Search results for: healthcare policy

Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

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Authors: Okpu Enoh Ndip Nkongho

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The type of political leadership in place impacts a state's economic development or underdevelopment directly and indirectly. One of the main challenges to Cameroon's economic development may be ineffective or misguided political leadership. The economy of the Cameroon state has declined significantly due to a number of factors, including a lack of effective and feasible economic policies, a reliance on crude oil that is excessive, tribal politics, the threat of insurgency, bribery, and corruption, violations of human rights, neglect of other sectors like science, technology, education, and transportation, and a careless attitude on the part of the administrators toward the general public. As a result, the standard of living has decreased, foreign exchange has decreased, and the value of the Cameroonian currency has depreciated. Therefore, from 2000 to 2023, this paper focused on the relationship between political leadership and economic development in Cameroon and offered suggestions for improving political leadership that will, in turn, lead to the country's economy getting back on track. The study employed a qualitative technique, with the framework for the investigation derived from the trait theory of leadership. According to the information provided above, the paper was able to conclude that there is a lack of cooperation between the three branches of government in Cameroon. This is shown in situations when one branch operates independently of the others and refuses to function as a backup when needed. The study recommended that the Executive collaborate closely with the National Assembly to speed action on some key legislation required to stimulate economic development. On the other hand, there is a need for more clarity and consistency in the government's policy orientation. There is no doubt that our current economic troubles are at least partially the result of a lack of economic policy leadership and confidence.

Keywords: politics, leadership, economic, development, Cameroon

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Authors: S. O. Okoro

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Some words become the catch phrase of a particular decade. Globalization, Openness, and Privatization are certainly among the most frequently encapsulation of 1990’s; the market is ‘in’, ‘the state is out’. In the 1970’s, there were many political economists who spoke of autarky as one possible response to global economic forces. Be self-contained, go it alone, put up barriers to trans-nationalities, put in place import-substitution industrialization policy and grow domestic industries. In 1990’s, the emasculation of the state is by no means complete, but there is an acceptance that the state’s power is circumscribed by forces beyond its control and potential leverage. Autarky is no longer as a policy option. Nigeria, since its emergence as an independent nation, has evolved two macroeconomic management regimes of the interventionist and market friendly styles. This paper investigates Nigeria’s growth performance over the periods incorporating these two regimes and finds that there is no structural break in Total Factor Productivity, (TFP) growth and besides, the TFP growth over the entire period of study 1970-2012 is very negligible and hence growth can only be achieved by the unsustainable factor accumulation. Another important finding of this work is that the openness-human capital interaction term has a significant impact on the TFP growth, but the sign of the estimated coefficient does not meet it a theoretical expectation. This is because the negative coefficient on the human capital outweighs the positive openness effect. The poor quality of human capital is considered to have given rise to this. Given these results a massive investment in the education sector is required. The investment should be targeted at reforms that go beyond mere structural reforms to a reform agenda that will improve the quality of human capital in Nigeria.

Keywords: globalization, emasculation, openness and privatization, total factor productivity

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Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

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Background: Soldiers' physical rehabilitation and long term health status has been hindered due to limited investment in and access to rehabilitation services. Home-based rehabilitation programmes could offer a potentially feasible alternative to facilitate long-term recovery. Objectives: To explore Sri Lankan soldiers' perceptions of barriers and facilitators to a home-based physical rehabilitation programme.Methods and Materials: We conducted qualitative semi-structured interviews with community re-integrated army veterans who had undergone unilateral lower limb amputation following war related trauma. Veterans were identified from five districts of Sri Lanka, based on a priori knowledge of veteran community settlements (Disabled Category Registry) obtained from Directorate of Rehabilitation, MoD, Sri Lanka. Individuals were stratified for purposive selection. The interview guide was developed from existing methods and adapted for context. Verbatim transcripts of interviews were analyzed for emerging themes using an inductive approach. Following consent, participants met the researcher (AW- a trained physiotherapist fluent in Sinhalese). Results: Twenty-five Interviews were conducted, totaling 7.2 hours of new data (Mean±SD: 0.28±0.11). All participants were male, aged 30-55 years (Mean±SD: 46.1±7.4), and had experienced traumatic amputation as a result of conflict. Twenty-four sub themes were identified. Inadequate space for exercises, absence of equipment and assistance to conduct the exercises at home, alongside absence of community healthcare services were all barriers. Burden of comorbidities, including chronic pain and disability level, were also barriers. Social support systems, including soldier societies, family, and kinship with other amputees, were seen as facilitators to an at-home programme. Motivation for independence was a strong indicator of engagement. Conclusion: Environment, chronic pain, and absence of well-established community health services were key barriers. Family and soldier support was a facilitator. Engagement with community healthcare providers (physiotherapist and primary care physicians) will be essential to the success of an at-home rehabilitation program.

Keywords: physical rehabilitation, home-based, soldiers, disability, lower-limb amputation, qualitative

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Authors: Demet Ozgur-Unluakin, Busenur Turkali, Ayse Karacaorenli

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Maintenance strategies can be classified into two types, which are reactive and proactive, with respect to the time of the failure and maintenance. If the maintenance activity is done after a breakdown, it is called reactive maintenance. On the other hand, proactive maintenance, which is further divided as preventive and predictive, focuses on maintaining components before a failure occurs to prevent expensive halts. Recently, the number of interacting components in a system has increased rapidly and therefore, the structure of the systems have become more complex. This situation has made it difficult to provide the right maintenance decisions. Herewith, determining effective decisions has played a significant role. In multi-component systems, many methodologies and strategies can be applied when a component or a system has already broken down or when it is desired to identify and avoid proactively defects that could lead to future failure. This study focuses on the comparison of various maintenance strategies on a multi-component dynamic system. Components in the system are hidden, although there exists partial observability to the decision maker and they deteriorate in time. Several predefined policies under corrective, preventive and predictive maintenance strategies are considered to minimize the total maintenance cost in a planning horizon. The policies are simulated via Dynamic Bayesian Networks on a multi-component system with different policy parameters and cost scenarios, and their performances are evaluated. Results show that when the difference between the corrective and proactive maintenance cost is low, none of the proactive maintenance policies is significantly better than the corrective maintenance. However, when the difference is increased, at least one policy parameter for each proactive maintenance strategy gives significantly lower cost than the corrective maintenance.

