Search results for: healthcare ethical implications 

Authors: Natina Roberts, Hanhee Lee

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The existing and emerging refugee research reports unfavorable resettlement outcomes in multiple domains. The proposed paper highlights trends in refugee research in which empirical studies investigate resettlement of former refugees from individual and culturally homogeneous perspectives. The proposed paper then aims to examine the reality of the lived experience of resettlement from family and cross-cultural viewpoints. Proponents for this focus include the United Nations High Commissioner for Refugees (UNHCR). The UNHCR is responsible for leading resettlement efforts for refugees through the durable solutions of repatriation, local integration and resettlement. Life experiences with refugee families, and a report of literary findings on former refugee resettlement from various cultural backgrounds – that highlight similarities and differences among various ethnic groups, will be discussed. The proposed paper is expected to frame underrepresented refugee perspectives, and review policy implications in healthcare, education, and public support systems.

Keywords: refugee, cross-cultural, families, resettlement policy

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Authors: Pedro M. Abreu, Bruno R. Mendes

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

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

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Authors: Sisira Edirippulige

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

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

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Authors: Mohammad Al-Mousawi

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

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

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Authors: John Pomerat, Aviv Segev

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

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

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Authors: Mahshid TalebianKiakalayeh

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As AI technologies can be used by both civilians and soldiers, it is vital to consider the consequences emanating from AI military as well as civilian use. Indeed, many of the same technologies can have a dual-use. This paper will explore the military uses of AI and assess its compliance with international legal norms. AI developments not only have changed the capacity of the military to conduct complex operations but have also increased legal concerns. The existence of a potential legal vacuum in legal principles on the military use of AI indicates the necessity of more study on compliance with International Humanitarian Law (IHL), the branch of international law which governs the conduct of hostilities. While capabilities of new means of military AI continue to advance at incredible rates, this body of law is seeking to limit the methods of warfare protecting civilian persons who are not participating in an armed conflict. Implementing AI in the military realm would result in potential issues, including ethical and legal challenges. For instance, when intelligence can perform any warfare task without any human involvement, a range of humanitarian debates will be raised as to whether this technology might distinguish between military and civilian targets or not. This is mainly because AI in fully military systems would not seem to carry legal and ethical judgment, which can interfere with IHL principles. The paper will take, as a case study, Canada’s compliance with IHL in the area of AI and the related legal issues that are likely to arise as this country continues to develop military uses of AI.

Keywords: artificial intelligence, military use, international humanitarian law, the Canadian perspective

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

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

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

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Authors: Venkatesan Sundaramoorthy

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The field of ceramics has undergone a remarkable transformation with the advent of additive manufacturing technologies. This comprehensive review explores the mechanical properties of additively manufactured ceramic components, focusing on key materials such as Alumina, Zirconia, and Silicon Carbide. The study delves into various authors' review technology into the various additive manufacturing techniques, including Stereolithography, Powder Bed Fusion, and Binder Jetting, highlighting their advantages and challenges. It provides a detailed analysis of the mechanical properties of these ceramics, offering insights into their hardness, strength, fracture toughness, and thermal conductivity. Factors affecting mechanical properties, such as microstructure and post-processing, are thoroughly examined. Recent advancements and future directions in 3D-printed ceramics are discussed, showcasing the potential for further optimization and innovation. This review underscores the profound implications of additive manufacturing for ceramics in industries such as aerospace, healthcare, and electronics, ushering in a new era of engineering and design possibilities for ceramic components.

