Search results for: healthcare policy instruments

Authors: Emma Worley, Mhairi De Sainte Croix, Savneet Lochab, Christopher Roberts, Mark Stroud, Mo Salehan, Kevin Jones

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Awareness about the importance of teaching about diversity at medical school is growing. In the realm of diversity includes discussion around the LGBTQ+ community. At Bristol, diversity is taught in first or second year. However, echoing and expanding that teaching throughout the curriculum is needed. This feeds into the spiral curriculum but also highlights the relevance of the topic. It is well known that some people in the LGBTQ+ community struggle the access healthcare due to previous negative experiences. In 2019, 1 in 7 LGBTQ+ people avoided seeking medical care due to fears about discrimination. If people have fears about seeking medical help, then seeking help from Palliative care when they are at their most vulnerable situation can be even harder. To improve positive healthcare situations for people who identify as LGBTQ+ needs to start with talking. Along with some of our CTAs (clinical teaching assistants) we created a teaching session to explore the barriers faced by LGBTQ+ and incorporated communication stations into this. Our plan is to run this session as a three-hour session first discussing different topics: ethnical diversity, ‘coming out’, LGBTQ+ in the older generation, transgender. This will be followed by looking more closely at the barriers to accessing the hospice. The next part of the session will encompass two or three communication scenarios hopefully prompting further discussion and reflection on ways to improve our communication. The first scenario outline is a gay man/lesbian woman with lung cancer discussing options around the hospice. The second scenario is a transgender person with female genitalia who now has cervical cancer (as was not followed up on pap smears after the change of name). The third scenario is a HIV homosexual male patient who has been admitted with dementia. He has a partner but is not married. His next of kin is down as his parents but his parents do not know about his sexuality and HIV status. It allows discussion around confidentiality as well as broaching the meaning of ‘family’ in the LGBTQ+ community. We have chosen to pitch this teaching session to Bristol Year 4 students. They will be currently doing their 6-week Palliative care block, which fits in well. Each session will have four students attend. We have been lucky enough to have two CTAs (clinical teaching assistants) who identify as LGBTQ+ offer their experiences and help. They have been able to help us with the preparation and delivery of the session. Given anecdotal evidence and stories helps to highlight the importance and relevance of this session. The aim is to increase awareness of some factors that may contribute to people who identify as LGBTQ+ having a negative healthcare experience. By starting to talk about it allows awareness and only then will we be able to start to change and improve. Our aim, if the sessions run well, is to expand these sessions to different academy hospitals. Therefore, all Bristol 4th year students would have the opportunity to take part in the teaching session. We would like to expand our portfolio of case scenarios, to address so tricker topics such as a transgender person with dementia who reverts back to a different gender. We would also like to recruit a diverse range of actors, ideally people who identify as the patient in the scenario does. For example, a transgender person acts the transgender scenario. This would give authenticity and enhance the student’s learning experience.

Keywords: communication skills, healthcare barriers, LGBTQ+, palliative care

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Authors: Gikunda Aloise, Mjema Saida, Barasa Herbert, Wanyungu John, Kimani Maureen

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Background: Community Health Workforce (CHW) is health care providers at the community level (Level 1) and serves as a bridge between the community and the formal healthcare system. This human resource has enormous potential to extend healthcare services and ensures that the vulnerable, marginalized, and hard-to-reach populations have access to quality healthcare services at the community and primary health facility levels. However, these cadres are neither recognized, remunerated, nor in most instances, registered in a master list. Management and supervision of CHWs is not easy if their individual demographics, training capacity and incentives is not well documented through a centralized registry. Description: In February 2022, Amref supported the Kenya Ministry of Health in developing a community health workforce database called Community Health Workers Master List Registry (CHWML), which is hosted in Kenya Health Information System (KHIS) tracker. CHW registration exercise was through a sensitization meeting conducted by the County Community Health Focal Person for the Sub-County Community Health Focal Person and Community Health Assistants who uploaded information on individual demographics, training undertaken and incentives received by CHVs. Care was taken to ensure compliance with Kenyan laws on the availability and use of personal data as prescribed by the Data Protection Act, 2019 (DPA). Results and lessons learnt: By June 2022, 80,825 CHWs had been registered in the system; 78,174 (96%) CHVs and 2,636 (4%) CHAs. 25,235 (31%) are male, 55,505 (68%) are female & 85 (1%) are transgender. 39,979. (49%) had secondary education and 2500 (3%) had no formal education. Only 27 641 (34%) received a monthly stipend. 68,436 CHVs (85%) had undergone basic training. However, there is a need to validate the data to align with the current situation in the counties. Conclusions/Next steps: The use of CHWML will unlock opportunities for building more resilient and sustainable health systems and inform financial planning, resource allocation, capacity development, and quality service delivery. The MOH will update the CHWML guidelines in adherence to the data protection act which will inform standard procedures for maintaining, updating the registry and integrate Community Health Workforce registry with the HRH system.

