Search results for: international medical graduates

Authors: Oscar Kallay

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Objective: This study compares the sustainability, financial implications, and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones. Methods: The observational study involves retrospective cataract surgery data collection at the Centre Médical de l'Alliance, Braine-L’alleud, Belgium, a tertiary eye care center. Information on cassette weight, quantities, and transport volume was obtained from routine procedures and purchasing records. The costs for each machine were calculated by reviewing the invoices received from the accounting department. Results: We found significant differences across comparisons. The reusable cassette machine, when compared to the single-use machine, used 306.7 kg less plastic (75.3% reduction), required 2,494 cubic meters less storage per 1000 surgeries (67.7% decrease), and cost €54.16 less per 10 procedures (16.9% reduction). The machine with daily reusable cassettes also exhibited a 7-minute priming time advantage for 10 procedures, reducing downtime between cases. Conclusions: Our findings underscore the benefits of adopting reusable cassette systems: reduced plastic consumption, storage volume, and priming time, as well as enhanced efficiency and cost savings. Healthcare professionals and institutions are encouraged to embrace environmentally conscious initiatives. The use of reusable cassette systems for cataract surgeries offers a pathway to sustainable practices.

Keywords: cataract, epidemiolog, surgery treatment, lens and zonules, public health

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Authors: Saira Mehnaz, Ali Jafar Abedi, Shazia Farooq Fazli, Sakeena Mushfiq, Zulfia Khan, M. Athar Ansari

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Introduction: Public health spending is a necessity in an underdeveloped country like India. The people are already suffering from poverty and that clubbed with out of pocket expenditure leads them to a very catastrophic situation, reducing the overall access to healthcare. Objectives: This study was designed to determine the usual source of medical care opted, the illness pattern, the expenditure incurred on illness and its source of procurement by the study population. It also intended to assess this expenditure as a determinant of access to health care. Methodology: Cities like Aligarh, which are classified as B grade cities in India are thought to be ripe sites for getting livelihood and hence are almost half filled with migrants living in urban slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results and Conclusions: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further being forced with into poverty and indebtedness on account of expenditure on illness. This lead to a significant decrease in access to health. National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

Keywords: access to healthcare, catastrophic health expenditure, new urban slums, out of pocket expenditure

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Authors: Bavneet Kaur Sidhu, Manoj Tiwari

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Global Developmental Delay (GDD) is a common pediatric condition. Etiologies of GDD might, however, differ in developing countries. In the last decade, sporadic families are being reported in various countries. As to the author’s best knowledge, many risk factors and their correlation with the prevalence of GDD have been studied but its statistical correlation has not been done. Thus we propose the present study by targeting the risk factor, prevalence and their statistical correlation with GDD. FMR1 gene was studied to confirm the disease and its penetrance. A complete questionnaire-based performance was designed for the statistical studies having a personal, past and present medical history along with their socio-economic status as well. Methods: We distributed the children’s age in 4 different age groups having 5-year intervals and applied structural equation modeling (SEM) techniques, Spearman’s rank correlation coefficient, Karl Pearson correlation coefficient, and chi-square test.Result: A total of 1100 families were enrolled for this study; among them, 330 were clinically and biologically confirmed (radiological studies) for the disease, 204 were males (61.8%), 126 were females (38.18%). We found that 27.87% were genetic and 72.12 were sporadic, out of 72.12 %, 43.277% cases from urban and 56.72% from the rural locality, the mothers' literacy rate was 32.12% and working women numbers were 41.21%. Conclusions: There is a significant association between mothers' age and GDD prevalence, which is also followed by mothers' literacy rate and mothers' occupation, whereas there was no association between fathers' age and GDD.

Keywords: global developmental delay, FMR1 gene, spearman’ rank correlation coefficient, structural equation modeling

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Authors: Lamin B Ceesay, Cecilia Rossignoli

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Inter-organizational collaboration is a growing phenomenon in both research and practice. The partnership between organizations enables firms to leverage external resources, experiences, and technology that lie with other firms. This collaborative practice is a source of improved business model performance, technological advancement, and increased competitive advantage for firms. However, the competitive intents, and even diverse institutional logics of firms, make inter-firm innovation-based partnership even more complex, and its governance more challenging. The purpose of this paper is to present a systematic review of research linking the inter-organizational relationship of firms with their innovation practice and specify the different project management issues and gaps addressed in previous research. To do this, we employed a systematic review of the literature on inter-organizational innovation using two complementary scholarly databases - ScienceDirect and Web of Science (WoS). Article scoping relies on the combination of keywords based on similar terms used in the literature:(1) inter-organizational relationship, (2) business network, (3) inter-firm project, and (4) innovation network. These searches were conducted in the title, abstract, and keywords of conceptual and empirical research papers done in English. Our search covers between 2010 to 2019. We applied several exclusion criteria including Papers published outside the years under the review, papers in a language other than English, papers neither listed in WoS nor ScienceDirect and papers that are not sharply related to the inter-organizational innovation-based partnership were removed. After all relevant search criteria were applied, a final list of 84 papers constitutes the data for this review. Our review revealed an increasing evolution of inter-organizational relationship research during the period under the review. The descriptive analysis of papers according to Journal outlets finds that International Journal of Project Management (IJPM), Journal of Industrial Marketing, Journal of Business Research (JBR), etc. are the leading journal outlets for research in the inter-organizational innovation project. The review also finds that Qualitative methods and quantitative approaches respectively are the leading research methods adopted by scholars in the field. However, literature review and conceptual papers constitute the least in the field. During the content analysis of the selected papers, we read the content of each paper and found that the selected papers try to address one of the three phenomena in inter-organizational innovation research: (1) project antecedents; (2) project management and (3) project performance outcomes. We found that these categories are not mutually exclusive, but rather interdependent. This categorization also helped us to organize the fragmented literature in the field. While a significant percentage of the literature discussed project management issues, we found fewer extant literature on project antecedents and performance. As a result of this, we organized the future research agenda addressed in several papers by linking them with the under-researched themes in the field, thus providing great potential to advance future research agenda especially, in the under-researched themes in the field. Finally, our paper reveals that research on inter-organizational innovation project is generally fragmented which hinders a better understanding of the field. Thus, this paper contributes to the understanding of the field by organizing and discussing the extant literature to advance the theory and application of inter-organizational relationship.

