Search results for: knowledge management into organizations

Authors: Ghadeer A.Al-Jabaree, Husam Aldeen Al-Khadash, M. Nassar

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This study aimed at investigating the effect of well-designed corporate governance system on the financial stability of insurance companies listed in ASE. Further, this study provides a comprehensive model for evaluating and analyzing insurance companies' financial position and prospective for comparing the degree of corporate governance application provisions among Jordanian insurance companies. In order to achieve the goals of the study, a whole population that consist of (27) listed insurance companies was introduced through the variables of (board of director, audit committee, internal and external auditor, board and management ownership and block holder's identities). Statistical methods were used with alternative techniques by (SPSS); where descriptive statistical techniques such as means, standard deviations were used to describe the variables, while (F) test and ANOVA analysis of variance were used to test the hypotheses of the study. The study revealed the existence of significant effect of corporate governance variables except local companies that are not listed in ASE on financial stability within control variables especially debt ratio (leverage),where it's also showed that concentration in motor third party doesn't have significant effect on insurance companies' financial stability during study period. Moreover, the study concludes that Global financial crisis affect the investment side of insurance companies with insignificant effect on the technical side. Finally, some recommendations were presented such as enhancing the laws and regulation that help the appropriate application of corporate governance, and work on activating the transparency in the disclosures of the financial statements and focusing on supporting the technical provisions for the companies, rather than focusing only on profit side.

Keywords: corporate governance, financial stability and solvency margin, insurance companies, Jordan

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Authors: Nitish Suvarna, Anjali Awasthi

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In an era marked by rapid technological advancements, the integration of Autonomous Vehicles into supply chain networks represents a transformative shift, promising to redefine the paradigms of logistics and transportation. This thesis delves into a comprehensive assessment of the impact of autonomous vehicles on supply chain performance, with a particular focus on network design, operational efficiency, and environmental sustainability. Employing the advanced simulation capabilities of anyLogistix (ALX), the study constructs a digital twin of a conventional supply chain network, encompassing suppliers, production facilities, distribution centers, and customer endpoints. The research methodically integrates Autonomous Vehicles into this intricate network, aiming to unravel the multifaceted effects on transportation logistics including transit times, cost-efficiency, and sustainability. Through simulations and scenarios analysis, the study scrutinizes the operational resilience and adaptability of supply chains in the face of dynamic market conditions and disruptive technologies like Autonomous Vehicles. Furthermore, the thesis undertakes carbon footprint analysis, quantifying the environmental benefits and challenges associated with the adoption of Autonomous Vehicles in supply chain operations. The insights from this research are anticipated to offer a strategic framework for industry stakeholders, guiding the adoption of Autonomous Vehicles to foster a more efficient, responsive, and sustainable supply chain ecosystem. The findings aim to serve as a cornerstone for future research and practical implementations in the realm of intelligent transportation and supply chain management.

Keywords: autonomous vehicle, agri-food supply chain, ALX simulation, anyLogistix

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Authors: C. Fernandez-Plaza, I. Abad, E. Diaz, I. Diaz

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Births occurring before the 37th week of gestation are considered preterm births. A threat of preterm is defined as the beginning of regular uterine contractions, dilation and cervical effacement between 23 and 36 gestation weeks. To author's best knowledge, the factors that determine the beginning of the birth are not completely defined yet. In particular, the incidence of sleep habits on preterm births is weekly studied. The aim of this study is to develop a model to predict the factors affecting premature delivery on pregnancy, based on the above potential risk factors, including those derived from sleep habits and light exposure at night (introduced as 12 variables obtained by a telephone survey using two questionnaires previously used by other authors). Thus, three groups of variables were included in the study (maternal, fetal and sleep habits). The study was approved by Research Ethics Committee of the Principado of Asturias (Spain). An observational, retrospective and descriptive study was performed with 481 births between January 1, 2015 and May 10, 2016 in the University Central Hospital of Asturias (Spain). A statistical analysis using SPSS was carried out to compare qualitative and quantitative variables between preterm and term delivery. Chi-square test qualitative variable and t-test for quantitative variables were applied. Statistically significant differences (p < 0.05) between preterm vs. term births were found for primiparity, multi-parity, kind of conception, place of residence or premature rupture of membranes and interruption during nights. In addition to the statistical analysis, machine learning methods to look for a prediction model were tested. In particular, tree based models were applied as the trade-off between performance and interpretability is especially suitable for this study. C5.0, recursive partitioning, random forest and tree bag models were analysed using caret R-package. Cross validation with 10-folds and parameter tuning to optimize the methods were applied. In addition, different noise reduction methods were applied to the initial data using NoiseFiltersR package. The best performance was obtained by C5.0 method with Accuracy 0.91, Sensitivity 0.93, Specificity 0.89 and Precision 0.91. Some well known preterm birth factors were identified: Cervix Dilation, maternal BMI, Premature rupture of membranes or nuchal translucency analysis in the first trimester. The model also identifies other new factors related to sleep habits such as light through window, bedtime on working days, usage of electronic devices before sleeping from Mondays to Fridays or change of sleeping habits reflected in the number of hours, in the depth of sleep or in the lighting of the room. IF dilation < = 2.95 AND usage of electronic devices before sleeping from Mondays to Friday = YES and change of sleeping habits = YES, then preterm is one of the predicting rules obtained by C5.0. In this work a model for predicting preterm births is developed. It is based on machine learning together with noise reduction techniques. The method maximizing the performance is the one selected. This model shows the influence of variables related to sleep habits in preterm prediction.

