Search results for: knowledge management in training

Authors: Ernest Tambo, Ghislaine Madjou, Jeanne Y. Ngogang, Shenglan Tang, Zhou XiaoNong

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Implementing national to community-based 'One Health' surveillance approach for human, animal and environmental consequences mitigation offers great opportunities and value-added in sustainable development and wellbeing. 'One Health' surveillance approach global partnerships, policy commitment and financial investment are much needed in addressing the evolving threats and epidemics crises mitigation in African countries. The paper provides insights onto how China-Africa health development cooperation in promoting “One Health” surveillance approach in response advocacy and mitigation. China-Africa health development initiatives provide new prospects in guiding and moving forward appropriate and evidence-based advocacy and mitigation management approaches and strategies in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). Early and continuous quality and timely surveillance data collection and coordinated information sharing practices in malaria and other diseases are demonstrated in Comoros, Zanzibar, Ghana and Cameroon. Improvements of variety of access to contextual sources and network of data sharing platforms are needed in guiding evidence-based and tailored detection and response to unusual hazardous events. Moreover, understanding threats and diseases trends, frontline or point of care response delivery is crucial to promote integrated and sustainable targeted local, national “One Health” surveillance and response approach needs implementation. Importantly, operational guidelines are vital in increasing coherent financing and national workforce capacity development mechanisms. Strengthening participatory partnerships, collaboration and monitoring strategies in achieving global health agenda effectiveness in Africa. At the same enhancing surveillance data information streams reporting and dissemination usefulness in informing policies decisions, health systems programming and financial mobilization and prioritized allocation pre, during and post threats and epidemics crises programs strengths and weaknesses. Thus, capitalizing on “One Health” surveillance and response approach advocacy and mitigation implementation is timely in consolidating Africa Union 2063 agenda and Africa renaissance capabilities and expectations.

Keywords: Africa, one health approach, surveillance, response

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Authors: Kari Björn, Mikael Soini

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Higher Education system reforms, especially Finnish system of Universities of Applied Sciences in 2014 are discussed. The new steering model is based on major legislative changes, output-oriented funding and open information. The governmental steering reform, especially the financial model and the resulting institutional level responses, such as a curriculum reforms are discussed, focusing especially in engineering programs. The paper is motivated by management need to establish objective steering-related performance indicators and to apply them consistently across all educational programs. The close relationship to governmental steering and funding model imply that internally derived indicators can be directly applied. Metropolia University of Applied Sciences (MUAS) as a case institution is briefly introduced, focusing on engineering education in Information and Communications Technology (ICT), and its related programs. The reform forced consolidation of previously separate smaller programs into fewer units of student application. New curriculum ICT students have a common first year before they apply for a Major. A framework of parallel and longitudinal comparisons is introduced and used across Majors in two campuses. The new externally introduced performance criteria are applied internally on ICT Majors using data ex-ante and ex-post of program merger.  A comparative performance of the Majors after completion of joint first year is established, focusing on previously omitted Majors for completeness of analysis. Some new research questions resulting from transfer of Majors between campuses and quota setting are discussed. Practical orientation identifies best practices to share or targets needing most attention for improvement. This level of analysis is directly applicable at student group and teaching team level, where corrective actions are possible, when identified. The analysis is quantitative and the nature of the corrective actions are not discussed. Causal relationships and factor analysis are omitted, because campuses, their staff and various pedagogical implementation details contain still too many undetermined factors for our limited data. Such qualitative analysis is left for further research. Further study must, however, be guided by the relevance of the observations.

Keywords: engineering education, integrated curriculum, learning outcomes, performance measurement

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Authors: Raj Chavan

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At present, the United States is home to more than 14,000 Water Resource Recovery Facilities (WRRFs), of which approximately 35% have implemented nutrient limits of some kind. These WRRFs contribute 10 to 15% of the total nutrient burden to surface rivers in the United States and account for approximately 1% of total power demand and 2% of total greenhouse gas emissions (GHG). There are several factors that have influenced the development of densification technologies in the direction of more compact and energy-efficient nutrient removal processes. Prior to surface water discharge, existing facilities that necessitate capacity expansion or biomass densification for greater treatability within the same footprint are being subjected to stricter nutrient removal requirements. Densification of activated sludge as a method for nutrient removal and process intensification at WRRFs has garnered considerable attention in recent times. The biological processes take place within the aerobic sediment granules, which form the basis of the technology. The possibility of generating granular sludge through continuous (or conventional) activated sludge processes (CAS) or densification of biomass through the transfer of activated sludge flocs to a denser biomass aggregate as an exceptionally efficient intensification technique has generated considerable interest. This presentation aims to furnish attendees with a foundational comprehension of densification through the illustration of practical concerns and insights. The subsequent subjects will be deliberated upon. What are some potential techniques for producing and preserving densified granules? What processes are responsible for the densification of biological flocs? How do physical selectors contribute to the process of biological flocs becoming denser? What viable strategies exist for the management of densified biological flocs, and which design parameters of physical selection influence the retention of densified biological flocs? determining operational solutions for floc and granule customization in order to meet capacity and performance objectives? The answers to these pivotal questions will be derived from existing full-scale treatment facilities, bench-scale and pilot-scale investigations, and existing literature data. By the conclusion of the presentation, the audience will possess a fundamental comprehension of the densification concept and its significance in attaining effective effluent treatment. Additionally, case studies pertaining to the design and operation of densification procedures will be incorporated into the presentation.

Keywords: densification, intensification, nutrient removal, granular sludge

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Authors: Rommila Chandra, Harshika Choudhary

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The present-day tourism sector is globally developing at a fast pace, searching for new ideas and new venues. In the Indian Himalayan Region (IHR), tourism has experienced a vast growth and continuous diversification over the last few years, thus becoming one of the fastest-growing economic sectors in India. With its majestic landscape, high peaks, rich floral and faunal diversity, and cultural history, the IHR has continuously attracted tourists and pilgrims from across the globe. The IHR has attracted a vast range of visitors who seek adventure sports, natural and spiritual solace, peace, cultural assets, food, and festivals, etc. Thus, the multi-functionality of the region has turned tourism into a key component of economic growth for the rural communities in the hills. For the local mountain people, it means valuable economic opportunity for income generation, and for the government and entrepreneurs, it brings profits. As the urban cities gain attention and investment in India, efforts have to be made to protect, safeguard, and strengthen the cultural, spiritual, and natural heritage of IHR for sustainable livelihood development. Furthermore, the socio-economic and environmental insecurities, along with geographical isolation, adds to the challenging survival in the tough terrains of IHR, creating a major threat of outmigration, land abandonment, and degradation. The question the paper intends to answer is: whether the rural community of IHR is aware of the new global trends in rural tourism and the extent of their willingness to adapt to the evolving tourism industry, which impacts the rural economy, including sustainable livelihood opportunity. The objective of the paper is to discuss the integrated nature of rural tourism, which widely depends upon natural resources, cultural heritage, agriculture/horticulture, infrastructural development, education, social awareness, and willingness of the locals. The sustainable management of all these different rural activities can lead to long-term livelihood development and social upliftment. It highlights some gap areas and recommends fewcommunity-based coping measures which the local people can adopt amidst the disorganized sector of rural tourism. Lastly, the main contribution is the exploratory research of the rural tourism vulnerability in the IHR, which would further help in studying the resilience of the tourism sector in the rural parts of a developing nation.

