Search results for: Greek public hospital sector

Authors: Prabhu Thangaraju, Manoj Deepak, A. Sivakumar

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Removal of inter vertebral disc along with spinal fusion has many disadvantages such as causing stress fractures. If it is possible regenerate the spine it would be possible avoid the complications of the surgery and achieve better results. Our study involves the use of mesenchymal stem cells in regenerating the discs. Our study involved 10 patients who presented with degenerative disc disease between 2008-2011 in our hospital. After adequate pre-operative check prepared mesenchymal stem cells were injected into the disc spaces. These patients were subjected to conservative therapy for a minimum of six weeks before they were accepted into the study. They were followed up regularly for a minimum of 2years with serial radiographs and MRI. 8 out of the 10 patients had completed reduction in the pain. The T2 weighted MRI images in 9 out of the 10 patients showed a bright signal compared the previous Images which indicated that there was improvement in the hydration levels. From the case study of 10 patients who were subjected to mesenchymal cell therapy in our hospital, we can conclude that the use of mesenchymal cells in treatment of intervertebral disc degeneration in a safe and effective option.

Keywords: mesenchymal stem cells, intervertebral disc, the spine, disc degeneration

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Authors: Aurélia Jandot

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With the oil and economic crises which began in the 1970’s, it has progressively appeared necessary to convince the French “general public“ that a use of new energy sources was essential. In this field, nuclear energy represented the future and concentrated lots of hopes. However, the discourse about nuclear energy has progressively seen negative arguments growing in the French media. The gradual changes in the perception of nuclear energy will be studied here through the arguments given in the main French weekly newsmagazines, which had a great impact on the readers, thus on the “general public“, from the 1970’s to the end of the 1980’s. Indeed, to understand better these changes will be taken into account the major international events, the reorientations of the French domestic policy, and the evolutions of the nuclear technology. As this represents a considerable amount of copies and thus of information, will be selected here the main articles which emphasize the “mental images“ aiming to direct the thought of the readers, and which have led the public awareness and acceptance to evolve. From the 1970’s to the end of the 1980’s, two dichotomous trends are in confrontation : one is promoting the perception of the nuclear energy, the other is discrediting it. Moreover, these two trends are organized in two axes. The first axis is about the engineerings evolutions, such as the main French media represent them, with its approximations, its exaggerations, its fictions sometimes. Is added the will to make accessible to the “general public“ some concepts which are quite difficult to understand for the largest number. The second axis rests on the way the major accidents of the period are approached, including those of Three Mile Island and Chernobyl. Thanks to these accidents and because of the international relations evolutions, the ecologist movements and their impacts have progressively grown, with evident consequences on the public perception of nuclear energy and on the way the successive governments can implement new power plants in France. Then, in both cases, over the period considered, the language has changed, as the perceptible objectives of the communication, allowing to discern the deepest intentions of the newsmagazines editing. This is all these changes that will be emphasized, over a period where the nuclear energy technology, to there a field for specialists, bearing mystery and secret, has become a social issue seemingly open to all.

Keywords: social issues, public acceptance, mediatization, discourse changes

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Authors: Mohammed Alokshiya, Alaeddinne D. Eljamassi

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This study discusses the condition of bus service in Gaza Strip through testing certain hypotheses assuming that public is not satisfied with bus system in Gaza. This testing is proceeded using questionnaire. The study also includes the evaluation of ten bus stops in Gaza city as a case study using GIS, and suggests a design case study for the bus system in the university zone in Gaza city. The research indicates that there is a general dissatisfaction with bus system in Gaza Strip, with respect to buses in service, drivers and bus stops. The study also gives a design for a bus stop and its frequency in university zone in Gaza city. Finally, the researcher recommends that more interest should be given to bus system, through actual procedures such as insuring the suitability of bus for transferring passengers before updating bus license, decreasing taxes of importing new buses, and holding awareness raising sessions for bus drivers.

Keywords: public transport, bus system, public satisfaction, bus stop locating

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Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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Authors: Alwyn John Lim

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Philippines is one of the most vulnerable areas to natural disasters in the world. Almost every year different types of natural disasters occur in Philippines and destroy many lives and resources of people. Although it is not possible to prevent the occurrence of disasters influenced by natural causes, proper plan and management such as disaster risk reduction may minimize the damage cause by natural disasters. Based on literature review this paper will analyze literatures on public/community awareness and education in disaster risk reduction that would help promote a country wide public disaster awareness and education program in the Philippines. This will include best practices and importance of community disaster awareness and education. The paper will also tackle ICT tools that will help boost the process and effectiveness of community/public disaster awareness and education.

Keywords: community awareness, disaster education, disaster risk reduction, Philippines

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Authors: S. Jeyarajan

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Concept of knowledge is discovered from conducted study for successive Competition in Sri Lankan Non-State Higher Educational Institutes. The Concept discovered out of collected Knowledge Management Practices from Emerald inside likewise reputed literatures and of Non-State Higher Educational sector. A test is conducted to reveal existences and its reason behind of these collected practices in Sri Lankan Non-State Higher Education Institutes. Further, unavailability of such study and uncertain on number of participants for data collection in the Sri Lankan context contributed selection of research method as qualitative method, which used attributes of Delphi Method to manage those likewise uncertainty. Data are collected under Dramaturgical Method, which contributes efficient usage of the Delphi method. Grounded theory is selected as data analysis techniques, which is conducted in intermixed discourse to manage different perspectives of data that are collected systematically through perspective and modified snowball sampling techniques. Data are then analysed using Grounded Theory Development Techniques in Intermix discourses to manage differences in Data. Consequently, Agreement in the results of Grounded theories and of finding in the Foreign Study is discovered in the analysis whereas present study conducted as Qualitative Research and The Foreign Study conducted as Quantitative Research. As such, the Present study widens the discovery in the Foreign Study. Further, having discovered reason behind of the existences, the Present result shows Concept for Knowledge from Sri Lankan Non-State sector to manage higher educational Institutes in successful manner.

