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Search Results: 1 - 10 of 5070 matches for " Susan Nakubulwa "
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Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study
Edward C. Jones-López equal contributor ,Irene Ayakaka equal contributor,Jonathan Levin,Nancy Reilly,Francis Mumbowa,Scott Dryden-Peterson,Grace Nyakoojo,Kevin Fennelly,Beth Temple,Susan Nakubulwa,Moses L. Joloba,Alphonse Okwera,Kathleen D. Eisenach,Ruth McNerney,Alison M. Elliott,Jerrold J. Ellner,Peter G. Smith,Roy D. Mugerwa
PLOS Medicine , 2011, DOI: 10.1371/journal.pmed.1000427
Abstract: Background Each year, 10%–20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated. Methods and Findings From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12–33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10–5.22), HIV infection (2.16; 1.01–4.61), age (aOR for 10-year increase 1.59; 1.13–2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04–1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0–53.4) and HIV-uninfected (14.7; 4.1–52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0–18.8) and Karnofsky score <70 (2.1; 1.1–4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1–10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0–3.5). Conclusions The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients. Please see later in the article for the Editors' Summary
Treatment Outcomes of New Tuberculosis Patients Hospitalized in Kampala, Uganda: A Prospective Cohort Study
Bruce J. Kirenga, Jonathan Levin, Irene Ayakaka, William Worodria, Nancy Reilly, Francis Mumbowa, Helen Nabanjja, Grace Nyakoojo, Kevin Fennelly, Susan Nakubulwa, Moses Joloba, Alphonse Okwera, Kathleen D. Eisenach, Ruth McNerney, Alison M. Elliott, Roy D. Mugerwa, Peter G. Smith, Jerrold J. Ellner, Edward C. Jones-López
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090614
Abstract: Background In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda Methods and findings Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 – 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/μL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 – 4.01, P = 0.045). Conclusion Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART.
Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda  [PDF]
Peter Chris Kawungezi, Douglas AkiiBua, Carol Aleni, Michael Chitayi, Anxious Niwaha, Andrew Kazibwe, Elizabeth Sunya, Eliud W. Mumbere, Carol Mutesi, Cathy Tukei, Arabat Kasangaki, Sarah Nakubulwa
Open Journal of Preventive Medicine (OJPM) , 2015, DOI: 10.4236/ojpm.2015.53016
Abstract: Introduction: Globally every year 529,000 maternal deaths occur, 99% of this in developing coun-tries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number “#REC REF 2012-117” before conducting the study. Results: A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as “near and accessible”, “my husband decided”, and “they are the only people I know”. 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn’t know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. Conclusion: The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to
Is Distance Education the Answer to the Nursing Shortage?  [PDF]
Susan Mee
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.43020

This study examined the effectiveness of distance education compared with campus based learning among nursing students. Distance education in nursing curricula is increasing. Academic nurse leaders must demonstrate the effectiveness of distance learning. This study is unique in that two cohorts, distance learners and campus learners, were taught synchronously by the same faculty member. Quantitative measures of student learning outcomes were compared using SPSS. There were no significant differences in learning outcomes between distance learners and campus learners. This study provides empiric support for distance education as a means to address the nursing shortage.

Fostering Competencies in Future Teachers: A Competency-Based Approach to Teacher Education  [PDF]
Susan Cydis
Creative Education (CE) , 2014, DOI: 10.4236/ce.2014.513130

The study investigated the characteristics of instruction and assessment used by instructors in teacher education courses that foster student competencies as perceived by students. The sampling method used to collect the sample of instructors and their courses was purposive, non-probability sampling. Student participants included those that were currently registered in classes of the respective instructors. A qualitative analysis of the data collected revealed that instructors used a variety of competency-based educational practices in their instructional and assessment tasks and that students perceived themselves as competent in the areas identified by the Teacher Education Accreditation Council (2009) as standards for student competencies in teacher education courses.

Plagiarism: Whose Responsibility Is It Anyway? An Administrator’s Choice to Teach Not Punish  [PDF]
Susan Polirstok
Creative Education (CE) , 2014, DOI: 10.4236/ce.2014.58066

This paper examines how plagiarism is viewed on college campuses and the resultant punitive consequences that follow. In this case, a college administrator must determine whether two graduate education students should be expelled as a consequence of having certain passages appearing from websites and journal articles without attribution in first two theses drafts. In assessing what contributed to this infraction, the college administrator determined that the students had never received direct instruction in plagiarism and how to avoid it. Working collaboratively with the referring faculty member, a 3-session instructional program was designed to teach how to paraphrase and use citations in tandem with an overcorrection procedure of positive practice coupled with restitution. The culminating session required each student to design a 5-lesson module on plagiarism and how to avoid it for their program peers. They also met with their faculty instructor to review the changes they had made in their drafts resulting in reinstatement in their research course. The entire process helped the academic program faculty recognize that the topic of plagiarism and skills necessary to avoid plagiarism required direct instruction at various points throughout the overall program to prevent students from encountering severe penalties.

