Search results for: cardiovascular disease policy model

Authors: Min-Ming Wen

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Applying the U.S. lodging and tourism industry as a research sample, we examine the relation between the corporate governance structure and managerial risk-taking behavior. In light of the global financial crisis, the importance of effective governance structures is essential in protecting claimholder interests. We propose a governance structure consisting of shareholder governance measured by anti-takeover provisions to examine whether the governance structure has a significant impact on managerial risk-taking behaviors in terms of the investment policy. We will use capital expenditure and R&D investment to measure managerial risk-taking and the firm’s investment policy. In addition, we will examine whether the effects of governance on investment policy differ significantly between speculative and investment-grade firms.

Keywords: corporate governance, risk-taking, firm value, lodging industry

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Authors: Farideh Doostan, Sahar Mohseni Taklloo, Mohammad Nosrati

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Chronic diseases are non-communicable and largely preventable by lifestyle changes including healthy diet consumption. They are the most common cause of death in the world and projected to increase by 15% globally between 2010 and 2020.The hazardous effects of behavioral and dietary risk factors on chronic disease have been established in prospective cohort studies and randomized trials. Because of some changes occur in college students’ lifestyle, assessment of dietary risk factors is important in these populations. Objective: This research was the first study that conducted to evaluate dietary intakes of Kermanian college students with WHO/FAO nutritional objectives. Material and Methods: In this descriptive cross-sectional study, 229 healthy college students of health faculty in Kerman University of Medical Sciences that do not intake any medical drugs were recruited using multistage sampling in 2013.Usual dietary intake was collected using a valid Food Frequency Questionnaire (FFQ) and diet quality was calculated based on WHO nutrient goals. To analysis of data between two groups, independent sample t. test and man whitney were applied. Results: Two hundred and twenty-nine college students; 151 females (65.9%) and 78 males (34.1%), the mean age of 21.9 years were studied. The mean of the Body Mass Index (Kg/m2) and Waist Circumference (cm) in males were 22.34 ±3.52 and 80.76±11.16 and in females were 21.19±2.62 and 73.67±7.65 respectively. Mean of daily cholesterol intake in males was significantly more than females (305±101 VS 268±98; P=0.008) and more than WHO/FAO recommendation (less than 300 mg/day). The mean of daily sodium intake in men and women were 10.4±1 and 10.9±5.3 respectively. These amounts were more than WHO/FAO recommendation (less than 2g/day). In addition, women were consumed fruit and vegetables more than men (839±336 VS 638±281; p ‹ 0.001) and these amounts were more than WHO/FAO recommendation (more than 400g/day) in both groups. Other intake indices were in the range of WHO/FAO recommendations, So that Percent of calories intake from total fat, saturated fatty acids, polyunsaturated fatty acids and added sugar were in compliance with WHO/FAO recommendations. Conclusion: Cholesterol intake in men and sodium intake in all participants were more than WHO/FAO recommendation. These dietary components are the most important causes of cardiovascular disease (one of the main causes of death in our population). These results indicated that proper nutritional education and interventions are needed in this population.

Keywords: college students, food intake, WHO /FAO nutrient intake goals, Kerman

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Authors: Rojan Dahal

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One Health refers to a collaborative effort between multiple disciplines - locally, nationally, and globally - to attain optimal health. Although there were unprecedented intersectoral alliances between the animal and human health sectors during the avian influenza outbreak, there are different views and perceptions concerning institutionalizing One Health in South Asia. It is likely a structural barrier between the relevant professionals working in different entities or ministries when it comes to collaborating on One Health actions regarding zoonotic diseases. Politicians and the public will likely need to invest large amounts of money, demonstrate political will, and understand how One Health works to overcome these barriers. One Health might be hard to invest in South Asian countries, where the benefits are based primarily on models and projections and where numerous issues related to development and health need urgent attention. The other potential barrier to enabling the One Health concept in responding to zoonotic diseases is a failure to represent One Health in zoonotic disease control and prevention measures in the national health policy, which is a critical component of institutionalizing the One Health concept. One Health cannot be institutionalized without acknowledging the linkages between animal, human, and environmental sectors in dealing with zoonotic diseases. Efforts have been made in the past to prepare a preparedness plan for One Health implementation, but little has been done to establish a policy environment to institutionalize One Health. It is often assumed that health policy refers specifically to medical care issues and health care services. When drafting, reviewing, and redrafting the policy, it is important to engage a wide range of stakeholders. One Health institutionalization may also be hindered by the interplay between One Health professionals and bureaucratic inertia in defining the priorities of diseases due to competing interests on limited budgets. There is a possibility that policymakers do not recognize the importance of veterinary professionals in preventing human diseases originating in animals. Compared to veterinary medicine, the human health sector has produced most of the investment and research outputs related to zoonotic diseases. The public health profession may consider itself superior to the veterinary profession. Zoonotic diseases might not be recognized as threats to human health, impeding integrated policies. The effort of One Health institutionalization remained only among the donor agencies and multi-sectoral organizations. There is a need for strong political will and state capacity to overcome the existing institutional, financial, and professional barriers for its effective implementation. There is a need to assess the structural challenges, policy challenges, and the attitude of the professional working in the multiple disciplines related to One Health. Limited research has been conducted to identify the reasons behind the barriers to institutionalizing the One Health concept in South Asia. Institutionalizing One Health in responding to zoonotic diseases breaks down silos and integrates animals, humans, and the environment.

Keywords: one health, institutionalization, South Asia, institutionalizations

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Authors: Sirilak Kongkaew, Pathumwadee Yodmanee, Nopporn Kaiyawet, Arthitaya Meeprasert, Thanyada Rungrotmongkol, Toshikatsu Kaburaki, Hiroshi Noguchi, Fujio Takeuch, Nawee Kungwan, Supot Hannongbua

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Behçet’s disease (BD) is a genetic autoimmune expressed by multisystemic inflammatory disorder mostly occurred at the skin, joints, gastrointestinal tract, and genitalia, including ocular, oral, genital, and central nervous systems. Most BD patients in Japan and Korea were strongly indicated by the genetic factor namely HLA-B*51 (especially, HLA-B*51:01) marker in HMC class I, while HLA-A*26:01 allele has been detected from the BD patients in Greek, Japan, and Taiwan. To understand the selective binding of the MICA-TM peptide towards the HLAs associated with BD, the molecular dynamics simulations were applied on the four HLA alleles (B*51:01, B*35:01, A*26:01, and A*11:01) in complex with such peptide. As a result, the key residues in the binding groove of HLA protein which play an important role in the MICA-TM peptide binding and stabilization were revealed. The Van der Waals force was found to be the main protein-protein interaction. Based on the binding free energy prediction by MM/PBSA method, the MICA-TM peptide interacted stronger to the HLA alleles associated to BD in the identical class by 7-12 kcal/mol. The obtained results from the present study could help to differentiate the HLA alleles and explain a source of Behçet’s disease.

