Search results for: healthcare policy

Authors: Ogbu Harry Omilonye

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This paper examines protest as a literary mechanism against the unpopular political policy of the white minority regime in South Africa. It examines some of Mtshali’s poems as examples of protest poetry, showing how he deploys his artistic acumen in the popular struggle of the oppressed South Africans against the aberrations and obnoxious apartheid policy.

Keywords: protest poetry, poems, minority, oppression

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Authors: Laila Al-Balushi, Suad Al-Kharosui

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Due to the increasing number of breast cancer cases in Oman and the impact of the novel coronavirus disease 2019 (COVID-19 on bed situation in the hospital, a policy of early discharge (ED) with drain after breast cancer surgery was initiated at one of the tertiary hospitals in Oman. The uniqueness of this policy is no home visit follow-up, conducted after discharge and the main mode of communication was Instagram media. This policy then was evaluated by conducting a quasi-experimental study using a questionnaire with ten open and closed-ended questions, five questions to explore patient experience using a five-point Likert scale. A total of 41 female patients responded to the questionnaire. Almost 96% of the participants stated being well informed about drain care pre- and post-surgery at home. 9% of the participants developed early sign of infection and was managed at out-patient clinics. Participants with bilateral drains expressed more pain than those with single drain. 90% stated satisfied being discharged with breast drain whereas 10% preferred to stay in the hospital until the drains were removed. This study found that the policy of ED with a drain after BC surgery is practical and well-accepted by most patients. The role of breast nurse and presence of family and institutional support enhanced the success of the policy implementation. To optimize patient care, conducting a training program by breast nurse for nurses at local health centres about care management of patients with drain could improve care and enhance patient satisfaction.

Keywords: breast cancer, surgery, early discharge, surgical drain

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Authors: Aaron Zhang, Alimire Kahaer, Gerald Weber, Nalin Arachchilage

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Access control is an essential safeguard for the security of enterprise data, which controls users’ access to information resources and ensures the confidentiality and integrity of information resources [1]. Research shows that the more common types of access control now have shortcomings [2]. In this direction, to improve the existing access control, we have studied the current technologies in the field of data security, deeply investigated the previous data access control policies and their problems, identified the existing deficiencies, and proposed a new extension structure of SPBAC. SPBAC extension proposed in this paper aims to combine Policy-Based Access Control (PBAC) with semantics to provide logically connected, real-time data access functionality by establishing associations between enterprise data through semantics. Our design combines policies with linked data through semantics to create a "Semantic link" so that access control is no longer per-database and determines that users in each role should be granted access based on the instance policy, and improves the SPBAC implementation by constructing policies and defined attributes through the XACML specification, which is designed to extend on the original XACML model. While providing relevant design solutions, this paper hopes to continue to study the feasibility and subsequent implementation of related work at a later stage.

Keywords: access control, semantic policy-based access control, semantic link, access control model, instance policy, XACML

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Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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Authors: Jingwei Du

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The need of optimizing air conditioning systems for existing buildings calls for control methods designed with energy-efficiency as a primary goal. The majority of current control methods boil down to two categories: empirical and model-based. To be effective, the former heavily relies on engineering expertise and the latter requires extensive historical data. Reinforcement Learning (RL), on the other hand, is a model-free approach that explores the environment to obtain an optimal control strategy often referred to as “policy”. This research adopts Proximal Policy Optimization (PPO) to improve chiller plant control, and enable the RL agent to collaborate with experienced engineers. It exploits the fact that while the industry lacks historical data, abundant operational data is available and allows the agent to learn and evolve safely under human supervision. Thanks to the development of language models, renewed interest in RL has led to modern, online, policy-based RL algorithms such as the PPO. This research took inspiration from “alignment”, a process that utilizes human feedback to finetune the pretrained model in case of unsafe content. The methodology can be summarized into three steps. First, an initial policy model is generated based on minimal prior knowledge. Next, the prepared PPO agent is deployed so feedback from both critic model and human experts can be collected for future finetuning. Finally, the agent learns and adapts itself to the specific chiller plant, updates the policy model and is ready for the next iteration. Besides the proposed approach, this study also used traditional RL methods to optimize the same simulated chiller plants for comparison, and it turns out that the proposed method is safe and effective at the same time and needs less to no historical data to start up.

Keywords: chiller plant, control methods, energy efficiency, proximal policy optimization, reinforcement learning

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Authors: Wendy I. E. Wesseling

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The unemployment rate has been on the rise since the outbreak of the global financial crisis in 2008. Especially labor market entrants suffer from economic downfall. Despite the abundance of programs and agencies that help to reintegrate unemployed youth, considerable less research attention has been paid to 'fit' between these programs and its participants that ensure a durable labor market transition. According to Self-Determination Theory, need satisfaction is associated with better (mental) adjustment. As such, three hypothesis were formulated: when workers’ needs for competence (H1), relatedness (H2), and autonomy (H3) are satisfied in the workplace, they are more likely to remain employed at the same employer. To test these assumptions, a sample of approximately 800 young people enrolled in a youth unemployment policy participated in a longitudinal study. The unemployment policy was aimed at the development of generic and vocational competences, and had a maximum duration of six months. Need satisfaction during the program was measured, as well as their employment outcomes up to 12 months after completion of the policy. All hypotheses were (partly) supported. Some limitations should be noted. First, since our sample consisted primarily of highly educated white graduates, it remains to be tested whether our results generalize to other groups of unemployed youth. Moreover, we are unable to conclude whether the results are due to the intervention, participants (selection effect), or both, because of the lack of a control group.