Keywords: community health registry, community health volunteers (CHVs), community health workers masters list (CHWML), data protection act

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Authors: Pieter De Vries, Renate Klaassen, Maria Ioannides

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This paper is about an explorative research into the use of emerging technologies for teaching and learning in higher engineering education. The assumption is that these technologies and applications, which are not yet widely adopted, will help to improve education and as such actively work on the ability to better deal with the mismatch of skills bothering our industries. Technologies such as 3D printing, the Internet of Things, Virtual Reality, and others, are in a dynamic state of development which makes it difficult to grasp the value for education. Also, the instruments in current educational research seem not appropriate to assess the value of such technologies. This explorative research aims to foster an approach to better deal with this new complexity. The need to find out is urgent, because these technologies will be dominantly present in the near future in all aspects of life, including education. The methodology used in this research comprised an inventory of emerging technologies and tools that potentially give way to innovation and are used or about to be used in technical universities. The inventory was based on both a literature review and a review of reports and web resources like blogs and others and included a series of interviews with stakeholders in engineering education and at representative industries. In addition, a number of small experiments were executed with the aim to analyze the requirements for the use of in this case Virtual Reality and the Internet of Things to better understanding the opportunities and limitations in the day-today learning environment. The major findings indicate that it is rather difficult to decide about the value of these technologies for education due to the dynamic state of change and therefor unpredictability and the lack of a coherent policy at the institutions. Most decisions are being made by teachers on an individual basis, who in their micro-environment are not equipped to select, test and ultimately decide about the use of these technologies. Most experiences are being made in the industry knowing that the skills to handle these technologies are in high demand. The industry though is worried about the inclination and the capability of education to help bridge the skills gap related to the emergence of new technologies. Due to the complexity, the diversity, the speed of development and the decay, education is challenged to develop an approach that can make these technologies work in an integrated fashion. For education to fully profit from the opportunities, these technologies offer it is eminent to develop a pro-active strategy and a sustainable approach to frame the emerging technologies development.

Keywords: emerging technologies, internet of things, pro-active strategy, virtual reality

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Authors: Mayuri Roy Choudhury, Deepti Paul

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Many states in the United States are aiming for high renewable energy targets by the year 2045. In order to achieve this goal, they must do transition to Electrical Vehicles (EVS). We first applied the Multi-Level perspective framework to describe the inter-disciplinary complexities associated with the transition to EVs. Thereafter we addressed these complexities by creating an inter-disciplinary policy framework that uses data science algorithms to create evidence-based policies in favor of EVs. Our policy framework uses a systems level approach as it addresses transitions to EVs from a technology, economic, business and social perspective. By Systems-Level we mean approaching a problem from a multi-disciplinary perspective. Our systems-level approach could be a beneficial decision-making tool to a diverse number of stakeholders such as engineers, entrepreneurs, researchers, and policymakers. In addition, it will add value to the literature of electrical vehicles, sustainable energy, energy economics, and management as well as efficient policymaking.

Keywords: transition, electrical vehicles, systems-level, algorithms

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

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Authors: Rafia Afroz

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This article examines the perceptions, consciousness and attitudes of farmers on climate change in Kedah Malaysia. To reach the objectives of this study, a survey was conducted on 350 farmers and the collected data were used to perform multiple regression analysis. The results show that factors such as age, farm income, farm experience, limited agricultural prevalence, inadequacies in credit availability and farm size are factors influencing adjustment practices. Moreover, farmers have a positive attitude through adaptation strategies that are appropriate for climate change issues. However, the study found that various adaptation barriers prevented farmers from implementing climate change adjustment policies. At present, Malaysia does not seem to have a specific policy aimed at counteracting the impacts and productivity of climate change on individual sectors. For this reason, the findings of this study will help policymakers to comply with an appropriate policy framework that takes into account the best fit alignment strategies that can come across all relevant obstacles.

Keywords: climate change, adaptation, awareness, perception, attitude

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Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

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Authors: Ibrahim Isa Ali (Pantami), Abdu Jaafaru Bambale, Abimbola Alale, Danjuma Ibrahim Ndihgihdah, Muhammad Alkali, Adamu Idris Umar, Moshood Kareem, Samson Olufunmilayo Abodunrin, Muhammad Dokko Zubairu

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The National Digital Economy Policy and Strategy, NDEPS document developed by Nigeria’s Federal Ministry of Communications & Digital Economy (FMoCDE) is anchored on 8 pillars for the acceleration of the National Digital Economy for a Digital Nigeria. NIGCOMSAT-1R and the planned HTS communication Satellite are critical assets for supporting the pillars in the drive for sustainable growth and development. This paper discusses on the gains and contribution of the strategy as a solid infrastructure. The paper also highlights these assets’ contribution as platform for Indigenous Content Development & Adoption, Digital Literacy & Skills, and Digital Services Development & Promotion.

