Search results for: Greek public hospital sector

Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Proteus mirabilis (P. mirabilis) is one of Gram-negative pathogens in human and it causes urinary tract and nosocomial infections. P. mirabilis is susceptible to β-lactams, aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. It was aimed to investigate the resistance status to antimicrobial agents of Proteus mirabilis strains produced from samples sent to Afyon Kocatepe University, ANS Research and Practice Hospital, Microbiology Laboratory from different clinics and polyclinics during the period of 24 months. Methods: Between October 2013 and September 2015, a total of 30 Proteus were isolated from clinical samples of patients were hospitalized in intensive care units and in various departments of Afyon Kocatepe University, ANS Research and Practice Hospital. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bioMérieux, France) was used additionally. Antibacterial susceptibility tests were performed by Kirby Bauer disc (Oxoid, Hempshire, England) diffusion method following the recommendations of CLSI. Results: Of the total 30 Proteus strains isolated from clinical samples, 19 from urine, 7 from wound, 4 from tracheal aspiration materials were isolated. Antimicrobial resistant for these strains were determined to 24,3% for meropenem, 26.2% for imipenem, 20.2% for amikacin 10.5% for cefepim, 33.3% for ciprofloxacin and levofloxacine, 31.6% for ceftazidime, 20% for ceftriaxone, 15.2% for gentamicin and 26.6% for amoxicillin-clavulanate, 26.2% trimethoprim-sulfamethoxale. Conclusion: In the present study, the highest number of clinical isolates of P. mirabilis were isolated from urine (63,3%), followed by the others (36,6%). The distribution of samples P. mirabilis strains to the clinics were as fallows; 16,8% intensive care unit (ICU), 29,9% polyclinics, 53,3% hospital service units The most effective antibiotic on the total of strains were found to be cefepim, the least effective antibiotics on the total of strains were found to be trimethoprim-sulfamethoxale.

Keywords: proteus mirabilis, antibiotic resistance, intensive care unit, Proteus spp.

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Authors: K. Genise, S. Murthy

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Introductory Statement: The results of this retrospective chart review suggest the effects of bacterial colonization in critically ill children with viral bronchiolitis, currently unproven, are clinically insignificant. Background: Viral bronchiolitis is one of the most prevalent causes of illness requiring hospitalization among children worldwide and one of the most common reasons for admission to pediatric intensive care. It has been hypothesized that co-infection with bacteria results in more severe clinical outcomes. Conversely, the effects of bacterial colonization in critically ill patients with bronchiolitis are poorly defined. Current clinical management of colonized patients consists primarily of supportive therapies with the role of antibiotics remaining controversial. Methods: A retrospective review of all critically ill children admitted to the BC Children’s Hospital Pediatric Intensive Care Unit (PICU) from 2014-2017 with a diagnosis of bronchiolitis was performed. Routine testing in this time frame consisted of complete pathogen testing, including PCR for Streptococcus pneumoniae. Analyses were performed to determine the impact of bacterial colonization and antibiotic use on a primary outcome of PICU length-of-stay, with secondary outcomes of hospital length-of-stay and duration of ventilation. Results: There were 92 patients with complete pathogen testing performed during the assessed timeframe. A comparison between children with detected Streptococcus pneumoniae (n=22) and those without (n=70) revealed no significant (p=0.20) differences in severity of illness on presentation as per Pediatric Risk of Mortality III scores (mean=3.0). Patients colonized with S. pneumoniae had significantly shorter PICU stays (p=0.002), hospital stays (p=0.0001) and duration of non-invasive ventilation (p=0.002). Multivariate analyses revealed that these effects on length of PICU stay and duration of ventilation do not persist after controlling for antibiotic use, presence of radiographic consolidation, age, and severity of illness (p=0.15, p=0.32). The relationship between colonization and duration of hospital stay persists after controlling for these variables (p=0.008). Conclusions: Children with viral bronchiolitis colonized with S. pneumoniae do not appear to have significantly different PICU length-of-stays or duration of ventilation compared to children who are not colonized. Colonized children appear to have shorter hospital stays. The results of this study suggest bacterial colonization is not associated with increased severity of presenting illness or negative clinical outcomes.

Keywords: bronchiolitis, colonization, critical care, pediatrics, pneumococcal, infection

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Authors: Mas Pertiwi I. G. AG Istri, Sri Kristinayanti Wayan, Oka Aryawan I. Gede Made

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Ability of government to meet the needs of infrastructure investment constrained by the size of the budget commitments for other sectors. Another barrier is the complexity of the process of land acquisition. Public Private Partnership can help bridge the investment gap by including the amount of funding from the private sector, shifted the responsibility of financing, construction of the asset, and the operation and post-project design and care to them. In principle, a construction project implementation always requires the investor as a party to provide resources in the form of funding which it must be contained in a successor agreement in the form of a contract. In general, construction contracts consist of contracts which passed in Indonesia and contract International. One source of funding used in the implementation of construction projects comes from funding that comes from the collaboration between the government and the private sector, for example with the system: BLT (Build Lease Transfer), BOT (Build Operate Transfer), BTO (Build Transfer Operate) and BOO (Build Operate Own). And form of payment under a construction contract can be distinguished several ways: monthly payment, payments based on progress and payment after completed projects (Turn Key). One of the tools used to analyze the feasibility of the investment is to use financial models. The financial model describes the relationship between different variables and assumptions used. From a financial model will be known how the cash flow structure of the project, which includes revenues, expenses, liabilities to creditors and the payment of taxes to the government. Net cash flow generated from the project will be used as a basis for analyzing the feasibility of investment source of project financing Public Private Partnership could come from equity or debt. The proportion of funding according to its source is a comparison of a number of investment funds originating from each source of financing for a total investment cost during the construction period by selected the contract system and several alternative financing percentage ratio determined according to sources will generate cash flow structure that is different. Of the various possibilities for the structure of the cash flow generated will be analyzed by software is to test T Paired to compared the contract system used by various alternatives comparison of financing to determine the effect of the contract system and the comparison of such financing for the feasibility of investment toll road construction project for the economic life of 20 (twenty) years. In this use case studies of toll road contruction project Bali Mandara. And in this analysis only covered two systems contracts, namely Build Operate Transfer and Turn Key. Based on the results obtained by analysis of the variable investment feasibility of the NPV, BCR and IRR between the contract system Build Operate Transfer and contract system Turn Key on the interest rate of 9%, 12% and 15%.

