Search results for: hospital policy

Authors: Mekonen Hailu, Gashaw Tesfaye, Adamneh Dagne, Hiwot Teshome

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Lake Hawassa is one of the most important lakes for Ethiopian fishery. It serves as a source of food and nutrition, income and livelihood for many inhabitants. However, the fishery in Lake Hawassa shows a declining trend, especially for the most valuable species, such as the Nile tilapia (Oreochromis niloticus L.), indicating that the existing management systems are either not fully enforced or inadequate. The aim of this study was therefore to develop management policy options for the sustainable utilization and management of fishery resources in Lake Hawassa. A blend of primary and secondary data was used for the study. Primary data were collected using Participatory Rural Appraisal (PRA) techniques such as focus group discussions with members of fishing co-operatives, co-operative leaders and key informant discussion to understand the current state of the fisheries resources. Then literatures were reviewed to obtain secondary data and develop alternative management policy options. It has been realized that Lake Hawassa is not very species-rich in terms of fish diversity. It contains only six species belonging to four families, of which only three are commercially important, including the Nile tilapia (90 % of catches), the African catfish Clarias gariepinus B. (7 % of catches) and the African large barb Labeobarbus intermedius R. (only 3 % of catches). The production has been declining since 2007. The top six challenges that could be responsible for this decline, identified by about two-thirds of respondents and supported by the literature review, are directly linked to fisheries and fisheries management, with overfishing, irregular monitoring, control, and surveillance (MCS) system and the lack of a fishing licensing system ranking first, second and third respectively. It is, therefore, important to address these and other problems identified in the study. Of the management options analyzed, we suggest adapting the management approach to sustain the fishery in Lake Hawaasa and its socio-economic benefits. We also present important conditions for successfully implementing co-management in this and other lakes in Ethiopia.

Keywords: comanagement, community-based management, fishery, overfishing, participatory approach, top-down management

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Authors: Arjun Paul, Adrijit Goswami

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In our present work, an economic order quantity inventory model with shortages is developed where holding cost is expressed as linearly increasing function of time and demand rate is a ramp type function of time. The items considered in the model are deteriorating in nature so that a small fraction of the items is depleted with the passage of time. In order to consider a more realistic situation, the deterioration rate is assumed to follow a continuous uniform distribution with the parameters involved being triangular fuzzy numbers. The inventory manager offers his customer a discount in case he is willing to backorder his demand when there is a stock-out. The optimum ordering policy and the optimum discount offered for each backorder are determined by minimizing the total cost in a replenishment interval. For better illustration of our proposed model in both the crisp and fuzzy sense and for providing richer insights, a numerical example is cited to exemplify the policy and to analyze the sensitivity of the model parameters.

Keywords: fuzzy deterioration rate, price discount on backorder, ramp type demand, shortage, time varying holding cost

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Authors: Kaushika Vinotheeswaran

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The Greater Toronto Area (GTA), located in Ontario, Canada, is among the fastest-growing metropolitan areas in North America. Rapid urbanization within the GTA has led to increased imperviousness and surface runoff, contributing to wetland loss. Wetland cover and land cover data from the Southern Ontario Land Resource Information System were analyzed to characterize wetland loss to built-up areas and land conversions between 2005 and 2015, evaluating the extent of urbanization-induced wetland loss. Spatial analysis revealed a significant increase in the number of wetlands lost from 2005 to 2011 compared to the period from 2011 to 2015, with these losses attributed to increased urban expansions within the GTA. Non-wetland conversions, such as agricultural and impervious built-up uses to support urban expansions, played a significant role in wetland loss. Current approaches to wetland policy implementation and land-use planning strategies do not effectively identify or mitigate damage to wetlands in advance of development, resulting in significant wetland loss. Therefore, wetland conservation policies must be re-evaluated to address gaps in policy practice and focus on minimizing wetland loss.

Keywords: wetland loss, urbanization, impervious, pervious, wetland conservation

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Authors: Policarpio Jr. Joves

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Physicians in most teaching hospitals are commonly promoted into managerial roles, yet their training is mostly in clinical and scientific skills but not in leadership competencies. When they shift into roles of physician leadership, the majority hold on to their primary identity of physicians. These conflicting roles affect their identity and eventually their work. The physician leaders also face additional challenges related to academics which include incorporation of new knowledge into the existing curriculum, use of technology in the delivery of teaching, the need to train medical students outside of hospital wards, etc. The study aims to explore how physician leaders in teaching hospitals of private medical schools enact their leadership roles and how they face the challenges as physician leaders. The study setting shall be teaching hospitals of three private medical schools situated in the National Capital Region, Philippines. A multiple case study design shall be adopted in this research. Physicians shall be eligible to participate in the study if they are practicing clinicians limited to the five major clinical specialty: Internal Medicine, Pediatrics, Family Medicine, Surgery, Obstetrics and Gynecology. They must be teaching in the College of Medicine prior to their appointments as physician leaders in both medical school and teaching hospital. Semi-structured face-to-face interviews shall be utilized as a means of data collection, with open-ended questions, enabling physician leaders to present narratives about their identity, role enactment, conflicts, reaction of colleagues, and the challenges encountered in their day-to-day work as physician leaders. Interviews shall be combined with observations and review of records to gain more insights into how the physician leaders are 'doing' management. Within-case analysis shall be done initially followed by a thematic analysis across the cases, referred to as cross–case analysis or cross-case synthesis.