Keywords: FMoCDE, HTS, NDEPS, nigcomsat!R, pillars

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Authors: Marian Lissett Olaya

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This article examined the factors associated with incorporating peer assessment into English language classes in a public university in Colombia. This is done in the context of writing English class for 4th-semester students. The research instruments consisted of peer assessment questionnaires, student diaries, and interviews. Findings showed that among the factors, motivation, frustration, anxiety, and lack of confidence appeared. Data revealed that peer assessment enables students to write competencies through training, teachers' guidance, and the provision of a collaborative environment.

Keywords: writing skills, peer assessment, formative assessment, language acquisition

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Authors: Simone Rondelli, Damiano Rondelli, Bishesh Poudyal, Juan Jose Cabrera-Lazarini

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One of the main obstacles for Social Entrepreneurship is to find a business model that is financially sustainable. In other words, the captured value generates enough cash flow to ensure business continuity and reinvestment for growth. Providing Health Services in poor countries for the uninsured population affected by a high-cost chronical disease is not the exception for this challenge. As a prime example, cancer has become a high impact on a global disease not only because of the high morbidity but also of the financial impact on both the patient family and health services in underdeveloped countries. Therefore, it is relevant to find a Social Entrepreneurship Model that provides affordable treatment for this disease while maintaining healthy finances not only for the patient but also for the organization providing the treatment. Using the methodology of Constructive Research, this paper applied a Positive Theory and four business models of Social Entrepreneurship to a case of a Private Foundation model whose mission is to address the challenge previously described. It was found that the Foundation analyzed, in this case, is organized as an Embedded Business Model and complies with the four propositions of the Positive Theory considered. It is recommended for this Private Foundation to explore implementing the Integrated Business Model to ensure more robust sustainability in the long term. It evolves as a scalable model that can attract investors interested in contributing to expanding this initiative globally.

Keywords: affordable treatment, global healthcare, social entrepreneurship theory, sustainable business model

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Authors: Nabil A. Albaser

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Background: There is a serious problem with adverse drug reactions (ADRs) everywhere, including Yemen. Since it helps with the detection, assessment, reporting and prevention of ADRs, pharmacovigilance (PV) is an essential part of the healthcare system. The unbiased reporting of ADRs remains the foundation of PV. Students majoring in healthcare should acquire the knowledge and skills necessary to conduct PV in a range of clinical settings. The primary objective of this study was to evaluate the understanding and attitudes of final-year Pharmacy, Nursing, and Midwifery students at Al-Razi University in Sana'a, Yemen, regarding PV and ADRs reporting. Methods: The study followed descriptive cross-sectional approach. A validated, self-administered questionnaire with three parts—demographic information, knowledge, and perceptions of Pharmacovigilance was online distributed to final-year Pharmacy, Nursing, and Midwifery students. The questionnaire was given to 175 students; 122 of them responded with a percentage (69.7%). Results: The majority of respondents were male (79.5%). More than the tow-third of the students, 68.9%, were beyond the age of 23. Although the majority of students, 80%, heard about the terms of ADRs and PV, but only 50% and 57.4% of the respondents, respectively, could define the both terms correctly. However, only 11.48 % of them, nevertheless, took a PV course. More than a half of them (56.6%) had a positive perceptions towards pharmacovigilance and ADR reporting and had a moderate degree of knowledge (68.9%). Conclusion: The study demonstrated that the participants lacked sufficient knowledge of pharmacovigilance and ADR reporting. They showed a moderate level of understanding of reporting ADRs as well as a favorable opinion of dealing with and reporting ADRs. Yemen's health care curriculum should include lessons on pharmacovigilance.

Keywords: adverse drug reaction reporting, pharmacovigilance, yemen, knowlegde

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Authors: Nadeem Qaiser, Sherjeel Munsif Khan, Muhammad Mustafa Hussian, Vincent Tung

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One of the emerging fields in the detection of chronic diseases is based on the point-of-care (POC) early monitoring of the symptoms and thus provides a state-of-the-art personalized healthcare system. Nowadays, wearable and flexible sensors are being used for analyzing sweat, glucose, blood pressure, and other skin conditions. However, localized jaw-bone swelling called parotid-swelling caused by some viruses has never been tracked before. To track physical motion or deformations, strain sensors, especially piezoresistive ones, are widely used. This work, for the first time, reports carbon nanotubes (CNTs)-based piezoresistive sensing patch that is highly flexible and stretchable and can record muscle deformations in real-time. The developed patch offers an excellent gauge factor for in-plane stretching and spatial expansion with low hysteresis. To calibrate the volumetric muscle expansion, we fabricated the pneumatic actuator that experienced volumetric expansion and thus redefined the gauge factor. Moreover, we employ a Bluetooth-low-energy system that can send information about muscle activity in real-time to a smartphone app. We utilized COMSOL calculations to reveal the mechanical robustness of the patch. The experiments showed the sensing patch's greater cyclability, making it a patch for personal healthcare and an excellent choice for monitoring the real-time POC monitoring of the human muscle swelling.