Keywords: community-based approach, sustainable livelihood development, Indian Himalayan region, rural tourism

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Authors: Nozar Kishi, Babak Kamrani, Filmon Habte

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Natural hazards such as earthquakes and tropical storms, are very frequent and highly destructive in Japan. Japan experiences, every year on average, more than 10 tropical cyclones that come within damaging reach, and earthquakes of moment magnitude 6 or greater. We have developed stochastic catastrophe models to address the risk associated with the entire suite of damaging events in Japan, for use by insurance, reinsurance, NGOs and governmental institutions. KCC’s (Karen Clark and Company) catastrophe models are procedures constituted of four modular segments: 1) stochastic events sets that would represent the statistics of the past events, hazard attenuation functions that could model the local intensity, vulnerability functions that would address the repair need for local buildings exposed to the hazard, and financial module addressing policy conditions that could estimates the losses incurring as result of. The events module is comprised of events (faults or tracks) with different intensities with corresponding probabilities. They are based on the same statistics as observed through the historical catalog. The hazard module delivers the hazard intensity (ground motion or wind speed) at location of each building. The vulnerability module provides library of damage functions that would relate the hazard intensity to repair need as percentage of the replacement value. The financial module reports the expected loss, given the payoff policies and regulations. We have divided Japan into regions with similar typhoon climatology, and earthquake micro-zones, within each the characteristics of events are similar enough for stochastic modeling. For each region, then, a set of stochastic events is developed that results in events with intensities corresponding to annual occurrence probabilities that are of interest to financial communities; such as 0.01, 0.004, etc. The intensities, corresponding to these probabilities (called CE, Characteristics Events) are selected through a superstratified sampling approach that is based on the primary uncertainty. Region specific hazard intensity attenuation functions followed by vulnerability models leads to estimation of repair costs. Extensive economic exposure model addresses all local construction and occupancy types, such as post-linter Shinand Okabe wood, as well as concrete confined in steel, SRC (Steel-Reinforced Concrete), high-rise.

Keywords: typhoon, earthquake, Japan, catastrophe modelling, stochastic modeling, stratified sampling, loss model, ERM

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Authors: Ellis Kofi Akwaa-Sekyi, Jordi Moreno Gené

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Managerial actions which negatively profile banks and impair corporate reputation are addressed through effective internal control systems. Disregard for acceptable standards and procedures for granting credit have affected bank loan portfolios and could be cited for the crises in some European countries. The study intends to determine the effectiveness of internal control systems, investigate whether perceived agency problems exist on the part of board members and to establish the relationship between internal controls and credit risk among listed banks in the European Union. Drawing theoretical support from the behavioural compliance and agency theories, about seventeen internal control variables (drawn from the revised COSO framework), bank-specific, country, stock market and macro-economic variables will be involved in the study. A purely quantitative approach will be employed to model internal control variables covering the control environment, risk management, control activities, information and communication and monitoring. Panel data from 2005-2014 on listed banks from 28 European Union countries will be used for the study. Hypotheses will be tested and the Generalized Least Squares (GLS) regression will be run to establish the relationship between dependent and independent variables. The Hausman test will be used to select whether random or fixed effect model will be used. It is expected that listed banks will have sound internal control systems but their effectiveness cannot be confirmed. A perceived agency problem on the part of the board of directors is expected to be confirmed. The study expects significant effect of internal controls on credit risk. The study will uncover another perspective of internal controls as not only an operational risk issue but credit risk too. Banks will be cautious that observing effective internal control systems is an ethical and socially responsible act since the collapse (crisis) of financial institutions as a result of excessive default is a major contagion. This study deviates from the usual primary data approach to measuring internal control variables and rather models internal control variables in a quantitative approach for the panel data. Thus a grey area in approaching the revised COSO framework for internal controls is opened for further research. Most bank failures and crises could be averted if effective internal control systems are religiously adhered to.

Keywords: agency theory, credit risk, internal controls, revised COSO framework

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Authors: Ahmed Gonnah, Omar Masoud, Mohamed Abdel-Wahab, Ahmed ElMosalamy, Abdulrahman Al-Naseem

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Introduction: Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with the highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple-areolar distortion, scarring and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option. Methods: A literature search was performed on the databases EMBASE. MEDLINE/PubMed, Google scholar and Ovid, for English language papers published between 1st of January 2000 and 17th of March 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were ‘HIFU’, ‘High-Intensity Focused Ultrasound’, ‘Fibroadenoma’, ‘Breast’, ‘Lesion’. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Recently, a thermal ablative technique, High Intensity Focused Ultrasound (HIFU), was found to be a safe, non-invasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients’ satisfaction with the cosmetic results and future recommendation of the procedure to other patients. Conclusion: Overall, HIFU is a well-tolerated treatment associated with a low risk of complications that can potentially include erythema, skin discoloration and bruising, with the majority of this self-resolving shortly after the procedure.

Keywords: ultrasound, HIFU, breast, efficacy, side effects, fibroadenoma

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Authors: Zulkifli Yusop

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The severity of December 2014 flood on the east coast of Peninsular Malaysia has raised concern over the adequacy of existing land use practices and policies. This article assesses flood responses to selective logging, plantation establishment (oil palm and rubber) and their subsequent management regimes. The hydrological impacts were evaluated on two levels: on-site (mostly in the upstream) and off-site to reflect the cumulative impact at downstream. Results of experimental catchment studies suggest that on-site impact of flood could be kept to a minimum when selecting logging strictly adhere to the existing guidelines. However, increases in flood potential and sedimentation rate were observed with logging intensity and slope steepness. Forest conversion to plantation show the highest impacts. Except on the heavily compacted surfaces, the ground revegetation is usually rapid within two years upon the cessation of the logging operation. The hydrological impacts of plantation opening and replanting could be significantly reduced once the cover crop has fully established which normally takes between three to six months after sowing. However, as oil palms become taller and the canopy gets closer, the cover crop tends to die off due to light competition, and its protecting function gradually diminishes. The exposed soil is further compacted by harvesting machinery which subsequently leads to greater overland flow and erosion rates. As such, the hydrological properties of matured oil palm plantations are generally poorer than in young plantation. In hilly area, the undergrowth in rubber plantation is usually denser compared to under oil palm. The soil under rubber trees is also less compacted as latex collection is done manually. By considering the cumulative effects of land-use over space and time, selective logging seems to pose the least impact on flood potential, followed by planting rubber for latex, oil palm and Latex Timber Clone (LTC). The cumulative hydrological impact of LTC plantation is the most severe because of its shortest replanting rotation (12 to 15 years) compared to oil palm (25 years) and rubber for latex (35 years). Furthermore, the areas gazetted for LTC are mostly located on steeper slopes which are more susceptible to landslide and erosion. Forest has limited capability to store excess rainfall and is only effective in attenuating regular floods. Once the hydrologic storage is exceeded, the excess rainfall will appear as flood water. Therefore, for big floods, rainfall regime has a much bigger influence than land use.

