Search results for: antiracist healthcare policy

Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

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Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman

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Paternalism, in its traditional form, seems largely incompatible with Western medicine. In contrast, Family-Centred Care, a partial response to historically authoritative paternalism, carries its own challenges, particularly when operationalized as family-directed care. Specifically, in neonatology, decision-making is left entirely to Substitute Decision Makers (most commonly parents). Most models of shared decision-making employ both the parents’ and medical team’s perspectives but do not recognize the inherent asymmetry of information and experience – asking parents to act like physicians to evaluate technical data and encourage physicians to refrain from strong medical opinions and proposals. They also do not fully appreciate the difficulties in adjudicating which perspective to prioritize and, moreover, how to mitigate disagreement. Introducing a mild form of paternalism can harness the unique skillset both parents and clinicians bring to shared decision-making and ultimately work towards decision-making in the best interest of the child. The notion expressed here is that within the model of shared decision-making, mild paternalism is prioritized inasmuch as optimal care is prioritized. This mild form of paternalism is known as Beneficent Paternalism and justifies our encouragement for physicians to root down in their own medical expertise to propose treatment plans informed by medical expertise, standards of care, and the parents’ values. This does not mean that we forget that paternalism was historically justified on ‘beneficent’ grounds; however, our recommendation is that a re-integration of mild paternalism is appropriate within our current Western healthcare climate. Through illustrative examples from the NICU, this paper explores the appropriateness and merits of Beneficent Paternalism and ultimately its use in promoting family-centered care, patient’s best interests and reducing moral distress. A distinctive feature of the NICU is the fact that communication regarding a patient’s treatment is exclusively done with substitute decision-makers and not the patient, i.e., the neonate themselves. This leaves the burden of responsibility entirely on substitute decision-makers and the clinical team; the patient in the NICU does not have any prior wishes, values, or beliefs that can guide decision-making on their behalf. Therefore, the wishes, values, and beliefs of the parent become the map upon which clinical proposals are made, giving extra weight to the family’s decision-making responsibility. This leads to why Family Directed Care is common in the NICU, where shared decision-making is mandatory. However, the zone of parental discretion is not as all-encompassing as it is currently considered; there are appropriate times when the clinical team should strongly root down in medical expertise and perhaps take the lead in guiding family decision-making: this is just what it means to adopt Beneficent Paternalism.

Keywords: care, ethics, expertise, NICU, paternalism

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Authors: Briante Barretto, Haley Carreon, Anesha-Maelene Ignacio

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This research paper explores the dynamic process of cultural resilience within the context of the modern tourism of two traditional island communities (Bali, Indonesia and Guam, Micronesia). It asks the question: How do indigenous people hold on to their foundational values that define their culture while moving forward in the modern world? Both Bali and Guam serve as famous destinations for tourists from all over the world, with millions of visitors on an annual basis. Both are continually being shaped in profound ways by the forces of modernity through globalization. And both are demonstrating cultural resilience while striving to find creative ways to sustain, preserve and strengthen their values and traditions within the context of a thriving modern tourist economy. This research paper, drawing on ethnographic methodologies, and in particular participant observation and in-depth interviews, explores the many challenges both communities face and the strategies and approaches they are learning to employ that help promote sustainable tourism while contributing to cultural preservation. Drawing on the insights gained from field work in both island communities, as well as the growing literature in this field study, the paper posits important lessons that can guide and inform indigenous communities that are being drawn into the global tourism market. One powerful idea emerges in the research and one that seems to guide and shape tourism policy both indigenous communities - that this current generation should be thought of as the ancestors of future generations, and thus they have a weighty responsibility to continue to learn and strive to sustain and preserve their cultures and traditions, their natural environments, and spiritual foundations for the future.

Keywords: bali, culture, environment, guam, tourism, values

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Authors: Peter Iyobosa Asemota

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This study on solid waste management practices addressed aspects of environmental and health impacts resulting from poor management of solid waste. The study was occasioned by the observed rate and volume of illegal and indiscriminate dumping of solid waste materials especially in informal settlements. The main focus of this study was to establish the impact of waste management practices on human health and the environment. The study, therefore, presents a critical analysis of the state of solid waste management in the study area and the implications for human health and the environment. The study was carried out in Kayamandi informal settlement within Stellenbosch municipality. The sustainable management of solid waste is very important in order to minimize the environmental and public health risks associated with improper solid waste management. There is no denying the fact that the problems of waste management will become critical as time goes on because of improper and inefficient waste management practices. Towns and cities exhibit the burdens of waste management which is a characteristics feature of most African cities. The study critically assess the implementation of waste management practices by the residents of the informal settlement; identify the factors affecting management issues in the operation of solid waste management system by the municipality; identify factors militating against the implementation of waste management policies and legislation. Furthermore, a waste assessment study was carried out to assess the generation; composition of the waste stream and also determine the attitudes and behavior of the residents with regard to waste management practices. Findings from the study revealed that Kayamandi is not different from other informal settlements with regards to waste management. People are of the opinion that solid waste management is the sole responsibility of municipal authorities and as such, the government should be responsible for bearing the cost of solid waste management.

Keywords: environment, waste, waste composition, waste stream, policy, waste categories, sanitary landfill, waste collection, integrated solid waste management

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Authors: Laid Fekih

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Background: Depression affects people in all communities across the world and in all aspects of their lives. Its spread varies from one country to another, can happen at any age and get rid of it is not easy. There is no clear policy in Algeria's higher education institutions to detect and treat these disorders or pay particular attention to those at risk. Identifying the prevalence of depression among Algerian students, its correlation with different variables, and studying gender differences in the light of a range of variables is necessary to develop an appropriate plan to raise the level of hope and love of life among students. Method: Random samples of 1500 University of Tlemcen students (967 girls and 533 boys), aged 19 to 24 years completed a self-administered questionnaire that included Beck's Depression Inventory ®-II (BDI®-II), (School Health Promotion: The Mood part), Other questions included in this survey focused on demographic characteristics including gender, age and year of study, academic performance (Annual Average Score (0-20) AAS), were examined. Results: The rate of depression (moderate, severe and extreme) varied from 03% to 13% among university students in Tlemcen University. There was no difference in the rates of depression in male and female students, which means that male and female students do have similar rates of depression. The rate of depression in the first-year of the study shows a higher score relative to students of other years. Depression has a negative relationship with academic performance, which means that depressed students have many difficulties in academic tasks at university. Conclusion: Depression among university students is an important center of interest in the world, not only because of the ease with which they can be followed, or the difficulties encountered during their studies and their technical courses but for the link between the level of depression and the quality of care of mental health services, especially if many students with mood and emotional problems don't meet the criteria for psychotherapy.

