Search results for: medical staff

Authors: Magdalena Chrabąszcz, Teresa Wolniewicz, Cezary Maciejewski, Joanna Czuwara

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BACKGROUND: Dermoscopy is a clinical tool known to improve the early detection of melanoma and other malignancies of the skin. Over the past few years melanoma has grown into a disease of socio-economic importance due to the increasing incidence and persistently high mortality rates. Early diagnosis remains the best method to reduce melanoma and non-melanoma skin cancer– related mortality and morbidity. Dermoscopy is a noninvasive technique that consists of viewing pigmented skin lesions through a hand-held lens. This simple procedure increases melanoma diagnostic accuracy by up to 35%. Dermoscopy is currently the standard for clinical differential diagnosis of cutaneous melanoma and for qualifying lesion for the excision biopsy. Like any clinical tool, training is required for effective use. The introduction of small and handy dermoscopes contributed significantly to the switch of dermatoscopy toward a first-level useful tool. Non-dermatologist physicians are well positioned for opportunistic melanoma detection; however, education in the skin cancer examination is limited during medical school and traditionally lecture-based. AIM: The aim of this randomized study was to determine whether the adjunct of dermoscopy to the standard fourth year medical curriculum improves the ability of medical students to distinguish between benign and malignant lesions and assess acceptability and satisfaction with the intervention. METHODS: We performed a prospective study in 2 cohorts of fourth-year medical students at Medical University of Warsaw. Groups having dermatology course, were randomly assigned to:  cohort A: with limited access to dermatoscopy from their teacher only – 1 dermatoscope for 15 people  Cohort B: with a full access to use dermatoscopy during their clinical classes:1 dermatoscope for 4 people available constantly plus 15-minute dermoscopy tutorial. Students in both study arms got an image-based test of 10 lesions to assess ability to differentiate benign from malignant lesions and postintervention survey collecting minimal background information, attitudes about the skin cancer examination and course satisfaction. RESULTS: The cohort B had higher scores than the cohort A in recognition of nonmelanocytic (P < 0.05) and melanocytic (P <0.05) lesions. Medical students who have a possibility to use dermatoscope by themselves have also a higher satisfaction rates after the dermatology course than the group with limited access to this diagnostic tool. Moreover according to our results they were more motivated to learn dermatoscopy and use it in their future everyday clinical practice. LIMITATIONS: There were limited participants. Further study of the application on clinical practice is still needed. CONCLUSION: Although the use of dermatoscope in dermatology as a specialty is widely accepted, sufficiently validated clinical tools for the examination of potentially malignant skin lesions are lacking in general practice. Introducing medical students to dermoscopy in their fourth year curricula of medical school may improve their ability to differentiate benign from malignant lesions. It can can also encourage students to use dermatoscopy in their future practice which can significantly improve early recognition of malignant lesions and thus decrease melanoma mortality.

Keywords: dermatoscopy, early detection of melanoma, medical education, skin cancer

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Authors: Ayami Umemura

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The purpose of this paper is to examine the meaning of verbalization in clinical practice using the keywords silence and singularity. A patient's experience of illness and treatment is singular, irreplaceable, and irreproducible and ultimately cannot be compared with that of others. In his book Difference and Repetition, Gilles Deleuze positioned irreplaceable singularity as the opposite concept of particularity as a generalizable and substitutable property and matched the former with universality. He also said that singularity could not be represented because of its irreplaceable nature. Representation or verbalization is a procedure that converts an irreplaceable, idiosyncratic reality into something that can be substituted. Considering the act of verbalizing medical diagnosis based on this, it can be said that diagnosis is the practice of decontextualizing and generalizing the suffering embedded in the patient's irreplaceable life history as a disease. This paper examines the above with the key concept of the practice of "non-verbalization" in traditional medical practices in Sri Lanka. In the practice of Sri Lankan traditional medicine and the inheritance of medical knowledge and care techniques, there is a tendency to avoid verbalizing specific matters or stating them aloud. Specifically, the following should be avoided. The healer informs the patient of the name of the disease, mentions the name of the herb used in front of the patient, explains the patient's condition to the healer, and referring the names of poisonous animals, such as poisonous snakes that have been damaged. And so on. Furthermore, when passing on medical knowledge and skills, it is also possible to avoid verbalizing knowledge of medicinal herbs and medical treatment methods and explaining them verbally. In addition to the local belief that the soul of language in Sri Lanka is deeply involved in this background, Sri Lankan traditional medicine has a unique view of the human body and personality that is rooted in the singularity that appears in the relationship with the movement of celestial bodies and the supernatural realm. It can be pointed out that it is premised on the view. In other words, the “silence” in Sri Lankan indigenous medicine is the reason for emphasizing specificity. Furthermore, we can say that "non-verbalization" is a practice aimed at healing. Based on these discussions, this paper will focus on the unique relationships between practitioners and patients that become invisible due to verbalization, which is overlooked by clinical medicine, where informed consent, ensuring transparency, and audit culture is dominant. We will examine the experience of treatment and aim to relativize clinical medicine, which is based on audit cultures.

