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Authors: Zolani Metu

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The death of more than 140 psychiatric patients who were unethically deinstitutionalized from the Life Esidimeni hospital Johannesburg, in 2016, shined a light on South Africa’s failing public mental healthcare system. Compounded by insufficient research evidence on African deinstitutionalization, this necessitates inquiries into deinstitutionalized mental healthcare, reintegration and community-based mental healthcare within the South African context. This study employed a quantitative research approach which utilized a cross-sectional research design, to investigate experiences with the reintegration of institutionalized forensic mental health service users into communities in the Western Cape, South Africa. A convenience sample of 100 mental health care workers from different occupational and organizational backgrounds in the Western Cape was purposively selected using the Western Cape Health Directorate as a sampling frame. A self-administered questionnaire (SAQ) was used as the data collection instrument. The results of the study indicate that criminogenic factors such as substance use, history of violent behaviour, criminal history and disruptive social behaviour complicate the reintegration of forensic mental health service users into communities. The current extent of reintegration of forensic mental health service users was found to be 'poor' (46%; n= 46); and financial difficulties, criminogenic factors and limited Community-Based Care (CBC) facilities were identified as key barriers to the reintegration process. 56% of all job applications for forensic mental health service users were unsuccessful, and 53% of all applications for their admission into CBC facilities were declined. Although social support (informal) was found to be essential for successful reintegration, institutional support (formal) through assertive community treatment (35%; n= 35) and CBC facilities (21%) and the disability grant (DG=50%) was found to be more important for family coping and reintegration. Moreover, 72% of respondents had positive perceptions about the process of reintegration; no statistically significant relationship was found between years of experience and perceptions about reintegration (P-value = 0.062); and perceptions were not found to be a barrier to reintegration. No statistically significant relationship was found between years of working experience and understanding the legislative framework of deinstitutionalization (P-Value =.0.061). However, using a Chi-square test, a significant relationship (P-value = 0.021) was found between sex and understanding the legal framework involved in the process of reintegration. The study recommends a post-2020 deinstitutionalization agenda that factors-in criminogenic realities associated with forensic mental health service users, and affirms the strengthening of PHC and community based care systems as precedents of successful deinstitutionalization and reintegration of mental health service users.

Keywords: forensic mental health, deinstitutionalization, reintegration, mental health service users

Procedia PDF Downloads 167

Authors: Febrian Tegar Wicaksana, Niqmatul Kurniati, Surya Nandika

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Indonesia is one of the countries that have great number of disaster occurrence and threat because it is located in not only between three tectonic plates such as Eurasia plates, Indo-Australia plates and Pacific plates, but also in the Ring of Fire path, like earthquake, Tsunami, volcanic eruption and many more. Recently, research shows that there are potential areas that will be devastated by Tsunami in southern coast of Java. Tsunami is a series of waves in a body of water caused by the displacement of a large volume of water, generally in an ocean. When the waves enter shallow water, they may rise to several feet or, in rare cases, tens of feet, striking the coast with devastating force. The parameter for reference such as magnitude, the depth of epicentre, distance between epicentres with land, the depth of every points, when reached the shore and the growth of waves. Interaction between parameters will bring the big variance of Tsunami wave. Based on that, we can formulate preparation that needed for disaster mitigation strategies. The mitigation strategies will take the important role in an effort to reduce the number of victims and damage in the area. It will reduce the number of victim and casualties. Reducing is directed to the most difficult mobilization casualties in the tsunami disaster area like old people, sick people and disabilities people. Until now, the method that used for rescuing people from Tsunami is basic horizontal evacuation. This evacuation system is not optimal because it needs so long time and it cannot be used by people with disabilities. The writers propose to create a vertical evacuation model with an escape bunker system. This bunker system is chosen because the downward vertical evacuation is considered more efficient and faster. Especially in coastal areas without any highlands surround it. The downward evacuation system is better than upward evacuation because it can avoid the risk of erosion at the ground around the structure which can affect the building. The structure of the bunker and the evacuation process while, and even after, disaster are the main priority to be considered. The power of bunker has quake’s resistance, the durability from water stream, variety of interaction to the ground, and waterproof design. When the situation is back to normal, victim and casualties can go into the safer place. The bunker will be located near the hospital and public places, and will have wide entrance supported by large slide in it so it will ease the disabilities people. The technology of the escape bunker system is expected to reduce the number of victims who have low mobility in the Tsunami.

Keywords: escape bunker, tsunami, vertical evacuation, mitigation, disaster management

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Authors: Dosun Shin, Assegid Kidane, Pavan Turaga

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According to the National Institute of Health, living a sedentary lifestyle leads to a number of health issues, including increased risk of cardiovascular dis-ease, type 2 diabetes, obesity, and certain types of cancers. This project brings together experts in multiple disciplines to bring product design, sensor design, algorithms, and health intervention studies to develop a product and system that helps reduce the amount of time sitting at the workplace. This paper illustrates ongoing improvements to prototypes the research team developed in initial research; including working prototypes with a software application, which were developed and demonstrated for users. Additional modifications were made to improve functionality, aesthetics, and ease of use, which will be discussed in this paper. Extending on the foundations created in the initial phase, our approach sought to further improve the product by conducting additional human factor research, studying deficiencies in competitive products, testing various materials/forms, developing working prototypes, and obtaining feedback from additional potential users. The solution consisted of an aesthetically pleasing seat cover cushion that easily attaches to common office chairs found in most workplaces, ensuring a wide variety of people can use the product. The product discreetly contains sensors that track when the user sits on their chair, sending information to a phone app that triggers reminders for users to stand up and move around after sitting for a set amount of time. This paper also presents the analyzed typical office aesthetics and selected materials, colors, and forms that complimented the working environment. Comfort and ease of use remained a high priority as the design team sought to provide a product and system that integrated into the workplace. As the research team continues to test, improve, and implement this solution for the sedentary workplace, the team seeks to create a viable product that acts as an impetus for a more active workday and lifestyle, further decreasing the proliferation of chronic disease and health issues for sedentary working people. This paper illustrates in detail the processes of engineering, product design, methodology, and testing results.

Keywords: anti-sedentary work behavior, new product development, sensor design, health intervention studies

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Authors: Gabriela Silva-Maceda, Silvia Romero-Contreras

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Spanish is a more transparent language than English given that it has more direct correspondences between sounds and letters. It has become important to understand how decoding and linguistic comprehension contribute to reading comprehension in the framework of the widely known Simple View Model. This study aimed to identify the level of prediction by these two components in a sample of 1st to 4th grade children attending two schools in central Mexico (one public and one private). Within each school, ten children were randomly selected in each grade level, and their parents were asked about reading habits and socioeconomic information. In total, 79 children completed three standardized tests measuring decoding (pseudo-word reading), linguistic comprehension (understanding of paragraphs) and reading comprehension using subtests from the Clinical Evaluation of Language Fundamentals-Spanish, Fourth Edition, and the Test de Lectura y Escritura en Español (LEE). The data were analyzed using hierarchical regression, with decoding as a first step and linguistic comprehension as a second step. Results showed that decoding accounted for 19.2% of the variance in reading comprehension, while linguistic comprehension accounted for an additional 10%, adding up to 29.2% of variance explained: F (2, 75)= 15.45, p <.001. Socioeconomic status derived from parental questionnaires showed a statistically significant association with the type of school attended, X2 (3, N= 79) = 14.33, p =.002. Nonetheless when analyzing the Simple View components, only decoding differences were statistically significant (t = -6.92, df = 76.81, p < .001, two-tailed); reading comprehension differences were also significant (t = -3.44, df = 76, p = .001, two-tailed). When socioeconomic status was included in the model, it predicted a 5.9% unique variance, even when already accounting for Simple View components, adding to a 35.1% total variance explained. This three-predictor model was also significant: F (3, 72)= 12.99, p <.001. In addition, socioeconomic status was significantly correlated with the amount of non-textbook books parents reported to have at home for both adults (rho = .61, p<.001) and children (rho= .47, p<.001). Results converge with a large body of literature finding socioeconomic differences in reading comprehension; in addition this study suggests that these differences were also present in decoding skills. Although linguistic comprehension differences between schools were expected, it is argued that the test used to collect this variable was not sensitive to linguistic differences, since it came from a test to diagnose clinical language disabilities. Even with this caveat, results show that the components of the Simple View Model can predict less than a third of the variance in reading comprehension in Spanish. However, the results also suggest that a fuller model of reading comprehension is obtained when considering the family’s socioeconomic status, given the potential differences shown by the socioeconomic status association with books at home, factors that are particularly important in countries where inequality gaps are relatively large.