Keywords: mechanical properties, additive manufacturing, ceramic materials, PBF

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Authors: Judith Partouche-Sebban, Saeedeh Rezaee Vessal

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Because of the rising number of new cases of cancer, especially among women, it is more than essential to better understand how women experience cancer in order to bring them adapted to support and care and enhance their well-being and patient experience. Cancer stands for a traumatic experience in which the diagnosis, its medical treatments, and the related side effects lead to deep physical and psychological changes that may arouse considerable stress and anxiety. In order to reduce these negative emotions, women tend to use various defense mechanisms, among which denial has been defined as the most frequent mechanism used by breast cancer patients. This study aims to better understand the consequences of the experience of cancer and their link with the adoption of a denial strategy. The empirical research was done among female cancer survivors in France. Since the topic of this study is relatively unexplored, a qualitative methodology and open-ended interviews were employed. In total, 25 semi-directive interviews were conducted with a female with different cancers, different stages of treatment, and different ages. A systematic inductive method was performed to analyze data. The content analysis enabled to highlight three different denial-related behaviors among women with cancer, which serve a self-protective function. First, women who expressed high levels of anxiety confessed they tended to completely deny the existence of their cancer immediately after the diagnosis of their illness. These women mainly exhibit many fears and a deep distrust toward the medical context and professionals. This coping mechanism is defined by the patient as being unconscious. Second, other women deliberately decided to deny partial information about their cancer, whether this information is related to the stages of the illness, the emotional consequences, or the behavioral consequences of the illness. These women use this strategy as a way to avoid the reality of the illness and its impact on the different aspects of their life as if cancer does not exist. Third, some women tend to reinterpret and give meaning to their cancer as a way to reduce its impact on their life. To this end, they may use magical thinking or positive reframing, or reinterpretation. Because denial may lead to delays in medical treatments, this topic deserves a deep investigation, especially in the context of oncology. As denial is defined as a specific defense mechanism, this study contributes to the existing literature in service marketing which focuses on emotions and emotional regulation in healthcare services which is a crucial issue. Moreover, this study has several managerial implications for healthcare professionals who interact with patients in order to implement better care and support for the patients.

Keywords: cancer, coping mechanisms, denial, healthcare services

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Authors: Jaishree Ellis

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

Keywords: health equity, inclusion, healthcare disparities, education

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Authors: Bliss Singhal

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Epilepsy is a prevalent neurological disorder affecting approximately 50 million individuals worldwide and 1.2 million Americans. There exist millions of pediatric patients with intractable epilepsy, a condition in which seizures fail to come under control. The occurrence of seizures can result in physical injury, disorientation, unconsciousness, and additional symptoms that could impede children's ability to participate in everyday tasks. Predicting seizures can help parents and healthcare providers take precautions, prevent risky situations, and mentally prepare children to minimize anxiety and nervousness associated with the uncertainty of a seizure. This research proposes a comprehensive framework to predict seizures in pediatric patients by evaluating machine learning algorithms on unimodal neuroimaging data consisting of electroencephalogram signals. The bandpass filtering and independent component analysis proved to be effective in reducing the noise and artifacts from the dataset. Various machine learning algorithms’ performance is evaluated on important metrics such as accuracy, precision, specificity, sensitivity, F1 score and MCC. The results show that the deep learning algorithms are more successful in predicting seizures than logistic Regression, and k nearest neighbors. The recurrent neural network (RNN) gave the highest precision and F1 Score, long short-term memory (LSTM) outperformed RNN in accuracy and convolutional neural network (CNN) resulted in the highest Specificity. This research has significant implications for healthcare providers in proactively managing seizure occurrence in pediatric patients, potentially transforming clinical practices, and improving pediatric care.

Keywords: intractable epilepsy, seizure, deep learning, prediction, electroencephalogram channels

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Authors: Maariyah Irfan

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

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

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Authors: Maiya Smith, Tyler Thorne

