Search results for: health care workers' knowledge

Authors: Jan Barak, Karel Frana, Joerg Stiller

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This work presents results of moist air condensation in heat exchanger. It describes theoretical knowledge and definition of moist air. Model with geometry of square canal was created for better understanding and post processing of condensation phenomena. Different approaches were examined on this model to find suitable software and model. Obtained knowledge was applied to geometry of real heat exchanger and results from experiment were compared with numerical results. One of the goals is to solve this issue without creating any user defined function in the applied code. It also contains summary of knowledge and outlook for future work.

Keywords: condensation, exchanger, experiment, validation

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Authors: Nanteza Rachel

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Background: Worldwide, there were 36.7 million people living with Human Immunodeficiency Virus (HIV) in 2015, up from 35 million at the end of 2013. Wakiso district is one of the hotspots for the Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) infection in Uganda, with the prevalence of 8.1 %. Herbal medicine has gained popularity among Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) patients as adjuvant therapy to reduce the adverse effects of ART. Regardless of the subsidized and physical availability of the Anti-Retroviral Therapy (ART), majority of Africans living with Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) resort to adding to their ART traditional medicine. Result found out from a pilot observation made by the PI that indicate 13 out of 30 People Living with AIDS(PLWA) who are attending Human Immunodeficiency Virus (HIV) clinics in Wakiso district reported to be using herbal preparations despite the fact that they were taking Anti Retro Viral (ARVs) this prompted this study to be done. Purpose of the study: To determine the prevalence and factors associated with concurrent use of herbal medicine and anti-retroviral therapy among HIV/AIDS patients attending selected HIV clinics in Wakiso district. Methodology: This was a cross sectional study with both quantitative data collection (use of a questionnaire) and qualitative data collection (key informants’ interviews). A mixed method of sampling was used, that is, purposive and random sampling. Purposive sampling was based on the location in the district and used to select 7 health facilities basing on the 7 health sub districts from Wakiso. Simple random sampling was used to select one HIV clinic from each of the 7 health sub districts. Furthermore, the study units were enrolled in to the study as they entered into the HIV clinics, and 105 respondents were interviewed. Both manual and computer packages (SPSS) were used to analyze the data Results: The prevalence of concurrent use of herbal medicine and ART was 38 (36.2%). Commonly HIV symptom treated with herbs was fever 27(71.1%), diarrhea 3(7.9%) and cough 2(5.3%). Commonly used herbs for fever (Omululuza (Vernonica amydalina), Ekigagi (Aloe sp), Nalongo (Justicia betonica Linn) while for diarrhea was Ntwatwa. The side effects also included; too much pain, itchy pain of HIV, aneamia,felt sick, loss/gain appetite, joint pain and bad dreams. Herbs used to sooth the side effects were; for aneamia was avocado leaves Parea Americana mill The significant factors associated with concurrent use of herbal medicine were being familiar with herbs and conventional medicine for management HIV symptoms being expensive. The other significant factor was exhibiting hostility to patients by health personnel providing HIV care. Conclusion: Herbal medicine is widely used by clients in HIV/AIDS care. Patients being familiar with herbs and conventional medicine being expensive were associated with concurrent use of herbal medicine and ART. The exhibition of hostility to the HIV/AIDS patients by the health care providers was also associated with concurrent use of herbal medicine and ART among HIV/AIDS patients.

Keywords: HIV patients, herbal medicine, antiretroviral therapy, factors associated

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Authors: Yiqi Zhu, Jean Francois Trani, Rameez Ulhassan

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Extreme weather phenomena increased by 46% between 2007 and 2017 and have become more intense with the rise in global average temperatures. This increased intensity of climate variations often induces humanitarian crises and particularly affects vulnerable populations in low- and middle-income countries (LMICs). Expectant and lactating mothers are among the most vulnerable groups. Pakistan ranks 10th among the most affected countries by climate disasters. In 2022, monsoon floods submerged a third of the country, causing the loss of 1,500 lives. Approximately 650,000 expectant and lactating mothers faced systematic stress from climatic disasters. Our study used participatory methods to investigate the systematic impact of climatic disasters on maternal health. In March 2023, we conducted six Group Model Building (GMB) workshops with healthcare workers, fathers, and mothers separately in two of the most affected areas in Pakistan. This study was approved by the Islamic Relief Research Review Board. GMB workshops consist of three sessions. In the first session, participants discussed the factors that impact maternal health. After identifying the factors, they discussed the connections among them and explored the system structures that collectively impact maternal health. Based on the discussion, a causal loop diagram (CLD) was created. Finally, participants discussed action ideas that could improve the system to enhance maternal health. Based on our discussions and the causal loop diagram, we identified interconnected factors at the family, community, and policy levels. Mothers and children are directly impacted by three interrelated factors: food insecurity, unstable housing, and lack of income. These factors create a reinforcing cycle that negatively affects both mothers and newborns. After the flood, many mothers were unable to produce sufficient breastmilk due to their health status. Without breastmilk and sufficient food for complementary feeding, babies tend to get sick in damp and unhygienic environments resulting from temporary or unstable housing. When parents take care of sick children, they miss out on income-generating opportunities. At the community level, the lack of access to clean water and sanitation (WASH) and maternal healthcare further worsens the situation. Structural failures such as a lack of safety nets and programs associated with flood preparedness make families increasingly vulnerable with each disaster. Several families reported that they had not fully recovered from a flood that occurred ten years ago, and this latest disaster destroyed their lives again. Although over twenty non-profit organizations are working in these villages, few of them provide sustainable support. Therefore, participants called for systemic changes in response to the increasing frequency of climate disasters. The study reveals the systematic vulnerabilities of mothers and children after climatic disasters. The most vulnerable populations are often affected the most by climate change. Collaborative efforts are required to improve water and forest management, strengthen public infrastructure, increase access to WASH, and gradually build climate-resilient communities. Governments, non-governmental organizations, and the community should work together to develop and implement effective strategies to prevent, mitigate, and adapt to climate change and its impacts.

Keywords: climatic disasters, maternal health, Pakistan, systematic impact, flood, disaster relief.