Keywords: decoding, linguistic comprehension, reading comprehension, simple view model, socioeconomic status, Spanish

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Authors: Michelle Rippy

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Medicolegal death investigation historically is a field that does not receive much research attention or advancement, as all of the subjects are deceased. Public health threats, drug epidemics and contagious diseases are typically recognized in decedents first, with thorough and accurate death investigations able to assist in epidemiology research and prevention programs. One vital component of medicolegal death investigation is determining the decedent’s time of death. An accurate time of death can assist in corroborating alibies, determining sequence of death in multiple casualty circumstances and provide vital facts in civil situations. Popular television portrays an unrealistic forensic ability to provide the exact time of death to the minute for someone found deceased with no witnesses present. The actuality of unattended decedent time of death determination can generally only be narrowed to a 4-6 hour window. In the mid- to late-20th century, liver temperatures were an invasive action taken by death investigators to determine the decedent’s core temperature. The core temperature was programmed into an equation to determine an approximate time of death. Due to many inconsistencies with the placement of the thermometer and other variables, the accuracy of the liver temperatures was dispelled and this once common place action lost scientific support. Currently, medicolegal death investigators utilize three major after death or post-mortem changes at a death scene. Many factors are considered in the subjective determination as to the time of death, including the cooling of the decedent, stiffness of the muscles, release of blood internally, clothing, ambient temperature, disease and recent exercise. Current research is utilizing non-invasive hospital grade tympanic thermometers to measure the temperature in the each of the decedent’s ears. This tool can be used at the scene and in conjunction with scene indicators may provide a more accurate time of death. The research is significant and important to investigations and can provide an area of accuracy to a historically inaccurate area, considerably improving criminal and civil death investigations. The goal of the research is to provide a scientific basis to unwitnessed deaths, instead of the art that the determination currently is. The research is currently in progress with expected termination in December 2018. There are currently 15 completed case studies with vital information including the ambient temperature, decedent height/weight/sex/age, layers of clothing, found position, if medical intervention occurred and if the death was witnessed. This data will be analyzed with the multiple variables studied and available for presentation in January 2019.

Keywords: algor mortis, forensic pathology, investigations, medicolegal, time of death, tympanic

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Authors: Vardan Melkonyan, Arman Azizyan, Astghik Boyajyan

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Virtual reality (VR) exposure therapy is a form of cognitive-behavioral therapy that uses immersive virtual environments to expose individuals to the feared stimuli or situations that trigger their phobia. VR exposure therapy has become an increasingly popular treatment for phobias, including fear of heights, public speaking, and flying, due to its ability to provide a controlled and safe environment for individuals to confront their fears while also allowing therapists to tailor the virtual exposure to the specific needs and goals of each individual. It is also a cost-effective and accessible treatment option, as it can be delivered remotely and does not require the use of drugs. Overall, VR exposure therapy has the potential to be a valuable tool for therapists in the treatment of phobias. But current methods may be improved by incorporating advanced technology such as photorealistic VR environments, tactile feedback suits, and responsive systems. The aim of this study was to identify the most effective approach for enhancing VR exposure therapy for the treatment of phobias. Photorealistic VR environments and stimuli can greatly enhance the effectiveness of VR exposure therapy for the treatment of phobias. By creating immersive, realistic virtual environments that closely mimic the real-life situations that trigger phobia responses, patients are able to more fully engage in the therapeutic process and confront their fears in a controlled and safe manner. This can help to reduce the severity of phobia symptoms and increase treatment outcomes. The use of tactile feedback suits and responsive systems can further enhance the VR exposure therapy experience by adding a physical element to the virtual environment. These suits, which can mimic the sensations of touch, pressure, and movement, allow patients to fully immerse themselves in the virtual world and feel as if they are physically present in the situation. This can help to increase the realism of the virtual environment and make it more effective in reducing phobia symptoms. Additionally, responsive systems can be used to trigger specific events or responses within the virtual environment based on the patient's actions, providing a more interactive and personalized treatment experience. A comprehensive literature review was conducted, including studies on VR exposure therapy for phobias and the use of advanced technology to enhance the therapy. Results indicate that incorporating these enhancements may significantly increase the effectiveness of VR exposure therapy for phobias. Further research is needed to fully understand the potential of these enhancements and to determine the optimal combination and implementation.

Keywords: virtual reality, mental health, phobias, fears, treatment, photorealistic, immersive, phobia

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Authors: Ramin Mehdiabadi, Neda Menbari, Mohammad Nazir Menbari

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As a pressing public health concern, breast cancer stands as the predominant oncological diagnosis and principal cause of cancer-related mortality among women globally, accounting for 11.7% of new cancer incidences and 6.9% of cancer-related deaths. The annual figures indicate that approximately 230,480 women are diagnosed with breast cancer in the United States alone, with 39,520 succumbing to the disease. While developed economies have reported a deceleration in both incidence and mortality rates across various forms of cancer, including breast cancer, emerging and low-income economies manifest a contrary escalation, largely attributable to lifestyle-mediated risk factors such as tobacco usage, physical inactivity, and high caloric intake. Breast cancer is distinctly characterized by molecular heterogeneity, manifesting in specific subtypes delineated by biomarkers—Estrogen Receptors (ER), Progesterone Receptors (PR), and Human Epidermal Growth Factor Receptor 2 (HER2). These subtypes, comprising Luminal A, Luminal B, HER2-enriched, triple-negative/basal-like, and normal-like, necessitate nuanced, subtype-specific therapeutic regimens, thereby challenging the applicability of generalized treatment protocols. Within this molecular complexity, the transcription factor Forkhead Box M1 (FoxM1) has garnered attention as a significant driver of cellular proliferation, tumorigenesis, metastatic progression, and treatment resistance in a spectrum of human malignancies, including breast cancer. Concurrently, microRNAs (miRs), specifically miR-216b-5p, have been identified as post-transcriptional gene expression regulators and potential tumor suppressors. The overarching objective of this academic investigation is to explicate the multifaceted interrelationship between FoxM1 and miR-216b-5p across the disparate molecular subtypes of breast cancer. Employing a methodologically rigorous, interdisciplinary research design that incorporates cutting-edge molecular biology techniques, sophisticated bioinformatics analytics, and exhaustive meta-analyses of extant clinical data, this scholarly endeavor aims to unveil novel biomarker-specific therapeutic pathways. By doing so, this research is positioned to make a seminal contribution to the advancement of personalized, efficacious, and minimally toxic treatment paradigms, thus profoundly impacting the global efforts to ameliorate the burden of breast cancer.

Keywords: breast cancer, fox m1, microRNAs, mir-216b-5p, gene expression

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Authors: Robin Anderson, Elizabeth Latham, David Nisbet

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Propagation and dissemination of antimicrobial resistant and pathogenic microbes from spoiled silages and composts represents a serious public health threat to humans and animals. In the present study, the antimicrobial activity of the short chain nitro-compound, 2-nitro-1-propanol (9 mM) as well as the medium chain fatty acid, lauric acid, and its glycerol monoester, monolaurin, (each at 25 and 17 µmol/mL, respectfully) were investigated against select pathogenic and multi-drug resistant antimicrobial resistant Gram-positive bacteria common to spoiled silages and composts. In an initial study, we found that growth rates of a multi-resistant Enterococcus faecalis (expressing resistance against erythromycin, quinupristin/dalfopristin and tetracycline) and Staphylococcus aureus strain 12600 (expressing resistance against erythromycin, linezolid, penicillin, quinupristin/dalfopristin and vancomycin) were more than 78% slower (P < 0.05) by 2-nitro-1-propanol treatment during culture (n = 3/treatment) in anaerobically prepared ½ strength Brain Heart Infusion broth at 37oC when compared to untreated controls (0.332 ± 0.04 and 0.108 ± 0.03 h-1, respectively). The growth rate of 2-nitro-1-propanol-treated Listeria monocytogenes was also decreased by 96% (P < 0.05) when compared to untreated controls cultured similarly (0.171 ± 0.01 h-1). Maximum optical densities measured at 600 nm were lower (P < 0.05) in 2-nitro-1-propanol-treated cultures (0.053 ± 0.01, 0.205 ± 0.02 and 0.041 ± 0.01, respectively) than in untreated controls (0.483 ± 0.02, 0.523 ± 0.01 and 0.427 ± 0.01, respectively) for E. faecalis, S. aureus and L. monocytogenes, respectively. When tested against mixed microbial populations during anaerobic 24 h incubation of spoiled silage, significant effects of treatment with 1 mg 2-nitro-1-propanol (approximately 9.5 µmol/g) or 5 mg lauric acid/g (approximately 25 µmol/g) on populations of wildtype Enterococcus and Listeria were not observed. Mixed populations treated with 5 mg monolaurin/g (approximately 17 µmol/g) had lower (P < 0.05) viable cell counts of wildtype enterococci than untreated controls after 6 h incubation (2.87 ± 1.03 versus 5.20 ± 0.25 log10 colony forming units/g, respectively) but otherwise significant effects of monolaurin were not observed. These results reveal differential susceptibility of multi-drug resistant enterococci and staphylococci as well as L. monocytogenes to the inhibitory activity of 2-nitro-1-propanol and the medium chain fatty acid, lauric acid and its glycerol monoester, monolaurin. Ultimately, these results may lead to improved treatment technologies to preserve the microbiological safety of silages and composts.