Keywords: depression, epidemiology, university students, academic performance

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Authors: Andrew Kizito Seruma, Dickson Okello, George Owuor

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Low adoption of food safety practices has serious consequences for smallholder dairy farmers’ productivity, profitability, and market access. Farmers’ low levels of knowledge concerning FSMs coupled with a negative perception of it have greatly influenced compliance with food safety standards. Therefore, it is imperative to understand the drivers that influence dairy farmers’ behaviors to perform safety and hygiene control practices at the farm level. Using data obtained from structured questionnaires completed by 757 smallholder farmers in Central Uganda, we construct a theoretical framework based on the theory of planned behavior and structural equation model to capture the mechanisms behind smallholder dairy farmers’ adoption of SHCP. The findings indicate that there was a positive relationship between perceived behavioral control (β = 0.121, p=0.06) and attitude (β = 0.883, p=0.01) with the adoption of safety and hygiene control practices. However, the relationship between subjective norms and the adoption of safety and hygiene control practices was negative (β = -0.533, p=0.02). It is noteworthy that perceived behavioral control and attitudes play a crucial role in increasing farmers’ adoption of SHCP. The result of this study shows that by fully understanding the merits and demerits of performing safety and hygiene control practices at the farm, smallholder farmers can make better decisions on adopting the SHCP at their farms linked to their cognitive behavior. Based on these findings, future policy interventions to promote SHCP should focus on improving farmers’ perception and attitude toward implementing safety and hygiene control practices through capacity building and providing incentives such as better milk prices through a quality-based buying system.

Keywords: food-safety, hygiene, behavioral, norms, attitude, smallholder, dairy

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Authors: Daniel M. Muntean, Viorel Ungureanu

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More than half of the urban population in Romania lives today in residential buildings made out of large prefabricated reinforced concrete panels. Since their initial design was made in the 1960’s, these housing units are now being technically and morally outdated, consuming large amounts of energy for heating, cooling, ventilation and lighting, while failing to meet the needs of the contemporary life-style. Due to their widespread use, the design of a system that improves their energy efficiency would have a real impact, not only on the energy consumption of the residential sector, but also on the quality of life that it offers. Furthermore, with the transition of today’s existing power grid to a “smart grid”, buildings could become an active element for future electricity networks by contributing in micro-generation and energy storage. One of the most addressed issues today is to find locally adapted strategies that can be applied considering the 20-20-20 EU policy criteria and to offer sustainable and innovative solutions for the cost-optimal energy performance of buildings adapted on the existing local market. This paper presents a possible adaptive design scenario towards sustainable retrofitting of these housing units. The apartments are transformed in order to meet the current living requirements and additional extensions are placed on top of the building, replacing the unused roof space, acting not only as housing units, but as active solar energy collection systems. An adaptive building envelope is ensured in order to achieve overall air-tightness and an elevator system is introduced to facilitate access to the upper levels.

Keywords: adaptive building, energy efficiency, retrofitting, residential buildings, smart grid

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Authors: Fiona Armstrong, David Gaul, Michael Barrett, Lorraine D'Arcy

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Playing is an instinctive and universal human behavior, is a child’s way of learning and an outlet for their innate need of activity. Risky play can be defined as any play that is thrilling or exciting involving the risk of injury. The benefits of risky play have been acknowledged as helping children to explore and conquer fears, develop confidence, reduce anxiety, and develop risk-management skills. Studies indicate that children learn sound judgment by assessing and confronting risks in relation to their own capabilities through exposure to carefully managed play experiences. Risky play has been associated with danger and increased risk of injury, with families focusing on risk aversion and protecting children from the risks inherent in the modern world. Despite children needing cultural, social, emotional, physical, and geographical space to play, the opportunity for children to play is diminishing. Aim: This study explores play behaviors and risky play in an Irish context by investigating parental attitudes to risky play. Methodology: This is a mixed methods study involving the State of Play survey and semi-structured interviews exploring parental attitudes to risky play. Data will be quantitatively analyzed using descriptive and inferential statistics using IBM SPSS and qualitatively analyzed via thematic analysis using NVivo. Conclusion: The information gathered could advise stakeholders regarding the creation and provision of developmentally appropriate, challenging, stimulating, adaptable, accessible, and safe as necessary outdoor play areas. This research can inform parents, planners, architects, and authorities involved in creating environments for play and contribute to policy development.

Keywords: child development, parental attitudes, play opportunities, risky play

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Authors: Rameesha Javaid

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Balochistan, the largest landmass named after and dominated by the 55% Baloch population, which has had a difficult anti-center history like their brothers the Kurds of Middle East, reluctantly acceded to Pakistan in 1947. The region, which attained the status of a province after two decades of accession, has lagged behind in social development and economic growth as compared to the other three federating units. The province has seen the least financial autonomy and administrative decentralization both in autocratic and democratic dispensations under geostrategic and security considerations. Significant corrections have been recently made in the policy framework through changing the formula for intra-provincial National Finance Award, curtailing the number of subjects under federal control, and reactivating the Council of Common Interests. Yet policymaking remains overwhelmingly bureaucratic under a weak parliamentary oversight. The provincial coalition governments are unwieldy and directionless. The government machinery has much less than the optimal capability, character, integrity, will, and opportunity to perform. Decentralization further loses its semblance in the absence of local governments for long intervals and with the hold of hereditary tribal chiefs. Increased allocations failed to make an impact in the highest per capita cost environment due to long distances and scattered settlements. Decentralization, the basic ingredient of federalism has remained mortgaged to geo-strategic factors, internal security perceptions, autocratic and individualistic styles of governments, bureaucratic policymaking structures, bad governance, non-existent local governments, and feudalistic tribal lords. This suboptimal federalism speaks for the present underdevelopment in Balochistan and will earmark the milestones in the future.