Keywords: selective logging, plantation, extreme rainfall, debris flow

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Authors: Rasha Shoumar

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Background: Since the onset of the Syria crisis in 2011, Jordan has hosted many Syrian refugees, many of which are residing in urban and rural areas. Vulnerability of refugees has increased due to the COVID-19 pandemic, adding to their already existing challenge in access to medical services, rendering them vulnerable to the complications of untreated medical conditions and amplifying their risk for severe COVID-19 disease. To improve health outcomes and access to health care services in a COVID-19 context, IOM (The International Organization for Migration) provided health services including awareness raising, direct primary health care through mobile teams and referrals to secondary services were extended to the vulnerable populations of refugees. Method: 6 community health volunteers were trained and deployed to different governorates to provide COVID-19 and non-communicable disease awareness and collect data rated to non-communicable disease and access to medical health services. Primary health care services were extended to 7 governorates through a mobile medical team, providing medical management. The collected Data was reviewed and analyzed. Results: 2150 refugees in rural areas were reached out by community health volunteers, out of which 78 received their medications through the Ministry of Health, 121 received their medications through different non-governmental organizations, 665 patients couldn’t afford buying any medications, 1286 patients were occasionally buying their medications when they were able to afford it. 853 patients received medications and follow up through IOM mobile clinics, the most common conditions were hypertension, diabetes, hyperlipidemia, anemia, heart disease, thyroid disease, asthma, seizures, and psychiatric conditions. 709 of these patients had more than 3 of the comorbidities. Multiple cases were referred for secondary and tertiary lifesaving interventions. Conclusion: Non communicable diseases are highly prevalent among refugee population in Jordan, access to medical services have proven to be a challenge in rural areas especially during the COVID-19 era, many of the patients have multiple uncontrolled medical conditions placing them at risk for complications and risk for severe COVID-19 disease. Deployment of mobile clinics to rural areas plays an essential role in managing such medical conditions, thus improving the continuum of health care approach, physical and mental wellbeing of refugees and reducing the risk for severe COVID-19 disease among this group, taking us one step forward toward universal health access.

Keywords: COVID-19, refugees, mobile clinics, primary health care

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Authors: Sema Cortoglu Koca

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Intellectual and industrial property rules, have a substantial effect on the sustainable development. Intellectual and industrial property rights, as temporary privileges over the products of intellectual activity, determine the supervision of information and technology. The level and scope of intellectual property protection thus influence the flow of technology between developed and developing countries. In addition, intellectual and industrial property rights are based on the notion of balance. Since they are time-limited rights, they reconcile private and public benefits. That is, intellectual and industrial property rights respond to both private interests and public interests by rewarding innovators and by promoting the dissemination of ideas, respectively. Intellectual and industrial property rights can, therefore, be a tool for sustainable development. If countries can balance their private and public interests according to their particular context and circumstances, they can ensure the intellectual and industrial property which promotes innovation and technology transfer relevant for them. People, enterprises and countries who need technology, can transfer developed technology which is acquired by people, enterprises and countries so as to decrease their technological necessity and improve their technology. Because of the significance of intellectual and industrial property rights on the technology transfer law as mentioned above, this paper is confined to intellectual and industrial property agreements especially technology transfer contracts. These are license contract, know-how contract, franchise agreement, joint venture agreement, management agreement, research and development agreement. In Turkey, technology transfer law is still a developing subject. For developing countries, technology transfer regulations are very important for their private international law because these countries do not know which technology transfer law is applicable when conflicts arise. In most technology transfer contracts having international elements, the parties choose a law to govern their contracts. Where the parties do not choose a law, either expressly or impliedly, and matters which is not excluded in party autonomy, the court has to determine the applicable law to contracts in a matter of capacity, material, the formal and essential validity of contracts. For determining the proper law of technology transfer contracts, it is tried to build a rule for applying all technology transfer contracts. This paper is confined to the applicable law to intellectual and industrial property agreements according to ‘5718 Turkish Act on Private International Law and Civil Procedure’ and ‘Regulation (EC) No 593/2008 of the European Parliament and of the Council of 17 June 2008 on the law applicable to contractual obligations (Rome I)’. Like these complex contracts, to find a rule can be really difficult. We can arrange technology transfer contracts in groups, and we can determine the rule and connecting factors to these groups. For the contracts which are not included in these groups, we can determine a special rule considering the characteristics of the contract.

Keywords: intellectual and industrial property agreements, Rome I regulation, technology transfer, Turkish act on private international law and civil procedure

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Authors: Mekroud Amel

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Introduction The rate of use by the elderly of emergency departments, operating rooms and intensive care units has increased worldwide. Emergency surgery is a context where evaluation is often insufficient, with incomplete information gathering. The aim of this work is to shed light on the frequent use of emergency surgeries by the elderly and their characteristics, as well as on the lack of geriatric assessment scores in the emergency room. Material : Prospective, observational and descriptive, monocentric study. Patients aged 65 and over, admitted for emergency surgery in the operating room, were counted. Emergency operating room including visceral surgery, urology, traumatology and neurosurgery. Parameters studied: Patient characteristics, degree of autonomy, type of surgical pathology, operative management times, preoperative evaluation, postoperative outcome Results : 192 patients were identified over 12 months, from 09.01.2017 to 08.31.2018 Age from 65 to 101 years, 79.81 years +/- 8.38. With predominance of the age group between [65-75 years] 41.1% Female predominance, Sexratio = 0.81 Elderly subjects with total motor autonomy are in the majority at 57.8% Subjects without pathological ATCD represent 12.5% of cases Those who are on only one type of medication or without any treatment are at 36.9% Discussion : The emergency operative care of the elderly patient for a surgical or traumatological pathology is characterized by many specificities linked first to the emergency context, where the evaluation is often insufficient, besides the fact that the elderly patient has particularities requiring reception in centers with experience in the care of this category of patient, or, failing that, a center which uses the minimum of geriatric evaluation scores which are simplified for the emergency departments. In our hospital, we have not yet made this evaluation routine in the emergency room and this delay in the introduction of these scores can be directly attributed to the covid 19 pandemic. Besides the standard preoperative assessment, only 43.2% of patients were assessed in the preoperative period by an anesthesiologist. Traumatological emergencies come first 68.2% followed by visceral emergencies 19.2% (including proctological, urological emergencies), neurosurgical emergencies 7.8% and finally peripheral emergency surgery all acts combined 4.7%. Hospital stay at 9.6 +/- 16.8 days, average operability time of 4.5 +/- 3 days. Death rate at 7.29% Conclusion This work has demonstrated the major impact of emergency surgery, which remains curable for the most part, on the elderly patient despite total motor and cognitive autonomy preoperatively. The improvement of the preoperative evaluation, the reduction of the operating time and enhanced recovery after surgery, with personalized protocols, are the only guarantee for the resumption of preoperative autonomy in these patients.

Keywords: emergency surgery, elderly patients, preoperative geriatric scores, curable emergency surgical pathologies

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Authors: Lacheheb Dhia Eddine Zakaria, Ballout Amor

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Today, it is necessary to be thrifty for its planet, on one hand the space being a rare, nonrenewable resource, and on the other hand the ecological, economic and social cost of the urban sprawl. It is commonly asserted that the promotion of a more compact and dense city has a positive effect in terms of public costs of investment, functioning and costs for the citizens and the users of the city. It is clear that the modes urban development management have to evolve profoundly, in particular towards a densification favourable to the raising of the urban quality through an ideal urban density on the scale of the individual housing estate. The lot as an individual housing estate was adopted as an alternative development model to the collective housing, thought in an anthropocentric perspective to emerge as a quality model where the density plays an important role, by being included in operations of a global coherence, in an optimal organization without forgetting the main importance of the deadlines of construction and the finalization of the works. The image of eternal construction site inflicted to our cities explains the renewed interest for the application of the regulatory framework and the completion of these limited operations without global coherence, which are summed up in our case to a ground cut in plots of land, sold then built independently without being finished, and support the relevance of the essential question of the improvement of the outside aspect bound to the appearance which can be revealed as a so important factor for a better use and a better acceptance of its housing environment, that the ratio of a number of houses on a plot of land or the number of square meters by house. To demonstrate the impact of the completion degree of the subdivision dwellings, roads system and urban public utilities on the density or the densification and therefore on the urban quality, we studied two residential subdivisions, the private subdivision Sellam and the subdivision El Imane with a common situation, and a different land surface, density and cutting, being occupied by various social classes, with different needs and different household average size. The approach of this work is based on the typo morphological analysis to reveal the differences in the degrees of completions of the subdivision’s built environment and on the investigation, by a household’s survey, to demonstrate importance of the degree of completion and to reveal the conditions of qualitative densification favourable and convenient to a better subdivision’s appropriation.

