Influence of Human Behavior on Success of Complex Public Infrastructural Megaprojects in Kenya

The main objective of this study was to investigate the influence of human behavior on the success of public infrastructural megaprojects in Kenya. The need for this study arose from the thesis that complexity due to human behavior is the main cause of waste and failure that results in infrastructural megaprojects being delivered over budget, behind schedule, with benefit shortfalls, over and over again. The study was designed as multiple-method research, based on virtual constructionist ontology recognizing that complexity is the mid-point between order and disorder. A cross-sectional census survey of 27 completed public infrastructural megaprojects was conducted using two interlinked questionnaires assessing human behavior constructs and project success. A total of 108 respondents made up of project managers, team members and organizational sponsors, participated in this study. Using both descriptive and inferential analysis, the results of this study have confirmed that human behavior significantly influences success of public infrastructural megaprojects. Optimism bias remains the main individual behavior that leads to cost and schedule underperformance in infrastructural megaprojects but loss aversion is the most occurring cognitive bias. In light of this finding, the study recommends that implementing organizations adopt structures that allow for continued business justification, focus on products and give project managers sufficient authority over project resources in line with the postulations of the structural contingency theory

An Overview of the Performance of Public Infrastructure Megaprojects in Kenya

The need for this study arose from the thesis that infrastructure megaprojects are often delivered over budget, behind schedule, with benefit shortfalls, over and over again. Many studies have been conducted towards this conclusion but these studies have not included Kenya which is increasingly adopting megaprojects as a model for delivering public goods and services. Through this quantitative study utilizing a cross-sectional census survey design, the performance of 27 completed public infrastructure megaprojects was assessed using broader measures of project success. The findings agree that these projects are delivered over budget and behind schedule but not with benefit shortfalls. It is also confirmed that process or project management success does not necessarily lead to product or organizational success. It is recommended that public infrastructure megaproject sponsors and implementers adopt project structures that allow for innovation through the use of advanced technology. Such structures should encourage the use of competitive tendering and a preference for pain/gain contractual arrangements to accommodate the differences in risk preferences between the client and the contractor, and to minimize the incidences of agency problem among the various stakeholders

Performance of Internet Marketing As A Marketing Strategy For Private Colleges In Mombasa County

The research examined the performance of internet marketing as marketing strategies in private colleges in Mombasa. Initially accessing the internet was the biggest challenge but this challenge has since been eliminated, since the penetration of hand held devices that can access the internet has really improved. If the online products can be tailor made to appeal to specific target segment then there is untapped potential in internet marketing, this is because the value propositions of products and services offered in the physical world are essentially limited “point solutions” that meet only part of a consumer’s need or want while in the internet world the target market can be met on a one to one basis at a lower cost. Despite the increased literacy level in the country, reducing cost of internet services, and the penetration of handheld devices that can access internet, there has been low adoption of internet marketing by Private Colleges in Mombasa. It is against this background that the researcher aimed at assessing the performance of internet as a marketing strategy in Private Colleges in Mombasa County.The researcher aimed at exploring the performance of internet marketing as a marketing strategy in Private Colleges in Mombasa County. Descriptive research design was used. The data collection was undertaken through the use of questionnaires and interviews. Samples from the targeted institutions were picked to extract a representative data. In total four Private Colleges were surveyed to ascertain the performance of internet marketing as a marketing strategy in private colleges in Mombasa County. The data collected by the researcher was analyzed using statistical package for social sciences; this software was able to compute the frequencies and regression analysis required by the researcher. At the initial stage data was captured using excel then later exported to SPSS for analysis. This data was presented using tables and graphs. It is expected that several factors are likely to be found to influence performance of internet marketing in the aforementioned institutions of higher learning. The factors included connectivity to the internet, demographic issues such as education level, attitude towards internet by the stakeholders, cost of implementing such systems and resistance by institutions and user to change from conventional media to internet plat forms and government policies. Keywords: Marketing strategy, Internet marketing performance, competitiveness

