Search results for: insurance claims
Commenced in January 2007
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Edition: International
Paper Count: 647

Search results for: insurance claims

137 On the Right an Effective Administrative Justice in the Republic of Macedonia: Challenges and Problems

Authors: Arlinda Memetaj

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A sound system of administrative justice represents a vital element of democratic governance. The proper control of public administration consists not only of a sound civil service framework and legislative oversight, but empowerment of the public and courts to hold public officials accountable for their decision-making through the application of fair administrative procedural rules and the use of appropriate administrative appeals processes and judicial review. The establishment of effective public administration, has been since 1990s among the most 'important and urgent' final strategic objectives of the Republic of Macedonia. To this aim the country has so far adopted a huge series of legislative and strategic documents related to any aspects of the administrative justice system. The latter is designed to strengthen the legal position of citizens, businesses, civic organizations, and other societal subjects. 'Changes and reforms' in this field have been thus the most frequent terms being used in the country for the last more than 20 years. Several years ago the County established Administrative Courts, while permanently amending the Law on the General Administrative procedure (LGAP). The new LGAP was adopted in 2015 and it introduced considerable innovations concerned. The most recent inputs in this regard includes the National Public Administration Reform Strategy 2017 – 2022, one of the key expected result of which includes both providing effective protection of the citizens` rights. In doing the aforesaid however there is still a series of interrelated shortcomings in this regard, such as (just to mention few) the complex appeal procedure, delays in enforcing court rulings, etc. Against the above background, the paper firstly describes the Macedonian institutional and legislative framework in the above field, and then illustrates the shortcomings therein. It finally claims that the current status quo situation may be overcome only if there is a proper implementation of the administrative courts decisions and far stricter international monitoring process thereof. A new approach and strong political commitment from the highest political leadership is thus absolutely needed to ensure the principles of transparency, accountability and merit in public administration. The main method used in this paper is the descriptive, analytical and comparative one due to the very character of the paper itself.

Keywords: administrative justice, administrative procedure, administrative courts/disputes, European Human Rights Court, human rights, monitoring, reform, benefit.

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136 An Experimental Study of Scalar Implicature Processing in Chinese

Authors: Liu Si, Wang Chunmei, Liu Huangmei

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A prominent component of the semantic versus pragmatic debate, scalar implicature (SI) has been gaining great attention ever since it was proposed by Horn. The constant debate is between the structural and pragmatic approach. The former claims that generation of SI is costless, automatic, and dependent mostly on the structural properties of sentences, whereas the latter advocates both that such generation is largely dependent upon context, and that the process is costly. Many experiments, among which Katsos’s text comprehension experiments are influential, have been designed and conducted in order to verify their views, but the results are not conclusive. Besides, most of the experiments were conducted in English language materials. Katsos conducted one off-line and three on-line text comprehension experiments, in which the previous shortcomings were addressed on a certain extent and the conclusion was in favor of the pragmatic approach. We intend to test the results of Katsos’s experiment in Chinese scalar implicature. Four experiments in both off-line and on-line conditions to examine the generation and response time of SI in Chinese "yixie" (some) and "quanbu (dou)" (all) will be conducted in order to find out whether the structural or the pragmatic approach could be sustained. The study mainly aims to answer the following questions: (1) Can SI be generated in the upper- and lower-bound contexts as Katsos confirmed when Chinese language materials are used in the experiment? (2) Can SI be first generated, then cancelled as default view claimed or can it not be generated in a neutral context when Chinese language materials are used in the experiment? (3) Is SI generation costless or costly in terms of processing resources? (4) In line with the SI generation process, what conclusion can be made about the cognitive processing model of language meaning? Is it a parallel model or a linear model? Or is it a dynamic and hierarchical model? According to previous theoretical debates and experimental conflicts, presumptions could be made that SI, in Chinese language, might be generated in the upper-bound contexts. Besides, the response time might be faster in upper-bound than that found in lower-bound context. SI generation in neutral context might be the slowest. At last, a conclusion would be made that the processing model of SI could not be verified by either absolute structural or pragmatic approaches. It is, rather, a dynamic and complex processing mechanism, in which the interaction of language forms, ad hoc context, mental context, background knowledge, speakers’ interaction, etc. are involved.

Keywords: cognitive linguistics, pragmatics, scalar implicture, experimental study, Chinese language

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135 Research Networks and Knowledge Sharing: An Exploratory Study of Aquaculture in Europe

Authors: Zeta Dooly, Aidan Duane

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The collaborative European funded research and development landscape provides prime environmental conditions for multi-disciplinary teams to learn and enhance their knowledge beyond the capability of training and learning within their own organisation cocoons. Whilst the emergence of the academic entrepreneur has changed the focus of educational institutions to that of quasi-businesses, the training and professional development of lecturers and academic staff are often not formalised to the same level as industry. This research focuses on industry and academic collaborative research funded by the European Commission. The impact of research is scalable if an optimum research network is created and managed effectively. This paper investigates network embeddedness, the nature of relationships, links, and nodes within a research network, and the enhancement of the network’s knowledge. The contribution of this paper extends our understanding of establishing and maintaining effective collaborative research networks. The effects of network embeddedness are recognized in the literature as pertinent to innovation and the economy. Network theory literature claims that networks are essential to innovative clusters such as Silicon valley and innovation in high tech industries. This research provides evidence to support the impact collaborative research has on the disparate individuals toward their innovative contributions to their organisations and their own professional development. This study adopts a qualitative approach and uncovers some of the challenges of multi-disciplinary research through case study insights. The contribution of this paper recommends the establishment of scaffolding to accommodate cooperation in research networks, role appointment, and addressing contextual complexities early to avoid problem cultivation. Furthermore, it suggests recommendations in relation to network formation, intra-network challenges in relation to open data, competition, friendships, and competency enhancement. The network capability is enhanced by the adoption of the relevant theories; network theory, open innovation, and social exchange, with the understanding that the network structure has an impact on innovation and social exchange in research networks. The research concludes that there is an opportunity to deepen our understanding of the impact of network reuse and network hoping that provides scaffolding for the network members to enhance and build upon their knowledge using a progressive approach.

Keywords: research networks, competency building, network theory, case study

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134 Qualitative Needs Assessment for Development of a Smart Thumb Prosthetic

Authors: Syena Moltaji, Stephanie Posa, Sander Hitzig, Amanda Mayo, Heather Baltzer

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Purpose: To critically assess deficits following thumb amputation and delineate elements of an ideal thumb prosthesis from the end-user perspective. Methods: This was a qualitative study based on grounded theory. End-user stakeholder groups of thumb amputees and prosthetists were interviewed. Transcripts were reviewed whole first for familiarity. Data coding was then performed by two individual authors. Coded units were grouped by similarity and reviewed to reach a consensus. Codes were then analyzed for emergent themes by each author. A consensus meeting was held with all authors to finalize themes. Results: Three patients with traumatic thumb amputation and eight prosthetists were interviewed. Seven themes emerged. First was the significant impact of losing a thumb, in which codes of functional impact, mental impact, and occupational impact were included. The second theme was the unique nature of each thumb amputee, including goals, readiness for prosthesis, nature of the injury, and insurance. The third emergent theme was cost, surrounding government funding, insurability, and prosthetic pricing. The fourth theme was patient frustration, which included mismatches of prosthetic expectations and realities, activity limitations, and causes of devices abandonment. Themes five and six surrounded the strengths and weaknesses of current prosthetics, respectively. Theme seven was the ideal design for a thumb prosthetic, including abilities, suspension, and materials. Conclusions: Representative data from stakeholders mapped the current status of thumb prosthetics. Preferences for an ideal thumb prosthetic emerged, with suggestions for a simple, durable design. The ability to oppose, grasp and sense pressure was reported as functional priorities. Feasible cost and easy fitting emerged as systemic objectives. This data will be utilized in the development of a sensate thumb prosthetic.

