Search results for: rural healthcare settings

Authors: Fiona Curran-Cournane

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Soil quality monitoring is a science-based soil management tool that assesses soil ecosystem health. A soil monitoring program in Auckland, New Zealand’s largest city, extends from 1995 to the present. The objective of this study was to firstly determine changes in soil parameters (basic soil properties and heavy metals) that were assessed from rural land in 1995-2000 and repeated in 2008-2012. The second objective was to determine differences in soil parameters across various land uses including native bush, rural (horticulture, pasture and plantation forestry) and urban land uses using soil data collected in more recent years (2009-2013). Across rural land, mean concentrations of Olsen P had significantly increased in the second sampling period and was identified as the indicator of most concern, followed by soil macroporosity, particularly for horticultural and pastoral land. Mean concentrations of Cd were also greatest for pastoral and horticultural land and a positive correlation existed between these two parameters, which highlights the importance of analysing basic soil parameters in conjunction with heavy metals. In contrast, mean concentrations of As, Cr, Pb, Ni and Zn were greatest for urban sites. Native bush sites had the lowest concentrations of heavy metals and were used to calculate a ‘pollution index’ (PI). The mean PI was classified as high (PI > 3) for Cd and Ni and moderate for Pb, Zn, Cr, Cu, As, and Hg, indicating high levels of heavy metal pollution across both rural and urban soils. From a land use perspective, the mean ‘integrated pollution index’ was highest for urban sites at 2.9 followed by pasture, horticulture and plantation forests at 2.7, 2.6, and 0.9, respectively. It is recommended that soil sampling continues over time because a longer spanning record will allow further identification of where soil problems exist and where resources need to be targeted in the future. Findings from this study will also inform policy and science direction in regional councils.

Keywords: heavy metals, pollution index, rural and urban land use, soil quality

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Authors: Sara Zelman, Courtney Meyer, Hiren Patel, Lisa Philpotts, Sue Lahey, Thomas Burke

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Background: As the global burden of disease shifts from infectious diseases to noncommunicable diseases, there is growing urgency to provide treatment for time-sensitive illnesses, such as ST-Elevation Myocardial Infarctions (STEMIs). The standard of care for STEMIs in developed countries is Percutaneous Coronary Intervention (PCI). However, this is inaccessible in resource-limited settings. Before the discovery of PCI, Streptokinase (STK) and other thrombolytic drugs were first-line treatments for STEMIs. STK has been recognized as a cost-effective and safe treatment for STEMIs; however, in settings which lack access to PCI, it has not become the established second-line therapy. A systematic literature review was conducted to geographically map the use of STK for STEMIs in resource-limited settings. Methods: Our literature review group searched the databases Cinhal, Embase, Ovid, Pubmed, Web of Science, and WHO’s Index Medicus. The search terms included ‘thrombolytics’ AND ‘myocardial infarction’ AND ‘resource-limited’ and were restricted to human studies and papers written in English. A considerable number of studies came from Latin America; however, these studies were not written in English and were excluded. The initial search yielded 3,487 articles, which was reduced to 3,196 papers after titles were screened. Three medical professionals then screened abstracts, from which 291 articles were selected for full-text review and 94 papers were chosen for final inclusion. These articles were then analyzed and mapped geographically. Results: This systematic literature review revealed that STK has been used for the treatment of STEMIs in 33 resource-limited countries, with 18 of 94 studies taking place in India. Furthermore, 13 studies occurred in Pakistan, followed by Iran (6), Sri Lanka (5), Brazil (4), China (4), and South Africa (4). Conclusion: Our systematic review revealed that STK has been used for the treatment of STEMIs in 33 resource-limited countries, with the highest utilization occurring in India. This demonstrates that even though STK has high utility for STEMI treatment in resource-limited settings, it still has not become the standard of care. Future research should investigate the barriers preventing the establishment of STK use as second-line treatment after PCI.

Keywords: cardiovascular disease, global health, resource-limited setting, ST-Elevation Myocardial Infarction, Streptokinase

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Authors: Minhas Alam, Muhammad Hidayat Rasool, Mohsin Khurshid, Bilal Aslam

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The genus Acinetobacter has emerged as a significant concern in hospital-acquired infections, particularly due to the versatility of Acinetobacter baumannii in causing nosocomial infections. The organism's remarkable metabolic adaptability allows it to thrive in various environments, including the environment, animals, and humans. However, the extent of antimicrobial resistance in Acinetobacter species from veterinary settings, especially in developing countries like Pakistan, remains unclear. This study aimed to isolate and characterize Acinetobacter spp. from veterinary settings in Punjab, Pakistan. A total of 2,230 specimens were collected, including 1,960 samples from veterinary settings (nasal and rectal swabs from dairy and beef cattle), 200 from the environment, and 70 from human clinical settings. Isolates were identified using routine microbiological procedures and confirmed by polymerase chain reaction (PCR). Antimicrobial susceptibility was determined by the disc diffusion method, and minimum inhibitory concentration (MIC) was measured by the micro broth dilution method. Molecular techniques, such as PCR and DNA sequencing, were used to screen for antimicrobial-resistant determinants. Genetic diversity was assessed using standard techniques. The results showed that the overall prevalence of A. baumannii in cattle was 6.63% (65/980). However, among cattle, a higher prevalence of A. baumannii was observed in dairy cattle, 7.38% (54/731), followed by beef cattle, 4.41% (11/249). Out of 65 A. baumannii isolates, the carbapenem resistance was found in 18 strains, i.e. 27.7%. The prevalence of A. baumannii in nasopharyngeal swabs was higher, i.e., 87.7% (57/65), as compared to rectal swabs, 12.3% (8/65). Class D β-lactamases genes blaOXA-23 and blaOXA-51 were present in all the CRAB from cattle. Among carbapenem-resistant isolates, 94.4% (17/18) were positive for class B β-lactamases gene blaIMP, whereas the blaNDM-1 gene was detected in only one isolate of A. baumannii. Among 70 clinical isolates of A. baumannii, 58/70 (82.9%) were positive for the blaOXA-23-like gene, and 87.1% (61/70) were CRAB isolates. Among all clinical isolates of A. baumannii, blaOXA-51-like gene was present. Hence, the co-existence of blaOXA-23 and blaOXA-51 was found in 82.85% of clinical isolates. From the environmental settings, a total of 18 A. baumannii isolates were recovered; among these, 38.88% (7/18) strains showed carbapenem resistance. All environmental isolates of A. baumannii harbored class D β-lactamases genes, i.e., blaOXA-51 and blaOXA-23 were detected in 38.9% (7/18) isolates. Hence, the co-existence of blaOXA-23 and blaOXA-51 was found in 38.88% of isolates. From environmental settings, 18 A. baumannii isolates were recovered, with 38.88% showing carbapenem resistance. All environmental isolates harbored blaOXA-51 and blaOXA-23 genes, with co-existence in 38.88% of isolates. MLST results showed ten different sequence types (ST) in clinical isolates, with ST 589 being the most common in carbapenem-resistant isolates. In veterinary isolates, ST2 was most common in CRAB isolates from cattle. Immediate control measures are needed to prevent the transmission of CRAB isolates among animals, the environment, and humans. Further studies are warranted to understand the mechanisms of antibiotic resistance spread and implement effective disease control programs.