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Authors: Saeeda Batool, Ather Maqsood Ahmed

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This study investigates the impact of public healthcare facilities and socio-economic circumstances on the status of child health in Pakistan. The complete analysis is carried out in correspondence with fourth and sixth millennium development goals. Further, the health variables chosen are also inherited from targeted indicators of the mentioned goals (MDGs). Trends in the Human Opportunity Index (HOI) for both health inequalities and coverage are analyzed using the Pakistan Social and Living Standards Measurement (PLSM) data set for 2001-02 to 2012-13 at the national and provincial level. To reveal the relative importance of each circumstance in achieving the targeted values for child health, Shorrocks decomposition is applied on HOI. The annual point average growth rate of HOI is used to simulate the time period for the achievement of target set by MDGs and universal access also. The results indicate an improvement in HOI for a reduction in child mortality rates from 52.1% in 2001-02 to 67.3% in 2012-13, which confirms the availability of healthcare opportunities to a larger segment of society. Similarly, immunization against measles and other diseases such as Diphtheria, Polio, Bacillus Calmette-Guerin (BCG), and Hepatitis has also registered an improvement from 51.6% to 69.9% during the period of study at the national level. On a positive note, no gender disparity has been found for child health indicators and that health outcome is mostly affected by the parental and geographical features and availability of health infrastructure. However, the study finds that this achievement has been uneven across provinces. Pakistan is not only lagging behind in achieving its health goals, disappointingly with the current rate of health care provision, but it will take many additional years to achieve its targets.

Keywords: socio-economic circumstances, unmet MDGs, public healthcare services, child and infant mortality

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Authors: Robin Ferguson

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The context which this paper explores is the provision of Technical Vocational Education and Training (TVET) of southern African workers at sea on local and foreign vessels using a blended learning approach. The pedagogical challenge of providing quality education in this context is that multiple African and foreign languages and cultural norms are found amongst the all-male crew; and there are widely differing levels of education, low levels of digital literacy and limited connectivity. The methodology used is a nested case study. The study describes the mechanisms used to provide ongoing, real-time workplace TVET on two foreign vessels. Some training was done in person when the vessels came into port, however, the majority of the TVET was achieved from shore to ship using a combination of commonly available Google and Microsoft Apps and WhatsApp. Voice, video and text in multiple languages were used to accommodate different learning styles. The learning was supported by the development of learning networks using social media. This paper also reflects on the shore-based organisational change processes required to support sea learning. The conceptual framework used is the Theory of Practice Architectures (TPA) as is provides a site-ontological perspective of the sayings/thinkings, doings and relatings of this workplace training which is multiplanar as it plays out at sea and ashore, in-person and on-line. Using TPA, the overarching practice architectures and supporting structures which confound or enable these learning practices are revealed. The contribution which this paper makes is an insight into an innovative vocational pedagogy which promotes ICT-mediated learning amongst workers who suffer from low levels of literacies and limited ICT-access and who work and live in remote places. It is a pedagogy of possibility which crosses the digital divide.

Keywords: theory of practice architecture, microsoft, google, whatsapp, vocational pedagogy, mariners, distributed workplaces

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Authors: Helena Baffoe

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Context: In the United States, there have been significant advancements in programs aimed at improving the lives of individuals with mental health disorders and substance abuse problems. However, public attitudes and beliefs regarding these issues have not improved correspondingly. This study aims to explore the perceptions and beliefs surrounding mental health disorders and substance abuse in the context of data analytics in the field of social work. Research Aim: The aim of this research is to provide empirical evidence on the beliefs and perceptions regarding mental health disorders and substance abuse. Specifically, the study seeks to answer the question of whether being diagnosed with a mental disorder implies a diagnosis of substance abuse. Additionally, the research aims to analyze the specific roles that social workers can play in addressing individuals with mental disorders. Methodology: This research adopts a data-driven methodology, acquiring comprehensive data from the Substance Abuse and Mental Health Services Administration (SAMHSA). A noteworthy causal connection between mental disorders and substance abuse exists, a relationship that current literature tends to overlook critically. To address this gap, we applied logistic regression with an Instrumental Variable approach, effectively mitigating potential endogeneity issues in the analysis in order to ensure robust and unbiased results. This methodology allows for a rigorous examination of the relationship between mental disorders and substance abuse. Empirical Findings: The analysis of the data reveals that depressive, anxiety, and trauma/stressor mental disorders are the most common in the United States. However, the study does not find statistically significant evidence to support the notion that being diagnosed with these mental disorders necessarily implies a diagnosis of substance abuse. This suggests that there is a misconception among the public regarding the relationship between mental health disorders and substance abuse. Theoretical Importance: The research contributes to the existing body of literature by providing empirical evidence to challenge prevailing beliefs and perceptions regarding mental health disorders and substance abuse. By using a novel methodological approach and analyzing new US data, the study sheds light on the cultural and social factors that influence these attitudes.

Keywords: mental health disorder, substance abuse, empirical evidence, logistic regression with IV

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Authors: Corinne Kowalski, Lea de Jong, Rainer Sauerborn, Niamh Herlihy, Anneliese Depoux, Jale Tosun

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Climate change is considered one of the biggest threats to human health of the 21st century. The link between climate change and health has received relatively little attention in the media, in research and in policy-making. A long term and broad overview of how health is represented in the legislation on climate change is missing in the legislative literature. It is unknown if or how the argument for health is referred in legal clauses addressing climate change, in national and European legislation. Integrating scientific based evidence into policies regarding the impacts of climate change on health could be a key step to inciting the political and societal changes necessary to decelerate global warming. This may also drive the implementation of new strategies to mitigate the consequences on health systems. To provide an overview of this issue, we are analyzing the Global Climate Legislation Database provided by the Grantham Research Institute on Climate Change and the Environment. This institution was established in 2008 at the London School of Economics and Political Science. The database consists of (updated as of 1st January 2015) legislations on climate change in 99 countries around the world. This tool offers relevant information about the state of climate related policies. We will use the database to systematically analyze the 829 identified legislations to identify how health is represented as a relevant aspect of climate change legislation. We are conducting explorative research of national and supranational legislations and anticipate health to be addressed in various forms. The goal is to highlight how often, in what specific terms, which aspects of health or health risks of climate change are mentioned in various legislations. The position and recurrence of the mention of health is also of importance. Data will be extracted with complete quotation of the sentence which mentions health, which will allow for second qualitative stage to analyze which aspects of health are represented and in what context. This study is part of an interdisciplinary project called 4CHealth that confronts results of the research done on scientific, political and press literature to better understand how the knowledge on climate change and health circulates within those different fields and whether and how it is translated to real world change.