Keywords: audit cultures, indigenous medicine, singularity, verbalization

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Authors: Daphne Alroy-Thiberge

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Trauma-impacted individuals present unique treatment challenges that include high reactivity, hyper-and hypo-arousal, poor adherence to therapy, as well as powerful transference and counter-transference experiences in therapy. This work provides an overview of the clinical tenets most often encountered in trauma-impacted individuals. Further, it provides readily applicable clinical techniques to optimize therapeutic rapport and facilitate accelerated positive mental health outcomes. Finally, integrated neuroscience and clinical evidence-based data are discussed to shed new light on crisis states in trauma-impacted individuals. This knowledge is utilized to provide effective and concrete interventions towards rapid and successful de-escalation of the impacted individual. A highly interactive, adult-learning-principles-based modality is utilized to provide an organic learning experience for participants. The information and techniques learned aim to increase clinical effectiveness, reduce staff injuries and burnout, and significantly enhance positive mental health outcomes and self-determination for the trauma-impacted individuals treated.

Keywords: clinical competencies, crisis interventions, psychotherapy techniques, trauma informed care

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Authors: Sudhir K. Gupta

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Introduction: When a forensic doctor determines that a suspicious death is a suicide, homicide, or accident, the decision virtually becomes incontestable by the investigating police officer, and it becomes an issue whether the medical opinion was created with necessary checks and balances on the other probabilities of the case. It is suggested that the opinion of Forensic Medical experts is conventional, mutable, and shifting from one expert to another. The determination of suicide, accident, or homicide is mandatorily required, which is the Gold Standard for conducting death investigations. Forensic investigations serve many audiences, but the court is by far the most critical. The likely questions on direct and cross-examination determine how forensic doctors gather and handle evidence and what conclusions they reach. Methodology: The author interacted with the investigative authority, and a crime scene visit was also done along with the perusal of the Postmortem report, subsequent opinion, and crime scene photographs and statements of the witness and accused. Further analysis of all relevant scientific documents and opinions of other forensic doctors, forensic scientists, and ballistic experts involved in these cases was done to arrive at an opinion with scientific justification. Findings: The opinions arrived at by the author and how they helped the judiciary in delivering justice in these cases have been discussed in this article. This can help the readers to understand the process involved in formulating a credible forensic medical expert opinion for investigators and the judiciary. Conclusion: A criminal case might be won or lost over doubt cast on the chain of custody. Medically trained forensic doctors, therefore, learn to practice their profession in legally appropriate ways, and opinions must be based on medical justifications with credible references.

Keywords: forensic doctor, professional credibility, investigation, expert opinion

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Authors: Bennasser Samira

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Meningitis, especially the meningococcal one, is a serious problem of public health. A system of vigilanceand surveillance is in place to allow effective actions to be taken on actual or potential health problems caused by all forms of meningitis. Objectives: 1. Describe the epidemiological surveillance system for meningitis in the province of Taza. 2. Evaluate the quality and responsiveness of the epidemiological surveillance system for meningitis in the province of Taza. 3. Propose measures to improve this system at the provincial level. Methods: This was a descriptive study with a purely quantitative approach by evaluating the quality and responsiveness of the system during 5 years between January 2016 and December 2020. We usedfor that the investigation files of meningitis cases and the provincial database of meningitis. We calculated some quality indicators of surveillance system already defined by the National Program for the Prevention and Control of Meningitis. Results: The notification is passive, the completeness of the data is quite good (94%), and the timeliness don’t exceed 71%. The quality of the data is acceptable (91% agreement). The systematic and rapid performance of lumbar punctures increases the diagnostic capabilities of the system. The local response actions are effected in 100%. Conclusion: The improvement of this surveillance system depends on strengthening the staff skills in diagnostic, reviewing surveillance tools, and encouraging judicious use of the data.

Keywords: evaluation, meningitis, system, taza, morocco

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Authors: Weic-Ting Chen, Jo-Ming Tseng

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Ammonium nitrate (AN) has caused many accidents in the world, which have caused a large number of people’s life and serious economic losses. In this study, the safety of the AN production process was discussed deeply, and the influence of incompatible substances was estimated according to the change of their heat value by mixing them with incompatible substances by thermal analysis techniques, and their safety parameters were calculated according to their kinetic parameters. In this study, differential scanning calorimeters (DSC) were applied for the temperature rise test and adiabatic thermal analysis in combination with the Advanced Reactive System Screening Tool (ARSST). The research results could contribute to the safety of the ammonium nitrate production process. Manufacturers can better understand the possibility of chemical heat release and the operating conditions that will cause a chemical reaction to be out of control when storing or adding new substances, so safety parameters were researched for these complex reactions. The results of this study will benefit the process of AN and the relevant staff, which also have safety protection in the working environment.

Keywords: ammonium nitrate, incompatible substances, differential scanning calorimeters, advanced reactive system screening tool, safety parameters

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Authors: Dina Alfreahat, Zoltan Sebestyen

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Safety is considered as one of the project’s success factors. Poor safety management may result in accidents that impact human, economic, and legal issues. Therefore, it is necessary to consider safety and health as a project success factor along with other project success factors, such as time, cost, and quality. Organizations have a knowledge deficit of the implementation of long-term safety practices, and due to cost control, safety problems tend to receive the least priority. They usually assume that safety management involves expenditures unrelated to production goals, thereby considering it unnecessary for profitability and competitiveness. The purpose of this study is to introduce, analysis and identify the correlation between the orientation of the public safety procedures of an organization and the public safety standards applied in the project. Therefore, the authors develop the process and collect the possible mathematical-statistical tools supporting the previously mentioned goal. The result shows that the adoption of management to safety is a major factor in implementing the safety standard in the project and thereby improving safety performance. It may take time and effort to adopt the mindset of safety orientation service development, but at the same time, the higher organizational investment in safety and health programs will contribute to the loyalty of staff to safety compliance.