Keywords: smart thumb, thumb prosthetic, sensate prosthetic, amputation

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133 Linguistic Analysis of Argumentation Structures in Georgian Political Speeches

Authors: Mariam Matiashvili

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Argumentation is an integral part of our daily communications - formal or informal. Argumentative reasoning, techniques, and language tools are used both in personal conversations and in the business environment. Verbalization of the opinions requires the use of extraordinary syntactic-pragmatic structural quantities - arguments that add credibility to the statement. The study of argumentative structures allows us to identify the linguistic features that make the text argumentative. Knowing what elements make up an argumentative text in a particular language helps the users of that language improve their skills. Also, natural language processing (NLP) has become especially relevant recently. In this context, one of the main emphases is on the computational processing of argumentative texts, which will enable the automatic recognition and analysis of large volumes of textual data. The research deals with the linguistic analysis of the argumentative structures of Georgian political speeches - particularly the linguistic structure, characteristics, and functions of the parts of the argumentative text - claims, support, and attack statements. The research aims to describe the linguistic cues that give the sentence a judgmental/controversial character and helps to identify reasoning parts of the argumentative text. The empirical data comes from the Georgian Political Corpus, particularly TV debates. Consequently, the texts are of a dialogical nature, representing a discussion between two or more people (most often between a journalist and a politician). The research uses the following approaches to identify and analyze the argumentative structures Lexical Classification & Analysis - Identify lexical items that are relevant in argumentative texts creating process - Creating the lexicon of argumentation (presents groups of words gathered from a semantic point of view); Grammatical Analysis and Classification - means grammatical analysis of the words and phrases identified based on the arguing lexicon. Argumentation Schemas - Describe and identify the Argumentation Schemes that are most likely used in Georgian Political Speeches. As a final step, we analyzed the relations between the above mentioned components. For example, If an identified argument scheme is “Argument from Analogy”, identified lexical items semantically express analogy too, and they are most likely adverbs in Georgian. As a result, we created the lexicon with the words that play a significant role in creating Georgian argumentative structures. Linguistic analysis has shown that verbs play a crucial role in creating argumentative structures.

Keywords: georgian, argumentation schemas, argumentation structures, argumentation lexicon

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132 Assessing Livelihood Vulnerability to Climate Change and Adaptation Strategies in Rajanpur District, Pakistan

Authors: Muhammad Afzal, Shahbaz Mushtaq, Duc-Anh-An-Vo, Kathryn Reardon Smith, Thanh Ma

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Climate change has become one of the most challenging environmental issues in the 21st century. Climate change-induced natural disasters, especially floods, are the major factors of livelihood vulnerability, impacting millions of individuals worldwide. Evaluating and mitigating the effects of floods requires an in-depth understanding of the relationship between vulnerability and livelihood capital assets. Using an integrated approach, sustainable livelihood framework, and system thinking approach, the study developed a conceptual model of a generalized livelihood system in District Rajanpur, Pakistan. The model visualizes the livelihood vulnerability system as a whole and identifies the key feedback loops likely to influence the livelihood vulnerability. The study suggests that such conceptual models provide effective communication and understanding tools to stakeholders and decision-makers to anticipate the problem and design appropriate policies. It can also serve as an evaluation technique for rural livelihood policy and identify key systematic interventions. The key finding of the study reveals that household income, health, and education are the major factors behind the livelihood vulnerability of the rural poor of District Rajanpur. The Pakistani government tried to reduce the livelihood vulnerability of the region through different income, health, and education programs, but still, many changes are required to make these programs more effective especially during the flood times. The government provided only cash to vulnerable and marginalized families through income support programs, but this study suggests that along with the cash, the government must provide seed storage facilities and access to crop insurance to the farmers. Similarly, the government should establish basic health units in villages and frequent visits of medical mobile vans should be arranged with advanced medical lab facilities during and after the flood.

Keywords: livelihood vulnerability, rural communities, flood, sustainable livelihood framework, system dynamics, Pakistan

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131 [Keynote Speech]: Curiosity, Innovation and Technological Advancements Shaping the Future of Science, Technology, Engineering and Mathematics Education

Authors: Ana Hol

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We live in a constantly changing environment where technology has become an integral component of our day to day life. We rely heavily on mobile devices, we search for data via web, we utilise smart home sensors to create the most suited ambiences and we utilise applications to shop, research, communicate and share data. Heavy reliance on technology therefore is creating new connections between STEM (Science, Technology, Engineering and Mathematics) fields which in turn rises a question of what the STEM education of the future should be like? This study was based on the reviews of the six Australian Information Systems students who undertook an international study tour to India where they were given an opportunity to network, communicate and meet local students, staff and business representatives and from them learn about the local business implementations, local customs and regulations. Research identifies that if we are to continue to implement and utilise electronic devices on the global scale, such as for example implement smart cars that can smoothly cross borders, we will need the workforce that will have the knowledge about the cars themselves, their parts, roads and transport networks, road rules, road sensors, road monitoring technologies, graphical user interfaces, movement detection systems as well as day to day operations, legal rules and regulations of each region and country, insurance policies, policing and processes so that the wide array of sensors can be controlled across country’s borders. In conclusion, it can be noted that allowing students to learn about the local conditions, roads, operations, business processes, customs and values in different countries is giving students a cutting edge advantage as such knowledge cannot be transferred via electronic sources alone. However once understanding of each problem or project is established, multidisciplinary innovative STEM projects can be smoothly conducted.

Keywords: STEM, curiosity, innovation, advancements

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130 From CBGB to F21: The Ramone's Band T-Shirt and Its Representations in the Mainstream Culture

Authors: Cláudia Pereira, Lívia Boeschenstein

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This article aims to present an analysis of rock band t-shirts as an element that claims a certain identity in modern-contemporary culture. This work focuses on the study of t-shirts that display the name, related elements and the logo of punk band The Ramones, because of its strong presence in the collective mind along the last decades. As we shall see, it is possible to observe a phenomenon of symbolic transition from the original cultural place of that object. At first, it was a piece of cloth that had been part of a specific subculture and then it became just a generic item diluted by the mainstream. This symbolic transitional phenomenon is significant in many ways and will be discussed furthermore. For the analysis, we begin with a brief introduction to the history of the band, followed by the study about the vintage rock band T-shirts and their meanings. From there, we will turn to a historical contextualization of band T-shirts as a subcultural item and to its redefinition after the appropriation made by the mainstream. To guide this reasoning, it will be used theories about the styles, subcultures and youth culture and about material culture from an anthropological perspective. In addition, we shall see the theories and concepts of social representations in order to understand the ways of using the Ramones’s T-shirt as a representative element of a fashionable style. This T-shirt, after being resignified by the standardization and the massive consumption, no longer symbolizes the punk movement, its behavioral motivations and original policies. Also has little to do with the rage the working class suburbs of London or New York. It seems to be a mute and vague sign of a restricted rebellion, foreseen and framed establishing a stylistic contrast to the designer clothes and good behavior predicted by establishment. It's an item that composes a specific style available on the market, but at the same time is accepted by the mainstream and provides a subcultural association that has some prestige in society. Another perspective is that of resignification loop. As the same way that punk resignified the conventional goods for their own social standards, fashion resignifies what was said to be an object of a subculture and absorbs in their own mass culture standards. Therefore, outsiders to the punk phenomenon wearing Ramones’s T-shirts can be perceived negatively by subcultural members, but at the same time are well received by those who are partially unaware or completely out of subcultural context. For the general public, the stamp of the Ramones’s logo happens to be appreciated as a diffuse allusion to a punk style, since its original meaning has being entirely neutralized.

