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ASSESSING THE VALIDITY OF RANDOM BLOOD GLUCOSE TESTING FOR MONITORING GLYCEMIC CONTROL AND PREDICTING HbA1c VALUES IN TYPE 2 DIABETICS AT KARL BREMER HOSPITALOYEKEMI FUNKE, DARAMOLA 23 July 2015 (has links)
Background: The number of adults affected by diabetes mellitus in developing countries, such as South Africa, is projected to grow by 170%, from 84 to 228 million people between 1995 and 2025 .This high and increasing prevalence of diabetes worldwide, and the economic burden of diabetes on developing countries like South Africa emphasizes the importance of ensuring good glycemic control so as to slow down the rate of disease progression and prevent complications. The district health care facilities are the foundation of the health care system of South Africa. The current practice is that diabetics have a point of care random blood glucose (RBG) done on the morning of their clinic appointment and this is used as a form of assessment of glycemic control during the consultation. For further clinical decision making a HbA1c is done once a year as a benchmark of glycemic control. The practical clinical question that arises is whether the assumptions underlying local clinical decision making using the RBG are valid and to what extent RBG can be used to guide clinical management.
Aim and Objectives: The aim of this study was to assess the strength of the correlation between RBG and HbA1c and to make recommendations for the interpretation of RBG results in adult patients with Type 2 Diabetes taken at Karl Bremer District Hospital out-patient department. The objectives were: To determine glycaemic control in the study population and compare differences between age, sex and racial groups , and determine the RBG cut-off with the best sensitivity and specificity for predicting poor glycaemic control (HbA1c>7.0% ) as well as the predictive value, likelihood ratio and pre/post-test odds and probability at this cut off.
Methods: A retrospective analysis of existing hospital data and the HbA1c tests requested from the NHLS by Karl Bremer Hospital over the 2011 year period. The data was analysed by means of a receiver operating characteristic (ROC) curve analysis to determine the value of RBG with the best combination of sensitivity and specificity to predict poor control of diabetes. A p-value of < 0.05 was assumed to represent statistical significance and 95% confidence intervals were used to describe the estimation of unknown parameters. HbA1c level of < = 7% was taken as representing good control and > 7% poor control.
Results: Data was obtained on 349 diabetic patients of whom 203 (58.2%) were female and 146 (41.8%) male. This study population had a mean age of 54.7 years, mean RBG of 13.0mmol/l and mean HBA1c of 9.4%. The total number of black patients was 79 (23%), coloured patients 147 (42%) and white patients 122 (35) % and their mean RBG were 15.4 mmol/l, 12.8 mmol/l and 11.9 mol/l respectively.
There was a statistically significant correlation between increasing RBG and increasing HbA1c (p< 0.01). The best value obtained on the ROC curve was an RBG of 9.8 mmol/l, which had a sensitivity of 77% and a specificity of 75%, positive predictive value of 0.88, positive likelihood ratio 3.08 and post-test probability of 88.2% for predicting an HbA1c above 7%.
Conclusion: It was concluded that a moderate correlation exists between RBG and HbA1c in this population of diabetic patients. .The best RBG for determining poor control, defined as a HbA1c>7.0%, was found to be 9.8mmol/l and this RBG had a sensitivity of 77% , specificity of 75% and positive predictive value of 88%. Significant differences were found in pre- and post -test probability for different racial groups. Point of care testing using this level of RBG for clinical decision making will inappropriately categorise 23% of patients in this population and therefore introducing point of care testing for HbA1c is recommended.