Keywords: machine learning, noise reduction, preterm birth, sleep habit

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Authors: Frederica Pettit

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Contribution: Stakeholder involvement in CSR is essential to ensuring pro-environmental attitudes and behaviours across multi-stakeholder groups. Despite increased awareness of the benefits surrounding a collaborative approach to sustainability communications, its success is limited by difficulties engaging with active online conversations with stakeholder groups. Whilst previous research defines the effectiveness of sustainability communications; this paper contributes to knowledge through the development of a theoretical framework that explores the processes to achieving pro-environmental attitudes and behaviours in stakeholder groups. The research will also consider social media as an opportunity to communicate CSR information to all stakeholder groups. Approach: A systematic review was chosen to investigate the effectiveness of the types of sustainability communications used in the hospitality and tourism industries. The systematic review was completed using Web of Science and Scopus using the search terms “sustainab* communicat*” “effective or effectiveness,” and “hospitality or tourism,” limiting the results to peer-reviewed research. 133 abstracts were initially read, with articles being excluded for irrelevance, duplicated articles, non-empirical studies, and language. A total of 45 papers were included as part of the systematic review. 5 propositions were created based on the results of the systematic review, helping to develop a theoretical framework of the processes needed for companies to encourage pro-environmental behaviours across multi-stakeholder groups. Results: The theoretical framework developed in the paper determined the processes necessary for companies to achieve pro-environmental behaviours in stakeholders. The processes to achieving pro-environmental attitudes and behaviours are stakeholder-focused, identifying the need for communications to be specific to their targeted audience. Collaborative communications that enable stakeholders to engage with CSR information and provide feedback lead to a higher awareness of CSR shared visions and pro-environmental attitudes and behaviours. These processes should also aim to improve their relationships with stakeholders through transparency of CSR, CSR strategies that match stakeholder values and ethics whilst prioritizing sustainability as part of their job role. Alternatively, companies can prioritize pro-environmental behaviours using choice editing by mainstreaming sustainability as the only option. In recent years, there has been extensive research on social media as a viable source of sustainability communications, with benefits including direct interactions with stakeholders, the ability to enforce the authenticity of CSR activities and encouragement of pro-environmental behaviours. Despite this, there are challenges to implementing CSR, including difficulties controlling stakeholder criticisms, negative stakeholder influences and comments left on social media platforms. Conclusion: A lack of engagement with CSR information is a reoccurring reason for preventing pro-environmental attitudes and behaviours across stakeholder groups. Traditional CSR strategies contribute to this due to their inability to engage with their intended audience. Hospitality and tourism companies are improving stakeholder relationships through collaborative processes which reduce single-use plastic consumption. A collaborative approach to communications can lead to stakeholder satisfaction, leading to changes in attitudes and behaviours. Different sources of communications are accessed by different stakeholder groups, identifying the need for targeted sustainability messaging, creating benefits such as direct interactions with stakeholders, the ability to enforce the authenticity of CSR activities, and encouraging engagement with sustainability information.

Keywords: hospitality, pro-environmental attitudes and behaviours, sustainability communication, social media

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Authors: Farzan Farhangian, Behnam Shakibafar, Bobda Cedric, Rene Jr. Landry

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Among the air navigation technologies, many of them are capable of increasing aviation sustainability as well as accuracy improvement in Alternative Positioning, Navigation, and Timing (APNT), especially avionics Distance Measuring Equipment (DME), Very high-frequency Omni-directional Range (VOR), etc. The integration of these air navigation solutions could make a robust and efficient accuracy in air mobility, air traffic management and autonomous operations. Designing a proper RF front-end, power amplifier and software-defined transponder could pave the way for reaching an optimized avionics navigation solution. In this article, the possibility of reaching an optimum front-end to be used with single low-cost Software-Defined Radio (SDR) has been investigated in order to reach a software-defined DME architecture. Our software-defined approach uses the firmware possibilities to design a real-time software architecture compatible with a Multi Input Multi Output (MIMO) BladeRF to estimate an accurate time delay between a Transmission (Tx) and the reception (Rx) channels using the synchronous scheduled communication. We could design a novel power amplifier for the transmission channel of the DME to pass the minimum transmission power. This article also investigates designing proper pair pulses based on the DO-178B avionics standard. Various guidelines have been tested, and the possibility of passing the certification process for each standard term has been analyzed. Finally, the performance of the DME was tested in the laboratory environment using an IFR6000, which showed that the proposed architecture reached an accuracy of less than 0.23 Nautical mile (Nmi) with 98% probability.

Keywords: avionics, DME, software defined radio, navigation

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Authors: Elhussaien Elshiekh

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A study was performed to management and compare radiation doses and image quality during Lumbar spine PA and Lumbar spine LAT, x- ray radiography using Computed Radiography (CR) and Digital Radiography (DR). Standard exposure factors such as kV, mAs and FFD used for imaging the Lumbar spine anthropomorphic phantom obtained from average exposure factors that were used with CR in five radiology centres. Lumbar spine phantom was imaged using CR and DR systems. Entrance surface air kerma (ESAK) was calculated X-ray tube output and patient exposure factor. Images were evaluated using visual grading system based on the European Guidelines on Quality Criteria for diagnostic radiographic images. The ESAK corresponding to each image was measured at the surface of the phantom. Six experienced specialists evaluated hard copies of all the images, the image score (IS) was calculated for each image by finding the average score of the Six evaluators. The IS value also was used to determine whether an image was diagnostically acceptable. The optimum recommended exposure factors founded here for Lumbar spine PA and Lumbar spine LAT, with respectively (80 kVp,25 mAs at 100 cm FFD) and (75 kVp,15 mAs at 100 cm FFD) for CR system, and (80 kVp,15 mAs at100 cm FFD) and (75 kVp,10 mAs at 100 cm FFD) for DR system. For Lumbar spine PA, the lowest ESAK value required to obtain a diagnostically acceptable image were 0.80 mGy for DR and 1.20 mGy for CR systems. Similarly for Lumbar spine LAT projection, the lowest ESAK values to obtain a diagnostically acceptable image were 0.62 mGy for DR and 0.76 mGy for CR systems. At standard kVp and mAs values, the image quality did not vary significantly between the CR and the DR system, but at higher kVp and mAs values, the DR images were found to be of better quality than CR images. In addition, the lower limit of entrance skin dose consistent with diagnostically acceptable DR images was 40% lower than that for CR images.

Keywords: image quality, dosimetry, radiation protection, optimization, digital radiography, computed radiography

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Authors: Muhammad Faisal, Zai-Jin You, Muhammad Naeem

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Concerns about the environment, public health, and the economy are raised by the fact that the world produces around 6 trillion cigarettes annually. Arguably the most pervasive forms of environmental litter, this dangerous trash must be eliminated. The researchers wanted to get an idea of how much pollution is seeping out of cigarette butts in metropolitan areas by studying their distribution and concentration. In order to accomplish this goal, the cigarette butt pollution indicator was applied in 29 different areas. The locations were monitored monthly for a full calendar year. The conditions for conducting the investigation of the venues were the same on both weekends and during the weekdays. By averaging the metal leakage ratio in various climates and the average weight of cigarette butts, we were able to estimate the total amount of heavy metal leakage. The findings revealed that the annual average value of the index for the areas that were investigated ranged from 1.38 to 10.4. According to these numbers, just 27.5% of the areas had a low pollution rating, while 43.5% had a major pollution status or worse. Weekends witnessed the largest fall (31% on average) in all locations' indices, while spring and summer saw the largest increase (26% on average) compared to autumn and winter. It was calculated that the average amount of heavy metals such as Cr, Cu, Cd, Zn, and Pb that seep into the environment from discarded cigarette butts in commercial, residential, and park areas, respectively, is 0.25 µg/m2, 0.078 µg/m2, and 0.18 µg/m2. Butt from cigarettes is one of the most prevalent forms of litter in the area that was examined. This litter is the origin of a wide variety of contaminants, including heavy metals. This toxic garbage poses a significant risk to the city.