Keywords: climate change, explorative research, health, policies

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Authors: Richard W. Jelier

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This research examines the emergence of the knowledge-based economies in three world cities in a comparative context. The Australian, American and British approaches to (KBE) are analyzed through the study of three premier world cities of Sydney, New York and London. Long considered leaders in the KBE, London and New York’s pre-imminence in this race to the top is not surprising. Sydney, Australia however has seen a remarkable transformation from an old economy to an emerging success in the new economy. After an examination of national KBE indicators (GDP comparisons and Knowledge Economy indexes) the research turns to a detailed investigation of specific strategies advanced in greater Sydney, New York City and London to advance the creative sector and compete for a spot among the world leaders in the knowledge age. These intense efforts at restructuring national and local economies have led to increasingly intense competition between cities and nations and there are clear winners and losers. Overall the conclusion of this research suggests that as Australia is rising, America is struggling to keep its position as a global world leader in the new economy. London’s urban primacy has helped elevate it role in the UK new economy and recent transformations have led London to compete successfully with New York City for the top position as the premier global city.

Keywords: knowledge-based economy, knowledge economy indexes, sustainable transformation, creative economies, New York, London and Sydney

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Authors: Arti Singh, Carolyn Jenkins, Oyedunni S. Arulogun, Mayowa O. Owolabi, Fred S. Sarfo, Bruce Ovbiagele, Enzinne Sylvia

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Background: Stroke, the leading cause of adult-onset disability and the second leading cause of death, is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur. The Stroke Investigative Research and Education Network (SIREN) seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other non communicable diseases in SSA. One of the first steps to address this goal was to effectively engage the communities that suffer the high burden of disease in SSA. This study describes how the SIREN project engaged six sites in Ghana and Nigeria over the past three years, describing the community engagement activities that have arisen since inception. Aim: The aim of community engagement (CE) within SIREN is to elucidate information about knowledge, attitudes, beliefs, and practices (KABP) about stroke and its risk factors from individuals of African ancestry in SSA, and to educate the community about stroke and ways to decrease disabilities and deaths from stroke using socioculturally appropriate messaging and messengers. Methods: Community Advisory Board (CABs), Focus Group Discussions (FGDs) and community outreach programs. Results: 27 FGDs with 168 participants including community heads, religious leaders, health professionals and individuals with stroke among others, were conducted, and over 60 CE outreaches have been conducted within the SIREN performance sites. Over 5,900 individuals have received education on cardiovascular risk factors and about 5,000 have been screened for cardiovascular risk factors during the outreaches. FGDs and outreach programs indicate that knowledge of stroke, as well as risk factors and follow-up evidence-based care is limited and often late. Other findings include: 1) Most recognize hypertension as a major risk factor for stroke. 2) About 50% report that stroke is hereditary and about 20% do not know organs affected by stroke. 3) More than 95% willing to participate in genetic testing research and about 85% willing to pay for testing and recommend the test to others. 4) Almost all indicated that genetic testing could help health providers better treat stroke and help scientists better understand the causes of stroke. The CABs provided stakeholder input into SIREN activities and facilitated collaborations among investigators, community members and stakeholders. Conclusion: The CE core within SIREN is a first-of-its kind public outreach engagement initiative to evaluate and address perceptions about stroke and genomics by patients, caregivers, and local leaders in SSA and has implications as a model for assessment in other high-stroke risk populations. SIREN’s CE program uses best practices to build capacity for community-engaged research, accelerate integration of research findings into practice and strengthen dynamic community-academic partnerships within our communities. CE has had several major successes over the past three years including our multi-site collaboration examining the KABP about stroke (symptoms, risk factors, burden) and genetic testing across SSA.

Keywords: community advisory board, community engagement, focus groups, outreach, SSA, stroke

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Authors: Esraa Elaraby, Dania Abu Zahra, Ghidaa Maswadah, Osama Amira, Mohamed Alshoura, Nihar Dash

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Background: Human being uses salon for a variety of purposes, from trimming of hair and shaving to a range of beauty treatments such as manicure and pedicure. Salon activities involve use of several instruments including scissors, scalpels and razors, materials such as soaps, solutions, creams and gels on human skin and body. Besides, salon customers also use chair, bed and many other common shared utensils and appliances. These salons related activities create a suitable environment for the transmission of several diseases and pathogens including hepatitis B and C, scabies, tuberculosis, staphylococcus and MRSA etc. The transmission of these pathogens can be prevented by maintenance of adequate hygiene and standard preventive measures. Aim: To assess the customer’s level of knowledge about salon-acquired infections and practices taken to prevent their transmission. Methods: A cross-sectional study was conducted among 500 participants across the Emirates. Moreover, self-administered questionnaires (in English and Arabic) were distributed through convenience sampling methods between February and April 2017. Results: The study included 500 participants of which 250 were females. The mean age of the study population was 33 years (SD=4.77). The participants were from several nationalities including 325 Arabs (Non-GCC) (66.2%), 108 Non-Arabs (22%), and 59 Arabs (GCC) (11.8%). The majority of the participants 421 (84.4%) had required knowledge about salon-associated infections with a mean knowledge score of 6/10 (60%). However, when it comes down to preventive practices, only 73 of the 500 participants (14.6%) did carry their own equipment. Thus, there was insufficient correlation between the level of knowledge and preventive practices (p=0.139) of salon-associated infections. Conclusion: People’s knowledge about the salon-associated infections among UAE residents was good, but only a small number practically took the required preventative measures towards this issue. Therefore, a public awareness program is recommended to enhance the deficiencies in knowledge and practices to prevent salon-acquired infections among the users. Up to our knowledge, this is the first study of this kind in the UAE targeting the salon customers about this important issue.

