Search results for: Greek public hospital sector

Authors: Lisa Fox, Jill Aylott

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There is a global need to identify ways to engage doctors in non-clinical matters such as medical leadership, service improvement and health system transformation. Using the core principles of Realistic Evaluation (RE), this study examined what works, for doctors of different grades, specialities and experience in an acute NHS Hospital Trust in the UK. Realistic Evaluation is an alternative to more traditional cause and effect evaluation models and seeks to understand the interdependencies of Context, Mechanism and Outcome proposing that Context (C) + Mechanism (M) = Outcome (O). In this study, the context, mechanism and outcome were examined from within individual medical leaders to determine what enables levels of medical engagement in a specific improvement project to reduce hospital inpatient mortality. Five qualitative case studies were undertaken with consultants who had regularly completed mortality reviews over a six month period. The case studies involved semi-structured interviews to test the theory behind the drivers for medical engagement. The interviews were analysed using a theory-driven thematic analysis to identify CMO configurations to explain what works, for whom and in what circumstances. The findings showed that consultants with a longer length of service became more engaged if there were opportunities to be involved in the beginning of an improvement project, with more opportunities to affect the design. Those that are new to a consultant role were more engaged if they felt able to apply any learning directly into their own settings or if they could use it as an opportunity to understand more about the organisation they are working in. This study concludes that RE is a useful methodology for better understanding the complexities of motivation and consultant engagement in a trust wide service improvement project. The study showed that there should be differentiated and bespoke training programmes to maximise each individual doctor’s propensity for medical engagement. The RE identified that there are different ways to ensure that doctors have the right skills to feel confident in service improvement projects.

Keywords: realistic evaluation, medical leadership, medical engagement, patient safety, service improvement

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Authors: Chrysanthos Maraveas, Argiris Plesias, Garyfalia G. Triantafyllou, Konstantinos Petronikolos

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The current paper presents a structural assessment and proposals for retrofit of the National Youth Foundation Building, an existing reinforced concrete (RC) building in the city of Igoumenitsa, Greece. The building is scheduled to be renovated in order to create a Municipal Cultural Center. The bearing capacity and structural integrity have been investigated in relation to the provisions and requirements of the Greek Retrofitting Code (KAN.EPE.) and European Standards (Eurocodes). The capacity of the existing concrete structure that makes up the two central buildings in the complex (buildings II and IV) has been evaluated both in its present form and after including several proposed architectural interventions. The structural system consists of spatial frames of columns and beams that have been simulated using beam elements. Some RC elements of the buildings have been strengthened in the past by means of concrete jacketing and have had cracks sealed with epoxy injections. Static-nonlinear analysis (Pushover) has been used to assess the seismic performance of the two structures with regard to performance level B1 from KAN.EPE. Retrofitting scenarios are proposed for the two buildings, including type Λ steel bracings and placement of concrete shear walls in the transverse direction in order to achieve the design-specification deformation in each applicable situation, improve the seismic performance, and reduce the number of interventions required.

Keywords: earthquake resistance, pushover analysis, reinforced concrete, retrofit, strengthening

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Authors: Rania Albsoul, Muhammad Ahmed Alshyyab, Baraa Ayed Al Odat, Nermeen Borhan Al Dwekat, Batool Emad Al-masri, Fatima Abdulsattar Alkubaisi, Salsabil Awni Flefil, Majd Hussein Al-Khawaldeh, Ragad Ayman Sa’ed, Maha Waleed Abu Ajamieh, Gerard Fitzgerald

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Purpose: The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan. Design/methodology/approach: This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons, and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data. Findings: Three main themes emerged from data analysis, namely compliance with the surgical safety checklist, the impact of the surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion, and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist and help enhance awareness about its importance. Originality/value: While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges to consistent, complete, and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.

Keywords: patient safety, surgical safety checklist, compliance, utility, operating room, quality healthcare, communication, teamwork

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Authors: Nilima Barman, M. Atiqul Haque, Debabrata Ghosh

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Background: Zinc, one of the vital micronutrients, has an incredible role in the immune system. Hypozincemia affects host defense by reducing the number of circulating T cells and phagocytosis activity of other cells which ultimately impair cell-mediated immunity 1, 2. The immune system is detrimentally suppressed in multidrug-resistant tuberculosis (MDR-TB) 3, 4, a major threat of TB control worldwide5. As zinc deficiency causes immune suppression, we assume that it might have a role in the development of MDR-TB. Objectives: To estimate the serum zinc level in newly diagnosed multidrug resistant tuberculosis (MDR-TB) in comparison with that of newly diagnosed pulmonary TB (NdPTB) and healthy individuals. Materials and Methods: This study was carried out in the department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka in collaboration with National Institute of Diseases of the Chest Hospital (NIDCH), Bangladesh from March’ 2012 to February 2013. A total of 337 respondents, of them 107 were MDR TB patients enrolled from NIDCH, 69 were NdPTB and 161 were healthy adults. All NdPTB patients and healthy adults were randomly selected from Sirajdikhan subdistrict of Munshiganj District. It is a rural community 22 kilometer south from capital city Dhaka. Serum zinc level was estimated by atomic absorption spectrophotometry method from early morning fasting blood sample. The evaluation of serum zinc level was done according to normal range from 70 to120 µgm/dL6. Results: Males were predominant in study groups (p>0.05). Mean (sd) serum zinc levels in MDR-TB, NdPTB and healthy adult group were 65.14 (12.52), 75.22(15.89), and 87.98 (21.80) μgm/dL respectively and differences were statistically significant (F=52.08, P value<0.001). After multiple comparison test (Bonferroni test) significantly lower level of serum zinc was found in MDRTB group than NdPTB and healthy adults (p<.001). Point biserial correlation showed a negative association of having MDR TB and serum zinc level (r= -.578; p value <0.001). Conclusion: The significant low level of serum zinc in MDR-TB patients suggested impaired immune status. We recommended for further exploration of low level of serum zinc as risk factor of MDR TB.

