Search results for: antiracist healthcare policy

Authors: Dereje Regasa

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The global food system is at a crossroads, which requires prompt action to minimize the effects of the crises. Agroecology is gaining prominence due to its contributions to sustainable food systems. To support efforts in mitigating the crises, the Food and Agriculture Organization (FAO) established alternative approaches for sustainable agri-food systems. Agroecological elements and principles were developed to guide and support measures that countries need to achieve the Sustainable Development Goals (SDGs). The SDGs require the systemic integration of practices for a smart intensification or adaptation of traditional or industrial agriculture. As one of the countries working towards SDGs, the agricultural practices in Ethiopia need to be guided by these agroecological elements and principles. Aiming at the identification of challenging aspects of a sustainable agri-food system and the characterization of an enabling environment for agroecology, as well as exploring to what extent the existing policies and strategies support the agroecological transition process, five policy and strategy documents were reviewed. These documents are the Rural Development Policy and Strategy, the Environment Policy, the Biodiversity Policy, and the Soil Strategy of the Ministry of Agriculture (MoA). Using the Agroecology Criteria Tool (ACT), the contents were reviewed, focusing on agroecological requirements and the inclusion of sustainable practices. ACT is designed to support a self-assessment of elements supporting agroecology. For each element, binary values were assigned based on the inclusion of the minimum requirements index and then validated through discussion with the document owners. The results showed that the documents were well below the requirements for an agroecological transition of the agri-food system. The Rural Development Policy and Strategy only suffice to 83% in Human and Social Value. It does not support the transition concerning the other elements. The Biodiversity Policy and Soil Strategy suffice regarding the inclusion of Co-creation and Sharing of knowledge (100%), while the remaining elements were not considered sufficiently. In contrast, the Environment Policy supports the transition with three elements accounting for 100%. These are Resilience, Recycling, and Human and Social Care. However, when the four documents were combined, elements such as Synergies, Diversity, Efficiency, Human and Social value, Responsible governance, and Co-creation and Sharing of knowledge were identified as fully supportive (100%). This showed that the policies and strategies complemented one another to a certain extent. However, the evaluation results call for improvements concerning elements like Culture and food traditions, Circular and solidarity economy, Resilience, Recycling, and Regulation and balance since the majority of the elements were not sufficiently observed. Consequently, guidance for the smart intensification of local practices is needed, as well as traditional knowledge enriched with advanced technologies. Ethiopian agricultural and environmental policies and strategies should provide sufficient support and guidance for the intensification of sustainable practices and should provide a framework for an agroecological transition towards a sustainable agri-food system.

Keywords: agroecology, diversity, recycling, sustainable food system, transition

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Authors: Mohammad Mehdi Mazaheri, Mohammad Motiee Lahromi

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Recently the two matters of how to evaluate art and what the influencing economic effects on cultural values are have attracted many researchers to investigate them. Therefore, in the present article the researcher made an attempt to answer the above questions. However, the fundamental distinction between this article and the other ones is in comparing the economic value (shown by monetary phrases) with cultural values (that reflects the aesthetic values and the importance of the artist). This article shows a different and trivial distinction that has a very clearly pivotal significance in the process of cultural policy making. The economic activities would be influenced when there are cultural values. The increase of commercial activities is measured by impact assessment. In other words, the value of culture is reflected in the satisfaction of the users of cultural activities. This kind of value is measured by “willingness to pay” researches. The researcher believes that these two values are dominant in the cultural policy but they include many aspects and are presented by different kinds of communities.

Keywords: economic influence, cultural values, monetary phrases, aesthetic values

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Authors: Knol Hester, Müller Swantje, Danchenko Natalya

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Objective: Falls in older people cause an autonomy loss and result in an economic burden. LCare is an AI-based application to manage fall risks. The study's aim was to assess the effect of LCare use on patient outcomes in nursing homes in Germany. Methods: LCare identifies and monitors fall risks through a 3D-gait analysis and a digital questionnaire, resulting in tailored recommendations on fall prevention. A study was conducted with AOK Baden-Württemberg (01.09.2019- 31.05.2021) in 16 care facilities. Assessments at baseline and follow-up included: a fall risk score; falls (baseline: fall history in the past 12 months; follow-up: a fall record since the last analysis); fall-related injuries and hospitalizations; gait speed; fear of falling; psychological stress; nurses experience on app use. Results: 94 seniors were aged 65-99 years at the initial analysis (average 84±7 years); 566 mobility analyses were carried out in total. On average, the fall risk was reduced by 17.8 % as compared to the baseline (p<0.05). The risk of falling decreased across all subgroups, including a trend in dementia patients (p=0.06), constituting 43% of analyzed patients, and patients with walking aids (p<0.05), constituting 76% of analyzed patients. There was a trend (p<0.1) towards fewer falls and fall-related injuries and hospitalizations (baseline: 23 seniors who fell, 13 injury consequences, 9 hospitalizations; follow-up: 14 seniors who fell, 2 injury consequences, 0 hospitalizations). There was a 16% improvement in gait speed (p<0.05). Residents reported less fear of falling and psychological stress by 38% in both outcomes (p<0.05). 81% of nurses found LCare effective. Conclusions: In the presented study, the use of LCare app was associated with a reduction of fall risk among nursing home residents, improvement of health-related outcomes, and a trend toward reduction in injuries and hospitalizations. LCare may help to improve senior resident care and save healthcare costs.

