Search results for: Chinese healthcare system reform

Authors: Arun Kumar, Neelesh Haulder

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This paper identifies and resolves some key issues relating to a specific aspect within the supply chain logistics of the public health care industry in the Republic of Mauritius. The analysis and the proposed solution are performed using soft systems methodology (SSM). Through the application of this relevant systematic approach at problem solving, the aim is to obtain an in-depth analysis of the problem, incorporating every possible world view of the problem and consequently to obtain a well explored solution aimed at implementing relevant changes within the current supply chain logistics of the health care industry, with the purpose of tackling the key identified issues.

Keywords: soft systems methodology, CATWOE, healthcare, logistics

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Authors: Weiqi Xia

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We assess the perceptions of China’s hotel m-bookers using the E-SERVQUAL model and technology affordance assessment metrics. The data analysis provides insight into Chinese hotel m-bookers’ perceptions of information quality items, system quality items, and functional quality items. Respondents’ perceived value of such items is greatly enhanced via mini-program support and self-service innovation, which are predicted to be of increasing importance in the future. The findings of this study help close the gap between hotel operators’ understanding and customers’ perceptions. Our findings may also provide valuable insights into the functioning of China’s hotel industry.

Keywords: mobile hotel booking, hotel m-bookers, user perception, China’s WeChat mini program, hotel booking apps.

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Authors: Szu-Mei Hsiao

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Many nurses have concerns about the difficulties of providing spiritual care for ethnic-Chinese patients and family members within their cultural context. This is due to a lack of knowledge and training. Most family caregivers are female. There has been little research exploring the potential impact of Chinese cultural values on the spiritual distress of couple dyadic participants in Taiwan. This study explores the spiritual issues of Taiwanese women coping with their husband’s advanced cancer during palliative care to death. Qualitative multiple case studies were used. Data was collected through participant observation and in-depth face-to-face interviews. Transcribed interview data was analyzed by using qualitative content analysis. Three couples were recruited from a community-based rural hospital in Taiwan where the husbands were hospitalized in a medical ward. Four spiritual distress themes emerged from the analysis: (1) A personal conflict in trying to come to terms with love and forgiveness; the inability to forgive their husband’s mistakes; and, lack of their family’s love and support. (2) A feeling of hopelessness due to advanced cancer, such as a feeling of disappointment in their destiny and karma, including expressing doubt on survival. (3) A feeling of uncertainty in facing death peacefully, such as fear of facing the unknown world; and, (4) A feeling of doubt causing them to question the meaning and values in their lives. This research has shown that caregivers needed family support, friends, social welfare, and the help of their religion to meet their spiritual needs in coping within the final stages of life and death. The findings of this study could assist health professionals to detect the spiritual distress of ethnic-Chinese patients and caregivers in the context of their cultural or religious background as early as possible.

Keywords: advanced cancer, Buddhism, Confucianism, Taoism, qualitative research, spiritual distress

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity is associated with significant personal impacts on health and has a substantial economic burden on payers due to increased healthcare use. A contemporary estimate of the healthcare costs associated with obesity at the population level are lacking. This evidence may provide further rationale for weight management strategies. Methods: Adults who underwent a medical procedure between 2012 and 2019 in Alberta, Canada were categorized into the investigational cohort (had body mass index [BMI]-defined class 2 or 3 obesity based on a procedure-associated code) and the control cohort (did not have the BMI procedure-associated code); those who had bariatric surgery were excluded. Characteristics were presented and healthcare costs ($CDN) determined over a 1-year observation period (2019/2020). Logistic regression and a generalized linear model with log link and gamma distribution were used to assess total healthcare costs (comprised of hospitalizations, emergency department visits, ambulatory care visits, physician visits, and outpatient prescription drugs); potential confounders included age, sex, region of residence, and whether the medical procedure was performed within 6-months before the observation period in the partial adjustment, and also the type of procedure performed, socioeconomic status, Charlson Comorbidity Index (CCI), and seven obesity-related health conditions in the full adjustment. Cost ratios and estimated cost differences with 95% confidence intervals (CI) were reported; incremental cost differences within the adjusted models represent referent cases. Results: The investigational cohort (n=220,190) was older (mean age: 53 standard deviation [SD]±17 vs 50 SD±17 years), had more females (71% vs 57%), lived in rural areas to a greater extent (20% vs 14%), experienced a higher overall burden of disease (CCI: 0.6 SD±1.3 vs 0.3 SD±0.9), and were less socioeconomically well-off (material/social deprivation was lower [14%/14%] in the most well-off quintile vs 20%/19%) compared with controls (n=1,955,548). Unadjusted total healthcare costs were estimated to be 1.77-times (95% CI: 1.76, 1.78) higher in the investigational versus control cohort; each healthcare resource contributed to the higher cost ratio. After adjusting for potential confounders, the total healthcare cost ratio decreased, but remained higher in the investigational versus control cohort (partial adjustment: 1.57 [95% CI: 1.57, 1.58]; full adjustment: 1.21 [95% CI: 1.20, 1.21]); each healthcare resource contributed to the higher cost ratio. Among urban-dwelling 50-year old females who previously had non-operative procedures, no procedures performed within 6-months before the observation period, a social deprivation index score of 3, a CCI score of 0.32, and no history of select obesity-related health conditions, the predicted cost difference between those living with and without obesity was $386 (95% CI: $376, $397). Conclusions: If these findings hold for the Canadian population, one would expect an estimated additional $3.0 billion per year in healthcare costs nationally related to BMI-defined obesity (based on an adult obesity rate of 26% and an estimated annual incremental cost of $386 [21%]); incremental costs are higher when obesity-related health conditions are not adjusted for. Results of this study provide additional rationale for investment in interventions that are effective in preventing and treating obesity and its complications.

