Search results for: healthcare regulations

Authors: Ibragim Issabekov, Byron Crape, Lyazzat Toleubekova

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Background: Palliative care substantially improves the quality of life of terminally-ill patients. Symptom control is one of the keystones in the management of patients in palliative care settings, lowering distress as well as improving the quality of life of patients with end-stage diseases. The most common symptoms causing significant distress for patients are pain, nausea and vomiting, increased respiratory secretions and mental health issues like depression. Aims are: 1. to identify best practices in symptom management in palliative patients in accordance with internationally approved guidelines and compare aforementioned with actual practices in Kazakhstan; to evaluate the criteria for assessing symptoms in terminally-ill patients, 2. to review the availability and utilization of pharmaceutical agents for pain control, management of excessive respiratory secretions, nausea, and vomiting, and delirium and 3. to develop recommendations for the systematic approach to end-of-life symptom management in Kazakhstan. Methods: The use of qualitative research methods together with systematic literature review have been employed to provide a rigorous research process to evaluate current approaches for symptom management of palliative patients in Kazakhstan. Qualitative methods include in-depth semi-structured interviews of the healthcare professionals involved in palliative care provision. Results: Obstacles were found in appropriate provision of palliative care. Inadequate education and training to manage severe symptoms, poorly defined laws and regulations for palliative care provision, and a lack of algorithms and guidelines for care were major barriers in the effective provision of palliative care. Conclusion: Assessment of palliative care in this medium-income transitional-economy country is one of the first steps in the initiation of integration of palliative care into the existing health system. Achieving this requires identifying obstacles and resolving these issues.

Keywords: end-of-life care, middle income country, palliative care, symptom control

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Authors: Zineb Taidirt, Fathia Sebahi, Mohamed Karim Guarchani, Anissa Berkane, Noureddine Smail, Ouahiba Hadjoudj

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Cardiovascular diseases are one of the most important causes of death in Algeria. Several risk factors are responsible for this, including the consumption of foods containing saturated fat and trans fatty acids TFAs. This brief presents the results of a descriptive study of the lipid composition of 251 food products marketed in Algeria. The objective of the study is to describe the nature and composition of lipids and to verify the compliance of saturated and trans fatty acids intakes with the regulations. The study is based on data from the nutrition labelling of marketed food products. The results showed that the lipids in foodstuffs are diverse in nature and of varying amounts, but their nature is not specified on all products. In addition, the required content of saturated fatty acids is mentioned only in 29.48% of the products; 21.62% of them do not comply with the standard. Hydrogenation of fats, which produced Trans fatty acids, is common: 19.92% of products contain hydrogenated fats, and 74.89% may contain them according to the aspect of the lipid (solid fat). However, the trans fatty acid content is only mentioned in 5.18% of the products. The latter is above the limits set by Algerian regulations in 50% of the butter samples studied. The composition of lipids in mono- and polyunsaturated fatty acids essential for the body is insufficient: only 13.94% of the products inform their contents on their labels. It is necessary to adopt mandatory restriction of trans fatty acids, to ban the use of partially-hydrogenated oils, and to require required mandatory labeling of the TFAs and the other fatty acids on packaged foods, and to conduct more studies in order to appreciate the intake of TFAs and saturated fat and appreciate their effects on the Algerian population and to get more informed about the composition of the lipid in packaged foods.

Keywords: cardiovascular diseases, lipids, nutrition labelling, lipids, trans fatty acids

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Authors: Briony Gray, Glenn Simpson, Hajira Dambha-Miller, Andrew Farmer

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Multimorbidity may be strongly affected by a variety of conditions, factors, and variables requiring higher demands on health and social care services, infrastructure, and expenses. Holding one or more conditions increases one’s risk for development of future conditions; with patients over 65 years old at highest risk. Psychosocial factors such as anxiety and depression are rising exponentially globally, which has been amplified by the COVID19 pandemic. These are highly correlated and predict poorer outcomes when held in coexistence and increase the likelihood of comorbid physical health conditions. While possible future reform of social and healthcare systems may help to alleviate some of these mounting pressures, there remains an urgent need to better understand the potential role health behaviours and psychosocial conditions - such as anxiety and depression – may have on aging populations. Using the UK healthcare scene as a lens for analysis, this study uses big data collected in the UK Longitudinal Study of Aging (ELSA) to examine the role of anxiety and depression in ageing populations (65yrs+). Using logistic regression modelling, results identify the 10 most significant variables correlated with both anxiety and depression from data categorised into the areas of health behaviour, psychosocial, socioeconomic, and life satisfaction (each demonstrated through literature review to be of significance). These are compared with wider global research findings with the aim of better understanding the areas in which social and healthcare reform can support multimorbidity interventions, making suggestions for improved patient-centred care. Scope of future research is outlined, which includes analysis of 59 total multimorbidity variables from the ELSA dataset, going beyond anxiety and depression.

Keywords: multimorbidity, health behaviours, patient centred care, psychosocial factors

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Authors: Samira Eskandari

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The image of Tehran has been impacted in recent years due to poor urban management and fragmented governance. There is no cohesive urban beautification framework in Tehran to enforce builders take aesthetic factors seriously when design and construct new buildings. The existing guidelines merely provide people with recommendations, not regulations. Obviously, Tehran needs a more comprehensive and strict urban beautification framework to restore its image. The damaged image has impacted the city’s social, economic and environmental growth. This research aims to find and examine a solution by which the employment of urban beautification regulation would be guaranteed, and city image would be organized. The methodology is based on a qualitative approach associated with analytical methods, in-depth surveys and interviews with Tehran citizens, authorities and experts, and use of academic resources as well as simulation. As a result, one practical solution is to incorporate aesthetic guidelines into a survival-related framework like a seismic guideline. Tehran is a seismic site, and all the buildings in Tehran have to be retrofitted against earthquake during construction. Hence, by integrating seismic regulations and aesthetic disciplines, urban beautification will be somehow guaranteed. Besides, the seismic image can turn into Tehran’s brand and enhances city identity. This research is trying to increase the social, environmental, and economic interconnectedness between urban planning and seismic planning by the usage of landscape architecture methods. As a case study, the potential outcomes are simulated in Tajrish, a suburb located in the north of Tehran. The result is that, by the redefinition of the morphology of seismic retrofitting systems, used in the significant city image elements, and re-function them in accordance with the Iranian culture and traditions, the city image would become more harmonized and legible.