Keywords: Bangladesh, immune status, multidrug-resistant tuberculosis, serum zinc

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Authors: Navid Mirzaei Varzeghani, Mahmoud Saffarzadeh, Ali Naderan, Amirhossein Taheri

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Countries are progressing, and the world's busiest airports see year-on-year increases in travel demand. Passenger acceptability of an airport depends on the airport's appeals, which may include one of these routes between the city and the airport, as well as the facilities to reach them. One of the critical roles of transportation planners is to predict future transportation demand so that an integrated, multi-purpose system can be provided and diverse modes of transportation (rail, air, and land) can be delivered to a destination like an airport. In this study, 356 questionnaires were filled out in person over six days. First, the attraction of business and non-business trips was studied using data and a linear regression model. Lower travel costs, a range of ages more significant than 55, and other factors are essential for business trips. Non-business travelers, on the other hand, have prioritized using personal vehicles to get to the airport and ensuring convenient access to the airport. Business travelers are also less price-sensitive than non-business travelers regarding airport travel. Furthermore, carrying additional luggage (for example, more than one suitcase per person) undoubtedly decreases the attractiveness of public transit. Afterward, based on the manner and purpose of the trip, the locations with the highest trip generation to the airport were identified. The most famous district in Tehran was District 2, with 23 visits, while the most popular mode of transportation was an online taxi, with 12 trips from that location. Then, significant variables in separation and behavior of travel methods to access the airport were investigated for all systems. In this scenario, the most crucial factor is the time it takes to get to the airport, followed by the method's user-friendliness as a component of passenger preference. It has also been demonstrated that enhancing public transportation trip times reduces private transportation's market share, including taxicabs. Based on the responses of personal and semi-public vehicles, the desire of passengers to approach the airport via public transportation systems was explored to enhance present techniques and develop new strategies for providing the most efficient modes of transportation. Using the binary model, it was clear that business travelers and people who had already driven to the airport were the least likely to change.

Keywords: multimodal transportation, demand modeling, travel behavior, statistical models

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Authors: Marco Vinicio Félix Lerma, Efrain Rubio Rosas, Fernando Ricardez Rueda, Victor Manuel Castaño Meneses

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This paper reports a spectral analysis of the exposure levels of radiofrequency electromagnetic fields originating from a wide variety of telecommunications sources present in an urban area of Lagos de Moreno, Jalisco, Mexico. The electromagnetic characterization of the urban zone under study was carried out by measurements in 118 sites. Measurements of TETRA,ISM434, LTE800, ISM868, GSM900, GSM1800, 3G UMTS,4G UMTS, Wlan2.4, LTE2.6, DECT, VHF Television and FM radio signals were performed at distances ranging over 10 to 1000m from 87 broadcasting towers concentrated in an urban area of about 3 hectares. The aim of these measurements is the evaluation of the electromagnetic fields power levels generated by communication systems because of their interaction with the human body. We found that in certain regions the general public exposure limits determined by ICNIRP (International Commission of Non Ionizing Radiation Protection) are overpassed from 5% up to 61% of the upper values, indicating an imminent health public hazard, whereas in other regions we found that these limits are not overpassed. This work proposes an electromagnetic pollution classification for urban zones according with ICNIRP standards. We conclude that the urban zone under study presents diverse levels of pollution and that in certain regions an electromagnetic shielding solution is needed in order to safeguard the health of the population that lives there. A practical solution in the form of paint coatings and fiber curtains for the buildings present in this zone is also proposed.

Keywords: electromagnetic field, telecommunication systems, electropollution, health hazards

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Authors: Mahmoud Hassan, Walid Oueslati, Damien Rousseliere

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This paper explores the channels through which energy taxes may affect economic growth, using a simultaneous equations model for a balanced panel data of 31 OECD countries over the 1994–2013 period. The empirical results reveal a negative impact of energy taxes on physical investment in the short and long term. This impact is negatively sensitive to the existence and level of public debt. Additionally, the results show that energy taxes have an indirect effect on human capital through their impact on polluting emissions. The taxes on energy products are able to reduce both the flux and the stock of polluting emissions that have a negative impact on human capital skills in the short and long term. Finally, we found that energy taxes could encourage eco-innovation in the short and long term.

Keywords: energy taxes, economic growth, public debt, simultaneous equations model, multiple imputation

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Authors: Jenney Perez Bacalla

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The study was conducted to assess the five (5) identified school administrators of the identified secondary schools in terms of professional characteristics, management skills and values patterns in the Division of Leyte Area IV for a proposed enhancement model for school administrators. The study utilized the qualitative method. There were two (2) groups of respondents: the teachers and the school administrators. The teachers perceived the management skills of the school administrators in their technical and conceptual skills and values in planning and organizing work, allocating and using of funds, submitting reports, decision-making, leading people, public relations and community involvement and other value development. It was found out in the study that most of the school administrators’ management skills were very well manifested. Their value patterns were also very well manifested. Most of them had earned master’s degree and with a unit in doctoral and five (5) years and above in service as a school administrator. Most administrators were performing and successfully execute the planning, organizing and utilizing funds and they were able to lead their subordinates. In planning, it shows that administrators studied the future and arrange the plan. Administrators also were able to manage, maintained the good environment wherein individual work together. School administrators were creating an environment conducive to learning. The school administrator is manifesting the desirable practices in school management. In terms of their educational qualifications, they were all qualified. Academic preparation, trainings and maturation were their attributes to the development of managerial skills of the school administrators. They showed competence in the areas of management skills that they were able to carry their functions with utmost responsibility and capability. School administrators in terms of seminars and trainings on administration and supervision were already equipped. It is concluded that the school administrators possessed the necessary skills and work values in administering the school.