Keywords: decision making, dynamic Bayesian networks, maintenance, multi-component systems, reliability

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Authors: Philip A. Szlosek, M. Susan Guyer, Mary G. Barnum, Elizabeth M. Mullin

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In the United States, athletic training is a healthcare profession that encompasses the prevention, examination, diagnosis, treatment, and rehabilitation of injuries and medical conditions. Athletic trainers work under the direction of or in collaboration with a physician and are recognized by the American Medical Association as allied healthcare professionals. Internationally, this profession is often known as athletic therapy. As healthcare professionals, athletic trainers must be prepared for autonomous practice immediately after graduation. However, new athletic trainers have been shown to have clinical areas of strength and weakness.To better assess professional readiness and improve the preparedness of new athletic trainers, the factors of athletic training professional readiness must be defined. Limited research exists defining the holistic aspects of professional readiness needed for athletic trainers. Confirming the factors of professional readiness in athletic training could enhance the professional preparation of athletic trainers and result in more highly prepared new professionals. The objective of this study was to further explore and confirm the factors of professional readiness in athletic training. Authors useda qualitative design based in grounded theory. Participants included athletic trainers with greater than 24 months of experience from a variety of work settings from each district of the National Athletic Trainer’s Association. Participants took the demographic questionnaire electronically using Qualtrics Survey Software (Provo UT). After completing the demographic questionnaire, 20 participants were selected to complete one-on-one interviews using GoToMeeting audiovisual web conferencing software. IBM Statistical Package for the Social Sciences (SPSS, v. 21.0) was used to calculate descriptive statistics for participant demographics. The first author transcribed all interviews verbatim and utilized a grounded theory approach during qualitative data analysis. Data were analyzed using a constant comparative analysis and open and axial coding. Trustworthiness was established using reflexivity, member checks, and peer reviews. Analysis revealed four overarching themes, including management, interpersonal relations, clinical decision-making, and confidence. Management was categorized as athletic training services not involving direct patient care and was divided into three subthemes, including administration skills, advocacy, and time management. Interpersonal Relations was categorized as the need and ability of the athletic trainer to properly interact with others. Interpersonal relations was divided into three subthemes, including personality traits, communication, and collaborative practice. Clinical decision-making was categorized as the skills and attributes required by the athletic trainer whenmaking clinical decisions related to patient care. Clinical decision-making was divided into three subthemes including clinical skills, continuing education, and reflective practice. The final theme was confidence. Participants discussed the importance of confidence regarding relationships building, clinical and administrative duties, and clinical decision-making. Overall, participants explained the value of a well-rounded athletic trainer and emphasized that athletic trainers need communication and organizational skills, the ability to collaborate, and must value self-reflection and continuing education in addition to having clinical expertise. Future research should finalize a comprehensive model of professional readiness for athletic training, develop a holistic assessment instrument for athletic training professional readiness, and explore the preparedness of new athletic trainers.

Keywords: autonomous practice, newly certified athletic trainer, preparedness for professional practice, transition to practice skills

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Authors: Phenphak Horadee, Rodchares Hanrinth, Saithip Suttiruksa

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Inappropriate use of antibiotics has happened in several hospitals, Thailand. Drug use evaluation (DUE) is one strategy to overcome this difficulty. However, most community hospitals still encounter incomplete evaluation resulting overuse of antibiotics with high cost. Consequently, drug-resistant bacteria have been rising due to inappropriate antibiotic use. The aim of this study was to involve stakeholders in conceptualizing, developing, and prioritizing a feasible intervention strategy to promote and support appropriate antibiotic prescribing in a community hospital, Thailand. Study antibiotics included four antibiotics such as Meropenem, Piperacillin/tazobactam, Amoxicillin/clavulanic acid, and Vancomycin. The study was conducted for the 1-year period between March 1, 2018, and March 31, 2019, in a community hospital in the northeastern part of Thailand. Concept mapping was used in a purposive sample, including doctors (one was an administrator), pharmacists, and nurses who involving drug use evaluation of antibiotics. In-depth interviews for each participant and survey research were conducted to seek the problems for inappropriate use of antibiotics based on drug use evaluation system. Seventy-seven percent of DUE reported appropriate antibiotic prescribing, which still did not reach the goal of 80 percent appropriateness. Meropenem led other antibiotics for inappropriate prescribing. The causes of the unsuccessful DUE program were classified into three themes such as personnel, lack of public relation and communication, and unsupported policy and impractical regulations. During the first meeting, stakeholders (n = 21) expressed the generation of interventions. During the second meeting, participants who were almost the same group of people in the first meeting (n = 21) were requested to independently rate the feasibility and importance of each idea and to categorize them into relevant clusters to facilitate multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the idealist, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were distributed to participants (n = 21) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 29 feasible and crucial interventions in seven clusters: development of information technology system, establishing policy and taking it into the action plan, proactive public relations of the policy, action plan and workflow, in cooperation of multidisciplinary teams in drug use evaluation, work review and evaluation with performance reporting, promoting and developing professional and clinical skill for staff with training programs, and developing practical drug use evaluation guideline for antibiotics. These interventions are relevant and fit to several intervention strategies for antibiotic stewardship program in many international organizations such as participation of the multidisciplinary team, developing information technology to support antibiotic smart use, and communication. These interventions were prioritized for implementation over a 1-year period. Once the possibility of each activity or plan is set up, the proposed program could be applied and integrated into hospital policy after evaluating plans. Effectiveness of each intervention could be promoted to other community hospitals to promote and support antibiotic smart use.

