Search results for: national teams

Authors: C. Treadgold, S. Sivaraman

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The Starlight Children's Foundation (Starlight) is an Australian non-profit organisation that delivers programs, in partnership with health professionals, to support children, adolescents, and their families who are living with a serious illness. While supporting children and adolescents with life-limiting conditions has always been a feature of Starlight's work, providing a dedicated program, specifically targeting and meeting the needs of the paediatric palliative population, is a recent area of focus. Recognising the challenges in providing children’s palliative services, Starlight initiated a research and development project to better understand and meet the needs of this group. The aim was to create a program which enhances the wellbeing of children, adolescents, and their families receiving paediatric palliative care in their community through the provision of on-going, tailored, positive experiences or 'moments'. This paper will present the results of the formative evaluation of this unique program, highlighting the development processes and outcomes of the pilot. The pilot was designed using an innovation methodology, which included a number of research components. There was a strong belief that it needed to be delivered in partnership with a dedicated palliative care team, helping to ensure the best interests of the family were always represented. This resulted in Starlight collaborating with both the Victorian Paediatric Palliative Care Program (VPPCP) at the Royal Children's Hospital, Melbourne, and the Sydney Children's Hospital Network (SCHN) to pilot the 'Moments' program. As experts in 'positive disruption', with a long history of collaborating with health professionals, Starlight was well placed to deliver a program which helps children, adolescents, and their families to experience moments of joy, connection and achieve their own sense of accomplishment. Building on Starlight’s evidence-based approach and experience in creative service delivery, the program aims to use the power of 'positive disruption' to brighten the lives of this group and create important memories. The clinical and Starlight team members collaborate to ensure that the child and family are at the centre of the program. The design of each experience is specific to their needs and ensures the creation of positive memories and family connection. It aims for each moment to enhance quality of life. The partnership with the VPPCP and SCHN has allowed the program to reach families across metropolitan and regional locations. In late 2019 a formative evaluation of the pilot was conducted utilising both quantitative and qualitative methodologies to document both the delivery and outcomes of the program. Central to the evaluation was the interviews conducted with both clinical teams and families in order to gain a comprehensive understanding of the impact of and satisfaction with the program. The findings, which will be shared in this presentation, provide practical insight into the delivery of the program, the key elements for its success with families, and areas which could benefit from additional research and focus. It will use stories and case studies from the pilot to highlight the impact of the program and discuss what opportunities, challenges, and learnings emerged.

Keywords: children, families, memory making, pediatric palliative care, support

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Authors: Fouzia Shersad, Sabeena Salam

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Introduction: Quality assurance cycles like RADAR, PDCA, ADRI are cycles of planning, implementation, assessment and improvement. These cycles are required when institutions apply for reaccreditation to accreditation bodies and for adoption of holistic models of institutional quality. Method of Study: The adoption of these cycles at the higher education institutions under the Dubai Medical University is studied to explore the feasibility and the benefits in institutions outcomes. After adequate faculty training, these steps were incorporated in all new activities and embedded in every new initiative and approach undertaken at unit and institutional levels. Conclusions: Improvement in student satisfaction rates and performance levels has been achieved. Wherever weaknesses or deficits have been identified, improvement strategies are implemented in a timely manner. The feedback has become an incentive for faculty members to implement new ideas. Implementation of these cycles for core processes at micro and macro levels have ensured that a systematic mechanism for corrective actions existed. This has led to increasing adoption of innovative initiatives. Another outcome was the recognition through national level awards for the overall institutions which have been certified by external reviewers.

Keywords: higher education, quality, accreditation, institutional improvement

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Authors: Lalrokima Chenkual

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Legal provision and various guidelines issued by the National Disaster Management Authority in India strives for setting up of disaster management authority from the central government to the district level. Community-Based Disaster Risk Reduction practice is still relevant as the communities are the victim as well as the first responder in any incidents. The primary goal of Community Based Disaster Risk Reduction is to reduce vulnerability of the concerned community and strengthen its existing capacity to cope with disaster. By involving the community in the preparedness phase, it not only increases the likelihood of coordinated action by the communities to help in mitigating disasters and lessening the impact of disaster but also brings the community together to address the issue collectively. Community participation ensures local ownership, addresses local needs, and promotes volunteerism and mutual help to prevent and minimise damage. Community-Based Disaster Risk Reduction is very much relevant for Mizoram as the society is closed knit, population is very less, religion homogeneity i.e Christianity, very active and widespread community-based organization viz, Young Mizo Association, MHIP (Women Federation), MUP (Elders Clubs which are guided together by Mizo code of morals conduct termed as Tlawmngaihna.