Keywords: subdivision, degree of completion, densification, urban quality

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Authors: Jason Hoellwarth, Atiya Oomatia, Anuj Chavan, Kevin Tetsworth, Munjed Al Muderis

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Introduction: Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Method: Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma. Result: The average age at which DO commenced was 39.4±15.9 years, and seven patients had their amputation more than ten years prior (average 25.5±18.8 years). The residual femurs, on average, started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of the goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery: four events of inadequate regeneration were managed with continued lengthening to the desired goal followed by autograft placement harvested from contralateral femur reaming; one patient had the cerclage wires break, which required operative replacement. All patients had osseointegration performed at 355±123 days after the initial lengthening nail surgery. One patient had K-level >2 before DO, at a mean of 3.4±0.6 (2.6-4.4) years following osseointegration. Six patients had K-level >2. The 6-Minute Walk Test remained unchanged (267±56 vs. 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection. Conclusion: Extremely short residual femurs, which make TSP use troublesome, can be lengthened with externally controlled telescoping nails and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regeneration or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee’s expectations before beginning a potentially arduous process.

Keywords: osseointegration, limb lengthening, quality of life, amputation

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Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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Authors: Seng Sing Tan

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Clamping of the umbilical cord after birth is widely practiced as a part of labor management. Further improvements were proposed to produce a smaller, lighter and more comfortable clamp while still maintaining current standards of clamping. A detachable holder was also developed to facilitate the clamping process. This pilot study on the efficacy of the mini-clamp was conducted to evaluate a tightness of the seal and a firm grip of the clamp on the umbilical cord. The study was carried out at National University Hospital, using 5 sets of placental cord. 18 samples of approximate 10 cm each were harvested. The test results showed that the mini-clamp was able to stop the flow through the cord after clamping without rupturing the cord. All slip tests passed with a load of 0.2 kg. In the pressure testing, 30kPa of saline was exerted into the umbilical veins. Although there was no physical sign of fluid leaking through the end secured by the mini-clamp, the results showed the pressure was not able to sustain the pressure set during the tests. 12 out of the 18 test samples have more than 7% of pressure drop in 30 seconds. During the pressure leak test, it was observed on several samples that when pressurized, small droplets of saline were growing on the outer surface of the cord lining membrane. It was thus hypothesized that the pressure drop was likely caused by the perfusion of the injected saline through the Wharton’s jelly and the cord lining membrane. The average pressure in the umbilical vein is roughly 2.67kPa (20 mmHg), less than 10% of 30kPa (~225mmHg), set for the pressure testing. As such, the pressure set could be over-specified, leading to undesirable outcomes. The development of the mini-clamp was an attempt to increase the comfort of newly born babies while maintaining the usability and efficacy of hospital grade umbilical cord clamp. The pressure leak in this study would be unfair to fully attribute it to the design and efficacy of the mini-clamp. Considering the unexpected leakage of saline through the umbilical membrane due to over-specified pressure exerted on the umbilical veins, improvements can definitely be made to the existing experimental setup to obtain a more accurate and conclusive outcome. If proven conclusive and effective, the mini-clamp with a detachable holder could be a smaller and potentially cheaper alternative to existing umbilical cord clamps. In addition, future clinical trials could be conducted to determine the user-friendliness of the mini-clamp and evaluate its practicality in the clinical setting by labor ward clinicians. A further potential improvement could be proposed on the sustainability factor of the mini-clamp. A biodegradable clamp would revolutionise the industry in this increasingly environmentally sustainability world.

Keywords: leak test, mini-clamp, slip test, umbilical cord

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Authors: Peter Clutterbuck, Terry Rowlands, Owen Seamons

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In this paper we describe one critical research program within a complex, ongoing multi-year project (2010 to 2014 inclusive) with the overall goal to improve the learning outcomes for first year undergraduate commerce/business students within an Information Systems (IS) subject with very large enrolment. The single research program described in this paper is the analysis of student attitudes and decision making in relation to the availability of formative assessment feedback via Web-based real time conferencing and document exchange software (Adobe Connect). The formative assessment feedback between teaching staff and students is in respect of an authentic problem-based, team-completed assignment. The analysis of student attitudes and decision making is investigated via both qualitative (firstly) and quantitative (secondly) application of the Theory of Planned Behavior (TPB) with a two statistically-significant and separate trial samples of the enrolled students. The initial qualitative TPB investigation revealed that perceived self-efficacy, improved time-management, and lecturer-student relationship building were the major factors in shaping an overall favorable student attitude to online feedback, whilst some students expressed valid concerns with perceived control limitations identified within the online feedback protocols. The subsequent quantitative TPB investigation then confirmed that attitude towards usage, subjective norms surrounding usage, and perceived behavioral control of usage were all significant in shaping student intention to use the online feedback protocol, with these three variables explaining 63 percent of the variance in the behavioral intention to use the online feedback protocol. The identification in this research of perceived behavioral control as a significant determinant in student usage of a specific technology component within a virtual learning environment (VLE) suggests that VLEs could now be viewed not as a single, atomic entity, but as a spectrum of technology offerings ranging from the mature and simple (e.g., email, Web downloads) to the cutting-edge and challenging (e.g., Web conferencing and real-time document exchange). That is, that all VLEs should not be considered the same. The results of this research suggest that tertiary students have the technological sophistication to assess a VLE in this more selective manner.

Keywords: formative assessment feedback, virtual learning environment, theory of planned behavior, perceived behavioral control

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Authors: R. Zhankina, U. Zhanbyrbekuly, A. Tamadon, M. Askarov, R. Sherkhanov, D. Akhmetov, D. Saipiyeva, N. Keulimzhaev