Keywords: need satisfaction, person-job fit, self-determination theory, youth unemployment policy

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Authors: Aron Miranda Burgos, Ergon Cugler de Moraes Silva

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In the present article, it is observed that the constant advancement of issues related to misinformation impacts the guarantee of the public policy cycle. Thus, it is found that the dissemination of false information has a direct influence on each of the component stages of this cycle. Therefore, in order to maintain scientific and theoretical credibility in the qualitative analysis process, it was necessary to logically interpose the concepts of firehosing of falsehood, fake news, public policy cycle, as well as using the epistemological and pragmatic mechanism at the intersection of such academic concepts, such as the scientific method. It was found, through the analysis of official documents and public notes, how the multiple theoretical perspectives evidence the commitment of the provision and elaboration of public policies, verifying the way in which the fake news impact each part of the process in this atmosphere.

Keywords: firehosing of falsehood, governance, misinformation, post-truth

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Authors: Aimilia Vlami

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This paper examines the tourist economic development of Greece on the basis of the analysis of the main characteristics of the financing and development processes and the spatial and temporal structure of supply and demand. Taking into consideration the evolution of the economic planning and the policy for the tourist development of Greece over time, we study at the same time: the composition, the changes and the dynamics of the hotel industry in the last 20 years and especially the period of the economic adjustment programmes, where tourism has become a key pillar of development. It is clearly evident that this paper is written in a specific economic situation, which directs as much the emphases as the flow of arguments around the central question of balance of interventions in the tourist space, between the need for planning and practice of policy for sustainable tourist growth and in the de facto adaptation of fragmentary and urgent interventions of shaping and transforming the tourist space, as they are shaped by the requirements of various institutions and interest groups.

Keywords: development, Greece, hospitality, economic policy, tourism investments

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Authors: Merav Ben Natan, Yaniv Steinfeld, Sara Badash, Galina Shmilov, Milena Abramov, Danny Epstein, Yaniv Yonai, Eyal Berbalek, Yaron Berkovich

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Introduction: Postoperative pain management is crucial for effective rehabilitation, with the Visual Analog Scale (VAS) being a common tool for assessing pain intensity due to its sensitivity and accuracy. However, challenges such as misunderstanding of instructions and discrepancies in pain reporting can affect its reliability. Additionally, the mandatory use of face masks during the COVID-19 pandemic may impair nonverbal and verbal communication, potentially impacting pain assessment and overall care quality. Aims: This study examines the association between the type of mask worn by health care professionals and the assessment of pain intensity in patients after orthopedic surgery using the visual analog scale (VAS). Design: A nonrandomized controlled trial was conducted among 176 patients hospitalized in an orthopedic department of a hospital located in northern-central Israel from January to March 2021. Methods: In the intervention group (n = 83), pain assessment using the VAS was performed by a healthcare professional wearing a transparent face mask, while in the control group (n = 93), pain assessment was performed by a healthcare professional wearing a standard nontransparent face mask. The initial assessment was performed by a nurse, and 15 minutes later, an additional assessment was performed by a physician. Results: Healthcare professionals wearing a standard non-transparent mask obtained higher VAS scores than healthcare professionals wearing a transparent mask. In addition, nurses obtained lower VAS scores than physicians. The discrepancy in VAS scores between nurses and physicians was found in 50% of cases. This discrepancy was more prevalent among female patients, patients after knee replacement or spinal surgery, and when health care professionals were wearing a standard nontransparent mask. Conclusions: This study supports the use of transparent face masks by healthcare professionals in an orthopedic department, particularly by nurses. In addition, this study supports the assumption of problems involving the reliability of VAS.

Keywords: postoperative pain management, visual analog scale, face masks, orthopedic surgery

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Authors: S. Hamid Mirmohammadi, Shahrazad Tamjidzad

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This paper is concerned with the single-item continuous review inventory system in which demand is stochastic and discrete. The budget consumed for purchasing the ordered items is not restricted but it incurs extra cost when exceeding specific value. The unit purchasing price depends on the quantity ordered under the all-units discounts cost structure. In many actual systems, the budget as a resource which is occupied by the purchased items is limited and the system is able to confront the resource shortage by charging more costs. Thus, considering the resource shortage costs as a part of system costs, especially when the amount of resource occupied by the purchased item is influenced by quantity discounts, is well motivated by practical concerns. In this paper, an optimization problem is formulated for finding the optimal (R, Q) policy, when the system is influenced by the budget limitation and a discount pricing simultaneously. Properties of the cost function are investigated and then an algorithm based on a one-dimensional search procedure is proposed for finding an optimal (R, Q) policy which minimizes the expected system costs .

