Search results for: crisis interventions

Authors: J. Van der Walt, N. A. Plastow, M. Unger

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Gross and fine motor skill difficulties among children affect their ability to learn and progress in school. Research indicates that children in low socio-economic areas are at a higher risk of motor skill difficulties, while therapy resources are limited. The Hopscotch motor skill programme is a well-researched accessible in-school intervention developed by occupational and physiotherapists through complex intervention development. The development stage of the complex intervention development model firstly included a prevalence study in a low-resourced area in the West Coast of South Africa, indicating a high prevalence with significant motor skill difficulties among pre-school children at 14.5% with fine motor skill difficulties at 24.6%. A scoping review identifies motor skill interventions for pre-school children and a proposed a framework of fundamental concepts to consider when developing a motor skill intervention. a Delphi-study considered the framework and encouraged collaboration between therapists and educators to make the programme accessible, resource and cost effective, specifically geared towards a rural, low resourced area. The results from the Delphi study, together with the proposed framework from the scoping review was used to develop the Hopscotch programme, adopting a task-shifting approach. The eight-week small-group programme is facilitated by teachers with the support of therapists. The programme aims to improve the motor skills of pre-school aged children with motor skill difficulties to promote academic readiness through obstacle courses, ball skill games and fine motor games and crafts. A randomised controlled trial is planned as a next stage to determine the preliminary effect of the programme on the motor and early academic skills of pre-school children.

Keywords: accesible learning, motor skill intervention, school readiness, task shifting

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Authors: Layal Mansour

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The aim of this paper is to identify whether oil price volatility or geopolitical risks can predict future financial stress periods or economic recessions in Kuwait. We construct the first Financial Stress Index for Kuwait (FSIK) that includes informative vulnerable indicators of the main financial sectors: the banking sector, the equities market, and the foreign exchange market. The study covers the period from 2000 to 2020, so it includes the two recent most devastating world economic crises with oil price fluctuation: the Covid-19 pandemic crisis and Ukraine-Russia War. All data are taken by the central bank of Kuwait, the World Bank, IMF, DataStream, and from Federal Reserve System St Louis. The variables are computed as the percentage growth rate, then standardized and aggregated into one index using the variance equal weights method, the most frequently used in the literature. The graphical FSIK analysis provides detailed information (by dates) to policymakers on how internal financial stability depends on internal policy and events such as government elections or resignation. It also shows how monetary authorities or internal policymakers’ decisions to relieve personal loans or increase/decrease the public budget trigger internal financial instability. The empirical analysis under vector autoregression (VAR) models shows the dynamic causal relationship between the oil price fluctuation and the Kuwaiti economy, which relies heavily on the oil price. Similarly, using vector autoregression (VAR) models to assess the impact of the global geopolitical risks on Kuwaiti financial stability, results reveal whether Kuwait is confronted with or sheltered from geopolitical risks. The Financial Stress Index serves as a guide for macroprudential regulators in order to understand the weakness of the overall Kuwaiti financial market and economy regardless of the Kuwaiti dinar strength and exchange rate stability. It helps policymakers predict future stress periods and, thus, address alternative cushions to confront future possible financial threats.

Keywords: Kuwait, financial stress index, causality test, VAR, oil price, geopolitical risks

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Authors: Tugba Cinarli, Tugba Kavalali Erdogan, Sevil Masat, Dilek Kiymaz, Nida Kiyici, Zeliha Koc

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This study was conducted in a descriptive and cross-sectional manner, in order to determine the self-esteem, life satisfaction and depression/anxiety levels of the patients with stoma. The study was conducted between June 15, 2016 and June 15, 2017 among 196 oncology patients that were hospitalized in the general surgery clinic of a public hospital in Turkey. The case group consisted of 98 cancer patients with stoma and the control group consisted of 98 cancer patients without stoma. The data were collected through the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, the Hospital Anxiety and Depression Scale, and a 21-question survey that aimed to determine the sociodemographic and clinical properties of the patients. The data were analyzed with percentage analysis, Mann Whitney U-test, Chi-square test and Spearmen’s correlation test. It was determined that for the case group; 44.9% had colon cancer, 29.6% had rectal cancer; 50% underwent temporary colostomia, 15.3% underwent permanent colostomia, 34.7% underwent temporary ileostomy. The experimental group's findings for the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, the Anxiety Subscale and the Depression subscale were 64 (20 - 84), 17 (5 - 38), 10 (1 - 18), and 9 (1 - 19), respectively. The control group's findings for the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, the Anxiety Subscale and the Depression Subscale were 68 (32 - 92), 21 (7 - 31), 8.5 (1 - 18), and 8 (1 - 18), respectively. It was found that the Coopersmith Self-Esteem Scale, Life Satisfaction Scale, and the Anxiety Subscale findings were significantly different for the experimental and control groups (p<0.05). It was determined that the self-esteem levels were positively correlated with life satisfaction and negatively correlated with anxiety and depression; also, the life satisfaction levels were negatively correlated with anxiety and depression. It is suggested that the nursing interventions should be planned in order to improve life-satisfaction and self-esteem levels of the patients, and to decrease depression and anxiety.

Keywords: anxiety, cancer, life satisfaction, self-esteem

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Authors: N. Elgendy, N. Hussein

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The current Syrian crisis has caused unprecedented practices of global mobility. The process of forced eviction and the resettlement of refugees could be seen through the insights of the “new mobilities paradigm”. The mobility of refugees in terms of meaning and practice is a subject that calls for further studies. There is a need for the development of an approach to human mobility to understand a practice that is turning into a phenomenon in the 21^st century. This paper aims at studying, from a qualitative point of view, the process of movement within the six constituents of mobility defined as the first phase of the journey of a refugee. The second phase would include the process of settling in and re-defining the host country as new “home” to refugees. The change in the refugee state of mind and crossing the physical and mental borders from a “foreigner” to a citizen is encouraged by both the governmental policies and the local communities’ efforts to embrace these newcomers. The paper would focus on these policies of social and economic integration. The concept of integration connotes the idea that refugees would enjoy the opportunities, rights and services available to the citizens of the refugee’s new community. So, this paper examines this concept through showcasing the two hosting countries of Canada and Egypt, as they provide two contrasting situations in terms of cultural, geographical, economic and political backgrounds. The analysis would highlight the specific policies defined towards the refugees including the mass communication, media calls, and access to employment. This research is part of a qualitative research project on the process of Urban Mobility practiced by the Syrian Refugees, drawing on conversational interviews with new-settlers who have moved to the different hosting countries, from their home in Syria. It explores these immigrants’ practical and emotional relationships with the process of movement and settlement. It uses the conversational interviews as a tool to document analysis and draw relationships in an attempt to establish an understanding of the factors that contribute to the new-settlers feeling of home and integration within the new community.

