Convergence Study Research Articles

Analytical solutions for the advective–diffusive ice column in the presence of strain heating

Abstract. A thorough understanding of ice thermodynamics is essential for an accurate description of glaciers, ice sheets and ice shelves. Yet there exists a significant gap in our theoretical knowledge of the time-dependent behaviour of ice temperatures due to the inevitable compromise between mathematical tractability and the accurate description of physical phenomena. In order to bridge this shortfall, we have analytically solved the 1D time-dependent advective–diffusive heat problem including additional terms due to strain heating and depth-integrated horizontal advection. Newton's law of cooling is applied as a Robin-type top boundary condition to consider potential non-equilibrium temperature states across the ice–air interface. The solution is expressed in terms of confluent hypergeometric functions following a separation of variables approach. Non-dimensionalization reduces the parameter space to four numbers that fully determine the shape of the solution at equilibrium: surface insulation, effective geothermal heat flow, the Péclet number and the Brinkman number. The initial temperature distribution exponentially converges to the stationary solution. Transient decay timescales are only dependent on the Péclet number and the surface insulation, so higher advection rates and lower insulating values imply shorter equilibration timescales, respectively. In contrast, equilibrium temperature profiles are mostly independent of the surface insulation parameter. We have extended our study to a broader range of vertical velocities by using a general power-law dependence on depth, unlike prior studies limited to linear and quadratic velocity profiles. Lastly, we present a suite of benchmark experiments to test numerical solvers. Four experiments of gradually increasing complexity capture the main physical processes for heat propagation. Analytical solutions are then compared to their numerical counterparts upon discretization over unevenly spaced coordinate systems. We find that a symmetric scheme for the advective term and a three-point asymmetric scheme for the basal boundary condition best match our analytical solutions. A further convergence study shows that n≥15 vertical points are sufficient to accurately reproduce the temperature profile. The solutions presented herein are general and fully applicable to any problem with an equivalent set of boundary conditions and any given initial temperature distribution.

Experiences Using Media Health Claims to Teach Evidence-Based Practice to Healthcare Students: A Mixed Methods Study

Background A multifaceted and interactive teaching approach is recommended for achieving proficiency in evidence-based practice, with critical thinking considered vital for connecting theory and practice. In this context, we advocate the strategic use of health claims in the media to promote critical thinking, complemented by a blended learning approach and a group exam. Method We conducted a convergent mixed methods study, including a cross-sectional survey with structured and open-ended questions as well as focus group interviews, at Oslo Metropolitan University, during the 2020-2021 academic year. Participants were bachelor’s students in healthcare. We employed a blended learning approach, combining digital learning resources, teaching in critical assessment of health claims and evidence-based practice, and a concurrent group exam assignment centered around media health claims. The outcome measures included students’ experiences integrating health claims into evidence-based practice teaching and their experiences with teaching approaches and the group exam. Results Out of 465 participants, 136 (29.2%) responded to the structured questions in the survey. In response to the open-ended questions within the survey, 109 (80.1%) of the respondents shared positive experiences about the course, while 98 (72%) suggested improvements. Additionally, 25 students participated in focus group interviews. Synthesizing the results, we found that students viewed the inclusion of health claim assessment as a useful entry point for learning evidence-based practice. In addition, the students identified both the blended learning design and the group exam as contributors to a positive perception of learning outcomes from the course. Conclusions Based on student feedback, integrating critical reflection on media health claims into evidence-based practice education, alongside a blended learning approach and a group exam, may be beneficial in teaching evidence-based practice to bachelor’s healthcare students. However, further rigorous study designs are needed to objectively assess the effect of the course on learning outcomes. Registration DOI 10.5281/zenodo.6985449

An efficient method to simulate ship self-propulsion in shallow waters and its application to optimize hull lines