Keywords: awareness, knowledge, practices, salon-associated infections

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Authors: Silvia D. Vaca, Benjamin J. Kuo, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda W. Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Patients with traumatic brain injury (TBI) can develop rapid neurological deterioration from swelling and intracranial hematomas, which can result in focal tissue ischemia, brain compression, and herniation. Moreover, delays in management increase the risk of secondary brain injury from hypoxemia and hypotension. Therefore, in TBI patients with subdural hematomas (SDHs) and epidural hematomas (EDHs), surgical intervention is both necessary and time sensitive. Significant delays are seen along the care continuum in low- and middle-income countries (LMICs) largely due to limited healthcare capacity to address the disproportional rates of TBI in Sub Saharan Africa (SSA). While many LMICs have subsidized systems to offset surgical costs, the burden of securing funds by the patients for medications, supplies, and CT diagnostics poses a significant challenge to timely surgical interventions. In Kampala Uganda, the challenge of obtaining timely CT scans is twofold: logistical and financial barriers. These bottlenecks contribute significantly to the care continuum delays and are associated with poor TBI outcomes. Objective: The objectives of this study are to 1) describe the temporal delays through a modified three delays model that fits the context of neurosurgical interventions for TBI patients in Kampala and 2) investigate the association between delays and mortality. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Four time intervals were constructed along five time points: injury, hospital arrival, neurosurgical evaluation, CT results, and definitive surgery. Time interval differences among mild, moderate and severe TBI and their association with mortality were analyzed. Results: The mortality rate of all TBI patients presenting to MNRH was 9.6%, which ranged from 4.7% for mild and moderate TBI patients receiving surgery to 81.8% for severe TBI patients who failed to receive surgery. The duration from injury to surgery varied considerably across TBI severity with the largest gap seen between mild TBI (174 hours) and severe TBI (69 hours) patients. Further analysis revealed care continuum differences for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 hours for interval 3 and 24 hours for interval 4) and mild TBI patients (19 hours for interval 3, and 96 hours for interval 4). These post-arrival delays were associated with mortality for mild (p=0.05) and moderate TBI (p=0.03) patients. Conclusions: To our knowledge, this is the first analysis using a modified 'three delays' framework to analyze the care continuum of TBI patients in Uganda from injury to surgery. We found significant associations between delays and mortality for mild and moderate TBI patients. As it currently stands, poorer outcomes were observed for these mild and moderate TBI patients who were managed non-operatively or failed to receive surgery while surgical services were shunted to more severely ill patients. While well intentioned, high mortality rates were still observed for the severe TBI patients managed surgically. These results suggest the need for future research to optimize triage practices, understand delay contributors, and improve pre-hospital logistical referral systems.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, traumatic brain injury

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Authors: Farshad Badie

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The central focus of this article is on the fact that knowledge is constructed from an interaction between humans’ experiences and over their conceptions of constructed concepts. Logical characterisation of ‘human inductive learning over human’s constructed concepts’ within terminological systems and providing a logical background for theorising over the Human Concept Learning Problem (HCLP) in terminological systems are the main contributions of this research. This research connects with the topics ‘human learning’, ‘epistemology’, ‘cognitive modelling’, ‘knowledge representation’ and ‘ontological reasoning’.

Keywords: human concept learning, concept construction, knowledge construction, terminological systems

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Authors: Syed Qasim Gilani, Muhammad Umair, Muhammad Noman, Syed Bilawal Shah, Aqib Abbasi, Muhammad Waheed

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Cardiovascular Diseases(CVD's) are the major cause of death in the world. The main reason for these deaths is the unavailability of first aid for heart failure. In many cases, patients die before reaching the hospital. We in this paper are presenting innovative online health service for Cardiac Patients. The proposed online health system has two ends. Users through device developed by us can communicate with their doctor through a mobile application. This interface provides them with first aid.Also by using this service, they have an easy interface with their doctors for attaining medical advice. According to the proposed system, we developed a device called Cardiac Care. Cardiac Care is a portable device which a patient can use at their home for monitoring heart condition. When a patient checks his/her heart condition, Electrocardiogram (ECG), Blood Pressure(BP), Temperature are sent to the central database. The severity of patients condition is checked using Artificial Intelligence Algorithm at the database. If the patient is suffering from the minor problem, our algorithm will suggest a prescription for patients. But if patient's condition is severe, patients record is sent to doctor through the mobile Android application. Doctor after reviewing patients condition suggests next step. If a doctor identifies the patient condition as critical, then the message is sent to the central database for sending an ambulance for the patient. Ambulance starts moving towards patient for bringing him/her to hospital. We have implemented this model at prototype level. This model will be life-saving for millions of people around the globe. According to this proposed model patients will be in contact with their doctors all the time.

Keywords: cardiovascular disease, classification, electrocardiogram, blood pressure

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Authors: Jonalee Das Bajpai, Sandeep Shastri

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The Indian Textile and Garment Industry is one of the major contributors to the country’s economy. This industry is also one of the largest labour intensive industries after agriculture and livestock. This Indian garment industry caters to both the domestic and international market. Although this industry comes under the purview of Indian Labour Laws and other voluntary work place standards yet, this industry is often criticized for the undue exploitation of the workers. This paper explored the status of forced labour and discrimination at work place in the garment manufacturing units in Bengaluru. This study is conducted from the perspective of women sewing operators as majority of operators in Bengaluru are women. The research also explored to study the impact of social compliance certification in abolishing forced labour and discrimination at work place. Objectives of the Research: 1. To study the impact of 'Social Compliance Certification' on abolition of forced labour among the women workforce. 2. To study the impact of 'Social Compliance Certification' on abolition of discrimination at workplace among the women workforce. Sample Size and Data Collection Techniques: The main backbone of the data which is the primary data was collected through a structured questionnaire. The questionnaire attempted to explore the extent of prevalence of forced labour and discrimination against women workers from the perspective of women workers themselves. The sample size for the same was 600 (n) women sewing operators from the garment industry with minimum one year of work experience. Three hundred samples were selected from units with Social Compliance Certification like SA8000, WRAP, BSCI, ETI and so on. Other three hundred samples were selected from units without Social Compliance Certification. Out of these three hundred samples, one hundred and fifty samples were selected from units with Buyer’s Code of Conduct and another one hundred and fifty were from domestic units that do not come under the purview of any such certification. The responses of the survey were further authenticated through on sight visit and personal interactions. Comparative analysis of the workplace environment between units with Social Compliance certification, units with Buyer’s Code of Conduct and domestic units that do not come under the purview of any such voluntary workplace environment enabled to analyze the impact of Social Compliance certification on abolition of workplace environment and discrimination at workplace. Correlation analysis has been conducted to measure the relationship between impact of forced labour and discrimination at workplace on the level of job satisfaction. The result displayed that abolition of forced labour and abolition of discrimination at workplace have a higher level of job satisfaction among the women workers.

