Search results for: leading economic indicators
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10788

Search results for: leading economic indicators

4518 Characteristics of the Poor in Malaysia: Evidence from E-Kasih Database an Explanatory Analysis

Authors: Zunaidah Ab Hasan, Azhana Othman, Abd Halim Mohd Noor, Nor Shahrina Mohd Rafien

Abstract:

This study highlights some of the factors of the poor in Malaysia by household and individual level. The discussion covers the demographic, economic and social aspects. The data is derived from the National Databank of Poverty Malaysia (eKasih) for the year of 2013. The explanatory analysis is used to analyse factor of poverty in Malaysia specifically in Malacca. The evidence confirms that male are prone to be poor. For the ethnic, majority of the poor are Malays. The number of dependency and unskilled head of household also contributes to the factors to be poor. Despite that health and physical condition condition does not affect the household head is likely to be poor. Outcome of this study hope to provide guideline that would beneficial to various stakeholders such as zakat institutions, policy makers, welfare department and other agencies related. This will lead to better standard of living as envisioned in the fourth National Key Result Areas (NKRAs).

Keywords: factors of poverty, eKasih, explanatory analysis, welfare department

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4517 Measuring Government’s Performance (Services) Oman Service Maturity Model (OSMM)

Authors: Angie Al Habib, Khalid Al Siyabi

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To measure or asses any government’s efficiency we need to measure the performance of this government in regards to the quality of the service it provides. Using a technological platform in service provision became a trend and a public demand. It is also a public need to make sure these services are aligned to values and to the whole government’s strategy, vision and goals as well. Providing services using technology tools and channels can enhance the internal business process and also help establish many essential values to government services like transparency and excellence, since in order to establish e-services many standards and policies must be put in place to enable the handing over of decision making to a mature system oriented mechanism. There was no doubt that the Sultanate of Oman wanted to enhance its services and move it towards automation and establishes a smart government as well as links its services to life events. Measuring government efficiency is very essential in achieving social security and economic growth, since it can provide a clear dashboard of all projects and improvements. Based on this data we can improve the strategies and align the country goals to them.

Keywords: government, maturity, Oman, performance, service

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4516 Applying the Global Trigger Tool in German Hospitals: A Retrospective Study in Surgery and Neurosurgery

Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

Abstract:

Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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4515 Cannabis Sativa L as Natural Source of Promising Anti-Alzheimer Drug Candidates: A Comprehensive Computational Approach Including Molecular Docking, Molecular Dynamics, ADMET and MM-PBSA Studies

Authors: Hassan Nour, Nouh Mounadi, Oussama Abchir, Belaidi Salah, Samir Chtita

Abstract:

Cholinesterase enzymes are biological catalysts essential for the transformation of acetylcholine, which is a neurotransmitter implicated in memory and learning, into acetic acid and choline, altering the neurotransmission process in Alzheimer’s disease patients. Therefore, inhibition of cholinesterase enzymes is a relevant strategy for the symptomatic treatment of Alzheimer’s disease. The current investigation aims to explore potential cholinesterase (ChE) inhibitors through a comprehensive computational approach. Forty-nine phytoconstituents extracted from Cannabis sativa L. were in-silico screened using molecular docking and pharmacokinetic and toxicological analysis to evaluate their possible inhibitory effect on the cholinesterase enzymes. Two phytoconstituents belonging to cannabinoid derivatives were revealed to be promising candidates for Alzheimer's therapy by acting as cholinesterase inhibitors. They have exhibited high binding affinities towards the cholinesterase enzymes and showed their ability to interact with key residues involved in cholinesterase enzymatic activity. In addition, they presented good ADMET profiles allowing them to be promising oral drug candidates. Furthermore, molecular dynamics (MD) simulations were executed to explore their interaction stability under mimetic biological conditions and thus support our findings. To corroborate the docking results, the binding free energy corresponding to the more stable ligand-ChE complexes was re-estimated by applying the MM-PBSA method. MD and MM-PBSA studies affirmed that the ligand-ChE recognition is a spontaneous reaction leading to stable complexes. The conducted investigations have led to great findings that would strongly guide the pharmaceutical industries toward the rational development of potent anti-Alzheimer agents.

Keywords: Alzheimer’s disease, molecular docking, Cannabis sativa L., cholinesterase inhibitors, molecular dynamics, ADMET, MM-PBSA

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4514 Effect of Crystallographic Characteristics on Toughness of Coarse Grain Heat Affected Zone for Different Heat Inputs

Authors: Trishita Ray, Ashok Perka, Arnab Karani, M. Shome, Saurabh Kundu

Abstract:

Line pipe steels are used for long distance transportation of crude oil and gas under extreme environmental conditions. Welding is necessary to lay large scale pipelines. Coarse Grain Heat Affected Zone (CGHAZ) of a welded joint exhibits worst toughness because of excessive grain growth and brittle microstructures like bainite and martensite, leading to early failure. Therefore, it is necessary to investigate microstructures and properties of the CGHAZ for different welding heat inputs. In the present study, CGHAZ for two heat inputs of 10 kJ/cm and 50 kJ/cm were simulated in Gleeble 3800, and the microstructures were investigated in detail by means of Scanning Electron Microscopy (SEM) and Electron Backscattered Diffraction (EBSD). Charpy Impact Tests were also done to evaluate the impact properties. High heat input was characterized with very low toughness and massive prior austenite grains. With the crystallographic information from EBSD, the area of a single prior austenite grain was traced out for both the welding conditions. Analysis of the prior austenite grains showed the formation of high angle boundaries between the crystallographic packets. Effect of these packet boundaries on secondary cleavage crack propagation was discussed. It was observed that in the low heat input condition, formation of finer packets with a criss-cross morphology inside prior austenite grains was effective in crack arrest whereas, in the high heat input condition, formation of larger packets with higher volume of low angle boundaries failed to resist crack propagation resulting in a brittle fracture. Thus, the characteristics in a crystallographic packet and impact properties are related and should be controlled to obtain optimum properties.