Keywords: project management perspective, safety orientation, safety performance, safety standards

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Authors: Haikal Achmad Thaha, Pujo Laksono, Dhamma Nibbana Putra

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Customer service is one of the core interest in a service sector of a company, whether as the core business or as service part of the operation. Most of the time, the people and the previous research in service industry is focused on finding the best business model solution for the service sector, usually to decide between total in house customer service, outsourcing, or something in between. Conventionally, to take this decision is some important part of the management job, and this is a process that usually takes some time and staff effort, meanwhile market condition and overall company needs may change and cause loss of income and temporary disturbance in the companies operation . However, in this paper we have offer a new concept model to assist decision making process in service industry. This model will featured information platform as central tool to integrate service industry operation. The result is service information model which would ideally increase response time and effectivity of the decision making. it will also help service industry in switching the service solution system quickly through machine learning when the companies growth and the service solution needed are changing.

Keywords: service industry, customer service, machine learning, decision making, information platform

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Authors: Nuruddeen Usman, Mohammad Sani

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The performance of project delivery methods has been an issue of concern to various stakeholders in the construction industry. The contracting system of project delivery is the traditional system used in the delivery of most public projects in Nigeria. The direct labor system is used most times as an alternative to the traditional system. There were so many complain about the performance of contracting system and the suitability of direct labor as an alternative to the delivery of public projects. Therefore, this paper is aimed at investigating the effect of project size on the project delivery methods in the completed public buildings. Questionnaires were self-administered to managerial staff in the study area and analyzed using descriptive statistics. The findings reveals that contracting system was choosing for large size building construction project delivery with higher frequency (F) of 40 (76.9%) against direct labor with 12 (23.1%). While the small size project, the result revealed a frequency (F) of 26 (50%) for contracting system and direct labor system respectively. Base on the research findings, the contracting system, was recommended for all sizes of building construction project delivery while direct labor system can only use as an alternative for small size building construction projects delivery.

Keywords: construction size, contracting system, direct labour, effect

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Authors: Lasha Kamashidze

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COVID19 has already become one of the biggest challenges in the modern world. The virus has also had a significant impact on the world economy, which has faced a major crisis. Each crisis and challenge creates new opportunities. Changes in the world have allowed us to see business in a new light. The aim of the article is to explore new opportunities in the business that have arisen as a result of the Corona virus. Now, organizations with a service profile are working to meet the rapidly changing needs of their staff and customers. Due to the situation created by the pandemic, it became necessary to make some changes in people's daily lives. It became necessary to adapt to the new reality. The changes caused by Coronavirus require in-depth research and analysis in the world economy, as the current situation is not ruled out to be repeated in the future. Many companies have resorted to remote work methods, which require organizational changes. The form of remote work is not new to the Georgian reality. In Georgia, as well as in the rest of the world, the business sector has undergone changes. It will be beneficial for many Georgian companies to make organizational changes that will allow them to work remotely. The current situation has shown the managers of both Georgian and other companies to have "weak points" in organizing modern business. A survey was conducted (online survey), as a result of which it received important information about the problems of remote work in Georgia.

Keywords: organizational change, coronomics, remote work, management

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Authors: Jo Angouri, Charlotte Kennedy, Shawnea Ting, David Rawlinson, Matthew Booker, Nigel Rees

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Ambulance services need to balance the large volume of emergency (999 in the UK) calls they receive (e.g., West Midlands Ambulance Service reports per day about 4,000 999 calls; about 679,000 calls per year are received in Wales), with dispatching limited resource for on-site intervention to the most critical cases. The process by which Emergency Medical Dispatch (EMD) decisions are made is related to risk assessment and involves the caller and call-taker as well as clinical teams negotiating risk levels on a case-by-case basis. Medical Priority Dispatch System (MPDS – also referred to as Advanced Medical Priority Dispatch System AMPDS) are used in the UK by NHS Trusts (e.,g WAST) to process and prioritise 999 calls. MPDS / AMPDS provide structured protocols for call prioritisation and call management. Protocols/policy frameworks have not been examined before in the way we propose in our project. In more detail, the risk factors that play a role in the EMD negotiation between the caller and call-taker have been analysed in both medical and social science research. Research has focused on the structural, morphological and phonological aspects that could improve, and train, human-to-human interaction or automate risk detection, as well as the medical factors that need to be captured from the caller to inform the dispatch decision. There are two significant gaps in our knowledge that we address in our work: 1. the role of backstage clinical teams in translating the caller/call-taker interaction in their internal risk negotiation and, 2. the role of policy frameworks, protocols and regulations in the framing of institutional priorities and resource allocation. We take a multi method approach and combine the analysis of 999 calls with the analysis of policy documents. We draw on interaction analysis, corpus methodologies and thematic analysis. In this paper, we report on our preliminary findings and focus in particular on the risk factors we have identified and the relationship with the regulations that create the frame within which teams operate. We close the paper with implications of our study for providing evidence-based policy intervention and recommendations for further research.