Keywords: administrative data, body mass index-defined obesity, healthcare cost, real world evidence

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Authors: Lin Fu-Gong

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Background: As WHO announced, people with intellectual disability (ID) were vulnerable to mental health problems. And there were few custom-made mental health scales for those people to monitor their mental health. Those people with mental problems often accompanied worse prognosis and usually became to be a heavier burden on the caregivers. Purpose: In this study, we intend to develop a psychopathy scale as a practical tool for monitoring the mental health for people with ID living in institute. Methods: In this study, we adopt the Psychopathology Inventory for Mentally Retarded Adults developed by professor Matson with certified reliability and validity in Western countries with Dr. Matson’s agreement in advance. We first translated the inventory into Chinese validated version considering the domestic culture background in the past year. And the validity and reliability evaluation of mental health status using this inventory among the people with intellectual living in the institute were done. Results: The inventory includes eight psychiatric disorder scales as schizophrenic, affective, psychosexual, adjustment, anxiety, somatoform, personality disorders and inappropriate mental adjustment. Around 83% of 40 invested people, who randomly selected from the institute, were found to have at least one disorder who were recommended with medical help by two evaluators. Among the residents examined, somatoform disorder and inappropriate mental adjustment were most popular with 60% and 78% people respectively. Conclusion: The result showed the prevalence psychiatric disorders were relatively high among people with ID in institute and the mental problems need to be further cared and followed for their mental health. The results showed that the psychopathology inventory was a useful tool for institute caregiver, manager and for long-term care policy to the government. In the coming stage, we plan to extend the use of the valid Chinese version inventory among more different type institutes for people with ID to establish their dynamic mental health status including medical need, relapse and rehabilitation to promote their mental health.

Keywords: intellectual disability, psychiatric disorder, psychopathology inventory, mental health, the institute

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Authors: Smita Nepal

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Despite being on the global education reform agenda for over two decades, interpretations and practices of inclusive education vary widely across the world. In Nepal, similar to many other developing countries, inclusive education is still an emerging concept and limited research is available to date in relation to how inclusive education is conceptualized and implemented here. Moreover, very little is known about how teachers who are at the frontline of providing inclusive education understand this concept and how well they are prepared to teach inclusively. This study addresses this research gap by investigating an overarching research question, ‘How prepared are Nepalese teachers to practice inclusive pedagogy?’ Different societies and cultures may have different interpretations of the concepts of diversity and inclusion. Acknowledging that such contextual differences influence how these issues are addressed, such as preparing teachers for providing inclusive education, this study has investigated the research questions using a sociocultural conceptual framework. A sequential mixed-method research design involved quantitative data from 203 survey responses collected in the first phase, followed by qualitative data in the second phase collected through semi-structured interviews with teachers. Descriptive analysis of the quantitative data and reflexive thematic analysis of the qualitative data revealed a narrow understanding of inclusive education in the participating Nepalese teachers with limited preparedness for implementing inclusive pedagogy. Their interpretation of inclusion substantially included the need for non-discrimination and the provision of equal opportunities. This interpretation was found to be influenced by the social context where a lack of a deep understanding of human diversity was reported, leading to discriminatory attitudes and practices. In addition, common norms established in society that experiencing privileges or disadvantages was normal for diverse groups of people appeared to have led to limited efforts to enhance teachers’ understanding of and preparedness for inclusive education. This study has significant implications, not only in the Nepalese context but globally, for reform in policies and practices and for strengthening the teacher education and professional development system to promote inclusion in education. In addition, the significance of this research lies in highlighting the importance of further context-specific research in this area to ensure inclusive education in a real sense by valuing socio-cultural differences.

Keywords: inclusive education, inclusive pedagogy, sociocultural context, teacher preparation

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Authors: Umamaheswari Shanmugam, Silvia Ronchi

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that can use the large amount and variety of data generated during healthcare services every day; one of the significant advantages of these new technologies is the ability to get experience and knowledge from real-world use and to improve their performance continuously. Healthcare systems and institutions can significantly benefit because the use of advanced technologies improves the efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and protect patients' safety. The evolution and the continuous improvement of software used in healthcare must consider the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device's approval. Still, they are necessary to ensure performance, quality, and safety. At the same time, they can be a business opportunity if the manufacturer can define the appropriate regulatory strategy in advance. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems

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Authors: Sharda Kumari

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As the Covid-19 pandemic continues to leave its mark on the global business landscape, companies have had to adapt to new realities and find ways to sustain their operations amid social distancing measures, government restrictions, and heightened public health concerns. This unprecedented situation has placed considerable stress on both employees and employers, underscoring the need for innovative approaches to manage the risks associated with Covid-19 transmission in the workplace. In response to these challenges, the pandemic has accelerated the adoption of digital technologies, with an increasing preference for remote interactions and virtual collaboration. Customer relationship management (CRM) systems have risen to prominence as a vital resource for organizations navigating the post-pandemic world, providing a range of benefits that include acquiring new customers, generating insightful consumer data, enhancing customer relationships, and growing market share. In the context of pandemic management, CRM systems offer three primary advantages: (1) integration features that streamline operations and reduce the need for multiple, costly software systems; (2) worldwide accessibility from any internet-enabled device, facilitating efficient remote workforce management during a pandemic; and (3) the capacity for rapid adaptation to changing business conditions, given that most CRM platforms boast a wide array of remotely deployable business growth solutions, a critical attribute when dealing with a dispersed workforce in a pandemic-impacted environment. These advantages highlight the pivotal role of CRM systems in helping organizations remain resilient and adaptive in the face of ongoing global challenges.

Keywords: healthcare, CRM, customer relationship management, customer experience, digital transformation, pandemic response, patient monitoring, patient management, healthcare automation, electronic health record, patient billing, healthcare information systems, remote workforce, virtual collaboration, resilience, adaptable business models, integration features, CRM in healthcare, telehealth, pandemic management

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Authors: Tianchen Dai

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Shantytowns are special historical products in china, possessing strong particularity and typicality, the theoretical value and the practical significance of which are deemed to hold great importance in the modern development of residential areas in China. The renovation planning of shantytowns can be very challenging in terms of cultural inheritance. The traditional lifestyle, one of the key elements building up residents’ perception of affiliation, should be carried forward in the renovation planning of shantytowns. Mobile vending can be considered as a rare business model survived within modern commercial environment, thanks to the unique spatial characteristics of Chinese shantytowns. This article mainly investigates the unique phenomenon of mobile vending in shantytowns, discussing the operating mechanism and rationality behind this commercial phenomenon. For humanistic concern, the innovative conservation of mobile vending, as a means to preserve the vivacious traditional lifestyle of local residents, can be realized through substantial urban design strategies, including spatial design of public space, height control of the facades, and traffic management around and inside shantytowns.

