The Community Health Fund:Assessing Implementation of New Management procedures in Hanang District,Tanzania

A key obstacle to the success of community-based health insurance initiatives in Africa is the dearth of well-trained health managers who can design and run the insurance schemes in a viable manner. Internal management controls are often not adequate to ensure the fund is protected from misuse and fraud carried out by members or its own staff. The Community Health Fund in Hanang district in Tanzania has introduced management procedures that help it to exercise control over revenue collection and reporting and provide management with sufficient information to assess the Fund’s performance. This report looks at the implementation of the new management procedures, identifies successes and shortcomings in fulfilling record keeping and reporting requirements in particular, and recommends steps to improve record keeping at health care facilities, reporting of data to the district level, and use of the new data by the district.\u

Assessing the Energy Impact of Different Strategies of Integrating PV/Thermal Heat Recovery Systems in Scottish Homes

The research on photovoltaic thermal (PV/T) solar systems has been on the rise. In 2005, the International Energy Agency (IEA) Solar Heating and Cooling (SHC) programme launched the 1st Task 35 experts meeting to initiate international collaboration on PV/T solar systems. Following the end of the Task 35 research activities, SHC and the Energy Conservation in Buildings and Community Systems (ECBCS) formed a Task 40/Annex 52 joint programme and commenced collaboration on net zero energy solar buildings. Their studies encompass the scrutiny of exemplary net zero energy solar building projects selected from each participating country. Canada’s first net zero energy home, called Écoterra house, built in 2007 through the federal government’s sustainable housing initiative, and the United Kingdom’s Z-en house are currently amongst them. Both projects have been aimed at demonstrating PV/T systems for space heating in addition to power generation. This feasibility study was initiated in order to lead Scottish Z-en house builder, ROBERTRYAN Homes, to thorough understanding of basic features and potential performance of a PV/T HR system under Scottish climatic conditions and further explore how the system can effectively be integrated with the Z-en house to be constructed in 2012/13. The house is being designed to circulate PV heated air throughout the interior via a mechanical ventilation heat recovery system—i.e. implementation of a PV/T MVHR system. In this study, the heat generating capacity of low efficient PV cells (amorphous silicon) and the high efficient counterparts (poly-crystalline) was analysed using the energy and environment simulation tool called EESLISM which was invented in 1989 by Prof. Mitsuhiro Udagawa, Kogakuin University, Japan. The air flow assisted by the MVHR system was assumed to be 300m3/h, 432m3/h or 864m3/h and the velocity of 0.45m/s, 0.5m/s or 1m/s, respectively. The fresh air is drawn under a 7% or 14% efficient PV roof whose module coverage is set according to the nominal power output of either 4kWp or 8kWp. This study confirmed that PV generates heat which makes the fresh air running under the PV roof 10-15˚C warmer than the outside temperature even during the Scottish winter. Low efficient amorphous silicon PV generates more heat than high efficient PV of the same nominal power output due to the necessarily larger area of amorphous PV roof coverage as well as the less sensitivity to temperature rise as opposed to the mono/polycrystalline counterparts. In short, the ventilated PV/T integrated roof helps raise the temperature of the fresh air running under the PV panels and being extracted by an MVHR system, if both the roof and the extractor are connected physically via a duct; thus, it contributes to supplementing the indoor space heating. The architectural integration was considered as important and was visualised in the course of this study. Moreover, the air flow of the PV/T HR system was also considered as one of the key cost-effective design factors that help improve the PV/T heat collecting performance while maintaining electricity generation properties as the PV modules are cooled by the ventilation. In the 7% efficient 4kWp PV/T roof with an angle of 30˚, the EESLISM simulation indicated that the annual rate of PV/T heat collection could be increased by 77% when the ventilation air velocity is changed from 0.5m/s to 1.0m/s. The mere manipulation of the air flow is more economic and about 13 times more efficient than the increase of the PV size from 4kWp to 8kWp. Similar tendency was observed in the 14% efficient PV/T roof. However, the simulation did not extend to analysing the effect of the ventilated PV/T air velocity any more than 1m/s; thus, it may be worth continuing to investigate the extended scope in order to clarify the relationship between PV/T heat collecting capacity and the further increased ventilation rate under the Scottish climate condition in depth