Keywords: falls, digital healthcare, falls prevention, nursing homes, seniors, AI, digital assessment

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Authors: Beatrice Adeoye

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Background: One of the health challenges developing countries face is air pollution from indoor and outdoor activities. Smoke as a result of cooking, burning wastes and power generators litter the air space on a continual basis due to poverty and governance challenges. The short and long term implications of these actions are enormous and studies have attributed smoke as one of the leading preventable risk factors contributing to global burden of respiratory infections. Design/Methods: The issue at hand therefore includes an exploration of the existing policy frameworks regarding smoke, adherence to international conventions and practices, and more importantly the activities of the government in addressing these issues. Aside this, an understanding of the implications of smoke on peoples’ health and well-being also become crucial. Consequently, this article seeks to interrogate the effect of smoke on the health and well-being of Nigerians and the activities of the policy makers in addressing these challenges. Results (Main Argument): This study reviewed both primary and secondary data on poverty, smoke emission and attendant health risks coupled with existing policies on smoke and air pollution in the country. For instance, over 69% of Nigerians are poor, ranking third in the world; 2.9 billion people live in homes using wood, coal or dung as their primary cooking fuel; equally, 50.6% of Nigerians has no access to regular electricity supply. Further, sustainable policy regarding smoke emission is lacking in the country. This work further submitted that continued low standard of living as a result of governance challenges coupled with a lack of sustainable policy have aggravated the health risks related to smoke in the country. Conclusions: The implication on the health of the children, mothers and vulnerable groups for the future of the country is enormous and may continue if not addressed. Urgent attention therefore needs to be focused on this area considering what this portends for the nation now and in the future.

Keywords: air pollution, indoor, outdoor, respiratory infections

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Authors: Nattapol Pourprasert

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This research is to study qualitative research having two objectives: 1. to study comparison of private sector of government to compare with ASEAN Member States, 2. to study trend of private enterprise administration of ASEAN Member States. The results are: (1) Thai people focus on personal resource administrative system, (2) Indonesia focuses on official system by good administrative principles, (3) Malaysia focuses on technology development to service people, (4) Philippines focuses on operation system development, (5) Singapore focuses on public service development, (6) Brunei Darussalam focuses on equality in government service of people, (7) Vietnam focuses on creating government labor base and develop testing and administration of operation test, (8) Myanmar focuses on human resources development, (9) Laos focuses on form of local administration, (10) Cambodia focuses on policy revolution in personal resources. The result of the second part of the study are: (1) Thailand created government personnel to be power under qualitative official structural event, (2) Indonesia has Bureaucracy Reform Roadmap of Bureaucracy Reform and National Development Plan Medium Term, (3) Malaysia has database for people service, (4) Philippines follows up control of units operation by government policy, (5) Singapore created reliability, participation of people to set government policy people’s demand, (6) Brunei Darussalam has social welfare to people, (7) Vietnam revolved testing system and administration including manpower base construction of government effectively, (8) Myanmar creates high rank administrators to develop country, (9) Laos distributes power to locality, and (10) Cambodia revolved personnel resource policy.

Keywords: public administration development, ASEAN member states, private sector, government

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Authors: R. Tariq, R. Lee

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Background: Heywood, Middleton & Rochdale Urgent Community Care Team (UCCT)1 is a great example of using a multidisciplinary team to cope with demand. The service reduces unnecessary admissions to hospitals and ensures that patients can leave the hospital quicker by making care more readily available within the community and patient’s homes. The team comprises nurses, community practitioners, and allied health professions, including physiotherapy, occupational therapy, pharmacy, and GPs. The main challenge for a team with a range of experiences and skill sets is to maintain consistency of care, which technology can help address. Allied healthcare professionals (HCPs) are often used in expanded roles with duties mainly involving patient consultations and decision making to ease pressure on doctors. The Clinical Reasoning Platform (CRP) Dem Dx is used to support new as well as experienced professionals in the decision making process. By guiding HCPs through diagnosing patients from an expansive directory of differential diagnoses, patients can receive quality care in the community. Actions on the platform are determined using NICE guidelines along with local guidance influencing the assessment and management of a patient. Objective: To compare the clinical assessment, decisions, and actions taken by the UCCT multidisciplinary team in the community and Dem Dx, using retrospective clinical cases. Methodology: Dem Dx was used to analyse 192 anonymised cases provided by the HMR UCCT. The team’s performance was compared with Dem Dx regarding the quality of the documentation of the clinical assessment and the next steps on the patient’s journey, including the initial management, actions, and any onward referrals made. The cases were audited by two medical doctors. Results: The study found that the actions outlined by the Dem Dx platform were appropriate in almost 87% of cases. When in a direct comparison between DemDX and the actions taken by the clinical team, it was found that the platform was suitable 83% (p<0.001) of the time and could lead to a potential improvement of 66% in the assessment and management of cases. Dem Dx also served to highlight the importance of comprehensive and high quality clinical documentation. The quality of documentation of cases by UCCT can be improved to provide a detailed account of the assessment and management process. By providing step-by-step guidance and documentation at every stage, Dem Dx may ensure that legal accountability has been fulfilled. Conclusion: With the ever expanding workforce in the NHS, technology has become a key component in driving healthcare outcomes. To improve healthcare provision and clinical reasoning, a decision support platform can be integrated into HCPs’ clinical practice. Potential assistance with clinical assessments, the most appropriate next step and actions in a patient’s care, and improvements in the documentation was highlighted by this retrospective study. A further study has been planned to ascertain the effectiveness of improving outcomes using the clinical reasoning platform within the clinical setting by clinicians.