Keywords: academic leaders, academic managers, physician leaders, physician managers

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Authors: Sara Alhabli, Eman Elashiry, Osama Felemban, Abdullah Almushayt, Faisal Dardeer, Ahmed Mohammad, Fajr Orri, Nada Bamashmous

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Background: In December of 2019, the coronavirus (SARS-CoV-2) first appeared and quickly spread to become a worldwide pandemic. This study aimed to evaluate the prevalence and types of pediatric dental emergencies during the COVID-19 lockdown in Jeddah, Saudi Arabia, at the University Dental Hospital (UDH) of King Abdulaziz University (KAU) and identified the management provided for these dental emergency visits. Materials and Methods: Data collection was done retrospectively from electronic dental records for children aged 0-18 that attended the UDH emergency clinic during the period from March 1st, 2020, to September 30th, 2020. An electronic form formulated specifically for this study was used to collect the required data from electronic patient records, including demographic data, emergency classification, management, and referrals. Results: A total of 3146 patients were seen at the emergency clinics during this period, of which 661 were children (21%). Types of emergency conditions included 0.8% emergency cases, 34% urgent, and 65.2% non-urgent conditions. Severe dental pain (73.1%) and abscesses (20%) were the most common urgent dental conditions. Most non-urgent conditions presented for initial or periodic visits, recalls, or routine radiographs (74%). Treatments rarely involved restorations, with 8% among urgent conditions and 5.4% among non-urgent conditions. Antibiotics were only prescribed to 6.9% of urgent conditions. Conclusions: The largest group of children presenting at the emergency dental clinics were found to be children with non-urgent conditions. Tele dentistry can be a solution to avoid large numbers of non-urgent patients presenting to emergency clinics. Additionally, dental care for non-urgent conditions during the pandemic should focus more on procedures with less aerosol generation.

Keywords: COVID-19 pandemic, dental emergencies, oral health, pediatric dentistry, children

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Authors: Vladimir Korovkin, Albert Park, Evgeny Kaganer

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The paper studies the second-level digital divide (the one defined by the way how digital technology is used in everyday life) between regions of the Russian Federation. The paper offers a systemic review of literature on the measurement of the digital divide; based upon this it suggests a composite Digital Life Index, that captures the complex multi-dimensional character of the phenomenon. The model of the index studies separately the digital supply and demand across seven independent dimensions providing for 14 subindices. The Index is based on Internet-borne data, a distinction from traditional research approaches that rely on official statistics or surveys. Regression analysis is used to determine the relative importance of factors like income, human capital, and policy in determining the digital divide. The result of the analysis suggests that the digital divide is driven more by the differences in demand (defined by consumer competencies) than in supply; the role of income is insignificant, and the quality of human capital is the key determinant of the divide. The paper advances the existing methodological literature on the issue and can also inform practical decision-making regarding the strategies of national and regional digital development.

Keywords: digital transformation, second-level digital divide, composite index, digital policy, regional development, Russia

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Authors: Trunov V.O., Ryabov A. B., Poddubny I.V

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Introduction: cystic and solid pancreatic tumors have a relevant and disruptive position in many positions. The results of the treatment of children with tumors and pancreatic cysts aged 3 to 17 years for the period from 2008 to 2019 on the basis of the Morozov State Children's Clinical Hospital in Moscow were analyzed. The total number of children with solid tumors was 17, and 31 with cysts. In all children, the diagnosis was made on the basis of ultrasound, followed by CT and MRI. In most patients with solid tumors, they were located in the area of the pancreas tail - 58%, in the body area - 14%, in the area of the pancreatic head - 28%. In patients with pancreatic cysts, the distribution of patients by topography was as follows: head of the pancreas - 10%, body of the pancreas - 16%, tail of the pancreas - 68%, total cystic transformation of the Wirsung duct - 6%. In pancreatic cysts, the method of surgical treatment was based on the results of MRCP, the level of amylase in the contents of the cyst, and the localization of the cyst. Thus, pathogenetically substantiated treatment included: excision of cysts, internal drainage on an isolated loop according to Ru, the formation of pancreatojejunoanastomosis in a child with the total cystic transformation of the Wirsung duct. In patients with solid pancreatic lesions, pancretoduodenalresection, central resection of the pancreas, and distal resection from laparotomy and laparoscopic access were performed. In the postoperative period, in order to prevent pancreatitis, all children underwent antisecretory therapy, parenteral nutrition, and drainage of the omental bursa. Results: hospital stay ranged from 7 to 12 days. The duration of postoperative fermentemia in patients with solid formations lasted from 3 to 6 days. In all cases, according to the histological examination, a pseudopapillary tumor of the pancreas was revealed. In the group of children with pancreatic cysts, fermentemia was observed from 2 to 4 days, recurrence of cysts in the long term was detected in 3 children (10%). Conclusions: the treatment of cystic and solid pancreatic neoplasms is a difficult task in connection with the anatomical and functional features of the organ.