Keywords: antibiotic, concept mapping, drug use evaluation, multidisciplinary teams

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Authors: Cheryl Forchuk, Sandra Fisman, Steve Cordes, Dan Catunto, Katherine Krakowski, Melissa Jeffrey, John D’Oria

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The discharge of youth aged 16-25 from hospital into homelessness is a prevalent issue despite research indicating social, safety, health and economic detriments on both the individual and community. Lack of stable housing for youth discharged into homelessness results in long-term consequences, including exacerbation of health problems and costly health care service use and hospital readmission. People experiencing homelessness are four times more likely to be readmitted within one month of discharge and hospitals must spend $2,559 more per client. Finding safe housing for these individuals is imperative to their recovery and transition back to the community. People discharged from hospital to homelessness experience challenges, including poor health outcomes and increased hospital readmissions. Youth are the fastest-growing subgroup of people experiencing homelessness in Canada. The needs of youth are unique and include supports related to education, employment opportunities, and age-related service barriers. This study aims to identify the needs of youth at risk of homelessness by evaluating the efficacy of the “Preventing Discharge to No Fixed Address – Youth” (NFA-Y) program, which aims to prevent youth from being discharged from hospital into homelessness. The program connects youth aged 16-25 who are inpatients at London Health Sciences Centre and St. Joseph’s Health Care London to housing and financial support. Supports are offered through collaboration with community partners: Youth Opportunities Unlimited, Canadian Mental Health Association Elgin Middlesex, City of London Coordinated Access, Ontario Works, and Salvation Army’s Housing Stability Bank. This study was reviewed and approved by Western University’s Research Ethics Board. A series of interviews are being conducted with approximately ninety-three youth participants at three time points: baseline (pre-discharge), six, and twelve months post-discharge. Focus groups with participants, health care providers, and community partners are being conducted at three-time points. In addition, administrative data from service providers will be collected and analyzed. Since homelessness has a detrimental effect on recovery, client and community safety, and healthcare expenditure, locating safe housing for psychiatric patients has had a positive impact on treatment, rehabilitation, and the system as a whole. If successful, the findings of this project will offer safe policy alternatives for the prevention of homelessness for at-risk youth, help set them up for success in their future years, and mitigate the rise of the homeless youth population in Canada.

Keywords: youth homelessness, no-fixed address, mental health, homelessness prevention, hospital discharge

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Authors: Martyn Queen, Diane Crone, Andrew Parker, Saul Bloxham

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Rationale: There is a growing body of evidence that supports the use of physical activity during and after cancer treatment. However, activity levels for patients remain low. As more cancer patients are treated successfully, and treatment costs continue to escalate, physical activity may be a promising adjunct to a person-centred healthcare approach to recovery. Aim: The aim was to further understand how physical activity may enhance the recovery process for a group of mixed-site cancer patients. Objectives: The research investigated longitudinal changes in physical activity and perceived the quality of life between two and six month’s post-exercise interventions. It also investigated support systems that enabled patients to sustain these perceived changes. Method: The respondent cohort comprised 14 mixed-site cancer patients aged 43-70 (11 women, 3 men), who participated in a two-phase physical activity intervention that took place at a university in the South West of England. Phase 1 consisted of an eight-week structured physical activity programme; Phase 2 consisted of four months of non-supervised physical activity. Semi-structured interviews took place three times over six months with each participant. Grounded theory informed the data collection and analysis which, in turn, facilitated theoretical development. Findings: Our findings propose three theories on the impact of physical activity for recovering cancer patients: 1) Knowledge gained through a structured exercise programme can enable recovering cancer patients to independently sustain physical activity to four-month follow-up. 2) Sustaining physical activity for six months promotes positive changes in the quality of life indicators of chronic fatigue, self-efficacy, the ability to self-manage and energy levels. 3) Peer support from patients facilitates adherence to a structured exercise programme and support from a spouse, or life partner facilitates independently sustained physical activity to four-month follow-up. Conclusions: This study demonstrates that qualitative research can provide an evidence base that could be used to support future care plans for cancer patients. Findings also demonstrate that a physical activity intervention can be effective at helping cancer patients recover from the side effects of their treatment, and recommends that physical activity should become an adjunct therapy alongside traditional cancer treatments.

Keywords: physical activity, health, cancer recovery, quality of life, support systems, qualitative, grounded theory, person-centred healthcare

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Authors: Germans Natuhwera, Peter Ellis, Acuda Wilson, Anne Merriman, Martha Rabwoni

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Objective: The aim of the study was to diagnose the socio-economic burden and impact of a diagnosis of cervical cancer (CC) in rural women in the context of low-resourced country Uganda, using a phenomenological enquiry. Methods: This was a multi-site phenomenological inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in southwestern, Little Hospice Hoima in Western, and Hospice Africa Uganda Kampala in central Uganda. A purposive sample of women with a histologically confirmed diagnosis of CC was recruited. Data was collected using open-ended audio-recorded interviews conducted in the native languages of participants. Interviews were transcribed verbatim in English, and Braun and Clarke’s (2019) framework of thematic analysis was used. Results: 13 women with a mean age of 49.2 and age range 29-71 participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A fuller reading of transcripts produced four major themes clustered under; (1) socioeconomic characteristics of women, (2) impact of CC on women’s relationships, (3) disrupted and impaired activities of daily living (ADLs), and (4) economic disruptions. Conclusions: A diagnosis of CC introduces significant socio-economic disruptions in a woman’s and her family’s life. CC causes disability, impairs the woman and her family’s productivity hence exacerbating levels of poverty in the home. High and expensive out-of-pocket expenditure on treatment, investigations, and transport costs further compound the socio-economic burden. Decentralizing cancer care services to regional centers, scaling up screening services, subsidizing costs of cancer care services, or making cervical cancer care treatment free of charge, strengthening monitoring mechanisms in public facilities to curb the vice of healthcare workers soliciting bribes from patients, increased mass awareness campaigns about cancer, training more healthcare professionals in cancer investigation and management, and palliative care, and introducing an introductory course on gynecologic cancers into all health training institutions are recommended.

Keywords: activities of daily living, cervical cancer, out-of-pocket, expenditure, phenomenology, socioeconomic

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Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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Authors: Francesco Lubrano, Fabrizio Bertone, Federico Stirano

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Modern societies strongly depend on Critical Infrastructures (CI). Hospitals, power supplies, water supplies, telecommunications are just few examples of CIs that provide vital functions to societies. CIs like hospitals are very complex environments, characterized by a huge number of cyber and physical systems that are becoming increasingly integrated. Ensuring a high level of security within such critical infrastructure requires a deep knowledge of vulnerabilities, threats, and potential attacks that may occur, as well as defence and prevention or mitigation strategies. The possibility to remotely monitor and control almost everything is pushing the adoption of network-connected devices. This implicitly introduces new threats and potential vulnerabilities, posing a risk, especially to those devices connected to the Internet. Modern medical devices used in hospitals are not an exception and are more and more being connected to enhance their functionalities and easing the management. Moreover, hospitals are environments with high flows of people, that are difficult to monitor and can somehow easily have access to the same places used by the staff, potentially creating damages. It is therefore clear that physical and cyber threats should be considered, analysed, and treated together as cyber-physical threats. This means that an integrated approach is required. SAFECARE, an integrated cyber-physical security solution, tries to respond to the presented issues within healthcare infrastructures. The challenge is to bring together the most advanced technologies from the physical and cyber security spheres, to achieve a global optimum for systemic security and for the management of combined cyber and physical threats and incidents and their interconnections. Moreover, potential impacts and cascading effects are evaluated through impact propagation models that rely on modular ontologies and a rule-based engine. Indeed, SAFECARE architecture foresees i) a macroblock related to cyber security field, where innovative tools are deployed to monitor network traffic, systems and medical devices; ii) a physical security macroblock, where video management systems are coupled with access control management, building management systems and innovative AI algorithms to detect behavior anomalies; iii) an integration system that collects all the incoming incidents, simulating their potential cascading effects, providing alerts and updated information regarding assets availability.