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Male infertility affects about 15% of couples of reproductive age. Approximately 10–15% have azoospermia who have previously been diagnosed with male infertility. Azoospermia is regarded as the absence of spermatozoa in the ejaculate and is found in 10-15% of infertile men. Non-obstructive azoospermia is considered a cause of male infertility that is not amenable to drug therapy. Patients with non-obstructive azoospermia are unable to have their "own" children and have only options for adoption or use of donor sperm. Advances in assisted reproductive technologies such as intracytoplasmic sperm injection in vitro fertilization have significantly changed the management of patients with non-obstructive azoospermia. Advances in biotechnology have increased the options for treating patients with non-obstructive azoospermia. Mesenchymal stem cell therapy has been recognized as a new option for infertility treatment. Material and methods of the study: After obtaining informed consent, 5 patients diagnosed with non-obstructive azoospermia were included in an open, non-randomized study. The age of the patients ranged from 24 to 35 years. The examination was carried out before the start of treatment, which included biochemical blood tests, hormonal profile levels (luteinizing hormone, follicle-stimulating hormone, testosterone, prolactin, inhibin B); tests for tumor markers; genetic research. All studies were carried out in compliance with the requirements of Protocol No. 8 dated 06/09/20, approved by the Local Ethical Commission of NJSC "Astana Medical University". The control examination of patients was carried out after 6 months, by re-taking the program and hormonal profile (testosterone, luteinizing hormone, follicle-stimulating hormone, prolactin, inhibin B). Before micro-TESE of the testis, all 5 patients underwent myeloexfusion in the operating room. During the micro-TESE, autotransplantation of mesenchymal stem cells into the testicular network, previously cultured in a cell technology laboratory for 2 weeks, was performed. Results of the study: in all patients, the levels of total testosterone increased, the level of follicle-stimulating hormone decreased, the levels of luteinizing hormone returned to normal, the level of inhibin B increased. IVF with a positive result; another patient (20%) had spermatogenesis cells. Non-obstructive azoospermia and mesenchymal stem cells Conclusions: The positive results of this work serve as the basis for the application of a new cellular therapeutic approach for the treatment of non-obstructive azoospermia using mesenchymal stem cells.

Keywords: cell therapy, regenerative medicine, male infertility, mesenchymal stem cells

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Authors: Evrim Genc Kumtepe, Elif Toprak, Aylin Ozturk, Gamze Tuna, Hakan Kilinc, Irem Aydin Menderis

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Support services are very significant elements for all educational institutions in general; however, for distance learners, these services are more essential than traditional (face-to-face) counterparts. One of the most important reasons for this is that learners and instructors do not share the same physical environment and that distance learning settings generally require intrapersonal interactions rather than interpersonal ones. Some learners in distance learning programs feel isolated. Furthermore, some fail to feel a sense of belonging to the institution because of lack of self-management skills, lack of motivation levels, and the need of being socialized, so that they are more likely to fail or drop out of an online class. In order to overcome all these problems, support services have emerged as a critical element for an effective and sustainable distance education system. Within the context of distance education support services, it is natural to include technology-based and web-based services and also the related materials. Moreover, institutions in education sector are expected to use information and communication technologies effectively in order to be successful in educational activities and programs. In terms of the sustainability of the system, an institution should provide distance education services through ICT enabled processes to support all stakeholders in the system, particularly distance learners. In this study, it is envisaged to develop a model based on the current support services literature in the field of open and distance learning and the applications of the distance higher education institutions. Specifically, content analysis technique is used to evaluate the existing literature in the distance education support services, the information published on websites, and applications of distance higher education institutions across the world. A total of 60 institutions met the inclusion criteria which are language option (English) and availability of materials in the websites. The six field experts contributed to brainstorming process to develop and extract codes for the coding scheme. During the coding process, these preset and emergent codes are used to conduct analyses. Two coders independently reviewed and coded each assigned website to ensure that all coders are interpreting the data the same way and to establish inter-coder reliability. Once each web page is included in descriptive and relational analysis, a model of support services is developed by examining the generated codes and themes. It is believed that such a model would serve as a quality guide for future institutions, as well as the current ones.

Keywords: support services, open education, distance learning, support model

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Authors: Rebecca Zahra, Joseph G. Vella, Ernest Cachia

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The notion of cloud computing is rapidly gaining ground in the IT industry and is appealing mostly due to making computing more adaptable and expedient whilst diminishing the total cost of ownership. This paper focuses on the software as a service (SaaS) architecture of cloud computing which is used for the outsourcing of databases with their associated business processes. One approach for offering SaaS is basing the system’s architecture on multi-tenancy. Multi-tenancy allows multiple tenants (users) to make use of the same single application instance. Their requests and configurations might then differ according to specific requirements met through tenant customisation through the software. Despite the known advantages, companies still feel uneasy to opt for the multi-tenancy with data security being a principle concern. The fact that multiple tenants, possibly competitors, would have their data located on the same server process and share the same database tables heighten the fear of unauthorised access. Security is a vital aspect which needs to be considered by application developers, database administrators, data owners and end users. This is further complicated in cloud-based multi-tenant system where boundaries must be established between tenants and additional access control models must be in place to prevent unauthorised cross-tenant access to data. Moreover, when altering the database state, the transactions need to strictly adhere to the tenant’s known business processes. This paper focuses on the fact that security in cloud databases should not be considered as an isolated issue. Rather it should be included in the initial phases of the database design and monitored continuously throughout the whole development process. This paper aims to identify a number of the most common security risks and threats specifically in the area of multi-tenant cloud systems. Issues and bottlenecks relating to security risks in cloud databases are surveyed. Some techniques which might be utilised to overcome them are then listed and evaluated. After a description and evaluation of the main security threats, this paper produces a list of software requirements to ensure that proper security policies are implemented by a software development team when designing and implementing a multi-tenant based SaaS. This would then assist the cloud service providers to define, implement, and manage security policies as per tenant customisation requirements whilst assuring security for the customers’ data.

Keywords: cloud computing, data management, multi-tenancy, requirements, security

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Authors: Emma Plante, Charles Ekwunwa, Diego Illanes

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Introduction: Serum Sickness-Like Reaction (SSLR) is an inflammatory immune response characterized by a rash, polyarthralgias, and fever. SSLR usually occurs in response to a new medication (most commonly antibiotics, anticonvulsants, or antiinflammatory agents) and is believed to involve the formation of drug-specific immune complexes. Here we present a case of a 16-year-old female patient who developed an SSLR in response to the D-mannose-containing over-the-counter supplement, Uqora, used to promote bladder health. Methodology: The methodology for this study included a thorough literature search for other cases of SSLR associated with D-Mannose containing products. Data collection was performed through a review of the patient’s medical record, including history, physical examination, relevant laboratory results, and treatment plan. Findings: A 16-year-old female with a history of overactive bladder and anemia presented with a diffuse urticarial rash, headaches, joint pain, and swelling for three days. Her medications included oral contraceptive pills, iron, mirabegron, UQora, and a probiotic. Physical examination revealed a diffuse urticarial rash, and her musculoskeletal exam revealed swelling and tenderness in her wrists. Her CBC, basic metabolic panel, liver function panel, lyme titers, and urinalysis were all within normal limits. The patient was referred to an allergist, who diagnosed her with SSLR. All medications were discontinued, and she was treated with a 7-day course of prednisone and cetirizine. Her symptoms resolved, and her medications were slowly resumed sequentially over several months. However, UQora triggered a recurrence of her symptoms, and it was identified as the culprit medication. Consequently, UQora was permanently discontinued, and the patient has remained symptom-free. Conclusion: This case report describes the first documented case of SSLR caused by UQora (active ingredient D-mannose). D-Mannose is a monosaccharide found in many plants and fruits, and it is commonly used to prevent urinary tract infections. While the clinical features and timeline, in this case, were typical of SSLR, UQora as the trigger was highly unusual. Clinicians should be aware of the diverse triggers of SSLR and the importance of prompt identification and management to enhance patient safety. It is possible D-mannose was not the trigger, and further research is necessary to better understand the potential therapeutic applications of D-mannose, as well as the potential risks and interactions.