Keywords: management skills and values, public secondary schools, qualitative, school administrators

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Authors: Marwa Sahnoun, Chokri Abdennadher

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This article comes, very timely, to look at the effectiveness of active labor market policies (ALMP) in improving labor market outcomes. Using panel data estimates for 19 European countries during the period 2000-2012, this article showed the role of institutional factors, especially the role of employment policies implementation based on three variables: the allocation of resources for the implementation of policies, continuity and timing in the implementation of policies to capture their effectiveness on the labor market. Empirical results shows favor effect of training, employment incentives, sheltered employment and rehabilitation and direct job creation on the entire population employment growth. Results shows also that start-up incentives seems to be more effective in increasing employment than other types of policies. Importantly, two aspects are important in terms of implementation: public expenditure on program administration, e.g. (PES) watches the most favorable aspect and the continuity of policies implemented.

Keywords: active labor market policies, implementation, public expenditure on program administration, start-up incentives, training

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

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Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Fatma Koksal Cakirlar, Murat Gunaydin, Nevri̇ye Gonullu, Nuri Kiraz

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During the last few decades, the increasing prevalence of methicillin resistant-CoNS isolates has become a common problem worldwide. Macrolide-lincosamide-streptogramin B (MLSB) antibiotics are effectively used for the treatment of CoNS infections. However, resistance to MLSB antibiotics is prevalent among staphylococci. The aim of this study is to determine species distribution and the incidence of inducible clindamycin resistance in CoNS isolates caused nosocomial bacteremia in our hospital. Between January 2014 and October 2015, a total of 484 coagulase-negative CoNS isolates were isolated from blood samples of patients with true bacteremia who were hospitalized in intensive care units and in other departments of Istanbul University Cerrahpasa Medical Hospital. Blood cultures were analyzed with the BACTEC 9120 system (Becton Dickinson, USA). The identification and antimicrobial resistance of isolates were determined by Phoenix automated system (BD Diagnostic Systems, Sparks, MD). Inducible clindamycin resistance was detected using D-test. The species distribution was as follows: Staphylococcus epidermidis 211 (43%), S. hominis 154 (32%), S. haemolyticus 69 (14%), S. capitis 28 (6%), S. saprophyticus 11 (2%), S. warnerii 7 (1%), S. schleiferi 5 (1%) and S. lugdunensis 1 (0.2%). Resistance to methicillin was detected in 74.6% of CoNS isolates. Methicillin resistance was highest in S.hemoliticus isolates (89%). Resistance rates of CoNS strains to the antibacterial agents, respectively, were as follows: ampicillin 77%, gentamicin 20%, erythromycin 71%, clindamycin 22%, trimethoprim-sulfamethoxazole 45%, ciprofloxacin 52%, tetracycline 34%, rifampicin 20%, daptomycin 0.2% and linezolid 0.2%. None of the strains were resistant to vancomycin and teicoplanin. Fifteen (3%) CoNS isolates were D-test positive, inducible MLSB resistance type (iMLSB-phenotype), 94 (19%) were constitutively resistant (cMLSB -phenotype), and 237 (46,76%) isolates were found D-test negative, indicating truly clindamycin-susceptible MS phenotype (M-phenotype resistance). The incidence of iMLSB-phenotypes was higher in S. epidermidis isolates (4,7%) compared to other CoNS isolates.

Keywords: bacteremia, inducible MLSB resistance phenotype, methicillin-resistant, staphylococci

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Authors: Tamrat Girma Biru

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Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to at least Refampicin and Isoniazed: the most two power full TB drugs. It is a leading cause of high rates of morbidity and mortality, and increasing psychosocial challenges to patients, especially when co-infected with Human Immunodeficiency Virus (HIV). Ethiopia faces the highest rates of MDR-TB infection in the world. Objectives: The main objective of this study was to identify the psychosocial challenges of MDR-TB patients, to investigate the extent of the psychosocial challenges on (self-esteem, depression, and stigma) that MDR-TB patients encounter, to examine whether there is a sex difference in experiencing psychosocial challenges and assess the counseling needs of MDR-TB patients. Methodology: A cross-sectional study was conducted at St. Peter TB Specialized Hospital, Addis Ababa on 40 patients (25 males and 15 females) who are hospitalized for treatment. The patients were identified by using purposive sampling and made fill a questionnaire measuring their level of self-esteem, depression and stigma. Besides, data were collected from 16 participants, 28 care providers and 8 guardians, using semi-structured interview. The obtained data were analyzed using SPSS statistical program, descriptive statistics, independent t-test, and qualitative description. Results and Discussion: The results of the study showed that the majority (80%) of the respondents had suffered psychological challenges and social discriminations. Thus, the significance of MDR-TB and its association with HIV/AIDS problems is considered. Besides the psychosocial challenges, various aggravating factors such as length of treatment, drug burden and insecurity in economy together highly challenges the life of patients. In addition, 60% of participants showed low level of self-esteem. The patients also reported that they experienced high self-stigma and stigma by other members of the society. The majority of the participants (75%) showed moderate and severe level of depression. In terms of sex there is no difference between the mean scores of males and females in the level of depression and stigmatization by others and by themselves. But females showed lower level of self-esteem than males. The analysis of the t-test also shows that there were no statistically significant sex difference on the level of depression and stigma. Based on the qualitative data MDR-TB patients face various challenges in their life sphere such as: Psychological (depression, low self value, lowliness, anxiety), social (stigma, isolation from social relations, self-stigmatization,) and medical (drug side effect, drug toxicity, drug burden, treatment length, hospital stays). Recommendations: Based on the findings of this study possible recommendations were forwarded: develop and extend MDR-TB disease awareness creation through by media (printing and electronic), school net TB clubs, and door to door community education. Strengthen psychological wellbeing and social relationship of MDR-TB patients using proper and consistent psychosocial support and counseling. Responsible bodies like Ministry of Health (MOH) and its stakeholders and Non Governmental Organizations (NGOs) need to assess the challenges of patients and take measures on this pressing issue.

