures described in this article have been written into a web-based program that is freely accessible to engineering practitioners.

BackgroundThe majority of children with neurodevelopmental disorders (NDDs) reside in low- and middle-income countries (LMICs). NDDs are a public health concern in countries in sub-Saharan Africa (SSA). Nurturing care has been recommended as a pathway for addressing the developmental needs and unlocking the full potential of children, including those with NDDs. However, little information exists on the strategies to support children with NDDs using the Nurturing Care Framework in many countries in SSA. This review aims to synthesize information on nurturing care practices for children with NDDs in SSA. The review will also determine gaps in the provision of nurturing care for children with NDDs. Further, the review will highlight the drivers of care as well as the experiences of the caregivers.MethodsThe review will be implemented in six steps: specification of the research question, identification of relevant studies, selection of studies to be included, extracting, mapping, and charting the data, collating, summarizing, and reporting the results, and stakeholder consultation. We propose a database search followed by a manual search for the literature synthesis. We will search the following electronic databases: PubMed, ScienceDirect, Scopus, Open Grey and African Journals Online (AJOL). All studies published after May 2018 to May 2023 that include relevant terms will be identified and included. The research team will develop a data extraction form for use in capturing relevant information from each of the included studies. A patterning chart that will summarize and analyze the key findings of each article will be created.DiscussionWe anticipate that the study will provide evidence on the existing nurturing care practices and unearth gaps in the provision of nurturing care for children with NDDs. Key determinants of care and the experiences of the parents/caregivers of children will also be identified. The study will provide key recommendations on interventions to improve the quality of care for children with NDDs. Through this study, awareness of the unmet nurturing care needs of these children will be increased. The evidence generated may assist policymakers and stakeholders in addressing the needs of children with NDDs.

Abstract We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre–post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score‐matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.

Railway transportation is widely recognized as an environment-friendly and sustainable means for conveying freight and passengers over long distances. This article investigates the effectiveness of utilizing scrap tire rubber granules and geosynthetics to enhance track performance in response to the growing demands for railway transport and the consequent escalation of train-induced loading. A multi-faceted methodology, incorporating experimental, numerical, and analytical techniques, is employed to examine the efficacy of these sustainable approaches. Results from three-dimensional (3D) finite element (FE) analyses conducted on slab tracks for high-speed railways reveal that the addition of a resilient layer, comprising scrap tire rubber granules, reduces vertical stress within the track substructure. Laboratory investigations on an innovative composite material consisting of soil, scrap rubber granules, and polyurethane demonstrate its potential to enhance track performance. Findings from two-dimensional (2D) FE analyses conducted on pile-supported railway embankments highlight an enhanced transfer of load to the pile head following the installation of a geogrid layer at the embankment base. Finally, the results from the analytical approach indicate a reduction in track settlement and a decrease in the track geometry degradation rate on reinforcing the ballast layer with 3D cellular geoinclusion. The novelty of this study lies in the comprehensive assessment of the innovative composite material under drained and cyclic loading conditions, the investigation of the influence of train loading on geosynthetic tension and the load transfer mechanism in railway embankments, and the development of an innovative computational methodology capable of assessing the effectiveness of 3D cellular inclusions in improving the ballasted railway track performance. The findings from this article underscore the effectiveness of these sustainable approaches in mitigating the challenges posed by increased loads on railway tracks, providing valuable insights for the ongoing efforts to optimize railway transportation infrastructure.

BackgroundRapid urbanization and increased women’s involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa.MethodsWe conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers’ knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment.FindingsA total of 129 childcare centers were identified and categorized as home-based (n = 45), center-based (n = 14), school-based (n = 61), and church-based (n = 9). The number of home-based centers was particularly high in Viwandani (n = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers’ education level, type of center, support received, caregiver–child ratio, number of children in the center, and center providers’ KAP score (p