Keywords: allied health professional, assessment, clinical reasoning, clinical records, clinical decision-making, ocumentation

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Authors: Sumitra Sharma, Christina Parker, Kathleen Finlayson, Clint Douglas, Niall Higgins

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Background: Telehealth services have potential to increase accessibility, utilization, and effectiveness of healthcare services. As the telehealth services are yet to integrate within regular hospital services in Nepal, the use of the telehealth services among adults with diabetes is scarce. Prior to implementation of telehealth services for adults with diabetes, it is necessary to examine influencing factors of telehealth services. Objective: This study aimed to investigate factors influencing telehealth services for diabetes care in Nepal. Methods: This study used a mixed-method study design which included a cross-sectional survey among adults with diabetes and semi-structured interviews among key healthcare professionals of Nepal. The study was conducted in a medical out-patient department of a tertiary hospital of Nepal. The survey adapted a previously validated questionnaire, while semi-structured questions for interviews were developed from literature review and experts consultation. All interviews were audio-recorded, and inductive content analysis was used to code transcripts and develop themes. For a survey, a descriptive analysis, chi-square test, and Mann Whitney U test were used to analyze the data. Results: One hundred adults with diabetes were participated in a survey, and seven healthcare professionals were recruited for interviews. In a survey, just over half of the participants (53%) were male, and others were female. Almost all participants (98%) owned a mobile phone, and 67% of them had a computer with internet access at home. Majority of participants had experience in using Facebook messenger (95%), followed by Viber (60%) and Zoom (26%). Almost all of the participants (96%) were willing to use telehealth services. There were significant associations between female sex and participants living 10 km away from the hospital with their willingness to use telehealth services. There was a significant association between participants' self-perception of good health status with their willingness to use video-conference calls and phone calls to use telehealth services. Seven themes were developed from interview data which are related to predisposing, reinforcing, and enabling factors influencing telehealth services for diabetes care in Nepal. Conclusion: In summary, several factors were found to influence the use of telehealth services for diabetes care in Nepal. For effective implementation of a sustainable telehealth services for adults with diabetes in Nepal, these factors need to be considered.

Keywords: contributing factors, diabetes mellitus, developing countries, telemedicine, telecare

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Authors: Kaesha M. Freyaldenhoven

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Chicago is a city in the United States whose cultural identity is largely shaped by public art pieces. Quintessential public works created by internationally renown artists – such as Anish Kapoor’s Cloud Gate in Millennium Park and 'The Picasso' in Daley Plaza – have historically contributed to developing a shared sense of community. In 2017, the city implemented a policy titled 50x50 Neighborhood Arts Project under the Chicago Public Art Plan. The policy promotes investments in contemporary public art to elevate neighborhood cultural assets and create a sense of place. Exclusively community-based artists were commissioned to accomplish the mission of the policy. Administrators felt only local artists would be capable of capturing the true essence of a neighborhood through art. This paper discusses the relationship between the public art and the culture of its respective neighborhood through close examination of aesthetic formal properties and social significance. Research compares the role of international artists with the role of local artists in cultivating the identity of a city through site-specific artworks in Chicago. Methodology unites theoretical research on understanding art and its function in the public space with empirical research on Chicago-based works. Theoretical frameworks provide an art historical foundation to explore the manner in which physical properties convey meaning through the work itself and its placement in an urban setting. Empirical research that examines policy documentation and press announcements released by the Department of Cultural Affairs and Special Events investigates project selection processes pertaining to the artists and neighborhoods. Ethnographies and interviews of individuals from diverse social segments in contemporary Chicago society measure impacts of the works on respective populations. Findings demonstrate works created by local artists activate neighborhoods and inculcate a sense of pride among community residents. Works created by international artists garner widespread media attention that frames the city’s cultural identity across temporal and geographic zones. This research can be utilized to inform future cultural policies pertaining to the commission of public art.

Keywords: Chicago, cultural policy, public art, urban art

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Authors: Myoungsoon You, Heejung Son

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During a pandemic, hospital workers should protect not only their vulnerable patients but also themselves from the consequences of rapidly spreading infection. However, the evidence on the psychological impact of an outbreak on hospital workers is limited. In this study, we aim to assess hospital workers’ psychological well-being and function at the workplace after an outbreak, by focusing on ‘psychological resilience’. Specifically, the effects of risk appraisal, emotional experience, and coping ability on resilience indicated by the likelihood of post-traumatic syndrome disorder and willingness to work were investigated. Such role and position of each factor were analyzed using a path model, and the result was compared between the healthcare worker and non-healthcare worker groups. In the investigation, 280 hospital workers who experienced the 2015 Middle East Respiratory Syndrome outbreak in South Korea have participated. The result presented, in both groups, the role of the appraisal of risk and coping ability appeared consistent with a previous research, that was, the former interrupted resilience while the latter facilitated it. In addition, the role of emotional experience was highlighted as, in both groups, emotional disruption not only directly associated with low resilience but mediated the effect of perceived risk on resilience. The differences between the groups were also identified, which were, the role of emotional experience and coping ability was more prominent in the non-HCW group in explaining resilience. From the results, implications on how to support hospital personnel during an outbreak in a way to facilitate their resilience after the outbreak were drawn.

Keywords: hospital workers, emotions, infectious disease outbreak, psychological resilience

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Authors: Medani Prasad Rijal

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The study outlines the impacts of decentralized forest policy on natural Sal (shorea robusta) forests in the Terai region of Nepal. The government has implemented community forestry program to manage the forest resources and improve the livelihood of local people collectively. The forest management authorities such as conserve, manage, develop and use of forest resources were shifted to the local communities, however, the ownership right of the forestland retained by the government. Local communities took the decision on harvesting, distribution, and sell of forest products by fixing the prices independently. The local communities were putting the low value of forest products and distributed among the user households on the name of collective decision. The decision of low valuation is devaluating the worth of forest products. Therefore, the study hypothesized that decision-making capacities are equally prominent next to the decentralized policy and program formulation. To accomplish the study, individual to group level discussions and questionnaire survey methods were applied with executive committee members and user households. The study revealed that the local intuition called Community Forest User Group (CFUG) committee normally took the decisions on consensus basis. Considering to the access and affording capacity of user households having poor economic backgrounds, low pricing mechanism of forest products has been practiced, even though the Sal timber is far expensive in the local market. The local communities thought that low pricing mechanism is accessible to all user households from poor to better off households. However, the analysis of forest products distribution opposed the assumption as most of the Sal timber, which is the most valuable forest product of community forest only purchased by the limited households of better economic conditions. Since the Terai region is heterogeneous by socio-economic conditions, better off households always have higher affording capacity and possibility of taking higher timber benefits because of low price mechanism. On the other hand, the minimum price rate of forest products has poor contribution in community fund collection. Consequently, it has poor support to carry out poverty alleviation activities to poor people. The local communities have been fixed Sal timber price rate around three times cheaper than normal market price, which is a strong evidence of forest product devaluation itself. Finally, the study concluded that the capacity building of local executives as the decision-makers of natural Sal forests is equally indispensable next to the policy and program formulation for effective decentralized forest management. Unilateral decentralized forest policy may devaluate the forest products rather than devolve of power to the local communities and empower to them.