Keywords: heavy metal, hazardous waste, waste management, litter

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Authors: Helida T. G. Soares, Antonio J. P. da Silva

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As the society develops, the accumulation of solid waste in landfills, in the environment, and the depletion of the raw material increases. In this way, there is relevance in researching the interaction between the environmental management and civil construction; therefore, this project has for scope the analysis and the effects of the rubber microparticles use as a small aggregate added to the sand, producing an ecological mortar for the pavement constitution, from the mixture of a paste, composed of Portland cement and water, and its application in sports courts. It was used the detailed reutilization of micro rubber in its most primordial, micro form, highlighting the powder pattern as the additional balancing of the mortar, analyzing the evolution of the mechanical properties. Percentages of 5, 10 and 15% rubber were used based on the total mass of the trace, where there is no removal of aggregates or cement, only increment of the rubber. The results obtained through the mechanical test of simple compression showed that the rubber, added to the mortar, presents low mechanical resistance compared to the reference trait, the study of this subject is vast of possibilities to be explored. In this sense, we seek sustainability and innovation from the use of an ecological material, thus adding value and reducing the impact of this material on the environment. The manufacturing process takes place from the direct mixing of cement paste and rubber, whether manually, mechanically or industrially. It results in the production of a low-cost mortar, through the use of recycled rubber, with high efficiency in general properties, such as compressive strength and friction coefficient, allowing its use for the construction of floors for sports courts with high durability. Thus, it is possible to reuse this micro rubber residue in other applications in simple concrete artifacts.

Keywords: civil construction, ecological mortar, high efficiency, rubber

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Authors: S. I. Nwadioha, M. S. Odimayo, J. A. Omotayo, A. Olu Taiwo, O. E. Olabiyi

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The current study was conducted to determine the epidemiology and antibiotic sensitivity pattern of bacteria isolated from blood of septicemic patients for improved antibiotic therapy. A three-year descriptive study has been carried out at Microbiology Laboratory, Ekiti State University Teaching Hospital, Ado Ekiti, from April 2012 to April 2015. Information compiled from patients’ records includes age, sex, isolated organisms and antibiotic susceptibility patterns. Three hundred and thirteen blood cultures were collected from neonatology and pediatrics wards, Out Patients’ Department (OPD) and from other adult patients. Forty-one cultures yielded mono microbial growth (no polymicrobial growth), giving an incidence of 13.1% positive blood culture (N=41/313). There were 58.4% Gram-negative bacilli and 41.6% Gram-positive cocci in the microbial growth. Bacteria isolated were Staphylococcus aureus 34%(14/41), Klebsiella species22% (9/41), Enterococci 17%(7/41), Proteus species12%(5/41), Escherichia coli 7%(3/41) and Streptococcal pneumoniae 7%(3/41). There was a (35%) higher occurrence of septicemia in neonates than in any other age groups in the hospital. Bacterial sensitivity to 13 antibiotic agents was determined by antibiotics disc diffusion using modified Kirby Bauer’s method. Gram-positive organisms showed a higher antibiotic sensitivity ranging from 14- 100% than the Gram-negative bacteria (11-80%). Staphylococcus aureus and Klebsiella species are the most prevalent organisms. The third generation Cephalosporins (Ceftriaxone) and Floroquinolone(Levofloxacin, Ofloxacin) have proved reliable for management of these blood infections.

Keywords: blood cultures, septicemia, antibiogram, Nigeria

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Authors: Sukhwinder Singh, Julian Park, Dinesh Kumar Benbi

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Although soil health, which is recognized as one of the key determinants of sustainable agricultural development, can be measured by a range of physical, chemical and biological parameters, the widely used parameters include pH, electrical conductivity (EC), organic carbon (OC), plant available phosphorus (P) and potassium (K). Soil health is largely affected by the occurrence of natural events or human activities and can be improved by various land management practices. A database of 120 soil samples collected from farmers’ fields spread across three major agro-climatic zones of Punjab suggested that the average pH, EC, OC, P and K was 8.2 (SD = 0.75, Min = 5.5, Max = 9.1), 0.27 dS/m (SD = 0.17, Min = 0.072 dS/m, Max = 1.22 dS/m), 0.49% (SD = 0.20, Min = 0.06%, Max = 1.2%), 19 mg/kg soil (SD = 22.07, Min = 3 mg/kg soil, Max = 207 mg/kg soil) and 171 mg/kg soil (SD = 47.57, Min = 54 mg/kg soil, Max = 288 mg/kg soil), respectively. Region-wise, pH, EC and K were the highest in south-western district of Ferozpur whereas farmers in north-eastern district of Gurdaspur had the best soils in terms of OC and P. The soils in the central district of Barnala had lower OC, P and K than the respective overall averages while its soils were normal but skewed towards alkalinity. Besides agro-climatic conditions, the size of landholding and farmer education showed a significant association with Soil Fertility Index (SFI), a composite index calculated using the aforementioned parameters’ normalized weightage. All the four stakeholder groups cited the current cropping patterns, burning of rice crop residue, and imbalanced use of chemical fertilizers for change in soil health. However, the current state of soil health in Punjab is unclear, which needs further investigation based on temporal data collected from the same field to see the short and long-term impacts of various crop combinations and varied cropping intensity levels on soil health.

Keywords: soil health, punjab agriculture, sustainability, soil fertility index

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Authors: Tingyu Zhang

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This paper utilizes the Super-SBM model to assess water resources green efficiency (WRGE) among provinces in China and investigate its spatial and temporal features, based on the characteristic framework of “economy-environment-society.” The social network analysis is employed to examine the network pattern and spatial interaction of WRGE. Further, the quadratic assignment procedure method is utilized for examining the influencing factors of the spatial association of WRGE regarding “relationship.” The study reveals that: (1) the spatial distribution of WRGE demonstrates a distribution pattern of Eastern>Western>Central; (2) a remarkable spatial association exists among provinces; however, no strict hierarchical structure is observed. The internal structure of the WRGE network is characterized by the feature of "Eastern strong and Western weak". The block model analysis discovers that the members of the “net spillover” and “two-way spillover” blocks are mostly in the eastern and central provinces; “broker” block, which plays an intermediary role, is mostly in the central provinces; and members of the “net beneficiary” block are mostly in the western region. (3) Differences in economic development, degree of urbanization, water use environment, and water management have significant impacts on the spatial connection of WRGE. This study is dedicated to the realization of regional linkages and synergistic enhancement of WRGE, which provides a meaningful basis for building a harmonious society of human and water coexistence.

