Search results for: graduates of tertiary institutions
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3045

Search results for: graduates of tertiary institutions

1215 Moving towards a General Definition of Public Happiness: A Grounded Theory Approach to the Recent Academic Research on Well-Being

Authors: Cristina Sanchez-Sanchez

Abstract:

Although there seems to be a growing interest in the study of the citizen’s happiness as an alternative measure of a country’s progress to GDP, happiness as a public concern is still an ambiguous concept, hard to define. Moreover, different notions are used indiscriminately to talk about the same thing. This investigation aims to determine the conceptions of happiness, well-being and quality of life that originate from the indexes that different governments and public institutions around the world have created to study them. Through the Scoping Review method, this study identifies the recent academic research in this field (a total of 267 documents between 2006 and 2016) from some of the most popular social sciences databases around the world, Web of Science, Scopus, JSTOR, Sage, EBSCO, IBSS and Google Scholar, and in Spain, ISOC and Dialnet. These 267 documents referenced 53 different indexes and researches. The Grounded Theory method has been applied to a sample of 13 indexes in order to identify the main categories they use to determine these three concepts. The results show that these are multi-dimensional concepts and similar indicators are used indistinctly to measure happiness, well-being and quality of life.

Keywords: common good, grounded theory, happiness economics, happiness index, quality of life, scoping review, well-being

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1214 Changes to Populations Might Aid the Spread Antibiotic Resistance in the Environment

Authors: Yasir Bashawri, Vincent N. Chigor James McDonald, Merfyn Williams, Davey Jones, A. Prysor Williams

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Resistance to antibiotics has become a threat to public health. As a result of their misuse and overuse, bacteria have become resistant to many common antibiotics. Βeta lactam (β-lactam) antibiotics are one of the most significant classes of antimicrobials in providing therapeutic benefits for the treatment of bacterial infections in both human and veterinary medicine, for approximately 60% of all antibiotics are used. In particular, some Enterobacteriaceae produce Extend Spectrum Beta Lactamases (ESBLs) that enable them to some break down multi-groups of antibiotics. CTX-M enzymes have rapidly become the most important ESBLs, with increases in mainly CTX-M 15 in many countries during the last decade. Global travel by intercontinental medical ‘tourists’, migrant employees and overseas students could theoretically be a risk factor for spreading antibiotic resistance genes in different parts of the world. Bangor city, North Wales, is subject to sudden demographic changes due to a large proportion (>25%) of the population being students, most of which arrive over a space of days. This makes it a suitable location to study the impacts of large demographic change on the presence of ESBLs. The aim of this study is to monitor the presence of ESBLs in Escherichia coli and faecal coliform bacteria isolated from Bangor wastewater treatment plant, before, during and after the arrival week of students to Bangor University. Over a five-week period, water samples were collected twice a week, from the influent, primary sedimentation tank, aeration tank and the final effluent. Isolation and counts for Escherichia coli and other faecal coliforms were done on selective agar (primary UTI agar). ESBL presence will be confirmed by phenotypic and genotypic methods. Sampling at all points of the tertiary treatment stages will indicate the effectiveness of wastewater treatment in reducing the spread of ESBLs genes. The study will yield valuable information to help tackle a problem which many regard to be the one of the biggest threats to modern-day society.

Keywords: extended spectrum β-lactamase, enterobacteriaceae, international travel, wastewater treatment plant

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1213 Evaluating Portfolio Performance by Highlighting Network Property and the Sharpe Ratio in the Stock Market

Authors: Zahra Hatami, Hesham Ali, David Volkman

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Selecting a portfolio for investing is a crucial decision for individuals and legal entities. In the last two decades, with economic globalization, a stream of financial innovations has rushed to the aid of financial institutions. The importance of selecting stocks for the portfolio is always a challenging task for investors. This study aims to create a financial network to identify optimal portfolios using network centralities metrics. This research presents a community detection technique of superior stocks that can be described as an optimal stock portfolio to be used by investors. By using the advantages of a network and its property in extracted communities, a group of stocks was selected for each of the various time periods. The performance of the optimal portfolios compared to the famous index. Their Sharpe ratio was calculated in a timely manner to evaluate their profit for making decisions. The analysis shows that the selected potential portfolio from stocks with low centrality measurement can outperform the market; however, they have a lower Sharpe ratio than stocks with high centrality scores. In other words, stocks with low centralities could outperform the S&P500 yet have a lower Sharpe ratio than high central stocks.

Keywords: portfolio management performance, network analysis, centrality measurements, Sharpe ratio

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1212 Angiographic Evaluation of ETT (Treadmill) Positive Patients in a Tertiary Care Hospital of Bangladesh

