Search results for: public health organizations
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 14682

Search results for: public health organizations

11082 Developing the Morphological Field of Problem Context to Assist Multi-Methodology in Operations Research

Authors: Mahnaz Hosseinzadeh, Mohammad Reza Mehregan

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In this paper, we have developed a morphological field to assist multi- methodology (combining methodologies together in whole or part) in Operations Research (OR) for the problem contexts in Iranian organizations. So, we have attempted to identify some dimensions for problem context according to Iranian organizational problems. Then, a general morphological program is designed which helps the OR practitioner to determine the suitable OR methodology as output for any configuration of conditions in a problem context as input and to reveal the fields necessary to be improved in OR. Applying such a program would have interesting results for OR practitioners.

Keywords: hard, soft and emancipatory operations research, General Morphological Analysis (GMA), multi-methodology, problem context

Procedia PDF Downloads 298
11081 Participatory Budgeting in South African Local Government: A Right or Illusion

Authors: Oliver Fuo

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One of the central features of post-apartheid constitutional reform was the establishment of local government as a distinct sphere of government in the Constitution of the Republic of South Africa, 1996. Local government, constituted by about 279 wall-to-wall municipalities, have legislative and executive powers vested in democratically elected municipal councils to govern areas within their jurisdiction subject only to limits imposed by the Constitution. In addition, unlike the past where municipalities merely played a service delivery role, they are now mandated to realise an expanded developmental mandate – pursue social justice and sustainable development; contribute, together with national and provincial government, to the realisation of socio-economic rights entrenched in the Bill of Rights; and facilitate public participation in local governance. In order to finance their developmental programmes, municipalities receive equitable allocations from national government and have legal powers to generate additional finances by charging rates on property and imposing surcharges on services provided. In addition to its general obligation to foster public participation in local governance, the law requires municipalities to facilitate public participation in their budgeting processes. This requirement is generally consistent with recent trends in local government democratic reforms which call for inclusive budget planning and implementation whereby citizens, civil society and NGOs participate in the allocation of resources. This trend is best captured in the concept of participatory budgeting. This paper specifically analyses the legal and policy framework for participatory budgeting at the local government level in South Africa. Using Borbet South Africa (Pty) Ltd and Others v Nelson Mandela Bay Municipality 2014 (5) SA 256 (ECP) as an example, this paper argues that the legal framework for participatory budgeting creates an illusory right for citizens to participate in municipal budgeting processes. This challenge is further compounded by the barrenness of the jurisprudence of courts that interpret the obligation of municipalities in this regard. It is submitted that the wording of s 27(4) of the Municipal Finance Management Act (MFMA) 53 of 2003 - which expressly stipulates that non-compliance by a municipality with a provision relating to the budget process or a provision in any legislation relating to the approval of a budget-related policy, does not affect the validity of an annual or adjustments budget – is problematic as it seems to trivialise the obligation to facilitate public participation in budgeting processes. It is submitted that where this provision is abused by municipal officials, this could lead to the sidelining of the real interests of communities in local budgets. This research is based on a critical and integrated review of primary and secondary sources of law.

Keywords: courts and jurisprudence, local government law, participatory budgeting, South Africa

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11080 Festival Gamification: Conceptualization and Scale Development

Authors: Liu Chyong-Ru, Wang Yao-Chin, Huang Wen-Shiung, Tang Wan-Ching

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Although gamification has been concerned and applied in the tourism industry, limited literature could be found in tourism academy. Therefore, to contribute knowledge in festival gamification, it becomes essential to start by establishing a Festival Gamification Scale (FGS). This study defines festival gamification as the extent of a festival to involve game elements and game mechanisms. Based on self-determination theory, this study developed an FGS. Through the multi-study method, in study one, five FGS dimensions were sorted through literature review, followed by twelve in-depth interviews. A total of 296 statements were extracted from interviews and were later narrowed down to 33 items under six dimensions. In study two, 226 survey responses were collected from a cycling festival for exploratory factor analysis, resulting in twenty items under five dimensions. In study three, 253 survey responses were obtained from a marathon festival for confirmatory factor analysis, resulting in the final sixteen items under five dimensions. Then, results of criterion-related validity confirmed the positive effects of these five dimensions on flow experience. In study four, for examining the model extension of the developed five-dimensional 16-item FGS, which includes dimensions of relatedness, mastery, competence, fun, and narratives, cross-validation analysis was performed using 219 survey responses from a religious festival. For the tourism academy, the FGS could further be applied in other sub-fields such as destinations, theme parks, cruise trips, or resorts. The FGS serves as a starting point for examining the mechanism of festival gamification in changing tourists’ attitudes and behaviors. Future studies could work on follow-up studies of FGS by testing outcomes of festival gamification or examining moderating effects of enhancing outcomes of festival gamification. On the other hand, although the FGS has been tested in cycling, marathon, and religious festivals, the research settings are all in Taiwan. Cultural differences of FGS is another further direction for contributing knowledge in festival gamification. This study also contributes to several valuable practical implications. First, this FGS could be utilized in tourist surveys for evaluating the extent of gamification of a festival. Based on the results of the performance assessment by FGS, festival management organizations and festival planners could learn the relative scores among dimensions of FGS, and plan for future improvement of gamifying the festival. Second, the FGS could be applied in positioning a gamified festival. Festival management organizations and festival planners could firstly consider the features and types of their festival, and then gamify their festival based on investing resources in key FGS dimensions.

Keywords: festival gamification, festival tourism, scale development, self-determination theory

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11079 Providing Emotional Support to Children under Long-Term Health Treatments

Authors: Ramón Cruzat, Sergio F. Ochoa, Ignacio Casas, Luis A. Guerrero, José Bravo

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Patients under health treatments that involve long stays at a hospital or health centre (e.g. cancer, organ transplants and severe burns), tend to get bored or depressed because of the lack of social interaction with family and friends. Such a situation also affects the evolution and effectiveness of their treatments. In many cases, the solution to this problem involves extra challenges, since many patients need to rest quietly (or remain in bed) to their being contagious. Considering the weak health condition in which usually are these kinds, keeping them motivated and quiet represents an important challenge for nurses and caregivers. This article presents a mobile ubiquitous game called MagicRace, which allows hospitalized kinds to interact socially with one another without putting to risk their sensitive health conditions. The game does not require a communication infrastructure at the hospital, but instead, it uses a mobile ad hoc network composed of the handheld devices used by the kids to play. The usability and performance of this application was tested in two different sessions. The preliminary results show that users experienced positive feelings from this experience.