Keywords: contract system, financing, internal rate of return, net present value

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Authors: Marja A. Bernardo, Coreena A. Bueser, Cybele Lara R. Abad, Raul V. Destura

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Pneumocystis jirovecii pneumonia (PCP) is the most common opportunistic infection among people with HIV. Early consideration of PCP should be made even in patients whose HIV status is unknown as delay in treatment may be fatal. The use of absolute lymphocyte count (ALC) has been suggested as an alternative predictor of PCP especially in resource limited settings where PCR testing is costly or delayed. Objective: To determine whether the absolute lymphocyte count (ALC) can be used as a screening tool to predict Pneumocystis pneumonia in patients with unknown HIV status admitted at a private tertiary hospital. Methods: A retrospective cross-sectional study was conducted at a private tertiary medical center. Inpatient medical records of patients aged 18 years old and above from January 2012 to May 2014, in whom a clinical diagnosis of Pneumocystis jirovecii pneumonia was made were reviewed for inclusion. Demographic data, clinical features, hospital course, PCP PCR and HIV results were recorded. Independent t-test and chi-square analysis was used to determine any statistical difference between PCP-positive and PCP-negative groups. Mann-Whitney U-test was used for comparison of hospital stay. Results: There were no statistically significant differences in baseline characteristics between PCP positive and negative groups. While both the percent lymphocyte count (0.14 ± 0.13 vs 0.21 ± 0.16) and ALC (1160 ± 528.67 vs 1493.70 ± 988.61) were lower for the PCP-positive group, only the percent lymphocyte count reached a statistically significant difference (p= 0.067 vs p= 0.042). Conclusion: A quick determination of the ALC may be useful as an additional parameter to help screen for and diagnose pneumocystis pneumonia. In our study, the ALC of patients with PCP appear to be lower than in patients without PCP. A low ALC (e.g. below 1200) may help with the decision regarding empiric treatment. However, it should be used in conjunction with the patient’s clinical presentation, as well as other diagnostic tests. Larger, prospective studies incorporating the ALC with other clinical predictors are necessary to optimally predict those who would benefit from empiric or expedited management for potential PCP.

Keywords: Pneumocystis carinii pneumonia, Absolute Lymphocyte Count, infection, PCP

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Authors: Paris Binos

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The present work investigates developmental aspects of the duration of isolated vowels in infants with normal hearing compared to those who received cochlear implants (CIs) before two years of age. Infants with normal hearing produced shorter vowel duration since this find related with more mature production abilities. First isolated vowels are transparent during the protophonic stage as evidence of an increased motor and linguistic control. Vowel duration is a crucial factor for the transition of prelexical speech to normal adult speech. Despite current knowledge of data for infants with normal hearing more research is needed to unravel productions skills in early implanted children. Thus, isolated vowel productions by two congenitally hearing-impaired Greek infants (implantation ages 1:4-1:11; post-implant ages 0:6-1:3) were recorded and sampled for six months after implantation with a Nucleus-24. The results compared with the productions of three normal hearing infants (chronological ages 0:8-1:1). Vegetative data and vocalizations masked by external noise or sounds were excluded. Participants had no other disabilities and had unknown deafness etiology. Prior to implantation the infants had an average unaided hearing loss of 95-110 dB HL while the post-implantation PTA decreased to 10-38 dB HL. The current research offers a methodology for the processing of the prelinguistic productions based on a combination of acoustical and auditory analyses. Based on the current methodological framework, duration measured through spectrograms based on wideband analysis, from the voicing onset to the end of the vowel. The end marked by two co-occurring events: 1) The onset of aperiodicity with a rapid change in amplitude in the waveform and 2) a loss in formant’s energy. Cut-off levels of significance were set at 0.05 for all tests. Bonferroni post hoc tests indicated that difference was significant between the mean duration of vowels of infants wearing CIs and their normal hearing peers. Thus, the mean vowel duration of CIs measured longer compared to the normal hearing peers (0.000). The current longitudinal findings contribute to the existing data for the performance of children wearing CIs at a very young age and enrich also the data of the Greek language. The above described weakness for CI’s performance is a challenge for future work in speech processing and CI’s processing strategies.

Keywords: cochlear implant, duration, spectrogram, vowel

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Authors: Hamad Albadr

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Joint Commission International (JCI) accreditation process intent to improve the safety and quality of care in the international community through the provision of education, publications, consultation, and evaluation services. These standards apply to the entire organization as well as to each department, unit, or service within the organization. Medical Technology that contains both medical equipment and devices, is an essential part of health care. Appropriate management of equipment maintenance for ensuring medical technology safe, the equipment life is maximized, and the total costs are minimized. JCI medical technology evaluation and accreditation use standards, intents, and measurable elements. The paper focuses on evaluation of JCI standards for medical technology in Saudi Arabian hospitals: a Study Case of PSMMC that define the performance expectation, structures, or functions that must be in place for a hospital to be accredited by JCI through measurable elements that indicate a score during the survey process that identify the requirements for full compliance with the standard specially through Facility Management and Safety (FMS) section that require the hospital establishes and implements a program for inspecting, testing, and maintaining medical technology and documenting the results, to ensure that medical technology is available for use and functioning properly, the hospital performs and documents; an inventory of medical technology; regular inspections of medical technology; testing of medical technology according to its use and manufacturers’ requirements; and performance of preventive maintenance.

