47 research outputs found
Stigma and access to care in first-episode psychosis
Aim
Mental health‐related stigma is considered a significant barrier to help‐seeking and accessing care in those experiencing mental illness. Long duration of untreated psychosis is associated with poorer outcomes. The impact of stigma on the duration of untreated psychosis, in first‐episode psychosis remains unexplored. To examine the association between mental health‐related stigma and access to care in people experiencing first‐episode psychosis in Birmingham, UK.
Methods
We collected data on a prospective cohort of first‐episode psychosis. The Stigma Scale was used as a measure of mental health‐related stigma, and duration of untreated psychosis as a measure of delay in accessing care. We performed logistic and linear regression analyses to explore the relationship between mental health‐related stigma and duration of untreated psychosis, adjusting for sex, age, educational level, religion and ethnicity.
Results
On the 89 participants included in this study, linear regression analysis revealed that overall stigma and the discrimination sub‐factor were significant predictors of longer duration of untreated psychosis, whereas logistic regression identified the disclosure sub‐factor to be a significant predictor of longer duration of untreated psychosis.
Conclusions
These findings demonstrate that stigmatizing views of mental illness from the patient's perspectives can result in delayed access to care. This emphasizes the importance of tackling mental health‐related stigma to ensure early treatment and improved outcomes for people experiencing first‐episode psychosis
Predictors of engagement in first-episode psychosis
Engagement with psychiatric services is critical for ensuring successful outcomes in patients experiencing a first episode of psychosis (FEP). However, it is not known how sociodemographic factors and patient beliefs about the causes of mental illness affect engagement. This study explored predictors of engagement in a cohort of 103 FEP patients presenting to an early-intervention service. Beliefs that mental illness is caused by social stress or thinking odd thoughts predicted higher engagement scores. Patients with no qualifications were found to have higher engagement scores than those educated to a higher level. Ethnicity, gender, age and socioeconomic factors were not significantly correlated with engagement scores. Duration of untreated illness (DUI) significantly predicted higher engagement scores, but only for values >1220days. Duration of untreated psychosis (DUP) was not a significant predictor of patient engagement scores. Patient beliefs about the causes of mental illness are an important factor to be taken into consideration and may represent a target of interventions to increase engagement in FEP
Consumer Adoption of Self-Service Technologies in the Context of the Jordanian Banking Industry: Examining the Moderating Role of Channel Types
YesThis study aimed to examine the key factors predicting Jordanian consumers’ intentions and
usage of three types of self-service banking technologies. This study also sought to test if the
impacts of these main predictors could be moderated by channel type. This study proposed a
conceptual model by integrating factors from the unified theory of acceptance and use of
technology (UTAUT), along with perceived risk. The required data were collected from a
convenience sample of Jordanian banking customers using a survey questionnaire. The
statistical results strongly support the significant influence of performance expectancy, social
influence, and perceived risk on customer intentions for the three types of SSTs examined. The
results of the X2 differences test also indicate that there are significant differences in the
influence of the main predictors due to the moderating effect of channel type. One of the key
contributions of this study is that three types of SSTs were tested in a single study, which had
not been done before, leading to the identification of the factors common to all three types, as
well as the salient factors unique to each type
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial
Background
Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.
Methods
In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.
Findings
Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.
Interpretation
Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.
Funding
London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation
Impact of internet of things (IoT) in disaster management: a task-technology fit perspective
YesDisaster management aims to mitigate the potential damage from the disasters, ensure immediate and suitable assistance to the victims, and attain effective and rapid recovery. These objectives require a planned and effective rescue operation post such disasters. Different types of information about the impact of the disaster are, hence, required for planning an effective and immediate relief operation. The IoT technology available today is quite mature and has the potential to be very useful in disaster situations. This paper analyzes the requirements for planning rescue operation for such natural disasters and proposes an IoT based solution to cater the identified requirements. The proposed solution is further validated using the task-technology fit (TTF) approach for analyzing the significance of the adoption of IoT technology for disaster management. Results from the exploratory study established the core dimensions of the task requirements and the TTF constructs. Results from the confirmatory factor analysis using PLS path modelling, further, suggest that both task requirements and IoT technology have significant impact on the IoT TTF in the disaster management scenario. This paper makes significant contributions in the development of appropriate constructs for modeling TTF for IoT Technology in the context of disaster management
Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)
Background
Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis.