Infectious disease outbreaks and increased complexity of care

Aim: This study examined the effects of healthcare-associated infectious disease outbreaks on nurses’ work in a large acute care hospital in Ontario, Canada. Background: The incidence of healthcare-associated infections has increased. Previous research focuses on epidemiology, healthcare systems, and the economic burden of outbreaks. Few published studies focus on the impact of outbreaks on nurses’ work in acute care facilities. Introduction: Since the severe acute respiratory syndrome epidemic in 2003, combating infectious diseases has become a key issue. Hospitals have implemented measures related to healthcare-associated infections. However, nurses experience challenges in preventing, controlling, and contending with outbreaks. Methods: A retrospective exploratory case study approach was used. Data were collected over a 4-month period in 2012. The incidence rates of site-specific HAIs were analysed, and individual interviews were held with 23 bedside nurses and five nurse managers. Findings: Five themes emerged from the interviews: comparison of healthcare-associated infections outbreaks; the nature of nurses’ work; impact of outbreaks on patient care; innovation and quality control in clinical practice; and increased and expanded IPAC measures. The incidence rates of methicillin-resistant Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci at the study site decreased, but remained above provincial benchmarks. Nurses experienced workload challenges, time pressures and psychological effects stemming from outbreaks and developed various innovations in response. Patient care was also affected. Conclusion: Nurses’ work has been impacted by healthcare-associated infectious disease outbreaks. Nursing workloads should be quantified to facilitate the development of guidelines for optimum nurse–patient ratio during outbreaks. Implications for Nursing and/or Health Policy: A strong evidence-based policy framework is required to address healthcare-associated infectious disease outbreaks. Infection prevention and control guidelines and procedures should be established provincially and nationally. An interdisciplinary approach is essential for the creation of comprehensive and innovative strategies. Nursing research has increased understanding of the implications of infectious diseases in hospitals. Building on the literature, findings from this study can be used to influence policies on the care of patients who have secondary infections. Nurse-driven protocols are important and can lead to the creation of best practice guidelines that can be implemented across settings

Intentions and consequences: An experimental investigation of trust and reciprocity determinants

We experimentally manipulate the efficiency of trust and reciprocity in a modified Investment Game. The aim of our manipulation is to test whether reciprocity is mainly affected by payoff consequences of trust or by intentions underlying it. We find that intentions matter and that consequences have an asymmetric impact: trustees reward trust more when trust is more efficient but do not adjust rewards to the efficiency of their own actions. As a result, profitability of trust is fostered by efficiency of trust as well as by efficiency of reciprocity. However, trustors do not fully exploit the high efficiency gains offered by investments and display only moderate trust

The morbidity and mortality of surgically treated urological patients in a tertiary centre in western Kenya

Objective: To determine the morbidity and mortality of surgically treated urological patients at Moi Teaching and Referral Hospital (MTRH) and compare them with those of other tertiary centres.Design: A fi ve year hospital based, retrospective study reviewing files of patients who underwent surgery for urological problems in MTRH for the period 1st January, 2005 to 31st December, 2009.Setting: The records department of Moi Teaching and Referral Hospital, a 750 bed capacity hospital in the Western region of Kenya.Subjects: Four hundred and twenty patients whose fi les were complete for the sought data.Main outcome measures: The primary outcome measures were the morbidity and mortality rates. Morbidity was depicted by the postoperative complications and hospital length of stay. The secondary outcome measures were patient demography, the type of surgery and the duration of surgery.Results: The male to female ratio was 13.5:1 with 49% of all the patients being older than 50 years. Seventy-seven patients (18.3%) had co morbid diseases with hypertension (22.5%), diabetes mellitus (14.3%) and Human Immunodefi ciency Virus (HIV) infection [7.8%] as the top three conditions. The top three procedures were prostate, urethral and bladder surgeries. The morbidity and mortality rates were 5.5% and 1.2% respectively.Conclusion: While prostate disease remains the leading urological problem, urethral strictures are signifi cantly higher than in the other reviewed regions. Co morbidities amenable to preoperative interventions and a relatively younger population make our morbidity and mortality rates acceptably low compared to other tertiary centres

Post-Anastomotic Enterocutaneous Fistulas: Associated Factors and Spontaneous Closure at a Tertiary Centre in Western Kenya