Suggested Strategies in Water Treatment by Using Situ Pressure in Reverse Osmosis  [PDF]
Susan Norouzi
Open Journal of Geology (OJG) , 2015, DOI: 10.4236/ojg.2015.55033
Abstract: Nowadays desalination is one of the main resources to obtain water in many areas. The most advanced method for water filtration is reverse osmosis. In this system, water is injected into semi-membranes by using power pumping, and its salt water is taken away from the solution. This paper has tried to offer guidelines to use the pressure createdin situof harvesting water, instead of utilizing power pump, which produces the necessary pressure for the reverse osmosis. These guidelines have been divided into 2 main groups: Using the created natural pressure, and the other way is using the pressures that are caused by the constructions built for harvesting water.
Classroom Management Strategies for Inclusive Classrooms  [PDF]
Susan Polirstok
Creative Education (CE) , 2015, DOI: 10.4236/ce.2015.610094
Abstract: Classrooms in the 21st century have by law become inclusive, typically comprised of general education and special needs students. Included students are those who present with mild to moderate learning and behavioral challenges. They add another layer of complexity to classroom management, requiring teachers to be highly structured, consistent and reinforcing. Teacher fidelity to behavioral expectations that have been established for the classroom is essential. Classroom management strategies discussed include changing the teacher approval to disapproval ratio, using selective ignoring, focusing on structure and routine, increasing student locus of control, de-escalating student aggression and hostility, and limiting the use of punishment. Hands-on strategies are highlighted.
Aircraft Clean Air Requirements Using Bleed Air Systems  [PDF]
Susan Michaelis
Engineering (ENG) , 2018, DOI: 10.4236/eng.2018.104011
Abstract: There are certification and airworthiness requirements relevant to the provision of clean breathing air in the crew and passenger compartments. There have been continuing reports and studies over the years regarding oil fumes in aircraft, including impaired crew performance. Oil fumes are viewed in varying ways ranging from rare seal bearing failures, to low level leakage in normal flight. A Masters of Science (MSc) research degree was undertaken to assess whether there is any gap between the certification requirements for the provision of clean air in crew and passenger compartments, and the theoretical and practical implementation of the requirements using the bleed air system. A comprehensive literature search reviewed applicable certification standards, documented and theoretical understanding of oil leakage. Two types of interviews were conducted to address the research questions. Key aviation regulators were questioned about the process by which they certify and ensure compliance with the clean air requirements. Aerospace engineers and sealing professionals were interviewed about their understanding of how oil may leak past compressor oil bearing seals, and into the air supply under various flight conditions. The outcome of the research showed that there is a gap between the clean air certification requirements, and the theoretical and practical implementation of the requirements using the bleed air system. Low level oil leakage into the aircraft cabin in normal flight operations is a function of the design of the engine lubricating system and bleed air systems, both utilising pressurised air. The use of the bleed air system to supply the regulatory required air quality standards is not being met or being enforced as required.
Socio-Cultural Identities, Perceptions of Sexuality/Sexual Behavior and Cultural Contexts as Determinants of HIV and AIDS Prevalence in Southern Africa  [PDF]
Chijioke Uwah, Susan Wright
World Journal of AIDS (WJA) , 2012, DOI: 10.4236/wja.2012.21003
Abstract: This paper attempts to examine the connection between one’s socio cultural setting and the prevalence of HIV/AIDS. Often, local communities form the contexts within which people negotiate their social and sexual lives and identities. These communities also play a key role in enabling or restraining people from taking control over their health. The paper will try to demonstrate through specific examples that in African societies, sexual behavior is a product of one’s socio-cultural environment and structural contexts and not the cognitive properties of the individual. The article draws from the qualitative study (Focus group sessions, individual interviews) conducted in three high schools in the Boland area of the Western Cape with about 18 learners, 3 Life skills teachers, 3 Performer-Educators on the efficacy of the HIV/AIDS intervention by The Centre for HIV/AIDS Management theatre group based at the University of Stellenbosch. The aim of the study was to ascertain the cultural content of their campaign model as well as their knowledge of the determinants of sex and sexuality of their target areas. Based on the findings of this study, I argue that theatre will achieve greater success in its campaign against HIV/AIDS in South Africa if the designers of the campaign models adopt a more participatory approach, make indigenous culture central to the design of their intervention model and pay closer attention to what Campbell refers to as “community level of analysis” which simply put implies a greater understanding of the target audiences local communities and its determinants of sex and sexuality.
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