Digital design and technology and market outreach in rural Zimbabwe

Despite producing top of the range products and services, entrepreneurs in Zimbabwe's rural Gokwe face limited access to markets. Access to local and regional trading markets is further aggravated by inadequate technological infrastructure and financial resources to carry out business activities. Aim: This article investigates the role of digital design and technology in expanding market outreach in Zimbabwe. Methods: A mixed methods research design was adopted. The qualitative data, obtained from semi-structured interviews and a focus group discussion, was analysed through thematic analysis. The quantitative data was obtained from the administration of a questionnaire and used to corroborate the findings of the qualitative tool. Results: The findings revealed that while digital design and technology had little effect on identifying entrepreneurial opportunities and communicating with potential customers in Gokwe, there were clear signs that plans were being made to integrate digital technology and internet connectivity in at least one sector of the rural economy of the district. Implications: The findings may provide vital information for rural entrepreneurs and policymakers looking to benefit from the digital revolution. Recommendation: The paper encourages the use of digital marketing and advertising to take advantage of entrepreneurial opportunities

Digital design and technology and market outreach in rural Zimbabwe

Despite producing top of the range products and services, entrepreneurs in Zimbabwe's rural Gokwe face limited access to markets. Access to local and regional trading markets is further aggravated by inadequate technological infrastructure and financial resources to carry out business activities. Aim: This article investigates the role of digital design and technology in expanding market outreach in Zimbabwe. Methods: A mixed methods research design was adopted. The qualitative data, obtained from semi-structured interviews and a focus group discussion, was analysed through thematic analysis. The quantitative data was obtained from the administration of a questionnaire and used to corroborate the findings of the qualitative tool. Results: The findings revealed that while digital design and technology had little effect on identifying entrepreneurial opportunities and communicating with potential customers in Gokwe, there were clear signs that plans were being made to integrate digital technology and internet connectivity in at least one sector of the rural economy of the district. Implications: The findings may provide vital information for rural entrepreneurs and policymakers looking to benefit from the digital revolution. Recommendation: The paper encourages the use of digital marketing and advertising to take advantage of entrepreneurial opportunities

The application of a distributed activation energy based model to the gasification and combustion of coal and biomass char blends

Thermo-gravimetric analysis was carried out on a vitrinite-rich coal (VC), highveld grass (HG) and pine wood (PW) chars, and coal-biomass char blends of each. The analysis was carried out on combustion and gasification tests using air and CO2 respectively. The blends were modeled by the application of a distributed activation energy (DAE) based model. The DAE based model is a modification of an algorithm developed by Scott et al. for the pyrolysis of complex fuels obeying linear kinetics (Scott et al., 2006). The modified DAE model was able to derive the activation energy, , the grouped pre-exponential factor, , and the number of reactions occurring in the thermal conversion process. Furthermore, the mass fraction associated with each unique reaction was obtained. The ability to determine multiple reactions distinguishes the DAE based model as a unique and robust method for kinetics determination. The first order and the random pore reaction models (RPM) were applied to describe the reaction profiles. The conversion of all the coal and biomass blends were successfully modeled using the RPM to high accuracy. During combustion, ’s and ’s in the range of 180-255kJ/mol and 5.34E+8 to 2.80E+15 s-1m-1 were determined for the PW char. ’s and ’s in the range of 125- 138kJ/mol and 5.38E+4 to 3.94E+5 s-1m-1 were determined for the rest of the chars and blends during combustion. For gasification, ’s and ’s in the range of 222 -304kJ/mol and 5.36E+5 to 3.96E+9 s-1m-1 were determined for all the chars and blends. The structural parameters ( ) obtained lie in the range of 8.3 to 18.9. The determined during combustion were sufficient for modeling the same material during gasification. Multiple reactions were identified for most of the chars during both gasification and combustion. Kinetic analysis showed that PW char was the most reactive char, followed by the HG and VC chars respectively. For the 50:50 heat input ratio coal-biomass blends during combustion, synergetic behavior and a decrease in was observed

Third sector intervention and sustainable development : an evaluation of selected non-governmental organization supported projects in the Eastern Cape, South Africa