Keywords: psychosocial challenges, counseling, multi-drug resistant tuberculosis (MDR-TB), tuberculosis therapy

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Authors: Pierre Mintom, William Djeukeu Asongni, Michelle Moni, William Dakam, Christine Fernande Nyangono Biyegue.

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Background: In order to prevent congestive heart failure, control of hypertension and hypercholesterolemia is necessary because those risk factors frequently occur in combination. Objective: The aim of the study is to determine the prevalence and risk factors of hypertension, hypercholesterolemia and double burden HTA-Hypercholesterolemia in patients with congestive heart failure. Methodology: A database of 98 patients suffering from congestive heart failure was used. The latter were recruited from August 15, 2017, to March 5, 2018, in the Cardiology department of Deido District Hospital of Douala. This database provides information on sociodemographic parameters, biochemical examinations, characteristics of heart failure and food consumption. ESC/ESH and NCEP-ATPIII definitions were used to define Hypercholesterolemia (total cholesterol ≥200mg/dl), Hypertension (SBP≥140mmHg and/or DBP≥90mmHg). Double burden hypertension-hypercholesterolemia was defined as follows: total cholesterol (CT)≥200mg/dl, SBP≥140mmHg and DBP≥90mmHg. Results: The prevalence of hypertension (HTA), hypercholesterolemia (hyperchol) and double burden HTA-Hyperchol were 61.2%, 66.3% and 45.9%, respectively. No sociodemographic factor was associated with hypertension, hypercholesterolemia and double burden, but Male gender was significantly associated (p<0.05) with hypercholesterolemia. HypoHDLemia significantly increased hypercholesterolemia and the double burden by 19.664 times (p=0.001) and 14.968 times (p=0.021), respectively. Regarding dietary habits, the consumption of rice, peanuts and derivatives and cottonseed oil respectively significantly (p<0.05) exposed to the occurrence of hypertension. The consumption of tomatoes, green bananas, corn and derivatives, peanuts and derivatives and cottonseed oil significantly exposed (p<0.05) to the occurrence of hypercholesterolemia. The consumption of palm oil and cottonseed oil exposed the occurrence of the double burden of hypertension-hypercholesterolemia. Consumption of eggs protects against hypercholesterolemia, and consumption of peanuts and tomatoes protects against the double burden. Conclusion: hypercholesterolemia associated with hypertension appears as a complicating factor of congestive heart failure. Key risk factors are mainly diet-based, suggesting the importance of nutritional education for patients. New management protocols emphasizing diet should be considered.

Keywords: risk factors, hypertension, hypercholesterolemia, congestive heart failure

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Authors: Mohammad Reza Zamanian

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The construction industry has always been recognized as one of the most dangerous available industries, and the statistics of accidents and injuries resulting from it say that the safety category needs more attention and the arrival of up-to-date technologies in this field. Building information modeling (BIM) is one of the relatively new and applicable technologies in Iran, that the necessity of using it is increasingly evident. The main purposes of this research are to evaluate the feasibility of using this technology in the safety sector of construction projects and to evaluate the effectiveness and operationality of its various applications in this sector. These applications were collected and categorized after reviewing past studies and researches then a questionnaire based on Delphi method criteria was presented to 30 experts who were thoroughly familiar with modeling software and safety guidelines. After receiving and exporting the answers to SPSS software, the validity and reliability of the questionnaire were assessed to evaluate the measuring tools. Fuzzy logic is a good way to analyze data because of its flexibility in dealing with ambiguity and uncertainty issues, and the implementation of the Delphi method in the fuzzy environment overcomes the uncertainties in decision making. Therefore, this method was used for data analysis, and the results indicate the usefulness and effectiveness of BIM in projects and improvement of safety status at different stages of construction. Finally, the applications and the sections discussed were ranked in order of priority for efficiency and effectiveness. Safety planning is considered as the most influential part of the safety of BIM among the four sectors discussed, and planning for the installation of protective fences and barriers to prevent falls and site layout planning with a safety approach based on a 3D model are the most important applications of BIM among the 18 applications to improve the safety of construction projects.

Keywords: building information modeling, safety of construction projects, Delphi method, fuzzy logic

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Authors: Hala M. El-hanbuli, Mohammed F. Darweesh

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The incidence rates of any tumor vary hugely with geographical location. Basal Cell Carcinoma (BCC) is one of the most common skin cancer that has many histopathologic subtypes. Objective: The aim was to study the histopathological features of BCC cases that were received in the Pathology Department, Kasr El-Aini hospital, Cairo University, Egypt during the period from Jan 2004 to Dec 2013 and to evaluate the clinical characters through the patient data available in the request sheets. Methods: Slides and data of BCC cases were collected from the archives of the pathology department, Kasr El-Aini hospital. Revision of all available slides and histological classification of BCC according to WHO (2006) was done. Results: A total number of 310 cases of BCC representing about 65% from the total number of malignant skin tumors examined during the 10-years duration in the department. The age ranged from 8 to 84 years, the mean age was (55.7 ± 15.5). Most of the patients (85%) were above the age of 40 years. There was a slight male predominance (55%). Ulcerated BCC was the most common gross picture (60%), followed by nodular lesion (30%) and finally the ulcerated nodule (10%). Most of the lesions situated in the high-risk sites (77%) where the nose was the most common site (35%) followed by the periocular area (22%), then periauricular (15%) and finally perioral (5%). No lesion was reported outside the head. The tumor size was less than 2 centimeters in 65% of cases, and from 2-5 centimeters in the lesions' greatest dimension in the rest of cases. Histopathological reclassification revealed that the nodular BCC was the most common (68%) followed by the pigmented nodular (18.75%). The histologic high-risk groups represented (7.5%) about half of them (3.75%) being basosquamous carcinoma. The total incidence for multiple BCC and 2nd primary was 12%. Recurrent BCC represented 8%. All of the recurrent lesions of BCC belonged to the histologic high-risk group. Conclusion: Basal Cell Carcinoma is the most common skin cancer in the 10-year survey. Histopathological diagnosis and classification of BCC cases are essential for the determination of the tumor type and its biological behavior.