Keywords: social representations, subcultures, material culture, punk

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129 Identifying the Challenges of Subcontractors Management in Building Area Projects and Providing Solutions (Supply Chain Management Approach)

Authors: Hamideh Sadat Zekri, Seyed Mojtaba Hosseinalipour, Mohammadreza Hafezi

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Nowadays, an organization cannot usually overcome all tasks singly due to the increasing complexity and vast expanse of projects, increment in uncertainty of activities, fast advances in technology, advent and influence of various factors in decision-making and implication of projects, and competitive atmosphere of different affairs. Thus, firms proceed to outsource the tasks to subcontractors. Nevertheless, large Iranian contracting companies suffer from extra consumed costs and time owing to conflicts between the activities of suppliers and subcontractors. The paucity of coordination in planning and execution, scarcity of coordination among suppliers, subcontractors, and the main contractor during the implementation of construction activities and also the lack of proper management of the aforesaid situation result in the growth of contradictions, number of claims, and legal issues in a project and consequently impose enormous expenses on those companies. Regarding the prosperity of supply chain management in other industries, its importance is increasingly getting appreciated in the field of construction. The ultimate aim of supply chain management is an effective delivery of the best value for customers, which is achievable by encouraging the members to interact and collaborate. In the present research, there was an effort to obtain a set of relevant challenges in the managing of subcontractors by identifying the main contractors and subcontractors and their role in the execution of projects and the supply chain management in the construction industry. Then, some of those challenges were selected in accordance with the views of industry professionals and academic experts. In the next step, a questionnaire was prepared and completed based on the analytic hierarchy process (AHP) and the challenges were prioritized. When it comes to subcontractors, the findings of the research demonstrate that difficulties in timely payments, alterations in approved drawings and the lack of rectification of job after completion by the subcontractor, paucity of a predetermined and legal process for qualifications of subcontractors, neglecting the supply chain processes in material procurement from producers, and delays in delivery of works by a subcontractor are the most significant problems. Finally, some solutions for encountering, eradicating, or reducing of mentioned problems are presented in accordance with previous studies and a survey from specialists.

Keywords: main contractors, subcontractors, supply chain management, construction supply chain, analytic hierarchy process, solution

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128 Estimation of Antiurolithiatic Activity of a Biochemical Medicine, Magnesia phosphorica, in Ethylene Glycol-Induced Nephrolithiasis in Wistar Rats by Urine Analysis, Biochemical, Histopathological, and Electron Microscopic Studies

Authors: Priti S. Tidke, Chandragouda R. Patil

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The present study was designed to investigate the effect of Magnesia phosphorica, a biochemical medicine on urine screeing, biochemical, histopathological, and electron microscopic images in ethylene glycol induced nepholithiasis in rats.Male Wistar albino rats were divided into six groups and were orally administered saline once daily (IR-sham and IR-control) or Magnesia phosphorica 100 mg/kg twice daily for 24 days.The effect of various dilutions of biochemical Mag phos3x, 6x, 30x was determined on urine output by comparing the urine volume collected by keeping individual animals in metabolic cages. Calcium oxalate urolithiasis and hyperoxaluria in male Wistar rats was induced by oral administration of 0.75% Ethylene glycol p.o. daily for 24 days. Simultaneous administration of biochemical 3x, 6x, 30xMag phos (100mg/kg p.o. twice a day) along with ethylene glycol significantly decreased calcium oxalate, urea, creatinine, Calcium, Magnesium, Chloride, Phosphorus, Albumin, Alkaline Phosphatase content in urine compared with vehicle-treated control group.After the completion of treatment period animals were sacrificed, kidneys were removed and subjected to microscopic examination for possible stone formation. Histological estimation of kidney treated with biochemical Mag phos (3x, 6x, 30xMag phos 100 mg/kg, p.o.) along with ethylene glycol inhibited the growth of calculi and reduced the number of stones in kidney compared with control group. Biochemical Mag phos of 3x dilution and its crude equivalent also showed potent diuretic and antiurolithiatic activity in ethylene glycol induced urolithiasis. A significant decrease in the weight of stones was observed after treatment in animals which received biochemical Mag phos of 3x dilution and its crude equivalent in comparison with control groups. From this study, it can be proposed that the 3x dilution of biochemical Mag phos exhibits a significant inhibitory effect on crystal growth, with the improvement of kidney function and substantiates claims on the biological activity of twelve tissue remedies which can be proved scientifically through laboratory animal studies.

Keywords: Mag phos, Magnesia phosphorica, ciochemic medicine, urolithiasis, kidney stone, ethylene glycol

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127 The Psychological Effects of Nature on Subjective Well-Being: An Experimental Approach

Authors: Tatjana Kochetkova

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This paper explores the pivotal role of environmental education, specifically outdoor education, in facilitating a psychological connection to nature among young adults. This research aims to contribute to building an empirical and conceptual basis of ecopsychology by providing a picture of psyche-nature interaction. It presents the results of the four-day connection-to-nature workshop. It intends to find out the effects of the awareness of nature on subjective well-being and perception of the meaning of life. This led to finding a battery-recharging effect of nature and the influence of nature at four levels of awareness: external physical perception, internal (bodily) sensation, emotions, and existential meaning. The research on the psychological bond of humans with the natural environment, the subject of ecopsychology, is still in its infancy. However, despite several courageous and fruitful attempts, there are still no direct answers to the fundamental questions about the way in which the natural environment influences humans and the specific role of nature in the human psyche. The urge to address this question was the primary reason for the current experiment. The methodology of this study was taken from the study of Patterson, and from White and Hendee. The methodology included a series of assignments on the perception of nature (the exercises are described in the attachment). Experiences were noted in a personal diary, which we used later for analysis. There are many trustworthy claims that contact with nature has positive effects on human subjective well-being and that it is of essential psychological and spiritual value. But, there is a need for more support and theoretical explanation for this phenomenon. As a contribution to filling these gaps, this qualitative study was conducted. The aim of this study is to explore the psychological effects of short-term awareness of wilderness on one’s subjective well-being and on one’s sense of the meaning of life. This specific study is based on the more general hypothesis that there are positive relationships between the experience of wilderness and the development of the self, feelings of community, and spiritual development. It restricted the study of the psychological effects of short term stay in nature to two variables (subjective well-being and the sense of meaning of life). The study aimed at (i) testing the hypothesis that there are positive effects of the awareness of wilderness on the subjective sense of well-being and meaning in life, (ii) understanding the nature of the psychological need for wilderness. Although there is a substantial amount of data on the psychological benefits of nature, we still lack a theory that explains the findings. The present research aims to contribute to such a theory. This is an experiment aimed specifically at the effects of nature on the sense of well-being and meaning in life.

