Administrative Intervention Research Articles

Staff and patient accounts of PRN medication administration and non-pharmacological interventions for anxiety.

Most psychiatric inpatients will receive psychotropic PRN medication during their hospital stay for agitation, anxiety, and/or insomnia. While helpful in some cases, caution is warranted with regard to PRN use due to inherent risks of additional medication; therefore, experts advise that non-pharmacological interventions should be attempted first where indicated. However, research to date highlights that, in practice, non-pharmaceutical approaches are attempted in a minority of cases. While some information is known about the practice of PRN administration and the use of and barriers to implementing non-pharmacological interventions for treating acute psychiatric symptoms, full understanding of this practice is hampered by poor or altogether missing documentation of the process. This study used interviews with patients and staff from two psychiatric hospitals to collect first-person accounts of administering PRN medication for anxiety, thereby addressing the limitations of relying on documented notation found in previous research. Our results indicate that nurses are engaging in non-pharmacological interventions more often than had previously been captured in research. However, the types of strategies suggested are not typically evidence based and further, only happening approximately half the time. The barriers to providing such care are centred on two main beliefs about client choice and efficacy of these non-medical strategies. Implications for research and practice are discussed.

A Community-Directed Integrated Strongyloides Control Program in Queensland, Australia.

This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven ‘treat-and-test’ mass drug administration (MDA) intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested) that resulted in increased morbidity and at least one death in the community. Between 2004–2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the ‘treat-and-test’ intervention was 16.6% [95% confidence interval 14.2–19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis, the community also takes pride in having developed and implemented this program. This appears to be the first community-directed S. stercoralis control program in Australia, and is an important part of the national story of controlling infectious diseases in Indigenous communities.

Governance Effects of Minority Shareholders under the Internet Environment: From a Perspective of Agency Cost

Governance Effects of Minority Shareholders under the Internet Environment: From a Perspective of Agency Cost

Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review

BackgroundEmergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among firefighters and other emergency responders. Though there are numerous strategies and interventions to prevent ESVIs, the evidence base for these strategies is limited and dispersed. The goal of this study was to gather and present a review of evidence-based ESVI interventions. MethodsWe searched five academic databases for articles published within the last decade featuring interventions to reduce or prevent ESVIs. We interviewed key informants from fire departments serving major metropolitan areas for additional interventions. Interventions from both sources were summarized and data on intervention effectiveness were reported when available. ResultsSixty-five articles were included in the final review and 17 key informant interviews were completed. Most articles focused on vehicle engineering interventions (38%), followed by policy and administration interventions (26%), environmental engineering interventions (19%) and education or training (17%). Most key informants reported policy (49%) and training interventions (29%). Enhanced drivers’ training and risk management programs were associated with 19–50% and 19–58% reductions in ESVIs, respectively. ConclusionsOnly a limited number of interventions to address ESVIs had adequate outcome data. Based on the available data, training and risk management approaches may be particularly effective approaches to reducing ESVIs.

Does Bitcoin bubble burst?

This paper explores when will occur and collapse in Bitcoin bubbles by applying generalized sup augmented Dickey–Fuller test method proposed by Phillips et al. (Testing for multiple bubbles: historical episodes of exuberance and collapse in the S&P 500. Singapore Management University, Working Paper, No. 04-2013, 2013). The results show that there are six explosive bubbles in China and five bubbles in U.S. market, mostly occur in the period of huge surges in Bitcoin price. This is consistent with the bubble model originated by Blanchard and Watson (Bubbles, rational expectations and financial markets. NBER Working Paper, No. 945 1982) that certain asset price is decomposed into fundamental and the bubble components. In particular, exogenous shocks, including foreign or domestic economic events lead to the origination of bubbles. Serious financial crisis may trigger long-term and large- scale bubbles, while relative not persistence (short-term) bubbles are caused by domestic particular components. It can be inferred that Bitcoin can be used as a hedge against market specific risk. Finally, Bitcoin bubbles would collapse due to the administrative intervention by economic authorities. Thereby, government should lead public expectation to keep the confidence to authority and reduce the speculation behavior to stabilize the asset price and financial market.