Keywords: community forestry program, decentralized forest policy, Nepal, Sal forests, Terai

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Authors: Shana Malio-Satele, Lemalu Silao Vaisola Sefo

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Introductory Statement: South Seas Healthcare is Ōtara’s largest Pacific health provider in South Auckland, New Zealand. Our vision is excellent health and well-being for Pacific people and all communities through strong Pacific values. During the DELTA and Omicron outbreak of COVID-19, our Pacific people, indigenous Māori, and the community of South Auckland were disproportionately affected and faced significant hardship with existing inequities magnified. This study highlights the community-based learnings of harnessing community-based strengths such as indigenous resilience, family-informed experiences and stories that provide critical insights that inform health reform changes that will be sustainable and equitable for all indigenous populations. This study is based on critical learnings acquired during COVID-19 that challenge the deficit narrative common in healthcare about indigenous populations. This study shares case studies of marginalised groups and religious groups and the successful application of indigenous cultural strengths, such as collectivism, positive protective factors, and using trusted relationships to create meaningful change in the way healthcare is delivered. The significance of this study highlights the critical conditions needed to adopt a community-informed way of creating integrated healthcare that works and the role that the community can play in being part of the solution. Methodologies: Key methodologies utilised are indigenous and Pacific-informed. To achieve critical learnings from the community, Pacific research methodologies, heavily informed by the Polynesian practice, were applied. Specifically, this includes; Teu Le Va (Understanding the importance of trusted relationships as a way of creating positive health solutions); The Fonofale Methodology (A way of understanding how health incorporates culture, family, the physical, spiritual, mental and other dimensions of health, as well as time, context and environment; The Fonua Methodology – Understanding the overall wellbeing and health of communities, families and individuals and their holistic needs and environmental factors and the Talanoa methodology (Researching through conversation, where understanding the individual and community is through understanding their history and future through stories). Major Findings: Key findings in the study included: 1. The collectivist approach in the community is a strengths-based response specific to populations, which highlights the importance of trusted relationships and cultural values to achieve meaningful outcomes. 2. The development of a “village model” which identified critical components to achieving health reform change; system navigation, a sense of service that was culturally responsive, critical leadership roles, culturally appropriate support, and the ability to influence the system enablers to support an alternative way of working. Concluding Statement: There is a strong connection between community-based strengths being implemented into healthcare strategies and reforms and the sustainable success of indigenous populations and marginalised communities accessing services that are cohesive, equitably resourced, accessible and meaningful for families. This study highlights the successful community-informed approaches and practices used during the COVID-19 response in New Zealand that are now being implemented in the current health reform.

Keywords: indigenous voice, community voice, health reform, New Zealand

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Authors: Bindu Shrestha, Sudarshan R. Tiwari, Sushil B. Bajracharya

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Urban household cooking fuel choice is highly influenced by human behavior and energy culture parameters such as cognitive norms, material culture and practices. Although these parameters have a leading role in Kathmandu for cleaner households, they are not incorporated in the city’s energy policy. This paper aims to identify trade-offs to transform resident behavior in cooking pattern towards cleaner technology from the questionnaire survey, observation, mapping, interview, and quantitative analysis. The analysis recommends implementing a Collaborative Cultural Model (CCM) for changing impact on the neighborhood from the policy level. The results showed that each household produces 439.56 kg of carbon emission each year and 20 percent used unclean technology due to low-income level. Residents who used liquefied petroleum gas (LPG) as their cooking fuel suffered from an energy crisis every year that has created fuel hoarding, which ultimately creates more energy demand and carbon exposure. In conclusion, the carbon emission can be reduced by improving the residents’ energy consumption culture. It recommended the city to use holistic action of changing habits as soft power of collaboration in two-way participation approach within residents, private sectors, and government to change their energy culture and behavior in policy level.

Keywords: energy consumption pattern, collaborative cultural model, energy culture, fuel stacking

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Authors: Lucas Paganin, Viliam Makis

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With the advent of globalization, the market competition has become a major issue for most companies. One of the main strategies to overcome this situation is the quality improvement of the product at a lower cost to meet customers’ expectations. In order to achieve the desired quality of products, it is important to control the process to meet the specifications, and to implement the optimal maintenance policy for the machines and the production lines. Thus, the overall objective is to reduce process variation and the production and maintenance costs. In this paper, an integrated model involving Statistical Process Control (SPC) and maintenance is developed to achieve this goal. Therefore, the main focus of this paper is to develop the jointly optimal maintenance and statistical process control policy minimizing the total long run expected average cost per unit time. In our model, the production process can go out of control due to either the deterioration of equipment or other assignable causes. The equipment is also subject to failures in any of the operating states due to deterioration and aging. Hence, the process mean is controlled by an Xbar control chart using equidistant sampling epochs. We assume that the machine inspection epochs are the times when the control chart signals an out-of-control condition, considering both true and false alarms. At these times, the production process will be stopped, and an investigation will be conducted not only to determine whether it is a true or false alarm, but also to identify the causes of the true alarm, whether it was caused by the change in the machine setting, by other assignable causes, or by both. If the system is out of control, the proper actions will be taken to bring it back to the in-control state. At these epochs, a maintenance action can be taken, which can be no action, or preventive replacement of the unit. When the equipment is in the failure state, a corrective maintenance action is performed, which can be minimal repair or replacement of the machine and the process is brought to the in-control state. SMDP framework is used to formulate and solve the joint control problem. Numerical example is developed to demonstrate the effectiveness of the control policy.