Keywords: Balochistan, economic development, federalism, political economy

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Authors: Alhaji M. H. Conteh, Xiangbin Yan, Issa Fofana, Brima Gegbe, Tamba I. Isaac

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Rice grain is Sierra Leone’s staple food and the nation imports over 120,000 metric tons annually due to a shortfall in its cultivation. Thus, the insufficient level of the crop's cultivation in Sierra Leone is caused by many problems and this led to the endlessly widening supply and demand for the crop within the country. Consequently, this has instigated the government to spend huge money on the importation of this grain that would have been otherwise cultivated domestically at a cheaper cost. Hence, this research attempts to explore the response of rice supply with respect to its demand in Sierra Leone within the period 1980-2010. The Nerlovian adjustment model to the Sierra Leone rice data set within the period 1980-2010 was used. The estimated trend equations revealed that time had significant effect on output, productivity (yield) and area (acreage) of rice grain within the period 1980-2010 and this occurred generally at the 1% level of significance. The results showed that, almost the entire growth in output had the tendency to increase in the area cultivated to the crop. The time trend variable that was included for government policy intervention showed an insignificant effect on all the variables considered in this research. Therefore, both the short-run and long-run price response was inelastic since all their values were less than one. From the findings above, immediate actions that will lead to productivity growth in rice cultivation are required. To achieve the above, the responsible agencies should provide extension service schemes to farmers as well as motivating them on the adoption of modern rice varieties and technology in their rice cultivation ventures.

Keywords: Nerlovian adjustment model, price elasticities, Sierra Leone, trend equations

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Authors: Rama Krishna Supramanian, Marzuki Isahak, Noran Naqiah Hairi

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Noise-induced hearing loss (NIHL) is one of the highest recorded occupational diseases, despite being preventable. Hearing Conservation Program (HCP) is designed to protect workers hearing and prevent them from developing hearing impairment due to occupational noise exposures. However, there is still a lack of evidence regarding the effectiveness of this program. The purpose of this study was to determine the effectiveness of a Hearing Conservation Program (HCP) in preventing or reducing audiometric threshold changes among vector control workers. This study adopts a cluster randomized controlled trial study design, with district health offices as the unit of randomization. Nine district health offices were randomly selected and 183 vector control workers were randomized to intervention or control group. The intervention included a safety and health policy, noise exposure assessment, noise control, distribution of appropriate hearing protection devices, training and education program and audiometric testing. The control group only underwent audiometric testing. Audiometric threshold changes observed in the intervention group showed improvement in the hearing threshold level for all frequencies except 500 Hz and 8000 Hz for the left ear. The hearing threshold changes range from 1.4 dB to 5.2 dB with largest improvement at higher frequencies mainly 4000 Hz and 6000 Hz. Meanwhile for the right ear, the mean hearing threshold level remained similar at 4000 Hz and 6000 Hz after 3 months of intervention. The Hearing Conservation Program (HCP) is effective in preserving the hearing of vector control workers involved in fogging activity as well as increasing their knowledge, attitude and practice towards noise-induced hearing loss (NIHL).

Keywords: adult, hearing conservation program, noise-induced hearing loss, vector control worker

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Authors: Bishal Saha, Musah Ahmed Rufai Muhyedeen, Jubeyer Hossain Joy, Muhammad Muhitur Rahman, Mohammad Shahedur Rahman, Md Arif Hasan, Syed Masiur Rahman

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Greenhouse gas (GHG) emission is one of the critical problems of today’s world. Many countries have been taking many short- and long-term plans to reduce climate change mitigation. However, the potential of behavioral changes in addressing this problem is promising, as reported by many researchers. This paper presents a comprehensive literature review that focuses on ways to influence people’s behavior in their homes, workplace, and transportation to mitigate the emission directly or indirectly. This study will investigate different theories pertinent to planned behavior and the key elements for modifying behavior like biophilia, reinforcement to use optimum energy and recyclable products, proper application of greenhouse tax, modern technology, and sustainable design adaptation, transportation sharing, social and community norms, proper education and information, and financial incentives. There is a number of challenges associated with behavioral changes. Behavioral interventions have different actions varied by their type and need to combine various policy tools and great social marketing. Many interventions can reduce GHG emissions without any compromise with household well-being. This study will develop a landscape of prevailing theories of environmental psychology by identifying and reviewing the key themes and findings of this field of study. It will support especially the developing countries to reduce GHG emissions without significant capital investment. It is also expected that the behavioral changes will lead to the successful adoption of climate-friendly policies easily. This study will also generate new research questions and directions.

Keywords: behavioral changes, climate change mitigation, environmental psychology, greenhouse gas emission

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Authors: Susana Gonçalves, Joana Lencart, Anabela Gregório Dias

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Introduction: In combination with chemotherapy, Total Body Irradiation (TBI) is most used as part of the conditioning regimen prior to allogeneic hematopoietic stem cell transplantation. Conventional TBI techniques have a long application time but non-conformality of beam-application with the inability to individually spare organs at risk. Our institution’s intention is to start using Volumetric Modulated Arc Therapy (VMAT) techniques to increase homogeneity of delivered radiation. As a first approach, a dosimetric plan was performed on a computed tomography (CT) scan of a Rando Alderson antropomorfic phantom (head and torso), using a set of six arcs distributed along the phantom. However, a full body anthropomorphic phantom is essential to carry out technique validation and implementation. Our aim is to define the physical and chemical characteristics and the ideal manufacturing procedure of upper and lower limbs to our anthropomorphic phantom, for later validate TBI using VMAT. Materials and Methods: To study the better fit between our phantom and limbs, a CT scan of Rando Alderson anthropomorphic phantom was acquired. CT was performed on GE Healthcare equipment (model Optima CT580 W), with slice thickness of 2.5 mm. This CT was also used to access the electronic density of soft tissue and bone through Hounsfield units (HU) analysis. Results: CT images were analyzed and measures were made for the ideal upper and lower limbs. Upper limbs should be build under the following measures: 43cm length and 7cm diameter (next to the shoulder section). Lower limbs should be build under the following measures: 79cm length and 16.5cm diameter (next to the thigh section). As expected, soft tissue and bone have very different electronic density. This is important to choose and analyze different materials to better represent soft tissue and bone characteristics. The approximate HU values of the soft tissue and for bone shall be 35HU and 250HU, respectively. Conclusion: At the moment, several compounds are being developed based on different types of resins and additives in order to be able to control and mimic the various constituent densities of the tissues. Concurrently, several manufacturing techniques are being explored to make it possible to produce the upper and lower limbs in a simple and non-expensive way, in order to finally carry out a systematic and appropriate study of the total body irradiation. This preliminary study was a good starting point to demonstrate the feasibility of TBI with VMAT.