Regulated multi-sited practice for physicians in China: incentives and barriers

Abstract The multi-sited practice (MSP) policy in China is expected to exert found implications upon uneven distribution of high-quality medical resources, coupled with the widespread phenomenon of physician’s informal practices on multiple sites. Since 2009, the Chinese government has upheld a policy that allows medical doctors to take on secondary jobs for the purpose of encouraging talented physicians to work in medical institutions and underdeveloped areas where their expertise is badly needed. This paper focuses on the MSP policy in China by examining how it has been implemented at the national and provincial levels through a review of government documents, statistical information, academic papers, and newspaper accounts. Despite the MSP policy is to offer incentive to physicians at first-tier public hospitals to work in primary care centers or areas where their expertise, the evidence is hard to find. This paper identifies several outstanding challenges to the MSP policy : (1) The importance of the MSP policy which is made by the central government is perceived differently at the provincial level by health officials and hospital administrators; (2) Interest in implementing the policy varies among physicians and hospitals; (3) Concerns about quality control and legal responsibilities for medical doctors to take on secondary jobs are widespread. China’s MSP policy differs from the “dual practice” policy in many countries because of its top-down approach, with its emphasis on government’s role and administrative intervention. This paper’s findings may be useful for other developing countries where medical expertise is unevenly distributed due to market forces. On the special occasion of the Alma Ata Declaration’s 40th anniversary and for the sake of promoting Universal Health Coverage, this paper also aims at sharing with other countries China’s experience in trying to develop an adequate force of primary care professionals. At the end of this paper, a four-point proposal is made for policy makers in China.

Regulation of Prostitution in the Netherlands: Liberal Dream or Growing Repression?

This paper focuses on the regulation of prostitution in the Netherlands from the twentieth century onward. It aims to provide a full description of the Dutch position on prostitution through the interpretation and explanation of current Dutch prostitution policy. This will be achieved by analyzing the legal narratives that substantiate the legal rules provided in both Dutch criminal and administrative law concerning the regulation of prostitution. We analyze the Dutch prostitution legislation of the past, present, and future, using a newly developed analytical framework. Using this framework, we reconstruct the legislator’s attitude towards prostitution using insights from previous theoretical work on prostitution and using models aimed at regulating this phenomenon that range from a total ban to full decriminalization. In our analysis, we also use the legitimating grounds for application of criminal law developed by Feinberg. These grounds are also used in this paper to interpret the administrative intervention in prostitution. This paper reveals a paradox: The idea of a liberal dream goes hand-in-hand with growing repression of freedom in the Dutch prostitution sector.

Cost-effectiveness analysis of a school-based dental caries prevention program using fluoridated milk in Bangkok, Thailand

BackgroundThis study modelled the cost-effectiveness, from a societal perspective, of a program that used fluoridated milk to prevent dental caries in children who were 6 years old at the beginning of the program, versus non-intervention, after 6 years.MethodsAfter 6 years, children in the milk-fluoridation program had a significant (34%) reduction in dental caries experience compared to those in the comparison community (i.e., received school milk without added fluoride) (DMFS: 1.06 vs. 1.60).ResultsThis improvement was achieved with an investment of Thailand Baht (THB) 5,345,048 over 6 years (or THB 11.88 per child, per year) (1 US$ = THB(2011) 30.0). When comparing the costs of the operation of the program and dental treatment in the test community with those of the comparison community, the program resulted in a net societal savings of THB 8,177,179 (range 18,597,122 to THB 7,920,711) after 6 years. This investment would result in 40,500 DMFS avoided in a community with a childhood population of 75,000 [DMFS avoided: 75,000 x (− 0.54)].ConclusionsWhile the analysis has inherent limitations due to its dependence on a range of assumptions, the results suggest that, from a societal perspective, when compared with the non-intervention group, the Bangkok Metropolitan Administration intervention appeared to be a more cost-efficient option than current standard oral health care.