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

Keywords: distance learning, Pacific, Palau, telehealth

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

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

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

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Authors: M. D. Antoine

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Despite the widespread use of complementary and alternative medicine (CAM) for autistic children, little is known about the communication flow between the different parties involved in autism care (e.g., parents/caregivers, conventional providers, alternative practitioners). This study aimed to describe how communication occurs through the first year following an autism spectrum disorder (ASD) diagnosis to identify challenges and potential barriers to communication within the healthcare system in Ottawa, Canada. From an ecological perspective, we collected qualitative data through 12 semi-structured interviews with six parents/caregivers, three conventional providers (e.g., family doctor, neurodevelopmental pediatrician, psychologist), and three alternative practitioners (e.g., naturopath, occupational therapist, speech and language pathologist) operating in Ottawa. We interpreted the data using thematic analysis. Findings revealed communication challenges between the parents/caregivers and conventional providers while they experience better communication flow with fewer challenges in alternative care settings. However, parents/caregivers are the only links between the health professionals of both streams. From the five contexts examined: organizational, interpersonal, media, cultural, and political-legal, we found four themes (provider knowledge, care integration, flexible care, and time constraints) underlining specific barriers to communication flow between the parties involved in the care of autistic children. The increasing interest in alternative medicine is forcing changes in the healthcare system. Communications occur outside the norms making openings for better communication and information-sharing increasingly essential. Within the identified themes in the current study, the necessity for better communication between all parties involved in the care of autistic children is evident. More ASD and CAM-related training for providers would support effective parent/caregiver-provider communication. The findings of the current study contribute to a better understanding of the role of communication in the care management of autism, which has implications for effective autism care.

Keywords: alternative medicine, autism care management, autism spectrum disorder, conventional medicine, parent-provider communication

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Authors: Abdelmenen Abobghala, Mahmud Ahmed, Mohamed Alwaheshi, Anwar Fanan, Meftah Mehdawi, Ahmed Abuhatira

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This research aims to predict academic performance and identify weak points in students to aid teachers in understanding their learning needs. Both quantitative and qualitative methods are used to identify difficult test items and the factors causing difficulties. The study uses interventions like focus group discussions, interviews, and action plans developed by the students themselves. The research questions explore the predictability of final grades based on mock exams and assignments, the student's response to action plans, and the impact on learning performance. Ethical considerations are followed, respecting student privacy and maintaining anonymity. The research aims to enhance student engagement, motivation, and responsibility for learning.

Keywords: prediction, academic performance, weak points, understanding, learning, quantitative methods, qualitative methods, formative assessments, feedback, emotional responses, intervention, focus group discussion, interview, action plan, student engagement, motivation, responsibility, ethical considerations

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Authors: Joan Casas-Roma

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Technology has become one of the main channels through which people engage in most of their everyday activities; from working to learning, or even when socializing, technology often acts as both an enabler and a mediator of such activities. Moreover, the affordances and interactions created by those technological tools determine the way in which the users interact with one another, as well as how they relate to the relevant environment, thus favoring certain kinds of actions and behaviors while discouraging others. In this regard, virtue ethics theories place a strong focus on a person's daily practice (understood as their decisions, actions, and behaviors) as the means to develop and enhance their habits and ethical competences --such as their awareness and sensitivity towards certain ethically-desirable principles. Under this understanding of ethics, this set of technologically-enabled affordances and interactions can be seen as the possibility space where the daily practice of their users takes place in a wide plethora of contexts and situations. At this point, the following question pops into mind: could these affordances and interactions be shaped in a way that would promote behaviors and habits basedonethically-desirable principles into their users? In the field of game design, the MDA framework (which stands for Mechanics, Dynamics, Aesthetics) explores how the interactions enabled within the possibility space of a game can lead to creating certain experiences and provoking specific reactions to the players. In this sense, these interactions can be shaped in ways thatcreate experiences to raise the players' awareness and sensitivity towards certain topics or principles. This research brings together the notions of technological affordances, the notions of practice and practical wisdom from virtue ethics, and the MDA framework from game design in order to explore how the possibility space created by technological interactions can be shaped in ways that enable and promote actions and behaviors supporting certain ethically-desirable principles. When shaped accordingly, interactions supporting certain ethically-desirable principlescould allow their users to carry out the kind of practice that, according to virtue ethics theories, provides the grounds to develop and enhance their awareness, sensitivity, and ethical reasoning capabilities. Moreover, and because ethical practice can happen collaterally in almost every context, decision, and action, this additional layer could potentially be applied in a wide variety of technological tools, contexts, and functionalities. This work explores the theoretical background, as well as the initial considerations and steps that would be needed in order to harness the potential ethically-desirable benefits that technology can bring, once it is understood as the space where most of their users' daily practice takes place.