Keywords: ubiquitous game, children's emotional support, social isolation, mobile collaborative interactions

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11078 Root Cause Analysis of Surveillance Quality in Tanjung Priok Port to Prevent Epidemic Potential Disease as a Form of Bioterrorism Threat

Authors: Dina A. Amu, Fifi N. Afifah, Catur Rosidati, Tirton Nefianto

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Indonesia was shaken up by the avian influenza cases that had caused the country suffered losses of millions of dollars. The avian influenza case had even been suspected as a bioterrorism attack since it was an uncommon case in epidemiology. Furthermore, this avian influenza virus is a high pathogenic one and Indonesia has the highest case of fatality rate in the world. Bioterrorism threats or epidemic potential disease outbreaks currently does not exist in Tanjung Priok port yet. However, the surveillance system enhancement on epidemic potential diseases should be taken as a prevention, especially because Indonesia is currently facing the ASEAN Economic Society (AES). Therefore, this research evaluates the health surveillance system which is organized by Control, Quarantine and Surveillance Department, Health Office of Tanjung Priok Port. This study uses qualitative-evaluative method which utilizes Urgency Seriousness Growth (USG) method to determine priority issues and Root Cause analysis to determine the cause of prior problem. The result of this research shows that the implementation of epidemic potential disease surveillance in Tanjung Priok port has not done in the best possible way. It is because the lack of time allocation and the succinctness of the check list of ship's environmental health inspection. Therefore, Health Ministry of Indonesia should recruit more employees at the health office of Tanjung Priok port, hold a simulation of ship's inspection and simplify the list for ship's environmental health inspection.

Keywords: surveillance, epidemic potential disease, port health, bioterrorism

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11077 The Polarization on Twitter and COVID-19 Vaccination in Brazil

Authors: Giselda Cristina Ferreira, Carlos Alberto Kamienski, Ana Lígia Scott

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The COVID-19 pandemic has enhanced the anti-vaccination movement in Brazil, supported by unscientific theories and false news and the possibility of wide communication through social networks such as Twitter, Facebook, and YouTube. The World Health Organization (WHO) classified the large volume of information on the subject against COVID-19 as an Infodemic. In this paper, we present a protocol to identify polarizing users (called polarizers) and study the profiles of Brazilian polarizers on Twitter (renamed to X some weeks ago). We analyzed polarizing interactions on Twitter (in Portuguese) to identify the main polarizers and how the conflicts they caused influenced the COVID-19 vaccination rate throughout the pandemic. This protocol uses data from this social network, graph theory, Java, and R-studio scripts to model and analyze the data. The information about the vaccination rate was obtained in a public database for the government called OpenDataSus. The results present the profiles of Twitter’s Polarizer (political position, gender, professional activity, immunization opinions). We observed that social and political events influenced the participation of these different profiles in conflicts and the vaccination rate.

Keywords: Twitter, polarization, vaccine, Brazil

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11076 Predictors of Recent Work-Related Injury in a Rapidly Developing Country: Results from a Worker Survey in Qatar

Authors: Ruben Peralta, Sam Thomas, Nazia Hirani, Ayman El-Menyar, Hassan Al-Thani, Mohammed Al-Thani, Mohammed Al-Hajjaj, Rafael Consunji

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Moderate to severe work-related injuries [WRI's] are a leading cause of trauma admission in Qatar but information on risk factors for their incidence are lacking. This study aims to document and analyze the predictive characteristics for WRI to inform the creation of targeted interventions to improve worker safety in Qatar. This study was conducted as part of the NPRP grant # 7 - 1120 - 3 - 288, titled "A Unified Registry for Occupational Injury Prevention in Qatar”. 266 workers were interviewed using a standard questionnaire, during ‘World Day for Safety and Health at Work’, a Ministry of Public Health event, none refused interview. Nurses and doctors from the Hamad Trauma Center conducted the interviews. Questions were translated into the worker’s native language when it was deemed necessary. Standard information on epidemiologic characteristics and incidence of work-related injury were collected and compared between nationalities and those injured versus those not injured. 262 males and 4 females were interviewed. 17 [6.4%] reported a WRI in the last 24 months. More than half of the injured worked in construction [59%] followed by water supply [11.8%]. Factors significantly associated with recent injury were: Working for a company with > 500 employees and speaking Hindi. Protective characteristics included: Being from the Philippines or Sri Lanka, speaking Arabic, working in healthcare, an office or trading and company size between 100-500 employees. Years of schooling and working in Qatar were not predictive factor for WRI. The findings from this survey should guide future research that will better define worker populations at an increased risk for WRI and inform recruiters and sending countries. A focus on worker language skills, interventions in the construction industry and occupational safety in large companies is needed.

Keywords: occupational injury, prevention, safety, trauma, work related injury

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11075 Revitalization of Pancasila as an Alternative Solution to the Conflict in Indonesia Is Based on a Case Study of Separatist Movements in Papua

Authors: Teten Masduki

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Indonesia is a unitary state which has a wide range of cultures, local languages, religions, ethnicity, race, traditions, and beliefs held by people who are scattered in several islands Indonesia. But with such diversity has the potential to cause various problems in society. Because one of the characteristics of diversity is the difference. Unresolved differences could develop into conflicts or contradictions in society. Pancasila as the philosophy and ideology of the nation was stated in the opening of the 1945 Constitution as an alternative solution to the conflict that occurred in Indonesia. Because the ideology of Pancasila role as a nation and also as an integral tool that upholds humanity, justice, unity, harmony, and balance on the belt by the five precepts. If the values contained in Pancasila can be applied and lived by the public of Indonesia, it will be the creation of a just, peaceful and peace. However, the lack of public awareness in implementing pancsila can lead to conflict within the community itself, such as the existence of separatist movements in Papua who gathered in the Organisasi Papua Merdeka (OPM) with the active movement that has a lot of casualties. This paper raised the topic of which offer solutions revitalization (reviving) the values of Pancasila as an alternative solution to the conflict in Indonesia is based on a case study of separatist movements in Papua. This paper will also discuss the implementation of strategic steps in the implementation of solutions which are summarized in the conclusions of this paper.