Keywords: pancreas, tumors, cysts, resection, laparoscopy, children

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Authors: William Gallagher, Harriet Bothwell, Lowri Evans, Kevin Jones

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Background: Worldwide, a third of adult deaths are caused by cardiovascular disease, a high proportion occurring in the developing world. Contributing to these poor outcomes are suboptimal assessments, treatments and monitoring of the acutely unwell patient. Successful training in trauma and neonates is recognised in the developing world but there is little literature supporting adult resuscitation. As far as the authors are aware no literature has been published on resuscitation training in Uganda since 2000 when a resuscitation training officer ran sessions in neonatal and paediatric resuscitation. The aim of this project was to offer training in Basic Life Support ( BLS) to staff and healthcare students based at Villa Maria Hospital in the Kalungu District, Central Uganda. This project was undertaken as a student selected component (SSC) offered by Swindon Academy, based at the Great Western Hospital, to medical students in their fourth year of the undergraduate programme. Methods: Semi-structured, informal interviews and focus groups were conducted with different clinicians in the hospital. These interviews were designed to focus on the level of training and understanding of BLS. A training session was devised which focused on BLS (excluding the use of an automatic external defribrillator) involving pre and post-training questionnaires and clinical assessments. Three training sessions were run for different cohorts: a pilot session for 5 Ugandan medical students, a second session for a group of 8 nursing and midwifery students and finally, a third was devised for physicians. The data collected was analysed in excel. Paired T-Tests determined statistical significance between pre and post-test scores and confidence before and after the sessions. Average clinical skill assessment scores were converted to percentages based on the area of BLS being assessed. Results: 27 participants were included in the analysis. 14 received ‘small group training’ whilst 13 received’ large group training’ 88% of all participants had received some form of resuscitation training. Of these, 46% had received theory training, 27% practical training and only 15% received both. 12% had received no training. On average, all participants demonstrated a significant increase of 5.3 in self-assessed confidence (p <0.05). On average, all participants thought the session was very useful. Analysis of qualitative date from clinician interviews in ongoing but identified themes identified include rescue breaths being considered the most important aspect resuscitation and doubts of a ‘good’ outcome from resuscitation. Conclusions: The results of this small study reflect the need for regular formal training in BLS in low resource settings. The active engagement and positive opinions concerning the utility of the training are promising as well as the evidence of improvement in knowledge.

Keywords: basic life support, education, resuscitation, sub-Saharan Africa, training, Uganda

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Fahad Al Beyahi, Justin Thomas, Md Mamunur Rashid

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Various definitions of digital well-being have emerged in recent years, most of which center on the impacts -beneficial and detrimental- of digital technology on health and well-being (psychological, social, and financial). Other definitions go further, emphasizing the attainment of balance, viewing digital well-being as wholly subjective, the individual’s perception of optimal balance between the benefits and ills associated with online connectivity. Based on this broad conceptualization of digital well-being, we undertook a global survey measuring various dimensions of this emerging construct. The survey was administered across 35 nations and 7 world regions, with 1000 participants within each territory (N= 35000). Along with attitudinal, behavioral, and sociodemographic variables, the survey included measures of depression, anxiety, problematic social media use, gaming disorder, and other relevant metrics. Coupled with nation-level policy audits, these data were used to create a multinational (global) digital well-being index. Nations are ranked based on various dimensions of digital well-being, and predictive models are used to identify resilience and risk factors for problem technology use. In this paper, we will discuss key findings from the survey and the index. This work can inform public policy and shape our responses to the emerging implications of lives increasingly lived online and interconnected with digital technology.

Keywords: technology, health, behavioral addiction, digital wellbeing

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Authors: Adelson G. Guillarte, M. D., Noel J. Belonguel, Jarungchai Anton S. Vatanagul

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Patients with malignant middle cerebral infarction (MCA) (with massive brain swelling and herniation) were reported to have a mortality rate of 80% even with the appropriate conservative medical therapy. European Trials (DECIMAL, DESTINY I, and II, HAMLET) showed significant improvement in mortality and functional outcome with hemicraniectomy. No known published local studies in the region, thus a local study is vital. This is a single center, retrospective, descriptive, cross-sectional, chart review study which includes ≥18 year-old patients with malignant MCA infarction, who underwent hemicraniectomy, and those who were given conservative medical therapy alone, from January 2008 to December 2012 at Perpetual Succour Hospital. Excluded were patients whose charts are with insufficient data, prior MCA stroke, with concomitant intracerebral hemorrhage and with other serious medical conditions or terminal illnesses. Minimum of 32 populations were needed. Data were presented in mean, standard deviation, frequency and percentage distribution. Man n Whitney U test and Chi Square test were used. P-values lesser than 0.05 alpha were considered statistically significant. A total of 672 stroke patients were admitted. 34 patients pass the inclusion criteria. 9 underwent hemicraniectomy and 25 were treated by conservative medical therapy alone. Although not statistically significant (64% vs 33%, p=0.112) there were more patients noted improved in the conservative treatment group. Meanwhile, the Hemicraniectomy group have increased percentage of mortality (67%) (p=0.112). There was a decreasing trend in the average NIHSS score in both groups from admission to post-op 7 days (p=0.198, p=0.78). A bigger multicenter prospective study is recommended to control inherent biases and limitations of a retrospective and smaller study.