Keywords: serum sickness-like reaction, d-mannose, hypersensitivity reaction, urticaria

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Authors: Michael Vieth, Aric Schadler, Hubert Ballard, J. A. Bauer, Pratibha Thakkar

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Introduction: Congenital diaphragmatic hernia (CDH) is a condition characterized by the herniation of abdominal contents into the thoracic cavity requiring postnatal surgical repair. Previous literature suggests improved CDH outcomes at high-volume regional referral centers compared to low-volume centers. The purpose of this study was to examine CDH outcomes at Kentucky Children’s Hospital (KCH), a low-volume center, compared to the Congenital Diaphragmatic Hernia Study Group (CDHSG). Methods: A retrospective chart review was performed at KCH from 2007-2019 for neonates with CDH, and then subdivided into two cohorts: those requiring ECMO therapy and those not requiring ECMO therapy. Basic demographic data and measures of mortality and morbidity including ventilator days and length of stay were compared to the CDHSG. Measures of morbidity for the ECMO cohort including duration of ECMO, clinical bleeding, intracranial hemorrhage, sepsis, need for continuous renal replacement therapy (CRRT), need for sildenafil at discharge, timing of surgical repair, and total ventilator days were collected. Statistical analysis was performed using IBM SPSS Statistics version 28. One-sample t-tests and one-sample Wilcoxon Signed Rank test were utilized as appropriate.Results: There were a total of 27 neonatal patients with CDH at KCH from 2007-2019; 9 of the 27 required ECMO therapy. The birth weight and gestational age were similar between KCH and the CDHSG (2.99 kg vs 2.92 kg, p =0.655; 37.0 weeks vs 37.4 weeks, p =0.51). About half of the patients were inborn in both cohorts (52% vs 56%, p =0.676). KCH cohort had significantly more Caucasian patients (96% vs 55%, p=<0.001). Unadjusted mortality was similar in both groups (KCH 70% vs CDHSG 72%, p =0.857). Using ECMO utilization (KCH 78% vs CDHSG 52%, p =0.118) and need for surgical repair (KCH 95% vs CDHSG 85%, p =0.060) as proxy for severity, both groups’ mortality were comparable. No significant difference was noted for pulmonary outcomes such as average ventilator days (KCH 43.2 vs. CDHSG 17.3, p =0.078) and home oxygen dependency (KCH 44% vs. CDHSG 24%, p =0.108). Average length of hospital stay for patients treated at KCH was similar to CDHSG (64.4 vs 49.2, p=1.000). Conclusion: Our study demonstrates that outcome in CDH patients is independent of center’s case volume status. Management of CDH with a standardized approach in a low-volume center can yield similar outcomes. This data supports the treatment of patients with CDH at low-volume centers as opposed to transferring to higher-volume centers.

Keywords: ECMO, case volume, congenital diaphragmatic hernia, congenital diaphragmatic hernia study group, neonate

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Authors: Lisa Monteiro, Jacqueline Saliba, Nadia Saiyouri, Humberto Y. Godoy

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Theevolution of the global environmental context incites companies to reduce their impact by reusing local materials and promoting circular economy. Dredged sediments represent a potential source of materials due to their large volume. Indeed, the dredging operations carried out in Gironde alone generated an annual volume of sediment of approximately 9 million m³. Moreover, on the eve of the evolution of laws concerning dredging practices, the recovery of sediments is necessary to create a viable economy for their management. This thesis work is oriented towards the development of an ecological binder from the fine fraction of untreated dredged sediments. In fact, their physico-chemical properties make them favorable for the synthesis of geopolymer, current competitor of cement, thanks to its lower carbon footprint and environmental impact. However, several obstacles must be overcome before implementing this new family of materials: the use of sediments without thermal or chemical treatment, the absence of a formulation approach, ignorance of the reactions produced, etc. During the first year of the thesis, a physico-chemical characterization of the sediments made it possible to validate their use as precursors forgeopolymerization according to three criteria: their fineness, their mineralogical composition, and the percentage of amorphous phase. Following these results, several formulations have been defined, taking into account the environmental impact. The sediments were activated with an alkaline solution of sodium hydroxide and sodium silicate. Two other formulations with cement and blast furnace slag have been defined for comparison. The results highlighted the possibility of forming geopolymers from untreated and still wet dredged sediments. The development of structural bonds through the formation of hydrated sodium aluminosilicate thus leads to higher strengths at 90 days (4.78 MPa) than a mixture with cement (0.75 MPa). A 30% gain in CO₂ emissions has also been obtained compared to cement. In order to reduce the uncertainties linked to the absence of a formulation approach, to optimize the number of experiments to be carried out in the laboratory, and to obtain an optimal formulation, an analysis by mixing plan was conducted in order to frame the responses according to the proportions of the constituents. Following the obtaining of an optimal binder, the work will focus on the study of the durability and the interspecific variability of the sediments on the mechanical properties by testing the binder developed with different sediments dredged from the Bordeaux estuary. , the Grand Port Maritime of Bayonne, La Rochelle, and the Bassinsd'Arcachon.

Keywords: compressive strength, dredged sediments, ecological binder, geopolymers

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Authors: M. Maleczek, Leszek Bogdan, Kazimierz Drabczyk, Agnieszka Iwan

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Crystalline silicon (Si) solar cells are the main product in the market among the various photovoltaic technologies concerning such advantages as: material richness, high carrier mobilities, broad spectral absorption range and established technology. However, photovoltaic technology on the stiff substrates are heavier, more fragile and less cost-effective than devices on the flexible substrates to be applied in special applications. The main goal of our work was to incorporate silicon solar cells into various fabric, without any change of the electrical and mechanical parameters of devices. This work is realized for the GEKON project (No. GEKON2/O4/268473/23/2016) sponsored by The National Centre for Research and Development and The National Fund for Environmental Protection and Water Management. In our work, the polyamide or polyester fabrics were used as a flexible substrate in the created devices. Applied fabrics differ in tensile and tear strength. All investigated polyamide fabrics are resistant to weathering and UV, while polyester ones is resistant to ozone, water and ageing. The examined fabrics are tight at 100 cm water per 2 hours. In our work, commercial silicon solar cells with the size 156 × 156 mm were cut into nine parts (called single solar cells) by diamond saw and laser. Gap and edge after cutting of solar cells were checked by transmission electron microscope (TEM) to study morphology and quality of the prepared single solar cells. Modules with the size of 160 × 70 cm (containing about 80 single solar cells) were created and investigated by electrical and mechanical methods. Weight of constructed module is about 1.9 kg. Three types of solar cell architectures such as: -fabric/EVA/Si solar cell/EVA/film for lamination, -backsheet PET/EVA/Si solar cell/EVA/film for lamination, -fabric/EVA/Si solar cell/EVA/tempered glass, were investigated taking into consideration type of fabric and lamination process together with the size of solar cells. In investigated devices EVA, it is ethylene-vinyl acetate, while PET - polyethylene terephthalate. Depend on the lamination process and compatibility of textile with solar cell an efficiency of investigated flexible silicon solar cells was in the range of 9.44-16.64 %. Multi folding and unfolding of flexible module has no impact on its efficiency as was detected by Instron equipment. Power (P) of constructed solar module is 30 W, while voltage about 36 V. Finally, solar panel contains five modules with the polyamide fabric and tempered glass will be produced commercially for different applications (dual use).