Keywords: coarse grain heat affected zone, crystallographic packet, toughness, line pipe steel

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4513 Climbing up to Safety and Security: The Facilitation of an NGO Awareness Culture

Authors: Mirad Böhm, Diede De Kok

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It goes without saying that for many NGOs a high level of safety and security are crucial issues, which often necessitates the support of military personnel to varying degrees. The relationship between military and NGO personnel is usually a difficult one and while there has been progress, clashes naturally still occur owing to different interpretations of mission objectives amongst many other challenges. NGOs tend to view safety and security as necessary steps towards their goal instead of fundamental pillars of their core ‘business’. The military perspective, however, considers them primary objectives; thus, frequently creating a different vision of how joint operations should be conducted. This paper will argue that internalizing safety and security into the NGO organizational culture is compelling in order to ensure a more effective cooperation with military partners and, ultimately, to achieve their goals. This can be accomplished through a change in perception of safety and security concepts as a fixed and major point on the everyday agenda. Nowadays, there are several training programmes on offer addressing such issues but they primarily focus on the individual level. True internalization of these concepts should reach further by encompassing a wide range of NGO activities, beginning with daily proceedings in office facilities far from conflict zones including logistical and administrative tasks such as budgeting, and leading all the way to actual and potentially hazardous missions in the field. In order to effectuate this change, a tool is required to help NGOs realize, firstly, how they perceive and define safety and security, and secondly, how they can adjust this perception to their benefit. The ‘safety culture ladder’ is a concept that suggests what organizations can and should do to advance their safety. While usually applied to private industrial scenarios, this work will present the concept as a useful instrument to visualize and facilitate the internalization process NGOs ought to go through. The ‘ladder’ allows them to become more aware of the level of their safety and security measures, and moreover, cautions them to take these measures proactively rather than reactively. This in turn will contribute to a rapprochement between military and NGO priority setting in regard to what constitutes a safe working environment.

Keywords: NGO-military cooperation, organisational culture, safety and security awareness, safety culture ladder

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4512 Microstructure of Virgin and Aged Asphalts by Small-Angle X-Ray Scattering

Authors: Dong Tang, Yongli Zhao

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The study of the microstructure of asphalt is of great importance for the analysis of its macroscopic properties. However, the peculiarities of the chemical composition of the asphalt itself and the limitations of existing direct imaging techniques have caused researchers to face many obstacles in studying the microstructure of asphalt. The advantage of small-angle X-ray scattering (SAXS) is that it allows quantitative determination of the internal structure of opaque materials and is suitable for analyzing the microstructure of materials. Therefore, the SAXS technique was used to study the evolution of microstructures on the nanoscale during asphalt aging. And the reasons for the change in scattering contrast during asphalt aging were also explained with the help of Fourier transform infrared spectroscopy (FTIR). SAXS experimental results show that the SAXS curves of asphalt are similar to the scattering curves of scattering objects with two-level structures. The Porod curve for asphalt shows that there is no obvious interface between the micelles and the surrounding mediums, and there is only a fluctuation of the hot electron density between the two. The Beaucage model fit SAXS patterns shows that the scattering coefficient P of the asphaltene clusters as well as the size of the micelles, gradually increase with the aging of the asphalt. Furthermore, aggregation exists between the micelles of asphalt and becomes more pronounced with increasing aging. During asphalt aging, the electron density difference between the micelles and the surrounding mediums gradually increases, leading to an increase in the scattering contrast of the asphalt. Under long-term aging conditions due to the gradual transition from maltenes to asphaltenes, the electron density difference between the micelles and the surrounding mediums decreases, resulting in a decrease in the scattering contrast of asphalt SAXS. Finally, this paper correlates the macroscopic properties of asphalt with microstructural parameters, and the results show that the high-temperature rutting resistance of asphalt is enhanced and the low-temperature cracking resistance decreases due to the aggregation of micelles and the generation of new micelles. These results are useful for understanding the relationship between changes in microstructure and changes in properties during asphalt aging and provide theoretical guidance for the regeneration of aged asphalt.

Keywords: asphalt, Beaucage model, microstructure, SAXS

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4511 Local and Global Sustainability: the Case-Study of Beja Municipality Local Agenda 21 Operationalization Challenges

Authors: Maria Inês Faria, João Miguel Simão

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Frequently, the Sustainable Development paradigm is considered the contemporary societies flag and is has been assuming different nuances on local and global dialogues. This reveals the ambivalent character associated to its implementation due, namely, to the kind of synergies that political institutions, social organizations and citizenry can actually create. The Sustainable Development concept needs further discussion so that it can be useful in decision-making processes. In fact, the polysemic nature of this concept has consistently undermined its credibility leading, among other factors, to the talk and action gap, as well as to misappropriations of this notion. The present study focuses on the importance in questioning the sustainable development operationalization, "To walk the talk", and intends, in a broad sense, identify prospects and the elements of sustainability that are included in strategic plans (global, national and local) and, in the strict sense, confront discourse and practice in the context of local public policies for sustainable development, in particular with regard to the implementation of Local Agenda 21 in the municipality of Beja (Portugal) in order to analyze at what extent the strategies adopted and implemented are aligned with the paradigm of sustainable development. The method is based on critical analysis of literature and official documentation, using three complementary approaches: a) exploratory review of literature in order to identify publications on sustainability and sustainable development; b) this second approach complements the first, focused on the official documentation for the adoption and implementation of sustainable development, which is produced in the global plan, regional, national and local levels; c) and the approach which is focused on official documentation that expresses the policy options, the strategic lines and actions for sustainable development implementation Beja´s Municipality. The main results of this study highlight the type of alignment of the Beja´s Municipality sustainable policies, concerning the officially stipulated for the promotion of sustainable development on the international agenda, stressing the potentialities, constraints and challenges of Agenda 21 Local implementation.