Keywords: Pancasila, separatism, revitalization, democracy

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11074 Potential Positive Impacts of Online Communities on Mental Health of Women Who Have Experienced Miscarriage

Authors: Mahtab Talafian

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With the advent of technology over the last decades, participation in online communities and discussion forums has become increasingly popular. Many studies have been done on the negative role of the online world on human beings’ psychological well-being and mental health, while relatively less attention has been given to the potentially positive role of technology in promoting mental health. Miscarriage is a common and emotionally challenging experience for women, and online communities seem to be a potential source of support for them. This study aimed to firstly find the most common types of support communicated in online communities of women who have miscarried and, secondly, investigate if there is a relationship between participation in online communities and mental health outcomes after miscarriage. In this study, three research methodologies, including content analysis, survey and interview, were employed to answer the research questions. With the analysis of 158 messages, including postings and comments in the online community of Mumsnet, it can be concluded that informational support and emotional support are the most prevalent types of support women share in the online community. Analysis of data gathered from the survey of 19 women who had experienced a miscarriage during the last year showed that participation in online communities makes a significant improvement in their mental health. Interviews also highlighted the helpful role of the online community in relieving emotional disorders, such as trauma, hopelessness, loneliness, stress, depression and anxiety about miscarriage.

Keywords: mental health, miscarriage, online community, support

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11073 Rethinking Modernization Strategy of Muslim Society: The Need for Value-Based Approach

Authors: Louay Safi

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The notion of secular society that evolved over the last two centuries was initially intended to free the public sphere from religious imposition, before it assumed the form a comprehensive ideology whose aim is to prevent any overt religious expression from the public space. The negative view of religious expression, and the desire by political elites to purge the public space from all forms of religious expressions were first experienced in the Middle East in the last decades of the twentieth century in relation to Islam, before it manifests itself in the twentieth century Europe. Arab regimes were encouraged by European democracies to marginalize all forms of religious expressions in the public as part of the secularization process that was deemed necessary for modernization and progress. The prohibition of Islamic symbols and outlawing the headscarf was first undertaken to Middle Eastern republics, such as Turkey in 1930s and Syria in 1970s, before it is implemented recently in France. Secularization has been perceived by European powers as the central aspect of social and political liberalization, and was given priority over democratization and human rights, so much so that European elites were willing to entrust the task of nurturing liberal democracy to Arab autocrats and dictators. Not only did the strategy of empowering autocratic regimes to effect liberal democratic culture failed, but it contributed to the rise of Islamist extremism and produced failed states in Syria and Iraq that undermine both national and global peace and stability. The paper adopts the distinction made by John Rawls between political and comprehensive liberalism to argue that the modernization via secularization in Muslim societies is counterproductive and has subverted early successful efforts at democratization and reform in the Middle East. Using case studies that illustrate the role of the secularization strategy in Syria, Iran, and Egypt in undermining democratic and reformist movements in those countries, the paper calls for adopting a different approach rooted in liberal and democratic values rather than cultural practices and lifestyle. The paper shows that Islamic values as articulated by reform movements support a democratic and pluralist political order, and emphasizes the need to legitimize and support social forces that advocate democracy and human rights. Such an alternative strategy allows for internal competition among social groups for popular support, and therefore enhances the chances that those with inclusive and forward-looking political principles and policies would create a democratic and pluralist political order more conducive to meaningful national and global cooperation, and respectful of human dignity.

Keywords: democracy, Islamic values, political liberalism, secularization

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11072 Critical Core Skills Profiling in the Singaporean Workforce

Authors: Bi Xiao Fang, Tan Bao Zhen

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Soft skills, core competencies, and generic competencies are exchangeable terminologies often used to represent a similar concept. In the Singapore context, such skills are currently being referred to as Critical Core Skills (CCS). In 2019, SkillsFuture Singapore (SSG) reviewed the Generic Skills and Competencies (GSC) framework that was first introduced in 2016, culminating in the development of the Critical Core Skills (CCS) framework comprising 16 soft skills classified into three clusters. The CCS framework is part of the Skills Framework, and whose stated purpose is to create a common skills language for individuals, employers and training providers. It is also developed with the objectives of building deep skills for a lean workforce, enhance business competitiveness and support employment and employability. This further helps to facilitate skills recognition and support the design of training programs for skills and career development. According to SSG, every job role requires a set of technical skills and a set of Critical Core Skills to perform well at work, whereby technical skills refer to skills required to perform key tasks of the job. There has been an increasing emphasis on soft skills for the future of work. A recent study involving approximately 80 organizations across 28 sectors in Singapore revealed that more enterprises are beginning to recognize that soft skills support their employees’ performance and business competitiveness. Though CCS is of high importance for the development of the workforce’s employability, there is little attention paid to the CCS use and profiling across occupations. A better understanding of how CCS is distributed across the economy will thus significantly enhance SSG’s career guidance services as well as training providers’ services to graduates and workers and guide organizations in their hiring for soft skills. This CCS profiling study sought to understand how CCS is demanded in different occupations. To achieve its research objectives, this study adopted a quantitative method to measure CCS use across different occupations in the Singaporean workforce. Based on the CCS framework developed by SSG, the research team adopted a formative approach to developing the CCS profiling tool to measure the importance of and self-efficacy in the use of CCS among the Singaporean workforce. Drawing on the survey results from 2500 participants, this study managed to profile them into seven occupation groups based on the different patterns of importance and confidence levels of the use of CCS. Each occupation group is labeled according to the most salient and demanded CCS. In the meantime, the CCS in each occupation group, which may need some further strengthening, were also identified. The profiling of CCS use has significant implications for different stakeholders, e.g., employers could leverage the profiling results to hire the staff with the soft skills demanded by the job.

