Search results for: Greek public hospital sector

Authors: Londeka Ntuli, Frasia Oosthuizen

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Background: Tenefovir disiproxil fumarate (TDF) is a nephrotoxic drug and has been proven to contribute to renal insufficiency necessitating intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. TDF is one of the preferred first-line drugs used in combination therapy in most regions. There are estimated 300 000 patients being initiated on the Efavirenz/TDF/Emtricitabine first-line regimen annually in South Africa. It is against this background that this study aims to investigate the effects of TDF on renal sufficiency of HIV positive patients. Methodology: A retrospective quantitative study was conducted, analysing clinical charts of HIV positive patient’s older than 18 years of age and on a TDF-containing regimen for more than 1 year. Data were obtained from the analysis of patient files and was transcribed into Microsoft® Excel® spreadsheet. Extracted data were coded, categorised and analysed using STATA®. Results: A total of 275 patient files were included in this study. Renal function started decreasing after 3 months of treatment (with 93.5% patients having a normal EGFR), and kept on decreasing as time progressed with only 39.6% normal renal function at year 4. Additional risk factors for renal insufficiency included age below 25, female gender, and additional medication. Conclusion: It is clear from this study that the use of TDF necessitates intensive monitoring and management of adverse effects arising from prolonged exposure to the drug. The findings from this study generated pertinent information on the safety profile of the drug TDF in a resource-limited setting of a public health institution. The appropriate management is of tremendous importance in the South African context where the majority of HIV positive individuals are on the TDF containing regimen; thus it is beneficial to ascertain the possible level of toxicities these patients may be experiencing.

Keywords: renal insufficiency, tenefovir, HIV, risk factors

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Authors: Paula Paulino, Alzira Matias, Ana Margarida Veiga Simão

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Self-regulated learning (SRL) directs students in analyzing proposed tasks, setting goals and designing plans to achieve those goals. The literature has suggested a metacognitive strategy for goal attainment known as Mental Contrasting with Implementation Intentions (MCII). This strategy involves Mental Contrasting (MC), in which a significant goal and an obstacle are identified, and Implementation Intentions (II), in which an "if... then…" plan is conceived and operationalized to overcome that obstacle. The present study proposes to assess the MCII process and whether it promotes students’ commitment towards learning goals during school tasks in sciences subjects. In this investigation, we intended to study the MCII strategy in a systemic context of the classroom. Fifty-six students from middle school and secondary education attending a public school in Lisbon (Portugal) participated in the study. The MCII strategy was explicitly taught in a procedure that included metacognitive modeling, guided practice and autonomous practice of strategy. A mental contrast between a goal they wanted to achieve and a possible obstacle to achieving that desire was instructed, and then the formulation of plans in order to overcome the obstacle identified previously. The preliminary results suggest that the MCII metacognitive strategy, applied to the school context, leads to more sophisticated reflections, the promotion of learning goals and the elaboration of more complex and specific self-regulated plans. Further, students achieve better results on school tests and worksheets after strategy practice. This study presents important implications since the MCII has been related to improved outcomes and increased attendance. Additionally, MCII seems to be an innovative process that captures students’ efforts to learn and enhances self-efficacy beliefs during learning tasks.

Keywords: implementation intentions, learning goals, mental contrasting, metacognitive strategy, self-regulated learning

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Authors: Ayedun Hassan, Ayadi Odunayo Peter

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The ancient city of Abeokuta has been supplied with pipe borne water since 1911, yet, a continuous increase in population and unplanned city expansion makes water a very precious and scarce commodity. The government reserved areas (GRA’s) are well planned, and public water supply is available; however, the sub-urban areas consist of scattered structures with individuals trying to source water by digging wells and boreholes. The geology of the city consists of basement rock which makes digging wells and boreholes very difficult. The present study was conducted to assess the risk arising from the consumption of toxic elements in the groundwater of Abeokuta, Ogun State, Nigeria. Forty-five groundwater samples were collected from nine different areas of Abeokuta and analyzed for physicochemical parameters and toxic elements. The physicochemical parameters were determined using standard methods, while the toxic elements were determined using Inductively Coupled Plasma-Mass Spectrometer (ICP/MS). Ninety-six percent (96%) of the water sample has pH < 6.5, and 11% has conductivity > 250 µSCm⁻¹ limits in drinking water as recommended by WHO. Seven percent (7%) of the samples have Pb concentration >10 µgL⁻¹ while 75% have Al concentration >200 µgL⁻¹ recommended by WHO. The order for risk of cancer from different area of Abeokuta are Cd²⁺ > As³⁺ > Pb²⁺ > Cr⁶⁺ for Funaab, Camp and Obantoko; As³⁺ > Cd²⁺ > Pb²⁺ > Cr⁶⁺ for Ita Osin, Isale Igbein, Ake and Itoku; Cd²⁺ >As > Cr⁶⁺ > Pb²⁺ for Totoro; Pb²⁺ > Cd²⁺ > As³⁺ > Cr⁶⁺ for Idiaba. The order of non-cancer hazard index (HI) calculated for groundwater of Abeokuta City are Cd²⁺ > As³⁺ > Mn²⁺ > Pb²⁺ > Ni²⁺ and were all greater than one, which implies susceptibility to other illnesses. The sources of these elements are the rock and inappropriate waste disposal method, which leached the elements into the groundwater. A combination of sources from food will accumulate these elements in the human body system. Treatment to remove Al and Pb is necessary, while the method of water distribution should be reviewed to ensure access to potable water by the residents.

Keywords: Abeokuta, groundwater, Nigeria, risk

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Authors: Sun-Young Jang, Sung-Ah Kim, Dongyoun Shin

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The Intelligent transportation system is essential to build smarter cities. Machine learning based transportation prediction could be highly promising approach by delivering invisible aspect visible. In this context, this research aims to make a prototype model that predicts transportation network by using big data and machine learning technology. In detail, among urban transportation systems this research chooses bus system.  The research problem that existing headway model cannot response dynamic transportation conditions. Thus, bus delay problem is often occurred. To overcome this problem, a prediction model is presented to fine patterns of bus delay by using a machine learning implementing the following data sets; traffics, weathers, and bus statues. This research presents a flexible headway model to predict bus delay and analyze the result. The prototyping model is composed by real-time data of buses. The data are gathered through public data portals and real time Application Program Interface (API) by the government. These data are fundamental resources to organize interval pattern models of bus operations as traffic environment factors (road speeds, station conditions, weathers, and bus information of operating in real-time). The prototyping model is designed by the machine learning tool (RapidMiner Studio) and conducted tests for bus delays prediction. This research presents experiments to increase prediction accuracy for bus headway by analyzing the urban big data. The big data analysis is important to predict the future and to find correlations by processing huge amount of data. Therefore, based on the analysis method, this research represents an effective use of the machine learning and urban big data to understand urban dynamics.