Authors: Syed Dawood Md. Taimur, Saidur Rahman Khan, Farzana Islam

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Objective: To evaluate the factors which predetermine the coronary artery disease in patients having positive Exercise Tolerance Test (ETT) that is treadmill results and coronary artery findings. Methods: This descriptive study was conducted at Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute,Dhaka,Bangladesh from 1st January, 2014 to 31st August, 2014. All patients who had done ETT (treadmill) for chest pain diagnosis were studied. One hundred and four patients underwent coronary angiogram after positive treadmill result. Patients were divided into two groups depending upon the angiographic findings, i.e. true positive and false positive. Positive treadmill test patients who have coronary artery involvement these are called true positive and who have no involvement they are called false positive group. Both groups were compared with each other. Results: Out of 104 patients, 81 (77.9%) patients had true positive ETT and 23 (22.1%) patients had false positive ETT. The mean age of patients in positive ETT was 53.46± 8.06 years and male mean age was 53.63±8.36 years and female was 52.87 ± 7.0 years. Sixty nine (85.19%) male patients and twelve (14.81%) female patients had true positive ETT, whereas 15 (65.21%) males and 8 (34.79%) females had false positive ETT, this was statistically significant (p<0.032)difference in the two groups(sex) in comparison of true and false positive ETT. The risk factors of these patients like diabetes mellitus, hypertension, dyslipidemia, family history and smoking were seen among these patients. Hypertensive patients having true positive which were statically significant (p<0.004) and diabetic, dyslipidaemic patients having true positive which were statically significant (p < 0.032 & 0.030).True positive patients had family history were 68 (83.95%) and smoking were 52 (64.20%), where family history patients had statistically significant(p<0.017) between two groups of patients and smokers were significant (p<0.012). 46 true positive patients achieved THR which was not statistically significant (P<0.138)and 79 true patients had abnormal resting ECG whether it was significant (p<0.036). Amongst the vessels involvement the most common was LAD 55 (67.90%), followed by LCX 42 (51.85%), RCA 36 (44.44%) and the LMCA was 9 (11.11%), .40 patients (49.38%) had SVD, 26 (30.10%) had DVD, 15(18.52%) had TVD and 23 had normal coronary arteries. Conclusion: It can be concluded that among the female patients who have positive ETT with normal resting ECG, who had achieved target heart rate are likely to have a false positive test result. Conversely male patients,resting abnormal ECG who had not achieved THR, symptom limited ETT, have a hypertension, diabetis, dyslipidaemic, family history and smoking are likely to have a true positive treadmill test result.

Keywords: exercise tolerance test, coronary artery disease, coronary angiography, true positive, false positive

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1211 Networks, Regulations and Public Action: The Emerging Experiences of Sao Paulo

Authors: Lya Porto, Giulia Giacchè, Mario Aquino Alves

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The paper aims to describe the linkage between government and civil society proposing a study on agro-ecological agriculture policy and urban action in São Paulo city underling the main achievements obtained. The negotiation processes between social movements and the government (inputs) and its results on political regulation and public action for Urban Agriculture (UA) in São Paulo city (outputs) have been investigated. The method adopted is qualitative, with techniques of semi-structured interviews, participant observation, and documental analysis. The authors conducted 30 semi-structured interviews with organic farmers, activists, governmental and non-governmental managers. Participant observation was conducted in public gardens, urban farms, public audiences, democratic councils, and social movements meetings. Finally, public plans and laws were also analyzed. São Paulo city with around 12 million inhabitants spread out in a 1522 km2 is the economic capital of Brazil, marked by spatial and socioeconomic segregation, currently aggravated by environmental crisis, characterized by water scarcity, pollution, and climate changes. In recent years, Urban Agriculture (UA) social movements gained strength and struggle for a different city with more green areas, organic food production, and public occupation. As the dynamics of UA occurs by the action of multiple actresses and institutions that struggle to build multiple senses on UA, the analysis will be based on literature about solidarity economy, governance, public action and networks. Those theories will mark out the analysis that will emphasize the approach of inter-subjectivity built between subjects, as well as the hybrid dynamics of multiple actors and spaces in the construction of policies for UA. Concerning UA we identified four main typologies based on land ownership, main function (economic or activist), form of organization of the space, and type of production (organic or not). The City Hall registers 500 productive unities of agriculture, with around 1500 producers, but researcher estimated a larger number of unities. Concerning the social movements we identified three categories that differ in goals and types of organization, but all of them work by networks of activists and/or organizations. The first category does not consider themselves as a movement, but a network. They occupy public spaces to grow organic food and to propose another type of social relations in the city. This action is similar to what became known as the green guerrillas. The second is configured as a movement that is structured to raise awareness about agro-ecological activities. The third one is a network of social movements, farmers, organizations and politicians that work focused on pressure and negotiation with executive and legislative government to approve regulations and policies on organic and agro-ecological Urban Agriculture. We conclude by highlighting how the interaction among institutions and civil society produced important achievements for recognition and implementation of UA within the city. Some results of this process are awareness for local production, legal and institutional recognition of the rural zone around the city into the planning tool, the investment on organic school public procurements, the establishment of participatory management of public squares, the inclusion of UA on Municipal Strategic Plan and Master Plan.

Keywords: public action, policies, agroecology, urban and peri-urban agriculture, Sao Paulo

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1210 Investigating University Language Teacher’s Perception of Their Identities in the Algerian Multilingual Context

Authors: Yousra Drissi

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This research explores language teacher identity in a multilingual context where both teachers and students come from different linguistic backgrounds. It seeks to understand how teachers perceive themselves as language teachers in this context in relation to different influencing factors, both internal and external. This study is being conducted due to the importance of language teacher identity (LTI) in the university context, which is being neglected in the present literature (in an attempt to address the gap in the present literature). The broader aim of this study is to bring attention to language teacher identity along with the different influencing elements which can either promote or hinder its development. In this research, we are using the sociocultural theory and post-structural theory. This research uses the mixed methods approach to collect and analyse relevant data. A structured survey was distributed to language teachers from different universities around Algeria, followed by in-depth interviews. Results are supposed to show the different points in self-perception that these teachers share or differ in. they will also help us identify the different internal and external factors that can be of influence. However, the results of this research can be used by institutions as well as decision-makers to better understand university teachers and help them improve their teaching practices by empowering their language teacher identity, starting from teacher education programs to continuous teacher development programs.

