Search results for: Stanford Health Care
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10774

Search results for: Stanford Health Care

1924 A Histopathological Study on Leech (Hirudo medicinalis) Application in the Management of Vicarcikā (Eczema)

Authors: K. M. Pratap Shankar, Dattatreya Rao, Sai Prasad

Abstract:

Background: Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. Eczema is such a skin ailment which cause psychological, social and financial burden on the patient and their families. Management of eczema with antibiotics, antihistamines, steroids etc., are available but even after their use relapses, recurrences and other complications are very common. Aim: The aim of this study was to assess the efficacy of leech application in the management of vicarcikā (Eczema) with Histopathological study. Methods: For the present study 10 patients having the classical symptoms of Vicarcikā, were randomly selected as per the inclusion and exclusion criteria from O.P.D. & I.P.D. sections of Śalya department, S.V. Āyurvedic Hospital, Tirupati. Minimum 4 sittings of Leech application was carried out with seven days interval. Total duration of treatment was 6 weeks. Biopsy samples were collected from the lesion site before and after treatment. Histopathological examination was done by the pathologist. Results: In eczema (dermatitis) the leech application therapy gives excellent response by reducing the inflammatory component, hyperkeratosis, spongiosis, irregular acanthosis and by evoking a granulation tissue response in the dermis and in most of the cases with complete recovery from the lesion. Most of the cases in the study were chronic dermatitis and sebhoric keratosis, almost all local/focal pigmented lesions is totally relieved by leech therapy especially in cases of sebhoric keratosis. Conclusion: In the present study it was found that, leech application evokes significant changes at histological level specifically in reduction of inflammatory component, hyperkeratosis, spongiosis and irregular acanthosis. It was also found that there was a considerable formation of granulation tissue, which helps in formation of healthy new tissues.

Keywords: acanthosis, eczema, hyperkeratosis, leech application, spongiosis

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1923 Prevalence of Diabetes Mellitus Among Human Immune Deficiency Virus-Positive Patients Under Anti-retroviral Attending in Rwanda, a Case Study of University Teaching Hospital of Butare

Authors: Venuste Kayinamura, V. Iyamuremye, A. Ngirabakunzi

Abstract:

Anti-retroviral therapy (ART) for HIV patient can cause a deficiency in glucose metabolism by promoting insulin resistance, glucose intolerance, and diabetes, diabetes mellitus keep increasing among HIV-infected patients worldwide but there is limited data on levels of blood glucose and its relationship with antiretroviral drugs (ARVs) and HIV-infection worldwide, particularly in Rwanda. A convenient sampling strategy was used in this study and it involved 323 HIV patients (n=323). Patients who are HIV positive under ARVs were involved in this study. The patient’s blood glucose was analyzed using an automated machine or glucometer (COBAS C 311). Data were analyzed using Microsoft Excel and SPSS V. 20.0 and presented in percentages. The highest diabetes mellitus prevalence was 93.33 % in people aged >40 years while the lowest diabetes mellitus prevalence was 6.67% in people aged between 21-and 40 years. The P-value was (0.021). Thus, there is a significant association between age and diabetes occurrence. The highest diabetes mellitus prevalence was 28.2% in patients under ART treatment for more than 10 years, 16.7% were <5years while 20% of patients were on ART treatment between 5-10 years. The P-value here is (0.03), thus the incidence of diabetes is associated with long-term ART use in HIV-infected patients. This study assessed the prevalence of diabetes among HIV-infected patients under ARVs attending the University Teaching Hospital of Butare (CHUB), it shows that the prevalence of diabetes is high in HIV-infected patients under ARTs. This study found no significant relationship between gender and diabetes mellitus growth. Therefore, regular assessment of diabetes mellitus especially among HIV-infected patients under ARVs is highly recommended to control other health issues caused by diabetes mellitus.

Keywords: anti-retroviral, diabetes mellitus, antiretroviral therapy, human immune deficiency virus

Procedia PDF Downloads 114
1922 A Prototype for Biological Breakdown of Plastic Bags in Desert Areas

Authors: Yassets Egaña, Patricio Núñez, Juan C. Rios, Ivan Balic, Alex Manquez, Yarela Flores, Maria C. Gatica, Sergio Diez De Medina, Rocio Tijaro-Rojas

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Globally, humans produce millions of tons of waste per year. An important percentage of this waste is plastic, which frequently ends up in landfills and oceans. During the last decades, the greatest plastics production in history have been made, a few amount of this plastic is recycled, the rest ending up as plastic pollution in soils and seas. Plastic pollution is disastrous for the environment, affecting essential species, quality of consumption water, and some economic activities such as tourism, in different parts of the world. Due to its durability and decomposition on micro-plastics, animals and humans are accumulating a variety of plastic components without having clear their effects on human health, economy, and wildlife. In dry regions as the Atacama Desert, up to 95% of the water consumption comes from underground reservoirs, therefore preventing the soil pollution is an urgent need. This contribution focused on isolating, genotyping and optimizing microorganisms that use plastic waste as the only source of food to construct a batch-type bioreactor able to degrade in a faster way the plastic waste before it gets the desert soils and groundwater consumed by people living in this areas. Preliminary results, under laboratory conditions, has shown an improved degradation of polyethylene when three species of bacteria and three of fungi act on a selected plastic material. These microorganisms have been inoculated in dry soils, initially lacking organic matter, under environmental conditions in the laboratory. Our team designed and constructed a prototype using the natural conditions of the region and the best experimental results.

Keywords: biological breakdown, plastic bags, prototype, desert regions

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1921 Enablers and Inhibitors of Effective Waste Management Measures in Informal Settlements in South Africa: A Case of Alaska

Authors: Lynda C. Mbadugha, Bankole Awuzie, Kwanda Khumalo, Lindokuhle Matsebula, Masenoke Kgaditsi

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Inadequate waste management remains a fundamental issue in the majority of cities around the globe, but it becomes a threat when it concerns informal settlements. Although studies have evaluated the performance of waste management measures, only a few have addressed that with a focus on South African informal settlements and the reasons for their apparent ineffectiveness in such locations. However, there may be evidence of variations in the extant problems due to the uniqueness of each location and the factors influencing the performance. Thus, there is a knowledge deficit regarding implementing waste management measures in South African informal settlements. This study seeks to evaluate the efficacy of waste management measures in the Alaska informal settlement in South Africa to assess the previously collected data of other areas using the degree of correlation. The research investigated a real-world scenario in the specified location using a case study approach and multiple data sources. The findings described various waste management practices used in Alaska's informal settlements; however, a correlation was found between the performance of these measures and those already used. The observed differences are primarily attributable to the physical characteristics of the locations, the lack of understanding of the environmental and health consequences of careless waste disposal, and the negative attitudes of the residents toward waste management practices. This study elucidates waste management implementation in informal settlements. It contributes to the relevant bodies of knowledge by describing these practices in South Africa. This paper's practical value emphasizes the general waste management characteristics of South Africa's informal settlements to facilitate the planning and provision of necessary interventions. The study concludes that the enablers and inhibitors are mainly political, behavioral, and environmental concerns.