Keywords: earthquake, retrofitting systems, Tehran image, urban beautification

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Authors: Elena Sherstoboeva, Elena Karzanova

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This paper explores the impact of the annexation of Crimea on the regulation of live performances and tour management of Russian pop music performers in Ukraine and of Ukrainian performers in Russia. Without a doubt, the cultural relationship between Russia and Ukraine is not limited to this issue. Yet concert markets tend to respond particularly rapidly to political, economic, and social changes, especially in Russia and Ukraine, where the high level of digital piracy means that the music businesses mainly depend upon income from performances rather than from digital rights sales. This paper argues that the rules formed in both countries after Russia’s annexation of Crimea in 2014 have contributed to the separation of a single cultural space that had existed in Soviet and Post-Soviet Russia and Ukraine before the annexation. These rules have also facilitated performers’ self-censorship and increased the politicisation of the music businesses in the two neighbouring countries. This study applies a comparative socio-legal approach to study Russian and Ukrainian live events and tour regulation. A qualitative analysis of Russian and Ukrainian national and intergovernmental legal frameworks is applied to examine formal regulations. Soviet and early post-Soviet laws and policies are also studied, but only to the extent that they help to track the changes in the Russian–Ukrainian cultural relationship. To identify and analyse the current informal rules, the study design includes in-depth semi-structured interviews with 30 live event or tour managers working in Russia and Ukraine. A case study is used to examine how the Eurovision Song Contest, an annual international competition, has played out within the Russian–Ukrainian conflict. The study suggests that modern Russian and Ukrainian frameworks for live events and tours have developed Soviet regulatory traditions when cultural policies served as a means of ideological control. At the same time, contemporary regulations mark a considerable perspective shift, as the previous rules have been aimed at maintaining close cultural connections between the Russian and Ukrainian nations. Instead of collaboration, their current frameworks mostly serve as forms of repression, implying that performers must choose only one national market in which to work. The regulatory instruments vary and often impose limitations that typically exist in non-democratic regimes to restrict foreign journalism, such as visa barriers or bans on entry. The more unexpected finding is that, in comparison with Russian law, Ukrainian regulations have created more obstacles to the organisation of live tours and performances by Russian artists in Ukraine. Yet this stems from commercial rather than political factors. This study predicts that the more economic challenges the Russian or Ukrainian music businesses face, the harsher the regulations will be regarding the organisation of live events or tours in the other country. This study recommends that international human rights organisations and non-governmental organisations develop and promote specific standards for artistic rights and freedoms, given the negative effects of the increasing politicisation of the entertainment business and cultural spheres to freedom of expression and cultural rights and pluralism.

Keywords: annexation of Crimea, artistic freedom, censorship, cultural policy

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Authors: Ashana Gupta

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Aim: In the UK, Botulinum Toxin (botox) is authorised for treating chronic myofascial pain secondary to masseter muscle hypertrophy (Fedorowicz et al. 2013). This audit aimed to ensure the Maxillofacial Unit is meeting the trust guidelines for the safe storage and disposal of botox. Method: The trust upholds a strict policy for botox handling. The audit was designed to optimise several elements including Staff awareness of regulations around botox handling A questionnaire was designed to test knowledge of advised storage temperatures, reporting of adverse events, disposal procedures and regulatory authorities. Steps taken to safely delivertoxin and eliminate unused toxin. A checklist was completed. These include marks for storagetemperature, identification checks, disposal of sharps, deactivation of toxin, and disposal. Results: All staff correctly stated storage requirements for toxin. 75% staff (n=8) were unsure about reporting and regulations. Whilst all staff knew how to dispose of vials, 0% staff showed awareness for the crucial step of deactivating toxin. All checklists (n=20) scored 100% for adequate storage, ID checks, and toxin disposal. However, there were no steps taken to deactivate toxin in any cases. Staff training took place with revision to clinical protocols. In line with Trust guidelines, an additional clinical step has been introduced including use of 0.5% sodium hypochlorite to deactivate botox. Conclusion: Deactivation is crucial to ensure residual toxin is not misused. There are cases of stolen botox within South-Tees Hospital (Woodcock, 2014). This audit was successful in increasing compliance to safe handling and disposal of botox by 100% and ensured our hospitalmeets Trust guidance.

Keywords: botulinum toxin, aesthetics, handling, disposal

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Authors: Rinat Gabbay-Benziv, Merav Ben-Natan, Ariel Roguin, Benyamine Abbou, Anna Ofir, Adi Klein, Dikla Dahan-Shriki, Mordechai Hallak, Boris Kessel, Mickey Dudkiewicz

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Introduction: Over recent decades, technology has become integral to healthcare, with electronic health records and advanced medical equipment now standard. However, this reliance has made healthcare systems increasingly vulnerable to ransomware attacks. On October 13, 2021, Hillel Yaffe Medical Center experienced a severe ransomware attack that disrupted all IT systems, including electronic health records, laboratory services, and staff communications. The attack, carried out by the group DeepBlueMagic, utilized advanced encryption to lock the hospital's systems and demanded a ransom. This incident caused significant operational and patient care challenges, particularly impacting the obstetrics department. Objective: The objective is to describe the challenges facing the obstetric division following a cyberattack and discuss ways of preparing for and overcoming another one. Methods: A retrospective descriptive study was conducted in a mid-sized medical center. Division activities, including the number of deliveries, cesarean sections, emergency room visits, admissions, maternal-fetal medicine department occupancy, and ambulatory encounters, from 2 weeks before the attack to 8 weeks following it (a total of 11 weeks), were compared with the retrospective period in 2019 (pre-COVID-19). In addition, we present the challenges and adaptation measures taken at the division and hospital levels leading up to the resumption of full division activity. Results: On the day of the cyberattack, critical decisions were made. The media announced the event, calling on patients not to come to our hospital. Also, all elective activities other than cesarean deliveries were stopped. The number of deliveries, admissions, and both emergency room and ambulatory clinic visits decreased by 5%–10% overall for 11 weeks, reflecting the decrease in division activity. Nevertheless, in all stations, there were sufficient activities and adaptation measures to ensure patient safety, decision-making, and workflow of patients were accounted for. Conclusions: The risk of ransomware cyberattacks is growing. Healthcare systems at all levels should recognize this threat and have protocols for dealing with them once they occur.