Keywords: cultural inheritance, mobile vending, renovation planning, shantytowns

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Authors: Xining Wang

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After-school educational service has been proven that it could benefit children’s academic performance, socio-emotional skills, and physical health level. However, there is little research demonstrating parents’ perspectives on the choice of after-school educational service from a level of cross-cultural backgrounds. China and Ireland are typical representatives of collectivist countries (e.g., estimated individualism score is 20) and individualist countries (e.g., estimated individualism score is 70) according to Hofstede's cultural dimensions theory. Living in countries with distinguished cultural backgrounds, there is an evident discrepancy in parents’ attitudes towards domestic after-school education and parents’ motivations for choosing after-school educational services. Through conducting a semi-structured interview with 15 parents from China and 15 parents from Ireland, using thematic analysis software (ATLAS) to extract the key information, and applying a comparative approach to process data analysis; results present polarization of Chinese and Irish parents' perspectives and motivations on after-school educational service. For example, Chinese parents tend to view after-school education as a complement to school education. It is a service they purchased for their children to acquire extra knowledge and skills so that they could adapt to the highly competitive educational setting. Given the fact that children’s education is a priority for Chinese families, most parents believe that their children would succeed in the future through massive learning. This attitude reflects that Chinese parents are more likely to apply authoritarian parenting methods and having a strong expectations for their children. Conversely, Irish parents' choice of after-school educational service is a consideration that primarily based on their own situation, secondly, for their family. For instance, with the expansion of the labor market, there is a change in household structure. Irish mothers are more likely to seek working opportunities instead of looking after the family. Irish parents view that after-school educational service is an essential need for themselves and a beneficial component for their family due to the external pressure (e.g., the growing work intensity and extended working hours, increasing numbers of separated families, as well as parents’ pursuit of higher education and promotion). These factors are fundamental agents that encourage Irish parents to choose after-school educational services. To conclude, the findings could provide readers with a better understanding of parents’ disparate and contrasting perspectives on after-school educational services from a multi-culture level.

Keywords: after-school, China, family studies, Ireland, parents

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Authors: Ziwei Guo, Liangping Hong, Zhiguo Ye

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The exogenous modernization process in China and other late-coming countries, is not resulted from a gradual growth of their own modernity features, but a conscious response to external challenges. Under this context, it had been equally important for Chinese cities to make themselves ‘Chinese’ as well as ‘modern’. Wuhan was the first opened inland treaty port in late Qing Dynasty. In the following one hundred years, Wuhan transferred from a feudal town to a modern industrial city. It is a good example to illustrate the urban construction and cultural heritage through the process and impact of social transformation. An overall perspective on transformation will contribute to develop the city`s uniqueness and enhance its inclusive development. The study chooses the history of Wuhan from 1861 to 1957 as the study period. The whole transformation process will be divided into four typical periods based on key historical events, and the paper analyzes the changes on urban structure and constructions activities in each period. Then, a lot of examples are used to compare the features of Wuhan modern city heritage in the four periods. In this way, three characteristics of Wuhan modern city heritage are summarized. The paper finds that globalization and localization worked together to shape the urban physical space environment. For Wuhan, social transformation has a profound and comprehensive impact on urban construction, which can be analyzed in the aspects of main construction, architecture style, location and actors. Moreover, the three towns of Wuhan have a disparate cityscape that is reflected by the varied heritages and architecture features over different transformation periods. Lastly, the protection regulations and conservation planning of heritage in Wuhan are discussed, and suggestions about the conservation of Wuhan modern heritage are tried to be drawn. The implications of the study are providing a new perspective on modern city heritage for cities like Wuhan, and the future local planning system and heritage conservation policies can take into consideration the ‘Modern Cultural Transformation Route’ in this paper.

Keywords: modern city heritage, transformation, identity, Wuhan

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Authors: Ahmad Abdul-Razzak Aboudi Al-Issa

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Thermal is the main important aspect in any hydraulic system since it is affected on the hydraulic system performance. Therefore must be simulated the hydraulic system -that was designed- in this aspect before constructing it. In this study, an existed expert system was using to simulate the thermal aspect of a designed hydraulic system that will be used in an industrial field. The expert system which is used in this study is (Hydraulic System Calculations), and its symbol (HSC). HSC had been designed and coded in an interactive program userfriendly named (Microsoft Visual Basic 2010).

Keywords: fluid power, hydraulic system, thermal and hydrodynamic, expert system

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Authors: D. Velayadum, P. Sthandiwe , N. Maharaj, T. Munien, S. Ndamase, G. Zulu, S. Xulu, F. Oosthuizen

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Introduction and aims of the study: It is the responsibility of the pharmacist to manage drug-related problems in order to ensure the greatest benefit to the patient. In order to prevent drug-related morbidity, pharmacists should be aware of medicines that may contribute to certain drug-related problems due to their pharmacological action. In an attempt to assist healthcare practitioners to prevent drug-related morbidity (PDRM), indicators for prevention have been designed. There are currently no indicators available for primary health care in developing countries like South Africa, where the majority of the population access primary health care. There is, therefore, a need to develop such indicators, specifically with the aim of assisting healthcare practitioners in primary health care. Methods: A literature study was conducted to compile a comprehensive list of PDRM indicators as developed internationally using the search engines Google Scholar and PubMed. MESH term used to retrieve suitable articles was 'preventable drug-related morbidity indicators'. The comprehensive list of PDRM indicators obtained from the literature study was further evaluated for face validity. Face validity was done in duplicate by 2 sets of independent researchers to ensure 1) no duplication of indicators when compiling a single list, 2) inclusion of only medication available in primary healthcare, and 3) inclusion of medication currently available in South Africa. Results: The list of indicators, compiled from PDRM indicators in the USA, UK, Portugal, Australia, India, and Canada contained 324 PDRM. 184 of these indicators were found to be duplicates, and the duplications were omitted, leaving a final list of 140. The 140 PDRM indicators were evaluated for face-validity, and 97 were accepted as relevant to primary health care in South Africa. 43 indicators did not comply with the criteria and were omitted from the final list. Conclusion: This study is a first step in compiling a list of PDRM indicators for South Africa. It is important to take cognizance to the fact the health systems differ vastly internationally, and it is, therefore, important to develop country-specific indicators.