Keywords: Behçet’s disease, MD simulations, HMC class I, autoimmune

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Authors: Sara Zelman, Courtney Meyer, Hiren Patel, Lisa Philpotts, Sue Lahey, Thomas Burke

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Background: As the global burden of disease shifts from infectious diseases to noncommunicable diseases, there is growing urgency to provide treatment for time-sensitive illnesses, such as ST-Elevation Myocardial Infarctions (STEMIs). The standard of care for STEMIs in developed countries is Percutaneous Coronary Intervention (PCI). However, this is inaccessible in resource-limited settings. Before the discovery of PCI, Streptokinase (STK) and other thrombolytic drugs were first-line treatments for STEMIs. STK has been recognized as a cost-effective and safe treatment for STEMIs; however, in settings which lack access to PCI, it has not become the established second-line therapy. A systematic literature review was conducted to geographically map the use of STK for STEMIs in resource-limited settings. Methods: Our literature review group searched the databases Cinhal, Embase, Ovid, Pubmed, Web of Science, and WHO’s Index Medicus. The search terms included ‘thrombolytics’ AND ‘myocardial infarction’ AND ‘resource-limited’ and were restricted to human studies and papers written in English. A considerable number of studies came from Latin America; however, these studies were not written in English and were excluded. The initial search yielded 3,487 articles, which was reduced to 3,196 papers after titles were screened. Three medical professionals then screened abstracts, from which 291 articles were selected for full-text review and 94 papers were chosen for final inclusion. These articles were then analyzed and mapped geographically. Results: This systematic literature review revealed that STK has been used for the treatment of STEMIs in 33 resource-limited countries, with 18 of 94 studies taking place in India. Furthermore, 13 studies occurred in Pakistan, followed by Iran (6), Sri Lanka (5), Brazil (4), China (4), and South Africa (4). Conclusion: Our systematic review revealed that STK has been used for the treatment of STEMIs in 33 resource-limited countries, with the highest utilization occurring in India. This demonstrates that even though STK has high utility for STEMI treatment in resource-limited settings, it still has not become the standard of care. Future research should investigate the barriers preventing the establishment of STK use as second-line treatment after PCI.

Keywords: cardiovascular disease, global health, resource-limited setting, ST-Elevation Myocardial Infarction, Streptokinase

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Authors: Geetu Gahlawat, Manisha Singh

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In the recent years, the concept of media literacy is being extended from its traditional focus on print and audio-visual media to encompass the internet and other new media within academic and policy discourses. This article throws revolves around three significant queries which are to be dealt by the academia, general public and the policy-makers: What is media literacy? How is it changing? And what is the significance of media literacy? At the beginning of the article, the definition 'media literacy' is the ability to access, analyse, evaluate and create messages across a variety of contexts are given and then this is further being tested in connection with the internet and other information and communication technologies.Having advocated this skills-based approach to media literacy in relation to the internet, the article identifies some outstanding issues for new media literacy crucial to any policy of promoting media literacy among the population. The outcome is better understanding of media literacy and also the impact of ICT on media literacy by the public as well as media literate people.

Keywords: media literacy, ICT, internet, education

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Authors: Myoungsoon You, Heejung Son

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Background: In the current study, we investigated the effects of emotions induced by an infectious disease outbreak on the various protective behaviors taken during the crisis and on the perception after the crisis. The investigation was based on two psychological theories of appraisal tendency and action tendency. Methods: A total of 900 participants in South Korea who experienced the 2015 Middle East Respiratory Syndrome outbreak were sampled by a professional survey agency. To assess the influence of the emotions fear and anger, a regression approach was used. The effect of emotions on various protective behaviors and perceptions was observed using a hierarchical regression method. Results: Fear and anger induced by the infectious disease outbreak were both associated with increased protective behaviors during the crisis. However, the differences between the emotions were observed. While protective behaviors with avoidance tendency (adherence to recommendations, self-mitigation), were raised by both fear and anger, protective behaviors with approach tendency (information-seeking) were increased by anger, but not fear. Regarding the effect of emotion on the risk perception after the crisis, only fear was associated with a higher level of risk perception. Conclusions: This study confirmed the role of emotions in crisis protective behaviors and post-crisis perceptions regarding an infectious disease outbreak. These findings could enhance understanding of the public’s protective behaviors during infectious disease outbreaks and afterward risk perception corresponding to emotions. The results also suggested strategies for communicating with the public that takes into account emotions that are prominently induced by crises associated with disease outbreaks.

Keywords: crisis communication, emotion, infectious disease outbreak, protective behavior, risk perception

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Authors: Anucha Wittayakorn-Puripunpinyoo

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The research objectives were 1) to study the situation and its trend of agricultural product export of Thailand 2) to study the impact of agricultural product export on income of Thai economy 3) the impact of agricultural product export on employment of Thai economy and 4) to find out the recommendations of agricultural product export policy of Thailand. In this research, secondary data were collected as yearly time series data from 1990 to 2016 accounted for 27 years. Data were collected from the Bank of Thailand database. Primary data were collected from the steakholders of agricultural product export policy of Thailand. Data analysis was applied descriptive statistics such as arithmetic mean, standard deviation. The forecasting of agricultural product was applied Mote Carlo Simulation technique as well as time trend analysis. In addition, the impact of agricultural product export on income and employment by applying econometric model while the estimated parameters were utilized the ordinary least square technique. The research results revealed that 1) agricultural product export value of Thailand from 1990 to 2016 was 338,959.5 Million Thai baht with its growth rate of 4.984 percent yearly, in addition, the forecasting of agricultural product export value of Thailand has increased but its growth rate has been declined 2) the impact of agricultural product export has positive impact on income in Thai economy, increasing in agricultural product export of Thailand by 1 percent would lead income increased by 0.0051 percent 3) the impact of agricultural product export has positive impact on employment in Thai economy, increasing in agricultural product export of Thailand by 1 percent would lead income increased by 0.079 percent and 4) in the future, agricultural product export policy would focused on finished or semi-finished agricultural product instead of raw material by applying technology and innovation in to make value added of agricultural product export. The public agricultural product export policy would support exporters in private sector in order to encourage them as agricultural exporters in Thailand.