Keywords: factors, informal settlement, performance, waste management

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1920 Conceptualizing a Strategic Facilities Management Decision Framework for Heritage Building Maintenance Management

Authors: Adegoriola Mayowa I., Lai Joseph H. K., Yung Esther H. K., Chan Edwin H. K.

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Heritage buildings (HBs) as structures with historical and architectural relevance that form an integral part of contemporary society. These buildings deserve to be protected for as long as possible to retain their significance. Therefore, the need to prioritize HB maintenance management is pertinent. However, the decision-making process of HBMM can be relatively daunting. The decision-making challenge may be attributed to the multiple 'stakeholders' expectation and requirement which needs to be met. To this end, professionals in the built environment have identified the need to apply the strategic concept of facilities management (FM) in decision making. Furthermore, the different maintenance dimensions have been applied to maintenance management of residential, commercial, and health facilities. Unfortunately, these different maintenance approaches, such as FM, sustainable FM, urban FM, green FM, and strategic FM, are yet to be fully explored in the decision-making process of HBMM. To bridge this gap, this study focuses on developing a framework for strategic decision-making HBMM, which helps achieve HBMM sustainability. At the study's inception, relevant works of literature in the domains of HBMM and FM were conducted. This review helped in the identification of contemporary maintenance practices and their applicability to HBMM. Afterward, a conceptual framework to aid decision-making in HBMM was developed. This framework integrated the concept of FM scope (people, place, process, and technology) while ensuring that decisions plans were made at strategic, tactical, and operational levels. Also, the different characteristics of HBs and stakeholders' requirements were considered in the framework. The conceptual framework presents a holistic guide for professionals in HBMM to ensure that decision processes and outcomes are practical and efficient. It also contributes to the existing body of knowledge on the integration of FM in HBMM. Furthermore, it will serve as a basis for future studies by applying the conceptualized framework in actual cases.

Keywords: decision-making, facility management, strategy, sustainability, heritage building, maintenance

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1919 Current Characteristic of Water Electrolysis to Produce Hydrogen, Alkaline, and Acid Water

Authors: Ekki Kurniawan, Yusuf Nur Jayanto, Erna Sugesti, Efri Suhartono, Agus Ganda Permana, Jaspar Hasudungan, Jangkung Raharjo, Rintis Manfaati

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The purpose of this research is to study the current characteristic of the electrolysis of mineral water to produce hydrogen, alkaline water, and acid water. Alkaline and hydrogen water are believed to have health benefits. Alkaline water containing hydrogen can be an anti-oxidant that captures free radicals, which will increase the immune system. In Indonesia, there are two existing types of alkaline water producing equipment, but the installation is complicated, and the price is relatively expensive. The electrolysis process is slow (6-8 hours) since they are locally made using 311 VDC full bridge rectifier power supply. This paper intends to discuss how to make hydrogen and alkaline water by a simple portable mineral water ionizer. This is an electrolysis device that is easy to carry and able to separate ions of mineral water into acidic and alkaline water. With an electric field, positive ions will be attracted to the cathode, while negative ions will be attracted to the anode. The circuit equivalent can be depicted as RLC transient ciruit. The diode component ensures that the electrolytic current is direct current. Switch S divides the switching times t1, t2, and t3. In the first stage up to t1, the electrolytic current increases exponentially, as does the inductor charging current (L). The molecules in drinking water experience magnetic properties. The direction of the dipole ions, which are random in origin, will regularly flare with the direction of the electric field. In the second stage up to t2, the electrolytic current decreases exponentially, just like the charging current of a capacitor (C). In the 3rd stage, start t3 until it tends to be constant, as is the case with the current flowing through the resistor (R).

Keywords: current electrolysis, mineral water, ions, alkaline and acid waters, inductor, capacitor, resistor

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1918 A Psychoanalytic Lens: Unmasked Layers of the Self among Post-Graduate Psychology Students in Surviving the COVID-19 Lockdown

Authors: Sharon Sibanda, Benny Motileng

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The World Health Organisation (WHO) identified the Sars-Cov-2 (COVID-19) as a pandemic on the 12ᵗʰ of March 2020, with South Africa recording its first case on the 5ᵗʰ of March 2020. The rapidly spreading virus led the South African government to implement one of the strictest nationwide lockdowns globally, resulting in the closing down of all institutions of higher learning effective March 18ᵗʰ 2020. Thus, this qualitative study primarily aimed to explore whether post-graduate psychology students were in a state of a depleted or cohesive self, post the psychological isolation of COVID-19 risk-adjusted level 5 lockdown. Semi-structured interviews from a qualitative interpretive approach comprising N=6 psychology post-graduate students facilitated a rich understanding of their intra-psychic experiences of the self. Thematic analysis of data gathered from the interviews illuminated how students were forced into the self by the emotional isolation of hard lockdown, with the emergence of core psychic conflict often defended against through external self-object experiences. The findings also suggest that lockdown stripped off this sample of psychology post-graduate students’ defensive escape from the inner self through external self-object distractions. The external self was stripped to the core of the internal self by the isolation of hard lockdown, thereby uncovering the psychic function of roles and defenses amalgamated throughout modern cultural consciousness that dictates self-functioning. The study suggests modelling reflexivity skills in the integration of internal and external self-experience dynamics as part of a training model for continued personal and professional development for psychology students.