Keywords: 2-nitro-1-propanol, lauric acid, monolaurin, gram positive bacteria

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Authors: Vidya Pratap, Seena Biju, Keshavdev A.

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In the educational town of Manipal (located in southern India) households dispose their wastes without segregation. Mixed wastes (organic, inorganic and hazardous items) are collected either by private collectors or by the local municipal body in trucks and taken to dump yards. These collectors select certain recyclables from the collected trash and sell them to scrap merchants to earn some extra money. Rag pickers play a major role in picking up card board boxes, glass bottles and milk sachets from dump yards and public areas and scrap iron from construction sites for recycling. In keeping with the Indian Prime Minister’s mission of Swachh Bharat (A Clean India), the local municipal administration is taking efforts to ensure segregation of domestic waste at source. With this in mind, each household in a residential area in Manipal was given two buckets – for wet and dry wastes (wet waste referred to organic waste while dry waste included recyclable and hazardous items). A study was conducted in this locality covering a cluster of 145 households to assess the residents’ knowledge of recyclable, organic and hazardous items commonly disposed by households. Another objective of this research was to evaluate the extent to which the residents actually dispose their wastes appropriately. Questionnaires were self-administered to a member of each household with the assistance of individuals speaking the local language whenever needed. Respondents’ knowledge of whether an item was organic, inorganic or hazardous was captured through a questionnaire containing a list of 50 common items. Their behaviour was captured by asking how they disposed these items. Results show that more than 70% of respondents are aware that banana and orange peels, potato skin, egg shells and dried leaves are organic; similarly, more than 70% of them consider newspapers, notebook and printed paper are recyclable. Less than 65% of respondents are aware that plastic bags and covers and plastic bottles are recyclable. However, the results of the respondents’ recycling behaviour is less impressive. Fewer than 35% of respondents recycle card board boxes, milk sachets and glass bottles. Unfortunately, since plastic items like plastic bags and covers and plastic bottles are not accepted by scrap merchants, they are not recycled. This study shows that the local municipal authorities must find ways to recycle plastic into products, alternate fuel etc.

Keywords: behaviour, knowledge, plastic waste management, recyclables

Procedia PDF Downloads 173

Authors: James D. Beauchemin

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Introduction: The incarceration of people with mental illness and substance use disorders is a major public health issue with social, clinical, and economic implications. Yoga participation has been associated with numerous psychological benefits; however, there is a paucity of research examining impacts of yoga with incarcerated populations. The purpose of this study was to evaluate effectiveness of a six-week yoga intervention on several mental health-related variables, including emotion regulation, body awareness, and warnings of substance relapse among incarcerated females. Methods: This study utilized a pre-post, three-arm design, with participants assigned to intervention, therapeutic community, or general population groups. A between-group analysis of covariance (ANCOVA) was conducted across groups to assess intervention effectiveness using the Difficulties in Emotion Regulation Scale (DERS), Scale of Body Connection (SBC), and Warnings of Relapse (AWARE) Questionnaire. Results: ANCOVA results for warnings of relapse (AWARE) revealed significant between-group differences F(2, 80) = 7.15, p = .001; np2 = .152), with significant pairwise comparisons between the intervention group and both the therapeutic community (p = .001) and the general population (p = .005) groups. Similarly, significant differences were found for emotional regulation (DERS) F(2, 83) = 10.521, p = .000; np2 = .278). Pairwise comparisons indicated a significant difference between the intervention and general population (p = .01). Finally, significant differences between the intervention and control groups were found for body awareness (SBC) F(2, 84) = 3.69, p = .029; np2 = .081). Between-group differences were clarified via pairwise comparisons, indicating significant differences between the intervention group and both the therapeutic community (p = .028) and general population groups (p = .020). Implications: Study results suggest that yoga may be an effective addition to integrative mental health and substance use treatment for incarcerated women and contributes to increasing evidence that holistic interventions may be an important component for treatment with this population. Specifically, given the prevalence of mental health and substance use disorders, findings revealed that changes in body awareness and emotion regulation might be particularly beneficial for incarcerated populations with substance use challenges as a result of yoga participation. From a systemic perspective, this proactive approach may have long-term implications for both physical and psychological well-being for the incarcerated population as a whole, thereby decreasing the need for traditional treatment. By integrating a more holistic, salutogenic model that emphasizes prevention, interventions like yoga may work to improve the wellness of this population while providing an alternative or complementary treatment option for those with current symptoms.

Keywords: wellness, solution-focused coaching, college students, prevention

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Authors: Milica Lilic, Marina Rosales Martínez

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Academic research cannot be oblivious to social problems and needs, so projects that have the capacity for transformation and impact should have the opportunity to go beyond the University circles and bring benefit to society. Apart from patents and R&D research contracts, this opportunity can be achieved through entrepreneurship as one of the most direct tools to turn knowledge into a tangible product. Thus, as an example of good practices, it is intended to analyze the case of an institutional entrepreneurship program carried out at the University of Seville, aimed at researchers interested in assessing the business opportunity of their research and expanding their knowledge on procedures for the commercialization of technologies used at academic projects. The program is based on three pillars: training, teamwork sessions and networking. The training includes aspects such as product-client fit, technical-scientific and economic-financial feasibility of a spin-off, institutional organization and decision making, public and private fundraising, and making the spin-off visible in the business world (social networks, key contacts, corporate image and ethical principles). On the other hand, the teamwork sessions are guided by a mentor and aimed at identifying research results with potential, clarifying financial needs and procedures to obtain the necessary resources for the consolidation of the spin-off. This part of the program is considered to be crucial in order for the participants to convert their academic findings into a business model. Finally, the networking part is oriented to workshops about the digital transformation of a project, the accurate communication of the product or service a spin-off offers to society and the development of transferable skills necessary for managing a business. This blended program results in the final stage where each team, through an elevator pitch format, presents their research turned into a business model to an experienced jury. The awarded teams get a starting capital for their enterprise and enjoy the opportunity of formally consolidating their spin-off company at the University. Studying the results of the program, it has been shown that many researchers have basic or no knowledge of entrepreneurship skills and different ways to turn their research results into a business model with a direct impact on society. Therefore, the described program has been used as an example to highlight the importance of knowledge transfer at the University and the role that this institution should have in providing the tools to promote entrepreneurship within it. Keeping in mind that the University is defined by three main activities (teaching, research and knowledge transfer), it is safe to conclude that the latter, and the entrepreneurship as an expression of it, is crucial in order for the other two to comply with their purpose.