Keywords: identity, language teacher identity, multilingualism, university teacher

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1209 Dialogues of Medical Places and Health Care in Oporto City (20th Century)

Authors: Monique Palma, Isabel Amaral

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This paper aims at mapping medical places in Oporto in the twentieth century in order to bring the urban history of medicine and healthcare in Portugal to a large audience, using Oporto as a case study. This analysis is consistent with the SDS's 2030 goals for policy guidance for heritage and development actors. As a result, it is critical to begin this research in order to place on the political agenda the preservation of Portuguese culture's history, memory, and heritage, particularly the medical culture, which is one of the most important drivers of civilizational development. To understand the evolution of medical care in urban history, we will conduct archive research (manuals, treatises, reports, periodic journals, newspapers, etc.) and interviews with key actors from medical institutions and medical museums. The findings of this study will be used to develop medical itineraries for inclusion in touristic agendas in Portugal and abroad, to include Portuguese medicine in global roadmaps, and to promote the preservation of the most iconic places of health care and medical heritage, as well as tools to promote social cohesion, dialogue among people, and "sense of place" globally.

Keywords: medical itineraries, history of medicine, urban history, Oporto

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1208 Conventional and Islamic Perspective in Accounting: Potential for Alternative Reporting Framework

Authors: Shibly Abdullah

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This paper provides an overview of fundamental philosophical and functional differences in conventional and Islamic accounting. The aim of this research is to undertake a detailed analysis focus on specific illustrations drawn from both these systems and highlight how these differences implicate in recording financial transactions and preparation of financial reports for a range of stakeholders. Accounting as being universally considered as a platform for providing a ‘true and fair’ view of corporate entities can be challenged in the current world view, as the business environment has evolved and transformed significantly. Growth of the non-traditional corporate entity such as Islamic financial institutions, fundamentally questions the applicability of conventional accounting standards in preparation of Shariah-compliant financial reporting. Coupled with this, there are significant concerns about the wider applicability of Islamic accounting standards and framework in order to achieve reporting practices satisfying the information needs generally. Against the backdrop of such a context, this paper raises fundamental question as to how potential convergence could be achieved between these two systems in order to provide users’ a transparent and comparable state of financial information resulting in an alternative framework of financial reporting.

Keywords: accounting, conventional accounting, corporate reporting, Islamic accounting

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1207 Artificial Intelligence as a Policy Response to Teaching and Learning Issues in Education in Ghana

Authors: Joshua Osondu

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This research explores how Artificial Intelligence (AI) can be utilized as a policy response to address teaching and learning (TL) issues in education in Ghana. The dual (AI and human) instructor model is used as a theoretical framework to examine how AI can be employed to improve teaching and learning processes and to equip learners with the necessary skills in the emerging AI society. A qualitative research design was employed to assess the impact of AI on various TL issues, such as teacher workloads, a lack of qualified educators, low academic performance, unequal access to education and educational resources, a lack of participation in learning, and poor access and participation based on gender, place of origin, and disability. The study concludes that AI can be an effective policy response to TL issues in Ghana, as it has the potential to increase students’ participation in learning, increase access to quality education, reduce teacher workloads, and provide more personalized instruction. The findings of this study are significant for filling in the gaps in AI research in Ghana and other developing countries and for motivating the government and educational institutions to implement AI in TL, as this would ensure quality, access, and participation in education and help Ghana industrialize.

Keywords: artificial intelligence, teacher, learner, students, policy response

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1206 Metabolic Variables and Associated Factors in Acute Pancreatitis Patients Correlates with Health-Related Quality of Life

Authors: Ravinder Singh, Pratima Syal

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Background: The rising prevalence and incidence of Acute Pancreatitis (AP) and its associated metabolic variables known as metabolic syndrome (MetS) are common medical conditions with catastrophic consequences and substantial treatment costs. The correlation between MetS and AP, as well as their impact on Health Related Quality of Life (HRQoL) is uncertain, and because there are so few published studies, further research is needed. As a result, we planned this study to determine the relationship between MetS components impact on HRQoL in AP patients. Patients and Methods: A prospective, observational study involving the recruitment of patients with AP with and without MetS was carried out in tertiary care hospital of North India. Patients were classified with AP if they were diagnosed with two or more components of the following criteria, abdominal pain, serum amylase and lipase levels two or more times normal, imaging trans-abdominal ultrasound, computed tomography, or magnetic resonance. The National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criterion was used to diagnose the MetS. The various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P≤.05) in AP patients. Finally, the correlation between AP and MetS, along with their impact on HRQoL was assessed using Student's t test, Pearson Correlation Coefficient, and Short Form-36 (SF-36). Results: AP with MetS (n = 100) and AP without MetS (n = 100) patients were divided into two groups. Gender, Age, Educational Status, Tobacco use, Body Mass Index (B.M.I), and Waist Hip Ratio (W.H.R) were the socio-demographic parameters found to be statistically significant (P≤.05) in AP patients with MetS. Also, all the metabolic variables were also found to statistically significant (P≤.05) and found to be increased in patients with AP with MetS as compared to AP without MetS except HDL levels. Using the SF-36 form, a greater significant decline was observed in physical component summary (PCS) and mental component summary (MCS) in patients with AP with MetS as compared to patients without MetS (P≤.05). Furthermore, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in PCS and MCS. Conclusion: The study demonstrated that patients with AP with MetS had a worse overall HRQOL than patients with AP without MetS due to number of socio-demographic and metabolic variables having direct correlation impacting physical and mental health of patients.