Keywords: integration, mobility, policy, refugees

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Authors: Nabila Dwi Agustin, Ria Septitis Mentari, Nugroho Adi Sasongko

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Indonesia is experiencing a crisis in the development of defense equipment. Most of Indonesia's defense equipment must import its parts from other countries. Moreover, the area of Indonesia is 2/3 of its territory is the sea areas. For the protection of marine areas, Indonesia relies solely on submarines in monitoring conditions and whether or not intruders enter their territory. In fact, we know the submarine has a large size so that the expenses are getting bigger, the time it takes longer and needs a big maneuver to operate the submarine. Indeed, the submarine can only be operated for deeper seas. Many other countries enter the underwater world of Indonesia but Indonesia could not do anything due to the limitations of underwater monitoring system. At the same time, reconnaissance and monitor for shallow seas cannot be done by submarine. Equipment that can be used for surveillance of shallow underwater areas shall be made. This study reviewed the current research and development initiative of the submarine unmanned vehicle (SUV) or unmanned undersea vehicle (UUV) in Indonesia. This can explore underwater without the need for an operator to operate in it, but we can monitor it from a long distance. UUV has several advantages that size can be reduced as we desired, rechargeable ship batteries, has a detection sonar commonly found on a submarine and agile movement to detect at shallow sea depth. In the sonar sensors consisted of MEMS (Micro Electro Mechanical System), the sonar system runs more efficiently and effectively to monitor the target. UUV that has been developed will be very useful if the equipment is used around the outlying islands and outer from Indonesia especially the island frequented by foreign submarines without us know. The impact of this may not be felt now but it will allow foreign countries to attack Indonesia from within for the future. In addition, UUV needs to be equipped with a anti-radar system so that submarines of other countries crossing borders cannot detect it and Indonesia anti-submarine vessels can take further security measures. As the recommendation, Indonesia should take decisive steps in the state border rules, especially submarines of other countries that deliberately cross the borders of the state. This decisive action not only by word alone but also action as well. Indonesia government should show the strength and sovereignty as the entire society unites and applies the principle of universal peace.

Keywords: submarine unmanned vehicle, submarine, development of defense equipment, the border of Indonesia

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Authors: Huang Chiung Chiu

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This article is about the nursing experience of assisting an outpatient with premature menopause, osteoporosis and sarcopenia through a multi-discipline care model. The nursing period is from September 22nd, 2020, to December 7th, 2020, collecting data through interviews with the patient, observation, and physical assessment. It was found that the main health problems were insufficient nutrition, less physical need, insomnia, and potentially dangerous falls. As an outpatient nurse, the author observed that in recent years, the age group of women with premature menopause, osteoporosis and sarcopenia had shifted downward. Integrated multi-disciplinary interventions were provided upon the initial diagnosis of osteoporosis and sarcopenia. Under the outpatient care setting, the collaborative team works between the doctors, nutritionists, osteoporosis educators, rehabilitates, physical therapists and other specialized teams were applied to provide individualized, integrated multi-disciplinary care. Through empathy and the establishment of attentive care, companionship and trust, we discussed care plans and treatment guidelines with the case, providing accurate, complete disease information and feedback education to strengthen the patient’s knowledge and motivation for exercise. Nursing guidance regarding the dietary nutrition and adjustment of daily routine was provided to increase the self-care ability, improve the health problems of muscle weakness and insomnia, and prevent falls. For patients with postmenopausal osteoporosis and sarcopenia, it is recommended that the nurses coordinate the multi-discipline integrated care model, adjust patients’ lifestyle and diet, and establish a regular exercise plan so that the cases can be evaluated holistically to improve the quality of care and physical and mental comfort.

Keywords: multi-discipline care model, premature menopause, osteoporosis, sarcopenia, insomnia

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Authors: WonSun Chen, James Boylan, Erwin Muharemovic, Denny Meyer

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In Australia, drivers aged between 18 and 24 remained at high risk of road fatality over the last decade. Despite the successful implementation of the Graduated Licensing System (GLS) that supports young drivers in their early phases of driving, the road fatality statistics for these drivers remains high. In response to these statistics, studies conducted in Australia prior to the start of the COVID-19 pandemic have demonstrated the benefits of using telematics devices for improving driving behaviour, However, the impact of COVID-19 lockdown on young drivers’ driving behaviour has emerged as a global concern. Therefore, this naturalistic study aimed to evaluate and compare the driving behaviour(such as acceleration, braking, speeding, etc.) of young drivers with the adoption of in-vehicle telematics devices. Forty-two drivers aged between 18 and 30 and residing in the Australian state of Victoria participated in this study during the period of May to October 2022. All participants drove with the telematics devices during the first 30-day. At the start of the second 30-day, twenty-one participants were randomised to an intervention group where they were provided with an additional telematics ray device that provided visual feedback to the drivers, especially when they committed to aggressive driving behaviour. The remaining twenty-one participants remined their driving journeys without the extra telematics ray device (control group). Such trustworthy data enabled the assessment of changes in the driving behaviour of these young drivers using a machine learning approach in Python. Results are expected to show participants from the intervention group will show improvements in their driving behaviour compared to those from the control group.Furthermore, the telematics data enable the assessment and quantification of such improvements in driving behaviour. The findings from this study are anticipated to shed some light in guiding the development of customised campaigns and interventions to further address the high road fatality among young drivers in Australia.

Keywords: driving behaviour, naturalistic study, telematics data, young drivers

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Authors: Nipuli Gajanayake

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The Russian military role beyond its national frontier has become a debatable hot topic in the international political arena. It’s advanced, and strategic responses in combating regional and international security problems have always been a factor to debate and criticize. Under such critical circumstances, Russia is attentive to play its military role according to the provisions of the Military Doctrine of the Russian Federation. Most importantly, the legal basis of the doctrine has also consisted with the generally recognized principles and norms of international law. Therefore, Russian international military assistances are pledged to accomplish international peace and security. The expansion of Russian military participation in the United Nations Peacekeeping operations, and military- political, and technical cooperation have largely evident the great effort of Russia in maintaining and restoring international peace and security. Moreover, the conflict management diplomacy and the development of dialogue with nation states to confront military risks and threats can also identify as a part of preserving international peace and security. In addition, Russia strives to strengthen the system of collective security with regional and international organizations through the legal framework of the Collective Security Treaty Organization (CSTO). Maintaining cooperative ties with the Commonwealth of Independent States (CIS), the Organization for Security and Cooperation in Europe (OSCE) and the Shanghai Cooperation Organization (SCO) have highlighted the Russian deliberation on maintaining regional peace and security. Nevertheless, the extension of cordial relations with nation states and providing of military assistances during tensions and conflicts on their territories can also underscore as Russians commitments on maintaining international peace and security. Observing and recognizing the disparity between the West portrayed terms like ‘illegal Russian interventions’ and the comprehensive reality behind the ‘Russian military assistances’ are important to understand. However, a lopsided vision or a perspective towards the Russian international military role would not present a clear understanding about its valued and also dedicated hard work on maintaining international peace and security.

