Search results for: healthcare policies

Authors: Sreejith Gopinath, Aspen Olmsted

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This paper is based on our previous work that proposed a risk-transference-based architecture for healthcare systems to store sensitive data outside the system boundary, rendering the system unattractive to would-be bad actors. This architecture also allows a compromised system to be abandoned and a new system instance spun up in place to ensure business continuity without paying a ransom or engaging with a bad actor. This paper delves into the details of various attacks we simulated against the prototype system. In the paper, we discuss at length the time and computational costs associated with storing and retrieving data in the prototype system, abandoning a compromised system, and setting up a new instance with existing data. Lastly, we simulate some analytical workloads over the data stored in our specialized data storage system and discuss the time and computational costs associated with running analytics over data in a specialized storage system outside the system boundary. In summary, this paper discusses the total costs of data storage, access, and analytics incurred with the proposed architecture.

Keywords: cybersecurity, healthcare, ransomware, resilience, risk transference

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Authors: Lukasz Kurowski, Paweł Smaga

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We explore the procyclicality of monetary policy decisions towards the financial cycle in the 1995−2015 period on a sample of six central banks. Using interest rate paths and the credit-to-GDP gap to construct a monetary policy procyclicality ratio, we provide evidence that monetary policy procyclicality was high in BoE and CNB and low in Riksbank and ECB. The results support the need for coordination between macroprudential and monetary policies, for example, by including financial stability considerations to the inflation targeting strategy.

Keywords: central bank, financial stability, macroprudential policy, monetary policy

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Authors: Frederick Monyepao

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Crack cocaine first appeared on the scene in the form of cocaine freebasing in the late 1970s. Stockbrokers, investment bankers, rock stars, Hollywood elites, and a few pro athletes were regular users of the substance. As criminogenic factors associated with substance abuse began to surface, congress passed new legislation. The laws led to the increase of health coverage insurances and the expansion of hospitals. By the mid-1980s, crack use spread into America's inner cities among impoverished African Americans and Latinos. While substance abuse increased among minority communities, legislation pertaining to substance abuse evolved. The prison industry also expanded the number of cells available. A qualitative approach was taken, drawing from a range secondary sources for contextual analysis. This paper traces out the continued marginalisation and racist undertones towards minorities as perpetuated by certain drug policies. It was discovered that the new legislation on crack was instrumental in the largest incarcerations the United States ever faced. Drug offenders increased in prisons eightfold from 1986 to 2000. The paper concludes that American drug control policies are consistently irrational and ineffective when measured by levels of substance use and abuse. On the contrary, these policies have been successful as agents of social control in maintaining the stratification patterns of racial/ethnic minorities and women. To move beyond prohibition, radical law and policy reform may require a change in narratives on substance use.

Keywords: crack, drug policy, minorities, racism, substance abuse

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Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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Authors: Amira A. Alshowkan, Aleya M. Gamal

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Background: Patient safety is a vital element in providing high quality health care. In psychiatric wards, numerous of physical and emotional factors have been found to affect patient safety. In addition, organization, healthcare provider and patients were identified to be significant factors in patient safety. Aim: This study aims to discover nurses' perception of patient safety in psychiatric wards in Saudi Arabian. Method: Date will be collected through semi-structure face to face interview with nurses who are working at psychiatric wards. Data will be analysed thought the used of thematic analysis. Results: The results of this study will help in understanding the psychiatric nurses' perception of patient safety in Saudi Arabia. Several suggestions will be recommended for formulation of policies and strategies for psychiatric wards. In addition, recommendation to nursing education and training will be tailored in order to improve patient safety culture.

Keywords: patient safety culture, psychiatric, qualitative, Saudi Arabia

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Authors: Pedro M. Abreu, Bruno R. Mendes

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The management of pharmacotherapy and the process of dispensing medicines is becoming critical in clinical pharmacy due to the increase of incidence and prevalence of chronic diseases, the complexity and customization of therapeutic regimens, the introduction of innovative and more expensive medicines, the unbalanced relation between expenditure and revenue as well as due to the lack of rationalization associated with medication use. For these reasons, co-payments emerged in Europe in the 70s and have been applied over the past few years in healthcare. Co-payments lead to a rationing and rationalization of user’s access under healthcare services and products, and simultaneously, to a qualification and improvement of the services and products for the end-user. This analysis, under hospital practices particularly and co-payment strategies in general, was carried out on all the European regions and identified four reference countries, that apply repeatedly this tool and with different approaches. The structure, content and adaptation of European co-payments were analyzed through 7 qualitative attributes and 19 performance indicators, and the results expressed in a scorecard, allowing to conclude that the German models (total score of 68,2% and 63,6% in both elected co-payments) can collect more compliance and effectiveness, the English models (total score of 50%) can be more accessible, and the French models (total score of 50%) can be more adequate to the socio-economic and legal framework. Other European models did not show the same quality and/or performance, so were not taken as a standard in the future design of co-payments strategies. In this sense, we can see in the co-payments a strategy not only to moderate the consumption of healthcare products and services, but especially to improve them, as well as a strategy to increment the value that the end-user assigns to these services and products, such as medicines.