Keywords: Acinetobacter baumannii, carbapenemases, drug resistance, MSLT

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Authors: Made Darmiati, Ni Putu Evi Wijayanti, Ni Ketut Wiwiek Agustina, Putu Gde Arie Yudhistira, Marcel Hardono

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The establishment of tourist village has been the main concern for pro-poor tourism in Indonesia especially in Bali in order to create alternative tourist destination. The case study of this research was Munduk, a tourist village located in Buleleng Regency, Bali Province. Munduk has been unstable in terms of tourist visit in 2012 until 2016. The concept of marketing strategy and its marketing mix are concepts that suitable for application in Munduk as the prime owner of trekking and other rural tour packages to increase the number of visitor in particularly during low season. The research study aims to determine the internal factors (strengths and weaknesses) and external factors (opportunities and threats) impacting the number of tourist visit so that they could formulate appropriate marketing strategy for Munduk Tourist Village. Data has been obtained by observation, interviews with stakeholders, questionnaire to 100 participants and documentation. In addition, this research study uses descriptive qualitative methods and techniques known as SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis by internal factors and external factors impacting the level of tourist visit to Munduk Tourist Village in Buleleng Regency, Bali. The sampling was done by ‘accidental sampling technique’ to obtain the participants to analyse the results of the SWOT analysis. Further assessment of internal and external weights has resulted respectively (1.84 , 1.84) which are in the first quadrant of the diagram in which S-O (Strengths-Opportunities) Strategy. As the prime owner of the trekking and other rural tour packages in the village, Munduk should maximise its strengths and take other opportunities as possible to wrap and design trekking and other rural tour packages and then offer the package to travel agents in Bali.

Keywords: marketing mix, marketing strategy, rural tourism, SWOT matrix

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Authors: Muneera Mohammed Al-Dossary, Fatimah Mohammed Al-Dossary, Mashael Al-Shahrani, Amal Al-Tammemi

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Johns Hopkins Aramco Healthcare (JAHA), a joint venture between Saudi Aramco and Johns Hopkins Medicine, delivers comprehensive healthcare services to a diverse patient population. Despite achieving high patient satisfaction rates and surpassing several operational targets, JAHA faces challenges such as appointment delays and resource inefficiencies. These issues highlight the need for an advanced, integrated approach to operational management. This paper proposes a Business Intelligence (BI) framework to address these challenges, leveraging tools such as Epic electronic health records and Tableau dashboards. The framework focuses on data integration, real-time monitoring, and predictive analytics to streamline operations and enhance decision-making. Key outcomes include reduced wait times (e.g., a 23% reduction in specialty clinic wait times) and improved operating room efficiency (from 95.83% to 98% completion rates). These advancements align with JAHA’s strategic objectives of optimizing resource utilization and delivering superior patient care. The findings underscore the transformative potential of BI in healthcare, enabling a shift from reactive to proactive operations management. The success of this implementation lays the foundation for future innovations, including machine learning models for more precise demand forecasting and resource allocation.

Keywords: business intelligence, operational efficiency, healthcare management, predictive analytics, patient care improvement, data integration, real-time monitoring, resource optimization, Johns Hopkins Aramco Healthcare, electronic health records, Tableau dashboards, predictive modeling, efficiency metrics, resource utilization, patient satisfaction

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Authors: Gabriela Prins, Quinette Louw, Dawn Ernstzen

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Background: Access to rehabilitation services is a major challenge globally, especially in low-and-middle income countries (LMICs) where resources and infrastructure are extremely limited. Telerehabilitation (TR) has emerged in recent decades as a highly promising method to dramatically expand accessibility to rehabilitation services globally. TR provides rehabilitation care remotely using communication technologies such as video conferencing, smartphones, and internet-connected devices. This boosts accessibility to underprivileged regions and allows for greater flexibility for patients. Despite this, TR is hindered by several factors, including limited technological resources, high costs, lack of digital access, and the unavailability of healthcare systems, which are major barriers to widespread adoption among LMIC patients. These barriers have collectively hindered the potential implementation and adoption of TR services in LMICs healthcare settings. Adoption of TR will also require the buy-in of end users and limited information is known on the perspectives of the SA population. Aim: The study aimed to understand patients' perspectives regarding the use of digital technology as part of their OA rehabilitation at a public community healthcare centre in the Cape Metropole Area. Methods: A qualitative descriptive study design was used on 10 OA patients from a public community rehabilitation centre in South Africa. Data collection included semi-structured interviews and patient-reported outcome measures (PSFS, ASES-8, and EuroQol EQ-5D-5L) on functioning and quality of life. Transcribed interview data were coded in Atlas.ti. 22.2 and analyzed using thematic analysis. The results were narratively documented. Results: Four themes arose from the interviews. The themes were Telerehabilitation awareness (Use of Digital Technology Information Sources and Prior Experience with Technology /TR), Telerehabilitation Benefits (Access to healthcare providers, Access to educational information, Convenience, Time and Resource Efficiency and Facilitating Family Involvement), Telerehabilitation Implementation Considerations (Openness towards TR Implementation, Learning about TR and Technology, Therapeutic relationship, and Privacy) and Future use of Telerehabilitation (Personal Preference and TR for the next generation). The ten participants demonstrated limited awareness and exposure to TR, as well as minimal digital literacy and skills. Skepticism was shown when comparing the effectiveness of TR to in-person rehabilitation and valued physical interactions with health professionals. However, some recognized potential benefits of TR for accessibility, convenience, family involvement and improving community health in the long term. Willingness existed to try TR with sufficient training. Conclusion: With targeted efforts addressing identified barriers around awareness, technological literacy, clinician readiness and resource availability, perspectives on TR may shift positively from uncertainty towards endorsement of this expanding approach for simpler rehabilitation access in LMICs.