Emerging environmental challenges, such as pronounced low water levels and a constantly increasing transport volume, underscore the need to address logistical complexities and to refocus attention on the performance of self-propulsion vessels in restricted and confined waters. Recognizing the demand for an accurate and efficient ship design method, we modified an actuator disk model to predict ship propulsion. This model was designed to be applicable to various kinds of ships, with special features tailored to meet the specific requirements of inland water vessels, particularly those equipped with ducted propellers. We implemented this model into the open-source CFD software library OpenFOAM to be used in conjunction with either single- or multiphase incompressible solvers. We validated this implemented model against model test data, thereby demonstrating its capability to accurately predict propulsion performance of a typical inland waterway vessel. Following validation, we employed this model in an automated optimization process, demonstrating its robust and efficient applicability for a practical user-defined case to improve a ship's afterbody lines. Meticulous grid convergence studies ensured the predictive convergence of our simulations. Our validation covered various ship speeds at three distinct water depths, ranging from a moderate water depth-to-draft ratio h/T of 2.67 to an extreme shallow water depth-to-draft ratio h/T of 1.25. We validated our simulated results against data extracted from our own previous model tests, comprising measured ship trim and ship sinkage, propeller thrust, duct thrust, propeller torque, propeller revolution rate, and propulsion power. We investigated the influence of water depth also on various parameters, such as friction and pressure distributions, free surface interactions, and velocity patterns. Finally, we integrated the developed method into an automated optimization process that we tailored for a selected test cases of the considered ship operating in water depth to draft ratios h/T of 2.67. This integrated process facilitated the systematic refinement of the ship's afterbody lines, representing a crucial step in the pursuit to enhance ship performance.

Uniform exponential stability approximations of semi‐discretization schemes for two hybrid systems

The uniform exponential stabilities (UESs) of two hybrid control systems comprised of a wave equation and a second‐order ordinary differential equation are investigated in this study. Linear feedback law and local viscosity are considered, as are nonlinear feedback law and internal anti‐damping. The hybrid system is first reduced to a first‐order port‐Hamiltonian system with dynamical boundary conditions, and the resulting system is discretized using the average central‐difference scheme. Second, the UES of the discrete system is obtained without prior knowledge of the exponential stability of the continuous system. The frequency domain characterization of UES for a family of contractive semigroups and the discrete multiplier approach are used to validate the main conclusions. Finally, the Trotter–Kato theorem is used to perform a convergence study on the numerical approximation approach. Most notably, the exponential stability of the continuous system is derived by the convergence of energy and UES, which is a novel approach to studying the exponential stability of some complex systems. Numerical simulation is used to validate the effectiveness of the numerical approximating strategy.

Impact of Regular and Irregular Pore Distributions on the Elasticity of Porous Materials: A Microstructure-Free Finite Element Study.

Conventional analytical formulas for predicting the effective Young's modulus of porous materials often rely on simplifying assumptions and do not explicitly incorporate microstructural information. This study investigates the impact of regular versus irregular pore distributions on the stiffness of porous materials using microstructure-free finite element modeling (MF-FEM). After conducting a convergence study, MF-FEM predictions were validated against experimental data and used to assess the accuracy of commonly employed analytical models. The results demonstrate that materials with irregular microstructures exhibit a rapid decrease in Young's modulus, approaching zero at porosities slightly greater than 50%. In contrast, regular microstructures show a more gradual decline, maintaining significant stiffness until the porosity exceeds 90%. Additionally, the study reveals that some analytical formulas align better with irregular microstructures while others are more suited to regular ones, attributable to the underlying assumptions of these models. These findings underscore the necessity of considering pore distribution patterns in modeling to accurately predict the mechanical behavior of porous materials.

Perceived structural empowerment, resilience, and intent to stay among midwives and registered nurses in Saudi Arabia: a convergent parallel mixed methods study

