Search results for: general practitioners

Authors: Jerry Gyimah, Ernest Kissi, Safowaa Osei-Tutu, Charles Dela Adobor, Theophilus Adjei-Kumi, Ernest Osei-Tutu

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Price fluctuation contract is imperative and of paramount essence, in the construction industry as it provides adequate relief and cushioning for changes in the prices of input resources during construction. As a result, several methods have been devised to better help in arriving at fair recompense in the event of price changes. However, stakeholders often appear not to be satisfied with the existing methods of fluctuation evaluation, ostensibly because of the challenges associated with them. The aim of this study was to identify the challenges to the usage of building construction cost indices in Ghana. Data was gathered from contractors and quantity surveying firms. The study utilized a survey questionnaire approach to elicit responses from the contractors and the consultants. Data gathered was analyzed scientifically, using the relative importance index (RII) to rank the problems associated with the existing methods. The findings revealed the following, among others, late release of data, inadequate recovery of costs, and work items of interest not included in the published indices as the main challenges of the existing methods. Findings provide useful lessons for policymakers and practitioners in decision making towards the usage and improvement of available indices.

Keywords: building construction cost indices, challenges, usage, Ghana

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Authors: Abdelghani Boudiaf

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The profusion of studies relating to the concept of organizational learning shows the importance that has been given to this concept in the management sciences. A few years ago, companies leaned towards ISO 9001 certification; this requires the implementation of the quality management system (QMS). In order for this objective to be achieved, companies must have a set of skills, which pushes them to develop learning through continuous training. The results of empirical research have shown that implementation of the QMS in the company promotes the development of learning. It should also be noted that several types of learning are developed in this sense. Given the nature of skills development is normative in the context of the quality demarche, companies are obliged to qualify and improve the skills of their human resources. Continuous training is the keystone to develop the necessary learning. To carry out continuous training, companies need to be able to identify their real needs by developing training plans based on well-defined engineering. The training process goes obviously through several stages. Initially, training has a general aspect, that is to say, it focuses on topics and actions of a general nature. Subsequently, this is done in a more targeted and more precise way to accompany the evolution of the QMS and also to make the changes decided each time (change of working method, change of practices, change of objectives, change of mentality, etc.). To answer our problematic we opted for the method of qualitative research. It should be noted that the case study method crosses several data collection techniques to explain and understand a phenomenon. Three cases of companies were studied as part of this research work using different data collection techniques related to this method.

Keywords: changing mentalities, continuing training, organizational learning, quality management system, skills development

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Authors: Shoaib Yousaf

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The main purpose of this research is to the empirical investigation of the bullwhip effect under sensitivity analysis in the two-tier supply chain. The simulation modeling technique has been applied in this research as a research methodology to see the sensitivity analysis of the bullwhip effect in the rice industry of Pakistan. The research comprises two case studies that have been chosen as a sample. The results of this research have confirmed that reduction in production delay reduces the bullwhip effect, which conforms to the time compressing paradigm and the significance of the reduction in production delay to lessen demand amplification. The result of this research also indicates that by increasing the value of time to adjust inventory decreases the bullwhip effect. Furthermore, by decreasing the value of alpha increases the damping effect of the exponential smoother, it is not surprising that it also reduces the bullwhip effect. Moreover, by reducing the value of time to work in progress also reduces the bullwhip effect. This research will help practitioners and operation managers to reduces the major costs of their products in three ways. They can reduce their i) inventory levels, ii) better utilize their capacity and iii) improve their forecasting techniques. However, this study is based on two tier supply chain, while in reality the supply chain has got many tiers. Hence, future work will be extended across more than two-tier supply chains.

Keywords: bullwhip effect, rice industry, supply chain dynamics, simulation, sensitivity analysis

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Authors: Hideki Kitamura

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Since Islamic banking has broadly started in the late 1970s, Islamic economy has been paid much attention by both academia and the business world. However, despite abundant studies, descriptive exploration of practices of Islamic economy from a sociological/anthropological perspective is underrepresented, and most are basically designed for evaluating current practice or proposing ideal types of Islamic economy in accordance with their religious conviction. Overall, their interest is not paid to actors of Islamic economy such as practitioner’s decision-making and thought, while sociological/anthropological studies on Muslim’s religious life can be observed well. Herein, the paper aims to look into the possibilities of sociology/anthropology for exploration of the role of actors of Islamic economy, by revisiting the benefit of sociological/anthropological studies on the religion of Islam and its adaptability to the research on Islamic economy. The paper suggests that practices of Islamic economy can be assumed as results of practitioner’s dilemma between Islamic ideals and market realities in each society, by applying the perspective of social constructivism. The paper then proposes focusing on the human agency of practitioners in translating Islamic principles into economic behavior, thereby enabling a more descriptive inquiry into how Islamic economy is produced and operated.

Keywords: Islamic economy, economic sociology/anthropology, human agency, social constructivism

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Authors: Shittu Bisi Agnes

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Ebola virus Diseases outbreak in Nigeria caused a lot of concerns considering the mode of transmission and no known cure discovered. Therefore a lot of safety measures were taken which eventually led to the eradication of the virus in Nigeria. This therefore attempted to determine the various safety measures, how socio-economic characteristic of the people affected adherence to safety measures. And provide reasonable recommendations for total eradication of the virus, future outbreak and general environmental safety Data were collected with the aid of well structured questionnaires and administered 180 randomly selected of the state and oral interview was also utilize. Data collected were analysed using both descriptive tools and inferential statistics vis-a-vis regression analysis. Finding showed that 70.5% was strongly adhere to almost all the measures, 15.2% was fairly advent, 3% was poorly observing the selected measures while 1.3% was in different. 65% of the respondents was strongly aware of the advent of ebola virus diseases, 20% was fairly in awareness, 8.5% was poorly in awareness while 6.55% was in aware of any disease outbreak. Safety measures put forwards were; hand washing, use of hand sanitize-rs, no shaking of hands non-consumption of wildlife games(Bush Meat) and general health and environmental safety measures. It was recommended that policy instrument to increase peoples income will accelerate eradication of diseases as this will enable households to pay for monetary safety measures, health and environmental education, in form of talk shop, workshop, lectures could be organised at the political ward levels, schools, market women, religious bodies functional unions and mass media.

