Search results for: long-term care services

Authors: Badli Shah Mohd Yusoff, Khairur Rijal Jamaludin, Rozetta Dollah

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The emerging of reverse logistics and product recovery management is an important concept in reconciling economic and environmental objectives through recapturing values of the end of life product returns. End of life products contains valuable modules, parts, residues and materials that can create value if recovered efficiently. The main objective of this study is to explore and develop a model to recover as much of the economic value as reasonably possible to find the optimality of return acquisition and sorting to meet demand and maximize profits over time. In this study, the benefits that can be obtained for remanufacturer is to develop demand forecasting of used products in the future with uncertainty of returns and quality of products. Formulated based on a generic disassembly tree, the proposed model focused on three reverse logistics activity, namely refurbish, remanufacture and disposal incorporating all plausible means quality levels of the returns. While stricter sorting policy, constitute to the decrease amount of products to be refurbished or remanufactured and increases the level of discarded products. Numerical experiments carried out to investigate the characteristics and behaviour of the proposed model with mathematical programming model using Lingo 16.0 for medium-term planning of return acquisition, disassembly (refurbish or remanufacture) and disposal activities. Moreover, the model seeks an analysis a number of decisions relating to trade off management system to maximize revenue from the collection of use products reverse logistics services through refurbish and remanufacture recovery options. The results showed that full utilization in the sorting process leads the system to obtain less quantity from acquisition with minimal overall cost. Further, sensitivity analysis provides a range of possible scenarios to consider in optimizing the overall cost of refurbished and remanufactured products.

Keywords: core acquisition, end of life, reverse logistics, quality uncertainty

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Authors: Murorunkwere Marie Claire

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Introduction: In Sub-Saharan Africa and specifically in Rwandan rural areas, mother-to-Child human immunodeficiency virus transmission remains a big challenge. This is mainly due to lack of awareness and ignorance among pregnant rural women, leading to neglect regular taking of prophylactic antiretroviral treatment and to persistently beliefs in traditional healers and home deliveries. This paper explores the factors associated with stagnant reduction in human immunodeficiency virus vertical transmission among pregnant rural women and provides solutions to tackle it. Methodology: The first phase of this research will be a qualitative survey was conducted to assess the knowledge, attitudes and practices towards vertical human immunodeficiency virus transmission among pregnant women in one rural district in Rwanda. The data generated from phase one of this research will be used to address the main factors revealed through community mobilization and motivation on attending required antenatal consultations and hospital deliveries, proper and regular antiretroviral treatment taking, and discouraging beliefs in traditional healers and home deliveries. Refresher training seminars will also be organized for healthcare providers qualified on conducting deliveries about current measures to maximize the reduction of chances that can lead to mother -child contamination (to avoid early rupture of membranes and to prevent any source of contamination). Results: This paper is expected to contribute in a significant reduction of the vertical human immunodeficiency virus transmission burden among pregnant rural women. Conclusion: Strong campaigns on prevention of mother- to-child human immunodeficiency virus transmission and community mobilization of pregnant rural women, and house to house education and continuous reminders as well as training seminars to health care personnel on updated measures is, key in addressing vertical human immunodeficiency virus transmission.

Keywords: attitudes transformation, community mobilisation, pregnant rural women, vertical HIV transmission

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Authors: Debasis Sarkar, Jatan Talati

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This paper is an attempt to develop an Integrated Mass Rapid Transit System (MRTS) for a smart city project in Western India. Integrated transportation is one of the enablers of smart transportation for providing a seamless intercity as well as regional level transportation experience. The success of a smart city project at the city level for transportation is providing proper integration to different mass rapid transit modes by way of integrating information, physical, network of routes fares, etc. The methodology adopted for this study was primary data research through questionnaire survey. The respondents of the questionnaire survey have responded on the issues about their perceptions on the ways and means to improve public transport services in urban cities. The respondents were also required to identify the factors and attributes which might motivate more people to shift towards the public mode. Also, the respondents were questioned about the factors which they feel might restrain the integration of various modes of MRTS. Furthermore, this study also focuses on developing a utility equation for respondents with the help of multiple linear regression analysis and its probability to shift to public transport for certain factors listed in the questionnaire. It has been observed that for shifting to public transport, the most important factors that need to be considered were travel time saving and comfort rating. Also, an Integrated MRTS can be obtained by combining metro rail with BRTS, metro rail with monorail, monorail with BRTS and metro rail with Indian railways. Providing a common smart card to transport users for accessing all the different available modes would be a pragmatic solution towards integration of the available modes of MRTS.

Keywords: mass rapid transit systems, smart city, metro rail, bus rapid transit system, multiple linear regression, smart card, automated fare collection system

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Authors: Kristel Faye Tandog

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The State Owned Enterprise (SOE) or also called Public Enterprise (PE) has been playing a vital role in a country’s social and economic development. Following this idea, this study focused on the Factor Structures of Financial Performance of the Local Economic Enterprises (LEEs) namely: Food Court, Market, Slaughterhouse, and Terminal in Matalam, Cotabato. It aimed to determine the profile of the LEEs in terms of organizational structure, manner of creation, years in operation, source of initial operating requirements, annual operating budget, geographical location, and size or description of the facility. This study also included the different financial ratios of LEE that covered a five year period from Calendar Year 2009 to 2013. Primary data using survey questionnaire was administered to 468 respondents and secondary data were sourced out from the government archives and financial documents of the said LGU. There were 12 dominant factors identified namely: “management”, “enforcement of laws”, “strategic location”, “existence of non-formal competitors”, “proper maintenance”, “pricing”, “customer service”, “collection process”, “rentals and services”, “efficient use of resources”, “staffing”, and “timeliness and accuracy”. On the other hand, the financial performance of the LEE of Matalam, Cotabato using financial ratios needs reformatting. This denotes that refinement as to the following ratios: Cash Flow Indicator, Activity, Profitability and Growth is necessary. The cash flow indicator ratio showed difficulty in covering its debts in successive years. Likewise, the activity ratios showed that the LEE had not been effective in putting its investment at work. Moreover, profitability ratios revealed that it had operated in minimum capacity and had incurred net losses and thus, it had a weak profit performance. Furthermore, growth ratios showed that LEE had a declining growth trend particularly in net income.