Importancia del grado de Satisfacción con la Simulación Clínica en la formación práctica de los alumnos de enfermería

La Simulación Clínica es una metodología de aprendizaje innovadora que aproxima al estudiante a la realidad profesional. La satisfacción es un criterio de evaluación de la formación recibida. Realizamos un estudio descriptivo para determinar y analizar la satisfacción de los alumnos de tercer curso del Grado en Enfermería de la ULPGC con la Simulación Clínica en los laboratorios de prácticas de la asignatura de Técnicas de Enfermería. Utilizamos la ESECS (Escala de Satisfacción de Experiencias Clínicas Simuladas) con sus 3 dimensiones de satisfacción práctica, cognitiva y realismo, resultando la primera, la satisfacción práctica, la que muestra valores mas altos (M=7,2), próximos a la satisfacción global (M=7,01). Los estudiantes se muestran satisfechos con la Simulación Clínica, aunque la misma podría mejorar con la adaptación de los laboratorios, la adquisición de simuladores de media/alta fidelidad y la reducción del número de alumnos por grupo en el laboratorio

Prevalence of myopia and its socio-demographic distribution amongst secondary school going adolescents in Lurambi Sub-County, Kakamega, Kenya

Background: Globally the prevalence of myopia has increased alarmingly and is expected to affect an estimated 2.56 billion people in the world by the end of 2020. It is believed to be the leading cause of visual impairment in Kenya, contributing 59.5% of all causes of visual impairment. Still, agreement on the exact prevalence in Kenya and whether socio-demographic factors have an influence on myopia is unknown. This study was aimed at evaluating the prevalence of myopia and its socio-demographic distribution amongst randomly selected school-going adolescent. This study was conducted in Lurambi Sub-County in Kakamega, Kenya. Material and methods: The study adopted a school-based cross-sectional descriptive study design. Using a multi-stage sampling technique, 733 participants from a population of 7,400 secondary school students within Lurambi Sub-County were randomly selected. A standard optometric vision-assessment protocol was applied to those who met the inclusion criteria and cycloplegic refraction was conducted to elicit those who had myopia. Results: The prevalence of myopia was found to be 7.5% of which 29 (52.7%) were male while 26 (47.3%) were female and there was no association between gender and myopia (p = 0.572). Myopia was found to be more prevalent in urban 49 (87.3%) as compared to rural 7 (12.7%) areas and there was no association between place of residences and myopia (p = 0.381). Similarly, 15–18 years was the dominant age group 39 (70.9%) and there was no association between age and having myopia (p = 0.926). The study also found that there was no association (p = 0.207) between school class of the participants and having myopia, although most myopic cases were in the form four class 15 (27.3%). Conclusion: Myopia was found to be mostly prevalent in the urban setting and upper classes as compared to rural and lower classes. This may link myopia to other risk factors such as near work and outdoor activities, but more research needs to be done in these areas.

3D - Printed Patient Specific Instrumentation in Corrective Osteotomy of the Femur and Pelvis: A Review of the Literature

Background: The paediatric patient population has considerable variation in anatomy. The use of Computed Tomography (CT)-based digital models to design three-dimensionally printed patient specific instrumentation (PSI) has recently been applied for correction of deformity in orthopedic surgery. This review sought to determine the existing application of this technology currently in use within paediatric orthopaedics, and assess the potential benefits that this may provide to patients and surgeons. Methods: A review was performed of MEDLINE, EMBASE, and CENTRAL for published literature, as well as Web of Science and clinicaltrials.gov for grey literature. The search strategy revolved around the research question: “What is the clinical impact of using 3D printed PSI for proximal femoral or pelvic osteotomy in paediatric orthopaedics?” Two reviewers, using predetermined inclusion criteria, independently performed title and abstract review in order to select articles for full text review. Data extracted included effect on operating time and intraoperative image use, as well as osteotomy and screw positioning accuracy. Data were combined in a narrative synthesis; meta-analysis was not performed given the diversity of study designs and interventions. Results: In total, ten studies were included: six case control studies, three case series and a case report. Five studies directly compared operating time using PSI to conventional techniques, with two showing a significant decrease in the number of intraoperative images and operative time. Eight studies reported improved accuracy in executing the surgical plan compared to conventional methods. Conclusion: Compared to conventional methods of performing femoral or pelvic osteotomy, use of PSI has led to improved accuracy and precision, decreased procedure times, and decreased intra-operative imaging requirements. Additionally, the technology has become more cost effective and accessible since its initial inception and use