Keywords: COVID-19, fragmentation, self-object experience, true/false self

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1917 A Study on Consumer Awareness, Safety Perceptions and Practices About Food Preservatives and Flavouring Agents Used in Packed / Canned Foods from South India

Authors: Harsha Kumar H. N., Anshu Kumar Jha, Khushboo Kamal Taneja, Krishan Kabra, Mohamed Hafeez Sadiq

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Introduction: The increasing use of preservatives and flavouring agents has the potential to cause health problem among the people. There are no published studies from India exploring the awareness, safety perception, & practices about Food Preservatives (FPs) and Flavouring Agents (FAs). So this study was conducted with the objectives of assessing the awareness, safety perceptions & practices about Food Preservatives (FPs), Flavouring Agents (FAs) in commonly bought / purchased packed food items. Materials & method: This cross-sectional study was conducted in January 2012. Sample size of 126 was computed using the formula for infinite population. People who bought packed food items in malls were approached and requested to fill a pre-tested semi-structured questionnaire. The questionnaire explored awareness, safety perception & practices of FPs & FAs. Data was then analyzed using SPSS version 10.0. Chi-square test was used to know if the observed differences were statistically significant. ‘p’ value <0.05 was considered significant. Results: Totally 123 people (males- 48.8% and females-51.2%) participated (response rate of 97.6%) in the study. Majority of the people were aware about presence of ‘FPs’ (91.7%) and ‘FAs’ (84.9%) though their knowledge was inadequate. Breakup of the study subjects according to level of awareness about FPs was as follows (%): Good (37.4), Satisfactory (40.6), Poor (22) & FAs (%): Good (49.6), Satisfactory (36) & Poor (14). Distribution according to type of practices for FPs was as follows (%): Favourable (14), Unfavourable (86) & FAs (%): Favourable (30.5), Unfavourable (69.5). There was a gap between knowledge and practices. Conclusion: Though there was awareness, the knowledge was inadequate. Unfavourable practices were observed. The gaps in the knowledge and unhealthy practices need to be addressed by public awareness campaign.

Keywords: food preservatives, flavouring agents, knowledge and practices, general population

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1916 Study of a Cross-Flow Membrane to a Kidney Encapsulation Engineering Structures for Immunosuppression Filter

Authors: Sihyun Chae, Ryoto Arai, Waldo Concepcion, Paula Popescu

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The kidneys perform an important role in the human hormones that regulate the blood pressure, produce an active form of vitamin D and control the production of red blood cells. Kidney disease can cause health problems, such as heart disease. Also, increase the chance of having a stroke or heart attack. There are mainly to types of treatments for kidney disease, dialysis, and kidney transplant. For a better quality of life, the kidney transplant is desirable. However, kidney transplant can cause antibody reaction and patients’ body would be attacked by immune system of their own. For solving that issue, patients with transplanted kidney always take immunosuppressive drugs which can hurt kidney as side effects. Patients willing to do a kidney transplant have a waiting time of 3.6 years in average searching to find an appropriate kidney, considering there are almost 96,380 patients waiting for kidney transplant. There is a promising method to solve these issues: bioartificial kidney. Our membrane is specially designed with unique perforations capable to filter the blood cells separating the white blood cells from red blood cells. White blood cells will not pass through the encapsulated kidney preventing the immune system to attack the new organ and eliminating the need of a matching donor. It is possible to construct life-time long encapsulation without needing pumps or a power supply on the cell’s separation method preventing futures surgeries due the Cross-Channel Flow inside the device. This technology allows the possibility to use an animal kidney, prevent cancer cells to spread through the body, arm and leg transplants in the future. This project aims to improve the quality of life of patients with kidney disease.

Keywords: kidney encapsulation, immunosuppression filter, leukocyte filter, leukocyte

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1915 Organizational Commitment and Job Satisfaction of Job Order Personnel in the Overseas Workers Welfare Administration Regional Welfare Office Caraga

Authors: Anne Jane M. Hallasgo

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This study assessed the level of job satisfaction and organizational commitment among job order personnel at the Overseas Workers Welfare Administration (OWWA) Regional Welfare Office Caraga. The primary objective of the study was to determine a correlation between the employees’ level of organizational commitment, job satisfaction, and their work performance. A carefully selected sample of twenty-five job orders from the OWWA Regional Welfare Office Caraga participated in the study. These individuals were chosen to represent the organization’s job order workforce. For accuracy and dependability, various types of statistical methods and instruments were employed, including advanced statistical tests like the independent sample T-test, one-way analysis of variance (ANOVA), and Spearman's rank correlation coefficient, as well as descriptive statistics like mean, frequency, and percentage. The study found an acceptable level of job satisfaction regarding work performance. It revealed a significant relationship between affective commitment and job satisfaction concerning leadership and coworkers. A correlation was observed between normative commitment and work performance. The findings suggest that organizations emphasizing positive leadership, fostering supportive coworker relationships, aligning with employee values, and promoting a culture of commitment are likely to enhance both affective and normative commitment, thereby improving overall employee satisfaction. The study recommends designing and implementing a holistic employee well-being program that addresses physical, mental, and emotional health contributing to increased job satisfaction and organizational commitment, creating a healthier and engaged workforce. This research contributes to the understanding of the dynamics of organizational commitment and job satisfaction among job order employees in the public sector.

Keywords: affective commitment, continuous commitment, normative commitment, job satisfaction

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1914 Healthcare Professionals' Utilization of Physical Exercise as a Strategy to Prevent Non-Communicable Diseases in Ethiopian Public Sector Hospitals

Authors: Jeanne Grace, Melkamu D. Kassa

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Background: Despite the recognized benefits of physical exercise, including a reduction of health risk factor indicators, illness and deaths related to Non-Communicable Diseases (NCDs) like cardiovascular disease, diabetes, hypertension, and cancer, the extent of its recognition and use as a prevention strategy by healthcare professionals working in Ethiopian referral hospitals is unknown. Objective: This study explored healthcare professionals’ use of physical exercise as a non-communicable disease prevention strategy in the Ethiopian public sector healthcare system. Methods: In this cross-sectional study, a self-administered questionnaire was conducted after being piloted to ensure validity and reliability. For the study, 312 participants were selected from 13 purposively selected Ethiopian referral hospitals, these being 99 physicians who were purposively selected and 213 nurses who were proportionately and randomly selected. Results: The results indicated that three-quarters (78%) of healthcare professionals working in Ethiopian hospitals are not using physical exercise as a strategy to prevent NCDs. Increased specialization (AOR = 20.203, p < 0.001), longer service years (AOR = 0.041, p = 0.014), young age (AOR = 19.871, p < 0.001), and being male (AOR = 0.269, p < 0.001), were predictors of using physical exercise as a strategy for the prevention of NCDs. Conclusion: Healthcare professionals’ utilization of physical exercise as a strategy for NCDs prevention was inadequate in Ethiopia. Given the increasing burden of NCD disease in Ethiopia, training nurses, physicians and medical managers have to acknowledge the use of physical exercise as an NCD prevention strategy. The results of this study highlight the importance of formulating physical exercise intervention strategies for NCDs patients, and the need to incorporate training for healthcare professionals on the type, intensity, duration, and frequency of physical exercise to prevent NCDs in the Ethiopian healthcare system.