Keywords: emergency (999) call, interaction analysis, discourse analysis, ambulance dispatch, medical discourse

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Authors: Toby Gibbs, Suwaree Yordchim

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This research analyzes factors affecting the success of Litecoin Value within Thailand and develops a guideline for self-reliance for effective business implementation. Samples in this study included 119 people through surveys. The results revealed four main factors affecting the success as follows: 1) Future Career training should be pursued in applied Litecoin development. 2) Didn't grasp the concept of a digital currency or see the benefit of a digital currency. 3) There is a great need to educate the next generation of learners on the benefits of Litecoin within the community. 4) A great majority didn't know what Litecoin was. The guideline for self-reliance planning consisted of 4 aspects: 1) Development planning: by arranging meet up groups to conduct further education on Litecoin and share solutions on adoption into every day usage. Local communities need to develop awareness of the usefulness of Litecoin and share the value of Litecoin among friends and family. 2) Computer Science and Business Management staff should develop skills to expand on the benefits of Litecoin within their departments. 3) Further research should be pursued on how Litecoin Value can improve business and tourism within Thailand. 4) Local communities should focus on developing Litecoin awareness by encouraging street vendors to accept Litecoin as another form of payment for services rendered.

Keywords: bitcoin, cryptocurrency, decentralized, business implementation

Procedia PDF Downloads 280

Authors: Nasir Khalid

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In Malaysia, higher education is big business. There are many companies that are willing if not already to invest heavily in higher education for students that aspire to pursue their degree in diploma, undergraduate as well as graduate studies. These companies sometimes even have a joint venture twinning program with other already established universities in and across Europe, Australia, the United States, and Canada. Some of these investments have been successful whereas others find themselves limited by the obstacle of receiving new students. Recently, the Malaysian Ministry of Higher Education has stopped issuing licenses to set up private institutions of higher education. This paper will thus examine the factors affecting the success of private higher education businesses in Malaysia. The samples will consist of thirty private institutions [N=30]. Among the factors that will be mentioned in the literature are academic programs, student quality and achievement, student employability, alumni satisfaction, student enrolment, institutional environment, lecturer-quality and effectiveness of supporting staff. A questionnaire was developed and analyzed using statistical analysis. The result of this study found that the top three factors affecting the success of private higher education businesses in Malaysia are student enrolment, institutional environment and the academic programs offered.

Keywords: higher education business, successful business factors, private institutions, business in Malaysia

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Authors: Ashok D. Satpute

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Ayurveda, the ancient Indian Medical system is practiced all over India and abroad, is rich in natural source of medicines, including marine products. The marine drugs which prominently used are pravala (coral), mukta (pearl), kapardika (cowry).Shukti (oyster shell), shankha (conch), agnijara (amber) etc. Except agnijara (amber) all are rich in calcium. Interestingly they are not used as supplements in calcium deficiency as done in conventional medical practice. They are used as medicines in the disease like fever, tuberculosis, bleeding disorders, eye problems, digestive complaints etc. Many scientific studies have shown their potent medicinal value. Each has its own properties and used therapeutically after subjecting them to various purificatory processes which are called shodhana in which several medicinal plants are used which also help in enhancing therapeutical activity. Then these purified marine products are subjected to marana (incineration) process and obtained in the form of Bhasma (a finest form of medicine). Agnijara, a derivative of whale is useful as aphrodisiac and prescribed in neuromuscular disorders and tetanus. The ancient scriptures written in Sanskrit language thousands of years back have rich information about all these natural marine products and their medicinal usage.

Keywords: Ayurveda, bhasma, marana, shodhana

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Authors: Abdulrahman H. Alrashidi

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Kuwait Oil Company provides health care services through Ahmadi hospital for oil sector employee and their families. Due to increasing number of entitled patients in Ahmadi hospital, the company starts health insurance option in 2010. In addition, a new Ahmadi hospital decided to build to accumulate all entitled patients. Operation and management of new Ahmadi hospital investigated in this research. In order to maintain the high quality of medical services and satisfaction rate among oil sector community and reducing the operation cost. Six operation and management options evaluated in order to implement in new Ahmadi hospital. Qualitative Risk assessment method used to investigate proposed options for operation and management of new Ahmadi hospital. Evaluation criteria consist of quality of medical services, operation cost and satisfaction rate among oil sector community. Results show that using the same operation and management system in existing Ahmadi hospital with new Ahmadi hospital will bring cost higher. This approach brings risk to KOC. Results from risk assessment show that partially operated new Ahmadi hospital is the best opportunity to meet the objectives of KOC’s medical group.