Keywords: (R, Q) policy, stochastic demand, backorders, limited resource, quantity discounts

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Authors: Isaura Bonneux

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District heating and cooling (DHC) is increasingly recognized as a viable path towards sustainable heating and cooling. While some countries like Sweden and Denmark have a longstanding tradition of DHC, Belgium is lacking behind. The Northern part of Belgium, Flanders, had only a total of 95 heating networks in July 2023. Nevertheless, it is increasingly exploring its possibilities to enhance the scope of DHC. DHC is a complex energy system, requiring a lot of collaboration between various stakeholders on various levels. Therefore, it is of interest to look closer at policy-related documents at the Flemish (regional) level, as these policies set the scene for DHC development in the Flemish region. This kind of analysis has not been undertaken so far. This paper has the following research question: “Who talks about DHC, and in which way and context is DHC discussed in Flemish policy-related documents?” To answer this question, the Overton policy database was used to search and retrieve relevant policy-related documents. Overton retrieves data from governments, think thanks, NGOs, and IGOs. In total, out of the 244 original results, 117 documents between 2009 and 2023 were analyzed. Every selected document included theme keywords, policymaking department(s), date, and document type. These elements were used for quantitative data description and visualization. Further, qualitative content analysis revealed patterns and main themes regarding DHC in Flanders. Four main conclusions can be drawn: First, it is obvious from the timeframe that DHC is a new topic in Flanders with still limited attention; 2014, 2016 and 2017 were the years with the most documents, yet this number is still only 12 documents. In addition, many documents talked about DHC but not much in depth and painted it as a future scenario with a lot of uncertainty around it. The largest part of the issuing government departments had a link to either energy or climate (e.g. Flemish Environmental Agency) or policy (e.g. Socio-Economic Council of Flanders) Second, DHC is mentioned most within an ‘Environment and Sustainability’ context, followed by ‘General Policy and Regulation’. This is intuitive, as DHC is perceived as a sustainable heating and cooling technique and this analysis compromises policy-related documents. Third, Flanders seems mostly interested in using waste or residual heat as a heating source for DHC. The harbors and waste incineration plants are identified as potential and promising supply sources. This approach tries to conciliate environmental and economic incentives. Last, local councils get assigned a central role and the initiative is mostly taken by them. The policy documents and policy advices demonstrate that Flanders opts for a bottom-up organization. As DHC is very dependent on local conditions, this seems a logic step. Nevertheless, this can impede smaller councils to create DHC networks and slow down systematic and fast implementation of DHC throughout Flanders.

Keywords: district heating and cooling, flanders, overton database, policy analysis

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Authors: Elza Jurun, Damir Piplica, Tea Poklepović

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Numerous studies carried out in the developed western democratic countries have shown that the ideological framework of the governing party has a significant influence on the monetary policy. The executive authority consisting of a left-wing party gives a higher weight to unemployment suppression and central bank implements a more expansionary monetary policy. On the other hand, right-wing governing party considers the monetary stability to be more important than unemployment suppression and in such a political framework the main macroeconomic objective becomes the inflation rate reduction. The political framework conditions in the transition countries which are new European Union (EU) members are still highly specific in relation to the other EU member countries. In the focus of this paper is the question whether the same monetary policy principles are valid in these transitional countries as well as they apply in developed western democratic EU member countries. The data base consists of inflation rate and unemployment rate for 11 transitional EU member countries covering the period from 2001 to 2012. The essential information for each of these 11 countries and for each year of the observed period is right or left political orientation of the ruling party. In this paper we use t-statistics to test our hypothesis that there are differences in inflation and unemployment between right and left political orientation of the governing party. To explore the influence of different countries, through years and different political orientations descriptive statistics is used. Inflation and unemployment should be strongly negatively correlated through time, which is tested using Pearson correlation coefficient. Regarding the fact whether the governing authority is consisted from left or right politically oriented parties, monetary authorities will adjust its policy setting the higher priority on lower inflation or unemployment reduction.

Keywords: inflation rate, monetary policy orientation, transition EU countries, unemployment rate

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Authors: Joseph Kwame Sarfo-Adu

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Social protection programs have been rolled out by successive governments in the quest of bridging the inequality gap in Ghana. Despite notable positive impacts of these programs across the country, there still remains worrying experience of the exclusion of the poor and vulnerable especially in rural Ghana Notwithstanding the rhetoric of participation within the discussion of social protection programs, less attention has been given to the design of these programs. In view of this, the study seeks to address how social protection programs are designed to address the needs of the poor. This study focused on five selected social protection programs in Ghana because they are programs with nationwide coverage. Qualitative thematic analysis was applied to analyze our data with the use of the Nvivo 12 version. We found out that there is a strong link between policy design and poverty alleviation. Our findings revealed that a well-designed program can significantly alleviate poverty, a poorly designed program can create more damage.