Keywords: drug-related morbidity, primary healthcare, South Africa, developing countries

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Authors: Muhammad Fayyaz Nazir, Ellen Wayenberg, Shahzadaah Faahed Qureshi

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Introduction: The study is based on the Contextual Interaction Theory (CIT) constructs to explore the role of policy actors in implementing the COVID-19 Disease Prevention and Control (DP&C) Policy. The study analyzes the role of healthcare workers' contextual factors, such as cognition, motives, and resources, and their interactions in implementing Social Distancing (SD). In this way, we test a two actors policy implementation theory, i.e., the CIT in a three-actor context. Methods: Data was collected through document analysis and semi-structured interviews. For a qualitative study design, interviews were conducted with questions on cognition, motives, and resources from the healthcare workers involved in implementing SD in the local context in Multan – Pakistan. The possible interactions resulting from contextual factors of the policy actors – healthcare workers were identified through framework analysis protocol guided by CIT and supported by trustworthiness criterion and data saturation. Results: This inquiry resulted in theory application, addition, and enrichment. The theoretical application in the three actor's contexts illustrates the different levels of motives, cognition, and resources of healthcare workers – senior administrators, managers, and healthcare professionals. The senior administrators working in National Command and Operations Center (NCOC), Provincial Technical Committees (PTCs), and Districts Covid Teams (DCTs) were playing their role with high motivation. They were fully informed about the policy and moderately resourceful. The policy implementors: healthcare managers working on implementing the SD within their respective hospitals were playing their role with high motivation and were fully informed about the policy. However, they lacked the required resources to implement SD. The target medical and allied healthcare professionals were moderately motivated but lack of resources and information. The interaction resulted in cooperation and the need for learning to manage the future healthcare crisis. However, the lack of resources created opposition to the implementation of SD. Objectives of the Study: The study aimed to apply a two actors theory in a multi actors context. We take this as an opportunity to qualitatively test the theory in a novel situation of the Covid-19 pandemic and make way for its quantitative application by designing a survey instrument so that implementation researchers can apply CIT through multivariate analyses or higher-order statistical modeling. Conclusion: Applying two actors' implementation theory in exploring a complex case of healthcare intervention in three actors context is a unique work that has never been done before, up to the best of our knowledge. So, the work will contribute to the policy implementation studies by applying, extending, and enriching an implementation theory in a novel case of the Covi-19 pandemic, ultimately fulfilling the gap in implementation literature. Policy institutions and other low or middle-income countries can learn from this research and improve SD implementation by working on the variables with weak significance levels.

Keywords: COVID-19, disease prevention and control policy, implementation, policy actors, social distancing

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Authors: Muhammad Shahbaz Akhtar

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Background; Tuberculosis remains a significant public health challenge in Pakistan, with high incidence and prevalence rates, particularly among vulnerable populations. Addressing the TB burden requires comprehensive efforts to improve healthcare infrastructure, increase access to quality diagnosis and treatment services, raise public awareness, and address socioeconomic determinants of health. Objective; To assess the knowledge and practices of healthcare workers and patients regarding prevention of tuberculosis at a tertiary care hospital of Southern Punjab.Material and methods; Data will be collected from 135 healthcare workers and 135 TB patients visiting Nishtar Hospital, Multan in this descriptive cross – sectional study using non – probability consecutive sampling technique. Proper approval will be taken from Hospital authorities to conduct this study. Study participants will be recruited after taking informed written consent, describing them objectives of this study. The study participants will be ensured of their confidentiality of the data and interviewed to assess their knowledge and practices regarding prevention of tuberculosis. Data Analysis Procedure; Data will be entered and analyzed by using SPSS version 25 to calculated mean and standard deviation for the numerical data such as age, duration of disease and duration of experience. Frequencies and percentages will be calculated for gender, age groups, level of knowledge, qualification, designation and practices. Impact of confounders like gender, age groups, duration of experience, disease duration, years of experience and designation will be assessed by stratification. Post stratification chi – square test will be applied at 0.05 level of significance at 95 % CI.

Keywords: tuberculosis, data analysis, HIV/AIDS, preventable

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Authors: R. Stoyanova, R. Dimova, M. Tarnovska, T. Boeva, R. Dimov, I. Doykov

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Patient safety culture (PSC) is an essential component of quality of healthcare. Improving PSC is considered a priority in many developed countries. Specialized software platform for registration and evaluation of hospital patient safety culture has been developed with the support of the Medical University Plovdiv Project №11/2017. The aim of the study is to assess the status of PSC in Bulgarian hospitals and to compare it to that in USA and Croatian hospitals. Methods: The study was conducted from June 01 to July 31, 2018 using the web-based Bulgarian Version of the Hospital Survey on Patient Safety Culture Questionnaire (B-HSOPSC). Two hundred and forty-eight medical professionals from different hospitals in Bulgaria participated in the study. To quantify the differences of positive scores distributions for each of the 42 HSOPSC items between Bulgarian, Croatian and USA samples, the x²-test was applied. The research hypothesis assumed that there are no significant differences between the Bulgarian, Croatian and US PSCs. Results: The results revealed 14 significant differences in the positive scores between the Bulgarian and Croatian PSCs and 15 between the Bulgarian and the USA PSC, respectively. Bulgarian medical professionals provided less positive responses to 12 items compared with Croatian and USA respondents. The Bulgarian respondents were more positive compared to Croatians on the feedback and communication of medical errors (Items - C1, C4, C5) as well as on the employment of locum staff (A7) and the frequency of reported mistakes (D1). Bulgarian medical professionals were more positive compared with their USA colleagues on the communication of information at shift handover and across hospital units (F5, F7). The distribution of positive scores on items: ‘Staff worries that their mistakes are kept in their personnel file’ (RA16), ‘Things ‘fall between the cracks’ when transferring patients from one unit to another’ (RF3) and ‘Shift handovers are problematic for patients in this hospital’ (RF11) were significantly higher among Bulgarian respondents compared with Croatian and US respondents. Conclusions: Significant differences of positive scores distribution were found between Bulgarian and USA PSC on one hand and between Bulgarian and Croatian on the other. The study reveals that distribution of positive responses could be explained by the cultural, organizational and healthcare system differences.