Keywords: factor structures, financial performance, financial ratios, state owned enterprises

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Authors: Antonios Paraskevas, Michael Madas

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For a university to maintain its international competitiveness in education, it is essential to recruit qualitative academic staff as it constitutes its most valuable asset. This selection demonstrates a significant role in achieving strategic objectives, particularly by emphasizing a firm commitment to exceptional student experience and innovative teaching and learning practices of high quality. In this vein, the appropriate selection of academic staff establishes a very important factor of competitiveness, efficiency and reputation of an academic institute. Within this framework, our work demonstrates a comprehensive methodological concept that emphasizes on the multi-criteria nature of the problem and on how decision makers could utilize our approach in order to proceed to the appropriate judgment. The conceptual framework introduced in this paper is built upon a hybrid neutrosophic method based on the Neutrosophic Analytical Hierarchy Process (N-AHP), which uses the theory of neutrosophy sets and is considered suitable in terms of significant degree of ambiguity and indeterminacy observed in decision-making process. To this end, our framework extends the N-AHP by incorporating the Neutrosophic Delphi Method (N-DM). By applying the N-DM, we can take into consideration the importance of each decision-maker and their preferences per evaluation criterion. To the best of our knowledge, the proposed model is the first which applies Neutrosophic Delphi Method in the selection of academic staff. As a case study, it was decided to use our method to a real problem of academic personnel selection, having as main goal to enhance the algorithm proposed in previous scholars’ work, and thus taking care of the inherit ineffectiveness which becomes apparent in traditional multi-criteria decision-making methods when dealing with situations alike. As a further result, we prove that our method demonstrates greater applicability and reliability when compared to other decision models.

Keywords: analytical hierarchy process, delphi method, multi-criteria decision maiking method, neutrosophic set theory, personnel recruitment

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Authors: Kehinde Joseph Awosan, Balarabe Adami Isah, Edzu Usman Yunusa, Sarafadeen Adeniyi Arisegi, Izuchukwu Obasi, Oluchi Solomon-Anucha

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Background: Metabolic syndrome (MetS) is prevalent in patients with diabetes mellitus and a significant risk for major cardiovascular events. Identifying its burden and peculiarities is crucial to preventing complications among those at risk. Aim: This study was conducted to determine the prevalence and predictors of metabolic syndrome among diabetes clinic attendees in Sokoto, Nigeria. Materials and Methods: A cross-sectional study was conducted among 365 patients with type 2 diabetes attending the diabetes clinic of Specialist Hospital, Sokoto, Nigeria. A structured questionnaire was used to obtain data on the respondents’ socio-demographic variables, treatment history, and lifestyle. Blood pressure and anthropometric measurements (including weight, height, and waist circumference) were done for the patients. Likewise, biochemical assessment (including fasting plasma glucose, high-density lipoprotein cholesterol (HDL-c), and triglyceride (TG) was done. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Data were analyzed using the IBM Statistical Package for Social Sciences (SPSS) version 25. Results: The ages of the patients ranged from 30 to 78 (mean = 50.9 ±11.7) years. The overall prevalence of MetS was 57.3%, with a higher prevalence in females (68.1%) than males (43.0%). The most common components of MetS observed were hypertension (69.2%), and elevated fasting plasma glucose (65.7%); while the predictors of MetS were age > 50 years (OR 6.960, 95% CI: 3.836-12.628, p < 0.001), female sex (OR 2.300, 95% CI: 1.355-3.903, p = 0.002), physical activity (OR 0.214, 95% CI: 0.126-0.363, p < 0.001), and overweight/obesity (OR 3.356, 95% CI: 1.838-6.127, p < 0.001). Conclusion: Metabolic syndrome is prevalent among patients with type 2 diabetes in Sokoto, Nigeria, and the predictors were age > 50 years, female sex, physical activity, and overweight/obesity. Diabetes care providers should screen their patients for MetS to prevent adverse cardiovascular events.

Keywords: prevalence, predictors, metabolic syndrome, diabetes

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Authors: Naveen Kumar Perumalla, Devadas Kuna, Mohammed Akhter Ali

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Satellite Navigation System such as the United States Global Positioning System (GPS) plays a significant role in determining the user position. Similar to that of GPS, Indian Regional Navigation Satellite System (IRNSS) is a Satellite Navigation System indigenously developed by Indian Space Research Organization (ISRO), India, to meet the country’s navigation applications. This system is also known as Navigation with Indian Constellation (NavIC). The NavIC system’s main objective, is to offer Positioning, Navigation and Timing (PNT) services to users in its two service areas i.e., covering the Indian landmass and the Indian Ocean. Six NavIC satellites are already deployed in the space and their receivers are in the performance evaluation stage. Four NavIC dual frequency receivers are installed in the ‘Advanced GNSS Research Laboratory’ (AGRL) in the Department of Electronics and Communication Engineering, University College of Engineering, Osmania University, India. The NavIC receivers can be operated in two positioning modes: Stand-alone IRNSS and Hybrid (IRNSS+GPS) modes. In this paper, analysis of various parameters such as Dilution of Precision (DoP), three Dimension (3D) Root Mean Square (RMS) Position Error and Horizontal Position Error with respect to Visibility of Satellites is being carried out using the real-time IRNSS data, obtained by operating the receiver in both positioning modes. Two typical days (6th July 2017 and 7th July 2017) are considered for Hyderabad (Latitude-17°24'28.07’N, Longitude-78°31'4.26’E) station are analyzed. It is found that with respect to the considered parameters, the Hybrid mode operation of NavIC receiver is giving better results than that of the standalone positioning mode. This work finds application in development of NavIC receivers for civilian navigation applications.

Keywords: DoP, GPS, IRNSS, GNSS, position error, satellite visibility

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Authors: M. Brockes, S. Beck, A. Sigaroudi, C. Brockes

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Over the last years, telemedicine and telemonitoring have become a popular way of treatment, especially in other chronic diseases. Therefore this type of treatment methodology was also implemented in interstitial lung disease (ILD) patients. In January 2024, a new service for patients with interstitial lung disease (ILD) treated with Nintedanib was established, which contains daily telemonitoring (home spirometry, pulse oximetry, and daily level of activity), daily evaluation of parameters as well as a telemedical availability answered by doctors and telemedical specialists throughout 365 days per year. The main motivational points of this service are the early detection of first signs of exacerbations and/or other symptoms/complications as well as easier access to healthcare professionals. The evaluation of the patient’s quality of life and the subjective feeling of safetyness was measured through patient reported experience measurements (PREMs) and patient reported outcome measurements (PROMs). Patients were introduced to the telemedical and telemonitoring service six-months ago. Within this period, every sixty days, the questionnaires were conducted by the scientific employees. Due to the unlimited time frame of the long-term service the evaluation is not completed. The first analysis of patient reported experience measurements (PREMs) and patient reported outcome measurements (PROMs) have shown an increased positive effect on the patients' quality of life as well as an increased positive effect on the subjective feeling of safety at home, plus a reduction and avoidance of secondary damages (e.g., exacerbations, deterioration of typical interstitial lung disease ILD symptoms and pharmaceutical side effects). The first results have shown a tendency that the telemedical treatment combined with telemonitoring at home and the encouragement of patients to actively participate in their healthcare has a positive effect on the patient’s overall well-being and could be implemented as a complementation of the traditional standard of care.