Keywords: joint commission international (JCI) accreditation, medical technology, Saudi Arabia, Saudi Arabian hospitals

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Authors: Albina Muratbekova

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One of the main tensions and challenges in the development of Sino-Indian relation is the demarcation of its frontiers. The fact that throughout the history borders had never been demarcated on ground occur a dispute between China and India after receiving sovereignty. Boundaries of India and China are divided into three sectors: Eastern, Middle and Western. The middle sector runs from India’s Uttar Pradesh to the Punjab, 545 km length of the Line of Actual Control, the lines of which was confirmed at the 9th meeting of the Expert Group held in 2001, in New Delhi. Other two sectors are still not determined and cause disputes. A western sector of the frontier is the Aksai Chin plateau, covers areas of Ladakh, Tibet, and Sinkiang. Another disputed area lies in the Eastern sector in the Himalayan region, which after 1986 became the Indian state called Arunachal Pradesh. There are two different approaches in the ways of resolving the border dispute. Chinese side keeps an opinion that the border dispute must be resolved in a timely matter unless it is favorable for China, the resolution can be left to a later generation. While India’s government due to security reasons is eager to demarcate the border. In order to study this conflict was used as a descriptive-comparative-analytical method. Also, it was done a profound analyze of conflict nature.

Keywords: border dispute, China, India, territorial claim

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Authors: Saheed Shittu, Lolwa Alansari, Fahed Nattouf, Tawa Olukade, Naji Abdallah, Tamara Alshdafat, Sarra Amdouni

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Cesarean sections (CS), a highly regarded surgical intervention for improving fetal-maternal outcomes and serving as an integral part of emergency obstetric services, are not without complications. Although CS has many advantages, it poses significant risks to both mother and child and increases healthcare expenditures in the long run. The escalating global prevalence of CS, coupled with variations in rates among immigrant populations, has prompted an inquiry into the correlation between CS rates and the nationalities of women undergoing deliveries at Al-Wakra Hospital (AWH), Qatar's second-largest public maternity hospital. This inquiry is motivated by the notable CS rate of 36%, deemed high in comparison to the 34% recorded across other Hamad Medical Corporation (HMC) maternity divisions This is Qatar's first comprehensive investigation of Caesarean section rates and nationalities. A retrospective cross-sectional study was conducted, and data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rate, the crude rate, and adjusted risks of Caesarean delivery for mothers from each nationality were determined. The common indications for CS were analysed based on nationality. The association between nationality and Caesarean rates was examined using binomial logistic regression analysis considering Qatari women as a standard reference group. The correlation between the CS rate in the country of nationality and the observed CS rate in Qatar was also examined using Pearson's correlation. This study included 4,816 births from 69 different nationalities. CS was performed in 1767 women, equating to 36.5%. The nationalities with the highest CS rates were Egyptian (49.6%), Lebanese (45.5%), Filipino and Indian (both 42.2%). Qatari women recorded a CS rate of 33.4%. The major indication for elective CS was previous multiple CS (39.9%) and one prior CS, where the patient declined vaginal birth after the cesarean (VBAC) option (26.8%). A distinct pattern was noticed: elective CS was predominantly performed on Arab women, whereas emergency CS was common among women of Asian and Sub-Saharan African nationalities. Moreover, a significant correlation was found between the CS rates in Qatar and the women's countries of origin. Also, a high CS rate was linked to instances of previous CS. As a result of these insights, strategic interventions were successfully implemented at the facility to mitigate unwarranted CS, resulting in a notable reduction in CS rate from 36.5% in 2019 to 34% in 2022. This proves the efficacy of the meticulously researched approach. The focus has now shifted to reducing primary CS rates and facilitating well-informed decisions regarding childbirth methods.

Keywords: maternal nationality, caesarean section rate variation, migrants, high-income country

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Authors: Somchai Buaroong

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This research attempted to study information system success in dimensions of the user satisfaction level and to find the association between the independent factors of the user experiences, user knowledge, and user attitude. The study sample was selected using simple random sampling that comprised of 190 users who had used the Bangkok HIS. The data were reported from 165 questionnaires. The results found that the user satisfaction was at a moderate level, user satisfaction on the information quality and system quality was at a moderate level, while satisfaction on service quality was at a high level. The computer knowledge of the user was at a moderate level, and the user attitude was at a positive level. The participation of the user was at a low level and the participation in decision and in evaluation was at a low level; however participation in implementation and in benefit was at a moderate.

Keywords: information system success, hospital information system, user attitude, user satisfaction

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Authors: Wei-Chih Huang, Pei-Lung Chung, Ching-Heng Lin, Hsuan-Chia Yang, Der-Ming Liou

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Background: In-Hospital Cardiac Arrest (IHCA) threaten life of the inpatients, cause serious effect to patient safety, quality of inpatients care and hospital service. Health providers must identify the signs of IHCA early to avoid the occurrence of IHCA. This study will consider the potential association between early signs of IHCA and the essence of patient care provided by nurses and other professionals before an IHCA occurs. The aim of this study is to identify significant associations between nursing interventions and abnormal early evaluation results of IHCA that can assist health care providers in monitoring inpatients at risk of IHCA to increase opportunities of IHCA early detection and prevention. Materials and Methods: This study used one of the data mining techniques called association rules mining to compute associations between nursing interventions and abnormal early evaluation results of IHCA. The nursing interventions and abnormal early evaluation results of IHCA were considered to be co-occurring if nursing interventions were provided within 24 hours of last being observed in abnormal early evaluation results of IHCA. The rule based methods were utilized 23.6 million electronic medical records (EMR) from a medical center in Taipei, Taiwan. This dataset includes 733 concepts of nursing interventions that coded by clinical care classification (CCC) codes and 13 early evaluation results of IHCA with binary codes. The values of interestingness and lift were computed as Q values to measure the co-occurrence and associations’ strength between all in-hospital patient care measures and abnormal early evaluation results of IHCA. The associations were evaluated by comparing the results of Q values and verified by medical experts. Results and Conclusions: The results show that there are 4195 pairs of associations between nursing interventions and abnormal early evaluation results of IHCA with their Q values. The indication of positive association is 203 pairs with Q values greater than 5. Inpatients with high blood sugar level (hyperglycemia) have positive association with having heart rate lower than 50 beats per minute or higher than 120 beats per minute, Q value is 6.636. Inpatients with temporary pacemaker (TPM) have significant association with high risk of IHCA, Q value is 47.403. There is significant positive correlation between inpatients with hypovolemia and happened abnormal heart rhythms (arrhythmias), Q value is 127.49. The results of this study can help to prevent IHCA from occurring by making health care providers early recognition of inpatients at risk of IHCA, assist with monitoring patients for providing quality of care to patients, improve IHCA surveillance and quality of in-hospital care.