Keywords: clinical pharmacy, co-payments, healthcare, medicines

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Authors: Sisira Edirippulige

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Background: Digital health education and training (DHET) is imperative for preparing current and future clinicians to work competently in digitally enabled environments. Despite rapid integration of digital health in modern health services, systematic education and training opportunities for health workers is still lacking. Objectives: This study aimed to investigate healthcare professionals’ perspectives and expectations regarding the knowledge, skills and competency needs in digital health for current and future healthcare workforce. Methods: A qualitative study design with semi-structured individual interviews was employed. A purposive sample method was adopted to collect relevant information from the health workers. Inductive thematic analysis was used to analyse data. Interviews were audio-recorded and transcribed verbatim. Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed when we reported this study. Results: Two themes emerged while analysing the data: (1) what to teach in DHET and (2) how to teach DHET. Overall, healthcare professionals agreed that DHET is important for preparing current and future clinicians for working competently in digitally enabled environments. Knowledge relating to what is digital health, types of digital health, use of technology and human factors in digital health were considered as important to be taught in DHET. Skills relating to digital health consultations, clinical information system management and remote monitoring were considered important to be taught. Blended learning which combined e-learning and classroom-based teaching, simulation sessions and clinical rotations were suggested by healthcare professionals as optimal approaches to deliver the above-mentioned content. Conclusions: This study is the first of its kind to investigate health professionals’ perspectives and expectations relating to the knowledge, skills and competency needs in digital health for current and future healthcare workforce. Healthcare workers are keen to acquire relevant knowledge, skills and competencies related to digital health. Different modes of education delivery is of interest to fit in with busy schedule of health workers.

Keywords: digital health, telehealth, telemedicine, education, curriculum

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Authors: Mohammad Al-Mousawi

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This academic article explores the indispensable role of critical thinking in the process of diagnosing diseases. Employing a multidisciplinary approach, we delve into the cognitive skills and analytical mindset that clinicians, researchers, and healthcare professionals must employ to navigate the complexities of disease identification. By examining the integration of critical thinking within the realms of medical education, diagnostic decision-making, and technological advancements, this article aims to underscore the significance of cultivating and applying critical thinking skills in the ever-evolving landscape of healthcare.

Keywords: critical thinking, medical education, diagnostic decision-making, fostering critical thinking

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Authors: Hussain Ali Bekhet, Endang Jati Mat Sahid

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For the past few decades, the Malaysian economy has expanded at an impressive pace, whilst, the Malaysian population has registered a relatively high growth rate. These factors had driven the growth of final energy demand. The ballooning energy demand coupled with the country’s limited indigenous energy resources have resulted in an increased of the country’s net import. Therefore, acknowledging the precarious position of the country’s energy self-sufficiency, this study has identified three main concerns regarding energy security, namely; over-dependence on fossil fuel, increasing energy import dependency, and increasing energy consumption per capita. This paper discusses the recent energy demand and supply trends, highlights the policies that are affecting energy security in Malaysia and suggests strategic options towards achieving energy security. The paper suggested that diversifying energy sources, reducing carbon content of energy, efficient utilization of energy and facilitating low-carbon industries could further enhance the effectiveness of the measures as the introduction of policies and initiatives will be more holistic.

Keywords: electricity, energy policy, energy security, Malaysia

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Authors: John Ahluwalia

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As an affluent first-world nation, Canada took swift and comprehensive action during the outbreak of the SARS-CoV-2 (COVID-19) pandemic compared to other countries in the same socio-economic cohort. The United States has stumbled to overcome obstacles most developed nations have faced, which has led to significantly more per capita cases and deaths. The initial outbreaks of COVID-19 occurred in the US and Canada within days of each other and posed similar potentially catastrophic threats to public health, the economy, and governmental stability. On a macro level, events that take place in the US have a direct impact on Canada. For example, both countries tend to enter and exit economic recessions at approximately the same time, they are each other’s largest trading partners, and their currencies are inexorably linked. Why is it that Canada has not shared the same fate as the US (and many other nations) that have realized much worse outcomes relative to the COVID-19 pandemic? Variables intrinsic to Canada’s national infrastructure have been instrumental in the country’s efforts to flatten the curve of COVID-19 cases and deaths. Canada’s coordinated multi-level governmental effort has allowed it to create and enforce policies related to COVID-19 at both the national and provincial levels. Canada’s policy of universal healthcare is another variable. Health care and public health measures are enforced on a provincial level, and it is within each province’s jurisdiction to dictate standards for public safety based on scientific evidence. Rather than introducing confusion and the possibility of competition for resources such as PPE and vaccines, Canada’s multi-level chain of government authority has provided consistent policies supporting national public health and local delivery of medical care. This paper will demonstrate that the coordinated efforts on provincial and federal levels have been the linchpin in Canada’s relative success in containing the deadly spread of the COVID-19 virus.