Keywords: avoidance of secondary damages, interstitial lung disease, telemedicine and telemonitoring, subjective feeling of safety

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Authors: Noah Emil Glisik

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Multiple sclerosis (MS) is a chronic, immune-mediated disorder characterized by neurodegenerative processes and a highly variable disease course. Recent research highlights a complex interplay between psychological stress and MS progression, with both acute and chronic stressors linked to heightened inflammatory activity, increased relapse risk, and accelerated disability. This review synthesizes findings from systematic analyses, cohort studies, and neuroimaging investigations to examine how stress contributes to disease dynamics in MS. Evidence suggests that psychological stress influences MS progression through neural and physiological pathways, including dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and heightened activity in specific brain regions, such as the insular cortex. Notably, functional MRI studies indicate that stress-induced neural activity may predict future atrophy in gray matter regions implicated in motor and cognitive function, thus supporting a neurobiological link between stress and neurodegeneration in MS. Longitudinal studies further associate chronic stress with reduced quality of life and higher relapse frequency, emphasizing the need for a multifaceted therapeutic approach that addresses both the physical and psychological dimensions of MS. Evidence from intervention studies suggests that stress management strategies, such as cognitive-behavioral therapy and mindfulness-based programs, may reduce relapse rates and mitigate lesion formation in MS patients. These findings underscore the importance of integrating stress-reducing interventions into standard MS care, with potential to improve disease outcomes and patient well-being. Further research is essential to clarify the causal pathways and develop targeted interventions that could modify the stress response in MS, offering an avenue to address disease progression and enhance quality of life.

Keywords: multiple sclerosis, psychological stress, disease progression, neuroimaging, stress management

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Authors: Anetta Caplanova, Eva Sirakovova, Estera Szakadatova

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Non-payment of taxes and fees represents a problem, which occurs at national and local government levels in many countries. An effective tax collection is key for generating government and local government budget revenues to finance public services and infrastructure; thus, there is the need to address this problem. The standard approach considers as a solution raising taxes/fees to boost public revenues, which may be politically challenging and time-consuming to implement. An alternative approach is related to using behavioral interventions. These can be usually implemented relatively quickly, and in most cases, they are associated with low cost. In the paper, we present the results of the behavioral experiment focused on raising the level of compliance with the payment of garbage collection fees in a selected municipality in the Slovak Republic. The experiment was implemented using the leaflets sent to residential households together with the invoice for the garbage collection in the municipality Hlohovec, Western Slovakia, in Spring 2021. The sample of about 10000 households was divided into three random groups, a control group and two intervention groups. Households in intervention group 1 were sent a leaflet using the social norm nudge, while households in intervention group 2 were sent a leaflet using the deterrence nudge. The social norm framing leaflet pointed out that in the municipality, the prevailing majority of people paid the garbage collection fee and encouraged recipients to join this majority. The deterrent leaflet reminded the recipients that if they did not pay the fee on time, enforcement proceedings would follow. This was aimed to increase the subjective perception of citizens of the enforcement proceedings in case of noncompliance. In the paper, we present and discuss the results from the experiment and formulate relevant generalizations for other municipalities.

Keywords: municipal governments, garbage fee collection, behavioural intervention, social norm, deterrence nudge

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Authors: Bianca W. O. Silva, Adriana C. M. Andrade, Gustavo C. M. Lucena, Virna M. S. Lima

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Introduction: Basic life support (BLS) involves the immediate recognition of cardiopulmonary arrest. Each year, 359.400 and 275.000 individuals with cardiac arrest are attended in emergency departments in USA and Europe. Brazilian data shows that 200.000 cardiac arrests occur every year, and half of them out of the hospital. Medical schools around the world teach BLS in the first years of the course, but studies show that there is a decline of the knowledge as the years go by, affecting the chain of survival. The objective was to analyze the knowledge of medical students about BLS and the retention of this learning throughout the course. Methods: This study included 150 students who were at the second and third year of a medical school in Salvador, Bahia, Brazil. The instrument of data collection was a structured questionnaire composed of 20 questions based on the 2015 American Heart Association guideline. The Pearson Chi-square test was used in order to study the association between previous training, sex and semester with the degree of knowledge of the students. The Kruskal-Wallis test was used to evaluate the different yields obtained between the various semesters. The number of correct answers was described by average and quartiles. Results: Regarding the degree of knowledge, 19.6% of the female students reached the optimal classification, a better outcome than the achieved by the male participants. Of those with previous training, 33.33% were classified as good and optimal, none of the students reached the optimal classification and only 2.2% of them were classified as bad (those who did not have 52.6% of correct answers). The analysis of the degree of knowledge related to each semester revealed that the 5th semester had the highest outcome: 30.5%. However, the acquaintance presented by the semesters was generally unsatisfactory, since 50% of the students, or more, demonstrated knowledge levels classified as bad or regular. When confronting the different semesters and the achieved scores, the value of p was 0.831. Conclusion: It is important to focus on the training of medical professionals that are capable of facing emergency situations, improving the systematization of care, and thereby increasing the victims' possibility of survival.

Keywords: basic life support, cardiopulmonary ressucitacion, education, medical students

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Authors: Shizrah Jamal, Robia Ghafoor, Farhan Raza

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Porcelain fused to metal crown is the most versatile variety of crown that is commonly placed worldwide. Various complications have been reported in the PFM crowns with use over the period of time. These include chipping of the porcelain, recurrent caries, loss of retention, open contacts, and tooth fracture. The objective of the present study was to determine the frequency of these complications in crowns cemented over a period of five years in a tertiary care hospital and also to report the survival of these crowns. A retrospective study was conducted in Dental clinics, Aga Khan University Hospital in which 150 PFM crowns cemented over a period of five years were evaluated. Patient demographics, oral hygiene habits, para-functional habits, crown insertion and follow-up dates were recorded in a specially designed proforma. All PFM crowns fulfilling the inclusion criteria were assessed both clinically and radiographically for the presence of any complication. SPSS version 22.0 was used for statistical analysis. Frequency distribution and proportion of complications were determined. Chi-square test was used to determine the association of complications of PFM crowns with multiple variables including tooth wear, opposing dentition and betel nut chewing. Kaplan- meier survival analysis was used to determine the survival of PFM crowns over the period of five years. Level of significance was kept at 0.05. A total of 107 patients, with a mean age of 43.51 + 12.4 years, having 150 PFM crowns were evaluated. The most common complication observed was open proximal contacts (8.7%) followed by porcelain chipping (6%), decementation (5.3%), and abutment fracture (1.3%). Chi square test showed that there was no statistically significant association of PFM crown complication with tooth wear, betel nut and opposing dentition (p-value <0.05). The overall success and survival rates of PFM crowns turned out to be 78.7 and 84.7% respectively. Within the limitations of the study, it can be concluded that PFM crowns are an effective treatment modality with high success and survival rates. Since it was a single centered study; the results should be generalized with caution.