Keywords: employability, skills profiling, skills measurement, soft skills

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11071 Nursing and Allied Health Perception of Desirable Junior Doctor Attributes for Effective Collaboration and Teamwork

Authors: Maneka Marianne Britto, Hansraj Riteesh Bookun

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The ability of a junior doctor to deliver complex multi-disciplinary care to patients in a paradigm of respect and collaboration requires a multitude of interpersonal skills and competencies. A short survey was used to explore the perspective of allied health staff on the desirable attributes of a junior doctor which are conducive to good teamwork. 23 allied health professionals (14 nurses, 4 physiotherapists, 2 dietitians, 1 occupational therapist, 1 speech therapist and 1 audiologist) responded to this 17-item survey. There were 17 females. The mean age of the respondents was 34.9 ± 10.1 years. The salient findings of our survey are that 95% of our respondents rated friendliness and non-clinical small talk with average importance or greater. 45% of them viewed these 2 items as very important or absolutely essential. A single respondent viewed these 2 items with little importance. The other criteria which were rated with high levels of importance were the acknowledgment of allied health suggestions and good ward organizational skills. Training these collaborative skills is challenging, and an enhanced understanding of interprofessional perspectives will help a junior doctor to achieve better clinical outcomes. It is hoped that this paper will further stimulate discussion in this area and will encourage junior doctors to engage in non-clinical conversations with allied health staff in the spirit of promoting effective teamwork.

Keywords: allied health, collaboration, doctor, medicine, surgery

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11070 Transforming Health Information from Manual to Digital (Electronic) World: A Reference and Guide

Authors: S. Karthikeyan, Naveen Bindra

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Introduction: To update ourselves and understand the concept of latest electronic formats available for Health care providers and how it could be used and developed as per standards. The idea is to correlate between the patients Manual Medical Records keeping and maintaining patients Electronic Information in a Health care setup in this world. Furthermore this stands with adapting to the right technology depending upon the organization and improve our quality and quantity of Healthcare providing skills. Objective: The concept and theory is to explain the terms of Electronic Medical Record (EMR), Electronic Health Record (EHR) and Personal Health Record (PHR) and selecting the best technical among the available Electronic sources and software before implementing. It is to guide and make sure the technology used by the end users without any doubts and difficulties. The idea is to evaluate is to admire the uses and barriers of EMR-EHR-PHR. Aim and Scope: The target is to achieve the health care providers like Physicians, Nurses, Therapists, Medical Bill reimbursements, Insurances and Government to assess the patient’s information on easy and systematic manner without diluting the confidentiality of patient’s information. Method: Health Information Technology can be implemented with the help of Organisations providing with legal guidelines and help to stand by the health care provider. The main objective is to select the correct embedded and affordable database management software and generating large-scale data. The parallel need is to know how the latest software available in the market. Conclusion: The question lies here is implementing the Electronic information system with healthcare providers and organisation. The clinicians are the main users of the technology and manage us to ‘go paperless’. The fact is that day today changing technologically is very sound and up to date. Basically the idea is to tell how to store the data electronically safe and secure. All three exemplifies the fact that an electronic format has its own benefit as well as barriers.

Keywords: medical records, digital records, health information, electronic record system

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11069 Indicators of Sustainable Intensification: Views from British Stakeholders

Authors: N. Mahon, I. Crute, M. Di Bonito, E. Simmons, M. M. Islam

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Growing interest in the concept of the sustainable intensification (SI) of agriculture has been shown by, national governments, transnational agribusinesses, intergovernmental organizations and research institutes, amongst others. This interest may be because SI is seen as a ‘third way’ for agricultural development, between the seemingly disparate paradigms of ‘intensive’ agriculture and more ‘sustainable’ forms of agriculture. However, there is a lack of consensus as to what SI means in practice and how it should be measured using indicators of change. This has led to growing confusion, disagreement and skepticism regarding the concept, especially amongst civil society organizations, both in the UK and other countries. This has prompted the need for bottom-up, participatory approaches to identify indicators of SI. Our aim is to identify the views of British stakeholders regarding the areas of agreement and disagreement as to what SI is and how it should be measured in the UK using indicators of change. Data for this investigation came from 32 semi-structured interviews, conducted between 2015 and 2016, with stakeholders from throughout the UK food system. In total 110 indicators of SI were identified. These indicators covered a wide variety of subjects including biophysical, social and political considerations. A number of indicators appeared to be widely applicable and were similar to those suggested in the global literature. These include indicators related to the management of the natural resources on which agriculture relies e.g., ‘Soil organic matter’, ‘Number of pollinators per hectare’ and ‘Depth of water table’. As well as those related to agricultural externalities, e.g., ‘Greenhouse gas emissions’ and ‘Concentrations of agro-chemicals in waterways’. However, many of the indicators were much more specific to the context of the UK. These included, ‘Areas of high nature value farmland’, ‘Length of hedgerows per hectare’ and ‘Age of farmers’. Furthermore, tensions could be seen when participants considered the relative importance of agricultural mechanization versus levels of agricultural employment, the pros and cons of intensive, housed livestock systems and value of wild biodiversity versus the desire to increase agricultural yields. These areas of disagreement suggest the need to carefully consider the trade-offs inherent in the concept. Our findings indicate that in order to begin to resolve the confusions surrounding SI it needs to be considered in a context specific manner, rather than as a single uniform concept. Furthermore, both the environmental and the social parameters in which agriculture operates need to be considered in order to operationalize SI in a meaningful way. We suggest that participatory approaches are key to this process, facilitating dialogue and collaborative-learning between all the stakeholders, allowing them to reach a shared vision for the future of agricultural development.

Keywords: agriculture, indicators, participatory approach, sustainable intensification

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11068 Effects of Harmful Alcohol Consumption and Gender on Academic and Personal-Emotional Adjustment in First Year University Students in Spain

Authors: M. F. Páramo, F. Cadaveira, M. S. Rodríguez

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The first year at university is a critical period for personal-emotional and academic adjustment in emerging adults. Moreover, some studies show that alcohol consumption increases in young adults on transition to university. The main purpose of this study was to analyze the impact of hazardous alcohol consumption and gender on adjustment to university, understood as a multidimensional construct involving an array of demands. A sample of 300 first year students in Spain completed the Student Adaptation to College Questionnaire (SACQ) and the Alcohol Use Disorders Identification Test (AUDIT). Examination of the data by analysis of variance revealed that adjustment to university was lower in the students undertaking hazardous alcohol consumption than in the other students. Surprisingly, the personal-emotional adjustment of students with hazardous alcohol consumption was not lower than in the other students. Analysis of the gender effect revealed that levels of personal-emotional adjustment were higher in males than in females. This is our first study examining the influence of alcohol consumption on university adjustment. Future research should examine this relationship more closely, with the aim of designing public health strategies focused on limiting abusive consumption of alcohol in university students.