Keywords: big data, machine learning, smart city, social cost, transportation network

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Authors: Arwin Malabanan, Carl Chester Ragudo, Jerome Tadiosa, John Dee Mangoba, Eric Augustus Tingatinga, Romeo Eliezer Longalong

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Concrete hollow blocks (CHB) are the most commonly used masonry block for walls in residential houses, school buildings and public buildings in the Philippines. During the recent 2013 Bohol earthquake (Mw 7.2), it has been proven that CHB walls are very vulnerable to severe external action like strong ground motion. In this paper, a numerical model of CHB structures is proposed, and seismic behavior of CHB houses is presented. In modeling, the Rigid Body Spring-Discrete Element method (RBS-DEM)) is used wherein masonry blocks are discretized into rigid elements and connected by nonlinear springs at preselected contact points. The shear and normal stiffness of springs are derived from the material properties of CHB unit incorporating the grout and mortar fillings through the volumetric transformation of the dimension using material ratio. Numerical models of reinforced and unreinforced walls are first subjected to linearly-increasing in plane loading to observe the different failure mechanisms. These wall models are then assembled to form typical model masonry houses and then subjected to the El Centro and Pacoima earthquake records. Numerical simulations show that the elastic, failure and collapse behavior of the model houses agree well with shaking table tests results. The effectiveness of the method in replicating failure patterns will serve as a basis for the improvement of the design and provides a good basis of strengthening the structure.

Keywords: concrete hollow blocks, discrete element method, earthquake, rigid body spring model

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Authors: Dorota M. Michalak

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The agricultural sector, due to the growing demand for food and over-exploitation of the natural environment, contributes to the deepening of climate change, on the one hand, and on the other hand, shrinking freshwater resources, as a negative effect of climate change, threaten the food security of each country. Therefore, adaptation measures to climate change should take into account effective water management and seek solutions ensuring food production at an unchanged or higher level, while not burdening the environment and not contributing to the worsening of the negative consequences of climate change. The problems of Poland's water management result not only from relatively small, natural water resources but to a large extent on the low efficiency of their use. Appropriate agricultural practices and state solutions in this field can contribute to achieving significant benefits in terms of economical water management in agriculture, providing a greater amount of water that could also be used for other purposes, including for purposes related to environmental protection. The aim of the article is to determine the level of use of water resources in Polish agriculture and the advancement of measures aimed at adapting Polish agriculture in the field of water management to climate change. The study provides knowledge about Polish legal regulations and water management tools, the shaping of water policy of Polish agriculture against the background of EU countries and other sources of energy, and measures supporting Polish agricultural holdings in the effective management of water resources run by state budget institutions. In order to achieve the above-mentioned goals, the author used research tools such as the analysis of existing sources and a survey conducted among five groups of entities, i.e. agricultural advisory centers and departments, agricultural, rural and environmental protection departments, regional water management boards, provincial agricultural chambers and restructuring and modernization of agriculture. The main conclusion of the analyses carried out is the low use of water in Polish agriculture in relation to other EU countries, other sources of intake in Poland, as well as irrigation. The analysis allows us to observe another problem, which is the lack of reporting and data collection, which is extremely important from the point of view of the effectiveness of adaptation measures to climate change. The results obtained from the survey indicate a very low level of support for government institutions in the implementation of adaptation measures to climate change and the water management of Polish farms. Some of the basic problems of the adaptation policy to change climate with regard to water management in Polish agriculture include a lack of knowledge regarding climate change, the possibilities of adapting, the available tools or ways to rationalize the use of water resources. It also refers to the lack of ordering procedures and the separation of responsibility with a proper territorial unit, non-functioning channels of information flow and practically low effects.

Keywords: water management, adaptation policy, agriculture, climate change

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Authors: Ayodeji Adebayo, Tolulope Soyannwo, Oluwakemi A. Sigbeku

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Intimate Partner Violence (IPV) is a significant public health problem with adverse health consequences. There is increasing evidence of association of IPV with mental health problems. Understanding the association between IPV and mental health status of women of reproductive aged group in the rural communities in Nigeria can provide information to improve maternal health status. Therefore, this study was conducted to examine the relationship between experience of IPV and mental health status of women of reproductive aged group in a rural community in Southwest Nigeria. A community based cross-sectional survey was conducted using a cluster sampling technique to select 283 non-pregnant women of reproductive age group (15-49 years Mental health was assessed based on respondents’ experience of any symptoms of depression, anxiety and/or low self-esteem. IPV was assessed over a period of 12 months and the forms of IPV assessed were emotional, physical and sexual. An interviewer administered questionnaire was used to collect information on experience of IPV, reproductive history and factors influencing mental health. Data was analyzed using descriptive statistics, Chi-square and multivariate logistic regression at 5% level of significance. The mean age of respondents was 26.1± 7.8 with 57.1% aged 15-24years. More than half (58.0%) were married. Overall, 60.7% of respondents had mental health problems while 84.8% experienced all categories of violence. The pattern of IPV includes physical violence (10.7%), emotional violence (82.7%) and sexual violence (20.8%). Women who experienced sexual violence by a partner are most likely to suffer from all mental issues. Also, gynaecological morbidities are associated with increasing risk of mental health problems. The research demonstrates an urgent need for mental health policies to recognize the relationship between intimate partner violence, gynaecological morbidities and mental health problems in women in Nigeria.

Keywords: intimate partner violence, mental health, reproductive age group, women

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Authors: Salah Al-Ali

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The role of technology transfer in technical and vocational education is significant since lecturers, trainers, and students can obtain the updated knowledge, skills, and attitudes that are currently being practiced by local and international businesses and industries. Technology transfer can indeed close the gap between what is being learned and practiced in technical and vocational institutions and the world of work. However, the success of technology transfer in technical and vocational education perspectives would depend entirely on the quality of management. It is their responsibility when signing an agreement with internal or external providers of technology, to include calluses that enable academic staff in related specialty to interact positively and freely with the supplier of technology. In other terms, ensuring no clear or hidden restriction is imposed by the supplier of technology to acquire the know-how and know-why that are embedded in the agreement. In this paper, I present some of the empirical results and observations which describe the interactions between the supplier of technology (Electrical Engineering System) and the recipient of the technology (PAAE&T) in the field of technology transfer. In another word, whether the PAAE&T have taken the opportunity while building its new headquarter, the transfer of technology from the supplier of an electrical engineering system to its academic staff in its various Electrical Engineering Academic Departments at the PAAE&T colleges and institutions. The paper argues that, for effective and efficient transfer of technology, the recipient (PAAE&T) must ensure that the agreement with the supplier of the Electrical Engineering System must include calluses that would allow the PAAE&T academic staff in its various Electrical Engineering Academic Departments in its various colleges and institutions to acquire the technology embedded in the agreement. The paper concludes that the transfer of technology and the building of a local scientific and technical infrastructure must be viewed by Kuwaiti decision-makers as complementary to one another. Thus, reducing, to great extent, the level of dependence on expatriates, particularly in the essential sectors of the economy.