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Dynamics of cognitive control and flexibility in the anterior cingulate and prefrontal corticesBoschin, Erica January 2013 (has links)
The body of work hereby presented aims at better defining the specific mechanisms underlying cognitive control and flexibility, and to investigate the neural substrates that might support these dynamics. More specifically, the anterior cingulate (ACC), dorsolateral prefrontal (dlPFC) and frontopolar (FPC) cortices have been proposed to play a fundamental role in monitoring and detecting the presence of environmental contingencies that require the recruitment of cognitive control (such as competition between responses in the presence of conflicting information), implementing cognitive control, and supporting higher-order cognitive processing, respectively. This thesis investigates the effects of damage to these regions, and of interference with their activity, on these processes. It also argues for the importance of dissociating possible separate cognitive control components that might differently contribute to behavioural adjustments (such as caution and attention/task-relevant processing), and provides one of the first attempts to quantify them within the parameters of a mathematical model of choice response-time, the Linear Ballistic Accumulator (LBA). The results confirm the crucial role of the dlPFC in modulating behavioural adjustments, as both damage and interference with this region’s activity significantly affect measures of conflict-induced behavioural adaptation. It is hypothesized that dlPFC might drive behavioural adjustments by encoding recent conflict history and/or supporting the automatization of a newly advantageous behavioural strategy during the early stages after a change in conflict levels. When a task does not involve competition between a habit and instructed behaviour, lesions or interference with ACC’s activity do not appear to affect behaviour in a manner that is consistent with the classic conflict-monitoring framework. It is suggested that its role might be better described as a more general monitoring and confirmatory mechanism that evaluates both actual and potential outcomes of an action, in order to proactively guide adjustments away from contextually disadvantageous responses. Finally, lesions to the FPC do not affect abstract-rule integration, but do impair the early stages of acquisition of a new abstract rule, when a previously rewarded rule stops being rewarded, and specifically when acquisition is dependent on self-initiated exploration. This suggests a role for FPC in the evaluation of multiple concurrent options in order to aid the development of new behavioural strategies.
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Rafraîchissement par la ventilation naturelle traversante des bâtiments en climat méditerranéen / Refreshments by the through natural ventilation of buildings mediterraneanFaggianelli, Ghjuvan Antone 14 November 2014 (has links)
Face à la nécessité de réduire les consommations énergétiques ainsi que les émissions de CO2 dans le secteur du bâtiment, nous voyons se succéder des réglementations thermiques de plus en plus strictes. Ainsi, en 2020, tous les bâtiments neufs devront être à énergie positive. Le recours à des stratégies passives, exploitant les ressources de l'environnement, est un point clé pour atteindre cet objectif.En climat méditerranéen, caractérisé des étés chauds et secs, la ventilation naturelle peut apporter un confort thermique acceptable si celle-ci est utilisée intelligemment. Son efficacité est cependant très dépendante des conditions météorologiques locales et peut varier grandement d'un site à l'autre. Malgré la simplicité de ce type de système, sa gestion peut également s'avérer complexe si l'utilisateur ne dispose pas d'informations suffisantes et n'est pas présent en permanence dans le bâtiment. Cela met en avant l'intérêt de disposer d'outils adaptés à son étude, ainsi que de proposer un pilotage simple et optimisé du bâtiment, basé sur le confort de l'occupant.Afin d'évaluer le potentiel de la ventilation naturelle sans avoir recours à une lourde campagne expérimentale ou à une phase de modélisation complexe, nous proposons tout d'abord des indicateurs climatiques permettant d'obtenir une première vue du site étudié.À partir d'une approche expérimentale et numérique en conditions réelles, nous nous intéressons ensuite à la problématique de la mesure dans les bâtiments ventilés naturellement et notamment à celle du débit d'air. L'instrumentation d'un bâtiment résidentiel de l'IESC, situé sur le site de l'Université de Corse et du CNRS, permet le développement et le test de différents modèles simplifiés et adaptés au cas d'étude. La partie aéraulique est traitée à l'aide d'outils statistiques tandis la partie thermique repose sur une modélisation par analogie électrique. Un cas d'application du modèle thermo-aéraulique ainsi développé est finalement proposé pour illustrer ses possibilités d'utilisation sur différents modes de gestion de la ventilation naturelle. / The need to reduce energy consumption and CO2 emissions in buildings leads to more and more stringent thermal regulations succeeding one another. In 2020, all new buildings should be positive energy buildings producing more energy than they use. Passive strategies, exploiting the resources of the environment, are a key point to meet this objective.In Mediterranean climate, characterized by hot and dry summers, natural ventilation can provide thermal comfort when used wisely. However, its efficiency is highly dependent on local weather conditions and can vary greatly from one site to another. Despite the simplicity of this type of system, its operation can be complex if the user does not have sufficient information and is not always present in the building. This shows the interest of developing appropriate tools for its study and implementing a simple and optimized control on the building, based on occupant comfort.To assess the potential of natural ventilation without the need of complex experimental measurement or modelling, we propose first of all several climate indicators which can give a first view of a site.Then, based on full-scale experimentations and numerical studies, we focus on the problem of measurement in naturally ventilated buildings with particular attention to the airflow rate. The instrumentation of a residential building at IESC (University of Corsica and CNRS) allows to develop and to test simplified models adapted to the case study. The airflow rate is obtained by statistical tools and the thermal model is based on an electrical analogy. Finally, an application of the coupled thermal and airflow model is proposed to highlight its possibilities on different natural ventilation control modes.