Keywords: ebola diseases, pay, safety, outbreak

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Authors: Natalia Pacheco Rego

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The Liezation functor is a map from the category of Leibniz algebras to the category of Lie algebras, which assigns a Leibniz algebra to the Lie algebra given by the quotient of the Leibniz algebra by the ideal spanned by the square elements of the Leibniz algebra. This functor is left adjoint to the inclusion functor that considers a Lie algebra as a Leibniz algebra. This environment fits in the framework of central extensions and commutators in semi-abelian categories with respect to a Birkhoff subcategory, where classical or absolute notions are relative to the abelianization functor. Classical properties of Leibniz algebras (properties relative to the abelianization functor) were adapted to the relative setting (with respect to the Liezation functor); in general, absolute properties have the corresponding relative ones, but not all absolute properties immediately hold in the relative case, so new requirements are needed. Following this line of research, it was conducted an analysis of central derivations of Leibniz algebras relative to the Liezation functor, called as Lie-derivations, and a characterization of Lie-stem Leibniz algebras by their Lie-central derivations was obtained. In this paper, we present an overview of these results, and we analyze some new properties concerning Lie-central derivations and almost inner Lie-derivations. Namely, a Leibniz algebra is a vector space equipped with a bilinear bracket operation satisfying the Leibniz identity. We define the Lie-bracket by [x, y]lie = [x, y] + [y, x] , for all x, y . The Lie-center of a Leibniz algebra is the two-sided ideal of elements that annihilate all the elements in the Leibniz algebra through the Lie-bracket. A Lie-derivation is a linear map which acts as a derivative with respect to the Lie-bracket. Obviously, usual derivations are Lie-derivations, but the converse is not true in general. A Lie-derivation is called a Lie-central derivation if its image is contained in the Lie-center. A Lie-derivation is called an almost inner Lie-derivation if the image of an element x is contained in the Lie-commutator of x and the Leibniz algebra. The main results we present in this talk refer to the conditions under which Lie-central derivation and almost inner Lie-derivations coincide.

Keywords: almost inner Lie-derivation, Lie-center, Lie-central derivation, Lie-derivation

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Authors: Rahmat Irawan, Mundhir Hanifsyam Harahap, Andar Ristabet Hesda

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As a public sector organization in Indonesia, Directorate General of State Asset Management (DGSAM) which is a unit under the Ministry of Finance of The Republic of Indonesia, has many constraints in managing its employees. While private organizations are able to conduct a human resource management as the best practice, DGSAM is limited by many regulations, especially about punishment and lay off policy for under-performance employees. Therefore, since 2015, DGSAM tries to implement a new and uncommon approach considering employees’ preference to encourage the motivation and performance of employees. DGSAM’s employees may propose the job places, and DGSAM considers them in deciding employees deployment. This study tries to determine the impact of preference-based approach toward employees’ satisfaction and organizational performance. This study uses quantitative approaches by regression analysis to measure the impact of deployment toward satisfaction of deployed employees and performance change of related units in DGSAM. The result of this study shows that preference-based approach significantly improves employees’ satisfaction and performance of related units as well. Based on the results of this study, it can be suggested that the approach is able to be implemented in the wider scope of the Ministry of Finance of The Republic of Indonesia and whole public sector organization in Indonesia. However, this study only focuses on short term measurement, so it is suggested to do further study to analyze the long-term impact.

Keywords: employee deployment, employee satisfaction, human resource management, organizational performance, preference-based approach

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Authors: Ivana Bulog, Ana Rimac Smiljanić, Sandra Pepur

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The financial fragility of households has received increased attention following the recent health crisis, which has created uncertainty and caused increased levels of stress and consequently impaired individual and family well-being. Job losses and/or reduced wages and insecurity increased the number of people that were unable to meet unexpected expenses, which, in many cases, led to increased household debt levels. This presents a threat to the stability of the financial system and the whole economy; therefore, reducing financial fragility and improving financial literacy present challenges for academicians, practitioners, and policymakers. Concerning financial fragility, significant research attention has been devoted to financial knowledge and financial literacy. However, apart from specific knowledge, personal characteristics are of great importance in making financial decisions in the household. Self-efficacy is one of the personal non-cognitive attributes that is a valuable framework for understanding how household financial decisions are made. Thus, this research proposes that individual levels of financial literacy and self-efficacy are related to the indebtedness and financial instability of the household. The primary data were collected using a structured, self-administered online questionnaire, and a snowball sampling method was applied to reach the participants. Preliminary results confirm our assumptions on the influence of financial literacy and self-efficacy on household financial stability.

Keywords: financial literacy, self-efficacy, household financial fragility, well-being

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Authors: Mucahit Unal, Ibrahim Arslan

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The New Turkish Commercial Code (TCC) No. 6102 was published in the Official Gazette on February 14, 2011. As stated in the New Turkish Commercial Code No. 6102 and Law No. 6103 on Validity and Application of the Turkish Commercial Code, TCC came into effect on July 1, 2012. The basic purpose of the TCC is to form corporate governance coherent with the international standards; to provide transparency in company management; to adjust the Turkish Commercial Code rules with European Union legislations and to simplify establishing a company for foreigner investors to move investments to Turkish market. In this context according to TCC, joint stock companies and limited liability companies can establish with only one single shareholder; the one single shareholder can be foreigner; all board of director members can be foreigner, also all shareholders and board of director members can be non-resident foreigners. Additionally, TCC does not require physical participation to the general shareholders and board members meetings. TCC allows that the general shareholders and board members meetings can hold in an electronic form and resolution of these meetings may also be approved via electronic signatures. Through this amendment, foreign investors no longer have to deal with red tapes. This amendment also means the TCC prevents foreign companies from incurring unnecessary travel expenses. In accordance with all this amendments about TCC, to invest in Turkish market is easy, simple and transparent for foreigner investors and also investors can establish a company in Turkey, irrespective of nationality or place of residence. This article aims to analyze ‘Establish a Company in Turkey for Foreigners’ and inform investors about investing (especially establishing a company) in the Turkish market.