Keywords: TBI, VMAT, anthropomorphic phantom, tissue equivalent materials

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Authors: Olamide Shittu, Olayinka Akanle

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Value Chain Analysis is a common method of examining the stages involved in the production of a product, mostly agricultural produce, from the input to the consumption stage including the actors involved in each stage. However, the Functional Institutional Analysis is the most common method in literature employed to analyze the value chain of products. Apart from studying the relatively neglected phenomenon of recycled polymer products in Lagos Metropolis, this paper adopted the use of social network analysis to attempt a grounded theory of the nature of social network that exists among the value chain actors of the subject matter. The study adopted a grounded theory approach by conducting in-depth interviews, administering questionnaires and conducting observations among the identified value chain actors of recycled polymer products in Lagos Metropolis, Nigeria. The thematic analysis of the collected data gave the researchers the needed background to formulate a truly representative network of the social relationships among the value chain actors of recycled polymer products in Lagos Metropolis. The paper introduced concepts such as Transient and Perennial Social Ties to explain the observed social relations among the actors. Some actors have more social capital than others as a result of the structural holes that exist in their triad network. Households and resource recoverers are at disadvantaged position in the network as they have high constraints in their relationships with other actors. The study attempted to provide a new perspective in the study of the environmental value chain by analyzing the network of actors to bring about policy action points and improve recycling in Nigeria. Government and social entrepreneurs can exploit the structural holes that exist in the network for the socio-economic and sustainable development of the state.

Keywords: recycled polymer products, social network analysis, social ties, value chain analysis

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Authors: Kenneth Nhundu, Leocadia Zhou, Farhad Aghdasi, Voster Muchenje

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Climate change poses increased risks to rural communities that rely on natural resources, such as forests, cropland and rangeland, waterways, and open spaces Because of their connection to the land and the potential for climate change to impact natural resources and disrupt ecosystems and seasons, rural livelihoods and well-being are disproportionately vulnerable to climate change. Climate change has the potential to affect the environment in a number of ways that place increased stress on everyone, but disproportionately on the most vulnerable populations, including the young, the old, those with chronic illness, and the poor. The communities in the study area are predominantly rural, resource-based and are generally surrounded by public or private lands that are dominated by natural resources, including forests, rangelands, and agriculture. The livelihoods of these communities are tied to natural resources. Therefore, targeted strategies to cope will be required. This paper assessed the household socio-economic characteristics and their implications to household vulnerability to climate change impacts in the rural Eastern Cape Province, South Africa. The results indicate that the rural communities are climate-vulnerable populations as they have a large proportion of people who are less economically or physically capable of adapting to climate change. The study therefore recommends that at each level, the needs, knowledge, and voices of vulnerable populations, including indigenous peoples and resource-based communities, deserve consideration and incorporation so that climate change policy (1) ensures that all people are supported and able to act, (2) provides as robust a strategy as possible to address a rapidly changing environment, and (3) enhances equity and justice.

Keywords: climate change, vulnerable, socio-economic, livelihoods

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Authors: Zhaozhang Sun

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Health communication is essential in promoting healthy lifestyles, preventing unhealthy behaviours, managing disease conditions, and eventually reducing health disparities. Nowadays, social media provides unprecedented opportunities for enhancing health communication for both healthcare providers and people with health conditions, including self-management of chronic conditions such as diabetes. Meanwhile, a special group of active social media users have started playing a pivotal role in providing health ‘solutions’. Such individuals are often referred to as ‘influencers’ because of their ‘central’ position in the online communication system and the persuasive effect their actions and advice may have on audiences' health-related knowledge, attitudes, confidence and behaviours. Work on social media influencers (SMIs) has gained much attention in a specific research field of “influencer marketing”, which mainly focuses on emphasising the use of SMIs to promote or endorse brands’ products and services in the business. Yet to date, a lack of well-studied and empirical evidence has been conducted to guide the exploration of health-related social media influencers. The failure to investigate health-related SMIs can significantly limit the effectiveness of communicating health on social media. Therefore, this article presents a study to identify key diabetes-related SMIs in the UK and the potential implications of information provided by identified social media influencers on their audiences’ diabetes-related knowledge, attitudes and behaviours to bridge the research gap that exists in linking work on influencers in marketing to health communication. The multidisciplinary theories and methods in social media, communication, marketing and diabetes have been adopted, seeking to provide a more practical and promising approach to investigate the potential of social media influencers in health communication. Twitter was chosen as the social media platform to initially identify health influencers and the Twitter API academic was used to extract all the qualitative data. Health-related Influencer Identification Model was developed based on social network analysis, analytic hierarchy process and other screening criteria. Meanwhile, a two-section English-version online questionnaire has been developed to explore the potential implications of social media influencers’ (SMI’s) diabetes-related narratives on the health-related knowledge, attitudes and behaviours (KAB) of their audience. The paper is organised as follows: first, the theoretical and research background of health communication and social media influencers was discussed. Second, the methodology was described by illustrating the model for the identification of health-related SMIs and the development process of the SMIKAB instrument, followed by the results and discussions. The limitations and contributions of this study were highlighted in the summary.