Keywords: discrimination, garment industry, forced labour, social compliance certification

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Authors: Xhevrie Mamaqi

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Organization capacity learning is a process referring to the sum total of individual and collective learning through training programs, experience and experimentation, among others. Today, in-business ongoing training is one of the most important strategies for human capital development and it is crucial to sustain and improve workers’ knowledge and skills. Many organizations, firms and business are adopting a strategy of continuous learning, encouraging employees to learn new skills continually to be innovative and to try new processes and work in order to achieve a competitive advantage and superior business results. This paper uses the Resource Based View and Capacities (RBV) approach to construct a hypothetical relationships model between training and business results. The test of the model is applied on transversal data. A sample of 266 business of Spanish sector service has been selected. A Structural Equation Model (SEM) is used to estimate the relationship between ongoing training, represented by two latent dimension denominated Human and Social Capital resources and economic business results. The coefficients estimated have shown the efficient of some training aspects explaining the variation in business results.

Keywords: business results, human and social capital resources, training, RBV theory, SEM

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Authors: N. Rashed, Z. Aysha, M. Fakher

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Patient satisfaction is one of the core objectives of health care facilities. It is difficult to evaluate patients response in the emergency setting. The current study aimed to evaluate patients and family aspects of satisfaction in both adult and pediatric emergency departments and their recommendations for improvement. Cross-section survey(Brief Emergency department Patient Satisfaction Scale (BEPSS), was translated and validated, then performed to evaluate patients satisfaction in two governmental hospitals Emergency departments. Three hundred patients and their families were enrolled in the study. The waiting time in the adult Emergency department ranged from (5 minutes to 120 minutes), and most admissions were at the morning shift while at the pediatric hospital the waiting time ranged from 5 minutes to 100 minutes) and most admissions were at the afternoon shift. The results showed that the main domain of satisfaction in BEPSS in the adult emergency department was respecting the patients family while in the pediatric emergency department, the main domain was the nursing care about treatment. The main recommendation of improvement in pediatric Emergency Department was modifying the procedures while in adult Emergency Department was improving the training of physicians.

Keywords: emergency, department-patient, satisfaction-adult-pediatric

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Authors: Joshna Rani S., Ahmadi Banu

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Artificial Intelligence (AI) has a significant task to carry out in the medical care contributions of things to come. As AI, it is the essential capacity behind the advancement of accuracy medication, generally consented to be a painfully required development in care. Albeit early endeavors at giving analysis and treatment proposals have demonstrated testing, we anticipate that AI will at last dominate that area too. Given the quick propels in AI for imaging examination, it appears to be likely that most radiology, what's more, pathology pictures will be inspected eventually by a machine. Discourse and text acknowledgment are now utilized for assignments like patient correspondence and catch of clinical notes, and their utilization will increment. The best test to AI in these medical services areas isn't regardless of whether the innovations will be sufficiently skilled to be valuable, but instead guaranteeing their appropriation in day by day clinical practice. For far reaching selection to happen, AI frameworks should be affirmed by controllers, coordinated with EHR frameworks, normalized to an adequate degree that comparative items work likewise, instructed to clinicians, paid for by open or private payer associations, and refreshed over the long haul in the field. These difficulties will, at last, be survived, yet they will take any longer to do as such than it will take for the actual innovations to develop. Therefore, we hope to see restricted utilization of AI in clinical practice inside 5 years and more broad use inside 10 years. It likewise appears to be progressively evident that AI frameworks won't supplant human clinicians for a huge scope, yet rather will increase their endeavors to really focus on patients. Over the long haul, human clinicians may advance toward errands and work plans that draw on remarkably human abilities like sympathy, influence, and higher perspective mix. Maybe the lone medical services suppliers who will chance their professions over the long run might be the individuals who will not work close by AI

Keywords: artificial intellogence, health care, breast cancer, AI applications

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Authors: Neusa Fernanda Torres, Buyisile Chibi, Lyn E. Middleton, Vernon P. Solomon, Tivani P. Mashamba-Thompson

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Background: Self-medication with antibiotics (SMA) is a global concern, with a higher incidence in low and middle-income countries (LMICs). Despite intense world-wide efforts to control and promote the rational use of antibiotics, continuing practices of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and other undesirable antibiotic side effects. Moreover, it increases the health systems costs of acquiring more powerful antibiotics to treat the resistant infection. This review thus maps evidence on the factors influencing self-medication with antibiotics in these settings. Methods: The search strategy for this review involved electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL with Full Text, Health Source - Consumer Edition, MEDLINE), Google Scholar, BioMed Central and World Health Organization library, using the search terms:’ Self-Medication’, ‘antibiotics’, ‘factors’ and ‘reasons’. Our search included studies published from 2007 to 2017. Thematic analysis was performed to identify the patterns of evidence on SMA in LMICs. The mixed method quality appraisal tool (MMAT) version 2011 was employed to assess the quality of the included primary studies. Results: Fifteen studies met the inclusion criteria. Studies included population from the rural (46,4%), urban (33,6%) and combined (20%) settings, of the following LMICs: Guatemala (2 studies), India (2), Indonesia (2), Kenya (1), Laos (1), Nepal (1), Nigeria (2), Pakistan (2), Sri Lanka (1), and Yemen (1). The total sample size of all 15 included studies was 7676 participants. The findings of the review show a high prevalence of SMA ranging from 8,1% to 93%. Accessibility, affordability, conditions of health facilities (long waiting, quality of services and workers) as long well as poor health-seeking behavior and lack of information are factors that influence SMA in LMICs. Antibiotics such as amoxicillin, metronidazole, amoxicillin/clavulanic, ampicillin, ciprofloxacin, azithromycin, penicillin, and tetracycline, were the most frequently used for SMA. The major sources of antibiotics included pharmacies, drug stores, leftover drugs, family/friends and old prescription. Sore throat, common cold, cough with mucus, headache, toothache, flu-like symptoms, pain relief, fever, running nose, toothache, upper respiratory tract infections, urinary symptoms, urinary tract infection were the common disease symptoms managed with SMA. Conclusion: Although the information on factors influencing SMA in LMICs is unevenly distributed, the available information revealed the existence of research evidence on antibiotic self-medication in some countries of LMICs. SMA practices are influenced by social-cultural determinants of health and frequently associated with poor dispensing and prescribing practices, deficient health-seeking behavior and consequently with inappropriate drug use. Therefore, there is still a need to conduct further studies (qualitative, quantitative and randomized control trial) on factors and reasons for SMA to correctly address the public health problem in LMICs.