Keywords: agricultural product export, income, employment, Thai economy

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Authors: Minna Chang

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Introduction: M. pneumoniae is a respiratory pathogen, which commonly causes upper and lower respiratory infections. It primarily affects children and young adults. Respiratory symptoms are well recognized, but extrapulmonary involvement is also common. Other systems that have been implicated in the disease include: skin, mucus membranes, central, peripheral nervous systems, cardiovascular, haematological, renal, and musculoskeletal systems. Here, we report a case of an otherwise healthy, young female with M. pneumonia, who presented with right upper quadrant abdominal pain. Case presentation: a healthy 25-year-old female was referred to A&E by her general practitioner, after presenting with fever, malaise, and right upper quadrant pain. M. pneumoniae was confirmed retrospectively by serology. The patient made a full recovery after a six-day course of doxycycline 100mg. Conclusion: M. pneumonia is a well-established cause of respiratory infections in children and young adults. Febrile illness with multisystem involvement, even in the absence of respiratory symptoms, should raise suspicion of M. pneumoniae infection in healthy, young adults. Our case illustrates the multi-system involvement of M. pneumoniae, which was initially missed, due to paucity of respiratory symptoms at presentation.

Keywords: infectious diseases, mycoplasma pneumoniae, respiratory infections, extra-pulmonary manifestations

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Authors: Leslie Beale

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Being a patient with a chronic disease is both a physical and emotional experience. The ability to recognize a patient’s emotional health is an important part of a health care provider’s skills. For the purposes of this paper, emotional health is viewed as the way that we feel, and the way that our feelings affect us. Understanding the patient’s emotional health leads to improved provider-patient relationships and health outcomes. For example, when a patient first hears his or her diagnosis from a provider, they might find it difficult to cope with their emotions. Struggling to cope with emotions interferes with the patient’s ability to read, understand, and act on health information and services. As a result, the patient becomes more frustrated and confused, creating barriers to accessing healthcare services. These barriers are challenging for both the patient and their healthcare providers. There are five basic emotions that are part of who we are and are always with us: fear, anger, sadness, joy, and compassion. Living with a chronic disease however can cause a patient to experience and express these emotions in new and unique ways. Within the provider-patient relationship, there needs to be an understanding that each patient experiences these five emotions and, experiences them at different times. In response to this need, the paper highlights a health promotion framework for patients with chronic disease. This framework emphasizes the emotional health of patients.

Keywords: health promotion, emotional health, patients with chronic disease, patient-centered care

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Authors: Munkhtuul G., Bolortsetseg Z., Lutzul M., Sugar N., Nyamdorj D., Nomundari B., Zesemdorj O., Erdenebayar N., Lkhagvasuren T. S., Munkhbayarlakh S., Bayasgalan T. Uurtuya S. H.

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Background: Elevated serum uric acid (SUA) levels are observed in metabolic and cardiovascular conditions as an early predictor of metabolic syndrome (MS). Hyperuricemia, characterised by high uric acid levels in serum, increases the risk of developing MS by 1.6 times. Being overweight and obese significantly contributes to developing MS and cardiovascular disorders. In Mongolia, the prevalence of overweight and obesity is reaching 48.8% among individuals aged 15 to 49 years, indicating a potential surge in the incidence of MS, cardiovascular disorders, diabetes mellitus, and gout.Objective: This study aimed to determine the SUA levels in men diagnosed with MS and investigate the factors influencing these levels.Methods: A total of 119 men aged 30-60, who underwent preventive examinations and resided in Ulaanbaatar city, were included in the study. The criteria established by the International Diabetes Federation (IDF), American Heart Association (AHA), and the National Heart, Lung, and Blood Institute (NHLBI) were employed to define metabolic syndrome. Hyperuricemia was defined as SUA levels ≥7 mg/dL. Dietary intake was evaluated through the 24-hour recall method.Results: The study revealed that the prevalence of MS among the participants was 42.9% (n=51), with hyperuricemia observed in 16.8% (n=20) of the individuals. Among men diagnosed with MS, 21.3% (n=10) exhibited hyperuricemia. The mean SUA levels were as follows: 4.7±0.8 mg/dL in the healthy group, 5.9±1.1 mg/dL in men without MS but presenting central obesity, and 6.2±1.3 mg/dL in men with MS. After adjusting for age and body mass index (BMI), a positive correlation was observed between SUA levels and triglycerides (β=0.93) as well as lipid accumulation product (LAP) (β=0.92) in men with MS. In the central obesity group, SUA levels exhibited a positive correlation with triglycerides (β=0.91), visceral adiposity index (VAI) (β=0.73), LAP (β=0.92), and cardiometabolic index (CMI) (β=0.69). The risk of hyperuricemia increased by 3.29 times with elevated triglycerides and 3.53 times with an increased LAP.Conclusion: The findings indicate that abdominal fat accumulation, as indicated by elevated triglyceride levels and LAP, is associated with increased SUA levels in men with MS. However, no significant relationship was observed between SUA levels and dietary intake.

Keywords: central obesity, obesity, triglycerides, hyperuricemia

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Authors: Recep Keşli, Onur Türkyılmaz, Hayriye Tokay, Kasım Demir

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Objective: Coeliac disease (CD) is a primary small intestine disorder caused by high sensitivity to gluten which is present in the crops, characterized by inflammation in the small intestine mucosa. The goal of this study was to determine and to compare the sensitivity and specificity values of anti-endomysial IgA (EMA IgA) (IFA) and anti-tissue transglutaminase IgA (anti-tTG IgA) (ELISA) antibodies in the diagnosis of patients suspected with the CD. Methods: One thousand two hundred seventy three patients, who have applied to gastroenterology and pediatric disease polyclinics of Afyon Kocatepe University ANS Research and Practice Hospital were included into the study between 23.09.2010 and 30.05.2016. Sera samples were investigated by immunofluorescence method for EMA positiveness (Euroimmun, Luebeck, Germany). In order to determine quantitative value of Anti-tTG IgA (EIA) (Orgentec Mainz, Germany) fully automated ELISA device (Alisei, Seac, Firenze, Italy) were used. Results: Out of 1273 patients, 160 were diagnosed with coeliac disease according to ESPGHAN 2012 diagnosis criteria. Out of 160 CD patients, 120 were female, 40 were male. The EMA specificity and sensitivity were calculated as 98% and 80% respectively. Specificity and sensitivity of Anti-tTG IgA were determined as 99% and 96% respectively. Conclusion: The specificity of EMA for CD was excellent because all EMA-positive patients (n = 144) were diagnosed with CD. The presence of human anti-tTG IgA was found as a reliable marker for diagnosis and follow-up the CD. Diagnosis of CD should be established on both the clinical and serologic profiles together.