Keywords: good practice, knowledge transfer, a spin-off company, university

Procedia PDF Downloads 148

Authors: K. C. M. Wong, C. P. Y. Cheng, K. Y. Chan, G. S. C. Fung, T. F. O. Lau, K. F. C. Leung, J. P. C. Fok

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Hospital Authority (HA) is the statutory body to manage all public hospitals in Hong Kong. Occupational Care Medicine Service (OMCS) is an in-house multi-disciplinary team responsible for injury management in HA. Hospital administrative services (AS) provides essential support in hospital daily operation to facilitate the provision of quality healthcare services. An occupational health enhancement program in Tai Po Hospital (TPH) domestic service supporting unit (DSSU) was piloted in 2013 with satisfactory outcome, the keys to success were staff engagement and management support. Riding on the success, the program was rolled out to another 5 AS departments of Alice Ho Miu Ling Nethersole Hospital (AHNH) and TPH in 2015. This paper highlights the indispensable components of disability management and occupational health enhancement program in hospital settings. Objectives: 1) Facilitate workplace to support staff with health affecting work problem, 2) Enhance staff’s occupational health. Methodology: Hospital Occupational Safety and Health (OSH) team and AS departments (catering, linen services, and DSSU) of AHNH and TPH worked closely with OMCS. Focus group meetings and worksite visits were conducted with frontline staff engagement. OSH hazards were identified with corresponding OSH improvement measures introduced, e.g., invention of high dusting device to minimize working at height; tailor-made linen cart to minimize back bending at work, etc. Specific MHO trainings were offered to each AS department. A disability management workshop was provided to supervisors in order to enhance their knowledge and skills in return-to-work (RTW) facilitation. Based on injured staff's health condition, OMCS would provide work recommendation, and RTW plan was formulated with engagement of staff and their supervisors. Genuine communication among stakeholders with expectation management paved the way for realistic goals setting and success in our program. Outcome: After implementation of the program, a significant drop of 26% in musculoskeletal disorders related sickness absence day was noted in 2016 as compared to the average of 2013-2015. The improvement was postulated by innovative OSH improvement measures, teamwork, staff engagement and management support. Staff and supervisors’ feedback were very encouraging that 90% respondents rated very satisfactory in program evaluation. This program exemplified good work sharing among departments to support staff in need.

Keywords: disability management, occupational health, return to work, occupational medicine

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Authors: Shaine Mehta, Neelam Parmar, Patrick White, Mark Ashworth

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Patients with a history of substance have a high prevalence of comorbidities, including asthma and chronic obstructive pulmonary disease (COPD). Mortality rates are higher than that of the general population and the link to respiratory disease is reported. Randomised controlled trials (RCTs) support opioid substitution therapy as an effective means for harm reduction. However, whilst a high proportion of patients receiving opioid substitution therapy are smokers, to the author’s best knowledge there have been no studies of respiratory disease and smoking intensity in these patients. A cross sectional prevalence study was conducted using an anonymised patient-level database in primary care, Lambeth DataNet (LDN). We included patients aged 18 years and over who had records of ever having been prescribed methadone in primary care. Patients under 18 years old or prescribed buprenorphine (because of uncertainty about the prescribing indication) were excluded. Demographic, smoking, alcohol and asthma and COPD coding data were extracted. Differences between methadone and non-methadone users were explored with multivariable analysis. LDN contained data on 321, 395 patients ≥ 18 years; 676 (0.16%) had a record of methadone prescription. Patients prescribed methadone were more likely to be male (70.7% vs. 50.4%), older (48.9yrs vs. 41.5yrs) and less likely to be from an ethnic minority group (South Asian 2.1% vs. 7.8%; Black African 8.9% vs. 21.4%). Almost all those prescribed methadone were smokers or ex-smokers (97.3% vs. 40.9%); more were non-alcohol drinkers (41.3% vs. 24.3%). We found a high prevalence of COPD (12.4% vs 1.4%) and asthma (14.2% vs 4.4%). Smoking intensity data shows a high prevalence of ≥ 20 cigarettes per day (21.5% vs. 13.1%). Risk of COPD, adjusted for age, gender, ethnicity and deprivation, was raised in smokers: odds ratio 14.81 (95%CI 11.26, 19.47), and in the methadone group: OR 7.51 (95%CI: 5.78, 9.77). Furthermore, after adjustment for smoking intensity (number of cigarettes/day), the risk was raised in methadone group: OR 4.77 (95%CI: 3.13, 7.28). High burden of respiratory disease compounded by the high rates of smoking is a public health concern. This supports an integrated approach to health in patients treated for opiate dependence, with access to smoking cessation support. Further work may evaluate the current structure and commissioning of substance misuse services, including smoking cessation. Regression modelling highlights that methadone as a ‘risk factor’ was independently associated with COPD prevalence, even after adjustment for smoking intensity. This merits further exploration, as the association may be related to unexplored aspects of smoking (such as the number of years smoked) or may be related to other related exposures, such as smoking heroin or crack cocaine.

Keywords: methadone, respiratory disease, smoking cessation, substance misuse

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Authors: Anette Alén

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Intellectual property (IP) regimes have traditionally been designed to integrate various conflicting elements stemming from private entitlement and the public good. In IP laws and regulations, this design takes the form of specific uses of protected subject-matter without the right-holder’s consent, or exhaustion of exclusive rights upon market release, and the like. More recently, the pursuit of ‘balance’ has gained ground in the conceptualization of these conflicting elements both in terms of IP law and related policy. This can be seen, for example, in European Union (EU) copyright regime, where ‘balance’ has become a key element in argumentation, backed up by fundamental rights reasoning. This development also entails an ever-expanding dialogue between the IP regime and the constitutional safeguards for property, free speech, and privacy, among others. This study analyses the concept of ‘balance’ in EU copyright law: the research task is to examine the contents of the concept of ‘balance’ and the way it is operationalized and pursued, thereby producing new knowledge on the role and manifestations of ‘balance’ in recent copyright case law and regulatory instruments in the EU. The study discusses two particular pieces of legislation, the EU Digital Single Market (DSM) Copyright Directive (EU) 2019/790 and the finalized EU Artificial Intelligence (AI) Act, including some of the key preparatory materials, as well as EU Court of Justice (CJEU) case law pertaining to copyright in the digital era. The material is examined by means of document analysis, mapping the ways ‘balance’ is approached and conceptualized in the documents. Similarly, the interaction of fundamental rights as part of the balancing act is also analyzed. Doctrinal study of law is also employed in the analysis of legal sources. This study suggests that the pursuit of balance is, for its part, conducive to new battles, largely due to the advancement of digitalization and more recent developments in artificial intelligence. Indeed, the ‘balancing act’ rather presents itself as a way to bypass or even solidify some of the conflicting interests in a complex global digital economy. Indeed, such a conceptualization, especially when accompanied by non-critical or strategically driven fundamental rights argumentation, runs counter to the genuine acknowledgment of new types of conflicting interests in the copyright regime. Therefore, a more radical approach, including critical analysis of the normative basis and fundamental rights implications of the concept of ‘balance’, is required to readjust copyright law and regulations for the digital era. Notwithstanding the focus on executing the study in the context of the EU copyright regime, the results bear wider significance for the digital economy, especially due to the platform liability regime in the DSM Directive and with the AI Act including objectives of a ‘level playing field’ whereby compliance with EU copyright rules seems to be expected among system providers.

Keywords: balance, copyright, fundamental rights, platform liability, artificial intelligence

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Authors: Aiman Mazhar Qureshi, Ahmed Rachid

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Extreme heat events are emerging human environmental health concerns in dense urban areas due to anthropogenic activities. High spatial and temporal resolution heat maps are important for urban heat adaptation and mitigation, helping to indicate hotspots that are required for the attention of city planners. The Heat Vulnerability Index (HVI) is the important approach used by decision-makers and urban planners to identify heat-vulnerable communities and areas that require heat stress mitigation strategies. Amiens is a medium-sized French city, where the average temperature has been increasing since the year 2000 by +1°C. Extreme heat events are recorded in the month of July for the last three consecutive years, 2018, 2019 and 2020. Poor air quality, especially ground-level ozone, has been observed mainly during the same hot period. In this study, we evaluated the HVI in Amiens during extreme heat days recorded last three years (2018,2019,2020). The Principal Component Analysis (PCA) technique is used for fine-scale vulnerability mapping. The main data we considered for this study to develop the HVI model are (a) socio-economic and demographic data; (b) Air pollution; (c) Land use and cover; (d) Elderly heat-illness; (e) socially vulnerable; (f) Remote sensing data (Land surface temperature (LST), mean elevation, NDVI and NDWI). The output maps identified the hot zones through comprehensive GIS analysis. The resultant map shows that high HVI exists in three typical areas: (1) where the population density is quite high and the vegetation cover is small (2) the artificial surfaces (built-in areas) (3) industrial zones that release thermal energy and ground-level ozone while those with low HVI are located in natural landscapes such as rivers and grasslands. The study also illustrates the system theory with a causal diagram after data analysis where anthropogenic activities and air pollution appear in correspondence with extreme heat events in the city. Our suggested index can be a useful tool to guide urban planners and municipalities, decision-makers and public health professionals in targeting areas at high risk of extreme heat and air pollution for future interventions adaptation and mitigation measures.