Keywords: social protection, poverty alleviation, policy design, effective outcome

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Authors: Ronit Chakraborty, Sugata Banerji

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There has been a marked increase in the reported prevalence of Autism Spectrum Disorder (ASD) among children in the US over the past two decades. This research has analyzed the growth in state-level ASD prevalence against 45 different potentially explanatory factors, including socio-economic, demographic, healthcare, public policy, and political factors. The goal was to understand if these factors have adequate predictive power in modeling the differential growth in ASD prevalence across various states and if they do, which factors are the most influential. The key findings of this study include (1) the confirmation that the chosen feature set has considerable power in predicting the growth in ASD prevalence, (2) the identification of the most influential predictive factors, (3) given the nature of the most influential predictive variables, an indication that a considerable portion of the reported ASD prevalence differentials across states could be attributable to over and under diagnosis, and (4) identification of Florida as a key outlier state pointing to a potential under-diagnosis of ASD there.

Keywords: autism spectrum disorder, clustering, machine learning, predictive modeling

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Authors: S. Jabeen

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Though Pakistan has a rich cultural history and a diverse population; its global image is tarnished with labels of Muslim ‘fundamentalism’ and ‘extremism.’ Cultural policy is a tool that can be used by the government of Pakistan to ameliorate this image, but instead, this fundamentalist reputation is reinforced in the 2005 draft of Pakistan’s cultural policy. With its stern focus on a homogenized cultural identity, this 2005 draft bases itself largely on forced participation from the largely Muslim public and leaves little or no benefits to them or cultural minorities in Pakistan. The effects of this homogenized ‘Muslim’ identity linger ten years later where the study and celebration of the cultural heritage of Pakistan in schools and educational festivals focus entirely on creating and maintaining a singular ‘Islamic’ cultural identity. The current lack of inclusion has many adverse effects that include the breeding of extremist mindsets through the usurpation of minority rights and lack of safe cultural public spaces. This paper argues that Pakistan can improve social inclusivity and boost its global image through cultural policy. The paper sets the grounds for research by surveying the effectiveness of different cultural policies across nations with differing socioeconomic status. Then, by sampling two public literary festivals in Pakistan as case studies, the National Youth Peace Festival hosted with a nationalistic agenda using public funds and the Lahore Literary Festival (LLF) that aims to boost the cultural literacy scene of Lahore using both private and public efforts, this paper looks at the success of the private, more inclusive LLF. A revision of cultural policy is suggested that combines public and private efforts to host cultural festivals for the sake of cultural celebration and human development, without a set nationalistic agenda. Consequently, this comparison which is grounded in the human capabilities approach, recommends revising the 2005 draft of the Cultural Policy to improve human capabilities in order to support cultural diversity and ultimately contribute to economic growth in Pakistan.

Keywords: cultural policy, festivals, human capabilities, Pakistan

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Authors: Ram Sharan Mehta

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Continuing changes in health and social care policy and practice have affected and changed the way in which nursing is practiced. One of the greatest challenges facing nursing today is to build on the essence of nursing as a caring profession whilst incorporating new technologies, ideas and approaches to future healthcare. The objective of this study was to find out the socio-demographic characteristics of the M.Sc. Nursing students and calculate the association between specialty subjects, caste, age group, and residence with SLC division, BN/BSN division, entrance score, and total nursing experience. Descriptive cross-sectional study design was used to conduct the study among all the 25 M.Sc. Nursing students studying at BPKIHS in 2012. Most of the students (56%) were of age group of 25-30 years, completed his academic courses with first division and succeeded in entrance test in first attempt (96%). Based on the results, it can conclude that most of the subjects were of young age, having high score achievers in SLC, I.Sc., CN, BN/BSN and Entrance test. The demographic characteristics do not influence in the academic scores of the students.

Keywords: profile, postgraduate nursing students, Nepal, influence

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Authors: Sujeet Kumar

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Education has greater importance particularly in terms of increasing human capital and economic competitiveness. It plays a crucial role in terms of cognitive and skill development. Its plays a vital role in process of socialization, fostering social justice, and enhancing social cohesion. Policy related to education has been always a priority for developed countries, which is later adopted by developing countries also. The government of India has also brought change in education polices in line with recognizing change at national and supranational level. However, quality education is still not become an open door for every child in India and several reports are produced year to year about level of school education in India. This paper is concerned with schooling in India. Particularly, it focuses on two government and two private schools in Bihar, but reference has made to schools in Delhi especially around slum communities. The paper presents brief historical context and an overview of current school systems in India. Later, it focuses on analysis of current development in policy in reference with field observation, which is anchored around choice, diversity, market – orientation and gap between different groups of pupils. There is greater degree of difference observed at private and government school levels in terms of quality of teachers, method of teaching and overall environment of learning. The paper concludes that the recent policy development in education particularly Sarva Siksha Abhiyaan (SAA) and Right to Education Act (2009) has required renovating new approach to bridge the gap through broader consultation at grassroots and participatory approach with different stakeholders.