Keywords: cerebral infarct, hemicraniectomy, ischemic stroke, malignant middle cerebral artery (MCA) infarct

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Authors: Jonathan E. Oghenekohwo

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The return to scale constitutes a significant investment index in the determination of the quantum of resources that is deployed in investment decision on worker’s continuing professional development. Such investment decision is always predicted on the expected outcomes to the individual, institution and the society in context. Several investments in the development of human capacity on the job have been made, but the return to the scale of such seems not to have been correlated positively with the quantum of resources invested in terms of productivity and performance among workers in many universities. This paper thus found out that, despite the commitment and policy instrument to avail workers the right of continuing professional development, the multiplier effects are not evident in diligence, commitment, honesty, dedication, productivity and improved performance on the job among most administrative staff in Nigerian Universities This author, therefore concludes that, given the policy on the right of workers to get trained on-the job, the outcomes of such training must reflect on the overall performance indices, otherwise, institutions should carry out a forensic analysis of the types of continuing professional development programmes that workers participate in, whether or not, they are consistent with the vision and mission of the institutions in terms of economies of scale of workers professional development to the individual, institution and the nation in context.

Keywords: continuing, professional development, economies of scale, worker’s education, administrative staff

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Authors: L. L. Ivy-Yap, H. A. Bekhet

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As the Malaysian residential electricity consumption continued to increase rapidly, effective energy policies, which address factors affecting residential electricity consumption, is urgently needed. This study attempts to investigate the relationship between residential electricity consumption (EC), real disposable income (Y), price of electricity (Pe) and population (Po) in Malaysia for 1978-2011 periods. Unlike previous studies on Malaysia, the current study focuses on the residential sector, a sector that is important for the contemplation of energy policy. The Phillips-Perron (P-P) unit root test is employed to infer the stationary of each variable while the bound test is executed to determine the existence of co-integration relationship among the variables, modeled in an Autoregressive Distributed Lag (ARDL) framework. The CUSUM and CUSUM of squares tests are applied to ensure the stability of the model. The results suggest the existence of long-run equilibrium relationship and bidirectional Granger causality between EC and the macroeconomic variables. The empirical findings will help policy makers of Malaysia in developing new monitoring standards of energy consumption. As it is the major contributing factor in economic growth and CO2 emission, there is a need for more proper planning in Malaysia to attain future targets in order to cut emissions.

Keywords: co-integration, elasticity, granger causality, Malaysia, residential electricity consumption

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Authors: Mohammad H. Yarmohammadian, Mehdi Nasr Isfahani, Elham Anbari

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Introduction: The awareness of using chemical, biological, and nuclear agents in everyday industrial and non-industrial incidents has increased recently; release of these materials can be accidental or intentional. Since hospitals are the forefronts of confronting Chemical, Biological, Radiological and Nuclear( CBRN) incidents, the goal of the present research was to provide a generic protocol for CBRN incidents through a comparative review of CBRN protocols and guidelines of different countries and reviewing various books, handbooks and papers. Method: The integrative approach or research synthesis was adopted in this study. First a simple narrative review of programs, books, handbooks, and papers about response to CBRN incidents in different countries was carried out. Then the most important and functional information was discussed in the form of a generic protocol in focus group sessions and subsequently confirmed. Results: Findings indicated that most of the countries had various protocols, guidelines, and handbooks for hazardous materials or CBRN incidents. The final outcome of the research synthesis was a 50 page generic protocol whose main topics included introduction, definition and classification of CBRN agents, four major phases of incident and disaster management cycle, hospital response management plan, equipment, and recommended supplies and antidotes for decontamination (radiological/nuclear, chemical, biological); each of these also had subtopics. Conclusion: In the majority of international protocols, guidelines, handbooks and also international and Iranian books and papers, there is an emphasis on the importance of incident command system, determining the safety degree of decontamination zones, maps of decontamination zones, decontamination process, triage classifications, personal protective equipment, and supplies and antidotes for decontamination; these are the least requirements for such incidents and also consistent with the provided generic protocol.

Keywords: hospital, CBRN, decontamination, generic protocol, CBRN Incidents

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Authors: Rodchares Hanrinth, Theerapong Srisil, Peeraya Sriphong, Pawich Paktipat

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The trigger tool is the low-cost, low-tech method to detect adverse events through clues called triggers. The Institute for Healthcare Improvement (IHI) has developed the Global Trigger Tool for measuring and preventing adverse events. However, this tool is not specific for detecting adverse drug events. The pharmacy-based trigger tool is needed to detect adverse drug events (ADEs). Group concept mapping is an effective method for conceptualizing various ideas from diverse stakeholders. This technique was used to identify a pharmacy-based trigger to detect adverse drug events (ADEs). The aim of this study was to involve the pharmacists in conceptualizing, developing, and prioritizing a feasible trigger tool to detect adverse drug events in a provincial hospital, the northeastern part of Thailand. The study was conducted during the 6-month period between April 1 and September 30, 2017. Study participants involved 20 pharmacists (17 hospital pharmacists and 3 pharmacy lecturers) engaging in three concept mapping workshops. In this meeting, the concept mapping technique created by Trochim, a highly constructed qualitative group technic for idea generating and sharing, was used to produce and construct participants' views on what triggers were potential to detect ADEs. During the workshops, participants (n = 20) were asked to individually rate the feasibility and potentiality of each trigger and to group them into relevant categories to enable multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the trigger list, cluster list, point map, point rating map, cluster map, and cluster rating map. The three workshops together resulted in 21 different triggers that were structured in a framework forming 5 clusters: drug allergy, drugs induced diseases, dosage adjustment in renal diseases, potassium concerning, and drug overdose. The first cluster is drug allergy such as the doctor’s orders for dexamethasone injection combined with chlorpheniramine injection. Later, the diagnosis of drug-induced hepatitis in a patient taking anti-tuberculosis drugs is one trigger in the ‘drugs induced diseases’ cluster. Then, for the third cluster, the doctor’s orders for enalapril combined with ibuprofen in a patient with chronic kidney disease is the example of a trigger. The doctor’s orders for digoxin in a patient with hypokalemia is a trigger in a cluster. Finally, the doctor’s orders for naloxone with narcotic overdose was classified as a trigger in a cluster. This study generated triggers that are similar to some of IHI Global trigger tool, especially in the medication module such as drug allergy and drug overdose. However, there are some specific aspects of this tool, including drug-induced diseases, dosage adjustment in renal diseases, and potassium concerning which do not contain in any trigger tools. The pharmacy-based trigger tool is suitable for pharmacists in hospitals to detect potential adverse drug events using clues of triggers.