Keywords: inter-organizational relationship, inter-firm collaboration, innovation projects, project management, systematic review

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Authors: Ajay Agrawal, Pritha Basnet, Achala Thakur, Pappu Rizal, Rubina Rai

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Context: Rapid expulsion of fetus in intrauterine fetal death (IUFD) is usually requested without any medical grounds for it. So; an efficient, safe method for induction of labor (IOL) is required. Objective: To determine if pre-treatment with mifepristone followed by IOL with misoprostol in late IUFD is more efficacious. Methods: We conducted a randomized controlled trial in 100 patients. Group-A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24-hour. Group-B women were induced only with vaginal misoprostol. In each group 5 dose of misoprostol was used 4 hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications. Results: Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group-A, 85.7% delivered within 24 hours of first dose of misoprostol while in group-B 70% delivered within 24 hour (p=0.07). More women in Group B required oxytocin. Conclusion: Pretreatment with mifepristone before IOL following late IUFD is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor.

Keywords: induction of labor, intrauterine fetal death, mifepristone, misoprostol

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Authors: Ibrahim Nadeem, Mohammed Rahman, Yasser Ad-Dab’Bagh, Mahmood Akhtar

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Depression is one of the most prevalent mental illnesses and is often associated with various other medical disorders. In this review, we aim to evaluate existing systematic reviews that investigate the use of probiotics as a treatment for depressive symptoms. Five online databases were searched for relevant studies up to December 2017. Systematic reviews that included randomized controlled trials assessing the efficacy of probiotics in the treatment of depressive symptoms were included. Seven systematic reviews met the inclusion criteria. Three of these reviews conducted meta-analyses, out of which, two found probiotics to significantly improve depressive symptoms in the sample population. Two meta-analyses conducted subgroup analysis based on health status, and both found probiotics to significantly decrease depressive symptoms in patients with major depressive disorder, but only one review found it to significantly decrease in healthy patients. Another subgroup analysis was conducted based on age, and found probiotics to produce significant effects on subjects under the age of 60, but close to no effect on patients over the age of 65. Out of the four reviews that conducted qualitative analysis, three reviews concluded that probiotics have the potential to be used as a treatment. Due to the differences in clinical trials, a definitive effect of probiotics on depressive symptoms cannot be concluded. Nonetheless, probiotics seem to produce a significant therapeutic effect for subjects with pre-existing depressive symptoms. Further studies are warranted for definitive conclusions.

Keywords: depression, gut-brain axis, gut microbiota, probiotic, psychobiotic

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Authors: Hannah Riva, Sarah Mazal, Jessica L. Marquez, Michael Rains

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A 70-year-old female with a Fitzpatrick skin phenotype II presented with a 13-year history of a scaly rash located on the left breast and bilateral pretibial regions. The patient’s past medical history was otherwise unremarkable, with the exception of surgery involving the left breast. Physical examination revealed infiltrative hyperpigmented scaly plaques and nodules located on the left breast and pretibial regions bilaterally. A negative systemic workup excluded organ involvement. A clinical diagnosis of cutaneous sarcoidosis was made. Prior treatments included triamcinolone 0.1% topical cream and clobetasol 0.05% ointment, which failed to show improvement. Full-body narrow-band UVB (NBUVB) treatment was performed on a tri-weekly basis for eight months. NBUVB dosage was slowly titrated from 300 mJ/cm2 to a final dose of 1800 mJ/cm2 to prevent discomfort and burning sensations. Throughout the duration of her treatment, the patient adhered to a regimen of clobetasol 0.05% topical ointment applied twice daily in two-week intervals. Improvement was noticed after two months, with continued improvement up to eight months. The patient is continuing NBUVB phototherapy treatments for maintenance. In our case, NBUVB phototherapy treatment demonstrated promising results with improvement after two months of treatment. Physicians should consider NBUVB phototherapy as an effective option for patients presenting with cutaneous sarcoidosis.

Keywords: dermatology, sarcoidosis, phototherapy, ultraviolet

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Authors: Frances Turner

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Gloves are significant physical objects, being one of the oldest forms of dress. Glove culture is part of every facet of life; its extraordinary history encompasses practicality, and symbolism reflecting a wide range of social practices. The survival of not only the gloves but associated articles enables the possibility to analyse real lives, however so far this area has been largely neglected. Limited information is available to students, researchers, or those involved with the design and making of gloves. There are several museums and independent collectors in England that hold collections of gloves (some from as early as 16th century), machinery, tools, designs and patterns, marketing materials and significant archives which demonstrate the rich heritage of English glove design and manufacturing, being of national significance and worthy of international interest. Through a research glove network which now exists thanks to research grant funding, there is potential for the holders of glove collections to make connections and explore links between these resources to promote a stronger understanding of the significance, breadth and heritage of the English glove industry. The network takes an interdisciplinary approach to bring together interested parties from academia, museums and manufacturing, with expert knowledge of the production, collections, conservation and display of English leather gloves. Academics from diverse arts and humanities disciplines benefit from the opportunities to share research and discuss ideas with network members from non-academic contexts including museums and heritage organisations, industry, and contemporary designers. The fragmented collections when considered in entirety provide an overview of English glove making since earliest times and those who wore them. This paper makes connections and explores links between these resources to promote a stronger understanding of the significance, breadth and heritage of the English Glove industry. The following areas are explored: current content and status of the individual museum collections, potential links, sharing of information histories, social and cultural and relationship to history of fashion design, manufacturing and materials, approaches to maintenance and conservation, access to the collections and strategies for future understanding of their national significance. The facilitation of knowledge exchange and exploration of the collections through the network informs organisations’ future strategies for the maintenance, access and conservation of their collections. By involving industry in the network, it is possible to ensure a contemporary perspective on glove-making in addition to the input from heritage partners. The slow fashion movement and awareness of artisan craft and how these can be preserved and adopted for glove and accessory design is addressed. Artisan leather glove making was a skilled and significant industry in England that has now declined to the point where there is little production remaining utilising the specialist skills that have hardly changed since earliest times. This heritage will be identified and preserved for future generations of the rich cultural history of gloves may be lost.