Keywords: piezoresistive strain sensor, FEM simulations, CNTs sensor, flexible

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Authors: Zhuang Yiwen

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The paper examines the challenges facing the Singapore healthcare system related to the tracking and traceability of medical devices. One of the major challenges identified is the lack of a standard coding system for medical devices, which makes it difficult to track them effectively. The paper suggests the use of the Unique Device Identifier (UDI) as a single standard for medical devices to improve tracking and reduce errors. The paper also explores the use of barcoding and image recognition to identify and document medical devices in nursing practices. In nursing practices, the use of barcodes for identifying medical devices is common. However, the information contained in these barcodes is often inconsistent, making it challenging to identify which segment contains the model identifier. Moreover, the use of barcodes may be improved with the use of UDI, but many subsidized accessories may still lack barcodes. The paper suggests that the readiness for UDI and barcode standardization requires standardized information, fields, and logic in electronic medical record (EMR), operating theatre (OT), and billing systems, as well as barcode scanners that can read various formats and selectively parse barcode segments. Nursing workflow and data flow also need to be taken into account. The paper also explores the use of image recognition, specifically the Tesseract OCR engine, to identify and document implants in public hospitals due to limitations in barcode scanning. The study found that the solution requires an implant information database and checking output against the database. The solution also requires customization of the algorithm, cropping out objects affecting text recognition, and applying adjustments. The solution requires additional resources and costs for a mobile/hardware device, which may pose space constraints and require maintenance of sterile criteria. The integration with EMR is also necessary, and the solution require changes in the user's workflow. The paper suggests that the long-term use of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) as a supporting terminology to improve clinical documentation and data exchange in healthcare. SNOMED CT provides a standardized way of documenting and sharing clinical information with respect to procedure, patient and device documentation, which can facilitate interoperability and data exchange. In conclusion, the paper highlights the challenges facing the Singapore healthcare system related to the tracking and traceability of medical devices. The paper suggests the use of UDI and barcode standardization to improve tracking and reduce errors. It also explores the use of image recognition to identify and document medical devices in nursing practices. The paper emphasizes the importance of standardized information, fields, and logic in EMR, OT, and billing systems, as well as barcode scanners that can read various formats and selectively parse barcode segments. These recommendations could help the Singapore healthcare system to improve tracking and traceability of medical devices and ultimately enhance patient safety.

Keywords: medical device tracking, unique device identifier, barcoding and image recognition, systematized nomenclature of medicine clinical terms

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Authors: Shivani Yadav

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The paper illustrates dynamics of nuclear resistance movements in India and how peoples’ power rises in response to subversion of justice and suppression of human rights. The need for democratizing nuclear policy runs implicit through the demands of the people protesting against nuclear programmes. The paper analyses the rationale behind developing nuclear energy according to the mainstream development model adopted by the state. Whether the prevalent nuclear discourse includes people’s ambitions and addresses local concerns or not is discussed. Primarily, the nuclear movements across India comprise of two types of actors i.e. the local population as well as the urban interlocutors. The first type of actor is the local population comprising of the people who are residing in the vicinity of the nuclear site and are affected by its construction, presence and operation. They have very immediate concerns against nuclear energy projects but also have an ideological stand against producing nuclear energy. The other types of actors are the urban interlocutors, who are the intellectuals and nuclear activists who have a principled stand against nuclear energy and help to aggregate the aims and goals of the movement on various platforms. The paper focuses on the nuclear resistance movements at five sites in India- Koodankulam (Tamil Nadu), Jaitapur (Maharashtra), Haripur (West Bengal), Mithivirdi (Gujrat) and Gorakhpur (Haryana). The origin, development, role of major actors and mass media coverage of all these movements are discussed in depth. Major observations from the Indian case include: first, nuclear policy discussions in India are confined to elite circles; secondly, concepts like national security and national interest are used to suppress dissent against mainstream policies; and thirdly, India’s energy policies focus on economic concerns while ignoring the human implications of such policies. In conclusion, the paper observes that the anti-nuclear movements question not just the feasibility of nuclear power but also its exclusionary nature when it comes to people’s participation in policy making, endangering the ecology, violation of human rights, etc. The character of these protests is non-violent with an aim to produce more inclusive policy debates and democratic dialogues.

Keywords: anti-nuclear movements, Koodankulam nuclear power plant, non-violent resistance, nuclear resistance movements, social movements

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Authors: Otu Otu Akanu

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The nexus between migration, national security, and human rights has become increasingly complex, particularly within Nigeria's geopolitical landscape. This study explores how Nigeria navigates the balance between safeguarding national security and upholding human rights amidst escalating regional crises, such as conflicts in the Lake Chad Basin and the Sahel. Through a comprehensive analysis of policy frameworks, security measures, and human rights protocols, this paper critically examines the challenges and opportunities in Nigeria's approach. The study employed a multidisciplinary methodology, integrating perspectives from International Relations, Human Security Studies, and Migration Law to provide a holistic understanding of the issue. Drawing on primary data from government reports, policy documents, and interviews with key stakeholders, alongside secondary literature, the study reveals a persistent tension between security imperatives and human rights obligations. While Nigeria has made strides in enhancing its security architecture, the findings highlight significant gaps in the protection of migrants' rights, often exacerbated by external pressures and domestic political dynamics. The paper argues that a recalibration of Nigeria's security and human rights policies is imperative for achieving sustainable peace and security in the region. By offering policy recommendations rooted in international best practices, this study contributes to the ongoing discourse on migration and security in West Africa and provides a framework for other nations grappling with similar challenges. This research underscores the need for an integrated approach that transcends traditional security paradigms, advocating a more inclusive and human-centered strategy in addressing the complexities of migration and national security.