Keywords: education, public policy, participatory approach

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Authors: Bruce X. B. Yu, Yan Liu, Keith C. C. Chan

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We propose to record Activities of Daily Living (ADLs) of elderly people using a vision-based system so as to provide better assistive and personalization technologies. Current ADL-related research is based on data collected with help from non-elderly subjects in laboratory environments and the activities performed are predetermined for the sole purpose of data collection. To obtain more realistic datasets for the application, we recorded ADLs for the elderly with data collected from real-world environment involving real elderly subjects. Motivated by the need to collect data for more effective research related to elderly care, we chose to collect data in the room of an elderly person. Specifically, we installed Kinect, a vision-based sensor on the ceiling, to capture the activities that the elderly subject performs in the morning every day. Based on the data, we identified 12 morning activities that the elderly person performs daily. To recognize these activities, we created a HARELCARE framework to investigate into the effectiveness of existing Human Activity Recognition (HAR) algorithms and propose the use of a transfer learning algorithm for HAR. We compared the performance, in terms of accuracy, and training progress. Although the collected dataset is relatively small, the proposed algorithm has a good potential to be applied to all daily routine activities for healthcare purposes such as evidence-based diagnosis and treatment.

Keywords: daily activity recognition, healthcare, IoT sensors, transfer learning

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Authors: Ghadeer Mohammad Said El-Sheikh, Samer Mohamad Shalhoob

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Medical equipment operation state is a valid reflection of health care organizations' performance, where such equipment highly contributes to the quality of healthcare services on several levels in which quality improvement has become an intrinsic part of the discourse and activities of health care services. In healthcare organizations, clinical and biomedical engineering departments play an essential role in maintaining the safety and efficiency of such equipment. One of the most challenging topics when it comes to such sophisticated equipment is the lifespan of medical equipment, where many factors will impact such characteristics of medical equipment through its life cycle. So far, many attempts have been made in order to address this issue where most of the approaches are kind of arbitrary approaches and one of the criticisms of existing approaches trying to estimate and understand the lifetime of a medical equipment lies under the inquiry of what are the environmental factors that can play into such a critical characteristic of a medical equipment. In an attempt to address this shortcoming, the purpose of our study rises where in addition to the standard technical factors taken into consideration through the decision-making process by a clinical engineer in case of medical equipment failure, the dimension of environmental factors shall be added. The investigations, researches and studies applied for the purpose of supporting the decision making process by a clinical engineers and assessing the lifespan of healthcare equipment’s in the Lebanese society was highly dependent on the identification of technical criteria’s that impacts the lifespan of a medical equipment where the affecting environmental factors didn’t receive the proper attention. The objective of our study is based on the need for introducing a new well-designed plan for evaluating medical equipment depending on two dimensions. According to this approach, the equipment that should be replaced or repaired will be classified based on a systematic method taking into account two essential criteria; the standard identified technical criteria and the added environmental criteria.

Keywords: technical, environmental, healthcare, characteristic of medical equipment

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Authors: G. Erkomaishvili, R. Gvelesiani, E. Kharaishvili, M. Chavleishvili

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The topic reviews the situation existing currently in Georgia in the field of tourism in conditions of globalization: Touristic resources, the paces of development of the tourism infrastructure, tourism policy, possibilities of development of the Wellness industry in Georgia that is the newest direction of the medical tourism. The factors impeding the development of the industry of tourism, namely-existence of the conflict zones, high rates of the bank credits, deficiencies associated with the tax laws, a level of infrastructural development, quality of services, deficit in the competitive staff, increase of prices in the peak seasons, insufficient promotion of the touristic opportunities of Georgia on the international markets are studied and analyzed. Besides, the levels of development of tourism in Georgia according to the World Economic Forum, aspects of cooperation with the European Union etc. are reviewed. As a result of these studies, a strategy of development of tourism and one of its directions-Wellness industries in Georgia is introduced with the relevant conclusions, on which basis the recommendations are provided.

Keywords: about tourism, tourism policy, wellness industry, business, innovation, technology

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Authors: Hong Wu, Naiji Lu, Chenguang Wang, Xinming Tu

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This article analyzes the causal effects of informal care, mental health, and physical health on falls and other accidents (e.g. traffic accidents) among elderly people. To purge potential reversal causal effects, e.g., past accidents induce more future informal care, we use two-stage least squares to identify the impacts. By using longitudinal data from a representative national China Health and retirement longitudinal study of people aged 45 and older in China, our findings indicate that informal care decreases while poor health conditions increase the occurrence of accidents. We also find heterogeneous impacts on the occurrence of accidents, varying by gender, urban status, and past accident history. Our findings suggest the following three policy implications. First, policy makers who aim to decrease accidents should take informal care to elders into account. Second, ease of birth policy and postponed retirement policy are urgent to meet the demand of informal care. Third, medical policies should attach great importance to not only physical health but also mental health of elderly parents especially for older people with accident history.