Keywords: patient safety culture, healthcare, HSOPSC, medical error

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Authors: Mai Ali

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The abstract underscores the critical importance of junior paediatricians acquiring expertise in handling paediatric emergencies, with a particular focus on Diabetic Ketoacidosis (DKA). Existing literature reveals a wealth of research on healthcare professionals' knowledge regarding DKA, encompassing diverse cultural backgrounds and medical specialties. Consistently, challenges such as the absence of standardized protocols and inadequacies in training emerge as common issues across healthcare centres. This research proposal seeks to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom in managing DKA within various clinical contexts. The primary objective is to assess their level of competence and propose effective strategies to enhance DKA training comprehensively.

Keywords: DKA, knowledge, Junior paediatricians, local protocols

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Authors: Binger Lu

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It remains unclear whether second language (L2) speakers could use discourse context cues to predict upcoming information as native speakers do during online comprehension. Some researchers propose that L2 learners may have a reduced ability to generate predictions during discourse processing. At the same time, there is evidence that discourse-level cues are weighed more heavily in L2 processing than in L1. Previous studies showed that L1 prediction is sensitive to the global validity of predictive cues. The current study aims to explore whether and to what extent L2 learners can dynamically and strategically adjust their prediction in accord with the global validity of predictive cues in L2 discourse comprehension as native speakers do. In a self-paced reading experiment, Chinese native speakers (N=128), C-E bilinguals (N=128), and English native speakers (N=128) read high-predictable (e.g., Jimmy felt thirsty after running. He wanted to get some water from the refrigerator.) and low-predictable (e.g., Jimmy felt sick this morning. He wanted to get some water from the refrigerator.) discourses in two-sentence frames. The global validity of predictive cues was manipulated by varying the ratio of predictable (e.g., Bill stood at the door. He opened it with the key.) and unpredictable fillers (e.g., Bill stood at the door. He opened it with the card.), such that across conditions, the predictability of the final word of the fillers ranged from 100% to 0%. The dependent variable was reading time on the critical region (the target word and the following word), analyzed with linear mixed-effects models in R. C-E bilinguals showed reliable prediction across all validity conditions (β = -35.6 ms, SE = 7.74, t = -4.601, p< .001), and Chinese native speakers showed significant effect (β = -93.5 ms, SE = 7.82, t = -11.956, p< .001) in two of the four validity conditions (namely, the High-validity and MedLow conditions, where fillers ended with predictable words in 100% and 25% cases respectively), whereas English native speakers didn’t predict at all (β = -2.78 ms, SE = 7.60, t = -.365, p = .715). There was neither main effect (χ^²(3) = .256, p = .968) nor interaction (Predictability: Background: Validity, χ^²(3) = 1.229, p = .746; Predictability: Validity, χ^²(3) = 2.520, p = .472; Background: Validity, χ^²(3) = 1.281, p = .734) of Validity with speaker groups. The results suggest that prediction occurs in L2 discourse processing but to a much less extent in L1, witha significant effect in some conditions of L1 Chinese and anull effect in L1 English processing, consistent with the view that L2 speakers are more sensitive to discourse cues compared with L1 speakers. Additionally, the pattern of L1 and L2 predictive processing was not affected by the global validity of predictive cues. C-E bilinguals’ predictive processing could be partly transferred from their L1, as prior research showed that discourse information played a more significant role in L1 Chinese processing.

Keywords: bilingualism, discourse processing, global validity, prediction, self-paced reading

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Authors: David C. Nwogbo

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Examining the impact of federalism on good governance is crucial for enhancing governance in Nigeria. This study focuses on the Federal Capital Territory (FCT), Abuja, as a case study. Employing a descriptive survey design, data was collected to explore the relationship between federalism and good governance in Abuja, Nigeria. A stratified random sampling method was used to select 289 respondents from the population of Abuja. The sample size was determined using a formula based on precision and population size. A survey questionnaire was employed to gather information on respondents' demographics, perceptions, and experiences concerning federalism and good governance in the FCT. Descriptive statistics, such as percentages and means, were utilized to analyze the study's findings. The findings provided insights into the perceptions and experiences of residents of the FCT with regard to the relationship between federalism and good governance. The results of this study will be useful for policy and decision-making related to the implementation of these concepts in Nigeria and, more specifically, in the FCT, Abuja. The study found that the majority of respondents believe that the federal system of government has not been effective in promoting accountability, transparency, and reducing corruption in Nigeria. There is a need for reforms to improve the effectiveness of the federal system in promoting good governance. These reforms include strengthening institutions, reallocation of resources, reform of the electoral system, decentralization of power, strengthening the role of the judiciary, capacity building, promoting transparency, and engagement of civil society. The findings also highlight the need for significant reforms to address these challenges and promote good governance in the country. The results of this study can be used to inform policy decisions and guide future research on the subject.