BackgroundRetaining midwives and registered nurses in the Obstetrics and Gynecology department/unit (OB/GYN) is not just a matter of organizational effectiveness and financial wellness. It’s a crucial aspect of ensuring quality healthcare delivery. This study aimed to discuss the degree to which midwives and nurses in OB/GYN departments are structurally empowered, resilient, and committed to remaining at the organizations and to examine whether nurses’ and midwives’sense of structural empowerment and resilience is a good predictor of their decision to stay with the organization.MethodsThis study employed a unique convergent parallel mixed methods approach. The research was conducted in two distinct phases. The first phase involved a cross-sectional quantitative survey with a convenience sample of 200 midwives and nurses in OB/GYN departments. The second phase was a qualitative study utilizing semi-structured, open-ended interviews. Eighteen nurses and midwives, specifically chosen as the target population, were invited to participate in individual interviews. The data collection took place at three major hospitals in Saudi Arabia, starting in January 2023 and concluding in February 2023.ResultsThe study results revealed that structural empowerment and resilience were statistically significant predictors of the intent to stay in the organization (F = 35.216, p < 0.001), with 26.3% variation, the structural empowerment is higher predictor (β = 0.486, p < 0.000) to intent to stay if compared to resilience (β = 0.215, p < 0.008). Five major themes emerged from the narratives of the nurses and midwives: the nurturing of the physical and physiological, the development of the psychological, the managing finances, the restructuring of the organization, and the enrichment of the professional and occupational.ConclusionThe study’s findings have significant implications for healthcare organizations. They highlight the importance of cultivating a culture of empowerment and resilience, which can serve as a powerful tool to encourage registered nurses and midwives to remain in their organizations. This insight empowers healthcare administrators, human resource managers, and obstetrics and gynecology professionals to take proactive steps toward improving retention rates.

African American Family Caregivers' Experiences and Mental Health: A Convergent Mixed-Methods Study.

Caregiving in the African American community is informed by strong cultural expectations but may be associated with negative experiences and poor mental health outcomes. The purpose of this convergent mixed-methods study is to understand the relationship between caregiving experiences and mental health and explore stress management strategies in African American family caregivers of adults with chronic or disabling conditions. African American family caregivers (N = 100) were recruited using community-engaged methods and completed a sociodemographic questionnaire, the Caregiver Reaction Assessment scale, and the Center for Epidemiologic Studies Depression (CES-D-10) Scale. A subsample (n = 24) participated in semi-structured interviews. Data were analyzed using linear regression and content analysis. A matrix was developed to integrate quantitative and qualitative results. Participants were on average 59 years old. Most were women and provided care to a parent. Lack of family support (B = 1.37, P = .03) and impact of caregiving on caregivers' finances (B = 1.74, P = .004), schedule (B = 2.92, P < .001), and health (B = 3.26, P < .001) were associated with depressive symptoms and were reported as stressful experiences. Negative interactions with the care recipient and caring for multiple people emerged as other sources of stress. Participants used independent and interpersonal coping strategies, as well as strategies to facilitate their caregiving role to reduce their stress. Values of reciprocity, limited use of community-based resources, and mental health stigma emerged as important cultural considerations. Our findings suggest the need for culturally-sensitive interventions to improve communication and care coordination within African American family caregiving networks and educational programs about mental health and caregiving resources endorsed by trusted community sources.

The active role of co-evolving haloes in stellar bar formation

ABSTRACT We use idealized N-body simulations of equilibrium discs in live and static haloes to study how dark matter co-evolution impacts the assembly of stellar particles into a bar and the halo response. Initial conditions correspond to a marginally unstable disc according to commonly used disc stability criteria, and are evolved for the equivalent of about 150 disc dynamical times (10 Gyr). An extensive convergence study ensures accurate modelling of the bar formation process. Live haloes lead to the formation of a strong bar, but the same disc remains unbarred when evolved in a static halo. Neither seeded disc instabilities nor longer (60 Gyr) simulations result in the formation of a bar when the halo is static. When the live halo is replaced with a static analogue at later times, the previously robust bar slowly dissipates, suggesting that (1) the co-evolution of the disc and halo is critical for the assembly and long-term survival of bars in marginally unstable discs and (2) global disc stability criteria must be modified for discs in the presence of live haloes. In our live halo runs, a ‘dark bar’ grows synchronously with the stellar bar. Processes that inhibit the transfer of angular momentum between the halo and disc may stabilize a galaxy against bar formation, and can lead to the dissolution of the bar itself. This raises further questions about the puzzling stability of observed discs that are marginally unstable, but unbarred.

Household economic burden of type-2 diabetes and hypertension comorbidity care in urban-poor Ghana: a mixed methods study

BackgroundNon-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra.MethodsA convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion.ResultsOut of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55–118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden.ConclusionThe economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions.