Keywords: establish a company, foreigner investors, invest in Turkish market, Turkish commercial code

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Authors: Rizwan Iqbal

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Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

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Authors: S. Nikpour, S. Vahidi, H. Haghani

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Introduction: Exercise has mental and physical health benefits for patients with advanced stage cancer who actively receive chemotherapy, yet little is known about patients’ levels of interest in becoming more active or their confidence in increasing their activity level. Methods and materials: A convenience sample of 200 patients with advanced-stage cancer who were receiving chemotherapy completed self-report measures assessing physical activity level, mood, and quality-of-life variables. Qualitative data on patient-perceived benefits of, and barriers to, physical activity also were collected, coded by independent raters, and organized by predominant themes. Results: Current physical activity level, physical activity outcome expectations, and positive mood were significantly associated with self-efficacy. Fatigue was the most frequently listed barrier to physical activity; improved physical strength and health were the most commonly listed benefits. Participants identified benefits related to both general health and cancer-symptom management that were related to exercise. 59.5% of participants reported that they were seriously planning to increase or maintain their physical activity level, and over 40% reported having interest in receiving an intervention to become more active. Conclusion: These results suggested that many advanced-stage cancer patients who receive chemotherapy are interested in maintaining or increasing their physical activity level and in receiving professional support for exercise. In addition, these individuals identified general health and cancer-specific benefits of, and barriers to, physical activity. Future research will investigate how these findings may be incorporated into physical activity interventions for advanced-stage oncology patients receiving medical treatment.

Keywords: physical activity, cancer, self-efficacy

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Authors: Hellal Abdelkader, Chafaa Salah, Touafri Lasnouni

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A simple, efficient and general method has been developed for the high diastereoselective synthesis of diethyl α-aminophosphonates in water through “one-pot” three-component reaction of aromatic aldehydes, aminophenols and dialkyl phosphites in the presence of a low catalytic amount (10mol%) of phosphorous acid as highly stable catalyst is described.

Keywords: DFT, HOMO-LUMO, phosphonic acid, aminophenols

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Authors: Liam Martin, Martha Watson

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Patients with learning disabilities (LD) are at increased risk of physical and mental illness due to health inequality. To address this, NICE recommends that people from the age of 14 with a learning disability should have an annual LD health check. This consultation should include a holistic review of the patient’s physical, mental and social health needs with a view of creating an action plan to support the patient’s care. The expected standard set by the Quality and Outcomes Framework (QOF) is that each general practice should review at least 75% of their LD patients annually. During COVID-19, there have been barriers to primary care, including health anxiety, the shift to online general practice and the increase in GP workloads. A surgery in North London wanted to assess whether they were falling short of the expected standard for LD patient annual reviews in order to optimize care post Covid-19. A baseline audit was completed to assess how many LD patients were receiving their annual reviews over the period of 29th September 2020 to 29th September 2021. This information was accessed using EMIS Web Health Care System (EMIS). Patients included were aged 14 and over as per QOF standards. Doctors were not notified of this audit taking place. Following the results of this audit, the creation of learning disability clinics was recommended. These clinics were recommended to be on the ground floor and should be a dedicated time for LD reviews. A re-audit was performed via the same process 6 months later in March 2022. At the time of the baseline audit, there were 71 patients aged 14 and over that were on the LD register. 54% of these LD patients were found to have documentation of an annual LD review within the last 12 months. None of the LD patients between the ages of 14-18 years old had received their annual review. The results were discussed with the practice, and dedicated clinics were set up to review their LD patients. A second pass of the audit was completed 6 months later. This showed an improvement, with 84% of the LD patients registered at the surgery now having a documented annual review within the last 12 months. 78% of the patients between the ages of 14-18 years old had now been reviewed. The baseline audit revealed that the practice was not meeting the expected standard for LD patient’s annual health checks as outlined by QOF, with the most neglected patients being between the ages of 14-18. Identification and awareness of this vulnerable cohort is important to ensure measures can be put into place to support their physical, mental and social wellbeing. Other practices could consider an audit of their annual LD health checks to make sure they are practicing within QOF standards, and if there is a shortfall, they could consider implementing similar actions as used here; dedicated clinics for LD patient reviews.

Keywords: COVID-19, learning disability, learning disability health review, quality and outcomes framework

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Authors: Nishi Bhuvandas, P. V. Timbadiya, P. L. Patel, P. D. Porey

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Recent perceived climate variability raises concerns with unprecedented hydrological phenomena and extremes. Distribution and circulation of the waters of the Earth become increasingly difficult to determine because of additional uncertainty related to anthropogenic emissions. According to the sixth Intergovernmental Panel on Climate Change (IPCC) Technical Paper on Climate Change and water, changes in the large-scale hydrological cycle have been related to an increase in the observed temperature over several decades. Although many previous research carried on effect of change in climate on hydrology provides a general picture of possible hydrological global change, new tools and frameworks for modelling hydrological series with nonstationary characteristics at finer scales, are required for assessing climate change impacts. Of the downscaling techniques, dynamic downscaling is usually based on the use of Regional Climate Models (RCMs), which generate finer resolution output based on atmospheric physics over a region using General Circulation Model (GCM) fields as boundary conditions. However, RCMs are not expected to capture the observed spatial precipitation extremes at a fine cell scale or at a basin scale. Statistical downscaling derives a statistical or empirical relationship between the variables simulated by the GCMs, called predictors, and station-scale hydrologic variables, called predictands. The main focus of the paper is on the need for using statistical downscaling techniques for projection of local hydrometeorological variables under climate change scenarios. The projections can be then served as a means of input source to various hydrologic models to obtain streamflow, evapotranspiration, soil moisture and other hydrological variables of interest.