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Desenvolvimento de apalpador de contato elétrico (\"touch trigger probe\") para atuação no processo de torneamento / Devefopment of a low cost touch trigger probe for CNC lathesDel Guerra, Marcelo 21 September 2004 (has links)
A utilização dos apalpadores acoplados a máquinas CNC se tornou uma realidade muito comum no mundo atual, principalmente devido à diminuição do tempo de preparação e possibilidades de realização de medições na própria máquina-ferramenta. Porém, ainda existem algumas barreiras a se transpor, como por exemplo, a dificuldade de programação, custo relativamente elevado e pouca literatura que trata exclusivamente a respeito da utilização dos apalpadores para medição nas máquinas-ferramentas. Nesse trabalho é realizada uma revisão bibliográfica sobre o uso dos apalpadores em ambiente industrial, discutindo-se as tecnologias utilizadas na geração do sinal de \"trigger\" e é proposto um novo modelo de apalpador de contato elétrico, de baixo custo, desenvolvido especialmente para atender as necessidades de medições em tornos CNC. Os testes em laboratório revelaram que a repetibilidade do protótipo construído foi de 0,003 mm dentro de uma confiabilidade de mais ou menos 3 \'sigma\' ou 99,73%. Concluiu-se que tais características são altamente compatíveis com os requisitos necessários para a maioria dos processos de torneamento. / The use of touch trigger probes attached to CNC machines has become a world standard, especially due the reduction of setup time and the ability to promote work piece measurements on machine. However, some barriers like measurement routines programming difficulties, high costs of these equipments and the low number of technical literature about this subject, still need to be transposed. This work presents a review on the applications of touch trigger probes on companies shop floor, discussing the nowadays technologies used to generate the trigger signal. A new touch trigger probe model based on a simple electrical contact is specially developed to provide the measuring characteristics required for Lathes, with the needed characteristics and low cost. The tests of the probe developed in the laboratory shown a repeatability of 0,003 mm (more and less 3 \'sigma\' or 99,73%). Those characteristics are high compatible with the most needs of the industry.
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Sistema de monitoramento remoto e controle de microrrede híbrida isoladaTiggemann, Henrique 09 October 2015 (has links)
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Previous issue date: 2015-10-09 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / PROSUP - Programa de Suporte à Pós-Gradução de Instituições de Ensino Particulares / A busca de novas alternativas para o suprimento de energia elétrica em comunidades isoladas sempre foi um desafio motivacional tanto de âmbito cientifico quanto social. Busca-se uma solução robusta, que consiga suprir a demanda solicitada da melhor forma possível e com o menor impacto ambiental. São apresentados neste trabalho a caracterização e o desenvolvimento de uma microrrede híbrida fotovoltaica, conectada a um simulador de carga experimental com suporte a acesso remoto. A microrrede é constituída de quatro módulos fotovoltaicos de duas tecnologias, mono e multicristalino, totalizando 570 W pico de potência e com capacidade máxima de suprir um conjunto de cargas de até 1 kW em tensão alternada de 220 V. Também faz parte da microrrede um banco de estocagem inicial de energia de 200 Ah com tensão nominal de 24 V, formado por baterias seladas associadas em série/paralelo e um quadro de comando onde fica situado o controlador Arduíno e demais componentes de conversão de energia. Para avaliar a microrrede em dias que o banco de estocagem estiver em nível mínimo, foi utilizada a rede da concessionária simulando uma fonte alternativa de energia, que pode ser pilha combustível, gerador a diesel, etc. Foi observado por meio de medições elétricas obtidas pelo sistema de aquisição que a microrrede está funcionando adequadamente. As cargas conectadas nesta microrrede são alimentadas segundo um perfil de funcionamento preestabelecido no projeto, com consumo diário de 962 Wh. Este perfil foi construído segundo um número de horas diárias para o funcionamento de cada carga da residência, podendo ser modificado pelo usuário visando uma economia de energia. A interrupção das cargas não prioritárias pode ser também realizada a distância. O sistema é monitorado e gerenciado através de um controlador Arduíno, e o acesso remoto realizado através de um computador conectado à rede de dados (internet). Tal acesso remoto permite visualizar o comportamento elétrico e energético da microrrede além de possibilitar a utilização do sistema para experimentos