Young Consumer’s Awareness on Food Packet Labeling in Rural Tamil Nadu – A Convergent Mixed Methods Study

Abstract Background: Food labeling is one medium by which consumers can acquire knowledge about the food they consider buying. This type of information is becoming increasingly important in a food market where direct contact with personnel over the counter is declining. Objectives: The objective of this study was to evaluate the level of awareness on food packet labeling and to explore the contributing factors of food packet label awareness among college students in Villupuram district, rural Tamil Nadu. Methodology: The study was carried out among 113 college students studying in Government Arts and Science College, Thiruvennainallur village, located in Villupuram district. A convergent mixed methods study design was used. A structured self-administered questionnaire was given to the students who participated in the National Nutrition Week awareness program. The questionnaire included variables such as checking for date of manufacturing, date of packaging, best-before date, storage conditions, lot number/code number/batch number, containing FSSAI code, and checking list of ingredients. In-depth interview was conducted among eight students who volunteered to explore the reasons for not checking food packet labels and solutions to improve the visibility of food package labeling. Categorical variables were summarized using percentages. Manual content analysis was done for in-depth interviews. Results: It was found that more than 90% of the study participants check for food packet labels, best-before dates, and date of packaging. However, more than half of the participants did not check for lot/code/batch number and storage conditions. The most common reason for not checking food labels was package-related factors such as font size very small, hidden, and hard to find and trust on brand and seller. The most common solution to improve the visibility of food labeling was increasing the font size and highlighting the important information. Conclusions: Our study highlights the level of awareness about food labels among youngsters and the solutions to improve the visibility of food labels. Need-based interventions have to be done to ensure the food safety of the consumers.

Distinct phenotypic consequences of cholangiocarcinoma-associated FGFR2 alterations depend on biliary epithelial maturity.

Epithelial cancers disrupt tissue architecture and are often driven by mutations in genes that normally play important roles in epithelial morphogenesis. The intrahepatic biliary system is an epithelial tubular network that forms within the developing liver via the de novo initiation and expansion of apical lumens. Intrahepatic biliary tumors are often driven by different types of mutations in the FGFR2 receptor tyrosine kinase which plays important roles in epithelial morphogenesis in other developmental settings. Using a physiologic and quantitative 3D model we have found that FGFR signaling is important for biliary morphogenesis and that oncogenic FGFR2 mutants disrupt biliary architecture. Importantly, we found that both the trafficking and signaling of normal FGFR2 and the phenotypic consequences of FGFR2 mutants are influenced by the epithelial state of the cell. Unexpectedly, we found that different tumor-driving FGFR2 mutants disrupt biliary morphogenesis in completely different and clinically relevant ways, informing our understanding of morphogenesis and tumorigenesis and highlighting the importance of convergent studies of both.

A community-based study on health seeking behaviour among NCD patients in rural and urban Tamil Nadu - A convergent mixed method study.

To analyse the hospital visitations and lifestyle modifications of NCD patients. To do a comparative study about the health seeking behaviour among NCD patients in Rural and Urban areas. To explore the various difficulties that patients face with regards to Lifestyle modifications. It is a convergent type mixed-methods design, undertaken in the field practicing areas of RHTCs and UPHCs of Government Medical College, Omandurar Government Estate. The data was collected by means of Free listing, Focussed Group Discussions, Key Informant Interviews and Structured Questionnaires from patients diagnosed with one or more non-communicable diseases. Smith's S value Manual Content Analysis Bivariate analysis. The health seeking behaviour of NCD patients is influenced by lesser crowding and shorter distance to travel, reduced waiting time, focused attention from and familiarity with the healthcare provider, community health, systematic dispensing of medications and regularised testing. Rural population have a higher positively inclined health seeking behaviour than urban population. The health seeking behaviour of patients with NCDs seem to be on the positive trend and is influenced by the locality of the respondents.

Adapting the WHO hand hygiene ‘reminders in the workplace’ to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study

IntroductionHand hygiene is key in preventing healthcare-associated infections, but it is challenging in maternity settings due to high patient turnover, frequent emergencies and volume of aseptic procedures. We sought to...