BackgroundInformal childcare centres have mushroomed in the informal settlements of Nairobi, Kenya to meet the increasing demand. However, centre providers are untrained and the facilities are below standard putting children at risk of poor health and development. We aimed to co-design and test the feasibility, acceptability, cost and potential benefits of a communities of practice (CoP) model where trained community health volunteers (CHVs) provide group training sessions to build skills and improve practices in informal childcare centres.MethodsA CoP model was co-designed with sub-county health teams, centre providers and parents with inputs from Kidogo, government nutritionists and ECD experts and implemented in 68 childcare centres by trained CHVs. Its feasibility and potential benefits were measured quantitatively and qualitatively. Centre provider (n = 68) and CHV (n = 20) knowledge and practice scores before and after the intervention were assessed and compared. Intervention benefits were examined using linear regressions adjusting for potential confounding factors. We conducted in-depth interviews with 10 parents, 10 CHVs, 10 centre providers and 20 local government officials, and two focus groups with CHVs and centre providers. Qualitative data were analysed, focusing on feasibility, acceptability, potential benefits, challenges and ideas for improvement. Cost for delivering and accessing the intervention were examined.ResultsThe intervention was acceptable and feasible to deliver within existing government community health systems; 16 CHVs successfully facilitated CoP sessions to 58 centre providers grouped into 13 groups each with 5–6 centre providers, each group receiving four sessions representing the four modules. There were significant improvements in provider knowledge and practice (effect size = 0.40; p

BackgroundGlobally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya.MethodsThis mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted.ResultsIn total, 129 childcare centers were identified −55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention.ConclusionImplementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

Amphotericin B (AmB) is an amphiphilic drug commonly formulated in liposomes and administered intravenously to treat systemic fungal infections. Recent studies on the liposomal drug product have shed light on the AmB aggregation status in the bilayer, which heat treatment (curing) modifies. Although toxicity was found related to aggregation status - loose aggregates significantly more toxic than tight aggregates - the precise mechanism linking aggregation and toxicity was not well understood. This study directly measured drug release rate from various AmB liposomal preparations made with modified curing protocols to evaluate correlations among drug aggregation state, drug release, and in vitro toxicity. UV–Vis spectroscopy of these products detected unique curing-induced changes in the UV spectral features: a ∼25 nm blue-shift of the main absorption peak (λmax) in aqueous buffer and a decrease in the OD346/OD322 ratio upon thermal curing, reflecting tighter aggregation. In vitro release testing (IVRT) data showed, by applying and fitting first-order release kinetic models for one or two pools, that curing impacts two significant changes: a 3–5-fold drop in the overall drug release rate and a ten-fold decrease in the ratio between the loosely aggregated and the tightly aggregated, more thermodynamically stable drug pool. The kinetic data thus corroborated the trend independently deduced from the UV–Vis spectral data. The in vitro toxicity assay indicated a decreased toxicity with curing, as shown by the significantly increased concentration, causing half-maximal potassium release (TC50). The data suggest that the release of AmB requires dissociation of the tight complexes within the bilayer and that the reduced toxicity relates to this slower rate of dissociation. This study demonstrates the relationship between AmB aggregation status within the lipid bilayer and drug release (directly measured rate constants), providing a mechanistic link between aggregation status and in vitro toxicity in the liposomal formulations.

Abstract Worldwide, there is a wide gap between what women can contribute to the economy and what they actually contribute. One of the main barriers to women’s engagement in the labor market and productivity at work is the societal expectation that they should take care of their children in addition to meeting the demands of employment. Furthermore, those in informal employment face difficulties due to long working hours and environments that are not appropriate for childcare. To address this, Kidogo runs an innovative “Hub & Spoke” model for low-income communities. Here, we present a study protocol aimed at evaluating whether the provision of quality childcare opportunities for working women through the Kidogo model is feasible and acceptable and whether it contributes to improvements in their incomes and productivity at work. The study reported in this protocol which is currently ongoing, employed a quasi-experimental design with two study arms: primary caregivers who use childcare services were recruited into the intervention (n = 170) and comparison groups (n = 170). Both groups are being followed up for one year. We are using a mixed-methods approach. Appropriate statistical methods including a difference-in-differences (DID) estimator will be used to analyze the effects of the intervention. We expect that the intervention will improve the quality of childcare services which in turn will improve the incomes of the center providers. We expect that providing improved childcare services will enhance women’s economic empowerment. Trial registration: PACTR202107762759962.