Keywords: anti-endomysial antibody, anti-tTG IgA, coeliac disease, immunofluorescence assay (IFA)

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Authors: Jessica Gu, Yu Chen

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Knowledge Management (KM) is undoubtable crucial to organizational value creation, learning, and adaptation. Although the rapidly growing KM domain has been fueled with full-fledged methodologies and technologies, studies on KM evolution that bridge the organizational performance and adaptation to the organizational environment are still rarely attempted. In particular, creation (or generation) and diffusion (or share/exchange) of knowledge are of the organizational primary concerns on the problem-solving perspective, however, the optimized distribution of knowledge creation and diffusion endeavors are still unknown to knowledge workers. This research proposed an agent-based model of knowledge creation and diffusion in an organization, aiming at elucidating how the intertwining knowledge flows at microscopic level lead to optimized organizational performance at macroscopic level through evolution, and exploring what exogenous interventions by the policy maker and endogenous adjustments of the knowledge workers can better cope with different environmental conditions. With the developed model, a series of simulation experiments are conducted. Both long-term steady-state and time-dependent developmental results on organizational performance, network and structure, social interaction and learning among individuals, knowledge audit and stocktaking, and the likelihood of choosing knowledge creation and diffusion by the knowledge workers are obtained. One of the interesting findings reveals a non-monotonic phenomenon on organizational performance under turbulent environment while a monotonic phenomenon on organizational performance under a stable environment. Hence, whether the environmental condition is turbulence or stable, the most suitable exogenous KM policy and endogenous knowledge creation and diffusion choice adjustments can be identified for achieving the optimized organizational performance. Additional influential variables are further discussed and future work directions are finally elaborated. The proposed agent-based model generates evidence on how knowledge worker strategically allocates efforts on knowledge creation and diffusion, how the bottom-up interactions among individuals lead to emerged structure and optimized performance, and how environmental conditions bring in challenges to the organization system. Meanwhile, it serves as a roadmap and offers great macro and long-term insights to policy makers without interrupting the real organizational operation, sacrificing huge overhead cost, or introducing undesired panic to employees.

Keywords: knowledge creation, knowledge diffusion, agent-based modeling, organizational performance, decision making evolution

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Authors: Ossai Paulinus Edwin

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Cash Management is a broad area having to do with the collection, concentration, and disbursement of cash including measuring the level of liquidity and managing the cash balance and short-Term Investments. Cash Management involves the efficient collection and disbursement of cash and cash equivalents. It also includes management of marketable securities because, in modern Terminology, money comprises marketable securities and actual cash in hand or in a bank. This cash management is concerned with management of cash inflow and cash outflow of a business especially as it concerns a developing nation like Nigeria. The paper throws light on the impact of cashless policy in Nigeria as it was introduced by the Central Bank of Nigeria (CBN) in December 2011 and was kick-started in Lagos in January 2012. Survey research was adopted with the questionnaires as data collection instrument. Responses show that cashless policy if adopted generally shall increase employment opportunities, reduce cash related robbery thereby reducing risk of carrying cash; it shall also reduce cash related corruption and attract more foreign investors to the country. It is expected that the introduction of cashless policy in Nigeria is a step in the right direction as it shall bring about modernization of Nigeria payment system, reduction in the cost of banking services, reduction in high security and safety risk and also curb banking related corruptions.

Keywords: cashless economy, cash management, cashless policy, e-banking, Nigeria

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Authors: Khachen Kongpakwattana, Nathorn Chaiyakunapruk

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Background: Decision-analytic models for Alzheimer’s disease (AD) have been advanced to discrete-event simulation (DES), in which individual-level modelling of disease progression across continuous severity spectra and incorporation of key parameters such as treatment persistence into the model become feasible. This study aimed to apply the DES to perform a cost-effectiveness analysis of treatment for AD in Thailand. Methods: A dataset of Thai patients with AD, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine or no treatment. Throughout the simulation period, the model randomly assigned each patient to discrete events including hospital visits, treatment discontinuation and death. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence, mortality and predictive equations for functional status, costs (Thai baht (THB) in 2017) and quality-adjusted life year (QALY) were derived from country-specific real-world data. The time horizon was 10 years, with a discount rate of 3% per annum. Cost-effectiveness was evaluated based on the willingness-to-pay (WTP) threshold of 160,000 THB/QALY gained (4,994 US$/QALY gained) in Thailand. Results: Under a societal perspective, only was the prescription of donepezil to AD patients with all disease-severity levels found to be cost-effective. Compared to untreated patients, although the patients receiving donepezil incurred a discounted additional costs of 2,161 THB, they experienced a discounted gain in QALY of 0.021, resulting in an incremental cost-effectiveness ratio (ICER) of 138,524 THB/QALY (4,062 US$/QALY). Besides, providing early treatment with donepezil to mild AD patients further reduced the ICER to 61,652 THB/QALY (1,808 US$/QALY). However, the dominance of donepezil appeared to wane when delayed treatment was given to a subgroup of moderate and severe AD patients [ICER: 284,388 THB/QALY (8,340 US$/QALY)]. Introduction of a treatment stopping rule when the Mini-Mental State Exam (MMSE) score goes below 10 to a mild AD cohort did not deteriorate the cost-effectiveness of donepezil at the current treatment persistence level. On the other hand, none of the AD medications was cost-effective when being considered under a healthcare perspective. Conclusions: The DES greatly enhances real-world representativeness of decision-analytic models for AD. Under a societal perspective, treatment with donepezil improves patient’s quality of life and is considered cost-effective when used to treat AD patients with all disease-severity levels in Thailand. The optimal treatment benefits are observed when donepezil is prescribed since the early course of AD. With healthcare budget constraints in Thailand, the implementation of donepezil coverage may be most likely possible when being considered starting with mild AD patients, along with the stopping rule introduced.