Keywords: digital technology, osteoarthritis, primary health care, telerehabilitation

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Authors: Zhankun Wang, Timothy Makubuya

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The efficiency of public sports service of prefecture-level cities in Zhejiang from 2008 to 2012 was evaluated by applying the DEA method, then its influencing factors were also analyzed through Tobit model. Upon analysis, the results revealed the following; (i) the change in average efficiency of public sports service in Zhejiang present a smooth uptrend and at a relatively high level from 2008 to 2012 (ii) generally, the productivity of public sports service in Zhejiang improved from 2008 to 2012, the productivity efficiency varied greatly in different years, and the regional difference of production efficiency increased. (iii) The correlations for urbanization rate, aging rate, per capita GDP and the population density were significantly positive with the public sports service efficiency in Zhejiang, of which the most significant was the aging rate. However, the population density and per capita GDP had less impact on the efficiency of public sports service in Zhejiang. In addition, whether the efficiency of public sports services in different areas in Zhejiang reciprocates to overall benefits in public wellbeing in both rural and urban settings is still arguable.

Keywords: DEA model, public sports service, efficiency, Tobit model, Malmquist productivity index, Zhejiang

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Authors: Stefanie Santorsola, Natasha Frank

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Improving healthcare safety necessitates examining current trends and beliefs about safety and devising strategies to improve. Errors in healthcare continue to increase and be experienced by patients, which is preventable and directly correlated to a breakdown in healthcare communication. TeamSTEPPS is an evidence-based process designed to improve the quality and safety of healthcare by improving communication and team processes. Communication is at the core of effective team collaboration and is vital for patient safety. TeamSTEPPS offers insights and strategies for improving communication and teamwork and reducing preventable errors to create a safer healthcare environment for patients. The academic, clinical, and educational environment for nursing students is vital in preparing them for professional practice by providing them with foundational knowledge and abilities. This environment provides them with a prime opportunity to learn about errors and the importance of effective communication to enhance patient safety, as nursing students are often unprepared to deal with errors. Proactively introducing and discussing errors through a supportive culture during the nursing student’s academic beginnings has the potential to carry key concepts into practice to improve and enhance patient safety. TeamSTEPPS has been used globally and has collectively positively impacted improvements in patient safety and teamwork. A workshop study was introduced in winter 2023 of registered practical nurses (RPN) students bridging to the baccalaureate nursing program; the majority of the RPNs in the bridging program were actively employed in a variety of healthcare facilities during the semester. The workshop study did receive academic institution ethics board approval, and participants signed a consent form prior to participating in the study. The premise of the workshop was to introduce TeamSTEPPS and a variety of strategies to these students and have students keep a reflective journal to incorporate the presented communication strategies in their practicum setting and keep a reflective journal on the effect and outcomes of the strategies in the healthcare setting. Findings from the workshop study supported the objective of the project, resulting in students verbalizing notable improvements in team functioning in the healthcare environment resulting from the incorporation of enhanced communication strategies from TeamSTEPPS that they were introduced to in the workshop study. Implication for educational institutions is the potential of further advancing the safety literacy and abilities of nursing students in preparing them for entering the workforce and improving safety for patients.

Keywords: teamstepps, education, patient safety, communication

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Authors: Nick Woodier, Iain Moppett

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Background: It is estimated that one in ten patients admitted to hospital will suffer an adverse event in their care. While the majority of these will result in low harm, patients are being significantly harmed by the processes meant to help them. Healthcare, therefore, seeks to make improvements in patient safety by taking learning from other industries that are perceived to be more mature in their management of safety events. Of particular interest to healthcare are ‘near misses,’ those events that almost happened but for an intervention. Healthcare does not have any guidance as to how best to manage and learn from near misses to reduce the chances of harm to patients. The authors, as part of a larger study of near-miss management in healthcare, sought to learn from the UK nuclear sector to develop principles for how healthcare can identify, report, and learn from near misses to improve patient safety. The nuclear sector was chosen as an exemplar due to its status as an ultra-safe industry. Methods: A Grounded Theory (GT) methodology, augmented by a scoping review, was used. Data collection included interviews, scenario discussion, field notes, and the literature. The review protocol is accessible online. The GT aimed to develop theories about how nuclear manages near misses with a focus on defining them and clarifying how best to support reporting and analysis to extract learning. Near misses related to radiation release or exposure were focused on. Results: Eightnuclear interviews contributed to the GT across nuclear power, decommissioning, weapons, and propulsion. The scoping review identified 83 articles across a range of safety-critical industries, with only six focused on nuclear. The GT identified that nuclear has a particular focus on precursors and low-level events, with regulation supporting their management. Exploration of definitions led to the recognition of the importance of several interventions in a sequence of events, but that do not solely rely on humans as these cannot be assumed to be robust barriers. Regarding reporting and analysis, no consistent methods were identified, but for learning, the role of operating experience learning groups was identified as an exemplar. The safety culture across nuclear, however, was heard to vary, which undermined reporting of near misses and other safety events. Some parts of the industry described that their focus on near misses is new and that despite potential risks existing, progress to mitigate hazards is slow. Conclusions: Healthcare often sees ‘nuclear,’ as well as other ultra-safe industries such as ‘aviation,’ as homogenous. However, the findings here suggest significant differences in safety culture and maturity across various parts of the nuclear sector. Healthcare can take learning from some aspects of management of near misses in nuclear, such as how they are defined and how learning is shared through operating experience networks. However, healthcare also needs to recognise that variability exists across industries, and comparably, it may be more mature in some areas of safety.

Keywords: culture, definitions, near miss, nuclear safety, patient safety

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Authors: Juhi Pandya, Elekes Zsuzsanna

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Health is related to every aspect of human being. Even a quintal change leads to ill-health of an individual. Gender plays an eminent role in determining an individual health exposure. Political implications on health have implicit effects on the individual, societal and economical. The inclusion of gender perspective into policies have plunged enormous attention globally, nationally and locally to detract inequalities and achieve economic growth. Simultaneously, there is an initiation of policies with gender perspective which are named differently but hold similar meaning or objective. They are named gender mainstreaming policies or gender sensitization policies. Gender budgeting acts as a tool for the application of gender mainstreaming policies. It incorporates gender perspective into the budgetary process by restricting the revenues and expenditures at all level of the budget. The current study takes into account the analysis of Gender Budgeting reports in terms of healthcare from the 2014-16 year of Gujarat State, India. The expenditures and literature under the heading of gender budgeting reports named “Health and Family Welfare Department” are discussed in the paper. The data analytics is done with the help of reports published by the Gujarat government on Gender Budgeting. The results discuss upon the expenditure and initiation of new policies as a roadmap for the promotion of gender equality from the path of gender budgeting. It states with the escalation of the budgetary numbers for the health expenditure. Additionally, the paper raises the questions on the hypothetical loopholes pertaining to the gender budgeting in Gujarat. The budget reports do not show a specify explanation to the expenditure use of budget for the schemes mentioned in healthcare. It also does not clarify that how many beneficiaries are benefited through gender budget. The explanation just provides an overlook of theory for healthcare Schemes/Yojana or Abhiyan.