Keywords: accountability, federalism, good, governance

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Authors: Yichao Lv, Minmin Cai, Yanqiang Tao, Xinyuan Zou, Chao Zhang, Xiangping Liu

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Objective: This study aims to explore the network structure of personality traits and mental health and identify key factors for effective intervention strategies. Methods: All participants (N = 6,067; 3,368 females) underwent the Eysenck Personality Scale (EPQ) to measure personality traits and the Symptom Self-rating Scale (SCL-90) to measure psychiatric symptoms. Using the mean value of the SCL-90 total score plus one standard deviation as the cutoff, 854 participants (14.08%; 528 females) were categorized as individuals exhibiting potential psychological symptoms and were included in the follow-up network analysis. The structure and bridge centrality of the network for dimensions of EPQ and SCL-90 were estimated. Results: Between the EPQ and SCL-90, psychoticism (P), extraversion (E), and neuroticism (N) showed the strongest positive correlations with somatization (Som), interpersonal sensitivity (IS), and hostility (Hos), respectively. Extraversion (E), somatization (Som), and anxiety (Anx) were identified as the most important bridge factors influencing the overall network. Conclusions: This study explored the network structure and complex connections between mental health and personality traits from a network perspective, providing potential targets for intervening in adolescent personality traits and mental health.

Keywords: EPQ, SCL-90, Chinese adolescents, network analysis

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Authors: Jia Guo, Qinyuan Huang, Qinyi Zhong, Yanjing Zeng, Yimeng Li, James Wiley, Kin Cheung, Jyu-Lin Chen

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Context: Mothers with abdominal obesity, particularly in China, face challenges in managing their health due to family responsibilities. Existing diabetes prevention programs do not cater specifically to this demographic. Research Aim: To assess the feasibility, acceptability, and efficacy of an mHealth-based diabetes prevention program tailored for Chinese mothers with abdominal obesity in reducing weight-related variables and diabetes risk. Methodology: A randomized controlled trial was conducted in Changsha, China, where the mHealth group received personalized modules and health messages, while the control group received general health education. Data were collected at baseline, 3 months, and 6 months. Findings: The mHealth intervention significantly improved waist circumference, modifiable diabetes risk scores, daily steps, self-efficacy for physical activity, social support for physical activity, and physical health satisfaction compared to the control group. However, no differences were found in BMI and certain other variables. Theoretical Importance: The study demonstrates the feasibility and efficacy of a tailored mHealth intervention for Chinese mothers with abdominal obesity, emphasizing the potential for such programs to improve health outcomes in this population. Data Collection: Data on various variables including weight-related measures, diabetes risk scores, behavioral and psychological factors were collected at baseline, 3 months, and 6 months from participants in the mHealth and control groups. Analysis Procedures: Generalized estimating equations were used to analyze the data collected from the mHealth and control groups at different time points during the study period. Question Addressed: The study addressed the effectiveness of an mHealth-based diabetes prevention program tailored for Chinese mothers with abdominal obesity in improving various health outcomes compared to traditional general health education approaches. Conclusion: The tailored mHealth intervention proved to be feasible and effective in improving weight-related variables, physical activity, and physical health satisfaction among Chinese mothers with abdominal obesity, highlighting its potential for delivering diabetes prevention programs to this population.

Keywords: type 2 diabetes, mHealth, obesity, prevention, mothers

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Authors: Kholoud Sheba

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Women refugees expectedly are physical, socially and mentally vulnerable due to their past traumatic experiences and their novel circumstances in their receiving countries. They may have a wide range of general, mental, and reproductive health problems, but reportedly avoid visiting health care facilities owing to complex elements. Women refugees are usually unfamiliar with their new country health system and unable to navigate it efficiently. They have limited English language skills, which makes it even harder to access culturally insensitive health services. This study examines barriers to health care for refugee women in Ottawa and offers suggestions to address these challenges. Drawing from culturally congruent health care models in Canada, the United Kingdom, and some parts of the United States, this study highlights the importance of cultivating compassion in the provision of health care for women refugees as a way of addressing some of the disparities in health care in Canada. To address the study purpose, a survey questionnaire was designed and pretested questionnaire and was administrated using SurveyMonkey, a paid source survey application, over a period of two weeks. Snowballing sampling procedures were used to recruit the participants. Data was measured using frequencies, percentages, t-test, ANOVA, and chi-square. The test of significance is set at p < .05. The study asked how refugees perceive their experience in accessing and navigating public health services in Ottawa; what challenges refugees face with healthcare in Canada, and, if gender is related to refugees’ perceptions of the health care system they are forced to use? Results show refugees perceived their experience accessing the healthcare services in Canada to be a positive experience and the health providers to be culturally sensitive and allowing enough time listening to their complaints. The language stood tall in their barriers accessing the services due to low English proficiency and the need for interpretation services to encourage them attending the services.

Keywords: women refugee, access barriers, Ottawa, resettlement

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Authors: Yuan Zhang, Xin Fu, Yixin Tan

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Gender role conflict is a key factor influencing the mental health condition of adolescents. It has a strong connection with the noticeably growing mental health crisis of high school students. This study elucidates the relationship between gender role conflict and reports of subjective well-being of teenagers through mixed-methods empirical research based on surveys conducted in two Chinese cities, namely Shenzhen and Yuxi. These two cities are from two provinces of very distinct economic and cultural backgrounds. We believe a comparison between the two cities reveals the unequally distributed social conditions in China. We found that teenagers who possess a higher degree of gender role conflict tend to exhibit more negative emotions and that this relationship is conditioned upon other important factors such as gender, only child status, and socio-economic factors. Furthermore, we discovered that the social environment that is more progressive and open to various gender roles is correlated with higher levels of subjective well-being of teenagers in Shenzhen and Yunnan.