Este artigo aborda o tema da autoavaliação institucional a partir do uso dos relatórios elaborados por uma Comissão Própria de Avaliação como instrumento de apoio para as tomadas de decisões democráticas de uma Instituição de Educação Superior privada, localizada na região sul do estado de Minas Gerais. O objetivo desta pesquisa foi analisar como os relatórios de autoavaliação do triênio 2015-2016-2017 contribuíram para a construção do Plano de Desenvolvimento Institucional 2019-2023. Trata-se de uma revisão de literatura e documental, de abordagem qualitativa, do tipo descritiva. Os resultados obtidos demonstram que a gestão da instituição utiliza os relatórios de autoavaliação como instrumento de apoio às tomadas de decisões democráticas na construção do Plano de Desenvolvimento Institucional e para a realização de ações acadêmico-administrativas de acordo com os apontamentos efetuados pela comunidade universitária na autoavaliação. No fim, constata-se a existência de uma gestão democrática no processo de autoavaliação institucional realizado pela Instituição de Educação Superior privada.

Toda sociedad requiere expandir y diversificar su capacidad productiva. El desafío de las naciones y sus gobiernos es lograr incrementos significativos de los ingresos (renta per cápita) y de las formas de vida de los individuos. El objetivo de este trabajo es dar cuenta de los aspectos teóricos que han determinado el tránsito desde los modelos exógenos a los endógenos. Para eso se desarrolló una investigación bibliográfica, empleando un corpus basado en los principales economistas que han abordado el tema. Se encuentran como algunos resultados que desde mediados de 1940 se han desarrollado toda una serie de modelos conocidos como de crecimiento exógeno, con el capital y el trabajo como variables principales (Solow, 1956). Sin embargo, se determinó que existe otro factor que ese modelo no recogía explícitamente, los desarrollos posteriores al modelo de Solow (1956) fueron y son un esfuerzo para endogeneizar ese tercer factor. Se concluye, que los modelos posteriores a Solow (1956), en especial los de Lucas (1988), Rebelo (1991) y Romer (1986), representaron avances significativos en cubrir las falencias de los modelos exógenos, pero basados en tasas de ahorro estables.

Code response spectrum models, which are used widely in the earthquake-resistant design of buildings, are simple to apply but they do not necessarily represent the real behavior of an earthquake. A code response spectrum model typically incorporates ground motion behavior in a diversity of earthquake scenarios affecting the site and does not represent any specific earthquake scenario. The soil amplification phenomenon is also poorly represented, as the current site classification scheme contains little information over the potential dynamic response behavior of the soil sediments. Site-specific response spectra have the merit of much more accurately representing real behavior. The improvement in accuracy can be translated into significant potential cost savings. Despite all the potential merits of adopting site-specific response spectra, few design engineers make use of these code provisions that have been around for a long time. This lack of uptake of the procedure by structural designers is related to the absence of a coherent set of detailed guidelines to facilitate practical applications. To fill in this knowledge gap, this paper aims at explaining the procedure in detail for generating site-specific response spectra for the seismic design or assessment of buildings. Surface ground motion accelerograms generated from the procedure can also be employed for nonlinear time-history analyses where necessary. A case study is presented to illustrate the procedure in a step-by-step manner.

The research addresses aspects related to intercultural medical care, considering that methodological limitations affect the performance of medical care in Ecuador. The objective of this study was to carry out a diagnosis on the level of relevance of medical care personnel regarding interculturality in health, with a sample calculated using neutrosophic statistics, which covered different specialties. The research uses methods of a theoretical order (analytical-synthetic, inductive-deductive, and systemic) and the empirical level (the survey) and mathematical statistics. The information was submitted to the corresponding statistical processing. The results obtained in the practical validation of the assessment of the relevance of intercultural medical care, since through the Pearson correlation test, it was confirmed the existence of significance.

This paper examines the impact of risk willingness and opportunity recognition on business owners’ performance in Sabah, Malaysia. The paper adopts non-probability sampling, known as a purposive sampling method, in selecting business owners. A total of 600 surveys using self-conducted questionnaires structured on a 7-point Likert scale is distributed, and subsequently, 525 questionnaires are returned. The EAO dimensions assessed in the paper are risk willingness and opportunity recognition. Data collected are analysed using the SEM-PLS technique through the SmartPLS 3.3.2 software. The study found a positive effect of risk willingness and opportunity recognition on the business owners’ performance. Accordingly, this paper’s theoretical and practical implication supports some of the previous findings and arguments that EAO plays an essential role in influencing micro-business owners’ performance.