Keywords: vocational and technical education, technology transfer, enhancing indigenous capabilities, Kuwait

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Authors: Ayesha Akbar

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Pakistan is moving from a security state to a welfare state despite several security challenges both internal and external. Human security signifies a varied approach in different regions depending upon the leadership and policy priorities. The link between human development and economic growth is not automatic. It has to be created consciously by forward-looking policies and strategies by national governments. There are seven components or categories of human security these include: Economic Security, Personal Security, Health Security, Environmental Security, Food Security, Community Security and Political Security. The increasing interest of the international community to clearly understand the dimensions of human security provided the grounds to Pakistani scholars as well to ponder on the issue and delineate lines of human security. A great deal of work has been either done or in process to evaluate human security indicators in Pakistan. Notwithstanding, after having been done a great deal of work the human security in Pakistan is not satisfactory. A range of deteriorating indicators of human development that lies under the domain of human security leaves certain inquiries to be answered. What are the dimensions of human security in Pakistan? And how are they being dealt from the perspective of policy and institution in terms of its operationalization in Pakistan? Is the human security discourse reflects evidence-based policy changes. The methodology is broadly based on qualitative methods that include interviews, content analysis of policy documents. Pakistan is among the most populous countries in the world and faces high vulnerability to climate change. Literacy rate has gone down with the surge of youth bulge to accommodate in the job market. Increasing population is creating food problems as the resources have not been able to compete with the raising demands of food and other social amenities of life. Majority of the people are facing acute poverty. Health outcomes are also not satisfactory with the high infant and maternal mortality rate. Pakistan is on the verge of facing water crisis as the water resources are depleting so fast with the high demand in agriculture and energy sector. Pakistan is striving hard to deal with the declining state of human security but the dilemma is lack of resources that hinders in meeting up with the emerging demands. The government requires to bring about more change with scaling-up economic growth avenues with enhancing the capacity of human resources. A modern performance drive culture with the integration of technology is required to deliver efficient and effective service delivery. On an already fast track process of reforms; e-governance and evidence based policy mechanism is being instilled in the government process for better governance and evidence based decisions.

Keywords: governance, human development index, human security, Pakistan, policy

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Authors: Anil K. Giri, Dipak Subedi, Kathleen Kassel, Ashok Mishra

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The United States Department of Agriculture’s programs has been accused of being discriminatory in the past based on the race of the farmer, especially African-American producers. This study examines if there was racial discrimination in payments from the most recent new USDA programs, including those made in response to the pandemic. This study uses the Analysis of Variance (ANOVA) to examine the payments after normalizing them relative to cash receipts to test if discrimination in the number of payments received exists. Three programs investigated in this study are: i) the Coronavirus Food Assistance Program (CFAP), ii) the Market Facilitation Program (MFP), and (iii) the Paycheck Protection Program (PPP). The PPP program was administered by the Small Business Administration, whereas the other two were designed and implemented by the USDA. The PPP made forgivable loans to small businesses and, initially, was heavily criticized for not reaching minority businesses (in general). The Small Business Administration then initiated a second draw of PPP loans, prioritizing minority-owned businesses. This study compares attributes of PPP loans made to African-American farming businesses and other farming businesses in the two draws of the PPP. We find that the number of African-American farming businesses participating in the second draw of PPP loans decreased significantly from the first draw. However, the average amount of PPP loans to African-American farming businesses increased in the second draw. In the first draw, the average cost of jobs reported per loan was higher for African-American farming businesses than for other producers. In the second draw, the average cost of jobs reported per loan was significantly higher for other farming businesses than for African-American businesses. The share of PPP loans forgiven for African-American farming businesses is significantly below the national rate of 89 percent. The rate of forgiveness for PPP loans made to African-American producers is unlikely to increase significantly without policy changes. This can increase financial burdens in the future to farm operations operated by African- Americans. Finally, we conclude that the initial goal of increasing minority participation in PPP loans in the second draw, at least among African-Americans in the agricultural sector, did not meet. CFAP made almost $600 million in direct payments to minority producers, including Black producers. Black or African American producers received more than $52 million in CFAP payments. CFAP payments were proportional to the value of agricultural commodities sold for most minority producers. The 2017 Census of Agriculture showed that the majority of minority producers, including African American producers but excluding Asian producers, raised livestock. CFAP made the highest payments to livestock minority producers.

Keywords: United States department of agriculture (USDA), coronavirus food assistance program (CFAP), paycheck protection program (PPP), African-American producers, minority American producers

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Authors: Laurent Bellemare

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After the showcase of traditional Indonesian performing arts at the Vancouver Expo 1986, Canadian universities inherited sets of Indonesian gamelan orchestras and soon began offering courses for music students interested in learning these diverse traditions. Among them, Université de Montréal was offered two sets of Balinese orchestras, a novelty that allowed a community of Montreal gamelan enthusiasts to form and engage with this music. A few generations later, a large body of archives have amassed, framing the history of this niche community’s achievements. This data, scattered in public and private archive collections, comes in various formats: Digital Audio Tape, audio cassettes, Video Home System videotape, digital files, photos, reel-to-reel audiotape, posters, concert programs, letters, TV shows, reports and more. Attempting to study these documents in order to unearth a chronology of gamelan in Montreal has proven to be challenging since no suitable platform for preservation, storage, and research currently exists. These files are, therefore, hard to find due to their decentralized locations. Additionally, most of the documents in older formats have yet to be digitized. In the case of recent digital files, such as pictures or rehearsal recordings, their locations can be even messier and their quantity overwhelming. Aside from the basic issue of choosing a suitable repository platform, questions of legal rights and methodology arise. For posterity, these documents should nonetheless be digitized, organized, and stored in an easily accessible online repository. This paper aims to underline the various challenges encountered in the early stages of such a project as well as to suggest ways of overcoming the obstacles to a thorough archival investigation.

Keywords: archival work, archives, Balinese gamelan, Canada, Gamelan, Indonesia, Javanese gamelan, Montreal

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Authors: Sıla Uzkul

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As a requirement of human rights and children's rights, the basic condition of inclusive education is that it covers all children. However, the reforms made in the context of education in Turkey and around the world include a limited level of inclusiveness. Generally, the inclusiveness mentioned is for individuals who need special education. Educational reforms superficially state that differences are tolerated, but these differences are extremely limited and often do not include sexual orientation. When we look at the education modules of the Ministry of National Education within the scope of inclusive education in Turkey, there are children with special needs, bilingual children, children exposed to violence, children under temporary protection, children affected by migration and terrorism, and children affected by natural disasters. No training modules or inclusion terms regarding sexual orientations could be found. This research aimed to understand the perspectives of research assistants working in the preschool education department regarding sexual orientations within the scope of inclusive education. Six research assistants working in the preschool teaching department at a public university in Ankara (Turkey) participated in this qualitative research study. Participants were determined by typical case sampling, which is one of the purposeful sampling methods. The data of this research was obtained through a "survey consisting of open-ended questions". Raw data from the surveys were analyzed and interpreted using the "content analysis technique" (Yıldırım & Şimşek, 2005). During the data analysis process, the data from the participants were first numbered, then all the data were read, and content analysis was performed, and possible themes, categories, and codes were extracted. The opinions of the participants in the research regarding sexual orientations in inclusive education are presented under three main headings within the scope of the research questions. These are: (a) their views on inclusive education, (b) their views on sexual orientations (c) their views on sexual orientations in the preschool period.