Keywords: cyber security, defence strategies, impact propagation, integrated security, physical security

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Authors: Ya-Hui Wang

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Lower speech therapy rate of tracheostomized patient was noted in comparison with previous researches. This study is aim to shed light on the referral status of speech therapy in those patients in Taiwan. This study developed an analysis for the size and key characteristics of the population of tracheostomized in-patient in the Taiwan. Method: We analyzed National Healthcare Insurance data (The Collaboration Center of Health Information Application, CCHIA) from Jan 1 2010 to Dec 31 2010. Result: over ages 3, number of tracheostomized in-patient is directly proportional to age. A high service loading was observed in North region in comparison with other regions. Only 4.87% of the tracheostomized in-patients were referred for speech therapy, and 1.9% for swallow examination, 2.5% for communication evaluation.

Keywords: refer, speech therapy, training, rehabilitation

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Authors: Harvey Hyman, Thomas Hull

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As one of the largest cancer treatment centers in the United States, we continuously confront the challenge of how to leverage the best possible technological solutions, in order to provide the highest quality of service to our customers – the doctors, nurses and patients at Moffitt who are fighting every day for the prevention and cure of cancer. This paper reports on the transition from a vertical to a horizontal IT infrastructure. We discuss how the new frameworks and methods such as public, private and hybrid cloud, brokering cloud services are replacing the traditional vertical paradigm for computing. We also report on the impact of containers, micro services, and the shift to continuous integration/continuous delivery. These impacts and changes in delivery methodology for computing are driving how we accomplish our strategic IT goals across the enterprise.

Keywords: cloud computing, IT infrastructure, IT architecture, healthcare

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Authors: Jessica J. Gillies

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Awareness of the tragedy that is human trafficking has increased exponentially over the past two decades. The four pillars widely recognised as global solutions to the problem are prevention, prosecution, protection, and partnership between government and non-government organisations. While ‘sex-trafficking’ initially received major attention, this focus has shifted to other industries that conceal broader experiences of exploitation. However, within the regions of focus for this study, namely Australia and Thailand, trafficking for the purpose of sexual exploitation remains the commonly uncovered narrative of criminal justice investigations. In these regions anti-trafficking action is characterised by government-led prevention and prosecution efforts; whereas protection and reintegration practices have received criticism. Typically, non-government organisations straddle the critical chasm between policy and practice; therefore, they are perfectly positioned to contribute valuable experiential knowledge toward understanding how both sectors can support survivors in the post-trafficking experience. The aim of this research is to inform improved partnerships throughout government and non-government post-trafficking services by illuminating gaps in protection and reintegration initiatives. This research will explore government and non-government responses to human trafficking in Thailand and Australia, in order to understand how meaning is constructed in this context and how the construction of meaning effects survivors in the post-trafficking experience. A qualitative, three-stage methodology was adopted for this study. The initial stage of enquiry consisted of a discursive analysis, in order to deconstruct the broader discourses surrounding human trafficking. The data included empirical papers, grey literature such as publicly available government and non-government reports, and anti-trafficking policy documents. The second and third stages of enquiry will attempt to further explore the findings of the discourse analysis and will focus more specifically on protection and reintegration in Australia and Thailand. Stages two and three will incorporate process observations in government and non-government survivor support services, and semi-structured interviews with employees and volunteers within these settings. Two key findings emerged from the discursive analysis. The first exposed conflicting feminist arguments embedded throughout anti-trafficking discourse. Informed by conflicting feminist discourses on sex-work, a discursive relationship has been constructed between sex-industry policy and anti-trafficking policy. In response to this finding, data emerging from the process observations and semi-structured interviews will be interpreted using a feminist theoretical framework. The second finding progresses from the construction in the first. The discursive construction of sex-trafficking appears to have had influence over perceptions of the legitimacy of survivors, and therefore the support they receive in the post-trafficking experience. For example; women who willingly migrate for employment in the sex-industry, and on arrival are faced with exploitative conditions, are not perceived to be deserving of the same support as a woman who is not coerced, but rather physically forced, into such circumstances, yet both meet the criteria for a victim of human trafficking. The forthcoming study is intended to contribute toward building knowledge and understanding around the implications of the construction of legitimacy; and contextualise this in reference to government led protection and reintegration support services for survivors in the post-trafficking experience.

Keywords: Australia, government, human trafficking, non-government, reintegration, Thailand

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Authors: David C. Nwogbo

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Examining the impact of federalism on good governance is crucial for enhancing governance in Nigeria. This study focuses on the Federal Capital Territory (FCT), Abuja, as a case study. Employing a descriptive survey design, data was collected to explore the relationship between federalism and good governance in Abuja, Nigeria. A stratified random sampling method was used to select 289 respondents from the population of Abuja. The sample size was determined using a formula based on precision and population size. A survey questionnaire was employed to gather information on respondents' demographics, perceptions, and experiences concerning federalism and good governance in the FCT. Descriptive statistics, such as percentages and means, were utilized to analyze the study's findings. The findings provided insights into the perceptions and experiences of residents of the FCT with regard to the relationship between federalism and good governance. The results of this study will be useful for policy and decision-making related to the implementation of these concepts in Nigeria and, more specifically, in the FCT, Abuja. The study found that the majority of respondents believe that the federal system of government has not been effective in promoting accountability, transparency, and reducing corruption in Nigeria. There is a need for reforms to improve the effectiveness of the federal system in promoting good governance. These reforms include strengthening institutions, reallocation of resources, reform of the electoral system, decentralization of power, strengthening the role of the judiciary, capacity building, promoting transparency, and engagement of civil society. The findings also highlight the need for significant reforms to address these challenges and promote good governance in the country. The results of this study can be used to inform policy decisions and guide future research on the subject.