Keywords: adverse drug events, concept mapping, hospital, pharmacy-based trigger tool

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Authors: Matheus Fonseca Durães, Bruno da Silva Pereira, Bruna Stewart

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The concept of Brazil’s water governance has been the topic of discussion and has undergone legal and organizational improvements due to the need to promote a more effective and sustainable relationship with natural resources and stemming from conflicts related to shortcomings in decision-making. The Waters Act has enabled Brazil to create interesting mechanisms for integrated management, but, on the other hand, it has created a challenge that involves the implementation of the principles established in this legal framework. This study aims to evaluate some challenges and opportunities for water governance in two watersheds based on data collection and analysis of concessions, the water use register, and flow data. The elements presented demonstrated, via an analysis of legally instituted criteria, that the level of commitment of water resources is high, especially to public supply, and the adoption of the reference flow constituted one of the main barriers to implementing an efficient system, demonstrating the need for a regulatory policy that considers the hydrological behavior of the watersheds. Finally, the current water management model presents challenges to be addressed to achieve the objectives proposed by the water policy, such as ensuring sustainable, rational, and integrated use of water resources.

Keywords: management, hydrology, public policies, Brazil

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Authors: Nazim Habibov, Alena Auchynnikava, Lida Fan

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The exploration of the relationship between social trust and the support of the welfare system in transitional countries has attracted growing interests in recent decades. This study estimates the effects of interpersonal and institutional trust on the support of the welfare system in 27 countries in Eastern Europe the former Soviet Union. We estimate the data sets from the Life-in-Transition Survey 2010 and 2016 with binomial regression models. The results indicate that both interpersonal and institutional trust have positive effects on the support for the welfare system in all the three areas under investigation: helping the needy, public healthcare and public education, both in the less developed countries of the former Soviet Union and in the more developed Eastern European countries. Furthermore, the positive effects of interpersonal and institutional trust on support for helping the needy, public healthcare and public education were found to grow over time. In conclusion, this study confirms that interpersonal and institutional trusts have positive effects for the public support of the welfare system in these transitional countries under investigation, regardless of their level of development.

Keywords: central and eastern Europe, former Soviet union, international social welfare policy, comparative social welfare policy

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Authors: Muna Mohamed Omer Mirghani

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This paper responds to one of the key national development strategies and a typical challenge in the Gash Basin as well as in different parts of Sudan, namely managing water scarcity in view of climate change impacts in minor water systems sustaining over 50% of the Sudan population. While now focusing on the Gash river basin, the ultimate aim is to replicate the same approach in similar water systems in central and west Sudan. The key objective of the paper is the identification of outcome-based water governance interventions in Gash Basin, guided by the global Sustainable Development Goal six (SDG 6 on water and sanitation) and the Sudan water resource policy framework. The paper concluded that improved water resources management of the Gash Basin is a prerequisite for ensuring desired policy outcomes of groundwater use and flood risk management purposes. Analysis of various water governance dimensions in the Gash indicated that the operationalization of a Basin-level institutional reform is critically focused on informed actors and adapted practices through knowledge and technologies along with the technical data and capacity needed to make that. Adapting the devolved Institutional structure at state level is recommended to strengthen the Gash basin regulatory function and improve compliance of groundwater users.

