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Background: Health workers (HWs) in Africa face challenges accessing and learning from existing online training opportunities. To address these challenges, we developed a modular, self-paced, mobile-ready and work-relevant online course covering foundational infection prevention and control (IPC) concepts. Here, we evaluate the first pilot of this course, conducted with HWs in Nigeria., Methods: We used a learner-centered design and prototyping process to create a new approach to delivering online training for HWs. The resulting course comprised 10 self-paced modules optimized for use on mobile devices. Modules presented IPC vignettes in which learning was driven by short assessment questions with feedback. Learners were recruited by distributing a link to the training through Nigeria-based email lists, WhatsApp groups and similar networks of HWs, managers and allied professionals. The course was open to learners for 8 weeks. We tracked question responses and time on task with platform analytics and assessed learning gains with pre- and post-testing. Significance was evaluated with the Wilcoxon signed-rank test, and effect size was calculated using Cohen's d., Results: Three hundred seventy-two learners, with roles across the health system, enrolled in the training; 59% completed all 10 modules and earned a certificate. Baseline knowledge of foundational IPC concepts was low, as measured by pre-test scores (29%). Post-test scores were significantly higher at 54% (effect size 1.22, 95% confidence interval 1.00-1.44). Learning gains were significant both among learners with low pre-test scores and among those who scored higher on the pre-test. We used the Net Promoter Score (NPS), a common user experience metric, to evaluate the training. The NPS was + 62, which is slightly higher than published scores of other self-paced online learning experiences., Conclusions: High completion rates, significant learning gains and positive feedback indicate that self-paced, mobile-ready training that emphasizes short, low-stakes assessment questions can be an effective, scalable way to train HWs who choose to enroll. Low pre-test scores suggest that there are gaps in IPC knowledge among this learner population., (© 2022. The Author(s).)

Background: The use of insecticide-treated nets (ITNs) is a strategy recommended by the World Health Organization (WHO) for malaria prevention. In Nigeria, ITNs have been periodically distributed since 2007 through campaigns. Campaign activities and assets are typically tracked using either a paper-based or digital system. In 2017, a digital approach was introduced in Ondo state for tracking attendance at training sessions as part of the ITN campaign. Following the success of the 2017 introduction, subsequent campaigns planned to digitise other aspects of the campaign to improve accountability and efficiency of the ITN distribution. The COVID-19 pandemic posed additional challenges for the ITN distribution planned for 2021 and adaptations were made to the programme strategy to ensure the campaign could go ahead safely. This article presents lessons and experiences from the 2021 ITN distribution campaign in Ondo state, Nigeria. Methods: The campaign used RedRose, a customised mobile application, to monitor the planning and delivery of the campaign, collect household information including training personnel and tracking the transfer of ITNs between distribution hubs and households. ITNs were delivered through a single-phase door-to-door distribution strategy. Results: The campaign distributed 2,965,125 ITNs covering 1,057,577 households across Ondo state. The digital application was beneficial for monitoring the quality of implementation and tracking assets and staff to ensure safety.. The single-phase door-to-door approach was more convenient for households compared to fixed-point distribution but increased the workload for mobilization and distribution teams. Conclusions: Single phase door-to-door strategy using digital tools was an effective method to increase coverage of ITNs while closely tracking the progress of distribution campaigns. High-quality population data are needed to further improve the planning and implementation of ITN campaigns and other health interventions. [ABSTRACT FROM AUTHOR]

Background: It is uncertain what could be the best training methods for infection prevention and control when an infectious disease threat is active or imminent in especially vulnerable or resource-scarce settings. Methods: A scoping review was undertaken to find and summarise relevant information about training modalities, replicability and effectiveness of IPC training programmes for clinical staff as reported in multiple study designs. Eligible settings were conflict-affected or in countries classified as low-income or lower-middle income (World Bank 2022 classifications). Search terms for LILACS and Scopus were developed with input of an expert working group. Initially found articles were dual-screened independently, data were extracted especially about infection threat, training outcomes, needs assessment and teaching modalities. Backwards and forwards citation searches were done to find additional studies. Narrative summary describes outcomes and aspects of the training programmes. A customised quality assessment tool was developed to describe whether each study could be informative for developing specific future training programmes in relevant vulnerable settings, based on six questions about replicability and eight questions about other biases. Findings: Included studies numbered 29, almost all (n = 27) were pre-post design, two were trials. Information within the included studies to enable replicability was low (average score 3.7/6). Nearly all studies reported significant improvement in outcomes suggesting that the predominant study design (pre-post) is inadequate to assess improvement with low bias, that any and all such training is beneficial, or that publication bias prevented reporting of less successful interventions and thus a informative overview. Conclusion: It seems likely that many possible training formats and methods can lead to improved worker knowledge, skills and / or practice in infection prevention and control. Definitive evidence in favour of any specific training format or method is hard to demonstrate due to incomplete descriptions, lack of documentation about unsuccessful training, and few least-biased study designs (experimental trials). Our results suggest that there is a significant opportunity to design experiments that could give insights in favour of or against specific training methods. "Sleeping" protocols for randomised controlled trials could be developed and then applied quickly when relevant future events arise, with evaluation for outcomes such as knowledge, practices, skills, confidence, and awareness. [ABSTRACT FROM AUTHOR]