Keywords: exercise, medical managers, nurses, physicians

Procedia PDF Downloads 176
1913 Healthy and Smart Building Projects

Authors: Ali A. Karakhan

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Stakeholders in the architecture, engineering, and construction (AEC) industry have been always searching for strategies to develop, design, and construct healthy and smart building projects. Healthy and smart building projects require that the building process including design and construction be altered and carefully implemented in order to bring about sustainable outcomes throughout the facility lifecycle. Healthy and smart building projects are expected to positively influence organizational success and facility performance across the project lifecycle leading to superior outcomes in terms of people, economy, and the environment. The present study aims to identify potential strategies that AEC organizations can implement to achieve healthy and smart building projects. Drivers and barriers for healthy and smart building features are also examined. The study findings indicate that there are three strategies to advance the development of healthy and smart building projects: (1) the incorporation of high-quality products and low chemical-emitting materials, (2) the integration of innovative designs, methods, and practices, and (3) the adoption of smart technology throughout the facility lifecycle. Satisfying external demands, achievement of a third-party certification, obtaining financial incentives, and a desire to fulfill professional duty are identified as the key drivers for developing healthy and smart building features; whereas, lack of knowledge and training, time/cost constrains, preference for/adherence to customary practices, and unclear business case for why healthy buildings are advantageous are recognized as the primary barriers toward a wider diffusion of healthy and smart building projects. The present study grounded in previous engineering, medical, and public health research provides valuable technical and practical recommendations for facility owners and industry professionals interested in pursuing sustainable, yet healthy and smart building projects.

Keywords: healthy buildings, smart construction, innovative designs, sustainable projects

Procedia PDF Downloads 162
1912 Insights on Workplace Bullying in the Nonprofit Sector

Authors: Shariffah Dawood

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During the past decade, workplace bullying has attracted increasing attention from researchers internationally as it is reported to be a major social problem and has severe consequences towards the job satisfaction and health of victims and towards the organization. It is characterized by “systematic aggression or violence targeted towards one or more individuals by one individual or by a group, consists of repeated and enduring acts, and the target is or ends up in an inferior position from which it is difficult to defend oneself.” Despite the seriousness of workplace bullying, not all sectors have received the same degree of scholarly attention. Most studies have been undertaken in the public and private sectors, such as, in hospitals, universities, retail industry, local council, and restaurant kitchens. The nonprofit sector has received limited attention despite its significant economic and social role in the society. In order to understand the nature of workplace bullying in non-profit sector, this research explored 29 British nonprofit organizations through surveys and interviews. Despite the nonprofit sector’s emphasis on an egalitarianism ethos, their reputation to be the defenders of the most vulnerable/disadvantaged and the perception that they are protected from such negative behaviors in the workplace, the findings uncovered pertinent factors that make this sector highly vulnerable towards workplace bullying. Overall, the study identifies some organizational factors which need to be addressed in order to curb bullying in this sector: management commitment towards a zero-tolerance bullying policy; management training in areas such as conflict resolution, organizational changes, and maintenance of the commitment of a conscientious workforce. The researcher further recommends that the nonprofit organizations work towards improving relationships with voluntary board members and funding bodies. The researcher will also outline the second phase of the study, which aims to investigate bullying in the nonprofit sector across cultures (the USA, Malaysia and Japan), and implications for the research will be identified.

Keywords: nonprofit sector, workplace bullying, harassment, management, HRM

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1911 Illness Experience Without Illness: A Qualitative Study on the Lived Experience of Young Adults During the COVID-19 Pandemic

Authors: Gemma Postil, Claire Zanin, Michael Halpin, Caroline Ritter

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Illness experience research typically focuses on people that are living with a medical condition; however, the broad consequences of the COVID-19 pandemic are impacting those without the virus itself, as many experienced extensive lockdowns, social isolation, and distress. Drawing on conceptual work in the illness experience literature, we argue that policy and social changes tied to COVID-19 produce biographical disruptions. In this sense, we argue that the COVID-19 pandemic produces illness experience without illness, as the pandemic comprehensively impacts health and biography. This paper draws on 30 in-depth interviews with young adults living in Prince Edward Island (PEI), which were conducted as part of a larger project to understand how young adults navigate compliance with the COVID-19 pandemic. We then inductively analyzed the interviews with a constructivist grounded theory approach. Specifically, we demonstrate that young adults living in PEI during the COVID-19 pandemic experienced biographical disruptions throughout the pandemic despite not contracting the virus. First, we detail how some participants experience biographical acceleration, with the pandemic accelerating relationships, home buying, and career planning. Second, we demonstrate biographical stagnation, wherein participants report being unable to pursue major life milestones. Lastly, we describe biographical regression, wherein participants feel they are losing ground during the pandemic and are actively falling behind their peers. These findings provide the novel application of illness experience concepts to the context of the COVID-19 pandemic, contribute to work on illness experience and ambiguity, and extend Bury’s conceptualization of biographical disruption. In conclusion, we demonstrate that young adults experienced the biographical disruption expected from having COVID-19 without having an illness, highlighting the depth to which the pandemic affected young adults.