Keywords: ransomware attack, healthcare cybersecurity, obstetrics challenges, IT system disruption

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Authors: R. Gautam, P. Sastha Kanagasabai, G. N. Rathna

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The proposed healthcare system enables quadriplegic patients, people with severe motor disabilities to send commands to electronic devices and monitor their vitals. The growth of Brain-Computer-Interface (BCI) has led to rapid development in 'assistive systems' for the disabled called 'assistive domotics'. Brain-Computer-Interface is capable of reading the brainwaves of an individual and analyse it to obtain some meaningful data. This processed data can be used to assist people having speech disorders and sometimes people with limited locomotion to communicate. In this Project, Emotiv EPOC Headset is used to obtain the electroencephalogram (EEG). The obtained data is processed to communicate pre-defined commands over the internet to the desired mobile phone user. Other Vital Information like the heartbeat, blood pressure, ECG and body temperature are monitored and uploaded to the server. Data analytics enables physicians to scan databases for a specific illness. The Data is processed in Intel Edison, system on chip (SoC). Patient metrics are displayed via Intel IoT Analytics cloud service.

Keywords: brain computer interface, Intel Edison, Emotiv EPOC, IoT analytics, electroencephalogram

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Authors: Bhavishya Ramchandani

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A little electronic device that is worn on the finger is called a smart ring. It incorporates mobile technology and has features that make it simple to use the device. These gadgets, which resemble conventional rings and are usually made to fit on the finger, are outfitted with features including access management, gesture control, mobile payment processing, and activity tracking. A poor sleep pattern, an irregular schedule, and bad eating habits are all part of the problems with health that a lot of people today are facing. Diets lacking fruits, vegetables, legumes, nuts, and whole grains are common. Individuals in India also experience metabolic issues. In the medical field, smart rings will help patients with problems relating to stomach illnesses and the incapacity to consume meals that are tailored to their bodies' needs. The smart ring tracks all bodily functions, including blood sugar and glucose levels, and presents the information instantly. Based on this data, the ring generates what the body will find to be perfect insights and a workable site layout. In addition, we conducted focus groups and individual interviews as part of our core approach and discussed the difficulties they're having maintaining the right diet, as well as whether or not the smart ring will be beneficial to them. However, everyone was very enthusiastic about and supportive of the concept of using smart rings in healthcare, and they believed that these rings may assist them in maintaining their health and having a well-balanced diet plan. This response came from the primary data, and also working on the Emerging Technology Canvas Analysis of smart rings in healthcare has led to a significant improvement in our understanding of the technology's application in the medical field. It is believed that there will be a growing demand for smart health care as people become more conscious of their health. The majority of individuals will finally utilize this ring after three to four years when demand for it will have increased. Their daily lives will be significantly impacted by it.

Keywords: smart ring, healthcare, electronic wearable, emerging technology

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Authors: Terryann Clark, Kabir Dasgupta, Sonia Lewycka, Gail Pacheco, Alexander Plum

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This paper focused on two main research aims using data from the Growing Up in New Zealand (GUINZ) birth cohort: 1. To examine ethnic differences in life-course trajectories in the use and experience of healthcare services in early childhood years (namely immunisation, dental checks and use of General Practitioners (GPs)) 2. To quantify the contribution of relevant explanatory factors to ethnic differences. Current policy in New Zealand indicates there should be, in terms of associated direct costs, equitable access by ethnicity for healthcare services. However, empirical evidence points to persistent ethnic gaps in several domains. For example, the data highlighted that Māori have the lowest immunisation rates, across a number of time points in early childhood – despite having a higher antenatal intention to immunise relative to NZ European. Further to that, NZ European are much more likely to have their first-choice lead maternity caregiver (LMC) and use child dental services compared to all ethnicities. Method: This research explored the underlying mechanisms behind ethnic differences in the use and experience of child healthcare services. First, a multivariate regression analysis was used to adjust raw ethnic gaps in child health care utilisation by relevant covariates. This included a range of factors, encompassing mobility, socio-economic status, mother and child characteristics, household characteristics and other social aspects. Second, a decomposition analysis was used to assess the proportion of each ethnic gap that can be explained, as well as the main drivers behind the explained component. The analysis for both econometric approaches was repeated for each data time point available, which included antenatal, 9 months, 2 years and 4 years post-birth. Results: The following findings emerged: There is consistent evidence that Asian and Pacific peoples have a higher likelihood of child immunisation relative to NZ Europeans and Māori. This was evident at all time points except one. Pacific peoples had a lower rate relative to NZ European for receiving all first-year immunisations on time. For a number of potential individual and household predictors of healthcare service utilisation, the association is time-variant across early childhood. For example, socio-economic status appears highly relevant for timely immunisations in a child’s first year, but is then insignificant for the 15 month immunisations and those at age 4. Social factors play a key role. This included discouragement or encouragement regarding child immunisation. When broken down by source, discouragement by family has the largest marginal effect, followed by health professionals; whereas for encouragement, medical professionals have the largest positive influence. Perceived ethnically motivated discrimination by a health professional was significant with respect to both reducing the likelihood of achieving first choice LMC, and also satisfaction levels with child’s GP. Some ethnic gaps were largely unexplained, despite the wealth of factors employed as independent variables in our analysis. This included understanding why Pacific mothers are much less likely to achieve their first choice LMC compared to NZ Europeans; and also the ethnic gaps for both Māori and Pacific peoples relative to NZ Europeans concerning dental service use.