Keywords: maintenance, semi-Markov decision process, statistical process control, Xbar control chart

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Authors: Rujijan Vichivanives

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This research aims to create a knowledge-based system as a database for self-healthcare analysis, diagnosis of simple illnesses, and the use of Thai herbs instead of modern medicine by using principles of Thai traditional medication theory. These were disseminated by website network programs within Suan Sunandha Rajabhat University. The population used in this study was divided into two groups: the first group consisted of four experts of Thai traditional medication and the second group was 300 website users. The methods used for collecting data were paper questionnaires and poll questionnaires on the website. The statistics used for analyzing data was at an average level. The results were divided into three parts: the first part was the development of a knowledge-based system and the second part was applied programs on website. Both parts could be fulfilled and achieved according to the set goal. The third part was the evaluation of the study: The evaluation of the viewpoints of the experts towards website designs were evaluated at a good level of 4.20. The satisfaction evaluation of the users was found at a good level of average satisfactory level at 4.24. It was found that the young population of those under the age of 16 had less cares about their health than the population of other teenagers, working age adults and those of older age. The research findings should be extended in order to encourage the lifestyle modifications to people of all ages by using the self-healthcare principles.

Keywords: developing, herbs, knowledge-based system, medical treatment

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Authors: Prince Amartey

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Water is critical to public health, quality of life, environmental preservation, economic activity, and long-term growth. In this environment, it is critical to ensure the ongoing improvement of all processes and practices that contribute to the quality and safety of water. Water safety plans (WSPs) developed by water companies are an essential public policy instrument for achieving these objectives. This manuscript examines international evidence of water safety planning adoption and implementation and reports on the current situation in Portugal as part of the necessary adaptation of the national legal framework to the publication of the Directive on water quality for human consumption. The goal is to take lessons from various successful WSP projects throughout the world while writing new legislation in Ghana and elsewhere. According to the findings, four crucial aspects and key factors of success in establishing and implementing WSPs exist commitment from leadership, technical proficiency, administration, and cooperation among agencies.

Keywords: safe drinking, risk, policy, implementation

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Authors: Sabrina Neururer, Marco Schweitzer, Werner Hackl, Bernhard Tilg, Patrick Raudaschl, Andreas Huber, Bernhard Pfeifer

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History and the current outbreak of Covid-19 have shown the deadly potential of infectious diseases. However, infectious diseases also have a serious impact on areas other than health and healthcare, such as the economy or social life. These areas are strongly codependent. Therefore, disease control measures, such as social distancing, quarantines, curfews, or lockdowns, have to be adopted in a very considerate manner. Infectious disease modeling can support policy and decision-makers with adequate information regarding the dynamics of the pandemic and therefore assist in planning and enforcing appropriate measures that will prevent the healthcare system from collapsing. In this work, an agent-based simulation package named “survival” for simulating infectious diseases is presented. A special focus is put on SARS-Cov-2. The presented simulation package was used in Austria to model the SARS-Cov-2 outbreak from the beginning of 2020. Agent-based modeling is a relatively recent modeling approach. Since our world is getting more and more complex, the complexity of the underlying systems is also increasing. The development of tools and frameworks and increasing computational power advance the application of agent-based models. For parametrizing the presented model, different data sources, such as known infections, wastewater virus load, blood donor antibodies, circulating virus variants and the used capacity for hospitalization, as well as the availability of medical materials like ventilators, were integrated with a database system and used. The simulation result of the model was used for predicting the dynamics and the possible outcomes and was used by the health authorities to decide on the measures to be taken in order to control the pandemic situation. The survival package was implemented in the programming language Java and the analytics were performed with R Studio. During the first run in March 2020, the simulation showed that without measures other than individual personal behavior and appropriate medication, the death toll would have been about 27 million people worldwide within the first year. The model predicted the hospitalization rates (standard and intensive care) for Tyrol and South Tyrol with an accuracy of about 1.5% average error. They were calculated to provide 10-days forecasts. The state government and the hospitals were provided with the 10-days models to support their decision-making. This ensured that standard care was maintained for as long as possible without restrictions. Furthermore, various measures were estimated and thereafter enforced. Among other things, communities were quarantined based on the calculations while, in accordance with the calculations, the curfews for the entire population were reduced. With this framework, which is used in the national crisis team of the Austrian province of Tyrol, a very accurate model could be created on the federal state level as well as on the district and municipal level, which was able to provide decision-makers with a solid information basis. This framework can be transferred to various infectious diseases and thus can be used as a basis for future monitoring.

Keywords: modelling, simulation, agent-based, SARS-Cov-2, COVID-19

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Authors: Keshavamurthy Ganapathy Bhat, Manvinderpal Singh Marwaha

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Background: Coronary artery Disease (CAD) is a common cause of morbidity, mortality and reason for unfitness amongst aircrew. Coronary angioplasty and stenting are the standard of care for CAD. Antiplatelet drugs like Aspirin and Clopidogrel(Dual Antiplatelet therapy) are routinely prescribed post-stenting which are permitted for flying. However, in the recent past, Ticagrelor is being used in place of Clopidogrel as per ACC AHA and ESC guidelines. However Ticagrelor is not permitted for flying. Case Presentation: A 55-year-old pilot suffered Anterior Wall Myocardial Infarction. Angiography showed blockages in Left Anterior Descending Artery(LAD) and Right coronary artery (RCA). He underwent primary angioplasty and stenting LAD and subsequent stenting to RCA. Recovery was uneventful. One year later he was asymptomatic with normal Left ventricular function and no reversible perfusion defect on stress MPI. He had patent stents and coronaries on check angiogram. However, he was not allowed to fly since he was on Ticagrelor. He had to be switched over to Clopidogrel from Ticagrelor one year after stenting to permit him for flying. Similarly, switching had to be done in a 45-year-old pilot. Ticagrelor has been proven to be more effective than clopidogrel and as safe as Clopidogrel in preventing stent thrombosis. If Clopidogrel is being permitted, there is no need to restrict Ticagrelor. Hence "Policy" needs to be changed. Conclusions: Dual Antiplatelet therapy is the standard of care post coronary stenting which has been proved safe and effective. Policy needs to be changed to permit flying with Ticagrelor which is more effective than Clopidogrel and equally safe.

