Search results for: public hospital unions

Authors: Qi Wang

Abstract:

With the expansion of trial-centered principles, the importance of witness examination in Korean criminal proceedings has been increasingly emphasized. However, several practical challenges have emerged in courtroom examinations, including concerns about witnesses’ memory deterioration due to prolonged trial periods, the possibility of inaccurate testimony due to courtroom anxiety and tension, risks of testimony retraction, and witnesses’ refusal to appear. These issues have led to a decline in the effective utilization of witness testimony. This study analyzes the deposition system, which is widely used in the U.S. evidence discovery process, and examines its potential implementation within the Korean criminal procedure framework. Furthermore, it explores the scope of application, procedural design, and measures to prevent potential abuse if the system were to be adopted. Under the adversarial litigation structure that has evolved through several amendments to the Criminal Procedure Act, the deposition system, although conducted pre-trial, serves as a preliminary procedure to facilitate efficient and effective witness examination during trial. This system not only aligns with the goal of discovering substantive truth but also upholds the practical ideals of trial-centered principles while promoting judicial economy. Furthermore, with the legal foundation established by Article 266 of the Criminal Procedure Act and related provisions, this study concludes that the implementation of the deposition system is both feasible and appropriate for the Korean criminal justice system. The specific functions of depositions include providing case-related information to refresh witnesses’ memory as a preliminary to courtroom examination, pre-reviewing existing statement documents to enhance trial efficiency, and conducting preliminary examinations on key issues and anticipated questions. The subsequent courtroom witness examination focuses on verifying testimony through public and cross-examination, identifying and analyzing contradictions in testimony, and conducting double verification of testimony credibility under judicial supervision. Regarding operational aspects, both prosecution and defense may request depositions, subject to court approval. The deposition process involves video or audio recording, complete documentation by court reporters, and the preparation of transcripts, with copies provided to all parties and the original included in court records. The admissibility of deposition transcripts is recognized under Article 311 of the Criminal Procedure Act. Given prosecutors’ advantageous position in evidence collection, which may lead to indifference or avoidance of depositions, the study emphasizes the need to reinforce prosecutors’ public interest status and objective duties. Additionally, it recommends strengthening pre-employment ethics education and post-violation disciplinary measures for prosecutors.

Keywords: witness examination, deposition system, Korean criminal procedure, evidence discovery, trial-centered principle

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Authors: Kim Anema, Matthias Max, Chris Zevenbergen

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For any flood risk manager the 'safety paradox' has to be a familiar concept: low probability leads to a sense of safety, which leads to more investments in the area, which leads to higher potential consequences: keeping the aggregated risk (probability*consequences) at the same level. Therefore, it is important to mitigate potential consequences apart from probability. However, when the (perceived) probability is so low that there is no recognizable trend for society to adapt to, addressing the potential consequences will always be the lagging point on the agenda. Preparedness programs fail because of lack of interest and urgency, policy makers are distracted by their day to day business and there's always a more urgent issue to spend the taxpayer's money on. The leading question in this study was how to address the social consequences of flooding in a context of (perceived) low probability. Disruptions of everyday urban life, large or small, can be caused by a variety of (un)expected things - of which flooding is only one possibility. Variability like this is typically addressed with resilience - and we used the concept of Community Resilience as the framework for this study. Drawing on face to face interviews, an extensive questionnaire and publicly available statistical data we explored the 'whole society response' to two recent urban flood events; the Brisbane Floods (AUS) in 2011 and the Dresden Floods (GE) in 2013. In Brisbane, we studied how the societal impacts of the floods were counteracted by both authorities and the public, and in Dresden we were able to validate our findings. A large part of the reactions, both public as institutional, to these two urban flood events were not fuelled by preparedness or proper planning. Instead, more important success factors in counteracting social impacts like demographic changes in neighborhoods and (non-)economic losses were dynamics like community action, flexibility and creativity from authorities, leadership, informal connections and a shared narrative. These proved to be the determining factors for the quality and speed of recovery in both cities. The resilience of the community in Brisbane was good, due to (i) the approachability of (local) authorities, (ii) a big group of ‘secondary victims’ and (iii) clear leadership. All three of these elements were amplified by the use of social media and/ or web 2.0 by both the communities and the authorities involved. The numerous contacts and social connections made through the web were fast, need driven and, in their own way, orderly. Similarly in Dresden large groups of 'unprepared', ad hoc organized citizens managed to work together with authorities in a way that was effective and speeded up recovery. The concept of community resilience is better fitted than 'social adaptation' to deal with the potential consequences of an (im)probable flood. Community resilience is built on capacities and dynamics that are part of everyday life and which can be invested in pre-event to minimize the social impact of urban flooding. Investing in these might even have beneficial trade-offs in other policy fields.

Keywords: community resilience, disaster response, social consequences, preparedness

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Authors: Samar Mousa, Galini Mavromatidou, Rebecca Shirley

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Surgeons carry out numerous operations in the busy burns and plastic surgery department daily. Writing an accurate operation note with all the essential information is crucial for communication not only within the plastics team but also to the multi-disciplinary team looking after the patient, including other specialties, nurses and GPs. The Royal college of surgeons of England, in its guidelines of good surgical practice, mentioned that the surgeon should ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. The notes should include the Date and time, Elective/emergency procedure, Names of the operating surgeon and assistant, Name of the theatre anesthetist, Operative procedure carried out, Incision, Operative diagnosis, Operative findings, Any problems/complications, Any extra procedure performed and the reason why it was performed, Details of tissue removed, added or altered, Identification of any prosthesis used, including the serial numbers of prostheses and other implanted materials, Details of closure technique, Anticipated blood loss, Antibiotic prophylaxis (where applicable), DVT prophylaxis (where applicable), Detailed postoperative care instructions and Signature. Fourteen random days were chosen in December 2021 to assess the accuracy of operative notes and post-operative care. A total of 163 operative notes were examined. The average completion rates in all domains were 85.4%. An electronic operative note template was designed to cover all domains mentioned in the Royal College of surgeons' good surgical practice. It is kept in the hospital drive for all surgeons to use.