Keywords: ethics, design methodology, human-computer interaction, philosophy of technology

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Authors: Raman Sharma, Ashok Kumar, Vipin Koushal

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

Keywords: healthcare, fires, smoke, management, strategies

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Authors: Norah Salem Al Mosa

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This paper critically examines the ethical position of academic scholarship concerning "women in leadership" in Saudi Arabia, focusing on the context of the Saudi Vision 2030 initiative. While this vision places a strong emphasis on empowering women and increasing their presence in the workforce, women still face significant cultural, organisational, and personal barriers to leadership roles. The existing literature highlights the challenges Saudi women encounter, including the male guardianship system, and international perspectives add complexity to the issue. The debate among scholars about considering cultural context versus highlighting ongoing challenges is explored. The paper underscores that despite efforts to enhance women's representation in leadership positions, progress has been slow due to cultural norms, the absence of legal quotas, and limited access to education and professional development. It raises questions about the seriousness of research efforts and the government's commitment to gender equality in leadership roles, emphasising the need for increased academic scrutiny in this area. Ultimately, the paper aims to enhance understanding of the challenges and opportunities for women in leadership roles, their contributions to corporate governance in Saudi Arabia, and potential implications beyond its borders.

Keywords: female directors, gender diversity, women on executive positions, Saudi vision 2030

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Authors: Zeynep Sener, Mehtap Dursun

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

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

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Authors: Sachiko Hosoya

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Objectives: The purpose of this paper is to investigate the social policy of preventive genetic medicine in Iran, by following the legalization process of abortion law and the factors affecting the process in wider Iranian contexts. In this paper, ethical discussions of prenatal diagnosis and selective abortion in Iran will be presented, by exploring Iranian social policy to control genetic diseases, especially a genetic hemoglobin disorder called Thalassemia. The ethical dilemmas in application of genetic medicine into social policy will be focused. Method: In order to examine the role of the policy for prevention of genetic diseases and selective abortion in Iran, various resources have been sutudied, not only academic articles, but also discussion in the Parliament and documents related to a court case, as well as ethnographic data on living situation of Thalassemia patients. Results: Firstly, the discussion on prenatal diagnosis and selective abortion is overviewed from the viewpoints of ethics, disability rights activists, and public policy for lower-resources countries. As a result, it should be noted that the point more important in the discussion on prenatal diagnosis and selective abortion in Iran is the allocation of medical resources. Secondly, the process of implementation of national thalassemia screening program and legalization of ‘Therapeutic Abortion Law’ is analyzed, through scrutinizing documents such as the Majlis record, government documents and related laws and regulations. Although some western academics accuse that Iranian policy of selective abortion seems to be akin to eugenic public policy, Iranian government carefully avoid to distortions of the policy as ‘eugenic’. Thirdly, as a comparative example, discussions on an Iranian court case of patient’s ‘right not to be born’ will be introduced. Along with that, restrictive living environments of people with Thalassemia patients and the carriers are depicted, to understand some disabling social factors for people with genetic diseases in the local contexts of Iran.