Keywords: in-hospital cardiac arrest, patient safety, nursing intervention, association rule mining

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Authors: W. Kongnoo, J. Loysongkroa, S. Chotivichien, N. Viriyautsahakul, N. Saiwongse

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Obesity, stunting and wasting problems among Thai school-aged children are increasing due to inappropriate food consumption behavior and poor environments for desirable nutritional behavior. Because of a low school lunch budget of only 0.40 USD per person per day, food quality is not up to nutritional standards. Therefore, the Health Department with the Education Ministry and the Thai Health Promotion Foundation have developed a quality school lunch project during 2009–2013. The program objectives were development and management of public policy to increase school lunch budget. The methods used a healthy public policy motivation process and movement in 241 local administrative organizations and 538 schools. The problem and solution research was organized to study school food and nutrition management, create a best practice policy mobilization model and hold a public hearing to motivate an increase of school meal funding. The results showed that local public policy has been motivated during 2009-2011 to increase school meal budget using local budgets. School children with best food consumption behavior and exercise increased from 13.2% in 2009 to 51.6% in 2013 and stunting decreased from 6.0% in 2009 to 4.7% in 2013. As the result of national policy motivation (2012-2013), the cabinet meeting on October 22, 2013 has approved an increase of school lunch budget from 0.40 USD to 0.62 USD per person per day. Thus, 5,800,469 school children nationwide have benefited from the budget increase.

Keywords: public policy, quality school lunch, Thailand, obesity

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Authors: Laura C. Solzbacher, Caja Thimm

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Journalists worldwide have been confronted with a variety of ethical challenges over the last years. Because of massive changes in media technology and the public sphere, especially online journalism has trouble to uphold the fundamental values of journalism. In particular, the increasing amount of fake news and hate speech puts journalists under more and more pressure. In order to understand better how journalists judge this development and how they adapt in their daily work, a survey with journalists in Germany was carried out. 303 professional journalists participated in an online questionnaire. Results show that 65% underline that economic pressure grows and nearly the same number describe a change in the role of journalists in society. Furthermore, 61% agree that they put more time into research to secure their work against accusations of fabricating fake news. Interestingly, over 60% see a change in the role of journalists in society. The majority (85%) confirms that print journalism has to give way for online platforms and that the influence of social media for journalism grows (75%). Half of the surveyed advocate for more personalized public activism on part of journalists, such as appearance in talk shows and public talks. The results of the study will be discussed in light of the ongoing debate on ethical standards as a condition for a sustainable and trustworthy digital public sphere.

Keywords: ethics, fake news, journalism, public sphere

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Authors: Po-Kun Tsai

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The issue of climate change is essential in the 21st century. State governments have launched types of strategic industrial policies to encourage more widespread R&D in green technology. Research also indicates that technology is an essential tool to mitigate some of extreme situations. However, one could learn from several prominent cases in international trade area that they have been easily argued and disputed by the foreign counterparts. Thus, how to justify the public sector’s R&D measures under the current world trading system and how to promote the transfer of environmentally sound technologies (EST) to developing states are crucial. The study is to undertake a preliminary examination of the current R&D research area in green technology in Taiwan. Through selective interviews and comparative approach, it tries to identify the loopholes under the current legal framework in Taiwan. It would be, as a basis, for further legal and policy recommendations for the benefits of mankind.

Keywords: government, R&D, innovation, environmentally sound technology (EST)

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Authors: An-Shik Yang, Chih-Yung Wen, Chiang-Ho Cheng, Yu-Hsuan Juan

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The objective of this study is to conduct computational fluid dynamic (CFD) simulations for evaluating the cooling efficacy from vegetation implanted in a public park in the Taipei, Taiwan. To probe the impacts of park renewal by means of adding three pavilions and supplementary green areas on urban microclimates, the simulated results have revealed that the park having a higher percentage of green coverage ratio (GCR) tended to experience a better cooling effect. These findings can be used to explore the effects of different greening modifications on urban environments for achieving an effective thermal comfort in urban public spaces.

Keywords: CFD simulations, Green Coverage Ratio, Urban heat island, Urban Public Park

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Authors: Praveenkumar Natarajan

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A 59-year-old male with no known co-morbidities was admitted to a private hospital for complaints of fever and cough and was diagnosed to haveCOVID-19. CT of the thorax revealed the involvement of 50% of the lungs. Screening ECG and ECHO were normal. The patient was treated with oxygen therapy and drugs and was discharged after 12 days of admission. Post-discharge, the patient remained symptom-free and continued his work. After one month, the patient developed a fever for three days, for which he took antipyretics. Subsequently, the patient developed sudden onset breathlessness, which rapidly progressed to grade 4 NYHA, and developed a cough as well. Suspecting COVID-19 reinfection, the patient visited a nearby hospital, where COVID–19 rt-PCR swabs turned out to be positive, and was referred to our hospital. On receiving, the patient had diffuse lung crepitations and a diastolic murmur in the neo-aortic area. CT thorax revealed pulmonary edema with areas of consolidation. ECHO revealed vegetation on the aortic valve with severe aortic regurgitation. Blood cultures were taken, which revealed the growth of Enterococcus faecalis. The diagnosis of infective endocarditis was made, and the patient was started on appropriate treatment. COVID–19 has effects on various systems, including the cardiovascular system. Even though infective endocarditis is common in the elderly with valvular heart disease, this patient had developed infective endocarditis in an apparently normal aortic valve. Infective endocarditis and COVID–19 can have similar presentations leading to diagnostic difficulties. COVID–19, affecting the heart valves causing valvulitis and predisposing them to the development of infective endocarditis, is also an area to be explored.