Keywords: Alzheimer's disease, cost-effectiveness analysis, discrete event simulation, health technology assessment

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Authors: Yufeng Wu, Yifan Gu, Bin Li, Wei Wang

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Resource recycling process contains a subsystem with interactions of three dimensions including coupling allocation of primary and secondary resources, responsibility coordination of stakeholders in forward and reverse supply chains, and trans-boundary transfer of hidden resource and environmental responsibilities between regions. Overlap or lack of responsibilities is easy to appear at the intersection of the three management dimensions. It is urgent to make an overall design of the policy system for recycling resources. From theoretical perspective, this paper analyzes the unique external differences of resource and environment in various dimensions and explores the reason why the effects of trans-dimensional policies are strongly correlated. Taking the example of the copper resources contained in the waste electrical and electronic equipment, this paper constructs reduction effect accounting model of resources recycling and set four trans-dimensional policy scenarios including resources tax and environmental tax reform of the raw and secondary resources, application of extended producer responsibility system, promotion of clean development mechanism, and strict entry barriers of imported wastes. In these ways, the paper simulates the impact effect of resources recycling process on resource deduction and emission reduction of waste water and gas, and constructs trans-dimensional policy mix scenario through integrating dominant strategy. The results show that combined application of various dimensional policies can achieve incentive compatibility and the trans-dimensional policy mix scenario can reach a better effect. Compared with baseline scenario, this scenario will increase 91.06% copper resources reduction effect and improve emission reduction of waste water and gas by eight times from 2010 to 2030. This paper further analyzes the development orientation of policies in various dimension. In resource dimension, the combined application of compulsory, market and authentication methods should be promoted to improve the use ratio of secondary resources. In supply chain dimension, resource value, residual functional value and potential information value contained in waste products should be fully excavated to construct a circular business system. In regional dimension, it should give full play to the comparative advantages of manufacturing power to improve China’s voice in resource recycling in the world.

Keywords: resource recycling, trans-dimension, policy design, incentive compatibility, life cycle

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Authors: Yiling Shao, Megan Dai

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This paper attempts to explore whether the cultural infrastructure supported by the Chinese government is still subject to a logic of “strict regulation”.Previous studies have pointed out that the "paternalism" tendency of China's cultural policy always leads to excessive government intervention in cultural development, while Chinese cultural practitioners can only seek cultural autonomy in the cracks of supervision. This can also explain why Chinese cultural policies sometimes have different effects than the official expectations.But this only reflects one aspect of China's cultural policy. In fact, the welfare cultural infrastructure funded by the government seems to highlight the principles of "safeguarding citizens' cultural rights" and "citizens' voluntary" rather than "indoctrination" and "enlightenment", What new features of China's cultural policy are reflected behind this policy orientation that is completely different from the logic of "regulation", which has also become an important issue in this paper. Based on the field survey of a cultural infrastructure (Gao ming District Cultural Center) in Gao ming District, Fo shan City, Guangdong Province, China, for nearly one year, the authors have obtained many text and picture materials.The paper discusses the dual role of cultural centers in China's cultural policy -both as a formal commitment by the state to protect citizens' basic cultural rights and as a social space for citizens to use preferential policies to obtain cultural capital. All in all, the author have conclued three operational logics of the cultural infrastructure currently supported by the Chinese government (at least in developed areas): first, the cultural center has become a versatile cultural space; second, grass-roots cultural cadres can be described as "policy entrepreneurs"; third, ordinary citizens will use the officially supported cultural infrastructure to increase cultural capital. This paper argues that, in comparison to the common “regulatory hand” in the field of cultural industries, in cultural infrastructure supported by state, the authorities and citizens are not in conflict. On the contrary, authorities must adopt a de-regulatory "pleasing" strategy to gain the support of citizens.

Keywords: cultural infrastructure, cultural capital, deregulation, policy entrepreneur

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Authors: Laura Gleason, Sahithi Talasila, Lauren Banner, Ladan Afifi, Neda Nikbakht

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Primary cutaneous anaplastic large cell lymphoma (pcALCL) accounts for 9% of all cutaneous T-cell lymphomas. pcALCL is classically characterized as a solitary papulonodule that often enlarges, ulcerates, and can be locally destructive, but overall exhibits an indolent course with overall 5-year survival estimated to be 90%. Distinguishing pcALCL from systemic ALCL (sALCL) is essential as sALCL confers a poorer prognosis with average 5-year survival being 40-50%. Although extremely rare, there have been several cases of ALK-positive ALCL diagnosed on skin biopsy without evidence of systemic involvement, which poses several challenges in the classification, prognostication, treatment, and follow-up of these patients. Objectives: We present a case of cutaneous ALK-positive ALCL without evidence of systemic involvement, and a narrative review of the literature to further characterize that ALK-positive ALCL limited to the skin is a distinct variant with a unique presentation, history, and prognosis. A 30-year-old woman presented for evaluation of an erythematous-violaceous papule present on her right chest for two months. With the development of multifocal disease and persistent lymphadenopathy, a bone marrow biopsy and lymph node excisional biopsy were performed to assess for systemic disease. Both biopsies were unrevealing. The patient was counseled on pursuing systemic therapy consisting of Brentuximab, Cyclophosphamide, Doxorubicin, and Prednisone given the concern for sALCL. Apropos of the patient we searched for clinically evident, cutaneous ALK-positive ALCL cases, with and without systemic involvement, in the English literature. Risk factors, such as tumor location, number, size, ALK localization, ALK translocations, and recurrence, were evaluated in cases of cutaneous ALK-positive ALCL. The majority of patients with cutaneous ALK-positive ALCL did not progress to systemic disease. The majority of cases that progressed to systemic disease in adults had recurring skin lesions and cytoplasmic localization of ALK. ALK translocations did not influence disease progression. Mean time to disease progression was 16.7 months, and significant mortality (50%) was observed in those cases that progressed to systemic disease. Pediatric cases did not exhibit a trend similar to adult cases. In both the adult and pediatric cases, a subset of cutaneous-limited ALK-positive ALCL were treated with chemotherapy. All cases treated with chemotherapy did not progress to systemic disease. Apropos of an ALK-positive ALCL patient with clinical cutaneous limited disease in the histologic presence of systemic markers, we discussed the literature data, highlighting the crucial issues related to developing a clinical strategy to approach this rare subtype of ALCL. Physicians need to be aware of the overall spectrum of ALCL, including cutaneous limited disease, systemic disease, disease with NPM-ALK translocation, disease with ALK and EMA positivity, and disease with skin recurrence.