Keywords: child health, cohort analysis, ethnic disparities, primary healthcare

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Authors: P. Chang, C. Lopez, C. Burbano

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Flood protection zones are riparian buffers that are formed to manage and mitigate the impact of flooding, and in turn, protect local populations. The purpose of this study was to evaluate the Guía Técnica de Criterios para el Acotamiento de las Rondas Hídricas in Colombia against international regulations in Canada and Spain, in order to determine its limitations and contribute to its improvement. The need to establish a specific corridor that allows for the dynamic development of a river is clear; however, limitations present in the Colombian Technical Guide are identified. The study shows that international regulations provide similar concepts as used in Colombia, but additionally integrate aspects such as regionalization that allows for a better characterization of the channel way, and incorporate the frequency of flooding and its probability of occurrence in the concept of risk when determining the protection zone. The case study analyzed in Dosquebradas - Risaralda aimed at comparing the application of the different standards through hydraulic modeling. It highlights that the current Colombian standard does not offer sufficient details in its implementation phase, which leads to a false sense of security related to inaccuracy and lack of data. Furthermore, the study demonstrates how the Colombian norm is ill-adapted to the conditions of Dosquebradas typical of the Andes region, both in the social and hydraulic aspects, and does not reduce the risk, nor does it improve the protection of the population. Our study considers it pertinent to include risk estimation as an integral part of the methodology when establishing protect flood zone, considering the particularity of water systems, as they are characterized by an heterogeneous natural dynamic behavior.

Keywords: environmental corridor, flood zone determination, hydraulic domain, legislation flood protection zone

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Authors: Chairun Wiedyaningsih, Sri Suryawati, Yati Soenarto, Muhammad Hakimi

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Background: Many drugs used in paediatrics are not commercially available in suitable dosage forms. Therefore, the drugs often prescribed in extemporaneous compounding dosage form. Compounding can pose health risks include poor quality and unsafe products. Studies of compounding dosage form have primarily focused on prescription profiles, reasons of prescribing never be explored. Objectives: The study was conducted to identify factors influencing physicians’ decision to prescribe extemporaneous compounding dosage form for paediatric outpatients. Setting: Daerah Istimewa Yogyakarta (DIY) province, Indonesia. Method: Qualitative semi-structured interviews were conducted with 15 general physicians and 7 paediatricians to identify the reason of prescribing extemporaneous compounding dosage form. The interviews were transcribed and analysed using thematic analysis. Results: Factors underlying prescribing of compounding could be categorized to therapy, healthcare system, patient and past experience. The primary reasons of therapy factors were limited availability of drug compositions, dosages or formulas specific for children. Beliefs in efficacy of the compounding forms were higher when the drugs used primarily to overcome complex cases. Physicians did not concern about compounding form containing several active substances because manufactured syrups may also contain several active substances. Although medicines were available in manufactured syrups, limited institutional budget was healthcare system factor of compounding prescribing. The prescribing factors related to patients include easy to use, efficient and lower price. The prescribing factors related to past experience were physicians’ beliefs to the progress of patient's health status. Conclusions: Compounding was prescribed based on therapy-related factors, healthcare system factors, patient factors and past experience.

Keywords: compounding dosage form, interview, physician, prescription

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Authors: Ojo Oo, Akinde S. B., Kiilani A. O., Jayeola Jo, Jogbodo T. M., Ajani Ka, Olaniyan So, Adeagbo Oy, Bolarinwa Ra, Durosomo Ha, Sule W. F.

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Lockdown imposed to control SARS-CoV-2 transmission hampered malaria control services in Nigeria. Considering COVID-19 vaccination, we assessed Plasmodium falciparum (Pf) antigen and SARS-CoV-2 immunoglobulin-G (IgG) positivity among adults in Osogbo, Osun State, Nigeria. Consenting attendees of four Healthcare Centres were consecutively enrolled for blood sampling; relevant socio-demographic/behavioral/clinical/environmental data were collected with a questionnaire. Samples were tested, using commercial rapid test kits, for Pf antigen and SARS-CoV-2 IgG and results were analyzed using logistic regression. Participants' mean age was 40.99 years (n=200), and they were predominantly females (84.5%), traders/businessmen/women (86.0%), with self-reported receipt of COVID-19 vaccine from 123 (61.5%). Pf antigen positivity was 17.5% (95% CI: 12.23–22.77%) with age (p=0.004), marital status (p=0.004), report of stagnant water around the workplace (p=0.041) and bush around homes (p=0.008) being associated. SARS-CoV-2 IgG positivity was 56.5% (95% CI: 49.63–63.37%) with age (p=0.012) and receipt of COVID-19 vaccination (p=0.001) being associated. Although the vaccinated had a 22.8 times higher likelihood of IgG positivity, no factor was predictive of COVID-19 vaccine receipt. We report 17.5% Pf antigen positivity with four predictors, and 56.5% SARS-CoV-2 IgG positivity with two predictors.

Keywords: COVID-19, vaccine, IgG, Plasmodium falciparum, SARS-CoV-2

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Authors: Faith O. Olanrewaju