Keywords: aortic regurgitation, COVID-19, infective endocarditis, valvulitis

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Authors: Agnieszka Szczudlińska-Kanoś

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Nowadays the participation of citizens in public life increasingly effect on management at all levels of public authority. Today, however, democratic systems in many countries, also in Poland, based on the first - on the institutions of representative democracy, which is mainly on elections, party activity, on the other hand - on the basic instruments of direct democracy, which, in particular, we can include a referendum or initiative of citizenship - although these are often rather complementary. Other forms of participatory democracy, such as deliberative democracy, participatory budgeting, public consultation in practice in many countries are still rare. Appropriate use of the potential invested in participatory democracy can bring enormous and multilateral benefits. On the one hand, local and regional communities taking an active part in public life express their needs, point out problems and thus affect the decisions of public authorities. Authorities using knowledge acquired from the citizens also implement the policy tailored to their needs, thus obtaining support in the next election. The purpose of this study is to show how the Polish citizens affect to resolve issues of social policy pursued at different levels of government. This problem is very important because today the observed changes seen in virtually all fields of life create new social problems, which nowadays are no longer only the problems of the region, the country but they are international, global issues. From such this perspective we should talk about them, discuss, try to solve at all levels. Article will be useful not only theorists involved in the management of the public, local government, or social but also practitioners - local government acting as their functions at different levels of government. Conclusions drawn from the publication will also be useful to politicians and those directly affecting for: functioning social security systems, the scope and quality of public services and the overall shape of the contemporary social policy in different countries.

Keywords: social policy, local government, social participation, social services

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Authors: Neil Fourati

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Collaboration between public and private stakeholders for agricultural development are today lacking in Tunisia. The last dictatorship witnessed by the country has deteriorated the necessary trust between the state and small farmers for the realization of development projects, in particular in the interior, disadvantaged regions of the country. These regions, where the youth unemployment rate is above 30%, have been the heart of the uprising that preceded the revolution. The transitional period that the country is going through since 2011 is an opportunity for the emergence of new governance systems in the context of the decentralization. The latter is recognized in the 2nd Tunisian Republic constitution as the basis of regional management. Civil society participation to the decision-making process is considered as a mean to identify measures that are more coherent with local populations’ needs. The development of agriculture and food value chains in rural areas is relevant within the framework of the implementation of new decisions systems that require public-private collaborations. These new systems can lead to actions in favor of improving living conditions of rural populations. The diverisification of activities around agriculture can be a solution for job creation and local value creation. The project for the promotion of sustainable agriculture and rural development in Tunisia has designed and implemented a multi-stakeholder dialogue process for the development of local value chains platforms in disadvantaged areas of the country. The platforms gather public and private organizations ; as well civil society organizations ; that intervene in a locality in relation to the production transformation or product’s commercialization. The role of these platforms is to formulate realize and evaluate collaborative actions or projects for the promotion of the concerned product and territory. The dialogue process steps allow to create the necessary collaboration conditions in order to promote viable collectivities, dynamic economies and healthy environments. Effectively, the dialogue process steps allow to identify the local leaders. These leaders recognize the development constraints and opportunities. They deal with key and gathering subjects around the collaborative projects or actions. They take common decisions in order to create effective coalitions for the implementation of common actions. The plateforms realize quick success so as to build trust. The project has supported the formulation of 22 collaborative projects. Seven priority collaborative projects have been realized. Each collaborative project includes 3 parts : the signature of the collaboration conventions between public and private organizations, investment in the relevant material in order to increase productivity and the quality of local and products and finally management and technical training in favour of producers’ organizations for the promotion of local products. The implementation of this process has enabled to enhance the capacities of collaboration between local actors : producers, traders, processors and support structures from public sector and civil society. It also allowed to improve the efficiency and relevance of actions and measures for agriculture and rural development programs. Thus, the process for the development of local value chain platform is a basis for sustainable development of agriculture.

Keywords: governance, public private collaboration, rural development, value chains

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Authors: Rafiqul Hasan, A. S. M. Tanim Anwar, Mohammad Azizul Hakim

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Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds.

Keywords: dialysis cost, peritoneal dialysis, peritonitis, CAPD, least developed area, remote area, Bangladesh

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Authors: Jakub Stelina, Janina Ciechanowicz-McLean

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Fifty years of existence and development of international environmental law brought a deep disappointment with efficiency and effectiveness of traditional command and control mechanisms of environmental regulation. Agenda 21 agreed during the first Earth Summit in Rio de Janeiro 1992 was one of the first international documents, which explicitly underlined the importance of public participation in environmental protection. This participation includes also the initiatives undertaken by business corporations in the form of private environmental standards setting. Twenty years later during the Rio 20+ Earth Summit the private sector obligations undertaken during the negotiations have proven to be at least as important as the ones undertaken by the governments. The private sector has taken the leading role in environmental standard setting. Among the research methods used in the article two are crucial in the analysis. The comparative analysis of law is the instrument used in the article to analyse the practice of states and private business companies in the field of sustainable development. The article uses economic analysis of law to estimate the costs and benefits of Corporate Social Responsibility Projects in the field of environmental protection. The study is based on the four premises. First is the role of social dialogue, which is crucial for both Corporate Social Responsibility and modern environmental protection regulation. The Aarhus Convention creates a procedural environmental human right to participate in administrative procedures of law setting and environmental decisions making. The public participation in environmental impact assessment is nowadays a universal standard. Second argument is about the role of precaution as a principle of modern environmental regulation. This principle can be observed both in governmental regulatory undertakings and also private initiatives within the Corporate Social Responsibility environmental projects. Even in the jurisdictions which are relatively reluctant to use the principle of preventive action in environmental regulation, the companies often use this standard in their own private business standard setting initiatives. This is often due to the fact that soft law standards are used as the basis for private Corporate Social Responsibility regulatory initiatives. Third premise is about the role of ecological education in environmental protection. Many soft law instruments underline the importance of environmental education. Governments use environmental education only to the limited extent due to the costs of such projects and problems with effects assessment. Corporate Social Responsibility uses various means of ecological education as the basis of their actions in the field of environmental protection. Last but not least Sustainable development is a goal of both legal protection of the environment, and economic instruments of companies development. Modern environmental protection law uses to the increasing extent the Corporate Social Responsibility. This may be the consequence of the limits of hard law regulation. Corporate Social Responsibility is nowadays not only adapting to soft law regulation of environmental protection but also creates such standards by itself, showing new direction for development of international environmental law. Corporate Social Responsibility in environmental protection can be good investment in future development of the company.