Keywords: alcohol consumption, first year university students, gender, SACQ

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11067 Coastal Cliff Protection in Beit Yanai, Israel: Examination of Alternatives and Public Preference Analysis

Authors: Tzipi Eshet

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The primary objectives of this work are the examination of public preferences and attributed importance to different characteristics of coastal cliff protection alternatives, and drawing conclusions about the applicable alternative in Beit-Yanai beach. Erosion of coastal cliffs is a natural phenomenon that occurs in many places in the world. This creates problems along the coastlines, which are densely populated areas with highly developed economic activity. In recent years, various aspects of the aeolianite cliffs along the Israeli coast have been studied extensively. There is a consensus among researchers regarding a general trend of cliff retreat. This affects civilian infrastructure, wildlife habitats and heritage values, as well as Increases the risk to human life. The Israeli government, committed to the integrated coastal zones management approach, decided on a policy and guidelines to deal with cliff erosion, which includes establishing physical protection on land and in the sea, sand nourishment and runoff drainage. Physical protection solutions to reduce the rate of retreat of the cliffs are considerably important both for planning authorities and visitors to the beach. Direct costs of different protection alternatives, as well as external costs and benefits, may vary, thus affecting consumer preferences. Planning and execution of sustainable coastal cliff protection alternatives must take into account the different characteristics and their impact on aspects of economics, environment and leisure. The rocky shore of Beit-Yanai Beach was chosen as a case study to examine the nature of the influence of various protective solutions on consumer preferences. This beach is located in the center of Israel's coastline, and acts as a focus of attraction for recreation, land and sea sports, and educational activities as well. If no action will be taken, cliff retreat will continue. A survey was conducted to reveal the importance of coastal protection alternatives characteristics and the visual preferences to visitors at beach Beit-Yanai and residents living on the cliff (N=287). Preferences and willingness-to-pay were explored using Contingent-Ranking and Choice-Experiments techniques. Results show that visitors’ and residents’ willingness-to-pay for coastal cliff protection alternatives is affected both by financial and environmental aspects, as well as leisure. They prefer coastal cliff protection alternatives that are not visible and do not need constant maintenance, do not affect the quality of seawater or the habitats of wildlife and do not lower the security level of the swimmers. No significant difference was found comparing willingness-to-pay among local and non-local users. Additionally, they mostly prefer a protection solution which is integrated in the coastal landscape and maintains the natural appearance of the beach. Of the possible protection alternatives proposed for the protection of the cliff in Beit Yanai beach are two techniques that meet public preferences: rock revetments and submerged detached breakwaters. Results indicate that the visiting public prefer the implementation of these protection alternatives and will be willing to pay for them. Future actions to reduce retreat rate in Beit-Yanai have to consider implications on the economic, environmental and social conditions, along with weighting public interest against the interest of the individual.

Keywords: contingent-ranking, choice-experiments, coastal cliff protection, erosion of coastal cliffs, environment

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11066 Protecting the Health of Astronauts: Enhancing Occupational Health Monitoring and Surveillance for Former NASA Astronauts to Understand Long-Term Outcomes of Spaceflight-Related Exposures

Authors: Meredith Rossi, Lesley Lee, Mary Wear, Mary Van Baalen, Bradley Rhodes

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The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. A better understanding of the individual, population, and mission impacts of astronaut occupational exposures is critical to providing clinical care, targeting occupational surveillance efforts, and planning for future space exploration. The ability to characterize the risk of latent health conditions is a significant component of this understanding. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA-Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential long-term health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging populations are necessary to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography); and expanded monitoring will increase NASA’s ability to better characterize conditions resulting from astronaut occupational exposures. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding the medical monitoring of former NASA astronauts under the Astronaut Occupational Health program. Increasing the breadth of monitoring services will ultimately enrich the existing evidence base of occupational health risks to astronauts. Such an expansion would therefore improve the understanding of the health of the astronaut population as a whole, and the ability to identify, mitigate, and manage such risks in preparation for deep space exploration missions.

Keywords: astronaut, long-term health, NASA, occupational health, surveillance

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11065 Trend and Distribution of Heavy Metals in Soil and Sediment: North of Thailand Region

Authors: Chatkaew Tansakul, Saovajit Nanruksa, Surasak Chonchirdsin

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Heavy metals in the environment can be occurred by both natural weathering process and human activity, which may present significant risks to human health and the wider environment. A number of heavy metals, i.e. Arsenic (As) and Manganese (Mn), are found with a relatively high concentration in the northern part of Thailand that was assumptively from natural parent rocks and materials. However, scarce literature is challenging to identify the accurate root cause and best available explanation. This study is, therefore, aim to gather heavy metals data in 5 provinces of the North of Thailand where PTT Exploration and Production (PTTEP) public company limited has operated for more than 20 years. A thousand heavy metal analysis is collected and interpreted in term of Enrichment Factor (EF). The trend and distribution of heavy metals in soil and sediment are analyzed by considering altogether the geochemistry of the regional soil and rock. . In addition, the relationship between land use and heavy metals distribution is investigated. In the first conclusion, heavy metal concentrations of (As) and (Mn) in the studied areas are equal to 7.0 and 588.6 ppm, respectively, which are comparable to those in regional parent materials (1 – 12 and 850 – 1,000 ppm for As and Mn respectively). Moreover, there is an insignificant escalation of the heavy metals in these studied areas over two decades.

Keywords: contaminated soil, enrichment factor, heavy metals, parent materials in North of Thailand

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11064 The Relationship between Corporate Governance and Intellectual Capital Disclosure: Malaysian Evidence

Authors: Rabiaal Adawiyah Shazali, Corina Joseph

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The disclosure of Intellectual Capital (IC) information is getting more vital in today’s era of a knowledge-based economy. Companies are advised by accounting bodies to enhance IC disclosure which complements the conventional financial disclosures. There are no accounting standards for Intellectual Capital Disclosure (ICD), therefore the disclosure is entirely voluntary. Hence, this study aims to investigate the extent of ICD and to examine the relationship between corporate governance and ICD in Malaysia. This study employed content analysis of 100 annual reports by the top 100 public listed companies in Malaysia during 2012. The uniqueness of this study lies on its underpinning theory used where it applies the institutional isomorphism theory to support the effect of the attributes of corporate governance towards ICD. In order to achieve the stated objective, multiple regression analysis were employed to conduct this study. From the descriptive statistics, it was concluded that public listed companies in Malaysia have increased their awareness towards the importance of ICD. Furthermore, results from the multiple regression analysis confirmed that corporate governance affects the company’s ICD where the frequency of audit committee meetings and the board size has positively influenced the level of ICD in companies. Findings from this study would provide an incentive for companies in Malaysia to enhance the disclosure of IC. In addition, this study would assist Bursa Malaysia and other regulatory bodies to come up with a proper guideline for the disclosure of IC.