Keywords: sustainable development, Local Agenda 21, sustainable local public policies, Beja

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4510 The Place of Open Distance Education in Achieving Sustainable Development Goals (SDGs)

Authors: Morakinyo Akintolu, Moeketsi Letseka

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In the year 2015, the United Nation member states, through the representative of all heads of states present, adopted the 17 Global goals known as the Sustainable Development Goals in their capacity to bring about social, economic, and cultural development to the world. Therefore, the need to accommodate equitable development one of the major goals is to achieve equitable and quality education for all to bring about international development. In this light, the study investigates the role of open distance learning in achieving sustainable development goals. Open distance learning comes as a second chance to individuals in disseminating educational content to students who missed the opportunity of attending the traditional school setting. Therefore, this study investigates if the SDGs reflect this type of learning (ODL) in creating Education for all according to the 2030 agenda by the United Nations. It further ascertains the role of ODL in achieving SDGs, the challenges encountered as well as the way forward.

Keywords: open distance learning, sustainable development goals, distance education, achieving, 2030 agenda

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4509 The Impact of Smart Educational Aids in Learning Listening Among Pupils with Attention and Listening Problems

Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Aayah Al Yaari, Ayman Al Yaari, Montaha Al Yaari, Sajedah Al Yaari, Fatehi Eissa

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The recent rise of smart educational aids and the move away from traditional listening aids are leading to a fundamental shift in the way in which individuals with attention and listening problems (ALP) manipulate listening inputs and/or act appropriately to the spoken information presented to them. A total sample of twenty-six ALP pupils (m=20 and f=6) between 7-12 years old was selected from different strata based on gender, region and school. In the sample size, thirteen (10 males and 3 females) received the treatment in terms of smart classes provided with smart educational aids in a listening course that lasted for four month-semester while others did not (they studied the same course by the same instructor but in ordinary class). A pretest was administered to assess participants’ levels, and a posttest was given to evaluate their attention and listening comprehension performance, namely in phonetic and phonological tests with sociolinguistic themes that have been designed for this purpose. Test results were analyzed both psychoneurolinguistically and statistically. Results reveal a remarkable change in pupils’ behavioral listening where scores witnessed a significant difference in the performance of the experimental ALP group in the pretest compared to the posttest (Pupils performed better at the pretest-posttest on phonetics than at the two tests on phonology). It is concluded that smart educational aids designed for listening skills help not only increase the listening command of pupils with ALP to understand what they listen to but also develop their interactive listening capability and, at the same rate, are responsible for increasing concentrated and in-depth listening capacity. Plus, ALP pupils become able to grasp the audio content of text recordings, including educational audio recordings, news, oral stories and tales, views, spiritual/religious text and general knowledge. However, the pupils have not experienced individual smart audio-visual aids that connect listening to other language receptive and productive skills, which could be the future area of research.

Keywords: language skills, implementing, listening skill, attention, smart aids

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4508 Addressing Factors Associated with Vertical HIV Transmission among Pregnant Women in Rwanda

Authors: Murorunkwere Marie Claire

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

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

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4507 Creating a Professional Teacher Identity in Britain via Accent Modification

Authors: Alex Baratta

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In Britain, accent is arguably still a sensitive issue, and for broad regional accents in particular, the connotations can often be quite negative. Within primary and secondary teaching, what might the implications be for teachers with such accents? To investigate this, the study collected the views of 32 British trainee teachers via semi-structured interviews, and questionnaires, to understand how their accent plays a role in the construction of a professional identity. From the results, it is clear that for teachers from the North and Midlands, in particular, accent modification is something that is required by their mentors; for teachers from the Home Counties, accent is rarely mentioned. While the mentors’ rationale for accent modification is to ensure teachers are better understood and/or to sound ‘professional’, many teachers feel that it is a matter of linguistic prejudice and therefore regard an accent modified for someone else as leading to a fraudulent identity. Moreover, some of the comments can be quite blunt, such as the Midlands teacher who resides in the South being told that it was ‘best to go back to where you come from’ if she couldn’t modify her accent to Southern pronunciation. From the results, there are three broad phonological changes expected: i) Northern/Midlands-accented teachers need to change to Southern pronunciation in words such as bath and bus; thus, a change from [baθ] [bʊs] to [bɑ:θ] [bʌs], ii) Teachers from the North, notably Yorkshire, told to change from monophthongs to diphthongs; thus, a change from [go:] to [goʊ], iii) Glottal stops are to be avoided; a teacher from South London was told by her mentor to write the word ‘water’ with a capital t (waTer), in order to avoid her use of a glottal stop. Thus, in a climate of respect for diversity and equality, this study is timely for the following reasons. First, it addresses an area for which equality is not necessarily relevant – that of accent in British teaching. Second, while many British people arguably have an instinct for ‘broad’ versus more ‘general’ versions of regional accents, there appear to be no studies which have attempted to explain what this means from a purely phonological perspective. Finally, given that the Teachers’ Standards do not mention accent as part of the desired linguistic standards, this study hopes to start a national debate as to whether or not they should, rather than shy away from what can be a potentially complex – and sensitive – topic.