Keywords: migration, national security, human rights, Nigeria, West Africa

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Authors: Onyinyechi Joy Kingdom

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Mergers and Acquisitions (M&A) have been proposed as a mechanism through which, problems associated with inefficiency or poor performance in financial institution could be addressed. The aim of this study is to examine the proposition that recapitalization of banks, which encouraged Mergers and Acquisitions in Nigeria banking system, would strengthen the domestic banks, improve financial deepening and the confidence of depositors. Hence, this study examines the impact of the 2005 M&A in the Nigerian-banking sector on financial deepening using mixed method (quantitative and qualitative approach). The quantitative process of this study utilised annual time series for financial deepening indicator for the period of 1997 to 2012. While, the qualitative aspect adopted semi-structured interview to collate data from three merged banks and three stand-alone banks to explore, understand and complement the quantitative results. Furthermore, a framework thematic analysis is employed to analyse the themes developed using NVivo 11 software. Using the quantitative approach, findings from the equality of mean test (EMT) used suggests that M&A have significant impact on financial deepening. However, this method is not robust enough given its weak validity as it does not control for other potential factors that may determine financial deepening. Thus, to control for other factors that may affect the level of financial deepening, a Multiple Regression Model (MRM) and Interrupted Times Series Analysis (ITSA) were applied. The coefficient for M&A dummy turned negative and insignificant using MRM. In addition, the estimated linear trend of the post intervention when ITSA was applied suggests that after M&A, the level of financial deepening decreased annually; however, this was statistically insignificant. Similarly, using the qualitative approach, the results from the interview supported the quantitative results from ITSA and MRM. The result suggests that interest rate should fall when capital base is increased to improve financial deepening. Hence, this study contributes to the existing literature the importance of other factors that may affect financial deepening and the economy when policies that will enhance bank performance and the economy are made. In addition, this study will enable the use of valuable policy instruments relevant to monetary authorities when formulating policies that will strengthen the Nigerian banking sector and the economy.

Keywords: mergers and acquisitions, recapitalization, financial deepening, efficiency, financial crisis

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Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

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Authors: Khairul Hasni

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A Memorandum of Understanding (MoU) for the cessation of hostilities was signed by Aceh's longstanding adversaries (the Government of Indonesia and the Free Aceh Movement (GAM) in August 2005. The Government of Indonesia has given the autonomy to Aceh Province of Indonesia, the Law Number 11 of 2006 the authority of the Aceh government to the implementation of the Islamic Sharia. The implementation of Islamic Sharia, Aceh can be a role model of Islam that glorifies women, the implementation of Islamic law in Aceh when enacted and got legality because it supported the socio-cultural and historical community. The value of the value of women's lives is shifted under the pressure of applying Islamic law, with this argument, the importance of justice and equality of policy enforcement in women's lives. Based on interviews conducted in 2016 and 2017 with women's activists, government officials, women non-governmental organizations in Aceh, this paper finds that there is lack of gender balance because of the many problems involving women in the enactment of regional regulations and control policies on women's bodies. The research points to ensure the implementation of Islamic Sharia practitioners have only directed to women and discrimination against women.

Keywords: women, policy, Islamic law, social

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Authors: Fadwa Chtioui

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The field of endodontics has witnessed constant advancements in treatment methods and instrument design, particularly for nickel-titanium (NiTi) files. Despite these developments, it remains crucial for clinicians to have a thorough understanding of their characteristics and behavior to choose the appropriate instruments for different clinical and anatomical situations. Research Aim: The aim of this work is to study and discuss the impact of heat treatment developments on the properties of endodontic NiTi files, with the ultimate goal of providing ways to adapt these files to the anatomical features of dental roots. Methodology: This study involves both clinical cases and extensive bibliographic research. Findings: The study highlights the importance of heat treatment in the design and manufacture of NiTi files, as it significantly affects their physical and mechanical properties. It also provides insights into the ways in which NiTi files can be adapted to the complex geometries of dental roots for more effective endodontic treatments. Theoretical Importance: Theoretical implications of this study include a better understanding of the relationship between heat treatment and the properties of NiTi files, leading to improvements in both their manufacturing methods and clinical applications. Data Collection and Analysis Procedures: The data for this study was collected through clinical cases and an extensive review of relevant literature. Analysis was performed through qualitative and quantitative methods, examining the impact of heat treatment on the physical and mechanical properties of NiTi files. Questions Addressed: This study aims to answer questions concerning the properties of NiTi files and the impact of heat treatment on their behavior. It also seeks to examine ways in which these files can be adapted to complex dental root geometries for more effective endodontic treatments. Conclusion: In conclusion, this study emphasizes the importance of heat treatment in the design and manufacture of NiTi files, as it significantly impacts their physical and mechanical properties. Further research is necessary to explore additional methods for adapting NiTi files to the unique anatomies of dental roots to improve endodontic treatments further. Ultimately, this study provides valuable insights into the continued evolution of endodontic treatment and instrument design.

