Search results for: drivers and barriers

Authors: Florian Tille, Heide Weishaar, Bernhard Gibis, Susanne Schnitzer

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Introduction: The quality of patient-doctor communication and of written health information is central to organizational health literacy (HL). Whether patients understand their doctors’ explanations and textual material on health, however, is understudied. This study identifies the overall levels of patient understanding of health information and its associations with patients’ social characteristics in outpatient health care in Germany. Materials & Methods: This analysis draws on data collected via a 2017 national health survey with a sample of 6,105 adults. Quality of communication was measured for consultations with general practitioners (GPs) and specialists (SPs) via the Ask Me 3 program questions, and through a question on written health material. Correlations with social characteristics were explored employing bivariate and multivariate logistic regression analyses. Results: Over 90% of all respondents reported that they had understood their doctors’ explanations during the last consultation. Failed understanding was strongly correlated with patients’ very poor health (Odds Ratio [OR]: 5.19; 95% confidence interval [CI]: 2.23–12.10; ref. excellent/very good health), current health problem (OR: 6.54, CI: 1.70–25.12; ref. preventive examination) and age 65 years and above (OR: 2.97, CI: 1.10–8.00; ref. 18 to 34 years). Fewer patients answered they understood written material well (86.7% for las visit at GP, 89.7% at SP). Understanding written material poorly was highly associated with basic education (OR: 4.20, CI: 2.76–6.39; ref. higher education) and 65 years old and above (OR: 2.66, CI: 1.43–4.96). Discussion: Overall ratings of oral patient-doctor communication and written communication of health information are high. Yet, a considerable share of patients reports not-understanding their doctors and poor understanding of the written health-related material. Interventions that can contribute to improving organizational HL in outpatient care in Germany include HL training for doctors, reducing system barriers to easily-accessible health information for patients and combining oral and written health communication means. Conclusion: This work adds to the study of organizational HL in Germany. To increase patient understanding of health-relevant information and thereby possibly reduce health disparities, meeting the communication needs especially of persons in different age groups, with basic education and in very poor health is suggested.

Keywords: health survey, organizational health literacy, patient-doctor communication, social characteristics, outpatient care, Ask Me 3

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Authors: Marvin Eslava

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The over-arching aim of this research is to determine the potential contribution of local food resources to the tourism growth of Nueva Vizcaya. It reviews some of the underpinning concepts and to provide a set of considerations for stakeholders to maximize the opportunity of local food can offer to businesses and the wider community. The basis of the study is to develop a sustainable food tourism model for Nueva Vizcaya. For the purpose of this research, there were 60 total numbers of respondents classified as samples from a six municipality. The respondents of the study were stakeholder consisting of government official, local producers, businessman and Non-government organizations in the selected municipalities of Nueva Vizcaya. Stratified purposive sampling was the appropriate technique that was used to the local government officials and employees, NGOs including the businessmen who are associated with local food resources and local producers. The documentary study, focus group discussion and survey questionnaire was used in order to meet the objectives of the study. Kruskall Wallis test was used to test the variances the ratings of the participants. This was used in the computation of hypothesis. The study concluded that the province of Nueva Vizcaya is blessed for its rich farmlands and fertile mountain soil boasts to produce high quality agricultural products. It is a home of various different indigenous groups creating a wide range of local cuisine. The province has substantial local food development evidence by the various food tourism related resources, increase in facilities and celebrating food tourism related events. The local food resources provide extensive potential economic empowerment and help in building the identity of the province. In addition, the local food resources extensively enhance the agriculture sector and other attractions in the province. Finally, it helps to preserve the authenticity of the food culture and generated pride among all stakeholders extensively. All stakeholders have the same perception on the potential contribution of local food resources to the development of the province of Nueva Vizcaya. The public and private sectors are cognizant on their roles to support the production of local food resources in Nueva Vizcaya. Major challenges and barriers in the development of sustainable food tourism in Nueva Vizcaya include production or supply and marketing.

Keywords: local food resources, contribution, food tourism, benefits

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Authors: Riina I. Bray, Yifan Wang, Nikolas Argiropoulos, Stephanie Robins, John Molot, Kelly Tragash, Lynn M. Marshall, Margaret E. Sears, Marie-Andrée Pigeon, Michel Gaudet, Pierre Auger, Emily Bélanger, Rohini Peris

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Multiple chemical sensitivity (MCS) is a chronic medical condition characterized by intolerances to chemical substances. Since the arrival of the COVID-19 pandemic and associated health measures, people experiencing MCS (PEMCS) are at a heightened risk of environmental exposures associated with cleaners, disinfectants, and sanitizers. Little attention has been paid to the well-being of PEMCS in the context of the COVID-19 pandemic. Objective: This study assesses the lived experiences of Canadian adults with MCS in relation to their living environment, access to healthcare, and levels of perceived social support before and during the pandemic. Methods: A total of 119 PEMCS completed an online questionnaire. McNemar Chi-Squared and Wilcoxon Signed Rank tests were used to evaluate if there were statistically significant changes in participants’ perception of their living environment, access to healthcare, and levels of social support before and after March 11, 2020. Results: Both positive and negative outcomes were noted. Participants reported an increase in exposure to disinfectants/sanitizers that entered their living environment (p<.001). There was a reported decrease in access to a family doctor during the pandemic (p<0.001). Although PEMCS experienced increased social isolation (p<0.001), they also reported an increase in understanding from family (p<0.029) and a decrease in stigma for wearing personal protective equipment (p<0.001). Conclusion: PEMCS reported experiencing: increased exposure to disinfectants or sanitizers, a loss of social support, and barriers in accessing healthcare during the pandemic. However, COVID-19 provided an opportunity to normalize the living conditions of PEMCS, such as wearing masks and social isolation. These findings can guide decision-makers on the importance of implementing nontoxic alternatives for cleaning and disinfection, as well as improving accommodation measures for PEMCS.

Keywords: covid-19, multiple chemical sensitivity, MCS, quality of life, social isolation, physical environment, healthcare

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Authors: Jiayun Shen, Lorenz Wyss, Thierry Golliard, Matthias Finger

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Innovation is widely recognized as the key for private enterprises to win the market competition. The state-owned-enterprises need to be innovative to compete in the market after the privatization as well. However, it is a lack of research to study how state-owned-enterprises manage innovation to create new products and services. Swiss Post, a Swiss state-owned-enterprises, has established a department to transform the corporate culture and foster innovation to achieve digital transformation. This paper describes the innovation management process at the Swiss Post and analyzes the impacts of the instruments, the organizational structure, and explores the barriers of innovation. This study used qualitative methods based on a review of the literature on innovation management and semi-structured interviews. Being established for over five years, the Swiss Post’s innovation management department has established a software-assisted modularized platform with systematic instruments to help the internal employees with the different innovation processes. It guides the innovators from idea creation to piloting in markets and supports with a separate financing source, with knowledge inputs and coaching, as well as with connections to external partners through the open innovation and venturing team. The platform also adapts to different business units within the corporate with a customized tailor for the various operational business units. The separate financing instruments enabled the creation and further development of new ideas; the coaching services contribute greatly to the transformation of teams’ innovation culture by providing new knowledge, thinking methods, and use cases for inspiration. It also facilitates organizational learning to help the whole corporate with the digital transformation. However, it is also confronted with a big challenge in twofold. Internally, the disruptive projects often hardly overcome the obstacles of long-established operational processes in the traditional business units; externally, the expectations of the public and restrictions from the federal government have become high hurdles for the company to stay and compete in the innovation track.