Culture, education and care of the patient with an ostomy

Para la adecuada aplicación de los cuidados enfermeros es necesario el conocimiento antropológico de las personas a las que van dirigidos. Concretando en las personas ostomizadas debemos evidenciar los cambios, modificaciones y trastornos producidos por la nueva situación (ser portador de un estoma), a todos los niveles: físico, psicológico, social y cultural. Estos conocimientos nos proporcionan la base para proporcionar unos cuidados flexibles, adaptados e individualizados dirigidos a prevenir, disminuir o solucionar los problemas que puedan presentar. Nos basamos en la visión holística y humanista de Virginia Henderson y en la autoridad y autonomía que tenemos las enfermeras para tratar las alteraciones que presenta la persona para cubrir de forma satisfactoria e independiente sus necesidades básicas. Hemos realizado un revisión bibliográfica para conocer cómo la cultura y la educación afectan a la aceptación y al logro de la independencia de la persona ostomizada.Adequate Nursing care demands anthropological knowledge of the people who are to be cared for. Patients with an ostomy experience changes, alterations and disturbances by their new situation at all levels: physical, psychological, social and cultural. This knowledge provides us with the basis for flexible, adapted and individualised care in order to prevent, minimise or sort out the problems that may arise. Our work is based upon Virginia Henderson's holistic and humanistic perspective and nurses' autonomy and authority to deal with the patient's trouble and satisfactory and independently fulfill his/her basic needs. Literature has been reviewed in search of the ways in which culture and education determine acceptance and independence of the patient with an ostomy

El Implante discal cervical como alternativa a la artrodesis en el tratamiento quirúrgico de la cervicoartrosis