Keywords: water resources green efficiency, super-SBM model, social network analysis, quadratic assignment procedure

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: Divya Vohora, Md. Jamir Anwar

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Antiepileptic drugs (AEDs)-induced adverse consequences on bone are now well recognized. Despite this, there is limited data on the effect of anti-osteoporotic therapies on AEDs-induced bone loss. Both phenytoin (PHT) and sodium valproate (SVP) inhibit human aromatase enzyme and stimulate microsomal catabolism of oestrogens. Estrogen deficiency states are known to reduce the deposition of transforming growth factor-β (TGF-β3), a bone matrix protein, having anti-osteoclastic property. Thus, an attempt was made to investigate the effect of raloxifene, a selective oestrogen receptor modulator, in comparison with CVD supplementation, on PHT and SVP-induced alterations in bone in mice. Further, the effect of raloxifene on seizures and on the antiepileptic efficacy of AEDs was also investigated. Swiss strains of female mice were treated with PHT (35 mg/kg, p.o.) and SVP (300 mg/kg, p.o.) for 120 days to induce bone loss as evidenced by reduced bone mineral density (BMD) and altered bone turnover markers in lumbar bones (alkaline phosphatase, tartarate resistant acid phosphatase, hydroxyproline) and urine (calcium). The bone loss was accompanied by reduced serum estradiol levels and bone TGF-β3 content. Preventive and curative treatment with raloxifene ameliorated bony alterations and was more effective than CVD. Deprived estrogen levels (that in turn reduced lumbar TGF-β3 content) following PHT and SVP, thus, might represent one of the various mechanisms of AEDs-induced bone loss. Raloxifene preserved the bony changes without interfering with their antiepileptic efficacy, and hence raloxifene could be a potential therapeutic option in the management of PHT and SVP-induced bone disease if clinically approved.

Keywords: antiepileptic drugs, osteoporosis, raloxifene, TGF-β3

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Authors: Paula García-Llamas, Polonia Díez González, Angela Taboada

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In an era marked by unprecedented anthropogenic alterations to landscapes and biodiversity, the consequential loss of fauna, flora, and habitats poses a grave concern. It is imperative to evaluate our capacity to manage and mitigate such changes effectively. This study aims to scrutinize the efficacy of the Natura 2000 Network (NN2000) in landscape conservation within the autonomous community of Castile and Leon (Spain), spanning from 1990 to 2018. Leveraging land use change maps from the European Corine Land Cover database across four subperiods (1990-2000, 2000-2006, 2006-2012, and 2012-2018), we quantified alterations occurring both within NN2000 protected sites and within a 5km buffer zone. Additionally, we spatially assess land use/land cover patterns of change considering fluxes of various habitat types defined within NN2000. Our findings reveal that the protected areas under NN2000 were particularly susceptible to change, with the most significant transformations observed during the 1990-2000 period. Predominant change processes include secondary succession and scrubland formation due to land use cessation, deforestation, and agricultural intensification. While NN2000 demonstrates efficacy in curtailing urbanization and industrialization within buffer zones, its management measures have proven insufficient in safeguarding landscapes against the dynamic changes witnessed between 1990 and 2018, especially in relation to rural abandonment.

Keywords: Corine land cover, land cover changes, site of community importance, special protection area

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Authors: Silindile Gumede, Amir Hossein Mohammadi, Mbuyu Germain Ntunka

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Goal 12 of the 17 Sustainable Development Goals (SDGs) encourages sustainable consumption and production patterns. This necessitates achieving the environmentally safe management of chemicals and all wastes throughout their life cycle and the proper disposal of pollutants and toxic waste. Fluid catalytic cracking (FCC) catalysts are widely used in the refinery to convert heavy feedstocks to lighter ones. During the refining processes, the catalysts are deactivated and discarded as hazardous toxic solid waste. Spent catalysts (SC) contain high-cost metal, and the recovery of metals from SCs is a tactical plan for supplying part of the demand for these substances and minimizing the environmental impacts. Leaching followed by solvent extraction, has been found to be the most efficient method to recover valuable metals with high purity from spent catalysts. However, the use of inorganic acids during the leaching process causes a secondary environmental issue. Therefore, it is necessary to explore other alternative efficient leaching agents that are economical and environmentally friendly. In this study, the waste catalyst was collected from a domestic refinery and was characterised using XRD, ICP, XRF, and SEM. Response surface methodology (RSM) and Box Behnken design were used to model and optimize the influence of some parameters affecting the acidic leaching process. The parameters selected in this investigation were the acid concentration, temperature, and leaching time. From the characterisation results, it was found that the spent catalyst consists of high concentrations of Vanadium (V) and Nickel (Ni); hence this study focuses on the leaching of Ni and V using a biodegradable acid to eliminate the formation of the secondary pollution.

Keywords: eco-friendly leaching, optimization, metal recovery, leaching

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Authors: Gordana Kordić, Petra Palić

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The European countries that during the past two decades based their exchange rate regimes on currency board arrangement (CBA) are usually analysed from the perspective of corner solution choice’s stabilisation effects. There is an open discussion on the positive and negative background of a strict exchange rate regime choice, although it should be seen as part of the transition process towards the monetary union membership. The focus of the paper is on the Baltic countries that after two decades of a rigid exchange rate arrangement and strongly influenced by global crisis are finishing their path towards the euro zone. Besides the stabilising capacity, the CBA is highly vulnerable regime, with limited developing potential. The rigidity of the exchange rate (and monetary) system, despite the ensured credibility, do not leave enough (or any) space for the adjustment and/or active crisis management. Still, the Baltics are in a process of recovery, with fiscal consolidation measures combined with (painful and politically unpopular) measures of internal devaluation. Today, two of them (Estonia and Latvia) are members of euro zone, fulfilling their ultimate transition targets, but de facto exchanging one fixed regime with another. The paper analyses the challenges for the CBA in unstable environment since the fixed regimes rely on imported stability and are sensitive to external shocks. With limited monetary instruments, these countries were oriented to the fiscal policies and used a combination of internal devaluation and tax policy measures. Despite their rather quick recovery, our second goal is to analyse the long term influence that the measures had on the national economy.