Keywords: empirical case study, innovation management, state-owned-enterprise, Swiss Post

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Authors: Yevheniia Varyvoda, Douglas Taren

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At the aggregate level, climate variability, the rising number of active violent conflicts, globalization and industrialization of agriculture, the loss in diversity of crop species, the increase in demand for agricultural production, and the adoption of healthy and sustainable dietary patterns are exacerbating factors of food system destabilization. The importance of pseudocereals to fuel and sustain resilient food systems is recognized by leading organizations working to end hunger, particularly for their critical capability to diversify livelihood portfolios and provide plant-sourced healthy nutrition in the face of systemic shocks and stresses. Amaranth, buckwheat, and quinoa are the most promising and used pseudocereals for ensuring food system resilience in the reality of climate change due to their high nutritional profile, good digestibility, palatability, medicinal value, abiotic stress tolerance, pest and disease resistance, rapid growth rate, adaptability to marginal and degraded lands, high genetic variability, low input requirements, and income generation capacity. The study provides the rationale and examples of advancing local and regional food systems' resilience by scaling up the utilization of amaranth, buckwheat, and quinoa along all components of food systems to architect indirect nutrition interventions and climate-smart approaches. Thus, this study aims to explore the drivers for ancient pseudocereal utilization, the potential resilience benefits that can be derived from using them, and the challenges and opportunities for pseudocereal utilization within the food system components. The PSALSAR framework regarding the method for conducting systematic review and meta-analysis for environmental science research was used to answer these research questions. Nevertheless, the utilization of pseudocereals has been slow for a number of reasons, namely the increased production of commercial and major staples such as maize, rice, wheat, soybean, and potato, the displacement due to pressure from imported crops, lack of knowledge about value-adding practices in food supply chain, limited technical knowledge and awareness about nutritional and health benefits, absence of marketing channels and limited access to extension services and information about resilient crops. The success of climate-resilient pathways based on pseudocereal utilization underlines the importance of co-designed activities that use modern technologies, high-value traditional knowledge of underutilized crops, and a strong acknowledgment of cultural norms to increase community-level economic and food system resilience.

Keywords: resilience, pseudocereals, food system, climate change

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Authors: Xue Li, Hui Xu

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Mild cognitive impairment (MCI) is a clinical stage that occurs between normal aging and dementia. Although MCI increases the risk of developing dementia, individuals with MCI may maintain stable cognitive function and even recover to a typical cognitive state. An intervention to prevent or delay the progression to dementia in individuals with MCI may involve promoting social engagement. Social participation is the engagement in socially relevant social exchanges and meaningful activities. Older adults with MCI may encounter restricted cognitive abilities, mood changes, and behavioral difficulties during social participation, influencing their willingness to engage. Therefore, this study aims to employ qualitative research methods to gain an in-depth comprehension of the authentic social participation experiences of older adults with mild cognitive impairment, which will establish a foundation for designing appropriate intervention programs. A phenomenological research was conducted. The study participants were selected using the purposive sampling method in combination with the maximum differentiation sampling strategy. Face-to-face semistructured interviews were conducted among 12 elderly individuals suffering from mild cognitive impairment in a community in Zhengzhou City from May to July 2023. Colaizzi 7-step method was used to analyze the data and extract the theme. The real experience of social participation in older adults with mild cognitive impairment can be summarized into 3 themes: (1) a single social relationship but a strong desire to participate, (2) a dual experience of social participation with both positive and negative aspects, (3) multiple barriers to social participation, including impaired memory capacity, heavy family responsibilities and lack of infrastructure. The study found that elderly individuals with mild cognitive impairment and one social interaction display an increased desire to engage in society. To improve social participation levels and reduce cognitive function decline, healthcare providers should work with relevant government agencies and the community to create a comprehensive social participation system. It is important for healthcare providers to note the social participation status of the elderly with mild cognitive impairment.

Keywords: mild cognitive impairment, the elderly, social participation, qualitative research

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Authors: David Holton, Michelle Dickinson, Giovanni Carta

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The principle of geological disposal is to isolate higher-activity radioactive wastes deep inside a suitable rock formation to ensure that no harmful quantities of radioactivity reach the surface environment. To achieve this, wastes will be placed in an engineered underground containment facility – the geological disposal facility (GDF) – which will be designed so that natural and man-made barriers work together to minimise the escape of radioactivity. Internationally, various multi-barrier concepts have been developed for the disposal of higher-activity radioactive wastes. High-heat-generating wastes (HLW, spent fuel and Pu) provide a number of different technical challenges to those associated with the disposal of low-heat-generating waste. Thermal management of the disposal system must be taken into consideration in GDF design; temperature constraints might apply to the wasteform, container, buffer and host rock. Of these, the temperature limit placed on the buffer component of the engineered barrier system (EBS) can be the most constraining factor. The heat must therefore be managed such that the properties of the buffer are not compromised to the extent that it cannot deliver the required level of safety. The maximum temperature of a buffer surrounding a container at the centre of a fixed array of heat-generating sources, arises due to heat diffusing from neighbouring heat-generating wastes, incrementally contributing to the temperature of the EBS. A range of strategies can be employed for managing heat in a GDF, including the spatial arrangements or patterns of those containers; different geometrical configurations can influence the overall thermal density in a disposal facility (or area within a facility) and therefore the maximum buffer temperature. A semi-analytical thermal dimensioning tool and methodology have been applied at a generic stage to explore a range of strategies to manage the disposal of high-heat-generating waste. A number of examples, including different geometrical layouts and chequer-boarding, have been illustrated to demonstrate how these tools can be used to consider safety margins and inform strategic disposal options when faced with uncertainty, at a generic stage of the development of a GDF.

Keywords: buffer, geological disposal facility, high-heat-generating waste, spent fuel

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Authors: Bagweneza Vedaste, Rugema Joselyne, Twagirayezu Innocent, Nikuze Bellancille, Nyirazigama Alice, Ishimwe Bazakare Marie Laetitia, Kaberuka Gerard, Mukeshimana Madeleine

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Background: Teen pregnancies have dramatically increased across the country in the past few years. Teen mothers usually face difficulties accessing the reproductive health (RH) services due to different reasons that include fear of getting discriminated or seen by other people. Some teen mothers do not also know their rights regarding the RH services, and they sometimes get discriminated. Little is known in Rwanda regarding how these teen mothers access the RH services compared to the general population, and views of teen mothers on their rights to access these services have not been clearly documented in the country. Specific Aims: To explore baseline information about SRH services among teen mothers; to explore factors that contribute to the use of SRH services among teen mothers; to identify strategies to increase awareness on SRHR (Sexual and Reproductive Health and Rights) among teen mothers in targeted area; and to explore views of teen mothers on rights for SRH services. Research design/Methodology: The qualitative exploratory descriptive research will be used among the teen mothers in five selected health centers of Rwamagana district. The study will use the qualitative descriptive study design. Setting: The study will be conducted in five selected health centers of Rwamagana district, which has been chosen due to a higher number of adolescent pregnancies in Eastern Province according to the DHS 2019-2020. Participants: The participants in this study will be teenage mothers who conceived after turning 11 but have delivered before turning 19. As the upper age for teenage is 19 years, this means that the researchers anticipated that those conceiving at 19 years may deliver in their twenties, which was the upper age limit in this study. Data collection measures: A semi-structured interview guide will be used to gather information from the respondents in focus group discussions. Significance: The findings of this study will provide a picture regarding the access of teen mothers to SRHS and their rights to SRH services. They will increase their awareness regarding SRH services and rights. Finally, the findings may help to address barriers faced by teen mothers to reach, pay and utilize SRHS.