Analysis of Domestic Research Trends in Convergent Studies on Nursing Education : A Review of Literature from the Last 10 Years

Analysis of Domestic Research Trends in Convergent Studies on Nursing Education : A Review of Literature from the Last 10 Years

A non-uniform compound strip method for effective buckling analysis of stiffened structures

In this paper, a versatile compound strip method (CSM) with non-uniform spline functions is developed for buckling analysis of stiffened structures. The proposed method further extends the existing CSM by permitting the flexible modification of local knots to place the stiffeners along the strip arbitrarily. In addition, a reasonable knot arrangement can achieve an accurate solving procedure with improved convergence. The displacements of stiffeners are expressed compatibly by the fundamental parameters of skin according to the beam-plate model. Consequently, the reinforcement of stiffeners is naturally incorporated by adding the beam stiffness matrix to the corresponding strips. Based on the first-order shear deformation plate theory and non-uniform spline functions, the semi-analytical formulations of stiffened structures are established. The present method provides the possibility to achieve the local mesh refinement in the finite strip methods. The convergence and validation study is demonstrated through the comparisons with the results of the existing literature solution and finite element method. In conclusion, a more efficient and applicable CSM is proposed to analyze the buckling behaviors of stiffened structures.

Environmental injustice in the air quality for digital platform delivery workers in Bogotá, Colombia, 2021

Air quality is a matter of interest for public health due to its rapid deterioration in low- and middle-income countries and the effects of polluted air on the health of populations. To explore the air quality conditions in which digital platform delivery workers carry out their work, evaluating the localities of Kennedy and Usaquén in Bogotá, 2021. We developed a mixed parallel convergent study based on four sources of information: 1) Ethnographic observation in five commercial locations of the two localities; 2) Monitoring of PM10 and PM2.5 in 56 delivery routes using a low-cost sensor; 3) Daily logs of the routes to support the device data interpretation, and 4) A semi-structured interview applied to the drivers to explore their danger perception during the routes. We identified elements causing environmental injustice among digital platform delivery workers between the two study locations. The routes made by the delivery drivers in the locality of Kennedy registered higher concentrations of PM10 and PM2.5, compared to the values observed in Usaquén. The sources of air pollution identified by the delivery drivers through ethnographic observation and the router logbook showed the worst parameters in Kennedy. We evidenced that air quality, urban equipment, road infrastructure, mobile sources, and geospatial location are elements that mark the presence of environmental injustice for the digital platform delivery drivers in the studied localities. To reduce this inequity, it is necessary for digital delivery platforms and the district government to implement strategies that reduce the exposure and emission of air pollutants to protect the health of digital platform delivery workers.

Precise analysis of the static bending response of functionally graded doubly curved shallow shells via an improved finite element shear model

Doubly curved shallow shells, common in aerospace and civil engineering, pose significant challenges in predicting bending responses due to their complex geometry and material properties. Therefore, this research focused on the development of an efficient eight-node quadrilateral isoparametric element model based on a new improved first-order shear deformation theory (IFSDT) to analyze the bending deflection and stresses distribution of Functionally Graded (FG) doubly curved shallow shells. The present IFSDT obviates the necessity of a shear correction factor, which has challenges in determining for FG doubly curved shallow shells, by adopting a simpler assumption about transverse shear stresses. This assumption guarantees that the model precisely predicts the parabolic shear stresses distribution throughout the thickness of the FG shell while also meeting the requirements for free traction conditions on the top and lower surfaces of the shell. In the present analysis, five distinct types of FG doubly curved shallow shells are modeled: flat plates, spherical shells, hyperbolic parabolic shells, cylindrical shells, and elliptical paraboloid shells. A power law is employed to describe the gradual changes in material properties through the thickness direction. Numerical results for displacements and stresses are obtained for various shell types, materials, power-law factors, radii of curvature, and boundary conditions under uniform and sinusoidal loads. Comprehensive comparison and convergence studies are conducted to assess the robustness and accuracy of the proposed numerical model. This study also contributes new numerical results that are valuable for future research. Ultimately, the proposed numerical model offers a robust and straightforward tool for engineers and researchers engaged in the design and analysis of complex shell structures.