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Internal displacement and the vulnerability of women are two critical aspects of forced migration that have dominated both global and local discourses. Statistics show that in November 2021, there were over 2.1 million internally displaced persons (IDPs) in Nigeria. Literature also states that displaced women and girls are more vulnerable than displaced men. They are susceptible to adversative experiences, including various forms of sexual violence and rape. As a result, the displaced women and girls are faced with psychological and physical traumas, including HIV/AIDS as well as unexpected or poorly spaced pregnancies. In addition, the poor condition of living of internally displaced women in IDP camps affects their reproductive health, pregnancy outcomes, and maternal mortality levels. Incontrovertibly, internally displaced women constitute an imperative contributor to the ills of Nigeria's maternal health status, which is the second worse globally and the worst in Africa. World Health Organisation statistics showed that approximately 536,000 girls and women die from pregnancy-related causes globally, and Nigeria accounts for 14% of the global maternal deaths. Undeniably, this supports the claims that maternal mortality remains a challenge in Nigeria and can be exacerbated by internal displacement crises. Therefore, maternal mortality remains a critical impediment to the actualisation of the 3.1 SDG target. Owing to this, concerns arise about the quality of the policy in Nigeria’s health sector. More specifically, this study is concerned with the maternal health care services displaced women receive in IDP camps in the three states affected by internal displacement in north-central Nigeria, an understudied area. The novelty of the study also lies in its comparative investigation of maternal healthcare service delivery in three different camp structures (faith-based, government, and informal IDP camps), a pattern that is absent in literature. Therefore, this study will investigate how the camp structures affect access to maternal health services in the study areas; analyse the successes and challenges in the delivery of maternal health care services to displaced women in the various camps; and recommendation and strategies for reducing maternal healthcare disparities/gaps across IDP camps in Nigeria (should they exist). It will adopt a mixed-method approach and multi-stage sampling technique. A total of 1,152 copies of the study questionnaire will be distributed to displaced pregnant and nursing mothers (PNM); nine focus group discussions will also be held with the displaced PNM; in-depth interviews will be conducted with humanitarian actors, policymakers, and health professionals. The quantitative and qualitative data will be analysed using Statistical Package for Social Science (SPSS) 21.0 and thematic analysis, respectively. The findings of the study will be used to develop a model of care that will address the fragmentations in Nigeria's healthcare system. The findings will also inform the development of best policies and practices in the maternal health of displaced women.

Keywords: forced displacement, internally displaced women, maternal healthcare, maternal mortality

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Authors: Khatir Omar, Fekih Sidi Mohamed, Sahli Abderahmene, Benkhettou Abdelkader, Boudjemaa Ismail

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Advancements in technology have revolutionized healthcare, with notable impacts on auditory health. This study introduces an approach aimed at optimizing materials for middle ear prostheses to enhance auditory performance. We have developed a finite element (FE) model of the ear incorporating a pure titanium TORP prosthesis, validated against experimental data. Subsequently, we applied the Functionally Graded Materials (FGM) methodology, utilizing linear, exponential, and logarithmic degradation functions to modify prosthesis materials. Biocompatible materials suitable for auditory prostheses, including Stainless Steel, titanium, and Hydroxyapatite, were investigated. The findings indicate that combinations such as Stainless Steel with titanium and Hydroxyapatite offer improved outcomes compared to pure titanium and Hydroxyapatite ceramic in terms of both displacement and stress. Additionally, personalized prostheses tailored to individual patient needs are feasible, underscoring the potential for further advancements in auditory healthcare.

Keywords: middle ear, prosthesis, ossicles, FGM, vibration analysis, finite-element method

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Authors: A. Hoppe, T. Kagele, B. Hall, A. Nichols, B. Messner

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The Spokane Street Medicine (SSM) Program aims to deliver medical care to members of Spokane, Washington, experiencing homelessness. Street medicine is designed to function in a non-traditional setting to help deliver healthcare to the underserved homeless population. In this analysis, clinical charts from street and shelter encounters made by the Spokane Street Medicine Program in early 2021 were reviewed in order to better understand the healthcare inequities prevalent among people experiencing homelessness in Spokane, WA. Pain, wound-care, and follow-up efforts were predominant concerns among the homeless population. More than half of the conditions addressed were acute, and almost a quarter of all chief complaints involved chronic unmanaged conditions. This analysis gives reason for the priorities of the SSM Program to be focused on pain, wound-care, and follow-up efforts. Understanding the specific medical needs of this population will allow for better resource allocation and improved health outcomes among people experiencing homelessness.

Keywords: equity issues in public health, health disparities, health services accessibility, medical public health, street medicine

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Authors: Scarlet Tabot Enanga Longsti

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Community-Based Health Insurance (CBHI) schemes have been proposed as a possible means to achieve affordable health care in low-and lower-middle-income countries. The existing evidence provides mixed results on the impact of CBHI schemes on healthcare utilisation and out -of-pocket payments (OOPP) for healthcare. Over 900 CBHI schemes have been implemented in underdeveloped countries, and these schemes have undergone different modifications over the years. Prior reviews have suggested that different designs of CBHI schemes may result in different outcomes. Objectives: This review sought to determine the interventions that affect the impact of CBHI schemes on OOPP and health service utilisation. Interventions in this study referred to any action or modification in the design of a CBHI scheme that affected the impact of the scheme on OOPP and/or healthcare utilization. Methods: Any CBHI study that was done in a lower middle-income country, that used an experimental design, that included OOPP or health care utilisation as outcome variables, and that was published in either English or French was included in this study. Studies were searched for in MEDLINE, Embase, CINAHL, EconLit, IBSS, Web of Science, Cochrane Library, and Global Index Medicus from July to August 2023. Bias was assessed using Joanna Brigs Institute tools for quality assessment for randomized control trials and quasi experimental studies. A narrative synthesis was done. Results: 12 studies were included in the review, with a total of 69 villages, 13,653 households, and 62,786 participants. Average premium collection was 4.8 USD/year. Most CBHI schemes had flat rates. The study revealed that a range of interventions impact OOPP and health care utilisation. Five categories of interventions were identified. The intervention with the highest impact on OOPP and utilisation was “Audit visits”. Next in line came external funds, training scheme workers, and engaging community leaders and village heads to advertise the scheme. Free healthcare led to a significant increase in utilisation of health services, a significant reduction in Catastrophic health expenditure, but an insignificant effect on OOPP among insured compared with uninsured. Conclusions: Community-Based Health Insurance could pave the way for Universal Health Care in low and middle-income countries. However, this can only be possible if careful thought is given to how schemes are designed. Due to the heterogeneity of studies and results on CBHI schemes, there is need for further research for more effective designs to be developed.