Keywords: sexual and reproductive health services, inclusiveness, qualitative study, adolescent mothers

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Authors: Mark Davies, Carolyn Wallace, Christina Lloydwin, Tom Powell

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Background: Frailty is increasingly recognized as a public health problem within an aging population. It is often characterized as an accumulation of clinical symptoms with progressive decline. We contend that dehydration is potentially the missing link driving the cycle of frailty; it contributes to malnutrition and cognitive decline and is a risk factor for other conditions. Frailty may also impact on fluid intake in cognitively intact older adults, indicating the cyclical nature of dehydration contributing to increasing frailty. Aim: To examine the relationships between fluid, hydration, and frailty in older adults in order to determine what works, for whom, how, why, and in what circumstances. Methods: A Realist Synthesis was first undertaken with n=50 studies, leading to the development of a Refined Programme Theory (RPT) articulating what hydration interventions work, for whom, to what degree, in what contexts, and how & why. Within the subsequent evaluation, the RPT was further confirmed/refuted/refined following semi-structured interviews with n=8 participants (healthcare professionals and patients). The RAMESES Quality Standards were followed throughout the study. Results: The Refined Programme Theory (RPT) highlighted three factors that result in optimized hydration for frail older people, i.e., Developing an Understanding Around Hydration, Empowering Participation, and System Reconfiguration. Our RPT indicates that hydration interventions work by developing an understanding of the importance of hydration, mitigating physical & cognitive barriers, increasing the agency of the patient, using a prompting process to reinforce drinking behavior, and routinizing hydration as a dimension of overall care. Conclusion: The study indicates that a greater understanding of the importance of hydration is required for all parties. Patients also require physical and psychological support if they are to be active agents in meeting their hydration needs. At a wider ‘system’ level, organizations must work in an integrated manner introducing processes that enable continuing professional development (CPD), encourage ongoing holistic assessment, and routinize hydration support.

Keywords: frailty, dehydration, older adults, realist review, realist evaluation

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Authors: Manzoor Ahmad

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The rapid advancement of mobile technology has transformed the way businesses engage with consumers, making mobile marketing a crucial strategy for organizations worldwide. This paper presents a comprehensive study on the adoption of mobile marketing in Pakistan, aiming to provide valuable insights into the current landscape, challenges, and opportunities in this emerging market. To achieve this objective, a mixed-methods approach was employed, combining quantitative surveys and qualitative interviews with industry experts, marketers, and consumers. The study encompassed a diverse range of sectors, including retail, telecommunications, banking, and e-commerce, ensuring a comprehensive understanding of mobile marketing practices across different industries. The findings indicate that mobile marketing has gained significant traction in Pakistan, with a growing number of organizations recognizing its potential for reaching and engaging with consumers effectively. Factors such as increasing smartphone penetration, affordable data plans, and the rise of social media usage have contributed to the widespread adoption of mobile marketing strategies. However, several challenges and barriers to mobile marketing adoption were identified. These include issues related to data privacy and security, limited digital literacy among consumers, inadequate infrastructure, and cultural considerations. Additionally, the study highlights the need for tailored and localized mobile marketing strategies to address the diverse cultural and linguistic landscape of Pakistan. Based on the insights gained from the study, practical recommendations are provided to support organizations in optimizing their mobile marketing efforts in Pakistan. These recommendations encompass areas such as consumer targeting, content localization, mobile app development, personalized messaging, and measurement of mobile marketing effectiveness. This research contributes to the existing literature on mobile marketing adoption in developing countries and specifically sheds light on the unique dynamics of the Pakistani market. It serves as a valuable resource for marketers, practitioners, and policymakers seeking to leverage mobile marketing strategies in Pakistan, ultimately fostering the growth and success of businesses operating in this region.

Keywords: mobile marketing, digital marketing, mobile advertising, adoption of mobile marketing

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Authors: Elvis Munyoka

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While the number of African refugees settling in Australia has significantly increased since the mid-1990s, the marginalisation and exclusion of young people from refugee backgrounds in employment remain a critical challenge. Unemployment or underemployment can negatively impact refugees in multiple areas, such as income, housing, life satisfaction, and social status. Higher rates of unemployment among refugees are linked in part to the intersection of pre-migration and daily challenges like trauma, racism, gender identity, and English language competency, all of which generate multiple employability disadvantages. However, the intersection of gender, race, social class, and age in impacting African refugee youth’s access to employment has received less attention. Using a qualitative case study approach, the presentation will explore how gender, race, social class, and age influence African refugee youth graduates’ access to employment in South Australia. The intersectionality theory and capability approach to social justice is used to explore intersecting factors impacting African refugee youth’s access to employment in South Australia. Participants were 16 African refugee graduates aged 18-30 living in South Australia who took part in the study for one year. Based on the trends in the data, the results suggest that long-term unemployment and underemployment, coupled with ongoing racism and marginalisation, have the potential to make refugees more vulnerable to several mental disorders such as depression, hopelessness, and suicidal thoughts. The analysis also reveals that resettlement challenges may limit refugees’ ability to recover from pre-migration trauma. The impact of resettlement challenges on refugee mental health highlights the need for comprehensive policy interventions to address the barriers refugees face in finding employment in resettlement communities. With African refugees constituting such an important part of Australian society, they should have equal access to meaningful employment, as decent work promotes good mental health, successful resettlement, hope, and self-sufficiency.

Keywords: African refugees, employment, mental health, Australia, underemployment

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Authors: Elvis Munyoka

Abstract:

While the number of African refugees settling in Australia has significantly increased since the mid-1990s, the marginalisation and exclusion of young people from refugee backgrounds in employment remain a critical challenge. Unemployment or underemployment can negatively impact refugees in multiple areas, such as income, housing, life satisfaction, and social status. Higher rates of unemployment among refugees are linked in part to the intersection of pre-migration and daily challenges like trauma, racism, gender identity, and English language competency, all of which generate multiple employability disadvantages. However, the intersection of gender, race, social class, and age in impacting African refugee youth’s access to employment has received less attention. Using a qualitative case study approach, the paper will explore how gender, race, social class, and age influence African refugee youth graduates’ access to employment in South Australia. The intersectionality theory and capability approach to social justice is used to explore intersecting factors impacting African refugee youth’s access to employment in South Australia. Participants were 16 African refugee graduates aged 18-30 living in South Australia who took part in the study for one year. Based on the trends in the data, the results suggest that long-term unemployment and underemployment, coupled with ongoing racism and marginalisation, have the potential to make refugees more vulnerable to several mental disorders such as depression, hopelessness, and suicidal thoughts. The analysis also reveals that resettlement challenges may limit refugees’ ability to recover from pre-migration trauma. The impact of resettlement challenges on refugee mental health highlights the need for comprehensive policy interventions to address the barriers refugees face in finding employment in resettlement communities. With African refugees constituting such an important part of Australian society, they should have equal access to meaningful employment, as decent work promotes good mental health, successful resettlement, hope, and self-sufficiency.