Keywords: antibiotics, factors, reasons, self-medication, low and middle-income countries (LMICs)

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Authors: Argaw Amare, Abbuna Fuffa, Stringer Andy

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Improving public knowledge and changing their attitudes towards antibiotic use will be a crucial early strategy to contain Antibiotic resistance. The current study was undertaken from November 2015 to June 2016. A cross-sectional survey using a pretested questionnaire was conducted on 392 residents (330 male and 62 female) aged 18 and above. Participants were selected randomly. Data was analyzed using simple descriptive statistics; the Chi-square test was used to determine any significant difference. The majority of participants (81%) were farmers in their occupation. Most of the respondents (76%) were not able to define the difference between antimicrobials and antibiotics. Furthermore, (61%) of participants were not able to define what antibiotics and for what purpose they are used. Thirty-four percent of participants do not know the names of antibiotics they have used for their animals and for themselves. Nearly 68% have no knowledge about the disease they have been treated for. The majority of participants (73.5%) agree to complete their course of treatment even if they feel better. About 72.5% of participants disagree that antibiotics are safe and can be used to treat different diseases, without prescription. Most of the participants (95%) treat their animals after diagnosis; more than 80% of them agree to not purchase veterinary drugs from local traders. This study showed that the participants have poor knowledge and good attitude, with an average score of 41.3±16.1% and 79.6±16, respectively. Knowledge and attitude are significantly correlated (p<0.01). The participants in this study had a good attitude toward the rational use of antibiotics. Whereas they lack knowledge with regard to the kinds of antibiotics and the diseases they are prescribed for. Therefore, further educational interventions are necessary to improve their understanding of the antibiotics currently available and the major bacterial diseases they are prescribed.

Keywords: AMR, knoweledge, attitude, perception

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Authors: Melvin Ouma

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Language is one of the most crucial tools in medical interaction. Its importance is as great today as it was many decades ago. Difficulty in openly discussing certain diseases and body parts is one of the challenges in language use in medical contexts. Guided by H. P. Grice’s Cooperative Principle, this paper explores the flouting of the cooperative principles in Swahili speaking medical setting. The paper examines how men flout the maxims using the Swahili language when reporting reproductive health problems to the doctor. The data used was gathered from a qualitative study carried out in a reproductive health clinic in a public facility in Nakuru County, Kenya. All the research protocols were observed by acquiring all the research permits. Respondents' ethical considerations of consent, privacy, and confidentiality were observed. The respondents recruited were men who visited the reproductive health clinic and voluntarily agreed to participate in the study without coercion or compensation. Participant observation was the key data collection tool, with the doctor and patient conversation digitally recorded. The researcher was allowed into the clinic in a socially acceptable role. Male patients flouted the maxims of quantity, quality, relation, and manner in order to describe their reproductive health problems without embarrassment using the Swahili language. The flouting was done through the discursive strategies of narration and circumlocution. Flouting of the maxims was acceptable to the doctor and patient due to the fact that sexual intercourse and private body parts are taboo topics and uncomfortable to talk about. The quality of health care received by the patient depended on the doctor’s patience when all the maxims were flouted. In the reproductive health clinic, flouting of maxims hindered communication and, at the same time, enhanced communication between the doctor and patient.

Keywords: cooperative principle, doctor, men, reproductive health

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Authors: Ayomi Indika Irugalbandara

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Reproductive Health (RE) education among Sri Lankan Adolescents (comprising one fifth inner population) remains unsatisfactory despite 91.8% of them completing primary education & 56.2 % receiving post secondary level education. The main reason for this large population not receiving satisfactory RH education is traditional values and longstanding taboos surrounding sexuality. The current study was undertaken with there objectives. The relevance of achieving them being to formulate RH educational policies and programs that address a sizable and sensitive chunk of the population thereby achieving the goal of mental and social well being and not merely the absence of reproductive disease or infirmity. This research was a descriptive study, using random sampling technique, sample of the study consisting of 160 adolescent in the age group of 16-19, studying in government schools in Sri Lanka. Questionnaire was the main instrument of data collection, qualitative and quantitative techniques were used in data analysis. According to the data it was revealed that a majority has some idea about RH education. While this awareness had been provided by the school, the source of information had been Health and Physical Education. The entire sample mentioned that more RH information, than was provided, should be given and everybody wanted further knowledge regarding sexuality, and in depth information on it was essential. About 96 adolescents were of the opinion that their behavior was respectful to elders and 64 felt embarrassed while communicating with elders regarding RH issues. About their preferred sources of information, both genders named health providers as their first choice, followed by family members and friends. The internet was cited by a few boys; less than 5 percent cited religious figures. More than 50% of respondents had no knowledge about abortion and they were unaware of dangerous abortion. The practice of abortion was reported among zero percent. Although every member of the sample did not possess knowledge of the scientific process involved in abortion, all of them totally rejected the idea of destroying a foetus. Adolescence is a critical period in the life of girls and boys and sexuality education empowers young people to protect their health and well-being. Schools have the proper staff, and environment for learning. It might be stated that the greater segment of individuals entering adolescents and going through their adolescence are still in the school. This becomes the reason why it is mandatory that the school should be geared to handle this critical stage of the students. Adolescents or those approaching adolescence are best educated by the relevant parents, but this being quite a sensitive issue in the socio cultural context, it is somewhat doubtful whether all parents are prepared to handle this candidly, due either to lack of knowledge or absence of the appropriate state of mind. As such it is best that seminars/workshops be conducted to enlighten parents on handling HR issues related to their adolescent children. Apart from the awareness on HR provided through the school curriculum a greater impact can be brought about through street dramas, exhibitions etc. specific to HR. Finally the researcher would like to suggest that Sunday schools be harnessed for the provision of HR education linked with cultural values, ethics, and social well-being.