Introduction: Pulmonary arterial hypertension (PAH) is a low prevalence condition for which there is very little information in Peru. Several studies indicate that it is associated with elevated costs for health systems in the world. Objective: To establish the economic burden of PAH in the Peruvian context. Methods: Information on the use of health resources was collected through consultations with clinical experts and key opinion leaders. Cost data was obtained from two tariff manuals and from the Observatory of Pharmaceutical Products (DIGEMID). Results: Expert consultations indicated that about 68% of the patients were in an intermediate stage of the disease and that the use of sequential combination therapy is predominant in FC III and FC IV stages, compared to earlier stages. The annual cost of PAH treatment in Peru was $ 14,842 USD, where the main cost driver was drugs (81.72%), followed by diagnosis (8.96%) and outpatient follow-up (5.75%). Conclusions: Information on pulmonary arterial hypertension in Peru is critical for decision makers, due to the high economic impact that the disease entails. Moreover, studies in this therapeutic area are relevant for the dissemination of knowledge of the disease to different health professionals.

Mayaro virus (MAYV) is an arboviral pathogen in the genus Alphavirus that is circulating in South America with potential to spread to naïve regions. MAYV is also one of the few viruses with the ability to be transmitted by mosquitoes in the genus Anopheles, as well as the typical arboviral transmitting mosquitoes in the genus Aedes. Few studies have investigated the infection response of Anopheles mosquitoes. In this study we detail the transcriptomic and small RNA responses of An. stephensi to infection with MAYV via infectious bloodmeal at 2, 7, and 14 days post infection (dpi). 487 unique transcripts were significantly regulated, 78 putative novel miRNAs were identified, and an siRNA response is observed targeting the MAYV genome. Gene ontology analysis of transcripts regulated at each timepoint shows a number of proteases regulated at 2 and 7 dpi, potentially representative of Toll or melanization pathway activation, and repression of pathways related to autophagy and apoptosis at 14 dpi. These findings provide a basic understanding of the infection response of An. stephensi to MAYV and help to identify host factors which might be useful to target to inhibit viral replication in Anopheles mosquitoes.

Los nuevos retos de la educación superior demandan la adquisición y desarrollo de competencias investigativas que puedan ser útiles para responder a las nuevas exigencias del entorno laboral, lo cual, es un fuerte motivador para replantear las estrategias pedagógicas empleadas, dado que se requieren nuevas formas de lograr el conocimiento en los estudiantes, integrando metodologías basadas en el trabajo en equipo, como es el caso del aprendizaje cooperativo. El objetivo de este artículo es describir la experiencia pedagógica de la implementación de un proyecto de aula basado en el aprendizaje cooperativo para el desarrollo de competencias investigativas psicométricas en estudiantes universitarios, a partir del análisis de la confiabilidad y validez de instrumentos de medición y evaluación psicológica. Se encontró que este tipo de estrategias favorece al desarrollo de habilidades para la investigación científica, potencia el trabajo en equipo y aumenta las interacciones sociales entre el alumnado. Se concluye, que el aprendizaje cooperativo es efectivo para la formación de diferentes competencias investigativas, así como otras habilidades importantes para acceder a oportunidades laborales actuales o futuras donde se requieran este tipo competencias. Se recomienda implementar este tipo de estrategias para lograr mejores resultados de aprendizaje en los estudiantes universitarios.

One of the most critical developments in the landscape of information and communication technology in the public sector is social media applications as a tool for disseminating information and increasing the performance in delivering services. We are confident that trust and posted topics can provide predictions to understand compliance with communication success. Thus, this study objective is to examine the influence of trust and posted topic towards communication success of the Department of Information of Sabah official Facebook page. A total of 350 questionnaires have been distributed, and 254 completed questionnaires have been subsequently collected. Partial Least Squared-Structural Equation Modeling (PLSSEM) using SmartPLS 3.3.2 is used to analyse the data. The results showed that trust and posted topics are essential determinants for the Department of Information’s communication success. This study’s insights prove that the government social media via its Department of Information of Sabah plays a crucial role in disseminating relevant information to the public through the social media platform. Future studies should explore other variables such as transparency and participation to examine their influence on communication success. Researchers may also want to adopt a longitudinal approach or compare communication success based on regions (e.g., West and East Malaysia) using multigroup analysis.