Keywords: COVID-19, Canada, GIS, temporal analysis, ESRI

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Authors: Bishwa Nath Oli

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Nepal is highly impacted by climate change and adaptation has been a major focus. This paper investigates the gaps and coherence in national policies across water, forestry, local development and agriculture sectors, identifies their links to climate change adaptation and national development plans and analyzes the effectiveness of climate change policy on adaptation. The study was based on a content analysis of relevant policy documents on the level of attention given to adaptation and key informant interviews. Findings show that sectoral policies have differing degrees of cross thematic coherence, often with mismatched priorities and differing the paths towards achieving climate change goal. They are somewhat coherent in addressing immediate disaster management issues rather than in climate adaptation. In some cases, they are too broad and complicated and the implementation suffers from barriers and limits due to lack of capacity, investment, research and knowledge needed for evidence-based policy process. They do not adequately provide operational guidance in supporting communities in adapting to climate change. The study recommends to a) embrace longer-term cross-sectoral planning within government structures to foster greater policy coherence and integrated adaptation planning, b) increase awareness and flow of information on the potential role of communities in climate change, c) review the existing development sectors from the climate change perspectives, and d) formulate a comprehensive climate change legislation based on the need to implement the new Constitution.

Keywords: agriculture, climate change adaptation, forestry, policies

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Authors: John Pomerat, Aviv Segev

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Recently, deep learning has had many theoretical breakthroughs. For deep learning to be successful in the industry, however, there need to be practical algorithms capable of handling many real-world hiccups preventing the immediate application of a learning algorithm. Although AI promises to revolutionize the healthcare industry, getting access to patient data in order to train learning algorithms has not been easy. One proposed solution to this is data- sharing. In this paper, we propose an alternative protocol, based on multi-party computation, to train deep learning models while maintaining both the privacy and security of training data. We examine three methods of training neural networks in this way: Transfer learning, average ensemble learning, and series network learning. We compare these methods to the equivalent model obtained through data-sharing across two different experiments. Additionally, we address the security concerns of this protocol. While the motivating example is healthcare, our findings regarding multi-party computation of neural network training are purely theoretical and have use-cases outside the domain of healthcare.

Keywords: neural network aggregation, multi-party computation, transfer learning, average ensemble learning

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Authors: Nchanji Yvonne Kiki, Mala William Armand, Nchanji Eileen Bogweh, Ramcilovik-Suominen Sabaheta, Kotilainen Juha

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The Campo Ma'an National Park was created as part of an environmental and biodiversity compensation for the Chad-Cameroon Oil Pipeline Project, which was meant to help alleviate poverty and boost the livelihood of rural communities around the area. This paper examines different strategies and coping mechanisms employed by the indigenous people and local communities to deal with the national and internationally driven conservation policies and initiatives in the case of the Campo Ma'an National Park. While most literature on park management/co-management/nature conservation has focused on the negative implications for local peoples’ livelihoods, fewer studies have investigated the strategies of local people to respond to these policies and renegotiate their position in a way that enables them to continue their traditional livelihoods using the existing local knowledge systems. This study contributes to the current literature by zooming into not only the impacts of nature conservation policies but also the local individual and collective strategies and responses to such policies and initiatives. We employ a qualitative research approach using ethnomethodology and a convivial lens to analyze data collected from October to November 2018. We find that conservation policies have worsened some existing livelihoods on the one hand and constrained livelihood improvement of indigenous people and local communities (IPLC) on the other hand. Nonetheless, the IPLC has devised individual and collective coping mechanisms to deal with these conservation interventions and the negative effects they have caused. Upon exploring these mechanisms and their effectiveness, this study proposes a management approach to conservation centered on both people and nature, based on indigenous and local people's knowledge and practices, promoting nature for and by humans and strengthening both livelihood and conservation. We take inspiration from the convivial conservation approach and thinking by Bucher and Fletcher.