Keywords: collective security, diplomacy, international military role of Russia, international peace and security

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Authors: Sulaiman Al-Hinai, Setyawan Widyarto

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The aim of this study is to identify the critically dominating factors on the delays of road constructions in the GCC countries and their effects on project delivery in Arab countries. Towards the achieved of the objectives the study used the empirical literature from the all relevant online sources and database as many as possible. The findings of this study have summarized and short listed of the success factors in the two categories such as internal and external factors have caused to be influenced to delay of road constructions in the Arab regions. However, in the category of internal factors, there are 63 factors short listed from seven group of factors which has revealed to effects on the delay of road constructions especially, the consultant related factors, the contractor related factors, designed related factors, client related factors, labor related factors, material related issues, equipment related issues respectively. Moreover, for external related factors are also considered to summarized especially natural disaster (flood, hurricanes and cyclone etc.), conflict, war, global financial crisis, compensation delay to affected property owner, price fluctuated, unexpected ground conditions (soil and high-water level), changing of government regulations and laws, delays in obtaining permission from municipality, loss of time by traffic control and restrictions at job site, problem with inhabitant of community, delays in providing service from utilities (water and electricity’s) and accident during constructions accordingly. The present study also concluded the effects of above factors which has delay road constructions through increasing of cost and overrun it, taken overtime, creating of disputes, going for lawsuits, finally happening of abandon of projects. Thus, the present study has given the following recommendations to overcome of above problems by increasing of detailed site investigations, ensure careful monitoring and regular meetings, effective site management, collaborative working and effective coordination’s, proper and comprehensive planning and scheduling and ensure full and intensive commitment from all parties accordingly.

Keywords: Arab GCC countries, critical success factors, road constructions delay, project management

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Authors: Jocelyn Jones

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The objective of this literature review is to provide an assessment of the current literature concerning gender-based violence (GBV) within indigenous communities in Argentina and Costa Rica, and various public intervention strategies that have been implemented to counter the increasing rates of violence within these populations. The review will address some of the unique challenges and contextual factors influencing the prevalence and response to such violence, including the enduring impact of colonialism on familial structures, community dynamics, and the perpetuation of violence. Drawing on indigenous feminist perspectives, the paper critically assesses the intersectionality of gender, ethnicity, and socio-economic status in shaping the experiences of indigenous women, men, and gender-diverse individuals. In comparing the two nations, the literature review identifies commonalities and divergences in policy frameworks, legal responses, and grassroots initiatives aimed at addressing GBV. Regarding the assessment of the efficacy of existing interventions, the paper will consider the role of cultural revitalization, community engagement, and collaborative efforts between indigenous communities and external agencies in the development of future policies. Moreover, the review will highlight the importance of decolonizing methodologies in research and intervention strategies, and the need to emphasise culturally sensitive approaches that respect and integrate indigenous worldviews and traditional knowledge systems. Additionally, the paper will explore the potential impact of colonial legacies, resource extraction, and land dispossession on exacerbating vulnerabilities to GBV within indigenous communities. The aim of this paper is to contribute to a more in-depth understanding of GBV in indigenous contexts in order to promote cross-cultural learning and inform future research. Ultimately, this review will demonstrate the necessity of adopting a holistic and context-specific approach to address gender-based violence in indigenous communities.

Keywords: gender based violence, indigenous, colonialism, literature review

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Authors: Joy Debski

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Due to the varying degrees of the problem posed by global warming, environmental sustainability dominates international discourse. International initiatives' aims and expectations have proven particularly challenging to put into practice in developing nations. To reduce human exploitation of the environment, stricter measures are urgently needed. However, putting them into practice has proven more difficult. Relatively recent information from the Climate Accountability Institute and academic researchers shows that fossil fuel companies are major contributors to the climate crisis. Host communities in oil and gas-producing areas, particularly in developing nations, have grown hostile toward both oil and gas companies and government policies. It is now essential that the three main stakeholders—government, the oil and gas sector, and host communities—cooperate to achieve the shared objective of environmental sustainability. This research, therefore, advocates a governance system for Nigeria that facilitates the achieving the goal of environmental sustainability. This objective is achieved by the research's examination of the main institutional framework for environmental sustainability, evaluation of the strategies used by major oil companies to increase stakeholder engagement in environmental sustainability, and examination of the involvement of host communities in environmental sustainability. The study reveals that while environmental sustainability is important to the identified stakeholders, it's challenging to accomplish without an informed synergy. Hence the research advocates the centralisation of CSR through a CSR commission for environmental sustainability. The commission’s mandate is to facilitate, partner with, and endorse companies. The commission is strongly advised to incorporate host community liaison offices into the process of negotiating contracts with oil and gas firms, as well as to play a facilitative role in helping firms adhere to both domestic and international regulations. The recommendations can benefit Nigerian policymakers in enhancing their unsuccessful efforts to pass CSR legislation. Through the research-proposed CSR department, which has competent training and stakeholder engagement strategies, oil and gas companies can enhance and centralise their goals for environmental sustainability. Finally, the CSR Commission's expertise would give host communities more leverage when negotiating their memorandum of understanding with oil and gas companies.