Keywords: adherence of snowball sampling into perspective sampling, Delphi method in qualitative method, grounded theory development in intermix discourses of analysis, knowledge management for success of higher educational institutes

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Authors: Birendra Kumar Bista, Rhitik Bista, Prafulla Koirala, Lokendra Mandal, Nikrsh Raj Shrestha, Vivek Kattel

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Introduction: Poorly controlled diabetes is associated with cause and poor outcome of stroke. High blood sugar reduces cerebral blood flow, increases intracranial pressure, cerebral edema and neuronal death, especially among patients with poorly controlled diabetes.1 SGLT2 inhibitors are associated with 50% reduction in hemorrhagic stroke compared with placebo. SGLT2 inhibitors decrease cardiovascular events via reducing glucose, blood pressure, weight, arteriosclerosis, albuminuria and reduction of atrial fibrillation.2,3 No study has been documented in low income countries to see the role of post stroke SGLT2 inhibitors on diabetic patients at and after ICU admission. Aims: The aim of the study was to measure the 12 months outcome of diabetic patients with acute stroke admitted in ICU set up with naïve SGLT2 inhibitors add on therapy. Method: It was prospective cohort study carried out in a 250 bedded tertiary neurology care hospital at the province capital Biratnagar Nepal. Diabetic patient with acute stroke admitted in ICU from 1st January 2022 to 31st December 2022 who were not under SGLT2 inhibitors were included in the study. These patients were managed as per hospital protocol. Empagliflozin was added to the alternate enrolled patients. Empagliflozin was continued at the time of discharged and during follow up unless contraindicated. These patients were followed up for 12 months. Outcome measured were mortality, morbidity requiring readmission or hospital visit other than regular follow up, SGLT2 inhibitors related adverse events, neuropsychiatry comorbidity, functional status and biochemical parameters. Ethical permission was taken from hospital administration and ethical board. Results: Among 147 diabetic cases 68 were not treated with empagliflozin whereas 67 cases were started the SGLT2 inhibitors. HbA1c level and one year mortality was significantly low among patients on empaglifozin arm. Over a period of 12 months 427 acute stroke patients were admitted in the ICU. Out of them 44% were female, 61% hypertensive, 34% diabetic, 57% dyslipidemia, 26% smoker and with median age of 45 years. Among 427 cases 4% required neurosurgical interventions and 76% had hemorrhagic CVA. The most common reason for ICU admission was GCS<8 (51%). The median ICU stay was 5 days. ICU mortality was 21% whereas 1 year mortality was 41% with most common reason being pneumonia. Empaglifozin related adverse effect was seen in 11% most commonly lower urinary tract infection in 6%. Conclusion: Empagliflozin can safely be started among acute stroke with better Hba1C control and low mortality outcome compared to treatment without SGLT2 inhibitor.

Keywords: diabetes, ICU, mortality, SGLT2 inhibitors, stroke

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Authors: Semaw A., Awet H., Yohannes M.

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Background: Hepatitis B Virus (HBV) is a major global public health problem. Individuals living in Sub-Sahara Africa have 60% lifetime risk of acquiring HBV infection. Evidences showed that 80-90% of those born from infected mothers developed chronic HBV. Perinatal HBV transmission is a major determinant of HBV carrier status, its chronic squeal and maintains HBV transmission across generations. Method: Institution based cross-sectional study was conducted among 406 pregnant mothers attending Antenatal clinics at Mekelle and Ayder referral hospital from January 30 to April 1/2014. Epidata version 3.1 was used for data entry and SPSS version 21 statistical software was used for data cleaning, management and finally determine associated factors of hepatitis B surface antigen adjusting important confounders using multivariable logistic regression analysis at 5% level of significance. Result: The overall prevalence of hepatitis B surface antigen among pregnant women was 33 (8.1%). The socio-demographic characteristic of the study population showed that there is high positivity among secondary school 189 (46.6%). In the multivariable logistic regression analysis, history of a contact with individuals who had history of hepatitis B infection or jaundice and lifetime number of multiple sexual partners were found to be significantly associated with HBsAg positivity at AOR = 3.73 95%C.I (1.373-10.182) and AOR = 2.57 95%C.I (1.173-5.654), respectively. Moreover, Human Immunodeficiency Virus (HIV) and HBV confection rate was found 3.6%. Conclusion: This study has shown that HBV prevalence in pregnant women is highly prevalent (8.1%) in the study area. Contact with individuals who had a history of hepatitis or have jaundice and report of multiple lifetime sexual partnership were associated with hepatitis B infection. Education about HBV transmission and prevention as well as screening all pregnant mothers shall be sought to reduce the serious public health crisis of HBV.