Abstract TP270: Stroke Code Simulation for Neurology and Emergency Medicine Residents

Background: Simulation-based learning has improved medical knowledge, proficiency and performance. The treatment window for acute stroke is limited, making preparedness exceedingly critical. We aimed to assess improvement in performance in first responders to ‘stroke codes’, namely junior Neurology and Emergency Medicine (EM) residents. EM residents were included because EM physicians often make tPA decisions at peripheral and non-academic hospitals. Methods: 14 Neurology and 10 EM residents participated at Upstate Medical University, Syracuse, New York. The simulation consisted of senior Neurology residents playing the roles of stroke patient, CT technician and radiologist, nurse, pharmacist and the stroke fellow on-call. The simulation included the time from patient arrival to acute stroke treatment. Each junior Neurology and EM resident completed this simulation, while the rest of the group observed. Cases included stroke mimics, strokes with large vessel occlusions, dissections, cases ineligible for acute intervention, intracerebral and subarachnoid hemorrhages, basilar thrombosis, wake-up strokes, seizure at onset and dissections. Participants reviewed non-contrast CT head, EKG and CT angiography of the head and neck to make decisions about tPA administration and endovascular interventions. This was followed by a debriefing session by the attending and chief residents. Participants filled a pre-and post-simulation graded questionnaire on medical knowledge and confidence (range 0-25, with higher scores reflecting higher performance). Results: The mean score was 18 (range 14-23) pre-simulation and 22 (range 18-25) post-simulation for Neurology residents and 14 (range 8-24) pre-simulation and 18 (range 10-23) post-simulation for EM residents. For all residents, pre-and post-median score was 17 and 19 (Wilcoxon signed-rank test p<0.0001). Conclusion: Because running an effective stroke code requires coordination and rapid analysis, stroke simulation is an effective way of improving knowledge and confidence among residents and should be integrated into the Neurology and EM residency curriculum.

International Scope of Emergency Ultrasound: Barriers in Applying Ultrasound to Guide Central Line Placement by Providers in Nairobi, Kenya.

Background While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US. Objective We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment. Methods Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine previous experience and perceived barriers. Survey responses were analyzed using summary statistics and the Rank-Sum test based on different specialty, gender, and previous US experience. Results There were 23 physicians who completed the course and the survey. 52% (95% CI: 0.30–0.73) had put in >20 CVCs. 21.7% (95% CI: 0.08–0.44) of participants had previous US training, but none in the use of US for CVC insertion. The respondents expressed agreement with statements describing the ease of the use and improved success rate with US guidance. There was less agreement to statements describing the relative convenience and cost effectiveness of US CVC placement compared to the landmark technique. The main perceived barriers to utilization of US guidance included lack of training and limited availability of US equipment and sterile sheaths. Conclusion Perceived barriers to US-guided CVC placement in our population closely mirrored those found among North American physicians, including lack of training and limited availability of US machines and equipment. These barriers have the potential to be addressed by targeted educational and administrative interventions.

The Causes of Late Coming among High School Students in Soshanguve, Pretoria, South Africa

Late coming to school has become a major problem in many schools, particularly township schools with serious consequences. Current research has demonstrated that many schools in South Africa are performing badly due to inefficient use of the teaching and learning time. In this article, we argue that while major administrative interventions are undertaken to improve the quality of learning and teaching, it seems that very little attention is paid to late-coming. Late-coming has become a cancer that saps away big interventions and strays the performance of selected township schools in a different direction. The purpose of this research is to investigate the causes of late-coming among high school students in selected secondary schools of Shoshanguve. A qualitative approach was used to draw data from high school students in selected secondary schools of Shoshanguve. The findings reveal that late-coming is common among learners in selected secondary schools of Shoshanguve. It happens every day for varying reasons. We recommended practical solutions ranging from administrative improvement to learner behavioural change.