Keywords: operative notes, plastic surgery, documentation, electronic

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Authors: Amin Padash, Mehran Khodaparast, Saadat Khodaparast

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Climate change is a significant and lasting change in the statistical distribution of weather patterns over periods ranging from decades to millions of years. Climate change is caused by factors such as biotic processes, variations in solar radiation received by Earth, plate tectonics, and volcanic eruptions. Certain human activities have also been identified as significant causes of recent climate change, often referred to as “Global Warming”. The ultimate goal of this paper is to determine how climate change affects the style of life and all of our activities. The paper focuses on what the effects of humans are on climate change and how communities can achieve sustainable development and use resources in a way that is good for the ecosystem and public. We opine Climate Change is a vital issue that can be called “Wicked Problem”. This paper attempts to address this wicked problem by COMPRAM Methodology as one of the possible solutions.

Keywords: climate change, COMPRAM, human influences, sustainable development, wicked problems

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Authors: Olgun Akbulut

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Turkey has entered in the European human rights monitoring in the early 1990s. Since then many improvements have been observed in domestic law. However, one area stays the least developed one: gender discrimination. Although the country is proud of the fact that electoral rights for women were recognized in Turkey even before many developed countries in the west, interestingly the first Turkish case where the European Court of Human Rights (ECrtHR) found discrimination concerned gender discrimination. With the proposed paper, the author is willing to determine and analyze the findings of the ECrtHR in cases decided against Turkey concerning gender discrimination, identify whether Turkish public institutions display coordination in engagement or disengagement in implementing the judgments where the ECrtHR found discrimination on the basis of gender and evaluate the effectiveness of the Court's jurisprudence on Turkish gender policy.

Keywords: equality, gender discrimination, human rights, Turkey

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Authors: Darshana Rathod, Kirtikumar Rathod, Kamlesh Kumari, Abhilasha Motghare

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Background and Aims: Hypospadias is one of the common congenital anomalies in males. Various modalities are used for pain management, including caudal, penile, pudendal, ring blocks, and systemic analgesics. There has yet to be a consensus regarding the most effective and safe analgesic method for controlling pain in these children. We planned this study to determine our institute's pain management practices for hypospadias surgeries. Material and Methods: This retrospective cohort study reviewed 150 children with hypospadias undergoing surgery from January 2020 to December 2023. Data regarding the mode of pain management, postoperative opioid requirement, PACU discharge, and complications was collected from the records. Results: For postoperative pain, 33 (22%) children received caudal block, 60 (40%) penile block, and 57 (38%) were managed by intravenous analgesics. A significant difference was found in the three groups, with the IV analgesic group requiring significantly higher opioid boluses in PACU [43 (75.4%) required two boluses (p < 0.05)]. The difference in PACU discharge time among the three groups was statistically significant (p< 0.05), with IV analgesics groups having the highest (55 mins [47, 60]), the Caudal group at 35mins (30, 40), and the dorsal penile block group at 35mins (25, 40). There was no significant difference in complications like edema, meatal stenosis, urethra-cutaneous fistula, or wound dehiscence among all three groups. Conclusion: Intravenous analgesics and regional blocks like caudal and penile blocks are the common pain management modalities in our institute. The regional blocks are effective in managing pain in the postoperative period and are not significantly associated with complications.

Keywords: caudal block, hypospadias, pain management, penile block

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Authors: Jamila Garba Audu, Peter Adamu

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This study investigates the role of forensic accounting in the fight against corruption in Nigeria for better utilization of public funds and economic growth and development of the Country. We adopted a trend analysis to show the performance of the Nigerian economy as well as the quality of institutions which government economic and political activities in the country. It is an established fact that Nigeria has performed badly since the 1960s to date in terms of institutional quality and economic development despite large amount of money obtained from the export of crude oil. It was revealed also that the fight against corruption has not been very successful in recent times because experts in the field of forensic accounting have not been utilized. With the successes recorded in dealing with fraud and embezzlement using forensic accounting, it has become imperative for the EFCC to use forensic accountants in the fight against corruption in the country. Also, there is the need to introduce very seriously, the teaching of forensic accounting in Nigerian Universities to train experts.

Keywords: corruption, economic performance, forensic accounting, Nigeria

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Authors: Kuay Hue San, Muaz Haqim Shaharum, Nasir Yusoff

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Gender plays a big role in psychosocial development. This study aimed to investigate whether gender moderates the relationship between moral identity (internalization and symbolization) and risk-smoking behavior. An online cross-sectional study was carried out on 388 (61% female) youths who fulfilled the study’s inclusion and exclusion criteria. While viewing images of smoking behavior, participants rated their emotional state, which ranged from unpleasant to pleasant. Participants were also asked to fill out the eight-item Moral Identity Scale and provide their socio-demographic information. Gender significantly moderated the relationship between symbolization and smoking behavior. However, the moderation effect was not shown by internalization Finding highlights the implication of gender on moral identity and smoking behavior and the importance of considering this in the public health intervention and program.