técnicos e implementação de novas ações de controle à distância. A microrrede está instalada no prédio C02 da UNISINOS. / The search for new alternatives for energy supply in island communities has always been a motivational challenge in the scientific and societal context. The aim is a robust solution which is able to meet the demand requested in the best way as possible and with the least environmental impact. Is being presented in this work the characterization and the development of a hybrid photovoltaic microgrid, connected to an experimental load simulator that supports remote access. The microgrid consists of four photovoltaic modules of two technologies, monocrystalline and multicrystalline totaling 570 W peak power and capacity to supply loads of up to 1 kW with alternating voltage of 220 V. Is also part of the microgrid an initial storage power bank of 200 Ah with a nominal voltage of 24 V, consisting of sealed batteries linked in series / parallel, and a control panel where the Arduino controller is located and other power conversion components. To assess the microgrid in days of the storage bank is at minimum, the power line grid was used to simulate an alternative source of energy, which can be fuel cell, diesel generator, etc. Has been observed through electrical measurements obtained by the acquisition system that the microrrede is working properly. Loads connected in this microgrid are powered according to operating profile predetermined in the project, with daily consumption of 962 Wh. This profile has been built according to a number of daily hours of operation of each residence load and can be modified by the user aiming energy savings. The interruption of non-priority loads can also be performed virtually. The system is monitored and managed through an Arduino controller, and remote access done through a computer connected to the data network (internet). Such remote access allows viewing the electrical and energetic behavior of the microrrede besides enabling the use of the system for technical experiments and implementing new distance control actions. The microgrid is installed on the C02 building at UNISINOS.
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Proposta de modelo para estruturação de centros de controle integrados em cidades médias / Model proposal for structuring of Integrated Control Centers (ICC) in medium-sized citiesBruhn, Jessie Carvalho January 2017 (has links)
As cidades, notadamente aquelas identificadas como de porte médio, acabam absorvendo mudanças de qualidade e passam a centralizar atividades econômicas. Se, por um lado, a urbanização traz oportunidades para o desenvolvimento social e econômico, de outro, resulta em significativa perda nas funcionalidades básicas e exerce pressão sobre as infraestruturas e recursos naturais. As Tecnologias da Informação e Comunicação (TIC) surgem como aliadas no enfrentamento a estes desafios. Baseadas no uso das TIC, iniciativas de Cidades Inteligentes exploram a instrumentalização das infraestruturas da cidade. Na tentativa de unificar a gestão dos diversos aspectos das cidades, por meio do monitoramento e análise em tempo real de dados públicos, diversas capitais estaduais do Brasil já contam com o suporte de centros de controle integrados. Dado o exposto, o presente trabalho propõe um modelo para a estruturação de Centros de Controle Integrados (CCI), compatíveis com a realidade de municípios de médio porte. Para tanto, por meio da revisão da literatura e de uma entrevista junto ao Centro Integrado de Comando da Cidade de Porto Alegre (CEIC), realizou-se o levantamento das melhores práticas a respeito da implantação de centros de controle. Complementarmente, entrevistaram-se os responsáveis de quatro prefeituras municipais para a determinação dos modelos de controle instituídos em cidades de médio porte. Para fins de validação, deu-se a avaliação do modelo por três especialistas da área de estudo. O modelo proposto – composto pelas dimensões de (i) coordenação, (ii) design, (iii) gerenciamento, (iv) comunicação, (v) práticas e rotinas de trabalho e (vi) processamento e gerenciamento de evidências, resulta do cruzamento destas informações e contribui, como ferramenta de gestão, para o desenvolvimento estruturado das cidades de médio porte. / The cities, especially those identified as medium-sized cities, end up absorbing quality changes and begin to centralize economic activities. If, on the one hand, urbanization brings opportunities for social and economic development, on the other hand, it results in a significant loss of basic functionalities, jeopardizing infrastructure and natural resources. In this way, Information and Communication Technologies (ICT) emerge as an alliy in face of these challenges. Based on the use of ICT, Smart Cities initiatives explore the