This study evaluates the impact of Third Sector- supported rural development projects in three rural communities of the Eastern Cape, South Africa. It focusses on how interventions driven by this sector – denoted by, among others, local and international non-governmental organisations (NGOs) - impact the lives and livelihoods of the rural poor. This is against the background of an established discourse that views NGOs as effective agents in the alleviation of poverty. The thesis contends that praise for the Third Sector is driven mostly by advocacy than based on systematic scientific evidence of the real impact of NGO-sponsored rural development interventions. Rural agricultural development projects supported by two Eastern Cape-based NGOs (the one a local NGO, and the other international) were selected for the study. A mini survey was conducted in the communities where the projects are located. Survey data were complemented by qualitative data obtained through focus groups, semi-structured and in-depth interviews as well as key informant interviews. The study found that whereas the projects had been established by the state later went moribund, they were resuscitated by the NGOs through a largely ‘bottom-up’ model of rural development intermediation. In other words, the interventions were resuscitated through a relatively robust prior engagement with project beneficiaries. As a result, while originally lacking a meaningful sense of local empowerment, ownership, and commitment, the projects had become revived and now played an important role in the livelihoods of some community members – even though social grants remained the primary and main source of income for those community members. Even so, the narratives of community members revealed what may be termed a ‘transformation paradox’ in the way the projects were implemented. The NGOs seemed to have replaced one kind of lop-sidedness in rural development (the exclusion of women) with another (the exclusion of men), by focussing on community projects that were ‘culturally’ deemed as ’women jobs’. In this way, the interventions appeared like a systematic attempt to do away with the ‘feminisation of rural poverty’ and entrench the ‘feminisation of rural development interventions’. The study concludes from these and other findings, that the key to understanding the significance and impact of Third Sector-supported development interventions in the rural arena – especially in the Eastern Cape context – is to go beyond the proliferation of NGOs and NGO-supported projects – and the broad sweep of advocacy that underpins it – and pay equally robust attention to systematically studying how these projects resonate at the grassroots, especially from a beneficiary perspective

Isotope-edited Infrared Spectroscopy of 3-10 Helical Peptides

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Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents:a retrospective cohort study

Abstract Background Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I hospitalizations that are specific to LTCFs remain poorly understood. Our objective was to evaluate the incidence of P&I hospitalization and associated person- and facility-level factors among post-acute (short-stay) and long-term (long-stay) care residents residing in LTCFs from 2013 to 2015. Methods In this retrospective cohort study, we used Medicare administrative claims linked to Minimum Data Set and LTCF-level data to identify short-stay (< 100 days, index = admission date) and long-stay (100+ days, index = day 100) residents who were followed from the index date until the first of hospitalization, LTCF discharge, Medicare disenrollment, or death. We measured incidence rates (IRs) for P&I hospitalization per 100,000 person-days, and estimated associations with baseline demographics, geriatric syndromes, clinical characteristics, and medication use using Cox regression models. Results We analyzed data from 1,118,054 short-stay and 593,443 long-stay residents. The crude 30-day IRs (95% CI) of hospitalizations with P&I in the principal position were 26.0 (25.4, 26.6) and 34.5 (33.6, 35.4) among short- and long-stay residents, respectively. The variables associated with P&I varied between short and long-stay residents, and common risk factors included: advanced age (85+ years), admission from an acute hospital, select cardiovascular and respiratory conditions, impaired functional status, and receipt of antibiotics or Beers criteria medications. Facility staffing and care quality measures were important risk factors among long-stay residents but not in short-stay residents. Conclusions Short-stay residents had lower crude 30- and 90-day incidence rates of P&I hospitalizations than long-stay LTCF residents. Differences in risk factors for P&I between short- and long-stay populations suggest the importance of considering distinct profiles of post-acute and long-term care residents in infection prevention and control strategies in LTCFs. These findings can help clinicians target interventions to subgroups of LTCF residents at highest P&I risk

Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes

BACKGROUND: More older adults enrolled in Medicare Advantage (MA) are entering nursing homes (NHs), and MA concentration could affect vaccination rates through shifts in resident characteristics and/or payer-related influences on preventive services use. We investigated whether rates of influenza vaccination and refusal differ across NHs with varying concentrations of MA-enrolled residents. METHODS: We analyzed 2014–2015 Medicare enrollment data and Minimum Data Set clinical assessments linked to NH-level characteristics, star ratings, and county-level MA penetration rates. The independent variable was the percentage of residents enrolled in MA at admission and categorized into three equally-sized groups. We examined three NH-level outcomes including the percentages of residents assessed and appropriately considered for influenza vaccination, received influenza vaccination, and refused influenza vaccination. RESULTS: There were 936,513 long-stay residents in 12,384 NHs. Categories for the prevalence of MA enrollment in NHs were low (0% to 3.3%; n = 4131 NHs), moderate (3.4% to 18.6%; n = 4127 NHs) and high (>18.6%; n = 4126 NHs). Overall, 81.3% of long-stay residents received influenza vaccination and 14.3% refused the vaccine when offered. Adjusting for covariates, influenza vaccination rates among long-stay residents were higher in NHs with moderate (1.70 percentage points [pp], 95% confidence limits [CL]: 1.15 pp, 2.24 pp), or high (3.05 pp, 95% CL: 2.45 pp, 3.66 pp) MA versus the lowest prevalence of MA. Influenza vaccine refusal was lower in NHs with moderate (−3.10 pp, 95% CL: −3.53 pp, −2.68 pp), or high (−4.63 pp, 95% CL: −5.11 pp, −4.15 pp) MA compared with NHs with the lowest prevalence of MA. CONCLUSION: A higher concentration of long-stay NH residents enrolled in MA was associated with greater influenza vaccine receipt and lower vaccine refusal. As MA becomes a larger share of the Medicare program, and more MA beneficiaries enter NHs, decisionmakers need to consider how managed care can be leveraged to improve the delivery of preventive services like influenza vaccinations in NH settings