Keywords: smoking behaviour, gender, emotion, moral identity

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Authors: Tuji Jemal Ahmed

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Food quality and safety challenges are prevalent in Ethiopia's food processing industry, which can have adverse effects on consumers' health and wellbeing. The country is known for its diverse range of agricultural products, which are essential to its economy. However, poor food quality and safety policies and management systems in the food processing industry have led to several health problems, foodborne illnesses, and economic losses. This paper aims to highlight the causes and effects of food safety and quality issues in the food processing industry of Ethiopia and discuss potential solutions to address these issues. One of the main causes of poor food quality and safety in Ethiopia's food processing industry is the lack of adequate regulations and enforcement mechanisms. The absence of comprehensive food safety and quality policies and guidelines has led to substandard practices in the food manufacturing process. Moreover, the lack of monitoring and enforcement of existing regulations has created a conducive environment for unscrupulous businesses to engage in unsafe practices that endanger the public's health. The effects of poor food quality and safety are significant, ranging from the loss of human lives, increased healthcare costs, and loss of consumer confidence in the food processing industry. Foodborne illnesses, such as diarrhea, typhoid fever, and cholera, are prevalent in Ethiopia, and poor food quality and safety practices contribute significantly to their prevalence. Additionally, food recalls due to contamination or mislabeling often result in significant economic losses for businesses in the food processing industry. To address these challenges, the Ethiopian government has begun to take steps to improve food quality and safety in the food processing industry. One of the most notable initiatives is the Ethiopian Food and Drug Administration (EFDA), which was established in 2010 to regulate and monitor the quality and safety of food and drug products in the country. The EFDA has implemented several measures to enhance food safety, such as conducting routine inspections, monitoring the importation of food products, and enforcing strict labeling requirements. Another potential solution to improve food quality and safety in Ethiopia's food processing industry is the implementation of food safety management systems (FSMS). An FSMS is a set of procedures and policies designed to identify, assess, and control food safety hazards throughout the food manufacturing process. Implementing an FSMS can help businesses in the food processing industry identify and address potential hazards before they cause harm to consumers. Additionally, the implementation of an FSMS can help businesses comply with existing food safety regulations and guidelines. In conclusion, improving food quality and safety policies and management systems in Ethiopia's food processing industry is critical to protecting public health and enhancing the country's economy. Addressing the root causes of poor food quality and safety and implementing effective solutions, such as the establishment of regulatory agencies and the implementation of food safety management systems, can help to improve the overall safety and quality of the country's food supply.

Keywords: food quality, food safety, policy, management system, food processing industry

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Authors: F. Slaven, M. Uys, Y. Erasmus

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The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

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Authors: Sagar R. Patil, Dinesh R. Gawade, Sudhir N. Divekar

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One of the medical devices we found when we visit a hospital care unit such device is ‘patient monitoring system’. This device (patient monitoring system) informs doctors and nurses about the patient’s physiological signals. However, this device (patient monitoring system) does not have a remote monitoring capability, which is necessitates constant onsite attendance by support personnel (doctors and nurses). Thus, we have developed a Remote Wireless Patient Monitoring System using some biomedical sensors and Android OS, which is a portable patient monitoring. This device(Remote Wireless Patient Monitoring System) monitors the biomedical signals of patients in real time and sends them to remote stations (doctors and nurse’s android Smartphone and web) for display and with alerts when necessary. Wireless Patient Monitoring System different from conventional device (Patient Monitoring system) in two aspects: First its wireless communication capability allows physiological signals to be monitored remotely and second, it is portable so patients can move while there biomedical signals are being monitor. Wireless Patient Monitoring is also notable because of its implementation. We are integrated four sensors such as pulse oximeter (SPO2), thermometer, respiration, blood pressure (BP), heart rate and electrocardiogram (ECG) in this device (Wireless Patient Monitoring System) and Monitoring and communication applications are implemented on the Android OS using threads, which facilitate the stable and timely manipulation of signals and the appropriate sharing of resources. The biomedical data will be display on android smart phone as well as on web Using web server and database system we can share these physiological signals with remote place medical personnel’s or with any where in the world medical personnel’s. We verified that the multitasking implementation used in the system was suitable for patient monitoring and for other Healthcare applications.

Keywords: patient monitoring, wireless patient monitoring, bio-medical signals, physiological signals, embedded system, Android OS, healthcare, pulse oximeter (SPO2), thermometer, respiration, blood pressure (BP), heart rate, electrocardiogram (ECG)

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Authors: Eman Elsebaie, A. Sedrak, R. Ziada

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Introduction: In the recent decades, heart failure (HF) has become one of the most prevalent cardio-vascular disease (CVDs), especially in the elderly and the main cause of hospitalization in Egypt cardiology departments. By 2030, the prevalence of HF is expected to increase by 25%. Total direct costs will increase to $818 billion, and the total indirect cost in terms of lost productivity is close to $275 billion. The current study was conducted to estimate the economic costs of services delivered for heart failure patients at the cardiology department in Cairo University Hospitals (CUHs). Aim: To gain an understanding of the cost of heart failure disease and its main drivers aiming to minimize associated health care costs. Subjects and Methods: Economic cost analysis study was conducted for a prospective group of all cases of HF admitted to the cardiology department in CUHs from end of March till end of April 2016 and another retrospective randomized sample from patients with HF, during the first 3 months of 2016 to measure estimated average cost per patient per day. Results: The mean age of the prospective group was 48.6 ± 17.16 years versus 52.3 ± 11.5 years for the retrospective group. The median (IQR) of Length of stay was 15 (15) days in the prospective group versus 9 (16) days in the retrospective group. The average HF inpatient cost/day in the cardiology department during April 2016 was 362.32 (255.5) L.E. versus 391.2(255.9) L.E. during January and February 2016. Conclusion: Up to 70% of expenditure in the management of HF is related to hospital admission. The average cost of such an admission was 5540.03 (IQR=7507.8) L.E. and 4687.4 (IQR=7818.8) L.E. with the average cost per day estimated at 362.32 (IQR=255.5) L.E. and 386.2(IQR=255.9) L.E. in prospective and retrospective groups respectively.