Keywords: metabolic disorers, QOL, cost effectiveness, pancreatitis

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1205 The Sociocultural Adaptation, Openness, and Success of Sojourn of Foreign Students in Tarlac City, Philippines

Authors: Maria Sheila S. Garcia

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A good number of researches indicate that living in another country may create different and unexpected adjustment problems, and foreign students are not exempted from this. To provide an understanding of this process, 30 foreign college students studying English in Tarlac City were asked to answer questionnaires. This is to determine their sociocultural adaptation, openness to the host culture and success of sojourn. Through statistical analysis, it was found that the students experience greater difficulty in the academic area. Moderate difficulty was attributed to everyday life and social interactions. Albeit difficult, what they like best is the school’s methods of teaching English while the areas that need improvement are the libraries and internet connection. The only significant relationship was found between sociocultural adaptation and success of sojourn. Negatively correlated, if students experience greater difficulties in their host country, they are likely to regret their stay and will not recommend it to anyone. Openness to the host culture did not have an effect on the adaptation and success of sojourn. The short period of time that the students have are spent in studying rather than making friends. Nonetheless, this indicates the need to look deeper into the academic, extra-curricular activities and facilities provided by learning institutions.

Keywords: foreign students, sociocultural adaptation, success of sojourn, Tarlac Philippines

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1204 ‘Green Gait’ – The Growing Relevance of Podiatric Medicine amid Climate Change

Authors: Angela Evans, Gabriel Gijon-Nogueron, Alfonso Martinez-Nova

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Background The health sector, whose mission is protecting health, also contributes to the climate crisis, the greatest health threat of the 21st century. The carbon footprint from healthcare exceeds 5% of emissions globally, surpassing 7% in the USA and Australia. Global recognition has led to the Paris Agreement, the United Nations Sustainable Development Goals, and the World Health Organization's Climate Change Action Plan. It is agreed that the majority of health impacts stem from energy and resource consumption, as well as the production of greenhouse gases in the environment and deforestation. Many professional medical associations and healthcare providers advocate for their members to take the lead in environmental sustainability. Objectives To avail and expand ‘Green Podiatry’ via the three pillars of: Exercise ; Evidence ; Everyday changes; to highlight the benefits of physical activity and exercise for both human health and planet health. Walking and running are beneficial for health, provide low carbon transport, and have evidence-based health benefits. Podiatrists are key healthcare professionals in the physical activity space and can influence and guide their patients to increase physical activity and avert the many non-communicable diseases that are decimating public health, eg diabetes, arthritis, depression, cancer, obesity. Methods Publications, conference presentations, and pilot projects pertinent to ‘Green Podiatry’ have been activated since 2021, and a survey of podiatrist’s knowledge and awareness has been undertaken.The survey assessed attitudes towards environmental sustainability in work environment. The questions addressed commuting habits, hours of physical exercise per week, and attitudes in the clinic, such as prescribing unnecessary treatments or emphasizing sports as primary treatment. Results Teaching and Learning modules have been developed for podiatric medicine students and graduates globally. These will be availed. A pilot foot orthoses recycling project has been undertaken and will be reported, in addition to established footwear recycling. The preliminary survey found almost 90% of respondents had no knowledge of green podiatry or footwear recycling. Only 30% prescribe sports/exercise as the primary treatment for patients, and 45% do not to prescribe unnecessary treatments. Conclusions Podiatrists are in a good position to lead in the crucial area of healthcare and climate change implications. Sufficient education of podiatrists is essential for the profession to beneficially promote health and physical activity, which is beneficial for the health of all peoples and all communities.

Keywords: climate change, gait, green, healthcare, sustainability

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1203 Managing Construction Wastes in Nigeria for Sustainable Development

Authors: Ezekiel Ejiofor Nnadi

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Nigeria construction industry is known for its active construction activities. This has earmarked the industry to be the key to economic growth of the nation. It has largest employer of labour and gives sustenance to other industries like manufacturing industry. While this is a sign of growth and prosperity; the waste generated by the industry has always been a problem and a serious concern. It results in wastage of economic gain and has resultant health effect on the populace apart from injury being sustained on sites. This work provides a platform to learn more about construction waste, its management strategy and how to reduce waste production in Nigeria construction industry. Construction sites, waste management authority and public health institutions in Lagos as the centre of most construction activities in Nigeria were selected, and a set of questionnaire was administered to using the systematic sampling technique. Descriptive statistics and relative importance index (RII) technique were employed for the analysis of the data gathered. The findings of the analysis show that excessive wastes reduce contractors’ profit margin and also that some construction wastes contain hazardous and toxic elements such as lead, asbestos or radioactive materials which required proper handling and effective disposal. The conclusion was drawn that the check on waste on construction sites starts with the designers to the contractors who execute on site.

Keywords: construction cost, construction industry, economic growth, materials wastes

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1202 Growing Acts of Terrorism in Local Conflicts: A Dire Need for International Attention

Authors: Yusuf Abubakar Mamud

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Highlighting the imperatives of local conflicts considering the dangerous dimensions of terrorism they are assuming in Africa has not attracted serious academic and political attention. The discourse about conflict in Africa was discussed within five identified conflict zones in the continent. The threats from these local conflicts are diverse and complex and the acts of terrorism in these local conflicts are driven by certain attitudes and behaviours linked to the African leadership. The paper examined and noted that the current conflict resolution model of the African Union (AU) was robust with requisite institutions to address the trends in local conflicts. However, it was observed that the AU peace and security framework lacked the requisite structural and technical capabilities to proactively address the drivers of local conflicts in Africa. It was found that the persistence of local conflicts in the African region may deny her the opportunities of achievement of the targets envisioned in the Sustainable Development Goals (SDGs). Consequently, the paper called on the international community to support Africa through provision of capacity. It urged the African leaders themselves to develop the political will to ensure that all issues concerning peace and security in the continent were guided by the provisions of the AU Constitutive Act. The need to strengthen the APRM in the light of the current trends in local conflicts was also highlighted.