Keywords: chipping, complication, crown, survival rate

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Authors: Fiorenza Misale

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The painful phenomenon of so-called white deaths and accidents at work, unfortunately, is always current. The key is to act on the culture of security through effective measures of attitudes and behaviors that go far beyond the knowledge and the know-how. It is necessary that there is an ‘introjection’ of safety culture through the conscious involvement of all workers. The legislation on work safety identifies the main tool to promote the culture of safety at work and prevention within the workplace. In law the term education is used to distinguish itself from the information with which they will simply theoretically transmit, and from the training with which they will provide the practical skills. The new decree fact fills several gaps in previous legislation and stresses the importance of training in the workplace, that is, the main activity through which it is possible to achieve the active participation of all workers in the company’s prevention system. This system is built only through the dissemination of risk information, the circulation of information, comparison and dialogue between all actors involved that are the necessary elements for a correct transmission of the culture of worker safety. Training activity should put the focus on work experience in order to bring out all the knowledge needed to identify and assess the risks in the work place, and especially the action to eliminate or control them, integrating, when necessary, the missing knowledge. In addition to traditional training and information systems can be utilized for the purpose of training that are able to affect both one emotionally and aesthetically, team-theatre is one of them. Among the methods of company theater that can be used in work safety we have: Lesson show, theater workshop, improvised theater, forum theater, theater playback. The theater can represent a complementary approach to traditional training and give information on safety measures, demonstrating that there are more engaging outreach tools. Team-theatre allows identification with the characters, a transmission of emotions and moods and it is through the staging of a story that the individual processes new information. It’ also s a means of experiential training that allows you to work with your mind, body, emotions.The aim of one work is the use of corporate theater on the personnel working in the health sector. Through a questionnaire we are able to analyze the knowledge of occupational safety and current risks; in particular in health care which is to be administered before and after the play.

Keywords: theater, training, occupational health, safety

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Authors: T. Iakovleva

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Present paper suggests a theoretical model that describes the process of the development of responsible innovations on the firm level in health and welfare sectors. There is a need to develop new firm strategies in these sectors. This paper suggests to look on the concept of responsible innovation that was originally developed on the social level and to apply this new concept to the new area of firm strategy. The rapid global diffusion of information and communication technologies has greatly improved access to knowledge. At the same time, communication is cheap, information is a commodity, and global trade increases technological diffusion. As a result, firms and users, including those outside of industrialized nations, get early exposure to the latest technologies and information. General-purpose technologies such as mobile phones and 3D printers enable individuals to solve local needs and customize products. The combined effect of these changes is having a profound impact on the innovation landscape. Meanwhile, the healthcare sector is facing unprecedented challenges, which are magnified by budgetary constraints, an aging population and the desire to provide care for all. On the other hand, patients themselves are changing. They are savvier about their diseases, they expect their relation with the healthcare professionals to be open and interactive, but above all they want to be part of the decision process. All of this is a reflection of what is already happening in other industries where customers have access to large amount of information and became educated buyers. This article addresses the question of how ICT research and innovation may contribute to developing solutions to grand societal challenges in a responsible way. A broad definition of the concept of responsibility in the context of innovation is adopted in this paper. Responsibility is thus seen as a collective, uncertain and future-oriented activity. This opens the questions of how responsibilities are perceived and distributed and how innovation and science can be governed and stewarded towards socially desirable and acceptable ends. This article addresses a central question confronting politicians, business leaders, and regional planners.

Keywords: responsible innovation, ICT, healthcare, welfare sector

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Authors: Brianna M. Soule, Jesslyn A. Bryk-Lucy, Linda M. Ritchie

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Colic, defined as abdominal pain in the horse, has several known predisposing factors. Decreased water intake has been shown to predispose equines to impaction colic. The objective of this study was to determine if offering flavored water (sweet feed or banana extract) would increase voluntary water intake in horses to serve as an assessable, noninvasive method for farm managers, veterinarians, or owners to decrease the risk of impaction colic. An a priori power analysis, which was conducted using G*Power version 3.1.9.7, indicated that the minimum sample size required to achieve 80% power for detecting a large effect at a significance level of α = .05 was 19 horses for a one-way repeated measures ANOVA with three treatment levels and assuming a non-sphericity correction of ε=0.5. After a three-day control period, 21 horses were randomly divided into two sequences and offered either banana or sweet feed flavored water. Horses always had a bucket of unflavored water available. A repeated measure study design was used to measure water consumption of each horse over a 62-hour period. A one-way repeated measures ANOVA was conducted to determine whether there were statistically significant differences among the means for the three-day average water intake (ml/kg). Although not statistically significant (F(2, 38) = 1.28, p = .290, partial η2 = .063), the three-day average water intake was largest for banana flavored water (M = 53.51, SD = 9.25 ml/kg), followed by sweet feed (M = 52.93, SD = 11.99 ml/kg), and, finally, unflavored water (M = 50.40, SD = 10.82 ml/kg). Paired-samples t-tests were used to determine whether there was a statistically significant difference between the three-day average water intake (ml/kg) for flavored versus unflavored water. The average unflavored water intake (M = 29.3 ml/kg, SD = 8.9) over the measurement period was greater than the banana flavored water (M = 27.7 ml/kg, SD = 9.8), but the average consumption of the sweet feed flavored water (M = 30.4 ml/kg, SD = 14.6) was greater than unflavored water (M = 24.3 ml/kg, SD = 11.4). None of these differences in average intake were statistically significant (p > .244). Future research is warranted to determine if other flavors significantly increase voluntary water intake in horses.