Keywords: reproductive health, awareness, perception, school curriculum

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Authors: Solehah Yaacob

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The study focuses on revisiting the effectiveness of Critical Thinking in human mind capability as a major faculty in human life. The tool used as a measurement of this knowledge ability consists of several processes including experience and education background. To emphasize the `Overview` concept, the researcher highlights two major aspects of philosophical approach, they are; Divine Revelation Concept and Modern Scientific Theory. The research compares between the both parties to introduce the Divine Revelation into Modern Scientific theory. An analytical and critical study of the both concepts become the methodology of the discussion.

Keywords: critical thinking, knowledge, intellectual, language

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Authors: Rana Parween, Rob Marchant

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With the continued loss of global biodiversity despite the application of modern conservation techniques, it has become crucial to investigate non-conventional methods. Accelerated destruction of ecosystems due to altered land use, climate change, cultural and social change, necessitates the exploration of society-biodiversity attitudes and links. While the loss of species and their extinction is a well-known and well-documented process that attracts much-needed attention from researchers, academics, government and non-governmental organizations, the loss of traditional ecological knowledge and practices is more insidious and goes unnoticed. The growing availability of 'indirect experiences' such as the internet and media are leading to a disaffection towards nature and the 'Extinction of Experience'. Exacerbated by the lack of documentation of traditional practices and skills, there is the possibility for the 'extinction' of traditional practices and skills before they are fully recognized and captured. India, as a mega-biodiverse country, is also known for its historical conservation strategies entwined in traditional beliefs. Indigenous communities hold skillsets, knowledge, and traditions that have accumulated over multiple generations and may play an important role in conserving biodiversity today. This study explores the differences in knowledge and attitudes towards conserving biodiversity, of three different stakeholder groups living around Jim Corbett National Park, based on their age, traditions, and association with the protected area. A triangulation designed multi-strategy investigation collected qualitative and quantitative data through a questionnaire survey of village elders, the general public, and forest officers. Following an inductive approach to analyzing qualitative data, the thematic content analysis was followed. All coding and analysis were completed using NVivo 11. Although the village elders and some general public had vast amounts of traditional knowledge, most of it was related to animal husbandry and the medicinal value of plants. Village elders were unfamiliar with the concept of the term ‘biodiversity’ albeit their way of life and attitudes ensured that they care for the ecosystem without having the scientific basis underpinning biodiversity conservation. Inherently, village elders were keen to conserve nature; the superimposition of governmental policies without any tangible benefit or consultation was seen as detrimental. Alienating villagers and consequently the village elders who are the reservoirs of traditional knowledge would not only be damaging to the social network of the area but would also disdain years of tried and tested techniques held by the elders. Forest officers advocated for biodiversity and conservation education for women and children. Women, across all groups, when questioned about nature conservation, showed more interest in learning and participation. Biodiversity not only has an ethical and cultural value, but also plays a role in ecosystem function and, thus, provides ecosystem services and supports livelihoods. Therefore, underpinning and using traditional knowledge and incorporating them into programs of biodiversity conservation should be explored with a sense of urgency.

Keywords: biological diversity, mega-biodiverse countries, traditional ecological knowledge, society-biodiversity links

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Authors: G. Yoga Sairam Teja, K. Harsha Vardhan, A. Vinay Kumar, K. Nithish Kumar, Ch. Shanthi Priyag

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The emergence of the Internet of Things (IoT) has facilitated better device control and monitoring in the modern world. The constant monitoring of a patient would be drastically altered by the usage of IoT in healthcare. As we've seen in the case of the COVID-19 pandemic, it's important to keep oneself untouched while continuously checking on the patient's heart rate and temperature. Additionally, patients with paralysis should be closely watched, especially if they are elderly and in need of special care. Our "IoT BASED PATIENT HEALTH MONITORING SYSTEM" project uses IoT to track patient health conditions in an effort to address these issues. In this project, the main board is an 8051 microcontroller that connects a number of sensors, including a heart rate sensor, a temperature sensor (LM-35), and a saline water measuring circuit. These sensors are connected via an ESP832 (WiFi) module, which enables the sending of recorded data directly to the cloud so that the patient's health status can be regularly monitored. An LCD is used to monitor the data in offline mode, and a buzzer will sound if any variation from the regular readings occurs. The data in the cloud may be viewed as a graph, making it simple for a user to spot any unusual conditions.

Keywords: IoT, ESP8266, 8051 microcontrollers, sensors

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Authors: Hassen Mohammed, Michelle Clarke, Helen Marshall

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Maternal immunization is an effective strategy to protect pregnant women and their offspring from vaccine-preventable diseases. Despite the recommendation of maternal influenza and more recently pertussis immunization in Australia, uptake of these vaccines has been suboptimal. Monitoring the impact of the current funded vaccine programs for pregnant women is limited. The study aimed to assess the impact of the funded program and determine factors associated with vaccine uptake in pregnant women. This observational prospective study was undertaken between November 2014 and July 2016 at the Women’s and Children’s Hospital in South Australia (WCH). Demographic details and vaccination history from South Australian pregnant women who attended the WCH were reviewed. A standardized self-reported survey was conducted in antenatal care with a follow up telephone interview at 8-10 weeks post-delivery. A midwife delivered immunization program for pregnant women in antenatal clinic commenced in April 2015. Of the 180 pregnant women who completed the survey questionnaire, 75.5% and 80.5 % received maternal influenza and pertussis vaccines respectively. First-time mothers had twice the odds of having received influenza vaccine during pregnancy than multiparous women (OR 2.4; CI 1.14 - 4.94; p= 0.021). The proportion of women who received pertussis vaccine during pregnancy, following the introduction of the midwife delivered pertussis vaccination program (140/155, 90.3%) was significantly higher compared with women who received maternal pertussis vaccination prior to the introduction of the program (5/22, 23.7%, p < 0.001). The odds of women receiving maternal pertussis vaccine following the implementation of the midwife delivered program were 31 times higher than women who delivered babies prior to the program (OR 31.7, CI 10.24- 98.27; p < 0.001). High uptake of influenza and pertussis vaccines during pregnancy can be attained with health care provider recommendation and inclusion of maternal immunization as part of standard antenatal care.