Keywords: conflicts, local conflicts, terrorism, sustainable development

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1201 Advancing Healthcare Excellence in China: Crafting a Strategic Operational Evaluation Index System for Chinese Hospital Departments amid Payment Reform Initiatives

Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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1200 Evaluation of Associated Risk Factors and Determinants of near Miss Obstetric Cases at B.P. Koirala Institute of Health Sciences, Dharan

Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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1199 Exploring the Impact of Corruption on Human Rights in Cameroon: The Quest for Sustainable Solutions

Authors: Eugene Muambeh Muntoh

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Corruption has a destructive effect on State institutions and on the capacity of States to respect, protect and fulfil human rights, particularly of those persons and groups in situation of vulnerability and marginalization. In Cameroon, corruption pose a major challenge as it divert public revenues and cripple public budgets that should provide healthcare, housing, education, and other essential services. Corruption has undermined the States’ ability to meet the minimum core obligations and pre-existing legal obligations to maximize all available resources to respect, protect and fulfil Economic, Social and Cultural Rights. This study therefore makes use of the qualitative research design, ranging from interviews, observations and content analysis of vital documents to provide evidence and associations between corruption and human rights concerns in Cameroon. The study made use of research material from both primary and secondary sources. Findings from the study reveals that the impact of corruption in Cameroon is especially pronounced regarding economic, social and cultural rights. In most cases, the right to be treated equally is violated, for example, when someone is requested to pay a bribe to obtain a public service. There is an urgent need for sustainable measures to counter corruption in order to protect and promote human rights.

Keywords: corruption, governance, human rights, law

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1198 Adequacy of Museums' Internet Resources to Infantile and Young Public

Authors: Myriam Ferreira

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Websites and social networks allow museums to divulge their works by new and attractive means. Besides, these technologies provide tools to generate a new history of art’s contents and promote visits to their installations. At the same time, museums are proposing more and more activities to families, children and young people. However, these activities usually take place in the museum’s physical installations, while websites and social networks seem to be mainly targeted to adults. The problem is that being children and young people digital natives, they feel apart from museums, so they need a presence of museums in digital means to feel attracted to them. Some institutions are making efforts to fill this vacuum. In this paper, resources designed specifically for children and teenagers have been selected from websites and social networks of five Spanish Museums: Prado Museum, Thyssen Museum, Guggenheim Museum, America Museum and Cerralbo Museum. After that, we have carried out an investigation in a school with children and teenagers between 11 and 15 years old. Those young people have been asked about their valuation of those web pages and social networks, with quantitative-qualitative questions. The results show that the least rated resources were videos and social networks because they were considered ‘too serious’, while the most rated were games and augmented reality. These ratings confirm theoretical papers that affirm that the future of technologies applied to museums is edutainment and interaction.

Keywords: children, museums, social networks, teenagers, websites

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1197 Digital Learning and Entrepreneurship Education: Changing Paradigms

Authors: Shivangi Agrawal, Hsiu-I Ting

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Entrepreneurship is an essential source of economic growth and a prominent factor influencing socio-economic development. Entrepreneurship education educates and enhances entrepreneurial activity. This study aims to understand current trends in entrepreneurship education and evaluate the effectiveness of diverse entrepreneurship education programs. An increasing number of universities offer entrepreneurship education courses to create and successfully continue entrepreneurial ventures. Despite the prevalence of entrepreneurship education, research studies lack inconsistency about the effectiveness of entrepreneurship education to promote and develop entrepreneurship. Strategies to develop entrepreneurial attitudes and intentions among individuals are hindered by a lack of understanding of entrepreneurs' educational purposes, components, methodology, and resources required. Lack of adequate entrepreneurship education has been linked with low self-efficacy and lack of entrepreneurial intent. Moreover, in the age of digitisation and during the COVID-19 pandemic, digital learning platforms (e.g., online entrepreneurship education courses and programs) and other digital tools (e.g., digital game-based entrepreneurship education) have become more relevant to entrepreneurship education. This paper contributes to the continuation of academic literature in entrepreneurship education by evaluating and assessing current trends in entrepreneurship education programs, leading to better understanding to reduce gaps between entrepreneurial development requirements and higher education institutions.

Keywords: entrepreneurship education, digital technologies, academic entrepreneurship, COVID-19

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1196 A Clinical Study of Placenta Previa and Its Effect on Fetomaternal Outcome in Scarred and Unscarred Uterus at a Tertiary Care Hospital

Authors: Sharadha G., Suresh Kanakkanavar

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Background: Placenta previa is a condition characterized by partial or complete implantation of the placenta in the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality. Materials and Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical, and treatment, along with maternal and neonatal outcome parameters, were noted in proforma. Results: The incidence of placenta previa among scarred uterus was 1.32%, and in unscarred uterus was 0.67%. The mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, and less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position, and adherent placenta were significantly associated with a scarred uterus compared to an unscarred uterus. The rate of caesarean hysterectomy was higher in the scarred uterus, along with statistical association to previous lower-segment caesarean sections. Intraoperative procedures like uterine artery ligation, bakri balloon insertion, and iliac artery ligation were higher in the scarred group. The maternal intensive care unit admission rate was higher in the scarred group and also showed its statistical association with previous lower segment caesarean section. Neonatal outcomes in terms of pre-term birth, still birth, neonatal intensive care unit admission, and neonatal death, though higher in the scarred group, did not differ statistically among the groups. Conclusion: Advancing maternal age, multiparity, prior uterine surgeries, and abortions are independent risk factors for placenta previa. Maternal morbidity is higher in the scarred uterus group compared to the unscarred group. Neonatal outcomes did not differ statistically among the groups. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome of placenta previa.