Keywords: conservation policies, national park management, indigenous and local people’s experiences, livelihoods, local knowledge, coping strategies, conviviality

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Authors: Ezinne K. Okoro, Takahiko Katoh, Yoko Kawamura, Stanley C. Meribe

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HIV infection in children is largely as a result of vertical transmission (mother to child transmission [MTCT]). Thus, elimination of mother to child transmission of HIV/AIDS is critical in eliminating HIV infection in children. In Nigeria, drawbacks such as; limited pediatric screening, limited human capital, insufficient advocacy and poor understanding of ART guidelines, have impacted efforts at combating the disease, even as treatment services are free. Prevention of Mother to Child Transmission (PMTCT) program relies on health workers who not only counsel pregnant women on first contact but can competently provide HIV-positive pregnant women with accurate information about the PMTCT program such as feeding techniques and drug adherence. In developing regions like Nigeria where health care delivery faces a lot of drawbacks, it becomes paramount to address these issues of poor PMTCT coverage by conducting a baseline assessment of the knowledge, practices and perceptions related to HIV prevention amongst healthcare workers in Nigeria. A descriptive cross-sectional study was conducted amongst 250 health workers currently employed in health facilities in Abuja, Nigeria where PMTCT services were offered with the capacity to carry out early infant diagnosis testing (EID). Data was collected using a self-administered, pretested, structured questionnaire. This study showed that the knowledge of PMTCT of HIV was poor (30%) among healthcare workers who offer this service day-to-day to pregnant women. When PMTCT practices were analyzed in keeping with National PMTCT guidelines, over 61% of the respondents reported observing standard practices and the majority (58%) had good attitudes towards caring for patients with HIV/AIDS. Although 61% of the respondents reported being satisfied with the quality of service being rendered, 63% reported not being satisfied with their level of knowledge. Predictors of good knowledge were job designation and level of educational attainment. Health workers who were more satisfied with their working conditions and those who had worked for a longer time in the PMTCT service were more likely to observe standard PMTCT practices. With over 62% of the healthcare workers suggesting that more training would improve the quality of service being rendered, this is a strong pointer to stakeholders to consider a ‘healthcare worker-oriented approach’ when planning and conducting PMTCT training for healthcare workers. This in turn will increase pediatric ARV coverage, the knowledge and effectiveness of the healthcare workers in carrying out appropriate PMTCT interventions and culminating in the reduction/elimination of HIV transmission to newborns.

Keywords: attitudes, HIV/AIDS, healthcare workers, knowledge, mother to child transmission, Nigeria, perceptions

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Authors: Jaishree Ellis

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The United States Centers for Disease Control tells us that many women with disabilities will not receive regular health screenings, including Pap Smears and mammograms. This article was comprised and written to recognize the barriers to care, gaps in existing healthcare implementation, and viable methodologies for the provision of comprehensive and robust gynecologic care for women with disabilities. According to the World Health Organization, 15% of the world's population, or approximately 1 billion people, have disabilities, most of whom are identified as women. Women with disabilities are described as being multi-disabled, as in some places, they suffer exclusion because of their disabilities as well as their gender. The paucity of information regarding how to create a healthcare system that is inclusive of every woman, regardless of her type of disability (physical, mental, intellectual or medical), has made it challenging to establish an environment that makes it possible for individuals to access care in an equitable, respectful and comprehensive way. A review of the current literature, institutional websites within the United States and American resource guides was implemented to determine where comprehensive models of care for women with disabilities exist, as well as the modalities that are being employed to meet their healthcare needs. The many barriers to care that women with disabilities face were also extracted from various sources within the literature to provide an exhaustive list that can be tackled, one by one. Of the 637 Hospital Systems in the United States, only 7 provide website documentation of health care services that address the unique needs of women with disabilities. The presumption is that if institutions have not marketed such interventions to the community, then it is likely that they do not have a robust suite of services with which to make gynecologic care available to patients with disabilities. Through this review, 7 main barriers to comprehensive gynecologic care were identified, with more than 20 sub-categories existing within those. As with many other areas of community life, inclusion remains lacking in the delivery of healthcare for women with disabilities. There are at least 7 barriers that must be overcome in order to provide equity in the medical office, the exam room, the hospital and the operating room. While few institutions have prioritized this, those few have provided blueprints that can easily be adopted by others. However, as the general population lives longer and ages, the incidence of disabilities increases, as do the healthcare disparities surrounding them. Further compounded by this is a lack of formal education for medical providers in the United States.

Keywords: health equity, inclusion, healthcare disparities, education

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Muhammad Nur Haniff Mohd Noor, Rokiah Kadir, Suriyani Muhamad

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The National Forestry Act (NFA) 1984 is the primary forest law that regulates forest-related activities in Peninsular Malaysia. In the 1990s, abundance of illegal logging cases have called for legislative reform of the NFA 1984. As a result, NFA 1984 was amended in 1993 with the principal goal of controlling illegal forest encroachment in the forms of illegal logging, unauthorized harvesting, unlicensed forest settlement and other forms of unlawful activities. At a conceptual level, this paper discusses the policies and strategies implemented under the NFA 1984 (Amendment 1993) that are dedicated to overcome illegal logging. Then, the policies and strategies employed are reviewed and evaluated. Next, this paper conceptually discusses the loopholes of NFA 1984 (Amendment 1993) in relation to aspects where the regulation is considered insufficient to curb illegal logging. In the final section, vital actions and suggested improvements to improve the overall effectiveness of NFA 1984 (Amendment 1993) are examined.