In Zimbabwe, the ZAZIC consortium employs two-way, text-based (2wT) follow-up to strengthen post-operative care for voluntary medical male circumcision (VMMC). 2wT scaled nationally with evidence of client support and strengthened follow-up. However, 2wT uptake among healthcare providers remains suboptimal. Understanding the gap between mobile health (mHealth) potential for innovation expansion and scale-up realization is critical for 2wT and other mHealth innovations. Therefore, we conducted an exploratory qualitative study with the objective of identifying 2wT program strengths, challenges, and suggestions for scale up as part of routine VMMC services. A total of 16 in-depth interviews (IDIs) with diverse 2wT stakeholders were conducted, including nurses, monitoring & evaluation teams, and technology partners–a combination of perspectives that provide new insights. We used both inductive and deductive coding for thematic analysis. Among 2wT drivers of expansion success, interviewees noted: 2wT care benefits for clients; effective hands-on 2wT training; ease of app use for providers; 2wT saved time and money; and 2wT strengthened client/provider interaction. For 2wT scale-up challenges, staff shortages; network infrastructure constraints; client costs; duplication of paper and electronic reporting; and complexity of digital tools integration. To improve 2wT robustness, respondents suggested: more staff training to offset turnover; making 2wT free for clients; using 2wT to replace paper VMMC reporting; integrating with routine VMMC reporting systems; and expanding 2wT to other health areas. High stakeholder participation in app design, implementation strengthening, and evaluation were appreciated. Several 2wT improvements stemmed from this study, including enrollment of multiple people on one number to account for phone sharing; 2wT inclusion of minors ages 15+; clients provided with $1 to offset SMS costs; and reduced SMS messages to clients. Continued 2wT mentoring for staff, harmonization of 2wT with Ministry e-health data systems, and increased awareness of 2wT's client and provider benefits will help ensure successful 2wT scale-up. [ABSTRACT FROM AUTHOR]

Background Only one out of every ten Nigerian adults with hypertension has their blood pressure controlled. Health worker training is essential to improve hypertension diagnosis and treatment. In-person training has limitations that mobile, on-demand training might address. This pilot study evaluated a self-paced, case-based, mobile-optimized online training to diagnose and manage hypertension for Nigerian health workers. Methods Twelve hypertension training modules were developed, based on World Health Organization and Nigerian guidelines. After review by local academic and government partners, the course was piloted by Nigerian health workers at government-owned primary health centers. Primary care physician, nurse, and community health worker participants completed the course on their own smartphones. Before and after the course, hypertension knowledge was evaluated with multiple-choice questions. Learners provided feedback by responding to questions on a Likert scale. Results Out of 748 users who sampled the course, 574 enrolled, of whom 431 (75%) completed the course. The average pre-test score of completers was 65.4%, which increased to 78.2% on the post-test (P<0.001, paired t-test). Health workers who were not part of existing hypertension control programs had lower pre-test scores and larger score gains. Most participants (96.1%) agreed that the training was applicable to their work, and nearly all (99.8%) agreed that they enjoyed the training. Conclusions An on-demand mobile digital hypertension training increases knowledge of hypertension management among Nigerian health workers. If offered at scale, such courses can be a tool to build health workforce capacity through initial and refresher training on current clinical guidelines in hypertension and other chronic diseases in Nigeria as well as other countries. [ABSTRACT FROM AUTHOR]

While research frequently points to immigrants' resilience and, to a lesser extent, their empowerment, these processes are rarely examined together, particularly when referring to the experiences of immigrant youth who face specific challenges. To fill this gap, the present study drew on the Transconceptual Model of Empowerment and Resilience (Brodsky & Cattaneo, American Journal of Community Psychology, 52, 333–346, 2013) to explore how resilience and empowerment sustained a group of young immigrants living in Italy during the acculturation processes. Secondary data were collected, and 32 life stories written by young migrants were used as a corpus of data. The authors were aged from 15 to 22 (M = 18.2, SD = 2.04), while countries of origin and the motives behind the migration differed among them. Analysis revealed that while empowerment and resilience supported very differently the acculturation processes, acculturation strategies were not mutually exclusive and changed over time. Immigrant youth reacted to fundamental risk with actions of resilience aimed at resisting or adapting to the many difficulties they faced, engaging in forms of separation and assimilation. Results suggest that even if resilience may be sufficient to survive the challenges of settling in another country, it is unlikely to promote proper integration by itself. In order for young people to be fully integrated it is crucial to dismantle social barriers that foster discrimination while ensuring them real opportunities for empowerment. [ABSTRACT FROM AUTHOR]