A form of steel baffles, which is made of steel poles encased in concrete and embedded into the ground, are introduced in this article. This type of protective installation is to be located on previously identified/designed catchment at multiple levels up the hillslope to fence off large fallen boulders during landslides or rockfalls. These baffles are intended to serve as added-on protection to filter barriers (array of baffles) that have recently gained popularity as a means of filtering out coarse debris. The aforementioned protective devices are to be installed in strategic positions close to unstable rocks (noting that the velocity of impact can be much reduced at the upstream end of the rockfall trajectory). The proposed design involves only a simple hollow steel section, which is embedded into the ground. The installation process involves manually excavating a hole in the ground to accommodate the baffle, followed by backfilling with concrete. A straightforward calculation method, which is found on the established principles of structural dynamics and soil mechanics, has been developed to determine the section sizes and embedment depths for a given impact scenario. Based on the presented design procedure, a set of design charts have been developed for expediting the design and analysis process. The presented calculation methodology based on use of design charts have been validated by comparison with data generated by LS-DYNA simulations.

El Covid-19 ha generado un gran impacto psicosocial en la población mundial, incluyendo a los niños, adolescentes y jóvenes, quienes también se han visto afectados en su vida social y emocional como consecuencia del confinamiento preventivo. El objetivo de este estudio fue medir el impacto psicosocial del Covid-19 en jóvenes de la Fundación Integral para el Desarrollo Social del municipio de Malambo-Atlántico, Colombia; para lo cual se diseñó una encuesta online para explorar aspectos de las relaciones familiares, con amigos y con vecinos u otras personas cercanas, así como para identificar las emociones mayormente experimentadas por estos jóvenes durante el confinamiento. Los resultados revelan que tanto adolescentes como adultos jóvenes, especialmente estos últimos, indican presentar afectación en la frecuencia, el compartir, la comunicación, la cercanía y el apoyo emocional en sus relaciones con la familia, los amigos y vecinos u otras personas, experimentando mayormente emociones como la tristeza, el estrés, el miedo y la ansiedad. Se concluye que es necesario la construcción de estrategias por parte de la fundación para mitigar estos efectos psicosociales de la pandemia en esta población.

Aquí se presentan los resultados de los análisis de espectroscopía Raman e Infrarroja de pigmentos rojos provenientes de dos contextos fúnebres del cementerio de Topater-1, además de otras dos muestras, una del sector San Salvador y otra sin referencia como muestra de control. Todos los pigmentos fueron hallados en el área de Calama, norte de Chile (ca. 500 AC – 100 DC). El cromóforo rojo identificado en todos los casos fue hematita, además de distintos tipos de arcilla y cantidades variables de materia orgánica. Los contenidos de arcillas se relacionan con diversas fuentes de aprovisionamiento, mientras que la presencia de materia orgánica sugiere procesos tecnológicos. Luego, el contraste de estos resultados con la evidencia arqueológica local permite explorar prácticas tecnológicas donde es importante la relación individuo-paisaje o medio ambiente. Esta evidencia es significativa porque confluye con prácticas fúnebres donde se depositan estos pigmentos en valvas de Concholepas concholepas. La realización en la región de estudios de largo alcance bajo esta óptica permitiría: i) dar fundamento estadístico a estas nociones preliminares, ii) proponer acciones analítico-instrumentales posteriores, y iii) inferir sobre el manejo y la circulación local de la hematita y las prácticas asociadas.