Keywords: illness experience, lived experience, biographical disruption, COVID-19, young adults

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1910 Impact of Tillage and Crop Establishment on Fertility and Sustainability of the Rice-Wheat Cropping System in Inceptisols of Varanasi, Up, India

Authors: Pramod Kumar Sharma, Pratibha Kumari, Udai Pratap Singh, Sustainability

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In the Indo-Gangetic Plains of South-East Asia, the rice-wheat cropping system (RWCS) is dominant with conventional tillage (CT) without residue management, which shows depletion of soil fertility and non-sustainable crop productivity. Hence, this investigation was planned to identify suitable natural resource management practices involving different tillage and crop establishment (TCE) methods along with crop residue and their effects, on the sustainability of dominant cropping systems through enhancing soil fertility and productivity. This study was conducted for two consecutive years 2018-19 and 2019-20 on a long-term field experiment that was started in the year 2015-16 taking six different combinations of TCE methods viz. CT, partial conservation agriculture (PCA) i.e. anchored residue of rice and full conservation agriculture (FCA)] i.e. anchored residue of rice and wheat under RWCS in terms of crop productivity, sustainability of soil health, and crop nutrition by the crops. Results showed that zero tillage direct-seeded rice (ZTDSR) - zero tillage wheat (ZTW) [FCA + green gram residue retention (RR)] recorded the highest yield attributes and yield during both the crops. Compared to conventional tillage rice (CTR)-conventional tillage wheat (CTW) [residue removal (R 0 )], the soil quality parameters were improved significantly with ZTDSR-ZTW (FCA+RR). Overall, ZTDSR-ZTW (FCA+RR) had higher nutrient uptake by the crops than CT-based treatment CTR-CTW (R 0 ) and CTR-CTW (RI).These results showed that there is significant profitability of yield and resource utilization by the adoption of FCA it may be a better alternative to the dominant tillage system i.e. CT in RWSC.

Keywords: tillage and crop establishment, soil fertility, rice-wheat cropping system, sustainability

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1909 Characterization of Tailings From Traditional Panning of Alluvial Gold Ore (A Case Study of Ilesa - Southwestern Nigeria Goldfield Tailings Dumps)

Authors: Olaniyi Awe, Adelana R. Adetunji, Abraham Adeleke

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Field observation revealed a lot of artisanal gold mining activities in Ilesa gold belt of southwestern Nigeria. The possibility of alluvial and lode gold deposits in commercial quantities around this location is very high, as there are many resident artisanal gold miners who have been mining and trading alluvial gold ore for decades and to date in the area. Their major process of solid gold recovery from its ore is by gravity concentration using the convectional panning method. This method is simple to learn and fast to recover gold from its alluvial ore, but its effectiveness is based on rules of thumb and the artisanal miners' experience in handling gold ore panning tool while processing the ore. Research samples from five alluvial gold ore tailings dumps were collected and studied. Samples were subjected to particle size analysis and mineralogical and elemental characterization using X-Ray Diffraction (XRD) and Particle-Induced X-ray Emission (PIXE) methods, respectively. The results showed that the tailings were of major quartz in association with albite, plagioclase, mica, gold, calcite and sulphide minerals. The elemental composition analysis revealed a 15ppm of gold concentration in particle size fraction of -90 microns in one of the tailings dumps investigated. These results are significant. It is recommended that heaps of panning tailings should be further reprocessed using other gold recovery methods such as shaking tables, flotation and controlled cyanidation that can efficiently recover fine gold particles that were previously lost into the gold panning tailings. The tailings site should also be well controlled and monitored so that these heavy minerals do not find their way into surrounding water streams and rivers, thereby causing health hazards.

Keywords: gold ore, panning, PIXE, tailings, XRD

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1908 Trends in Incisional and Ventral Hernia Repair: A Population Analysis from 2001 to 2021

Authors: Lakmali Anthony, Madeline Gillies

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Background: Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods: This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare, and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results: There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for the population was 182 per 100,000; this increased by 9.578 per year during the study period (95% CI = 8.431- 10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year. (95% CI = 0.654- 1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95% CI = 0.510 -0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions: Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Keywords: ventral, incisional, hernia, trends

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1907 Organ Transplantation in Pakistan from an Anthropological Perspectives

Authors: Qurratulain Faheem

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The human body often serves as a reference point to analyse the notions of self and society. Situating on Merleau-Ponty and Bourdieu theories of embodiments, this research explores the notions around the human body and its influence on the ethical considerations in regards to organ transplantation among the Muslim communities in Pakistan. The context of Pakistan makes an intriguing case study as cadaveric organ transplantation is not in practise. Whereas living organ transplantation is commonly is practised between family membersonly. These contradictory practices apparently rests on the ideologies around the human body and religious beliefs as well the personal judgements and authority of healthcare professionals. This research is a year-long ethnographic study carried out as part of doctoral studies. An anthropological approach towards organ transplantation in Pakistan brought forward various socio-cultural notions around the human body and selfhood that serve as a framework around biomedical ethical issues in various societies. Further, it surface the contradictions and issues associated with organ transplantation that makes it a dilemma situated in a nexus of various socio-cultural and political factors rather seeing it as an isolated health concern. This research is a novel study on the subject of organ transplantation in the context of Pakistan but also put forward ethnographic data that could serve as a reference in other religious societies. Further, the ethnographic data bring forward experiences and stories of organ receivers, organ donors, religious leaders, healthcare professionals, and the general public, which aspire to encourage biomedical ethicists and social-scientists to consider ethnography as a research methodology and rely upon people’s lived experiences while establishing policies and practices around biomedical ethical issues.

Keywords: organ transplantation, ethics, pakistan, gender, islam, muslims, living organ donation

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1906 Toxicity Identification and Evaluation for the Effluent from Seawater Desalination Facility in Korea Using D. magna and V. fischeri

Authors: Sung Jong Lee, Hong Joo Ha, Chun Sang Hong

Abstract:

In recent years, the interests on the impacts of industrial wastewater on aquatic ecosystem have increased with concern about ecosystem protection and human health. Whole effluent toxicity tests are used to monitor toxicity by unknown toxic chemicals as well as conventional pollutants from industrial effluent discharges. This study describes the application of TIE (toxicity identification evaluation) procedures to an acutely toxic effluent from a Seawater desalination facility in industrial complex which was toxic to Daphnia magna. In TIE phase I (characterization step), the toxic effects by heavy metals, organic compounds, oxidants, volatile organic compounds, suspended solids and ammonia were screened and revealed that the source of toxicity is far from these toxicants group. Chemical analysis (TIE phase II) on TDS showed that the concentration of chloride ion (24,215 ~ 29,562 mg/L) was substantially higher than that predicted from EC50 for D. magna. In confirmation step (TIE phase III), chloride ion was demonstrated to be main toxicant in this effluent by the spiking approach, species sensitivity approach, and deletion approach. Calcium, potassium, magnesium, sodium, fluorine, sulfate ion concentration was not shown toxicity from D. magna. Finally, we concluded that chloride was the most contributing toxicant in the waste water treatment plant. Further research activities are needed for technical support of toxicity identification and evaluation on the various types of wastewater treatment plant discharge in Korea. Acknowledgement: This research was supported by a grant (16IFIP-B089911-03) from Plant Research Program funded by Ministry of Land, Infrastructure and Transport of Korean government.