Keywords: health communication, Interdisciplinary research, social media influencers, diabetes management

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Authors: Ilona Pavlovska, Aneka Klavina, Agris Auce, Ivars Vanadzins, Alise Silova, Laura Komarovska, Linda Paegle, Baiba Silamikele, Linda Dobkevica

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Freshwater sapropel is a common material formed by complex biological transformations of Holocene sediments in the water basement of the lakes in Latvia that has the potential to be used as medical mud. Sapropel forms over a long period in shallow waters by slowly decomposing organic sediment and has different compositions depending on the location of the source, surroundings, the water regime, etc. Official geological survey of Latvia lakes, from Latvian lake database (ezeri.lv), used in the selection of the area of the exploration. The multifunctional effect of sapropel on the whole organism explained by its complex chemical and biological structure. This unique, organic substance and its ability to maintain heat for a long time ensures deep tissue warming and has a positive effect on the treatment of various joint and skin diseases. Sapropel is a valuable resource with multiple areas of application. Investigation of sapropel sediments and survey of the five sites selected according to the criteria performed in the current study. Also, our study includes sampling at different depths and their initial treatment, evaluation of external signs, and study of physical-chemical parameters, as well as analysis of biochemical parameters and evaluation of microbiological indicators. The main selection criteria were sapropel deposits depth, hydrological regime, the history of agriculture next to the lake, and the potential exposure to industrial waste. One hundred and five sapropel samples obtained from five lakes (Audzelu, Dunakla, Ivusku, Zielu, and Mazars Kivdalova) during the wintertime. The main goal of the study is to carry out detailed and systematic research on the medical properties of sapropel to be obtained in Latvia, to promote its scientifically based use in balneology, to develop new medical procedures and services, and to promote the development of new exportable products. Latvian freshwater sapropel could be used as raw material for getting sapropel extract and use it as a remedy. All mentioned above brings us to the main question for sapropel usage in medicine, balneology, and pharmacy “how to develop quality criteria for raw sapropel and its extracts. The research was co-financed by the project "Analysis of characteristics of medical sapropel and its usage for medical purposes and elaboration of industrial extraction methods" No.1.1.1.1/16/A/165.

Keywords: balneology, extracts, freshwater sapropel, Latvian lakes, medical mud, sapropel

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Authors: Vitus Onyebuchim Onyemailu, Olive Obianuju Okalibe

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The study tried to examine relationship between exchange rate variations on the balance of payments in Nigeria from 1970 to 2012. Using time series on econometric measures such as Granger causality and ordinary least square (OLS), the study found that exchange rate movements especially the depreciation of naira has not contributed significantly on the balance of payments under the year of the study. The granger result conform the Marshall-Lerner short and long run prepositions that exchange rate devaluation enhances balance of payments. On disaggregation exchange rate granger causes current and capital account balances give the Nigeria data from 1970 to 2012. Overall in the long run OLS regression analysis, exchange rate on semi log functional form, exchange rate variation did not record significant effect on balance of payment equation. This height was also maintained in the current or trade balance which does not match the Marshall-Lerner. The capital account balance in reverse reported a significant impact of exchange rate variability on the capital account balance. Finally, on exchange rate determination equation, where many fundamentals were considered including lagged of exchange rate. Thus, the lagged of exchange rate recorded a positive and significant influence on the present exchange rate. This means that players in the financial markets usually out plays authority’s policy’s stances through their speculative tendencies. The work therefore, recommend that effort should be made by the authorities to providing enabling environment for production of goods and services to triumph in order to take advantages of steady devaluation of its currency. This is done by providing infrastructure, provision of science and technology. Thus, when this is done Nigeria would be able to have competitive power against the rest of the world.

Keywords: exchange rate variation, balance of payments, current account, capital account, Marshall-Lerner hypothesis

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Authors: Brock Liden, Eric Janowitz

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Introduction: Diabetic peripheral neuropathy (DPN) affects 70% of individuals with diabetes1. DPN causes a loss of protective sensation, which can lead to tissue damage and diabetic foot ulcer (DFU) formation2. These ulcers can result in infections and lower-extremity amputations of toes, the entire foot, and the lower leg. Even after a DFU is healed, recurrence is common, with 49% of DFU patients developing another ulcer within a year and 68% within 5 years3. This case series examines the use of sensory insoles and newly available plantar data (pressure, temperature, step count, adherence) and remote patient monitoring in patients at risk of DFU. Methods: Participants were provided with custom-made sensory insoles to monitor plantar pressure, temperature, step count, and daily use and were provided with real-time cues for pressure offloading as they went about their daily activities. The sensory insoles were used to track subject compliance, ulceration, and response to feedback from real-time alerts. Patients were remotely monitored by a qualified healthcare professional and were contacted when areas of concern were seen and provided coaching on reducing risk factors and overall support to improve foot health. Results: Of the 40 participants provided with the sensory insole system, 4 presented with a DFU. Based on flags generated from the available plantar data, patients were contacted by the remote monitor to address potential concerns. A standard clinical escalation protocol detailed when and how concerns should be escalated to the provider by the remote monitor. Upon escalation to the provider, patients were brought into the clinic as needed, allowing for any issues to be addressed before more serious complications might arise. Conclusion: This case series explores the use of innovative sensory technology to collect plantar data (pressure, temperature, step count, and adherence) for DFU detection and early intervention. The results from this case series suggest the importance of sensory technology and remote patient monitoring in providing proactive, preventative care for patients at risk of DFU. This robust plantar data, with the addition of remote patient monitoring, allow for patients to be seen in the clinic when concerns arise, giving providers the opportunity to intervene early and prevent more serious complications, such as wounds, from occurring.

Keywords: diabetic foot ulcer, DFU prevention, digital therapeutics, remote patient monitoring

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Authors: Anjali Kanagali, Astha Sinha

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Climate change is the greatest threat being faced by mankind in the 21st century. It no longer is merely an environmental, scientific or economic issue but is a humanitarian issue as well. Paris Agreement put great pressure on the businesses to reduce carbon emissions and mitigate the impact of climate change. However, the already increased climate variability and extreme weather are aggravating emergency humanitarian needs. According to the Intergovernmental Panel on Climate Change (IPCC), if efficient policy changes are not made in time to combat the climate change issues, the situation will deteriorate with an estimated global temperature rise of 4 degrees. The existing international network of Humanitarian system is not adequately structured to handle the projected natural disasters and climate change crisis. The 2030 Agenda which embraces the 17 Sustainable Development Goals (SGDs) discussed the relationship between the climate change and humanitarian assistance. The Humanitarian law aims to protect, amongst other things, ‘internally displaced persons’ which includes people displaced due to natural hazard related disasters engulfing the hazards of climate change. ‘Legal protection’ of displaced people to protect their rights is becoming a pressing need in such times. In this paper, attempts will be made to analyze the causes of the displacement, identify areas where the effect of the climate change is most likely to occur and to examine the character of forced displacement triggering population movement. We shall discuss the pressure on the Humanitarian system and assistance due to climate change issues and the need for vesting powers to the local communities or local government players to deal with the climate changes. We shall also discuss the possibility of setting up a new framework where non-state actors could be set up for climate change impact and its governance.