Keywords: anaplastic large cell lymphoma, systemic, cutaneous, anaplastic lymphoma kinase, ALK, ALCL, sALCL, pcALCL, cALCL

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Authors: Abidemi C. Adegboye, Nosakhare Ikponmwosa, Rogers A. Akinsokeji

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For many resource-rich developing countries, fiscal policy has become a key tool used for short-run fiscal management since it is considered as playing a critical role in injecting part of resource rents into the economies. However, given its instability, reliance on revenue from commodity exports renders fiscal management, budgetary planning and the efficient use of public resources difficult. In this study, the linkage between commodity prices and fiscal operations among a sample of commodity-exporting countries in sub-Saharan Africa (SSA) is investigated. The main question is whether commodity price fluctuations affects the effectiveness of fiscal policy as a macroeconomic stabilization tool in these countries. Fiscal management effectiveness is considered as the ability of fiscal policy to react countercyclically to output gaps in the economy. Fiscal policy is measured as the ratio of fiscal deficit to GDP and the ratio of government spending to GDP, output gap is measured as a Hodrick-Prescott filter of output growth for each country, while commodity prices are associated with each country based on its main export commodity. Given the dynamic nature of fiscal policy effects on the economy overtime, a dynamic framework is devised for the empirical analysis. The panel cointegration and error correction methodology is used to explain the relationships. In particular, the study employs the panel ECM technique to trace short-term effects of commodity prices on fiscal management and also uses the fully modified OLS (FMOLS) technique to determine the long run relationships. These procedures provide sufficient estimation of the dynamic effects of commodity prices on fiscal policy. Data used cover the period 1992 to 2016 for 11 SSA countries. The study finds that the elasticity of the fiscal policy measures with respect to the output gap is significant and positive, suggesting that fiscal policy is actually procyclical among the countries in the sample. This implies that fiscal management for these countries follows the trend of economic performance. Moreover, it is found that fiscal policy has not performed well in delivering macroeconomic stabilization for these countries. The difficulty in applying fiscal stabilization measures is attributable to the unstable revenue inflows due to the highly volatile nature of commodity prices in the international market. For commodity-exporting countries in SSA to improve fiscal management, therefore, fiscal planning should be largely decoupled from commodity revenues, domestic revenue bases must be improved, and longer period perspectives in fiscal policy management are the critical suggestions in this study.

Keywords: commodity prices, ECM, fiscal policy, fiscal procyclicality, fully modified OLS, sub-saharan africa

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Authors: Wera Supa, Panita Wannapiroon

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This paper is a report on the designing of the social collaborative learning model based on proactive involvement to Promote the global merit principle in cultivating youths’ morality. The research procedures into two phases, the first phase is to design the social collaborative learning model based on proactive involvement to promote the global merit principle in cultivating youths’ morality, and the second is to evaluate the social collaborative learning model based on proactive involvement. The sample group in this study consists of 15 experts who are dominant in proactive participation, moral merit principle and youths’ morality cultivation from executive level, lecturers and the professionals in information and communication technology expertise selected using the purposive sampling method. Data analyzed by arithmetic mean and standard deviation. This study has explored that there are four significant factors in promoting the hands-on collaboration of global merit scheme in order to implant virtues to adolescences which are: 1) information and communication Technology Usage; 2) proactive involvement; 3) morality cultivation policy, and 4) global merit principle. The experts agree that the social collaborative learning model based on proactive involvement is highly appropriate.

Keywords: social collaborative learning, proactive involvement, global merit principle, morality

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Authors: Gulnaz Erkomaishvili

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The article analyzes the modern level of industrial production in Georgia, shows the export-import of industrial products and evaluates the results of the activities of institutions implementing industrial policy. The research showed us that the level of development of industry in the country and its export potential are quite low. The article concludes that in the modern phase of industrial development, the country should choose a model focused on technological development and maximum growth of export potential. Objectives. The aim of the research is to develop an economic policy that promotes the development of industry and to look for ways to implement it effectively. Methodologies This paper uses general and specific methods, in particular, analysis, synthesis, induction, deduction, scientific abstraction, comparative and statistical methods, as well as experts’ evaluation. In-depth interviews with experts were conducted to determine quantitative and qualitative indicators; Publications of the National Statistics Office of Georgia are used to determine the regularity between analytical and statistical estimations. Also, theoretical and applied research of international organizations and scientist-economists are used. Contributions Based on the identified challenges in the area of industry, recommendations for the implementation of an active industrial policy in short and long term periods were developed. In particular: the government's priority orientation of industrial development; paying special attention to the processing industry sectors that Georgia has the potential to produce; supporting the development of scientific fields; Determination of certain benefits for those investors who invest money in industrial production; State partnership with the private sector, manifested in the fight against bureaucracy, corruption and crime, creating favorable business conditions for entrepreneurs; Coordination between education - science - production should be implemented in the country. Much attention should be paid to basic scientific research, which does not require purely commercial returns in the short term, science should become a real productive force; Special importance should be given to the creation of an environment that will support the expansion of export-oriented production; Overcoming barriers to entry into export markets.

Keywords: industry, sectoral structure of industry, exsport-import of industrial products, industrial policy

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Authors: Yue Wang

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Five years passed since the newest English curriculum reform policy was published in China, hand-wringing spread among teachers who accused that this is another 'Wearing New Shoes to Walk the Old Road' policy. This paper provides a thoroughly philosophical policy analysis of serious efforts that had been made to support this reform and reveals the hindrances that bridled the reform to yield the desired effect. Blame could be easily put on teachers for their insufficient pedagogical content knowledge, conservative resistance, and the handicaps of large class sizes and limited teaching times, and so on. However, the underlying causes for this implementation failure are the interrelated factors in the NCEE-centred education system, such as the reluctant from students, the lack of school and education bureau support, and insufficient teacher training. A further discussion of 2017 to 2020’s NCEE reform on English prompt new possibilities for the authentic pedagogical approach reform in secondary English classes. In all, the pedagogical approach reform at the secondary level is heading towards a brighter future with the initiation of new NCEE reform.