Keywords: basal cell carcinoma, high risk, histopathological features, statistical analysis

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Authors: Provides Ng

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Platform economy is a peer-to-peer model of distributing resources facilitated by community-based digital platforms. In recent years, digital platforms are rapidly reconfiguring the public realm using hyper-personalisation techniques. This paper aims at investigating how urban planning can leapfrog into the digital age to help relieve the rising tension of the global issue of labour flow; it discusses the means to transfer techniques of hyper-personalisation into urban planning for plasticity using platform technologies. This research first denotes the limitations of the current system of urban residency, where the system maintains itself on the circulation of documents, which are data on paper. Then, this paper tabulates how some of the institutions around the world, both public and private, digitise data, and streamline communications between a network of systems and citizens using platform technologies. Subsequently, this paper proposes ways in which hyper-personalisation can be utilised to form a digital planning platform. Finally, this paper concludes by reviewing how the proposed strategy may help to open up new ways of thinking about how we affiliate ourselves with cities.

Keywords: platform urbanism, hyper-personalisation, digital inventory, urban accessibility

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Authors: Kwaku Damoah

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The agricultural sector is characterized by continuous transformation, driven by factors such as demographic shifts, evolving consumer preferences, climate change, and migration trends. This dynamic environment presents complex challenges for key stakeholders including farmers, governments, and investors, who must navigate these changes to achieve optimal investment returns. To effectively predict market trends and uncover promising investment opportunities, a systematic, data-driven approach is essential. This paper introduces the Structural Evolution Index (SEI), a machine learning-based methodology. SEI is specifically designed to analyse long-term trends and forecast the potential of emerging agricultural products for investment. Versatile in application, it evaluates various agricultural metrics such as production, yield, trade, land use, and consumption, providing a comprehensive view of the evolution within agricultural markets. By harnessing data from the UN Food and Agricultural Organisation (FAOSTAT), this study demonstrates the SEI's capabilities through Comparative Exploratory Analysis and evaluation of international trade in agricultural products, focusing on Malaysia and Singapore. The SEI methodology reveals intricate patterns and transitions within the agricultural sector, enabling stakeholders to strategically identify and capitalize on emerging markets. This predictive framework is a powerful tool for decision-makers, offering crucial insights that help anticipate market shifts and align investments with anticipated returns.

Keywords: agricultural investment, algorithm, comparative exploratory analytics, machine learning, market trends, predictive analytics, structural evolution index

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Authors: Rhodine Hickman, Craig Wylie, Michael G. McCaul

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Introduction: The World Health Organisation has called on governments around the world to recognise emergency conditions as a global public health problem and respond with appropriate steps for effective preventative strategies. However, to understand the magnitude of the problem, good quality epidemiological data is required. This is especially challenging in low and middle-income countries, where routine data is scarce, specifically within the prehospital setting. Methods: We conducted a retrospective cross-sectional study of a national prehospital private sector EMS database. The database being the property of ER24 (private Emergency Medical Services (EMS) company in South Africa) contains claims submitted by the majority of ambulance services in South Africa during the period between 1 January 2008 to 28 March 2017. We used descriptive statistics and control charts to describe the data using STATA 14. Results: 299,257 calls were included in the analysis. The top clinical conditions requiring ambulance transport were transport accidents (10% of total call volume) and ischaemic heart disease (4.4%). The number of transport accidents consistently increased between 2009 and 2014 and reached beyond the limit for normal variation in 2015. Victims of transport accidents required basic life support services 60% of the time with 80% of injuries being minor to moderate. The frequency of ischaemic heart disease had a steady incline from 2011 to 2016. Advanced life support services were required about 50% of the time, with 60% of patients needing urgent care. Conclusion: Transport accidents, followed by ischaemic heart disease, are the most prevalent conditions in South African private EMS. There is a potential to address these conditions by developing the capacity of low and mid-level providers in trauma and advanced EMS providers in ischaemic heart disease.

Keywords: emergency care, emergency medicine, prehospital providers, South Africa

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Authors: Merad Boudia Omar Rafik, Feham Mohammed

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Data aggregation in wireless sensor networks (WSNs) provides a great reduction of energy consumption. The limited resources of sensor nodes make the choice of an encryption algorithm very important for providing security for data aggregation. Asymmetric cryptography involves large ciphertexts and heavy computations but solves, on the other hand, the problem of key distribution of symmetric one. The latter provides smaller ciphertexts and speed computations. Also, the recent researches have shown that achieving the end-to-end confidentiality and the end-to-end integrity at the same is a challenging task. In this paper, we propose (SA-SPKC), a novel security protocol which addresses both security services for WSNs, and where only the base station can verify the individual data and identify the malicious node. Our scheme is based on stateful public key encryption (StPKE). The latter combines the best features of both kinds of encryption along with state in order to reduce the computation overhead. Our analysis

Keywords: secure data aggregation, wireless sensor networks, elliptic curve cryptography, homomorphic encryption

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Authors: Lucia Ceccherini Nelli, Alessandra Donato

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The ABITA Master course of the University of Florence offered by the Department of Architecture covers nearly all the energy-relevant issues that can arise in public and private companies and sectors. The main purpose of the Master course, active since 2003, is to analyse the energy consumption of building technologies, components, and structures at the conceptual design stage, so it could be very helpful, for designers, when making decisions related to the selection of the most suitable design alternatives and for the materials choice that will be used in an energy-efficient building. The training course provides a solid basis for increasing the knowledge and skills of energy managers and is developed with an emphasis on practical experiences related to the knowledge through case studies, measurements, and verification of energy-efficient solutions in buildings, in the industry and in the cities. The main objectives are: i)To raise the professional standards of those engaged in energy auditing, ii) To improve the practice of energy auditors by encouraging energy auditing professionals in a continuing education program of professional development, iii) Implement in the use of instrumentations for the typical measurements, iv) To propose an integrated methodology that links energy analysis tools with green building certification systems. This methodology will be applied at the early design stage of a project’s life. The final output of the practical training is to achieve an elevated professionalism in the study of environmental design and Energy management in buildings. The results are the redaction of line guides instruction for the energy refurbishment of Public schools in Florence. The school heritage of the Municipality of Florence requires interventions for the control of energy performance, as old construction buildings are often made without taking into account the necessary envelope performance. For this reason, every year, the Master's course aims to study groups of public schools to enable the Municipality to carry out energy redevelopment interventions on the existing building heritage. The future challenges of the education and training program are related to follow-up activities, the development of interactive tools and the curriculum's customization to meet the constantly growing needs of energy experts from industry.