Keywords: accident, China, fall, informal care, mental health, physical health

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Authors: Kannapha Amaruchkul

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We formulate a dynamic overbooking model for a tour operator, in which most reservations contain at least two people. The cancellation rate and the timing of the cancellation may depend on the group size. We propose two overbooking policies, namely economic- and service-based. In an economic-based policy, we want to minimize the expected oversold and underused cost, whereas, in a service-based policy, we ensure that the probability of an oversold situation does not exceed the pre-specified threshold. To illustrate the applicability of our approach, we use tour package data in 2016-2018 from a tour operator in Thailand to build a data-driven robust optimization model, and we tested the proposed overbooking policy in 2019. We also compare the data-driven approach to the conventional approach of fitting data into a probability distribution.

Keywords: applied stochastic model, data-driven robust optimization, overbooking, revenue management, tour operator

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Authors: Julia Wimmers Klick

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Interprofessional Education (IPE) is widely recognized as a valuable approach in healthcare education, despite the challenges it presents. This study explores IP surface anatomy lab sessions, with a focus on fostering trust and collaboration among healthcare students. The research is conducted within the context of rural healthcare settings in British Columbia (BC), where a medical school and a physical therapy (PT) program operate under the Faculty of Medicine at the University of British Columbia (UBC). While IPE sessions addressing soft skills have been implemented, the integration of hard skills, such as Anatomy, remains limited. To address this gap, a pilot feasibility study was conducted with a positive outcome, a follow-up study involved these IPE sessions aimed at exploring the influence of bonding and trust between medical and PT students. Data were collected through focus groups comprising participating students and faculty members, and a structured SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis was conducted. The IPE sessions, 3 in total, consisted of a 2.5-hour lab on surface anatomy, where PT students took on the teaching role, and medical students were newly exposed to surface anatomy. The focus of the study was on the relationship-building process and trust development between the two student groups, rather than assessing the acquisition of surface anatomy skills. Results indicated that the surface anatomy lab served as a suitable tool for the application and learning of soft skills. Faculty members observed positive outcomes, including productive interaction between students, reversed hierarchy with PT students teaching medical students, practicing active listening skills, and using a mutual language of anatomy. Notably, there was no grade assessment or external pressure to perform. The students also reported an overall positive experience; however, the specific impact on the development of soft skill competencies could not be definitively determined. Participants expressed a sense of feeling respected, welcomed, and included, all of which contributed to feeling safe. Within the small group environment, students experienced becoming a part of a community of healthcare providers that bonded over a shared interest in health professions education. They enjoyed sharing diverse experiences related to learning across their varied contexts, without fear of judgment and reprisal that were often intimidating in single professional contexts. During a joint Christmas party for both cohorts, faculty members observed students mingling, laughing, and forming bonds. This emphasized the importance of early bonding and trust development among healthcare colleagues, particularly in rural settings. In conclusion, the findings emphasize the potential of IPE sessions to enhance trust and collaboration among healthcare students, with implications for their future professional lives in rural settings. Early bonding and trust development are crucial in rural settings, where healthcare professionals often rely on each other. Future research should continue to explore the impact of content-concentrated IPE on the development of soft skill competencies.

Keywords: interprofessional education, rural healthcare settings, trust, surface anatomy

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Authors: Veronika Solilová, Danuše Nerudová

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The paper examines the interaction between the environmental taxation, size of government spending on environmental protection and greenhouse gas emissions and gross inland energy consumption. The aim is to analyze the effects of environmental taxation and government spending on environmental protection as an environmental policy instruments on greenhouse gas emissions and gross inland energy consumption in the EU15. The empirical study is performed using a VAR approach with the application of aggregated data of EU15 over the period 1995 to 2012. The results provide the evidence that the reactions of greenhouse gas emission and gross inland energy consumption to the shocks of environmental policy instruments are strong, mainly in the short term and decay to zero after about 8 years. Further, the reactions of the environmental policy instruments to the shocks of greenhouse gas emission and gross inland energy consumption are also strong in the short term, however with the deferred effects. In addition, the results show that government spending on environmental protection together with gross inland energy consumption has stronger effect on greenhouse gas emissions than environmental taxes in EU15 over the examined period.

Keywords: VAR analysis, greenhouse gas emissions, environmental taxation, government spending

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Authors: Yunqi Wang

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Benefiting from the demographic dividend, China has enjoyed export-led economic growth since 1978. While Lewis's model marks the structural transformation from the low-wage 'subsistence' sector to the 'modern sector' as the end of labour surplus, the Chinese government seems eager to extend such benefit by promoting a series of fertility encouragement policies, contrasting to its firm and strict birth control since last century. Based on a Attride-Stirling’s thematic analysis of interviews with unmarried female millennials in China, this paper argues that the young female generation responded to current fertility policies negatively, where the policy ineffectiveness and irresponsiveness have further worsened their marriage and childbirth reluctance. Instead of focusing on changes in wage level, this research contributes a qualitative perspective to the existing theoretical debate on the Lewis turning point, implying an inevitable end of demographic dividend in China. Highlighting the greater focus on female consciousness among the younger generation, it also suggests a policy orientation towards resolving outdated social norms to accommodate the rising female consciousness since millennials will become the childbirth mainstay in forthcoming years.