Keywords: heat vulnerability index, heat mapping, heat health-illness, remote sensing, urban heat mitigation

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Authors: Eun-Jeong Jang

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Inequality has been considered as a core issue in public policy. Korea is categorized into one of the countries in the high level of inequality, which matters to not only current but also future generations. The relationship between individuals' origin and destination has an implication of intergenerational inequality. The previous work on this was mostly conducted at macro level using panel data to our knowledge. However, in this level, there is no room to track down what happened during the time between origin and destination. Individuals' origin is represented by their parents' socio-economic status, and in the same way, destination is translated into their own socio-economic status. The first research question is that how origin is related to the destination. Certainly, destination is highly affected by origin. In this view, people's destination is already set to be more or less than a reproduction of previous generations. However, educational achievement is widely believed as an independent factor from the origin. From this point of view, there is a possibility to change the path given by parents by educational attainment. Hence, the second research question would be that how education is related to destination and also, which factor is more influential to destination between origin and education. Also, the focus lies in the mediation of education between origin and destination, which would be the third research question. Socio-economic status in this study is referring to class as a sociological term, as well as wealth including labor and capital income, as an economic term. The combination of class and wealth would be expected to give more accurate picture about the hierarchy in a society. In some cases of non-manual and professional occupations, even though they are categorized into relatively high class, their income is much lower than those who in the same class. Moreover, it is one way to overcome the limitation of the retrospective view during survey. Education is measured as an absolute term, the years of schooling, and also as a relative term, the rank of school. Moreover, all respondents were asked the effort scaled by time intensity, self-motivation, before and during the course of their college based on a standard questionnaire academic achieved model provides. This research is based on a survey at an individual level. The target for sampling is an individual who has a job, regardless of gender, including income-earners and self-employed people and aged between thirties and forties because this age group is considered to reach the stage of job stability. In most cases, the researcher met respondents person to person visiting their work place or home and had a chance to interview some of them. One hundred forty individual data collected from May to August in 2017. It will be analyzed by multiple regression (Q1, Q2) and structural equation modeling (Q3).

Keywords: class, destination, educational achievement, effort, income, origin, socio-economic status, South Korea

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Authors: Debalina Ghoshal

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Nuclear security is the ‘prevention and detection of, and response to unauthorised removal, sabotage, unauthorised access, illegal transfer or other malicious acts involving nuclear or radiological material or their associated facilities.’ Ever since the end of Cold War, nuclear materials security has remained a concern for global security. However, with the increase in terrorist attacks not just in India especially, security of nuclear materials remains a priority. Therefore, India has made continued efforts to tighten its security on nuclear materials to prevent nuclear theft and radiological terrorism. Nuclear security is different from nuclear safety. Physical security is also a serious concern and India had been careful of the physical security of its nuclear materials. This is more so important since India is expanding its nuclear power capability to generate electricity for economic development. As India targets 60,000 MW of electricity production by 2030, it has a range of reactors to help it achieve its goal. These include indigenous Pressurised Heavy Water Reactors, now standardized at 700 MW per reactor Light Water Reactors, and the indigenous Fast Breeder Reactors that can generate more fuel for the future and enable the country to utilise its abundant thorium resource. Nuclear materials security can be enhanced through two important ways. One is through proliferation resistant technologies and diplomatic efforts to take non proliferation initiatives. The other is by developing technical means to prevent any leakage in nuclear materials in the hands of asymmetric organisations. New Delhi has already implemented IAEA Safeguards on their civilian nuclear installations. Moreover, the IAEA Additional Protocol has also been ratified by India in order to enhance its transparency of nuclear material and strengthen nuclear security. India is a party to the IAEA Conventions on Nuclear Safety and Security, and in particular the 1980 Convention on the Physical Protection of Nuclear Material and its amendment in 2005, Code of Conduct in Safety and Security of Radioactive Sources, 2006 which enables the country to provide for the highest international standards on nuclear and radiological safety and security. India's nuclear security approach is driven by five key components: Governance, Nuclear Security Practice and Culture, Institutions, Technology and International Cooperation. However, there is still scope for further improvements to strengthen nuclear materials and nuclear security. The NTI Report, ‘India’s improvement reflects its first contribution to the IAEA Nuclear Security Fund etc. in the future, India’s nuclear materials security conditions could be further improved by strengthening its laws and regulations for security and control of materials, particularly for control and accounting of materials, mitigating the insider threat, and for the physical security of materials during transport. India’s nuclear materials security conditions also remain adversely affected due to its continued increase in its quantities of nuclear material, and high levels of corruption among public officials.’ This paper would study briefly the progress made by India in nuclear and nuclear material security and the step ahead for India to further strengthen this.

Keywords: India, nuclear security, nuclear materials, non proliferation

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Authors: Mike Wei, Mario Cedillo, Jiahui Lin, Carol Lorraine Storey-Johnson, Carla Boutin-Foster

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Purpose: The extent to which health insurance enrollment succeeds under the Affordable Care Act (ACA) rests heavily on the ability to reach the uninsured and motivate them to enroll. We sought to identify perceptions about the ACA among uninsured patients at a free clinic in New York City. Background: The ACA holds tremendous promise for reducing the number of uninsured Americans. As of April 2014, nearly 8 million people had signed up for health insurance through the Health Insurance Marketplace. Despite this early success, future and continued enrollment rests heavily on the degree of public awareness. Reaching eligible individuals and increasing their awareness and understanding remains a fundamental challenge to realizing the full potential of the ACA. Reaching out to uninsured patients who are seeking care through safety net facilities such as free clinics may provide important avenues for reaching potential enrollees. This project focuses on the experience at the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic (WCCC), and seeks to understand perceptions about the ACA among its patient population. Methods: This was a cross-sectional study of all patients who visited the free clinic at Weill Cornell Medical College, the Weill Cornell Community Clinic, from July 2013 to May 2014. Patients who provided informed consent at their visit and completed a semi-structured questionnaire were included (N=62). The questionnaire comprised of questions about demographic characteristics and open-ended questions about their knowledge and perception of the impact of the ACA. Descriptive statistics were used to characterize the population demographics. Qualitative coding techniques were used for open-ended items. Results: Approximately one third of patients surveyed never had health insurance. Of the remaining 65%, 20% lost their insurance within the past year. Only 55% had heard about the ACA, and only 10% knew about the Health Benefits Exchange. Of those who had heard about the ACA, sentiments were tinged with optimistic misperceptions, such as “it will be free health care for all.” While optimistic, most of the responses focused on the economic implications of the ACA. Conclusions: These findings reveal the immense amount of misconception and lack of understanding with regards to the ACA. As such, the study highlights the need to educate and address the concerns of those who remain skeptical or uncertain about the implications of the ACA.

Keywords: Affordable Care Act, demographics, free clinics, underserved.

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Authors: Roger WUMBA

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The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV) symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients. In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women) with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl–Neelsen stainings, real-time polymerase chain reaction (PCR), immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR) and 95% confidence intervals were used to quantify the risk. Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of ,100 cells/mm³, and no antiretroviral therapy (ART), respectively. The majority of those with opportunistic intestinal parasites and C. hominis, and all with C. parvum and new E. bieneusi genotypes, had diarrhea, low CD4+ counts of ,100 cells/mm³, and no ART. There was a significant association between Entamoeba coli, Kaposi sarcoma, herpes zoster, chronic diarrhea, and asthenia, and the presence of 28 cases with opportunistic intestinal parasites. Rural areas, public toilets, and exposure to farm pigs were the univariate risk factors present in the 28 cases with opportunistic intestinal parasites. In logistic regression analysis, a CD4 count of ,100 cells/mm³ (OR = 4.60; 95% CI 1.70–12.20; P = 0.002), no ART (OR = 5.00; 95% CI 1.90–13.20; P , 0.001), and exposure to surface water (OR = 2.90; 95% CI 1.01–8.40; P = 0.048) were identified as the significant and independent determinants for the presence of opportunistic intestinal parasites. E. bieneusi and Cryptosporidium are becoming more prevalent in Kinshasa, Congo. Based on the findings, we recommend epidemiology surveillance and prevention by means of hygiene, the emphasis of sensitive PCR methods, and treating opportunistic intestinal parasites that may be acquired through fecal–oral transmission, surface water, normal immunity, rural area-based person–person and animal–human nfection, and transmission of HIV. Therapy, including ART and treatment with fumagillin, is needed.