Estimated Cardiorespiratory Hospitalizations Attributable to Influenza and Respiratory Syncytial Virus Among Long-term Care Facility Residents

IMPORTANCE: Older adults residing in long-term care facilities (LTCFs) are at a high risk of being infected with respiratory viruses, such as influenza and respiratory syncytial virus (RSV). Although these infections commonly have many cardiorespiratory sequelae, the national burden of influenza- and RSV-attributable cardiorespiratory events remains unknown for the multimorbid and vulnerable LTCF population. OBJECTIVE: To estimate the incidence of cardiorespiratory hospitalizations that were attributable to influenza and RSV among LTCF residents and to quantify the economic burden of these hospitalizations on the US health care system by estimating their associated cost and length of stay. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used national Medicare Provider Analysis and Review inpatient claims and Minimum Data Set clinical assessments for 6 respiratory seasons (2011-2017). Long-stay residents of LTCFs were identified as those living in the facility for at least 100 days (index date), aged 65 years or older, and with 6 months of continuous enrollment in Medicare Part A were included. Follow-up occurred from the resident’s index date until the first hospitalization, discharge from the LTCF, disenrollment from Medicare, death, or the end of the study. Residents could re-enter the sample; thus, long-stay episodes of care were identified. Data analysis was performed between January 1 and September 30, 2020. EXPOSURES: Seasonal circulating pandemic 2009 influenza A(H1N1), human influenza A(H3N2), influenza B, and RSV. MAIN OUTCOMES AND MEASURES: Cardiorespiratory hospitalizations (eg, asthma exacerbation, heart failure) were identified using primary diagnosis codes. Influenza- and RSV-attributable cardiorespiratory events were estimated using a negative binomial regression model adjusted for weekly circulating influenza and RSV testing data. Length of stay and costs of influenza- and RSV-attributable events were then estimated. RESULTS: The study population comprised 2 909 106 LTCF residents with 3 138 962 long-stay episodes and 5 079 872 person-years of follow-up. Overall, 10 939 (95% CI, 9413-12 464) influenza- and RSV-attributable cardiorespiratory events occurred, with an incidence of 215 (95% CI, 185-245) events per 100 000 person-years. The cost of influenza- and RSV-attributable cardiorespiratory events was $91 055 393 (95$77 885 316-$104 225 470), and the length of stay was 56 858 (95% CI, 48 757-64 968) days. CONCLUSIONS AND RELEVANCE: This study found that many cardiorespiratory hospitalizations among LTCF residents in the US were attributable to seasonal influenza and RSV. To minimize the burden these events place on the health care system and residents of LTCFs and to prevent virus transmission, additional preventive measures should be implemented

Persistence of Racial Inequities in Receipt of Influenza Vaccination among Nursing Home Residents in the United States

BACKGROUND: We sought to determine if the racial differences in influenza vaccination among nursing home (NH) residents during the 2008-09 influenza season persisted in 2018-19. METHODS: We conducted a cross-sectional study of NHs certified by the U.S. Centers for Medicare & Medicaid Services during the 2018-19 influenza season in U.S. states with ≥ 1% black NH residents and a white-black gap in influenza vaccination of NH residents (N=2,233,392) of at least one percentage point (N=40 states). NH Residents during October 1, 2018 through March 31, 2019 aged ≥ 18 years and self-identified as black or white race were included. Residents' influenza vaccination status (vaccinated, refused, and not offered) was assessed. Multilevel modeling was used to estimate facility-level vaccination status and inequities by state. RESULTS: The white-black gap in influenza vaccination was 9.9 percentage points. In adjusted analyses, racial inequities in vaccination were more prominent at the facility- than at the state-level. Black residents disproportionately lived in NHs with majority blacks, which generally had the lowest vaccination. Inequities were most concentrated in the Midwestern region, also the most segregated. Not being offered the vaccine was negligible by difference in absolute percentage points among whites (2.6%) and blacks (4.8%) whereas refusals were higher among black (28.7%) than white residents (21.0%). CONCLUSIONS: The increase in the white-black vaccination gap among NH residents is occurring at the facility-level, in more states, especially those with the most segregation. Standing orders for vaccinations, previously reported to narrow the racial gap in vaccination among NH residents, should be considered

Geographic Variation in Pneumonia and Influenza in Long-Term Care Facilities:A National Study

There is large county-level geographic variation in pneumonia and influenza hospitalizations among short-stay and long-stay long-term care facility residents in the United States. Long-term care facilities in counties in the Southern and Midwestern regions had the highest rates of pneumonia and influenza from 2013 to 2015. Future research should identify reasons for these geographic differences