Keywords: climate change, downscaling, GCM, RCM

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Authors: Roya Yumul, Ofelia Loani Elvir-Lazo, Sevan Komshian, Ruby Wang, Jun Tang

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BACKGROUND: An objective means for monitoring the anti-nociceptive effects of perioperative medications has long been desired as a way to provide anesthesiologists information regarding a patient’s level of antinociception and preclude any untoward autonomic responses and reflexive muscular movements from painful stimuli intraoperatively. To this end, electroencephalogram (EEG) based tools including BIS and qCON were designed to provide information about the depth of sedation while qNOX was produced to inform on the degree of antinociception. The goal of this study was to compare the reliability of qCON/qNOX to BIS as specific indicators of response to nociceptive stimulation. METHODS: Sixty-two patients undergoing general anesthesia with LMA were included in this study. Institutional Review Board (IRB) approval was obtained, and informed consent was acquired prior to patient enrollment. Inclusion criteria included American Society of Anesthesiologists (ASA) class I-III, 18 to 80 years of age, and either gender. Exclusion criteria included the inability to consent. Withdrawal criteria included conversion to the endotracheal tube and EEG malfunction. BIS and qCON/qNOX electrodes were simultaneously placed on all patients prior to induction of anesthesia and were monitored throughout the case, along with other perioperative data, including patient response to noxious stimuli. All intraoperative decisions were made by the primary anesthesiologist without influence from qCON/qNOX. Student’s t-distribution, prediction probability (PK), and ANOVA were used to statistically compare the relative ability to detect nociceptive stimuli for each index. Twenty patients were included for the preliminary analysis. RESULTS: A comparison of overall intraoperative BIS, qCON and qNOX indices demonstrated no significant difference between the three measures (N=62, p> 0.05). Meanwhile, index values for qNOX (62±18) were significantly higher than those for BIS (46±14) and qCON (54±19) immediately preceding patient responses to nociceptive stimulation in a preliminary analysis (N=20, * p= 0.0408). Notably, certain hemodynamic measurements demonstrated a significant increase in response to painful stimuli (MAP increased from 74 ±13 mm Hg at baseline to 84 ± 18 mm Hg during noxious stimuli [p= 0.032] and HR from 76 ± 12 BPM at baseline to 80 ± 13 BPM during noxious stimuli [p=0.078] respectively). CONCLUSION: In this observational study, BIS and qCON/qNOX provided comparable information on patients’ level of sedation throughout the course of an anesthetic. Meanwhile, increases in qNOX values demonstrated a superior correlation to an imminent response to stimulation relative to all other indices

Keywords: antinociception, BIS, general anesthesia, LMA, qCON/qNOX

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Authors: Abdelbaset Rabaiah

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e-Government mobile applications provide an extension for effective e-government services in today’s omniconnected world. They constitute part of m-government platforms. This study explores the usefulness, availability, discoverability and maturity of such applications. While this study impacts theory by addressing a relatively lacking area, it impacts practice more. The outcomes of this study suggest valuable recommendations for practitioners-developers of e-government applications. The methodology followed is to examine a large number of e-government smartphone applications. The focus is on applications available at the Google Play Store. Moreover, the study investigates applications published on government portals of a number of countries. A sample of 15 countries is researched. The results show a diversity in the level of discoverability, development, maturity, and usage of smartphone apps dedicated for use of e-government services. It was found that there are major issues in discovering e-government applications on both the Google Play Store and as-well-as on local government portals. The study found that only a fraction of mobile government applications was published on the Play Store. Only 19% of apps were multilingual, and 43% were developed by third parties including private individuals. Further analysis was made, and important recommendations are suggested in this paper for a better utilization of e-government smartphone applications. These recommendations will result in better discoverability, maturity, and usefulness of e-government applications.

Keywords: mobile applications, e-government, m-government, Google Play Store

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Authors: D. Hilton

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An analysis of the Australian Diabetes Screening Study estimated undiagnosed diabetes mellitus [DM] prevalence in a high risk general practice based cohort. DM prevalence varied from 9.4% to 18.1% depending upon the diagnostic criteria utilised with age being a highly significant risk factor. Utilising the gold standard oral glucose tolerance test, the prevalence of DM was 22-23% in those aged >= 70 years and <15% in those aged 40-59 years. Opportunistic screening in Australian general practice potentially can identify many persons with undiagnosed type 2 DM. An Australian Bureau of Statistics document published three years ago, reported the highest rate of DM in men aged 65-74 years [19%] whereas the rate for women was highest in those over 75 years [13%]. If you consider that the Australian Bureau of Statistics report in 2007 found that 13% of the population was over 65 years of age and that this will increase to 23-25% by 2056 with a further projected increase to 25-28% by 2101, obviously this information has to be factored into the equation when age related diabetes prevalence predictions are calculated. This 10-15% proportional increase of elderly persons within the population demographics has dramatic implications for the estimated number of elderly persons with DM in these age groupings. Computational methodology showing the age related demographic changes reported in these official statistical documents will be done showing estimates for 2056 and 2101 for different age groups. This has relevance for future diabetes prevalence rates and shows that along with many countries worldwide Australia is facing an increasing pandemic. In contrast Japan is expected to have a decrease in the next twenty years in the number of persons with diabetes.