Keywords: Kuwait Oil Company, new Ahmadi hospital, operation and management, risk assessment

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Authors: Yared Yitagesu Tilahun

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Every nation, developed or developing, relies on transportation, but Addis Abeba City's transportation service is impacted by a number of variables. The current study's objectives are to determine the factors that influence transportation and gauge consumer satisfaction with such services in Addis Abeba. Customers and employees of Addis Ababa's transportation service authority would be the study's target group. 40 workers of the authority would be counted as part of the 310 000 clients that make up the population of the searcher service. Using a straightforward random selection technique, the researcher only chose 99 customers and 28 staff from this enormous group due to the considerable cost and time involved. Data gathering and analysis options included both quantitative and qualitative approaches. The results of this poll show that young people between the ages of 18 and 25 make up the majority of respondents (51.6%). The majority of employees and customers indicated that they are not satisfied with Addis Ababa's overall transportation system. The Addis Abeba Transportation Authority prioritizes client happiness by providing fair service. The company should have a system in place for managing time, resources, and people effectively. It should also provide employees the opportunity to contribute to client handling policies.

Keywords: transportation, customer satisfaction, services, determinants

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Authors: Sachi Matsuoka

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This study aimed at implicating a current community health in South India focusing on a Vaidya, a non-codified traditional doctor, based on long-term field works. As the prevalence of colonic diseases is increasing in all over the world, it is needed to know the potential of non-codified medicines and how they can effectively take in a part in community health. Describing the people’s treatment seeking behaviours in a suburban village which is susceptible to modernization can give us a new insight for studying Indian medicines, that is included not only non-codified but also codified traditional ones, affected by global, national and local communities. Both qualitative and quantitative data were gathered via participatory fieldworks and open-ended interviews to a Vaidya and his 97 patients and 31 individuals who lived in a community near the Vaidya’s station. It was found that the community members seldom consulted the Vaidya while a number of patients outside the village (mainly from urban nearby area) daily visited the Vaidya. Thus, the role of the Vaidya as the community’ s primary health care provider had nearly disappeared. Nonetheless, the Vaidya was deeply respected as one of the community’ s leaders by its members because of the spiritual and financial support he provided to them. The reasons for choosing the Vaidya for the patients from urban area are characterized by several social factors of the patients such as their religious belief, seriousness, occupation and medical history. Meanwhile, not only the Vaidya but also other codified traditional medicines, e.g., Ayurveda, were less popular among the community members. It sounds paradoxical given that the traditional Indian medical system has been becoming popular as an alternative medicine in societies outside of India, such as in Europe. The community members who are less educated and engaged in religious activities in daily life preferred to allopathy, the biomedicine in Indian context. It is thus concluded that roles of non-codified medicine has changed depending on its cultural and social contexts, even though its medical system is not authorized by the government. Nowadays, traditional medical effectiveness is recognized as evidenced by scientific survey and the codified medical doctors treats diseases rather than people. However, this study implicated that people’s treatment seeking behaviors are likely based on the social context in which people live their lives even though evidenced based codified medicine is provided in their community.

Keywords: medical pluralism, non-codified medicine, south india, treatment-seeking behaviours

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Authors: Christiane H. Kellner, Sarah Reker

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The UN-Convention on the Rights of Persons with Disabilities, which Germany also ratified, postulates the necessity of user-centred design, especially when it comes to evaluating the individual needs and wishes of all citizens. Therefore, a multidimensional approach is required. Based on this insight, the structure of the town-like centre in Schönbrunn - a large residential complex and service provider for persons with disabilities in the outskirts of Munich - will be remodelled to open up the community to all people as well as transform social space. This strategy should lead to more equal opportunities and open the way for a much more diverse community. The research project “Index for participation development and quality of life for persons with disabilities” (TeLe-Index, 2014-2016), which is anchored at the Technische Universität München in Munich and at the Franziskuswerk Schönbrunn supports this transformation process called “Vision 2030”. In this context, we have provided academic supervision and support for three projects (the construction of a new school, inclusive housing for children and teenagers with disabilities and the professionalization of employees using person-centred planning). Since we cannot present all the issues of the umbrella-project within the conference framework, we will be focusing on one sub-project more in-depth, namely “The Person-Centred Think Tank” [Arbeitskreis Personenzentriertes Denken; PZD]. In the context of person-centred thinking (PCT), persons with disabilities are encouraged to (re)gain or retain control of their lives through the development of new choice options and the validation of individual lifestyles. PCT should thus foster and support both participation and quality of life. The project aims to establish PCT as a fundamental approach for both employees and persons with disabilities in the institution through in-house training for the staff and, subsequently, training for users. Hence, for the academic support and supervision team, the questions arising from this venture can be summed up as follows: (1) has PCT already gained a foothold at the Franziskuswerk Schönbrunn? And (2) how does it affect the interaction with persons with disabilities and how does it influence the latter’s everyday life? According to the holistic approach described above, the target groups for this study are both the staff and the users of the institution. Initially, we planned to implement the group discussion method for both target-groups. However, in the course of a pretest with persons with intellectual disabilities, it became clear that this type of interview, with hardly any external structuring, provided only limited feedback. In contrast, when the discussions were moderated, there was more interaction and dialogue between the interlocutors. Therefore, for this target-group, we introduced structured group interviews. The insights we have obtained until now will enable us to present the intermediary results of our evaluation. We analysed and evaluated the group interviews and discussions with the help of qualitative content analysis according to Mayring in order to obtain information about users’ quality of life. We sorted out the statements relating to quality of life obtained during the group interviews into three dimensions: subjective wellbeing, self-determination and participation. Nevertheless, the majority of statements were related to subjective wellbeing and self-determination. Thus, especially the limited feedback on participation clearly demonstrates that the lives of most users do not take place beyond the confines of the institution. A number of statements highlighted the fact that PCT is anchored in the everyday interactions within the groups. However, the implementation and fostering of PCT on a broader level could not be detected and thus remain further aims of the project. The additional interviews we have planned should validate the results obtained until now and open up new perspectives.