Keywords: antiplatelet drugs, coronary artery disease, stenting, ticagrelor

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Authors: Madhukar Kasarla, Sumit Fogla, Kiran Panuganti, Gaurav Jain, Abhijit Ramanujam, Astha Jain, Shashank Kraleti, Sharat Musham, Arun Chaudhury

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Patients have often chosen to travel for care — making pilgrimages to academic meccas and state-of-the-art hospitals for sophisticated surgery. This culture is still persistent in the landscape of US healthcare, with hundred thousand of visitors coming to the shores of United States to seek the high quality of medical care. One of the major challenges in this form of medical tourism has been the language barrier. Thus, an Iraqi patient, with immediate needs of communicating the healthcare needs to the treating team in the hospital, may face huge barrier in effective patient-doctor communication, delaying care and even at times reducing the quality. To circumvent these challenges, we are proposing the use of a state-of-the-art tool, Talk2All, which can translate nearly one hundred international languages (and even sign language) in real time. The tool is an easy to download app and highly user friendly. It builds on machine learning principles to decode different languages in real time. We suggest that the use of Talk2All will tremendously enhance communication in the hospital setting, effectively breaking the language barrier. We propose that vigorous incorporation of Talk2All shall overcome practical challenges in international medical and surgical tourism.

Keywords: language translation, communication, machine learning, medical tourism

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Authors: Mai Ali

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Advancing beyond the junior stage of a paediatrician’s career is a crucial step where they accumulate essential skills and knowledge. This process prepares them for the challenges they'll encounter throughout their profession, particularly in dealing with paediatric emergencies. This can be especially demanding for trainees specializing in fields like endocrinology, particularly in the management of Diabetic Ketoacidosis (DKA) in the UK. In different societal contexts, junior doctors, whether specializing in pediatrics or other medical fields, are generally expected to possess a fundamental level of knowledge and skills necessary for managing diabetic ketoacidosis (DKA) emergencies. These physicians consistently concurred in recognizing prevalent problems in the healthcare facilities they examined. Such issues include the lack of established guidelines for DKA treatment and the inadequate availability of comprehensive training opportunities. The abstract underscores the critical importance of junior paediatricians acquiring expertise in managing paediatric emergencies, with a specific focus on DKA. Commonly, issues like the lack of standardized protocols and training deficiencies are recurring themes across healthcare facilities. This research proposal aims to conduct a thematic analysis of the proficiency of paediatric trainees in the United Kingdom when handling DKA in various clinical contexts. The primary goal is to assess their competency and suggest effective strategies for comprehensive DKA training improvement.

Keywords: junior pediatrician, DKA, standardized protocols, level of competence

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Authors: Patrick T. I. Lam, Wenjing Yang

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A smart city project embraces benefits and costs which can be classified under direct and indirect categories. Externalities come into the picture, but they are often difficult to quantify. Despite this barrier, policy makers need to carry out cost-benefit analysis to justify the huge investments needed to make a city smart. The recent trend is towards the engagement of the private sector to utilize their resources and expertise, especially in the Information and Communication Technology (ICT) areas, where innovations blossom. This study focuses on the identification of costs (on a life cycle basis) and benefits associated with smart city project developments based on a comprehensive literature review and case studies, where public-private partnerships would warrant consideration, the related costs and benefits are highlighted. The findings will be useful for policy makers of cities.

Keywords: smart city projects, costs and benefits, identification, public-private partnerships

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Authors: Gaafar Muhammed, N. T. Ersoy

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The role of electricity in the economic development of any country is undeniable. The main goal of utilizing renewable sources in electricity generation, especially in the emerging countries, is to improve electricity access, economic development and energy sustainability. Germany’s recent transition from conventional to renewable energy technologies is overwhelming, this might not be associated with its abundant natural resources but owing to the policies in place. In line with the fast economic and technological developments recorded in recent years, Germany currently produces approximately 1059 GW of its energy from renewable sources. Hence, at the end of 2016, Germany is among the world leaders in terms of installed renewable energy capacity. As one of the most important factors that lead to renewable energy utilization in any nation is an effective policy, this study aims at examining the effect of policies on renewable energy (RE) development in Germany. Also, the study will focus on the evolution of the adopted feed-in tariff policies, as this evolution has affected the renewable energy capacity in Germany over a period of 15 years (2000 to 2015). The main contribution of the study is to establish a link between the feed-in tariff and the increase of RE in Germany’s energy mix. This is done by analyzing the characteristics of various feed-in tariff mechanisms adopted through the years. These characteristics include the feed-in-tariff rate, degression, special conditions, supported technology, etc. Then, the renewable energy development in Germany has been analyzed through the years along with the targets and the progress in reaching these targets. The study reveals that Germany’s renewable energy support policies (especially feed-in tariff) lead to several benefits and contribute towards the targets existing for renewable energy.

Keywords: feed-in tariff, Germany, policy, penewable energy

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Authors: Olumide Simeon Ogunnusi, Shukor Abd Razak, Michael Kolade Adu

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Inter-agent communication manager facilitates communication among mobile agents via message passing mechanism. Until now, all Foundation for Intelligent Physical Agents (FIPA) compliant agent systems are capable of exchanging messages following the standard format of sending and receiving messages. Previous works tend to secure messages to be exchanged among a community of collaborative agents commissioned to perform specific tasks using cryptosystems. However, the approach is characterized by computational complexity due to the encryption and decryption processes required at the two ends. The proposed approach to secure agent communication allows only agents that are created by the host agent server to communicate via the agent communication channel provided by the host agent platform. These agents are assumed to be harmless. Therefore, to secure communication of legitimate agents from intrusion by external agents, a 2-phase policy enforcement system was developed. The first phase constrains the external agent to run only on the network server while the second phase confines the activities of the external agent to its execution environment. To implement the proposed policy, a controller agent was charged with the task of screening any external agent entering the local area network and preventing it from migrating to the agent execution host where the legitimate agents are running. On arrival of the external agent at the host network server, an introspector agent was charged to monitor and restrain its activities. This approach secures legitimate agent communication from Man-in-the Middle and Replay attacks.