Keywords: TIE, D. magna, V. fischeri, seawater desalination facility

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1905 Exploration of FOMO, or the 'Fear of Missing out' and the Use of Mindfulness and Values-Based Interventions for Alleviating Its Effects and Bolstering Well-Being

Authors: Chasity O'Connell

Abstract:

The use of social media and networking sites play a significant role in the lives of adolescents and adults. While research supports that social support and connectedness in general is beneficial; the nature of communication and interaction through social media and its subsequent benefits and impacts could be arguably different. As such, this research aims to explore a specific facet of social media interaction called fear of missing out, or 'FOMO' and investigate its relationship within the context of life stressors, social media usage, anxiety and depressive-symptoms, mindfulness, and psychological well-being. FOMO is the 'uneasy and sometimes all-consuming feeling that you’re missing out—that your peers are doing, in the know about, or in possession of more or something better than you'. Research suggests that FOMO can influence an individual’s level of engagement with friends and social media consumption, drive decisions on participating in various online or offline activities, and ultimately impact mental health. This study hopes to explore the potentially mitigating influence of mindfulness and values-based interventions in reducing the discomfort and distress that can accompany FOMO and increase the sense of psychological well-being in allowing for a more thoughtful and deliberate engagement in life. This study will include an intervention component wherein participants (comprised of university students and adults in the community) will partake in a six-week, group-based intervention focusing on learning practical mindfulness skills and values-exploration exercises (along with a waitlist control group). In doing so, researchers hope to understand if interventions centered on increasing one’s awareness of the present moment and one’s internal values impact decision-making and well-being with regard to social interaction and relationships.

Keywords: FOMO, mindfulness, values, stress, psychological well-being, intervention, distress

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1904 Single Item Presenteeism Question Reliability and Validity of Persian Version in Low Back Pain Patients

Authors: Mohammadreza Khanmohammadi, Noureddin Nakhostin Ansari, Soofia Naghdi

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Purpose: Our study aimed to validate single item presenteeism question (SIPQ) into the Persian language for patients with low back pain. Background information: low back pain is a common health problem, and it is one of the most prevalent disorder in working people. There are the different subjective way to evaluate the effect of back pain on work productivity that one of them is by implementing single item presenteeism question. This question has not been validated into the Persian language. Method: Patients were asked to answer SIPQ and pain from 0 to 10 according to numerical rating scale (NRS). The functional rating index was administrated to evaluate construct validity. For test-retest reliability, almost 50 patients re-completed the Persian SIPQ. The construct validity of SIPQ was assessed by analyzing Spearman rank correlation between this question and the Persian version of Functional rating index questionnaire. To analyze test-retest reliability, we assessed intraclass correlation coefficient (agreement) (ICC agreement) (two-way random effects model, single measure). Results: The SIPQ score of two groups of patients (84 males, 16 females, mean age ±SD: 33.85±11.16 years, range: 19-67 years) and healthy subjects (48 male, 2 female ones, mean age ±SD: 24.24 ±8.07 years) was statistically significant. (Mann-Whitney U =198.00, P<.001). The Spearman correlation of data showed that there is a significant correlation between Persian SIPQ score and Persian FRI band (r= .559, P<.001). The ICC was .62. So, the analysis indicated good, test-retest reliability. Conclusion: This study showed that Persian version of SIPQ is reliable and valid when applied to back pain patients.

Keywords: cross cultural adaptation, economic burden, low back pain, Persian language, translation

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1903 Cognitive Methods for Detecting Deception During the Criminal Investigation Process

Authors: Laid Fekih

Abstract:

Background: It is difficult to detect lying, deception, and misrepresentation just by looking at verbal or non-verbal expression during the criminal investigation process, as there is a common belief that it is possible to tell whether a person is lying or telling the truth just by looking at the way they act or behave. The process of detecting lies and deception during the criminal investigation process needs more studies and research to overcome the difficulties facing the investigators. Method: The present study aimed to identify the effectiveness of cognitive methods and techniques in detecting deception during the criminal investigation. It adopted the quasi-experimental method and covered a sample of (20) defendants distributed randomly into two homogeneous groups, an experimental group of (10) defendants be subject to criminal investigation by applying cognitive techniques to detect deception and a second experimental group of (10) defendants be subject to the direct investigation method. The tool that used is a guided interview based on models of investigative questions according to the cognitive deception detection approach, which consists of three techniques of Vrij: imposing the cognitive burden, encouragement to provide more information, and ask unexpected questions, and the Direct Investigation Method. Results: Results revealed a significant difference between the two groups in term of lie detection accuracy in favour of defendants be subject to criminal investigation by applying cognitive techniques, the cognitive deception detection approach produced superior total accuracy rates both with human observers and through an analysis of objective criteria. The cognitive deception detection approach produced superior accuracy results in truth detection: 71%, deception detection: 70% compared to a direct investigation method truth detection: 52%; deception detection: 49%. Conclusion: The study recommended if practitioners use a cognitive deception detection technique, they will correctly classify more individuals than when they use a direct investigation method.

Keywords: the cognitive lie detection approach, deception, criminal investigation, mental health

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1902 Duplex Real-Time Loop-Mediated Isothermal Amplification Assay for Simultaneous Detection of Beef and Pork

Authors: Mi-Ju Kim, Hae-Yeong Kim

Abstract:

Product mislabeling and adulteration have been increasing the concerns in processed meat products. Relatively inexpensive pork meat compared to meat such as beef was adulterated for economic benefit. These food fraud incidents related to pork were concerned due to economic, religious and health reasons. In this study, a rapid on-site detection method using loop-mediated isothermal amplification (LAMP) was developed for the simultaneous identification of beef and pork. Each specific LAMP primer for beef and pork was designed targeting on mitochondrial D-loop region. The LAMP assay reaction was performed at 65 ℃ for 40 min. The specificity of each primer for beef and pork was evaluated using DNAs extracted from 13 animal species including beef and pork. The sensitivity of duplex LAMP assay was examined by serial dilution of beef and pork DNAs, and reference binary mixtures. This assay was applied to processed meat products including beef and pork meat for monitoring. Each set of primers amplified only the targeted species with no cross-reactivity with animal species. The limit of detection of duplex real-time LAMP was 1 pg for each DNA of beef and pork and 1% pork in a beef-meat mixture. Commercial meat products that declared the presence of beef and/or pork meat on the label showed positive results for those species. This method was successfully applied to detect simultaneous beef and pork meats in processed meat products. The optimized duplex LAMP assay can identify simultaneously beef and pork meat within less than 40 min. A portable real-time fluorescence device used in this study is applicable for on-site detection of beef and pork in processed meat products. Thus, this developed assay was considered to be an efficient tool for monitoring meat products.