Keywords: person-centered thinking, research with persons with disabilities, residential complex and service provider, participation, self-determination.

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Authors: Saimir Cenameri, Arjana Tereziu, Kastriot Dallaku

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Introduction: Intra-uterine death is a common problem in obstetrical practice, and can lead to complications if left to resolve spontaneously. The cervix is unprepared, making inducing of labor difficult. Misoprostol is a synthetic prostaglandin E1 analogue, inexpensive, and is presented valid thanks to its ability to bring about changes in the cervix that lead to the induction of uterine contractions. Misoprostol is quickly absorbed when taken orally, resulting in high initial peak serum concentrations compared with the vaginal route. The vaginal misoprostol peak serum concentration is not as high and demonstrates a more gradual serum concentration decline. This is associated with many benefits for the patient; fast induction of labor; smaller doses; and fewer side effects (dose-depended). Mostly it has been used the regime of 50 μg/4 hour, with a high percentage of success and limited side effects. Objective: Evaluation of the efficiency of the use of oral and vaginal misoprostol in inducing labor, and comparing it with its use not by a previously defined protocol. Methods: Participants in this study included patients at U.H.O.G. 'Koco Gliozheni', Tirana from April 2004-July 2006, presenting with an indication for inducing labor in the third trimester for pregnancy termination. A total of 37 patients were randomly admitted for birth inducing activity, according to protocol (26), oral or vaginal protocol (10 vs. 16), and a control group (11), not subject to the protocol, was created. Oral or vaginal misoprostol was administered at a dose of 50 μg/4 h, while the fourth group participants were treated individually by the members of the medical staff. The main result of interest was the time between induction of labor to birth. Kruskal-Wallis test was used to compare the average age, parity, women weight, gestational age, Bishop's score, the size of the uterus and weight of the fetus between the four groups in the study. The Fisher exact test was used to compare day-stay and causes in the four groups. Mann-Whitney test was used to compare the time of the expulsion and the number of doses between oral and vaginal group. For all statistical tests used, the value of P ≤ 0.05 was considered statistically significant. Results: The four groups were comparable with regard to woman age and weight, parity, abortion indication, Bishop's score, fetal weight and the gestational age. There was significant difference in the percentage of deliveries within 24 hours. The average time from induction to birth per route (vaginal, oral, according to protocol and not according to the protocol) was respectively; 10.43h; 21.10h; 15.77h, 21.57h. There was no difference in maternal complications in groups. Conclusions: Use of vaginal misoprostol for inducing labor in the third trimester for termination of pregnancy appears to be more effective than the oral route, and even more to uses not according to the protocols approved before, where complications are greater and unjustified.

Keywords: inducing labor, misoprostol, pregnancy termination, third trimester

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Authors: Barry Ardley, Abi Hunt, Nick Taylor

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As a theoretical and practical framework, this study uses the student-as-producer approach to learning in higher education, as adopted by the Lincoln International Business School, University of Lincoln, UK. Students as producer positions learners as skilled and capable agents, able to participate as partners with tutors in live research projects. To illuminate the nature of this approach to learning and to highlight its critical issues, the authors report on two guided student consultancy projects. These were set up with the assistance of two local organisations in the city of Lincoln, UK. Using the student as a producer model to deliver the projects enabled learners to acquire and develop a range of key skills and knowledge not easily accessible in more traditional educational settings. This paper presents a systematic case study analysis of the eight organising principles of the student-as-producer model, as adopted by university tutors. The experience of tutors implementing students as producers suggests that the model can be widely applied to benefit not only the learning and teaching experiences of higher education students and staff but additionally a university’s research programme and its community partners.

Keywords: consultancy, learning, student as producer, research

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Authors: Guerrero Ramírez Sandra, Ramos Salinas Norma Maricela, Muriel Amezcua Vanesa

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This article presents the beginning of a wider study that intends to demonstrate how within organizations of the automotive industry from the city of Querétaro. Knowledge management and technological management are required, as well as people’s initiative and the interaction embedded at the interior of it, with the appropriate environment that facilitates information conversion with wide information technologies management (ITM) range. A company was identified for the pilot study of this research, where descriptive and inferential research information was obtained. The results of the pilot suggest that some respondents did noted entity the knowledge management topic, even if staffs have access to information technology (IT) that serve to enhance access to knowledge (through internet, email, databases, external and internal company personnel, suppliers, customers and competitors) data, this implicates that there are Knowledge Management (KM) problems. The data shows that academically well-prepared organizations normally do not recognize the importance of knowledge in the business, nor in the implementation of it, which at the end is a great influence on how to manage it, so that it should guide the company to greater in sight towards a competitive strategy search, given that the company has an excellent technological infrastructure and KM was not exploited. Cultural diversity is another factor that was observed by the staff.