Keywords: currency board arrangement, internal devaluation, exchange rate regime, great recession

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Authors: Mucahit Unal, Ibrahim Arslan

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The New Turkish Commercial Code (TCC) No. 6102 was published in the Official Gazette on February 14, 2011. As stated in the New Turkish Commercial Code No. 6102 and Law No. 6103 on Validity and Application of the Turkish Commercial Code, TCC came into effect on July 1, 2012. The basic purpose of the TCC is to form corporate governance coherent with the international standards; to provide transparency in company management; to adjust the Turkish Commercial Code rules with European Union legislations and to simplify establishing a company for foreigner investors to move investments to Turkish market. In this context according to TCC, joint stock companies and limited liability companies can establish with only one single shareholder; the one single shareholder can be foreigner; all board of director members can be foreigner, also all shareholders and board of director members can be non-resident foreigners. Additionally, TCC does not require physical participation to the general shareholders and board members meetings. TCC allows that the general shareholders and board members meetings can hold in an electronic form and resolution of these meetings may also be approved via electronic signatures. Through this amendment, foreign investors no longer have to deal with red tapes. This amendment also means the TCC prevents foreign companies from incurring unnecessary travel expenses. In accordance with all this amendments about TCC, to invest in Turkish market is easy, simple and transparent for foreigner investors and also investors can establish a company in Turkey, irrespective of nationality or place of residence. This article aims to analyze ‘Establish a Company in Turkey for Foreigners’ and inform investors about investing (especially establishing a company) in the Turkish market.

Keywords: establish a company, foreigner investors, invest in Turkish market, Turkish commercial code

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Authors: Tomasz Balabanski, Anna Biedunkiewicz

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Research on basic bacteriological and physicochemical parameters conducted by state institutions (Provincial Sanitary and Epidemiological Station and District Sanitary and Epidemiological Station) are limited to bathing waters under constant sanitary and epidemiological supervision. Unfortunately, no routine or monitoring tests are carried out for the presence of microfungi. This also applies to beach sand used for recreational purposes. The purpose of the planned own research was to determine the diversity of the mycobiota present on supervised and unsupervised sandy beaches, on the shores of lakes, of municipal baths used for recreation. The research material consisted of microfungi isolated from April to October 2019 from sandy beaches of supervised and unsupervised lakes located within the administrative boundaries of the city of Olsztyn (North-Eastern Poland, Europe). Four lakes, out of the fifteen available (Tyrsko, Kortowskie, Skanda, and Ukiel), whose bathing waters are subjected to routine bacteriological tests, were selected for testing. To compare the diversity of the mycobiota composition on the surface and below the sand mixing layer, samples were taken from two depths (10 cm and 50 cm), using a soil auger. Micro-fungi from sand samples were obtained by surface inoculation on an RBC medium from the 1st dilution (1:10). After incubation at 25°C for 96-144 h, the average number of CFU/dm³ was counted. Morphologically differing yeast colonies were passaged into Sabouraud agar slants with gentamicin and incubated again. For detailed laboratory analyses, culture methods (macro- and micro-cultures) and identification methods recommended in diagnostic mycological laboratories were used. The conducted research allowed obtaining 140 yeast isolates. The total average population ranged from 1.37 × 10⁻² CFU/dm³ before the bathing season (April 2019), 1.64 × 10⁻³ CFU/dm³ in the season (May-September 2019), and 1.60 × 10⁻² CFU/dm³ after the end of the season (October 2019). More microfungi were obtained from the surface layer of sand (100 isolates) than from the deeper layer (40 isolates). Reported microfungi may circulate seasonally between individual elements of the lake ecosystem. From the sand/soil from the catchment area beaches, they can get into bathing waters, stopping periodically on the coastal phyllosphere. The sand of the beaches and the phyllosphere are a kind of filter for the water reservoir. The presence of microfungi with various pathogenicity potential in these places is of major epidemiological importance. Therefore, full monitoring of not only recreational waters but also sandy beaches should be treated as an element of constant control by appropriate supervisory institutions, allowing recreational areas for public use so that the use of these places does not involve the risk of infection. Acknowledgment: 'Development Program of the University of Warmia and Mazury in Olsztyn', POWR.03.05.00-00-Z310/17, co-financed by the European Union under the European Social Fund from the Operational Program Knowledge Education Development. Tomasz Bałabański is a recipient of a scholarship from the Programme Interdisciplinary Doctoral Studies in Biology and Biotechnology (POWR.03.05.00-00-Z310/17), which is funded by the 'European Social Fund'.

Keywords: beach, microfungi, sand, yeasts

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Authors: Ferdinand de la Paz

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In highly creative environments such as in the business of architecture, business models exhibit more focus on the traditional practice of mainstream design consultancy services as mandated and constrained by existing legislation. Architectural design firms, as business units belonging to the creative industries, have long been provoked to innovate not only in terms of their creative outputs but, more significantly, in the way they create and capture value from what they do. In the Philippines, there is still a dearth of studies exploring organizational creativity within the context of architectural firm practice, let alone across other creative industries. The study sought to determine the effects, measure the extent, and assess the relationships of managerial encouragement, organizational encouragement, and resource sufficiency on creativity as perceived by architects. A survey questionnaire was used to gather data from 100 respondents. The analysis was done using descriptive statistics, correlational, and causal-explanatory methods. The findings reveal that there is a weak positive relationship between Managerial Encouragement (ME), Organizational Encouragement (OE), and Sufficient Resources (SR) toward Creativity (C). The study also revealed that while Organizational Creativity and Sufficient Resources have significant effects on Creativity, Managerial Encouragement does not. It is recommended that future studies with a larger sample size be pursued among architects holding top management positions in architectural design firms to further validate the findings of this research. It is also highly recommended that the other stimulant scales in the KEYS framework be considered in future studies covering other locales to generate a better understanding of the architecture business landscape in the Philippines.