Keywords: annual report, content analysis, corporate governance, intellectual capital disclosure

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11063 Lumbar Tuberculous Spondylitis in a Child Treated by Posterior Osteosynthesis: Apropos of a Case

Authors: Ghoul Rachid Brahim

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Introduction: Tuberculous spondylodiscitis is an infection of the spine by Mycobacterium tuberculosis. Tuberculous spondylodiscitis still remains a topical disease in developing countries and continues to pose a public health problem in endemic countries. Materials and methods: Clinical case: This is a 12-year-old child followed in pediatrics for weight loss and progressively worsening low back pain. The neurological examination found an irritative pyramidal syndrome in both lower limbs with a severe lumbar spinal syndrome. The radiological assessment: (Rx of the spine supplemented by CT and MRI) shows L1L2 spondylodiscitis. Treatment: The child is put on anti-tuberculosis treatment, and the spine is restrained with a corset. Control MRI shows a worsening of the dorsal kyphosis with a backward movement of the posterior wall and spinal cord compression. The child is operated on via the posterior approach (the operative procedure consists of an L1 laminectomy and D11 L3 osteosynthesis). Results: Spinal cord décompression and stabilization of the spine. Conclusion: Tuberculous spondylodiscitis in children remains a rare, aggressive, and progressive condition. The prognosis depends on the diagnosis's precocity and the therapeutic management quality.

Keywords: tuberculous spondylodiscitis, mycobacterium tuberculosis, laminectomy, MRI

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11062 Research on Ecological Space Improvement Strategy from the Perspective of Urban Double Reform

Authors: Sisi Xia, Dezhuan Tao

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Urban Double Reform is an effective means to improve the quality of ecological space, based on improving the living environment and urban functions and promoting the organic integration of the city and nature. This paper takes the design of Qinyang Wetland Park in Jiaozuo, Henan Province, as an example, attempting to closely link the ecological restoration of wetland with the urban culture and to extend the urban spirit of the ancient county of Qinyang while purifying the ecological water system. This design uses ecological technology to repair underwater forests and underwater turf, rapidly improving the quality of urban water without biological side effects. The ecological grass slope is used to create multiple bank forms, combining with a number of hydrophilic platforms to provide a good view of the public. Through the placement of ecological education bases, urban cultural exhibition halls, and other means, the cultural value of wetland parks will be enhanced, and the citizens will return to nature and experience the ecology and appreciate the charm of urban culture in the ecological space. Repair the ecosystem, sculpt the urban culture, let the public return to nature, experience the ecology, and experience the charm of urban culture in the ecological space.

Keywords: urban double reform, ecological space, improvement strategy, wetland park design

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11061 Study Protocol: Impact of a Sustained Health Promoting Workplace on Stock Price Performance and Beta - A Singapore Case

Authors: Wee Tong Liaw, Elaine Wong Yee Sing

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Since 2001, many companies in Singapore have voluntarily participated in the bi-annual Singapore HEALTH Award initiated by the Health Promotion Board of Singapore (HPB). The Singapore HEALTH Award (SHA), is an industry wide award and assessment process. SHA assesses and recognizes employers in Singapore for implementing a comprehensive and sustainable health promotion programme at their workplaces. The rationale for implementing a sustained health promoting workplace and participating in SHA is obvious when company management is convinced that healthier employees, business productivity, and profitability are positively correlated. However, performing research or empirical studies on the impact of a sustained health promoting workplace on stock returns are not likely to yield any interests in the absence of a systematic and independent assessment on the comprehensiveness and sustainability of a health promoting workplace in most developed economies. The principles of diversification and mean-variance efficient portfolio in Modern Portfolio Theory developed by Markowitz (1952) laid the foundation for the works of many financial economists and researchers, and among others, the development of the Capital Asset Pricing Model from the work of Sharpe (1964), Lintner (1965) and Mossin (1966), and the Fama-French Three-Factor Model of Fama and French (1992). This research seeks to support the rationale by studying whether there is a significant relationship or impact of a sustained health promoting workplace on the performance of companies listed on the SGX. The research shall form and test hypotheses pertaining to the impact of a sustained health promoting workplace on company’s performances, including stock returns, of companies that participated in the SHA and companies that did not participate in the SHA. In doing so, the research would be able to determine whether corporate and fund manager should consider the significance of a sustained health promoting workplace as a risk factor to explain the stock returns of companies listed on the SGX. With respect to Singapore’s stock market, this research will test the significance and relevance of a health promoting workplace using the Singapore Health Award as a proxy for non-diversifiable risk factor to explain stock returns. This study will examine the significance of a health promoting workplace on a company’s performance and study its impact on stock price performance and beta and examine if it has higher explanatory power than the traditional single factor asset pricing model CAPM (Capital Asset Pricing Model). To study the significance there are three key questions pertinent to the research study. I) Given a choice, would an investor be better off investing in a listed company with a sustained health promoting workplace i.e. a Singapore Health Award’s recipient? II) The Singapore Health Award has four levels of award starting from Bronze, Silver, Gold to Platinum. Would an investor be indifferent to the level of award when investing in a listed company who is a Singapore Health Award’s recipient? III) Would an asset pricing model combining FAMA-French Three Factor Model and ‘Singapore Health Award’ factor be more accurate than single factor Capital Asset Pricing Model and the Three Factor Model itself?