Keywords: epidemiological methods, aging, prevalence, diabetes mellitus

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Authors: Salehah Tahkin, Norlaila Mustafa, Dayang Anita Abdul Aziz

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Knowledge of medical ethics is important to all practitioners so the best care can be delivered to all patients through safe practice. Surgeons are not exceptions to this. Knowledge, attitude, and practice (KAP) of medical ethics among paediatric surgeons and trainees in Malaysia has not been evaluated before. This study aims to determine the level of KAP regarding medical ethics among these groups. This was a cross-sectional study involving three groups of samples, i.e., paediatric surgeons (PS), paediatric surgical trainees (PST), and medical officers with a special interest in paediatric surgery (MO). A validated KAP questionnaire was used. Standard formulas were used to calculate objective indexes for measuring KAP, which were then compared for statistical significance across different sample groups; p less than 0.05 is taken as significant. The index is rated into 5 classes using a score of 0 to 10, i.e., poor (1-2.99), fair (3-4.99), good (5-6.99), very good (7-8.99), and excellent (9-10). There were 117 samples, i.e., PS n=45 (38.5%), PST n=25 (21.3%), and MO n=47 (40.2%). For knowledge, all three groups display a good index score (mean score of 5.44). For attitude, PS and MO also display an index score of good (mean score of 5.81), while the PST index score was fair (4.82). For practice, our study shows a highest score of 7.14 (very good) among PST. However, these differences were not statistically significant (p> 0.05). Conclusion: Training in paediatric surgery must continue to emphasize professionalism and medical ethics education to deliver the best health care services.

Keywords: KAP, medical ethics, paediatric, surgeons, trainees

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Authors: Angelis P. Barlampas

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Purpose: A 29 years old woman presented in the emergency department with psychiatric symptoms. The psychiatrist ordered a computed tomography scan as part of a general examination. Material and methods: The CT showed bilateral enlarged choroid plexus structures mimicking papillomata and situated in the trigones of the lateral ventricles. The left choroid plexus was heavily calcified, but the right one has no any obvious calcifications. Results: It is well kown that any brain mass can present with behavioral changes and even psychiatric symptomatology. Papillomata of the ventricular system have been described to cause psychotic episodes. According to literature, choroid plexus papillomas are seldom neuroepithelial intraventricular tumors, which are benign and categorized as WHO grade 1 tumors. They are more common in the pediatric population, but they can occur in the adults, too1. In addition, the distinction between choroid plexus papilloma and carcinoma is very difficult and impossible by imagine alone. It can only be implied with more advanced imaging, such as arterial spin labeling and MRI. The final diagnosis is, of course, after surgical excision. The usual location in adults is the fourth ventricle, but in children, it is the lateral ventricles. Their imaging appearance is that of a solid vascular tumor, which enhances intensely after the intravenous administration of contrast material. One out of fourth tumors presents speckled calcifications1. In our case, there are symmetrically sized masses at the trigones, and there are no calcifications in one of them, whereas the other one is grossly calcified. Also, there is no obvious hydrocephalus or any other evidence of increased intracranial pressure. General conclusions: When there is a new psychiatric patient, someone must undergo any possible examination, and of course, a brain CT study should be done to exclude any rare organic causes that may be responsible for the disease.

Keywords: phycosis, intraventricular masses, CT, brain calcifications

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Authors: Suparna Bharadwaj, Sriganesh Kamath, Gopalakrishna K. N., Subhas Konar

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Introduction: Post-operative cognitive dysfunction (POCD) is a spectrum of clinical syndrome presenting as emergence delirium (ED) and/or post-operative delirium (POD). ED is a transient state (minutes to hours) of marked agitation after the discontinuation of general anesthesia, which does not respond to consoling measures. On the other hand, POD without identifiable etiology is not temporally related to emergence from anesthesia. These patients often emerge smoothly and may be lucid in the post-anesthesia care unit (PACU), but may develop fluctuating mental status, most commonly between postoperative days one and three. General anesthesia (GA) has been identified as a risk factor for POCD. Cranial surgeries involve brain handling in addition to exposure to GA. We hypothesize that the incidence of postoperative delirium after cranial surgery is twice that of spinal surgery. The primary objective of this study was to evaluate the incidence of emergence delirium and postoperative delirium in patients undergoing cranial and spinal neurosurgeries. The secondary objective was to identify the perioperative risk factors of ED and POD. Methods: This was a prospective cohort observation study conducted from March 2020 to September 2023 conducted at a tertiary neurocentre. After obtaining institutional ethics committee approval, adult patients undergoing cranial or spinal surgery with a Glasgow coma scale of 15 were included in the study. Patients undergoing cranial surgery are considered exposed to risk factors, while patients undergoing spinal surgery are considered unexposed. All study subjects received standard general anesthesia. About twenty perioperative parameters were identified as risk factors for POCD. ED was assessed using the Riker sedation agitation scale, and POD was assessed using the confusion assessment method. A sample size of 2000 patients was planned with 1000 each cranial and spinal cases. However, around 700 spinal patients could be recruited for this study. Results: In this study, about two thousand patients were screened for inclusion. However, 1185 cranial cases and 742 spinal cases were considered for final analysis. Both the groups were similar in terms of demographics. Incidence of ED was 25.8% after cranial surgery vs 10.24% after spinal surgery (relative risk 2.5). The incidence of POD after cranial surgery is 20.25% vs 2.15% after cranial surgery (relative risk 9.3). All the proposed risk factors were assessed using binomial logistic regression. Conclusion: Cranial cases expose patients to a nine times higher risk for the development of postoperative delirium. The presence of ED predisposes to POD representing a spectrum.