Keywords: expert in energy, energy auditing, public buildings, thermal analysis

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Authors: Ziwei Huang

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The standard unit of Shenzhen land spatial planning has the characteristics of vertical conduction, horizontal evaluation, internal balance and supervision of implementation. It mainly assumes the role of geospatial unit, assists in promoting the complex development of the business in Shenzhen and undertakes the management and transmission of upper and lower levels of planning as well as the Urban management functions such as gap analysis of public facilities, planning evaluation and dynamic monitoring of planning information. Combining with the application examples of the analysis of gaps in public facilities in Longgang District, it can be found that the standard unit of land spatial planning in Shenzhen as a small-scale geographic basic unit, has a stronger urban spatial coupling effect. However, the universality of the application of the system is still lacking and it is necessary to propose more scientific and powerful standard unit delineation standards and planning function evaluation indicators to guide the implementation of the system's popularization and application.

Keywords: Shenzhen city, land spatial planning, standard unit system, urban delicacy management

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Authors: Tannia Vindel, Angel Matute, Erik Elvir, Kelvin Santos

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Currently in Honduras, is been incentivized the generation of energy using renewable fonts, such as: hydroelectricity, wind power, biomass and, more recently with the strongest growth, photovoltaic energy. In July 2015 were installed 455.2 MW of photovoltaic energy, increasing by 24% the installed capacity of the national interconnected system existing in 2014, according the National Energy Company (NEC), that made possible reduce the thermoelectric dependency of the system. Given the good results of those large-scale photovoltaic plants, arises the question: is it interesting for the distribution utility and for the consumers the integration of photovoltaic systems in micro-scale in the urban and rural areas? To answer that question has been researched the insertion of photovoltaic energy in the residential sector in Tegucigalpa and Comayagüela (Central District), Honduras to determine the technical and economic viability. Francisco Morazán department, according the National Statistics Institute (NSI), in 2001 had more than 180,000 houses with power service. Tegucigalpa, department and Honduras capital, and Comayagüela, both, have the highest population density in the region, with 1,300,000 habitants in 2014 (NSI). The residential sector in the south-central region of Honduras represents a high percentage being 49% of total consumption, according with NEC in 2014; where 90% of this sector consumes in a range of 0 to 300 kWh / month. All this, in addition to the high level of losses in the transmission and distribution systems, 31.3% in 2014, and the availability of an annual average solar radiation of 5.20 kWh/(m2∙day) according to the NASA, suggests the feasibility of the implementation of photovoltaic systems as a solution to give a level of independency to the households, and besides could be capable of injecting the non-used energy to the grid. The capability of exchange of energy with the grid could make the photovoltaic systems acquisition more affordable to the consumers, because of the compensation energy programs or other kinds of incentives that could be created. Technical viability of the photovoltaic systems insertion has been analyzed, considering the solar radiation monthly average to determine the monthly average of energy that would be generated with the technology accessible locally and the effects of the injection of the energy locally generated on the grid. In addition, the economic viability has been analyzed too, considering the photovoltaic systems high costs, costs of the utility, location and monthly energy consumption requirements of the families. It was found that the inclusion of photovoltaic systems in Tegucigalpa and Comayagüela could decrease in 6 MW the demand for the region if 100% of the households use photovoltaic systems, which acquisition may be more accessible with the help of government incentives and/or the application of energy exchange programs.

Keywords: grid connected, photovoltaic, residential, technical analysis

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Authors: Rawan K. Al-Duaij, Salem A. Al-Salem

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Projects, the unique and temporary process of achieving a set of requirements have always been challenging; Planning the schedule and budget, managing the resources and risks are mostly driven by a similar past experience or the technical consultations of experts in the matter. With that complexity of Projects in Scope, Time, and execution environment, Adjustment Orders are tools to reflect changes to the original project parameters after Contract signature. Adjustment Orders are the official/legal amendments to the terms and conditions of a live Contract. Reasons for issuing Adjustment Orders arise from changes in Contract scope, technical requirement and specification resulting in scope addition, deletion, or alteration. It can be as well a combination of most of these parameters resulting in an increase or decrease in time and/or cost. Most business leaders (handling projects in the interest of the owner) refrain from using Adjustment Orders considering their main objectives of staying within budget and on schedule. Success in managing the changes results in uninterrupted execution and agreed project costs as well as schedule. Nevertheless, this is not always practically achievable. In this paper, a detailed study through utilizing Industrial Engineering & Systems Management tools such as Six Sigma, Data Analysis, and Quality Control were implemented on the organization’s five years records of the issued Adjustment Orders in order to investigate their prevalence, and time and cost impact. The analysis outcome revealed and helped to identify and categorize the predominant causations with the highest impacts, which were considered most in recommending the corrective measures to reach the objective of minimizing the Adjustment Orders impacts. Data analysis demonstrated no specific trend in the AO frequency in past five years; however, time impact is more than the cost impact. Although Adjustment Orders might never be avoidable; this analysis offers’ some insight to the procedural gaps, and where it is highly impacting the organization. Possible solutions are concluded such as improving project handling team’s coordination and communication, utilizing a blanket service contract, and modifying the projects gate system procedures to minimize the possibility of having similar struggles in future. Projects in the Oil and Gas sector are always evolving and demand a certain amount of flexibility to sustain the goals of the field. As it will be demonstrated, the uncertainty of project parameters, in adequate project definition, operational constraints and stringent procedures are main factors resulting in the need for Adjustment Orders and accordingly the recommendation will be to address that challenge.