Keywords: accent, accommodation, identity, teaching

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4506 A Machine Learning-Based Analysis of Autism Prevalence Rates across US States against Multiple Potential Explanatory Variables

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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4505 Assessment of Agricultural Intervention on Ecosystem Services in the Central-South Zone of Chile

Authors: Steven Hidalgo, Patricio Neumann

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The growth of societies has increased the consumption of raw materials and food obtained from nature. This has influenced the services offered by ecosystems to humans, mainly supply and regulation services. One of the indicators used to evaluate these services is Net Primary Productivity (NPP), which is understood as the energy stored in the form of biomass by primary organisms through the process of photosynthesis and respiration. The variation of NPP by defined area produces changes in the properties of terrestrial and aquatic ecosystems, which alter factors such as biodiversity, nutrient cycling, carbon storage and water quality. The analysis of NPP to evaluate variations in ecosystem services includes harvested NPP (understood as provisioning services), which is the raw material from agricultural systems used by humans as a source of energy and food, and the remaining NPP (expressed as a regulating service) or the amount of biomass that remains in ecosystems after the harvesting process, which is mainly related to factors such as biodiversity. Given that agriculture is a fundamental pillar of Chile's integral development, the purpose of this study is to evaluate provisioning and regulating ecosystem services in the agricultural sector, specifically in cereal production, in the communes of the central-southern regions of Chile through a conceptual framework based on the quantification of the fraction of Human Appropriation of Net Primary Productivity (HANPP) and the fraction remaining in the ecosystems (NPP remaining). A total of 161 communes were analyzed in the regions of O'Higgins, Maule, Ñuble, Bio-Bío, La Araucanía and Los Lagos, which are characterized by having the largest areas planted with cereals. It was observed that the region of La Araucanía produces the greatest amount of dry matter, understood as provisioning service, where Victoria is the commune with the highest cereal production in the country. In addition, the maximum value of HANPP was in the O'Higgins region, highlighting the communes of Coltauco, Quinta de Tilcoco, Placilla and Rengo. On the other hand, the communes of Futrono, Pinto, Lago Ranco and Pemuco, whose cereal production was important during the study, had the highest values of remaining NPP as a regulating service. Finally, an inverse correlation was observed between the provisioning and regulating ecosystem services, i.e., the higher the cereal or dry matter production in a defined area, the lower the net primary production remaining in the ecosystems. Based on this study, future research will focus on the evaluation of ecosystem services associated with other crops, such as forestry plantations, whose activity is an important part of the country's productive sector.

Keywords: provisioning services, regulating services, net primary productivity, agriculture

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4504 Evaluating and Improving Healthcare Staff Knowledge of the [NG179] NICE Guidelines on Elective Surgical Care during the COVID-19 Pandemic: A Quality Improvement Project

Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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4503 Need for a Tailor Made HIV Prevention Services to the Migrants Community: Evidence from Implementing Migrant Service Delivery System (MSDS) among Migrant Workers, National AIDS Control Program, and India

Authors: Debasish Chowdhury, Sunil Mekale, Sarvanamurthy Sakthivel, Sukhvinder Kaur, Rambabu Khambampati, Ashok Agarwal

Abstract:

Introduction: The migrant intervention in India was initiated during the National AIDS Control Program (NACP) Phase-2 (2002-2007). HIV Sentinel surveillance Studies (HSS) conducted in 2012-13 indicated higher HIV prevalence among migrants (0.99%) compared to general populations (0.35%). Migrants continue to bear a heightened risk of HIV infection which results from the condition and structure of the migration process. USAID PHFI-PIPPSE project in collaboration with the National AIDS Control Organization (NACO) developed a unique system called Migrant Service Delivery System (MSDS) to capture migrants profile with respect to their risk profile and to provide tailor made services to them. Description: MSDS is a web-based system, designed and implemented to increase service uptake among migrants through evidence based planning. 110 destination migrants Targeted Intervention (TI) from 11 states were selected for study with varied target populations in terms of occupations; to understand occupation related risk behaviors among the migrants. Occupation wise registration data of high risk vulnerable migrants were analyzed through MSDS for the period April 2014–June 2016. Analysis was made on specific indicators among these occupational groups to understand the risk behavior and their vulnerability to HIV and STIs. Findings: Out of total HIV positive migrant’s workers (N= 847) enrolled in MSDS HIV rate is found to be highest among Auto-Rickshaw (18.66%) followed by Daily wage laborers (14.46%), Loom workers (10.73%), Industrial workers (10.04%) and Construction worker 7.93%. With 45.14% positivity, industrial workers are found to be most vulnerable to Sexually Transmitted Infections (STIs) (N=10057) among all occupational categories followed by loom workers (16.28%), Skilled worker (Furniture, Jeweler)-7.14%, daily wage laborers (5.45%). Conclusion: MSDS is an effective tool to assess migrants’ risk and their vulnerability to HIV for designing evidence informed program. This system calls for a replication across all destination TIs by NACO for differential strategies for different occupation groups to ensure better yield through scientific planning of intervention among high risk and high vulnerable migrants.