Factors Contributing to Social Risk Management in China: Evaluation in the Context of SSRA Initiative

Managing social risk has become a policy concern in contemporary public administration. In China, the Social Stability Risk Assessment (SSRA) was conceived as a government-driven and performance-based system to tackle the challenges of social instability, with the last decade witnessing an increasing imperative to promote its implementation. In practice, local administrations have asserted the importance of social risk management in improving the capability of handling uncertainties, yet studies on SSRA effectiveness are relatively limited. To fill the gap, this paper examines factors for mobilizing local administrators in implementing effective SSRA enforcement through a framework constructed from the perspective of government agencies. Using field survey data collected from four provincial regions, we refined five theoretical constructs and affiliated thirty-five items critical for SSRA operational effectiveness, and found that administrative intervention by the local government plays a crucial role. This study contributes to an understanding of China's social risk management practice, and offers assessment criteria to monitor its effectiveness in public administration.

Establishment and evaluation of a theater influenza monitoring platform

BackgroundInfluenza is an acute respiratory infectious disease with a high incidence rate in the Chinese army, which directly disturbs military training and affects soldiers’ health. Influenza surveillance systems are widely used around the world and play an important role in influenza epidemic prevention and control.MethodsAs a theater centers for disease prevention and control, we established an influenza monitoring platform (IMP) in 2014 to strengthen the monitoring of influenza-like illness and influenza virus infection. In this study, we introduced the constitution, influenza virus detection, and quality control for an IMP. The monitoring effect was also evaluated by comparing the monitoring data with data from national influenza surveillance systems. The experiences and problems associated with the platform also were summarized.ResultsA theater IMP was established based on 3 levels of medical units, including monitoring sites, testing laboratories and a checking laboratory. A series of measures were taken to guarantee the quality of monitoring, such as technical training, a unified process, sufficient supervision and timely communication. The platform has run smoothly for 3 monitoring years to date. In the 2014–2015 and 2016–2017 monitoring years, sample amount coincided with that obtained from the National Influenza Surveillance program. In the 2015–2016 monitoring year, due to the strict prevention and control measures, an influenza epidemic peak was avoided in monitoring units, and the monitoring data did not coincide with that of the National Influenza Surveillance program. Several problems, including insufficient attention, unreasonable administrative intervention or subordination relationships, and the necessity of detection in monitoring sites were still observed.ConclusionsA theater IMP was established rationally and played a deserved role in the prevention and control of influenza. However, several problems remain to be solved.

EFFECTIVENESS OF A MEDICATION BOOKLET AND COUNSELING ON TREATMENT ADHERENCE IN TYPE 2 DIABETES MELLITUS PATIENTS

Objective: This study aimed to evaluate the effectiveness of counseling and the use of a medication booklet on the level of treatment compliancethrough reduced levels of glycated hemoglobin (HbA1C) and Morisky Medication Adherence Scale (MMAS-8) scores in patients with type 2 diabetesmellitus.Methods: This pre-experimental prospectively study was conducted at Dr. Adjidarmo General Hospital, KabupatenLebak, Banten Province, Indonesia.The study sample consisted of 30 type 2 diabetic patients who met the inclusion and exclusion criteria and who underwent a counseling interventionsession and received a medication booklet. Compliance was measured against the MMAS-8 scores and HbA1C levels before the intervention and after10 weeks of administration of counseling and receipt of the booklet).Results: The MMAS-8 scores before and after the intervention were 2.63±1.50 and 0.7±1.18, respectively. The HbA1C levels before and after theintervention were 11.31±2.95 and 8.12±2.79, respectively. The measurement results for MMAS-8 and HbA1C were analyzed using the Wilcoxon test.Conclusions: The analysis showed a significant difference (p<0.001) between the HbA1Cvalues and MMAS-8 scores before and after the intervention.Therefore, this study’s finding indicate that the provision of counseling and an informational booklet can improve type 2 diabetes mellitus patientcompliance with treatment.

Beat-by-Beat Estimation of the Left Ventricular Pressure-Volume Loop Under Clinical Conditions.