Introduction: Cell phones and personal computers have become popular mechanisms for delivering and monitoring health information and education, including the delivery of tobacco cessation education and support. Tobacco smoking is prevalent among American Indians (AIs) and Alaska Natives (ANs), with 26% AI/AN adult men smoking compared to 19% of Caucasian adult males and 22% of African American adult males. Smoking is even more prevalent in Northern Plains AI populations, with 42% of men and women reporting current smoking. The literature on the availability and use of cell phones and computers, or the acceptability of use in health promotion among AIs and ANs, is scant. The authors report findings from a survey of AI students regarding their cell phone and computer access and use. The survey was conducted to inform the development and implementation of a text messaging smoking cessation intervention modeled on a program developed and used in Australia. Methods: A 22-item paper and pencil survey was administered to students at tribal colleges in rural Montana. The survey questions included cell phone ownership and access to service, use of cell phones and computers for health information, demographics, tobacco use habits, and interest in an intervention study. The study was reviewed and determined exempt by the institutional review boards at the tribal colleges and the lead research university. The study was conducted by researchers at the tribal colleges. Survey respondents received $10 when the survey was completed and returned. Data analysis was performed with the Statistical Package for the Social Sciences.Results: Among 153 AI respondents, the mean age was 29 years, range was 18–64 years. Overall, 40% reported smoking cigarettes with a mean age of 16 years at initiation. A total of 131 participants (86%) had cell phones and, of those, 122 (93%) had unlimited text messaging. A total of 104 (68%) had smart phones (with internet access), although 40% of those with smart phones reported that internet access on their phone was very slow or location limited. A total of 146 (95%) participants reported having access to a computer, although 32% of those did not have daily access. Students aged less than 23 years were more likely to have cell phones with internet access. Cell phone ownership differed by site (93% vs 77%, p=0.007). About 60% of the respondents who smoked indicated interest in participating in the intervention study. Conclusions: This study revealed that AI tribal college students in the rural communities surveyed had less cell phone, smart phone, and computer and internet access than that reported for undergraduate college students elsewhere in the USA. Research efforts and public health interventions must be culturally appropriate and technologically viable, therefore access to and acceptability of mobile technology must be evaluated when planning and implementing interventions for rural and other marginalized populations. The findings from this study contribute to the literature regarding the access to and acceptability of mobile technology for health promotion among AI/AN college students in rural and remote areas, and helped introduce the proposed study to the community and solicited useful data regarding tobacco prevalence and interest in tobacco research in the target population. [ABSTRACT FROM AUTHOR]

This study examines the factors affecting millennials and generation Z’s purchase intention in online shopping. The variables under investigation, namely, impulse purchase orientation, quality orientation, brand orientation, online trust, and online purchase experience, were tested. The data collection approach used a web-based questionnaire that was created and distributed to 584 university students in Malaysia. Data were analyzed via the Partial Least Squares-Structural Equation Modeling (PLS-SEM) approach to examine the posited research hypotheses. The results revealed that impulse purchase orientation was the strongest predictor of consumers’ online purchase intention in Malaysia. This is followed by online trust, and the online purchase experience and quality orientation. Meanwhile, brand orientation did not affect customers’ intention to purchase online. The results contribute new and extensive inputs into the marketing theory and expand the emergent literature on consumer intention to shop online in Malaysia, whereby rich multi-ethnic cultures should be fully exploited. Future directions are offered.

This study seeks to understand the financing strategy used by companies listed on the Mexican Stock Exchange (BVM), the São Paulo Stock Exchange (VVSP), and the Santiago Stock Exchange (BCS). To this end, the data observed in the Economática database for a sample of 29 companies were considered. Then, through a long panel data model, the study concludes that in the organizations reviewed, there is a degree of association between the variables “short-term liabilities” and “share price”, as the former increases by 1%, and the value of the shares increases by 0.09% in the subsequent period. This confirms a procyclical financial leverage.

In electrical substations, glass-fibre reinforced polymer (GFRP) insulators provide an alternative to porcelain insulators for better seismic performance. The bonded connection between the composite tube and the metal end fitting is a weak link under earthquake actions, and the failure risk of ultra-high voltage (UHV) substation equipment with GFRP composite insulators can be considerable in places with high seismicity. This study solved the problem by retrofitting and experimentally qualifying the seismic performance of surge arresters made of composite insulators. To ensure safety under a bending moment corresponding to the seismic demand, the bonded sleeve joint between the tube and end fitting was retrofitted by shear stiffeners and higher strength end fitting. A full-scale shaking table test was carried out to verify the performance of the retrofitted surge arrester, and the seismic responses to increasing earthquake actions were analyzed. The specimens in this study were full-scale, had the largest dimensions among substation equipment of the same type, and were subjected to an extremely high earthquake action of 0.5 g; therefore, the seismic testing results produced in this study can serve as an important reference for the industry.