Keywords: English curriculum, failure, NCEE, new possibilities, pedagogical, policy analysis, reform

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Authors: Mona Hamdy, Iman Shaheen, Hadeel Seif Eldin, Basma Ali, Omnia Abdeldayem

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Summary: Bone involvement of sickle cell disease (SCD) patients varies from acute clinical manifestations of painful vaso-occlusive crises or osteomyelitis to more chronic affection of bone mineral density (BMD) and debilitating osteonecrosis and osteoporosis. Secreted klotho protein is involved in calcium (Ca) reabsorption in the kidney. This study aimed to measure serum klotho levels in children with SCD to determine the possibility of using it as a marker of low BMD in children with SCD in correlation with a dual-energy radiograph absorptiometry scan. This study included 60 sickle disease patients and 30 age-matched and sex-matched control participants without SCD. A highly statistically significant difference was found between patients with normal BMD and those with low BMD, with serum Ca and klotho levels being lower in the latter group. Klotho serum level correlated positively with both serum Ca and BMD. Serum klotho level showed 94.9% sensitivity and 95.2% specificity in the detection of low BMD. Both serum Ca and klotho serum levels may be useful markers for detection of low BMD related to SCD with high sensitivity and specificity; however, klotho may be a better indicator as it is less affected by the nutritional and endocrinal status of patients or by intake of Ca supplements.

Keywords: sickle cell disease, BMD, osteoporosis, DEXA, klotho

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Authors: H. Shola Adeosun, F. Ajoke Adebiyi

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This study appraises the impact of television on the coverage of Lassa Fever disease. The objectives of the study are to find out whether television is an effective tool for raising awareness about Lassa fever shapes the perception of members of the public. The research work was based on the theoretical foundation of Agenda – setting and reinforcement theory. Survey research method was adopted in the study to elicit data from the residents of Obafemi Owode Local Government, area of Ogun state. Questionnaire and oral interview were adopted as a tool for data gathering. Simple random sampling techniques were used to draw a sample for this study. Out of filled 400 questionnaires distributed to the respondents. 37 of them were incorrectly filled and returned at the stipulated time. This is about (92.5% Tables, percentages, and figures were used to analyse and interpret the data and hypothesis formulation for this study revealed that Lassa fever diseases with higher media coverage were considered more serious and more representative of a disease and estimated to have lower incidents, than diseases less frequently found in the media. Thus, 92% of the respondents agree that they have access to television coverage of Lassa fever disease led to exaggerated perceptions of personal vulnerability. It, therefore, concludes that there is a need for relevant stakeholders to ensure better community health education and improved housing conditions in southwestern Nigeria, with an emphasis on slum areas and that Nigeria need to focus on the immediate response, while preparing for the future because a society or community is all about the people who inhabit. Therefore every effort must be geared towards their society and survival.

Keywords: impact, television, coverage, Lassa fever disease

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Authors: Björn de Kruijf, Arjen Edzes, Sietske Waslander

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In an ever-quickly changing society, lifelong development is seen as a solution to labor market problems by politicians and policymakers. In this paper, we investigate how policy instruments are used to increase participation in lifelong development and on which behavioral principles policy is based. Digitization, automation, and an aging population change society and the labor market accordingly. Skills that were once most sought after in the workforce can become abundantly present. For people to remain relevant in the working population, they need to continue adapting new skills useful in the current labor market. Many reports have been written that focus on the role of lifelong development in this changing society and how lifelong development can help keep people adapt and stay relevant. Inspired by these reports, governments have implemented a broad range of policies to support participation in lifelong development. The question we ask ourselves is how government policies promote participation in lifelong development. This stems from a complex interplay of policy instruments and learning. Regulation, economic and soft instruments can be combined to promote lifelong development, and different types of education further complex policies on lifelong development. Literature suggests that different stages in people’s lives might warrant different methods of learning. Governments could anticipate this in their policies. In order to influence people’s behavior, the government can tap into a broad range of sociological, psychological, and (behavioral) economic principles. The traditional economic assumption that behavior is rational is known to be only partially true, and the government can use many biases in human behavior to stimulate participation in lifelong development. In this paper, we also try to find which biases the government taps into to promote participation if they tap into any of these biases. The goal of this paper is to analyze government policies intended to promote participation in lifelong development. To do this, we develop a framework to analyze the policies on lifelong development. We specifically incorporate the role of learning and the behavioral principles underlying policy instruments in the framework. We apply this framework to the case of the Netherlands, where we examine a set of policy documents. We single out the policies the government has put in place and how they are vertically and horizontally related. Afterward, we apply the framework and classify the individual policies by policy instrument and by type of learning. We find that the Dutch government focuses on formal and non-formal learning in their policy instruments. However, the literature suggests that learning at a later age is mainly done in an informal manner through experiences.

Keywords: learning, lifelong development, policy analysis, policy instruments

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Authors: Kehinde Peter Oyeduntan, Kayode Oshinubi

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Nigeria is referred as the ‘Giant of Africa’ due to high population, land mass and large economy. However, it still trails far behind many smaller economies in the continent in terms of maritime operations. As we have seen that the maritime industry is the spark plug for national growth, because it houses the most crucial infrastructure that generates wealth for a nation, it is worrisome that a nation with six seaports lag in maritime activities. In this research, we have studied how the Gross Domestic Product (GDP) of the maritime transport influences the Nigerian economy. To do this, we applied Simple Linear Regression (SLR), Support Vector Machine (SVM), Polynomial Regression Model (PRM), Generalized Additive Model (GAM) and Generalized Linear Mixed Model (GLMM) to model the relationship between the nation’s Total GDP (TGDP) and the Maritime Transport GDP (MGDP) using a time series data of 20 years. The result showed that the MGDP is statistically significant to the Nigerian economy. Amongst the statistical tool applied, the PRM of order 4 describes the relationship better when compared to other methods. The recommendations presented in this study will guide policy makers and help improve the economy of Nigeria in terms of its GDP.

Keywords: maritime transport, economy, GDP, regression, port

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Authors: Yifan Lu, Ying Cui, Ying Zhu, Edward S. Lu, Rebecca Zeng, Rohan Bajaj, Raviv Katz, Rongrong Le, Jay C. Wang, John B. Miller