Keywords: migrants, migrant service delivery system, risk, vulnerability

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4502 Hydrogeomatic System for the Economic Evaluation of Damage by Flooding in Mexico

Authors: Alondra Balbuena Medina, Carlos Diaz Delgado, Aleida Yadira Vilchis Fránces

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In Mexico, each year news is disseminated about the ravages of floods, such as the total loss of housing, damage to the fields; the increase of the costs of the food, derived from the losses of the harvests, coupled with health problems such as skin infection, etc. In addition to social problems such as delinquency, damage in education institutions and the population in general. The flooding is a consequence of heavy rains, tropical storms and or hurricanes that generate excess water in drainage systems that exceed its capacity. In urban areas, heavy rains can be one of the main factors in causing flooding, in addition to excessive precipitation, dam breakage, and human activities, for example, excessive garbage in the strainers. In agricultural areas, these can hardly achieve large areas of cultivation. It should be mentioned that for both areas, one of the significant impacts of floods is that they can permanently affect the livelihoods of many families, cause damage, for example in their workplaces such as farmlands, commercial or industry areas and where services are provided. In recent years, Information and Communication Technologies (ICT) have had an accelerated development, being reflected in the growth and the exponential evolution of the innovation giving; as a result, the daily generation of new technologies, updates, and applications. Innovation in the development of Information Technology applications has impacted on all areas of human activity. They influence all the orders of life of individuals, reconfiguring the way of perceiving and analyzing the world such as, for instance, interrelating with people as individuals and as a society, in the economic, political, social, cultural, educational, environmental, etc. Therefore the present work describes the creation of a system of calculation of flood costs for housing areas, retail establishments and agricultural areas from the Mexican Republic, based on the use and application of geotechnical tools being able to be useful for the benefit of the sectors of public, education and private. To generate analysis of hydrometereologic affections and with the obtained results to realize the Geoinformatics tool was constructed from two different points of view: the geoinformatic (design and development of GIS software) and the methodology of flood damage validation in order to integrate a tool that provides the user the monetary estimate of the effects caused by the floods. With information from the period 2000-2014, the functionality of the application was corroborated. For the years 2000 to 2009 only the analysis of the agricultural and housing areas was carried out, incorporating for the commercial establishment's information of the period 2010 - 2014. The method proposed for the resolution of this research project is a fundamental contribution to society, in addition to the tool itself. Therefore, it can be summarized that the problems that are in the physical-geographical environment, conceiving them from the point of view of the spatial analysis, allow to offer different alternatives of solution and also to open up slopes towards academia and research.

Keywords: floods, technological innovation, monetary estimation, spatial analysis

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4501 Developing Heat-Power Efficiency Criteria for Characterization of Technosphere Structural Elements

Authors: Victoria Y. Garnova, Vladimir G. Merzlikin, Sergey V. Khudyakov, Aleksandr A. Gajour, Andrei P. Garnov

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This paper refers to the analysis of the characteristics of industrial and lifestyle facilities heat- energy objects as a part of the thermal envelope of Earth's surface for inclusion in any database of economic forecasting. The idealized model of the Earth's surface is discussed. This model gives the opportunity to obtain the energy equivalent for each element of terrain and world ocean. Energy efficiency criterion of comfortable human existence is introduced. Dynamics of changes of this criterion offers the possibility to simulate the possible technogenic catastrophes with a spontaneous industrial development of the certain Earth areas. Calculated model with the confirmed forecast of the Gulf Stream freezing in the Polar Regions in 2011 due to the heat-energy balance disturbance for the oceanic subsurface oil polluted layer is given. Two opposing trends of human development under the limited and unlimited amount of heat-energy resources are analyzed.

Keywords: Earth's surface, heat-energy consumption, energy criteria, technogenic catastrophes

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4500 Towards Inclusive Learning Society: Learning for Work in the Swedish Context

Authors: Irina Rönnqvist

Abstract:

The world is constantly changing; therefore previous views or cultural patterns and programs formed by the “old world” cannot be suitable for solving actual problems. Indeed, reformation of an education system is unlikely to be effective without understanding of the processes that emerge in the field of employment. There is a problem in overcoming of the negative trends that determine imbalance of needs of the qualified work force and preparation of professionals by an education system. At the contemporary stage of economics the processes occurring in the field of labor and employment reproduce the picture of economic development of the country that cannot be imagined without the factor of labor mobility (e.g. migration). On the one hand, adult education has a significant impact on multifaceted development of economy. On the other hand, Sweden has one of the world's most generous asylum reception systems and the most liberal labor migration policy among the OECD countries. This effect affects the increased productivity. The focus of this essay is on problems of education and employment concerning social inclusion of migrants in working life in Sweden.

Keywords: migration, adaptation, formal learning, informal learning, Sweden

Procedia PDF Downloads 318
4499 Study of the Adsorptives Properties of Zeolites X Exchanged by the Cations Cu2 + and/or Zn2+

Authors: H. Hammoudi, S. Bendenia, I. Batonneau-Gener, A. Khelifa

Abstract:

Applying growing zeolites is due to their intrinsic physicochemical properties: a porous structure, regular, generating a large free volume, a high specific surface area, acidic properties of interest to the origin of their activity, selectivity energy and dimensional, leading to a screening phenomenon, hence the name of molecular sieves is generally attributed to them. Most of the special properties of zeolites have been valued as direct applications such as ion exchange, adsorption, separation and catalysis. Due to their crystalline structure stable, their large pore volume and their high content of cation X zeolites are widely used in the process of adsorption and separation. The acidic properties of zeolites X and interesting selectivity conferred on them their porous structure is also have potential catalysts. The study presented in this manuscript is devoted to the chemical modification of an X zeolite by cation exchange. Ion exchange of zeolite NaX by Zn 2 + cations and / or Cu 2 + is gradually conducted by following the evolution of some of its characteristics: crystallinity by XRD, micropore volume by nitrogen adsorption. Once characterized, the different samples will be used for the adsorption of propane and propylene. Particular attention is paid thereafter, on the modeling of adsorption isotherms. In this vein, various equations of adsorption isotherms and localized mobile, some taking into account the adsorbate-adsorbate interactions, are used to describe the experimental isotherms. We also used the Toth equation, a mathematical model with three parameters whose adjustment requires nonlinear regression. The last part is dedicated to the study of acid properties of Cu (x) X, Zn (x) X and CuZn (x) X, with the adsorption-desorption of pyridine followed by IR. The effect of substitution at different rates of Na + by Cu2 + cations and / or Zn 2 +, on the crystallinity and on the textural properties was treated. Some results on the morphology of the crystallites and the thermal effects during a temperature rise, obtained by scanning electron microscopy and DTA-TGA thermal analyzer, respectively, are also reported. The acidity of our different samples was also studied. Thus, the nature and strength of each type of acidity are estimated. The evaluation of these various features will provide a comparison between Cu (x) X, Zn (x) X and CuZn (x) X. One study on adsorption of C3H8 and C3H6 in NaX, Cu (x) X , Zn (x) x and CuZn (x) x has been undertaken.

Keywords: adsorption, acidity, ion exchange, zeolite

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4498 The Dead Alexandrian Historic Vein: The Revitalization of Mahmoudiyah Canal 'The Forgotten Environmental Asset'

Authors: Sara S. Fouad, Omneya Messallam

Abstract:

In 1818, a seventy-five kilometer long canal was dug (called the Mahmoudiyah canal) connecting between Alexandria city in Egypt and the western branch of the Nile. It was a productive resource and vital to its environment, context, transportation, and recreation. It played a significant role in people’s lives and Alexandria city’s shape. The canal, which was the main vein of goods’ transporting from Alexandria’s seaport to the different parts of Egypt, was still in use today as a major source of clear water in the city. But nowadays, Mahmoudiyah canal is converting into ‘dead waterway’. The canal became sources of pollution as a result of solid and industrial waste thus causing many diseases, destroying communities and biodiversity, with urban invasion, the loss of community aesthetic value and healthy environment. Therefore, this paper aims to propose an urban strategy, as a solution to revive the forgotten canal, through recreating a cultural promenade on its shore. The main aim of this research is to formulate decent quality of life, unpolluted space, an area gathering the city space for nature, tourism and investments. As a case study, this paper investigates Mahmoudiyah canal through urban and ecological analyses, aiming to design an urban strategy for reviving it by creating a cultural promenade enriched with public spaces and green areas, which can most probably enhance the quality of life, city re-living and development. Community participation is also considered as vital and intrinsic implementation stage. The empirical research involved using several data assembly methods such as interviews, mental mapping, structural observations and questionnaires. The paper ends with a set of conclusions leading to proposals for the Mahmoudiyah canal revitalization considering the complex challenges and processes of sustainable regeneration focusing on city’s rehabilitation and lost identity.

Keywords: Mahmoudiyah canal, community aesthetic value, city re-living, cultural promenade

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4497 Saudi and U.S. Newspaper Coverage of Saudi Vision 2030 Concerning Women in Online Newspapers

Authors: Ziyad Alghamdi

Abstract:

This research investigates how issues concerning Saudi women have been represented in selected U.S. and Saudi publications. Saudi Vision 2030 is the Kingdom of Saudi Arabia's development strategy, which was revealed on April 25, 2016. This study used 115 news items across selected newspapers as its sampling. The New York Times and the Washington Post were chosen to represent U.S. newspapers and picked two Saudi newspapers, Al Jazirah, and Al Watan. This research examines how these issues were covered before and during the implementation of Saudi Vision 2030. The news pieces were analyzed using both quantitative and qualitative methodologies. The qualitative study employed an inductive technique to uncover frames. Furthermore, this work looked at how American and Saudi publications had framed Saudi women depicted in images by reviewing the photographs used in news reports about Saudi women's issues. The primary conclusion implies that the human-interest frame was more prevalent in American media, whereas the economic frame was more prevalent in Saudi publications. A variety of diverse topics were considered.

Keywords: Saudi newspapers, Saudi Vision 2030, framing theory, Saudi women

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4496 Psychosocial Risk Factors among Women: A Case-Study of the Nigerian Female Worker

Authors: Bassey Odiong Akan

Abstract:

In recent decades potentially significant changes have taken place in the world of work and these have led to the emergence of new challenges in occupational safety and health. The working environment is now not only wroth with concerns about physical, biological and chemical risks but also emerging risks which are completely new risks that have never been seen before or previously known risks that are evolving in unexpected ways with unanticipated consequences. Psychosocial risk factors and its attendant hazards happen to be one of them and can impact health directly or indirectly, mediated by work-related stress. These risks are related to the way work is designed, organised and managed, as well as the economic and social contexts of work. It has become necessary to identify, explore and anticipate the dynamics of these risks factors and hazards with regards to how it affects women. This presentation is a review of information gathered from books of distinguished authors, research work and scientific/professional journals on the psychosocial work environment intended as a guide to stimulate discussion, raise awareness and encourage research and action at different levels.