Keywords: artisan glove-making skills, English leather gloves, glove culture, the glove network

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Authors: Sadia Suri Kashif, Raheeda Fatima, Maqsood Ahmed Khan

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Purpose of the study: The objective of this research was to determine the perception of Pakistani physicians (whether primary care, specialists or residents) in Karachi, being one of the largest and highly populated cities of Pakistan, regarding clinical approaches towards diet, exercise, and therapy in obese patients. This research determines their understanding of obesity and employability of obesity management in their daily practices. Research methodology: This is a questionnaire-based survey. A minimum of 300 questionnaires (N=300) were distributed and filled by practicing physicians in a random selection of medical setups in Karachi. Randomly 246 physicians responded to the survey. The survey tested their views regarding weight management, importance of general awareness and their strategies to control weight. Results: In the first part of survey the physicians responded to almost 66% regarding the seriousness of obesity management with advising diet modification, physical exercise and decreasing calorie intake; 57% failed to employ Body Mass Index and Waist Hip Ratio as weight measurement tools in their daily practice; 50% disagreed on using pharmacotherapy as an option; 67% were not sure about the proper dosage and indication of anti-obesity medication while almost same disagreed on using surgical options for management of obesity; 83.3% physicians agreed on the increased obesity pandemic in Pakistan. Conclusion: The findings indicate that there is a gap between awareness and knowledge among Pakistani practicing physicians regarding pharmacotherapy for obesity. There is a need to frequently update latest guidelines to help manage this condition, which is becoming more prevalent in our country day by day. Physicians should be obligated to use updated knowledge for managing obesity.

Keywords: obesity, physicians, BMI, weight management, obesity awareness

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Authors: Phenphak Horadee, Rodchares Hanrinth, Saithip Suttiruksa

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Inappropriate use of antibiotics has happened in several hospitals, Thailand. Drug use evaluation (DUE) is one strategy to overcome this difficulty. However, most community hospitals still encounter incomplete evaluation resulting overuse of antibiotics with high cost. Consequently, drug-resistant bacteria have been rising due to inappropriate antibiotic use. The aim of this study was to involve stakeholders in conceptualizing, developing, and prioritizing a feasible intervention strategy to promote and support appropriate antibiotic prescribing in a community hospital, Thailand. Study antibiotics included four antibiotics such as Meropenem, Piperacillin/tazobactam, Amoxicillin/clavulanic acid, and Vancomycin. The study was conducted for the 1-year period between March 1, 2018, and March 31, 2019, in a community hospital in the northeastern part of Thailand. Concept mapping was used in a purposive sample, including doctors (one was an administrator), pharmacists, and nurses who involving drug use evaluation of antibiotics. In-depth interviews for each participant and survey research were conducted to seek the problems for inappropriate use of antibiotics based on drug use evaluation system. Seventy-seven percent of DUE reported appropriate antibiotic prescribing, which still did not reach the goal of 80 percent appropriateness. Meropenem led other antibiotics for inappropriate prescribing. The causes of the unsuccessful DUE program were classified into three themes such as personnel, lack of public relation and communication, and unsupported policy and impractical regulations. During the first meeting, stakeholders (n = 21) expressed the generation of interventions. During the second meeting, participants who were almost the same group of people in the first meeting (n = 21) were requested to independently rate the feasibility and importance of each idea and to categorize them into relevant clusters to facilitate multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the idealist, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were distributed to participants (n = 21) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 29 feasible and crucial interventions in seven clusters: development of information technology system, establishing policy and taking it into the action plan, proactive public relations of the policy, action plan and workflow, in cooperation of multidisciplinary teams in drug use evaluation, work review and evaluation with performance reporting, promoting and developing professional and clinical skill for staff with training programs, and developing practical drug use evaluation guideline for antibiotics. These interventions are relevant and fit to several intervention strategies for antibiotic stewardship program in many international organizations such as participation of the multidisciplinary team, developing information technology to support antibiotic smart use, and communication. These interventions were prioritized for implementation over a 1-year period. Once the possibility of each activity or plan is set up, the proposed program could be applied and integrated into hospital policy after evaluating plans. Effectiveness of each intervention could be promoted to other community hospitals to promote and support antibiotic smart use.

Keywords: antibiotic, concept mapping, drug use evaluation, multidisciplinary teams

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Sara Mercedes Barroso Pinzón, Antonio Javier Sanchéz Herencia, Begoña Ferrari, Álvaro Jesús Castro

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The current need for durable implants and bone substitutes characterised by biocompatibility, bioactivity and mechanical properties, without immunological rejection, is a major challenge for scientists. Hydroxyapatite (HAp) has been considered for decades as an ideal biomaterial for bone regeneration due to its chemical and crystallographic similarity to the mineral structure bioapatites. However, the lack of trace elements in the hydroxyapatite structure gives it very low mechanical and biological properties. In this sense, the objective of the research is to address the synthesis of hydroxyapatite with Mg from phosphate rock from sedimentary deposits in the central-eastern region of Colombia, taking advantage of the release of the species contained as natural precursors of Ca, P and Mg. The minerals present were studied, fluorapatite as the mineral of interest associated with mineralogical species of magnesium carbonates and quartz. The chemical and mineralogical composition was determined by X-ray fluorescence (XRF) and X-ray diffraction (XRD), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX); as well as the evaluation of the surface physicochemical properties of zeta potential (PZC), with the aim of studying the surface behaviour of the microconstituents present in the phosphate rock and to elucidate the synergistic mechanism between the minerals and establish the optimum conditions for the wet concentration process. From the products obtained and characterised by XRD, XRF, SEM, FTIR, RAMAN, HAp-Mg biocomposite scaffolds are fabricated and the influence of Mg on the morphometric parameters, mechanical and biological properties of the designed materials is evaluated.