Keywords: corporate social responsibility, environmental CSR, environmental justice, stakeholders dialogue

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Authors: Peter Collett, Mike Pynn, Haseeb Ur Rahman

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For the last few years across the UK there has been a push towards implementing treatment escalation plans (TEP) for every patient admitted to hospital. This is a paper form which is completed by a junior doctor then countersigned by the consultant responsible for the patient's care. It is designed to address what level of care is appropriate for the patient in question at point of entry to hospital. It helps decide whether the patient would benefit for ward based, high dependency or intensive care. They are completed to ensure the patient's best interests are maintained and aim to facilitate difficult decisions which may be required at a later date. For example, a frail patient with significant co-morbidities, unlikely to survive a pathology requiring an intensive care admission is admitted to hospital the decision can be made early to state the patient would not benefit from an ICU admission. This decision can be reversed depending on the clinical course of the patient's admission. It promotes discussions with the patient regarding their wishes to receive certain levels of healthcare. This poster describes the steps taken in the Aneurin Bevan University Health Board (ABUHB) when implementing the TEP form. The team implementing the TEP form campaigned for it's use to the board of directors. The directors were eager to hear of experiences of other health boards who had implemented the TEP form. The team presented the data produced in a number of health boards and demonstrated the proposed form. Concern was raised regarding the legalities of the form and that it could upset patients and relatives if the form was not explained properly. This delayed the effectuation of the TEP form and further research and discussion would be required. When COVID 19 reached the UK the National Institute for Health and Clinical Excellence issued guidance stating every patient admitted to hospital should be issued a TEP form. The TEP form was accelerated through the vetting process and was approved with immediate effect. The TEP form in ABUHB has now been in circulation for a month. An audit investigating it's uptake and a survey gathering opinions have been conducted.

Keywords: acute medicine, clinical governance, intensive care, patient centered decision making

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Authors: Megersa Dugasa Fite

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This paper analyses regulatory and supervisory issues in the Ethiopian micro finance sector, which caters to the needs of those who have been excluded from the formal financial sector. Micro-finance has received increased importance in development because of its grand goal to give credits to the poor to raise their economic and social well-being and improve the quality of lives. The micro-finance at present has been moving towards a credit-plus period through covering savings and insurance functions. It thus helps in reducing the rate of financial exclusion and social segregation, alleviating poverty and, consequently, stimulating development. The Ethiopian micro finance policy has been generally positive and developmental but major regulatory and supervisory limitations such as the absolute prohibition of NGOs to participate in micro credit functions, higher risks for depositors of micro-finance institutions, lack of credit information services with research and development, the unmet demand, and risks of market failures due to over-regulation are disappointing. Therefore, to remove the limited reach and high degree of problems typical in the informal means of financial intermediation plus to deal with the failure of formal banks to provide basic financial services to a significant portion of the country’s population, more needs to be done on micro finance. Certain key regulatory and supervisory revisions hence need to be taken to strengthen the Ethiopian micro finance sector so that it can practically provide majority poor access to a range of high quality financial services that help them work their way out of poverty and the incapacity it imposes.

Keywords: micro-finance, micro-finance regulation and supervision, micro-finance institutions, financial access, social segregation, poverty alleviation, development, Ethiopia

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Authors: Banu Baybars Hawks

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To date, academic attention in social sciences remains inadequate with regard to research and analysis of public opinion in Turkey. Most of the existing research has assessed the public opinion during political election periods. Therefore, it is of great interest to find out what the public thinks about current issues in Turkey, and how to interpret the results to be able to reveal whether they may have any reflections on social, political, and cultural structure of the country. Accordingly, the current study seeks to fill the gap in the social sciences literature in English regarding Turkey’s social and political stand which may be perceived to be very different by other nations. Without timely feedback from public surveys, various programs for improving different services and institutions functioning in the country might not achieve their expected goal, nor can decisions about which programs to implement be made rationally. Additionally, the information gathered may not only yield important insights into public’s opinion regarding current agenda in Turkey, but also into the correlates shaping public policies. Agenda-setting studies including agenda-building, agenda melding, reversed agenda-setting and information diffusion studies will be used to explain the roles of factors and actors in the formation of public opinion in Turkey. Knowing the importance of public agenda in the agenda setting and building process, this paper aims to reveal the social and political tendencies of the Turkish public. For that purpose, a survey will be carried out in December of 2014 to determine the social and political trends in Turkey for that same year. The subjects for the study, which utilize a questionairre in one-on-one interviews, will include 1,000 individuals aged 18 years and older from 26 cities representing general population. A stratified random sampling frame will be used. The topics covered by the survey include: The most important current problem in Turkey; the Economy; Terror; Approaches to the Kurdish Issue; Evaluations of the Government and Opposition Parties; Evaluations of Institutional Efficiency; Foreign Policy; the Judicial System/Constitution; Democracy and the Media; and, Social Relations/Life in Turkey. Since the beginning of the 21st century, Turkey has been undergoing a rapid transformation. The reflections of the changes can be seen in all areas from economics to politics. It is my hope that findings of this study may shed light on the important aspects of institutions, variables setting the agenda, and formation process of public opinion in Turkey.