Keywords: colic, equine, equine science, water intake, flavored water, horses, equine management, equine health, horse health, horse health care management, colic prevention

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Authors: Dina Mohamed Ayman, Rafieu Akin

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In an attempt to increase the female total entrepreneurial activities (TEA) within Egypt and Nigeria, this paper aims to investigate the challenges facing female entrepreneurs operating in Egypt, in relative to Nigeria. In this regard, both researchers undertook a qualitative approach due to the scarcity of the literature reviewed on the topic; in those particular countries, and as an in-depth comparative mode. Therefore, ten Egyptian entrepreneurs in relative to ten Nigerian entrepreneurs were in-depth investigated. The research findings prove that female entrepreneurs face complex problems for being both gender and country-specific. Regarding the gender-specific obstacles, the work/life imbalance due to the scarcity of child-care nurseries and the prevalence of the gender-role division while performing the house chores rather than the concept of co-operation, acted as a main source of cultural challenge because women are considered mostly as 'housewives'. However, interestingly, this specific gender-discrimination challenge is proven to have no grounded effect in terms of the business-establishment and daily dealings neither in Egypt nor Nigeria, as one of the sample exclaimed 'as long as you pay, then no gender difference is set on the table'. Other country-specific challenges facing female entrepreneurs, lied in, the aggregate weak entrepreneurial framework governing both countries, also, women faced the difficulty of access to financial institutions with collateral requirements that are usually "hardly to be met", besides, the absence of the "micro-credit-Grameen-banks" concept. As well, the scarcity of incubators and business training centers providing network, consultancy and well-trained workforce to female entrepreneurs constitute a major hurdle for women entrepreneurs operating in both countries. Finally, this paper will conclude the research by offering a set of public-policy recommendations to pave the way for females to choose self-employment as a career path.

Keywords: entrepreneurship, female entrepreneurship, obstacles, framework conditions, culture, micro-credit

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Authors: Vaishali Joshi

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In the past, companies and buyers operated as if there was infinite availability of natural resources for usage, which has resulted in the loss of our globe's natural ecosystem. People's consciousness of ecological concerns had increased, which showed the way for the evolution of the green revolution with the objective of discontinuing the use of products that are harmful to the ecosystem of the earth. This green revolution has made the consumers head toward those companies which are providing eco-friendly products s/service s through less eco-harmful ways. Studies show that companies started gaining a reputation in the market through their eco-friendly activities in their business. Hence companies should be alert to understand the consumer's environmentally friendly consumption behavior to survive and be in the game of the competition. Green marketing efforts guarantee beneficial exchanges without harmful consequences for current and /or upcoming generations. This hits the green policies of those companies which are claiming environmental concern. This means that these companies not only focus on the impact of their production and products on the ecosystem but also on every small activity in their value chain. One of the most ignored parts of the value chain is the medium through which the marketing of products/services is done. These companies should also take into account to what degree their selection of advertising media affects the ecosystem of the earth. In this study, a hypothetical fashion apparel brand known as "Dolphin" will be studied. In particular, the following objectives are framed: i) to study the brand attitude of the given fashion brand due to its selection of eco-friendly advertising medium ii) to study the advertisement attitude of the given fashion brand due to its selection of eco-friendly advertising medium and iii) to study the purchase intention of the given fashion brand due to its selection of eco-friendly advertising medium. An online experiment will be conducted. Respondents between the ages of 20-and 64 years will be selected randomly from the online consumer panel database. The findings of this study will have a great impact on the companies that are claiming environmental concerns by understanding how the advertising media is affecting the company’s brand image in the long run.

Keywords: eco-friendly advertising media, fashion, attitude, purchase intention

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Authors: Tria Moore Aimee Walker-Clarke

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The purpose of the study was to develop a deeper understanding of how self-identity is negotiated and reconstructed by people in recovery from substance abuse. The approach draws on the notion that self-identity is constructed through stories. Specifically, dominant narratives of substance abuse involve the 'addict identity' in which the meaning of being an addict is constructed though social interaction and informed by broader social meanings of substance misuse, which are considered deviant. The addict is typically understood as out of control, weak and feckless. Users may unconsciously embody this addict identity which makes recovery less likely. Typical approaches to treatment employ the notion that recovery is much more likely when users change the way they think and feel about themselves by assembling a new identity. Recovery, therefore, involves a reconstruction of the self in a new light, which may mean rejecting a part of the self (the addict identity). One limitation is that previous research on this topic has been quantitative which, while useful, tells us little about how this process is best managed. Should one, for example, reject the past addict identity completely and move on to the new identity, or, is it more effective to accept the past identity and use this in the formation of the new non-user identity? The purpose of this research, then, is to explore how addicts in recovery have managed the transition between their past and current selves and whether this may inform therapeutic practice. Using a narrative approach, data were analyzed from five in-depth interviews with former addicts who had been abstinent for at least a year, and who were in some form of volunteering role at substance treatment services in the UK. Although participants' identified with a previous ‘addict identity,’ and made efforts to disassociate themselves from this, they also recognized that acceptance was an important part of reconstructing their new identity. The participants' narratives used familiar plot lines to structure their stories, in which they positioned themselves as the heroes in their own stories, rather than as victim of circumstance. Instead of rejecting their former addict identity, which would mean rejecting a part of the self, participants used their experience in a reconstructive and restorative way. The findings suggest that encouraging people to tell their story and accept their addict identity are important factors in successful recovery.

Keywords: addiction, identity, narrative, recovery, substance abuse

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Authors: Sangeeta Girdhar, Amanat Grewal, Nahush Bansal

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Introduction: There is an increasing burden of hypertension in India. The morbidity and mortality arising from complications are mainly due to non-adherence to medication, unhealthy dietary habits, and lack of physical activity. Non-adherence is a well-recognised factor contributing to inadequate control of high blood pressure. Adherence to pharmacotherapy for hypertension varies from 43% to 88%. Non-adherence is influenced by various socio-demographic factors. Understanding these factors is useful in managing non-adherence. Therefore, the study was planned to determine adherence among hypertensives and factors associated with non-adherence to treatment. Methodology: A cross-sectional study was conducted at Urban Health Training Centre of Dayanand Medical College and Hospital Ludhiana. Patients attending the OPD over a period of 3 months were included in the study. Prior ethical approval was obtained, and informed consent was taken from subjects. A predesigned semi-structured questionnaire was applied, which included socio-demographic profile, treatment-seeking behaviour, adherence to the antihypertensive medication, lifestyle factors (intake of alcohol, smoking, consumption of junk food, high salt intake) contributing to the development of the disease. Reasons for non-adherence to the therapy were also explored. Data was entered into excel, and SPSS 26 version was used for analysis. Results: A total of 186 individuals were interviewed. Out of these, 113 females (60.8%) and 73 males (39.2%) participated in the study. Mean age of participants was 60.9 ± 10.7 years. Adherence to anti-hypertensive treatment was found in 68.3% of the participants. It was observed that adherence was more in literate individuals as compared to illiterate (p value- 0.78). Adherence was lower among smokers (33.3%) and alcohol consumers (53.8%) as compared to non-users (69.4% and 70.6%, respectively). The predominant reasons for skipping medications were discontinuing medication when feeling well, forgetfulness and unawareness. Conclusion: There is a need to generate awareness regarding the importance of adherence to therapy among patients. Intensive health education and counselling of the patients is the need of the hour.