Keywords: environmental education, psychological connection to nature, subjective well-being, symbolic meaning of nature, emotional reaction to nature, meaning of life

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126 Exploration of the Possible Link Between Emotional Problems and Cholesterol Levels Among Children Diagnosed with Attention-Deficit Hyperactivity Disorder

Authors: Rosa S. Wong, Keith T.S. Tung, H.W. Tsang, Frederick K. Ho, Patrick Ip

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Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and hyperactive-impulsive behavior. Evidence shows that ADHD and mood problems such as depression and anxiety often co-occur and yet not everyone with ADHD reported elevated emotional problems. Given that cholesterol is essential for healthy brain development including the regions governing emotion regulation, reports found lower cholesterol levels in patients with major depressive disorder and those with suicide attempt behavior compared to healthy subjects. This study explored whether ADHD adolescents experienced more emotional problems and whether emotional problems correlated with cholesterol levels in these adolescents. This study used a portion of data from the longitudinal cohort study which was designed to investigate the long-term impact of family socioeconomic status on child development. In 2018/19, parents of 300 adolescents (average age: 12.57+/-0.49 years) were asked to rate their children’s emotional problems and report whether their children had doctor-diagnosed psychiatric diseases. We further collected blood samples from 263 children to study their lipid profile (total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol). Regression analyses were performed to test the relationships between variables of interest. Among 300 children, 27 (9%) had ADHD diagnosis. Analysis based on overall sample found no association between ADHD and emotional problems, but when investigating the relationship by gender, there was a significant interaction effect of ADHD and gender on emotional problems (p=0.037), with ADHD males displaying more emotional problems than ADHD females. Further analyses based on 263 children (21 with ADHD diagnosis) found significant interaction effect of ADHD and gender on total cholesterol (p=0.038) and low LDL-cholesterol levels (p=0.013) after adjusting for the child’s physical disease history. Specifically, ADHD males had significantly lower total cholesterol and low lipoprotein-cholesterol levels than ADHD females. In ADHD males, more emotional problems were associated with lower LDL-cholesterol levels (B = -4.26, 95%CI (-7.46, -1.07), p=0.013). We found preliminary support for the association between more emotional problems and lower cholesterol levels in ADHD children, especially among males. Although larger prospective studies are needed to substantiate these claims, the evidence highlights the importance of healthy lifestyle to keep cholesterol levels in normal range which can have positive effects on physical and mental health.

Keywords: attention-deficit hyperactivity disorder, cholesterol, emotional problems, adolescents

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125 The Correlation between Clostridium Difficile Infection and Bronchial Lung Cancer Occurrence

Authors: Molnar Catalina, Lexi Frankel, Amalia Ardeljan, Enoch Kim, Marissa Dallara, Omar Rashid

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Introduction: Clostridium difficile (C. diff) is a toxin-producing bacteria that can cause diarrhea and colitis. U.S. Center for Disease Control and Prevention revealed that C. difficile infection (CDI) has increased from 31 cases per 100,000 persons per year in 1996 to 61 per 100,000 in 2003. Approximately 500,000 cases per year occur in the United States. After exposure, the bacteria colonize the colon, where it adheres to the intestinal epithelium where it produces two toxins: TcdA and TcdB. TcdA affects the intestinal epithelium, causing fluid secretion, inflammation, and tissue necrosis, while TcdB acts as a cytotoxin purpose of this study was to evaluate the association between C diff infection and bronchial lung cancer development. Methods: Using ICD- 9 and ICD-10 codes, the data was provided by a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to assess the patients infected with C diff as opposed to the non-infected patients. The Holy Cross Health, Fort Lauderdale, granted access to the database for the purpose of academic research. Patients were matched for age and Charlson Comorbidity Index (CCI). Standard statistical methods were used. Results: Bronchial lung cancer occurrence in the population not infected with C diff infection was 4741, as opposed to the population infected with C. diff, where 2039 cases of lung cancer were observed. The difference was statistically significant (p-value < 2.2x10^e-16), which reveals that C diff might be protective against bronchial lung cancer. The data was then matched by treatment to create to minimize the effect of treatment bias. Bronchial cancer incidence was 422 and 861 in infected vs. non-infected (p-value of < 2.2x10^e-16), which once more indicates that C diff infection could be beneficial in diminishing bronchial cancer development. Conclusion: This retrospective study conveys a statistical correlation between C diff infection and decreased incidence of lung bronchial cancer. Further studies are needed to comprehend the protective mechanisms of C. Diff infection on lung cancer.

Keywords: C. diff, lung cancer, protective, microbiology

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124 Literature Review on the Barriers to Access Credit for Small Agricultural Producers and Policies to Mitigate Them in Developing Countries

Authors: Margarita Gáfaro, Karelys Guzmán, Paola Poveda

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This paper establishes the theoretical aspects that explain the barriers to accessing credit for small agricultural producers in developing countries and identifies successful policy experiences to mitigate them. We will test two hypotheses. The first one is that information asymmetries, high transaction costs and high-risk exposure limit the supply of credit to small agricultural producers in developing countries. The second hypothesis is that low levels of financial education and productivity and high uncertainty about the returns of agricultural activity limit the demand for credit. To test these hypotheses, a review of the theoretical and empirical literature on access to rural credit in developing countries will be carried out. The first part of this review focuses on theoretical models that incorporate information asymmetries in the credit market and analyzes the interaction between these asymmetries and the characteristics of the agricultural sector in developing countries. Some of the characteristics we will focus on are the absence of collateral, the underdevelopment of the judicial systems and insurance markets, and the high dependence on climatic factors of production technologies. The second part of this review focuses on the determinants of credit demand by small agricultural producers, including the profitability of productive projects, security conditions, risk aversion or loss, financial education, and cognitive biases, among others. There are policies that focus on resolving these supply and demand constraints and managing to improve credit access. Therefore, another objective of this paper is to present a review of effective policies that have promoted access to credit for smallholders in the world. For this, information available in policy documents will be collected. This information will be complemented by interviews with officials in charge of the design and execution of these policies in a subset of selected countries. The information collected will be analyzed in light of the conceptual framework proposed in the first two parts of this section. The barriers to access to credit that each policy attempts to resolve and the factors that could explain its effectiveness will be identified.

Keywords: agricultural economics, credit access, smallholder, developing countries

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123 Body, Experience, Sense, and Place: Past and Present Sensory Mappings of Istiklal Street in Istanbul

Authors: Asiye Nisa Kartal

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An attempt to recognize the undiscovered bounds of Istiklal Street in Istanbul between its sensory experiences (intangible qualities) and physical setting (tangible qualities) could be taken as the first inspiration point for this study. ‘The dramatic physical changes’ and ‘their current impacts on sensory attributions’ of Istiklal Street have directed this study to consider the role of changing the physical layout on sensory dimensions which have a subtle but important role in the examination of urban places. The public places have always been subject to transformation, so in the last years, the changing socio-cultural structure, economic and political movements, law and city regulations, innovative transportation and communication activities have resulted in a controversial modification of Istanbul. And, as the culture, entertainment, tourism, and shopping focus of Istanbul, Istiklal Street has witnessed different changing stages within the last years. In this process, because of the projects being implemented, many buildings such as cinemas, theatres, and bookstores have restored, moved, converted, closed and demolished which have been significant elements in terms of the qualitative value of this area. And, the multi-layered socio-cultural, and architectural structure of Istiklal Street has been changing in a dramatical and controversial way. But importantly, while the physical setting of Istiklal Street has changed, the transformation has not been spatial, socio-cultural, economic; avoidably the sensory dimensions of Istiklal Street which have great importance in terms of intangible qualities of this area have begun to lose their distinctive features. This has created the challenge of this research. As the main hypothesis, this study claims that the physical transformations have led to change in the sensory characteristic of Istiklal Street, therefore the Sensescape of Istiklal Street deserve to be recorded, decoded and promoted as expeditiously as possible to observe the sensory reflections of physical transformations in this area. With the help of the method of ‘Sensewalking’ which is an efficient research tool to generate knowledge on sensory dimensions of an urban settlement, this study suggests way of ‘mapping’ to understand how do ‘changes of physical setting’ play role on ‘sensory qualities’ of Istiklal Street which have been changed or lost over time. Basically, this research focuses on the sensory mapping of Istiklal Street from the 1990s until today to picture, interpret, criticize the ‘sensory mapping of Istiklal Street in present’ and the ‘sensory mapping of Istiklal Street in past’. Through the sensory mapping of Istiklal Street, this study intends to increase the awareness about the distinctive sensory qualities of places. It is worthwhile for further studies that consider the sensory dimensions of places especially in the field of architecture.