Keywords: gender, gender budgeting, gender equality, healthcare

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Authors: Jakia Rajoana

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The aim of this paper is to examine the role of women entrepreneurs in bringing about sustainable rural tourism (SRT) development in Sundarbans area of Bangladesh. Theoretically, it draws upon empowerment and entrepreneurial marketing concepts. Women entrepreneurship development and lack of empowered women as role models is an important issue for developing economies in South Asia. Despite the substantial role women play in rural economy of Sundarbans, their contribution remains overlooked as enterprises led by them are run on an informal basis and their business acumen is not taken seriously both by their families and society at large. Studies on SRT fail to engage in sufficient depth with the term applied in this paper as ‘invisible women on the margins’ who run their enterprises with no formal training or societal/familial support. Moreover, the link between their (non) tourism enterprise and their empowerment remains under-theorized. Thus empirically, this research seeks to fill a significant gap by focusing on a considerably under-researched Sundarbans region. Methodologically, this study follows a qualitative research design using visual ethnographic approach. Participant observation, semi-structured interviews, and documentation are the primary data collection instruments in three coastal communities – Munshigonj, Burigoalini and Gabura – in the Sundarbans area. By focusing on the narratives of these under-investigated women, this work aims to provide in-depth and nuanced insights into salient issues on marginal communities experience from rural women’s perspectives. Initial findings illustrate that the Sundarbans women have low income due to no or little education. In addition, socio-cultural and religious factors also restrict the scope of their extensive contribution to workplace. In addition, physical and social violence which is a common occurrence for these women inhibits their agency and contributes to their disempowerment.

Keywords: gender, empowerment, entrepreneurial marketing, sustainable rural tourism, Sundarbans

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Authors: Ladda Thiamwong, Renata Komalasari

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Falls are the leading cause of disability and hospitalization in low-income older adults. Fear of falling is present in 20% to 85 % of older adults and has been identified as an independent risk factor of fall risk, activity restriction, and loss of independence. About 12% of American older adults have subjective cognitive decline. Cognitive impairment is also an established factor of fall risk. However, it is unclear whether measures of fear of falling and subjective cognitive decline have the greatest association with fall risk in low-income older adults. The aim of this study was to evaluate the association between fear of falling, subjective cognitive decline-functional performance (SCD-FP), and fall risk using simple screening tools. In this cross-section study, we collected data from community-dwelling older adults 60 years or older in low-income settings in Central Florida, and 86 participants were included in the data analysis. Fear of falling was assessed by the Short Fall Efficacy Scale- International (Short FES-I) with seven items. Subjective cognitive decline-functional performance (SCD-FP) was assessed by a self-reported experience of worsening or more frequent confusion or memory loss in the past 12 months and its functional implications. Fall risk was evaluated by the Centers for Disease Control and Prevention (CDC)'s Stay Independent checklist with 12 items. The majority of participants were female, and more than half of the participants were African American. More than half of the participants had a higher school degree or higher, and less than 20% had no financial problems. Less than 30% of the participants perceived their general health as very good- excellent. More than half of the participants lived alone, and less than 15% lived with a partner or spouse. About 60% of the participants had hypertension, 40% had diabetes, 16% had cancer, and 50% had arthritis. About 30% of the participants had difficulty walking up ten steps without resting, more than 40% felt unsteady when walking, and 30% had been advised to use a cane or walker to get around safely. Regression analysis showed that fall risk was associated with fear of falling ( = .524, p <.001) and subjective cognitive decline-functional performance ( = .465, p =.027). The structure coefficient showed that fear of falling (rs2 = .922) was a stronger predictor of fall risk than subjective cognitive decline-functional performance (rs2= .200). Fear of falling and subjective cognitive decline-functional performance are growing public health issues, and addressing those issues is a public priority. Proactive screening for fear of falling and subjective cognitive decline-functional performance is critical in fall prevention. A combination of all three self-reported tools (Short FES-I, SCD-FP, and CDC's Stay Independent checklist) takes less than 5 minutes to complete. Primary care providers or public health professionals should consider including these tools to screen fear of falling and subjective cognitive decline-functional performance as part of fall risk assessment, especially in low-income settings. Thus, encouraging older adults and healthcare professionals to discuss fear of falling, subjective cognitive decline, and fall risk during routine medical office visits.

Keywords: falls, fall risk, fear of falling, cognition, subjective cognitive decline, low-income, older adults, community, screening, nursing, primary care

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Authors: Sahar Heidary

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Radiography and radiotherapy have emerged as crucial pillars of modern medical practice, revolutionizing diagnostics and treatment for a myriad of health conditions. This abstract highlights the pivotal role of radiography and radiotherapy in favor of healthcare and society. Radiography, a non-invasive imaging technique, has significantly advanced medical diagnostics by enabling the visualization of internal structures and abnormalities within the human body. With the advent of digital radiography, clinicians can obtain high-resolution images promptly, leading to faster diagnoses and informed treatment decisions. Radiography plays a pivotal role in detecting fractures, tumors, infections, and various other conditions, allowing for timely interventions and improved patient outcomes. Moreover, its widespread accessibility and cost-effectiveness make it an indispensable tool in healthcare settings worldwide. On the other hand, radiotherapy, a branch of medical science that utilizes high-energy radiation, has become an integral component of cancer treatment and management. By precisely targeting and damaging cancerous cells, radiotherapy offers a potent strategy to control tumor growth and, in many cases, leads to cancer eradication. Additionally, radiotherapy is often used in combination with surgery and chemotherapy, providing a multifaceted approach to combat cancer comprehensively. The continuous advancements in radiotherapy techniques, such as intensity-modulated radiotherapy and stereotactic radiosurgery, have further improved treatment precision while minimizing damage to surrounding healthy tissues. Furthermore, radiography and radiotherapy have demonstrated their worth beyond oncology. Radiography is instrumental in guiding various medical procedures, including catheter placement, joint injections, and dental evaluations, reducing complications and enhancing procedural accuracy. On the other hand, radiotherapy finds applications in non-cancerous conditions like benign tumors, vascular malformations, and certain neurological disorders, offering therapeutic options for patients who may not benefit from traditional surgical interventions. In conclusion, radiography and radiotherapy stand as indispensable tools in modern medicine, driving transformative improvements in patient care and treatment outcomes. Their ability to diagnose, treat, and manage a wide array of medical conditions underscores their favor in medical practice. As technology continues to advance, radiography and radiotherapy will undoubtedly play an ever more significant role in shaping the future of healthcare, ultimately saving lives and enhancing the quality of life for countless individuals worldwide.