Keywords: environmental sustainability, corporate social responsibility, CSR, oil and gas, nigeria

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Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) are a major cause of pain and disability. It is likely to become a greater economic and public health burden that is unnecessary. Thus, reliable prevalence figures are important for both clinicians and policy-makers to plan health care needs for those affected with the disease. This study estimated hospital based real-world prevalence of MSDs in Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out to identify common MSDs including low back pain (LBP), cervical spondylosis (CSD), post immobilization stiffness (PIS), sprain, osteoarthritis (OA), and other conditions. Occupational class of the patients was determined using the International Labour Classification (ILO). Data were analysed using descriptive statistics of frequency and percentages. Overall, medical charts of 3,340 patients were reviewed within the span of ten years (2009 to 2018). Majority of the patients (62.8%) were in the middle class, and the remaining were in low class (25.1%) and high class (10.5%) category. An overall prevalence of 47.35% of MSD was found within the span of ten years. Of this, the prevalence of LBP, CSD, PIS, sprain, OA, and other conditions was 21.6%, 10%, 18.9%, 2%, 6.3%, and 41.3%, respectively. The highest (14.2%) and lowest (10.5%) prevalence of MSDs was recorded in the year of 2012 and 2018, respectively. The prevalence of MSDs is considerably high among Nigerian patients attending outpatient a physiotherapy clinic. The high prevalence of MSDs underscores the need for clinicians and decision makers to put in place appropriate strategies to reduce the prevalence of these conditions. In addition, they should plan and evaluate healthcare services to improve the health outcomes of patients with MSDs. Further studies are required to determine the economic burden of the condition and examine the clinical and cost-effectiveness of physiotherapy interventions for patients with MSDs.

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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Authors: J. Chakwizira, P. Bikam, T. A. Adeboyejo

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This paper seeks to illustrate the impact of rapid urbanization (in terms of both increase in people and vehicles) in the Gauteng region (which includes Johannesburg, Pretoria and Ekurhuleni). The impact that existing transport systems and options place on the capacity of residents from low income areas to travel and conduct various socio-economic activities is discussed. The findings are drawn from a 2013 analysis of a random transport household survey of 1550 households carried out in Gauteng province. 91.4% of the study respondents had access to public transport, while 8.6% had no access to public transport. Of the 91.4% who used public transport, the main reason used to explain this state of affairs was that it was affordable (54.3%), convenient (15.9%), Accessible (11.9%), lack of alternatives (6.4%) and reliable at 4.1%. Recommendations advanced revolve around the need to reverse land use and transportation effects of apartheid planning, growing and developing a sustainable critical mass of public transport interventions supported by appropriate transport systems that are environmentally sustainable through proper governance. 38.5% of the respondents indicated that developing compact, smart and integrated urban land spaces was key to reducing travel challenges in the study area. 23.4% indicated that the introduction and upgrading of BRT buses to cover all areas in the study area was a step in the right direction because it has great potential in shifting travel patterns to favor public modes of transport. 15.1% indicated that all open spaces should be developed so that fragmentation of land uses can be addressed. This would help to fight disconnected and fragmented space and trip making challenges in Gauteng. 13.4% indicated that improving the metro rail services was critical since this is a mass mover of commuters. 9.6% of the respondents highlighted that the bus subsidy policy has to be retained in the short to medium term since the spatial mismatches and challenges created by apartheid are yet to be fully reversed.

Keywords: urbanisation, population, public, transport systems, Gauteng

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Authors: Ayalkibet Mekonnen, Adane Abebe

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In hydrological cycle there are many water-related human interventions that modify the natural systems. Rainwater harvesting is one such intervention that involves harnessing of water in the upstream. Water harvesting used in upstream prevents water runoff on downstream mainly disturbance on biodiversity and ecosystems. The main objectives of the study are to assess the effects of water harvesting technologies on downstream water availability in the Woreda. To address the above problem, SWAT model, cost-benefit ratio and optimal control approach was used to analyse the hydrological and socioeconomic impact and tradeoffs on water availability of the community, respectively. The downstream impacts of increasing water consumption in the upstream rain-fed areas of the Bilate and Shala Catchment are simulated using the semi-distributed SWAT model. The two land use scenarios tested at sub basin levels (1) conventional land use represents the current land use practice (Agri-CON) and (2) in-field rainwater harvesting (IRWH), improving soil water availability through rainwater harvesting land use scenario. The simulated water balance results showed that the highest peak mean monthly direct flow obtained from Agri-CON land use (127.1 m3/ha), followed by Agri-IRWH land use (11.5 mm) and LULC 2005 (90.1 m3/ha). The Agri-IRWH scenario reduced direct flow by 10% compared to Agri-CON and more groundwater flow contributed by Agri-IRWH (190 m3/ha) than Agri-CON (125 m3/ha). The overall result suggests that the water yield of the Woreda may not be negatively affected by the Agri-IRWH land use scenario. The technology in the Woreda benefited positively having an average benefit cost ratio of 4.2. Water harvesting for domestic use was not optimal that the value of the water per demand harvested was less than the amount of water needed. Storage tanks, series of check dams, gravel filled dams are an alternative solutions for water harvesting.

Keywords: water harvesting, SWAT model, land use scenario, Agri-CON, Agri-IRWH, trade off, benefit cost ratio

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Authors: Mbuso Siwela

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Background: The Sub-Saharan Africa region has the greatest number of people eligible to receive antiretroviral treatment (ART). Multi-month Drug dispensing (MMD) of antiretroviral treatment (ART) aims to reduce patient-related barriers to access long-term treatment and improve health system efficiency. In Eswatini, however, few children and adolescents are on MMD. Young Heroes is implementing an HIV program that aims to avert new HIV infections in children and youth and improve treatment outcomes for children and adolescents living with HIV (C/ALHIV: 0-19 Years) and OVC caregivers with HIV prevention and impact mitigation interventions that prevent new HIV infections and reduce vulnerability. Aim of the study: The study aimed to ascertain factors that are associated with the assignment of the MMD model on C/ALHIVs. Methodology: The project provides treatment adherence support through well-trained community cadres (Home Visitors - HVs) at both community and health facility levels. During door-to-door visits, HVs track all C/ALHIV enrolled in the project monthly and refer any who might have stopped or interrupted treatment. C/ALHIV with unsuppressed viral load is supported through case conferencing and teen clubs. A quantitative cross-sectional analysis was conducted using STATA for children and adolescents living with HIV enrolled in the project. Bivariate analysis was conducted, and the Logistic Regression model was used to ascertain the effects of duration on ART on the choice of MMD model. Results: Data for 544 C/ALHIV (0-19 Years) was analyzed in STATA. Results show a strong association between (duration on ART, Age, being in teen club) and enrolment in an MMD model. Duration on ART is a major predictor for the choice of MMD model at (95% CI: 0.0012905 – 0.0039812; P = <0.0001). C/ALHIV who have been on ART for less than a year are less likely to be on MMD. C/ALHIVs who are 1 or more years on ART are more likely to be in 3 months dispensing, while those who are 5 years or more are most likely to be in 6 months model.