Keywords: phosphate rock, hydroxyapatite, magnesium, biomaterials

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Authors: Sanaz Moayer, Fang Huang, Scott Gardner

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In the highly leveraged business world of today, an organisation’s success depends on how it can manage and organize its traditional and intangible assets. In the knowledge-based economy, knowledge as a valuable asset gives enduring capability to firms competing in rapidly shifting global markets. It can be argued that ability to create unique knowledge assets by configuring ICT and human capabilities, will be a defining factor for international competitive advantage in the mid-21st century. The concept of KM is recognized in the strategy literature, and increasingly by senior decision-makers (particularly in large firms which can achieve scalable benefits), as an important vehicle for stimulating innovation and organisational performance in the knowledge economy. This thinking has been evident in professional services and other knowledge intensive industries for over a decade. It highlights the importance of social capital and the value of the intellectual capital embedded in social and professional networks, complementing the traditional focus on creation of intellectual property assets. Despite the growing interest in KM within professional services there has been limited discussion in relation to multinational resource based industries such as mining and petroleum where the focus has been principally on global portfolio optimization with economies of scale, process efficiencies and cost reduction. The Australian minerals and metals mining industry, although traditionally viewed as capital intensive, employs a significant number of knowledge workers notably- engineers, geologists, highly skilled technicians, legal, finance, accounting, ICT and contracts specialists working in projects or functions, representing potential knowledge silos within the organisation. This silo effect arguably inhibits knowledge sharing and retention by disaggregating corporate memory, with increased operational and project continuity risk. It also may limit the potential for process, product, and service innovation. In this paper the strategic application of knowledge management incorporating contemporary ICT platforms and data mining practices is explored as an important enabler for knowledge discovery, reduction of risk, and retention of corporate knowledge in resource based industries. With reference to the relevant strategy, management, and information systems literature, this paper highlights possible connections (currently undergoing empirical testing), between an Strategic Knowledge Management (SKM) framework incorporating supportive Data Mining (DM) practices and competitive advantage for multinational firms operating within the Australian resource sector. We also propose based on a review of the relevant literature that more effective management of soft and hard systems knowledge is crucial for major Australian firms in all sectors seeking to improve organisational performance through the human and technological capability captured in organisational networks.

Keywords: competitive advantage, data mining, mining organisation, strategic knowledge management

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Authors: Phang Moon Leng

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Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. The hospital adopted the Modified Early Warning Scores (MEWS) Scoring System and MEWS Clinical Response into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced and is used more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. The automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome which translates to better care for patient.

Keywords: automated early warning score, clinical quality and safety, patient safety, medical technology

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Authors: Rosina U. Ndukwe, Diane Crone, Nick Cavill

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Active transport (i.e. walking to school, cycle to work schemes etc.) is an effective approach with multiple social and environmental benefits for transforming urban environments into active urban environments. Although walking and cycling often remain on the margins of urban planning and infrastructure, there are new approaches emerging, along with policy intervention relevant for the creation of sustainable urban active environments conductive to active travel, increasing physical activity levels of involved communities and supporting social inclusion through more active participation. SPAcE - Supporting Policy and Action for Active Environments is a 3 year Erasmus+ project that aims to integrate active transport programmes into public policy across the EU. SPAcE focuses on cities/towns with recorded low physical activity levels to support the development of active environments in 5 sites: Latvia [Tukums], Italy [Palermo], Romania [Brasov], Spain [Castilla-La Mancha] and Greece [Trikala]. The first part of the project involved a review of good practice including case studies from across the EU and project partner countries. This has resulted in the first output from the project, an evidence of good practice summary with case study examples. In the second part of the project, working groups across the 5 sites have carried out co-production to develop Urban Active Environments (UActivE) Action Plans aimed at influencing policy and practice for increasing physical activity primarily through the use of cycling and walking. Action plans are based on international evidence and guidance for healthy urban planning. Remaining project partners include Universities (Gloucestershire, Oxford, Zurich, Thessaly) and Fit for Life programme (National physical activity promotion program, Finland) who provide support and advice incorporating current evidence, healthy urban planning and mentoring. Cooperation and co-production with public health professionals, local government officers, education authorities and transport agencies has been a key approach of the project. The third stage of the project has involved training partners in the WHO HEAT tool to support the implementation of the Action Plans. Project results show how multi-agency, transnational collaboration can produce real-life Action Plans in five EU countries, based on published evidence, real-life experience, consultation and collaborative working with other organisations across the EU. Learning from the processes adopted within this project will demonstrate how public health, local government and transport agencies across the EU, can work together to create healthy environments that have the aim of facilitating active behaviour, even in times of constrained public budgets. The SPAcE project has captured both the challenges and solutions for increasing population physical activity levels, health and wellness in urban spaces and translating evidence into policy and practice ensuring innovation at policy level. Funding acknowledgment: SPAcE (www.activeenvironments.eu) is co-funded by the Sport action of the ERASMUS+ programme.

Keywords: action plans, active transport, SPAcE, UActivE urban active environments, walking and cycling

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Authors: A. Kulprasutidilok

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In order to address the social factors of elderly health care, researcher and community members have turned to more inclusive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received increased attention as the academic and public health communities struggle to address the persistent problems of disparities in the use of health care and health outcomes for several over the past decade. As Thailand becomes an ageing society, health services and proper care systems specifically for the elderly group need to be prepared and well established. The purpose of this assignment was to study the health problems and was to explore the process of community participation in elderly health care. Participants in this study were member of elderly group of Paisanee Ramintra 65 community in Bangkok, Thailand. The results indicated two important components of community participation process in elderly health care: 1) a process to develop community participation in elderly health care, and 2) outcomes resulting from such process. The development of community participation consisted of four processes. As for the outcomes of the community participation development process, they consisted of elderly in the community got jointly and formulated a group, which strengthened the project because of collaborative supervision among themselves. Moreover, inactive health care services have changed to being energetic and focus on health promotion rather than medical achievement and elderly association of community can perform health care activities for chronically illness through the achievement of this development; consequently, they increasingly gained access to physical, cognitive, and social activity.

Keywords: community-based participatory research, elderly, heath care, Thailand.

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Authors: Y. Y. Babanyara, B. A. Gana, T. Garba, M. A. Batari

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Proper management of dental waste is a crucial issue for maintaining human health and the environment. The waste generated in the dental clinics has the potential for spreading infections and causing diseases, so improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist, waste handlers, general public and the environment through production of toxins or as by-products of the destruction process. Staff that provide dental healthcare ought to be aware of the proper handling and the system of management of dental waste used by different dental hospitals. The method of investigation adopted in the paper involved a desk study in which documents and records relating to dental waste handling were studied to obtain background information on existing dental waste management in Nigeria other countries of the world are also mentioned as examples. Additionally, information on generation, handling, segregation, risk associated during handling and treatment of dental medical waste were sought in order to determine the best method for safe disposal. This article provides dentists with the information they need to properly dispose of mercury and amalgam waste, and provides suggestions for managing the other wastes that result from the day-to-day activities of a dental office such as: used X-ray fixers and developers; cleaners for X-ray developer systems; lead foils, shields and aprons; chemiclave/chemical sterilant solutions; disinfectants, cleaners, and other chemicals; and, general office waste. Additionally, this study may be beneficial for authorities and researchers of developing countries to work towards improving their present dental waste management system.