Keywords: placenta previa, scarred uterus, unscarred uterus, adherent placenta

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1195 Factors Affecting Corruption in Ethiopia from Higher Education Instructors' Perceptions: Evidence from Business and Economics College, Bahir Dar University

Authors: Asmamaw Yigzaw Chirkos

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Corruption increasingly has become one of the greatest challenges of the contemporary world. It undermines good government and rule of law and in turn leads to the misallocation of public resources, harms both the private and public sector and particularly hurts the poor. Corruption is found everywhere, but it is deep-rooted in the poor countries of Sub-Saharan Africa countries. Corruption in developing countries continues to be one of the greatest factors of poverty and underdevelopment. As it is the case in other developing countries, in Ethiopia, the culture of corruption has grown roots in the society at large and become endemic. Institutions, which were designed for the regulation of the relationships between citizens and the State, are being used instead for the personal enrichment of public officials and other corrupt private agents. This paper, therefore, assesses the major factors affecting Corruption in Ethiopia from higher education instructors’ Perceptions with special reference to Business and Economics College of Bahir Dar University. The findings of the study support several previously conducted studies in that each factor examined had a moderate to high positive correlation with corruption, where r ranged between .35 and .54. In addition, the 13 variables together explain about 37 percent change in perceived corruption in Ethiopia (R²= .37).

Keywords: Bahir Dar university, corruption, Ethiopia, factors, instructors perceptions

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1194 Efficiency and Performance of Legal Institutions in the Middle East in the 21st Century

Authors: Marco Khalaf Ayad Milhaail

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In thinking about the role of legal rules and their impact on social ethics and social structures, scholars have explored many issues related to gender, power, and ideology. First, it provides a framework for defining feminist legal studies through an overview of the field's evolution in terms of equality, rights, and justice. Secondly, it encourages those interested in equality, rights, and justice regarding women's issues to participate in international comparative law research. Third, we must emphasize that those seeking solutions to disability and discrimination must be aware of the need to confront the so-called undermining of culture. Therefore, an effective way for women to solve this problem is to rely heavily on international law, which establishes basic legal principles such as gender equality, rights, and justice and can help create a domestic environment. Woman has gained many advantages by adopting the law of Divorce in the Islamic Sharea. Any Egyptian woman can get divorce by letting her rightful rights and wealth to her husband in return for her freedom.

Keywords: stability, harsh environments, techniques, thermal, properties, materials, applications, brittleness, fragility, disadvantages, bank, branches, profitability, setting prediction, effective target, measurement, evaluation, performance, commercial, business, profitability, sustainability, financial, system, banks

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1193 Let’s Work It Out: Effects of a Cooperative Learning Approach on EFL Students’ Motivation and Reading Comprehension

Authors: Shiao-Wei Chu

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In order to enhance the ability of their graduates to compete in an increasingly globalized economy, the majority of universities in Taiwan require students to pass Freshman English in order to earn a bachelor's degree. However, many college students show low motivation in English class for several important reasons, including exam-oriented lessons, unengaging classroom activities, a lack of opportunities to use English in authentic contexts, and low levels of confidence in using English. Students’ lack of motivation in English classes is evidenced when students doze off, work on assignments from other classes, or use their phones to chat with others, play video games or watch online shows. Cooperative learning aims to address these problems by encouraging language learners to use the target language to share individual experiences, cooperatively complete tasks, and to build a supportive classroom learning community whereby students take responsibility for one another’s learning. This study includes approximately 50 student participants in a low-proficiency Freshman English class. Each week, participants will work together in groups of between 3 and 4 students to complete various in-class interactive tasks. The instructor will employ a reward system that incentivizes students to be responsible for their own as well as their group mates’ learning. The rewards will be based on points that team members earn through formal assessment scores as well as assessment of their participation in weekly in-class discussions. The instructor will record each team’s week-by-week improvement. Once a team meets or exceeds its own earlier performance, the team’s members will each receive a reward from the instructor. This cooperative learning approach aims to stimulate EFL freshmen’s learning motivation by creating a supportive, low-pressure learning environment that is meant to build learners’ self-confidence. Students will practice all four language skills; however, the present study focuses primarily on the learners’ reading comprehension. Data sources include in-class discussion notes, instructor field notes, one-on-one interviews, students’ midterm and final written reflections, and reading scores. Triangulation is used to determine themes and concerns, and an instructor-colleague analyzes the qualitative data to build interrater reliability. Findings are presented through the researcher’s detailed description. The instructor-researcher has developed this approach in the classroom over several terms, and its apparent success at motivating students inspires this research. The aims of this study are twofold: first, to examine the possible benefits of this cooperative approach in terms of students’ learning outcomes; and second, to help other educators to adapt a more cooperative approach to their classrooms.