Keywords: Istiklal street, sense, sensewalking, sensory mapping

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122 Floorboards, Whitewalls and Butterflies: Ethnography of a Community Mental Health Cafe

Authors: J. N. Bardi, N. Wright, S. Timmons, P. Crawford

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Introduction: In the United Kingdom (UK), the transfer of care from the asylums to the community has meant that some people with mental health problems (MHP) may not have access to suitable or adequate statutory community mental health services (CMHS). However, in addition to statutory CMHS, there are informal CMHS that provide spaces where people with MHP can attend such as faith communities, clubhouses, user-led organisations, day centres including drop-in-centres and community hubs and community mental health cafés (CMHCs). Aim: To qualitatively understand what happens in a community mental health café in relation to the place, people and processes, from the participant's perspective. Methodology: Ethnography Methods: Data collection will be field notes from observations written as thick description and interviews with participants. Data analysis will be thematic and narrative analysis. Relevance: The study seeks to observe what happens in a user-led community mental health café and explore if it provides the services that it claims to offer. Therefore, a literature review was conducted to examine the research evidence related to informal CMHS, focusing on similarities and differences. Results indicated that informal CMHS differ with regards to why, how, who set them up and who funds them, but they are similar because people with MHP who attend them report related psychological, vocational, and social interaction benefits. In addition to the differences listed above, CMHCs differ in their adoption of the commercial café model of social space and some CMHCs claim to address needs of social isolation and loneliness which they assert are not properly addressed by statutory CMHS and some informal CMHS. Therefore, CMHCs explicitly differentiate themselves from statutory CMHS and some informal CMHS such as day centres, hospitals and social services. However, CMHCs were found to be like drop-in-centres and community hubs which are also free for MHP to attend without the need for assessments, membership or appointments. To situate community mental health café within other informal CMHS and provide a rationale for the proposed study a scoping review was conducted to determine the scope of available research evidence on CMHCs. Findings from the scoping review reflected the literature review findings with regards to the benefits of attending informal CMHCs for people with MHP. Of the ten studies included in the scoping review, seven were on CMHCs for people living with dementia and two were on CMHCs for people with a broader range of MHP. The researcher hopes that findings from the proposed PhD study will build on the existing understanding of informal CMHS, extend the research evidence on CMHCs and address any gap in the literature.

Keywords: cafe, community, ethnography, mental health

Procedia PDF Downloads 165
121 [Keynote Talk]: Let Us Move to Ethical Finance: A Case Study of Takaful

Authors: Syed Ahmed Salman

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Ethicality is essential in our daily activities, including personal and commercial activities. This is evidenced by referring to the historical development of the corporate governance and ethical guidelines. The first corporate governance guideline, i.e. Cadbury Report from U.K. focuses the responsibility of board members towards the shareholders only. Gradually, realising the need to take care of the society and community, stakeholders are now concerns of business entities. Consequently, later codes of corporate governance started extending the responsibility to the other stakeholders in addition to the shareholders. One prevailing corporate governance theory, i.e. stakeholder theory, has been widely used in the research to explore the effects of business entities on society. In addition, the Global Reporting Initiative (GRI) is the leading organisation which promotes social care from businesses for sustainable development. Conventionally, history shows that ethics is key to the long term success of businesses. Many organisations, societies, and regulators give full attention and consideration to ethics. Several countries have introduced ethical codes of conduct to direct trade activities. Similarly, Islam and other religions prohibit the practice of interest, uncertainty, and gambling because of its unethical nature. These prohibited practices are not at all good for the society, business, and any organisation especially as it is detrimental to the well-being of society. In order to avoid unethicality in the finance industry, Shari’ah scholars come out with the idea of Islamic finance which is free from the prohibited elements from the Islamic perspective. It can also be termed ethical finance. This paper highlights how Takaful as one of the Islamic finance products offers fair and just products to the contracting parties and the society. Takaful is framed based on ethical guidelines which are extracted from Shari’ah principles and divine sources such as the Quran and Sunnah. Takaful products have been widely offered all over the world, including in both Muslim and non-Muslim countries. It seems that it is gaining acceptance regardless of religion. This is evidence that Takaful is being accepted as an ethical financial product.

Keywords: ethics, insurance, Islamic finance, religion and takaful

Procedia PDF Downloads 248
120 The Clash of the Clans in the British Divorce

Authors: Samuel Gary Beckton

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Ever since the Scottish Independence Referendum in 2014, there has been a threat of a second referendum. However, if there was another referendum and the majority favoured independence, it is highly likely to be by a small majority. In this paper, it will look into the hypothetical situation of what could have happened if Scotland had voted in favour of independence in 2014. If this occurred, there would be many Unionists within Scotland, including devoted supporters of the Better Together campaign. There was a possibility of some Scottish Unionists not willing to accept the result of the Referendum unchallenged and use their right of self-determination through the UN Charter for their region to remain within the United Kingdom. The Shetland and Orkney Islands contemplated of opting out of an independent Scotland in 2013. This caught the attention of some politicians and the media, via confirming the possibility of some form of partition in Scotland and could have gained extra attention if partition quickly became a matter of ‘need’ instead of ‘want’. Whilst some Unionists may have used petitions and formed pressure groups to voice their claims, others may have used more hard-line tactics to achieve their political objectives, including possible protest marches and acts of civil unrest. This could have possibly spread sectarian violence between Scottish Unionists and Nationalists. Glasgow has a serious issue of this kind of sectarianism, which has escalated in recent years. This is due to the number communities that have been established from Irish Immigrants, which maintain links with Northern Irish loyalists and republicans. Some Scottish Unionists not only have sympathy towards Northern Irish loyalists but actively participate with the paramilitary groups and gave support. Scottish loyalists could use these contacts to create their own paramilitary group(s), with aid from remaining UK (RUK) benefactors. Therefore, this could have resulted in the RUK facing a serious security dilemma, with political and ethical consequences to consider. The RUK would have the moral obligation to protect Scottish Unionists from persecution and recognise their right of self-determination, whilst ensuring the security and well-being of British citizens within and outside of Scotland. This work takes into consideration the lessons learned from the ‘Troubles’ in Northern Ireland. As an era of ‘Troubles’ could occur in Scotland, extending into England and Northern Ireland. This is due to proximity, the high number of political, communal and family links in Scotland to the RUK, and the delicate peace process within Northern Ireland which shares a similar issue. This paper will use British and Scottish Government documents prior to the Scottish referendum to argue why partition might happen and use cartography of maps of a potential partition plan for Scotland. Reports from the UK National Statistics, National Rail, and Ministry of Defence shall also be utilised, and use of journal articles that were covering the referendum.