Keywords: community based health insurance, developing countries, health service utilisation, out of pocket payment

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Authors: P. Phenpun, S. Wareewan

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This qualitative study aimed to describe the opinions in relation to humanized care emerging from the volunteer activities of nursing students at Boromarajonani College of Nursing, Chonburi, Thailand. One hundred and twenty-seven second-year nursing students participated in this study. The volunteer activity model was composed of preparation, implementation, and evaluation through a learning log, in which students were encouraged to write their daily activities after completing practical training at the healthcare center. The preparation content included three main categories: service minded, analytical thinking, and client participation. The preparation process took over three days that accumulates up to 20 hours only. The implementation process was held over 10 days, but with a total of 70 hours only, with participants taking part in volunteer work activities at a healthcare center. A learning log was used for evaluation and data were analyzed using content analysis. The findings were as follows. With service minded, there were two subcategories that emerged from volunteer activities, which were service minded towards patients and within themselves. There were three categories under service minded towards patients, which were rapport, compassion, and empathy service behaviors, and there were four categories under service minded within themselves, which were self-esteem, self-value, management potential, and preparedness in providing good healthcare services. In line with analytical thinking, there were two components of analytical thinking, which were analytical skill for their works and analytical thinking for themselves. There were four subcategories under analytical thinking for their works, which were evidence based thinking, real situational thinking, cause analysis thinking, and systematic thinking, respectively. There were four subcategories under analytical thinking for themselves, which were comparative between themselves, towards their clients that leads to the changing of their service behaviors, open-minded thinking, modernized thinking, and verifying both verbal and non-verbal cues. Lastly, there were three categories under participation, which were mutual rapport relationship; reconsidering client’s needs services and providing useful health care information.

Keywords: humanized care service, volunteer activity, nursing student, learning log

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Authors: Narottam Puri, Bishnu Panigrahi, Narayan Pendse

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Background: Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from the patient care. Reporting of outcomes and its continuous monitoring provides an opportunity for both assessing and improving the quality of patient care. In 2012, International Consortium Of HealthCare Outcome Measurement (ICHOM) was founded which has defined global Standard Sets for measuring the outcome of various treatments. Method: Monitoring of Clinical Outcomes was identified as a pillar of Fortis’ core value of Patient Centricity. The project was started as an in-house developed Clinical Outcomes Reporting Portal by the Fortis Medical IT team. Standard sets of Outcome measurement developed by ICHOM were used. A pilot was run at Fortis Escorts Heart Institute from Aug’13 – Dec’13.Starting Jan’14, it was implemented across 11 hospitals of the group. The scope was hospital-wide and major clinical specialties: Cardiac Sciences, Orthopedics & Joint Replacement were covered. The internally developed portal had its limitations of report generation and also capturing of Patient related outcomes was restricted. A year later, the company provisioned for an ICHOM Certified Software product which could provide a platform for data capturing and reporting to ensure compliance with all ICHOM requirements. Post a year of the launch of the software; Fortis Healthcare has become the 1st Healthcare Provider in Asia to publish Clinical Outcomes data for the Coronary Artery Disease Standard Set comprising of Coronary Artery Bypass Graft and Percutaneous Coronary Interventions) in the public domain. (Jan 2016). Results: This project has helped in firmly establishing a culture of monitoring and reporting Clinical Outcomes across Fortis Hospitals. Given the diverse nature of the healthcare delivery model at Fortis Network, which comprises of hospitals of varying size and specialty-mix and practically covering the entire span of the country, standardization of data collection and reporting methodology is a huge achievement in itself. 95% case reporting was achieved with more than 90% data completion at the end of Phase 1 (March 2016). Post implementation the group now has one year of data from its own hospitals. This has helped identify the gaps and plan towards ways to bridge them and also establish internal benchmarks for continual improvement. Besides the value created for the group includes: 1. Entire Fortis community has been sensitized on the importance of Clinical Outcomes monitoring for patient centric care. Initial skepticism and cynicism has been countered by effective stakeholder engagement and automation of processes. 2. Measuring quality is the first step in improving quality. Data analysis has helped compare clinical results with best-in-class hospitals and identify improvement opportunities. 3. Clinical fraternity is extremely pleased to be part of this initiative and has taken ownership of the project. Conclusion: Fortis Healthcare is the pioneer in the monitoring of Clinical Outcomes. Implementation of ICHOM standards has helped Fortis Clinical Excellence Program in improving patient engagement and strengthening its commitment to its core value of Patient Centricity. Validation and certification of the Clinical Outcomes data by an ICHOM Certified Supplier adds confidence to its claim of being leaders in this space.

Keywords: clinical outcomes, healthcare delivery, patient centricity, ICHOM

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Authors: Jorge Luis Morales Romero, Enrique Murillo Othón

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Business to business (B2B) relationships generally go beyond a purely profit-based result, with firms seeking to maintain a relationship for many years because a breakup or getting a new supplier can be very costly. Therefore, identifying the factors which determine a successful relationship in the long term is of great interest to companies. That is why their reputation and the brand image that customers have of them are among the main factors that can achieve a successful relationship; Because of the positive effect which is driven by the client’s loyalty. Additionally, the perception that a customer may have about a brand is different when it is related to goods or to services. Thereby, they create in their minds their own brand image of it based on the past experiences they have had; Thus, a positive relationship is established between goods-related brand image, service-related brand image, and customer loyalty. The present investigation examines the boundary conditions of said relationship by testing the moderating effects of trust, commitment, and relationship value in a B2B environment. All the variables were tested independently as moderators for service-related brand image/loyalty and for goods-related brand image/loyalty, as they are assumed to be separate variables. Survey data was collected through interviews with customers that have both a product-buying relationship and a service relationship with a global B2B brand of healthcare equipment operating in the Mexican healthcare market. Interviewed respondents were either the user or the purchasing manager and/or the responsible for the equipment maintenance for the customer organization. Hence, they were appropriate informants regarding the B2B relationship with this healthcare brand. The moderation models were estimated using the PROCESS macro for the Statistical Package for the Social Sciences Software (SPSS). Results show statistical evidence that both Relationship Value and Trust are significant moderators for the service-related brand image/loyalty relation but not significant for the goods-related brand/loyalty relation. On the other hand, Commitment results in a significant moderator for the goods-related brand/loyalty relation but is not significant for the service-related brand image/loyalty relation.