Keywords: radiology, radiotherapy, medical imaging, cancer treatment

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Authors: Isabelle Snyder

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Microgrid protection presents challenges to conventional protection techniques due to the low induced fault current. Protection relays present in microgrid applications require a combination of settings groups to adjust based on the architecture of the microgrid in islanded and grid-connected mode. In a radial system where the microgrid is at the other end of the feeder, directional elements can be used to identify the direction of the fault current and switch settings groups accordingly (grid connected or microgrid connected). However, with multiple microgrid connections, this concept becomes more challenging, and the direction of the current alone is not sufficient to identify the source of the fault current contribution. ORNL has previously developed adaptive relaying schemes through other DOE-funded research projects that will be evaluated and used as a baseline for this research. The four protection techniques in this study are the following: (1) Adaptive Current only Protection System (ACPS), Intentional (2) Unbalanced Control for Protection Control (IUCPC), (3) Adaptive Protection System with Communication Controller (APSCC) (4) Adaptive Model-Driven Protective Relay (AMDPR). The first two methods focus on identifying the islanded mode without communication by monitoring the current sequence component generated by the system (ACPS) or induced with inverter control during islanded mode (IUCPC) to identify the islanding condition without communication at the relay to adjust the settings. These two methods are used as a backup to the APSCC, which relies on a communication network to communicate the islanded configuration to the system components. The fourth method relies on a short circuit model inside the relay that is used in conjunction with communication to adjust the system configuration and computes the fault current and adjusts the settings accordingly.

Keywords: adaptive relaying, microgrid protection, sequence components, islanding detection, communication controlled protection, integrated short circuit model

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Authors: Alyaa Farouk Ibrahim, Gehan ElSayed, Ola Mamdouh, Nazek AbdelGhany

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Background: Primary health care (PHC) can be considered the first contact between the patient and the health care system. It includes all the basic health care services to be provided to the community. Patient's satisfaction regarding health care has often improved the provision of care, also considered as one of the most important measures for evaluating the health care. Objective: This study aims to identify patient’s satisfaction with services provided at the primary health care settings in Alexandria. Setting: Seven primary health care settings representing the seven zones of Alexandria governorate were selected randomly and included in the study. Subjects: The study comprised 386 patients attended the previously selected settings at least twice before the time of the study. Tools: Two tools were utilized for data collection; sociodemographic characteristics and health status structured interview schedule and patient satisfaction scale. Reliability test for the scale was done using Cronbach's Alpha test, the result of the test ranged between 0.717 and 0.967. The overall satisfaction was computed and divided into high, medium, and low satisfaction. Results: Age of the studied sample ranged between 19 and 62 years, more than half (54.2%) of them aged 40 to less than 60 years. More than half (52.8%) of the patients included in the study were diabetics, 39.1% of them were hypertensive, 19.2% had cardiovascular diseases, the rest of the sample had tumor, liver diseases, and orthopedic/neurological disorders (6.5%, 5.2% & 3.2%, respectively). The vast majority of the study group mentioned high satisfaction with overall service cost, environmental conditions, medical staff attitude and health education given at the PHC settings (87.8%, 90.7%, 86.3% & 90.9%, respectively), however, medium satisfaction was mostly reported concerning medical checkup procedures, follow-up data and referral system (41.2%, 28.5% & 28.9%, respectively). Score level of patient satisfaction with health services provided at the assessed Primary health care settings proved to be significantly associated with patients’ social status (P=0.003, X²=14.2), occupation (P=0.011, X²=11.2), and monthly income (P=0.039, X²=6.50). In addition, a significant association was observed between score level of satisfaction and type of illness (P=0.007, X²=9.366), type of medication (P=0.014, X²=9.033), prior knowledge about the health center (P=0.050, X²=3.346), and highly significant with the administrative zone (P=0.001, X²=55.294). Conclusion: The current study revealed that overall service cost, environmental conditions, staff attitude and health education at the assessed primary health care settings gained high patient satisfaction level, while, medical checkup procedures, follow-up, and referral system caused a medium level of satisfaction among assessed patients. Nevertheless, social status, occupation, monthly income, type of illness, type of medication and administrative zones are all factors influencing patient satisfaction with services provided at the health facilities.

Keywords: patient satisfaction, chronic illness, quality of health service, quality of service indicators

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Authors: Ikrima Zaleda Zia, Devi Fitri Kumalasari, Rosita Khusna, Farah Hidayati, Ilham Fajrul Haq, Amin Yusuf Efendi

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Fertilizer is one of the production factors that are important to agriculture. Fertilizers contribution to the agricultural sector improvement is quite high. Fertilizers scarcity on the society are giving effect to agricultural sector, that is decreasing farmers production. Through a system called Kemal Propuri, society will be taught how to be independent, especially in terms of supplying the fertilizer and how to earn extra income besides of relying on the agriculture production. This research aims to determine implementation measures of Kemal Propuri in realizing farmers independence. This research was designed to use descriptive research with a qualitative approach. In this case, writers are trying to make an illustration of the increasing role of KUD (rural unit cooperative) through Kemal Propuri system (Independence System Through Individual Fertilizer Production) towards farmer independence. It can be concluded that Kemal Propuri system can contribute in order to achieve farmers independence. Independence fertilizer production will overcome farmers dependence of the subsidized fertilizer from the government.