This paper develops a method for the minimally invasive, beat-by-beat estimation of the left ventricular pressure-volume loop. This method estimates the left ventricular pressure and volume waveforms that make up the pressure-volume loop using clinically available inputs supported by a short, baseline echocardiography reading. Validation was performed across 142,169 heartbeats of data from 11 Piétrain pigs subject to two distinct protocols encompassing sepsis, dobutamine administration and clinical interventions. The method effectively located pressure-volume loops, with low overall median errors in end-diastolic volume of 8.6%, end-systolic volume of 17.3%, systolic pressure of 19.4% and diastolic pressure of 6.5%. The method further demonstrated a low overall mean error of 23.2% predicting resulting stroke work, and high correlation coefficients along with a high percentage of trend compass 'in band' performance tracking changes in stroke work as patient condition varied. This set of results forms a body of evidence for the potential clinical utility of the method. While further validation in humans is required, the method has the potential to aid in clinical decision making across a range of clinical interventions and disease state disturbances by providing real-time, beat-to-beat, patient specific information at the intensive care unit bedside without requiring additional invasive instrumentation.

Urban planning in vernacular governance: Land use planning and violations in Bangalore, India

This paper examines the relationship between urban planning practice and planning violations in Bangalore. Through ethnography of the practice of planning networks, It demonstrates that the domain of urban planning in Bangalore is shaped by the ethos and practices of mutually contesting Public and Private interest associational networks working to achieve Public and Private interest outcomes respectively. This is demonstrated using ho w private interest networks shape planning through plan violations and planning for violations as well as how public interest networks shape planning through multiple political, legal and administrative interventions, both of which together prevents the formation of any ideal typical planning system for a Comprehensive Master Planning Regime. Rather than a deviation, violations are identified as the outcome of the particular kind of planning practice embedded within the political culture of democratic governance in India. Ethnographies of Indian state constantly points to the blurred boundaries between the categories of state and society in India. Findings from this research conform to this; actors from both inside and outside government rather than act to achieve the cause of their positions act in the interest of the networks within which they are associated with – public or private interest. Therefore, combining lessons from political systems and policy networks studies of the state and governance with ethnographies of the everyday state in India I propose a conceptual language of Vernacular Governance to trace the constantly changing shape of planning practice in Bangalore through its relationship with planning violations. This paper attempts to raise questions on theorizing planning practices as embedded within the political culture of particular contexts, rather than taking for granted dualist conceptualizations of state and society producing on the one hand theorizations of planning failures and on the other, informality, implementation failure and corruption.

A Security Monitoring Framework For Virtualization Based HEP Infrastructures

High Energy Physics (HEP) distributed computing infrastructures require automatic tools to monitor, analyze and react to potential security incidents. These tools should collect and inspect data such as resource consumption, logs and sequence of system calls for detecting anomalies that indicate the presence of a malicious agent. They should also be able to perform automated reactions to attacks without administrator intervention. We describe a novel framework that accomplishes these requirements, with a proof of concept implementation for the ALICE experiment at CERN. We show how we achieve a fully virtualized environment that improves the security by isolating services and Jobs without a significant performance impact. We also describe a collected dataset for Machine Learning based Intrusion Prevention and Detection Systems on Grid computing. This dataset is composed of resource consumption measurements (such as CPU, RAM and network traffic), logfiles from operating system services, and system call data collected from production Jobs running in an ALICE Grid test site and a big set of malware samples. This malware set was collected from security research sites. Based on this dataset, we will proceed to develop Machine Learning algorithms able to detect malicious Jobs.

Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis.