Keywords: commitment, trust, relationship value, loyalty, B2B, moderator

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Authors: Hilmi Rafet Yüncü

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Today Internet has very important role to promote products and services all over the world. Companies and destinations in tourism industry use Internet to sell and to promote their core products to directly potential tourists. Internet technologies have redefined the relationships between tourists, tourism companies, and travel agents. The new relationship allows for accessing and tapping tourism information and services. Internet technologies ensure new opportunities to available for the tourism industry, including travel accommodation, and tourist destination organizations. Websites are important devices to the marketing of a destination. Most people make a research about the destination before arriving via internet. Governments have a considerable role in the process of marketing tourism destinations. Governments make policies and regulations; furthermore, they help to market destinations to potential tourists. Governments have a comprehensive overview of the sector to see changes in tourism market and design better policies, programs and marketing plans. At the same time, governments support developing of alternative tourism in the country with regulations and marketing tools. The aim of this study is to analyse of an Internet website of governmental tourism portal in Turkey to determine effectiveness about gastronomy tourism. The Turkish government has established a culture portal for foreign and local tourists. The Portal provides local and general information about tourism attractions of cities and Turkey. There are 81 official cities in Turkey and all these cities are conducted to analyse to determine how effective marketing is done by Turkish Government in the manner of gastronomy tourism. A content analysis will be conducted to Internet website of the portal with food content, recipes and gastronomic feature of cities.

Keywords: culture portal, gastronomy tourism, government, Turkey

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Authors: M. J. Zuroni, O. Syuhaily, M. A. Afida Mastura, M. S. Roslina, A. K. Nurul Aini

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The impact of country development has caused an increase of solid waste. The increase in population causes of excess usage thus effecting the sustainable environment. Zero waste management involves maximizing practices of recycling and minimizing residual waste. This paper seeks to analyze the relationship between knowledge, attitude, perceived behavior control, subjective norm and behavior of household solid waste towards household solid waste management among urban households in 8 states that have been implemented and enforced regulations under the Solid Waste Management and Public Cleansing Act 2007 (Act 672) in Malaysia. A total of respondents are 605 and we used a purposive sampling for location and simple sampling for sample size. Data collected by using self-administered questionnaire and were analyzed using SPSS software. The Pearson Correlation Test is to examine the relationship between four variables. Results show that knowledge scores are high because they have an awareness of the importance of managing solid waste. For attitude, perceived behavior control, subjective norm and behavioral scores at a moderate level in solid waste management activities. The findings show that there is a significant relationship between knowledge and behavior of household solid waste (r = 0.136 **, p = 0.001), there is a significant relationship between attitude and behavior (r = 0.238 **, p = 0.000), there is a significant relationship between perceived behavior control and behavior (r = 0.516 **, p = 0.000) and there is a significant relationship between subjective norm and behavior (r = 0.494 **, p = 0.000). The conclusion is that there is a relationship between knowledge, attitude, perceived behavior control and subjective norm toward the behavior of household solid waste management. Therefore, in the findings of the study, all parties including the government should work together to enhance the knowledge, attitude, perceived behavior control and behavior of household solid waste management in other states that have not implemented and enforced regulations under the Solid Waste and Public Cleansing Management Act 2007 (Act 672).

Keywords: solid waste management, knowledge, attitude, perceived behavior control, subjective norm, behavior

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Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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Authors: Lloyd A. Taylor

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An increase in the prevalence of Attention Deficit-Hyperactivity Disorder (ADHD) highlights the need to consider factors that may be exacerbating symptom presentation. Traditional diagnostic criteria provide a little framework for healthcare providers to consider as they attempt to diagnose and treat children with behavioral problems. In fact, aside from exclusion criteria, limited alternative considerations are available, and approaches fail to consider the impact of outside factors that could increase or decrease the likelihood of appropriate diagnosis and success of interventions. This paper will consider specific systems-based factors that influence behavior and intervention successes that, when not considered, could account for the upsurge of diagnoses. These include understanding (1) challenges in the healthcare system, (2) the influence and impact of educators and the educational system, (3) technology use, and (4) patient and parental attitudes about the diagnosis of ADHD. These factors must be considered both individually and as a whole when considering both the increase in diagnoses and the subsequent increases in prescriptions for psychostimulant medication. A theoretical model based on a risk management approach will be presented. Finally, data will be presented that demonstrates pediatric provider satisfaction with this approach to diagnoses and treatment of ADHD as it relates to practice trends.

Keywords: ADHD, diagnostic criteria, risk management model, pediatricians

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Authors: Mouli Banga, Chaya Ravindra

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Wound classification is a crucial step in wound diagnosis. An effective classifier can aid wound specialists in identifying wound types with reduced financial and time investments, facilitating the determination of optimal treatment procedures. This study presents a deep neural network-based classifier that leverages wound images and their corresponding locations to categorize wounds into various classes, such as diabetic, pressure, surgical, and venous ulcers. By incorporating a developed body map, the process of tagging wound locations is significantly enhanced, providing healthcare specialists with a more efficient tool for wound analysis. We conducted a comparative analysis between two prominent convolutional neural network models, ResNet50 and MobileNetV2, utilizing a dataset of 730 images. Our findings reveal that the RestNet50 outperforms MovileNetV2, achieving an accuracy of approximately 90%, compared to MobileNetV2’s 83%. This disparity highlights the superior capability of ResNet50 in the context of this dataset. The results underscore the potential of integrating deep learning with spatial data to improve the precision and efficiency of wound diagnosis, ultimately contributing to better patient outcomes and reducing healthcare costs.