Keywords: clinic, dental, disposal, environment, waste management

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Authors: Getachew Adugna

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Background: Chronic energy malnutrition and human immune deficiency virus among pregnant women are highly prevalent in Sub-Saharan Africa, and they are interrelated in a vicious cycle. However, the prevalence of chronic energy malnutrition and its determinant factors among human immune deficiency virus-positive pregnant women is not well studied in Ethiopia and Addis Ababa in particular. Objective: To determine the prevalence & associated factors of chronic energy malnutrition among human immune deficiency virus-positive pregnant women in health centres of Addis Ababa Ethiopia. Methods: An institution-based cross-sectional study was conducted and a systematic random sampling technique was used to select study subjects. A total of 253 study subjects were enrolled in the study—a structured and pre-tested questionnaire collected sociodemographic, maternal health-related, and nutritional-related variables. MUAC measurements were taken and medical charts were reviewed. Bi-variable and multi-variable logistic regression analyses were used to assess the effect of different factors on chronic energy malnutrition. Result: The overall prevalence of chronic energy malnutrition was 32.0%. It was significantly associated with dietary counselling (AOR: 0.062; 95%CI: 0.007, 0.549), CD4 level (AOR: 0.219; 95%CI: 0.025, 1.908), and clinical stage (AOR: 0.127; 95%CI: 0.053, 0.305). Conclusions: The prevalence of chronic energy malnutrition among Human Immune deficiency virus-infected pregnant women in Addis Ababa was high and Nutritional Intervention should be an integral part of the HIV care program.

Keywords: chronic energy malnutrition, HIV, MUAC, Addis Ababa

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Authors: Luay Alsalmi

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Background: Facial filler is the most common type of cosmetic surgery next to botox. Permanent filler is preferred nowadays due to the low cost brought about by non-recurring injection appointments. However, such fillers pose a higher risk for complications, with even greater adverse effects when the procedure is done using unknown dermal filler injections. AIM: This study aimed to establish an algorithm to categorize and manage patients that receive permanent fillers. Materials and Methods: Twelve participants were presented to the service through emergency or as outpatient from November 2015 to May 2021. Demographics such as age, sex, date of injection, time of onset, and types of complications were collected. After examination, all cases were managed based on an algorithm established. FACE-Q was used to measure overall satisfaction and psychological well-being. Results: The algorithm to diagnose and manage these patients effectively with a high satisfaction rate was established in this study. All participants were non-smoker females with no known medical comorbidities. The algorithm presented determined the treatment plan when faced with complications. Results revealed high appearance-related psychosocial distress was observed prior to surgery, while it significantly dropped after surgery. FACE-Q was able to establish evidence of satisfactory ratings among patients prior to and after surgery. Conclusion: This treatment algorithm can guide the surgeon in formulating a suitable plan with fewer complications and a high satisfaction rate.

Keywords: facial filler, FACE-Q, psycho-social stress, botox, treatment algorithm

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Authors: Marzieh Yassin, Fereshteh Navaee, Javad Sarrafzadeh, Reza Salehi

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Introduction: Myofascial trigger point (MTrP) is one of the most common sources of musculoskeletal pain. Approximately 30-85% of the patients with musculoskeletal pains would experience MTrP in their life. The prevalence of MTrP has reported in the patients seen in a general orthopedic clinic, general medical clinic and specialty pain management centers, 21%, 30% and 93% respectively. Nowadays, dry needling is suggested as a standard treatment for MTrPs. The purpose of the present study was to examine the effectiveness of dry needling with stretching upper trapezius muscle on pain and pain pressure threshold in participants with active myofascial trigger point. Methods: Thirty participants with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the treatments for three weeks. The outcomes were pain intensity and pain pressure threshold that were assessed with visual analogue scale and algometer respectively. Results: Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. Also, the results showed a significant difference in measurements between two groups (P<0.05). Conclusion: Dry needling with passive stretch can be more effective on pain and pain pressure threshold than passive stretching alone in short term in participants with active myofascial trigger points.

Keywords: dry needling, myofascial pain syndrome, myofascial trigger point, stretching

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Authors: Rohan M. Dalal, Elena Pirondini, Shanu Somvanshi

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Introduction: The current state of reproductive health outcomes in lower-income countries is poor, with inadequate knowledge and culture among adolescent boys. Moreover, boys have traditionally not been a priority target. To explore the opportunity to educate adolescent boys in the developing world regarding accurate reproductive health information, the purpose of this study is to investigate how adolescent boys in the developing world engage and use technology, utilizing cell phones. This electronic survey and video interview study were conducted to determine the feasibility of a mobile phone platform for an educational video game specifically designed for boys that will improve health knowledge, influence behavior, and change health outcomes, namely teen pregnancies. Methods: With the assistance of Plan India, a subsidiary of Plan International, informed consent was obtained from parents of adolescent males who participated in an electronic survey and video interviews via Microsoft Teams. An electronic survey was created with 27 questions, including topics of mobile phone usage, gaming preferences, and sexual and reproductive health, with a sample size of 181 adolescents, ages 11-25, near New Delhi, India. The interview questions were written to explore more in-depth topics after the completion of the electronic survey. Eight boys, aged 15, were interviewed for 40 minutes about gaming and usage of mobile phones as well as sexual and reproductive health. Data/Results. 154 boys and 27 girls completed the survey. They rated their English fluency as relatively high. 97% of boys (149/154) had access to mobile phones. The majority of phones were smartphones (97%, 143/148). 48% (71/149) of boys borrowed cell phones. The most popular phone platform was Samsung (22%, 33/148). 36% (54/148) of adolescent males looked at their phones 1-10 times per day for 1-2 hours. 55% (81/149) of the boys had parental restrictions. 51% (76/148) had 32 GB of storage on their phone. 78% (117/150) of the boys had wifi access. 80% (120/150) of respondents reported ease in downloading apps. 97% (145/150) of male adolescents had social media, including WhatsApp, Facebook, and YouTube. 58% (87/150) played video games. Favorite video games included Free Fire, PubG, and other shooting games. In the video interviews, the boys revealed what made games fun and engaging, including customized avatars, progression to higher levels, realistic interactive platforms, shooting/guns, the ability to perform multiple actions, and a variety of worlds/settings/adventures. Ideas to improve engagement in sexual and reproductive health classes included open discussions in the community, enhanced access to information, and posting on social media. Conclusion: This study involving an electronic survey and video interviews provides an initial foray into understanding mobile phone usage among adolescent males and understanding sexual and reproductive health education in New Delhi, India. The data gathered from this study support using mobile phone platforms, and this will be used to create a serious video game to educate adolescent males about sexual and reproductive health in an attempt to lower the rate of unwanted pregnancies in the world.