Keywords: community, close-knit, first responder, Tlawmngaihna

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Authors: Sapfo A. Mortaki

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From the early 1960s and until the middle of the next decade, the lack of favorable conditions for the development of art along with the imposition of the 1967 military dictatorship resulted in a great flow of Greek artists abroad. The fall of the dictatorship and the change of the political scene after 1974 constitute crucial milestones in the cultural life of the country. In the field of visual arts significant changes are attempted in the state's effort to formulate a national cultural policy. This article examines the presence of Greek migrant artists (painters and sculptors) in Paris during the 1970s. Since the mid-1970s, and particularly in the early 1980s, Modern Greek Diaspora undergoes a new transition phase, when the concept of immigration changes. The aim of this study is to record and give prominence to the presence of the Greek artists -through archival research in the daily and periodical press- as well as present the impact of their artistic activity on French intellectual life and on the country’s society during this period. Furthermore, the presence and work of these artists are discussed in an environment of cultural coexistence which, to a certain extent, can be regarded as the result of the social phenomenon of their migration in the era of postmodernity. Finally, their contribution to the development of the cultural life of Greece, inside and outside its borders, is also being examined.

Keywords: art and society, cultural policy, Greek artists, postmodernity

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Authors: María José Benítez Jiménez

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Article 3 of the European Convention for the Protection of Human Rights and Fundamental Freedoms (E.C.H.R.) proclaims that no one may be subjected to torture, punishment or degrading treatment. The legislative correlate in Spain is embodied in Article 15 of the Spanish Constitution, and there must be an overlapping interpretation of both precepts on the ideal plane. While it is true that there are not many cases in which the European Court of Human Rights (E.C.t.H.R. (The Strasbourg Court)) has sanctioned Spain for its failure to investigate complaints of torture, it must be emphasized that the tendency to violate Article 3 of the Convention appears to be on the rise, being necessary to know possible factors that may be affecting it. This paper addresses the analysis of sentences that directly or indirectly reveal the violation of Article 3 of the European Convention. To carry out the analysis, sentences of the Strasbourg Court have been consulted from 2012 to 2016, being able to address any previous sentences to this period if it provided justified information necessary for the study. After the review it becomes clear that there are two key groups of subjects that request a response to the Strasbourg Court on the understanding that they have been tortured or degradingly treated. These are: immigrants and terrorists. Both phenomena, immigration and terrorism, respond to patterns that have mutated in recent years, and it is important for this study to know if national regulations begin to be dysfunctional.

Keywords: E.C.H.R., E.C.t.H.R. sentences, Spanish Constitution, torture

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Authors: Norhayati Mat Wajid, Abdul Murad Zainal Abidin, Faiz Fadzil, Mohd Yusof Aizad Mukhtar

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One of the areas that present an opportunity to reduce the national carbon emission is the energy management of public buildings. To our present knowledge, there is no easy-to-use and centralized mechanism that enables the government to monitor the overall energy performance, as well as the carbon footprint, of Malaysia’s public buildings. Therefore, the Public Works Department Malaysia, or PWD, has developed a web-based energy performance reporting tool called JENOSYS (JKR Energy Online System), which incorporates a database of utility account numbers acquired from the utility service provider for analysis and reporting. For test case purposes, 23 buildings under PWD were selected and monitored for their monthly energy performance (in kWh), carbon emission reduction (in tCO₂eq) and utility cost (in MYR), against the baseline. This paper demonstrates the simplicity with which buildings without energy metering can be monitored centrally and the benefits that can be accrued by the government in terms of building energy disclosure and concludes with the recommendation of expanding the system to all the public buildings in Malaysia.