Keywords: managerial encouragement, organizational encouragement, resource sufficiency, organizational creativity, architecture firm practice, creative industries

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Authors: Alae El Fahsi

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This study explores the ‘Tajawob’ app's role in urban development, demonstrating how mobile applications can empower citizens and facilitate urban planning. Tajawob serves as a digital platform for community feedback, engagement, and participatory governance, addressing urban challenges through innovative tech solutions. This research synthesizes data from a variety of sources, including user feedback, engagement metrics, and interviews with city officials, to assess the app’s impact on citizen participation in urban development in Morocco. By integrating advanced data analytics and user experience design, Tajawob has bridged the communication gap between citizens and government officials, fostering a more collaborative and transparent urban planning process. The findings reveal a significant increase in civic engagement, with users actively contributing to urban management decisions, thereby enhancing the responsiveness and inclusivity of urban governance. Challenges such as digital literacy, infrastructure limitations, and privacy concerns are also discussed, providing a comprehensive overview of the obstacles and opportunities presented by mobile app-based citizen engagement platforms. The study concludes with strategic recommendations for scaling the Tajawob model to other contexts, emphasizing the importance of adaptive technology solutions in meeting the evolving needs of urban populations. This research contributes to the burgeoning field of smart city innovations, offering key insights into the role of digital tools in facilitating more democratic and participatory urban environments.

Keywords: smart cities, digital governance, urban planning, strategic design

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Authors: S. O. Okoro

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Some words become the catch phrase of a particular decade. Globalization, Openness, and Privatization are certainly among the most frequently encapsulation of 1990’s; the market is ‘in’, ‘the state is out’. In the 1970’s, there were many political economists who spoke of autarky as one possible response to global economic forces. Be self-contained, go it alone, put up barriers to trans-nationalities, put in place import-substitution industrialization policy and grow domestic industries. In 1990’s, the emasculation of the state is by no means complete, but there is an acceptance that the state’s power is circumscribed by forces beyond its control and potential leverage. Autarky is no longer as a policy option. Nigeria, since its emergence as an independent nation, has evolved two macroeconomic management regimes of the interventionist and market friendly styles. This paper investigates Nigeria’s growth performance over the periods incorporating these two regimes and finds that there is no structural break in Total Factor Productivity, (TFP) growth and besides, the TFP growth over the entire period of study 1970-2012 is very negligible and hence growth can only be achieved by the unsustainable factor accumulation. Another important finding of this work is that the openness-human capital interaction term has a significant impact on the TFP growth, but the sign of the estimated coefficient does not meet it a theoretical expectation. This is because the negative coefficient on the human capital outweighs the positive openness effect. The poor quality of human capital is considered to have given rise to this. Given these results a massive investment in the education sector is required. The investment should be targeted at reforms that go beyond mere structural reforms to a reform agenda that will improve the quality of human capital in Nigeria.

Keywords: globalization, emasculation, openness and privatization, total factor productivity

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Authors: Alli Smith Yemisi Rufina, Adanlawo Isaac Gbadura

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Liver disorders are one of the major problems of the world. Despite its frequent occurrence, high morbidity, and high mortality, its medical management is currently inadequate. This study was designed to evaluate the Hepatoprotective effect of saponin extract of the root of Garcinia kola on the integrity of the liver of paracetamol induced Wistar albino rats. Twenty-five male adult Wistar albino rats were divided into five (5) groups. Group I, was the Control group that received distilled water only, group II was the negative control that received 2 g/kg of paracetamol on the 13th day, and group III, IV, and V were pre-treated with 100, 200 and 400 mg/kg of the saponin extract before inducing the liver damage on the 13th day with 2 g/kg of paracetamol. Twenty-four hours after administration, the rats were sacrificed, and blood samples were collected. The serum Alanine Transaminase (ALT), Aspartate Transaminase (AST), Alkaline Phosphatase (ALP) activities, Bilirubin and Conjugated Bilirubin, Glucose and Protein concentrations were evaluated. The liver was fixed immediately in Formalin and was processed and stained with Haematoxylin and Eosin (H&E). Administration of saponin extract from the root of Garcinia kola significantly decreased paracetamol induced elevated enzymes in the test group. Also, histological observations showed that saponin extract of the root of Garcinia kola exhibited a significant liver protection against the toxicant as evident by the cells trying to return to normal. Saponin extract from the root of Garcinia kola indicated a protection of the structural integrity of the hepatocytic cell membrane and regeneration of the damaged liver.

Keywords: hepatoprotective, liver damage, Garcinia kola, saponin, paracetamol

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Authors: Gözde Arzu Sarıcan

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Contemporary urbanization processes and spatial transformations are intensely debated across various fields of social sciences. One prominent concept in these discussions is "common spaces." Common spaces offer a critical theoretical framework, particularly for addressing the social and economic inequalities brought about by urbanization. This study examines the processes of commoning and their impacts through the lens of squatter neighborhoods in Turkey, emphasizing the importance of affordable housing. It focuses on the role and significance of these neighborhoods in the formation of common spaces, analyzing the collective actions and resistance strategies of residents. This process, which began with the construction of shelters to meet the shelter needs of low-income households migrating from rural to urban areas, has turned into low-quality squatter settlements over time. For low-income households lacking the economic power to rent or buy homes in the city, these areas provided an affordable housing solution. Squatter neighborhoods reflect the efforts of local communities to protect and develop their communal living spaces through collective actions and resistance strategies. This collective creation process involves the appropriation of occupied land as a common resource through the rules established by the commons. Organized occupations subdivide these lands, shaped through collective creation processes. For the squatter communities striving for economic and social adaptation, these areas serve as buffer zones for urban integration. In squatter neighborhoods, bonds of friendship, kinship, and compatriotism are strong, playing a significant role in the creation and dissemination of collective knowledge. Squatter areas can be described as common spaces that emerge out of necessity for low-income and marginalized groups. The design and construction of housing in squatter neighborhoods are shaped by the collective participation and skills of the residents. Streets are formed through collective decision-making and labor. Over time, the demands for housing are communicated to local authorities, enhancing the potential for commoning. Common spaces are shaped by collective needs and demands, appropriated, and transformed into potential new spaces. Common spaces are continually redefined and recreated. In this context, affordable housing becomes an essential aspect of these common spaces, providing a foundation for social and economic stability. This study evaluates the processes of commoning and their effects through the lens of squatter neighborhoods in Turkey. Communities living in squatter neighborhoods have managed to create and protect communal living spaces, especially in situations where official authorities have been inadequate. Common spaces are built on values such as solidarity, cooperation, and collective resistance. In urban planning and policy development processes, it is crucial to consider the concept of common spaces. Policies that support the collective efforts and resistance strategies of communities can contribute to more just and sustainable living conditions in urban areas. In this context, the concept of common spaces is considered an important tool in the fight against urban inequalities and in the expression and defense mechanisms of communities. By emphasizing the importance of affordable housing within these spaces, this study highlights the critical role of common spaces in addressing urban social and economic challenges.