Keywords: post operative cognitive dysfunction, Neurosurgical patients cohort study, cohort study, emergence delirium

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Authors: José Eduardo García-Mendiola

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In this work, a phenomenological approach to computational modeling of analogy processing is carried out. The paper goes through the consideration of the structure of the analogy, based on the possibility of sustaining the genesis of its elements regarding Husserl's genetic theory of association. Among particular processes which take place in order to get analogical inferences, there is one which arises crucial for enabling efficient base cases retrieval through long-term memory, namely analogical transference grounded on familiarity. In general, it has been argued that analogical reasoning is a way by which a conscious agent tries to determine or define a certain scope of objects and relationships between them using previous knowledge of other familiar domain of objects and relations. However, looking for a complete description of analogy process, a deeper consideration of phenomenological nature is required in so far, its simulation by computational programs is aimed. Also, one would get an idea of how complex it would be to have a fully computational account of the analogy elements. In fact, familiarity is not a result of a mere chain of repetitions of objects or events but generated insofar as the object/attribute or event in question is integrable inside a certain context that is taking shape as functionalities and functional approaches or perspectives of the object are being defined. Its familiarity is generated not by the identification of its parts or objective determinations as if they were isolated from those functionalities and approaches. Rather, at the core of such a familiarity between entities of different kinds lays the way they are functionally encoded. So, and hoping to make deeper inroads towards these topics, this essay allows us to consider that cognitive-computational perspectives can visualize, from the phenomenological projection of the analogy process reviewing achievements already obtained as well as exploration of new theoretical-experimental configurations towards implementation of analogy models in specific as well as in general purpose machines.

Keywords: analogy, association, encoding, retrieval

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Authors: Seyed Ebrahim Hosseini, Shahbaz Pervez

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As people go through aging, maintenance and improvement of the quality of life become more important for them. To know the role of smartphone technology and communications applications on quality of life, a sample group of old people living in Dar-Iran was selected for a quasi-experimental study. The participants were registered senior inhabitants from public health centers in Dar, Iran in 2022. The number of participants was 39. Participants were randomly categorized into intervention and control groups. A validated Persian version of the Control, Autonomy, Self-realisation, Pleasure scale (CASP-19) scale questionnaire was provided for them which answers were used for the quality of life assessment. The paired t-test between pre-and post-test (t= -8.45, p<.00), post-and follow-up-test (t= -2.12, p=.01), and pre-test and the follow-up test (t= -8.27, p<.00) in the intervention group revealed a considerable mean difference. Based on the results of paired t-test for the control group, this was not significant between pre-test and post-test (t= 1.26, p=.15), post-test and follow-up test (t= .33, p=.67) and pre-test and follow-up test (t= 1.85, p=.08) for quality of life. Considering the educational training associated with it, this study aimed at helping families and aging field practitioners to understand the essentiality of modern communication technology teaching in promoting a greater life quality of the elderly’s community.

Keywords: Iranian elderly, quality of life, smartphone, social applications, CASP-19

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Authors: Vaida Zemlickiene

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Scientists around the world and practitioners are working to identify the factors that influence the results of technology commercialization and to propose the ideal model for the technology commercialization process. In other words, all stakeholders of technology commercialization seek to find a formula or set of rules to succeed in commercializing technologies in order to avoid unproductive investments. In this article, the process of commercialization technology is understood as the process of transforming inventions into marketable products, services, and processes, or the path from the idea of using an invention to a product that incorporates process from 1 to 9 technology readiness level (TRL). There are many publications in the field of management literature, which are aimed at managing the commercialization process. However, there is an apparent lack of research for communication in decision-making in the process of technology commercialization. Works were done in the past, and the last decade's global research analysis led to the unambiguous conclusion that the methodological framework is not mature enough to be of practical use in business. The process of technology commercialization and the decisions made in the process should be explored in-depth. An archival analysis is performed to find insights into decision-making communication in the process of technologies commercialization, to find out the content of technology commercialization process: decision-making stages and participants, to analyze the internal factors of technology commercialization, to perform their critical analysis, to analyze the concept of successful/unsuccessful technology commercialization.

Keywords: the process of technology commercialization, communication in decision-making process, the content of technology commercialization process, successful/unsuccessful technology commercialization

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Authors: Anjelika Kremer, Irina Nachimov, Dan Justo

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Background: C-reactive protein (CRP) serum levels are commonly measured in hospitalized patients. Elevated admission CRP serum levels and in-hospital mortality has been seldom studied in the general population of elderly patients admitted to the acute Geriatrics department. Methods: A retrospective cross-sectional study was conducted at a tertiary medical center. Included were all elderly patients (age 65 years or more) admitted to a single acute Geriatrics department from the emergency room between April 2014 and January 2015. CRP serum levels were measured routinely in all patients upon the first 24 hours of admission. A logistic regression analysis was used to study if admission CRP serum levels were associated with in-hospital mortality independent of age, gender, functional status, and co-morbidities. Results: Overall, 498 elderly patients were included in the analysis: 306 (61.4%) female patients and 192 (38.6%) male patients. The mean age was 84.8±7.0 years (median: 85 years; IQR: 80-90 years). The mean admission CRP serum levels was 43.2±67.1 mg/l (median: 13.1 mg/l; IQR: 2.8-51.7 mg/l). Overall, 33 (6.6%) elderly patients died during the hospitalization. A logistic regression analysis showed that in-hospital mortality was independently associated with history of stroke (p < 0.0001), heart failure (p < 0.0001), and admission CRP serum levels (p < 0.0001) – and to a lesser extent with age (p = 0.042), collagen vascular disease (p=0.011), and recent venous thromboembolism (p=0.037). Receiver operating characteristic (ROC) curve showed that admission CRP serum levels predict in-hospital mortality fairly with an area under the curve (AUC) of 0.694 (p < 0.0001). Cut-off value with maximal sensitivity and specificity was 19.7 mg/L. Conclusions: Admission CRP serum levels may be used to predict in-hospital mortality in the general population of elderly patients admitted to the acute Geriatrics department.