The concept of 'young radicals' is gaining ground in a context of generalized discontent – often, this is due to the fact that young people engage increasingly in unconventional forms of political activism. Much less is known about young people holding radical political attitudes. This article advances our understanding of those young people who place themselves on the extremes of the ideological scale and investigates how those with radical right attitudes differ from those with radical left ones. Drawing on a survey that gathers data from nine European countries, with a sample of young people aged 18–35, we test those factors that have been used to explain why people use violent repertoires of action: social background, gender, political values, and prior experience in protest activism. The results relate 'radicalness' to experienced economic difficulties and the more contentious political activism. The difference between the young 'radicals' in right and left are, however, defined by gender and adherence to authoritarian values. [ABSTRACT FROM AUTHOR]

Focusing on individuals aged 14–35 still living with their family of origin, we compare the political activism of Italian natives with their first and second-generation migrant peers. We based our analysis on two different national household surveys, carried out by the Italian National Institute of Statistics (ISTAT) in 2011–2012: the survey 'Condizione e integrazione sociale dei cittadini stranieri' [Condition and Social Integration of Foreign Citizens] and 'Aspetti della vita quotidiana' [Multipurpose Survey on the Aspects of Everyday Life]. Our results revealed that natives are more likely to be involved in politics compared to their migrant peers. However, the migrant background is not a factor negatively affecting youth participation or involvement in politics in itself. The gap with native is fully explained by differences in socio-economic background and family political socialisation. When these aspects are controlled, data suggest that no differences exist in participation to most time-consuming acts (such as taking part in political meetings, demonstrations, participation in a political association, etc.). More of it, young people with migrant backgrounds are more likely to be engaged in activities that reflect a general interest in politics, such as discussing politics, seeking information on Italian politics, and listening to political debates, compared to their native counterparts. [ABSTRACT FROM AUTHOR]

This paper is aimed at understanding how we engage with the future in different ways in everyday life. Many empirical studies have emphasised that what we usually call 'imagination' of the future takes diverse forms and meanings. Varied narratives of the future that are possible coexist in daily life in a bumpy, semi-conscious and occasionally tense dialogue with one another. To understand this variation of narratives, a thorough exploration of the different modes of engaging with the future that various forms of agency bring into play is required, together with a sensitive empirical analysis. I use Thévenot's theory of regimes of engagement as a starting point to at least partially explain this variety. Thévenot's idea that different types of individual involvement in relation to different definitions of the relevant reality (e.g. familiarity, plans and the public domain of justification and exploration) contain interesting implications for the analysis of what I define as modes of engagement with the future. As involved as we are with social reality through specific formats, so are we with the future. As the 'relevant reality' is different according to the regime of engagement that we are involved in, the nature of anticipation also varies. The future is 'made and measured' within the logic of probability in the regime of plans; of possibility in the regime of justification; of practical anticipation in the regime of familiarity; and of discovery in the regime of exploration. This perspective helps to avoid a reification of the future as something that is 'there' and that we simply discover and avoids easy dichotomisation of forms of anticipation of the future as realistic or unrealistic. [ABSTRACT FROM AUTHOR]

Nurses, working around the clock, are in an ideal position to participate or play a leading role in taking initiatives that aimed to ensure quality of care and thus to enhance patient safety which includes prevention of surgical site infections. Previous research has used survey, chart audit and algorithm methods to describe wound care practices. However, little research has been published using contemporaneous observations to describe the surgical wound management practices of nurses. The aim of this study is to describe the postoperative wound care practices of surgical nurses and the evidence-based guideline recommendation of wounds. [ABSTRACT FROM AUTHOR]