Keywords: affordable housing, common space, squating process, turkey

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Authors: Fadila Hadjeris

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The study aims at investigating the functions of English-Arabic code switching in English as a foreign language classroom oral discourse and the extent to which they can contribute to the flow of classroom interaction. It also seeks to understand the views, beliefs, and perceptions of teachers and learners towards this practice. We hypothesized that code switching is a communicative strategy which facilitates classroom interaction. Due to this fact, both teachers and learners support its use. The study draws on a key body of literature in bilingualism, second language acquisition, and classroom discourse in an attempt to provide a framework for considering the research questions. It employs a combination of qualitative and quantitative research methods which include classroom observations and questionnaires. The analysis of the recordings shows that teachers’ code switching to Arabic is not only used for academic and classroom management reasons. Rather, the data display instances in which code switching is used for social reasons. The analysis of the questionnaires indicates that teachers and pupils have different attitudes towards this phenomenon. Teachers reported their deliberate switching during EFL teaching, yet the majority was against this practice. According to them, the use of the mother has detrimental effects on the acquisition and the practice of the target language. In contrast, pupils showed their preference to their teachers’ code switching because it enhances and facilitates their understanding. These findings support the fact that the shift to pupils’ mother tongue is a strategy which aids and facilitates the teaching and the learning of the target language. This, in turn, necessitates recommendations which are suggested to teachers and course designers.

Keywords: bilingualism, codeswitching, classroom interaction, classroom discourse, EFL learning/ teaching, SLA

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Authors: Abdullah Arafat, Ali Al-Farhan, Amir Omair

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Objectives: To review and assess the effectiveness of the implemented modified five-levels triage and acuity scale triage system in AL-Yarmook Urgent Care Center (UCC), King Abdulaziz Residential city, Riyadh, Saudi Arabia. Method: The applied study design was an observational cross sectional design. A data collection sheet was designed and distributed to triage nurses; the data collection was done during triage process and was directly observed by the co-investigator. Triage system was reviewed by measuring three time intervals as quality indicators: time before triage (TBT), time before being seen by physician (TBP) and total length of stay (TLS) taking in consideration timing of presentation and level of triage. Results: During the study period, a total of 187 patients were included in our study. 118 visits were at weekdays and 68 visits at weekends. Overall, 173 patients (92.5%) were seen by the physician in timely manner according to triage guidelines while 14 patients (7.5%) were not seen at appropriate time.Overall, The mean time before seen the triage nurse (TBT) was 5.36 minutes, the mean time to be seen by physician (TBP) was 22.6 minutes and the mean length of stay (TLS) was 59 minutes. The data didn’t showed significant increase in TBT, TBP, and number of patients not seen at the proper time, referral rate and admission rate during weekend. Conclusion: The CTAS is adaptable to countries beyond Canada and worked properly. The applied CTAS triage system in Al-Yarmook UCC is considered to be effective and well applied. Overall, urgent cases have been seen by physician in timely manner according to triage system and there was no delay in the management of urgent cases.

Keywords: CTAS, emergency, Saudi Arabia, triage, urgent care

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Authors: Varun Kumar, Chandra Shakher

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Micro-optical components such as microlenses and microlens array have numerous engineering and industrial applications for collimation of laser diodes, imaging devices for sensor system (CCD/CMOS, document copier machines etc.), for making beam homogeneous for high power lasers, a critical component in Shack-Hartmann sensor, fiber optic coupling and optical switching in communication technology. Also micro-optical components have become an alternative for applications where miniaturization, reduction of alignment and packaging cost are necessary. The compliance with high-quality standards in the manufacturing of micro-optical components is a precondition to be compatible on worldwide markets. Therefore, high demands are put on quality assurance. For quality assurance of these lenses, an economical measurement technique is needed. For cost and time reason, technique should be fast, simple (for production reason), and robust with high resolution. The technique should provide non contact, non-invasive and full field information about the shape of micro- optical component under test. The interferometric techniques are noncontact type and non invasive and provide full field information about the shape of the optical components. The conventional interferometric technique such as holographic interferometry or Mach-Zehnder interferometry is available for characterization of micro-lenses. However, these techniques need more experimental efforts and are also time consuming. Digital holography (DH) overcomes the above described problems. Digital holographic microscopy (DHM) allows one to extract both the amplitude and phase information of a wavefront transmitted through the transparent object (microlens or microlens array) from a single recorded digital hologram by using numerical methods. Also one can reconstruct the complex object wavefront at different depths due to numerical reconstruction. Digital holography provides axial resolution in nanometer range while lateral resolution is limited by diffraction and the size of the sensor. In this paper, Mach-Zehnder based digital holographic interferometric microscope (DHIM) system is used for the testing of transparent microlenses. The advantage of using the DHIM is that the distortions due to aberrations in the optical system are avoided by the interferometric comparison of reconstructed phase with and without the object (microlens array). In the experiment, first a digital hologram is recorded in the absence of sample (microlens array) as a reference hologram. Second hologram is recorded in the presence of microlens array. The presence of transparent microlens array will induce a phase change in the transmitted laser light. Complex amplitude of object wavefront in presence and absence of microlens array is reconstructed by using Fresnel reconstruction method. From the reconstructed complex amplitude, one can evaluate the phase of object wave in presence and absence of microlens array. Phase difference between the two states of object wave will provide the information about the optical path length change due to the shape of the microlens. By the knowledge of the value of the refractive index of microlens array material and air, the surface profile of microlens array is evaluated. The Sag of microlens and radius of curvature of microlens are evaluated and reported. The sag of microlens agrees well within the experimental limit as provided in the specification by the manufacturer.

Keywords: micro-optics, microlens array, phase map, digital holographic interferometric microscopy

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Authors: Leonie Bradfield, Stephen Fityus, John Simmons