Keywords: Kemal Propuri, KUD (Rural Unit Cooperative), independence farmers, fertilizer production

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Authors: Jared Abuga, Wesley Too

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Medical error is the third leading cause of death in US, with approximately 98,000 deaths occurring every year as a result of medical errors. The world financial burden of medication errors is roughly USD 42 billion. Medication errors may lead to at least one death daily and injure roughly 1.3 million people every year. Medical error reporting is essential in creating a culture of accountability in our healthcare system. Studies have shown that attitudes and practice of healthcare workers in reporting medical errors showed that the major factors in under-reporting of errors included work stress and fear of medico-legal consequences due to the disclosure of error. Further, the majority believed that increase in reporting medical errors would contribute to a better system. Most hospitals depend on nurses to discover medication errors because they are considered to be the sources of these errors, as contributors or mere observers, consequently, the nurse’s perception of medication errors and what needs to be done is a vital feature to reducing incidences of medication errors. We sought to explore knowledge among nurses on medical errors and factors affecting or hindering reporting of medical errors among nurses working at the emergency unit, KNH. Critical care nurses are faced with many barriers to completing incident reports on medication errors. One of these barriers which contribute to underreporting is a lack of education and/or knowledge regarding medication errors and the reporting process. This study, therefore, sought to determine the availability and the use of reporting systems for medical errors in critical care unity. It also sought to establish nurses’ perception regarding medical errors and reporting and document factors facilitating timely identification and reporting of medical errors in critical care settings. Methods: The study used cross-section study design to collect data from 76 critical care nurses from Kenyatta Teaching & Research National Referral Hospital, Kenya. Data analysis and results is ongoing. By October 2022, we will have analysis, results, discussions, and recommendations of the study for purposes of the conference in 2023

Keywords: errors, medical, kenya, nurses, safety

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Authors: Ward Makhoul

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Code-switching (CS) is known as a ubiquitous phenomenon in multilingual societies and countries. Vernacular Palestinian Arabic (PA) variety spoken in Israel is among these languages, informally used for day-to-day conversations only. Such conversations appear to contain code-switched instances from Hebrew, the formal and dominant language of the country, even in settings where the need for CS seems to be unnecessary. This study examines the CS practices in PA and investigates the reason behind these CS instances in controlled settings and the correlation between bilingual dominance and CS. In the production-task interviews and Bilingual Language Profile test (BLP), there was a correlation between language dominance and CS; 13 participants were interviewed to elicit and analyze natural speech-containing CS instances, along with undergoing a BLP test. The acceptability judgment task observed the limits and boundaries of different code-switched linguistic structures.

Keywords: code-switching, Hebrew, Palestinian-Arabic, vernacular

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Authors: David Tennison

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In the wake of the Covid-19 pandemic, a new chronic illness emerged onto the global stage: Long Covid. Long Covid presents with several symptoms commonly seen in other poorly-understood illnesses, such as fibromyalgia (FM) and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). However, while Long Covid has swiftly become a recognised illness, FM and ME/CFS are still seen as contested, which impacts patient care and healthcare experiences. This study aims to examine what the differences are between Long Covid and FM; and if the Long Covid case can provide guidance for how to address the healthcare challenge of contested illnesses. To address this question, this study performed comprehensive research into the history of FM; our current biomedical understanding of it; and available healthcare interventions (within the context of the UK NHS). Analysis was undertaken of the stigma and stereotypes around FM, and a comparison made between FM and the emerging Long Covid literature, along with the healthcare response to Long Covid. This study finds that healthcare for chronic contested illnesses in the UK is vastly insufficient - in terms of pharmaceutical and holistic interventions, and the provision of secondary care options. Interestingly, for Long Covid, many of the treatment suggestions are pulled directly from those used for contested illnesses. The key difference is in terms of funding and momentum – Long Covid has generated exponentially more interest and research in a short time than there has been in the last few decades of contested illness research. This stands to help people with FM and ME/CFS – for example, research has recently been funded into “brain fog”, a previously elusive and misunderstood symptom. FM is culturally regarded as a “women’s disease” and FM stigma stems from notions of “hysteria”. A key finding is that the idea of FM affecting women disproportionally is not reflected in modern population studies. Emerging data on Long Covid also suggests a slight leaning towards more female patients, however it is less feminised, potentially due to it emerging in the global historical moment of the pandemic. Another key difference is that FM is rated as an extremely low-prestige illness by healthcare professionals, while it was in large part due to the advocacy of affected healthcare professionals that Long Covid was so quickly recognised by science and medicine. In conclusion, Long Covid (and the risk of future pandemics and post-viral illnesses) highlight a crucial need for implementing new, and reinforcing existing, care networks for chronic illnesses. The difference in how contested illnesses like FM, and new ones like Long Covid are treated have a lot to do with the historical moment in which they emerge – but cultural stereotypes, from within and without medicine, need updating. Particularly as they contribute to disease stigma that causes genuine harm to patients. However, widespread understanding and acceptance of Long Covid could help fight contested illness stigma, and the attention, funding and research into Long Covid may actually help raise the profile of contested illnesses and uncover answers about their symptomatology.

Keywords: long COVID, fibromyalgia, myalgic encephalomyelitis, chronic fatigue syndrome, NHS, healthcare, contested illnesses, chronic illnesses, COVID-19 pandemic

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Authors: André M. Senna, Mary L. G. S. Senna, Rosa M. Machado-de-Sena

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One of the great challenges presented in educational practice is how to ensure the students not only acquire knowledge of training courses throughout their academic life, but also how to apply it in their current professional activities. Consequently, aiming to incite changes in the education system of healthcare professionals noticed the inadequacy of the training providers to solve the social problems related to health, the education related to these procedures should initiate in the earliest years of process. Following that idea, there is another question that needs an answer: If the change in the education should start sooner, in the period of basic training of healthcare professionals, what guidelines should a permanent education program incorporate to promote changes in an already established system? For this reason, the objective of this paper is to present different views of the teaching-learning process, with the purpose of better understanding the behavior adopted by healthcare professionals, through bibliographic study. The conclusion was that more than imparting knowledge to the individual, a larger approach is necessary on permanent education programs concerning the performance of professional health services in order to foment significant changes in education.

Keywords: Health Education, continuing education, training, behavior

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Authors: Abrar R. Al-Hasan

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Despite the widespread use of social media by consumers and marketers, empirical research investigating their economic value in the healthcare industry still lags. This study explores the impact of the use of social media marketing efforts on a hospital's brand equity and, ultimately, consumer response. Using social media data from Twitter and Facebook, along with an online and offline survey methodology, data is analyzed using logistic regression models. A random sample of (728) residents of the Kuwaiti population is used. The results of this study found that social media marketing efforts (SMME) in terms of use and validation lead to higher hospital brand equity and in turn, patient loyalty and patient visit. The study highlights the impact of SMME on hospital brand equity and patient response. Healthcare organizations should guide their marketing efforts to better manage this new way of marketing and communicating with patients to enhance their consumer loyalty and financial performance.