Keywords: HBsAg, hepatitis B, pregnant women, prevalence

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Authors: Siti Rajaah Binti Sayed Sultan

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Managing the code blue event is stressful for nurses, the patient, and the patient's families. The rapid response from the first and second responders in the code blue event will improve patient outcomes and prevent tissue hypoxia that leads to brain injury and other organ failures. Providing 1 minute for the cardiac massage and 2 minutes for defibrillation will significantly improve patient outcomes. As we know, the American Heart Association came out with guidelines for managing cardiac arrest patients. The hospital must provide competent staff to manage this situation. It can be achieved when the staff is well equipped with the skill, attitude, and knowledge to manage this situation with well-planned strategies, i.e., clear guidelines for managing the code blue event, competent staff, and functional equipment. The code blue simulation (CBS) was chosen in the training program for code blue management because it can mimic real scenarios. Having the code blue simulation module will allow the staff to appreciate what they will face during the code blue event, especially since it rarely happens in that area. This CBS module training will help the staff familiarize themselves with the activities that happened during actual events and be able to operate the equipment accordingly. Being challenged and independent in managing the code blue in the early phase gives the patient a better outcome. The CBS module will help the assessor and the hospital management team with the proper tools and guidelines for managing the code blue drill accordingly. As we know, prompt action will benefit the patient and their family. It also indirectly increases the confidence and job satisfaction among the nurses, increasing the standard of care, reducing the complication and hospital burden, and enhancing cost-effective care.

Keywords: code blue simulation module, development of code blue simulation module, code blue response time, code blue drill, cardiorespiratory arrest, managing code blue

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Authors: Raeda F. Abualrub, Amani Abdulnabi

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Aim: The aims of this study were to (a) examine the levels of nurses' political efficacy and involvement in health policy; and (b) explore the relationships between political efficacy, involvement in health policy, and participants’ background variables. Background: Nurses as citizens and health care providers have the right to express their opinions and beliefs in regard to issues that are concerned with the health care system or the public health domain. Methods: A descriptive, cross-sectional design using was utilized. A self-administered questionnaire (Political Efficacy Scale & Involvement in Health Policy Scale) was completed by a convenience sample of 302 nurses. Results: The results of this study showed low levels of involvement in health policy and political efficacy and a positive weak correlation between political efficacy and involvement in health policy. The perceived level of political efficacy was associated positively with nurses’ age and experience. Conclusions: Nurse administrators and managers may empower, support, and encourage nurses to enhance their involvement in health policy. Implications for Nursing Management: The findings have implications for nursing leaders and administrators to design appropriate strategies to enhance nurses’ involvement in health policy development.

Keywords: health policy, Jordan, nurses, political efficacy

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Authors: Rani Silvia

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English has surpassed other languages to become the most widely taught and studied foreign language in Indonesia. This reflects the tendency of the Indonesian public to participate in global mainstream culture, which is longstanding but has been greatly facilitated by the widespread availability of television, the traditional media, and more recently the Internet and social media. However, despite increasing exposure and a history of teaching and study, mastery of English remains low, even as interest and perceived importance continue to increase. This along with Indonesia’s extremely complex linguistic environment has increased the status and value associated with the use of English and is changing the dynamic of language use nationwide. This study investigates the use of English in public settings in Indonesia as well as the attitudes of Indonesian speakers towards English. A case study was developed to explicate this phenomenon in a major Indonesian city. Fifty individuals, including both professionals and lay people, were interviewed about their language preferences as well as their perceptions about English as compared to other languages, such as the local language, Indonesian as the national language, and other foreign languages. Observations on the use of language in the public environment in advertising, signs, and other forms of public expression were analyzed to identify language preferences at this level and their relationship to current language policy. This study has three major findings. First, Indonesian speakers have more positive attitudes towards English than other languages; second, English has encroached on domains in which Indonesian should be used; and third, perceived awareness of the importance of Indonesian as an introduced national language seems to be declining to suggest a failure of policy. The study includes several recommendations for the future development of language planning in determining and directing language use in a public context in Indonesia.

Keywords: English, Indonesia, language attitudes, language policy

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Authors: Vasundhara Arora, Anupam Jhobta, Suresh Thakur, Sanjiv Sharma

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Aims and Objectives: Intracranial tuberculosis (TB) is one of the most devastating manifestations of TB and a challenging public health issue of considerable importance and magnitude world over. This study elaborates on the imaging spectrum of neurotuberculosis on magnetic resonance imaging (MRI) in 29 clinically suspected cases from a tertiary care hospital. Materials and Methods: The prospective hospital based evaluation of MR imaging features of neuro-tuberculosis in 29 clinically suspected cases was carried out in Department of Radio-diagnosis, Indira Gandhi Medical Hospital from July 2017 to August 2018. MR Images were obtained on a 1.5 T Magnetom Avanto machine and were analyzed to identify any abnormal meningeal enhancement or parenchymal lesions. Microbiological and Biochemical CSF analysis was performed in radio-logically suspected cases and the results were compared with the imaging data. Clinical follow up of the patients started on anti-tuberculous treatment was done to evaluate the response to treatment and clinical outcome. Results: Age range of patients in the study was between 1 year to 73 years. The mean age of presentation was 11.5 years. No significant difference in the distribution of cerebral tuberculosis was noted among the two genders. Imaging findings of neuro-tuberculosis obtained were varied and non specific ranging from lepto-meningeal enhancement, cerebritis to space occupying lesions such as tuberculomas and tubercular abscesses. Complications presenting as hydrocephalus (n= 7) and infarcts (n=9) was noted in few of these patients. 29 patients showed radiological suspicion of CNS tuberculosis with meningitis alone observed in 11 cases, tuberculomas alone were observed in 4 cases, meningitis with parenchymal tuberculomas in 11 cases. Tubercular abscess and cerebritis were observed in one case each. Tuberculous arachnoiditis was noted in one patient. Gene expert positivity was obtained in 11 out of 29 radiologically suspected patients; none of the patients showed culture positivity. Meningeal form of the disease alone showed higher positivity rate of gene Xpert (n=5) followed by combination of meningeal and parenchymal forms of disease (n=4). The parenchymal manifestation of disease alone showed least positivity rates (n= 3) with gene xpert testing. All 29 patients were started on anti tubercular treatment based on radiological suspicion of the disease with clinical improvement observed in 27 treated patients. Conclusions: In our study, higher incidence of neuro- tuberculosis was noted in paediatric population with predominance of the meningeal form of the disease. Gene Xpert positivity obtained was low due to paucibacillary nature of cerebrospinal fluid (CSF) with even lower positivity of CSF samples in parenchymal form of the manifestation. MRI showed high accuracy in detecting CNS lesions in neuro-tuberculosis. Hence, it can be concluded that MRI plays a crucial role in the diagnosis because of its inherent sensitivity and specificity and is an indispensible imaging modality. It caters to the need of early diagnosis owing to poor sensitivity of microbiological tests more so in the parenchymal manifestation of the disease.