Keywords: C/ALHIV, OVC, HIV, treatment

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Authors: Ravinder Kaur

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Introduction Global cerebrovascular reactivity (CVR) mapping is a promising clinical assessment for stress-testing the brain using physiological challenges, such as CO₂, to elicit changes in perfusion. It enables real-time assessment of cerebrovascular integrity and health. Conventional imaging approaches solely use steady-state parameters, like cerebral blood flow (CBF), to evaluate the integrity of the resting parenchyma and can erroneously show a healthy brain at rest, despite the underlying pathogenesis in the presence of cerebrovascular disease. Conversely, coupling CO₂ inhalation with phase-contrast MRI neuroimaging interrogates the capacity of the vasculature to respond to changes under stress. It shows promise in providing prognostic value as a novel health marker to measure neurovascular function in disease and to detect early brain vasculature dysfunction. Objective This exploratory study was established to:(a) quantify the CBF response to CO₂ in hypocapnia and hypercapnia,(b) evaluate disparities in CVR between internal carotid (ICA) and vertebral artery (VA), and (c) assess sex-specific variation in CVR. Methodology Phase-contrast MRI was employed to measure the cerebrovascular reactivity to CO₂ (±10 mmHg). The respiratory interventions were presented using the prospectively end-tidal targeting RespirActTM Gen3 system. Post-processing and statistical analysis were conducted. Results In 9 young, healthy subjects, the CBF increased from hypocapnia to hypercapnia in all vessels (4.21±0.76 to 7.20±1.83 mL/sec in ICA, 1.36±0.55 to 2.33±1.31 mL/sec in VA, p < 0.05). The CVR was quantitatively higher in ICA than VA (slope of linear regression: 0.23 vs. 0.07 mL/sec/mmHg, p < 0.05). No statistically significant effect was observed in CVR between male and female (0.25 vs 0.20 mL/sec/mmHg in ICA, 0.09 vs 0.11 mL/sec/mmHg in VA, p > 0.05). Conclusions The principal finding in this investigation validated the modulation of CBF by CO₂. Moreover, it has indicated that regional heterogeneity in hemodynamic response exists in the brain. This study provides scope to standardize the quantification of CVR prior to its clinical translation.

Keywords: cerebrovascular disease, neuroimaging, phase contrast MRI, cerebrovascular reactivity, carbon dioxide

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Authors: Zyrah Lou R. Samar, Genecarlo Liwanag

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Type 2 Diabetes Mellitus is the more prevalent type, caused by a combination of insulin resistance and inadequate insulin response to hyperglycemia1. Aside from pharmacologic interventions, medical nutrition therapy is an integral part of the management of patients with Type 2 Diabetes Mellitus. Whey protein, which is one of the best protein sources, has been investigated for its applicability in improving glycemic control in patients with Type 2 Diabetes Mellitus. This systematic review and meta-analysis was conducted to measure the magnitude of the effect of whey protein on glycemic control in type 2 diabetes mellitus. The aim of this review is to evaluate the efficacy and safety of whey protein in patients with type 2 diabetes mellitus. Methods: A systematic electronic search for studies in the PubMed and Cochrane Collaboration database was done. Included in this review were randomized controlled trials of whey protein enrolling patients with type 2 diabetes mellitus. Three reviewers independently searched, assessed, and extracted data from the individual studies. Results: A systematic literature search on online databases such as Cochrane Central Registry, PubMed, and Herdin Plus was conducted in April to September 2021 to identify eligible studies. The search yielded 21 randomized controlled trials after removing duplicates. Only 5 articles were included after reviewing the full text, which met the criteria for selection. Conclusion: Whey protein supplementation significantly reduced fasting blood glucose. However, it did not reduce post-prandial blood glucose, HbA1c level, and weight when compared with the placebo. There has been a considerate heterogeneity across all studies, which may have contributed/confounded its effects. A larger sample size and better inclusion, and a more specific study may be included in the future reviews.

Keywords: whey protein, diabetes, nutrition, fasting blood sugar, postprandial glucose, HbA1c, weight reduction

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Authors: Yasmeen Coaxum

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The year 2020 became synonymous with the words “Emergency Remote Teaching,” which was imposed upon educators during the COVID-19 pandemic. Consequently, teachers were compelled to find new and engaging ways to educate their students outside of the face-to-face classroom setting. Now online instruction has become more of the norm rather than a way to manage educational expectations during a crisis. Therefore, implementing a strategic way to create online environments for students to thrive, create, and fully engage in their learning process is essential. The Synchronous Online Flipped Learning Approach or SOFLA® is a distance learning model that most closely replicates actual classroom teaching. SOFLA® includes structured, interactive, multimodal activities in an eight-step learning cycle with both asynchronous and synchronous components that foster autonomous and interactive learning among today’s online learners. The results of a pilot study in an Intensive English Program at a university, using SOFLA® methodology to facilitate podcasting in an online learning environment will be shared. Previous findings on student-produced podcasting projects have shown that students felt they improved their pronunciation, vocabulary, and speaking skills. However, few if any studies have been conducted on using a structured online flipped learning approach to facilitate such projects. Therefore, the purpose of this study is to assess the effect of using the SOFLA® framework to enhance optimum engagement in the online environment while using podcasts as the primary tool of instruction. Through data from interviews, questionnaires, and the results of formative and summative assessments, this study also investigates the affective and academic impact this flipped learning method combined with podcasting has on the students in terms of speaking confidence and vocabulary retention, and production. The steps of SOFLA will be illustrated, a video demonstration of the Anchor podcasting app will be shown, and final student projects and questionnaire responses will be shared. The specific context is a 14-week advanced level conversation and listening class. Participants vary in age but are all adult language learners representing a diverse array of countries.

Keywords: mall online flipped learning, podcasting, productive vocabulary

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Authors: Md. Rasel Mia, Ashik Billah

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The empowerment of girls and youth in Bangladesh is a demanding issue in today's digital age, where online learning and education have become integral to personal and societal development. This abstract explores the critical importance of creating a secure online environment for girls and youth in Bangladesh, emphasizing the transformative impact it can have on their access to education and knowledge. Bangladesh, like many developing nations, faces gender inequalities in education and access to digital resources. The creation of a safe digital space not only mitigates the gender digital divide but also fosters an environment where girls and youth can thrive academically and professionally. This manuscript draws attention to the efforts through a mixed-method study to assess the current digital landscape in Bangladesh, revealing disparities in phone and internet access, online practices, and awareness of cyber security among diverse demographic groups. Moreover, the study unveils the varying levels of familial support and barriers encountered by girls and youth in their quest for digital literacy. It emphasizes the need for tailored training programs that address specific learning needs while also advocating for enhanced internet accessibility, safe online practices, and inclusive online platforms. The manuscript culminates in a call for collaborative efforts among stakeholders, including NGOs, government agencies, and telecommunications companies, to implement targeted interventions that bridge the gender digital divide and pave the way for a brighter, more equitable future for girls and youth in Bangladesh. In conclusion, this research highlights the undeniable significance of creating a safe digital space as a catalyst for the empowerment of girls and youth in Bangladesh, ensuring that they not only access but excel in the online space, thereby contributing to their personal growth and the advancement of society as a whole.