Keywords: African refugee youth, mental health, employment, resettlement, racism

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Authors: Samuel N. Forjuoh, Marcia G. Ory, Jaewoong Won, Samuel D. Towne, Suojin Wang, Chanam Lee

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The public health burden of obesity is well established as is the influence of physical activity (PA) on the health and wellness of individuals who are obese. This study examined the influence of selected demographic, health, and socioenvironmental factors on the walking behaviors of middle-aged and older overweight and obese adults. Online and paper surveys were administered to community-dwelling overweight and obese adults aged ≥ 50 years residing in four cities in central Texas and seen by a family physician in the primary care clinic from October 2013 to June 2014. Descriptive statistics were used to characterize participants’ anthropometric and demographic data as well as their health conditions and walking, socioenvironmental, and more broadly defined PA behaviors. Then Pearson chi-square tests were used to assess differences between participants who reported walking the recommended ≥ 150 minutes for any purpose in a typical week as a proxy to meeting the U.S. Centers for Disease Control and Prevention’s PA guidelines and those who did not. Finally, logistic regression was used to predict walking the recommended ≥ 150 minutes for any purpose, controlling for covariates. The analysis was conducted in 2016. Of the total sample (n=253, survey response rate of 6.8%), the majority were non-Hispanic white (81.7%), married (74.5%), male (53.5%), and reported an annual household income of ≥ $50,000 (65.7%). Approximately, half were employed (49.6%), or had at least a college degree (51.8%). Slightly more than 1 in 5 (n=57, 22.5%) reported walking the recommended ≥150 minutes for any purpose in a typical week. The strongest predictors of walking the recommended ≥ 150 minutes for any purpose in a typical week in adjusted analysis were related to education and a high favorable perception of the neighborhood environment. Compared to those with a high school diploma or some college, participants with at least a college degree were five times as likely to walk the recommended ≥ 150 minutes for any purpose (OR=5.55, 95% CI=1.79-17.25). Walking the recommended ≥ 150 minutes for any purpose was significantly associated with participants who disagreed that there were many distracted drivers (e.g., on the cell phone while driving) in their neighborhood (OR=4.08, 95% CI=1.47-11.36) and those who agreed that there are sidewalks or protected walkways (e.g., walking trails) in their neighborhood (OR=3.55, 95% CI=1.10-11.49). Those employed were less likely to walk the recommended ≥ 150 minutes for any purpose compared to those unemployed (OR=0.31, 95% CI=0.11-0.85) as were those who reported some difficulty walking for a quarter of a mile (OR=0.19, 95% CI=0.05-0.77). Other socio-environmental factors such as having care-giver responsibilities for elders, someone to walk with, or a dog in the household as well as Walk Score™ were not significantly associated with walking the recommended ≥ 150 minutes for any purpose in a typical week. Neighborhood perception appears to be an important factor associated with the walking behaviors of middle-aged and older overweight and obese individuals. Enhancing the neighborhood environment (e.g., providing walking trails) may promote walking among these individuals.

Keywords: determinants of walking, obesity, older adults, physical activity

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Authors: Brid Dinnee, Jessica Taylor, Joseph Hartland, Michael Natarajan

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Background:The third stage of labour (TSL) can be complicated by Post-Partum Haemorrhage (PPH), which can have a significant impact on maternal mortality and morbidity. In Africa, 33.9% of maternal deaths are attributable to PPH1. In order to minimise this figure, current recommendations for the developing world are that all women have active management of the third stage of labour (AMTSL). The aim of this project was to examine TSL practice in a rural Ugandan Hospital, highlight any deviation from best practice and identify barriers to change in resource limited settings as part of a 4th year medical student External Student Selected Component field trip. Method: Five key elements from the current World Health Organisation (WHO) guidelines on AMTSL were used to develop an audit tool. All daytime vaginal deliveries over a two week period in July 2016 were audited. In addition to this, a retrospective comparison of PPH rates, between 2006 (when ubiquitous use of intramuscular oxytocin for management of TSL was introduced) and 2015 was performed. Results: Eight vaginal deliveries were observed; at all of which intramuscular oxytocin was administered and controlled cord traction used. Against WHO recommendation, all umbilical cords were clamped within one minute, and no infants received early skin-to-skin contact. In only one case was uterine massage performed after placental delivery. A retrospective comparison of data rates identified a 40% reduction in total number of PPHs from November 2006 to November 2015. Maternal deaths per delivery reduced from 2% to 0.5%. Discussion: Maternal mortality and PPH are still major issues in developing countries. Maternal mortality due to PPH can be reduced by good practices regarding TSL, but not all of these are used in low-resource settings. There is a notable difference in outcomes between the developed and developing world. At Kitovu Hospital, there has been a reduction in maternal mortality and number of PPHs following introduction of IM Oxytocin administration. In order to further improve these rates, staff education and further government funding is key.

Keywords: post-partum haemorrhage, PPH, third stage labour, Uganda

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Authors: Hani Malik

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Background: Clinician burnout is a growing phenomenon in current health systems worldwide. Increasing emotional exhaustion, depersonalisation, and reduced personal accomplishment threaten the effective delivery of healthcare. This can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in clinicians. Objectives: To conduct a scoping review and identify high-quality studies on mindfulness practice in clinician burnout, synthesize themes that emerge from these studies, and discuss the implications of the results to healthcare leadership and innovation. Methodology: A focused scoping review was carried out to investigate the effects of mindfulness practice on clinician burnout. High-ranking journals were targeted to analyse high-quality studies and synthesize common themes in the literature. Studies conducted on current, practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Grey literature and studies conducted only on allied health personnel were excluded from this review. Analysis:31 studies were included in this scoping review. Mindfulness practice was found to decrease emotional exhaustion and depersonalisation while improving mood, responses to stress, and vigour. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged which include: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to clinician mindfulness practice. Conclusion: Mindfulness had widely been reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate clinician leader will play a crucial role in addressing gaps in current practice, prioritise staff mental health, and provide a supportive platform for innovation.

Keywords: mindfulness practice, clinician burnout, healthcare leadership, COVID-19

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Authors: Dalicia Bouallouche, Jean-Baptiste Vioix, Stéphane Millot, Eric Busvelle

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When researchers or logistics software developers deal with vehicle routing optimization, they mainly focus on minimizing the total travelled distance or the total time spent in the tours by the trucks, and maximizing the number of visited customers. They assume that the upstream real data given to carry the optimization of a transporter tours is free from errors, like customers’ real constraints, customers’ addresses and their GPS-coordinates. However, in real transporter situations, upstream data is often of bad quality because of address geocoding errors and the irrelevance of received addresses from the EDI (Electronic Data Interchange). In fact, geocoders are not exempt from errors and could give impertinent GPS-coordinates. Also, even with a good geocoding, an inaccurate address can lead to a bad geocoding. For instance, when the geocoder has trouble with geocoding an address, it returns those of the center of the city. As well, an obvious geocoding issue is that the mappings used by the geocoders are not regularly updated. Thus, new buildings could not exist on maps until the next update. Even so, trying to optimize tours with impertinent customers GPS-coordinates, which are the most important and basic input data to take into account for solving a vehicle routing problem, is not really useful and will lead to a bad and incoherent solution tours because the locations of the customers used for the optimization are very different from their real positions. Our work is supported by a logistics software editor Tedies and a transport company Upsilon. We work with Upsilon's truck routes data to carry our experiments. In fact, these trucks are equipped with TOMTOM GPSs that continuously save their tours data (positions, speeds, tachograph-information, etc.). We, then, retrieve these data to extract the real truck routes to work with. The aim of this work is to use the experience of the driver and the feedback of the real truck tours to validate GPS-coordinates of well geocoded addresses, and bring a correction to the badly geocoded addresses. Thereby, when a vehicle makes its tour, for each visited customer, the vehicle might have trouble with finding this customer’s address at most once. In other words, the vehicle would be wrong at most once for each customer’s address. Our method significantly improves the quality of the geocoding. Hence, we achieve to automatically correct an average of 70% of GPS-coordinates of a tour addresses. The rest of the GPS-coordinates are corrected in a manual way by giving the user indications to help him to correct them. This study shows the importance of taking into account the feedback of the trucks to gradually correct address geocoding errors. Indeed, the accuracy of customer’s address and its GPS-coordinates play a major role in tours optimization. Unfortunately, address writing errors are very frequent. This feedback is naturally and usually taken into account by transporters (by asking drivers, calling customers…), to learn about their tours and bring corrections to the upcoming tours. Hence, we develop a method to do a big part of that automatically.