Keywords: forest law and regulation, illegal logging, National Forestry Act 1984, NFA 1984, Amendment 1993, Peninsular Malaysia

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Authors: Ellen Holtmaat

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With an ever increasing influence of international organizations (IOs) on national policies and with the expectation that IOs are the transmission belts of world ideologies it is interesting to see to what extent IOs express a specific ideology and what determines the dominance of this ideology. This thesis looks at the OECD as IO and higher education as a field of policy. Evidence is found that the OECD promotes neoliberal developments in higher education and that its position is influenced by business, dominant countries and the dominant beliefs that are carried by the people working for the OECD that form an epistemic community. These results can possibly be extrapolated to other IOs.

Keywords: higher education, international organizations, neoliberal, OECD

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Authors: Maiya Smith, Tyler Thorne

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Background: The Pacific faces multiple healthcare crises, including high rates of noncommunicable diseases, infectious disease outbreaks, and susceptibility to natural disasters. These issues are expected to worsen in the coming decades, increasing the burden on an already understaffed healthcare system. Telehealth is not new to the Pacific, but improvements in technology and accessibility have increased its utility and have already proven to reduce costs and increase access to care in remote areas. Telehealth includes distance learning; a form of education that can help alleviate many healthcare issues by providing continuing education to healthcare professionals and upskilling staff, while decreasing costs. This study examined distance learning programs at the Ministry of Health in the Pacific nation of Palau and identified key elements to their successful distance learning programs. Methods: Staff at the Belau National Hospital in Koror, Palau as well as private practitioners were interviewed to assess distance learning programs utilized. This included physicians, IT personnel, public health members, and department managers of allied health. In total, 36 people were interviewed. Standardized questions and surveys were conducted in person throughout the month of July 2019. Results: Two examples of successful distance learning programs were identified. Looking at the factors that made these programs successful, as well as consulting with staff who undertook other distance learning programs, four factors for success were determined: having a cohort, having a facilitator, dedicated study time off from work, and motivation. Discussion: In countries as geographically isolated as the Pacific, with poor access to specialists and resources, telehealth has the potential to radically change how healthcare is delivered. Palau shares similar resources and issues as other countries in the Pacific and the lessons learned from their successful programs can be adapted to help other Pacific nations develop their own distance learning programs.

Keywords: distance learning, Pacific, Palau, telehealth

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Authors: Samuel Fekadu A., Esayas Alemayehu B., Bultum Oljira D., Seid Tiku D., Dessalegn Dadi D., Bart Van Der Bruggen A.

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The peroxi-photoelectrocoagulation process was evaluated for the removal of chemical oxygen demand (COD) and color from healthcare wastewater. A 2-level full factorial design with center points was created to investigate the effect of the process parameters, i.e., initial COD, H₂O₂, pH, reaction time and current density. Furthermore, the total energy consumption and average current efficiency in the system were evaluated. Predictive models for % COD, % color removal and energy consumption were obtained. The initial COD and pH were found to be the most significant variables in the reduction of COD and color in peroxi-photoelectrocoagulation process. Hydrogen peroxide only has a significant effect on the treated wastewater when combined with other input variables in the process like pH, reaction time and current density. In the peroxi-photoelectrocoagulation process, current density appears not as a single effect but rather as an interaction effect with H₂O₂ in reducing COD and color. Lower energy expenditure was observed at higher initial COD, shorter reaction time and lower current density. The average current efficiency was found as low as 13 % and as high as 777 %. Overall, the study showed that hybrid electrochemical oxidation can be applied effectively and efficiently for the removal of pollutants from healthcare wastewater.

Keywords: electrochemical oxidation, UV, healthcare pollutants removals, factorial design

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Authors: Ondrej Slach, Jan Machacek, Jan Zenka, Lucie Hyllova, Petr Rumpel

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The aim of the paper is to identify and asses different trajectories of two fashionable urban policies –creative and smart cities– in specific post-socialistic context. Drawing on the case of Czechia, we employ the concept of policy mobility research. More specifically, we employ a discourse analysis in order to identify the so-called 'infrastructure' of both policies (such as principal actors, journals, conferences, events), with the special focus on 'agents of transfer' in a multiscale perspective. The preliminary results indicate faster and more aggressive spatial penetration of smart cities policy compared to creative cities policy in Czechia. Further, it seems that existed translation and implementation of smart cities policy into the national and urban context resulted in deliberated fragmented policy of smart cities in Czechia (pure technocratic view), which might be a threat for the future development of social sustainability, especially in cities that are facing increasing social polarisation. Last but not least, due to the fast spatial penetration of the concept and policies of smart cities, it seems that creative cities policy has almost been crowded out of the Czech urban agenda.