Keywords: accountability, federalism, good, governance

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Authors: Ishrat Zakia Sultana

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The consistent persecution, ethnic cleansing, and genocide against the Rohingya in Burma resulted four major influxes of the Rohingya people to the neighboring country Bangladesh. After the latest influx of October 2016 and August 2017, the total number of Rohingya in Bangladesh stands somewhere between 900,000 to over one million, placing Bangladesh much ahead with the number of refugees compared to Dadaab and Kakuma in Kenya, Bidibidi in Uganda and Zaatari in Jordan. While Bangladesh received recognition and appreciation for receiving a huge number of the Rohingya, one of the fundamental human rights of the Rohingya – education – has never been fulfilled in Bangladesh. The Ministry of Disaster Management and Relief of the government of Bangladesh has been looking after the Rohingya and managing various programs for the Rohingya. On its website, the Ministry claims that it provides the basic supports/services to the Rohingya, including providing education. In practice, however, education for the Rohingya include only the provisions for registered Rohingya refugees – who are a very small number of populations among the entire Rohingya hosted in Bangladesh – and that is only up to grade 7 within the registered camps at Teknaf and Ukhia of Cox’s Bazar district of the country. There is no answer of the question, ‘What’s next’? Although refugees in Canada, Sudan, Turkey and other countries have been allowed to go to mainstream schools, Rohingya refugees in Bangladesh are not allowed to do so legally. Due to the lack of proof of nationality of the Rohingya, the government of Bangladesh imposes restrictions on their access to Bangladeshi schools. However, despite their vulnerability and statelessness, many Rohingyas are desperate to pursue education outside the camps and find their own way not only within Cox’s Bazar but also even in the capital city of the country. But they must hide their refugee identity to accomplish this. My research aims to explore how they manage to get admission amid government restrictions on their access to education in the mainstream institutions in Bangladesh. It will reveal how Rohingya people use adopted identity to get access to education in Bangladesh, and how they apply their own techniques to achieve their goals without having government approved identity. This research examined the strategies the Rohingya applied to manage documents related to their identity to ensure their admission to Bangladeshi education institutions – in schools, colleges, and universities. The research employed a qualitative approach. It used semi structured individual interviews and Focused Group Discussions (FGDs) with 20 male and female Rohingya refugees who are 18 years old and above, and have enrolled in Bangladeshi education institutions with adopted identity. Also I interviewed 5 local community members and policy makers to understand their perceptions and roles in this process. The findings of this research will allow the policy makers to rethink the outcomes of the restrictions on Rohingya’s education in Bangladesh, the ramifications of the denial of Rohingya’s access to education, and initiate policy dialogues on how to allow Rohingya refugees to pursue education in Bangladesh in legal way.

Keywords: Rohingya, Refugee, Bangladesh, Education

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Authors: Babatunde Kasim Oladele

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One of the major objectives of the Nigeria national policy on education is the provision of equal educational opportunities to all citizens at different levels of education. With regards to higher education, an aspect of the policy encourages distance learning to be organized and delivered by tertiary institutions in Nigeria. This study therefore, determines how much of the Government resources are committed, how the resources are utilized and what alternative sources of funding are available for this system of education. This study investigated the trends in recurrent costs between 2004/2005 and 2013/2014 at University of Ibadan Distance Learning Centre (DLC). A descriptive survey research design was employed for the study. Questionnaire was the research instrument used for the collection of data. The population of the study was 280 current distance learning education students, 70 academic staff and 50 administrative staff. Only 354 questionnaires were correctly filled and returned. Data collected were analyzed and coded using the frequencies, ratio, average and percentages were used to answer all the research questions. The study revealed that staff salaries and allowances of academic and non-academic staff represent the most important variable that influences the cost of education. About 55% of resources were allocated to this sector alone. The study also indicates that costs rise every year with increase in enrolment representing a situation of diseconomies of scale. This study recommends that Universities who operates distance learning program should strive to explore other internally generated revenue option to boost their revenue. University of Ibadan, being the premier university in Nigeria, should be given foreign aid and home support, both financially and materially, to enable the institute to run a formidable distance education program that would measure up in planning and implementation with those of developed nation.

Keywords: open education, distance education, University of Ibadan, Nigeria, cost of education

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Authors: Hanee Ryu

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The supporting policies for renewable energy have been designed to deploy renewable energy technology targeting domestic market. The government encourages market creation through obligations such as FIT or RPS on an energy supplier. With these policy measures, the securing vast market needs to induce technology development. Furthermore, it is crucial that ensuring developing market can make the environment nurture the renewable energy industry. Overseas expansion to countries being in demand is essential under immature domestic market. Extending its business abroad can make the domestic company get the knowledge through learning-by-doing. Besides, operation in the countries to be rich in renewable resources such as weather conditions helps to develop proven track record required for verifying technologies. This paper figures out the factor to hamper the global market entry and build up the strategies to overcome difficulties. Survey conducted renewable energy company having overseas experiences at least once. Based on the survey we check the obstacle against exporting home goods and services. As a result, securing funds is salient fact to proceed to business. It is difficult that only private bank or investment agencies participate in the project under uncertainty which renewable energy development project bears inherently. These uncertainties need public fund such as ODA to encourage private sectors to start a business. Furthermore, international organizations such as IRENA or multilateral development banks as WBG play a role to guarantee the investment including risk insurance against uncertainty. It can also manage excavation business cooperating with developing countries and supplement inadequate government funding involved. With survey results strategies to obtain the order, the international organization places are categorized according to the type of getting a contract. This paper suggests 3 types approaching to the international organization project (going through international competitive bidding, using ODA and project financing) and specifies the role of government to support the domestic firms with running out of funds. Under renewable energy industry environment where hard to being created as a spontaneous market, government policy approach needs to motivate the actors to get into the business. It is one of the good strategies that countries with the low demand of renewable energies participate in the project international agencies order in the developing countries having abundant resources. This provides crucial guidance for the formulation of renewable energy development policy and planning with consideration of business opportunities and funding.

Keywords: exporting strategies, multilateral development banks, promoting in developing countries, renewable energy technologies

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Authors: M. Chobotová, Ž. Rylková

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Time full of changes which is associated with globalization, tougher competition, changes in the structures of markets and economic downturn, that all force companies to think about their competitive advantages. These changes can bring the company a competitive advantage and that can help improve competitive position in the market. Policy of the European Union is focused on the fast growing innovative companies which quickly respond to market demands and consequently increase its competitiveness. To meet those objectives companies need the right conditions and support of their state.