Keywords: humanitarian assistance to climate change, humanitarian crisis, internally displaced person, legal framework for climate migrants, non-state actors

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Authors: Satendra Pal Singh, Dalip Kr. Kakru, Jyoti Mishra, Rajesh Thakur, Tarana Sarwat

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COVID-19 is still an intrigue as far as morbidity or mortality is concerned. The rate of recovery varies from person to person, & it depends upon the accessibility of the healthcare system and the roles played by the physicians and caregivers. It is envisaged that with the passage of time, people would become immune to this virus, and those who are vulnerable would sustain themselves with the help of vaccines. The proposed study deals with the severeness of COVID-19 is associated with some specific biomarkers linked to correlate age and gender. We will be assessing the overall homeostasis of the persons who were affected by the coronavirus infection and also of those who recovered from it. Some people show more severe effects, while others show very mild symptoms, however, they show low CT values. Thus far, it is unclear why the new strain of Covid has different effects on different people in terms of age, gender, and ABO blood typing. According to data, the fatality rate with heart disease was 10.5 percent, 7.3 percent were diabetic, and 6 percent who are already infected from other comorbidities. However, some COVID-19 cases are worse than others & it is not fully explainable as of date. Overall data show that the ABO blood group is effective or prone to the risk of SARS-COV2 infection, while another study also shows the phenotypic effects of the blood group related to covid. It is an accepted fact that females have more strong immune systems than males, which may be related to the fact that females have two ‘X’ chromosomes, which might contain a more effective immunity booster gene on the X chromosome, and are capable to protect the female. Also specific sex hormones also induce a better immune response in a specific gender. This calls for in-depth analysis to be able to gain insight into this dilemma. COVID-19 is still not fully characterized, and thus we are not very familiar with its biology, mode of infection, susceptibility, and overall viral load in the human body. How many virus particles are needed to infect a person? How, then, comorbidity contribute to coronavirus infection? Since the emergence of this virus in 2020, a large number of papers have been published, and seemingly, vaccines have been prepared. But still, a large number of questions remain unanswered. The proneness of humans for infection by covid-19 needs to be established to be able to develop a better strategy to fight this virus. Our study will be on the Impact of demography on the Severity of covid-19 infection & at the same time, will look into gender-specific sensitivity of Covid-19 and the Operational variation of different biochemical markers in Covid-19 positive patients. Besides, we will be studying the co-relation, if any, of COVID severity & ABO Blood group type and the occurrence of the most common blood group type amongst positive patience.

Keywords: coronavirus, ABO blood group, age, gender

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Authors: Hamad Albadr

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With the growth that has occurred in the orientation of universities from liability cognitive and maintain the culture of the community to liability functional creating graduates to work according to the needs of the community development; representing the university in today's world, the prime mover of the wheel of development in the community and find appropriate solutions to the problems they are facing and adapt to the demands of the changing environment. This paper deals with the role of Saudi universities as institutions, government agencies, non-governmental organizations and the extent of its responsibility to the environmental awareness of the community members in various segments, where it will use the research methodology descriptive and analytical, to gather information, data and analysis answers the study sample consisting of 1500 people from the staff of the Saudi universities: The members of the faculty, and members of the administrative and technical bodies, and current students, 500 of them are responsible for employment in the labor sector and graduates. Where will review the paper to identify the extent to which the objectives of the academic programs in Saudi universities to the needs of the community, and the extent to which the course content submitted to the characteristics of the local environment for the community and how he benefited them to ensure its conformity with the changing needs of society, and how to address the research presented in academic programs to the needs of society and its problems , and the extent to which graduate students to deal enough of social responsibility and commitment to community service and the preservation of the environment, and the availability of a clear policy to serve the community with the academic programs, and how to encourage faculty, staff and students to participate in community service. And the availability of counseling services for school students for vocational guidance, scientific, environmental, and the contribution of Academic Programs publishes scientific and technical culture and the environmental community members.

Keywords: universities in Saudi Arabia, environmental awareness, academic programs, environmental community

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Authors: Arshad Hussain

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Background: Sukh Initiative is a multi-donor funded, family planning and reproductive health project, primed by Aman Healthcare Services; implemented through a consortium of local and international organizations, in a selected one million underserved peri-urban population of Karachi, Sindh; which aims at increasing modern contraceptive prevalence rate by 15 percentage point. Objective: To empower women to access contraception by increasing knowledge, improving quality of services and expanding the basket of choices; contributing to the goals of FP2020. Methods: A five years project has a multi-pronged approach with door to door services by LHWs and CHWs in an LHWs covered population and provision of quality FP/RH services both at public and private health care facilities. The project engages youth (12-16 years) both with community and at secondary schools to mentor them for responsible adulthood with life skilled base initiative. A 24/7 availability of youth and FP helpline service provides counselling, referrals in addition with a follow-up mechanism. Results: 131,810 MWRAs were reached by 191 community health workers through 29,693 of community support group meetings and 166,775 house hold visits. These MWRAs were counselled on FP related myths and misconception and referred to 216 providers trained for quality family planning services and maintaining average 64% quality scores in 43 public health and 35 private facilities in the project area. Of those referred 26% MWRAs opted modern contraception with 17.56% in LARCs and 41% PPFP as compared to baseline. Aman TeleHealth is linked with 24/7 counselling, referrals and post services follow-ups to clients, showing 14% proportion of FP call volume. Sukh has a unique role in engaging all partners on youth SRHR issues through family life education sessions, 30 higher sec. schools in Sukh area have been provided LSBE to 16,000 students (aged 15-17), and in community approximately 10, 496 girls and boys have received SRHR information. Conclusion: Through individual counselling, access to quality family planning services and involvement of stakeholders, Suk created an enabling environment to rapid increase in family planning in the project intervention area.