Keywords: diarrhea, enterocytozoon bieneusi, cryptosporidium hominis, cryptosporidium parvum, risk factors, africans

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Authors: Jason Gica, Yi-Hsieng Samuel Wu, Deng-Jye Yang, Yi-Chen Chen

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Mycotoxins, harmful secondary metabolites produced by certain fungi species, pose significant risks to animals and humans worldwide. Their stable properties lead to contamination during grain harvesting, transportation, and storage, as well as in processed food products. The prevalence of mycotoxin contamination has attracted significant attention due to its adverse impact on food safety and global trade. The secondary contamination pathway from animal products has been identified as an important route of exposure, posing health risks for livestock and humans consuming contaminated products. Pork, one of the highly consumed meat products in Taiwan according to the National Food Consumption Database, plays a critical role in the nation's diet and economy. Given its substantial consumption, pork processing products are a significant component of the food supply chain and a potential source of mycotoxin contamination. This study is paramount for formulating effective regulations and strategies to mitigate mycotoxin-related risks in the food supply chain. By establishing a reliable analytical method, this research contributes to safeguarding public health and enhancing the quality of pork processing products. The findings will serve as valuable guidance for policymakers, food industries, and consumers to ensure a safer food supply chain in the face of emerging mycotoxin challenges. An innovative and efficient analytical approach is proposed using Ultra-High Performance Liquid Chromatography coupled with Temperature Control Fluorescence Detector Light (UHPLC-TCFLD) to determine multiple mycotoxins in pork meat samples due to its exceptional capacity to detect multiple mycotoxins at the lowest levels of concentration, making it highly sensitive and reliable for comprehensive mycotoxin analysis. Additionally, its ability to simultaneously detect multiple mycotoxins in a single run significantly reduces the time and resources required for analysis, making it a cost-effective solution for monitoring mycotoxin contamination in pork processing products. The research aims to optimize the efficient mycotoxin QuEChERs extraction method and rigorously validate its accuracy and precision. The results will provide crucial insights into mycotoxin levels in pork processing products.

Keywords: multiple-mycotoxin analysis, pork processing products, QuEChERs, UHPLC-TCFLD, validation

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Authors: Andrew Green, Jiaming Liu, Kellathur Srinivasan, Raymond Chua

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Introduction: The size of Singapore’s online health product (HP) market (e-commerce) is largely unknown. However, it is recognized that a large majority comes from overseas and thus, unregulated. As buying HP from unauthorized sources significantly compromises public health safety, understanding e-commerce users’ demographics and their perceptions on online HP purchasing becomes a pivotal first step to form a basis for recommendations in Singapore’s pharmacovigilance efforts. Objective: To assess the prevalence of online HP purchasing behaviour among Singaporean e-commerce users. Methodology: This is a cross-sectional study targeting Singaporean e-commerce users recruited from various local websites and online forums. Participants were not randomized into study arms but instead stratified by random sampling method based on participants’ age. A self-administered anonymous questionnaire was used to explore participants' demographics, online HP purchasing behaviour, knowledge and attitude. The association of different variables with online HP purchasing behaviour was analysed using logistic regression statistics. Main outcome measures: Prevalence of HP e-commerce users in Singapore (%) and variables that contribute to the prevalence (adjusted prevalent ratio). Results: The study recruited 372 complete and valid responses. The prevalence of online HP consumers among e-commerce users in Singapore is estimated to be 55.9% (1.7 million consumers). Online purchasing of complementary HP (46.9%) was the most prevalent, followed by medical devices (21.6%) and Western medicine (20.5%). Multivariate analysis showed that age is an independent variable that correlates with the likelihood of buying HP online. The prevalence of HP e-commerce users is highest in the 35-44 age group (64.1%) and lowest among the 16-24 age group (36.4%). The most bought HP through the internet are vitamins and minerals (21.5%), non-herbal (15.9%), herbal (13.9%), weight loss (8.7%) and sports (8.4%) supplements. While the top 3 products are distributed equally between the genders, there is a skew towards female respondents (12.4% in females vs. 4.9% in males) for weight loss supplements and towards males (13.2% in males vs. 3.7% in females) for sports supplements. Even though online consumers are in the younger age brackets, our study found that up to 72.0% of HP bought online are bought for others (buyer’s family and/or friends). Multivariate analysis showed a statistically significant association between purchasing HP through online means and the perceptions that 'internet is safe' (adjusted Prevalence Ratio=1.15, CI 1.03-1.28), 'buying HP online is time saving' (PR=1.17, CI 1.01-1.36), and 'recognition of HP brand' (PR=1.21 CI 1.06-1.40). Conclusions: This study has provided prevalence data for online HP market in Singapore, and has allowed the country’s regulatory body to formulate a targeted pharmacovigilance approach to this growing problem.

Keywords: e-commerce, pharmaceuticals, pharmacovigilance, Singapore

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Authors: Thaminda Liyanage, Anuga Liyanage, Chamila Kurukulasuriya, Sidath Bandara

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Background: The burden of chronic kidney disease (CKD) is growing rapidly around the world, particularly in Asia. Over the last two decades Sri Lanka has experienced an epidemic of CKD with ever growing number of patients pursuing medical care due to CKD and its complications, specially in the “Mahaweli” river basin in north central region of the island nation. This was apparently a new form of CKD which was not attributable to conventional risk factors such as diabetes mellitus, hypertension or infection and widely termed as “CKD-unknown” or “CKDu”. In the past decade a number of small scale studies were conducted to determine the aetiology, prevalence and complications of CKDu in North Central region. These hospital-based studies did not provide an accurate estimate of the problem as merely 10% or less of the people with CKD are aware of their diagnosis even in developed countries with better access to medical care. Interestingly, similar observations were made on the changing epidemiology of obesity in the region but no formal study was conducted to date to determine the magnitude of obesity burden. Moreover, if increasing obesity in the region is associated with CKD epidemic is yet to be explored. Methods: We will conduct an area wide cross sectional survey among all adult residents of the “Mahaweli” development project area 5, in the North Central Province of Sri Lanka. We will collect relevant medical history, anthropometric measurements, blood and urine for hematological and biochemical analysis. We expect a participation rate of 75%-85% of all eligible participants. Participation in the study is voluntary, there will be no incentives provided for participation. Every analysis will be conducted in a central laboratory and data will be stored securely. We will calculate the prevalence of obesity and chronic kidney disease, overall and by stage using total number of participants as the denominator and report per 1000 population. The association of obesity and CKD will be assessed with regression models and will be adjusted for potential confounding factors and stratified by potential effect modifiers where appropriate. Results: This study will provide accurate information on the prevalence of obesity and CKD in the region. Furthermore, this will explore the association between obesity and CKD, although causation may not be confirmed. Conclusion: Obesity and CKD are increasingly recognized as major public health problems in Sri Lanka. Clearly, documenting the magnitude of the problem is the essential first step. Our study will provide this vital information enabling the government to plan a coordinated response to tackle both obesity and CKD in the region.

Keywords: BMI, Chronic Kidney Disease, obesity, Sri Lanka

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Authors: Begum Koru, Isik Aybay, Demet Celik Ulusoy

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The discipline of law is quite complex and has its own terminology. Apart from written legal rules, there is also living law, which refers to legal practice. Basic legal rules aim at the happiness of individuals in social life and have different characteristics in different branches such as public or private law. On the other hand, law is a national phenomenon. The law of one nation and the legal system applied on the territory of another nation may be completely different. People who are experts in a particular field of law in one country may have insufficient expertise in the law of another country. Today, in addition to the local nature of law, international and even supranational law rules are applied in order to protect basic human values and ensure the protection of human rights around the world. Systems that offer algorithmic solutions to legal problems using artificial intelligence (AI) tools will perhaps serve to produce very meaningful results in terms of human rights. However, algorithms to be used should not be developed by only computer experts, but also need the contribution of people who are familiar with law, values, judicial decisions, and even the social and political culture of the society to which it will provide solutions. Otherwise, even if the algorithm works perfectly, it may not be compatible with the values of the society in which it is applied. The latest developments involving the use of AI techniques in legal systems indicate that artificial law will emerge as a new field in the discipline of law. More AI systems are already being applied in the field of law, with examples such as predicting judicial decisions, text summarization, decision support systems, and classification of documents. Algorithms for legal systems employing AI tools, especially in the field of prediction of judicial decisions and decision support systems, have the capacity to create automatic decisions instead of judges. When the judge is removed from this equation, artificial intelligence-made law created by an intelligent algorithm on its own emerges, whether the domain is national or international law. In this work, the aim is to make a general analysis of this new topic. Such an analysis needs both a literature survey and a perspective from computer experts' and lawyers' point of view. In some societies, the use of prediction or decision support systems may be useful to integrate international human rights safeguards. In this case, artificial law can serve to produce more comprehensive and human rights-protective results than written or living law. In non-democratic countries, it may even be thought that direct decisions and artificial intelligence-made law would be more protective instead of a decision "support" system. Since the values of law are directed towards "human happiness or well-being", it requires that the AI algorithms should always be capable of serving this purpose and based on the rule of law, the principle of justice and equality, and the protection of human rights.