Keywords: sexual orientation, inclusive education, child rights, preschool education

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Authors: Noemi Schneider, Richard Blaese, Pietro Morandi, Brigitte Liebig

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While women are increasingly frequent among the founders of innovative companies and advanced researchers in many university research institutes today, they are still an exception among initiators of research-based spin-offs. This also applies to countries such as Switzerland, which does have a leading position in international innovation rankings. Starting from a gender-sensitive neo-institutionalist perspective, this paper examines formal and non-formal institutional framework conditions for academic spin-offs at Swiss universities of applied sciences. This field, which stresses vocational education and practice-oriented research, seems to conserve the gender gap in the area of establishing research-based spin-offs spin-off rates strongly. The analysis starts from a survey conducted in 2017 and 2018 at all seven public universities of applied sciences in Switzerland as well as on an evaluation of expert interviews performed with heads of start-up centers, where also spin-offs from universities of applied sciences get support. The results show the mechanisms, which contribute to gender gaps in academic entrepreneurship in higher education. University's female employees have hardly been discovered as target groups. Thus, only 10.5% of universities of applied sciences offer specific support measures for women in academia. And only 1 out of 7 universities of applied sciences offer mentoring programs for female entrepreneurs while in addition there are no financial resources available to support female founders in academia. Moreover, the awareness of the gender gap in academic entrepreneurship is low among founding commissioners. A consistent transfer strategy might be key for bringing in line the formal and non-formal preconditions relevant for the formation of research-based spin-offs and for providing an effective incentive structure to promote women.

Keywords: gender, science-based spin-off, universities of applied sciences, knowledge transfer strategy

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Authors: Malika Souada, Juanita Rausch, Benjamin Guinot, Christine Bugajny

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The increase of global commerce and tourism makes the shipping sector an important contributor of atmospheric pollution. Both, airborne particles and gaseous pollutants have negative impact on health and climate. This is especially the case in port cities, due to the proximity of the exposed population to the shipping emissions in addition to other multiple sources of pollution linked to the surrounding urban activity. The objective of this study is to determine the concentrations of fine particles (immission), specifically PM2.5, PM1, PM0.3, BC and sulphates, in a context where maritime passenger traffic plays an important role (port area of Bordeaux centre). The methodology is based on high temporal resolution measurements of pollutants, correlated with meteorological and ship movements data. Particles and gaseous pollutants from seven maritime passenger ships were sampled and analysed during the docking, manoeuvring and berthing phases. The particle mass measurements were supplemented by measurements of the number concentration of ultrafine particles (<300 nm diameter). The different measurement points were chosen by taking into account the local meteorological conditions and by pre-modelling the dispersion of the smoke plumes. The results of the measurement campaign carried out during the summer of 2021 in the port of Bordeaux show that the detection of concentrations of particles emitted by ships proved to be punctual and stealthy. Punctual peaks of ultrafine particle concentration in number (P#/m3) and BC (ng/m3) were measured during the docking phases of the ships, but the concentrations returned to their background level within minutes. However, it appears that the influence of the docking phases does not significantly affect the air quality of Bordeaux centre in terms of mass concentration. Additionally, no clear differences in PM2.5 concentrations between the periods with and without ships at berth were observed. The urban background pollution seems to be mainly dominated by exhaust and non-exhaust road traffic emissions. However, temporal high-resolution measurements suggest a probable emission of gaseous precursors responsible for the formation of secondary aerosols related to the ship activities. This was evidenced by the high values of the PM1/BC and PN/BC ratios, tracers of non-primary particle formation, during periods of ship berthing vs. periods without ships at berth. The research findings from this study provide robust support for port area air quality assessment and source apportionment.

Keywords: characterization, fine particulate matter, harbour air quality, shipping impacts

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Authors: Ronel Solis, Leonardo Collado

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Migration law in the Republic of Panama has been regulated mainly by the executive branch. This has created a crisis not only institutional but also social because the evolution of these norms has rested greatly from the discretion of the government in office. This has created instability in immigration regulation and more now, with the migration crisis of which Panama is also part. Different migration policies have been established. The most recent is that of the controlled migration flow, in which, for humanitarian reasons, migrants move from the border with Colombia to the border with Costa Rica. Unfortunately, such control is not enough, and in some cases, unprotected migrants have been confined for months, their passports have been withheld, and no recognition of their rights is offered. The Inter-American Court of Human Rights has condemned Panama for the unfair detention of an irregular migrant, who was detained for two years in Panamanian prisons, without having committed a crime and without accessing a just defense. This is the case Vélez Loor vs. the Republic of Panama. Uncontrollable migration has been putting pressure on Panamanian public health services. The recent denunciation of HIV-related NGOs that warns that there are hundreds of foreigners who receive expensive antiretroviral therapy in Panama is serious, and several of them are irregular migrants. On the other hand, there are no border control posts with the Republic of Colombia, because it is a jungle area and migrants are exposed to arms and drug trafficking, and unfortunately, also to prostitution. Government entities such as the border police service have provided humanitarian support to migrants on the border with Colombia, although it is not their administrative function, and various entities discuss who should address this crisis. However, few economic resources are allocated by the government to solve this problem, especially with the recent mass migration of Venezuelans who have fled their country. The establishment of a migratory normative code is necessary to establish uniformity in the recognition and application of migratory rights. In this way, dependence on the changing migration policies of the different Panamanian governments would be eliminated, and the rights of migrants and nationals would be guaranteed.

Keywords: executive branch, irregular migration, migration code, Republic of Panama

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Authors: Golson Mohamed, Yasmine Gamasy, Khaled EL-Khatib, Anas Al-Natour, Shady Fadel, Haytham Rashwan, Haytham Badawy, Nadia Farghaly

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Introduction: Wilm's tumor is the most common malignant renal tumor in children. Much progress has been made in the management of patients with this malignancy over the last 3 decades. Today treatments are based on several trials and studies conducted by the International Society of Pediatric Oncology (SIOP) in Europe and National Wilm's Tumor Study Group (NWTS) in the USA. It is necessary for us to understand why do we follow either of the protocols, NWTS which follows the upfront surgery principle or the SIOP which follows the upfront chemotherapy principle in all stages of the disease. Objective: The aim of is to assess outcome in patients treated with preoperative chemotherapy and patients treated with upfront surgery to compare their effect on overall survival. Study design: to decide which protocol to follow, study was carried out on records for patients aged 1 day to 18 years old suffering from Wilm's tumor who were admitted to Alexandria University Hospital, pediatric oncology, pediatric urology and pediatric surgery departments, with a retrospective survey records from 2010 to 2015, Design and editing of the transfer sheet with a (PRISMA flow study) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (11) Qualitative data were described using number and percent. Quantitative data were described using Range (minimum and maximum), mean, standard deviation and median. Comparison between different groups regarding categorical variables was tested using Chi-square test. When more than 20% of the cells have expected count less than 5, correction for chi-square was conducted using Fisher’s Exact test or Monte Carlo correction. The distributions of quantitative variables were tested for normality using Kolmogorov-Smirnov test, Shapiro-Wilk test, and D'Agstino test, if it reveals normal data distribution, parametric tests were applied. If the data were abnormally distributed, non-parametric tests were used. For normally distributed data, a comparison between two independent populations was done using independent t-test. For abnormally distributed data, comparison between two independent populations was done using Mann-Whitney test. Significance of the obtained results was judged at the 5% level. Results: A significantly statistical difference was observed for survival between the two studied groups favoring the upfront chemotherapy(86.4%)as compared to the upfront surgery group (59.3%) where P=0.009. As regard complication, 20 cases (74.1%) out of 27 were complicated in the group of patients treated with upfront surgery. Meanwhile, 30 cases (68.2%) out of 44 had complications in patients treated with upfront chemotherapy. Also, the incidence of intraoperative complication (rupture) was less in upfront chemotherapy group as compared to upfront surgery group. Conclusion: Upfront chemotherapy has superiority over upfront surgery.As the patient who started with upfront chemotherapy shown, higher survival rate, less percent in complication, less percent needed for radiotherapy, and less rate in recurrence.