Keywords: family planning and reproductive health, married women with reproductive age, urban squatter, Pakistan

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Authors: Fall Abdourahmane, Lazrak Meryem, El Hsaini Houda, El Ammari Laila, Gamih Hasnae, Yahyane Abdelhakim, Benjouad Abdelaziz, Aguenaou Hassan, El Kari Khalid

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Introduction: The double burden of malnutrition (DBM), defined by the concurrent occurrence of undernutrition and overnutrition, represents a critical public health issue, particularly in low- and middle-income countries. In Morocco, 61.3% of women of reproductive age (WRA) are classified as overweight or obese, with 30.4% meeting the criteria for obesity. Furthermore, 34.4% of WRA are affected by anaemia, and 49.7% present with iron deficiency anaemia. Objective: The objective of this study is to assess the individual-level prevalence of the double burden of malnutrition (DBM) among Moroccan WRA, focusing on the simultaneous presence of iron deficiency anaemia and overweight/obesity. Methods: A national cross-sectional survey was carried out on a representative sample of 2090 Moroccan WRA. The data collected encompassed blood samples, anthropometric measurements and socio-economic factors. Haemoglobin levels were assessed using a Hemocue device, while ferritin and CRP levels were determined through immunoturbidimetric analysis. Results: The prevalence of overweight/obesity among WRA in Morocco was 60.2%, iron deficiency affected 30.6%, anaemia was found in 34.4%, and 50.0% had iron deficiency anaemia. The coexistence of overweight/obesity with anaemia was observed in 19.2% and with iron deficiency in 16.3%. Among overweight/obese women, 32.5% were anaemic, 28.4% had iron deficiency, and 47.6% had iron deficiency anaemia. The prevalence of DBM was higher in urban areas compared to rural settings. Conclusion: The DBM among women of WRA showed an emergent reality of the interconnection and the coexistence at individual level of the undernutrition and the overnutrition. Therefore, effective and dual actions that could simultaneously address the double dimension of the DBM have to be implemented for the policy solutions to be successful.

Keywords: the double burden of malnutrition, iron deficiency anemia, overweight, obesity

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Authors: Madre Paarlber, Alwiena Blignaut

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Background: Medication administration errors remains a global patient safety problem targeted by the WHO (World Health Organization), yet research on this matter is sparce within the South African context. Objective: The aim was to explore and describe nurses’ (medication administrators) perceptions regarding medication administration safety-related culture, incidence, causes, and reporting in the Gauteng Province of South Africa, and to determine any relationships between perceived variables concerned with medication safety (safety culture, incidences, causes, reporting of incidences, and reasons for non-reporting). Method: A quantitative research design was used through which self-administered online surveys were sent to 768 nurses (medication administrators) (n=217). The response rate was 28.26%. The survey instrument was synthesised from the Agency of Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture, the Registered Nurse Forecasting (RN4CAST) survey, a survey list prepared from a systematic review aimed at generating a comprehensive list of medication administration error causes and the Medication Administration Error Reporting Survey from Wakefield. Exploratory and confirmatory factor analyses were used to determine the validity and reliability of the survey. Descriptive and inferential statistical data analysis were used to analyse quantitative data. Relationships and correlations were identified between items, subscales and biographic data by using Spearmans’ Rank correlations, T-Tests and ANOVAs (Analysis of Variance). Nurses reported on their perceptions of medication administration safety-related culture, incidence, causes, and reporting in the Gauteng Province. Results: Units’ teamwork deemed satisfactory, punitive responses to errors accentuated. “Crisis mode” working, concerns regarding mistake recording and long working hours disclosed as impacting patient safety. Overall medication safety graded mostly positively. Work overload, high patient-nurse ratios, and inadequate staffing implicated as error-inducing. Medication administration errors were reported regularly. Fear and administrative response to errors effected non-report. Non-report of errors’ reasons was affected by non-punitive safety culture. Conclusions: Medication administration safety improvement is contingent on fostering a non-punitive safety culture within units. Anonymous medication error reporting systems and auditing nurses’ workload are recommended in the quest of improved medication safety within Gauteng Province private hospitals.

Keywords: incidence, medication administration errors, medication safety, reporting, safety culture

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Authors: Kelechi E. Ezeji

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The inclusion of relevant content in curricula of architecture schools is vital for attainment of Computer Aided Design (CAD) proficiency by graduates. Implementing this content involves, among other variables, the presence of competent tutors. Consequently, this study sought to investigate the importance of personnel recruitment for inclusion of content vital to the implementation of CAD in the curriculum for architecture education. This was with a view to developing a framework for appropriate implementation of CAD curriculum. It was focused on departments of architecture in universities in south-east Nigeria which have been accredited by National Universities Commission. Survey research design was employed. Data were obtained from sources within the study area using questionnaires, personal interviews, physical observation/enumeration and examination of institutional documents. A multi-stage stratified random sampling method was adopted. The first stage of stratification involved random sampling by balloting of the departments. The second stage involved obtaining respondents’ population from the number of staff and students of sample population. Chi Square analysis tool for nominal variables and Pearson’s product moment correlation test for interval variables were used for data analysis. With ρ < 0.5, the study found significant correlation between the number of CAD literate academic staff and use of CAD in design studio/assignments; that increase in the overall number of teaching staff significantly affected total CAD credit units in the curriculum of the department. The implications of these findings were that for successful implementation leading to attainment of CAD proficiency to occur, CAD-literacy should be a factor in the recruitment of staff and a policy of in-house training should be pursued.