Keywords: agent communication, introspective agent, isolation of agent, policy enforcement system

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Authors: Vladimir Siska, Lukas Kober

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Introduction: The research deals with the work satisfaction of nurses working in healthcare institutions in the Slovak Republic, and factors influencing it. Employers should create working conditions that are consonant with the requirements of their employees and make the most of motivation strategies to help them answer to the employess' needs in concordance with various needs and motivation process theories. Methodology: In our research, we aimed to investigate the level of work satisfaction in nurses by carrying out a quantitative analysis using the standardized McCloskey/Mueller Satisfaction scale questionnaire. We used the descriptive positioning characteristics (average, median and variability, standard deviation, minimum and maximum) to process the collected data and, to verify our hypotheses; we employed the double-selection Student T-test, Mann-Whitney U test, and a one-way analysis of variance (One-way ANOVA). Results: Nurses´satisfaction with external rewards is influenced by their age, years of experience, and level of completed education, with all of the abovementioned factors also impacting on the nurses' satisfaction with their work schedule. The type of founding authority of the healthcare institution also constitutes an influence on the nurses' satisfaction concerning relationships in the workplace. Conclusion: The feelling of work dissatisfaction can influence employees in many ways, e.g., it can take the form of burn-out syndrome, absenteeism, or increased fluctuation. Therefore, it is important to pay increased attention to all employees of an organisation, regardless of their position.

Keywords: motivation, nurse, work satisfaction, McCloskey/Mueller satisfaction scale

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Authors: Jevonte Abioye, Dylan Savary

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The aim of this research is to present a disaggregated geostatistical analysis of the subnational provincial trends of child mortality variation in Zimbabwe from a child health policy perspective. Soon after gaining independence in 1980, the government embarked on efforts towards promoting equitable health care, namely through the provision of primary health care. Government intervention programmes brought hope and promise, but achieving equity in primary health care coverage was hindered by previous existing disparities in maternal health care disproportionately concentrated in urban settings to the detriment of rural communities. The article highlights policies and programs adopted by the government during the millennium development goals period between 1990-2015 as a response to the inequities that characterised the country’s maternal health care. A longitudinal comparative method for a spatial variation on child mortality rates across provinces is developed based on geostatistical analysis. Cross-sectional and time-series data was extracted from the World Health Organisation (WHO) global health observatory data repository, demographic health survey reports, and previous academic and technical publications. Results suggest that although health care policy was uniform across provinces, not all provinces received the same antenatal and perinatal services. Accordingly, provincial rates of child mortality growth between 1994 and 2015 varied significantly. Evidence on the trends of child mortality rates and maternal health policies in Zimbabwe can be valuable for public child health policy planning and public service delivery design both in Zimbabwe and across developing countries pursuing the sustainable development agenda.

Keywords: antenatal care, perinatal care, infant mortality rate, neonatal mortality rate, under-five mortality rate, millennium development goals, sustainable development agenda

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Authors: Nana Benma Osei

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Patient discharge can be a hectic process. Patients are sometimes sent to the wrong location or forgotten in lounges in the waiting room. This ends up compromising patient care because the delay in picking the patients can affect how they adhere to medication. Patients may fail to take their medication, and this will lead to negative outcomes. The situation highlights the demands of modern-day healthcare, and the use of technology can help in reducing such challenges and in enhancing the patient’s experience, leading to greater satisfaction with the care provided. The paper contains the proposed changes to a healthcare facility by introducing the clinical decision support system, which will be needed to improve coordination and communication during patient discharge. This will be done under Kurt Lewin’s Change Management Model, which recognizes the different phases in the change process. A pilot program is proposed initially before the program can be implemented in the entire organization. This allows for the identification of challenges and ways of managing them. The paper anticipates some of the possible challenges that may arise during implementation, and a multi-disciplinary approach is considered the most effective. Opposition to the change is likely to arise because staff members may lack information on how the changes will affect them and the skills they will need to learn to use the new system. Training will occur before the technology can be implemented. Every member will go for training, and adequate time is allocated for training purposes. A comparison of data will determine whether the project has succeeded.

Keywords: patient discharge, clinical decision support system, communication, collaboration

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Authors: J. Milton, C. Uzoigwe, O. Ayeko, B. Offorha, K. Anderson, R. G. Middleton

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Background: We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 units in order to determine if the unit volume was associated with performance for each particular outcome. Method: We analysed 175 institutions treating a total of 67,673 patients over the course of a year. Results: The number of hip fractures seen per unit ranged between 86 and 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. Patients treated at large institutions had shorter lengths of stay. With regard to most other outcomes, there was no association between unit case volume and performance, notably compliance with the Best Practice Tariff, time to surgery, proportion of eligible patients undergoing total hip arthroplasty, length of stay, delirium risk, and pressure sore risk assessments. Conclusion: There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

Keywords: institution volume, mortality, neck of femur fractures, osteoporosis

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Authors: S. Halioui, I. Arikan, M. Schmidt

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Tourism sector in Tunisia faces several problems that range from economic challenges to environmental degradation and social instability. These problems have been intensified because of the increased competition in the tourism market, the political instability, financial crises, and recently terrorism problems have aggravated the situation. As a consequence, a new framework that promotes sustainable tourism in the country and increases its competitiveness is urgently needed. Planning for sustainable tourism sector requires the integration of complex interactions between economic, social and environmental aspects. Sustainable tourism principles can be implemented with the help of Strategic Environmental Assessment (SEA) process, which ensures the full integration of economic, social and environmental considerations while planning for the tourism sector in Tunisia. Results of the paper have broad implications for policy makers and tourism professionals.