Keywords: lewis model, fertility policy, demographic dividend, one-child policy

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Authors: Emmanuel Chinaguh, Kehinde Adeosun

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Nigerians die untimely, with 55.75 years of life expectancy, which is 17.45 below the world average of 73.2 (Worldometer, 2020). This is due, among other factors, to the country's limited access to high-quality healthcare. To increase access to good and affordable healthcare services, the National Health Insurance Authority (NHIA) Bill 2022 – which repealed the National Health Insurance Scheme Act 2004 – was passed into law. Applying Jacob Mey’s (2001) pragmatics act (pract) theory, this study explores how NHIA seeks to actualise these healthcare goals by characterising the general situational prototype or pragmemes and pragmatic acts in institutional communications. Data was sourced from the NHIA operational guidelines, which has 147 pages and four sections, and shared posters on NHIA Nigeria Twitter Handle with 14,200 followers. Digital humanities tools, like AntConc and Voyant, were engaged in the data analysis for text encoding and data visualisation. This study identifies these discourse tokens in the data: advertisement and programmes, standards and accreditation, records and information, and offences and penalties. Advertisement and programmes pract facilitating, propagating, prospecting, advising and informing; standards and accreditation, and records and information pract stating, informing and instructing; and offences and penalties pract stating and sanctioning. These practs combined to advance the goals of affordable care and universal accessibility to quality healthcare services. The pragmatic acts were marked by these pragmatic tools: shared situational knowledge (SSK), relevance (REL), reference (REF) and inference (INF). This paper adds to the understanding of health insurance discourse in Nigeria as a mediated social practice that promotes the health of Nigerians.

Keywords: affordable care, NHIA, Nigeria’s health insurance discourse, pragmatic acts.

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Authors: Pakinee Pooprasert, Wanxin Wang, Tina Parmar, Dana Ahnood, Tafadzwa Young-Zvandasara, James Morgan

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Homelessness has been shown to be correlated to poor health outcomes, including increased visual health morbidity. Despite this, there are relatively few studies regarding visual health in the homeless population, especially in the UK. This research aims to investigate visual disability and access barriers prevalent in the homeless population in Cardiff, South Wales. Data was collected from 100 homeless participants in three different shelters. Visual outcomes included near and distance visual acuity as well as non-cycloplegic refraction. Qualitative data was collected via a questionnaire and included socio-demographic profile, ocular history, subjective visual acuity and level of access to healthcare facilities. Based on the participants’ presenting visual acuity, the total prevalence of myopia and hyperopia was 17.0% and 19.0% respectively based on spherical equivalent from the eye with the greatest absolute value. The prevalence of astigmatism was 8.0%. The mean absolute spherical equivalent was 0.841D and 0.853D for right and left eye respectively. The number of participants with sight loss (as defined by VA= 6/12-6/60 in the better-seeing eye) was 27.0% in comparison to 0.89% and 1.1% in the general Cardiff and Wales population respectively (p-value is < 0.05). Additionally, 1.0% of the homeless subjects were registered blind (VA less than 3/60), in comparison to 0.17% for the national consensus after age standardization. Most participants had good knowledge regarding access to prescription glasses and eye examination services. Despite this, 85.0% never had their eyes examined by a doctor and 73.0% had their last optometrist appointment in more than 5 years. These findings suggested that there was a significant disparity in ocular health, including visual acuity and refractive error amongst the homeless in comparison to the general population. Further, the homeless were less likely to receive the same level of support and continued care in the community due to access barriers. These included a number of socio-economic factors such as travel expenses and regional availability of services, as well as administrative shortcomings. In conclusion, this research demonstrated unmet visual health needs within the homeless, and that inclusive policy changes may need to be implemented for better healthcare outcomes within this marginalized community.

Keywords: homelessness, refractive error, visual disability, Wales

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Authors: Xiao Chen, Alice Ho, Mabel Tie, Xiaoheng Xu

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Background and Significance of the Study: School-enterprise cooperation has been the cornerstone of vocational education in China and many other countries. Researchers and policymakers have paid much attention to ensuring the implementation and improving the quality of school-enterprise cooperation. However, many problems still exist on the implementation level of the cooperation. On the one hand, the enterprises lack the motivation to participate in the cooperation. On the other hand, there is a lack of effective guidance and management during the cooperation. Furthermore, the current literature focuses greatly on policy recommendations on the national level while failing to provide a detailed practical understanding of how school-enterprise cooperation is carried out on the ground level. With emerging social problems, such as the aging population in China, there is an increasing need for diverse nursing services and better nursing quality. Methodology: To gain a deeper understanding of the influencing factors of the implementation of school-enterprise cooperation, this work conducted 37 exploratory interviews in four Chinese cities spanning first-tier to fourth-tier cities with hospital department directors, vocational school deans, nurses, and vocational students. Multiple critical policy documents that founded the current vocational education system in China were analyzed, along with the data collected from the interviews. Major Findings: Based on the policy and interview analyses, this work reveals a set of influencing factors for school-enterprise cooperation implementation. Findings from each region contribute to an overall model of influencing factors for implementing school-enterprise cooperation in vocational nursing education in China, which leads to practical insights for policy recommendation. The key influencing factors are found based on the policy, hospital, school, and social levels. Following practical policy recommendations were presented. Moving forward, further research on the implementation of school-enterprise cooperation in specific industries will become increasingly critical to improving the effectiveness of educational policies and the quality of vocational education.