Keywords: beef, duplex real-time LAMP, meat identification, pork

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1901 Integrated Gas Turbine Performance Diagnostics and Condition Monitoring Using Adaptive GPA

Authors: Yi-Guang Li, Suresh Sampath

Abstract:

Gas turbine performance degrades over time, and the degradation is greatly affected by environmental, ambient, and operating conditions. The engines may degrade slowly under favorable conditions and result in a waste of engine life if a scheduled maintenance scheme is followed. They may also degrade fast and fail before a scheduled overhaul if the conditions are unfavorable, resulting in serious secondary damage, loss of engine availability, and increased maintenance costs. To overcome these problems, gas turbine owners are gradually moving from scheduled maintenance to condition-based maintenance, where condition monitoring is one of the key supporting technologies. This paper presents an integrated adaptive GPA diagnostics and performance monitoring system developed at Cranfield University for gas turbine gas path condition monitoring. It has the capability to predict the performance degradation of major gas path components of gas turbine engines, such as compressors, combustors, and turbines, using gas path measurement data. It is also able to predict engine key performance parameters for condition monitoring, such as turbine entry temperature that cannot be directly measured. The developed technology has been implemented into digital twin computer Software, Pythia, to support the condition monitoring of gas turbine engines. The capabilities of the integrated GPA condition monitoring system are demonstrated in three test cases using a model gas turbine engine similar to the GE aero-derivative LM2500 engine widely used in power generation and marine propulsion. It shows that when the compressor of the model engine degrades, the Adaptive GPA is able to predict the degradation and the changing engine performance accurately using gas path measurements. Such a presented technology and software are generic, can be applied to different types of gas turbine engines, and provide crucial engine health and performance parameters to support condition monitoring and condition-based maintenance.

Keywords: gas turbine, adaptive GPA, performance, diagnostics, condition monitoring

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1900 Attitudes Towards Homosexuality, Bisexuality and Transgenderism among Medical Students of a Sri Lankan University

Authors: Rajapaksha J. S. R. L., Rajapaksha R. G. D. T., Ranawaka A. U. R., Rangalla R. D. M. P., Ranwala R. D. E. B., Chandratilake M. N.

Abstract:

Introduction: Lesbian, gay, bisexual, and transgender (LGBT) patients experience discrimination, insensitivity, and ignorance about LGBT-specific health needs among healthcare providers. Developing the correct attitudes among medical students towards LGBT may help provide them with optimal healthcare. Objectives: This study aimed at assessing the attitudes of medical students towards the LBGT community. Methodology: A cross-sectional descriptive study was among all the medical students in the Faculty of Medicine, University of Kelaniya, Sri Lanka, using a validated online questionnaire. The questionnaire focused on eight areas. The data were descriptively analyzed, and the demographic groups were compared. Results: 358 students completed the survey. The response rate was 34.26%. Their attitudes on traditional gender roles and comfortability in interacting with LGBT people were moderate, and they disagreed with negative LGBT social beliefs. They knew less about the origin of sexuality/gender of LGBT. Although they accepted LGBT as a part of diversity, they discouraged normalizing the social practices of LGBT people. Their acceptance and association of LGBT were moderately positive. A minority has encountered LGBT in close social circles, and the majority of them were batch-mates. Although males’ knowledge about the origin of LGBT was higher, they favoured traditional gender roles more. The religious groups showed no differences. The favourability of attitudes towards LGBT reflected respondents’ political ideology. Conclusion: Although medical students’ knowledge on the sexuality/gender basis of LGBT is poor, they have moderately favourable attitudes towards them. They accept LGBT as a part of social diversity but not their social practices. Poor knowledge, lack of encounters, cultural influences, and political ideology may have influenced their attitudes.

Keywords: medical students, attitude, LGBT, diversity

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1899 Night Shift Work as an Oxidative Stressor: A Systematic Review

Authors: Madeline Gibson

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Night shift workers make up an essential part of the modern workforce. However, night shift workers have higher incidences of late in life diseases and earlier mortality. Night shift workers are exposed to constant light and experience circadian rhythm disruption. Sleep disruption is thought to increase oxidative stress, defined as an imbalance of excess pro-oxidative factors and reactive oxygen species over anti-oxidative activity. Oxidative stress can damage cells, proteins and DNA and can eventually lead to varied chronic diseases such as cancer, diabetes, cardiovascular disease, Alzheimer’s and dementia. This review aimed to understand whether night shift workers were at greater risk of oxidative stress and to contribute to a consensus on this relationship. Twelve studies published in 2001-2019 examining 2,081 workers were included in the review. Studies compared both the impact of working a single shift and in comparisons between those who regularly work night shifts and only day shifts. All studies had evidence to support this relationship across a range of oxidative stress indicators, including increased DNA damage, reduced DNA repair capacity, increased lipid peroxidation, higher levels of reactive oxygen species, and to a lesser extent, a reduction in antioxidant defense. This research supports the theory that melatonin and the sleep-wake cycle mediate the relationship between shift work and oxidative stress. It is concluded that night shift work increases the risk for oxidative stress and, therefore, future disease. Recommendations are made to promote the long-term health of shift workers considering these findings.