Keywords: adolescent males, India, mobile phone, sexual and reproductive health

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Authors: Samuel McLennan, Tane Moleta, Andre Brown, Marc Aurel Schnabel

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The development of Ecclesiastical buildings within New Zealand has produced some unique design characteristics that take influence from both international styles and local building methods. What this research looks at is how procedural modelling can be used to define such common characteristics and understand how they are shared and developed within different examples of a similar architectural style. This will be achieved through the creation of procedural digital reconstructions of the various timber Gothic Churches built during the 19th century in the city of Wellington, New Zealand. ‘Procedural modelling’ is a digital modelling technique that has been growing in popularity, particularly within the game and film industry, as well as other fields such as industrial design and architecture. Such a design method entails the creation of a parametric ‘ruleset’ that can be easily adjusted to produce many variations of geometry, rather than a single geometry as is typically found in traditional CAD software. Key precedents within this area of digital heritage includes work by Haegler, Müller, and Gool, Nicholas Webb and Andre Brown, and most notably Mark Burry. What these precedents all share is how the forms of the reconstructed architecture have been generated using computational rules and an understanding of the architects’ geometric reasoning. This is also true within this research as Gothic architecture makes use of only a select range of forms (such as the pointed arch) that can be accurately replicated using the same standard geometric techniques originally used by the architect. The methodology of this research involves firstly establishing a sample group of similar buildings, documenting the existing samples, researching any lost samples to find evidence such as architectural plans, photos, and written descriptions, and then culminating all the findings into a single 3D procedural asset within the software ‘Houdini’. The end result will be an adjustable digital model that contains all the architectural components of the sample group, such as the various naves, buttresses, and windows. These components can then be selected and arranged to create visualisations of the sample group. Because timber gothic churches in New Zealand share many details between designs, the created collection of architectural components can also be used to approximate similar designs not included in the sample group, such as designs found beyond the Wellington Region. This creates an initial library of architectural components that can be further expanded on to encapsulate as wide of a sample size as desired. Such a methodology greatly improves upon the efficiency and adjustability of digital modelling compared to current practices found in digital heritage reconstruction. It also gives greater accuracy to speculative design, as a lack of evidence for lost structures can be approximated using components from still existing or better-documented examples. This research will also bring attention to the cultural significance these types of buildings have within the local area, addressing the public’s general unawareness of architectural history that is identified in the Wellington based research ‘Moving Images in Digital Heritage’ by Serdar Aydin et al.

Keywords: digital forensics, digital heritage, gothic architecture, Houdini, procedural modelling

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Authors: Carolina Cuéllar, Paz González

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Research has shown that school leadership has a significant indirect effect on students’ achievements. In Chile, evidence has also revealed that this impact is stronger in vulnerable schools. With the aim of strengthening school leadership, public policy has taken up the challenge of enhancing capabilities of novice principals through the implementation of induction programs, which include a mentoring component, entrusting the task of delivering these programs to universities. The importance of using mentoring or coaching models in the preparation of novice school leaders has been emphasized in the international literature. Thus, it can be affirmed that building leadership capacity through partnership is crucial to facilitate cognitive and affective support required in the initial phase of the principal career, gain role clarification and socialization in context, stimulate reflective leadership practice, among others. In Chile, mentoring is a recent phenomenon in the field of school leadership and it is even more new in the preparation of new principals who work in public schools. This study, funded by the Chilean Ministry of Education, sought to explore the challenges and lessons arising from the design and implementation of mentoring processes which are part of the induction programs, according to the perception of the different actors involved: ministerial agents, university coordinators, mentors and novice principals. The investigation used a qualitative design, based on a study of three cases (three induction programs). The sources of information were 46 semi-structured interviews, applied in two moments (at the beginning and end of mentoring). Content analysis technique was employed. Data focused on the uniqueness of each case and the commonalities within the cases. Five main challenges and lessons emerged in the design and implementation of mentoring within the induction programs for new principals from Chilean public schools. They comprised the need of (i) developing a shared conceptual framework on mentoring among the institutions and actors involved, which helps align the expectations for the mentoring component within the induction programs, along with assisting in establishing a theory of action of mentoring that is relevant to the public school context; (ii) recognizing trough actions and decisions at different levels that the role of a mentor differs from the role of a principal, which challenge the idea that an effective principal will always be an effective mentor; iii) improving mentors’ selection and preparation processes trough the definition of common guiding criteria to ensure that a mentor takes responsibility for developing critical judgment of novice principals, which implies not limiting the mentor’s actions to assist in the compliance of prescriptive practices and standards; (iv) generating common evaluative models with goals, instruments and indicators consistent with the characteristics of mentoring processes, which helps to assess expected results and impact; and (v) including the design of a mentoring structure as an outcome of the induction programs, which helps sustain mentoring within schools as a collective professional development practice. Results showcased interwoven elements that entail continuous negotiations at different levels. Taking action will contribute to policy efforts aimed at professionalizing the leadership role in public schools.