Keywords: AI and law, artificial law, protection of human rights, AI tools for legal systems

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Authors: Chantal Maille

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This paper is about gender-based analysis plus (GBA+), an intersectional gender policy used in Canada to assess the impact of policies and programs for men and women from different origins. It looks at Canada’s political culture to explain the nature of its gender policies. GBA+ is defined as an analysis method that makes it possible to assess the eventual effects of policies, programs, services, and other initiatives on women and men of different backgrounds because it takes account of gender and other identity factors. The ‘plus’ in the name serves to emphasize that GBA+ goes beyond gender to include an examination of a wide range of other related identity factors, such as age, education, language, geography, culture, and income. The point of departure for GBA+ is that women and men are not homogeneous populations and gender is never the only factor in defining a person’s identity; rather, it interacts with factors such as ethnic origin, age, disabilities, where the person lives, and other aspects of individual and social identity. GBA+ takes account of these factors and thus challenges notions of similarity or homogeneity within populations of women and men. Comparative analysis based on sex and gender may serve as a gateway to studying a given question, but women, men, girls, and boys do not form homogeneous populations. In the 1990s, intersectionality emerged as a new feminist framework. The popularity of the notion of intersectionality corresponds to a time when, in hindsight, the damage done to minoritized groups by state disengagement policies in concert with global intensification of neoliberalism, and vice versa, can be measured. Although GBA+ constitutes a form of intersectionalization of GBA, it must be understood that the two frameworks do not spring from a similar logic. Intersectionality first emerged as a dynamic analysis of differences between women that was oriented toward change and social justice, whereas GBA is a technique developed by state feminists in a context of analyzing governmental policies and aiming to promote equality between men and women. It can nevertheless be assumed that there might be interest in such a policy and program analysis grid that is decentred from gender and offers enough flexibility to take account of a group of inequalities. In terms of methodology, the research is supported by a qualitative analysis of governmental documents about GBA+ in Canada. Research findings identify links between Canadian gender policies and its political culture. In Canada, diversity has been taken into account as an element at the basis of gendered analysis of public policies since 1995. The GBA+ adopted by the government of Canada conveys an opening to intersectionality and a sensitivity to multiculturalism. The Canadian Multiculturalism Act, adopted 1988, proposes to recognize the fact that multiculturalism is a fundamental characteristic of the Canadian identity and heritage and constitutes an invaluable resource for the future of the country. In conclusion, Canada’s distinct political culture can be associated with the specific nature of its gender policies.

Keywords: Canada, gender-based analysis, gender policies, political culture

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Authors: Bistra Kunovska, Kremena Ivanova, Jana Djounova, Desislava Djunakova, Zdenka Stojanovska

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The carcinogenic effects of radon as a radioactive noble gas have been studied and show a strong correlation between radon exposure and lung cancer occurrence, even in the case of low radon levels. The major part of the natural radiation dose in humans is received by inhaling radon and its progenies, which originates from the decay chain of U-238. Indoor radon poses a substantial threat to human health when build-up occurs in confined spaces such as homes, mines and caves and the risk increases with the duration of radon exposure and is proportional to both the radon concentration and the time of exposure. Tourist caves are a case of special environmental conditions that may be affected by high radon concentration. Tourist caves are a recognized danger in terms of radon exposure to cave workers (guides, employees working in shops built above the cave entrances, etc.), but due to the sensitive nature of the cave environment, high concentrations cannot be easily removed. Forced ventilation of the air in the caves is considered unthinkable due to the possible harmful effects on the microclimate, flora and fauna. The risks to human health posed by exposure to elevated radon levels in caves are not well documented. Various studies around the world often detail very high concentrations of radon in caves and exposure of employees but without a follow-up assessment of the overall impact on human health. This study was developed in the implementation of a national project to assess the potential health effects caused by exposure to elevated levels of radon in buildings with public access under the National Science Fund of Bulgaria, in the framework of grant No КП-06-Н23/1/07.12.2018. The purpose of the work is to assess the radon level in Bulgarian caves and the exposure of the visitors and workers. The number of caves (sampling size) was calculated for simple random selection from total available caves 65 (sampling population) are 13 caves with confidence level 95 % and confidence interval (margin of error) approximately 25 %. A measurement of the radon concentration in air at specific locations in caves was done by using CR-39 type nuclear track-etch detectors that were placed by the participants in the research team. Despite the fact that all of the caves were formed in karst rocks, the radon levels were rather different from each other (97–7575 Bq/m3). An assessment of the influence of the orientation of the caves in the earth's surface (horizontal, inclined, vertical) on the radon concentration was performed. Evaluation of health hazards and radon risk exposure causing by inhaling the radon and its daughter products in each surveyed caves was done. Reducing the time spent in the cave has been recommended in order to decrease the exposure of workers.

Keywords: tourist caves, radon concentration, exposure, Bulgaria

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Authors: Dmytro Symak

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The experience in other countries shows that, the role of accreditation of higher education as one of the types of quality assurance process for providing educational services increases. This was the experience of highly developed countries such as USA, Canada, France, Germany, because without proper quality assurance process is impossible to achieve a successful future of the nation and the state. In most countries, the function of Higher Education Accreditation performs public authorities, in particular, such as the Ministry of Education. In the US, however, the quality assurance process is independent on the government and implemented by private non-governmental organization - the Council of Higher Education Accreditation. In France, the main body that carries out accreditation of higher education is the Ministry of National Education. As part of the Bologna process is the mutual recognition and accreditation of degrees. While higher education institutions issue diplomas, but the ministry could award the title. This is the main level of accreditation awarded automatically by state universities. In total, there are in France next major level of accreditation of higher education: - accreditation for a visa: Accreditation second level; - recognition of accreditation: accreditation of third level. In some areas of education to accreditation ministry should adopt formal recommendations on specific organs. But there are also some exceptions. Thus, the French educational institutions, mainly large Business School, looking for non-French accreditation. These include, for example, the Association to Advance Collegiate Schools of Business, the Association of MBAs, the European Foundation for Management Development, the European Quality Improvement System, a prestigious EFMD Programme accreditation system. Noteworthy also German accreditation system of education. The primary here is a Conference of Ministers of Education and Culture of land in the Federal Republic of Germany (Kultusministerkonferenz or CCM) was established in 1948 by agreement between the States of the Federal Republic of Germany. Among its main responsibilities is to ensure quality and continuity of development in higher education. In Germany, the program of bachelors and masters must be accredited in accordance with Resolution Kultusministerkonerenz. In Ukraine Higher Education Accreditation carried out the Ministry of Education, Youth and Sports of Ukraine under four main levels. Ukraine's legislation on higher education based on the Constitution Ukraine consists of the laws of Ukraine ‘On osvititu’ ‘On scientific and technical activity’, ‘On Higher osvititu’ and other legal acts and is entirely within the competence of the state. This leads to considerable centralization and bureaucratization of the process. Thus, analysis of expertise shined can conclude that reforming the system of accreditation and quality of higher education in Ukraine to its integration into the global space requires solving a number of problems in the following areas: improving the system of state certification and licensing; optimizing the network of higher education institutions; creating both governmental and non-governmental organizations to monitor the process of higher education in Ukraine and so on.