Keywords: energy-efficient buildings, energy management systems, government buildings, JENOSYS

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Authors: Azza Taha Zaki

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Modern drama was characterised by realism and naturalism as dominant literary movements that focused on contemporary people and their issues to reflect the status of modern man and his environment. However, some modern dramatists have often fallen on classical mythology in ancient Greek tragedies to create a sense of the universality of the human experience. The tragic overtones of classical myths have helped modern dramatists in their attempts to create an enduring piece by evoking the majestic grandeur of the ancient myths and the heroic struggle of man against forces he cannot fight. Myths have continued to appeal to modern playwrights not only for the plot and narrative material but also for the vision and insight into the human experience and human condition. This paper intends to study how the reworking of Sophocles’ Antigone by Jean Anouilh in his Antigone, written in 1942 at the height of the Second World War and during the German occupation of his country, France, fits his own purpose and his own time. The paper will also offer an analysis of the vision in both plays to show how Anouilh has used the classical Antigone freely to produce a modern vision of the dilemma of man when faced by personal and national conflicts.

Keywords: Anouilh, Antigone, drama, Greek tragedy, modern, myth, sophocles

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Authors: Paolo Russu

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This paper investigates the economic and ecological dynamics that emerge in Protected Areas (PAs) as a result of interactions between visitors to the area and the animals that live there. We suppose that the PAs contain two species whose interactions are determined by the Lotka-Volterra equations system. Visitors' decisions to visit PAs are influenced by the entrance cost required to enter the park as well as the chance of witnessing the species that live there. Visitors have contradictory effects on the species and thus on the sustainability of the protected areas: on the one hand, an increase in the number of tourists damages the natural habitat of the areas and thus the species living there; on the other hand, it increases the total amount of entrance fees that the managing body of the PAs can use to perform defensive expenditures that protect the species from extinction. For a given set of parameter values, the existence of saddle-node bifurcation, Hopf bifurcation, homoclinic orbits, and a Bogdanov–Takens bifurcation of codimension two has been investigated. The system displays periodic doubling and chaotic solutions, as demonstrated by numerical examples. Pontryagin's Maximum Principle was utilized to develop an optimal admission charge policy that maximized both social gain and ecosystem conservation.

Keywords: environmental preferences, singularities point, dynamical system, chaos

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Authors: Pankaj Kumar Jha, Mahendra Singh Hada, Brijendra Singh

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Protection system is an essential feature of the electrical system which helps in detection and removal of faults. Protection system consists of many subsystems like relays, circuit breakers, instrument transformers, auxiliary DC system, auxiliary relays etc. Although the fundamental protective and relay operating concepts are similar throughout the world, there are very significant differences in their implementation. These differences arise through different traditions, operating philosophies, experiences and national standards. Protection system mis-operation due to problem in one or more of its subsystem or inadequate knowledge of numerical relay settings and configuration are very common throughout the world. Protection system mis-operation leads to unstable and unreliable grid operation. In this paper we will discuss about the fundamental concepts of protective relaying and the reasons for protection system mis-operation due to one or more of its subsystems. Many real-world case studies of protection system mis-operation from Indian power sector are discussed in detail in this paper.

Keywords: auxiliary trip relays, bus zone, check zone, CT saturation, dead zone protection, DC ground faults, DMT, DR, end fault protection, instrument transformer, SOTF, STUB

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Authors: Rosie Cooper, Tracey Chantler, Ellen Pringle, Sadie Bell, Emily Edmundson, Heidi Nielsen, Sheila Roberts, Michael Edelstein, Sandra Mounier Jack