Methods
In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability.
Findings
Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis
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Alignment between the English language curriculum and assessment system
In Bangladesh, English is a compulsory subject from primary to higher secondary level. The introduction of Communicative Language Teaching (CLT) has influenced the curriculum, textbooks and teaching methods of English since the 90s. New contents were included in the curriculum for practising and achieving language competence in four skill areas: listening, speaking, reading and writing. However, the aims and objectives of this communicative curriculum can never be achieved without an assessment system that assesses the communicative ability of the learners (Haider, 2008). When new contents are introduced in the curriculum, teachers often need to review their teaching and assessment procedures in order to cope with the demands of change. The current study aimed to explore - to what extent, the assessment measures used in secondary schools are being treated as means to gather evidence on the targeted learning outcomes and best meet the learners’ needs for future learning.
Describing the background of the study, interview and observation data gathered from teacher and students in 38 schools will be used to discuss the gaps found in current practices with regard to the curriculum content, pedagogy and the formative and summative assessments strategies used to measure the learning outcomes
Barriers to Offsite Construction Adoption in Jordan:an Exploratory Factor Analysis
This research investigated the barriers to Offsite Construction (OSC) adoption in Jordan. Four hypothesised groups, with their associated items, were used to develop a questionnaire survey to gather data. Twenty-three survey items were finalised through an extensive literature review and a pilot study. The questionnaire was used to collect data from 208 construction professionals in Jordan. An exploratory factor analysis revealed that the OSC adoption is affected by three groups of barriers: economic, social, and environmental. The analysis assists in developing evaluation frameworks for continuous and process improvements. Understanding the barriers to OSC adoption is essential so that decision-makers and practitioners can effectively plan and implement effective strategies and development plans, thriving the adoption of OSC in Jordan
Critical success factors for cost management in public-housing projects
This is an accepted manuscript of an article published by Emerald in Construction Innovation: Information, Process, Management on 25/01/2021, available online at: https://doi.org/10.1108/CI-10-2020-0166
The accepted version of the publication may differ from the final published version.Purpose
Effective cost performance is a crucial criterion measuring successful project management in Public-housing
projects. This paper analyses the vital underlying factors surrounding the successful Cost Management Process
(CMP) outcomes in Public Housing Projects (PHPs).
Design/methodology
The research was conducted in three stages. The first stage consisted of a detailed literature review to document
Success factors affecting Cost performances and management. In stage two, Brainstorming sessions were
undertaken with construction experts knowledgeable in cost management practices and have been involved in
PHPs. These sessions were used to refine those Success factors for the PHPs settings and define their criticality
with respect to the CMP stages using Interpretive Ranking Process (IRP). In Stage three, focus group sessions
were performed to validate the interrelationships of the contextualised Success factors.
Findings
The top three most critical factors for successful implementation and outcomes at all CMP stages in PHPs
settings were found to relate to competencies, team qualities and collaborative practices of Project Team (PT).
Early contractor involvement and effective construction planning and management also emerged relevant to
the process.
Practical implications
Government project departments, project managers and construction organisations (consultants and
contractors) need to commit and mandate continuous development of cost management competencies for all
professionals engaged in PHPs. Channels supporting Team integration and collaborative practices between
design and construction teams are required to increase the likelihood of successful project cost management
practice and outcomes in PHPs.
Originality/value
The research has developed a Factor-Process relationship model that can be used to improve and evaluate the
efficacy of CMP implementation in PHP settings