Keywords: Knowledge Management (KM), Technological Knowledge Management (TKM), Technology Information Management (TI), access to knowledge

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Authors: Zofia Hammerin, Goran Basic, Disa Bergnehr

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Ever since the Ottawa charter in 1986, health promotion through schools has been stressed across the globe. Both in the global and national discourse, schools are made responsible not only for providing education but also for working with pupil health and well-being. In Sweden, where the study is set, it is emphasized in national directives that promoting pupil health should be part of the school practice. Since the Swedish school system is decentralized, these directives need to be interpreted and recontextualized locally. This study aims to explore how the student comes across in Swedish local health policy documents. The data consists of 37 such documents called student health plans collected from different high schools throughout Sweden. The analysis was inspired by critical discourse analysis, and tentative results are divided into two main themes; the invisible actor and the passive recipient. The pupil is largely invisible in the documents, and the discourse instead focuses on school health service staff and, to some extent, the teachers. When the pupils are visible, they mainly come across as passive recipients of health promoting actions. Since participation, taking action, and feeling empowered are key aspects of health promotion, the findings could impact the pupils’ possibilities for health and well-being.

Keywords: health promotion, high school, student, sweden

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Authors: Mubita Namuyamba

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Despite an increase in the number of cancer programs and partnerships in cancer care provision, the burden of cancer in Zambia is increasingly having a significant impact on morbidity and mortality rates. The increase in cancer morbidity and mortality rates has given rise to psychological and psycho social implications (PPsI) in cancer care. Cancer patients, care givers and health care providers are faced with a multitude of PPsIs in cancer care that mainly impact negatively on the management of cancer patients. The study adopted a case study design and was purposively conducted at the Cancer Diseases Hospital in Lusaka (Zambia) after obtaining ethical clearance from the Ethics committee. The sample for this study included 70 cancer patients, 20 care givers and 5 hospital staff (4 nurses and 1 doctor). Data was collected using interviews guides, focus group discussion guides and questionnaires respectively. The qualitative data was analysed thematically. The various psychological and psychosocial challenges that conspire to deter the provision of effective cancer care nursing and improved methods of minimizing the psychological and psychosocial implications in cancer care are the products of this study.

Keywords: case study, enquiry, psychological and psycho social aspects, Zambia

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Authors: Amirmehdi Dokhanchi, Babak Ziyae

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Studying and prioritizing effective factors on productivity of human resources through TOPSIS method is the main aim of the present research study. For this reason, while reviewing concepts existing in productivity, effective factors were studied. Managers, supervisors, staff and personnel of Tabriz Tractor Manufacturing Company are considered subject of this study. Of total individuals, 160 of them were selected through the application of random sampling method as 'subject'. Two questionnaires were used for collecting data in this study. The factors, which had the highest effect on productivity, were recognized through the application of software packages. TOPSIS method was used for prioritizing recognized factors. For this reason, the second questionnaire was put available to statistics sample for studying effect of each of factors towards predetermined indicators. Therefore, decision-making matrix was obtained. The result of prioritizing factors shows that existence of accurate organizational strategy, high level of occupational skill, application of partnership and contribution system, on-the-job-training services, high quality of occupational life, dissemination of appropriate organizational culture, encouraging to creativity and innovation, and environmental factors are prioritized respectively.

Keywords: productivity of human resources, productivity indicators, TOPSIS, prioritizing factors

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Authors: Adinarayana Badveeti, Mohammad Shafi Mir

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In Srinagar City, in India, traffic congestion is a condition on transport networks that occurs as use increases and is characterized by slower speeds, longer trip times, and increased vehicular queuing. Traffic congestion is conventionally measured using indicators such as roadway level-of-service, the Travel Time Index and their variants. Several measures have been taken in order to counteract congestion like road pricing, car pooling, improved traffic management, etc. While new road construction can temporarily relieve congestion in the longer term, it simply encourages further growth in car traffic through increased travel and a switch away from public transport. The full paper report, on which this abstract is based, aims to provide policymakers and technical staff with the real-time data, conceptual framework and guidance on some of the engineering tools necessary to manage congestion in such a way as to reduce its overall impact on individuals, families, communities, and societies dynamic, affordable, liveable and attractive urban regions will never be free of congestion. Road transport policies, however, should seek to manage congestion on a cost-effective basis with the aim of reducing the burden that excessive congestion imposes upon travellers and urban dwellers throughout the urban road network.

Keywords: traffic congestion, modeling, traffic management, travel time index

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Authors: Wang Liguang, Zhang Xueqing

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The build-operate-transfer (BOT) project delivery system has provided effective routes to mobilize private sector funds, innovative technologies, management skills and operational efficiencies for public infrastructure development and have been widely used in China during the last 20 years. Many BOT projects in China will be smoothly transferred to the government soon and the transfer stage, which is considered as the last stage, must be studied carefully and handled well to achieve the overall success of BOT projects. There will be many issues faced by both the public sector and private sector in the transfer stage of BOT projects, including project post-assessment, technology and documents transfer, personal training and staff transition, etc. and sometimes additional legislation is needed for future operation and management of facilities. However, most previous studies focused on the bidding, financing, and building and operation stages instead of transfer stage. This research identifies nine key issues in the transfer stage of BOT projects through a comprehensive study on three cases in China, and the expert interview and expert discussion meetings are held to validate the key issues and give detail analysis. A proposed framework of transfer management is prepared based on the experiences derived and lessons drawn from the case studies and expert interview and discussions, which is expected to improve the transfer management of BOT projects in practice.