Keywords: identity, nationalism, Scotland, unionism

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119 Carbonaceous Monolithic Multi-Channel Denuders as a Gas-Particle Partitioning Tool for the Occupational Sampling of Aerosols from Semi-Volatile Organic Compounds

Authors: Vesta Kohlmeier, George C. Dragan, Juergen Orasche, Juergen Schnelle-Kreis, Dietmar Breuer, Ralf Zimmermann

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Aerosols from hazardous semi-volatile organic compounds (SVOC) may occur in workplace air and can simultaneously be found as particle and gas phase. For health risk assessment, it is necessary to collect particles and gases separately. This can be achieved by using a denuder for the gas phase collection, combined with a filter and an adsorber for particle collection. The study focused on the suitability of carbonaceous monolithic multi-channel denuders, so-called Novacarb™-Denuders (MastCarbon International Ltd., Guilford, UK), to achieve gas-particle separation. Particle transmission efficiency experiments were performed with polystyrene latex (PSL) particles (size range 0.51-3 µm), while the time dependent gas phase collection efficiency was analysed for polar and nonpolar SVOC (mass concentrations 7-10 mg/m3) over 2 h at 5 or 10 l/min. The experimental gas phase collection efficiency was also compared with theoretical predictions. For n-hexadecane (C16), the gas phase collection efficiency was max. 91 % for one denuder and max. 98 % for two denuders, while for diethylene glycol (DEG), a maximal gas phase collection efficiency of 93 % for one denuder and 97 % for two denuders was observed. At 5 l/min higher gas phase collection efficiencies were achieved than at 10 l/min. The deviations between the theoretical and experimental gas phase collection efficiencies were up to 5 % for C16 and 23 % for DEG. Since the theoretical efficiency depends on the geometric shape and length of the denuder, flow rate and diffusion coefficients of the tested substances, the obtained values define an upper limit which could be reached. Regarding the particle transmission through the denuders, the use of one denuder showed transmission efficiencies around 98 % for 1-3 µm particle diameters. The use of three denuders resulted in transmission efficiencies from 93-97 % for the same particle sizes. In summary, NovaCarb™-Denuders are well applicable for sampling aerosols of polar/nonpolar substances with particle diameters ≤3 µm and flow rates of 5 l/min or lower. These properties and their compact size make them suitable for use in personal aerosol samplers. This work is supported by the German Social Accident Insurance (DGUV), research contract FP371.

Keywords: gas phase collection efficiency, particle transmission, personal aerosol sampler, SVOC

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118 Young Adult Gay Men's Healthcare Access in the Era of the Affordable Care Act

Authors: Marybec Griffin

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Purpose: The purpose of this cross-sectional study was to get a better understanding of healthcare usage and satisfaction among young adult gay men (YAGM), including the facility used as the usual source of healthcare, preference for coordinated healthcare, and if their primary care provider (PCP) adequately addressed the health needs of gay men. Methods: Interviews were conducted among n=800 YAGM in New York City (NYC). Participants were surveyed about their sociodemographic characteristics and healthcare usage and satisfaction access using multivariable logistic regression models. The surveys were conducted between November 2015 and June 2016. Results: The mean age of the sample was 24.22 years old (SD=4.26). The racial and ethnic background of the participants is as follows: 35.8% (n=286) Black Non-Hispanic, 31.9% (n=225) Hispanic/Latino, 20.5% (n=164) White Non-Hispanic, 4.4% (n=35) Asian/Pacific Islander, and 6.9% (n=55) reporting some other racial or ethnic background. 31.1% (n=249) of the sample had an income below $14,999. 86.7% (n=694) report having either public or private health insurance. For usual source of healthcare, 44.6% (n=357) of the sample reported a private doctor’s office, 16.3% (n=130) reported a community health center, and 7.4% (n=59) reported an urgent care facility, and 7.6% (n=61) reported not having a usual source of healthcare. 56.4% (n=451) of the sample indicated a preference for coordinated healthcare. 54% (n=334) of the sample were very satisfied with their healthcare. Findings from multivariable logistical regression models indicate that participants with higher incomes (AOR=0.54, 95% CI 0.36-0.81, p < 0.01) and participants with a PCP (AOR=0.12, 95% CI 0.07-0.20, p < 0.001) were less likely to use a walk-in facility as their usual source of healthcare. Results from the second multivariable logistic regression model indicated that participants who experienced discrimination in a healthcare setting were less likely to prefer coordinated healthcare (AOR=0.63, 95% CI 0.42-0.96, p < 0.05). In the final multivariable logistic model, results indicated that participants who had disclosed their sexual orientation to their PCP (AOR=2.57, 95% CI 1.25-5.21, p < 0.01) and were comfortable discussing their sexual activity with their PCP (AOR=8.04, 95% CI 4.76-13.58, p < 0.001) were more likely to agree that their PCP adequately addressed the healthcare needs of gay men. Conclusion: Understanding healthcare usage and satisfaction among YAGM is necessary as the healthcare landscape changes, especially given the relatively recent addition of urgent care facilities. The type of healthcare facility used as a usual source of care influences the ability to seek comprehensive and coordinated healthcare services. While coordinated primary and sexual healthcare may be ideal, individual preference for this coordination among YAGM is desired but may be limited due to experiences of discrimination in primary care settings.

Keywords: healthcare policy, gay men, healthcare access, Affordable Care Act

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117 Incidence of Lymphoma and Gonorrhea Infection: A Retrospective Study

Authors: Diya Kohli, Amalia Ardeljan, Lexi Frankel, Jose Garcia, Lokesh Manjani, Omar Rashid

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Gonorrhea is the second most common sexually transmitted disease (STDs) in the United States of America. Gonorrhea affects the urethra, rectum, or throat and the cervix in females. Lymphoma is a cancer of the immune network called the lymphatic system that includes the lymph nodes/glands, spleen, thymus gland, and bone marrow. Lymphoma can affect many organs in the body. When a lymphocyte develops a genetic mutation, it signals other cells into rapid proliferation that causes many mutated lymphocytes. Multiple studies have explored the incidence of cancer in people infected with STDs such as Gonorrhea. For instance, the studies conducted by Wang Y-C and Co., as well as Caini, S and Co. established a direct co-relationship between Gonorrhea infection and incidence of prostate cancer. We hypothesize that Gonorrhea infection also increases the incidence of Lymphoma in patients. This research study aimed to evaluate the correlation between Gonorrhea infection and the incidence of Lymphoma. The data for the research was provided by a Health Insurance Portability and Accountability Act (HIPAA) compliant national database. This database was utilized to evaluate patients infected with Gonorrhea versus the ones who were not infected to establish a correlation with the prevalence of Lymphoma using ICD-10 and ICD-9 codes. Access to the database was granted by the Holy Cross Health, Fort Lauderdale for academic research. Standard statistical methods were applied throughout. Between January 2010 and December 2019, the query was analyzed and resulted in 254 and 808 patients in both the infected and control group, respectively. The two groups were matched by Age Range and CCI score. The incidence of Lymphoma was 0.998% (254 patients out of 25455) in the Gonorrhea group (patients infected with Gonorrhea that was Lymphoma Positive) compared to 3.174% and 808 patients in the control group (Patients negative for Gonorrhea but with Lymphoma). This was statistically significant by a p-value < 2.210-16 with an OR= 0.431 (95% CI 0.381-0.487). The patients were then matched by antibiotic treatment to avoid treatment bias. The incidence of Lymphoma was 1.215% (82 patients out of 6,748) in the Gonorrhea group compared to 2.949% (199 patients out of 6748) in the control group. This was statistically significant by a p-value <5.410-10 with an OR= 0.468 (95% CI 0.367-0.596). The study shows a statistically significant correlation between Gonorrhea and a reduced incidence of Lymphoma. Further evaluation is recommended to assess the potential of Gonorrhea in reducing Lymphoma.