Keywords: collaboration, cyber security, digital literacy, digital resources, inclusiveness

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Authors: Lina María Martínez Sánchez, Juliana Molina Valencia, Esteban Vallejo Agudelo, Daniel Gallego González, María Isabel Pérez Palacio, Juan Ricardo Gaviria García, María De Los Ángeles Rodríguez Gázquez, Gloria Inés Martínez Domínguez

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Alternative and complementary therapies constitute a vast and complex combination of interventions, philosophies, approaches, and therapies that acquire a holistic healthcare point of view, becoming an alternative for the treatment of patients with chronic pain. Objective: determine the characteristics of the use of alternative and complementary therapies in patients with chronic pain who consulted in a medical institution. Methodology: cross-sectional and descriptive study, with a population of patients that assisted to the outpatient consultation and met the eligibility criteria. Sampling was not conducted. A form was used for the collection of demographic and clinical variables and the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was validated. The analysis and processing of information was carried out using the SPSS program vr.19. Results: 220 people with chronic pain were included. The average age was 54.7±16.2 years, 78.2% were women, and 75.5% belonged to the socioeconomic strata 1 to 3. Musculoskeletal pain (77.7%), migraine (15%) and neuralgia (9.1%) were the most frequently types of chronic pain. 33.6% of participants have used some kind of alternative and complementary therapy; the most frequent were: homeopathy (14.5%), phytotherapy (12.7%), and acupuncture (11.4%). The total average HCAMQ score for the study group was 30.2±7.0 points, which shows a moderate attitude toward the use of complementary and alternative medicine. The highest scores according to the type of pain were: neuralgia (32.4±5.8), musculoskeletal pain (30.5±6.7), fibromyalgia (29.6±7.3) and migraine (28.5±8.8). The reliability of the HCAMQ was acceptable (Cronbach's α: 0.6). Conclusion: it was noted that the types of chronic pain and the clinical or therapeutic management of patients correspond to the data available in current literature. Despite the moderate attitude toward the use of these alternative and complementary therapies, one of every three patients uses them.

Keywords: chronic pain, complementary therapies, homeopathy, acupuncture analgesia

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Authors: Ashimolowo Olubunmi

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Contraception use helps prevent pregnancy as well as health-related challenges, most especially among youths and girls. Our communities are bedeviled with many problems, including rape, defilement, neglect by the spouse, and intimate partner violence. Current interventions target only adults, with most facilities having youth and unfriendly adolescent services. To further support the need for this research, especially with our target beneficiaries, the partnership embarked on qualitative evidence-finding research through focus group discussions and in-depth-interview in Abeokuta and Ibadan (the capital cities of Ogun). The Focus Group Discussion (FGD) sessions were held in the state with adolescents (10-18 years) and young women (18-30 years). The result revealed that teenagers and youths who receive formal and sexual education on abstinence, and birth control methods, are likely to have healthier sexual behaviours through the promotion of abstinence and the use of condoms and other forms of contraceptives at their first intercourse, thereby protecting themselves against HIV/AIDs (Human Immunodeficiency Virus/Acquired immunodeficiency syndrome. The result further revealed that parents do not discuss issues around Adolescent and Sexual Reproductive Health (ASRH) with their adolescent girls, leading to gaps in knowledge of ASRH. Stakeholders’ involvement and trust are low. Respondents noted that there were few outreaches on ASRH and that youth-friendly adolescent centres are not common in the community. Respondents noted that there were few outreaches on ASRH organised within the community. Also, youth-friendly services were not common. There is a need to work with all stakeholders to promote those foundational life skills on pubertal changes, menstruation, and sexual life to prepare youths and girls for challenges ahead through sex education; we should work to institutionalize youth and adolescent-friendly Sexual and Reproductive Health (SRH) in our communities.

Keywords: contraception, family planning, focus group discussion, adolescents

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Authors: Tsu-Yin Wu, Jenni Hoffman, Lydia McMurrows, Sarah Lally

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Recent events of the Flint Water Crisis and elevated lead levels in Detroit public school water have highlighted a specific public health disparity and shown the need for better education of healthcare providers on lead education. Identifying children and pregnant women with a high risk for lead poisoning and ensuring lead testing is completed is critical. The purpose of this study is to explore the impact of an educational intervention on knowledge and confidence levels among nursing students enrolled in the prelicensure Bachelor of Science in Nursing (BSN) and Registered Nurse to BSN program (R2B). The study used both quantitative and qualitative research methods to assess the impact of multi-modal pedagogy on knowledge and confidence of lead screening and prevention among prelicensure and R2B nursing students. The students received lead poisoning and prevention content in addition to completing an e-learning module developed by the Pediatric Environmental Health Specialty Units. A total of 115 students completed the pre-and post-test instrument that consisted of demographic, lead knowledge, and confidence items. Despite the increase of total knowledge, three dimensions of lead poisoning, and confidence from pre- to post-test scores for both groups, there was no statistical significance on the increase between prelicensure and R2B students. Thematic analysis of qualitative data showed five themes from participants' learning experiences: lead exposure, signs and symptoms of lead poisoning, screening and diagnosis, prevention, and policy and statewide issues. The study is limited by a small sample and participants recalling some correct answers from the pretest, thus, scoring higher on the post-test. The results contribute to the minimally existent literature examining a critical public health concern regarding lead health exposure and prevention education of nursing students. Incorporating such content area into the nursing curriculum is essential in ensuring that such public health disparities are mitigated.