Keywords: wound classification, MobileNetV2, ResNet50, multimodel

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Authors: Adnan Kedir Jarso, Mesfin Megra Rorisa, Haftom Gebreslassie Gebregwergis, Frie Ayalew Yimam, Seada Hussen Adem

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A microgrid is a small-scale power grid that can operate independently or in conjunction with the main power grid. It is a promising solution for providing reliable and sustainable energy to remote areas. The integration of solar and vertical axis wind turbines (VAWTs) in a microgrid can provide a stable and efficient source of renewable energy. This paper provides a comprehensive overview of the integration of solar and VAWTs in a microgrid. The paper discusses the design, operation, and control of a microgrid that integrates solar and VAWTs. The paper also examines the performance of the microgrid in terms of efficiency, reliability, and cost-effectiveness. The paper highlights the advantages and disadvantages of using solar and VAWTs in a microgrid. The paper concludes that the integration of solar and VAWTs in a microgrid is a promising solution for providing reliable and sustainable energy to remote areas. The paper recommends further research to optimize the design and operation of a microgrid that integrates solar and VAWTs. The paper also recommends the development of policies and regulations that promote the use of microgrids that integrate solar and VAWTs. In conclusion, the integration of solar and VAWTs in a microgrid is a promising solution for providing reliable and sustainable energy to remote areas. The paper provides a comprehensive overview of the integration of solar and VAWTs in a microgrid and highlights the advantages and disadvantages of using solar and VAWTs in a microgrid. The paper recommends further research and the development of policies and regulations that promote the use of microgrids that integrate solar and VAWTs.

Keywords: hybrid generation, intermittent power, optimization, photovoltaic, vertical axis wind turbine

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Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

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In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos

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Authors: Chryssa Thermolia, Ekaterini S. Bei, Stelios Sotiriadis, Kostas Stravoskoufos, Euripides G. M. Petrakis

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Moving into a new era of healthcare, new tools and devices are developed to extend and improve health services, such as remote patient monitoring and risk prevention. In this concept, Internet of Things (IoT) and Cloud Computing present great advantages by providing remote and efficient services, as well as cooperation between patients, clinicians, researchers and other health professionals. This paper focuses on patients suffering from bipolar disorder, a brain disorder that belongs to a group of conditions called effective disorders, which is characterized by great mood swings.We exploit the advantages of Semantic Web and Cloud Technologies to develop a patient monitoring system to support clinicians. Based on intelligently filtering of evidence-knowledge and individual-specific information we aim to provide treatment notifications and recommended function tests at appropriate times or concluding into alerts for serious mood changes and patient’s non-response to treatment. We propose an architecture, as the back-end part of a cloud platform for IoT, intertwining intelligence devices with patients’ daily routine and clinicians’ support.

Keywords: bipolar disorder, intelligent systems patient monitoring, semantic web technologies, healthcare

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Authors: Vitor S. Mendonca, Maria Luisa S. Schmidt

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The Brazilian medical profession is viewed as being error-free, so healthcare professionals who commit an error are condemned there. Medical errors occur frequently in the Brazilian healthcare system, so identifying better options for handling this issue has become of interest primarily for physicians. The purpose of this study is to better understand the tensions involved in the fear of making an error due to the harm and risk this would represent for those involved. A qualitative study was performed by means of the narratives of the lived experiences of ten acting physicians in the State of Sao Paulo. The concept and characterization of errors were discussed, together with the fear of making an error, the near misses or error in itself, how to deal with errors and what to do to avoid them. The analysis indicates an excessive pressure in the medical profession for error-free practices, with a well-established physician-patient relationship to facilitate the management of medical errors. The error occurs, but a lack of information and discussion often leads to its concealment due to fear or possible judgment by society or peers. The establishment of programs that encourage appropriate medical conduct in the event of an error requires coherent answers for humanization in Brazilian medical science. It is necessary to improve the discussion about medical errors and disseminate models of communication and notification of errors in Brazil.

Keywords: medical error, narrative, physician-patient relationship, qualitative research

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Authors: Olanrewaju Aladeitan, Obiageli Phina Anaghara-Uzor

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Despite the abundance of natural gas deposits in Nigeria and the immense potential, this presents both for the domestic and export oriented revenue, there exists an imbalance in the preference for export as against the development and optimal utilization of natural gas for the domestic industry. Considerable amounts of gas are still being wasted by flaring in the country to this day. Although the government has set in place initiatives to harness gas at the flare and thereby reduce volumes flared, the gas producers would rather direct the gas produced to the export market whereas gas apportioned to the domestic market is often marred by the low domestic gas price which is often discouraging to the gas producers. The exported fraction of gas production no doubt yields healthy revenues for the government and an encouraging return on investment for the gas producers and for this reason export sales remain enticing and preferable to the domestic sale of gas. This export pull impacts negatively if left unchecked, on the domestic market which is in no position to match the price at the international markets. The issue of gas price remains critical to the optimal development of the domestic gas industry, in that it comprises the basis for investment decisions of the producers on the allocation of their scarce resources and to what project to channel their output in order to maximize profit. In order then to rebalance the domestic industry and streamline the market for gas, the Gas Aggregation Company of Nigeria, also known as the Strategic Aggregator was proposed under the Nigerian Gas Master Plan of 2008 and then established pursuant to the National Gas Supply and Pricing Regulations of 2008 to implement the domestic gas supply obligation which focuses on ramping-up gas volumes for domestic utilization by mandatorily requiring each gas producer to dedicate a portion of its gas production for domestic utilization before having recourse to the export market. The 2008 Regulations further stipulate penalties in the event of non-compliance. This study, in the main, assesses the adequacy of the legal framework for the Nigerian Gas Industry, given that the operational laws are structured more for oil than its gas counterpart; examine the legal basis for the Strategic Aggregator in the light of the Domestic Gas Supply and Pricing Policy 2008 and the National Domestic Gas Supply and Pricing Regulations 2008 and makes a case for a review of the pivotal role of the Aggregator in the Nigerian Gas market. In undertaking this assessment, the doctrinal research methodology was adopted. Findings from research conducted reveal the reawakening of the Federal Government to the immense potential of its gas industry as a critical sector of its economy and the need for a sustainable domestic natural gas market. A case for the review of the ownership structure of the Aggregator to comprise a balanced mix of the Federal Government, gas producers and other key stakeholders in order to ensure the effective implementation of the domestic supply obligations becomes all the more imperative.

Keywords: domestic supply obligations, natural gas, Nigerian gas sector, strategic gas aggregator

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