Keywords: freshman English, cooperative language learning, EFL learners, learning motivation, zone of proximal development

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1192 Global and Domestic Response to Boko Haram Terrorism on Cameroon 2014-2018

Authors: David Nchinda Keming

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The present study is focused on both the national and international collective fight against Boko Haram terrorism on Cameroon and the rule played by the Lake Chad Basin Countries (LCBCs) and the global community to suffocate the sect’s activities in the region. Although countries of the Lake Chad Basin include: Cameroon, Chad, Nigeria and Niger others like Benin also joined the course. The justification for the internationalisation of the fight against Boko Haram could be explained by the ecological and international climatic importance of the Lake Chad and the danger posed by the sect not only to the Lake Chad member countries but to global armed, civil servants and the international political economy. The study, therefore, kick start with Cameroon’s reaction to Boko Haram’s terrorist attacks on its territory. It further expounds on Cameroon’s request on bilateral diplomacy from members of the UN Security Council for an international collective support to staple the winds of the challenging sect. The study relies on the hypothesis that Boko Haram advanced terrorism on Cameroon was more challenging to the domestic military intelligence thus forcing the government to seek for bilateral and multilateral international collective support to secure its territory from the powerful sect. This premise is tested internationally via (multilateral cooperation, bilateral response, regional cooperation) and domestically through (solidarity parade, religious discourse, political manifestations, war efforts, the vigilantes and the way forward). To accomplish our study, we made used of the mixed research methodologies to interpret the primary, secondary and tertiary sources consulted. Our results reveal that the collective response was effectively positive justified by the drastic drop in the sect’s operations in Cameroon and the whole LCBCs. Although the sect was incapacitated, terrorism remains an international malaise and Cameroon hosts a fertile ground for terrorists’ activism. Boko Haram was just weakened and not completely defeated and could reappear someday even under a different appellation. Therefore, to absolutely eradicate terrorism in general and Boko Haram in particular, LCBCs must improve their military intelligence on terrorism and continue to collaborate with advanced experienced countries in fighting terrorism.

Keywords: Boko Haram, terrorism, domestic, international, response

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1191 A Retrospective Study on the Spectrum of Infection and Emerging Antimicrobial Resistance in Type 2 Diabetes Mellitus

Authors: Pampita Chakraborty, Sukumar Mukherjee

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People with diabetes mellitus are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defences. People with diabetes are more adversely affected when they get an infection than someone without the disease, because you have weakened immune defences in diabetes. People who have minimally elevated blood sugar levels experience worse outcomes with infections. Diabetic patients in hospitals do not necessarily have a higher mortality rate due to infections, but they do face longer hospitalisation and recovery times. A study was done in a tertiary care unit in eastern India. Patients with type 2 diabetes mellitus infection were recruited in the study. A total of 520 cases of Type 2 Diabetes Mellitus were recorded out of which 200 infectious cases was included in the study. All subjects underwent detailed history & clinical examination. Microbiological samples were collected from respective site of the infection for microbial culture and antibiotic sensitivity test. Out of the 200 infectious cases urinary tract infection(UTI) was found in majority of the cases followed by diabetic foot ulcer (DFU), respiratory tract infection(RTI) and sepsis. It was observed that Escherichia coli was the most commonest pathogen isolated from UTI cases and Staphylococcus aureus was predominant in foot ulcers followed by other organisms. Klebsiella pneumonia was the major organism isolated from RTI and Enterobacter aerogenes was commonly observed in patients with sepsis. Isolated bacteria showed differential sensitivity pattern against commonly used antibiotics. The majority of the isolates were resistant to several antibiotics that are usually prescribed on an empirical basis. These observations are important, especially for patient management and the development of antibiotic treatment guidelines. It is recommended that diabetic patients receive pneumococcal and influenza vaccine annually to reduce morbidity and mortality. Appropriate usage of antibiotics based on local antibiogram pattern can certainly help the clinician in reducing the burden of infections.

Keywords: antimicrobial resistance, diabetic foot ulcer, respiratory tract infection, urinary tract infection

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1190 Determinants of Market Entry Modes Used by Universities to Expand Internationally

Authors: Ali Bhayani

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The article analyses determinants of the market entry modes used by corporate firms to expand internationally and explore whether higher education institutions uses the same determinants to decide on mode adopted to enter the market. Determinants like transaction costs, location advantage, idiosyncratic capabilities, isomorphic pressure to mimic, psychic distance, uncertainty, risks, the control over academic process, previous internationalisation experience and entry to homogenous markets are considered with regards to universities. A sample consisting of 40+ branch campuses from United Arab Emirates (UAE), host to highest number of branch campuses, is selected to study the determinants of the entry modes adopted. The aim of this article is not to prescribe or offer a solution for the best-available model of market entry that can be adopted by universities but rather to act as a trigger for a critical check up on universities planning to internationalize their offering. Determinants like idiosyncratic capabilities, isomorphic pressure and control over the academic process were found to be most prevalent. However, determinants like transaction cost efficiency, internationalisation experience, psychic distance, uncertainty and risks are not significant factors.

Keywords: higher education, UAE, internationalisation, market entry, international branch campuses

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1189 Impact of Clinical Pharmacist Intervention in Improving Drug Related Problems in Patients with Chronic Kidney Disease

Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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1188 Success of Trabeculectomy: May Not Always Depend on Mitomycin C