Keywords: neurotuberculosis, tubercular abscess, tuberculoma, tuberculous meningitis

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Authors: Ramanjaneyulu Mogili, G.V.R.K. Acharyulu

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Indian organized retail sector is growing at a faster pace and gaining popularity. Indian Brand Equity Foundation (IBEF) reveals that the current market size of Indian retail industry is about US$ 520 billion with for growth rate 14 to 15 percent annually by 2018 the Indian retail sector is likely to grow at a CAGR of 13% to reach a size of US$ 950 billion. Developments in Information Technology have enabled online Retail sector that empowers customers to order products, conduct transactions without the need to interact physically with the retailers. In recent years, the online shopping industry has gained popularity to the point where certain categories of customers would consider buying electronic products online rather than visiting the stores. Conventionally the physical location of a store is seen as a source of competitive advantage. Online Retailing service sites provide virtual shopping space to the customers. Online Retail services are gaining momentum in India, with internet penetration improving in the country and smartphones becoming affordable along with changing lifestyles and preferences of customers. Although online shoppers prefer the convenience and choice available in online shopping, certain issues raised due to the occurrence of service failure. The proposed study attempts to measure the service recovery and failure process of electronic goods in Indian retail channels.

Keywords: service recovery, customer satisfaction, e-shopping, service failure

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Authors: Pornthip Seangsanga

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Sepsis or septic shock needs urgent care because it is a cause of the high mortality rate if patients do not receive timely treatment. Songkhla Hospital does not have a clear system or clinical practice guidelines for treatment of patients with severe sepsis or septic shock, which contributes to the said problem.To compare clinical outcomes based on the protocol after using the clinical guidelines between the Emergency Room, Intensive Care Unit, and the Ward. This quasi-experimental study was conducted on the population and 50 subjects who were diagnosed with severe sepsis or septic shock from December 2013 to May 2014. The data were collected using a nursing care and referring record form for patients with severe sepsis or septic shock at Songkhla Hospital. The record form had been tested for its validity by three experts, and the IOC was 1.The mortality rate in patients with severe sepsis or septic shock who were moved from the ER to the ICU was significantly lower than that of those patients moved from the Ward to the ICU within 48 hours. This was because patients with severe sepsis or septic shock who were moved from the ER to the ICU received more fluid within the first six hours according to the protocol which helped patients to have adequate tissue perfusion within the first six hours, and that helped improve blood flow to the kidneys, and the patients’ urine was found to be with a higher quantity of 0.5 cc/kg/hr, than those patients who were moved from the Ward to the ICU. This study shows that patients with severe sepsis or septic shock need to be treated immediately. Using the clinical practice guidelines along with timely diagnosis and treatment based on the sepsis bundle in giving sufficient and suitable amount of fluid to help improve blood circulation and blood pressure can clearly prevent or reduce severity of complications.

Keywords: clinical practice guidelines, caring, septic shock, sepsis bundle protocol

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Authors: Jacquelyn Burkell, Jane Bailey

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Artificial intelligence (AI) solutions deployed within the justice system face the critical task of providing acceptable explanations for decisions or actions. These explanations must satisfy the joint criteria of public and professional accountability, taking into account the perspectives and requirements of multiple stakeholders, including judges, lawyers, parties, witnesses, and the general public. This research project analyzes and integrates two existing literature on explanations in order to propose guidelines for explainable AI in the justice system. Specifically, we review three bodies of literature: (i) explanations of the purpose and function of 'explainable AI'; (ii) the relevant case law, judicial commentary and legal literature focused on the form and function of reasons for judicial decisions; and (iii) the literature focused on the psychological and sociological functions of these reasons for judicial decisions from the perspective of the public. Our research suggests that while judicial ‘reasons’ (arguably accurate descriptions of the decision-making process and factors) do serve similar explanatory functions as those identified in the literature on 'explainable AI', they also serve an important ‘justification’ function (post hoc constructions that justify the decision that was reached). Further, members of the public are also looking for both justification and explanation in reasons for judicial decisions, and that the absence of either feature is likely to contribute to diminished public confidence in the legal system. Therefore, artificially automated judicial decision-making systems that simply attempt to document the process of decision-making are unlikely in many cases to be useful to and accepted within the justice system. Instead, these systems should focus on the post-hoc articulation of principles and precedents that support the decision or action, especially in cases where legal subjects’ fundamental rights and liberties are at stake.