Keywords: induction programs, mentoring, novice principals, school leadership preparation

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Authors: Dana Zelicha

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A 6-week mindfulness programme was launched to improve the well being and performance of 20 managers (including the supervisor) of an international corporation in London. A unique assessment methodology was customised to the organisation’s needs, measuring four parameters: prioritising skills, listening skills, mindfulness levels and happiness levels. All parameters showed significant improvements (p < 0.01) post intervention, with a remarkable increase in listening skills and mindfulness levels. Although corporate mindfulness programmes have proven to be effective, the challenge remains the low engagement levels at home and the implementation of these tools beyond the scope of the intervention. This study has offered an innovative approach to enforce home engagement levels, which yielded promising results. The programme launched with a 2-day introduction intervention, which was followed by a 6-week training course (1 day a week; 2 hours each). Participants learned all basic principles of mindfulness such as mindfulness meditations, Mindfulness Based Stress Reduction (MBSR) techniques and Mindfulness Based Cognitive Therapy (MBCT) practices to incorporate into their professional and personal lives. The programme contained experiential mindfulness meditations and innovative mindfulness tools (OWBA-MT) created by OWBA - The Well Being Agency. Exercises included Mindful Meetings, Unitasking and Mindful Feedback. All sessions concluded with guided discussions and group reflections. One fundamental element of this programme was engagement level outside of the workshop. In the office, participants connected with a mindfulness buddy - a team member in the group with whom they could find support throughout the programme. At home, participants completed online daily mindfulness forms that varied according to weekly themes. These customised forms gave participants the opportunity to reflect on whether they made time for daily mindfulness practice, and to facilitate a sense of continuity and responsibility. At the end of the programme, the most engaged team member was crowned the ‘mindful maven’ and received a special gift. The four parameters were measured using online self-reported questionnaires, including the Listening Skills Inventory (LSI), Mindfulness Attention Awareness Scale (MAAS), Time Management Behaviour Scale (TMBS) and a modified version of the Oxford Happiness Questionnaire (OHQ). Pre-intervention questionnaires were collected at the start of the programme, and post-intervention data was collected 4-weeks following completion. Quantitative analysis using paired T-tests of means showed significant improvements, with a 23% increase in listening skills, a 22% improvement in mindfulness levels, a 12% increase in prioritising skills, and an 11% improvement in happiness levels. Participant testimonials exhibited high levels of satisfaction and the overall results indicate that the mindfulness programme substantially impacted the team. These results suggest that 6-week mindfulness programmes can improve employees’ capacities to listen and work well with others, to effectively manage time and to experience enhanced satisfaction both at work and in life. Limitations noteworthy to consider include the afterglow effect and lack of generalisability, as this study was conducted on a small and fairly homogenous sample.

Keywords: corporate mindfulness, listening skills, organisational well being, prioritising skills, mindful leadership

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Authors: Ya-Ju Ju, Li-Chen Yang, Yi-Chun Du, Rong-Ju Cherng

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Introduction: It is estimated that 5-6% of school-aged children may be diagnosed to have developmental coordination disorder (DCD). Children with DCD are characterized with motor skill difficulty which cannot be explained by any medical or intellectual reasons. Such motor difficulties limit children’s participation to sports activity, further affect their physical fitness, cardiopulmonary function and balance, and may lead to obesity. The purpose of the project was to develop an exergaming system for children with DCD aiming to improve their physical fitness, cardiopulmonary function and balance ability. Methods: This study took five steps to build up the system: system planning, tasks selection, tasks programming, system integration and usability test. The system basically adopted virtual reality technique to integrate self-developed training programs. The training programs were developed to brainstorm among team members and after literature review. The selected tasks for training in the system were a combination of fundamental movement tor skill. Results and Discussion: Based on the theory of motor development, we design the training task from easy ones to hard ones, from single tasks to dual tasks. The tasks included walking, sit to stand, jumping, kicking, weight shifting, side jumping and their combination. Preliminary study showed that the tasks presented an order of development. Further study is needed to examine its effect on motor skill and cardiovascular fitness in children with DCD.

Keywords: virtual reality, virtual reality system, developmental coordination disorder, children

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Authors: Maria Luisa Nozawa Ribeiro, Maria Teresa Miceli Kerbauy

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This paper aims to present the theories of public participation in order to understand the context of the public GMO (Genetic Modified Organisms) policies in Brazil, highlighting the characteristics of its configuration and the dialog with the experts. As a controversy subject, the commercialization of GMO provoked manifestation of some popular and environmental representative groups questioning the decisions of policy makers and experts on the matter. Many aspects and consequences of the plantation and consumption of this crops emerged and the safety of this technology was questioned. Environmentalists, Civil Right's movement, representatives of rural workers, farmers and organics producers, etc. demonstrated their point of view, also sustained by some experts of medical, genetical, environmental, agronomical sciences, etc. fields. Despite this movement, the precautionary principle (risk management), implemented in 1987, suggested precaution facing new technologies and innovations in the sustainable development society. This principle influenced many legislation and regulation on GMO around the world, including Brazil, which became a reference among the world regulatory GMO systems. The Brazilian legislation ensures the citizens participation on GMO discussion, characteristic that was important to establish the connection between the subject and the participation theory. These deliberation spaces materialized in Brazil through the "Public Audiences", which are managed by the National Biosafety Technical Commission (CTNBio), the department responsible for controlling the research, production and commercialization of GMOs in Brazil.

Keywords: public engagement, public participation, science and technology studies, transgenic politics

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Authors: Raheel Shakoor Siddiqui, Calvin Mathias, Manikandar Srinivas Cheruvu, Bobin Varghese

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A 58 year old gentleman presented to accident and emergency at the district general hospital with worsening shortness of breath and a non-productive cough over a period of five days. He was initially admitted under the medical team for suspicion of SARS-CoV-2 (COVID-19) pneumonitis. Subsequently, upon deterioration of observations and a positive COVID-19 PCR, he was taken to intensive care for invasive mechanical ventilation. He required frequent proning, inotropic support and was intubated for thirty-three days. After successful extubation, he developed myopathy with a limited range of motion to his right knee and right shoulder. Plain film imaging of these limbs demonstrated an unusual formation of heterotopic ossification without any precipitating trauma or surgery. Current literature demonstrates limited case series portraying heterotopic ossification post-COVID-19. There has been negligible evidence of heterotopic ossification in the ipsilateral knee and shoulder post-prolonged immobility secondary to a critical illness. Physiotherapy and rehabilitation are post-intensive care can be prolonged due to the formation of heterotopic ossification around joints. Prolonged hospital stays may lead to a higher risk of developing infections of the chest, urine and pressure sores. This raises the question of whether a severe systemic inflammatory immune response from the SARS-CoV-2 virus results in histopathological processes leading to the formation of heterotopic ossification not previously seen, requiring prolonged physiotherapy.