Keywords: hypertension, anti-hypertensive, adherence, counselling

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Authors: Stephanie Boue, Nicolas Sierro, Julia Hoeng, Manuel C. Peitsch

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Systems biology relies on large numbers of data points and sophisticated methods to extract biologically meaningful signal and mechanistic understanding. For example, analyses of transcriptomics and proteomics data enable to gain insights into the molecular differences in tissues exposed to diverse stimuli or test items. Whereas the interpretation of endpoints specifically measuring a mechanism is relatively straightforward, the interpretation of big data is more complex and would benefit from comparing results obtained with diverse analysis methods. The sbv IMPROVER project was created to implement solutions to verify systems biology data, methods, and conclusions. Computational challenges leveraging the wisdom of the crowd allow benchmarking methods for specific tasks, such as signature extraction and/or samples classification. Four challenges have already been successfully conducted and confirmed that the aggregation of predictions often leads to better results than individual predictions and that methods perform best in specific contexts. Whenever the scientific question of interest does not have a gold standard, but may greatly benefit from the scientific community to come together and discuss their approaches and results, datathons are set up. The inaugural sbv IMPROVER datathon was held in Singapore on 23-24 September 2016. It allowed bioinformaticians and data scientists to consolidate their ideas and work on the most promising methods as teams, after having initially reflected on the problem on their own. The outcome is a set of visualization and analysis methods that will be shared with the scientific community via the Garuda platform, an open connectivity platform that provides a framework to navigate through different applications, databases and services in biology and medicine. We will present the results we obtained when analyzing data with our network-based method, and introduce a datathon that will take place in Japan to encourage the analysis of the same datasets with other methods to allow for the consolidation of conclusions.

Keywords: big data interpretation, datathon, systems toxicology, verification

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Authors: Helene Eller

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The aim of non-profit organizations (NPO) is to provide services and goods for its clientele, with profit being a minor objective. By having this definition as the basic purpose of doing business, it is obvious that the goal of an organisation is to serve several bottom lines and not only the financial one. This approach is underpinned by the non-distribution constraint which means that NPO are allowed to make profits to a certain extent, but not to distribute them. The advantage is that there are no single shareholders who might have an interest in the prosperity of the organisation: there is no pie to divide. The gained profits remain within the organisation and will be reinvested in purposeful projects. Good governance is mandatory to support the aim of NPOs. Looking for a measure of good governance the principals of corporate governance (CG) will come in mind. The purpose of CG is direction and control, and in the field of NPO, CG is enlarged to consider the relationship to all important stakeholders who have an impact on the organisation. The recognition of more relevant parties than the shareholder is the link to corporate social responsibility (CSR). It supports a broader view of the bottom line: It is no longer enough to know how profits are used but rather how they are made. Besides, CSR addresses the responsibility of organisations for their impact on society. When transferring the concept of CSR to the non-profit area it will become obvious that CSR with its distinctive features will match the aims of NPOs. As a consequence, NPOs who apply CG apply also CSR to a certain extent. The research is designed as a comprehensive theoretical and empirical analysis. First, the investigation focuses on the theoretical basis of both concepts. Second, the similarities and differences are outlined and as a result the interconnection of both concepts will show up. The contribution of this research is manifold: The interconnection of both concepts when applied to NPOs has not got any attention in science yet. CSR and governance as integrated concept provides a lot of advantages for NPOs compared to for-profit organisations which are in a steady justification to show the impact they might have on the society. NPOs, however, integrate economic and social aspects as starting point. For NPOs CG is not a mere concept of compliance but rather an enhanced concept integrating a lot of aspects of CSR. There is no “either-nor” between the concepts for NPOs.

Keywords: business ethics, corporate governance, corporate social responsibility, non-profit organisations

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Authors: Simont Toussi

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Cameroon and the Central African Republic arebound by the provisions of many regional and international charters, which condemn the manipulation of information, obstacles to access reliable information, or the limitation of freedoms of expression and opinion. These two countries also have constitutional guarantees for free speech and access to true and liable information. However, they are yet to define specific policies and regulations for access to information, disinformation, or misinformation. Yet, certain countries’ laws and regulations related to information and communication technologies, to criminal procedures, to terrorism, or intelligence services contain provisions that rather hider human rights by condemning false information. Like many other African countries, Cameroon and the Central African Republic face a profound democratic regression, and governments use multiple methods to stifle online discourse and digital rights. Despite the increased uptake of digital tools for political participation, there is a lack of interactivity and adoption of these tools. This enables a scarcity of information and creates room for the spreading of disinformation in the public space, hamperingdemocracy and the respect for human rights. This research aims to analyse the adequacy of stakeholders’ responses to disinformation in Cameroon and the Central African Republic in periods of political contestation, such as elections and anti-government protests, to highlight the nature, perpetrators, strategies, and channels of disinformation, as well as its effects on democratic actors, including civil society, bloggers, government critics, activists, and other human rights defenders. The study follows a qualitative method with literature review, content analysis, andkey informant’sinterviews with stakeholders’ representatives, emphasized crowdsourcing as a data and information collecting method in the two countries.