instrumentalization of the city's infrastructures. In an attempt to unify the management of the various aspects of cities through real-time monitoring and analysis of public data, several state capitals in Brazil already rely on the support of Integrated Control Centers. Thus, the present work proposes a model for structuring the Integrated Control Centers (ICC), compatible with the reality of medium-sized municipalities. Through a literature review and an interview with the Centro Integrado de Comando of Porto Alegre (CEIC), the best practices regarding the implementation of control centers were surveyed. Complementarily, the heads of four city halls were interviewed to determine the control models established in medium-sized cities. Furthermore, the model was also assessed by three specialists in the study area. The proposed model - composed by the dimensions of (i) coordination, (ii) design, (iii) management, (iv) communication, (v) practices and work routines and (vi) processing and management of evidence, results from the cross-referencing of this information and contributes as a management tool to the structured development of medium-sized cities.
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Evaluation of health-related outcomes following a self-management program for older people with heart failureShao, Jung-Hua January 2008 (has links)
Background. Heart failure (HF) which is a chronic, disabling disorder is mainly found in older people and is one of the leading causes of hospitalisation and readmission around the world. Unfortunately, the mortality and morbidity rates for HF remain high. HF is a complex combination of symptoms which are related to an inadequate perfusion of the body tissues caused by fluid and sodium retention. Hence, enhancing HF patients’ self-efficacy to change their behaviours to perform fluid & sodium control is one of the most important issues for the management of HF. A self-management program has the potential to raise self-efficacy and self-care which is a method to improve health for those with chronic illness and to decrease patients’ health service utilisation and also to enhance these patients’ health status. Aim. The study aims to examine the effectiveness of a self-management program, based on self-efficacy theory, in older people with heart failure in Taiwan. Methods. An experimental design was used to examine the effectiveness of a self-management program on diet and fluid control among HF patients. A total of 93 subjects from two medical centres in Taiwan were randomly assigned to the intervention and control groups. In order to examine the effectiveness of self-management, data were collected at baseline, week 4, and week 12 using the following instruments: self-efficacy for salt and fluid control, HF self-management behaviour, HF related symptoms, and body weight. Moreover, health service utilisation and patient’s evaluation of care received were collected on all patients for the 12 weeks prior to commencing the study and for the 12 week study period. Demographic and disease information was also collected including age, gender, marital state, education, and New York Heart Association (NYHA) functional classification. A structured, individualized self-management training program created by the investigator was implemented for the intervention group through home visits and telephone follow-ups. This program emphasized self-monitoring of diet control and body weight for the self-management of heart failure. The purpose was to improve patients’ self-efficacy in their diet control behaviour. The “diet control” in this study focussed on sodium and fluid restriction. Outcome measures were analysed using the Statistical Package for the Social Sciences (SPSS) 15.0 version, and the level of significance (á) was set at 0.05 for statistical analysis. Results. There were differences for older Taiwanese HF patients’ self-efficacy for salt and fluid control, self-management behaviour, and HF related symptoms for participants who received a self-management intervention compared to those who did not. However, there were no significant differences between the two groups in weight and health serves utilization (p>.001). Conclusion. The self-management program had a positive impact on the improvement of self-efficacy for salt and fluid control, HF related self-management behaviours and symptoms in older Taiwanese with HF. This program may bridge the gap between theory and practice. Health care providers need to provide older people in Taiwan with HF the appropriate skills for self-managing their condition and thereby promoting their health status. These patients with HF and their caregivers have to receive individualized education that emphasizes self-efficacy in the self-management of their disease, thus improving their quality of life.