Keywords: policy mobility, smart cities, creative cities, Czechia

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Authors: Raman Sharma, Ashok Kumar, Vipin Koushal

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Healthcare facilities are always seen as places of haven and protection for managing the external incidents, but the situation becomes more difficult and challenging when such facilities themselves are affected from internal hazards. Such internal hazards are arguably more disruptive than external incidents affecting vulnerable ones, as patients are always dependent on supportive measures and are neither in a position to respond to such crisis situation nor do they know how to respond. The situation becomes more arduous and exigent to manage if, in case critical care areas like Intensive Care Units (ICUs) and Operating Rooms (OR) are convoluted. And, due to these complexities of patients’ in-housed there, it becomes difficult to move such critically ill patients on immediate basis. Healthcare organisations use different types of electrical equipment, inflammable liquids, and medical gases often at a single point of use, hence, any sort of error can spark the fire. Even though healthcare facilities face many fire hazards, damage caused by smoke rather than flames is often more severe. Besides burns, smoke inhalation is primary cause of fatality in fire-related incidents. The greatest cause of illness and mortality in fire victims, particularly in enclosed places, appears to be the inhalation of fire smoke, which contains a complex mixture of gases in addition to carbon monoxide. Therefore, healthcare organizations are required to have a well-planned disaster mitigation strategy, proactive and well prepared manpower to cater all types of exigencies resulting from internal as well as external hazards. This case report delineates a true OR fire incident in Emergency Operation Theatre (OT) of a tertiary care multispecialty hospital and details the real life evidence of the challenges encountered by OR staff in preserving both life and property. No adverse event was reported during or after this fire commotion, yet, this case report aimed to congregate the lessons identified of the incident in a sequential and logical manner. Also, timely smoke evacuation and preventing the spread of smoke to adjoining patient care areas by opting appropriate measures, viz. compartmentation, pressurisation, dilution, ventilation, buoyancy, and airflow, helped to reduce smoke-related fatalities. Henceforth, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer healthcare environment for every worker and patient.

Keywords: healthcare, fires, smoke, management, strategies

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Authors: Adrián P. Gómez Mañas

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Autonomous vehicles have already transformed urban policies and cities. This is the main assumption of our research, which aims to understand how the representations of the possible arrival of autonomous vehicles already transform priorities or actions in transport and more largely, urban policies. This research is done within the framework of a Ph.D. doctorate directed by Professor Xavier Desjardins at the Sorbonne University of Paris. Our hypotheses are: (i) the perspectives, representations, and imaginaries on autonomous vehicles already affect the stakeholders of urban policies; (ii) the discourses on the opportunities or threats of autonomous vehicles reflect the current strategies of the stakeholders. Each stakeholder tries to integrate a discourse on autonomous vehicles that allows them to change as little as possible their current tactics and strategies. The objective is to eventually make a comparison between three different cases: Paris, United Arab Emirates, and Bogota. We chose those territories because their contexts are very different, but they all have important interests in mobility and innovation, and they all have started to reflect on the subject of self-driving mobility. The main methodology used is to interview actors of the metropolitan area (local officials, leading urban and transport planners, influent experts, and private companies). This work is supplemented with conferences, official documents, press articles, and websites. The objective is to understand: 1) What they know about autonomous vehicles and where does their knowledge come from; 2) What they expect from autonomous vehicles; 3) How their ideas about autonomous vehicles are transforming their action and strategy in managing daily mobility, investing in transport, designing public spaces and urban planning. We are going to present the research and some preliminary results; we will show that autonomous vehicles are often viewed by public authorities as a lever to reach something else. We will also present that speeches are very influenced by local context (political, geographical, economic, etc.), creating an interesting balance between global and local influences. We will analyze the differences and similarities between the three cases and will try to understand which are the causes.

Keywords: autonomous vehicles, self-driving mobility, urban planning, urban mobility, transport, public policies

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Authors: Zeynep Sener, Mehtap Dursun

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Supplier evaluation and selection is one of the most important components of an effective supply chain management system. Due to the expanding competition in healthcare, selecting the right medical device suppliers offers great potential for increasing quality while decreasing costs. This paper proposes a fuzzy decision making approach for medical supplier selection. A real-world medical device supplier selection problem is presented to illustrate the application of the proposed decision methodology.