Keywords: emerging risks, psychosocial hazards, psychosocial risk factors, work related stress

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4495 Colonialism, Health and Women’s Print Culture in South Asia: A Study of Urdu Journals in Colonial India 1900-1930

Authors: Khanday Pervaiz Ahmad

Abstract:

It was in 19th century when the Indian educated class started to reform their socio-religious set up as an imperative to respond to the challenges put forward by the colonial empire. The colonial discourse on India from the very beginning was gendered, as the colonized society was feminized and its ‘effeminate’ character, as opposed to ‘colonial masculinity’ was held to be a justification for its loss of independence. The ‘women health figure’ is prominently in these gender discourses. The women’s health received a much place in the colonial discourse. Lack of health consciousness, illiteracy, and belief in myths, rituals and superstitions were deemed the main factors taken as an indicator of miserable condition of Indian women’s health. As the low position of women caused shame to the natives, reforming the condition of women, its health occupied a major place in their intellectual as well as activist engagements. Magazines (journals) for women began to appear in various Indian languages in the mid to late 19th century with Bengal leading the front. These sources (Magazines) like Harm, Tehzib un Niswan, Saheli, Khatoon etc. are essential for the study of the emergence of an ideology of respectable domesticity in Indian Muslim upper middle class. Similarly for the study of development of Women’s health consciousness, women’s magazines are very essential. These earliest women Urdu magazines were first started by men, and then followed by the women’s own magazines. Various health issues, like pregnancy, child-rearing, menstruation, midwives training, Pardah, and health etc. were discussed at a time when it was impossible to discuss them in public sphere. These women magazines were brave pioneers, expanding the frontiers of women’s roles, and consciousness at a time when those frontiers were severely limited. This paper will try to focus on how women responded to the question of colonial discourse about their bodies. How health consciousness developed among Indian Muslim women and in what way it contributed in the development of feminist consciousness in South Asian Muslim Women community.

Keywords: Ashraf class, khatoon, haram women, feminism

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4494 The Effect of Newspaper Reporting on COVID-19 Vaccine Hesitancy: A Randomised Controlled Trial

Authors: Anna Rinaldi, Pierfrancesco Dellino

Abstract:

COVID-19 vaccine hesitancy can be observed at different rates in different countries. In June 2021, 1,068 people were surveyed in France and Italy to inquire about individual potential acceptance, focusing on time preferences in a risk-return framework: having the vaccination today, in a month, and in 3 months; perceived risks of vaccination and COVID-19; and expected benefit of the vaccine. A randomized controlled trial was conducted to understand how everyday stimuli like fact-based news about vaccines impact an audience's acceptance of vaccination. The main experiment involved two groups of participants and two different articles about vaccine-related thrombosis taken from two Italian newspapers. One article used a more abstract description and language, and the other used a more anecdotal description and concrete language; each group read only one of these articles. Two other groups were assigned categorization tasks; one was asked to complete a concrete categorization task, and the other an abstract categorization task. Individual preferences for vaccination were found to be variable and unstable over time, and individual choices of accepting, refusing, or delaying could be affected by the way news is written. In order to understand these dynamic preferences, the present work proposes a new model based on seven categories of human behaviors that were validated by a neural network. A treatment effect was observed: participants who read the articles shifted to vaccine hesitancy categories more than participants assigned to other treatments and control. Furthermore, there was a significant gender effect, showing that the type of language leading to a lower hesitancy rate for men is correlated with a higher hesitancy rate for women and vice versa. This outcome should be taken into consideration for an appropriate gender-based communication campaign aimed at achieving herd immunity. The trial was registered at ClinicalTrials.gov NCT05582564 (17/10/2022).

Keywords: vaccine hesitancy, risk elicitation, neural network, covid19

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4493 Analysing the Influence of COVID-19 on Major Agricultural Commodity Prices in South Africa

Authors: D. Mokatsanyane, J. Jansen Van Rensburg

Abstract:

This paper analyses the influence and impact of COVID-19 on major agricultural commodity prices in South Africa. According to a World Bank report, the agricultural sector in South Africa has been unable to reduce the domestic food crisis that has been occurring over the past years, hence the increased rate of poverty, which is currently at 55.5 percent as of April 2020. Despite the significance of this sector, empirical findings concluded that the agricultural sector now accounts for 1.88 percent of South Africa's gross domestic product (GDP). Suggesting that the agricultural sector's contribution to the economy has diminished. Despite the low contribution to GDP, this primary sector continues to play an essential role in the economy. Over the past years, multiple factors have contributed to the soaring commodities prices, namely, climate shocks, biofuel demand, demand and supply shocks, the exchange rate, speculation in commodity derivative markets, trade restrictions, and economic growth. The COVID-19 outbursts have currently disturbed the supply and demand of staple crops. To address the disruption, the government has exempted the agricultural sector from closure and restrictions on movement. The spread of COVID-19 has caused turmoil all around the world, but mostly in developing countries. According to Statistic South Africa, South Africa's economy decreased by seven percent in 2020. Consequently, this has arguably made the agricultural sector the most affected sector since slumped economic growth negatively impacts food security, trade, farm livelihood, and greenhouse gas emissions. South Africa is sensitive to the fruitfulness of global food chains. Restrictions in trade, reinforced sanitary control systems, and border controls have influenced food availability and prices internationally. The main objective of this study is to evaluate the behavior of agricultural commodity prices pre-and during-COVID to determine the impact of volatility drivers on these crops. Historical secondary data of spot prices for the top five major commodities, namely white maize, yellow maize, wheat, soybeans, and sunflower seeds, are analysed from 01 January 2017 to 1 September 2021. The timeframe was chosen to capture price fluctuations between pre-COVID-19 (01 January 2017 to 23 March 2020) and during-COVID-19 (24 March 2020 to 01 September 2021). The Generalised Autoregressive Conditional Heteroscedasticity (GARCH) statistical model will be used to measure the influence of price fluctuations. The results reveal that the commodity market has been experiencing volatility at different points. Extremely high volatility is represented during the first quarter of 2020. During this period, there was high uncertainty, and grain prices were very volatile. Despite the influence of COVID-19 on agricultural prices, the demand for these commodities is still existing and decent. During COVID-19, analysis indicates that prices were low and less volatile during the pandemic. The prices and returns of these commodities were low during COVID-19 because of the government's actions to respond to the virus's spread, which collapsed the market demand for food commodities.