Keywords: driver experience feedback, geocoding correction, real truck tours

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Authors: Xiaoshuang Jia, Huiling Feng, Li Niu, Wei Hai

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Led by Humanistic Beijing Studies Center in Renmin University of China, My Peking Memory Project(MPMP) is a long-time digital memory project under guarantee of public participation to enable the cultural and intellectual memory of Beijing to be collected, organized, preserved and promoted for discovery and research. Taking digital memory as a new way, MPMP is an important part of Peking Memory Project(PMP) which is aimed at using digital technologies to protect and (re)present the cultural heritage in Beijing. The key outcome of MPMP is the co-building of a total digital collection of knowledge assets about Beijing. Institutional memories are central to Beijing’s collection and consist of the official published documentary content of Beijing. These have already fall under the archival collection purview. The advances in information and communication technology and the knowledge form social memory theory have allowed us to collect more comprehensively beyond institutional collections. It is now possible to engage citizens on a large scale to collect private memories through crowdsourcing in digital formats. Private memories go beyond official published content to include personal narratives, some of which are just in people’s minds until they are captured by MPMP. One aim of MPMP is to engage individuals, communities, groups or institutions who have formed memories and content about Beijing, and would like to contribute them. The project hopes to build a culture of remembering and it believes ‘Every Memory Matters’. Digital memory contribution was achieved through the development of the MPMP. In reducing barriers to digital contribution and promoting high public Participation, MPMP has taken explored the harvesting of transcribe service for digital ingestion, mobile platform and some off-line activities like holding social forum. MPMP has also cooperated with the ‘Implementation Plan of Support Plan for Growth of Talents in Renmin University of China’ to get manpower and intellectual support. After six months of operation, now MPMP have more than 2000 memories added and 7 Special Memory Collections now online. The work of MPMP has ultimately helped to highlight the important role in safeguarding the documentary heritage and intellectual memory of Beijing.

Keywords: digital memory, public participation, MPMP, cultural heritage, collection

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Authors: Raymond Chi Fai Si Tou, Jacey Ja Young Choe, Amy Siu Ian So

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Smart hotels can be defined as the hotel which has an intelligent system, through digitalization and networking which achieve hotel management and service information. In addition, smart hotels include high-end designs that integrate information and communication technology with hotel management fulfilling the guests’ needs and improving the quality, efficiency and satisfaction of hotel management. The purpose of this study is to identify appropriate factors that may influence guests’ satisfaction and intention to revisit Smart Hotels based on service quality measurement of lodging quality index and extended UTAUT theory. Unified Theory of Acceptance and Use of Technology (UTAUT) is adopted as a framework to explain technology acceptance and use. Since smart hotels are technology-based infrastructure hotels, UTATU theory could be as the theoretical background to examine the guests’ acceptance and use after staying in smart hotels. The UTAUT identifies four key drivers of the adoption of information systems: performance expectancy, effort expectancy, social influence, and facilitating conditions. The extended UTAUT modifies the definitions of the seven constructs for consideration; the four previously cited constructs of the UTAUT model together with three new additional constructs, which including hedonic motivation, price value and habit. Thus, the seven constructs from the extended UTAUT theory could be adopted to understand their intention to revisit smart hotels. The service quality model will also be adopted and integrated into the framework to understand the guests’ intention of smart hotels. There are rare studies to examine the service quality on guests’ satisfaction and intention to revisit in smart hotels. In this study, Lodging Quality Index (LQI) will be adopted to measure the service quality in smart hotels. Using integrated UTAUT theory and service quality model because technological applications and services require using more than one model to understand the complicated situation for customers’ acceptance of new technology. Moreover, an integrated model could provide more perspective insights to explain the relationships of the constructs that could not be obtained from only one model. For this research, ten in-depth interviews are planned to recruit this study. In order to confirm the applicability of the proposed framework and gain an overview of the guest experience of smart hotels from the hospitality industry, in-depth interviews with the hotel guests and industry practitioners will be accomplished. In terms of the theoretical contribution, it predicts that the integrated models from the UTAUT theory and the service quality will provide new insights to understand factors that influence the guests’ satisfaction and intention to revisit smart hotels. After this study identifies influential factors, smart hotel practitioners could understand which factors may significantly influence smart hotel guests’ satisfaction and intention to revisit. In addition, smart hotel practitioners could also provide outstanding guests experience by improving their service quality based on the identified dimensions from the service quality measurement. Thus, it will be beneficial to the sustainability of the smart hotels business.

Keywords: intention to revisit, guest satisfaction, qualitative interviews, smart hotels

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Authors: Md. Ashikur Rahman

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Optimal breastfeeding practice is essential to reducing childhood morbidity and mortality and helps to achieve Millennium Development Goal (MDG). A cross-sectional study was conducted in a rural area in Dhaka district to explore the barrier to optimal breastfeeding practices. The population of this study constitutes all nursing mothers having children aged 0-6 months, and they were selected purposively. The study adopted a structured and in-depth interview procedure consisting of open and closed-ended questions. Four hundred rural nursing mothers constituted the sample of the structured interview, while 15 were involved in the in-depth interview. Among the respondent's majority (67%) were in the age group 17-25 years, with a mean age of 24.44 years. Most (39.5%) of the mothers were housewives with a secondary level of education (46.5%). About 32% of mothers started breastfeeding within one hour after birth. But delayed initiation was reported in 31.5% of mothers, whereas 36.8% of mothers forgot the exact time of initiation of breastfeeding. The main reason not to practice colostrum was mothers tried to breastfeed, but there was no milk, stated 13.8% of mothers. In addition, about one-third (34.3%) of the respondents practiced pre-lacteal feeding, and among them, 12.8% introduced sugar with water. Reasons given by the mothers for bottle-feeding was that baby was not satisfied with breast milk only; 22.0% of mothers indicated this cause. The main influence to take formula milk by their mother and mothers-in-law was stated by 18.8% of mothers. Some mothers stated that major constraints to EBF were the perception of not having enough milk (25.5 %) and babies crying seems to be hungry (8.8%). One-third of the mothers (31.5%) felt uncomfortable during breastfeeding. Access to antenatal and postnatal counseling in the study area also was a key obstacle to optimal breastfeeding practices. In a qualitative survey, some mothers believed that there was no difference between breast milk and formula milk. Colostrum feeding, pre-lacteal feeding, early initiation of breastfeeding, and exclusive breastfeeding were strongly associated with family type, family member, birth order, religion, husbands' occupation, delivery attendants and delivery type, postnatal care, and health care facilities. To reduce the barriers to the successful practice of exclusive breastfeeding, there is a need for a grass-roots approach to educating and counseling nursing mothers with identifying factors influencing or discouraging the optimal practice.