Keywords: flexible devices, mechanical properties, silicon solar cells, textiles

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Authors: Uwizera Egide

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Introduction: Dermatological conditions are one of the most burdensome diseases in our health system. Global studies suggest that around 1 in 3 people gets a skin disease at a certain point in their life, though this does not necessarily guarantee the urge to consult. For a high-ranking disease, it is surprising how there is not enough data to support its effect on the economy and the general health system impact. It is for that reason that this study’s aim is to identify the burden of dermatological conditions in Rwanda so as to have a general picture of what our population is going through in regards to dermatological conditions. Methods: We used a cross sectional retrospective study. Data were obtained from patient’s information recorded in an open clinic at CHUB in a period of six months from July to December of the year 2021. Results: The study had a total of 4600 patients who attended dermatology service in a period of six months from July to December of the year 2021. We found a list of 102 dermatological diseases that presented at variable rates. The most prevalent disease was atopic dermatitis, at a rate of 23%. About 90% of presented conditions had only one choice of treatment from the hospital pharmacy. Most patients who presented were between 18-35 years old and with a predominance of the female gender; the level of education was either secondary or University Degree in our study, 65.4% of patients who presented were female; the majority, around 45% were between 18-35 years old, mostly being single 56%. The majority came from Southern province as it is the location of the hospital. The insurance mostly used was community-based health insurance with 63.8%, followed by RSSB with 18.5%, MS/UR, and other private insurances. The frequency of group drugs prescribed among all dermatological medications, steroids were the most commonly given medications at a rate of 39%, followed by emollients, antibiotics, and antifungal. The drugs prescribed were mostly available in the pharmacy of CHUB, with 60% and 40% being found in pharmacies outside the hospital. Conclusion: Dermatological conditions are prevalent in all age groups and distributed through all socioeconomic classes. About 9.2% of patient who consulted CHUB in 2021 presented one Dermatological condition of which 40 % of prescribed medications is never found in Hospital urging a need to buy medication in private pharmacies with more expenses and a risk of not complying on prescribed medication if in case they can’t afford paying them outside the CHUB. This finding urges a need to avail all essential dermatological drugs in hospital pharmacies to allow our patients to get them for the proper compliance of prescribed drugs in the management of skin diseases.

Keywords: atopic dermatitis, CHUB (centre hopitalier univerisitaire de butare), dermatological condition, fungal infections

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Authors: Shan Jiang

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China is a country with a distinct cultural system. The Chinese Communist Party (CCP) is the central factor for everything, which naturally includes culture. There are quite a lot of cultural policies in China. The same goes for TV dramas. This paper traces the evolution of Chinese TV drama policy since 1986, examines the realistic situation behind the changes, and explores the structure and role of the government in shaping the process. Using historical documents and media reports, it first analyzes four key time nodes: 1986, 2003, 2012, and 2022. It shows how the policy shifts from restricting private production to opening up to public participation, from imposing one censorship to another, and from promoting some content to restricting some other area. It finds that the policy process is not simply rectilinear but rather wandering between deregulation and strengthening control. Secondly, it divides the policies into "basic" policies that establish the overall layout and more refined "strategic" policies that respond to more refined needs. It argues that the "basic" policy process is caused by China's political, economic, and cultural system reform, and then the "strategic" policy process is affected by more environmental factors, such as the government's follow-up development strategy, industrial development, technological innovation, and specific situations. Thirdly, it analysis the main body of the 104 policies from 2000 to 2021 and puts these subjects into China's power structure and cultural system, revealing that the policy issuers are all under the highest leadership of the Chinese Central Committee. Further, the paper challenges the typical description of Chinese cultural policy, which focuses on state control exclusively, identifies the forces within and outside the system that participate in or affect the policy-making process, and reveals the inter-subjective mechanism of policy change. In conclusion, the paper reveals that China's TV drama policy is under the unified leadership of the Party and the government, which greatly guarantees the consistency of the overall direction of cultural policy, that is, the right to speak firmly in the hands. The forces within the system can sometimes promote policy changes due to common development needs. However, folk discourse is only the object of control: when it breeds a certain amount of industrial space, the government will strengthen control over this space, suppress its potential "adverse effects", and instead provide protection and create conditions for the cultivation and growth of its mainstream discourse. However, the policy combination of basic policy and strategic policy, while having a strong effect and emergency capacity, also inhibits the innovation and diversification of the TV drama market. However, the state's substantial regulation will continue to exist in the future.

Keywords: TV Policy, China, policy process, cultural policy, culture management

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Authors: Byeongju Choi, Sanggil Lee, Kyung-Eun Lee

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Introduction: In the republic of Korea, the number of workers in the beauty industry has been increasing. Because the prevalence of hepatitis B carriers in Korea is higher than in other countries, the risk of blood-borne infection including viral hepatitis B and C, among the workers by using the sharp and contaminated instruments during procedure can be expected among beauty salon workers. However, the health care policies for the workers to prevent the blood-borne infection are not established due to the lack of evidences. Moreover, the workers in hair and nail salon were mostly employed at small businesses, where national mandatory systems or policies for workers’ health management are not applied. In this study, the risk of the viral hepatitis B and C from the job experiencing the hair and nail procedures in the mortality was assessed. Method: We conducted a retrospective review of the job histories and causes of death in the female deaths from 2006-2016. 132,744 of female deaths who had one more job experiences during their lifetime were included in this study. Job histories were assessed using the employment insurance database in Korea Employment Information Service (KEIS) and the causes of death were in death statistics produced by Statistics Korea. Case group (n= 666) who died from viral hepatitis was classified the death having record involved in ‘B15-B19’ as a cause of deaths based on Korean Standard Classification of Diseases(KCD) with the deaths from other causes, control group (n=132,078). The group of the workers in the beauty service industry were defined as the employees who had ever worked in the industry coded as ‘9611’ based on Korea Standard Industry Classification (KSIC) and others were others. Other than job histories, birth year, marital status, education level were investigated from the death statistics. Multiple logistic regression analysis were used to assess the risk of deaths from viral hepatitis in the case and control group. Result: The number of the deaths having ever job experiences at the hair and nail salon was 255. After adjusting confounders of age, marital status and education, the odds ratio(OR) for deaths from viral hepatitis was quite high in the group having experiences with working in the beauty service industry with 3.14(95% confidence interval(CI) 1.00-9.87). Other associated factors with increasing the risk of deaths from viral hepatitis were low education level(OR=1.34, 95% CI 1.04-1.73), married women (OR=1.42, 95% CI 1.02-1.97). Conclusion: The risk of deaths from viral hepatitis were high in the workers in the beauty service industry but not statistically significant, which might attributed from the small number of workers in beauty service industry. It was likely that the number of workers in beauty service industry could be underestimated due to their temporary job position. Further studies evaluating the status and the incidence of viral infection among the workers with consideration of the vertical transmission would be required.