Keywords: computer-aided design, education, personnel recruitment, curriculum

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Authors: Amna I. Shibeika, Batoul Y. Hittini, Tasneem B. Abd Bakri

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Regulation and integration of public policy, economy, insurance industry, education, and construction stakeholders are the main contributors to achieve sustainable development. Building environmental assessment methods were introduced in the field to address issues such as global warming and conservation of natural resources. In the UAE, Estidama framework with its associated Pearl Building Rating System (PBRS) has been introduced in 2010 to address and spread sustainability practices within the country’s fast-growing built environment. Based on literature review of relevant studies investigating different project characteristics that influence sustainability outcomes, this paper presents a conceptual framework for understanding the adoption of PBRS in UAE projects. The framework also draws on Diffusion of Innovations theory to address the questions of how the assessment method is chosen in the first place and what is the impact of PBRS on the multi-disciplinary design and construction processes. The study highlights the mandatory nature of the adoption of PBRS for government buildings as well as imbedding Estidama principles within Abu Dhabi building codes as key factors for raising awareness about sustainable practices. Moreover, several project-related elements are addressed to understand their relationship with the adoption process, including project team collaboration; communication and coordination; levels of commitment and engagement; and the involvement of key actors as sustainability champions. This conceptualization of the adoption of PBRS in UAE projects contributes to the growing literature on the adoption of energy assessment tools and addresses the UAE vision is to be at the forefront of innovative sustainable development by 2021.

Keywords: adoption, building assessment, design management, innovation, sustainability

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Authors: Sedigheh Abbasnasab Sardareh

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The current study investigates ESL teachers' voices in order to formulate further research on the effectiveness of the SBOA practices. It is an attempt to find out (1) what are ESL experienced teachers’ perceptions, experiences, attitudes, and beliefs of SBOA; (2) what teaching and learning aspects of SBOA needs focus to enhance its effectiveness; (3) external issues related to the implementation of SBOA; (4) internal issues related to the implementation of SBOA; and also (5) perceived recommendations on SBOA. The study utilized focus group discussion sessions. 9 experienced ESL (5 females and 4 males) teachers were selected based on the consent letters sent to them. These teachers had over 20 years experience in both traditional and SBOA-type assessment and the train-the-trainer experts recommended by the Ministry of Education. Respondents were guided with open-ended questions to extracts their perceived experiences implementing SBOA guided structurally by the author as the moderator. Data were first discussed with the respondents for further clarifications and then only analyzed and re-confirmed with some recommendations before the final presentation of this preliminary results were presented here. The focus group discussions yielded some important perceived views on the SBOA implementation. Some of the themes were discussed and some recommendations were proposed for further in-depth study by the Ministry of Education. Some of the future directions based on the results were also put forward. Some external and internal variables were important in order for successful implementation of SBOA. Mere implementing a policy should be taken into consideration because this might impede some of the teaching and learning processes both by the classroom stakeholders such as teachers and student. More research methods such as the use of questionnaires could be utilized to further investigate to large populations of teacher educators in Malaysia.

Keywords: school based oral assessment, Malaysia, ESL, focus group discussion

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Authors: Jaeyoung Lee, Minji Je

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Objectives: The adolescents not attending school are named out-of-school adolescents. They are more vulnerable to health management and are likely to be exposed to a number of risk factors. This study was conducted to investigate the problem behavior of out-of-school adolescents and analyze the difference caused by gender. Methods: In this study, the problem behaviors of out-of-school adolescents, the vulnerable class, were defined in 8 types and based on this definition, the survey on run away from home, drop out, prostitution, violence, internet game addiction, theft, drug addiction, and smoking was conducted. The study was conducted in a total of 507 out-of-school adolescents, including 342 males, and 165 females. The type, frequency and start time of the 8 problem behaviors were identified. The collected data were analyzed with chi-square test and t-test using SPSS statistics 22. Results: Among the problem behaviors of the subjects, violence ( =17.41, p < .001), internet game addiction ( =16.14, p < .001), theft ( =22.48, p < .001), drug addiction ( =4.17, p=.041), and smoking ( =3.90, p=.048) were more significantly high in male out-of-school adolescents than female out-of-school adolescents. In addition, the frequency of the problem behavior was higher in male out-of-school adolescents with statistical significance than in female out-of-school adolescents (t=5.08, p= < .001). In terms of the start time of the problem behavior, only internet game addiction was higher in male out-of-school adolescents with the statistical significance than in female out-of-school adolescents ( =6.22, p=.032). No statistically significant difference was found in other problem behaviors (p > .05). Conclusions: In this study, it was found that gender difference in problem behaviors of out-of-school adolescents exists, and its frequency and difference of types were identified. When the social countermeasures were provided for those adolescents, a distinguished approach is required depending on the patterns of problem behavior and gender. When preparing policy alternatives and interventions for out-of-school adolescents, it is required to reflect the results of this study.

Keywords: addictive behavior, adolescent, gender, problem behavior

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Authors: Monjur E-Khoda Tarafdar

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Institutional autonomy and academic freedom corresponding to accountability are seen as a core concept of university governance. Universities are crucial factors in search of truth for knowledge production and dissemination. Academic leaders are the pivots to progressively influence the university governance. Therefore, in a continuum of debate about autonomy and accountability in the aspect of perception, academic leadership has been studied. Having longstanding acquaintance in the field the researcher has been instrumental to gain lived experiences of the informants in this qualitative study. Case studies are useful to gain an understanding of the complexities of a particular site to preserve a sense of wholeness of the site being investigated. Thus, multiple case study approach has been employed with a sample size of seventy-one. Such large size of informants was interviewed in order to capture a wider range of views that exist in Bangladesh. This qualitative multiple case study has engaged in-depth interviewing method of academic leaders and policy makers of three case universities. Open-ended semi-structured questionnaires are used to have a comprehensive understanding of how the perception of autonomy and accountability of academic leaders has impacted university governance in the context of Bangladesh. The paper has interpreted the voices of the informants and distinguished both the transformational and transactional style of academic leaderships in local university settings against the globally changed higher education demography. The study finds contextual dissimilarity in the perspectives of autonomy and accountability of academic leadership towards university governance. Unaccountability results in losing autonomous power and collapsing academic excellence. Since accountability grows competitiveness and competence, the paper also focuses on how academic leaders abuse the premise of academic loyalty to universities.

Keywords: academic loyalty, accountability, autonomy, leadership, perception, university governance

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