Keywords: gonorrhea, lymphoma, STDs, cancer, ICD

Procedia PDF Downloads 174
116 Reclaiming The Sahara as a Bridge to Afro-Arab solidarity

Authors: Radwa Saad

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The Sahara is normatively treated as a barrier separating “two Africas"; one to the North with closer affinity to the Arab world, and one to the South that encompasses a diverse range of racial, ethnic and religious groups, commonly referred to as "Sub-Saharan Africa". This dichotomy however was challenged by many anticolonial leaders and intellectuals seeking to advance counter-hegemonic narratives that treat the Sahara as a bridge facilitating a long history of exchange, collaboration, and fusion between different civilizations on the continent. This paper reexamines the discourses governing the geographic distinction between North Africa and Sub-Saharan Africa. It argues that demarcating the African continent along the lines of the Sahara is part-and-parcel of a Euro-centric spatial imaginary that has served to enshrine a racialized global hierarchy of power. By drawing on Edward Said’s concept of ‘imagined geography’ and Charles Mill’s notion of “the racial contract”, it demonstrates how spatial boundaries often coincide with racial epistemologies to reinforce certain geopolitical imaginaries, whilst silencing others. It further draws on the works of two notable post-colonial figures - Gamal Abdel Nasser and Leopold Senghor - to explore alternative spatial imaginaries while highlighting some of the tensions embedded in advancing a trans-Saharan political project. Firstly, it deconstructs some of the normative claims used to justify the distinction between North and “sub-Saharan” Africa across political, literary and disciplinary boundaries. Secondly, it draws parallels between Said’s and Mills’ work to demonstrate how geographical boundaries and demarcations have been constructed to create racialized subjects and reinforce a hierarchy of color that favors European standpoints and epistemologies. Third, it draw on Leopard Senghor’s The Foundations of Africanité and Gamal Abdel Nasser’s The Philosophy of the Egyptian Revolution to examine some of the competing strands of unity that emerged out of the Saharan discourse. In these texts, one can identify a number of convergences and divergences in how post-colonial African elites attempts to reclaim and rearticulate the function of the Sahara along different epistemic, political and cultural premises. It concludes with reflections on some of the policy challenges that emerge from reinforcing the Saharan divide, particularly in the realm of peace and security.

Keywords: regional integration, politics of knowledge production, arab-african relations, african solutions to african problems

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115 Sovereign Debt Restructuring: A Study of the Inadequacies of the Contractual Approach

Authors: Salamah Ansari

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In absence of a comprehensive international legal regime for sovereign debt restructuring, majority of the complications arising from sovereign debt restructuring are frequently left to the uncertain market forces. The resort to market forces for sovereign debt restructuring has led to a phenomenal increase in litigations targeting assets of defaulting sovereign nations, internationally across jurisdictions with the first major wave of lawsuits against sovereigns in the 1980s with the Latin American crisis. Recent experiences substantiate that majority of obstacles faced during sovereign debt restructuring process are caused by inefficient creditor coordination and collective action problems. Collective action problems manifest as grab race, rush to exits, holdouts, the free rider problem and the rush to the courthouse. On defaulting, for a nation to successfully restructure its debt, all the creditors involved must accept some reduction in the value of their claims. As a single holdout creditor has the potential to undermine the restructuring process, hold-out creditors are snowballing with the increasing probability of earning high returns through litigations. This necessitates a mechanism to avoid holdout litigations and reinforce collective action on the part of the creditor. This can be done either through a statutory reform or through market-based contractual approach. In absence of an international sovereign bankruptcy regime, the impetus is mostly on inclusion of collective action clauses in debt contracts. The preference to contractual mechanisms vis- a vis a statutory approach can be explained with numerous reasons, but that's only part of the puzzle in trying to understand the economics of the underlying system. The contractual approach proposals advocate the inclusion of certain clauses in the debt contract for an orderly debt restructuring. These include clauses such as majority voting clauses, sharing clauses, non- acceleration clauses, initiation clauses, aggregation clauses, temporary stay on litigation clauses, priority financing clauses, and complete revelation of relevant information. However, voluntary market based contractual approach to debt workouts has its own complexities. It is a herculean task to enshrine clauses in debt contracts that are detailed enough to create an orderly debt restructuring mechanism while remaining attractive enough for creditors. Introduction of collective action clauses into debt contracts can reduce the barriers in efficient debt restructuring and also have the potential to improve the terms on which sovereigns are able to borrow. However, it should be borne in mind that such clauses are not a panacea to the huge institutional inadequacy that persists and may lead to worse restructuring outcomes.

Keywords: sovereign debt restructuring, collective action clauses, hold out creditors, litigations

Procedia PDF Downloads 136
114 Comparing the ‘Urgent Community Care Team’ Clinical Referrals in the Community with Suggestions from the Clinical Decision Support Software Dem DX

Authors: R. Tariq, R. Lee

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Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

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113 Ambivilance, Denial, and Adaptive Responses to Vulnerable Suspects in Police Custody: The New Limits of the Sovereign State

Authors: Faye Cosgrove, Donna Peacock

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This paper examines current state strategies for dealing with vulnerable people in police custody and identifies the underpinning discourses and practices which inform these strategies. It has previously been argued that the state has utilised contradictory and conflicting responses to the control of crime, by employing opposing strategies of denial and adaptation in order to simultaneously both display sovereignty and disclaim responsibility. This paper argues that these contradictory strategies are still being employed in contemporary criminal justice, although the focus and the purpose have now shifted. The focus is upon the ‘vulnerable’ suspect, whose social identity is as incongruous, complex and contradictory as his social environment, and the purpose is to redirect attention away from negative state practices, whilst simultaneously displaying a compassionate and benevolent countenance in order to appeal to the voting public. The findings presented here result from intensive qualitative research with police officers, with health care professionals, and with civilian volunteers who work within police custodial environments. The data has been gathered over a three-year period and includes observational and interview data which has been thematically analysed to expose the underpinning mechanisms from which the properties of the system emerge. What is revealed is evidence of contemporary state practices of denial relating to the harms of austerity and the structural relations of vulnerability, whilst simultaneously adapting through processes of ‘othering’ of the vulnerable, ‘responsibilisation’ of citizens, defining deviance down through diversionary practices, and managing success through redefining the aims of the system. The ‘vulnerable’ suspect is subject to individual pathologising, and yet the nature of risk is aggregated. ‘Vulnerable’ suspects are supported in police custody by private citizens, by multi-agency partnerships, and by for-profit organisations, while the state seeks to collate and control services, and thereby to retain a veneer of control. Late modern ambivalence to crime control and the associated contradictory practices of abjuration and adjustment have extended to state responses to vulnerable suspects. The support available in the custody environment operates to control and minimise operational and procedural risk, rather than for the welfare of the detained person, and in fact, the support available is discovered to be detrimental to the very people that it claims to benefit. The ‘vulnerable’ suspect is now subject to the bifurcated logics employed at the new limits of the sovereign state.

Keywords: custody, policing, sovereign state, vulnerability

Procedia PDF Downloads 146
112 Prenatal Can Reduce the Burden of Preterm Birth and Low Birthweight from Maternal Sexually Transmitted Infections: US National Data

Authors: Anthony J. Kondracki, Bonzo I. Reddick, Jennifer L. Barkin

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We sought to examine the association of maternal Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and treponema pallidum (TP) (syphilis) infections with preterm birth (PTB) (<37 weeks gestation), low birth weight (LBW) (<2500 grams) and prenatal care (PNC) attendance. This cross-sectional study was based on data drawn from the 2020 United States National Center for Health Statistics (NCHS) Natality File. We estimated the prevalence of all births, early/late PTBs, moderately/very LBW, and the distribution of sexually transmitted infections (STIs) according to maternal characteristics in the sample. In multivariable logistic regression models, we examined adjusted odds ratios (aORs) and their corresponding 95% confidence intervals (CIs) of PTB and LBW subcategories in the association with maternal/infant characteristics, PNC status, and maternal CT, NG, and TP infections. In separate logistic regression models, we assessed the risk of these newborn outcomes stratified by PNC status. Adjustments were made for race/ethnicity, age, education, marital status, health insurance, liveborn parity, previous preterm birth, gestational hypertension, gestational diabetes, PNC status, smoking, and infant sex. Additionally, in a sensitivity analysis, we assessed the association with early, full, and late term births and the potential impact of unmeasured confounding using the E-value. CT (1.8%) was most prevalent STI in pregnancy, followed by NG (0.3%), and TP (0.1%). Non-Hispanic Black women, 20-24 years old, with a high school education, and on Medicaid had the highest rate of STIs. Around 96.6% of women reported receiving PNC and about 60.0% initiated PNC early in pregnancy. PTB and LBW were strongly associated with NG infection (12.2% and 12.1%, respectively) and late initiation/no PNC (8.5% and 7.6%, respectively), and ≤10 prenatal visits received (13.1% and 10.3%, respectively). The odds of PTB and LBW were 2.5- to 3-foldhigher for each STI among women who received ≤10 prenatal visits than >10 visits. Adequate prenatal care utilization and timely screening and treatment of maternal STIs can substantially reduce the burden of adverse newborn outcomes.