Keywords: innovation, performance, measurements metrics, indices

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Authors: Hsing Yuan Liu

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Background: Considerable theoretical and empirical work has identified a relationship between collaboration interactions and creativity in an organizational context. The mechanisms underlying this link, however, are not well understood in healthcare education. Objectives: The aims of this study were to explore the impact of collaboration interactions on team creativity and its underlying mechanism and to verify a moderated mediation model. Design, setting, and participants: This study utilized a cross-sectional, quantitative, descriptive design. The survey data were collected from 177 nursing students who enrolled in 18-week capstone courses of small interdisciplinary groups collaborating to design healthcare products in Taiwan during 2018 and 2019. Methods: Questionnaires assessed the nursing students' perceptions about their teams' swift trust (of cognition- and affect-based), conflicts (of task, process, and relationship), interaction behaviors (constructive controversy, helping behaviors, and spontaneous communication), and creativity. This study used descriptive statistics to compare demographics, swift trust scores, conflict scores, interaction behavior scores, and creativity scores for interdisciplinary teams. Data were analyzed using Pearson’s correlation coefficient and simple and hierarchical multiple regression models. Results: Pearson’s correlation analysis showed the cognition-based team swift trust was positively correlated with team creativity. The mediation model indicated constructive controversy fully mediated the effect of cognition-based team swift trust on student teams’ creativity. The moderated mediation model indicated that task conflict negatively moderates the mediating effect of the constructive controversy on the link between cognition-based team swift trust and team creativity. Conclusion: Our findings suggest nursing student teams’ interaction behaviors and task conflict are crucial mediating and moderated mediation variables on the relationship between collaboration interactions and team creativity, respectively. The empirical data confirms the validity of our proposed moderated mediation models of team creativity. Therefore, this study's validated moderated mediation model could provide guidance for nursing educators to improve collaboration interaction outcomes and creativity on nursing student teams.

Keywords: team swift trust, team conflict, team interaction behavior, moderated mediating effects, interdisciplinary education, nursing students

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Authors: Mumtaz Ali Baloch

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This article aims at to review the policies and gaps including the socioeconomic and institutional factors that affected the enrollment of disabled children and caused drop-outs. It provides insights to scrutinize the gaps in policies, socioeconomic, and institutional factors with the specific concern in enrollment and drop out of disabled children in Pakistan, and Balochistan in particular. The findings of this study revealed that the old-age centralized policies and a number of socio-economic and institutional factors seemed to have significantly affected the enrollment and quality education in the case of physically disabled children. There were only a few schools functional in entire Balochistan. For example, an entire province (Balochistan) there are only two schools for disabled children, established in Quetta city. In the other 31 districts, an estimated population of 300,000 people of each district there were no schools for the disabled children. The findings of this study revealed that there is a great distinction between the policy and practice in the case of physically disabled children in Quetta, Balochistan. Consequently, such children seemed to have been out of schools. Dropout after the class eighth grade is almost 100%, as there are no high schools available for physically/disabled children, in Balochistan. The concerned organizations and authorities need to develop and ratify specific policies, provide required) facilities to the schools including sufficient budget, streamline the academic planning, and an effective monitoring and evaluation system. Only awareness and motivation could not help in improving the enrollment rate and decreasing the dropout in the case of physically disabled children. There is an urgent need to provide the required facilities to the schools. Almost all students needed assistive equipment, effective physical therapy as well as regular medical facilities. Such measures can improve the enrolment and rehabilitation of children.

Keywords: education policy, practices, physically disabled children, challenges, Balochistan, Pakistan

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Authors: Isabelle Gobatto

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Based on an anthropological approach, this paper explores the medical profession and the construction of medical practices by considering the multiform articulations between structural poverty and the production of care from a low-resource francophone West African country, Burkina Faso. This country is considered in its exemplary dimension of culturally differentiated countries of the African continent that share the same situation of structural poverty. The objective is to expose the effects of structural poverty on the ways of constructing professional knowledge and thinking about the sense of the medical profession. If doctors are trained to have the same capacities in South and West countries, which are to treat and save lives whatever the cultural contexts of the practice of medicine, the ways of investing their role and of dealing with this context of action fracture the homogenization of the medical profession. In the line of anthropology of biomedicine, this paper outlines the complex effects of structural poverty on health care, care relations, and the moral economy of doctors. The materials analyzed are based on an ethnography including two temporalities located thirty years apart (1990-1994 and 2020-2021), based on long-term observations of care practices conducted in healthcare institutions, interviews coupled with the life histories of physicians. The findings reveal that disabilities faced by doctors to deliver care are interpreted as policy gaps, but they are also considered by physicians as constitutive of the social and cultural characteristics of patients, making their capacities and incapacities in terms of accompanying caregivers in the production of care. These perceptions have effects on know-how, structured around the need to act even when diagnoses are not made so as not to see patients desert health structures if the costs of care are too high for them. But these interpretations of highly individualizing dimensions of these difficulties place part of the blame on patients for the difficulties in using learned knowledge and delivering effective care. These situations challenge the ethics of caregivers but also of ethnologists. Firstly because the interpretations of disabilities prevent caregivers from considering vulnerabilities of care as constituting a common condition shared with their patients in these health systems, affecting them in an identical way although in different places in the production of care. Correlatively, these results underline that these professional conceptions prevent the emergence of a figure of victim, which could be shared between patients and caregivers who, together, undergo working and care conditions at the limit of the acceptable. This dimension directly involves politics. Secondly, structural poverty and its effects on care challenge the ethics of the anthropologist who observes caregivers producing, without intent to arm, experiences of care marked by an ordinary violence, by not giving them the care they need. It is worth asking how anthropologists could get doctors to think in this light in west-African societies.