Consultable des del TDXTítol obtingut de la portada digitalitzadaObjetivo: Evaluación de la prótesis de Bryan como alternativa a la artrodesis en el tratamiento de la espondilosis cervical. Materiales y métodos: 54 pacientes consecutivos con radiculopatía o mielopatía fueron intervenidos quirúrgicamente de discectomía cervical con implantación de la prótesis discal cervical. Dichos implantes presentan medidas variables que van de 14 a 18 mm. El seguimiento se realizo a las seis semanas, seis meses y un ano y consistió en una evaluación del dolor (VAS), la SF-36 y el «neck dissability index» (NDI). Los resultados totales fueron combinados para obtener un resultado clínico basado en los criterios de Odom (excelente, bueno, aceptable y malo). La evaluación radiológica consistió en el análisis del movimiento así como de la estabilidad y la subsidencia de la prótesis. Este análisis se realizo a través de un radiólogo independiente. Además estudiamos la asociación de un marcador genético como la apolipoproteína «e4» como factor de riesgo en pacientes intervenidos de espondilosis cervical mielopática. Resultados: Habían 33 varones y 21 hembras. La edad media fue de 47.8 años (DE=10.9). Se observo una diferencia estadísticamente muy significativa comparando los controles preoperatorios con los postoperatorios en las tres escalas de resultados. : VAS (Z=7.1, p<0.0001), SF36MCS (Z=-5.9, p<0.0001), SF36PCS (Z=-5.8, p<0.0001) y NDI (Z=7.8, p<0.0001). Del mismo modo se observo una diferencia estadísticamente significativa entre la edad y los resultados quirúrgicos; la edad y la estancia intrahospitalaria; la presentación clínica y la duración de los síntomas y con la duración de los síntomas y los resultados quirúrgicos. Los pacientes con el genotipo de la apolipoproteina e4 debutaron a una edad mas temprana (Edad media 49 años) versus 59 años en el grupo restante (t-test p<0.05). Los pacientes con el alelo e4, obtuvieron peores resultados postoperatoriamente, según las escalas de resultados: Prueba del caminar, (_2 p<0.01), EMS (t-test p<0.009), JOA (t-test p<0.03), Nurick's class (_2 p< 0.02), Ranawat class (t-test p<0.03 CME. Además, aquellos con el gen de la Apo «e4» parecen sufrir una progresión de la enfermedad más rápidamente según las prueba del caminar (_2 p< 0.03) y Nurick's' class (_2 p< 0.05). Aquellos pacientes con el gen de la apolipoproteína «e4» tenían una compresión medular menor que aquellos sin el gen de la Apo «e4» (__, P<0.01) Conclusiones: La prótesis de Bryan ha demostrado ser fiable y seguirá en el tratamiento de los pacientes aquejados de espondilosis cervical. A pesar de ello, para obtener resultados mas objetivos que sean capaces de determinar que la artroplastia es superior a la artrodesis a corto y largo plazo, nosotros proponemos el estudio CEDRIC, que consiste en un estudio prospectivo , randomizado con randomización intraoperativa bien a artroplastia o a artrodesis mediante caja íntersomática.Objective: Evaluation of the Bryan disc arthroplasty as an alternative to arthrodesis in the treatment of cervical spondylosis. Material and methods: 54 consecutive patients with either radiculopathy or myelopathy had a cervical discectomy with implantation of the cervical disc prosthesis. The implants have a variable measure from 14 to 18 mm of diameter. Follow-up was arranged at 6 weeks, 6 months and 1 year and included Visual Analogue Scale (VAS), the Short Form 36 (SF 36) and the Neck disability index (NDI). The results were categorized according to the modified Odom's criteria: excellent, good, fair and poor. Radiological evaluation looked at movement, stability and subsidence of the prosthesis, by an independent radiologist. We also studied the presence of a genetic marker «apolipoprotein e4» as a risk factor in the outcome of cervical spondylotic myelopathy. Results: There were 33 male and 21 female. The mean age was 47.8 years (SD=10.9). A highly significant difference was found for all 3 outcome measures comparing the preoperative with the post-operative follow-up values: VAS (Z=7.1, p<0.0001), SF36MCS (Z=-5.9, p<0.0001), SF36PCS (Z=-5.8, p<0.0001) and NDI (Z=7.8, p<0.0001). There were also found statistical significance between age and surgical outcome; age and hospital stay; clinical presentation and duration of symptoms and duration of symptoms with surgical outcome. Patients with apolipoprotein e4 genotype presented with the disease earlier (mean age 49 years) versus 59 years in the rest of the group (t-test p< 0.05). Patients with positive Apo e genotype had poorer outcome at six months of surgery as seen with: walking test (_2 p<0.01), EMS (t-test p<0.009), JOA (t-test p<0.03), Nurick's class (_2 p< 0.02), Ranawat class (t-test p<0.03). Those patients with Apo e4 allele also seemed to suffer from further progression of the disease earlier as one year outcomes were worse for walking test (_2 p< 0.03) and Nurick's' class (_2 p< 0.05) Radiological analyses revealed that those individuals with Apo E4 allele were rendered myelopathic with less compression than those without the gene. (_2 p< 0.01) Conclusion: The Bryan cervical disc replacement has shown to be reliable and safe for the treatment of patients with cervical spondylosis. However in order to find objective results which will determine if the arthroplasty is better than arthrodesis in the short and the long term, we propose the CEDRIC trial, which consists in a prospective randomized clinical trial with intraoperative randomization to either an artificial disc or a interbody cage