Keywords: endodontic files, nickel-titanium, tooth anatomy, heat treatment

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Authors: Eduard Fosch-Villaronga

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This paper pioneers Care Robot Impact Assessment (CRIA), a methodology used to identify, analyze, mitigate and eliminate the risks posed by the insertion of non-medical personal care robots (PCR) in medical care facilities. Its precedent instruments (Privacy and Surveillance Impact Assessment (PIA and SIA)) fall behind in coping with robots. Indeed, personal care robots change dramatically how care is delivered. The paper presents a specific risk-sector methodology, identifies which robots are under its scope and presents some of the challenges introduced by these robots.

Keywords: ethics, impact assessment, law, personal care robots

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Authors: Rosina U. Ndukwe, Diane Crone, Nick Cavill

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Active transport (i.e. walking to school, cycle to work schemes etc.) is an effective approach with multiple social and environmental benefits for transforming urban environments into active urban environments. Although walking and cycling often remain on the margins of urban planning and infrastructure, there are new approaches emerging, along with policy intervention relevant for the creation of sustainable urban active environments conductive to active travel, increasing physical activity levels of involved communities and supporting social inclusion through more active participation. SPAcE - Supporting Policy and Action for Active Environments is a 3 year Erasmus+ project that aims to integrate active transport programmes into public policy across the EU. SPAcE focuses on cities/towns with recorded low physical activity levels to support the development of active environments in 5 sites: Latvia [Tukums], Italy [Palermo], Romania [Brasov], Spain [Castilla-La Mancha] and Greece [Trikala]. The first part of the project involved a review of good practice including case studies from across the EU and project partner countries. This has resulted in the first output from the project, an evidence of good practice summary with case study examples. In the second part of the project, working groups across the 5 sites have carried out co-production to develop Urban Active Environments (UActivE) Action Plans aimed at influencing policy and practice for increasing physical activity primarily through the use of cycling and walking. Action plans are based on international evidence and guidance for healthy urban planning. Remaining project partners include Universities (Gloucestershire, Oxford, Zurich, Thessaly) and Fit for Life programme (National physical activity promotion program, Finland) who provide support and advice incorporating current evidence, healthy urban planning and mentoring. Cooperation and co-production with public health professionals, local government officers, education authorities and transport agencies has been a key approach of the project. The third stage of the project has involved training partners in the WHO HEAT tool to support the implementation of the Action Plans. Project results show how multi-agency, transnational collaboration can produce real-life Action Plans in five EU countries, based on published evidence, real-life experience, consultation and collaborative working with other organisations across the EU. Learning from the processes adopted within this project will demonstrate how public health, local government and transport agencies across the EU, can work together to create healthy environments that have the aim of facilitating active behaviour, even in times of constrained public budgets. The SPAcE project has captured both the challenges and solutions for increasing population physical activity levels, health and wellness in urban spaces and translating evidence into policy and practice ensuring innovation at policy level. Funding acknowledgment: SPAcE (www.activeenvironments.eu) is co-funded by the Sport action of the ERASMUS+ programme.

Keywords: action plans, active transport, SPAcE, UActivE urban active environments, walking and cycling

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Authors: Domenico Chizzoniti, Monica Moscatelli, Letizia Cattani, Luca Preis

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A primary healthcare facility in developing countries should be a multifunctional space able to respond to different requirements: Flexibility, modularity, aggregation and reversibility. These basic features could be better satisfied if applied to an architectural artifact that complies with the typological, figurative and constructive aspects of the context in which it is located. Therefore, the purpose of this paper is to identify a procedure that can define the figurative aspects of the architectural structure of the health prototype for the marginal areas of developing countries through a critical approach. The application context is the rural areas of the Northeast of Bahia in Brazil. The prototype should be located in the rural district of Quingoma, in the municipality of Lauro de Freitas, a particular place where there is still a cultural fusion of black and indigenous populations. Based on the historical analysis of settlement strategies and architectural structures in spaces of public interest or collective use, this paper aims to provide a procedure able to identify the categories and rules underlying typological and figurative aspects, in order to detect significant and generalizable elements, as well as materials and constructive techniques typically adopted in the rural areas of Brazil. The object of this work is therefore not only the recovery of certain constructive approaches but also the development of a procedure that integrates the requirements of the primary healthcare prototype with its surrounding economic, social, cultural, settlement and figurative conditions.

Keywords: architectural typology, developing countries, local construction techniques, primary health care.