Keywords: adjustment orders, data analysis, oil and gas sector, systems management

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Authors: Alexandra Doga, Andreas Lioumpas, Sotiris Petropoulos

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This paper assesses China-Greece relations since 2006, examining them as part of China’s Grand Strategy and Greece’s perception of them. Τhe first aim of the paper is to provide an overview of China-Greece relations in connection with its long- and short-term goals. In essence, it focuses on understanding whether a Chinese grand strategy towards Greece exists. Secondly, it aims to examine the perception of Greeks over China’s foreign policy towards Greece. The intended contribution of the paper is to illustrate the response of national discourses over China’s increased presence in both the global sphere and specific countries in particular. This paper is based on qualitative analysis of secondary data as well as a thorough primary research scheme based on semi-structured interviews. The study made use of official Chinese government documents as well as academic journal articles and books. Local news outlets like newspapers provide data, and news surrounding Greece’s perception of China-Greece relations were also included. Moreover, a number of interviews of Greek officials, academics, journalists, and businessmen were conducted. This paper concluded that the period that began with the 2006 Joint Communiqué between China and Greece on the Establishment of Comprehensive Strategic Partnership has been one of the rapid strengthening of bilateral economic and political relations and frequent high-level visits. There are diverging/opposing views on whether China’s strategic choices towards Greece form part of a broader strategic approach and on whether this strategy is closely connected to the BRI initiative and its priorities.

Keywords: China, Greece, Grand Strategy, BRI, COSCO, Piraeus Port, Mediterranean

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Authors: Sinisa Prvanov

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This research is an attempt to analyze the existing urban form of outdoor public space of Duhok city and to give proposals for their improvements in terms of urban seating. The aim of this research is to identify the main urban furniture elements and behaviour of users of three central parks of Duhok city, recognizing their functionality and the most common errors. Citizens needs, directly related to the physical characteristics of the environment, are categorized in terms of contact with nature. Parks as significant urban environments express their aesthetic preferences, as well as the need for recreation and play. Citizens around the world desire to contact with nature and places where they can socialize, play and practice different activities, but also participate in building their community and feeling the identity of their cities. The aim of this research is also to reintegrate these spaces in the wider urban context of the city of Duhok, to develop new functions by designing new seating patterns, more improved urban furniture, and necessary supporting facilities and equipment. Urban furniture is a product that uses an enormous number of people in public space. It has a high level of wear and damage due to intense use, exposure to sunlight and weather conditions. Iraq has a hot and dry climate characterized by long, warm, dry summers and short, cold winters. The climate is determined by the Iraq location at the crossroads of Arab desert areas and the subtropical humid climate of the Persian Gulf. The second part of this analysis will describe the possibilities of traditional and contemporary materials as well as their advantages in urban furniture production, providing users protection from extreme local climate conditions, but also taking into account solidities and unwelcome consequences, such as vandalism. In addition, this research represents a preliminary stage in the development of IND307 furniture design course for needs of the Department of Interior design, at the American University in Duhok. Based on results obtained in this research, the course would present a symbiosis between people and technology, promotion of new street furniture design that perceives pedestrian activities in an urban setting, and practical use of anthropometric measurements as a tool for technical innovations.

Keywords: Furniture design, Street furniture, Social interaction, Public space

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Authors: Takahiro Katayama, Hsueh-Sheng Chang

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Due to the global climate change, it has increased the extreme rainfall that led to serious floods around the world. In recent years, urbanization and population growth also tend to increase the number of impervious surfaces, resulting in significant loss of life and property during floods especially for the urban areas of Taiwan. In the past, the primary governmental response to floods was structural flood control and the only flood protection standards in use were the design standards. However, these design standards of flood control facilities are generally calculated based on current hydrological conditions. In the face of future extreme events, there is a high possibility to surpass existing design standards and cause damages directly and indirectly to the public. To cope with the frequent occurrence of floods in recent years, it has been pointed out that there is a need for a different standard called FPSR (Flood Protection Standard of Regions) in Taiwan. FPSR is mainly used for disaster reduction and used to ensure that hydraulic facilities draining regional flood immediately under specific return period. FPSR could convey a level of flood risk which is useful for land use planning and reflect the disaster situations that a region can bear. However, little has been reported on FPSR and its impacts to the public in Taiwan. Hence, this study proposes a quantity procedure to evaluate the FPSR. This study aimed to examine FPSR of the region and public perceptions of and knowledge about FPSR, as well as the public’s WTP (willingness to pay) for FPSR. The research is conducted via literature review and questionnaire method. Firstly, this study will review the domestic and international research on the FPSR, and provide the theoretical framework of FPSR. Secondly, CVM (Contingent Value Method) has been employed to conduct this survey and using double-bounded dichotomous choice, close-ended format elicits households WTP for raising the protection level to understand the social costs. The samplings of this study are citizens living in Taichung city, Taiwan and 700 samplings were chosen in this study. In the end, this research will continue working on surveys, finding out which factors determining WTP, and provide some recommendations for adaption policies for floods in the future.