Keywords: fuzzy decision making, fuzzy multiple objective programming, medical supply chain, supplier selection

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Authors: Emmanuel Pedler, Elena Raevskikh, Maxime Jaffré

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Can the cultural geography of European cities be durably managed by European policies? To answer this question, two hypotheses can be proposed. (1) Either European cultural policies are able to erase cultural inequalities between the territories through the creation of new areas of cultural attractiveness in each beneficiary neighborhood, city or country. Or, (2) each European region historically rooted in a number of endogenous socio-historical, political or demographic factors is not receptive to exogenous political influences. Thus, the cultural attractiveness of a territory is difficult to measure and to impact by top-down policies in the long term. How do these two logics - European and local - interact and contribute to the emergence of a valued, popular sense of a common European cultural identity? Does this constant interaction between historical backgrounds and new political concepts encourage a positive identification with the European project? The European cultural policy programs, such as ECC (European Capital of Culture), seek to develop new forms of civic cohesion through inclusive and participative cultural events. The cultural assets of a city elected ‘ECC’ are mobilized to attract a wide range of new audiences, including populations poorly integrated into local cultural life – and consequently distant from pre-existing cultural offers. In the current context of increasingly heterogeneous individual perceptions of Europe, the ECC program aims to promote cultural forms and institutions that should accelerate both territorial and cross-border European cohesion. The new cultural consumption pattern is conceived to stimulate integration and mobility, but also to create a legitimate and transnational ideal European citizen type. Our comparative research confronts contrasting cases of ‘European Capitals of Culture’ from the south and from the north of Europe, cities recently concerned by the ECC political mechanism and cities that were elected ECC in the past, multi-centered cultural models vs. highly centralized cultural models. We aim to explore the impacts of European policies on the urban cultural geography, but also to understand the current obstacles for its efficient implementation.

Keywords: urbanism, cultural policies, cultural institutions, european cultural capitals, heritage industries, exclusion effects

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Authors: Gaafar Muhammed, N. T. Ersoy

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The role of electricity in the economic development of any country is undeniable. The main goal of utilizing renewable sources in electricity generation, especially in the emerging countries, is to improve electricity access, economic development and energy sustainability. Germany’s recent transition from conventional to renewable energy technologies is overwhelming, this might not be associated with its abundant natural resources but owing to the policies in place. In line with the fast economic and technological developments recorded in recent years, Germany currently produces approximately 1059 GW of its energy from renewable sources. Hence, at the end of 2016, Germany is among the world leaders in terms of installed renewable energy capacity. As one of the most important factors that lead to renewable energy utilization in any nation is an effective policy, this study aims at examining the effect of policies on renewable energy (RE) development in Germany. Also, the study will focus on the evolution of the adopted feed-in tariff policies, as this evolution has affected the renewable energy capacity in Germany over a period of 15 years (2000 to 2015). The main contribution of the study is to establish a link between the feed-in tariff and the increase of RE in Germany’s energy mix. This is done by analyzing the characteristics of various feed-in tariff mechanisms adopted through the years. These characteristics include the feed-in-tariff rate, degression, special conditions, supported technology, etc. Then, the renewable energy development in Germany has been analyzed through the years along with the targets and the progress in reaching these targets. The study reveals that Germany’s renewable energy support policies (especially feed-in tariff) lead to several benefits and contribute towards the targets existing for renewable energy.

Keywords: feed-in tariff, Germany, policy, penewable energy

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Authors: Mingyang Sun, Guozheng Yan, Dasheng Liu, Lei Yang

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Driven by the demand of intelligent monitoring in rehabilitation centers or hospitals, a high accuracy real-time location system based on UWB (ultra-wideband) technology was proposed. The system measures precise location of a specific person, traces his movement and visualizes his trajectory on the screen for doctors or administrators. Therefore, doctors could view the position of the patient at any time and find them immediately and exactly when something emergent happens. In our design process, different algorithms were discussed, and their errors were analyzed. In addition, we discussed about a , simple but effective way of correcting the antenna delay error, which turned out to be effective. By choosing the best algorithm and correcting errors with corresponding methods, the system attained a good accuracy. Experiments indicated that the ranging error of the system is lower than 7 cm, the locating error is lower than 20 cm, and the refresh rate exceeds 5 times per second. In future works, by embedding the system in wearable IoT (Internet of Things) devices, it could provide not only physical parameters, but also the activity status of the patient, which would help doctors a lot in performing healthcare.