Keywords: higher education, accreditation, decentralization, education institutions

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Authors: Nasim Hashemi, Abbas Sheikhtaheri

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Telemedicine is the use of telecommunication and information technologies to provide health care services that would often not be consistently available in distant rural communities to people at these remote areas. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Thus, teleophthalmology can overcome geographical barriers and improve quality, access, and affordability of eye health care services. Since teleophthalmology has been widespread applied in recent years, the aim of this study was to determine the different applications of teleophthalmology in the world. To this end, three bibliographic databases (Medline, ScienceDirect, Scopus) were comprehensively searched with these keywords: eye care, eye health care, primary eye care, diagnosis, detection, and screening of different eye diseases in conjunction with telemedicine, telehealth, teleophthalmology, e-services, and information technology. All types of papers were included in the study with no time restriction. We conducted the search strategies until 2015. Finally 70 articles were surveyed. We classified the results based on the’type of eye problems covered’ and ‘the type of telemedicine services’. Based on the review, from the ‘perspective of health care levels’, there are three level for eye health care as primary, secondary and tertiary eye care. From the ‘perspective of eye care services’, the main application of teleophthalmology in primary eye care was related to the diagnosis of different eye diseases such as diabetic retinopathy, macular edema, strabismus and aged related macular degeneration. The main application of teleophthalmology in secondary and tertiary eye care was related to the screening of eye problems i.e. diabetic retinopathy, astigmatism, glaucoma screening. Teleconsultation between health care providers and ophthalmologists and also education and training sessions for patients were other types of teleophthalmology in world. Real time, store–forward and hybrid methods were the main forms of the communication from the perspective of ‘teleophthalmology mode’ which is used based on IT infrastructure between sending and receiving centers. In aspect of specialists, early detection of serious aged-related ophthalmic disease in population, screening of eye disease processes, consultation in an emergency cases and comprehensive eye examination were the most important benefits of teleophthalmology. Cost-effectiveness of teleophthalmology projects resulted from reducing transportation and accommodation cost, access to affordable eye care services and receiving specialist opinions were also the main advantages of teleophthalmology for patients. Teleophthalmology brings valuable secondary and tertiary care to remote areas. So, applying teleophthalmology for detection, treatment and screening purposes and expanding its use in new applications such as eye surgery will be a key tool to promote public health and integrating eye care to primary health care.

Keywords: applications, telehealth, telemedicine, teleophthalmology

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Authors: Gadinga Walter Forje, Martin Ngankam Tchamba, Nyong Princely Awazi, Barnabas Neba Nfornka

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Ecotourism is viewed as a double edge sword for the enhancement of conservation and local livelihood within a protected landscape. The Campo Ma’an National Park (CMNP) adopted ecotourism in its management plan as a strategic axis for better management of the park. The growing importance of ecotourism as a strategy for the sustainable management of CMNP and its environs requires adequate information to bolster the sector. This study was carried out between November 2018 and September 2021, with the main objective to contribute to the sustainable management of the CMNP through suggestions for enhancing the capacity of ecotourism in and around the park. More specifically, the study aimed at; 1) Analyse the governance of ecotourism in the CMNP and its surrounding; 2) Assessing the impact of ecotourism on local livelihood around the CMNP; 3) Evaluating the contribution of ecotourism to biodiversity conservation in and around the CMNP; 4) Evaluate the determinants of ecotourism possibilities in achieving sustainable livelihood and biodiversity conservation in and around the CMNP. Data were collected from both primary and secondary sources. Primary data were obtained from household surveys (N=124), focus group discussions (N=8), and key informant interviews (N=16). Data collected were coded and imputed into SPSS (version 19.0) software and Microsoft Excel spreadsheet for both quantitative and qualitative analysis. Findings from the Chi-square test revealed overall poor ecotourism governance in and around the CMNP, with benefit sharing (X2 = 122.774, p <0.01) and conflict management (X2 = 90.839, p<0.01) viewed to be very poor. For the majority of the local population sampled, 65% think ecotourism does not contribute to local livelihood around CMNP. The main factors influencing the impact of ecotourism around the CMNP on the local population’s livelihood were gender (logistic regression (β) = 1.218; p = 0.000); and level of education (logistic regression (β) = 0.442; p = 0.000). Furthermore, 55.6% of the local population investigated believed ecotourism activities do not contribute to the biodiversity conservation of CMNP. Spearman correlation between socio-economic variables and ecotourism impact on biodiversity conservation indicated relationships with gender (r = 0.200, p = 0.032), main occupation (r = 0.300 p = 0.012), time spent in the community (r = 0.287 p = 0.017), and number of children (r =-0.286 p = 0.018). Variables affecting ecotourism impact on biodiversity conservation were age (logistic regression (β) = -0.683; p = 0.037) and gender (logistic regression (β) = 0.917; p = 0.045). This study recommends the development of ecotourism-friendly policies that can accelerate Public Private Partnership for the sustainable management of the CMNP as a commitment toward good governance. It also recommends the development of gender-sensitive ecotourism packages, with fair opportunities for rural women and more parity in benefit sharing to improve livelihood and contribute more to biodiversity conservation in and around the Park.

Keywords: biodiversity conservation, Campo Ma’an national park, ecotourism, ecotourism governance, rural livelihoods, protected area management

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Authors: Patcharaporn Sudchada, Nuntika Prommee

Abstract:

Background: Herbal medicines constitute a vital component of Thailand's healthcare system and possess significant potential for international recognition. However, the absence of standardized clinical research guidelines aligned with international standards, coupled with unique local challenges, has hindered the development and registration of Thai herbal medicines in the global market. Objective: To establish comprehensive research and development guidelines for herbal medicine formulations that comply with international standards, with particular emphasis on enhancing research quality, scientific credibility, and facilitating both domestic registration and international market acceptance. Methods: The research methodology comprised eight sequential phases: (1) systematic collection and review of relevant documentation and regulatory frameworks; (2) development of preliminary content structure and template designs; (3) systematic analysis and synthesis of scientific evidence and regulatory data; (4) creation of detailed research guidelines and accompanying templates; (5) execution of domestic and international consultation meetings and study visits involving nine stakeholder groups; (6) systematic expert review of the draft guidelines; (7) incorporation of feedback from relevant regulatory and research agencies; and (8) finalization and validation of the comprehensive guidelines. Results: The study produced comprehensive research and development guidelines for herbal medicines that meet international standards, encompassing the complete development pathway from initial concept through pre-clinical studies, product development, preparation protocols, clinical trial conduct, and product registration procedures. The guidelines include standardized templates and forms specifically designed for clinical research documentation. Conclusion: The established guidelines represent a significant advancement in standardizing clinical research for Thai herbal medicines, enhancing their scientific credibility and potential for international acceptance. Nevertheless, Thailand continues to face specific challenges, including insufficient specialized personnel in herbal research (particularly in clinical trials), challenges in integrating traditional Thai medicine principles with modern scientific methodology, limited research infrastructure, inadequate funding mechanisms, complex registration procedures, and public skepticism toward herbal products. The policy recommendations outlined in this research provide a strategic framework for addressing these challenges and promoting sustainable development of Thai herbal medicines within the national context.

Keywords: herbal medicine, clinical research, international standards, research guidelines, drug development, traditional thai medicine, regulatory compliance

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Authors: Fahad Ibrahim, Raphaël Akamavi

Abstract:

Bangladesh has encountered several industrial disasters (e.g. fire and building collapse tragedies) leading to the loss of valuable human lives. Irrespective of various institutions’ making effort to improve the safety situation, industry compliance and safety behaviour have not yet been improved. Hence, one question remains, to what extent does the institutional elements efficient enough to make any difference in improving safety behaviours? Thus, this study explores the relationship between institutional perspective and safety performance. Structural equation modelling results, using survey data from 256 RMG workers’ of 128 garments manufacturing factories in Bangladesh, show that institutional facets strongly influence management safety commitment to induce workers participation in safety activities and reduce workplace accident rates. The study also found that by upholding industrial standards and inspecting the safety situations, institutions facets significantly and directly affect workers involvement in safety participations and rate of workplace accidents. Additionally, workers involvement to safety practices significantly predicts the safety environment of the workplace. Subsequently, our findings demonstrate that institutional culture, norms, and regulations enact play an important role in altering management commitment to set-up a safer workplace environment. As a result, when workers’ perceive their management having high level of commitment to safety, they are inspired to be involved more in the safety practices, which significantly alter the workplace safety situation and lessen injury experiences. Due to the fact that institutions have strong influence on management commitment, legislative members should endorse, regulate, and strictly monitor workplace safety laws to be exercised by the factory owners. Further, management should take initiatives for adopting OHS features and conceive strategic directions (i.e., set up safety committees, risk assessments, innovative training) for promoting a positive safety climate to provide a safe workplace environment. Arguably, an inclusive public-private partnership is recommended for ensuring better and safer workplace for RMG workers. However, as our data were under a cross-sectional design; the respondents’ perceptions might get changed over a period of time and hence, a longitudinal study is recommended. Finally, further research is needed to determine the impact of improvement mechanisms on workplace safety performance, such as how workplace design, safety training programs, and institutional enforcement policies protect the well-being of workers.

Keywords: institutional perspective, management commitment, safety participation, work injury, safety performance, occupational health and safety

Procedia PDF Downloads 208