Keywords: water governance, Gash Basin, integrated groundwater management, Sudan

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Authors: Godiya Pius Atsiya

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One of the most devastating impacts of terrorism on the Nigerian state is the danger it has posed on women, children and other vulnerable groups. The complexity of terrorism in Nigeria, especially in most parts of Northern Nigeria has entrenched unprecedented security challenges such as refugee crisis, kidnapping, food shortages, increase in death tolls, malnutrition, fear, rape and several other psychological factors. Of particular interest in this paper as it relates to terrorism is the high rate of Internally Displaced Persons(IDPs), with women, children and the aged being the most affected. Empirical evidence arising from recent development in Nigeria’s North-East geo-political zone shows that large numbers of refugees fleeing the Boko Haram attacks have doubled. The attendant consequences of this mass exodus of people in the affected areas are that the victims now suffer untold and unwarranted economic hardship. In another dimension, recent findings have it that most powerless women and young teenage girls have been forcefully conscripted into the Islamic extremist groups and used as shields. In some respect, these groups of people have been used as available tools for suicide bombing and other criminal tendencies, the result of which can be detrimental to social cohesion and integration. This work is a theoretical insight into terrorism discourses; hence, the paper relies on existing works of scholars in carrying out the research. The paper argues that the implications of terrorism on women gender have grounding effects on the moral psyche of women who are supposed to be home managers and custodians of morality in society. The burden of terrorism and all it tends to propagate has literally upturned social lives and hence, Nigeria is gradually being plunged into the Hobesian state of nature. As a panacea to resolving this social malaise, the paper submits that government and indeed, all stakeholders in the nation’s democratic project must expedite action to nip this trend in the bud. The paper sums up with conclusion and other alternative policy measures to mitigate the challenges of terrorism in Nigeria.

Keywords: changing democratic state, policy measures, terrorism, women

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Authors: A B M Enamol Hassan

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The forest storing up in Bangladesh is of deep concern to policy analysts because of increasing encroachment that results in deforestation and degradation of the ecosystem. To address these problems, forest-dependent people, as responsible for encroachment, could be involved in the co-management process along with other local stakeholders through a participatory approach. On the basis of this premise, this paper conceptualizes and empirically assesses the integration of all stakeholders in the co-management process through two lenses such as participation and collaboration. The study also analyzed the issues of sustainability in local communities along with examining constraints that limit the processes of integration. The study used a qualitative research method, which included face-to-face interviews with semi-structured questionnaires and field notes following the purposive sampling technique focusing on Comilla Sadar South Upazila (CSSU), Bangladesh. The findings of this paper reveal beneficiaries, Bangladesh Forest Department (BFD) and Union Parishad (UP), come together as leading actors, while NGOs and business entrepreneurs are ignored in the co-management process of social forestry. However, integrated management contributes to the strength of community sustainability, although it has some major limitations causing the matter of concerns among the local communities and policy analysts.

Keywords: integration, participation, collaboration, stakeholders, community sustainability

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Authors: Jessica Leigh Doyle

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In recent years there has been increasing academic and policy interest in domestic violence (DV) and in the implications of DV for the physical and psychological well-being of those who experience it. Yet, despite this interest, very few detailed empirical explorations of these issues have been conducted to date. Of the detailed empirical work that does exist, most studies have focused narrowly on physical violence and the impact of physical violence on rates of depression, post-traumatic stress disorder (PTSD) and substance use. This has often been to the exclusion of wider experiences of DV in relation to psychological, sexual and financial abuse, and of broader victim self-perceptions of psychological well-being that include self-esteem, social participation and quality of life as core components. This paper contributes towards filling this gap by examining these issues on the basis of comprehensive empirical evidence from the Northern Ireland context. Using qualitative methods, the paper presents the findings from 63 semi-structured interviews with women victims of DV from across Northern Ireland. The findings discuss the varied types of violence (physical, psychological, sexual, and financial) that women experience, how these experiences shape their broad physical and psychological well-being and capacity to live active and fulfilling lives and the processes of recovery from IPV. The implications of these findings for research and policy are then discussed.

Keywords: domestic violence, gender equality, intimate partner violence, violence against women, well-being

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Authors: Nahian Salsabeel, Faria Leera

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—“Whoever controls the Indian Ocean, dominates Asia. This ocean is the key to the seven seas. In the 21st century, the destiny of the world will be decided on its waters” -Alfred Mahan South Asia is increasingly becoming a hub for international politics. Numerous ventures are taking place in the strategic region. Of them, the most prominent is the Belt and Road Initiative (BRI). Originating from the concept of ancient Silk Route, the Chinese Xi Jin Ping regime looks to reestablish the vast connectivity project to connect the world through infrastructure and trade. On the other hand, the US, teamed up with India, Australia and Japan, thereby forming the Quad, have launched their own foreign policy, the Indo-Pacific Strategy. The ambitious 21st century initiative for the development of maritime trade, security and governance focuses critical importance to the Indo-Pacific region, especially to South Asia. Against the backdrop of contemporary political scenario, both the Quad and China airs to establish their own footprint across the region through respective mega projects, the Indo-Pacific Strategy and the BRI. This research employs a comparative case study research method, using a secondary research design. The paper looks at the variety of opportunities and challenges posed by the BRI and the Indo Pacific, and gives the comparative study on both ends.

Keywords: BRI, Foreign Policy, Indo-Pacific, South Asia

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Authors: Tadesse Melaku Abegaz