Keywords: health care cost, heart failure, hospitalization, inpatient

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Authors: S. Mazifah, A. Azahan, A. Kadir

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This paper aims to examine the relationship between the needs of ex-landfill redevelopment and the adequacy of open space provision in the context of sustainable urban development planning in Malaysia as seen from the perspective of the National Urban Policy. With a specific focus on the Action Plan DPN6 and DPN9, ex-landfill redevelopment needs and provision of open space are detailed to identify their potential and constraints in the development of sustainable cities. As a result, this paper found a link between the needs of urban ex-landfill redevelopment and approach to provide adequate urban open space. Through the proposal of the development of public park at urban ex-landfill sites, the needs of ex-landfill redevelopment and the adequacy of urban open space provision is being 'united' and translated as an approach to create a sustainable urban development in Malaysia.

Keywords: ex-landfill redevelopment, open spaces, National Urban Policy, sustainable urban development

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Authors: Mirjana Dokmanovic

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The main topic of this paper is the analysis of the presence of gender stereotypes in the media content in the Republic of Serbia with respect to the state commitments to eliminate discrimination against women. The research methodology included the analysis of the media content of six daily newspapers and two magazines on the date of 28 December 2015 and the analysis of the reality TV show programs in 2015 from gender perspective. The methods of the research has also included a desk research and a qualitative analysis of the available data, statistics, policy papers, studies, and reports produced by the government, the Ministry of Culture and Information, the Regulatory Body for Electronic Media, the Press Council, the associations of media professionals, the independent human rights bodies, and civil society organizations (CSOs). As a State Signatory to the Convention on the Elimination of All Forms of Discrimination against Women, the Republic of Serbia has adopted numerous measures in this field, including the Law on Equality between Sexes and the national gender equality strategies. Special attention has been paid to eliminating gender stereotypes and prejudices in the media content and portraying of women. This practice has been forbidden by the Law on Electronic Media, the Law on Public Information and Media, the Law on Public Service Broadcasting and the Bylaw on the Protection of Human Rights in the Provision of Media Services. Despite these commitments, there has not been achieved progress regarding eliminating gender stereotypes in the media content. The research indicates that the media perpetuate traditional gender roles and patriarchal patterns. Female politicians, entrepreneurs, academics, scientists, and engineers have been very rarely portrayed in the media. On the other side, women are in their focus as celebrities, singers, and actresses. Women are underrepresented in the pages related to politics and economy, while they are mostly present in the cover stories related to show-business, health care, family and household matters. Women are three times more than men identified on the basis of their family status, as mothers, wives, daughters, etc. Hate speech, misogyny, and violence against women are often present in the reality TV shows. The abuse of women and their bodies in advertising is still widely present. The cases of domestic violence are still presented with sensationalism, although there has been achieved progress in portraying victims of domestic violence with respect and dignity. The issues related to gender equality and the position of the vulnerable groups of women, such as Roma women or rural women, are not visible in the media. This research, as well as warnings of women’s CSOs and independent human rights bodies, indicates the necessity to implement legal and policy measures in this field consistently and with due diligence. The aim of the paper is to contribute eliminating gender stereotypes in the media content and advancing gender equality.

Keywords: discrimination against women, gender roles, gender stereotypes, media, misogyny, portraying women in the media, prejudices against women, Republic of Serbia

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Authors: Siyathorn Khunon, Thanawit Buafai

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This paper aims to investigate management of beach safety with a focus on tourist drownings in Samui. The data collected in this investigation will then lead to the proposal of a practical management model suitable for use in Samui. Qualitative research was conducted in the following manner: nine stakeholders from local government organizations and tourism businesses were interviewed in-depth. Additionally, a best practice case study from Phuket was applied to analyze beach safety. Twelve foreign tourists were also interviewed. Then, a focus group comprised of 32 people was used to determine practical solutions for enhancing tourists’ safety on the beach in Samui. A steering committee to coordinate between public and private organizations was proposed to manage and enhance tourists’ safety. A practical model is proposed to increase the safety level of tourists in Samui

Keywords: beach safety, drowning, tourist, Samui

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Authors: Shannon Hearney, Jeffrey Hoch

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Pancreatic cancer is a notoriously costly and deadly form of cancer. Many types of treatment centers exist for patients to seek care from, including high-volume centers which have shown promise to provide the highest quality of care. While it may be true that this type of center provides the best care it is unclear if that care is cost-effective. Studies in the US have confirmed that high-volume hospitals do provide higher quality of care but have shown inconsistencies in the cost-effectiveness of that care. Other studies, like those from Finland have shown that high-volume centers had lower mortality and lower costs than low-volume centers. This paper thus seeks to review the current scientific literature to better understand if high-volume centers are cost-effective in delivering care in both a European setting and in the US. A review of major reference databases such as Medline, Embase and PubMed will be conducted for cost-effectiveness studies on the surgical treatment of pancreatic cancer at high-volume centers. Possible MeSH terms to be included, but not limited to, are: “pancreatic cancer”, “cost analysis”, “cost-effectiveness”, “economic evaluation”, “pancreatic neoplasms”, “surgical”, and “high-volume”. Studies must also have been available in the English language. This review will encompass European scientific literature, as well as those in the US. Based on our preliminary findings, we anticipate high-volume hospitals to provide better care at greater costs. We anticipate that high-volume hospitals may be cost-effective in different contexts depending on the national structure of a healthcare system. Countries with more centralized and socialized healthcare may yield results that are more cost-effective. High-volume centers may differ in their cost-effectiveness of the surgical care of pancreatic cancer internationally especially when comparing those in the United States to others throughout Europe.