Keywords: disinformation, democracy, political manipulation, social media, media, fake news, central Africa, cameroon, misinformation, free speech

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Authors: Wilfred Elliam

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Background: Pain is a prevalent and debilitating symptom among breast cancer patients, impacting their quality of life and overall well-being. The experience of pain in this population is multifaceted, influenced by a combination of disease-related factors, treatment side effects, and individual characteristics. Despite advancements in cancer treatment and pain management, many breast cancer patients continue to suffer from chronic pain, which can persist long after the completion of treatment. Understanding the progression of pain in breast cancer patients over time and identifying its correlates is crucial for effective pain management and supportive care strategies. The purpose of this research is to understand the patterns and progression of pain experienced by breast cancer survivors over time. Methods: Data were collected from breast cancer patients at Hartford Hospital at four time points: baseline, 3, 6 and 12 weeks. Key variables measured include pain, body mass index (BMI), fatigue, musculoskeletal pain, sleep disturbance, and demographic variables (age, employment status, cancer stage, and ethnicity). Binomial generalized linear mixed models were used to examine changes in pain and symptoms over time. Results: A total of 100 breast cancer patients aged  18 years old were included in the analysis. We found that the effect of time on pain (p = 0.024), musculoskeletal pain (p= <0.001), fatigue (p= <0.001), and sleep disturbance (p-value = 0.013) were statistically significant with pain progression in breast cancer patients. Patients using aromatase inhibitors have worse fatigue (<0.05) and musculoskeletal pain (<0.001) compared to patients with Tamoxifen. Patients who are obese (<0.001) and overweight (<0.001) are more likely to report pain compared to patients with normal weight. Conclusion: This study revealed the complex interplay between various factors such as time, pain, sleep disturbance in breast cancer patient. Specifically, pain, musculoskeletal pain, sleep disturbance, fatigue exhibited significant changes across the measured time points, indicating a dynamic pain progression in these patients. The findings provide a foundation for future research and targeted interventions aimed at improving pain in breast cancer patient outcomes.

Keywords: breast cancer, chronic pain, pain management, quality of life

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Authors: Mequanint Birhan

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Modern urban environments present a dynamically growing field where, notwithstanding shared goals, several mutually conflicting interests frequently collide. However, it has a big impact on the city's socioeconomic standing, waiting lines and queues are common occurrences. This results in extremely long lines for both vehicles and people on incongruous routes, service coagulation, customer murmuring, unhappiness, complaints, and looking for other options sometimes illegally. The root cause of this is corruption, which leads to traffic jams, stopping, and packing vehicles beyond their safe carrying capacity, and violating the human rights and freedoms of passengers. This study focused on the optimizing time of passengers had to wait in public vehicle stations. This applied research employed both data gathering sources and mixed approaches, then 166 samples of key informants of transport station were taken by using the Slovin sampling formula. The length of time vehicles, including the drivers and auxiliary drivers ‘Weyala', had to wait was also studied. To maximize the service level at vehicle stations, a queuing model was subsequently devised ‘Menaharya’. Time, cost, and quality encompass performance, scope, and suitability for the intended purposes. The minimal response time for passengers and vehicles queuing to reach their final destination at the stations of the Tepi, Mizan, and Bonga towns was determined. A new bus station system was modeled and simulated by Arena simulation software in the chosen study area. 84% improvement on cost reduced by 56.25%, time 4hr to 1.5hr, quality, safety and designed load performance calculations employed. Stakeholders are asked to put the model into practice and monitor the results obtained.

Keywords: Arena 14 automatic rockwell, queue, transport services, vehicle stations

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Authors: Kerry Hull, Mark Wright

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This paper brings light to ethnobotanical medicines used by the Maya of Belize to treat snake bites. The varying ecological zones of Belize boast over fifty species of snakes, nine of which are poisonous and dangerous to humans. Two distinct Maya groups occupy neighboring regions of Belize, the Q’eqchi’ and the Mopan. With Western medical care often far from their villages, what traditional methods are used to treat poisonous snake bites? Based primarily on data gathered with native consultants during the authors’ fieldwork with both groups, this paper details the ethnobotanical resources used by the Q’eqchi’ and Mopan traditional healers. The Q’eqchi’ and Mopan most commonly rely on traditional ‘bush doctors’ (ilmaj in Mopan), both male and female, and specialized ‘snake doctors’ to heal bites from venomous snakes. First, this paper presents each plant employed by healers for bites for the nine poisonous snakes in Belize along with the specific botanical recipes and methods of application for each remedy. Individual chemical and therapeutic qualities of some of those plants are investigated in an effort to explain their possible medicinal value for different toxins or the symptoms caused by those toxins. In addition, this paper explores mythological associations with certain snakes that inform local understanding regarding which plants are considered efficacious in each case, arguing that numerous oral traditions (recorded by the authors) help to link botanical medicines to episodes within their mythic traditions. Finally, the use of plants to counteract snakebites brought about through sorcery is discussed inasmuch as some snakes are seen as ‘helpers’ of sorcerers. Snake bites given under these circumstances can only be cured by those who know both the proper corresponding plant(s) and ritual prayer(s). This paper provides detailed documentation of traditional ethnomedicines and practices from the dying art of traditional Maya healers and argues for multi-faceted diagnostic techniques to determine toxin severity, the presence or absence of sorcery, and the appropriate botanical remedy.

Keywords: ethnobotany, Maya, medicine, snake bites

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Authors: Cytha Nilam Chairani, Ditha Noviantika, Hidayati Amir, Nurul Khairiyah, Siti Rahmadita, Fadila Khairani

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Background: Dental caries is one of the most common diseases with high prevalence in children. The first permanent molar (FPM) has an essential role in establishing the occlusion. Nevertheless, FPM is very prone to caries because of various factors, such as their anatomical structure and early emergence in oral cavity. It is due to the little knowledge from parents and children regarding the timing of emergence of FPM in oral cavity which is still considered as primary teeth. Furthermore, the lack of knowledge from parents and children may affect their oral hygiene practice resulting to carious process. Objective: The aim of this study was to assess the status of FPM caries and its association with children’s oral hygiene practice in 9-12-year-old school children in Lubuk Kilangan Community Health Centre, Padang City. Methods: A cross-sectional study was performed in 50 school children (9-12 years old) using random sampling technique from two randomly selected schools in Lubuk Kilangan Community Health Centre, Padang City. A questionnaire was developed from other studies consisting of four closed ended questions regarding oral health practice. The data obtained were analyzed statistically using Mann-Whitney Test to assess the status of FPM caries and its association with children’s oral hygiene practice. Results: The results showed that 32% of children had FPMs sound and the remaining 68% had FPMs carious which were grouped into 1-2 FPMs carious (60%) and 3-4 FPMs carious (8%). The caries status of mandibular FPM (64%) was higher compared to maxillary FPM (10%). Conclusion: There was significant association in subject who did not visit dentist in the last 6 months which had more carious FPMs compared to subject who visited dentist (p < 0.05). There was no significant association between the status of FPM caries and knowledge of the timing eruption of FPM, oral hygiene instruction from parents and tooth brushing (p > 0.05).