Keywords: night shift work, coxidative stress, circadian rhythm, melatonin, disease, circadian rhythm disruption

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1898 Effect of Dietary Graded Levels of L-Theanine on Growth Performance, Carcass Traits, Meat Quality, and Immune Response of Broilers

Authors: Muhammad Saeed, Sun Chao

Abstract:

L-theanine is water soluble non-proteinous amino acid found in green tea leaves. Despite the availability of abundant literature on green tea, studies on the use of L-theanine as an additive in animals especially broilers are scanty. The objective of this study was to evaluate the effectiveness of different dietary levels of L-theanine on growth performance, meat quality, growth, immune response and blood chemistry in broilers. A total of 400 day-old chicks were randomly divided into four treatment groups (A, B, C, and D) using a complete randomized design. Treatments were as follows: A; control (basal diet), B; basal diet+100 mg L-theanine / kg diet, C; basal diet+ 200 mg L-theanine / kg diet, and D; basal diet+ 300 mg L-theanine / kg diet. Results revealed that intermediate level of L-theanine (200 mg/ kg diet, group C) showed better results in terms of BWG, FC, and FCR compared with control and other L-theanine levels. The live weight eviscerated weight and gizzard weight was higher in all L-theanine levels as compared to that of the control group. The heaviest (P > 0.05) spleen and bursa were found in group C (200 mg L-theanine / kg diet). Analysis of meat colors according to yellowness (b*), redness (a*), and lightness (L*) showed significantly higher values of a* and b* in L-theanine groups. Supplementing broiler diet with L-theanine minimized (P=0.02) total cholesterol contents in serum. Further analysis revealed , lower mRNA expression of TNF-α and IL-6 in thymus and IFN- γ and IL-2 in spleen was observed in L-theanine group It is concluded that supplementation of L-theanine at 200mg/kg diet showed better results in terms of performance and it could be utilized as a natural feed additive alternative to antibiotics to improve overall performance of broilers. Increasing the levels up to 300 mg L-theanine /kg diet may has deleterious effects on performance and other health aspects.

Keywords: blood chemistry, broilers growth, L-theanine, meat quality

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1897 Extent to Which Various Academic Factors Cause Stress in Undergraduate Students at a University in Karachi and What Unhealthy Coping Strategies They Use

Authors: Sumara Khanzada

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This research investigated how much stress is induced by various study-related factors, in undergraduate students belonging to a renowned university in Karachi along with the unhealthy coping strategy the students use to manage the stress. The study related factors considered for the purpose of the study were curriculum and instruction based stress, teacher-student relationship, assessment system and different components related to academic work. A survey in which questionnaires were administered to hundred students was conducted. The data were analyzed quantitatively to determine the percentages of stress induced by the various factors. The study found that student-teacher relationship is the strongest factor that causes stress in the undergraduate students specifically when teachers do not deliver the lectures effectively and give assignments and presentations to students without clear guidelines and instructions. The second important factor that causes stress was the different components of academic life, such as, parental expectations and pressures to achieve one's goals. Assessment system was found to be the third key factor inducing stress and affecting students' cognitive and psychological functioning. The most commonly used unhealthy coping strategy for stress management was procrastination. In light of the findings, it is recommended that importance be given to teacher training to ensure that instruction is proper and healthy teacher student relationship exists. Effective support programs, workshops, seminars, and different awareness programs should be arranged for promoting awareness regarding mental health in educational institutions. Moreover, additional zero credit courses should be offered to teach students how to learn stress management and healthy coping skills. Sumara Khanzada Clinical Psychologist [email protected]

Keywords: Stress, coping stretigies, acadamic stress, relationship

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1896 Preparation of Zinc Oxide Nanoparticles and Its Anti-diabetic Effect with Momordica Charantia Plant Extract in Diabetic Mice

Authors: Zahid Hussain, Nayyab Sultan

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This study describes the preparation of zinc oxide nanoparticles and their anti-diabetic effect individually and with the combination of Momordica charantia plant extract. This plant is termed bitter melon, balsam pear, bitter gourd, or karela. Blood glucose levels in mice were monitored in their random state before and after the administration of zinc oxide nanoparticles and plant extract. The powdered form of nanoparticles and the selected plant were used as an oral treatment. Diabetes was induced in mice by using a chemical named as streptozotocin. It is an artificial diabetes-inducing chemical. In the case of zinc oxide nanoparticles (3mg/kg) and Momordica charantia plant extract (500mg/kg); the maximum anti-diabetic effect observed was 70% ± 1.6 and 75% ± 1.3, respectively. In the case of the combination of zinc oxide nanoparticles (3mg/kg) and Momordica charantia plant extract (500mg/kg), the maximum anti-diabetic effect observed was 86% ± 2.0. The results obtained were more effective as compared to standard drugs Amaryl (3mg/kg), having an effectiveness of 52% ± 2.4, and Glucophage (500mg/kg), having an effectiveness of 29% ± 2.1. Results indicate that zinc oxide nanoparticles and plant extract in combination are more helpful in treating diabetes as compared to their individual treatments. It is considered a natural treatment without any side effects rather than using standard drugs, which shows adverse side effects on health, and most probably detoxifies in liver and kidneys. More experimental work and extensive research procedures are still required in order to make them applicable to pharmaceutical industries.

Keywords: albino mice, amaryl, anti-diabetic effect, blood glucose level, Camellia sinensis, diabetes mellitus, Momordica charantia plant extract, streptozotocin, zinc oxide nanoparticles

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1895 Two-Stage Hospital Efficiency Analysis Including Qualitative Evidence: A Greek Case

Authors: Panos Xenos, Milton Nektarios, John Yfantopoulos

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Background: Policy makers, professional organizations and payers have introduced a variety of initiatives and reforms for the health systems worldwide, aimed at improving hospital efficiency. Their efforts are concentrated in two main categories: to constrain increasing healthcare costs and to enhance quality of services provided. Research Objectives: This study examines the efficiency of 112 Greek public hospitals for the year 2009, evaluates the importance of bootstrapping techniques and investigates the effect of contextual factors on hospital efficiency. Furthermore, the effect of qualitative evidence, on hospital efficiency is explored using data from 28 large hospitals. Methods: We applied Data Envelopment Analysis, augmented by bootstrapping techniques, to estimate efficiency scores. In order to measure the effect of environmental factors on hospital efficiency we used Tobit regression analysis. The significance of our models is evaluated using statistical tests to compare distributions. Results: The Kolmogorov-Smirnov test between the original and the bootstrap-corrected efficiency indicates that their distributions are significantly different (p-value<0.01). The environmental factors, that seem to influence efficiency, are Occupancy Rating and the ratio between Outpatient Visits and Inpatient Days. Results indicate that the inclusion of the quality variable in DEA modelling generates statistically significant variations in efficiency scores (p-value<0.05). Conclusions: The inclusion of quality variables and the use of bootstrap resampling in efficiency analysis impose a statistically significant effect on the distribution of efficiency scores. As a policy conclusion we highlight the importance of these methods on hospital efficiency analysis and, by implication, on healthcare resource allocation.

Keywords: hospitals, efficiency, quality, data envelopment analysis, Greek public hospital sector

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