Keywords: commodities market, commodity prices, generalised autoregressive conditional heteroscedasticity (GARCH), Price volatility, SAFEX

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4492 Recruitment Strategies and Migration Regulations for International Students in the United States and Canada: A Comparative Study

Authors: Aynur Charkasova

Abstract:

The scientific and economic contributions of international students cannot be underestimated. International education continues to be a competitive global industry, and many countries are seeking to recruit the best and the brightest to reinforce scientific innovations, boost intercultural learning, and bring more funding to universities and colleges. Substantial changes in international educational policies and migration regulations have been made in the hopes of recruiting global talent. This paper explores and compares recruitment strategies, employment opportunities, and a legal path to permanent residency policies related to international students in the United States of America and Canada. This study will utilize the legal information available from the government websites of both countries and peer-reviewed scholarly articles and will highlight which approach promises a better path in recruiting and retention of international students. The findings from the study will be discussed and recommendations will be provided.

Keywords: International students, current immigration policies, STEM, employability, visa reforms for international students, Canadian recruitment policy

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4491 Advantages of Computer Navigation in Knee Arthroplasty

Authors: Mohammad Ali Al Qatawneh, Bespalchuk Pavel Ivanovich

Abstract:

Computer navigation has been introduced in total knee arthroplasty to improve the accuracy of the procedure. Computer navigation improves the accuracy of bone resection in the coronal and sagittal planes. It was also noted that it normalizes the rotational alignment of the femoral component and fully assesses and balances the deformation of soft tissues in the coronal plane. The work is devoted to the advantages of using computer navigation technology in total knee arthroplasty in 62 patients (11 men and 51 women) suffering from gonarthrosis, aged 51 to 83 years, operated using a computer navigation system, followed up to 3 years from the moment of surgery. During the examination, the deformity variant was determined, and radiometric parameters of the knee joints were measured using the Knee Society Score (KSS), Functional Knee Society Score (FKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scales. Also, functional stress tests were performed to assess the stability of the knee joint in the frontal plane and functional indicators of the range of motion. After surgery, improvement was observed in all scales; firstly, the WOMAC values decreased by 5.90 times, and the median value to 11 points (p < 0.001), secondly KSS increased by 3.91 times and reached 86 points (p < 0.001), and the third one is that FKSS data increased by 2.08 times and reached 94 points (p < 0.001). After TKA, the axis deviation of the lower limbs of more than 3 degrees was observed in 4 patients at 6.5% and frontal instability of the knee joint just in 2 cases at 3.2%., The lower incidence of sagittal instability of the knee joint after the operation was 9.6%. The range of motion increased by 1.25 times; the volume of movement averaged 125 degrees (p < 0.001). Computer navigation increases the accuracy of the spatial orientation of the endoprosthesis components in all planes, reduces the variability of the axis of the lower limbs within ± 3 °, allows you to achieve the best results of surgical interventions, and can be used to solve most basic tasks, allowing you to achieve excellent and good outcomes of operations in 100% of cases according to the WOMAC scale. With diaphyseal deformities of the femur and/or tibia, as well as with obstruction of their medullary canal, the use of computer navigation is the method of choice. The use of computer navigation prevents the occurrence of flexion contracture and hyperextension of the knee joint during the distal sawing of the femur. Using the navigation system achieves high-precision implantation for the endoprosthesis; in addition, it achieves an adequate balance of the ligaments, which contributes to the stability of the joint, reduces pain, and allows for the achievement of a good functional result of the treatment.

Keywords: knee joint, arthroplasty, computer navigation, advantages

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4490 Urbanization Level and Tempo (Speed) in Tigray Regional State, Ethiopia

Authors: Fikre Belay Tekulu

Abstract:

Background and objective: The study attempts to determine the level and tempo or speed of urbanization in the Tigray regional state based on census data from 1994 to 2013 in Ethiopia. Methods: The study examined the level and tempo of urbanization based on the 1994 and 2007 censuses as well as the 2013 CSA projection data. Findings: The level of urbanization at the regional level was found in 1994, 2007, and 2020 at 14.9%, 21.7%, and 27.7 % respectively. Whereas the level of urbanization varies among the zones of the region, the higher level of urbanization was recorded in the Eastern zone, followed by the Western, Southern Zone and Central zone of Tigray. The tempo or speed of urbanization was determined to be 0.49 percent per year at the regional level, with the Eastern area of Tigray showing the greatest tempo or speed of urbanization. Conclusions: Unbalanced urbanization among the zones results in socio-economic challenges. The study recommended several policy interventions aimed at judicious urbanization suitable for sustainable development.

Keywords: urbanization, census, tempo or speed, urbanization level, Tigray

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4489 Principles and Guidance for the Last Days of Life: Te Ara Whakapiri

Authors: Tania Chalton

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In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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