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Introduction: In line with the National Health Service’s (NHS) long-term plan, the NHS is looking to implement more digital health interventions. This study explores a case study in this area: a digital intervention used by NHS Trusts in London to consent adolescents for Human Papilloma Virus (HPV) immunisation. Methods: The electronic consent intervention was implemented in 14 secondary schools in inner city, London. These schools were statistically matched with 14 schools from the same area that were consenting using paper forms. Schools were matched on deprivation and English as an additional language. Consent form return rates and HPV vaccine uptake were compared quantitatively between intervention and matched schools. Data from observations of immunisation sessions and school feedback forms were analysed thematically. Individual and group interviews were undertaken with implementers parents and adolescents and a focus group with adolescents were undertaken and analysed thematically. Results: Twenty-eight schools (14 e-consent schools and 14 paper consent schools) comprising 3219 girls (1733 in paper consent schools and 1486 in e-consent schools) were included in the study. The proportion of pupils eligible for free school meals, with English as an additional language and students' ethnicity profile, was similar between the e-consent and paper consent schools. Return of consent forms was not increased by the implementation of the e-consent intervention. There was no difference in the proportion of pupils that were vaccinated at the scheduled vaccination session between the paper (n=14) and e-consent (n=14) schools (80.6% vs. 81.3%, p=0.93). The transition to using the system was not straightforward, whilst schools and staff understood the potential benefits, they found it difficult to adapt to new ways of working which removed some level or control from schools. Part of the reason for lower consent form return in e-consent schools was that some parents found the intervention difficult to use due to limited access to the internet, finding it hard to open the weblink, language barriers, and in some cases, the system closed a few days prior to sessions. Adolescents also highlighted the potential for e-consent interventions to by-pass their information needs. Discussion: We would advise caution against dismissing the e-consent intervention because it did not achieve its goal of increasing the return of consent forms. Given the problems embedding a news service, it was encouraging that HPV vaccine uptake remained stable. Introducing change requires stakeholders to understand, buy in, and work together with others. Schools and staff understood the potential benefits of using e-consent but found the new ways of working removed some level of control from schools, which they found hard to adapt to, possibly suggesting implementing digital technology will require an embedding process. Conclusion: The future direction of the NHS will require implementation of digital technology. Obtaining electronic consent from parents could help streamline school-based adolescent immunisation programmes. Findings from this study suggest that when implementing new digital technologies, it is important to allow for a period of embedding to enable them to become incorporated in everyday practice.

Keywords: consent, digital, immunisation, prevention

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Authors: Asaiel Alohaly

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A theoretical framework for corporate governance is needed to bridge the gap between the corporate governance of private companies and State-owned Enterprises (SOEs). The two dominant models, being shareholder and stakeholder, do not always address the specific requirements and challenges posed by ‘hybrid’ companies; namely, previously national bodies that have been privatised bffu t where the government retains significant control or holds a majority of shareholders. Thus, an exploratory theoretical study is needed to identify how ‘hybrid’ companies should be defined and why the state model should be acknowledged since it is the less conspicuous model in comparison with the shareholder and stakeholder models. This research focuses on ‘the state model of corporate governance to understand the complex ownership, control pattern, goals, and corporate governance of these hybrid companies. The significance of this research lies in the fact that there is a limited available publication on the state model. The outcomes of this research are as follows. It became evident that the state model exists in the ecosystem. However, corporate governance theories have not extensively covered this model. Though, there is a lot being said about it by OECD and the World Bank. In response to this gap between theories and industry practice, this research argues for the state model, which proceeds from an understanding of the institutionally embedded character of hybrid companies where the government is either a majority of the total shares or a controlling shareholder.

Keywords: corporate governance, control, shareholders, state model

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Authors: Soni T. L.