Keywords: low birthweight, prenatal care, preterm birth, sexually transmitted infections

Procedia PDF Downloads 158
111 Advancing Healthcare Excellence in China: Crafting a Strategic Operational Evaluation Index System for Chinese Hospital Departments amid Payment Reform Initiatives

Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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110 Building up of European Administrative Space at Central and Local Level as a Key Challenge for the Kosovo's Further State Building Process

Authors: Arlinda Memetaj

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Building up of a well-functioning administrative justice system is one of the key prerequisites for ensuring the existence of an accountable and efficient public administration in Kosovo as well. To this aim, the country has already established an almost comprehensive legislative and institutional frameworks. The latter derives from (among others) the Kosovo`s Stabilisation and Association Agreement with the EU of 2016. A series of efforts are being presently still undertaken by all relevant domestic and international stakeholders being active in both the Kosovo`s public administration reform and the country` s system of a local self-government. Both systems are thus under a constant state of reform. Despite the aforesaid, there is still a series of shortcomings in the country in above context. There is a lot of backlog of administrative cases in the Prishtina Administrative court; there is a public lack in judiciary; the public administration is organized in a fragmented way; the administrative laws are still not properly implemented at local level; the municipalities` legislative and executive branches are not sufficiently transparent for the ordinary citizens ... Against the above short background, the full paper firstly outlines the legislative and institutional framework of the Kosovo's systems of an administrative justice and local self-government (on the basis of the fact that public administration and local government are not separate fields). It then illustrates the key specific shortcomings in those fields, as seen from the perspective of the citizens' right to good administration. It finally claims that the current status quo situation in the country may be resolved (among others) by granting Kosovo a status of full member state of the Council of Europe or at least granting it with a temporary status of a contracting party of (among others) the European Human Rights Convention. The later would enable all Kosovo citizens (regardless their ethnic or other origin whose human rights are violated by the Kosovo`s relative administrative authorities including the administrative courts) to bring their case/s before the respective well-known European Strasbourg-based Human Rights Court. This would consequently put the State under permanent and full monitoring process, with a view to obliging the country to properly implement the European Court`s decisions (as adopted by this court in those cases). This would be a benefit first of all for the very Kosovo`s ordinary citizens regardless their ethnic or other background. It would provide for a particular positive input in the ongoing efforts being undertaken by Kosovo and Serbia states within the EU-facilitated Dialogue, with a view to building up of an integral administrative justice system at central and local level in the whole Kosovo` s territory. The main method used in this paper is the descriptive, analytical and comparative one.

Keywords: administrative courts, administrative justice, administrative procedure, benefit, European Human Rights Court, human rights, monitoring, reform.

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109 Weed Out the Bad Seeds: The Impact of Strategic Portfolio Management on Patent Quality

Authors: A. Lefebre, M. Willekens, K. Debackere

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Since the 1990s, patent applications have been booming, especially in the field of telecommunications. However, this increase in patent filings has been associated with an (alleged) decrease in patent quality. The plethora of low-quality patents devalues the high-quality ones, thus weakening the incentives for inventors to patent inventions. Despite the rich literature on strategic patenting, previous research has neglected to emphasize the importance of patent portfolio management and its impact on patent quality. In this paper, we compare related patent portfolios vs. nonrelated patents and investigate whether the patent quality and innovativeness differ between the two types. In the analyses, patent quality is proxied by five individual proxies (number of inventors, claims, renewal years, designated states, and grant lag), and these proxies are then aggregated into a quality index. Innovativeness is proxied by two measures: the originality and radicalness index. Results suggest that related patent portfolios have, on average, a lower patent quality compared to nonrelated patents, thus suggesting that firms use them for strategic purposes rather than for the extended protection they could offer. Even upon testing the individual proxies as a dependent variable, we find evidence that related patent portfolios are of lower quality compared to nonrelated patents, although not all results show significant coefficients. Furthermore, these proxies provide evidence of the importance of adding fixed effects to the model. Since prior research has found that these proxies are inherently flawed and never fully capture the concept of patent quality, we have chosen to run the analyses with individual proxies as supplementary analyses; however, we stick with the comprehensive index as our main model. This ensures that the results are not dependent upon one certain proxy but allows for multiple views of the concept. The presence of divisional applications might be linked to the level of innovativeness of the underlying invention. It could be the case that the parent application is so important that firms are going through the administrative burden of filing for divisional applications to ensure the protection of the invention and the preemption of competition. However, it could also be the case that the preempting is a result of divisional applications being used strategically as a backup plan and prolonging strategy, thus negatively impacting the innovation in the portfolio. Upon testing the level of novelty and innovation in the related patent portfolios by means of the originality and radicalness index, we find evidence for a significant negative association with related patent portfolios. The minimum innovation that has been brought on by the patents in the related patent portfolio is lower compared to the minimum innovation that can be found in nonrelated portfolios, providing evidence for the second argument.

Keywords: patent portfolio management, patent quality, related patent portfolios, strategic patenting

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108 Analysing the Perception of Climate Hazards on Biodiversity Conservation in Mining Landscapes within Southwestern Ghana

Authors: Salamatu Shaibu, Jan Hernning Sommer

Abstract:

Integrating biodiversity conservation practices in mining landscapes ensures the continual provision of various ecosystem services to the dependent communities whilst serving as ecological insurance for corporate mining when purchasing reclamation security bonds. Climate hazards such as long dry seasons, erratic rainfall patterns, and extreme weather events contribute to biodiversity loss in addition to the impact due to mining. Both corporate mining and mine-fringe communities perceive the effect of climate on biodiversity from the context of the benefits they accrue, which motivate their conservation practices. In this study, pragmatic approaches including semi-structured interviews, field visual observation, and review were used to collect data on corporate mining employees and households of fringing communities in the southwestern mining hub. The perceived changes in the local climatic conditions and the consequences on environmental management practices that promote biodiversity conservation were examined. Using a thematic content analysis tool, the result shows that best practices such as concurrent land rehabilitation, reclamation ponds, artificial wetlands, land clearance, and topsoil management are directly affected by prolonging long dry seasons and erratic rainfall patterns. Excessive dust and noise generation directly affect both floral and faunal diversity coupled with excessive fire outbreaks in rehabilitated lands and nearby forest reserves. Proposed adaptive measures include engaging national conservation authorities to promote reforestation projects around forest reserves. National government to desist from using permit for mining concessions in forest reserves, engaging local communities through educational campaigns to control forest encroachment and burning, promoting community-based resource management to promote community ownership, and provision of stricter environmental legislation to compel corporate, artisanal, and small scale mining companies to promote biodiversity conservation.

Keywords: biodiversity conservation, climate hazards, corporate mining, mining landscapes

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