Keywords: nursing, policy recommendation, school-enterprise cooperation, vocational education

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Authors: Jessica J. Gillies

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Human trafficking is a gross violation of human rights and thus invokes a strong response particularly throughout the global academic community. A longstanding tension throughout academic debate remains the question of a relationship between anti-trafficking policy and sex industry policy. In Australia, over the previous decade, many human trafficking investigations have related to the sexual exploitation of female victims, and convictions in Australia to date have often been for trafficking women from Thailand. Sex industry policy in Australia varies between states, providing a rich contextual landscape in which to explore this relationship. The purpose of this study was to deconstruct how meaning is constructed surrounding human trafficking throughout these supposedly related political discourses in Australia. In order to analyse the discursive construction of the problem of human trafficking in relation to sex industry policy, a discursive analysis was conducted. The methodology of the study was informed by a feminist theoretical framework, and included academic sources and grey literature such as organisational reports and policy statements regarding anti-trafficking initiatives. The scope of grey literature was restricted to Australian and Thai government and non-government organisation texts. The chosen methodology facilitated a qualitative exploration of the influence of feminist discourses over political discourse in this arena. The discursive analysis exposed clusters of active feminist debates interacting with sex industry policy within individual states throughout Australia. Additionally, strongly opposed sex industry perspectives were uncovered within these competing feminist frameworks. While the influence these groups may exert over policy differs, the debate constructs a discursive relationship between human trafficking and sex industry policy. This is problematic because anti-trafficking policy is drawn to some extent from this discursive construction, therefore affecting support services for survivors of human trafficking. The discursive analysis further revealed misalignment between government and non-government priorities, Australian government anti-trafficking policy appears to favour criminal justice priorities; whereas non-government settings preference human rights protections. Criminal justice priorities invoke questions of legitimacy, leading to strict eligibility policy for survivors seeking support following exploitation in the Australian sex industry, undermining women’s agency and human rights. In practice, these two main findings demonstrate a construction of policy that has serious outcomes on typical survivors in Australia following a lived experience of human trafficking for the purpose of sexual exploitation. The discourses constructed by conflicting feminist arguments influence political discourses throughout Australia. The application of a feminist theoretical framework to the discursive analysis of the problem of human trafficking is unique to this study. The study has exposed a longstanding and unresolved feminist debate that has filtered throughout anti-trafficking political discourse. This study illuminates the problematic construction of anti-trafficking policy, and the implications in practice on survivor support services. Australia has received international criticism for the focus on criminal justice rather than human rights throughout anti-trafficking policy discourse. The outcome of this study has the potential to inform future language and constructive conversations contributing to knowledge around how policy effects survivors in the post trafficking experience.

Keywords: Australia, discursive analysis, government, human trafficking, non-government, Thailand

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Authors: Nelson Kimeli Kemboi Yego, Juma Kasozi, Joseph Nkruzinza, Francis Kipkogei

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The study investigated the low uptake of health insurance in Kenya despite efforts to achieve universal health coverage through various health insurance schemes. Unsupervised machine learning techniques were employed to identify patterns in health insurance uptake based on sociodemographic factors among Kenyan households. The aim was to identify key demographic groups that are underinsured and to provide insights for the development of effective policies and outreach programs. Using the 2021 FinAccess Survey, the study clustered Kenyan households based on their health insurance uptake and sociodemographic features to reveal patterns in health insurance uptake across the country. The effectiveness of k-prototypes clustering, hierarchical clustering, and agglomerative hierarchical clustering in clustering based on sociodemographic factors was compared. The k-prototypes approach was found to be the most effective at uncovering distinct and well-separated clusters in the Kenyan sociodemographic data related to health insurance uptake based on silhouette, Calinski-Harabasz, Davies-Bouldin, and Rand indices. Hence, it was utilized in uncovering the patterns in uptake. The results of the analysis indicate that inclusivity in health insurance is greatly related to affordability. The findings suggest that targeted policy interventions and outreach programs are necessary to increase health insurance uptake in Kenya, with the ultimate goal of achieving universal health coverage. The study provides important insights for policymakers and stakeholders in the health insurance sector to address the low uptake of health insurance and to ensure that healthcare services are accessible and affordable to all Kenyans, regardless of their socio-demographic status. The study highlights the potential of unsupervised machine learning techniques to provide insights into complex health policy issues and improve decision-making in the health sector.

Keywords: health insurance, unsupervised learning, clustering algorithms, machine learning

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