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The effect of pressure differential and provider movement on isolation room containment efficiencyAdams, Noah John. January 2008 (has links) (PDF)
Thesis--University of Oklahoma. / Bibliography: leaves 50-53.
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Proposta de modelo para estruturação de centros de controle integrados em cidades médias / Model proposal for structuring of Integrated Control Centers (ICC) in medium-sized citiesBruhn, Jessie Carvalho January 2017 (has links)
As cidades, notadamente aquelas identificadas como de porte médio, acabam absorvendo mudanças de qualidade e passam a centralizar atividades econômicas. Se, por um lado, a urbanização traz oportunidades para o desenvolvimento social e econômico, de outro, resulta em significativa perda nas funcionalidades básicas e exerce pressão sobre as infraestruturas e recursos naturais. As Tecnologias da Informação e Comunicação (TIC) surgem como aliadas no enfrentamento a estes desafios. Baseadas no uso das TIC, iniciativas de Cidades Inteligentes exploram a instrumentalização das infraestruturas da cidade. Na tentativa de unificar a gestão dos diversos aspectos das cidades, por meio do monitoramento e análise em tempo real de dados públicos, diversas capitais estaduais do Brasil já contam com o suporte de centros de controle integrados. Dado o exposto, o presente trabalho propõe um modelo para a estruturação de Centros de Controle Integrados (CCI), compatíveis com a realidade de municípios de médio porte. Para tanto, por meio da revisão da literatura e de uma entrevista junto ao Centro Integrado de Comando da Cidade de Porto Alegre (CEIC), realizou-se o levantamento das melhores práticas a respeito da implantação de centros de controle. Complementarmente, entrevistaram-se os responsáveis de quatro prefeituras municipais para a determinação dos modelos de controle instituídos em cidades de médio porte. Para fins de validação, deu-se a avaliação do modelo por três especialistas da área de estudo. O modelo proposto – composto pelas dimensões de (i) coordenação, (ii) design, (iii) gerenciamento, (iv) comunicação, (v) práticas e rotinas de trabalho e (vi) processamento e gerenciamento de evidências, resulta do cruzamento destas informações e contribui, como ferramenta de gestão, para o desenvolvimento estruturado das cidades de médio porte. / The cities, especially those identified as medium-sized cities, end up absorbing quality changes and begin to centralize economic activities. If, on the one hand, urbanization brings opportunities for social and economic development, on the other hand, it results in a significant loss of basic functionalities, jeopardizing infrastructure and natural resources. In this way, Information and Communication Technologies (ICT) emerge as an alliy in face of these challenges. Based on the use of ICT, Smart Cities initiatives explore the instrumentalization of the city's infrastructures. In an attempt to unify the management of the various aspects of cities through real-time monitoring and analysis of public data, several state capitals in Brazil already rely on the support of Integrated Control Centers. Thus, the present work proposes a model for structuring the Integrated Control Centers (ICC), compatible with the reality of medium-sized municipalities. Through a literature review and an interview with the Centro Integrado de Comando of Porto Alegre (CEIC), the best practices regarding the implementation of control centers were surveyed. Complementarily, the heads of four city halls were interviewed to determine the control models established in medium-sized cities. Furthermore, the model was also assessed by three specialists in the study area. The proposed model - composed by the dimensions of (i) coordination, (ii) design, (iii) management, (iv) communication, (v) practices and work routines and (vi) processing and management of evidence, results from the cross-referencing of this information and contributes as a management tool to the structured development of medium-sized cities.