Keywords: climate change, CVM (Contingent Value Method), FPSR (Flood Protection Standard of Regions), urban flooding

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Authors: Ilgoun Kim, Jongpil Jeong

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Recently, a connected industrial parks (CIPs) architecture using new technologies such as RFID, cloud computing, CPS, Big Data, 5G 5G, IIOT, VR-AR, and ventral AI algorithms based on IoT has been proposed. This researcher noted the vehicle junction problem (VJP) as a more specific detail of the CIPs architectural models. The VJP noted by this researcher includes 'efficient AI physical connection challenges for vehicles' through ventilation, 'financial and financial issues with complex vehicle physical connections,' and 'welfare and working conditions of the performing personnel involved in complex vehicle physical connections.' In this paper, we propose a public solution architecture for the 'electronic financial problem of complex vehicle physical connections' as a detailed task during the vehicle junction problem (VJP). The researcher sought solutions to businesses, consumers, and Korean social problems through technological advancement. We studied how the beneficiaries of technological development can benefit from technological development with many consumers in Korean society and many small and small Korean company managers, not some specific companies. In order to more specifically implement the connected industrial parks (CIPs) architecture using the new technology, we noted the vehicle junction problem (VJP) within the smart factory industrial complex and noted the process of achieving the vehicle junction problem performance among several electronic processes. This researcher proposes a more detailed, integrated public finance enterprise architecture among the overall CIPs architectures. The main details of the public integrated financial enterprise architecture were largely organized into four main categories: 'business', 'data', 'technique', and 'finance'.

Keywords: enterprise architecture, IT Finance, smart logistics, CIPs

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Authors: Eyup Dogan

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One criticism of the energy-growth-environment literature, to the best of our knowledge, is that only a few studies analyze the influence of tourism on CO₂ emissions even though tourism sector is closely related to the environment. The other criticism is the selection of methodology. Panel estimation techniques that fail to consider both heterogeneity and cross-sectional dependence across countries can cause forecasting errors. To fulfill the mentioned gaps in the literature, this study analyzes the impacts of real GDP, renewable energy and tourism on the levels of carbon dioxide (CO₂) emissions for the top 10 most-visited countries around the world. This study focuses on the top 10 touristic (most-visited) countries because they receive about the half of the worldwide tourist arrivals in late years and are among the top ones in 'Renewables Energy Country Attractiveness Index (RECAI)'. By looking at Pesaran’s CD test and average growth rates of variables for each country, we detect the presence of cross-sectional dependence and heterogeneity. Hence, this study uses second generation econometric techniques (cross-sectionally augmented Dickey-Fuller (CADF), and cross-sectionally augmented IPS (CIPS) unit root test, the LM bootstrap cointegration test, and the DOLS and the FMOLS estimators) which are robust to the mentioned issues. Therefore, the reported results become accurate and reliable. It is found that renewable energy mitigates the pollution whereas real GDP and tourism contribute to carbon emissions. Thus, regulatory policies are necessary to increase the awareness of sustainable tourism. In addition, the use of renewable energy and the adoption of clean technologies in tourism sector as well as in producing goods and services play significant roles in reducing the levels of emissions.

Keywords: air pollution, tourism, renewable energy, income, panel data

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Authors: Xiao Chen, Alice Ho, Mabel Tie, Xiaoheng Xu

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Background and Significance of the Study: School-enterprise cooperation has been the cornerstone of vocational education in China and many other countries. Researchers and policymakers have paid much attention to ensuring the implementation and improving the quality of school-enterprise cooperation. However, many problems still exist on the implementation level of the cooperation. On the one hand, the enterprises lack the motivation to participate in the cooperation. On the other hand, there is a lack of effective guidance and management during the cooperation. Furthermore, the current literature focuses greatly on policy recommendations on the national level while failing to provide a detailed practical understanding of how school-enterprise cooperation is carried out on the ground level. With emerging social problems, such as the aging population in China, there is an increasing need for diverse nursing services and better nursing quality. Methodology: To gain a deeper understanding of the influencing factors of the implementation of school-enterprise cooperation, this work conducted 37 exploratory interviews in four Chinese cities spanning first-tier to fourth-tier cities with hospital department directors, vocational school deans, nurses, and vocational students. Multiple critical policy documents that founded the current vocational education system in China were analyzed, along with the data collected from the interviews. Major Findings: Based on the policy and interview analyses, this work reveals a set of influencing factors for school-enterprise cooperation implementation. Findings from each region contribute to an overall model of influencing factors for implementing school-enterprise cooperation in vocational nursing education in China, which leads to practical insights for policy recommendation. The key influencing factors are found based on the policy, hospital, school, and social levels. Following practical policy recommendations were presented. Moving forward, further research on the implementation of school-enterprise cooperation in specific industries will become increasingly critical to improving the effectiveness of educational policies and the quality of vocational education.

Keywords: nursing, policy recommendation, school-enterprise cooperation, vocational education

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Authors: Mohammad Hossein Badamchi

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As Leo Strauss demonstrates in his works, Political Philosophy in the western tradition is an epistemic-naturalistic tradition insofar Hanna Arendt mentioning the deep conflict between philosophy and politics, opposed to be named “political philosopher” prefer the title “political thinker” for herself. In fact, the Western political philosophy’s tendency to derive politics from natural law and epistemic argumentations makes a paradox between the actual “the political” and the theoretical “natural politics” in the western tradition. In this paper, we want to show that Hanna Arendt, in her exploration to find a new realm of the non-naturalistic way of thinking about the political is walking on a completely different tradition of political philosophy which was first established by Al-Farabi, the founder of Islamic political philosophy around thousand years after Greek Philosophy. Despite Aristotelian Polis which is a Natural community based on true natural rationality to reach the natural purposes of mankind, Al-Farabi’s Madine (his reconstructed concept of Aristotelian Polis) is completely constructed against natural cities, which are formulated by necessity logic of natural arguments and natural deception of humanity. In fact, Farabi considers the natural understanding of politics as Ignorant ideologies used by governments to suppress people. Madine in Farabi’s work is not a natural institution but is a collaborative constitution founded by citizens. So despite Aristotelian thinking, here we don’t have just A Polis that is the one true polis, but we have various multiple Madines among one, is virtuous not by definition but by real action of citizens and civil relations. Al-Farabi’s political philosophy is not a Naturalistic-epistemic Political Philosophy but is a Phronetic Political Philosophy which Hanna Arendt wants to establish outside of western contemplative anti-active political philosophy tradition.

Keywords: al-farabi, hanna arendt, natural politics, the political, political philosophy

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