Keywords: c-reactive protein, elderly, mortality, prediction

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Authors: Elizabeth R. LaFave, Grayson Sink, Anna Vassallo, Samantha Mills, Eli G. Hvastkovs

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Throughout history and into modern times, the continuation of male influence over female healthcare has created inadequacies in availability and access to treatments, often further limited in rural communities. The historical plight of women in healthcare can be understood by studying the advancements made by women in the field, both through their career arcs and by delving into the treatments they offer. An early example is the case of Martha Ballard (1735-1812), a midwife in New York who practiced when female practitioners were dismissed in favor of less educated male physicians, which was a well-accepted practice into the twentieth century. In order to overcome these setbacks, a strategy used by some female practitioners was to develop and market their own remedies in an attempt to better serve female patients. By highlighting the compromises and social manipulation of female entrepreneurs, in comparison with the medicines they developed and used, we can map their ability to carve a specific niche for themselves and their targeted customers. The application of modern chemical approaches in a historical context serves to enhance a variety of perspectives within the museum sphere necessary for the comprehension and understanding of the female plight in both medical care and service. In order to further examine the overall bias and scrutiny for women in the medical field, specifically those undertaking entrepreneurial roles, examples of alternative remedies from female founders will be analyzed utilizing these approaches. Modern analytical chemistry techniques, specifically mass spectrometry (MS), have been successful in offering compositional analyses for both labeled and unlabeled ingredients in old medicines. Previously, we have analyzed two forms of alternative treatment options created by male medical professionals to address lingering historical questions of purity and validity. Although primarily sugar based, both Humphreys’ Specifics and Boericke & Tafel remedies also contained unique ingredients, albeit in small quantities, with medicinal properties. Here, we applied the same methodology to study another highly politicized 19th-century debate surrounding the contribution and role of women in the medical profession through analyzing three remedies, each from a different female-led manufacturing company; Mrs. Joe Persons, Lydia Pinkham, and Winslow’s Syrups. Following MS analyses for both labeled and unlabeled ingredients, both Winslow’s and Pinkham’s remedies were similar to their male counterparts in advertisement strategy, targeted customer base, and overall composition of remedy (primarily sugar-based with small amounts of unique ingredients). In effect, these unbiased chemical assessments are used to dissect the rationality of both market and physician criticism for each individual manufacturer through assessment of authenticity, benefaction, and comparison among female entrepreneurs and their aims to enter the medical community (i.e., geographic location, market size). Our work aims to increase collaboration between STEM (Science, Technology, Engineering, Mathematics)-based fields and historical museum studies on a larger scale while also answering questions of potential bias towards females in the medical community as means of comparison to their male counterparts and in-depth historical analyses to unravel individual strategies to overcome the setback.

Keywords: nineteenth-century medicine, alternative remedies, female healthcare, chemical analyses, mass spectrometry

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Authors: Alireza Nikbakht Shahbazi

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There are various factors that affect climate changes; drought is one of those factors. Investigation of efficient methods for estimating climate change impacts on drought should be assumed. The aim of this paper is to investigate climate change impacts on drought in Karoon3 watershed located south-western Iran in the future periods. The atmospheric general circulation models (GCM) data under Intergovernmental Panel on Climate Change (IPCC) scenarios should be used for this purpose. In this study, watershed drought under climate change impacts will be simulated in future periods (2011 to 2099). Standard precipitation index (SPI) as a drought index was selected and calculated using mean monthly precipitation data in Karoon3 watershed. SPI was calculated in 6, 12 and 24 months periods. Statistical analysis on daily precipitation and minimum and maximum daily temperature was performed. LRAS-WG5 was used to determine the feasibility of future period's meteorological data production. Model calibration and verification was performed for the base year (1980-2007). Meteorological data simulation for future periods under General Circulation Models and climate change IPCC scenarios was performed and then the drought status using SPI under climate change effects analyzed. Results showed that differences between monthly maximum and minimum temperature will decrease under climate change and spring precipitation shall increase while summer and autumn rainfall shall decrease. The precipitation occurs mainly between January and May in future periods and summer or autumn precipitation decline and lead up to short term drought in the study region. Normal and wet SPI category is more frequent in B1 and A2 emissions scenarios than A1B.

Keywords: climate change impact, drought severity, drought frequency, Karoon3 watershed

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Authors: Abrar Almutairi, Alyaa Farouk, Amal Gouda

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Background: Social capital is a factor that helps in bonding in a social network. The individual and the neighborhood social capital affect the health status of members of a particular society. In addition, to the influence of social health on the health of the population, social health has a significant effect on women, especially those with pregnancy. Study objective was to assess the impact of the social capital on the health status of pregnant women Design: A descriptive crosssectional correlational design was utilized in this study. Methods: A convenient sample of 210 pregnant women who attended the outpatient antenatal clinicsfor follow-up in King Fahad hospital (Ministry of National Guard Health Affairs/Riyadh) and King Abdullah bin Abdelaziz University Hospital (KAAUH, Ministry of Education /Riyadh) were included in the study. Data was collected using a self-administered questionnaire that was developed by the researchers based on the “World Bank Social Capital Assessment Tool” and SF-36 questionnaire (Short Form Health Survey). The questionnaire consists of 4 parts to collect information regarding socio-demographic data, obstetric and gynecological history, general scale of health status and social activity during pregnancy and the social capital of the study participants, with different types of questions such as multiple-choice questions, polar questions, and Likert scales. Data analysis was carried out by using Statistical Package for the Social Sciences version 23. Descriptive statistic as frequency, percentage, mean, and standard deviation was used to describe the sample characteristics, and the simple linear regression test was used to assess the relationship between the different variables, with level of significance P≤0.005. Result: This study revealed that only 31.1% of the study participants perceived that they have good general health status. About two thirds (62.8%) of the participants have moderate social capital, more than one ten (11.2٪) have high social capital and more than a quarter (26%) of them have low social capital. All dimensions of social capital except for empowerment and political action had positive significant correlations with the health status of pregnant women with P value ranging from 0.001 to 0.010in all dimensions. In general, the social capital showed high statistically significant association with the health status of the pregnant (P=0.002). Conclusion: Less than one third of the study participants had good perceived health status, and the majority of the study participants have moderate social capital, with only about one ten of them perceived that they have high social capital. Finally, neighborhood residency area, family size, sufficiency of income, past medical and surgical history and parity of the study participants were all significantly impacting the assessed health domains of the pregnant women.