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Authors: Anil Anand

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Despite enormous strides made during the past decade, particularly with the adoption and expansion of community policing, there remains much that police leaders can do to improve police-public relations. The urgency is particularly evident in cities across the United States and Europe where an increasing number of police interactions over the past few years have ignited large, sometimes even national, protests against police policy and strategy, highlighting a gap between what police leaders feel they have archived in terms of public satisfaction, support, and legitimacy and the perception of bias among many marginalized communities. The decision on which one policing strategy is chosen over another, how many resources are allocated, and how strenuously the policy is applied resides primarily with the police and the units and subunits tasked with its enforcement. The scope and opportunity for police officers in impacting social attitudes and social policy are important elements that cannot be overstated. How do police leaders, for instance, decide when to apply one strategy—say community-based policing—over another, like intelligence-led policing? How do police leaders measure performance and success? Should these measures be based on quantitative preferences over qualitative, or should the preference be based on some other criteria? And how do police leaders define, allow, and control discretionary decision-making? Mending Broken Fences Policing provides police and security services leaders with a model based on social cohesion, that incorporates intelligence-led and community policing (IP-CP), supplemented by a quality/quantity/crime (QQC) framework to provide a four-step process for the articulable application of police intervention, performance measurement, and application of discretion.

Keywords: social cohesion, quantitative performance measurement, qualitative performance measurement, sustainable leadership

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Authors: Marcos Centurion-Vicencio

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This study discusses the idea of ‘dominance’ in economic policy and its practical influence over monetary decisions. The discretionary use of repurchase agreements in Brazil over the period 2006-2016 and its effects on the overall price level are the specific issues we will be focusing on. The set of in-depth interviews carried out with public servants at the Brazilian central bank and national treasury, alongside data collected from the National Institution of Statistics (IBGE), suggest that monetary and fiscal dominance do not differ in nature once the assumption of depoliticized central bankers is relaxed. In both regimes, the pursuit of private gains via public institutions affects price stability. While short-sighted politicians in the latter are at the origin of poor monetary decisions, the action of short-sighted financial interest groups is likely to generate a similar outcome in the former. This study then contributes to rethinking monetary policy theory as well as the nature of public borrowing.

Keywords: fiscal and monetary interactions, interest groups, monetary capture, public borrowing

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Authors: Mona M. Salem, Khaled S. Al-Hagla, Hany M. Ayad

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The concept of urban metabolism has increasingly been employed in a diverse range of disciplines as a mean to analyze and theorize the city. Urban ecology has a particular focus on the implications of applying the metabolism concept to the urban realm. This approach has been developed by a few researchers, though it has rarely if ever been used in policy development for city planning. The aim of this research is to use ecologically informed urban planning interventions to increase the sustainability of urban metabolism; with special focus on land stock as a most important city resource by developing a system dynamic based DSS. This model identifies two critical management strategy variables for the Strategic Urban Plan Alexandria SUP 2032. As a result, this comprehensive and precise quantitative approach is needed to monitor, measure, evaluate and observe dynamic urban changes working as a decision support system (DSS) for policy making.

Keywords: ecology, land resource, LULCC, management, metabolism, model, scenarios, system dynamics, urban development

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Authors: Gubhinder Kundhi, Paul Rilstone

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It is well established that Instrumental Variable (IV) estimators in the presence of weak instruments can be poorly behaved, in particular, be quite biased in finite samples. Finite sample approximations to the distributions of these estimators are obtained using Edgeworth and Saddlepoint expansions. Departures from normality of the distributions of these estimators are analyzed using higher order analytical corrections in these expansions. In a Monte-Carlo experiment, the performance of these expansions is compared to the first order approximation and other methods commonly used in finite samples such as the bootstrap.

Keywords: bootstrap, Instrumental Variable, Edgeworth expansions, Saddlepoint expansions

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Authors: Ioannis Manikas

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The increased consumer demand for environmentally friendly production and distribution practices and the stricter environmental regulations turned environmental aspects into important criteria in business decision-making. On the other hand, Food and Nutrition Security (FNS) has evolved dramatically during the last decades in theory and practice serving as a reference point for exchanging experiences among all agents involved in programs and projects to fostering policy and strategy development. Global pressures make it more important than ever to gain a better understanding of the contribution that agrifood businesses make to FNS and to examine ways to make them more resilient in an increasingly globalized and uncertain world. This study extends the standard three-dimensional model of sustainability to include two more dimensions: A technological dimension and a policy/political dimension. Apart from the economic, environmental and social dimensions regularly used in sustainability literature, the extended model will accurately represent the measures and policies addressing food and nutrition security.