Keywords: cost-effectiveness analysis, economic evaluation, pancreatic cancer, scientific literature review

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Authors: Wipanee Maen-In

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This research aims to study the tourism marketing and the trip behaviors profile of international tourists who visited Phuket in Thailand and study the influence of their selected demographic characters on their selected trip behaviors. The study was conducted through survey by using questionnaires asking 400 sample respondents from international tourists who visited Phuket. The result found out that type of group travel is the key variable that indicates higher and lower daily spending tourists, tourists spend more when they visit with their family. Trip arrangement is the key variables that indicate shorter and longer stay tourists. From these findings, it is recommended that both private and public sectors should make marketing to potential tourists in order to increase tourism revenue and to be a sustainable tourism, all of agencies that involves in Phuket tourism industry should coordinate to satisfy tourists to revisit and recommend Phuket to friends and relatives.

Keywords: consumer behavior, international tourists, Phuket province, tourism marketing

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Authors: Taye O. Famuditi, Jonathan Potts, Malcolm Bray

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This paper examines the shoreline management planning policy in England and its suitability for ameliorating the diverse environmental problems associated with Nigeria’s coastal zones. It examines the success of SMPs in England since the mid-1990s and progress achieved, with the aim of understudying the current management approach that can be transferred to Nigeria to strengthen its adoption, and as a necessary corollary, implementation of the SMPs. This paper also examines key elements of the shoreline management frameworks in England and provides answers to the question: Would shoreline management planning approach in England be appropriate and feasible in Nigeria? It further concludes that many of the action plans and principles of participation should be adoptable provided that a participatory approach that involves all stakeholders including community members and relevant sectorial ministries as well as appropriate legal framework is encouraged.

Keywords: shoreline management plans, coastal zone management, stakeholder engagement, participatory approach, Nigeria

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Authors: Domenica Tambasco, Riina Bray, Sophia Jaworski, Gillian Grant, Celeste Corkery

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Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and reduced function. Management of symptoms include medications, physical treatments and mindfulness therapies. Myofascial Release is a modality that has been successfully applied in var-ious musculoskeletal conditions. However, to the author’s best knowledge, it is not yet recog-nized as a self-management therapy option in Fibromyalgia. In this study, we investigated whether Self-applied Myofascial Release (SMR) is associated with overall improved function and symptoms in Fibromyalgia. Methods: Eligible adult patients with a confirmed diagnosis of Fibromyalgia at Women’s College Hospital were recruited to SMR. Sessions ran for 1 hour once a week for 7 weeks, led by the same two Physiotherapists knowledgeable in this physical treat-ment modality. The main outcome measure was an overall impact score for function and symp-toms based on the validated assessment tool for Fibromyalgia, the Revised Fibromyalgia Impact Questionnaire (FIQR), measured pre and post-intervention. Both descriptive and analytical methods were applied and reported. Results: We analyzed results using a paired t-test to deter-mine if there was a statistically significant difference in mean FIQR scores between initial (pre-intervention) and final (post-intervention) scores. A clinically significant difference in FIQR was defined as a reduction in score by 10 or more points. Conclusions: Our pilot study showed that SMR appeared to be a safe and effective intervention for our Fibromyalgia participants and the overall impact on function and symptoms occurred in only 7 weeks. Further studies with larger sample sizes comparing SMR to other physical treatment modalities (such as stretching) in an RCT are recommended.

Keywords: fibromyalgia, myofascial release, physical therapy, FIQR

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Authors: Ayantika Biswas

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Hypertension still remains one of the most important preventable contributors to adult mortality and morbidity and a major public health challenge worldwide. Studying regional and rural-urban differences in prevalence and assessment of the contributions of different indicators is essential in determining the drivers of this condition. The 2015-16 National Family Health Survey data has been used for the study. Bivariate analysis, multinomial regression analysis, concentration indices and decomposition of concentration indices assessing contribution of factors has been undertaken in the present study. An overall concentration index of 0.003 has been found for hypertensive population, which shows its concentration among the richer wealth quintiles. The contribution of factors like age 45 to 49 years, years of schooling between 5 to 9 years are factors that are important contributors to inequality in hypertension occurrence. Studies should be conducted to find approaches to prevent or delay the onset of the condition.