Keywords: asset pricing model, company's performance, stock prices, sustained health promoting workplace

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11060 An Assessment of Health Hazards in Urban Communities: A Study of Spatial-Temporal Variations of Dengue Epidemic in Colombo, Sri Lanka

Authors: U. Thisara G. Perera, C. M. Kanchana N. K. Chandrasekara

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Dengue is an epidemic which is spread by Aedes Egyptai and Aedes Albopictus mosquitoes. The cases of dengue show a dramatic growth rate of the epidemic in urban and semi urban areas spatially in tropical and sub-tropical regions of the world. Incidence of dengue has become a prominent reason for hospitalization and deaths in Asian countries, including Sri Lanka. During the last decade the dengue epidemic began to spread from urban to semi-urban and then to rural settings of the country. The highest number of dengue infected patients was recorded in Sri Lanka in the year 2016 and the highest number of patients was identified in Colombo district. Together with the commercial, industrial, and other supporting services, the district suffers from rapid urbanization and high population density. Thus, drainage and waste disposal patterns of the people in this area exert an additional pressure to the environment. The district is situated in the wet zone and thus low lying lands constitute the largest portion of the district. This situation additionally facilitates mosquito breeding sites. Therefore, the purpose of the present study was to assess the spatial and temporal distribution patterns of dengue epidemic in Kolonnawa MOH area (Medical Officer of Health) in the district of Colombo. The study was carried out using 615 recorded dengue cases in Kollonnawa MOH area during the south east monsoon season from May to September 2016. The Moran’s I and Kernel density estimation were used as analytical methods. The analysis of data was accomplished through the integrated use of ArcGIS 10.1 software packages along with Microsoft Excel analytical tool. Field observation was also carried out for verification purposes during the study period. Results of the Moran’s I index indicates that the spatial distribution of dengue cases showed a cluster distribution pattern across the area. Kernel density estimation emphasis that dengue cases are high where the population has gathered, especially in areas comprising housing schemes. Results of the Kernel Density estimation further discloses that hot spots of dengue epidemic are located in the western half of the Kolonnawa MOH area, which is close to the Colombo municipal boundary and there is a significant relationship with high population density and unplanned urban land use practices. Results of the field observation confirm that the drainage systems in these areas function poorly and careless waste disposal methods of the people further encourage mosquito breeding sites. This situation has evolved harmfully from a public health issue to a social problem, which ultimately impacts on the economy and social lives of the country.

Keywords: Dengue epidemic, health hazards, Kernel density, Moran’s I, Sri Lanka

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11059 Ecological Effects of Oil Spill on Water and Sediment from Two Riverine Communities in Warri

Authors: Doris Fovwe Ogeleka, L. E. Tudararo-Aherobo, F. E. Okieimen

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The ecological effects of oil spill in the environment were studied in Warri riverine areas of Ubeji and Jeddo, Delta State. In the two communities, water and sediment samples were analysed for organics (polyaromatic hydrocarbon; total petroleum hydrocarbon (TPH)) and heavy metals (lead, copper, zinc, iron and chromium). The American Public Health Association (APHA) and the American Society for Testing and Materials (ASTM) methods were employed for the laboratory test. The results indicated that after a long period of oil spill (above one year), there were still significant concentrations (p<0.05) of organics indicating hydrocarbon pollution. Mean concentrations recorded for TPH in Ubeji and Jeddo waters were 23.60 ± 1.18 mg/L and 29.96 ± 0.14 mg/L respectively while total PAHs was 0.009 ± 0.002 mg/L and 0.008 ± 0.001 mg/L. Mean concentrations of TPH in the sediment was 48.83 ± 1.49 ppm and 1093 ± 74 ppm in the above order while total PAHs was 0.012 ± 0.002 ppm and 0.026 ± 0.004 ppm. Low concentrations were recorded for most of the heavy metals in the water and sediment. The observed concentrations of hydrocarbons in the study areas should provide the impetus for regulatory surveillance of oil discharged intentionally/unintentionally into the Warri riverine waters and sediment since hydrocarbon released into the environment sorb to the sediment particles where they cause harm to organisms in the sediment and overlying waters.

Keywords: crude oil, PAHs, TPH, oil spillage, water, sediment

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11058 Using Machine Learning to Classify Human Fetal Health and Analyze Feature Importance

Authors: Yash Bingi, Yiqiao Yin

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Reduction of child mortality is an ongoing struggle and a commonly used factor in determining progress in the medical field. The under-5 mortality number is around 5 million around the world, with many of the deaths being preventable. In light of this issue, Cardiotocograms (CTGs) have emerged as a leading tool to determine fetal health. By using ultrasound pulses and reading the responses, CTGs help healthcare professionals assess the overall health of the fetus to determine the risk of child mortality. However, interpreting the results of the CTGs is time-consuming and inefficient, especially in underdeveloped areas where an expert obstetrician is hard to come by. Using a support vector machine (SVM) and oversampling, this paper proposed a model that classifies fetal health with an accuracy of 99.59%. To further explain the CTG measurements, an algorithm based on Randomized Input Sampling for Explanation ((RISE) of Black-box Models was created, called Feature Alteration for explanation of Black Box Models (FAB), and compared the findings to Shapley Additive Explanations (SHAP) and Local Interpretable Model Agnostic Explanations (LIME). This allows doctors and medical professionals to classify fetal health with high accuracy and determine which features were most influential in the process.

Keywords: machine learning, fetal health, gradient boosting, support vector machine, Shapley values, local interpretable model agnostic explanations

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11057 Factors Influencing Health-related Quality of Life in Thai AMI Survivors

Authors: K. Masingboon, S. Duangpaeng, N. Chaiwong

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Acute myocardial infarction (AMI) is the most common cause of death among Thai with coronary heart disease (CHD). Thai AMI survivors are most likely to have impaired health-related quality of life (HRQoL) due to their lifestyle, functional, and psychological problems. Guided by the Individual and Family Self-Management Theory, this study aimed to explore HRQoL and identify its predictors among Thai AMI survivors. 155 Thai AMI survivors were recruited by stratified random sampling from three hospitals located in eastern region of Thailand. HRQol was measured using the Short Form -12 Health Survey (SF-12). The Center for Epidemiologic studies Depression Scale (CES-D) was utilized to assess the presence of depression, and the Family Support questionnaire was administered to examine family support. Results revealed that 92 percent of Thai AMI survivors reported a generally high level of HRQoL and 80 percent of them reported higher level of HRQoL in physical health and mental health dimension. Depression and family support were significantly predicted HRQoL among Thai AMI survivors and accounted for 28.5 percent of variance (p < .001). Interestingly, depression was the most significant predictors of HRQoL (β = -.65, p < .001) In conclusion, depression is a significant predictor of HRQoL in Thai AMI survivors. Increasing awareness of depression among these survivors is important. Depressive symptoms in should be routinely assessed. In addition, intervention to improve HRQoL among Thai AMI survivors should be addressed through depressive symptom management and family collaboration.