Keywords: lead poisoning, emerging public health issue, community health, nursing edducation

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Authors: Les Moncrieff

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In a world awash with potent opioids flaming an international crisis, the need to explore safe alternatives has never been more urgent. Bio-electrode Therapy is a novel adjunctive treatment method for relieving acute opioid withdrawal symptoms and many types of complex acute and chronic pain (often the underlying cause of opioid dependence). By combining the science of developmental bioelectricity with Traditional Chinese Medicine’s theory of meridians, rapid relief from pain is routinely being achieved in the clinical setting. Human body functions are dependent on electrical factors, and acupuncture points on the body are known to have higher electrical conductivity than surrounding skin tissue. When tiny gold- and silver-plated electrodes are secured to the skin at specific acupuncture points using established Chinese Medicine principles and protocols, an enhanced microcurrent and electrical field are created between the electrodes, influencing the entire meridian and connecting meridians. No external power source or electrical devices are required. Endogenous DC electric fields are an essential fundamental component for development, regeneration, and wound healing. Disruptions in the normal ion-charge in the meridians and circulation of blood will manifest as pain and development of disease. With the application of these simple electrodes (gold acting as cathode and silver as anode) according to protocols, the resulting microcurrent is directed along the selected meridians to target injured or diseased organs and tissues. When injured or diseased cells have been stimulated by the microcurrent and electrical fields, the permeability of the cell membrane is affected, resulting in an immediate relief of pain, a rapid balancing of positive and negative ions (sodium, potassium, etc.) in the cells, the restoration of intracellular fluid levels, replenishment of electrolyte levels, pH balance, removal of toxins, and a re-establishment of homeostasis.

Keywords: bioelectricity, electrodes, electrical fields, acupuncture meridians, complex pain, opioid withdrawal management

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Authors: Oluwayemisi Femi-Pius, Kazeem Arogundade, Eberechukwu Eke, Jimmy Eko

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Introduction: Globally, community involvement in improving their own health has been widely adopted as a strategy in Sub-Saharan Africa principally to ensure equitable access to essential health care as well as improve the uptake of maternal and newborn health services especially in poor-resource settings. Method: The Saving Mother Giving Life (SMGL) Initiative implemented by Pathfinder International with funding support from USAID conducted a Health Facility Assessment (HFA) and found out that maternal mortality ratio in Cross River State was 812 per 100,000 live birth and perinatal mortality was 160 per 1000 live birth. To reduce maternal and perinatal mortality, Pathfinder International mobilized, selected and trained community members as community volunteers, traditional birth attendants, and emergency transport service volunteer drivers mainly to address the delay in decision making and reaching the health facility among pregnant women. Results: The results showed that maternal mortality ratio in Cross River State decrease by 25% from 812 per 100,000 live birth at baseline to 206 per 100,000 live birth at June 2018 and perinatal mortality reduced by 35% from 160 per 100,000 at baseline to 58 per 1000 live birth at June 2018. Data also show that ANC visit increased from 7,451 to 11,344; institutional delivery increased from 8,931 at baseline to 10,784 in June 2018. There was also a remarkable uptake of post-partum family planning from 0 at baseline to 233 in June 2018. Conclusion: There is clear evidence that community involvement yields positive maternal outcomes and is pivotal for sustaining most health interventions.

Keywords: maternal mortality, Nigeria, pathfinder international, perinatal mortality, saving mother giving life

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Authors: M. Macchiaroli, V. Pellecchia, L. Dolores

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Within any European and world model of management of the integrated water service (in Italy only since 2012 is regulated by a national Authority, that is ARERA), a significant part is covered by the development of assets in terms of hydraulic networks and wastewater collection networks, including all their relative building works. The process of selecting the investments to be made starts from the preventive analysis of critical issues (water losses, unserved areas, low service standards, etc.) who occur in the managed territory of the Operator. Through the Program of Interventions (Provision by ARERA n. 580/2019/R/idr), the Operator provides to program the projects that can meet the emerged needs to determine the improvement of the water service levels. This phase (analyzed and solved by the author with a work published in 2019) involves the use of evaluation techniques (cost-benefit analysis, multi-criteria, and multi-objective techniques, neural networks, etc.) useful in selecting the most appropriate design answers to the different criticalities. However, at this point, the problem of establishing the time priorities between the various works deemed necessary remains open. That is, it is necessary to hierarchize the investments. In this decision-making moment, the interests of the private Operator are often opposed, which favors investments capable of generating high profitability, compared to those of the public controller (ARERA), which favors investments in greater social impact. In support of the concertation between these two actors, the protocol set out in the research has been developed, based on the AHP and capable of borrowing from the programmatic documents an orientation path for the settlement of the conflict. The protocol is applied to a case study of the Campania Region in Italy and has been professionally applied in the shared decision process between the manager and the local Authority.

Keywords: analytic hierarchy process, decision making, economic evaluation of projects, integrated water service

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Authors: Naomi W. Maina

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Fertility preference is a subject of great significance in developing countries. Studies reveal that the preferences of fertility are actually significant in determining the society’s fertility levels because the fertility behavior of the future has a high likelihood of falling under the effect of currently observed fertility inclinations. The objective of this study was to establish the factors associated with fertility preference amongst couples in Kenya by fitting a multinomial logistic regression model against 5,265 couple data obtained from Kenya demographic health survey 2014. Results revealed that the type of place of residence, the region of residence, age and spousal age gap significantly influence desire for additional children among couples in Kenya. There was the notable high likelihood of couples living in rural settlements having similar fertility preference compared to those living in urban settlements. Moreover, geographical disparities such as in northern Kenya revealed significant differences in a couples desire to have additional children compared to Nairobi. The odds of a couple’s desire for additional children were further observed to vary dependent on either the wife or husbands age and to a large extent the spousal age gap. Evidenced from the study, was the fact that as spousal age gap increases, the desire for more children amongst couples decreases. Insights derived from this study would be attractive to demographers, health practitioners, policymakers, and non-governmental organizations implementing fertility related interventions in Kenya among other stakeholders. Moreover, with the adoption of devolution, there is a clear need for adoption of population policies that are County specific as opposed to a national population policy as is the current practice in Kenya. Additionally, researchers or students who have little understanding in the application of multinomial logistic regression, both theoretical understanding and practical analysis in SPSS as well as application on real datasets, will find this article useful.