Keywords: gender role conflict, mental health conditions, subjective well-being, social environment

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Authors: Martin Cai, Khadijah B. Hashim, Leng Leo, Edmund F. Tian

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Analysis of traditional Chinese medicinal (TCM) supplements has always been a laborious task, particularly in the case of multi‐ingredient formulations. Traditionally, herbal extracts are analysed using one or few markers compounds. In the recent years, however, pharmaceutical companies are introducing health supplements of TCM active ingredients to cater to the needs of consumers in the fast-paced society in this age. As such, new problems arise in the aspects of composition identification as well as quality analysis. In most cases of products or supplements formulated with multiple TCM herbs, the chemical composition, and nature of each raw material differs greatly from the others in the formulation. This results in a requirement for individual analytical processes in order to identify the marker compounds in the various botanicals. Thin-layer Chromatography (TLC) is a simple, cost effective, yet well-regarded method for the analysis of natural products, both as a Pharmacopeia-approved method for identification and authentication of herbs, and a great analytical tool for the discovery of chemical compositions in herbal extracts. Recent technical advances introduced High-Performance TLC (HPTLC) where, with the help of automated equipment and improvements on the chromatographic materials, both the quality and reproducibility are greatly improved, allowing for highly standardised analysis with greater details. Here we report an industrial consultancy project with ONI Global Pte Ltd for the analysis of LAC Liver Protector, a TCM formulation aimed at improving liver health. The aim of this study was to identify 4 key components of the supplement using HPTLC, following protocols derived from Chinese Pharmacopeia standards. By comparing the TLC profiles of the supplement to the extracts of the herbs reported in the label, this project proposes a simple and cost-effective analysis of the presence of the 4 marker compounds in the multi‐ingredient formulation by using 4 different HPTLC methods. With the increasing trend of small and medium-sized enterprises (SMEs) bringing natural products and health supplements into the market, it is crucial that the qualities of both raw materials and end products be well-assured for the protection of consumers. With the technology of HPTLC, science can be incorporated to help SMEs with their quality control, thereby ensuring product quality.

Keywords: traditional Chinese medicine supplement, high performance thin layer chromatography, active ingredients, product quality

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Authors: Atchara Sankom, Warapa Mahakarnchanakul, Ronnarit Rittiron, Tanaboon Sajjaanantakul, Thammasak Thongket

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Vegetables are frequently contaminated with pesticides residues resulting in the most food safety concern among agricultural products. The objective of this work was to develop a method to detect the organophosphate (OP) pesticides residues in vegetables using Near Infrared (NIR) spectroscopy technique. Low concentration (ppm) of OP pesticides in vegetables were investigated. The experiment was divided into 2 sections. In the first section, Chinese kale spiked with different concentrations of chlorpyrifos pesticide residues (0.5-100 ppm) was chosen as the sample model to demonstrate the appropriate conditions of sample preparation, both for a solution or solid sample. The spiked samples were extracted with acetone. The sample extracts were applied as solution samples, while the solid samples were prepared by the dry-extract system for infrared (DESIR) technique. The DESIR technique was performed by embedding the solution sample on filter paper (GF/A) and then drying. The NIR spectra were measured with the transflectance mode over wavenumber regions of 12,500-4000 cm⁻¹. The QuEChERS method followed by gas chromatography-mass spectrometry (GC-MS) was performed as the standard method. The results from the first section showed that the DESIR technique with NIR spectroscopy demonstrated good accurate calibration result with R² of 0.93 and RMSEP of 8.23 ppm. However, in the case of solution samples, the prediction regarding the NIR-PLSR (partial least squares regression) equation showed poor performance (R² = 0.16 and RMSEP = 23.70 ppm). In the second section, the DESIR technique coupled with NIR spectroscopy was applied to the detection of OP pesticides in vegetables. Vegetables (Chinese kale, cabbage and hot chili) were spiked with OP pesticides (chlorpyrifos ethion and profenofos) at different concentrations ranging from 0.5 to 100 ppm. Solid samples were prepared (based on the DESIR technique), then samples were scanned by NIR spectrophotometer at ambient temperature (25+2°C). The NIR spectra were measured as in the first section. The NIR- PLSR showed the best calibration equation for detecting low concentrations of chlorpyrifos residues in vegetables (Chinese kale, cabbage and hot chili) according to the prediction set of R2 and RMSEP of 0.85-0.93 and 8.23-11.20 ppm, respectively. For ethion residues, the best calibration equation of NIR-PLSR showed good indexes of R² and RMSEP of 0.88-0.94 and 7.68-11.20 ppm, respectively. As well as the results for profenofos pesticide, the NIR-PLSR also showed the best calibration equation for detecting the profenofos residues in vegetables according to the good index of R² and RMSEP of 0.88-0.97 and 5.25-11.00 ppm, respectively. Moreover, the calibration equation developed in this work could rapidly predict the concentrations of OP pesticides residues (0.5-100 ppm) in vegetables, and there was no significant difference between NIR-predicted values and actual values (data from GC-MS) at a confidence interval of 95%. In this work, the proposed method using NIR spectroscopy involving the DESIR technique has proved to be an efficient method for the screening detection of OP pesticides residues at low concentrations, and thus increases the food safety potential of vegetables for domestic and export markets.

Keywords: NIR spectroscopy, organophosphate pesticide, vegetable, food safety

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Authors: Chunhua Ma

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Background: There is a relationship between cultural identity and psychological health. Resilience is an important factor of psychological health, and cultural identity will protect the resilience. The research showed that the cultural identity, resilience, and self-concordance of students from different cultures. It should be a theoretical basis to improve mental health of different nationalities students. And the role of resilience factors for adults’ cultural identity and self-concordance was deserve studied. Aims: The current study aimed to examine the relationship between cultural identity and self-concordance among Chinese academician from 3 minorities, postulating mediating by resilience. Methods: This study used cross-sectional and correlational design. Participants were 328 Chinese aged between 18 and 25 years. Data was collected via self-reports including both closed and opened questions. Results: Linear regression analysis controlling for age, gender, the result showed that: (a) Cultural identity was related to self-concordance, resilience was related to self-concordance and cultural identity was related to resilience, (b) Resilience mediated the link between cultural identity and self-concordance, respectively. Discussion: Our findings suggested that resilience and cultural identity are important factors in self-concordance. If minority college students realized the heterogeneous culture, it would alleviate their psychological conflict, stimulate their strength potential and improve their self-concordance.