Keywords: explainable AI, judicial reasons, public accountability, explanation, justification

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Authors: Jeana Cadby, Kae Miyazawa

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With rapidly expanding worldwide adoption of mobile technologies, Information and Communication Technology (ITC) is a major energy user and a contributor to global carbon emissions, due to infrastructure and operational energy consumption. The agricultural sector is also significantly responsible for contributing to global carbon emissions. However, ICT cloud computing using mobile technology can directly reduce environmental impacts in the agricultural sector through applications and mobile connectivity, such as precision fertilizer and pesticide applications, or access to weather data, for example. While direct impacts are easily calculated, indirect environmental impacts from ICT cloud computing usage have not been thoroughly investigated. For example, while women may be more poorly equipped for adaptation to environmentally sustainable agricultural practices due to resource constraints, this research concludes that indirect environmental benefits can be achieved by improving rural access to mobile technology for women. Women in advanced roles and secure land tenure are more likely to invest in long-term agricultural conservation strategies, which protect against environmental degradation. This study examines how ICT using mobile technology advances the role of women in rural agricultural systems and indirectly reduces environmental impacts from agricultural production, through literature examination from secondary sources. Increasing access for women to ICT mobile technology provides indirect environmental and social benefits in the rural agricultural sector.

Keywords: cloud computing, environmental benefits, mobile technology, women

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Authors: Dina Siniora, Jasia Baig

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During the past few decades, the healthcare system has undergone profound changes in their healthcare decision-making competencies and moral aptitudes due to the vast advancement in technology, clinical skills, and scientific knowledge. Healthcare decision-making deals with morally contentious dilemmas ranging from illness, life and death judgments that require sensitivity and awareness towards the patient’s preferences while taking into consideration medicine’s abilities and boundaries. As the ever-evolving field of medicine continues to become more scientifically and morally multifarious; physicians and the hospital administrators increasingly rely on ethics committees to resolve problems that arise in everyday patient care. The role and latitude of responsibilities of ethics committees which includes being dispute intermediaries, moral analysts, policy educators, counselors, advocates, and reviewers; suggest the importance and effectiveness of a fully integrated committee. Despite achievements on Integrated Ethics and progress in standards and competencies, there is an imminent necessity for further improvement in quality within ethics consultation services in areas of credentialing, professionalism and standards of quality, as well as the quality of healthcare throughout the system. These concerns can be resolved first by collecting data about particular quality gaps and comprehend the level to which ethics committees are consistent with newly published ASBH quality standards. Policymakers should pursue improvement strategies that target both academic bioethics community and major stakeholders at hospitals, who directly influence ethics committees. This broader approach oriented towards education and intervention outcome in conjunction with preventive ethics to address disparities in quality on a systematic level. Adopting tools for improving competencies and processes within ethics consultation by implementing a credentialing process, upholding normative significance for the ASBH core competencies, advocating for professional Code of Ethics, and further clarifying the internal structures will improve productivity, patient satisfaction, and institutional integrity. This cannot be systemically achieved without a written certification exam for HCEC practitioners, credentialing and privileging HCEC practitioners at the hospital level, and accrediting HCEC services at the institutional level.

Keywords: ethics consultation, hospital, medical ethics, quality

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Authors: Abdulsamad Qadir Hussien

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This paper examines the impact of funders on the media industry in the Kurdistan Region Iraqi (henceforth KRI). The key objectives of the study are also looking at: how the media industry funder influences the media organization and journalists’ practices in the Kurdish community; how the media organizations attempt to utilize the available capabilities to serve the goals of the funded entities, whether they are parties, NGOs, governments, commercial companies or have individual ownership of media institutes. Further, the research project seeks to discover the influence and role of the funder on the media content and determine the prioritizing that will broadcast on the media. Furthermore, the project tries to understand to what extent the media organizations have a commitment to achieve the public interest and public affairs by following the key ethical principles. The study also attempts to explain the situation of the public service media. These variables are measured through a survey questionnaire distributed among a sample of 108 journalists and media practitioners. This research project, therefore, explores a new topic for study in the Kurdish community regarding the media industry, funding, and financial support. This article adopted surveys (n=108) as data collection tools by using a statistical method (SPSS 21). The data of the study have been tabulated, coded, and presented in a descriptive form.

Keywords: funding, journalists’ practices, Kurdish media industry, public services media

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Authors: Dragan Zivotic, Mirjana Ilic, Aleksandra Perovic, Predrag Gavrilovic

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As with the provision of other services, the service quality perception is one of the key factors that the modern manager must pay attention to. Countries in which the state regulation is in transition also have specific features in providing fitness services. Identification of the dimensions in which the most significant different service quality perception between different types of fitness centers, enables managers to profile the offer according to the wishes and expectations of users. The aim of the paper was the comparison of the quality of services perception in the field of fitness in Serbia between three categories of fitness centers: the privately owned centers, the publicly owned centers, and the Public-private partnership centers. For this research 350 respondents of both genders (174 men and 176 women) were interviewed, aged between 18 and 68 years, being beneficiaries of fitness services for at least 1 year. Administered questionnaire with 100 items provided information about the 15 basic areas in which they expressed the service quality perception in the gym. The core sample was composed of 212 service users in private fitness centers, 69 service users in public fitness centers and 69 service users in the public-private partnership. Sub-samples were equal in representation of women and men, as well as by age and length of use of fitness services. The obtained results were subject of univariate analysis with the Kruskal-Wallis non-parametric analysis of variance. Significant differences between the analyzed sub-samples were not found solely in the areas of rapid response and quality outcomes. In the multivariate model, the results were processed by backward stepwise discriminant analysis that extracted 3 areas that maximize the differences between sub-samples: material and technical basis, secondary facilities and coaches. By applying the classification function 93.87% of private centers services users, 62.32% of public centers services users and 85.51% of the public-private partnership centers users of services were correctly classified (total 86.00%). These results allow optimizing the allocation of the necessary resources in profiling offers of a fitness center in order to optimally adjust it to the user’s needs and expectations.