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An evaluation of UK sheep farmers' attitudes and behaviours towards sustainable roundworm controlJack, Corin Malcolm January 2018 (has links)
One of the major constraints limiting the efficiency of sheep production is the control of gastrointestinal nematode parasites. Parasite control by strategic use of anthelmintics is threatened by the emergence of nematode populations that are resistant to the drugs available. It is therefore increasingly apparent that steps toward maintaining sustainable productivity in the growing face of anthelmintic resistance (AR) is required by farmers. To facilitate the uptake of sustainable approaches to parasite management, a comprehensive understanding of the various factors that may influence farmers’ decision-making processes is required. In order to establish which factors are influential, and determine their impact on farmers’ roundworm control behaviours, both qualitative and quantitative research methods were used including focus groups as well as attitudinal and behavioural questionnaires. A retrospective analysis was initially conducted of historical surveys designed to identify farm specific characteristics and parasite management practices including anthelmintic usage. The objectives of the analysis were to identify factors associated with uptake of best practice advice including farm characteristics and information sourcing. In addition, the implementation of sustainable roundworm control practices was investigated using two surveys conducted in 2000 and 2010. Logistic regression models were applied for univariable and multivariable analysis of dependent and independent variables. The next step was to conduct a series of focus groups in different geographic regions of Scotland. The main purposes were to explore sheep farmers’ attitudes towards different aspects of roundworm management, as well as to identify potential motivators and barriers to uptake of sustainable parasite control practices. The findings aided in the development of an attitudinal questionnaire used to canvass opinions representative on a national level. The concluding study involved a telephone survey of 400 Scottish sheep farmers, designed to elicit attitudes regarding roundworm control, AR and sustainable roundworm control practices. A quantitative statistical analysis technique (Structural Equation Modelling) was then used to test the relationships between socio-psychological factors and the uptake of sustainable roundworm control practices. The analysis of historical questionnaire data demonstrated evidence of a shift towards the use of practices to reduce the rate of AR development, most notably a decline in the practice of ‘dose and move’ as well as an overall reduction in treatment frequency. Statistical analysis identified significant associations between farm characteristics and specific treatment strategies. For example, larger farms were more likely to adopt a set treatment regimen (P=0.036), compared with smaller farms, which were more likely to treat based on clinical signs of infection (P=0.021). Sourcing of roundworm control information primarily from veterinarians was most associated with treatment timings with no parallels between time points. From the qualitative focus group studies conducted we identified four overarching themes impacting on sheep producers’ attitudes to roundworm control and best practice advice. These themes comprised: a lack of perceived need to change, the complexity of advice, the ease of implementation of recommended practices and the effectiveness of extension approaches. Additionally, the most important and implementable guidelines identified by sheep farmers were: ‘working out a roundworm control strategy with an advisor’ and ‘administering anthelmintics effectively’ with regard to correct drenching practice i.e. appropriate dosing, administration and drug storage procedures. These findings exhibited similarities with veterinarians’ rankings with also, ‘testing for AR’, ‘preserving susceptible parasites’ and ‘reducing dependence on anthelmintics’ receiving the lowest rankings for importance and implementability. The quantitative analysis from the attitudinal/behavioural questionnaire identified eleven factors with significant influences on the adoption of sustainable roundworm control practices. The key influences on overall adoption were farmers’ baseline understanding about roundworm control and self-reported confirmation of anthelmintic resistance in their flock. Additional positive influences included, positive attitudes to veterinary services, enterprise type and perceived risk of AR. Factors that were shown to have the greatest relative effects on individual parasite control practices included; the perceived resource requirements for implementing a quarantine strategy, farmers’ AR suspicions for instigating AR testing and the confirmation of AR for adopting faecal egg count monitoring. The findings have highlighted several factors which can influence sheep farmers’ decisions to reject or adopt recommended roundworm control practices. It is evident that the perceived complexity, lack of need and practicality of the current recommendations necessitates changes to how extension is designed and disseminated to farmers. The findings also suggest that improving farmers’ acceptance and uptake of diagnostic testing and improving underlying knowledge and awareness about nematode control is a significant target to influencing adoption of best practice behaviours. The importance of veterinarians as highly-trusted information resources validates the need for further engagement with veterinarians concerning sustainable parasite control approaches, to facilitate collaboration with farmers. The need for interaction between farmers and their advisors is key to resolving the issues raised to enable the necessary explanation, justification and execution of recommended practices to suit farmers’ needs and farming conditions.
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