Keywords: Wilm's tumor, renal tumor, chemotherapy, surgery

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Authors: Osman Zorbaz, Selen Demirtas-Zorbaz, Ozlem Ulas

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The factors that cause adolescents to drop out school were several. One of the frameworks about school dropout focuses on the contextual factors around the adolescents whereas the other one focuses on individual factors. It can be said that both factors are important equally. In this study, both adolescent’s individual factors (anti-social behaviors, academic success) and contextual factors (parent academic involvement, parent academic support, number of siblings, living with parent) were examined in the term of school dropout. The study sample consisted of 346 high school students in the public schools in Ankara who continued their education in 2015-2016 academic year. One hundred eighty-five the students (53.5%) were girls and 161 (46.5%) were boys. In addition to this 118 of them were in ninth grade, 122 of them in tenth grade and 106 of them were in eleventh grade. Multiple regression and one-way ANOVA statistical methods were used. First, it was examined if the data meet the assumptions and conditions that are required for regression analysis. After controlling the assumptions, regression analysis was conducted. Parent academic involvement, parent academic support, number of siblings, anti-social behaviors, academic success variables were taken into the regression model and it was seen that parent academic involvement (t=-3.023, p < .01), anti-social behaviors (t=7.038, p < .001), and academic success (t=-3.718, p < .001) predicted school dropout whereas parent academic support (t=-1.403, p > .05) and number of siblings (t=-1.908, p > .05) didn’t. The model explained 30% of the variance (R=.557, R2=.300, F5,345=30.626, p < .001). In addition to this the variance, results showed there was no significant difference on high school students school dropout levels according to living with parents or not (F2;345=1.183, p > .05). Results discussed in the light of the literature and suggestion were made. As a result, academic involvement, academic success and anti-social behaviors will be considered as an important factors for preventing school drop-out.

Keywords: adolescents, anti-social behavior, parent academic involvement, parent academic support, school dropout

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Authors: Sidharth Talan, Sanjay Kumar Sharma, Eoin Joseph Wallace, Nikita Agrawal

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Underground mining is at the core of rapidly evolving metals and minerals sector due to the increasing mineral consumption globally. Even though the surface mines are still more abundant on earth, the scales of industry are slowly tipping towards underground mining due to rising depth and complexities of orebodies. Thus, the efficient and productive functioning of underground operations depends significantly on the synchronized performance of key elements such as operating site, mining equipment, manpower and mine services. Production drilling is the process of conducting long hole drilling for the purpose of charging and blasting these holes for the production of ore in underground metal mines. Thus, production drilling is the crucial segment in the underground metal mining value chain. This paper presents the process mapping tool to evaluate the production drilling process in the underground metal mining operation by dividing the given process into three segments namely Input, Process and Output. The three segments are further segregated into factors and sub-factors. As per the study, the major input factors crucial for the efficient functioning of production drilling process are power, drilling water, geotechnical support of the drilling site, skilled drilling operators, services installation crew, oils and drill accessories for drilling machine, survey markings at drill site, proper housekeeping, regular maintenance of drill machine, suitable transportation for reaching the drilling site and finally proper ventilation. The major outputs for the production drilling process are ore, waste as a result of dilution, timely reporting and investigation of unsafe practices, optimized process time and finally well fragmented blasted material within specifications set by the mining company. The paper also exhibits the drilling loss matrix, which is utilized to appraise the loss in planned production meters per day in a mine on account of availability loss in the machine due to breakdowns, underutilization of the machine and productivity loss in the machine measured in drilling meters per unit of percussion hour with respect to its planned productivity for the day. The given three losses would be essential to detect the bottlenecks in the process map of production drilling operation so as to instigate the action plan to suppress or prevent the causes leading to the operational performance deficiency. The given tool is beneficial to mine management to focus on the critical factors negatively impacting the production drilling operation and design necessary operational and maintenance strategies to mitigate them. 

Keywords: process map, drilling loss matrix, SIPOC, productivity, percussion rate

Procedia PDF Downloads 191

Authors: Salima R. Rajwani, Tazeen Ali, Rubina Barolia, Yasmin Parpio, Nasreen Alwani, Salima B. Virani

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Introduction: Nurses and physicians have a critical role in initiating lifesaving interventions during cardiac arrest. It is important that timely delivery of high quality Cardio Pulmonary Resuscitation (CPR) with advanced resuscitation skills and management of cardiac arrhythmias is a key dimension of code during cardiac arrest. It will decrease the chances of patient survival if the healthcare professionals are unable to initiate CPR timely. Moreover, traditional training will not prepare physicians and nurses at a competent level and their knowledge level declines over a period of time. In this regard, simulation training has been proven to be effective in promoting resuscitation skills. Simulation teaching learning strategy improves knowledge level, and skills performance during resuscitation through experiential learning without compromising patient safety in real clinical situations. The purpose of the study is to evaluate the effectiveness of simulation training in Advanced Cardiac Life Support Courses by using the selfefficacy tool. Methods: The study design is a quantitative research design and non-randomized quasi-experimental study design. The study examined the effectiveness of simulation through self-efficacy in two instructional methods; one is Medium Fidelity Simulation (MFS) and second is Traditional Training Method (TTM). The sample size was 220. Data was compiled by using the SPSS tool. The standardized simulation based training increases self-efficacy, knowledge, and skills and improves the management of patients in actual resuscitation. Results: 153 students participated in study; CG: n = 77 and EG: n = 77. The comparison was done between arms in pre and post-test. (F value was 1.69, p value is <0.195 and df was 1). There was no significant difference between arms in the pre and post-test. The interaction between arms was observed and there was no significant difference in interaction between arms in the pre and post-test. (F value was 0.298, p value is <0.586 and df is 1. However, the results showed self-efficacy scores were significantly higher within experimental group in post-test in advanced cardiac life support resuscitation courses as compared to Traditional Training Method (TTM) and had overall (p <0.0001) and F value was 143.316 (mean score was 45.01 and SD was 9.29) verses pre-test result showed (mean score was 31.15 and SD was 12.76) as compared to TTM in post-test (mean score was 29.68 and SD was 14.12) verses pre-test result showed (mean score was 42.33 and SD was 11.39). Conclusion: The standardized simulation-based training was conducted in the safe learning environment in Advanced Cardiac Life Suport Courses and physicians and nurses benefited from self-confidence, early identification of life-threatening scenarios, early initiation of CPR, and provides high-quality CPR, timely administration of medication and defibrillation, appropriate airway management, rhythm analysis and interpretation, and Return of Spontaneous Circulation (ROSC), team dynamics, debriefing, and teaching and learning strategies that will improve the patient survival in actual resuscitation.