Keywords: health-related quality of life, AMI survivors, predictors, collaboration

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11056 The Conditionality of Financial Risk: A Comparative Analysis of High-Tech and Utility Companies Listed on the Shenzhen Stock Exchange (SSE)

Authors: Joseph Paul Chunga

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The investment universe is awash with a myriad of financial choices that investors have to opt for, which principally culminates into a duality between aggressive or conservative approaches. Howbeit, it is pertinent to emphasize that the investment vehicles with an aggressive approach tend to take on more risk than the latter group in an effort to generate higher future returns for their respective investors. This study examines the conditionality effect that such partiality in financing has on the High-Tech and Public Utility companies listed on the Shenzhen Stock Exchange (SSE). Specifically, it examines the significance of the relationship between capitalization ratios of Total Debt Ratio (TDR), Degree of Financial Leverage (DFL) and profitability ratios of Earnings per Share (EPS) and Returns on Equity (ROE) on the Financial Risk of the two industries. We employ a modified version of the Panel Regression Model used by Rahman (2017) to estimate the relationship. The study finds that there is a significant positive relationship between the capitalization ratios on the financial risk of Public Utility companies more than High-Tech companies and a substantial negative relationship between the profitability ratios and the financial risk of the former than the latter companies. This then spells an important insight for prospective investors with regards to the volatility of earnings of such companies.

Keywords: financial leverage, debt financing, conservative firms, aggressive firms

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11055 Foresight in Food Supply System in Bogota

Authors: Suarez-Puello Alejandro, Baquero-Ruiz Andrés F, Suarez-Puello Rodrigo

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This paper discusses the results of a foresight exercise which analyzes Bogota’s fruit, vegetable and tuber supply chain strategy- described at the Food Supply and Security Master Plan (FSSMP)-to provide the inhabitants of Bogotá, Colombia, with basic food products at a fair price. The methodology consisted of using quantitative and qualitative foresight tools such as system dynamics and variable selection methods to better represent interactions among stakeholders and obtain more integral results that could shed light on this complex situation. At first, the Master Plan is an input to establish the objectives and scope of the exercise. Then, stakeholders and their relationships are identified. Later, system dynamics is used to model product, information and money flow along the fruit, vegetable and tuber supply chain. Two scenarios are presented, discussing actions by the public sector and the reactions that could be expected from the whole food supply system. Finally, these impacts are compared to the Food Supply and Security Master Plan’s objectives suggesting recommendations that could improve its execution. This foresight exercise performed at a governmental level is intended to promote the widen the use of foresight as an anticipatory, decision-making tool that offers solutions to complex problems.

Keywords: decision making, foresight, public policies, supply chain, system dynamics

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11054 A Settlement Strategy for Health Facilities in Emerging Countries: A Case Study in Brazil

Authors: Domenico Chizzoniti, Monica Moscatelli, Letizia Cattani, Piero Favino, Luca Preis

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A settlement strategy is to anticipate and respond the needs of existing and future communities through the provision of primary health care facilities in marginalized areas. Access to a health care network is important to improving healthcare coverage, often lacking, in developing countries. The study explores that a good sanitary system strategy of rural contexts brings advantages to an existing settlement: improving transport, communication, water and social facilities. The objective of this paper is to define a possible methodology to implement primary health care facilities in disadvantaged areas of emerging countries. In this research, we analyze the case study of Lauro de Freitas, a municipality in the Brazilian state of Bahia, part of the Metropolitan Region of Salvador, with an area of 57,662 km² and 194.641 inhabitants. The health localization system in Lauro de Freitas is an integrated process that involves not only geographical aspects, but also a set of factors: population density, epidemiological data, allocation of services, road networks, and more. Data were collected also using semi-structured interviews and questionnaires to the local population. Synthesized data suggest that moving away from the coast where there is the greatest concentration of population and services, a network of primary health care facilities is able to improve the living conditions of small-dispersed communities. Based on the health service needs of populations, we have developed a methodological approach that is particularly useful in rural and remote contexts in emerging countries.

Keywords: healthcare, settlement strategy, urban health, rural

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11053 Barriers to Health Promotion Advice Delivered by Paramedics and Emergency Department Nurses – Promoted Study

Authors: B. Schofield, F. Gul, S. McClean, R. Hoskins, R. Terry, U. Rolfe, A. Gibson, S. Voss, J. Benger

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Aim: The aim of this study is to determine whether and how health promotion activities are undertaken by paramedics and emergency department nurses and investigate ways of overcoming potential barriers. Background: Paramedics and emergency department nurses are uniquely placed to reach millions of people and could use these contacts as positive opportunities to help people improve their health by identifying people with risk factors and provide information, brief interventions, and signposting to locally provided services. These interventions can be carried out when the opportunity arises, typically take no more than a few minutes, have a low financial cost and can be a highly efficient method of health promotion. Methodology: Three NHS Emergency Departments and four Ambulance Trusts in England were recruited to the study. A link to an online survey was distributed to paramedics and emergency department nurses at participating sites. Staff were invited to participate in virtual semi-structured interviews. Patients seen, treated, and discharged at the participating sites were invited to virtual semistructured interviews. Findings: A total of 331 survey responses were received, 21 virtual semi-structured staff interviews and 11 patient interviews were completed. Staff reported lack of time to prioritise, lack of knowledge, resources, and confidence as barriers. Receptiveness of patients guided their decision to undertake health promotion activities. They reported a desire to learn how to undertake health promotion conversations. Emergency department nurses felt more supported than paramedics by their organisations to undertake health promotion activities. Patients were not aware of health promotion activities and reported fear and lack of privacy as barriers. Conclusions: These results will guide the development of an intervention to support the provision of health promotion by staff in urgent and emergency care settings. The components of the intervention will be mapped to a framework which will consider the needs of staff working within these settings, patients they treat, and organisational issues and practices related to the implementation of such an intervention.

Keywords: emergency service, hospital, nursing, allied health personnel, emergency medical services, health promotion

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