Keywords: abortion, Iran, prenatal diagnosis, public health ethics, Thalassemia prevention program

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Authors: Kevser Cakmak, Adrián Montesano, Lourdes Artigas, Marta Salla, Clara Mateu

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The main objective of this research is to explore the relational letter writing technique as an intervention in couple therapy for reconnecting couples with their values and ethical preferences. This is a recently developed therapeutic tool within the framework of Narrative Therapy that consists of two interviews and a letter writing task, in which a meta-conversation between the relationship itself, the couple members, and the therapists is fostered. Although this specific therapeutic technique can be used within the therapy process, in this case study, it is used as a brief stand-alone narrative intervention for a middle age heterosexual couple breast cancer survivor. Couple’s relational and personal wellbeing was monitored before, during, and after the intervention by means of the dyadic adjustment and the clinical outcomes in routine evaluation-outcome measure, respectively. The couple showed a significant improvement after the intervention in both levels. The content of the letter writing exercises was qualitatively analysed to explore the reconstruction of their ethical values. Results from both methods are integrated in order to get an in-depth perspective of the newly developed tool. The potential of the letter writing technique as stand-alone and as adjunct brief intervention is discussed.

Keywords: couple therapy, narrative therapy, psychotherapy tool, relational letter writing

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Authors: Saori Fujimoto, Hiromi Kawasaki, Mari Murakami, Yoko Ueno

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Background: Coronavirus disease (COVID-19) has been spreading throughout the world. In Japan, many nursing universities have conducted online clinical practices to secure students’ learning opportunities. In the field of women’s health nursing, even after the pandemic ended, it will be worthwhile to utilize online practice in declining birthrate and reducing the burden of mothers. This study examined the learning effects of conducting online visits for mothers with infants during the COVID-19 pandemic by nursing students to enhance the students’ ability to carry out the online practice even in ordinary times effectively. Methods: Students were divided into groups of three, and information on the mothers was assessed, and the visits were planned. After role-play was conducted by the students and teachers, an online visit was conducted. The analysis target was the self-evaluation score of nine students who conducted online visits in June 2020 and had consented to participate. The evaluation contents included three items for assessment, two items for planning, one item for ethical consideration, five items for nursing practice, and two items for evaluation. The self-evaluation score ranged from 4 (‘Can do with a little advice’) to 1 (‘Can’t do with a little advice’). A univariate statistical analysis was performed. This study was approved by the Ethical Committee for Epidemiology of Hiroshima University. Results: The items with the highest mean (standard deviation) scores were ‘advocates for the dignity and the rights of mothers’ (3.89 (0.31)) and ‘communication behavior needed to create a trusting relationship’ (3.89 (0.31)).’ Next were the ‘individual nursing practice tailored to mothers (3.78 (0.42))’ and ‘review own practice and work on own task (3.78 (0.42)).’ The mean (standard deviation) of the items by type were as follows: three assessment items, 3.26 (0.70), two planning items, 3.11 (0.49), one ethical consideration item, 3.89 (0.31), five nursing practice items, 3.56 (0.54), and two evaluation items, 3.67 (0.47). Conclusion: The highest self-evaluations were for ‘advocates for the dignity and the rights of mothers’ and ‘communication behavior needed to create a trusting relationship.’ These findings suggest that the students were able to form good relationships with the mothers by improving their ability to effectively communicate and by presenting a positive attitude, even when conducting health visits online. However, the self-evaluation scores for assessment and planning were lower than those of ethical consideration, nursing practice, and evaluation. This was most likely due to a lack of opportunities and time to gather information and the need to modify and add plans in a short amount of time during one online visit. It is necessary to further consider the methods used in conducting online visits from the following viewpoints: methods of gathering information and the ability to make changes through multiple visits.

Keywords: infants, learning effects, mothers, online visit practice

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Authors: Lin Shang Neng

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Due to rapid changes in the societal environment, career development and planning have become increasingly crucial, leading more individuals to seek the assistance of career consultations. However, the training process for career consultants often emphasizes the application of assessment tools and guidance in job-seeking behavior. The abilities of case conceptualization and consulting skills require further in-service supervision. This study aims to inquire about the supervised experiences of employment specialists at the Employment Service Center of the Taiwan Ministry of Labor or career consultants who held private clinics for at least three years. The research participants were continuously supervised by the Adlerian approach twice a month for at least one year, helping them integrate the whole picture of the client through Lifestyle Assessment (the qualitative way, specific diagnosis) and other Adlerian assessment tools (the quantitative way, general diagnosis.) The supervisor was familiar with Adlerian Psychology and certified by the North American Society of Adlerian Psychology. The research method involves semi-structured interviews and qualitative analysis. For the ethical considerations, the participants were invited to interview after the supervision sessions finished. The findings of this research were discussed with possible implications, like how they applied Adlerian Psychology to their career consultations, especially to case conceptualizations and consulting skills. Recommendations for further research and training for career consultants are also discussed.