Keywords: beauty service, viral hepatitis, blood-borne infection, viral infection

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Authors: Jonathan Turner, Julie Doyle, Laura O’Philbin, Dympna O’Sullivan

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People living with dementia should be at the centre of decision-making regarding goals for daily living. These goals include basic activities (dressing, hygiene, and mobility), advanced activities (finances, transportation, and shopping), and meaningful activities that promote well-being (pastimes and intellectual pursuits). However, there is limited involvement of people living with dementia in the design of technology to support their goals. A project is described that is co-designing intelligent computer-based support for, and with, people affected by dementia and their carers. The technology will support self-management, empower participation in shared decision-making with carers and help people living with dementia remain healthy and independent in their homes for longer. It includes information from the patient’s care plan, which documents medications, contacts, and the patient's wishes on end-of-life care. Importantly for this work, the plan can outline activities that should be maintained or worked towards, such as exercise or social contact. The authors discuss how to integrate care goal information from such a care plan with data collected from passive sensors in the patient’s home in order to deliver individualized planning and interventions for persons with dementia. A number of scientific challenges are addressed: First, to co-design with dementia patients and their carers computerized support for shared decision-making about their care while allowing the patient to share the care plan. Second, to develop a new and open monitoring framework with which to configure sensor technologies to collect data about whether goals and actions specified for a person in their care plan are being achieved. This is developed top-down by associating care quality types and metrics elicited from the co-design activities with types of data that can be collected within the home, from passive and active sensors, and from the patient’s feedback collected through a simple co-designed interface. These activities and data will be mapped to appropriate sensors and technological infrastructure with which to collect the data. Third, the application of machine learning models to analyze data collected via the sensing devices in order to investigate whether and to what extent activities outlined via the care plan are being achieved. The models will capture longitudinal data to track disease progression over time; as the disease progresses and captured data show that activities outlined in the care plan are not being achieved, the care plan may recommend alternative activities. Disease progression may also require care changes, and a data-driven approach can capture changes in a condition more quickly and allow care plans to evolve and be updated.

Keywords: care goals, decision-making, dementia, self-care, sensors

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Authors: Rashmi Uchil, A. H. Sequeira

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Post-liberalization era in India has seen an unprecedented growth of mergers, both domestic as well as cross-border deals. Indian organizations have slowly begun appreciating this inorganic method of growth. However, all is not well as is evidenced in the lowering value creation of organizations after mergers. Several studies have identified that organizational culture is one of the key factors that affects the success of mergers. But very few studies have been attempted in this realm in India. The current study attempts to identify the factors in the organizational culture variable that may be unique to India. It also focuses on the difference in the impact of organizational culture on merger of organizations in the manufacturing and service sectors in India. The study uses a mixed research approach. An exploratory research approach is adopted to identify the variables that constitute organizational culture specifically in the Indian scenario. A few hypotheses were developed from the identified variables and tested to arrive at the Grounded Theory. The Grounded Theory approach used in the study, attempts to integrate the variables related to organizational culture. Descriptive approach is used to validate the developed grounded theory with a new empirical data set and thus test the relationship between the organizational culture variables and the success of mergers. Empirical data is captured from merged organizations situated in major cities of India. These organizations represent significant proportions of the total number of organizations which have adopted mergers. The mix of industries included software, banking, manufacturing, pharmaceutical and financial services. Mixed sampling approach was adopted for this study. The first phase of sampling was conducted using the probability method of stratified random sampling. The study further used the non-probability method of judgmental sampling. Adequate sample size was identified for the study which represents the top, middle and junior management levels of the organizations that had adopted mergers. Validity and reliability of the research instrument was ensured with appropriate tests. Statistical tools like regression analysis, correlation analysis and factor analysis were used for data analysis. The results of the study revealed a strong relationship between organizational culture and its impact on the success of mergers. The study also revealed that the results were unique to the extent that they highlighted a marked difference in the manner of internalization of change of organizational culture after merger by the organizations in the manufacturing sector. Further, the study reveals that the organizations in the service sector internalized the changes at a slower rate. The study also portrays the industries in the manufacturing sector as more proactive and can contribute to a change in the perception of the said organizations.

Keywords: manufacturing industries, mergers, organizational culture, service industries

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Authors: Nivedhitha Venkatakrishnan

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Flooding in urban areas in India has become a usual ritual phenomenon and a nightmare to most cities, which is a consequence of man-made disruption resulting in disaster. The City planning in India falls short of withstanding hydro generated disasters. This has become a barrier and challenge in the process of development put forth by urbanization, high population density, expanding informal settlements, environment degradation from uncollected and untreated waste that flows into natural drains and water bodies, this has disrupted the natural mechanism of hazard protection such as drainage channels, wetlands and floodplains. The magnitude and the impact of the mishap was high because of the failure of development policies, strategies, plans that the city had adopted. In the current scenario, cities are becoming the home for future, with economic diversification bringing in more investment into cities especially in domains of Urban infrastructure, planning and design. The uncertainty of the Urban futures in these low elevated coastal zones faces an unprecedented risk and threat. The study on focuses on three major pillars of resilience such as Recover, Resist and Restore. This process of getting ready to handle the situation bridges the gap between disaster response management and risk reduction requires a shift in paradigm. The study involved a qualitative research and a system design approach (framework). The initial stages involved mapping out of the urban water morphology with respect to the spatial growth gave an insight of the water bodies that have gone missing over the years during the process of urbanization. The major finding of the study was missing links between traditional water harvesting network was a major reason resulting in a manmade disaster. The research conceptualized the ideology of a sponge city framework which would guide the growth through institutional frameworks at different levels. The next stage was on understanding the implementation process at various stage to ensure the shift in paradigm. Demonstration of the concepts at a neighborhood level where, how, what are the functions and benefits of each component. Quantifying the design decision with rainwater harvest, surface runoff and how much water is collected and how it could be collected, stored and reused. The study came with further recommendation for Water Mitigation Spaces that will revive the traditional harvesting network.

Keywords: flooding, man made disaster, resilient city, traditional harvesting network, waterbodies

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Authors: Soma Sarkar

Abstract:

A number of authors have recently argued that there are strong links between ecosystem services and sustainable development, particularly development efforts that aim to reduce rural poverty. We see two distinct routes by which the science of ecosystem services can contribute to both nature conservation and sustainable development. First, a thorough accounting of ecosystem services and a better understanding of how and at what rates ecosystems produce these services can be used to motivate payment for nature conservation. At least part of the generated funds can be used to compensate people who suffer lost economic opportunities to protect these services. For example, if rural poor are asked to take actions that reduce farm productivity to protect and regulate water supply, those farmers could be compensated for the reduced productivity they experience. When the benefits of natural ecosystems are explicitly quantified, those benefits are more valued both by the people who directly interact with the ecosystems and the governmental and other agencies that would have to pay for substitute sources of these services if these ecosystems should become impaired. Appreciating the value of ecosystem services can motivate increased conservation investment to prevent having to pay for substitutes later. This approach could be characterized as a ‘‘government investment’’ approach because the payments will generally come from beneficiaries outside of the local area, and a governmental or other agency is typically responsible for collecting and redistributing the funds. Second, a focus on the conservation of ecosystem services could improve the success of projects that attempt to both conserve nature and improve the welfare of the rural poor by fostering markets for the goods and services that local people produce or extract from ecosystems. These projects could be characterized as more ‘‘community based’’ because the goal is to foster the more organic, or grassroots, development of cottage industries, such as ecotourism, or the production of non-timber forest products, that are enhanced by better protection of local ecosystems. Using this framework, we discuss the factors that may have contributed to failure or success for several projects in the district of Purulia, one of the most backward districts of India and inhabited by indigenous group of people. A large majority of people in this district are dependent on environment based incomes for their sustenance. The erosion of natural resource base owing to poor governance in the district has led to the reductions in the household incomes of these people. The scale of our analysis is local or project level. The plight of poor has little to do with the production functions of ecosystem services. But for rural poor, at the local level, the status of ecosystem services can make a big difference in their daily lives.

Keywords: ecosystem services, governance, rural poor, community based natural resource management

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