Keywords: couples' desire, fertility, fertility preference, multinomial regression analysis

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Authors: Tosin Deborah Akanbi

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The Building Information Modeling Execution Plan (BEP) is a document that manifests the specifications for the adoption and execution of building information modeling in the construction sector in an organized manner so as to attain the listed goals. In this regard, the study examined the barriers to the adoption of building information modeling, evaluated the effect of building information modeling adoption characteristics on the key elements of a building information modeling execution plan and developed a strategic framework for a BEP in the Lagos State construction industry. Data were gathered through a questionnaire survey with 332 construction professionals in the study area. Three online structured interviews were conducted to support and validate the findings of the quantitative analysis. The results showed the significant relationships and connections between the variables in the framework: BIM usage and model quality control (aBIMskill -> dMQ, Beta = 0.121, T statistics = 1.829), BIM adoption characteristics and information exchange (bBIM_CH -> dIE, Beta = 0.128, T statistics = 1.727), BIM adoption characteristics and process design (bBIM_CH -> dPD, Beta = 0.170, T statistics = 2.754), BIM adoption characteristics and roles and responsibilities (bBIM_CH -> dRR, Beta = 0.131, T statistics = 2.181), interest BIM barriers and BIM adoption characteristics (cBBIM_INT -> bBIM_CH, Beta = 0.137, T statistics = 2.309), legal BIM barriers and BIM adoption characteristics (cBBIM_LEG -> bBIM_CH, Beta = 0.168, T statistics = 2.818), professional BIM barriers and BIM adoption characteristics (cBBIM_PRO -> bBIM_CH, Beta = 0.152, T statistics = 2.645). The results also revealed that seven final themes were generated, namely: model structure and process design, BIM information exchange and collaboration procedures, project goals and deliverables, project model quality control, roles and responsibilities, reflect Lagos state construction industry and validity of the BEP framework. Thus, there is a need for the policy makers to direct interventions to promote, encourage and support the understanding and adoption of BIM by emphasizing the various benefits of using the technology in the Lagos state construction industry.

Keywords: building information modelling execution plan, BIM adoption characteristics, BEP framework, construction industry

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Authors: Geetanjali Yadav, Arpit Mishra, Parthsarathi Ghosh, Ramkrishna Sen

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The world is facing problems of increasing global CO2 emissions, climate change and fuel crisis. Therefore, several renewable and sustainable energy alternatives should be investigated to replace non-renewable fuels in future. Algae presents itself a versatile feedstock for the production of variety of fuels (biodiesel, bioethanol, bio-hydrogen etc.) and high value compounds for food, fodder, cosmetics and pharmaceuticals. Microalgae are simple microorganisms that require water, light, CO2 and nutrients for growth by the process of photosynthesis and can grow in extreme environments, utilize waste gas (flue gas) and waste waters. Mixing, however, is a crucial parameter within the culture system for the uniform distribution of light, nutrients and gaseous exchange in addition to preventing settling/sedimentation, creation of dark zones etc. The overarching goal of the present study is to improve photobioreactor (PBR) design for enhancing dissolution of CO2 from ambient air (0.039%, v/v), pure CO2 and coal-fired flue gas (10 ± 2%) into microalgal PBRs. Computational fluid dynamics (CFD), a state-of-the-art technique has been used to solve partial differential equations with turbulence closure which represents the dynamics of fluid in a photobioreactor. In this paper, the hydrodynamic performance of the PBR has been characterized and compared with that of the conventional bubble column PBR using CFD. Parameters such as flow rate (Q), mean velocity (u), mean turbulent kinetic energy (TKE) were characterized for each experiment that was tested across different aeration schemes. The results showed that the modified PBR design had superior liquid circulation properties and gas-liquid transfer that resulted in creation of uniform environment inside PBR as compared to conventional bubble column PBR. The CFD technique has shown to be promising to successfully design and paves path for a future research in order to develop PBRs which can be commercially available for scale-up microalgal production.

Keywords: computational fluid dynamics, microalgae, bubble column photbioreactor, flue gas, simulation

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Authors: Tambe Daniel Atem

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Background: Clinical Research is an organized research on human beings intended to provide adequate information on the drug use as a therapeutic agent on its safety and efficacy. The significance of the study is to educate the global health and life science graduates in Clinical Research in depth to perform better as it involves testing drugs on human beings. Objectives: to provide an overall understanding of the scientific approach to the evaluation of new and existing medical interventions and to apply ethical and regulatory principles appropriate to any individual research. Methodology: It is based on – Primary data analysis and Secondary data analysis. Primary data analysis: means the collection of data from journals, the internet, and other online sources. Secondary data analysis: a survey was conducted with a questionnaire to interview the Clinical Research Professionals to understand the need of training to perform clinical trials globally. The questionnaire consisted details of the professionals working with the expertise. It also included the areas of clinical research which needed intense training before entering into hardcore clinical research domain. Results: The Clinical Trials market worldwide worth over USD 26 billion and the industry has employed an estimated 2,10,000 people in the US and over 70,000 in the U.K, and they form one-third of the total research and development staff. There are more than 2,50,000 vacant positions globally with salary variations in the regions for a Clinical Research Coordinator. R&D cost on new drug development is estimated at US$ 70-85 billion. The cost of doing clinical trials for a new drug is US$ 200-250 million. Due to an increase trained Clinical Research Professionals India has emerged as a global hub for clinical research. The Global Clinical Trial outsourcing opportunity in India in the pharmaceutical industry increased to more than $2 billion in 2014 due to increased outsourcing from U.S and Europe to India. Conclusion: Assessment of training need is recommended for newer Clinical Research Professionals and trial sites, especially prior the conduct of larger confirmatory clinical trials.

Keywords: clinical research, clinical trials, clinical research professionals

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Authors: Asad Salahuddin

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Crime rates seem to be severely augmenting over the past several years in Pakistan which has perpetuated concerns as to what, when and how this upsurge will be eradicated. State institutions are posed to be in utmost perplexity, given the enormity of worsening law and order situation, compelling government on the flip side to expend more resources in strengthening institutions to confront crime, whereas, the economy has been confronted with massive energy crisis, mass unemployment and considerable inflation which has rendered most of the people into articulate apprehension as to how to satisfy basic necessities. A framework to investigate the variability in the rising street crimes, as affected by social and institutional outcomes, has been established using a cross-sectional study. Questionnaire, entailing 7 sections incorporating numerous patterns of behavior and history of involvement in different crimes for potential street criminals was observed as data collection instrument. In order to specifically explicate the intent of street crimes on micro level, various motivational and de-motivational factors that stimulate people to resort to street crimes were scrutinized. Intent of mobile snatching and intent of street assault as potential dependent variables were examined using numerous variables that influence the occurrence and intent of these crimes using ordered probit along with ordered logit and tobit as competing models. Model Estimates asserts that intent of mobile snatching has been significantly enhanced owing to perceived judicial inefficiency and lower ability of police reforms to operate effectively, which signifies the inefficiency of institutions that are entitled to deliver justice and maintaining law and order respectively. Whereas, intent of street assaults, as an outcome, affirms that people with lack of self-stability and severe childhood punishments were more tempted to be involved in violent acts. Hence, it is imperative for government to render better resources in form of training, equipment and improved salaries to police and judiciary in order to enhance their abilities and potential to curb inflating crime.

Keywords: deprivation, street assault, self control, police reform

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