Keywords: Africa, care, ethics, poverty

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Authors: Adey Nigatu Mersha, Ilyas Masih, Charlotte de Fraiture, Tena Alamirew

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Conflicts over water are increasing mainly as a result of water scarcity in response to higher water demand and climatic variability. There is often not enough water to meet all demands for different uses. Thus, decisions have to be made as to how the available resources can be managed and utilized. Correspondingly water allocation goals, practically national water policy goals, need to be revised accordingly as the pressure on water increases from time to time. A case study is conducted in the Upper Awash Basin, Ethiopia, to assess and evaluate prioritized comprehensive water demand management options based on the framework of integrated water resources management in account of stakeholders’ knowledge and preferences as well as practical prominence within the Upper Awash Basin. Two categories of alternative management options based on policy analysis and stakeholders' consultation were evaluated against the business-as-usual scenario by using WEAP21 model as an analytical tool. Strong effects on future (unmet) demands are observed with major socio-economic assumptions and forthcoming water development plans. Water management within the basin will get more complex with further abstraction which may lead to an irreversible damage to the ecosystem. It is further confirmed through this particular study that efforts to maintain users’ preferences alone cannot insure economically viable and environmentally sound development and vice versa. There is always a tradeoff between these factors. Hence, all of these facets must be analyzed separately, related with each other in equal footing, and ultimately taken up in decision making in order for the whole system to function properly.

Keywords: water demand, water availability, WEAP21, scenarios

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Authors: Tuji Jemal Ahmed

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Food quality and safety challenges are prevalent in Ethiopia's food processing industry, which can have adverse effects on consumers' health and wellbeing. The country is known for its diverse range of agricultural products, which are essential to its economy. However, poor food quality and safety policies and management systems in the food processing industry have led to several health problems, foodborne illnesses, and economic losses. This paper aims to highlight the causes and effects of food safety and quality issues in the food processing industry of Ethiopia and discuss potential solutions to address these issues. One of the main causes of poor food quality and safety in Ethiopia's food processing industry is the lack of adequate regulations and enforcement mechanisms. The absence of comprehensive food safety and quality policies and guidelines has led to substandard practices in the food manufacturing process. Moreover, the lack of monitoring and enforcement of existing regulations has created a conducive environment for unscrupulous businesses to engage in unsafe practices that endanger the public's health. The effects of poor food quality and safety are significant, ranging from the loss of human lives, increased healthcare costs, and loss of consumer confidence in the food processing industry. Foodborne illnesses, such as diarrhea, typhoid fever, and cholera, are prevalent in Ethiopia, and poor food quality and safety practices contribute significantly to their prevalence. Additionally, food recalls due to contamination or mislabeling often result in significant economic losses for businesses in the food processing industry. To address these challenges, the Ethiopian government has begun to take steps to improve food quality and safety in the food processing industry. One of the most notable initiatives is the Ethiopian Food and Drug Administration (EFDA), which was established in 2010 to regulate and monitor the quality and safety of food and drug products in the country. The EFDA has implemented several measures to enhance food safety, such as conducting routine inspections, monitoring the importation of food products, and enforcing strict labeling requirements. Another potential solution to improve food quality and safety in Ethiopia's food processing industry is the implementation of food safety management systems (FSMS). An FSMS is a set of procedures and policies designed to identify, assess, and control food safety hazards throughout the food manufacturing process. Implementing an FSMS can help businesses in the food processing industry identify and address potential hazards before they cause harm to consumers. Additionally, the implementation of an FSMS can help businesses comply with existing food safety regulations and guidelines. In conclusion, improving food quality and safety policies and management systems in Ethiopia's food processing industry is critical to protecting public health and enhancing the country's economy. Addressing the root causes of poor food quality and safety and implementing effective solutions, such as the establishment of regulatory agencies and the implementation of food safety management systems, can help to improve the overall safety and quality of the country's food supply.

Keywords: food quality, food safety, policy, management system, food processing industry

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Authors: Umedov Mekhroz, Griaznova Svetlana

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In connection with the growth of oncological diseases, the design of centers for diagnostics and the production of radiopharmaceuticals is the most relevant area of healthcare facilities. The design of new nuclear medicine centers should be carried out from the standpoint of solving the following tasks: the availability of medical care, functionality, environmental friendliness, sustainable development, improving the safety of drugs, the use of which requires special care, reducing the rate of environmental pollution, ensuring comfortable conditions for the internal microclimate, adaptability. The purpose of this article is to substantiate architectural and planning solutions, formulate recommendations and principles for the design of nuclear medicine centers and determine the connections between the production and medical functions of a building. The advantages of combining the production of radiopharmaceuticals and the department of medical care: less radiation activity is accumulated, the cost of the final product is lower, and there is no need to hire a transport company with a special license for transportation. A medical imaging department is a structural unit of a medical institution in which diagnostic procedures are carried out in order to gain an idea of the internal structure of various organs of the body for clinical analysis. Depending on the needs of a particular institution, the department may include various rooms that provide medical imaging using radiography, ultrasound diagnostics, and the phenomenon of nuclear magnetic resonance. The production of radiopharmaceuticals is an object intended for the production of a pharmaceutical substance containing a radionuclide and intended for introduction into the human body or laboratory animal for the purpose of diagnosis, evaluation of the effectiveness of treatment, or for biomedical research. The research methodology includes the following subjects: study and generalization of international experience in scientific research, literature, standards, teaching aids, and design materials on the topic of research; An integrated approach to the study of existing international experience of PET / CT scan centers and the production of radiopharmaceuticals; Elaboration of graphical analysis and diagrams based on the system analysis of the processed information; Identification of methods and principles of functional zoning of nuclear medicine centers. The result of the research is the identification of the design principles of nuclear medicine centers with the functions of the production of radiopharmaceuticals and the department of medical imaging. This research will be applied to the design and construction of healthcare facilities in the field of nuclear medicine.