Keywords: hypertension, decomposition, inequalities, India

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Authors: Luiza Toschi

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This work presents part of an empirical and theoretical master's degree meta-research that is interested in the relationship between the disciplinary area of Social Communication, to be investigated with the characteristics of the Bourdieusian scientific field, and the emergence of public interest in Nonviolent Communication (NVC) in Brazil and the world. To this end, the state of the art of this conceptual and practical relationship is investigated based on scientific productions available in spaces of academic credibility, such as conferences and scientific journals renowned in the field. From there, agents and the sociological aspects that make them contribute or not to scientific production in Brazil and the world are mapped. In this work, a brief dive into the international context is presented to understand if and how nonviolent communication permeates scientific production in communication in a systematic way. Using three accessible articles published between 2013 and 2022 in the 117 magazines classified as Quartiles Q1 in the Journal Ranking of Communication, the international production on the subject is compared with the Brazilian one from its context. The social conditions of the international circulation of ideas are thus discussed. Science is a product of its social environment, arising from relations of interest and power that compete in the political dimension at the same time as in the epistemological dimension. In this way, scientific choices are linked to the resources mobilized from or through the prestige and recognition of peers. In this sense, an object of interest stands out to a scientist for its academic value, but also and inseparably that which has a social interest within the collective, their social stratification, and the context of legitimacy created in their surroundings, influenced by cultural universalism. In Brazil, three published articles were found in congresses and journals that mention NVC in their abstract or keywords. All were written by Public Relations undergraduate students. Between the most experienced researchers who guided or validated the publications, it is possible to find two professionals who are interested in the Culture of Peace and Dialogy. Likewise, internationally, only three of the articles found mention the term in their abstract or title. Two analyze journalistic coverage based on the principles of NVC and Journalism for Peace. The third is from one of the Brazilian researchers identified as interested in dialogic practices, who analyses audiovisual material and promotes epistemological reflections. If, on the one hand, some characteristics inside and outside Brazil are similar: small samples, relationship with peace studies, and female researchers, two of whom are Brazilian, on the other hand, differences are obvious. If within the country, the subject is mostly Organizational Communication, outside this intersection, it is not presented explicitly. Furthermore, internationally, there is an interest in analyzing from the perspective of NVC, which has not been found so far in publications in Brazil. Up to the present moment, it is possible to presume that, universally, the legitimacy of the topic is sought by its association with conflict conciliation research and communication for peace.

Keywords: academic field sociology, international circulation of ideas, meta research in communication, nonviolent communication

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Authors: Aliya Moreira, Blake Duffy, Sam Kosinski, Kate Heckman, Erika Steensma

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Introduction: The One Health initiative promotes recognition of the interrelatedness between people, animals, plants, and their shared environment. The field of comparative medicine studies the similarities and differences between humans and animals for the purpose of advancing medical sciences. Currently, medical school education is narrowly focused on human anatomy and physiology, but as the COVID-19 pandemic has demonstrated, a holistic understanding of health requires comprehension of the interconnection between health and the lived environment. To prepare future physicians for unique challenges from emerging zoonoses to climate change, medical students can benefit from exposure to and experience with One Health and Comparative Medicine content. Methods: In January 2020, an elective course for medical students on One Health and Comparative Medicine was created to provide medical students with the background knowledge necessary to understand the applicability of animal and environmental health in medical research and practice. The 2-week course was continued in January 2021, with didactic and experiential activities taking place virtually due to the COVID-19 pandemic. In response to student feedback, lectures were added to expand instructional content on zoonotic and wildlife diseases for the second iteration of the course. Other didactic sessions included interprofessional lectures from 20 physicians, veterinarians, public health professionals, and basic science researchers. The first two cohorts of students were surveyed regarding One Health and Comparative Medicine concepts at the beginning and conclusion of the course. Results: 16 medical students have completed the comparative medicine course thus far, with 87.5% (n=14) completing pre-and post-course evaluations. 100% of student respondents indicated little to no exposure to comparative medicine or One Health concepts during medical school. Following the course, 100% of students felt familiar or very familiar with comparative medicine and One Health concepts. To assess course efficacy, questions were evaluated on a five-point Likert scale. 100% agreed or strongly agreed that learning Comparative Medicine and One Health topics augmented their medical education. 100% agreed or strongly agreed that a course covering this content should be regularly offered to medical students. Conclusions: Data from the student evaluation surveys demonstrate that the Comparative Medicine course was successful in increasing medical student knowledge of Comparative Medicine and One Health. Results also suggest that interprofessional training in One Health and Comparative Medicine is applicable and useful for medical trainees. Future iterations of this course could capitalize on the inherently interdisciplinary nature of these topics by enrolling students from veterinary and public health schools into a longitudinal course. Such recruitment may increase the course’s value by offering multidisciplinary student teams the opportunity to conduct research projects, thereby strengthening both the individual learning experience as well as sparking future interprofessional research ventures. Overall, these efforts to educate medical students in One Health topics should be reproducible at other institutions, preparing more future physicians for the diverse challenges they will encounter in practice.

Keywords: medical education, interprofessional instruction, one health, comparative medicine

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Authors: Muhammad A. Ishaq, S. U. R. Aliyu

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This paper on an exposition of Islamic fiscal policy attempts to discuss the basic principles of Islamic fiscal policy in an Islamic economy. The paper presents a number of definitions of the subject matter, its nature and its tools of application. Government spending, taxation and public borrowings were identified as the tools of the policy. The paper identifies zakat both as a veritable source of revenue and a major instrument of economic stabilization. Furthermore, the paper presents an algebraic 2-sector and 3-sector models from the basic Keynesian model. The paper posits that in view of uniqueness of its instruments, absence of interest rate in the economy and the policy’s derive towards socioeconomic justice and redistribution, Islamic fiscal policy is capable of stabilizing Islamic economy and ushering it into the path of long term economic growth and prosperity.