Keywords: fitness, quality perception, management, public ownership, private ownership, public-private partnership, discriminative analysis

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Authors: Jingjing Ye, Cijun Fan, Yan Dong

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The development of financial sector plays an important role in shaping industrial structure. However, evidence on the micro-level channels through which this relation manifest remains relatively sparse, particularly for developing countries. In this paper, we compile an industry-by-city dataset based on manufacturing firms and registered banks in 287 Chinese cities from 1998 to 2008. Based on a difference-in-difference approach, we find the highly concentrated banking sector decreases the competitiveness of firms in each manufacturing industry. There are two main reasons: i) bank accessibility successfully fosters firm expansion within each industry, however, only for sufficiently large enterprises; ii) state-owned enterprises are favored by the banking industry in China. The results are robust after considering alternative concentration and external finance dependence measures.

Keywords: bank concentration, China, difference-in-difference, industry structure

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Authors: S. O. Ayansina, R. A. Oyeyinka, K. K. Bolarinwa

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There is an increasing demand for a functional extension delivery services in Nigeria with a view to meet up with the food and fiber needs of the ever growing population of human and animal respectively. This study was designed to examine farmers’ involvement in public and private extension services in southwestern Nigeria, specifically to explore the farmers’ participation in the two types of organizations involved. It also evaluates the performances of personnel in the organizations. A multi-stage random sampling technique was used to select 30 respondents from each of the three selected organizations in Ogun, Osun and Oyo states in Southwestern Nigeria. Data was collected with interview schedule and analyzed both at descriptive and inferential levels. Kruskal Wallis one-way Analysis of variance was used to test the differences between the participation of beneficiaries who are farmers under the public and private extension services and the level of benefit accrued to them from the various extension organizations involved in the study. Results revealed that private extension organizations were performing better and were more preferred by the beneficiaries. Results of the tested hypotheses as shown by Kruskal Wallis test of difference (x2 = 0.709) S no significant difference between farmers’ participation in the extension services of public and private organizations but however showed significant difference (X2 =12.074) in the benefits achieved by respondents in the two organizations. These include: increased quantity of crop produced, farm income, skill acquisition, and improved education in private extension organizations. Based on this result, it could be inferred that beneficiaries generally preferred private extension organizations because of their effectiveness and vibrancy in programme administration. Public extension is therefore recommended for general overhauling and possibly privatization in order to cater for teeming population of farmers demanding for efficient and functional extension services to better their lots in production, processing and marketing of agricultural produce.

Keywords: public and private involvement, extension services, farmers' participation

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Authors: Nurazean Maarop, Noorjan Mohd Mustapha, Rasimah Yusoff, Roslina Ibrahim, Norziha Megat Mohd Zainuddin

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The goal of this study is to identify success factors that could influence the ISMS self-implementation in government sector from qualitative perspective. This study is based on a case study in one of the Malaysian government agency. Semi-structured interviews involving five key informants were conducted to examine factors addressed in the conceptual framework. Subsequently, thematic analysis was executed to describe the influence of each factor on the success implementation of ISMS. The result of this study indicates that management commitment, implementer commitment and implementer competency are part of the success factors for ISMS self-implementation in Malaysian Government Sector.

Keywords: ISMS success factors, IT project management, IS success, information security

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Authors: Shamila Manie, Soraya Maart, Ayesha Osman

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Introduction: People diagnosed with multidrug resistant pulmonary tuberculosis (MDR-PTB) is subjected to prolonged hospitalization in South Africa. It has thus become essential for research to shift its focus from a purely medical approach, but to include social and environmental factors when looking at the impact of the disease on those affected. Aim: To explore the factors affecting individuals with multi-drug resistant pulmonary tuberculosis during long-term hospitalization using the comprehensive ICF core-sets for obstructive pulmonary disease (OPD) and cardiopulmonary (CPR) conditions at Brooklyn Chest Hospital (BCH). Methods: A quantitative descriptive, cross-sectional study design was utilized. A convenient sample of 19 adults at Brooklyn Chest Hospital were interviewed. Results: Most participants reported a decrease in exercise tolerance levels (b455: n=11). However it did not limit participation. Participants reported that a lack of privacy in the environment (e155) was a barrier to health. The presence of health professionals (e355) and the provision of skills development services (e585) are facilitators to health and well-being. No differences exist in the functional ability of HIV positive and negative participants in this sample. Conclusion: The ICF Core Sets appeared valid in identifying the barriers and facilitators experienced by individuals with MDR-PTB admitted to BCH. The hospital environment must be improved to add to the QoL of those admitted, especially improving privacy within the wards. Although the social grant is seen as a facilitator, greater emphasis must be placed on preparing individuals to be economically active in the labour for when they are discharged.

Keywords: multidrug resistant tuberculosis, MDR ICF core sets, health-related quality of life (HRQoL), hospitalization

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Authors: Roman Kulikov, Svetlana Kolesnikova

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Last decade Cloud Computing technologies have been rapidly becoming ubiquitous. Each year more and more organizations, corporations, internet services and social networks trust their business sensitive information to Public Cloud. The data storage in Public Cloud is protected by security mechanisms such as firewalls, cryptography algorithms, backups, etc.. In this way, however, only outsider attacks can be prevented, whereas virtualization tools can be easily compromised by insider. The protection of Public Cloud’s critical elements from internal intruder remains extremely challenging. A hypervisor, also called a virtual machine manager, is a program that allows multiple operating systems (OS) to share a single hardware processor in Cloud Computing. One of the hypervisor's functions is to enforce access control policies. Furthermore, it prevents guest OS from disrupting each other and from accessing each other's memory or disk space. Hypervisor is the one of the most critical and vulnerable elements in Cloud Computing infrastructure. Nevertheless, it has been poorly protected from being compromised by insider. By exploiting certain vulnerabilities, privilege escalation can be easily achieved in insider attacks on hypervisor. In this way, an internal intruder, who has compromised one process, is able to gain control of the entire virtual machine. Thereafter, the consequences of insider attacks in Public Cloud might be more catastrophic and significant to virtual tools and sensitive data than of outsider attacks. So far, almost no preventive security countermeasures have been developed. There has been little attention paid for developing models to assist risks mitigation strategies. In this paper formal model of insider attacks on hypervisor is designed. Our analysis identifies critical hypervisor`s vulnerabilities that can be easily compromised by internal intruder. Consequently, possible conditions for successful attacks implementation are uncovered. Hence, development of preventive security countermeasures can be improved on the basis of the proposed model.