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Background: there was paucity of data on the self-reported adverse drug reactions (ADRs), level of adherence and clinical outcomes with antidepressants among major depressive disorder (MDD) patients in Ethiopia. Hence, the present study sought to determine the level of adherence for and clinical outcome with antidepressants and the magnitude of ADRs. Methods: A prospective cross-sectional study was employed on MDD patients from September 2016 to January 2017 at Gondar university hospital psychiatry clinic. All patients who were available during the study period were included under the study population. The Naranjo adverse drug reaction probability scale was employed to assess the adverse drug reaction. The rate of medication adherence was determined using morisky medication adherence measurement scale eight. Clinical Outcome of patients was measured by using patient health questionnaire. Multivariable logistic carried out to determine factors for adherence and patient outcome. Results: two hundred seventy patients were participated in the study. More than half of the respondents were males 122(56.2%). The mean age of the participants was 30.94 ± 8.853. More than one-half of the subjects had low adherence to their medications 124(57.1%). About 186(85.7%) of patients encountered ADR. The most common ADR was weight gain 29(13.2). Around 198(92.2%) ADRs were probable and 19(8.8%) were possible. Patients with long standing MDD had high risk of non-adherence COR: 2.458[4.413-4.227], AOR: 2.424[1.185-4.961]. More than one-half 125(57.6) of respondents showed improved outcome. Optimal level of medication adherence was found to be associated with reduced risk of progression of the diseases COR: 0.37[0.110-5.379] and AOR: 0.432[0.201-0.909]. Conclusion: Patient reported adverse drug reactions were more prevalent in major depressive disorder patients. Adherence to medications was very poor in the setup. However, the clinical outcome was relatively higher. Long standing depression was associated with non-adherence. In addition, clinical outcome of patients were affected by non-adherence. Therefore, adherence enhancing interventions should be provided to improve medication adherence and patient outcome.

Keywords: adverse drug reactions, clinical outcomes, Ethiopia, prospective study, medication adherence

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Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli

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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.

Keywords: consumer health, health informatics, hospital information system, universal medical record number

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Authors: Khachen Kongpakwattana, Charungthai Dejthevaporn, Orapitchaya Krairit, Piyameth Dilokthornsakul, Devi Mohan, Nathorn Chaiyakunapruk

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Background: Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HR-QoL) associated with AD in Low- and Middle-Income Countries (LMICs) is still lacking. We, therefore, aimed to collect real-world cost and HR-QoL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. Methods: We recruited AD patients aged ≥ 60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HR-QoL and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HR-QoL. Results: Among 148 community-dwelling patients, average annual total societal costs of AD care were 8,014 US$ [95% Confidence Interval (95% CI): 7,295 US$ - 8,844 US$] per patient. Total costs of patients with severe stage (9,860 US$; 95% CI: 8,785 US$ - 11,328 US$) were almost twice as high as those of mild stage (5,524 US$; 95% CI: 4,649 US$ - 6,593 US$). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HR-QoL (p-value < 0.001). Conclusions: Our real-world findings suggest the distinct major cost driver which results from expensive AD treatment, emphasizing the demand for country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement on patient’s HR-QoL.

Keywords: Alzheimer's disease, associations, costs, disease-severity indicators, health-related quality of life

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Authors: P. Mbecke

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The role of the government to tangibly alleviate poverty, improve and sustain the quality of people’s lives remains a “work in progress” twenty-two years after the dawn of democracy in South Africa despite a host of socio-economic programs and pro-poor policies and legislations. This paper assesses the development process and the implementation of the White Paper on Families in South Africa as one of the pro-poor policies intended to curb poverty and redress the imbalances of the apartheid regime. The paper is the result of a qualitative implementation research theory facilitated through in-depth interviews with social work managers complemented by literature and policy review techniques. It investigates the level of basic knowledge and understanding as well as the implementation challenges of the White Paper on Families as causes of its failure. The paper emphasizes the importance of the family-centered approach in the implementation of pro-poor policies. To facilitate the understanding of the White Paper on Families by its users, the Department of Social Development needs take stock of the identified challenges of its implementation so as to facilitate its success in fostering positive family well-being that will directly contributes to the overall socio-economic development of South Africa.

Keywords: poverty alleviation, pro-poor policy, social development, social welfare, South Africa

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Authors: Rahaf Mandura

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Background: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure (ICP) more than 250 mm H₂O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. The aim of this research is to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. Methodology: This is a retrospective observational study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital (JEH), Saudi Arabia. A total of fifty-one patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. Results: Most of the patients were females (43, 91.5%) with a mean age of presentation of 30.83±11.40 years. The most common presenting symptom was headache (40 patients, 85.1%), followed by transient visual obscuration (20 patients, 42.6%), and reduced visual acuity (15 patients, 31.9%). All 47 patients were started on medical treatment with oral acetazolamide with four patients (8.5%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.5%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. Conclusion: The present study has shown that IIH-related papilledema is common in young female patients with headaches, transient visual obscurations and reduced visual acuity. Those are the commonest symptoms in our IIH population. Medical treatment of IIH is significantly efficacious and should be considered in order to enhance the prognosis of IIH-related complications. Therefore, the visual status should be frequently monitored for these patients.