Keywords: public opinion, media, agenda setting, information diffusion, government, freedom, Turkey

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Authors: Cheila Cristina Leonardo Oliveira Gaioli, Fernanda Ludmilla Rossi Rocha, Sandra Cristina Pillon

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Resilience is a psychological process that facilitates the maintenance of health, developed in response to numerous existing stressors in daily life. Furthermore, resilience can be described as the ability which allows an individual or group to hold up well before unfavorable situations. This study aimed to identify nursing workers’ resilience at a psychiatric hospital in Brazil. This is an exploratory research with quantitative data approach. The sample consisted of 56 workers, using the Resilience Scale. Of the 56 subjects, 45 (80.4%) were women; 22 (39.2%) were 20- to 40-years-old and 30 (53.6%) were 41- to 60-years-old; 11 (19.6%) were nurses and 45 (80.4%) were technicians or nursing assistants. The results also showed that 50% of subjects showed a high resilience degree and 42.9% an average resilience degree. Thus, it was found that workers seek to develop protective factors in coping with a work environment that does not value the individual subjectivity and does not allow professional development, discouraging workers.

Keywords: health promotion, nursing, occupational health, resilience

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Authors: An-Shik Yang, Chiang-Ho Cheng, Jen-Hao Wu, Yu-Hsuan Juan

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Natural ventilation has played an important role for many low energy-building designs. It has been also noticed as a essential subject to persistently bring the fresh cool air from the outside into a building. This study carried out the computational fluid dynamics (CFD)-based simulations to examine the natural ventilation development of a work area in a public building. The simulated results can be useful to better understand the indoor microclimate and the interaction of wind with buildings. Besides, this CFD simulation procedure can serve as an effective analysis tool to characterize the airing performance, and thereby optimize the building ventilation for strengthening the architects, planners and other decision makers on improving the natural ventilation design of public buildings.

Keywords: CFD simulations, natural ventilation, microclimate, wind environment

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Authors: Ivory A. Rulona, Jarungchai Anton S. Vatanagul

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Background: Depression is common after stroke with quoted rates ranging from 18% to 61%. 8 Mood disturbance is common after stroke and may present as depression or anxiety. Psychological mood disturbance is associated with higher rates of mortality, long term disability, and hospital readmission. Objectives: To investigate the incidence of post-stroke depression in a tertiary hospital in Cebu City, Philippines and to determine its associated factors. The study is designed to be prospective, descriptive, cross-sectional survey. Participants: Adult patients seen and diagnosed to have stroke either infarct or hemorrhage within the period of January 1 to July 31, 2014. Results: A total of 100 patients with stroke were interviewed using the 17-item Hamilton Depression Rating Scale (HDRS) questionnaire. The average age of the respondents was 60.50 years old ±1.18, majority were males (55%), 83% were married, and 81% were employed. The most common co-morbidity was hypertension 78% followed by diabetes mellitus at 50%. Moreover, 39% of these patients had stroke in months, 26% in years, and 18% in weeks. The average functional capacity based on Modified Rankin Scale was 2.14+/-0.14. Among 100 patients, a total of 30 patients (30%) had depression: 2 (2%) very severe, 5 (5%) moderate and 23 (23%) had mild depression while 70 patients (70%) had no depression. Stroke located at the dominant hemisphere was not associated with severe depression (p=0.102). A similar trend was also noted among those with stroke at the right side (p=0.183), pons (p=0.634), bilateral (p=0.776), and midbrain (p=0.336). Conclusion: This study showed that majority of stroke patients were males with average age of 60.50 years. Hypertension was the most common co-morbidity. There was no association between stroke location and depression. The incidence of PSD was 30%.

Keywords: post-stroke depression, co-morbidity, disturbance, bilateral

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Authors: Ana Neves

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The European Union’s multi-level constitutionalism is grounded in an intricate network of vertical and horizontal legal relationships among different levels and types of public authorities. In a very significant way since the 2008 crisis, evolving institutional arrangements and institutional dynamics in the European Union have been progressively impacting Member States and the terms under which national public authorities are organised, interact and exercise their powers. This impact occurs in both macro and micro dimensions. Several examples are relevant here, such as the involvement of national Parliaments in the activities of the European Union, the enhanced integration of public administrations, the side effects of the Council framework decision on the European Arrest Warrant, the European Union Justice Scoreboard, the protection of whistle-blowers regulation, the enhanced cooperation on the establishment of the European Public Prosecutor’s Office, the regime for the protection of the Union budget and the European Rule of Law Mechanism. A common trend or denominator underlies the deepening of institutional interdependence and the increased interactions between the European Union, Member States, and public authorities at different levels. This seems to be conditionality as a general principle. The European multi-level constitutionalism must be considered in the light of this conditionality principle, which does not “imply a relationship of command and obedience”. Nevertheless, it might be more effective or be a very compelling principle. It is as if the extension of the shared rule is being accompanied by a contrapuntal dialogue. The different public authorities at various levels are being called to rethink and readjust themselves within a broader and more plural framework concerning understanding the limitation of power.

Keywords: european union -, multi-level hierarchy, conditionality, separation of powers

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Authors: Hsin-Hung Lai, Wei Lo