Keywords: advanced cardiac life support, cardio pulmonary resuscitation, return of spontaneous circulation, simulation

Procedia PDF Downloads 58

Authors: Arsalan Jabbar, Wajiha Javed, Nelofer Mehboob, Zahid Memon

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Introduction: There are multiple social, individual and cultural factors that influence an individual’s decision to adopt family planning methods especially among non-users in patriarchal societies like Pakistan.Non-users, if targeted efficiently, can contribute significantly to country’s CPR. A research study showed that non-users if convinced to adopt lactational amenorrhea method can shift to long-term methods in future. Research shows that if non-users are targeted efficiently a 59% reduction in unintended pregnancies in Saharan Africa and South-Central and South-East Asia is anticipated. Methods: We did secondary data analysis on Pakistan Demographic Heath Survey (2012-13) dataset. Use of contraception (never-use/ever-use) was the outcome variable. At univariate level Chi-square/Fisher Exact test was used to assess relationship of baseline covariates with contraception use. Then variables to be incorporated in the model were checked for multi-collinearity, confounding, and interaction. Then binary logistic regression (with an urban-rural stratification) was done to find the relationship between contraception use and baseline demographic and social variables. Results: The multivariate analyses of the study showed that younger women (≤ 29 years) were more prone to be never users as compared to those who were > 30 years and this trend was seen in urban areas (AOR 1.92, CI 1.453-2.536) as well as rural areas (AOR 1.809, CI 1.421-2.303). While looking at regional variation, women from urban Sindh (AOR 1.548, CI 1.142-2.099) and urban Balochistan (AOR 2.403, CI 1.504-3.839) had more never users as compared to other urban regions. Women in the rich wealth quintile were more never users and this was seen both in urban and rural localities (urban (AOR 1.106 CI .753-1.624); rural areas (AOR 1.162, CI .887-1.524)) even though these were not statistically significant. Women idealizing more children(> 4) are more never users as compared to those idealizing less children in both urban (AOR 1.854, CI 1.275-2.697) and rural areas (AOR 2.101, CI 1.514-2.916). Women who never lost a pregnancy were more inclined to be non-users in rural areas (AOR 1.394, CI 1.127-1.723) .Women familiar with only traditional or no method had more never users in rural areas (AOR 1.717, CI 1.127-1.723) but in urban areas it wasn’t significant. Women unaware of Lady Health Worker’s presence in their area were more never users especially in rural areas (AOR 1.276, CI 1.014-1.607). Women who did not visit any care provider were more never users (urban (AOR 11.738, CI 9.112-15.121) rural areas (AOR 7.832, CI 6.243-9.826)). Discussion/Conclusion: This study concluded that government, policy makers and private sector family planning programs should focus on the untapped pool of never users (younger women from underserved provinces, in higher wealth quintiles, who desire more children.). We need to make sure to cover catchment areas where there are less LHWs and less providers as ignorance to modern methods and never been visited by an LHW are important determinants of never use. This all is in sync with previous literate from similar developing countries.

Keywords: contraception, demographic and health survey, family planning, never users

Procedia PDF Downloads 387

Authors: Chen Yuan, Nick Green, Stuart Blackburn

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The investment casting process offers a great freedom of design combined with the economic advantage of near net shape manufacturing. It is widely used for the production of high value precision cast parts in particularly in the aerospace sector. Various combinations of materials have been used to produce the ceramic moulds, but most investment foundries use a silica based binder system in conjunction with fused silica, zircon, and alumino-silicate refractories as both filler and coarse stucco materials. However, in the context of advancing alloy technologies, silica based systems are struggling to keep pace, especially when net-shape casting titanium alloys. Study has shown that the casting of titanium based alloys presents considerable problems, including the extensive interactions between the metal and refractory, and the majority of metal-mould interaction is due to reduction of silica, present as binder and filler phases, by titanium in the molten state. Cleaner, more refractory systems are being devised to accommodate these changes. Although yttria has excellent chemical inertness to titanium alloy, it is not very practical in a production environment combining high material cost, short slurry life, and poor sintering properties. There needs to be a cost effective solution to these issues. With limited options for using pure oxides, in this work, a silica-free magnesia spinel MgAl₂O₄ was used as a primary coat filler and alumina as a binder material to produce facecoat in the investment casting mould. A comparison system was also studied with a fraction of the rare earth oxide Y₂O₃ adding into the filler to increase the inertness. The stability of the MgAl₂O₄/Al₂O₃ and MgAl₂O₄/Y₂O₃/Al₂O₃ slurries was assessed by tests, including pH, viscosity, zeta-potential and plate weight measurement, and mould properties such as friability were also measured. The interaction between the face coat and titanium alloy was studied by both a flash re-melting technique and a centrifugal investment casting method. The interaction products between metal and mould were characterized using x-ray diffraction (XRD), scanning electron microscopy (SEM) and Energy Dispersive X-Ray Spectroscopy (EDS). The depth of the oxygen hardened layer was evaluated by micro hardness measurement. Results reveal that introducing a fraction of Y₂O₃ into magnesia spinel can significantly increase the slurry life and reduce the thickness of hardened layer during centrifugal casting.

Keywords: titanium alloy, mould, MgAl₂O₄, Y₂O₃, interaction, investment casting

Procedia PDF Downloads 90

Authors: Esraa A. Khalil, Mohamed N. AbouZeid

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Building materials selection is critical for the sustainability of any project. The choice of building materials has a huge impact on the built environment and cost of projects. Building materials emit huge amount of carbon dioxide (CO₂) due to the use of cement as a basic component in the manufacturing process and as a binder, which harms our environment. Energy consumption from buildings has increased in the last few years; a huge amount of energy is being wasted from using unsustainable building and finishing materials, as well as from the process of heating and cooling of buildings. In addition, the construction sector in Egypt is taking a good portion of the economy; however, there is a lack of awareness of buildings environmental impacts on the built environment. Using advanced building materials and different wall systems can help in reducing heat consumption, the project’s initial and long-term costs, and minimizing the environmental impacts. Red Bricks is one of the materials that are being used widely in Egypt. There are many other types of bricks such as Autoclaved Aerated Concrete (AAC); however, the use of Red Bricks is dominating the construction industry due to its affordability and availability. This research focuses on the New Egyptian Administrative Capital as a case study to investigate the potential of the influence of using different wall systems such as AAC on the project’s cost and the environment. The aim of this research is to conduct a comparative analysis between the traditional and most commonly used bricks in Egypt, which is Red Bricks, and AAC wall systems. Through an economic and environmental study, the difference between the two wall systems will be justified to encourage the utilization of uncommon techniques in the construction industry to build more affordable, energy efficient and sustainable buildings. The significance of this research is to show the potential of using AAC in the construction industry and its positive influences. The study analyzes the factors associated with choosing suitable building materials for different projects according to the need and criteria of each project and its nature without harming the environment and wasting materials that could be saved or recycled. The New Egyptian Administrative Capital is considered as the country’s new heart, where ideas regarding energy savings and environmental benefits are taken into consideration. Meaning that, Egypt is taking good steps to move towards more sustainable construction. According to the analysis and site visits, there is a potential in reducing the initial costs of buildings by 12.1% and saving energy by using different techniques up to 25%. Interviews with the mega structures project engineers and managers reveal that they are more open to introducing sustainable building materials that will help in saving the environment and moving towards green construction as well as to studying more effective techniques for energy conservation.