Keywords: exclusive, breast feeding, practices, Bangladesh

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Authors: Carlos Tapia Cortez, Serkan Saydam, Jeff Coulton, Claude Sammut

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Strategic mineral commodities (SMC) both energetic and metals have long been fundamental for human beings. There is a strong and long-run relation between the mineral resources industry and society's evolution, with the provision of primary raw materials, becoming one of the most significant drivers of economic growth. Due to mineral resources’ relevance for the entire economy and society, an understanding of the SMC market behaviour to simulate price fluctuations has become crucial for governments and firms. For any human activity, SMC price fluctuations are affected by economic, geopolitical, environmental, technological and psychological issues, where cognition has a major role. Cognition is defined as the capacity to store information in memory, processing and decision making for problem-solving or human adaptation. Thus, it has a significant role in those systems that exhibit dynamic equilibrium through time, such as economic growth. Cognition allows not only understanding past behaviours and trends in SCM markets but also supports future expectations of demand/supply levels and prices, although speculations are unavoidable. Technological developments may also be defined as a cognitive system. Since the Industrial Revolution, technological developments have had a significant influence on SMC production costs and prices, likewise allowing co-integration between commodities and market locations. It suggests a close relation between structural breaks, technology and prices evolution. SCM prices forecasting have been commonly addressed by econometrics and Gaussian-probabilistic models. Econometrics models may incorporate the relationship between variables; however, they are statics that leads to an incomplete approach of prices evolution through time. Gaussian-probabilistic models may evolve through time; however, price fluctuations are addressed by the assumption of random behaviour and normal distribution which seems to be far from the real behaviour of both market and prices. Random fluctuation ignores the evolution of market events and the technical and temporal relation between variables, giving the illusion of controlled future events. Normal distribution underestimates price fluctuations by using restricted ranges, curtailing decisions making into a pre-established space. A proper understanding of SMC's price dynamics taking into account the historical-cognitive relation between economic, technological and psychological factors over time is fundamental in attempting to simulate prices. The aim of this paper is to discuss the SMC market cognition hypothesis and empirically demonstrate its dynamic-cognitive capacity. Three of the largest and traded SMC's: oil, copper and gold, will be assessed to examine the economic, technological and psychological cognition respectively.

Keywords: commodity price simulation, commodity price uncertainties, dynamic-cognition, dynamic systems

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Authors: Layla Mujahed

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Amman, the capital of Jordan, is the main political, economic, social and cultural center of Jordan and beyond. The city faces multitude demographic challenges related to the unstable political situation in the surrounded countries. It has regional and local migrants who left their homes to find better life in the capital. This resulted with random and unequaled population distribution. Some districts have high population and pressure on the infrastructure and services more than other districts.Government works to resolve this challenge in compliance with 100 Cities Resilience Framework (CRF). Amman participated in this framework as a member in December 2014 to work in achieving the four goals: health and welfare, infrastructure and utilities, economy and education as well as administration and government.  Previous research studies lack in studying Amman resilient work in neighborhood scale and the population growth as resilient challenge. For that, this study focuses on Al-Thahabiah neighborhood in Shafa Badran district in Amman. This paper studies the reasons and drivers behind this population growth during the selected period in this area then provide strategies to improve the resilient work in neighborhood scale. The methodology comprises of primary and secondary data. The primary data consist of interviews with chief officer in the executive part in Great Amman Municipality and resilient officer. The secondary data consist of papers, journals, newspaper, articles and book’s reading. The other part of data consists of maps and statistical data which describe the infrastructural and social situation in the neighborhood and district level during the studying period. Based upon those data, more detailed information will be found, e.g., the centralizing position of population and the provided infrastructure for them. This will help to provide these services and infrastructure to other neighborhoods and enhance population distribution. This study develops an analytical framework to assess urban demographical time series in accordance with the criteria of CRF to make accurate detailed projections on the requirements for the future development in the neighborhood scale and organize the human requirements for affordable quality housing, employment, transportation, health and education in this neighborhood to improve the social relations between its inhabitants and the community. This study highlights on the localization of resilient work in neighborhood scale and spread the resilient knowledge related to the shortage of its research in Jordan. Studying the resilient work from population growth challenge perspective helps improve the facilities provide to the inhabitants and improve their quality of life.

Keywords: city resilience framework, demography, population growth, stakeholders, urban resilience

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Authors: Xuerui Niu, Bolin Wang, Xinchuang Zhang, Xiaohua Ma, Bin Hou, Ling Yang

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The application of discrete GaN-based power switches requires the collaboration of silicon-based peripheral circuit structures. However, the packages and interconnection between the Si and GaN devices can introduce parasitic effects to the circuit, which has great impacts on GaN power transistors. GaN-based monolithic power integration technology is an emerging solution which can improve the stability of circuits and allow the GaN-based devices to achieve more functions. Complementary logic circuits consisting of GaN-based E-mode p-channel heterostructure field-effect transistors (p-HFETs) and E-mode n-channel HEMTs can be served as the gate drivers. E-mode p-HFETs with recessed gate have attracted increasing interest because of the low leakage current and large gate swing. However, they suffer from a poor interface between the gate dielectric and polarized nitride layers. The reliability of p-HFETs is analyzed and discussed in this work. In circuit applications, the inverter is always operated with dynamic gate voltage (VGS) rather than a constant VGS. Therefore, dynamic electrical stress has been simulated to resemble the operation conditions for E-mode p-HFETs. The dynamic electrical stress condition is as follows. VGS is a square waveform switching from -5 V to 0 V, VDS is fixed, and the source grounded. The frequency of the square waveform is 100kHz with the rising/falling time of 100 ns and duty ratio of 50%. The effective stress time is 1000s. A number of stress tests are carried out. The stress was briefly interrupted to measure the linear IDS-VGS, saturation IDS-VGS, As VGS switches from -5 V to 0 V and VDS = 0 V, devices are under negative-bias-instability (NBI) condition. Holes are trapped at the interface of oxide layer and GaN channel layer, which results in the reduction of VTH. The negative shift of VTH is serious at the first 10s and then changes slightly with the following stress time. However, different phenomenon is observed when VDS reduces to -5V. VTH shifts negatively during stress condition, and the variation in VTH increases with time, which is different from that when VDS is 0V. Two mechanisms exists in this condition. On the one hand, the electric field in the gate region is influenced by the drain voltage, so that the trapping behavior of holes in the gate region changes. The impact of the gate voltage is weakened. On the other hand, large drain voltage can induce the hot holes generation and lead to serious hot carrier stress (HCS) degradation with time. The poor-quality interface between the oxide layer and GaN channel layer at the gate region makes a major contribution to the high-density interface traps, which will greatly influence the reliability of devices. These results emphasize that the improved etching and pretreatment processes needs to be developed so that high-performance GaN complementary logics with enhanced stability can be achieved.