Keywords: supervision, Adlerian psychology, case conceptualization, career consultant

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Authors: Miral Sabry AlAshry

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The main objective of the study is to investigate the effectiveness of Egyptian Journalists through the Anti-Cyber and Information Technology Crimes Law, as well as its implications for journalistic practice and the implications for press freedom in Egypt. Questionnaires were undertaken with 192 journalists representing four official newspapers, and in-depth interviews were held with 15 journalists. The study used an Authoritarian theory as a theoretical framework. The study revealed that the government placed restrictions on journalists by using the law to oppress them.

Keywords: anti-cyber and information technology crimes law, media legislation, personal information, Egyptian constitution

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

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

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

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Authors: Etta Conteh, Tracy Macintosh

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

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

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

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

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

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Authors: Yasmin Nanabhay

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The paper scrutinizes the literature on accountability and non-accountability, and then presents an analysis of a South African case which demonstrated consequences of a lack of accountability. Ethical conduct displayed by members of the public sector is integral to creating a sustainable democratic government, which upholds the constitutional tenets of accountability, transparency and professional ethicality. Furthermore, a true constitutional democracy emphasises and advocates the notion of service leadership that nurtures public participation and engages with citizens in a positive manner. Ethical conduct and accountability in the public sector earns public trust; hence these are key principles in good governance. Yet, in the years since the advent of democracy in South Africa, the government has been plagued by rampant corruption and mal-administration by public officials and politicians in leadership positions. The control measures passed by government in an attempt to ensure ethicality and accountability within the public sector include codes of ethics, rules of conduct and the enactment of legislation. These are intended to shape the mindset of members of the public sector, with the ultimate aim of an efficient, effective, ethical, responsive and accountable public service. The purpose of the paper is to analyse control systems and accountability within the public sector and to present reasons for non-accountability by means of a selected case study. The selected case study is the corruption trial of Jackie Selebi, who served as National Commissioner of the South African Police Service but was dismissed from the post. The reasons for non-accountability in the public sector as well as recommendations based on the findings to enhance accountability will be undertaken. The case study demonstrates the experience and impact of corruption and/or mal-administration, as a result of a lack of accountability, which has contributed to the increasing loss of confidence in political leadership in the country as elsewhere in the world. The literature is applied to the erstwhile National Commissioner of the South African Police Service and President of Interpol, as a case study of non-accountability.

Keywords: corruption, internal control, maladministration, non-compliance, oversight mechanisms, public accountability, public sector

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Authors: Sulaiman D. Al Sabei, Amy M. Ross, Christopher S. Lee

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Nurse leaders play a fundamental role in transforming healthcare system and improving quality of patient care. Several healthcare organizations have called to increase the number of nurse leaders across all levels and in every practice setting. Identification of factors influencing nurses’ willingness to lead can inform healthcare leaders and policy makers of potentially illuminating strategies for establishing favorable work environments that motivate nurses to engage in leadership roles. The aim of this study was to investigate determinants of nurses’ willingness to engage in future leadership roles. The study was conducted at a public hospital in the Sultanate of Oman. A total of 171 registered nurses participated. A multilevel modeling was conducted. Findings revealed that 80% of nurses were likely to seek out opportunities to engage in leadership roles. The quality of the nurse-physician collegial relationships was a significant predictor of nurses’ willingness to lead. Establishing a work environment’s culture of positive nurse-physician relationships is critical to enhance nurses’ work attitude and engage them in leadership roles.

Keywords: interprofessional relationship, leadership, motivation, nurses

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