Keywords: insider attack, public cloud, cloud computing, hypervisor

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Authors: Sima E. Rugarabamu, Mecky I. Matee, Elison N. M. Simon

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Background: In Tanzania bacteriological studies of etiological agents of oro-facial infections are very limited, and very few have investigated anaerobes. The aim of this study was to determine the spectrum of bacterial agents involved in oral and maxillofacial infections in patients attending Muhimbili National Hospital, Dar-es-salaam, Tanzania. Method: This was a hospital based descriptive cross-sectional study that was conducted in the Department of Oral and Maxillofacial Surgery of the Muhimbili National Hospital in Dar es Salaam, Tanzania from 1st January 2014 to 31st August 2014. Seventy (70) patients with various forms of oral and maxillofacial infections who were recruited for the study. The study participants were interviewed using a prepared questionnaire after getting their consent. Pus aspirate was cultured on Blood agar, Chocolate Agar, MacConkey agar and incubated aerobically at 37°C. Imported blood agar was used for anaerobic culture whereby they were incubated at 37°Cin anaerobic jars in an atmosphere of generated using commercial gas-generating kits in accordance with manufacturer’s instructions. Plates were incubated at 37°C for 24 hours (For aerobic culture and 48 hours for anaerobic cultures). Gram negative rods were identified using API 20E while all other isolates were identified by conventional biochemical tests. Antibiotic sensitivity testing for isolated aerobic and anaerobic bacteria was detected by the disk diffusion, agar dilution and E-test using routine and commercially available antibiotics used to treat oral facial infections. Results: This study comprised of 41 (58.5%) males and 29 (41.5%) females with a mean age of 32 years SD +/-15.1 and a range of 19 to 70 years. A total of 161 bacteria strains were isolated from specimens obtained from 70 patients which were an average of 2.3 isolates per patient. Of these 103 were aerobic organism and 58 were strict anaerobes. A complex mix of strict anaerobes and facultative anaerobes accounted for 87% of all infections.The most frequent aerobes isolated was streptococcus spp 70 (70%) followed by Staphylococcus spp 18 (18%). Other organisms such as Klebsiella spp 4 (4%), Proteus spp 5 (5%) and Pseudomonas spp 2 (2%) were also seen. The anaerobic group was dominated by Prevotella spp 25 (43%) followed by Peptostreptococcus spp 18 (31%); other isolates were Pseudomonas spp 2 (1%), black pigmented Pophyromonas spp 4 (5%), Fusobacterium spp 3 (3%) and Bacteroides spp 5 (8%). Majority of these organisms were sensitive to Amoxicillin (98%), Gentamycin (89%), and Ciprofloxacin (100%). A 40% resistance to metronidazole was observed in Bacteroides spp otherwise this drug and others displayed good activity against anaerobes. Conclusions: Oral and maxillofacial facial infections at Muhimbili National Hospital are mostly caused by streptococcus spp and Prevotella spp. Strict anaerobes accounted for 36% of all isolates. The profile of isolates should assist in selecting empiric therapy for infections of the oral and maxillofacial region. Inclusion of antimicrobial agents against anaerobic bacteria is highly recommended.

Keywords: bacteria, oral and maxillofacial infections, antibiotic susceptibility, Tanzania

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Authors: Sandesh Yadav

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Earthquake constitutes one of the most terrible natural hazards which often turn into a disaster or causing extensive devastation and loss of human lives and their properties. In the year 2015, Nepal experienced the most devastating earthquakes on 25th April, 2015 and 12th May, 2015 respectively. Several villages, towns, human constructions and their properties, lives were completely damaged. The hazardous effect of Nepal earthquakes depends not only on their magnitude of Richter Scale on intensity alone, but also on so many factors, such as geology of earth crust (lithology, elasticity, soil condition, permissible stress, rock structures etc.). The unscientifically and non-seismically designed buildings resulted in huge loss of life and property. Further, the loss due to earthquake can be grouped into three broad categories namely agriculture sector (loss of livestock, poultry and food stocks), industrial sector (mainly brick production industry) and infrastructural sector (transportation infrastructure). The present research study begins with the tracing of Geological history of earthquakes in Nepal along with identification of causes of Nepal earthquakes, 2015. Secondly, research study identifies the extent of tremors of earthquakes of 2015 in Nepal and surrounding areas along with their sphere of impact. Thirdly, the research study tries to assess the agricultural loss, industrial loss and infrastructural loss due to earthquakes in Nepal. Lastly, the research study ends with the various recommendations and suggestions in order to minimize the loss due to earthquakes in the future.