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The shearing behavior of current and planned coal mine spoil dumps up to 400m in height is studied using large-sample-high-stress direct shear tests performed on a range of spoils common to the coalfields of Eastern Australia. The motivation for the study is to address industry concerns that some constructed spoil dump heights ( > 350m) are exceeding the scale ( ≤ 120m) for which reliable design information exists, and because modern geotechnical laboratories are not equipped to test representative spoil specimens at field-scale stresses. For more than two decades, shear strength estimation for spoil dumps has been based on either infrequent, very small-scale tests where oversize particles are scalped to comply with device specimen size capacity such that the influence of prototype-sized particles on shear strength is not captured; or on published guidelines that provide linear shear strength envelopes derived from small-scale test data and verified in practice by slope performance of dumps up to 120m in height. To date, these published guidelines appear to have been reliable. However, in the field of rockfill dam design there is a broad acceptance of a curvilinear shear strength envelope, and if this is applicable to coal mine spoils, then these industry-accepted guidelines may overestimate the strength and stability of dumps at higher stress levels. The pressing need to rationally define the shearing behavior of more representative spoil specimens at field-scale stresses led to the successful design, construction and operation of a large direct shear machine (LDSM) and its subsequent application to provide reliable design information for current and planned very-high dumps. The LDSM can test at a much larger scale, in terms of combined specimen size (720mm x 720mm x 600mm) and stress (σn up to 4.6MPa), than has ever previously been achieved using a direct shear machine for geotechnical testing of rockfill. The results of an extensive LDSM testing program on a wide range of coal-mine spoils are compared to a published framework that widely accepted by the Australian coal mining industry as the standard for shear strength characterization of mine spoil. A critical outcome is that the LDSM data highlights several non-compliant spoils, and stress-dependent shearing behavior, for which the correct application of the published framework will not provide reliable shear strength parameters for design. Shear strength envelopes developed from the LDSM data are also compared with dam engineering knowledge, where failure envelopes of rockfills are curved in a concave-down manner. The LDSM data indicates that shear strength envelopes for coal-mine spoils abundant with rock fragments are not in fact curved and that the shape of the failure envelope is ultimately determined by the strength of rock fragments. Curvilinear failure envelopes were found to be appropriate for soil-like spoils containing minor or no rock fragments, or hard-soil aggregates.

Keywords: coal mine, direct shear test, high dump, large scale, mine spoil, shear strength, spoil dump

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Authors: Ruvaitha Banu, Amaladhithyan Krishnamoorthy

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IoT networks today solve various consumer problems, from home automation systems to aiding in driving autonomous vehicles with the exploration of multiple devices. For example, in an autonomous vehicle environment, multiple sensors are available on roads to monitor weather and road conditions and interact with each other to aid the vehicle in reaching its destination safely and timely. IoT systems are predominantly dependent on the cloud environment for data storage, and computing needs that result in latency problems. With the advent of Fog networks, some of this storage and computing is pushed to the edge/fog nodes, saving the network bandwidth and reducing the latency proportionally. Managing the data stored in these fog nodes becomes crucial as it might also store sensitive information required for a certain application. Data management in fog nodes is strenuous because Fog networks are dynamic in terms of their availability and hardware capability. It becomes more challenging when the nodes in the network also live a short span, detaching and joining frequently. When an end-user or Fog Node wants to access, read, or write data stored in another Fog Node, then a new protocol becomes necessary to access/manage the data stored in the fog devices as a conventional static way of managing the data doesn’t work in Fog Networks. The proposed solution discusses a protocol that acts by defining sensitivity levels for the data being written and read. Additionally, a distinct data distribution and replication model among the Fog nodes is established to decentralize the access mechanism. In this paper, the proposed model implements stewardship towards the data stored in the Fog node using the application of Reinforcement Learning so that access to the data is determined dynamically based on the requests.

Keywords: IoT, fog networks, data stewardship, dynamic access policy

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Authors: Nelson Igaba, C. Onaga, S. Hlongwane

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Background: Medical Male Circumcision (MMC) is part of a comprehensive HIV prevention strategy. The quality of MMC done at Right To Care (RtC) sites is maintained by Continuous Quality Improvement (CQI) based on findings of assessments by internal and independent external assessors who evaluate such parameters as the quality of the surgical procedure, infection control, etc. There are 12 RtC MMC teams in Mpumalanga, two of which are headed by Medical Officers and 10 by Clinical Associates (Clin A). Objectives: To compare the quality (i) of care rendered at doctor headed sites (DHS) versus Clin A headed sites (CHS); (ii) of CQI assessments (external versus internal). Methodology: A retrospective review of data from RightMax™ (a novel RtC data management system) and CQI reports (external and internal) was done. CQI assessment scores of October 2015 and October 2016 were taken as the baseline and latest respectively. Four sites with 745-810 circumcisions per annum were purposively selected; the two DHS (group A) and two CHS (group B). Statistical analyses were conducted using R (2017 version). Results: There were no significant difference in latest CQI scores between the two groups (DHS and CHS) (Anova, F = 1.97, df = 1, P = 0.165); between internal and external CQI assessment scores (Anova, F = 2.251, df = 1, P = 0.139) or among the individual sites (Anova, F = 1.095, df = 2, P = 0.341). Of the total of 16 adverse events reported by the four sites in the 12 months reviewed (all were infections), there was no statistical evidence that the documented severity of the infection was different for DHS and CHS (Fisher’s exact test, p-value = 0.269). Conclusion: At RtC VMMC sites in Mpumalanga, internal and external/independent CQI assessments are comparable, and quality of care of VMMC is standardized with the performance of well-supervised clinical associates comparing well with those of medical officers.

Keywords: adverse events, Right to Care, male medical circumcision, continuous quality improvement

Procedia PDF Downloads 156

Authors: Shivani Kuttuva, Bridget Fergie, Andrew Mishreki, Shovkat Mir, Fintan Bergin

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Diaphragm disease (DD) of the small bowel is a condition wherein the bowel lumen is divided into a series of short compartments by multiple circumferential membranes of mucosa and submucosa, leading to pinhole lumen and subsequent obstruction. It is a rare condition commonly attributed to non-steroidal anti-inflammatory drugs (NSAIDs) usage. Herein we present a 31-yr-old-female with a history of NSAIDs usage for one year following neurosurgery, who presented with recurrent idiopathic small bowel obstruction, recalcitrant anaemia, and impaction of capsule endoscope on investigating for anaemia. The capsule endoscopy images demonstrated multiple circumferential strictures with ulcers at its tip and villous atrophy in the proximal bowel, suggestive of NSAIDs related damage. However, due to the lack of awareness of the detrimental effects of NSAIDs on bowel mucosa distal to the duodenum, the underlying aetiology of this clinical presentation remained a mystery for a significant duration. The patient had to undergo repeated laparotomies in order to relieve the symptoms of recurring acute small bowel obstruction. Upon examining the resected specimen under microscopy, the histopathological hallmark of expanded, fibrotic, and congested submucosa was picked up, leading to the confirmation of diaphragm disease. Thus, this case report aims to widen the awareness among clinicians and aid surgeons in devising a management plan for young individuals presenting with recurring episodes of obstruction due to Diaphragm disease.

Keywords: capsule endoscopy, diaphragm disease, NSAIDs, recurrent small bowel obstruction

Procedia PDF Downloads 151