Keywords: food and nutrition security, sustainability, food safety, resilience

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Authors: Sipho Mbatha, Anne Mastament-Mason

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The Multi-Fibre Arrangement (MFA) which regulated all trade in the Apparel Manufacturing Industries (AMI) for four decades was dissolved in 2005. Since 2005, the Apparel Manufacturing Industry of South Africa (AMISA) has been battling to adjust to an environment of liberalised trade, mainly due to strategic, infrastructural and skills factors. In developing competitive advantage strategy for the AMISA, the study aimed to do the following (1) to apply Porter’s diamond model’s determinant “Factor Condition” as framework to develop competitive advantage strategies. (2) Examine the effectiveness of government policy Industrial Policy Action Plan (IPAP 2007) in supporting AMISA. (3) Examine chance events that could be used as bases for competitive advantage strategies for the AMISA. This study found that the lack of advanced skills and poor infrastructure are affecting the competitive advantage of AMISA. The then Clothing, Textiles, Leather and Footwear Sector Education and Training Authority (CTLF-SETA) has also fallen short of addressing the skills gap within the apparel manufacturing industries. The only time that AMISA have shown signs of competitive advantage was when they made use of government grants and incentives available to only compliant AMISA. The findings have shown that the apparel retail groups have shown support for the AMISA by shouldering raw material costs, making it easier to manufacture the required apparel at acceptable lead times. AMISA can compete in low end apparel, provided quick response is intensified, the development of local textiles and raw materials is expedited.

Keywords: compliance rule, apparel manufacturing idustry, factor conditions, advance skills, industrial policy action plan of South Africa

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Authors: Hend Albalawi

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Amid the dynamic use of the Arabic language worldwide, Saudi Arabia employs Modern Standard Arabic (MSA) as its formal, official language, whereas other dialects of Arabic are common in informal situations. Such trends not only maintain the powerful, state-supported status of MSA but are liable to also affect the use and status of other varieties, including Bedouin dialects, and prompt code-mixing behaviour among their speakers. Exposure to MSA and English in education in Saudi Arabia may also be liable to reduce the vitality of Bedouin dialects in the country, particularly among current generations of educated Bedouin speakers. Therefore, the proposed research will involve examining the perceived vitality of Bedouin dialects in Saudi language policies prescribing MSA as the official national language of Saudi Arabia and requiring university students to complete English-language coursework in the national education system. It will also entail identifying Bedouin speakers’ attitudes towards the use of Bedouin dialects in order to assess the need, if any, to implement policies in Saudi Arabia that can enhance the use of those dialects amid the competing use of MSA and English in the country. Empirical data collected from questionnaires and semi-structured interviews that purport patterns of the everyday use of languages among Bedouin-speaking university students in Tabuk, as well as the content of language policy documents, can clarify whether policy-based pressure to use MSA and English in mainstream educational and social activities in Saudi Arabia has jeopardised the language vitality of Bedouin dialects in north-west Saudi Arabia. The findings of the research can thus ultimately contribute to the development of policies to support and enhance the use of Bedouin dialects and, in turn, their language vitality.

Keywords: attitudes, Bedouin dialects, language policy, vitality

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Authors: Elizaveta S. Prokofyeva, Svetlana V. Maltseva, Roman D. Zaitsev

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Rapidly evolving modern data analysis technologies in healthcare play a large role in understanding the operation of the system and its characteristics. Nowadays, one of the key tasks in urban healthcare is to optimize the resource allocation. Thus, the application of data analysis in medical institutions to solve optimization problems determines the significance of this study. The purpose of this research was to establish the dependence between the indicators of the effectiveness of the medical institution and its resources. Hospital discharges by diagnosis; hospital days of in-patients and in-patient average length of stay were selected as the performance indicators and the demand of the medical facility. The hospital beds by type of care, medical technology (magnetic resonance tomography, gamma cameras, angiographic complexes and lithotripters) and physicians characterized the resource provision of medical institutions for the developed models. The data source for the research was an open database of the statistical service Eurostat. The choice of the source is due to the fact that the databases contain complete and open information necessary for research tasks in the field of public health. In addition, the statistical database has a user-friendly interface that allows you to quickly build analytical reports. The study provides information on 28 European for the period from 2007 to 2016. For all countries included in the study, with the most accurate and complete data for the period under review, predictive models were developed based on historical panel data. An attempt to improve the quality and the interpretation of the models was made by cluster analysis of the investigated set of countries. The main idea was to assess the similarity of the joint behavior of the variables throughout the time period under consideration to identify groups of similar countries and to construct the separate regression models for them. Therefore, the original time series were used as the objects of clustering. The hierarchical agglomerate algorithm k-medoids was used. The sampled objects were used as the centers of the clusters obtained, since determining the centroid when working with time series involves additional difficulties. The number of clusters used the silhouette coefficient. After the cluster analysis it was possible to significantly improve the predictive power of the models: for example, in the one of the clusters, MAPE error was only 0,82%, which makes it possible to conclude that this forecast is highly reliable in the short term. The obtained predicted values of the developed models have a relatively low level of error and can be used to make decisions on the resource provision of the hospital by medical personnel. The research displays the strong dependencies between the demand for the medical services and the modern medical equipment variable, which highlights the importance of the technological component for the successful development of the medical facility. Currently, data analysis has a huge potential, which allows to significantly improving health services. Medical institutions that are the first to introduce these technologies will certainly have a competitive advantage.

Keywords: data analysis, demand modeling, healthcare, medical facilities

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