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Purpose: Retinal artery occlusion (RAO) is an ophthalmic emergency that can lead to poor visual outcome and is associated with an increased risk of cerebral stroke and cardiovascular events. Fluorescein angiography (FA) is the traditional diagnostic tool for RAO; however, wide-field swept-source optical coherence tomography angiography (WF SS-OCTA), as a nascent imaging technology, is able to provide quick and non-invasive angiographic information with a wide field of view. In this study, we looked for associations between OCT-A vascular metrics and visual acuity in patients with prior diagnosis of RAO. Methods: Patients with diagnoses of central retinal artery occlusion (CRAO) or branched retinal artery occlusion (BRAO) were included. A 6mm x 6mm Angio and a 15mm x 15mm AngioPlex Montage OCT-A image were obtained for both eyes in each patient using the Zeiss Plex Elite 9000 WF SS-OCTA device. Each 6mm x 6mm image was divided into nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. The average measurement of the central foveal subfield, inner ring, and outer ring was calculated for each parameter. Non-perfusion area (NPA) was manually measured using 15mm x 15mm Montage images. A linear regression model was utilized to identify a correlation between the imaging metrics and visual acuity. A P-value less than 0.05 was considered to be statistically significant. Results: Twenty-five subjects were included in the study. For RAO eyes, there was a statistically significant negative correlation between vision and retinal thickness as well as superficial capillary plexus vessel density (SCP VD). A negative correlation was found between vision and deep capillary plexus vessel density (DCP VD) without statistical significance. There was a positive correlation between vision and choroidal thickness as well as choroidal volume without statistical significance. No statistically significant correlation was found between vision and the above metrics in contralateral eyes. For NPA measurements, no significant correlation was found between vision and NPA. Conclusions: This is the first study to our best knowledge to investigate the utility of WF SS-OCTA in RAO and to demonstrate correlations between various retinal vascular imaging metrics and visual outcomes. Further investigations should explore the associations between these imaging findings and cardiovascular risk as RAO patients are at elevated risk for symptomatic stroke. The results of this study provide a basis to understand the structural changes involved in visual outcomes in RAO. Furthermore, they may help guide management of RAO and prevention of cerebral stroke and cardiovascular accidents in patients with RAO.

Keywords: OCTA, swept-source OCT, retinal artery occlusion, Zeiss Plex Elite

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Authors: Ghada Esheba, Bayan Hafiz, Ashwaq Al-Qarni, Abdulelah AlMalki, Esraa Kaheel

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Hydatid disease is caused by genus Echinococcus, it is transmitted to human through sheep and cattle. People who lived in an endemic area should be suspected to have the disease. Pulmonary hydatid disease can be presented by respiratory manifestations as in our case. We report a case of child, 13 years old, who was presented by shortness of breath and non-productive cough 2 months ago. The patient had an attack of hemoptysis 3 months ago but there is no history of fever, other constitutional symptoms or any medical illness. The patient has had a close contact with a horse. On examination, the patient was oriented and vitally stable. Both side of chest were moving equally with decrease air entry on the left side of the chest. Cervical lymph node enlargement was also detected. The case was provisionally diagnosed as tuberculosis. The x-ray was normal, while CT scan showed two cysts in the left side. The patient was treated surgically with resection of both cysts without lobectomy. Broncho-alveolar lavage was done and together with plural effusion and both cysts were sent for histopathology. The patient received the following medication: albendazole 200MG/BID/Orally for 30 days and Cefuroxime 250MG/Q12H/Orally for 10 days.

Keywords: Echinococcus granulosus, hydatid disease, pediatrics, pulmonary hydatid cyst

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Authors: Abhijit Trailokya

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Background: Cardiovascular diseases (CVD’s) are the major cause of morbidity and mortality in both developed and developing countries. Many clinical trials have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, reduces the incidence of coronary and cerebrovascular events across a broad spectrum of patients at risk. Guidelines for the management of patients at risk have been established in Europe and North America. The guidelines have advocated progressively lower LDL-C targets and more aggressive use of statin therapy. In Indian patients, comprehensive data on dyslipidemia management and its treatment outcomes are inadequate. There is lack of information on existing treatment patterns, the patient’s profile being treated, and factors that determine treatment success or failure in achieving desired goals. Purpose: The present study was planned to determine the lipid control status in high-risk dyslipidemic patients treated with lipid-lowering therapy in India. Methods: This cross-sectional, non-interventional, single visit program was conducted across 483 sites in India where male and female patients with high-risk dyslipidemia aged 18 to 65 years who had visited for a routine health check-up to their respective physician at hospital or a healthcare center. Percentage of high-risk dyslipidemic patients achieving adequate LDL-C level (< 70 mg/dL) on lipid-lowering therapy and the association of lipid parameters with patient characteristics, comorbid conditions, and lipid lowering drugs were analysed. Results: 3089 patients were enrolled in the study; of which 64% were males. LDL-C data was available for 95.2% of the patients; only 7.7% of these patients achieved LDL-C levels < 70 mg/dL on lipid-lowering therapy, which may be due to inability to follow therapeutic plans, poor compliance, or inadequate counselling by physician. The physician’s lack of awareness about recent treatment guidelines also might contribute to patients’ poor adherence, not explaining adequately the benefit and risks of a medication, not giving consideration to the patient’s life style and the cost of medication. Statin was the most commonly used anti-dyslipidemic drug across population. The higher proportion of patients had the comorbid condition of CVD and diabetes mellitus across all dyslipidemic patients. Conclusion: As per the European Society of Cardiology guidelines the ideal LDL-C levels in high risk dyslipidemic patients should be less than 70%. In the present study, 7.7% of the patients achieved LDL-C levels < 70 mg/dL on lipid lowering therapy which is very less. Most of high risk dyslipidemic patients in India are on suboptimal dosage of statin. So more aggressive and high dosage statin therapy may be required to achieve target LDLC levels in high risk Indian dyslipidemic patients.

Keywords: cardiovascular disease, diabetes mellitus, dyslipidemia, LDL-C, lipid lowering drug, statins

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Authors: Clive Sealey

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This article will analyse the impact that the increasingly multicultural nature of the UK has had on the nature and direction of social policy. The increasingly multicultural nature of the UK is being driven by a variety of demographic changes, particularly increased net migration from EU10 and the EU 2 enlargement. This has become an increasingly political issue, as exemplified by the specific rise of the United Kingdom Independence Party as a political force with the primary intention of restricting such migration. Perhaps not surprisingly, this has also had a significant impact on the nature and direction of social policies, as evident in the prominence given to efforts to reducing immigration and to restrict welfare benefits paid to such migrants. These policies have largely reflected the retreat away from the emphasis in UK policy on multiculturalism towards assimilation for all migrants, both prior and newly domiciled. Linking these two main policy emphases of reducing immigration and limiting entitlement to benefits is the concept of citizenship. An important point that this article will highlight, is that this changed citizenship does not just relate to new migrants, but also to existing domiciled migrants, such as in relation to specifying the assimilation of ‘Britishness’ and ‘British values’ in their daily life. Additionally, the article also analyses how the changes in welfare entitlements for new migrants is also impacting in an exclusionary way on the living standards of the native population, and therefore also their social rights as citizens. The article discusses the implication that this change presents for social work practice, particularly in terms of both migrants and native population changed citizenship.

Keywords: migration, citizenship, exclusion, social policy, migrant welfare

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