Keywords: automatic built-in-stabilizers, government spending, Islamic fiscal policy, taxation, zakat

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Authors: Yong Hwang, Kang Yeol Suh, Yundeok Jang, Tae Hoon Kim

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Introduction: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Acute kidney injury is a potential complication of severe rhabdomyolysis and the prognosis is substantially worse if renal failure develops. We try to identify the factors that were predictive of AKI in severe trauma patients with rhabdomyolysis. Methods: This retrospective study was conducted at the emergency department of a level Ⅰ trauma center. Patients enrolled that initial creatine phosphokinase (CPK) levels were higher than 1000 IU with acute multiple trauma, and more than 18 years older from Oct. 2012 to June 2016. We collected demographic data (age, gender, length of hospital day, and patients’ outcome), laboratory data (ABGA, lactate, hemoglobin. hematocrit, platelet, LDH, myoglobin, liver enzyme, and BUN/Cr), and clinical data (Injury Mechanism, RTS, ISS, AIS, and TRISS). The data were compared and analyzed between AKI and Non-AKI group. Statistical analyses were performed using IMB SPSS 20.0 statistics for Window. Results: Three hundred sixty-four patients were enrolled that AKI group were ninety-six and non-AKI group were two hundred sixty-eight. The base excess (HCO3), AST/ALT, LDH, and myoglobin in AKI group were significantly higher than non-AKI group from laboratory data (p ≤ 0.05). The injury severity score (ISS), revised Trauma Score (RTS), Abbreviated Injury Scale 3 and 4 (AIS 3 and 4) were showed significant results in clinical data. The patterns of CPK level were increased from first and second day, but slightly decreased from third day in both group. Seven patients had received hemodialysis treatment despite the bleeding risk and were survived in AKI group. Conclusion: We recommend that HCO3, CPK, LDH, and myoglobin should be checked and be concerned about ISS, RTS, AIS with injury mechanism at the early stage of treatment in the emergency department.

Keywords: acute kidney injury, emergencies, multiple trauma, rhabdomyolysis

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Authors: Hiroshi Nakayama, Yuji Ito

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Synthetic cannabinoids have attracted much public attention recently in Japan. 1-pentyl-3-(1-naphthoyl)-indole (JWH-018), 1-pentyl-2-methyl-3-(1-naphthoyl) indole (JWH-015), 1-(5-fluoropentyl)-3- (1-(2,2,3,3- tetramethylcyclopropyl)) indole (XLR-11) and 1-methyl-3- (1-admantyl) indole (JWH-018 adamantyl analog) are known as synthetic cannabinoids and are also considered dangerous illegal drugs in Japan. It has become necessary to develop sensitive and useful methods for detection of synthetic cannabinoids. We produced two monoclonal antibodies (MAb) against synthetic cannabinoids, named NT1 (IgG1) and NT2 (IgG1), using Hybridoma technology. The cross-reactivity of these produced MAbs was evaluated using a competitive enzyme-linked immunosorbent assay (ELISA). In the results, we found both of these antibodies recognize many kinds of synthetic cannabinoids analog. However, neither of these antibodies recognizes naphtoic acid, 1-methyl-indole and indole known as a raw material of synthetic cannabinoid. Thus, the MAbs produced in this study could be a useful tool for the detection of synthetic cannabinoids.

Keywords: ELISA, monoclonal antibody, sensor, synthetic cannabinoid

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Authors: Hasan Frookh Jamal

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This is a case of a 36-year-old Bahraini gentleman diagnosed to have Cushing's Syndrome with a large anterior mediastinal mass. He was sent abroad to the Speciality hospital in Jordan, where he underwent diagnostic video-assisted thoracoscopy, partial thymectomy and pericardial fat excision. Histopathology of the mass was reported to be an Atypical carcinoid tumor with a low Ki67 proliferation index of 5%, the mitotic activity of 4 MF/10HPF and pathological stage classification(pTNM): pT1aN1. MRI of the pituitary gland showed an ill-defined non-enhancing focus of about 3mm on the Rt side of the pituitary on coronal images, with a similar but smaller one on the left side, which could be due to enhancing pattern rather than a real lesion as reported. The patient underwent Ga68 Dotate PET/CT scan post-operatively, which showed multiple somatostatin receptor-positive lesions seen within the tail, body and head of the pancreas and positive somatostatin receptor lymph nodes located between the pancreatic head and IVC. There was no uptake detected at the anterior mediastinum nor at the site of thymic mass resection. There was no evidence of any positive somatostatin uptake at the soft tissue or lymph nodes. The patient underwent IPSS, which proved that the source is, in fact, an ectopic source of ACTH secretion. Unfortunately, the patient's serum cortisol remained elevated after surgery and failed to be suppressed by 1 mg ODST and by 2 days LLDST with a high ACTH value. The patient was started on Osilodrostat for treatment of hypercortisolism for the time being and his future treatment plan with Lutetium-177 Dotate therapy vs. bilateral adrenalectomy is to be considered in an MDT meeting.

Keywords: cushing syndrome, neuroendocrine tumur, carcinoid tumor, Thymoma

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Authors: Merav Ben Natan, May Revach, Or Sade, Yaniv Yonay, Yaron Berkovich

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Background: The inclusion of nurse practitioners (NPs) specializing in orthopedics holds promise for enhancing the quality of care for orthopedic patients. Understanding patients’ perspectives on this role is crucial for evaluating the feasibility and acceptance of integrating NPs into orthopedic settings. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic NPs and examines potential associations between patients’ willingness to engage with NPs, their familiarity with the NP role, perceptions of nursing, and satisfaction with orthopedic nursing care. Methods: This cross-sectional study involved patients admitted to an orthopedic department at a central Israeli hospital between January and February 2023. Data was collected using a validated questionnaire consisting of five sections, reviewed by content experts. Statistical analyses were conducted using SPSS and included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression. Results: Participants in the study showed a moderate willingness to receive treatment from orthopedic NPs, with more than two-thirds expressing strong openness. Patients were generally receptive to NPs performing various clinical tasks, though there was less enthusiasm for NPs’ involvement in medication management and preoperative evaluations. Positive attitudes towards nurses and familiarity with the NP role were significant predictors of patient receptiveness to NP treatment. Conclusion: Patient acceptance of orthopedic NPs varies across different aspects of care. While there is a general willingness to receive care from NPs, these nuanced preferences must be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions of the NP role play crucial roles in shaping patients’ willingness to engage with NPs.