Keywords: idiopathic intracranial hypertension, intracranial hypertension, papilledema, headache

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Authors: Eumsin Payan

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The article desires the Association of Southeast Asian Nations (ASEAN) to take interest in the policies and give importance to India over other powerful countries in the World, including powerful countries in Asia, comprising of: People’s Republic of China (PRC), Russia, and India countries with the ability to drive the Asian continent, specifically, the ASEAN Economic Community (AEC). (Japan was incapable of stepping up to become the leader of ASEAN due to the fact that Japan has created “wounds” from military history with too many countries in Asia, including wounds from the Greater East Asia War, combining with economic problems Japan is currently facing and also several natural disasters, therefore Japan is not considered a good option of our era.) China appears to be an option that stands out, which could be seen through countless published articles in the general public. However, this article desires to propose India as an option to develop and drive the relationship between ASEAN countries in the future development of Computer Science Technology and allow India to be the leader in driving the Asian Economy in place of China and the United States. As for Russia, its location is distant and apart from South East Asia. Moreover, Russia does not give as much importance to ASEAN. In this light, the author perceives that India already has the “Look East” policy. Therefore, it would be simple for ASEAN to look back at India by simply starting cooperation through policies related to collaboration in the areas of computer science. In effect, this will continuously adjust and improve the relationship towards cooperation in the areas of economics, society, and culture. Referring to the above, the author suggests a word that could be used to call the relationship between India and ASEAN, INSEAN or IN-SEAN. Hereinafter, the author hopes that Thailand, in the position of one in the five founders of ASEAN, could become the leader or be the entity that pushes forward the ASEAN policies that will increase the importance of looking towards India. India is an emerging giant that has the ability to step up in Asia. With the proficient use of English, India is able to pass on the knowledge and drive the ASEAN’s Economic relationship better than China or Russia, as faced with higher language barriers. Moreover, India has cultivated democratic civilization from the colonization of the British Empire, similar to other nations of Southeast Asia, which are familiar with various heritage cultures that the British has brought them. The most important aspect in the author’s perspective is the fact that India is not aggressive and that they have courtesy. Through developing policies of the East through the “Look East” policy, it enabled India to establish a more smooth relationship with Asian countries comparing to China. China has imposed harsh policies towards democracy to the land above the South China Sea, which directly affect the ASEAN countries. From the above reasons, India, therefore, is an appropriate option in the establishment of a closer relationship with ASEAN, as the author has proposed relationship as INSEAN or IN-SEAN.

Keywords: IN-SEAN, INSEAN, look west policy, look east policy, ASEAN, India

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Authors: Sara Bonetti

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The use of quantitative data to support policies and justify investments has become imperative in many fields including the field of education. However, the topic of data literacy has only marginally touched the early care and education (ECE) field. In California, within the ECE workforce, there is a group of professionals working in policy and advocacy that use quantitative data regularly and whose educational and professional experiences have been neglected by existing research. This study aimed at analyzing these experiences in accessing, using, and producing quantitative data. This study utilized semi-structured interviews to capture the differences in educational and professional backgrounds, policy contexts, and power relations. The participants were three key professionals from county-level organizations and one working at a State Department to allow for a broader perspective at systems level. The study followed Núñez’s multilevel model of intersectionality. The key in Núñez’s model is the intersection of multiple levels of analysis and influence, from the individual to the system level, and the identification of institutional power dynamics that perpetuate the marginalization of certain groups within society. In a similar manner, this study looked at the dynamic interaction of different influences at individual, organizational, and system levels that might intersect and affect ECE professionals’ experiences with quantitative data. At the individual level, an important element identified was the participants’ educational background, as it was possible to observe a relationship between that and their positionality, both with respect to working with data and also with respect to their power within an organization and at the policy table. For example, those with a background in child development were aware of how their formal education failed to train them in the skills that are necessary to work in policy and advocacy, and especially to work with quantitative data, compared to those with a background in administration and/or business. At the organizational level, the interviews showed a connection between the participants’ position within the organization and their organization’s position with respect to others and their degree of access to quantitative data. This in turn affected their sense of empowerment and agency in dealing with data, such as shaping what data is collected and available. These differences reflected on the interviewees’ perceptions and expectations for the ECE workforce. For example, one of the interviewees pointed out that many ECE professionals happen to use data out of the necessity of the moment. This lack of intentionality is a cause for, and at the same time translates into missed training opportunities. Another interviewee pointed out issues related to the professionalism of the ECE workforce by remarking the inadequacy of ECE students’ training in working with data. In conclusion, Núñez’s model helped understand the different elements that affect ECE professionals’ experiences with quantitative data. In particular, what was clear is that these professionals are not being provided with the necessary support and that we are not being intentional in creating data literacy skills for them, despite what is asked of them and their work.

Keywords: data literacy, early childhood professionals, intersectionality, quantitative data

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Authors: Ali Ait Si Mhamed, Rita Kasa, Hans Vossensteyn

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Kazakhstan is the eight largest country on the globe, in terms of the territory, it is rich in natural resources and is developing dynamically. Kazakhstan strives to become one of the top 30 global economies by 2050. This goal preconditions intensive reforms in all sectors of economy, including higher education. This paper focuses on the higher education funding reforms that take place in Kazakhstan and their alignment with the strategic goals of national development. Currently, the government funds higher education costs for only a limited number of students while the majority of students pay full cost covering tuition fees. Only students with high examination scores at the end of the secondary education are eligible to be admitted to publically funded study places in higher education. While this merit-based higher education funding model is overall well-received in the country, there is also a discourse calling to change the existing approach of higher education funding. This paper draws on interviews with national policy makers and leadership at institutions of higher education in Kazakhstan collected during 2016. It seeks to answer a question about how well the current higher education funding mechanism is aligned with the strategic development goals in higher education. The paper discusses how stakeholders see the fit between the current higher education funding mechanism and the ability of higher education institutions to achieve the aims of national strategic development.

Keywords: higher education reform, higher education funding, higher education policy, Kazakhstan

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