Keywords: brand equity, healthcare marketing, patient visit, social media, SMME

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Authors: Heather Fulford, Melanie Liddell

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The recruitment and retention of high quality employees can prove to be challenging for social enterprises, particularly in some of the core business support functions such as marketing, communications, IT and finance. This holds true for social enterprises in urban contexts, where roles with more attractive remuneration in these business functions can often be found quite readily in the private sector. For social enterprises situated in rural locations, the challenges of staff recruitment and retention are even more acute. Such challenges can lead to a skills deficit in rural social enterprises, which can, at best, hinder their growth potential, and worse, jeopardise their chances of survival. This in turn, can have a negative impact on the sustainability and resilience of the surrounding rural community in which the social enterprise is located. The purpose of this paper is to report on aspects of a collaborative initiative established to stimulate innovation and business growth in remote rural businesses in Scotland. Launched in 2010, this initiative was designed to attract young students and graduates from the region to stay in the region upon completion of their studies, and to attract others from outside the region to re-locate there post-university. To facilitate this, SMEs in the region were offered wage subsidies to encourage them to recruit a student or graduate on a work placement for up to one year to participate in an innovation or business growth-oriented project. A number of the employers offering work placements were social enterprises. Through analysis of the placement project and role specifications devised by the participating social enterprises, an overview is provided of their business development needs and the skills they require to stimulate innovation and growth. Scrutiny of the reflective accounts compiled by the students and graduates at the close of their work placements highlights the benefits they derived from being able to put their academic knowledge and skills into action within a social enterprise. Examination of interviews conducted with a sample of placement employers reveals the contribution the students and graduates made during the business development projects with the social enterprises. The challenges of hosting such placements are also discussed. The paper concludes with indications of the lessons learned and an outline of the wider implications for other remote rural locations in which social enterprises play an important role in the local economy and life of the community.

Keywords: resilience, rural development, regeneration, regional development, recruitment, resource management, retention, remuneration

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Authors: Benny Sand, Yotam Lurie, Shlomo Mark

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Medical Internet of Things (MIoT), AI, and data privacy are linked forever in a gordian knot. This paper explores the conflicts of interests between the stakeholders regarding data privacy in the MIoT arena. While patients are at home during healthcare hospitalization, MIoT can play a significant role in improving the health of large parts of the population by providing medical teams with tools for collecting data, monitoring patients’ health parameters, and even enabling remote treatment. While the amount of data handled by MIoT devices grows exponentially, different stakeholders have conflicting understandings and concerns regarding this data. The findings of the research indicate that medical teams are not concerned by the violation of data privacy rights of the patients' in-home healthcare, while patients are more troubled and, in many cases, are unaware that their data is being used without their consent. MIoT technology is in its early phases, and hence a mixed qualitative and quantitative research approach will be used, which will include case studies and questionnaires in order to explore this issue and provide alternative solutions.

Keywords: MIoT, data privacy, stakeholders, home healthcare, information privacy, AI

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Authors: Lindiwe Ngcobo

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The aim of the study is to describe and understand the benefits and costs of having biogas digesters at both household and society level. On a household level, the purpose is to understand how rural households benefit from the biogas digesters, for example, by converting animal and human waste through biogas digesters, and at what costs the benefits are realized. At a societal level, the purpose is to understand the costs and benefits of biogas digesters relative to the situation of rural communities who do not have flush toilets and have no appropriate waste disposal services while they incur electricity costs. Multiple regression analysis was used to determine the effect of biogas digesters on electricity availability and waste management. The results showed that beneficiaries spent less on electricity using household waste, and also waste disposal costs were eliminated from household expenses. A move to biogas energy production can be beneficial to rural households. It is economically and environmentally friendly. Small-scale farmers need to be introduced to agricultural innovations that can assist them in producing nutritious crops at a low cost. This can be a good opportunity to start an agribusiness that focuses on organic crops. Extensions and training institutions have to play a part in supporting households to develop entrepreneurial skills. Cost-benefit analysis showed that the benefits of biogas exceed the costs of the biogas projects. This implies that this technology should be promoted in rural households. Government financial incentives must be put in place to motivate a generation of organic Agri-prenuers.

Keywords: Agri-prenuers, biogas digester, biogas energy, disposal costs

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Authors: Hoda Hashemi

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This study aimed to explore K-12 educators’ perceptions of using sensory-based strategies (SBS) with students on the autism spectrum in classroom settings. One hundred and ninety-three educators, including 107 special education teachers, 48 general education teachers, and 38 paraprofessionals, participated in this study. They answered 44 questions about using SBS in classroom settings, the degree to which they use the strategies on a 5-point Likert scale, the outcomes they targeted, and their perception of the strategies' effectiveness. The survey results indicated that most educators rated only one sensory-based strategy, which was alternated seating options, as highly effective in addressing the targeted behaviors of students on the autism spectrum. However, in some instances, educators' perceptions of the effectiveness of some strategies did not align with other research findings, highlighting the need for further evidence to confidently implement them.

Keywords: sensory-based strategies, K-12, educators, autism, survey

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Authors: Wegene Demeke

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Background: The demand for healthcare services is growing in developing and developed countries. Information and communication technology is used to facilitate healthcare services. In the case of developing countries, implementing telemedicine is aimed at providing healthcare for people living in remote areas where health service is not accessible. The implementations of telemedicine in developing countries are unsuccessful. For example, the recent study indicates that 90% of telemedicine projects are abandoned or failed in developing countries. Several researchers reported the technological challenges as the main factor for the non-adoption of telemedicine. However, this research reports the health professionals’ perspectives arising from technical, social and organizational factors that are considered as key elements for the setting and running of telemedicine in Ethiopia. The importance and significance of telemedicine for healthcare is growing. For example, the use of telemedicine in the current pandemic situation becomes an essential strategic element in providing healthcare services in developed countries. Method: Qualitative and quantitative exploratory research methods used to collect data to find factors affecting the adoption of Information and communication technologies for telemedicine use. The survey was distributed using emails and Google forms. The email addresses were collected from personal contact and publicly available websites in Ethiopia. The thematic analysis used to build the barriers and facilitators factors for establishing telemedicine services. A survey questionnaire with open-and-close questions was used to collect data from 175 health professionals. Outcome: The result of this research will contribute to building the key barriers and facilitators factors of telemedicine from the health professional perspectives in developing countries. The thematic analysis provides barriers and facilitators factors arising from technical, organizational, and social sources.