Keywords: earthquake, richter scale, sphere of impact, tremors

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Authors: Hsien Hwa Kuo, Lin Wen Chun, Lin Wen Chun, Hsien Wen Kuo

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Objective: Nurses represent an important occupational group frequently affected by wrist musculoskeletal disorders (WMSDs) due to a heavy workload, working shifts, poor posture, giving shots, making beds, lifting patients, bending their waist and insufficient rest time every day. However, lack of research reported nurses whether workload in household correlated with the severity of WMSDs. Methods: 550 nurses from a hospital in Taoyuan were interviewed using a modified standardized Nordic Musculoskeletal (NMQ) questionnaire including the demographic information, workplace condition and nine body parts of musculoskeletal disorders. Results: 17.9% and 23.9% of severity and symptoms in WMSDs among nurses with children were significant higher than among nurses without children (1​2.4% and 15.9%). Based on multiple logistic regression models adjusted for age, work duration, job title and body mass index (BMI), we found that heavy workload in hospital had higher odds ratio (OR) of the severity and symptoms of WMSD among nurses with children (OR= 8.67 and OR= 4.30, p<0.05) compared to nurses without children (OR= 1.94 and OR= 1.70). Conclusion: The severity and symptoms of WMSDs among nurses significantly correlated with workload in hospital among nurses with children. If women are at greater risk because of the combination of their work and family demands, synergistic effect of WMSDs was found among nurses. Comment: Women's domestic work, especially once they become mothers, they invest more time and energy caring for children, helping others, and doing housework. Thus domestic work, per se, may be a risk factor for wrist musculoskeletal problems, and, more importantly, it may constrain women's ability to protect themselves from the effects of their paid work. If nurses with more domestic work periodically make efforts to physical activity or modify inappropriate posture, their WMSDs symptoms will be alleviated.

Keywords: musculoskeletal disorders, nurse, NMQ, WMSDs

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Authors: Nikolaos Georgantzis, Efi Vasileiou

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We present results from experimental price-setting oligopolies in which green firms undertake different levels of energy-saving investments motivated by public subsidies and demand-side advantages. We find that consumers reveal higher willingness to pay for greener sellers’ products. This observation in conjunction to the fact that greener sellers set higher prices is compatible with the use and interpretation of energy-saving behaviour as a differentiation strategy. However, sellers do not exploit the resulting advantage through sufficiently high price-cost margins, because they seem trapped into “run to stay still” competition. Regarding the use of public subsidies to energy-saving sellers we uncover an undesirable crowding-out effect of consumers’ intrinsic tendency to support green manufacturers. Namely, consumers may be less willing to support a green seller whose energy-saving strategy entails a direct financial benefit. Finally, we disentangle two alternative motivations for consumer’s attractions to pro-social firms; first, the self-interested recognition of the firm’s contribution to the public and private welfare and, second, the need to compensate a firm for the cost entailed in each pro-social action. Our results show the prevalence of the former over the latter.

Keywords: corporate social responsibility, energy savings, public good, experiments, vertical differentiation, altruism

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Authors: A. Danbaba

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Samurai Sudoku consists of five Sudoku square designs each having nine treatments in each row (column or sub-block) only once such the five Sudoku designs overlaps. Two or more Samurai designs can be joint together to give an extended Samurai design. In addition, two Samurai designs, each containing five Sudoku square designs, are mutually orthogonal (Graeco). If we superimpose two Samurai designs and obtained a pair of Latin and Greek letters in each row (column or sub-block) of the five Sudoku designs only once, then we have Graeco Samurai design. In this paper, simple method of constructing Samurai designs and mutually orthogonal Samurai design are proposed. In addition, linear models and methods of data analysis for the designs are proposed.

Keywords: samurai design, graeco samurai design, sudoku design, row or column swap

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Authors: Bouchekoua Myriam, Aloui Dorsaf, Trabelsi Sonia

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Introduction Food hygiene in hospitals is important, particularly among patients who could be more vulnerable than healthy subjects to microbiological and nutritional risks. The consumption of contaminated food may be responsible for foodborne diseases, which can be severe among hospitalized patients, especially those immunocompromised. The aim of our study was to assess the state of hygiene in the internal catering department of a Tunisian hospital. Methodology and major results: A prospective study was conducted for one year in the Parasitology-Mycology laboratory of Charles Nicolle Hospital. Samples were taken from the kitchen staff, worktops, and cooking utensils used in the internal catering department. Thirty one employees have benefited from stool exams and scotch tape in order to evaluate the degree of infestation of parasites. 35% of stool exams were positive. Protozoa were the only parasites detected. Blastocystis sp was the species mostly found in nine food handlers. Its role as a human pathogen is still controversial. Pathogenic protozoa were detected in two food handlers (Giardia intestinalis in one person and Dientamoeba fragilis in the other one. Non-pathogenic protozoa were found in two cases; among them, only one had digestive symptoms without a statistically significant association with the carriage of intestinal parasites. Moreover, samples were performed from the hands of the staff in order to search for a fungal carriage. Thus, 25 employees (81%) were colonized by fungi, including molds. Besides, mycological examination among food handlers with a suspected dermatomycosis for diagnostic confirmation concluded foot onychomycosis in 32% of cases and interdigital intertrigo in 26%. Only one person had hand onychomycosis. Among the 17 samples taken from worktops and kitchen utensils, fungal contamination was detected in 13 sites. Hot and cold equipment were the most contaminated. Molds were mainly identified as belonging to five different genera. Cladosporium sp was predominant. Conclusion: In the view of the importance of intestinal parasites among food handlers, the intensity of fungi hand carriage among these employees, and the high level of fungal contamination in worktops and kitchen utensils, a reinforcement of hygiene measures is more than essential in order to minimize the alimentary contamination-risk.

Keywords: hospital kitchen, environment, intestinal parasitosis, fungal carriage, fungal contamination

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