Keywords: GaN-based E-mode p-HFETs, dynamic electric stress, threshold voltage, monolithic power integration technology

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Authors: Rhea Khosla, Victoria Tzortziou-Brown

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Introduction: Adolescent SRH has been neglected since the start of the millennium. Adolescents comprise 16% of the global population, with the largest proportion living in Asia (650 million). By late adolescence, individuals in these regions are likely to become sexually active, and thus they must understand their SRH rights. Many lack knowledge of SRH, using unreliable sources for such information. Sex education is necessary to standardize and inform sexual knowledge, which empowers adolescents to make informed SRH decisions. School is an appropriate environment for this, however, SRH education requires effective policy to enforce. Nonetheless, this issue remains of low political priority in Asia and Africa. Current literature on sex education policy in schools in these regions is scarce and tends to have broad aims. Thus, a scoping review was necessary. Methods: Literature searches were conducted in February 2023 using six databases, including grey literature databases (PubMed, Scopus, Embase, Web of Science, Google Scholar, Global Index Medicus), returning a total of 1537 unique articles. After screening titles, abstracts and full text, 17 articles remained. References of included articles were additionally searched, producing a further 7 articles, which then underwent thematic analysis Results: Most countries in Africa and Asia did not have studies on this topic. Studies derived data from interviews with key stakeholders and quantitative methods quantified questionnaire responses. Barriers were: policy/curriculum issues, societal opinions, teaching discomfort, and lack of educator training. Limitations were insufficient timing, inconsistent implementation, insufficient hours dedicated to teaching, education received late into schooling, and discrepancies between teachers, schools, and students about whether policies were being implemented. Discussion: Based on the existing limited evidence, a cultural shift to reduce stigma seems necessary, alongside teacher and student involvement in policy formulation with effective implementation monitoring and educator training.

Keywords: adolescent, Africa, Asia, education, sexual and reproductive health, policy

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Authors: Gulnaz Erkomaishvili

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

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

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Authors: Cesar Julio Recalde

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Background: The role of intangible assets in today´s society is undeniable and continuously growing. More than 80% of corporate market is related to intellectual capital(IC). However, corporate governance principles and practices seem strongly based and oriented towards tangible assets. The impact of intangible assets on corporate governance might require prevention and adaptative actions. Adherence to voluntary mechanisms of intellectual capital reporting (ICR) seems to be a gateway towards adapting corporate governance to intangible assets influence and a conceptual cornerstone. The impact of adherence to intellectual capital reporting on corporate governance and performance needs to be evaluated. Purposes: This work has a sequential two folded purpose: (1) exploring the influences exerted by IC on corporate governance theory and practice, and within that context (2) analyzing the impact of adherence to voluntary mechanisms of ICR on corporate governance. Design and summary: This work employs the theory of the firm and agency theory in order to conceptually explore the effects of each dimension of IC on key corporate governance issues, namely property rights and control by shareholders and residual claims by stakeholders, fiduciary duties of management and the board, opportunistic behavior and transparency. A comprehensive IC taxonomy and map is presented. Within the resulting context, internal and external impact of ICR on corporate governance and performance is conceptually analyzed. IRC constraint and barriers are identified. Intellectual liabilities are presented within the context of IRC. Finally, IRC regulatory framework is surveyed. Findings: Relevant conclusions were rendered on the influence of intellectual capital on corporate governance. Sufficient evidence of a positive impact of IRC on corporate governance and performance was found. Additionally, it was found that IRC exerts a leveraging effect on IC itself. Intellectual liabilities are insufficiently researched and seem to have a relevant importance on IC measuring. IRC regulatory framework was found to be insufficiently developed to capture the essence of intangible assets and to meet corporate governance challenges facing IC. Originality: This work develops a progressive approach to conceptually analyze the mutual influences between IC and corporate governance. An epistemic ideogram represents the intersection of analyzed theories. An IC map is presented. The relatively new topic of intellectual liabilities is conceptually analyzed in the context of IRC. Social liabilities and client liabilities are presented.

Keywords: corporate governance, intellectual capital, intellectual capital reporting, intellectual assets, intellectual liabilities, voluntary mechanisms, regulatory framework

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Authors: Poonam Goswami

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Background: The diagnosis of a serious illness like cancer can have an impact on a patient’s emotional well-being and may result in psychological symptoms, anxiety, depression, and loss of control. Advance care planning discussions ensure patients’ values and goals of care, including patients’ freedom to choose their place of death, are respected. Unfortunately, these discussions are often delayed and are not initiated early in patients’ cancer trajectory. As a result, patients’ wishes often remains unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which does lead to higher resource utilization, decreased quality of life, and increased cost. Additionally, the novel coronavirus disease 2019 (COVID-19) pandemic challenged the health care systems worldwide and raised important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. The importance of goal concordant care is now even substantially important and is heightened in the context of this pandemic. Problem: Although there is growing evidence on the effects of the ACP on the completion of advanced directives, improved patient and family concordance for preferences for medical care, and receipt of care, there is still a lack of standardized ACP conversation strategies for patients with cancer. Methods: The Key concepts of ACP include (1) assessing patient and family readiness, (2) identifying a surrogate decision maker ( medical power of attorney), (3) exploring patient and family understanding of the disease and treatment options,(4) discussing the values and goals of care, and options for end-of-life care, (5) documenting patient preferences in the medical record, and (6) revisiting the discussions at every change in the treatment plan and /or change in clinical status, including at every hospitalization. Conclusion/Implication for practice: Advance Care Planning (ACP) and end-of-life (EOL) discussions are important for patients, families, and health care providers. Adopting the verbal and nonverbal communication strategies can help overcome the barriers to effective communication on these difficult discussions. ACP with goals of care discussions should not be delayed until the patient is hospitalized.

Keywords: advance care planning, end of life, cancer, global, pandemic

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Authors: Abiola Falilat Ibraheem, Akinyimika Sowunmi, Valerie Otti

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Background: Introduction of innovative cancer clinical trials to Nigeria is a critical step in addressing global inequities of cancer burden. Low health and clinical trial literacy among Nigerian patients have been sighted as a significant barrier to ensuring that patients enrolled in clinical trials are truly informed. Video intervention has been shown to be the most proactive method to improving patient’s clinical trial knowledge. In the US, video interventions have been successful at improving education about cancer clinical trials among minority patients. Thus, this study aimed to apply and adapt video interventions addressing attitudinal barriers peculiar to Nigerian patients. Methods: A hospital-based representative mixed-method study was conducted at the Lagos State University Teaching Hospital (LASUTH) from July to December 2020, comprising of cancer patients aged 18 and above. Patients were randomly selected during every clinic day, of which 63 patients volunteered to participate in this study. We first administered a cancer literacy survey to determine patients’ knowledge about clinical trials. For patients who had prior knowledge, a pre-intervention test was administered, after which a 15-minute video (attitudes and intention to enroll in therapeutic clinical trials (AIET)) to improve patients’ knowledge, perception, and attitudes towards clinical trials was played, and then ended by administering a post-intervention test to the patients. For patients who had no prior knowledge, the AIET video was played for them, followed by the post-intervention test. Results: Out of 63 patients sampled, 43 (68.3%) had breast cancer. On average, patients agreed to understand their cancer diagnosis and treatment very well. 84.1% of patients had never heard about cancer clinical trials, and 85.7% did not know what cancer clinical trials were. There was a strong positive relationship (r=0.916) between the pretest and posttest, which means that the intervention improved patients’ knowledge, perception, and attitudes about cancer clinical trials. In the focus groups, patients recommended adapting the video in Nigerian settings and representing all religions in order to address trust in local clinical trialists. Conclusion: Due to the small size of patients, change in clinical trial knowledge was not statistically significant. However, there is a trend suggesting that culturally adapted video interventions can be used to improve knowledge and perception about cancer clinical trials.