Keywords: cultural identity, resilience, self-concordance, mediating effect

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Authors: Choedchoo Kwanhathai

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This study explores attitudes towards ASEAN plus ONE (namely ASEAN plus China) accents of English as a Lingua Franca. The study draws attention to features of ASEAN’s diversity of English and specifically examines the extent of which the English accent in ASEAN countries of three of the ten members plus one were perceived in terms of correctness, acceptability, pleasantness, and familiarity. Three accents were used for this study; Chinese, Philippine and Thai. The participants were ninety eight Thai students enrolled in a foundation course of Suan Dusit Rajabhat University, Bangkok Thailand. The students were asked in questionnaires to rank how they perceived each specifically ASEAN plus One English accent after listening to audio recordings of three stories spoken by the three different ASEAN plus ONE English speakers. SPSS was used to analyze the data. The findings of attitudes towards varieties of English accent from the 98 respondents regarding correctness, acceptability, pleasantness, and familiarity of Thai English accents found that Thai accent was overall at level 3 (X = 2.757, SD= o.33), %Then Philippines accents was at level 2 (X = 2.326, SD = 16.12), and Chinese accents w2as at level 3 (X 3.198, SD = 0.18). Finally, the present study proposes pedagogical implications for teaching regarding awareness of ‘Englishes’ of ASEAN and their respective accents and their lingua cultural background of instructors.

Keywords: English as a lingua franca, English accents, English as an international language, ASEAN plus one, ASEAN English varieties

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Authors: Halimat M. Ajose-Adeogun, Zaynab A. Bello

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Artificial Intelligence (AI) and Natural Language Processing (NLP) have transformed computer language comprehension, allowing computers to comprehend spoken and written language with human-like cognition. NLP, a multidisciplinary area that combines rule-based linguistics, machine learning, and deep learning, enables computers to analyze and comprehend human language. NLP applications in medicine range from tackling issues in electronic health records (EHR) and psychiatry to improving diagnostic precision in orthopedic surgery and optimizing clinical procedures with novel technologies like chatbots. The technology shows promise in a variety of medical sectors, including quicker access to medical records, faster decision-making for healthcare personnel, diagnosing dysplasia in Barrett's esophagus, boosting radiology report quality, and so on. However, successful adoption requires training for healthcare workers, fostering a deep understanding of NLP components, and highlighting the significance of validation before actual application. Despite prevailing challenges, continuous multidisciplinary research and collaboration are critical for overcoming restrictions and paving the way for the revolutionary integration of NLP into medical practice. This integration has the potential to improve patient care, research outcomes, and administrative efficiency. The research methodology includes using NLP techniques for Sentiment Analysis and Emotion Recognition, such as evaluating text or audio data to determine the sentiment and emotional nuances communicated by users, which is essential for designing a responsive and sympathetic chatbot. Furthermore, the project includes the adoption of a Personalized Intervention strategy, in which chatbots are designed to personalize responses by merging NLP algorithms with specific user profiles, treatment history, and emotional states. The synergy between NLP and personalized medicine principles is critical for tailoring chatbot interactions to each user's demands and conditions, hence increasing the efficacy of mental health care. A detailed survey corroborated this synergy, revealing a remarkable 20% increase in patient satisfaction levels and a 30% reduction in workloads for healthcare practitioners. The poll, which focused on health outcomes and was administered to both patients and healthcare professionals, highlights the improved efficiency and favorable influence on the broader healthcare ecosystem.

Keywords: natural language processing, artificial intelligence, healthcare communication, electronic health records, patient care

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Authors: Naziema Begum Jappie

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This paper explores the relationship between educational transformation and gender equity in higher education. It draws on various policies and experiences and investigates the paradox of increased female leadership in higher education and the persistence of gender discrimination in the sphere of work. The paper will also address specific aspects of culture and education in post-colonial South Africa. Traditional features of past education systems were not isolated, they became an essential component of the education system, post-democracy. This is currently contested through the call for decolonizing the education system. The debates and discussions seek to rectify the post-colonial education structure within which women suffered triple oppression. Using feminist critical policy analysis and post-colonial theory, the paper examines how transformation over the past two decades has impacted on gender equity and how educational reform is itself gendered. It considers the nature of gender restructuring and key developments in gender equity policy. The social inequality in education is highlighted throughout this discussion. Through an analysis of research and interviews, this paper argues that gender can no longer be privileged when identifying and responding to educational and workplace inequality. In conclusion, the paper discusses the important assumptions that support how social and educational change deliver equity and how social justice may inform equity policy and practice in a culturally diverse educational framework.

Keywords: culture, educational leadership, gender inequality in the workplace, policy implementation

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Authors: Ana L. Martins, Luis Orfão

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Healthcare systems have been subject to various research efforts aiming at process improvement under a lean approach. Another perspective, agility, has also been used, though in a lower scale, in order to analyse the ability of different hospital services to adapt to demand uncertainties. Both perspectives have a common denominator, the improvement of effectiveness and efficiency of the services in a healthcare setting context. Mixing the two approached allows, on one hand, to streamline the processes, and on the other hand the required flexibility to deal with demand uncertainty in terms of both volume and variety. The present research aims to analyse the impacts of the combination of both perspectives in the effectiveness and efficiency of an hospital service. The adopted methodology is based on a case study approach applied to the process of the ambulatory surgery service of Hospital de Lamego. Data was collected from direct observations, formal interviews and informal conversations. The analyzed process was selected according to three criteria: relevance of the process to the hospital, presence of human resources, and presence of waste. The customer of the process was identified as well as his perception of value. The process was mapped using flow chart, on a process modeling perspective, as well as through the use of Value Stream Mapping (VSM) and Process Activity Mapping. The Spaghetti Diagram was also used to assess flow intensity. The use of the lean tools enabled the identification of three main types of waste: movement, resource inefficiencies and process inefficiencies. From the use of the lean tools improvement suggestions were produced. The results point out that leagility cannot be applied to the process, but the application of lean and agility in specific areas of the process would bring benefits in both efficiency and effectiveness, and contribute to value creation if improvements are introduced in hospital’s human resources and facilities management.

Keywords: case study, healthcare systems, leagility, lean management

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