Developing Erikson's concept of 'psychological moratorium' (1968), literature on youth transitions has a central focus in the procrastination of adult roles. Forms of time taking may either be erratic, or take more institutionalised and/or middle-class-oriented shapes such as 'gap years,' and they are generally justified by the aim of self-experimentation. However, on a different institutional level, they enter in contrast with the recent imperative of becoming 'fit for work,' which is realised mainly through obtaining an increasing number of qualifications and skills considered essential to meet the challenges of employment, and ultimately embody a model of 'active citizenship.' But how do these two contrasting demands come to terms with each other in the experiences of youth? And how is youth itself re-shaped through this interaction? Contrasting the concept of psychological moratorium (and its developments) with a wider literature on social acceleration, where an emphasis on active citizenship and employability can be framed, this article revisits forms of time taking among youths. It does so by discussing a Sardinian case study, where varieties of time taking also reverse into forms of 'waithood,' and are therefore in contrast with social acceleration. More analytically, I have identified two modalities of moratorium (i.e. classic moratorium and waithood) and two sub-modalities of waithood (justified by either the accomplishment of procedures or by waiting for someone else's intervention). These findings are discussed with reference to a broad political framework through which it is possible to revisit the changing shape of youth under the pressures of late modern society. [ABSTRACT FROM AUTHOR]

Youth research recognises that the struggles typical of the transition to adulthood can no longer be assumed to occur ‘at home’. However, few investigations have focused on how the imagination of mobility shapes that which is not home yet but which may later become so. To address this lacuna, this article engages with how the imagination of the future of young people is entrenched with ‘motility’, namely, the possibility for a type of movement that arises out of a specific relationship with one’s current context. Focusing on Sardinian youth, the article problematises the strong mobility orientation which can occur through the unfolding of an imagined continuous ‘lived’ relationship with Sardinia. The author calls this ‘rooted mobility’. The article discusses the limits that accompany such mobility, and the potential for social action that emerges, framing narratives of the future within the conditions of peripherality in which young Sardinians live. The article draws on 341 essays on the topic of the future collected from students in their penultimate year of school. [ABSTRACT FROM AUTHOR]

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Premise of research. The Iris flower is considered to be a pseudoinflorescence by having three pollination units, each acting as a labiate flower. The sepal provides the entrance, "floor," and "walls" of the pollination tunnel and is sometimes adaxially elaborated with various structures, such as ridges, crests, and protuberances. Crested sepals have a prominent median crest that lies along the proximal-distal axis of the pollination tunnel and sometimes also have various lateral structures on the entrance, floor, or walls of the pollination tunnel, suggesting that they may play a role in pollination. Crested sepals are morphologically diverse and have evolved at least five times in Iris. Understanding their micromorphology and anatomy will shed light on the diversification of perianth and provide insights into flower-pollinator interaction. Methodology. Micromorphologies of the adaxial epidermis and anatomical characteristics of selected crested sepals representing different patterns of structural elaborations as well as ridged and nonelaborated sepals were studied using scanning electron microscopy and light microscopy. Pivotal results. Compared with nonelaborated sepals, the occurrence of the median and sometimes lateral structures on crested sepals changes not only the architecture of the pollination tunnel and its entrance but also the epidermal topology within the pollination tunnel by creating new epidermal zones. Compared with ridged sepals, crested sepals have a more sophisticated median structure that is usually more prominent and elaborated at the pollinator entrance and/or the distal half of the pollination tunnel. Vascular tissues and trichomes are also present in or on some of the median and lateral structures. Conclusions. The micromorphologies and anatomical features of crested sepals are diverse even though convergences in terms of epidermal topology and the occurrence of vascular tissues in elaborate structures also occur among independently evolved crested lineages in Iris. Structural elaborations may provide optical and tactile cues or stimuli to pollinators. [ABSTRACT FROM AUTHOR]

The necessity for governments to borrow in order to finance deficit budgets has led to the development of external debt. This study examines how the use of budget deficits as an instrument of stabilization leads to the accumulation of external debt with the attending effects on growth in Nigeria between 1970 and 2003. By synthesizing a relationship between budget deficits and external debt the study shows the implications on economic growth of conducting a fiscal policy within the contexts of debt stabilization and debt sustainability. The results of the econometric analysis confirm the existence of the debt Laffer curve and the nonlinear effects of external debt on growth in Nigeria. The study concludes that if debt-financed budget deficits are operated in order to stabilize the debt ratio at the optimum sustainable level debt overhang problems would be avoided and the benefits of external borrowing would be maximized. [ABSTRACT FROM AUTHOR]

Presents several abstracts of studies on physical therapy to be presented at PT 2001: The Annual Conference and Exposition of the American Physical Therapy Association. `Reasons Why Patients Refuse Physical Therapy in the Acute Care Setting,' by D. Taylor, C. Appleton et al.; `Effects of Graded Hypoperfusion on Pulse Oximetry Function,' by D.H. Nielsen, C.J. Casey et al.; `Current Issues Facing Physical Therapy Clinical Education,' by K.A.M. Moran, S. Andrews et al.

Shortage of nurses harms patient outcomes and health care. In sub-Saharan Africa, insufficient resources and lack of trained educators have limited nursing education, leading to shortages. Online nursing education, particularly [...]