Keywords: clinical trials, culturally targeted intervention, patient education, video intervention

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Authors: Konstantinos Kottikas, Vlasis Stathakopoulos, Ioannis G. Theodorakis, Efthymia Kottika

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Theorists have argued that Market Orientation is comprised of two facets, namely the Market Driven and the Market Driving components. The present theoretical paper centers on the latter, which to date has been notably under-investigated. The term Market Driving (MD) pertains to influencing the structure of the market, or the behavior of market players in a direction that enhances the competitive edge of the firm. Presently, the main objectives of the paper are the specification of key antecedents and outcomes of Market Driving behavior. Market Driving firms behave proactively, by leading their customers and changing the rules of the game rather than by responding passively to them. Leading scholars were the first to conceptually conceive the notion, followed by some qualitative studies and a limited number of quantitative publications. However, recently, academicians noted that research on the topic remains limited, expressing a strong necessity for further insights. Concerning the key antecedents, top management’s Transformational Leadership (i.e. the form of leadership which influences organizational members by aligning their values, goals and aspirations to facilitate value-consistent behaviors) is one of the key drivers of MD behavior. Moreover, scholars have linked the MD concept with Entrepreneurship. Finally, the role that Employee’s Creativity plays in the development of MD behavior has been theoretically exemplified by a stream of literature. With respect to the key outcomes, it has been demonstrated that MD Behavior positively triggers firm Performance, while theorists argue that it empowers the Competitive Advantage of the firm. Likewise, researchers explicate that MD Behavior produces Radical Innovation. In order to test the robustness of the proposed theoretical framework, a combination of qualitative and quantitative methods is proposed. In particular, the conduction of in-depth interviews with distinguished executives and academicians, accompanied with a large scale quantitative survey will be employed, in order to triangulate the empirical findings. Given that it triggers overall firm’s success, the MD concept is of high importance to managers. Managers can become aware that passively reacting to market conditions is no longer sufficient. On the contrary, behaving proactively, leading the market, and shaping its status quo are new innovative approaches that lead to a paramount competitive posture and Innovation outcomes. This study also exemplifies that managers can foster MD Behavior through Transformational Leadership, Entrepreneurship and recruitment of Creative Employees. To date, the majority of the publications on Market Orientation is unilaterally directed towards the responsive (i.e. the Market Driven) component. The present paper further builds on scholars’ exhortations, and investigates the Market Driving facet, ultimately aspiring to conceptually integrate the somehow fragmented scientific findings, in a holistic framework.

Keywords: entrepreneurial orientation, market driving behavior, market orientation

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Authors: O. A. Adeyemi, M. O. Idris, W. A. Oke, O. T. Olorode, S. O. Alayande, A. E. Adeoye

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The purpose of this paper is to investigate the process of capability building at subsidiary level and the challenges to such process. The relevance of external factors for capability development, have not been explicitly addressed in empirical studies. Though, internal factors, acting as enablers, have been more extensively studied. With reference to external factors, subsidiaries are actively influenced by specific characteristics of the host country, implying a need to become fully immersed in local culture and practices. Specifically, in MNCs, there has been a widespread trend in management practice to increase subsidiary autonomy,  with subsidiary managers being encouraged to act entrepreneurially, and to take advantage of host country specificity. As such, it could be proposed that: P1: The degree at which subsidiary management is connected to the host country, will positively influence the capability development process. Dynamic capabilities reside to a large measure with the subsidiary management team, but are impacted by the organizational processes, systems and structures that the MNC headquarter has designed to manage its business. At the subsidiary level, the weight of the subsidiary in the network, its initiative-taking and its profile building increase the supportive attention of the HQs and are relevant to the success of the process of capability building. Therefore, our second proposition is that: P2: Subsidiary role and HQ support are relevant elements in capability development at the subsidiary level. Design/Methodology/Approach: This present study will adopt the multiple case studies approach. That is because a case study research is relevant when addressing issues without known empirical evidences or with little developed prior theory. The key definitions and literature sources directly connected with operations of western subsidiaries in emerging markets, such as China, are well established. A qualitative approach, i.e., case studies of three western subsidiaries, will be adopted. The companies have similar products, they have operations in China, and both of them are mature in their internationalization process. Interviews with key informants, annual reports, press releases, media materials, presentation material to customers and stakeholders, and other company documents will be used as data sources. Findings: Western Subsidiaries in Emerging Market operate in a way substantially different from those in the West. What are the conditions initiating the outsourcing of operations? The paper will discuss and present two relevant propositions guiding that process. Practical Implications: MNCs headquarter should be aware of the potential for capability development at the subsidiary level. This increased awareness could induce consideration in headquarter about the possible ways of encouraging such known capability development and how to leverage these capabilities for better MNC headquarter and/or subsidiary performance. Originality/Value: The paper is expected to contribute on the theme: drivers of subsidiary performance with focus on emerging market. In particular, it will show how some external conditions could promote a capability-building process within subsidiaries.

Keywords: case studies, dynamic capability, emerging market, subsidiary

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Authors: R. A. C. H. Seneviratne, M. Gunawardana, R. P. N. P. Rajapakse

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To address the micronutrient deficiencies in the Asian region, the World Food Program in its current mandate highlights the requirement of employing efficient fortification of micronutrients in rice, under the program 'Scaling-up Rice Fortification in Asia'. The current industrial methods of rice fortification with micronutrients are not promising due to poor permeation or retention of fortificants. This study was carried out to develop a method to improve fortification of micronutrients in rice by removing the air barriers for diffusing micronutrients through the husk. For the purpose, soaking stage of paddy was coupled with vacuum (- 0.6 bar) for different time periods. Both long and short grain varieties of paddy (BG 352 and BG 358, respectively) initially tested for water uptake during hot soaking (70 °C) under vacuum (28.5 and 26.15%, respectively) were significantly (P < 0.05) higher than that of non-vacuum conditions (25.24 and 25.45% respectively), exhibiting the effectiveness of water diffusion into the rice grains through the cleared pores under negative pressure. To fortify the selected micronutrients (iron and zinc), paddy was vacuum-soaked in Fe2+ or Zn2+ solutions (500 ppm) separately for one hour, and continued soaking for another 3.5 h without vacuum. Significantly (P<0.05) higher amounts of Fe2+ and Zn2+ were observed throughout the soaking period, in both short and long grain varieties of rice compared to rice treated without vacuum. To achieve the recommended limits of World Food Program standards for fortified iron (40-48 mg/kg) and zinc (60-72 mg/kg) in rice, soaking was done with different concentrations of Fe2+ or Zn2+ for varying time periods. For both iron and zinc fortifications, hot soaking (70 °C) in 400 ppm solutions under vacuum (- 0.6 bar) during the first hour followed by 2.5 h under atmospheric pressure exhibited the optimum fortification (Fe2+: 46.59±0.37 ppm and Zn2+: 67.24±1.36 ppm) with a greater significance (P < 0.05) compared to the controls (Fe2+: 38.84±0.62 ppm and Zn2+: 52.55±0.55 ppm). This finding was further confirmed by the XRF images, clearly showing a greater fixation of Fe2+ and Zn2+ in the rice grains under vacuum treatment. Moreover, there were no significant (P>0.05) differences among both Fe2+ and Zn2+ contents in fortified rice even after polishing and washing, confirming their greater retention. A seven point hedonic scale showed that the overall acceptability for both iron and zinc fortified rice were significantly (P < 0.05) higher than the parboiled rice without fortificants. With all the drawbacks eliminated, per kilogram cost will be less than US$ 1 for both iron and zinc fortified rice. The new method of rice fortification studied and developed in this research, can be claimed as the best method in comparison to other rice fortification methods currently deployed.

Keywords: fortification, vacuum assisted diffusion, micronutrients, parboiling

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