Objective To determine the factors associated with the occurrence and spontaneous closure of enterocutaneous fistulas. Design A retrospective, hospital-based study of patients who developed enterocutaneous fistulas after resection and anastomosis. Setting The general and paediatric surgical wards of Moi Teaching and Referral Hospital (MTRH), a 550 bed tertiary teaching and referral hospital in the Western region of Kenya. Subjects Two hundred and twenty patients of all ages who underwent gut resection and anastomosis for varied reasons between 2002 and 2006. Main outcome measures The primary outcome measures were variables associated with development and spontaneous closure of fistulas while the secondary outcome measures were morbidity and mortality associated with enterocutaneous fistulas. Results Enterocutaneous fistulas formed in 22 of 220 patients and constituted 44% of all the complications after gut resection and anastomosis. Age younger than 20 years (p=0.04), female gender (p=0.032), duration of symptoms greater than one day prior to presentation to hospital (0.032), deranged electrolytes (p=0.042), delay in surgery after admission (p=0.043) and the use of ileal segment in the anastomosis (p=0.018) were significantly associated with occurrence of fistulas on univariate analysis. The use of ileal segment in the anastomosis (p=0.033), deranged electrolytes (p=0.045) and duration prior to surgery (p=0.045) were also found to be predictive of fistula formation on multivariate analysis. The spontaneous closure rate was 45.5%. Factors significantly associated with spontaneous closure were age greater than 20 years (p= 0.027) and occurrence of the fistula in an ileal segment (p=0.031). Enterocutaneous fistulas had a case specific mortality rate of 50%.The factor most significantly associated with mortality was re-operation (

Hidden Facts and the Role of Truthfulness in Academic Dishonesty

Background: Academic dishonesty is widespread across the world and studies done have largely relied on self-reporting to establish the extent and factors contributing to the practice. This demands of researchers to take at face value what people who may not be entirely truthful are saying. It is not a surprise, therefore, that varied interesting findings have been made in different studies. This paper delves into the complexity of determining the key components of academic dishonesty and brings into focus the role of truthfulness in understanding the elicited data. The objective of this study was to establish the role of truthfulness in understanding various components of academic dishonesty. Methods: This was a Cross sectional study using self-administered questionnaire. The Setting was the School of Medicine, Moi University, Eldoret - Kenya. The study subjects were 156 students in the clinical (4th, 5th and 6 th) years of study. They anonymously filled a 20-item self-administered questionnaire. The questionnaire captured the demographic data and the views of the students on various aspects of academic dishonesty ranked in a Likert scale of six levels starting with strongly agree to strongly disagree. Results: The overall level of truthfulness among these medical students was 55.8%. While more males had prior experience with academic dishonesty in secondary school and involvement at College, they were also more truthful than the females. The untruthful were 2.2 times as often involved in academic dishonesty as the truthful and were also less likely to report on their classmates. Conclusion: There are hidden facts in academic dishonesty that can only be revealed by subjecting gathered data to a scrutiny on how truthful the respondents are. Truthfulness is an inversely proportional surrogate predictor of academic dishonesty.Key words: Role. Thruthfulness, academic, dishonest

Academic Dishonesty in Medical Schools

Background: Dishonesty can be found in all aspects of human interaction and is known to be rampant in educational institutions. Little is known about it in medical training and the characteristics of those involved. This study explores the factors that drive academic dishonesty among aspiring doctors.Objective: To establish the factors driving academic dishonesty among senior medical students.Design: Cross sectional survey using self-administered questionnaire.Setting: The School of Medicine, Moi University.Subjects: One hundred and fifty-six students in the clinical years of study.Results: Those who had past experience with academic dishonesty had a 70.4% chance of cheating in university compared to 58.9% for those not previously exposed. The odds ratio was 3.6 for males to be involved in academic dishonesty than females. Being aware of academic dishonesty in the Medical School made it 86.3% likely that a student would participate. Having witnessed academic dishonesty in progress was the strongest predictor of likely involvement in cheating.Conclusion: The cheating medical student in the clinical years is likely to be a male in the early part of the study with similar previous experience, has witnessed cheating and believes that the classmates are actively equally involved.Key words: Academic Dishonesty, Medical Training, Medical Student