Keywords: impact, social capital, health status, pregnant women

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Authors: Chiahsu Yang, Peiling Wu, Ted Ho

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From emphasizing economic development to stressing public happiness, the international community mainly hopes to be able to understand whether the quality of life for the public is becoming better. The Better Life Index (BLI) constructed by OECD uses living conditions and quality of life as starting points to cover 11 areas of life and to convey the state of the general public’s well-being. In light of the BLI framework, the Directorate General of Budget, Accounting and Statistics (DGBAS) of the Executive Yuan instituted the Gross National Happiness Index to understand the needs of the general public and to measure the progress of the aforementioned conditions in residents across the island. Whereas living conditions consist of income and wealth, jobs and earnings, and housing conditions, health status, work and life balance, education and skills, social connections, civic engagement and governance, environmental quality, personal security. The ICT area consists of health care, living environment, ICT-enabled communication, transportation, government, education, pleasure, purchasing, job & employment. In the wake of further science and technology development, rapid formation of information societies, and closer integration between lifestyles and information societies, the public’s well-being within information societies has indeed become a noteworthy topic. the Board of Science and Technology of the Executive Yuan use the OECD’s BLI as a reference in the establishment of the Taiwan-specific ICT-Enabled Better Life Index. Using this index, the government plans to examine whether the public’s quality of life is improving as well as measure the public’s satisfaction with current digital quality of life. This understanding will enable the government to gauge the degree of influence and impact that each dimension of digital services has on digital life happiness while also serving as an important reference for promoting digital service development. The content of the ICT Enabled Better Life Index. Information and communications technology (ICT) has been affecting people’s living styles, and further impact people’s quality of life (QoL). Even studies have shown that ICT access and usage have both positive and negative impact on life satisfaction and well-beings, many governments continue to invest in e-government programs to initiate their path to information society. This research is the few attempts to link the e-government benchmark to the subjective well-being perception, and further address the gap between user’s perception and existing hard data assessment, then propose a model to trace measurement results back to the original public policy in order for policy makers to justify their future proposals.

Keywords: information and communications technology, quality of life, satisfaction, well-being

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Authors: Samar Mousa, Ryan Kerstein, Mohanad Adam

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Regional anaesthesia has been associated with favourable outcomes in patients undergoing a wide range of surgeries. Beneficial effects have been demonstrated in terms of postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia. Our project aimed at assessing the regional anaesthesia practice in the plastic surgery department of Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. It is a retrospective study associated with a questionnaire filled out by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). The operative notes of all patients who had an operation under plastic surgery, whether emergency or elective, were reviewed. The criteria of suitable candidates for the regional block were put by the consultant anaesthetists as follows: age above 16, single surgical site (arm, forearm, leg, foot), no drug allergy, no pre-existing neuropathy, no bleeding disorders, not on ant-coagulation, no infection to the site of the block. For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the previously mentioned criteria. However, only seven patients had their operations under the regional block, and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled out by both plastic surgeons and anaesthetists of different training levels to find out the reasons behind the obvious preference for general over regional anaesthesia, even if this was against the patients’ interest. The questionnaire included the following points: training level, time taken to give GA or RA, factors that influence the decision, percentage of RA candidates that had GA, reasons behind this percentage, recommendations. Forty-four clinicians filled out the questionnaire, among which were 23 plastic surgeons and 21 anaesthetists. As regards the training level, there were 21 consultants, 4 associate specialists, 9 registrars, and 10 senior house officers. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. The replies estimated this percentage as between 10-30%. 29% of the respondents thought that this percentage is because of surgeons’ preference to have GA rather than RA for their operations without medical support for the decision. 37% of the replies thought that anaesthetists prefer giving GA even if the patient is a suitable candidate for RA. 22.6% of the replies thought that patients refused to have RA, and 11.3% had other causes. The recommendations were in 5 main accesses, which are protocols and pathways for regional blocks, more training opportunities for anaesthetists on regional blocks, providing a separate block room in the hospital, better communication between surgeons and anaesthetists, patient education about the benefits of regional blocks.

Keywords: regional anaesthesia, regional block, plastic surgery, general anaesthesia

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Authors: Odoh Ben Uruchi

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Information Technology is an outcome of the nexus between the computer technology and the communication technology which has grown as silver fiber in Nigeria. Information Technology represents the fourth generation of human communication after sight, oral and written communications. The internet, as with all path-breaking technological developments gives us all the ample privileges to act as a global community; advertise and operate across all frontiers; over boarders and beyond the control of any government. The security concerns, computer abuse and the side effects of this technology have moved to the forefront of the consciousness of law enforcement agencies. Unfortunately, Nigeria is one of the very few countries in the world to have not legislated Cyber Laws, although several unsuccessful attempts have been made in recent times at providing the legal framework for regulating the activities in Nigerian cyberspace. Traditional legal systems have led to great difficulty in keeping pace with the rapid growth of the internet and its impact throughout Nigeria. The only existing legal frameworks are constantly being challenged by technological advancement. This has created a need to constantly update and adapt the way in which we organize ourselves as Legal Practitioners in order to maintain overall control of its domestic and national interests. This paper seeks to appraise the challenges facing the legal profession in Nigeria because of want of Cyber Laws. In doing this, the paper shall highlight the loopholes in the existing laws and recommends the way forward.

Keywords: information technology, challenges, legal profession, Nigeria

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