Keywords: architectural planning solutions, functional zoning, nuclear medicine, PET/CT scan, production of radiopharmaceuticals, radiotherapy

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Authors: Szymon Rutkowski, Tomasz Korbak

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We present a reinforcement-learning-based method of training neural machine translation models without parallel corpora. The standard encoder-decoder approach to machine translation suffers from two problems we aim to address. First, it needs parallel corpora, which are scarce, especially for low-resource languages. Second, it lacks psychological plausibility of learning procedure: learning a foreign language is about learning to communicate useful information, not merely learning to transduce from one language’s 'encoding' to another. We instead pose the problem of learning to translate as learning a policy in a communication game between two agents: the translator and the classifier. The classifier is trained beforehand on a natural language inference task (determining the entailment relation between a premise and a hypothesis) in the target language. The translator produces a sequence of actions that correspond to generating translations of both the hypothesis and premise, which are then passed to the classifier. The translator is rewarded for classifier’s performance on determining entailment between sentences translated by the translator to disciple’s native language. Translator’s performance thus reflects its ability to communicate useful information to the classifier. In effect, we train a machine translation model without the need for parallel corpora altogether. While similar reinforcement learning formulations for zero-shot translation were proposed before, there is a number of improvements we introduce. While prior research aimed at grounding the translation task in the physical world by evaluating agents on an image captioning task, we found that using a linguistic task is more sample-efficient. Natural language inference (also known as recognizing textual entailment) captures semantic properties of sentence pairs that are poorly correlated with semantic similarity, thus enforcing basic understanding of the role played by compositionality. It has been shown that models trained recognizing textual entailment produce high-quality general-purpose sentence embeddings transferrable to other tasks. We use stanford natural language inference (SNLI) dataset as well as its analogous datasets for French (XNLI) and Polish (CDSCorpus). Textual entailment corpora can be obtained relatively easily for any language, which makes our approach more extensible to low-resource languages than traditional approaches based on parallel corpora. We evaluated a number of reinforcement learning algorithms (including policy gradients and actor-critic) to solve the problem of translator’s policy optimization and found that our attempts yield some promising improvements over previous approaches to reinforcement-learning based zero-shot machine translation.

Keywords: agent-based language learning, low-resource translation, natural language inference, neural machine translation, reinforcement learning

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Authors: Prima Fithri, Lusi Susanti, Karin Bestarina

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Indonesia's electrification ratio is still around 80.1%, which means that approximately 19.9% of households in Indonesia have not been getting the flow of electrical energy. Household electricity consumptions in Indonesia are generally still dominated by the public urban. In the city of Padang, West Sumatera, Indonesia, about 94.10% are power users of government services (PLN). The most important thing of the issue is human resources efficient energy. Consumer behavior in utilizing electricity becomes significant. Intensive questioner survey, in-depth interview and statistical analysis are carried out to collect scientific evidences of the behavioral based changes instruments to reduce electricity consumption in household sector. The questioner was developed to include five factors assuming affect the electricity consumption pattern in household sector. They are: attitude, energy price, household income, knowledge and other determinants. The survey was carried out in Padang, West Sumatra Province Indonesia. About 210 questioner papers were proportionally distributed to households in 11 districts in Padang. Stratified sampling was used as a method to select respondents. The results show that the household size, income, payment methods and size of house are factors affecting electricity saving behavior in residential sector. Household expenses on electricity are strongly influenced by gender, type of job, level of education, size of house, income, payment method and level of installed power. These results provide a scientific evidence for stakeholders on the potential of controlling electricity consumption and designing energy policy by government in residential sector.

Keywords: electricity, energy saving, household, behavior, policy

Procedia PDF Downloads 526

Authors: Ernest Nweke

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This paper examines the changing trend in ownership of Mongolian companies and how this trend has influenced corporate governance mechanisms in Mongolian companies. A study of this magnitude is essential as it x-rays the systematic transformation of Mongolia’s corporate world from the public to private ownership and the tremendous impact it has had on firm governance mechanisms. Owing to Mongolia’s Soviet past, much of the companies in Mongolia were state-owned, state-directed and state-controlled resulting in serious inefficiencies in these companies. This scenario is antithetical to the economic growth and development of any nation as it is grossly at variance with the fundamental principles of good corporate governance that drive prosperity. Consequently, the Mongolian government has in the past decades fine-tuned government policy to prioritize private ownership, establishing various frameworks that will strengthen corporate governance structures in Mongolia. These efforts have paid off and gone a long way in changing the trend in the ownership of companies in Mongolia reversing the old order. The expectation locally and internationally is that companies in post-socialist Mongolia will be more closely aligned to generally accepted corporate governance mechanisms, generally improving company performance and ultimately returns to shareholders. To achieve the research objectives, the survey research method was employed utilizing a sample of seventy randomly selected listed companies representing 22% of Mongolian Stock Exchange listings. Research hypotheses formulated to guide the conduct of the study were tested using Chi-Square analysis, and results show that ownership trend has drastically changed in the post-socialist Mongolia leading to better corporate governance practices in Mongolian companies. This result has important policy implications.

Keywords: corporate disclosure, free market, private ownership, Mongolia

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Authors: Yu Chen Su

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Introduction: Gestational diabetes mellitus (GDM) refers to impaired glucose tolerance in pregnant women, impacting both the mother and newborn with short and long-term effects. It increases risks of preeclampsia, hypertension, type 2 diabetes, cesarean section, and preterm birth. GDM is associated with fetal macrosomia, shoulder dystocia, neonatal hypoglycemia, and future type 2 diabetes risk. A study on 6,421 pregnant women found 12% experienced high stress, linked to maladaptive coping and depressive emotions. Women with high-risk pregnancies may experience greater stress and depression. Research suggests GDM increases depression prevalence. A study on 632 Hispanic women with GDM showed severe stress and depression tendencies. Involving 95 women with GDM, 33.4% exhibited depression symptoms. Another study compared 180 GDM women to 186 with normal glucose levels, revealing higher depression levels in GDM women. They found GDM women were 1.85 times more likely to receive antidepressants during pregnancy and 1.69 times more likely to experience postpartum depression. Maternal stress and depressive symptoms during pregnancy are significant factors. Early identification by healthcare professionals can greatly benefit GDM women, their infants, and their families. Objectives: The purpose of this study was to investigate the association between gestational diabetes mellitus (GDM) and the risk of depression. Methods: This study reviewed and analyzed relevant literature on gestational diabetes mellitus (GDM) and depression in 6,876 patients. The literature search followed PRISMA guidelines and included databases like Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library. Prospective or retrospective studies with relevant risk ratios and estimates were included, using a random-effects model for the analysis of depression risk correlation. Studies without depression data or relevant risks were excluded. The search period extended until October 2022. Results: Systematic review of 7 studies (6,876 participants) found a significant association (OR = 8.77, CI: 7.98-9.64, p < 0.05) between gestational diabetes mellitus (GDM) and higher depression risk compared to healthy pregnant women. Conclusions: Pregnancy is a significant life transition involving physiological, psychological, and social changes. Gestational diabetes poses challenges to women's physical and mental well-being. Sensitive healthcare professionals identifying issues early can greatly benefit women, babies, and the family.

Keywords: gestational diabetes, depression, systematic review, neta-analysis

Procedia PDF Downloads 75