Keywords: orthopedic nurse practitioners, patient receptiveness, perceptions of nursing, clinical tasks

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Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

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This paper proposes a method to optimize the layout of an emergency department (ED) based on real executions of care processes by considering several planning objectives simultaneously. Recently, demand for healthcare services has been dramatically increased. As the demand for healthcare services increases, so do the need for new healthcare buildings as well as the need for redesign and renovating existing ones. The importance of implementation of a standard set of engineering facilities planning and design techniques has been already proved in both manufacturing and service industry with many significant functional efficiencies. However, high complexity of care processes remains a major challenge to apply these methods in healthcare environments. Process mining techniques applied in this study to tackle the problem of complexity and to enhance care process analysis. Process related information such as clinical pathways extracted from the information system of an ED. A 0-1 goal programming approach is then proposed to find a single layout that simultaneously satisfies several goals. The proposed model solved by optimization software CPLEX 12. The solution reached using the proposed method has 42.2% improvement in terms of walking distance of normal patients and 47.6% improvement in walking distance of critical patients at minimum cost of relocation. It has been observed that lots of patients must unnecessarily walk long distances during their visit to the emergency department because of an inefficient design. A carefully designed layout can significantly decrease patient walking distance and related complications.

Keywords: healthcare operation management, goal programming, facility layout problem, process mining, clinical processes

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Authors: Ena Arora, Rong Fan, Aleksandr Fuks, Kolawole Felix Akinnawonu

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Introduction: Leiomyomas are benign tumors that are derived from the overgrowth of uterine smooth muscle cells. Women with symptomatic leiomyomas who desire future fertility, myomectomy should be the standard surgical treatment. Perioperative hemorrhage is a common complication in myomectomy. We performed the study to investigate blood transfusion rate in abdominal myomectomies, risk factors influencing blood loss and modalities to improve perioperative blood loss. Methods: Retrospective chart review was done for patients who underwent myomectomy from 2016 to 2022 at Queens hospital center, New York. We looked at preoperative patient demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Mann-Whitney U test were used for parametric and non-parametric continuous variable comparisons, respectively. Results: A total of 159 myomectomies were performed between 2016 and 2022, including 1 laparoscopic, 65 vaginal and 93 abdominal. 44 patients received blood transfusion during or within 72 hours of abdominal myomectomy. The blood transfusion rate was 47.3%. Blood transfusion rate was found to be twice higher than the average documented rate in literature which is 20%. Risk factors identified were black race, preoperative hematocrit<30%, preoperative blood transfusion within 72 hours, large fibroid burden, prolonged surgical time, and abdominal approach. Conclusion: Preoperative optimization with iron supplements or GnRH agonists is important for patients undergoing myomectomy. Interventions to decrease intra operative blood loss should include cell saver, tourniquet, vasopressin, misoprostol, tranexamic acid and gelatin-thrombin matrix hemostatic sealant.

Keywords: myomectomy, perioperative blood loss, cell saver, tranexamic acid

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Authors: Jeni Stolow, Lina Moses, Carl Kendall

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Zika virus (ZIKV) reemerged as a global threat in 2015 with Brazil at its epicenter. Brazilians have a long history of combatting Aedes aegypti mosquitos as it is a common vector for dengue, chikungunya, and yellow fever. As a response to the epidemic, public health authorities promoted ZIKV prevention behaviors such as mosquito bite prevention, reproductive counseling for women who are pregnant or contemplating pregnancy, pregnancy avoidance, and condom use. Most prevention efforts from Brazil focused on the mosquito vector- utilizing recycled dengue approaches without acknowledging the context in which women were able to adhere to these prevention messages. This study used qualitative methods to explore how women in Fortaleza, Brazil perceive ZIKV, the Brazilian authorities’ ZIKV prevention recommendations, and the feasibility of adhering to these recommendations. A core study aim was to look at how women perceive their physical, social, and natural environment as it impacts women’s ability to adhere to ZIKV prevention behaviors. A Rapid Anthropological Assessment (RAA) containing observations, informational interviews, and semi-structured in-depth interviews were utilized for data collection. The study utilized Grounded Theory as the systematic inductive method of analyzing the data collected. Interviews were conducted with 35 women of reproductive age (15-39 years old), who primarily utilize the public health system. It was found that women’s self-identified economic class was associated with how strongly women felt they could prevent ZIKV. All women interviewed technically belong to the C-class, the middle economic class. Although all members of the same economic class, there was a divide amongst participants as to who perceived themselves as higher C-class versus lower C-class. How women saw their economic status was dictated by how they perceived their physical, social, and natural environment. Women further associated their environment and their economic class to their likelihood of contracting ZIKV, their options for preventing ZIKV, their ability to prevent ZIKV, and their willingness to attempt to prevent ZIKV. Women’s perceived economic status was found to relate to their structural environment (housing quality, sewage, and locations to supplies), social environment (family and peer norms), and natural environment (wetland areas, natural mosquito breeding sites, and cyclical nature of vectors). Findings from this study suggest that women’s perceived environment and economic status impact their perceived feasibility and desire to attempt behaviors to prevent ZIKV. Although ZIKV has depleted from epidemic to endemic status, it is suggested that the virus will return as cyclical outbreaks like that seen with similar arboviruses such as dengue and chikungunya. As the next ZIKV epidemic approaches it is essential to understand how women perceive themselves, their abilities, and their environments to best aid the prevention of ZIKV.

Keywords: Aedes aegypti, environment, prevention, qualitative, zika

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