Keywords: AAC blocks, building material, environmental impact, modern construction, new Egyptian administrative capital

Procedia PDF Downloads 103

Authors: Aldila Dyas Nurfitri

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Nowadays, leadership has became the one of main issues in forming organization groups even countries. The concept of a social contract between the leaders and subordinates become one of the explanations for the leadership process. The interests of the two parties are not always the same, but they must work together to achieve both goals. Based on the concept at the previous it comes “The Leader Member Exchange Theory”—well known as LMX Theory, which assumes that leadership is a process of social interaction interplay between the leaders and their subordinates. High-quality LMX relationships characterized by a high carrying capacity, informal supervision, confidence, and power negotiation enabled, whereas low-quality LMX relationships are described by low support, large formal supervision, less or no participation of subordinates in decision-making, and less confidence as well as the attention of the leader Application of formal supervision system in a low LMX behavior was in line with strict controls on toxic leadership model. Leaders must be able to feel toxic control all aspects of the organization every time. Leaders with this leadership model does not give autonomy to the staff. This behavior causes stagnation and make a resistant organizational culture in an organization. In Indonesia, the pattern of toxic leadership later evolved into a dysfunctional system that is growing rapidly. One consequence is the emergence of corrupt behavior. According to Kellerman, corruption is defined as a pattern and some subordinates behave lie, cheat or steal to a degree that goes beyond the norm, they put self-interest than the common good.According to the corruption data in Indonesia based on the results of ICW research on 2012 showed that the local government sector ranked first with 177 cases. Followed by state or local enterprises as much as 41 cases. LMX is defined as the quality of the relationship between superiors and subordinates are implications for the effectiveness and progress of the organization. The assumption of this theory that leadership as a process of social interaction interplay between the leaders and his followers are characterized by a number of dimensions, such as affection, loyalty, contribution, and professional respect. Meanwhile, the toxic leadership is dysfunctional leadership in organization that is led by someone with the traits are not able to adjust, do not have integrity, malevolent, evil, and full of discontent marked by a number of characteristics, such as self-centeredness, exploiting others, controlling behavior, disrespecting others, suppress innovation and creativity of employees, and inadequate emotional intelligence. The leaders with some characteristics, such as high self-centeredness, exploiting others, controlling behavior, and disrespecting others, tends to describe a low LMX relationships directly with subordinates compared with low self-centeredness, exploiting others, controlling behavior, and disrespecting others. While suppress innovation and creativity of employees aspect and inadequate emotional intelligence, tend not to give direct effect to the low quality of LMX.

Keywords: leader-member exchange, toxic leadership, leadership

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Authors: Şeyda Kaya

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The aim of this study is to examine the relationship between corporate social responsibility perception and organizational commitment among Turkish cabin crew. At the same time, the social responsibility perception and organizational commitment scores of the participants were compared according to their gender, age, education level, title, and work experience. In the globalizing world, businesses have developed some innovative marketing methods in order to survive and strengthen their place in the market. Nowadays, consumers who are connected to the brand with an emotional bond rather than being just consumers. Corporate Social Responsibility Projects, on the one hand, provide social benefit, on the other hand, increase the brand awareness of businesses by providing credibility in the eyes of consumers. The rapid increase of competition, requires businesses to use their human resources, which is the most important resource to sustain their existence, in the most effective and efficient way. For this reason, the concept of ‘Organizational Commitment’ has become an important research topic for business and academics. Although there are studies in the literature to determine the effect of the perception of corporate social Responsibility on Organizational Commitment in Banking and Finance and Tourism sectors, there are no studies conducted specifically for the Turkish aviation sector to our best knowledge. Personal information form, CSR scale, Importance of CSR scale, Organizational commitment scale were used as data collection tools in the research. CSR Scale created by Türker (2006). was used to find out how employees felt about CSR. Importance of CSR Scale through a subscale of the Perceived Role of Ethics and Social Responsibility (PRESOR) that Etheredge (1999) converted into a two-factor framework, the significance of social responsibility for employees was assessed. Organizational Commitment Scale, Mowday, Steers, and Porter (1979) created the OCQ, which uses 15 measures to evaluate global commitment to the organization. As a result of the study, there is a significant positive relationship between the participants' CSR scale sub-dimensions, CSR to Employees, CSR to Customers, CSR to Society, CSR to Government, CSR to Natural Environment, CSR to Next Generation, CSR to Governmental Organizations, Importance of CSR, and Organizational Commitment scores. As a result; as the participants' Corporate Social Responsibility scores increase, their organizational commitment increases. To summarize the findings of our study, the scores obtained from the CSR scale and the scores obtained from the Organizational Commitment scale were found to have a positive and significant relationship. In other words, if the participants value the corporate social responsibility projects of the institution they work for and think that they spare time and effort, the importance they attach to the corporate social responsibility projects and their organizational commitment to the institution they work for, increase. Similarly, the scores obtained from the Importance of CSR and the scores obtained from the Organizational Commitment scale also have a positive and significant relationship. As the importance given to corporate social responsibility projects by the participants increases, their organizational commitment to the institution they work for also increases.

Keywords: corporate social responsibility, organizational commitment, Turkish cabin crew, aviation

Procedia PDF Downloads 87

Authors: Xingmao Ma, Wenjie Sun

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Rice paddies are frequently co-contaminated by arsenic (As) and cadmium (Cd), both of which demonstrate a high propensity for accumulation in rice grains and cause global food safety and public health concern. Even though different agricultural management strategies have been explored for their simultaneous control in rice grains, a viable solution is yet to be developed. Interestingly, several nanoagrichemicals, such as the zinc nanofertilizer and copper nanopesticide have displayed strong potential to reduce As or Cd accumulation in rice tissues. In order to determine whether these nanoagrichemicals can lower the accumulation of both As and Cd in rice, a series of bench studies were performed. Our results show that zinc oxide nanoparticles at 100 mg/Kg significantly lowered both As, and Cd in rice roots and shoots in flood irrigated rice seedlings, while equivalent amount of zinc ions only reduced As concentration in rice shoots. Zinc ions significantly increased Cd concentration in rice shoots by almost 30%. The results demonstrate a unique 'nano-effect' of zinc oxide nanoparticles, which is ascribed to the slow releasing of zinc ions from nanoparticles and the formation of different transformation products in these two treatments. We also evaluated the effect of nanoscale soil amendment, silicon oxide nanoparticles (SiO₂NPs) on the simultaneous reduction in both flooding and alternate wet and dry irrigation scheme. The effect of SiO₂NPs on As and Cd accumulation in rice tissues was strongly affected by the irrigation scheme. While 2000 mg/kg of SiO₂NPs significantly reduced As in rice roots and insignificantly reduced As in rice shoots in flooded rice, it increased As concentration in rice shoots in alternate wet and dry irrigation. In both irrigation scenarios, SiO₂NPs significantly reduced Cd concentration in rice roots, but only reduced Cd concentration in rice shoots in alternate wet and dry irrigation. Our results demonstrate a marked effect of nanoagrichemicals on the accumulation of As and Cd in rice and can be a potential solution to simultaneously control both in certain conditions.