Keywords: telemedicine, ICT, developing country, Ethiopia, health service

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Authors: Nilgün Katrancı, Pınar Göv

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With the acceleration and assessment of quality and patient safety works in healthcare services in the 21st century, activities to reduce errors have gained importance. The prevention and reduction of unintended consequences related to healthcare services and errors made during the delivery of healthcare services can be achieved by understanding the causes of the errors. Communication is the basic reason most frequently seen in such cases. Nurses who communicate with patients more closely and for longer time play a more critical role in ensuring patient safety compared to other healthcare professionals. To reduce the risk of medical errors and increase the quality of care, it is important to raise the awareness of nurses about patient safety in training period. This descriptive study was conducted between February 2017 and May 2017 to assess intern students' attitudes towards and knowledge of patient safety and medical errors. The target population of the study consists of intern students at the Faculty of Nursing in Gaziantep University (N=180). The study did not apply any sample selection method, and the research group consisted of 90 female and 37 male senior students who were available and accepted to take part in the study (N=127). The study used personal information form and medical error attitude scale to collect data. The medical error attitude scale consists of 16 items and 3 sub-dimensions. The most frequently seen medical error in the clinics the interns worked at was found as ‘Failure to comply with asepsis rules’ with a rate of 67,7%. The most frequent case among reasons for not disclosing an error is ‘noticing and correcting the error before affecting the patient’ with the rate of 70,9%. The most frequently expressed implications of disclosing a serious error for the intern students participating in the study are ‘harming patient trust (78%)’ and ‘possibility of overreaction by patient (62,2%)’. According to the results of the study, the awareness of the students about the importance of medical errors and error reporting was found high (3,48 ± 0,49). Consequently, it is important to assess and positively improve the attitudes of nurses and other healthcare professionals towards medical errors for the determination of causes of medical errors and their prevention.

Keywords: healthcare service, intern student, medical error, patient safety

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Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

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Authors: Sudha Arlikatti, Laura Siebeneck, Simon A. Andrew

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The objective of this research is to measure organizational resiliency through five attributes namely, rapidity, redundancy, resourcefulness, and robustness and to provide recommendations for resiliency building in flood risk communities. The research was conducted in Thailand following the severe floods of 2011 triggered by Tropical Storm Nock-ten. The floods lasted over eight months starting in June 2011 affecting 65 of the country’s 76 provinces and over 12 million people. Funding from a US National Science Foundation grant was used to collect ephemeral data in rural (Ayutthaya), suburban (Pathum Thani), and urban (Bangkok) provinces of Thailand. Semi-structured face-to-face interviews were conducted in Thai with 44 contacts from public, private, and non-profit organizations including universities, schools, automobile companies, vendors, tourist agencies, monks from temples, faith based organizations, and government agencies. Multiple triangulations were used to analyze the data by identifying selective themes from the qualitative data, validated with quantitative data and news media reports. This helped to obtain a more comprehensive view of how organizations in different geographic settings varied in their understanding of what enhanced or hindered their resilience and consequently their speed and capacities to respond. The findings suggest that the urban province of Bangkok scored highest in resourcefulness, rapidity of response, robustness, and ability to rebound. This is not surprising considering that it is the country’s capital and the seat of government, economic, military and tourism sectors. However, contrary to expectations all 44 respondents noted that the rural province of Ayutthaya was the fastest to recover amongst the three. Its organizations scored high on redundancy and rapidity of response due to the strength of social networks, a flood disaster sub-culture due to annual flooding, and the help provided by monks from and faith based organizations. Organizations in the suburban community of Pathum Thani scored lowest on rapidity of response and resourcefulness due to limited and ambiguous warnings, lack of prior flood experience and controversies that government flood protection works like sandbagging favored the capital city of Bangkok over them. Such a micro-level examination of organizational resilience in rural, suburban and urban areas in a country through mixed methods studies has its merits in getting a nuanced understanding of the importance of disaster subcultures and religious norms for resilience. This can help refocus attention on the strengths of social networks and social capital, for flood mitigation.

Keywords: disaster subculture, flood response, organizational resilience, Thailand floods, religious beliefs and response, social capital and disasters

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Authors: Sidra Jawed

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The accessibility constructs and the body privilege discourse has been a major problem while dealing with health inequities and inaccessibility. The inherent problem in this arbitrary view of disability is that disability would never be the productive way of living. For past thirty years, disability activists have been working to differentiate ‘impairment’ from ‘disability’ and probing for more understanding of limitation imposed by society, this notion is ultimately known as the Social Model of Disability. The vulnerable population as disability community remains marginalized and seen relentlessly fighting to highlight the importance of social factors. It does not only constitute physical architectural barriers and famous blue symbol of access to the healthcare but also invisible, intangible barriers as attitudes and behaviours. Conventionally the idea of ‘disability’ has been laden with prejudiced perception amalgamating with biased attitude. Equity in contemporary setup necessitates the restructuring of organizational structure. Apparently simple, the complex interplay of disability and contemporary healthcare set up often ends up at negotiating vital components of basic healthcare needs. The role of society is indispensable when it comes to people with disability (PWD), everything from the access to healthcare to timely interventions are strongly related to the set up in place and the attitude of healthcare providers. It is vital to understand the association between assumptions and the quality of healthcare PWD receives in our global healthcare setup. Most of time the crucial physician-patient relationship with PWD is governed by the negative assumptions of the physicians. The multifaceted, troubled patient-physicians’ relationship has been neglected in past. To compound it, insufficient work has been done to explore physicians’ perspective about the disability and access to healthcare PWD have currently. This research project is directed towards physicians’ perspective on the intersection of health and access of healthcare for PWD. The principal aim of the study is to explore the perception of disability in family medicine physicians, highlighting the underpinning of medical perspective in healthcare institution. In the quest of removing barriers, the first step must be to identify the barriers and formulate a plan for future policies, involving all the stakeholders. There would be semi-structured interviews to explore themes as accessibility, medical training, construct of social model and medical model of disability, time limitations, financial constraints. The main research interest is to identify the obstacles to inclusion and marginalization continuing from the basic living necessities to wide health inequity in present society. Physicians point of view is largely missing from the research landscape and the current forum of knowledge with regards to physicians’ standpoint. This research will provide policy makers with a starting point and comprehensive background knowledge that can be a stepping stone for future researches and furthering the knowledge translation process to strengthen healthcare. Additionally, it would facilitate the process of knowledge translation between the much needed medical and disability community.

Keywords: disability, physicians, social model, accessibility

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