Keywords: orthopaedics, rehabilitation, physiotherapy, heterotopic ossification, COVID-19

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Authors: Asif Arsalan

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The mortality rate of type 2 diabetes increasing day by day at an alarming rate. Changing lifestyle and environment have contributory effect in increase rate of type 2 diabetes mellitus. This study introduces a new method in physiotherapy field of treating a disease like diabetes, and gives the new way to control the diabetes without medicines.50 patients were selected on the basis of inclusion and exclusion criteria and were assigned to receive either TENS (group A) on the bilateral ST36 acupoints at a frequency of 25 Hz with intensity of 9 mA or placebo (group B) treatment for 5 minutes for 7 days. The blood glucose level was measured at both pre and post stimulation. Stimulation was given after 3 hours of food on every day regularly on stipulated time.There was significant improvement (P<0.05) in random blood sugar level of type 2 diabetes mellitus. It has been found TENS on bilateral ST36 acupoints have an effect to control plasma glucose level for type 2 diabetic mellitus patients and can be used without having any side effect. This study gives new idea to treat the type 2 diabetes conservatively with the TENS. As there are some study that TENS had been used to treat nausea, spasticity etc. condition by stimulating the acupoint but it is the very first time that TENS has been used to treat diabetes like disease. This study help the physiotherapy community to spread the physiotherapy treatment in other branches of the medical field and this gives a new identity for the physiotherapy. This also gives the benefit to patients to take a safe and cost effective treatment for the diabetes, and make the new use of TENS to treat other condition rather than pain.

Keywords: acupoint, plasma glucose level, type 2 diabetic mellitus, TENS

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Authors: Jessica Kate Simonds

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The last successful hijacking perpetrated by Somali pirates in 2012 represented a critical turning point for the identity and brand of Indian Ocean (IO) insecurity, coined in this paper as the era of the post-piratical. This paper explores the broadening of the PMSC business model to account and contribute to the design of a new IO security environment that prioritises foreign and insurgency drone activity and Houthi rebel operations as the main threat to merchant shipping in the post-2012 era. This study is situated within a longer history of analysing maritime insecurity and also contributes a bespoke conceptual framework that understands the sea as a space that is produced and reproduced relative to existing and emerging threats to merchant shipping based on bespoke models of information sharing and intelligence acquisition. This paper also makes a prominent empirical contribution by drawing on a post-positivist methodology, data drawn from original semi-structured interviews with senior maritime insurers and active merchant seafarers that is triangulated with industry-produced guidance such as the BMP series as primary data sources. Each set is analysed through qualitative discourse and content analysis and supported by the quantitative data sets provided by the IMB Piracy Reporting center and intelligence networks. This analysis reveals that mechanisms such as the IGP&I Maritime Security Committee and intelligence divisions of PMSC’s have driven the exchanges of knowledge between land and sea and thus the reproduction of the maritime security environment through new regulations and guidance to account dones, rebels and bombs as the key challenges in the IO, beyond piracy. A contribution of this paper is the argument that experts who may not be in the highest-profile jobs are the architects of maritime insecurity based on their detailed knowledge and connections to vessels in transit. This paper shares the original insights of those who have served in critical decision making spaces to demonstrate that the development and refinement of industry produced deterrence guidance that has been accredited to the mitigation of piracy, have shaped new editions such as BMP 5 that now serve to frame a new security environment that prioritises the mitigation of risks from drones and WBEID’s from both state and insurgency risk groups. By highlighting the experiences and perspectives of key players on both land and at sea, the key finding of this paper is outlining that as pirates experienced a financial boom by profiteering from their bespoke business model during the peak of successful hijackings, the private security market encountered a similar level of financial success and guaranteed risk environment in which to prospect business. Thus, the reproduction of the Indian Ocean as a maritime security environment reflects a new found purpose for PMSC’s as part of the broader conglomerate of maritime insurers, regulators, shipowners and managers who continue to redirect the security consciousness and IO brand of insecurity.

Keywords: maritime security, private security, risk intelligence, political geography, international relations, political economy, maritime law, security studies

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Authors: Manju Bala Jassi

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The Covid 19 pandemic has badly mauled Dubai’s GDP heavily dependent on hospitality, tourism, entertainment, logistics, property and the retail sectors. In the context of the World Health protocols on social distancing for better maintenance of health and hygiene, the revival of the battered tourism and hospitality sectors has serious lessons for designers- interiors and public places. The tangible and intangible aesthetic elements and design –ambiance, materials, furnishings, colors, lighting and interior with architectural design issues of tourism and hospitality need a rethink to ensure a memorable tourist experience. Designers ought to experiment with sustainable places of tourism and design, develop, build and projects are aesthetic and leave as little negative impacts on the environment and public as possible. In short, they ought to conceive public spaces that makes use of little untouched materials and energy, and creates pollution and waste that are minimal. The spaces can employ healthier and more resource-efficient prototypes of construction, renovation, operation, maintenance, and demolition and thereby mitigate the environment impacts of the construction activities and it is sustainable These measures encompass the hospitality sector that includes hotels and restaurants which has taken the hardest fall from the pandemic. The paper sought to examine building energy efficiency and materials and design employed in public places, green buildings to achieve constructive sustainability and to establish the benefits of utilizing energy efficiency, green materials and sustainable design; to document diverse policy interventions, design and Spatial dimensions of tourism and hospitality sectors; to examine changes in the hospitality, aviation sector especially from a design perspective regarding infrastructure or operational constraints and additional risk-mitigation measures; to dilate on the nature of implications for interior designers and architects to design public places to facilitate sustainable tourism and hospitality while balancing convenient space and their operations' natural surroundings. The qualitative research approach was adopted for the study. The researcher collected and analyzed data in continuous iteration. Secondary data was collected from articles in journals, trade publications, government reports, newspaper/ magazine articles, policy documents etc. In depth interviews were conducted with diverse stakeholders. Preliminary data indicates that designers have started imagining public places of tourism and hospitality against the backdrop of the government push and WHO guidelines. For instance, with regard to health, safety, hygiene and sanitation, Emirates, the Dubai-based airline has augmented health measures at the Dubai International Airport and on board its aircraft. It has leveraged high tech/ Nano-tech, social distancing to encourage least human contact, flexible design layouts to limit the occupancy. The researcher organized the data into thematic categories and found that the Government of Dubai has initiated comprehensive measures in the hospitality, tourism and aviation sectors in compliance with the WHO guidelines.

Keywords: Covid 19, design, Dubai, hospitality, public spaces, tourism

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