Keywords: BOT project, key issues, transfer management, transfer stage

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Authors: Fatemeh Yazdani

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This paper explores the student intake policies in high-performing private schools in Iran by studying both sides involved in the school choice processes, parents and the school leaders. It is based on in-depth interviews with 27 parents and private schools’ staff and principals supplemented by ethnographic observation in two private schools in Tehran. From the Bourdieusian point of view, this paper argues that the school leadership engineers the composition of private schools’ students via different gatekeeping strategies, and these strategies represent and reconstruct the school’s institutional habitus. It further explores the ways that parents who look for quality education among non-state education providers deal with the school's institutional habitus based on their familial habitus and possessed economic, social, and cultural capital. The conclusion highlights that investigating school choice as a reciprocal process between family and school leadership can shed more light on the ways that an exclusive environment has been created in some high-performing private schools for certain class strata maintaining a distance that needs to be kept from ‘others.’ In a broader sense, this paper engages into an exploration of social inequality reproduction through private education.

Keywords: institutional habitus, private education, school choice, social inequality, student intake

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Authors: Ling-Lang Huang

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Background: The holistic health care should ideally cover physical, mental, spiritual, and social aspects of a patient. With very constrained time in current clinical practice system, medical decisions often tip the balance in favor of evidence-based medicine (EBM) in comparison to patient's personal values. Even in the era of competence-based medical education (CBME), when scrutinizing the items of entrustable professional activities (EPAs), we found that EPAs of establishing doctor-patient relationship remained incomplete or even missing. This phenomenon prompted us to raise this project aiming at advocating value-based medicine (VBM), which emphasizes the importance of patient’s values in medical decisions. A true and effective doctor-patient communication and relationship should be a well-balanced harmony of EBM and VBM. By constructing VBM into current EPAs, we can further promote genuine shared decision making (SDM) and fix the missing link in holistic health care. Methods: In this project, we are going to find out EPA elements crucial for establishing an ideal doctor-patient relationship through three distinct pairs of doctor-patient relationships: patients with pulmonary arterial hypertension (relatively young but with grave disease), patients undergoing surgery (facing critical medical decisions), and patients with terminal diseases (facing forthcoming death). We’ll search for important EPA elements through the following steps: 1. Narrative approach to delineate patients’ values among 2. distinct groups. 3.Hermeneutics-based interview: semi-structured interview will be conducted for both patients and physicians, followed by qualitative analysis of collected information by compiling, disassembling, reassembling, interpreting, and concluding. 4. Preliminarily construct those VBM elements into EPAs for doctor-patient relationships in 3 groups. Expected Outcomes: The results of this project are going to give us invaluable information regarding the impact of patients’ values, while facing different medical situations, on the final medical decision. The competence of well-blending and -balanced both values from patients and evidence from clinical sciences is the missing link in holistic health care and should be established in future EPAs to enhance an effective SDM.

Keywords: value-based medicine, shared decision making, entrustable professional activities, holistic health care

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Authors: Sharifah Liew, Azlihanis Abdul Hadi, Nurul Shahida Mohd Saffe, Azhar Hamzah, Maslina Musa

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Fatigue is a common health problem among healthcare workers, ranging from ambulance drivers to specialist doctors. In Malaysia, majority of healthcare workers prefer to commute to work by their own vehicle compared to public transport. Thus, exposed to risk on the road while commuting to work. The aim of the study is to find out the effects of fatigue on road crashes among healthcare workers while they commute to work. The research conducted using the semi-quantitative approach based on self- reported questionnaires. In total, five hundred and fifty-one healthcare workers from selected five hospitals were involved in this study. Results showed significant differences between crash involvement, travelling distance and time to and from work among healthcare workers. Most of the participants (37%) reported that causes of road crashes were due to fatigue, sleepiness and microsleep while driving to and back from work. In addition, there were significant differences between fatigue and road crashes and near misses. This research suggests that the hospitals’ management may need to review their staffs’ job scopes and workloads to overcome the fatigue problems and, consider their feedback when designing work schedules and investigate staff commuting distance from home to workplace and vice-versa.

Keywords: fatigue, healthcare, road crashes, near misses, Malaysia

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Authors: Audu Aly Fada, Adejoh Apeh Matthew

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This research assesses the effects of social conflicts on tourism products in Plateau State. It was specifically set out to find out the major causes of social conflicts in Jos, evaluate the effects of social conflicts on the influx of tourists to Hill station hotel Jos, and the impact on revenue generation of the hotel. To achieve these objectives research questions were formulated and a sample of 30 hotel staff was selected as the respondents. Data collected were organized and analyzed using tables, percentages and mean statistics. It was found that the hospitality and tourism industry was adversely affected. The crisis brought about a decline in the number of tourist arrivals, increase in cancelled bookings, a decrease in the average length of stay of tourists and the average room occupancy. Peace is the best friend of travel and tourism, while war and insecurity are among its worst enemies. It is recommended that all stakeholders involved in tourism administration should device safer environment that supports continued patronage by providing modern security apparatus. In the same spirit, government as the main stake-holder in security provision should do more than paying lip service to guarantee security and safety of lives and properties.

Keywords: social conflict, crisis, security, tourism development

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