Authors: Sushma Tejwani, Shoruba Dinakaran, Rupa Rokhade, K. Bhujang Shetty

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Introduction and aim: One of the major causes for failure of trabeculectomy is fibrosis and scarring of subconjunctival tissue around the bleb, and hence intra operative usage of anti-fibrotic agents like Mitomycin C (MMC) has become very popular. However, the long term effects of MMC like thin, avascular bleb, hypotony, bleb leaks and late onset endophthalmitis cannot be ignored, and may preclude its usage in routine trabeculectomy. In this particular study we aim to study the outcomes of trabeculectomy with and without MMC in uncomplicated glaucoma patients. Methods: Retrospective study of series of patients that underwent trabeculectomy with or without cataract surgery in glaucoma department of a tertiary eye care centre by a single surgeon for primary open angle glaucoma (POAG), angle closure glaucoma (PACG), Pseudoexfoliation glaucoma (PXF glaucoma). Patients with secondary glaucoma, juvenile and congenital glaucoma were excluded; also patients undergoing second trabeculectomy were excluded. The outcomes were studied in terms of IOP control at 1 month, 6 months, and 1 year and were analyzed separately for surgical outcomes with and without MMC. Success was considered if IOP was < 16 mmHg on applanation tonometry. Further, the necessity of medication, 5 fluorouracil (5FU) postoperative injections, needling post operatively was noted. Results: Eighty nine patient’s medical records were reviewed, of which 58 patients had undergone trabeculectomy without MMC and 31 with MMC. Mean age was 62.4 (95%CI 61- 64), 34 were females and 55 males. MMC group (n=31): Preoperative mean IOP was 21.1mmHg (95% CI: 17.6 -24.6), and 22 patients had IOP > 16. Three out of 33 patients were on single medication and rests were on multiple drugs. At 1 month (n=27) mean IOP was 12.4 mmHg (CI: 10.7-14), and 31/33 had success. At 6 months (n=18) mean IOP was 13mmHg (CI: 10.3-14.6) and 16/18 had good outcome, however at 1 year only 11 patients were available for follow up and 91% (10/11) had success. Overall, 3 patients required medication and one patient required postoperative injection of 5 FU. No MMC group (n=58): Preoperative mean IOP was 21.9 mmHg (CI: 19.8-24.2), and 42 had IOP > 16 mmHg. 12 out of 58 patients were on single medication and rests were on multiple drugs. At 1 month (n=52) mean IOP was14.6mmHg (CI: 13.2-15.9), and 45/ 58 had IOP < 16mmHg. At 6 months (n=31) mean IOP was 13.5 mmHg (CI: 11.9-15.2) and 26/31 had success, however at 1 year only 23 patients came for follow up and of these 87% (20/23) patients had success. Overall, 1 patient required needling, 5 required 5 FU injections and 5 patients required medication. The success rates at each follow up visit were not significantly different in both the groups. Conclusion: Intra-operative MMC usage may not be required in all patients undergoing trabeculectomy, and the ones without MMC also have fairly good outcomes in primary glaucoma.

Keywords: glaucoma filtration surgery, mitomycin C, outcomes of trabeculectomy, wound modulation

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1187 English Syllabus in the Iranian Education System

Authors: Shaghayegh Mirshekari, Atiyeh Ghorbani

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EThe Iranian system of education has been politically influenced by the thoughts of the governing religious party. It has brought many religious books into the educational system from grade one up to graduation from high school, and therefore, teaching English as a non-Islamic language has been put aside the system, focusing on the Islamic language of Arabic. Teaching English has been widely talked about in international academia, but the Iranian educational system has not brought in any of its outcomes due to the general policy of keeping people away from international Western thoughts. Because of the increasing interest among Iranians in learning English, this language is being taught and studied in public and private schools, commercial and adult schools, language institutes, colleges, universities, and numerous homes throughout the country. Methods and techniques of teaching English, the attitude of the teachers and learners towards the language, and the availability of textbooks and other language materials are quite different in any one of the different institutions. This paper has evaluated the outcome of the Iranian educational system in teaching English in terms of their methods of teaching, as well as the policies regarding the educational system. The results show that not only has there been no progress in the system in terms of teaching English, rather there is backwardness in this regard due to the political policy of preventing people from learning English. Therefore, we see the majority of the youth not speaking English properly at the age where they need to enter the international arena.

Keywords: English, public school, language, Iran, teaching

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1186 The Psychosocial Issues and Support Needs of Patients with Chronic Kidney Disease Undergoing Hemodialysis: A Qualitative Study from Nepal

Authors: Akriti Kafle Baral, Ruixing Zhang, Dzifa K Lalit, Manthar M Alli

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Introduction: Hemodialysis is the most common type of dialysis globally approximately million are reported to receive this type of dialysis. Psychosocial issues in hemodialysis are the psychological and socioeconomic burdens emanating from the initiation and course of treatment and have the potential for gross deterioration in the quality of life and general well-being of patients. Understanding the psychosocial issues and needs of patients undergoing hemodialysis could pave the way for comprehensive support and therapies designed to reduce stress, improve social support, and foster mental resilience. Objectives: The aim of this study was to explore the psychosocial issues and support needs of patients undergoing hemodialysis at a tertiary care center in Nepal. Methods: A qualitative descriptive study was conducted among 20 purposefully selected patients attending hemodialysis treatment at Pokhara Academy of Health Sciences, Nepal. Data was analyzed via thematic analysis. Results: The study resulted in three major themes which included Emotional, psychological, and spiritual struggles, Social and economic impacts, and Support and information needs. Moreover, 16 sub-themes emerged which are Frustration with daily life, Constant fear of death, Thoughts of self-harm, Perceived Burden on Family, Sense of Divine Punishment, Sense of Unfairness, Fear about future uncertainties, Social avoidance, Social stigmatization, Loss of employment, Financial strain, Transportation challenges, Need for early, clear and comprehensive information, Need for support and reassurance from family, Support through peer connections, and Reassurance from healthcare providers. Conclusion: The findings of this study indicate that patients undergoing hemodialysis in Nepal experience numerous hardships and multifaceted struggles that require support from different dimensions. Establishing robust support systems that include family involvement, peer networks, and effective communication from healthcare professionals can significantly mitigate feelings of anxiety and isolation.

Keywords: hemodialysis, psychosocial issues, support needs, chronic kidney disease, end stage renal disease, Nepal

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