In sub-Saharan Africa, adult mortality estimates mainly obtained from nationally representative surveys such as Demographic and Health Surveys show discrepancies in all-cause mortality between men and women. It is important to understand factors that explain these differences. Using data for adults aged ≥15 years from the Nairobi Urban Demographic Health Surveillance System (NUHDSS), this study assesses whether gender differences in all-cause mortality are mediated through household poverty. We used the generalised structural equation model, a unified framework that allows to calculate both direct and indirect effects of exposure on outcome. Results show that overall mortality rates in 151,865 individuals were 32.9 and 28.4 per 100 person years among men and women, respectively during median(IQR) follow-up of 7.3 (3.7, 10.6) years. The effects of gender on mortality decreased with age. We observed a male versus female aOR 1.39 [95% CI (1.25, 1.53)] which represents a higher odds of dying among men compared to women in the 15–35 age group, but lower odds of dying in the age group 35–60 years and >60 years, aOR 0.90 [95% CI (0.81, 0.99)], aOR 0.91 [95% CI (0.73, 1.12)], respectively. We estimated the direct effect of gender on mortality mediated through household poverty but the mediated effects were marginal.All estimates are adjusted for age, slum area, education level and ethnicity. In summary, differences in mortality between men and women decrease with age, and partly are mediated by household poverty. Given that differences in mortality between men and women who share the same household decreases with age, it is essential for future interventions aimed at reducing the gap in gender mortality particularly in older age groups, to consider other factors that interact with poverty.

We report a previously healthy infant presenting with cytomegalovirus (CMV) pneumonia and Pneumoncystis jiroveci (PJP) pneumonia. Immune suppression was primarily caused by perinatal CMV infection with a significant contribution by systemic steroid therapy. The potential role of CMV infection in the development of (usually transient) immunodeficiency in young children is reviewed. The complex interaction of CMV infection and the immune effects of steroids with host defense in young children are reviewed. Other factors that may contribute to immune suppression or affect outcome in dual infection with CMV and PJP are discussed. [ABSTRACT FROM AUTHOR]

In Chile there is a growing interest from society in improving the access of people with disabilities to the labor market. However, applied research on this topic is not abundant. The purpose of this research is to estimate the job opportunities of people with disabilities in Chile. For this, the data from the second Chilean national disability study were used to make a Multinomial Logistic Regression Model that would help to predict the probability of certain variables that influence job opportunity. For the generated model, variables related to the additional income of people (subsidies or extra income), educational level attained, pursuit of studies, and the degree of disability itself were found. It was determined how some variables affect the employment opportunity, particularly, variables related to continuity and access to studies.

OBJECTIVES: Describes prevalence of traumatic brain injury (TBI) and associated neuropsychiatric problems among two American Indian (AI) communities. DESIGN: Analysis of cross-sectional epidemiological data. SETTING: A Southwest (SW) and 2 Northern Plains (NP) AI reservations. PARTICIPANTS: AI tribal members (N=2687; 394 with history of TBI and 2293 noninjured comparisons) aged 15 to 54. OUTCOME MEASURES: Mood or anxiety disorders present more than 1 year after injury. RESULTS: Prevalences were high (>20% in males; >10% in females) in these populations. Associations between TBI and disorders meeting Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria were strong in the SW community (adjusted odds ratio [OR]=2.4; 95% confidence interval [CI]=1.5-3.8), less so in the NP community (adjusted OR=1.4; 95% CI=0.9-2.2). CONCLUSIONS: TBI is prevalent among AIs and is associated with increased OR of neuropsychiatric difficulties. This association may vary between tribes, though no interaction effect was found. AIs with TBI may require more thorough psychiatric screening to promote healthier outcomes. [ABSTRACT FROM AUTHOR]

As there is an increasing trend of Muslims and non-Muslims accepting Islamic banking, it is crucial to reconnoitre customers’ intention to use Islamic banking products. Such rationale is based on theoretical foundation and empirical evidence that customers’ perception towards a particular product would lead to their intention to choose that product. The purpose of this study is to examine the determinants of intention to use Islamic banking products in an emerging and vibrant market. 200 copies of questionnaires were distributed, 131 usable copies were subsequently collected. The data were then analysed using PLS-SEM. The findings show that attitude, government support, and social influence possess explanatory and predictive capacity to envisage customers’ intention to use Islamic banking products. As banking service is localized to better serve the customers, this study extends the literature by providing insights into the subject matter in emerging markets.