Facilitators, Barriers, Conditions, and Recommendations of Pediatric Nurses Reassigned to Adult Care During COVID-19 Pandemic: A Mixed Methods Study

Aims To describe the conditions, facilitators, barriers, and recommendations of pediatric nurses reassigned to adult care during the COVID-19 pandemic. Background During COVID-19 pandemic, nurses who were certified, received advanced education, and with years of experience in their fields were asked to, or mandated to, care for adult patients, often with COVID-19 and in intensive care units. Introduction Nurses struggled with this transition worldwide. Literature searches reflected no guidance in specialty reassignment during a pandemic. Methods International, mixed method, convergent study using GRAMMS Mixed Methods framework. Two instruments disseminated internationally during 2021 on Survey Monkey© in three languages: (1) Researcher-developed, validated, feelings, beliefs, circumstances, and recommendations survey, (2) Medical-surgical skills survey from Canadian Association of Schools of Nursing. Integrated quantitative and qualitative design for investigatory depth. Analysis using SocialSciences calculator© and Narrative Inquiry methodology. Meleis's Transitions theory provided framework. Results A total of 122 nurses from 12 countries responded. Sixty-four percent of pediatric nurses reported they were mandated to work with adults with no choice; 64% received no preparation for change in specialty. Respondents reported suffering, absence of training to care for adults, lack of COVID-19 related skills such as care of ventilated patient, proning, mental health support, palliative care, or comforting families of the dying. Ninety-two percent recommended improvement, advising advance planning for transition in assignments, making transitions smoother, and diminishing number of transitions. National and international policies on floating supported the participants’ recommendations. Discussion Study reports challenges experienced by nurses reassigned outside of their specialties without training or preparation and offers critical recommendations to ensure both nurse and patient safety during future disasters or pandemics. Conclusion/Implications Nursing and Health Policy Planning for quality nursing care during transitions between specialties is possible. Staff nurses must be included, trained, and prepared. Literature on floating provides solid background for moving nurses between specialties.

Heart Failure With Reduced Ejection Fraction Polypill Implementation Strategy in India: A Convergent Parallel Mixed Methods Study.

A polypill-based implementation strategy has been proposed to increase rates of guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction. This has the potential to improve mortality and morbidity in India and undertreated populations globally. We conducted a convergent parallel mixed methods study integrating quantitative data from stakeholder surveys using modified implementation science outcome measures and qualitative data from key informant in-depth interviews. Our objective was to explore physician, nurse, pharmacist, and patient perspectives on a HFrEF polypill implementation strategy in India from January 2021 to April 2021. Quantitative and qualitative data were integrated to develop an Implementation Research Logic Model. Among 69 respondents to the stakeholder survey, there was moderate acceptability (mean [SD] 3.8 [1.0]), appropriateness (3.6 [1.0]), and feasibility (3.7 [1.0]) of HFrEF polypill implementation strategy. Participants in the key-informant in-depth interviews (n = 20) highlighted numerous relative advantages of the HFrEF polypill innovation including potential to simplify medication regimens and improve patient adherence. Key relative disadvantages elucidated, include concerns about side effects and interruption of multiple GDMT medications due to polypill discontinuation for side effects or hospitalizations. Based on this data, the proposed implementation strategies in the Implementation Research Logic Model include 1) HFrEF polypills, 2) HFrEF polypill initiation, titration, and maintenance protocols, and 3) HFrEF polypill laboratory monitoring protocols for safety which we postulate will lead to desired clinical and implementation outcomes through multiple mechanisms including increased medication adherence to a single pill. This study demonstrates that a HFrEF polypill-based implementation strategy is considered acceptable, feasible, and appropriate among healthcare providers in India. We identified contextually relevant determinants, strategies, mechanism, and outcomes outlined in an Implementation Research Logic Model to inform future research to improve heart failure care in South Asia.

Solid health care waste management practice in Ethiopia, a convergent mixed method study

IntroductionHealthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods.This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town.MethodA mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town.ResultSeventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility ‘‘the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market’’. The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus.ConclusionHand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level.