Keywords: influenza, maternal immunization, pertussis, provider recommendation

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Authors: José Carlos Rodríguez, Mario Gómez

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The aim of this paper is to get insight on the nature of university-industry technology transfer (UITT) and technology transfer offices (TTOs) activity at universities in the case of emerging economies. In relation to the process of transferring knowledge/technology in the case of emerging economies, knowledge/technology transfer in these economies are more reactive than in developed economies due to differences in maturity of technologies. It is assumed in this paper that knowledge/technology transfer is a complex phenomenon, and thus the paper contributes to get insight on the nature of UITT and TTOs creation in the case of emerging economies by using a system dynamics model of knowledge/technology transfer in these countries. The paper recognizes the differences between industrialized countries and emerging economies on these phenomena.

Keywords: university-industry technology transfer, technology transfer offices, technology transfer models, emerging economies

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Authors: Witri Pratiwi, Shopa Nur Fauzah, Dini Norviatin

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WHO recommends breastfeeding exclusively for infants aged 0 to 6 months because breast milk is the best nutrition. There are several factors associated with the success of exclusive breastfeeding. This study aims to determine the factors associated with the success of exclusive breastfeeding. A cross-sectional study was conducted at 6 community health centers in Cirebon City, Indonesia. Primary data were obtained from a validated questionnaire given to mothers who have children aged 6 to 24 months. A total of 326 mothers participated in this study. Two hundred and eighteen (66.9%) mothers gave exclusive breastfeeding to their babies, and 108 (33.1%) did not give exclusive breastfeeding. The baby gender (p=0.240), birth weight (p=0.436), and place of birth (0.137) were not related to exclusive breastfeeding. Mode of delivery (p=0.029) and early initiation of breastfeeding (p=0.001) were significantly associated with exclusive breastfeeding. Infants with early initiation of breastfeeding are three times more likely to get exclusive breastfeeding compared to those who do not get breastfeeding early (p=0.001; OR=3.696 [95% CI 1.764 – 7.746]). Early initiation of breastfeeding is the most important factor in determining the success of exclusive breastfeeding. Promotion and education on the importance of early breastfeeding initiation to prospective mothers, families, and health workers are expected to be improved.

Keywords: early initiation of breastfeeding, exclusive breastfeeding, mode of delivery, Indonesia

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Authors: Ummi Sholihah Pertiwi Abidin, Eva Fadhilah

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Social changes are more and more growing and having many different forms as the time passed and thought methods in the society. One of many forms of that social changes is the emancipation of women that is flourishing by the inception of gender equality perception between men and women in all aspects including education. It’s not anymore found the distinction between genders in learning and the education achieving right at this globalized era. But, it is still many perceptions which are against that equality of education achieving right, either come from the women’s selves or many external factors. They assumed that they are going to be a mother in the future, and a wife, someone with responsible for taking care of the household and everything inside, while the husband is the one who has the responsible for looking for the living. So comes from this kind of assumption, the perception against the education equality between genders, which means there is no need for them –women- to achieve the high education because they will still end up as housewives. Except those working or career women that need high education to support their works. These women are not aware that even a mother needs the high and capable education. Because, as the 'mother to be,' they surely need broad knowledge from the education to educate their children in the future. It is such a big fault to say the kind of thing, 'It is no matter that I am not educated, in case I’m just a housewife. The important thing is my children get a great education'. Unfortunately, it is still often found, saying 'A housewife job is not a big deal to do with high education.' This qualitative method paper raises a theme about the importance of education for women, no matter what will they be in the future. Because however, and whatever is the woman’s career outside the house, or even not working outside, she’s still a mother for her children, and 'educational provision' is a great need. And so forth, this educational provision is a big deal to do with future generation’s foredoom, regarding the first source of children’s knowledge and the first school for them is their mother.

Keywords: women education, mother to be, educational provision, first school, future generation’s foredoom

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Authors: Anuruddha Jagoda, Samiddhi Samarakoon, Anil Jasinghe

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In an emergency department ‘where every second count for patient’s management’ timely availability of X- rays play a vital role in early diagnosis and management of patients. Trauma care centers rely heavily on timely radiologic imaging for patient care and radiology plays a crucial role in the emergency department (ED) operations. A research study was carried out to assess timeliness of availability of X-rays and total turnaround time at the Accident Service of National Hospital of Sri Lanka which is the premier trauma center in the country. Digital Radiology system was implemented as an intervention to improve the timeliness of availability of X-rays. Post-implementation assessment was carried out to assess the effectiveness of the intervention. Reduction in all three aspects of waiting times namely waiting for initial examination by doctors, waiting until X –ray is performed and waiting for image availability was observed after implementation of the intervention. However, the most significant improvement was seen in waiting time for image availability and reduction in time for image availability had indirect impact on reducing waiting time for initial examination by doctors and waiting until X –ray is performed. The most significant reduction in time for image availability was observed when performing 4-5 X rays with DR system. The least improvement in timeliness was seen in patients who are categorized as critical.

Keywords: emergency department, digital radilogy, timeliness, trauma care

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Authors: Daniel A. Montoya, Marta L. Tostes

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This investigation aims at analyzing and determining the relation between two very important variables in the human resource management: The organizational climate and the performance assessment. This study aims at contributing with knowledge in the search of the relation between the mentioned variables because the literature still does not provide solid evidence to this respect and the cases revised are incipient to reach conclusions enabling a typology about this relation.To this regard, a correlational and cross-sectional perspective was adopted in which quantitative and qualitative techniques were chosen with the total of the workers of the tourist service company PTS Peru. In order to measure the organizational climate, the OCQ (Organization Climate Questionnaire) from was used; it has 50 items and measures 9 dimensions of the Organizational Climate. Also, to assess performance, a questionnaire with 21 items and 6 dimensions was designed. As a means of assessment, a focus group was prepared and was applied to a worker in every area of the company. Additionally, interviews to human resources experts were conducted. The results of the investigation show a clear relation between the organizational climate and the personnel performance assessment as well as a relation between the nine dimensions of the organizational climate and the work performance in general and with some of its dimensions.

Keywords: job performance, job satisfaction, organization climate, performance assessment

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