Keywords: arsenic, cadmium, rice, nanoagrichemicals

Procedia PDF Downloads 131

Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

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Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

Procedia PDF Downloads 137

Authors: Michael Naidoo

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The purpose and functions of higher education institutions in the 21st century are evolving because of rapid changes in the global landscape. To remain germane, higher education institutions are in a period of swift and radical change. The success of these changes is highly dependent on the effective leadership of the institution. Consequently, many higher education institutions have invested time and finances into the management and leadership development of their staff. The development has taken many different forms and focus areas, depending on the societal and institutional needs, as well as available financial resources and infrastructural practices. South Africa has many public and private higher education institutions which are also undergoing significant changes to meet the contextual needs of the country. Many of these institutions have provided management and leadership development programs for their staff. This research aims at exploring the common, critical content, structure and practices of effective management and leadership development programs at higher educational institutions. This research will also examine a specific management development program (MDP) at a South African private higher educational institution. Finally, the research will review how organizational leadership is utilized in management and leadership development programs. The research is underpinned by the paradigm of interpretivism. This is because the aims of the research will be achieved by the collection of qualitative data. The qualitative data will be gathered through individual semi-structured interviews with the facilitators of the MDP program and some of the MDP candidates. The validity of the findings will be increased by the triangulation of data from both sets of interviews. An embedded, single case study design will be used. All ethical protocols will be followed throughout the research. The findings of the research should reveal more information about the key elements that should be incorporated into management and leadership development programs. These include crucial content, structure and practices. The research should also reveal how organizational leadership can be successfully incorporated into the programs. This research can then be used by higher educational institutions to strengthen their management and leadership development programs.

Keywords: managment, leadership, development, organizational leadership

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Authors: Alina Murtishcheva

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The tendency of globalization, challenges to democracy and peace caused by the Russian invasion of Ukraine, and other global conflicts require searching general orientations of governmental development, including local government. The formation of a common theoretical framework for local government guarantees not only of harmonisation of European legislation but also creates prerequisites for the integration of new members into the European Union. One of the most important milestones of such a theoretical framework is the concept of decentralization. Decentralization as a phenomenon is characteristic of most European Union countries at different historical stages. For Ukraine, as a country that has clearly defined a European integration vector of development, understanding not only the legal but also the theoretical basis of decentralisation processes in European countries is an important prerequisite for further reforms. Decentralisation takes different forms, which leads to a variety of understandings in doctrine and, consequently, different interpretations in national legislation. Despite of this, decentralisation is based on common ideas and values such as democracy, participation, the rule of law, and proximity government that are shared by all EU member states. Nevertheless, not all EU countries are currently implementing broad decentralization in their political and legal practices. Some countries are gradually moving in this direction, while others remain quite centralised. There is also a new, insufficiently studied trend today – recentralisation, which can be broadly defined as the strengthening of centralization tendencies in countries that were considered to be decentralized. Consequently, an exploratory theoretical study is needed to identify how the concept of decentralization is combined with the recentralization tendency in EU member states. The purpose of this study is to empirically analyse scientific approaches to the concept of “decentralisation”, to highlight the tendency of recentralisation and its consequences, to analyse Ukraine's experience in the field of decentralisation of public power, and to outline the prospects for further development of Ukrainian legislation in this area.

Keywords: centralization, decentralization, local government, recentralization, reforms

Procedia PDF Downloads 55

Authors: Nelomi Anandagoda, Leanne J. Eveson

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During the COVID-19 pandemic, the surge in in-patient admissions across the medical directorate of a district general hospital necessitated the implementation of an incident rota. Conscious of the impact on training and professional development, the idea of developing a virtual teaching programme was conceived. The programme initially aimed to provide junior doctors, specialist nurses, pharmacists, and allied healthcare professionals from medical specialties and those re-deployed from other specialties (e.g., ophthalmology, GP, surgery, psychiatry) the knowledge and skills to manage the deteriorating patient with COVID-19. The programme was later developed to incorporate the general internal medicine curriculum. To facilitate continuing medical education whilst maintaining social distancing during this period, a virtual platform was used to deliver teaching to junior doctors across two large district general hospitals and two community hospitals. Teaching sessions were recorded and uploaded to a common platform, providing a resource for participants to catch up on and re-watch teaching sessions, making strides towards reducing discrimination against the professional development of less than full-time trainees. Thus, creating a learning environment, which is inclusive and accessible to adult learners in a self-directed manner. The negative impact of the pandemic on the well-being of healthcare professionals is well documented. To support the multi-disciplinary team, the virtual teaching programme evolved to included sessions on well-being, resilience, and work-life balance. Providing teaching for learners across the multi-disciplinary team (MDT) has been an eye-opening experience. By challenging the concept that learners should only be taught within their own peer groups, the authors have fostered a greater appreciation of the strengths of the MDT and showcased the immense wealth of expertise available within the trust. The inclusive nature of the teaching and the ease of joining a virtual teaching session has facilitated the dissemination of knowledge across the MDT, thus improving patient care on the frontline. The weekly teaching programme has been running for over eight months, with ongoing engagement, interest, and participation. As described above, the teaching programme has evolved to accommodate the needs of its learners. It has received excellent feedback with an appreciation of its inclusive, multi-disciplinary, and holistic nature. The COVID-19 pandemic provided a catalyst to rapidly develop novel methods of working and training and widened access/exposure to the virtual technologies available to large organisations. By merging pedagogical expertise and technology, the authors have created an effective online learning environment. Although the authors do not propose to replace face-to-face teaching altogether, this model of virtual multidisciplinary team, cross-site teaching has proven to be a great leveler. It has made high-quality teaching accessible to learners of different confidence levels, grades, specialties, and working patterns.

Keywords: cross-site, cross-speciality, inter-disciplinary, multidisciplinary, virtual teaching

Procedia PDF Downloads 151

Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fast-growing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. The aim of this paper is to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia. Methods and Materials: A quantitative and cross-sectional community-based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. Conclusion: In order to improve ANC adequacy in the study area, the policymaking, planning, and implementation processes should focus on the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Keywords: Addis Ababa, adequacy of antenatal care, slum residents, maternal mortality

Procedia PDF Downloads 395