Keywords: sustainable tourism, strategic environmental assessment, tourism planning, policy

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Authors: Miriam Schiff, Hadas Rosenne, Ran Nir-Paz, Shiri Shinan Altman

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To examine (1) the level, predictors, and subjective perception of professional quality of life (PRoQL), posttraumatic growth, roles, task changes during the pandemic, and perceived preparedness for the next pandemic. These variables were added as part of an international study on social workers in healthcare stress, resilience, and perceived preparedness we took part in, along with Australia, Canada, China, Hong Kong, Singapore, and Taiwan. (2) The extent to which background variables, rate of exposure to the virus, working in COVID wards, profession, personal resilience, and resistance to organizational change predict posttraumatic growth, perceived preparedness, and PRoQL (the latter was examined among social workers only). (3) The teams' perceptions of how the pandemic impacted them at the personal, professional, and organizational levels and what assisted them. Methodologies: Mixed quantitative and qualitative methods were used. 1039 hospital healthcare workers from various professions participated in the quantitative study while 32 participated in in-depth interviews. The same methods were used in six other countries. Findings: The level of PRoQL was moderate, with higher burnout and secondary traumatization level than during routine times. Differences between countries in the level of PRoQL were found as well. Perceived preparedness for the next pandemic at the personal level was moderate and similar among the different health professions. Higher exposure to the virus was associated with lower perceived preparedness of the hospitals. Compared to other professions, doctors and nurses perceived hospitals as significantly less prepared for the next pandemic. The preparedness of the State of Israel for the next pandemic is perceived as low by all healthcare professionals. A moderate level of posttraumatic growth was found. Staff who worked at the COVID ward reported a greater level of growth. Doctors reported the lowest level of growth. The staff's resilience was high, with no differences among professions or levels of exposure. Working in the COVID ward and resilience predicted better preparedness, while resistance to organizational change predicted worse preparedness. Findings from the qualitative part of the study revealed that healthcare workers reported challenges at the personal, professional and organizational level during the different waves of the pandemic. They also report on internal and external resources they either owned or obtained during that period. Conclusion: Exposure to the COVID-19 virus is associated with secondary traumatization on one hand and personal posttraumatic growth on the other hand. Personal and professional discoveries and a sense of mission helped cope with the pandemic that was perceived as a historical event, war, or mass casualty event. Personal resilience, along with the support of colleagues, family, and direct management, were seen as significant components of coping. Hospitals should plan ahead and improve their preparedness to the next pandemic.

Keywords: covid-19, health-care, social workers, burnout, preparedness, international perspective

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Authors: Chijioke Oliver Nwodoh, Jonah Ikechukwu Eze, Loretta Chika Ukwuaba, Ifeoma Ndubuisi, Ada Carol Nwaneri, Ijeoma Lewechi Okoronkwo

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Presence of nursing workforce with unequal qualification and status in Nigeria has undermined the growth of nursing profession in the country. Upgrading of the existing basic and post-basic nursing schools to degree-awarding institutions in Nigeria is a way-forward to solving this inequality problem and Nigeria teaching hospitals are in vantage position for this project due to the already existing supportive structure and manpower in those hospitals. What the nurse trainers and the stakeholders of the teaching hospitals may hold for or against the upgrading is a determining factor for the upgrading project, but that is not clear and has not been investigated in Nigeria. The study investigated the perception of nurse trainers and stakeholders of teaching hospitals in Enugu State of Nigeria on the obstacles and ways-forward to upgrading nursing schools to degree-awarding institutions in Nigeria. The study specifically elicited what the subjects may view as obstacles to upgrading basic and post-basic nursing schools to degree-awarding institutions in Nigeria and ascertained their suggestions on the possible ways of overcoming the obstacles. By utilizing cross-sectional descriptive design and a purposive sampling procedure, 78 accessible subjects out of a total population of 87 were used for the study. The generated data from the subjects were analyzed using frequencies, percentages and mean for the research questions and Pearson’s chi-square for the hypotheses, with the aid of Statistical Package for Social Sciences Version 20.0. The result showed that lack of extant policy, fund, and disunity among policy makers and stakeholders of nursing profession are the main obstacles to the upgrading. However, the respondents did not see items like: stakeholders and nurse trainers of basic and post-basic schools of nursing; fear of admitting and producing poor quality nurses; and so forth, as obstacles to the upgrading project. Institution of the upgrading policy by Nursing and Midwifery Council of Nigeria, funding, awareness creation for the upgrading and unison among policy makers and stakeholders of nursing profession are the major possible ways to overcome the obstacles. The difference in the subjects’ perceptions between the two hospitals was found to be statistically insignificant (p > 0.05). It is recommended that the policy makers and stakeholders of nursing in Nigeria should unite and liaise with Federal Ministries of Health and Education for modalities and actualization of upgrading nursing schools to degree-awarding institutions in Nigeria.

Keywords: nurse trainers, obstacles, perception, stakeholders, teaching hospital, upgrading basic nursing schools, ways-forward

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Authors: Olgun Akbulut

Abstract:

Turkey has entered in the European human rights monitoring in the early 1990s. Since then many improvements have been observed in domestic law. However, one area stays the least developed one: gender discrimination. Although the country is proud of the fact that electoral rights for women were recognized in Turkey even before many developed countries in the west, interestingly the first Turkish case where the European Court of Human Rights (ECrtHR) found discrimination concerned gender discrimination. With the proposed paper, the author is willing to determine and analyze the findings of the ECrtHR in cases decided against Turkey concerning gender discrimination, identify whether Turkish public institutions display coordination in engagement or disengagement in implementing the judgments where the ECrtHR found discrimination on the basis of gender and evaluate the effectiveness of the Court's jurisprudence on Turkish gender policy.

Keywords: equality, gender discrimination, human rights, Turkey

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