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Whether it is in virtue or vice for a construction quality of public construction project, it is one of the important indicators for national economic development and overall construction, the impact on the quality of national life is very deep. In recent years, a number of scandal of public construction project occurred, the requirements of the government agencies and the public require the quality of construction of public construction project are getting stricter than ever, the three-level public construction project construction quality of quality control system implemented by the government has a profound impact. This study mainly aggregated the evolution of ISO 9000 quality control system, the difference between the practice of implementing management of construction quality by many countries and three-level quality control of our country, so we explored and found that almost all projects of enhancing construction quality are dominated by civil organizations in foreign countries, whereas, it is induced by the national power in our country and develop our three-level quality control system and audit mechanism based on IOS system and implement the works by legislation, we also explored its enhancement and relevance with construction quality of public construction project that are intervened by such system and national power, and it really presents the effectiveness of construction quality been enhanced by the audited result. The three-level quality control system of our country to promote the policy of public construction project is almost same with the quality control system of many developed countries; however our country mainly implements such system on public construction project only, we promote the three-level quality control system is for enhancing the quality of public construction project, for establishing effective quality management system, so as to urge, correct and prevent the defects of quality management by manufacturers, whereas, those developed countries is comprehensively promoting (both public construction project and civil construction) such system. Therefore, this study is to explore the scope for public construction project only; the most important is the quality recognition by the executor, either good quality or deterioration is not a single event, there is a certain procedure extends from the demand and feasibility analysis, design, tendering, contracting, construction performance, inspection, continuous improvement, completion and acceptance, transferring and meeting the needs of the users, all of mentioned above have a causal relationship and it is a systemic problems. So the best construction quality would be manufactured and managed by reasonable cost if it is by extensive thinking and be preventive. We aggregated the implemented results in the past 10 years (2005 to 2015), the audited results of both in central units and local ones were slightly increased in A-grade while those listed in B-grade were decreased, although the levels were not evidently upgraded, yet, such result presents that the construction quality of concept of manufacturers are improving, and the construction quality has been established in the design stage, thus it is relatively beneficial to the enhancement of construction quality of overall public construction project.

Keywords: ISO 9000, three-level quality control system, audit and review mechanism for construction implementation, quality of construction implementation

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Authors: Shengdan Yang

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The outbreak of the COVID-19 pandemic in early 2020 has made public health issues to be re-examined. The value of green space configuration is an important measure of community health quality. By combining quantitative and qualitative methods, the structure and function of community green space can be better evaluated. This study selects Wuhan Kunhou Community as the site and proposes to analyze the daily health service function of the community's green infrastructure. Through GIS-based spatial analysis, case study, and field investigation, this study evaluates the accessibility of green infrastructure and discusses the ideal green space form based on health indicators. The findings show that Kunhou Community lacks access to green infrastructure and public space for daily activities. The research findings provide a bridge between public health indicators and community space planning and propose design suggestions for green infrastructure planning.

Keywords: accessibility, community health, GIS, green infrastructure

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Authors: Soraya Tharani

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Social media has changed how public opinion is shaped by enabling more diversified and inclusive participation of audiences. New online forums provide spaces in which governments, NGOs and other organizations can create content and receive feedback. These forums are sites where debate can constitute public opinion. Studies of audience engagement can give an understanding of how different voices from the civil society participate in debates and how discussions can reinforce or bring into question established societal beliefs. The UN’s refugee agency, UNHCR, produces audio-visual stories about displaced people for global audiences on social media platforms. The availability of many views in these forums can give insight into how dialogues regarding transnational issues are formed. The public sphere, as defined by Habermas, is a discursive arena where reasoned debate can take place. Habermas’ concept is combined with theories on celebrity advocacy, and discussions about the role and effect celebrities have in raising public awareness for humanitarian issues. The personal and public lives of celebrities often create emotional engagement from their fans and other audiences. In this study, quantitative and qualitative methods have been used on YouTube comments for uncovering how emotion and reason are constituted in a global public debate on celebrity endorsed UNHCR stories of displaced people. The study shows that engagement intensity is not equally distributed between comment threads; comments presented as facts or emotional claims are often supported by recourse to intertextuality, and specific linguistic strategies are used to put forward emotional and reasoned claims regarding individual and group identities. The findings from this research aim to contribute to an understanding of audience engagement on issues of human survival and solidarity in a global social media public sphere.

Keywords: emotions, engagement, global public sphere, linguistic strategies, reason, refugees, social media, UNHCR

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Authors: Xabier Barandiaran, Igone Guerra

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The economic and financial crisis that hit European countries in 2008 revealed the inability of governments to respond unilaterally to the so-called “wicked” problems that affect our societies. Closely linked to this, the increasing disaffection of citizens towards politics has resulted in growing distrust of the citizenry not only in the institutions in general but also in the political system, in particular. Precisely, these two factors provoked the action of the local government of Gipuzkoa (Basque Country) to move from old ways of “doing politics” to a new way of “thinking politics” based on a collaborative approach, in which innovative modes of public decision making are prominent. In this context, in 2015, the initiative Etorkizuna Eraikiz (Building the Future), a contemporary form of networked governance, was launched by the Provincial Government. The paper focuses on the Etorkizuna Eraikiz initiative, a sound commitment from a local government to build jointly with the citizens the future of the territory. This paper will present preliminary results obtained from three different experiences of co-creation developed within Etorkizuna Eraikiz in which the formulation of networked governance is a mandatory pre-requisite. These experiences show how the network building approach among the different agents of the territory as well as the co-creation of public policies is the cornerstone of this challenging mission. Through the analysis of the information and documentation gathered during the four years of Etorkizuna-Eraikiz, and, specifically by delving into the strategy promoted by the initiative, some emerging analytical conclusions resulting from the promotion of this collaborative culture will be presented. For example, some preliminary results have shown a significant positive relationship between shared leadership and the formulation of the public good. In the period 2016-2018, a total of 73 projects were launched and funding by the Provincial Government of Gipuzkoa within the Etorkizuna Eraikiz initiative, that indicates greater engagement of the citizenry in the process of policy-making and therefore improving, somehow, the quality of the public policies. These statements have been supported by the last survey about the perspectives of the citizens toward politics and policies. Some of the more prominent results show us that there is still a high level of distrust in Politics (78,9% of respondents) but a greater trust in institutions such the Political Government of Gipuzkoa (40,8% of respondents declared as “good” the performance of this provincial institution). Regarding the Etorkizuna Eraikiz Initiative, it is being more readily recognized by citizens over this period of time (25,4% of the respondents in June 2018 agreed to know about the initiative giving it a mark of 5,89 ) and thus build trust and a sense of ownership. Although, there is a clear requirement for further research on the linkages between collaborative governance and level of trust, the paper, based on these findings, will provide some managerial and theoretical implications for collaborative governance in the territory.

Keywords: network governance, collaborative governance, public sector innovation, citizen participation, trust

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