Keywords: dental caries, children, first permanent molar, oral hygiene practice

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Authors: Ferdi Sönmez, Nihal Yorulmaz

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Decision making on the true planning of the public transportation systems to serve potential users is a must for metropolitan areas. To take attraction of travelers to projected modes of transport, adequately fair overall travel times should be provided. In this fashion, other benefits such as lower traffic congestion, road safety and lower noise and atmospheric pollution may be earned. The congestion which comes with increasing demand of public transportation is becoming a part of our lives and making residents’ life difficult. Hence, regulations should be done to reduce this congestion. To provide a constructive and balanced regulation in public transportation systems, right stations should be located in right places. In this study, it is aimed to design and implement a Decision Support System (DSS) Application to determine the optimal bus stop places for public transport in Istanbul which is one of the biggest and oldest cities in the world. Required information is gathered from IETT (Istanbul Electricity, Tram and Tunnel) Enterprises which manages all public transportation services in Istanbul Metropolitan Area. By using the most real-like values, cost assignments are made. The cost is calculated with the help of equations produced by bi-level optimization model. For this study, 300 buses, 300 drivers, 10 lines and 110 stops are used. The user cost of each station and the operator cost taken place in lines are calculated. Some components like cost, security and noise pollution are considered as significant factors affecting the solution of set covering problem which is mentioned for identifying and locating the minimum number of possible bus stops. Preliminary research and model development for this study refers to previously published article of the corresponding author. Model results are represented with the intent of decision support to the specialists on locating stops effectively.

Keywords: operator cost, bi-level optimization model, user cost, urban transportation

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Authors: Said Benaissa, David Plets, Emmeric Tanghe, Jens Trogh, Luc Martens, Leen Vandaele, Annelies Van Nuffel, Frank A. M. Tuyttens, Bart Sonck, Wout Joseph

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The herd monitoring and managing - in particular the detection of ‘attention animals’ that require care, treatment or assistance is crucial for effective reproduction status, health, and overall well-being of dairy cows. In large sized farms, traditional methods based on direct observation or analysis of video recordings become labour-intensive and time-consuming. Thus, automatic monitoring systems using sensors have become increasingly important to continuously and accurately track the health status of dairy cows. Wireless sensor networks (WSNs) and internet-of-things (IoT) can be effectively used in health tracking of dairy cows to facilitate herd management and enhance the cow welfare. Since on-cow measuring devices are energy-constrained, a proper characterization of the off-body wireless channel between the on-cow sensor nodes and the back-end base station is required for a power-optimized deployment of these networks in barns. The aim of this study was to characterize the off-body wireless channel in indoor (barns) environment at 868 MHz using LoRa nodes. LoRa is an emerging wireless technology mainly targeted at WSNs and IoT networks. Both large scale fading (i.e., path loss) and temporal fading were investigated. The obtained path loss values as a function of the transmitter-receiver separation were well fitted by a lognormal path loss model. The path loss showed an additional increase of 4 dB when the wireless node was actually worn by the cow. The temporal fading due to movement of other cows was well described by Rician distributions with a K-factor of 8.5 dB. Based on this characterization, network planning and energy consumption optimization of the on-body wireless nodes could be performed, which enables the deployment of reliable dairy cow monitoring systems.

Keywords: channel, channel modelling, cow monitoring, dairy cows, health monitoring, IoT, LoRa, off-body propagation, PLF, propagation

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Authors: Iruka C. Anugwo, Winston M. Shakantu

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The objective of this study is to uncover the basic business-forces that necessitated the survival and sustainable performance of the medium scale contractors in the South African construction market. This study is essential as it set to contribute towards long-term strategic solutions for combating the incessant failure of start-ups construction organizations within South African. The study used a qualitative research methodology; as the most appropriate approach to elicit and understand, and uncover the phenomena that are basic business-forces for the active contractors in the market. The study also adopted a phenomenological study approach; and in-depth interviews were conducted with 20 medium scale contractors in Port Elizabeth, South Africa, between months of August to October 2015. This allowed for an in-depth understanding of the critical and basic business-forces that influenced their survival and performance beyond the first five years of business operation. Findings of the study showed that for potential contractors (startups), to survival in the competitive business environment such as construction industry, they must possess the basic business-forces. These forces are educational knowledge in construction and business management related disciplines, adequate industrial experiences, competencies and capabilities to delivery excellent services and products as well as embracing the spirit of entrepreneurship. Convincingly, it can be concluded that the strategic approach to minimize the endless failure of startups construction businesses; the potential construction contractors must endeavoring to access and acquire the basic educationally knowledge, training and qualification; need to acquire industrial experiences in collaboration with required competencies, capabilities and entrepreneurship acumen. Without these basic business-forces as been discovered in this study, the majority of the contractors gaining entrance in the market will find it difficult to develop and grow a competitive and sustainable construction organization in South Africa.

Keywords: basic business-forces, medium scale contractors, South Africa, sustainable organisations

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Authors: Roongtiwa Chobchuen, Angkana Srikhan, Pattra Wattanapan

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Background: Neurogenic bowel is common condition after spinal cord injury. Most of spinal cord injured patients have motor weakness, mobility impairment which leads to constipation. Moreover, the neural pathway involving bowel function is interrupted. Therefore, the bowel management program should be implemented in nursing care in the earliest time after the onset of the disease to prevent the morbidity and mortality. Objective: To study the outcome of bowel management program of the patients with spinal cord injury who admitted for rehabilitation program. Study design: Descriptive study. Setting: Rehabilitation ward in Srinagarind Hospital. Populations: patients with subacute to chronic spinal cord injury who admitted at rehabilitation ward, Srinagarind hospital, aged over 18 years old. Instrument: The neurogenic bowel dysfunction score (NBDS) was used to determine the severity of neurogenic bowel. Procedure and statistical analysis: All participants were asked to complete the demographic data; age gender, duration of disease, diagnosis. The individual bowel function was assessed using NBDS at admission. The patients and caregivers were trained by nurses about the bowel management program which consisted of diet modification, abdominal massage, digital stimulation, stool evacuation including medication and physical activity. The outcome of the bowel management program was assessed by NBDS at discharge. The chi-square test was used to detect the difference in severity of neurogenic bowel at admission and discharge. Results: Sixteen spinal cord injured patients were enrolled in the study (age 45 ± 17 years old, 69% were male). Most of them (50%) were tetraplegia. On the admission, 12.5%, 12.5%, 43.75% and 31.25% were categorized as very minor (NBDS 0-6), minor (NBDS 7-9), moderate (NBDS 10-13) and severe (NBDS 14+) respectively. The severity of neurogenic bowel was decreased significantly at discharge (56.25%, 18.755%, 18.75% and 6.25% for very minor, minor, moderate and severe group respectively; p < 0.001) compared with NBDS at admission. Conclusions: Implementation of the effective bowel program decrease the severity of the neurogenic bowel in patient with spinal cord injury.

Keywords: neurogenic bowel, NBDS, spinal cord injury, bowel program

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