Keywords: intelligent monitoring, ultra-wideband technology, real-time location, IoT devices, smart healthcare

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Authors: Etta Conteh, Tracy Macintosh

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Introduction: Restraints are often used in the Emergency Department when it is necessary for a patient to be restrained in order to decrease their agitation and better treat them. Chemical and physical restraints may be used on these patients at the discretion of the medical provider. Racism and injustice are rampant within our country, and medicine and healthcare are not spared. While racism and racial bias in medicine and healthcare have been studied, information on the differences in the use of restraints by race are scarce. Objective: The objective of this study is to determine if African Americans and Hispanic-American patients are restrained at higher rates compared to their White counterparts. Methods: This study will be carried out through a retrospective analysis utilizing the Hospital Corporation of America (HCA) national Emergency Department (ED) and inpatient database with patient visits from 2016-2019. All patient visits, with patients aged 18 years or older, will be reviewed, looking specifically for the race and the use and type of restraints. Other factors, such a pre-existing psychiatric condition, will be used for sub-analysis. Rationale: The outcome of this project will demonstrate the absence or presence of a racial disparity in the use of restraints in the Emergency Department. These results can be used as a foundation for improving racial equity in healthcare treatment.

Keywords: emergency medicine, public health, racism, restraint use

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Authors: Mirim Kim, Won-Oak Oh

Abstract:

Purpose: The purpose of this study was to identify hospitalized children's fall risk factors, fall prevention status and fall prevention strategies recognized by nurses and caregivers of hospitalized children and present an ecological model for fall preventive management in hospitalized children. Method: The participants of this study were 14 nurses working in medical institutions and having more than one year of child care experience and 14 adult caregivers of children under 6 years of age receiving inpatient treatment at a medical institution. One to one interview was attempted to identify their perception of fall preventive management. Transcribed data were analyzed through latent content analysis method. Results: Fall risk factors in hospitalized children were 'unpredictable behavior', 'instability', 'lack of awareness about danger', 'lack of awareness about falls', 'lack of child control ability', 'lack of awareness about the importance of fall prevention', 'lack of sensitivity to children', 'untidy environment around children', 'lack of personalized facilities for children', 'unsafe facility', 'lack of partnership between healthcare provider and caregiver', 'lack of human resources', 'inadequate fall prevention policy', 'lack of promotion about fall prevention', 'a performanceism oriented culture'. Fall preventive management status of hospitalized children were 'absence of fall prevention capability', 'efforts not to fall', 'blocking fall risk situation', 'limit the scope of children's activity when there is no caregiver', 'encourage caregivers' fall prevention activities', 'creating a safe environment surrounding hospitalized children', 'special management for fall high risk children', 'mutual cooperation between healthcare providers and caregivers', 'implementation of fall prevention policy', 'providing guide signs about fall risk'. Fall preventive management strategies of hospitalized children were 'restrain dangerous behavior', 'inspiring awareness about fall', 'providing fall preventive education considering the child's eye level', 'efforts to become an active subject of fall prevention activities', 'providing customed fall prevention education', 'open communication between healthcare providers and caregivers', 'infrastructure and personnel management to create safe hospital environment', 'expansion fall prevention campaign', 'development and application of a valid fall assessment instrument', 'conversion of awareness about safety'. Conclusion: In this study, the ecological model of fall preventive management for hospitalized children reflects various factors that directly or indirectly affect the fall prevention of hospitalized children. Therefore, these results can be considered as useful baseline data for developing systematic fall prevention programs and hospital policies to prevent fall accident in hospitalized children. Funding: This study was funded by the National Research Foundation of South Korea (grant number NRF-2016R1A2B1015455).

Keywords: fall down, safety culture, hospitalized children, risk factors

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Authors: Esther M. Folarin, Evans Osabuohien, Ademola Onabote

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Agriculture constitutes an important part of development and poverty mitigation in lower-middle-income countries, like Nigeria. The level of agricultural productivity in the Nigerian economy in line with the level of demand necessary to meet the desired expectation of the Nigerian populace is threatening to meeting the standard of the United Nations (UN) Sustainable Development Goals (SDGs); This includes the SDG-2 (achieve food security through agricultural productivity). The overall objective of the study is to reveal the performance of the interaction variable in the model among other factors that help in the achievement of greater Nigerian agricultural productivity. The study makes use of Wave 4 (2018/2019) of the Living Standard Measurement Studies, Integrated Survey on Agriculture (LSMS-ISA). Qualitative analysis of the information was also used to provide complimentary answers to the quantitative analysis done in the study. The study employed human capital theory and Grossman’s theory of health Demand in explaining the relationships that exist between the variables within the model of the study. The study engages the Instrumental Variable Regression technique in achieving the broad objectives among other techniques for the other specific objectives. The estimation results show that there exists a positive relationship between female healthcare and the level of female agricultural productivity in Nigeria. In conclusion, the study emphasises the need for more provision and empowerment for greater female access to healthcare and educational attainment levels that aids higher female agricultural productivity and consequently an improvement in the total agricultural productivity of the Nigerian economy.

Keywords: agricultural productivity, education, female, healthcare, investment

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