Study Design: Retrospective case series. Objective: Little is known about operative management of traumatic spinal injuries (TSI) in low- and middle-income countries (LMIC). In patients undergoing surgery for TSI in Tanzania, we sought to (1) determine factors involved in the operative decision-making process, specifically implant availability and surgical judgment; (2) report neurologic outcomes; and (3) evaluate time to surgery. Methods: All patients from October 2016 to June 2019 who presented with TSI and underwent surgical stabilization. Fracture type, operation, neurologic status, and time-to-care was collected. Results: Ninety-seven patients underwent operative stabilization, 23 (24%) cervical and 74 (77%) thoracic/lumbar. Cervical operations included 4 (17%) anterior cervical discectomy and fusion with plate, 7 (30%) anterior cervical corpectomy with tricortical iliac crest graft and plate, and 12 (52%) posterior cervical laminectomy and fusion with lateral mass screws. All 74 (100%) of thoracic/lumbar fractures were treated with posterolateral pedicle screws. Short-segment fixation was used in 86%, and constructs often ended at an injured (61%) or junctional (62%) level. Sixteen (17%) patients improved at least 1 ASIA grade. The sole predictor of neurologic improvement was faster time from admission to surgery (odds ratio = 1.04, P = .011, 95%CI = 1.01-1.07). Median (range) time in days included: injury to admission 2 (0-29), admission to operating room 23 (0-81), and operating room to discharge 8 (2-31). Conclusions: In a cohort of LMIC patients with TSI undergoing stabilization, the principle driver of operative decision making was cost of implants. Faster time from admission to surgery was associated with neurologic improvement, yet significant delays to surgery were seen due to patients’ inability to pay for implants. Several themes for improvement emerged: early surgery, implant availability, prehospital transfer, and long-term follow-up.
Introduction: Our study assessed the efficacy of blended learning, which combines in-person learning and e-learning, in a pediatric scoliosis training program through an international collaborative effort. Methods: The course comprised two parts: the online portion, where participants reviewed educational materials for 3 weeks and met with faculty once/week for discussion, and the in-person session, where participants reviewed cases in a team-based approach and came to a consensus on treatment strategy, followed by discussion with an international expert. All participants completed a needs assessment (NA) and clinical quiz at three points: before the course, after the online session, and after the in-person session, which covered various topics in pediatric spine deformity. Results: Thirty-six surgeons enrolled in the course from 13 College of Surgeons of East, Central and Southern Africa countries. The NA assessment scores improved significantly over the course of the surveys from 67.3, to 90.9, to 94.0 (P = 0.02). The clinical quiz scores also improved from 9.91, to 11.9, to 12.3 (P = 0.002). Conclusion:The blended learning approach in a pediatric spine deformity program is effective and feasible and shows a statistically significant change in participants' confidence and knowledge base in these complex pathologies. This approach should be explored further with larger numbers and/or other spinal pathologies. Blended learning is a relatively new form of education for surgical trainees that combines in-person learning and e-learning and has rapidly expanded in the wake of the COVID-19 pandemic. E-learning leverages internet technologies to enhance knowledge and performance. Advantages of this modality include control over content, learning sequence, and pace of learning, allowing participants to tailor their experience to meet their personal learning objectives. 1 As standard teaching strategies may be insufficient to meet changing needs, alternatives based on direct communication
Purpose The purpose of this paper is to determine the factors influencing adoption of African indigenous vegetables (AIVs) into the agro-pastoral farming systems aiming at improving livelihoods. Design/methodology/approach The paper is based upon the diffusion theory which is linked to the random utility theory. A survey of 205 agro-pastoral households obtained through multistage sampling technique was used. Factors influencing adoption of AIVs were estimated using a logit model. Findings Findings indicate that the acreage under AIVs was still very low compared to other crop enterprises with the most common types of AIVs grown being Solanum nigrum, Amaranthus spp., Cucurbita maxima, Vigna unguiculata, Basella alba and Cleome gynandra. Factors influencing adoption were found to be gender, age, farm size, education level, off-farm income and number of visits to extension officer. Research limitations/implications Limitations include reliance on respondents’ willingness to provide correct information. Originality/value This paper adds value in its contribution to literature on diversifying agro-pastoral livelihoods through production of AIVs for income and food security.
This study adds to the knowledge base of Entrepreneurial Education (EE) in selected technical training institutes in Kenya. Using qualitative research inquiry, semi-structured interviews were conducted with a question guidebook and follow-up questioning. Data were collected from students, instructors, and administrators selected through purposive sampling. Open and axial coding was used to categorize the transcribed interview responses. Peer review was used to ensure credibility and confirmability. The results reveals that the learning institutions prepared students as entrepreneurs through coursework, mandatory field internships, internal projects, participation in agricultural and business fairs, and providing startup capital for cooperative shops. EE delivery faces numerous constraints including inadequate start-up capital, inadequate access to land, and output and input market resulting from poor infrastructure, competition, lack of marketing skills, and exam-oriented curricula. Dairy, horticulture, poultry, and apiculture enterprises were identified as the most promising and viable enterprises for graduates of middlelevel tertiary institutions. In conclusion, EE was being offered in these institutions as certificate courses or integrated as a topic in their existing curricula. In order to improve upon the delivery of the programs, the institutions needed to upgrade learning facilities, incorporating ICT in the curricula, enhance practical learning, conduct rigorous follow-up evaluations of graduates, and establish business incubators for providing start-up capital to graduates.
This study focused on Kenyan farmers in the Moiben area who participated in three agricultural seminars at Twiga demonstration farm. The problem of interest was the need for increased dissemination of improved agricultural practices to enhance production and processing of crops related to food security and socio-economic well-being. The study investigated associations between adoptive behaviors of participants and their subsequent behavior related to diffusing improved practices to others. Data was collected using a demographic questionnaire and two structured interview schedules. Correlational analysis was conducted on post-training behavior variables, using Kendall’s tau calculations. The study found that farmers across the samples who exhibited higher levels of adoption of workshop-recommended innovations also had a moderate to strong likelihood of showing correspondingly higher levels of diffusion-related behavior. It was concluded that these findings align well with Rogers’ (2003) discussion of change-agent credibility, and also with Bandura’s (2006) work on social modeling and perceived self-efficacy. It was recommended that offering community-based agricultural seminars such as those in this study be continued and expanded, as an important component in a pluralistic model of agricultural extension methodology for Sub-Saharan Africa. It was further recommended that farmers who adopt improved practices learned in training be identified specifically for further interventions related to implementation and diffusion of agricultural innovations.
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