This study aimed to assess the effects of perioperative dexmedetomidine as an adjuvant to tonsillectomy compared with opioid or sham in children. Five databases (PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) were searched from inception of article collections to April 2017. Prospective, randomized controlled studies that compared outcomes between children who underwent tonsillectomy plus dexmedetomidine administration (intervention) and children who underwent tonsillectomy with placebo or opioid (control) were systemically and independently reviewed by two researchers. The outcomes of interest were emergence agitation, postoperative pain intensity, rescue analgesic consumption, and other morbidities (nausea and vomiting and agitation). Fifteen studies with n = 1,552 met the inclusion criteria. Postoperative pain scores and the need for analgesics in the postanesthesia care unit (PACU) were significantly decreased in the dexmedetomidine group versus the control group. The incidence and degree of agitation and desaturation incidence in the PACU also were significantly lower in the dexmedetomidine group than in the control group. Additionally, there was no significant difference in the duration of staying PACU between both groups. In subgroup analyses by administration method (bolus injection or continuous injection), dexmedetomidine was shown to be effective at reducing postoperative morbidities regardless of administration method. Perioperative administration of dexmedetomidine can provide pain and agitation relief without side effects in children undergoing adenotonsillectomy. Considering the high heterogeneity of results within some parameters; however, further clinical trials with robust research methodology should be conducted to confirm the results of this study. Laryngoscope, 128:E184-E193, 2018.

Nationwide cross-sectional survey of schistosomiasis and soil-transmitted helminthiasis in Sudan: study protocol

BackgroundSchistosomiasis and soil-transmitted helminthiasis (STHs) are target neglected tropical diseases (NTDs) of preventive chemotherapy, but the control and elimination of these diseases have been impeded due to resource constraints. Few reports have described study protocol to draw on when conducting a nationwide survey. We present a detailed methodological description of the integrated mapping of schistosomiasis and STHs on the basis of our experiences, hoping that this protocol can be applied to future surveys in similar settings. In addition to determining the ecological zones requiring mass drug administration interventions, we aim to provide precise estimates of the prevalence of these diseases.MethodsA school–based cross-sectional design will be applied for the nationwide survey across Sudan. The survey is designed to cover all districts in every state. We have divided each district into 3 different ecological zones depending on proximity to bodies of water. We will employ a probability-proportional-to-size sampling method for schools and systematic sampling for student selection to provide adequate data regarding the prevalence for schistosomiasis and STHs in Sudan at the state level. A total of 108,660 students will be selected from 1811 schools across Sudan. After the survey is completed, 391 ecological zones will be mapped out. To carry out the survey, 655 staff members were recruited. The feces and urine samples are microscopically examined by the Kato-Katz method and the sediment smears for helminth eggs respectively. For quality control, a minimum of 10% of the slides will be rechecked by the federal supervisors in each state and also 5% of the smears are validated again within one day by independent supervisors.DiscussionThis nationwide mapping is expected to generate important epidemiological information and indicators about schistosomiasis and STHs that will be useful for monitoring and evaluating the control program. The mapping data will also be used for overviewing the status and policy formulation and updates to the control strategies. This paper, which describes a feasible and practical study protocol, is to be shared with the global health community, especially those who are planning to perform nationwide mapping of NTDs by feces or urine sampling.

Positive Psychology Interventions for Chronic Physical Illnesses: A Systematic Review

Positive health focuses on enhancing health along with curing illness to bring about well-being. Treatment for physical illness generally involves drug therapy, while the psycho-social aspects, specifically the positive psychology perspectives, are largely ignored; nevertheless, a growing number of investigations are now studying the effects of positive psychology interventions on health outcomes. The objective of this paper is to systematically review positive psychology interventions in chronic physical illness. A literature search through the databases of EBSCO, PubMed and PsycINFO, reference lists of significant papers and grey literature was conducted following four criteria set for this review. The number of studies selected finally that acceded to the criteria was 14. These studies were analysed by focusing on the study characteristics, kinds of intervention and outcomes of positive psychology interventions. Overall findings reveal that different intervention programmes have been devised by combining various exercises, writing is the most commonly used method for administration and positive psychology interventions are considered feasible and acceptable by patients, but findings about their usefulness are inconclusive. Suggestions for future research, clinical practice and application in communities have been provided which may be useful for clinicians, practitioners and caregivers.