Introduction: septic shock is a common cause of death in children worldwide, it is the first cause of admission to the units of non-coronary intensive care and it is an emerging disease. Objective: to describe the results of therapy with fluid in patients with septic shock at “José Luis Miranda” Hospital in one year of study. Method: a descriptive, longitudinal, prospective study between January and December 2012 with patients admitted to the Intensive Care Unit of the hospital was realized. Data were recorded in the statistical professional program SPSS version 15.0, the information was showed in tables and graphs and inferential statistics tests were applied. Results: the most affected age group was that of one month to one year, of male sex; severe acute respiratory infections were the most frequent etiologies; the administration of intravenous fluids contributed to the recovery of clinical parameters related to perfusion at six hours; with the administration of 60ml/kg of intravenous fluids there was a recovery of blood pressure in most children. Conclusions: aggressive and early administration of intravenous fluids contributes to the recovery of clinical parameters related to perfusion at six hours and reducing mortality in children with septic shock.

La estructura agraria en el Ecuador tiene una marcada diferenciación debido a la tenencia y acceso a la tierra. El crecimiento de la producción pecuaria dentro de las pequeñas y medianas explotaciones ha sido constante en los últimos años, así como la feminización del campo. En la serranía del Ecuador, estos procesos pueden observarse con mayor detalle, especialmente en aquellas provincias que se encuentran en el centro del país. Esto ha motivado a analizar la dinámica de los pequeños productores de las provincias de Chimborazo, Cotopaxi y Tungurahua, por medio de la aplicación de una encuesta a 793 agricultores, donde se revisan las características socio-productivas relacionadas con la producción de leche de ganado bovino. Algunos resultados demuestran que, comparativamente, la producción de leche se concentra entre las extensiones de 0,5 y 1 hectárea, siendo la provincia de Tungurahua en donde existe una mayor distribución de acuerdo al tamaño. Finalmente, se concluye que, la concentración de la tierra ha influenciado a una reducción del número de unidades bovinas, incidiendo directamente sobre los ingresos familiares, provenientes de la producción lechera, que en este caso no superan el 40% la remuneración básica mensual. del Ecuador.

Buildings possessing an asymmetrical arrangement of structural elements are torsionally unbalanced and can be vulnerable in a seismic event. Building codes of practices typically recommend the use of three-dimensional dynamic analysis to determine the seismic demands of a multi-storey building. Whilst most design practices are well equipped with commercial software for undertaking such analyses, designers often find it difficult to verify results. Much of the published technical articles present findings for buildings based on an idealised single-storey model. As a result of challenges in dealing with real multi-storey buildings, there has been very limited uptake of research findings in design practices. This article presents a three-tiered approach of estimating the displacement behaviour of the building in term of 3D/2D displacement ratio. The estimate can be used for verifying results reported from a computer package conveniently. The quick method provides predictions of the 3D/2D ratio and only requires the gross plan dimensions of the building to be known. The refined method requires knowledge of the torsional stiffness properties to be known, whereas the detailed method requires the eccentricity properties to be known as well. The proposed methodology is robust and reliable, as is demonstrated by case studies undertaken on six real multi-storey buildings.

O artigo relata a experiência realizada em um curso de Ciências Contábeis a partir da necessidade de expandir as abordagens metodológicas para o desenvolvimento da leitura e iniciação à pesquisa dos estudantes. No âmbito da sala de aula, o professor tem papel fundamental no gerenciamento do processo educacional, pois é ele que concilia as necessidades dos alunos e os recursos disponíveis. O projeto teve como objetivo estimular e orientar os alunos na produção de conhecimentos por meio da leitura e pesquisa e, assim, fazê-los coparticipantes das aulas, por meio da técnica de aulas interativas, amparados na experiência realizada Sauaia e Hazoff Júnior (2009). Especificamente, utilizou-se a leitura e a pesquisa como estratégia metodológica dialética para tornar as aulas mais interativas e retirar os alunos da situação passiva em sala de aula. Parte-se da concepção de que as aulas expositivas mantêm uma comunicação unidirecional, com o professor dominando a comunicação, enquanto os alunos ficam na situação de passividade. Em uma proposta de aulas interativas, ou participantes, as estratégias de ensino preconizam uma comunicação multidirecional, baseada em atividades compartilhadas e com maiores possibilidades de relações interpessoais, que estimulam o envolvimento de todos os presentes em sala de aula. Os resultados da experiência demonstraram maior envolvimento dos alunos com o empréstimo de materiais na biblioteca e maior quantidade de escrita de artigos acadêmicos, com a criação de um Seminário Científico e publicação de livros, tendo a participação de alunos e professores. Os resultados corroboram as pesquisas desenvolvidas na área.