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Sustainable environmental stress is a major concern which needs immediate attention. This paper is an attempt to present participatory action research for sustainable agriculture. Being first and best culture, agriculture protects and improves the natural environment, the social and economic conditions of people, and safeguards the health and welfare of all groups. During course of time agriculture turned to agribusiness, then the values are not safeguarded. Moreover, in today’s busy life many are not taking efforts to take part in agriculture production. Then children are not getting the opportunity to understand agriculture and farming practices. So student initiatives are vital to make them aware. Here the programmes structured by the researcher come under the auspicious of National Service Scheme, a student-centered educational programme, organized by Ministry of Youth Affairs, Government of India. The twin objectives of the study are to examine the role of student initiatives for sustainable agriculture and the role of participatory action research in student initiatives. SWOT analysis is made to study strengths, weaknesses, threats and opportunities. The Methodology adopted is Participatory Action Research. The method is participatory in a sense there is collaboration through participation. The method is action, there is lab land experiences which is real. The method is research that there is documented lessons and creation of new knowledge. Plan of action cover measures adopted and strategies taken i.e., bhavana – kalpana – yojana – sadhana. Through the team effort, the team was successful in converting more than 10 hectares of barren land into cultivable land within and outside the campus. Team efforts of students saved a huge amount of labour cost and produced a huge quantity of organic output and the team was also successful in creating 1000 rain pits in the premises of College for rainwater harvesting. The findings include conveyance of the Message: Food Production is superior to Food donation. Moreover, the study fostered good work ethic and social responsibility among students. Students undertake innovative programmes underlying social and environmental issues and participants got increased opportunities to interact with local and less privileged and acquired increased awareness about real-life experiences which make them confident to interact with people and it resulted in the strengthening of social capital- cooperation, team spirit, social commitment among students. Participants promoted sustainable domestic efforts and ultimately environmental protection is ensured. Finally, there is recognition to the team, institution and the researcher at the university level, state level and at the national level. The learned lessons are, if the approach is good, the response is good and success generates success. Participatory action research is empowering experience for practitioners, focusing the combined time, energy and creativity of a committed group we should lead so many programmes which makes the institution centre of excellence. Authorities should take necessary steps for the Inclusion of community development activities in the curriculum. Action research is problem, client and action centered. So, we must adapt and adopt, coordinates and correlates measures which preserve and conserve the environment.

Keywords: participatory action research, student initiatives, sustainable development, sustainability

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Authors: Wang Zhaoming, Shao Shegang, Chen Xiaorong, Qi Yanan, Tian Lei, Wang Jian

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This study conducts a comparative analysis of the spectral curves of asphalt pavements at various aging stages to improve road information extraction from high-resolution remote sensing imagery. By examining the distinguishing capabilities and spectral characteristics, the research aims to establish a pavement information extraction methodology based on China's high-resolution satellite images. The process begins by analyzing the spectral features of asphalt pavements to construct a spectral assessment model suitable for evaluating pavement health. This model is then tested at a national highway traffic testing site in China, validating its effectiveness in distinguishing different pavement aging levels. The study's findings demonstrate that the proposed model can accurately assess road health, offering a valuable tool for road maintenance planning and infrastructure management.

Keywords: spectral analysis, asphalt pavement aging, high-resolution remote sensing, pavement health assessment

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Authors: Narottam Puri, Gurvinder Kaur

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Background: The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is India’s apex standard setting accrediting body in health care which evaluates and accredits healthcare organizations. NABH requires accredited organizations to become reaccredited every three years. It is often though that once the initial accreditation is complete, the foundation is set and reaccreditation is a much simpler process. Fortis Hospital, Shalimar Bagh, a part of the Fortis Healthcare group is a 262 bed, multi-specialty tertiary care hospital. The hospital was successfully accredited in the year 2012. On completion of its first cycle, the hospital underwent a reaccreditation assessment in the year 2015. This paper aims to gain a better understanding of the challenges that accredited hospitals face when preparing for a renewal of their accreditations. Methods: The study was conducted using a cross-sectional mixed methods approach; semi-structured interviews were conducted with senior leadership team and staff members including doctors and nurses. Documents collated by the QA team while preparing for the re-assessment like the data on quality indicators: the method of collection, analysis, trending, continual incremental improvements made over time, minutes of the meetings, amendments made to the existing policies and new policies drafted was reviewed to understand the challenges. Results: The senior leadership had a concern about the cost of accreditation and its impact on the quality of health care services considering the staff effort and time consumed it. The management was however in favor of continuing with the accreditation since it offered competitive advantage, strengthened community confidence besides better pay rates from the payors. The clinicians regarded it as an increased non-clinical workload. Doctors felt accountable within a professional framework, to themselves, the patient and family, their peers and to their profession; but not to accreditation bodies and raised concerns on how the quality indicators were measured. The departmental leaders had a positive perception of accreditation. They agreed that it ensured high standards of care and improved management of their functional areas. However, they were reluctant in sparing people for the QA activities due to staffing issues. With staff turnover, a lot of work was lost as sticky knowledge and had to be redone. Listing the continual quality improvement initiatives over the last 3 years was a challenge in itself. Conclusion: The success of any quality assurance reaccreditation program depends almost entirely on the commitment and interest of the administrators, nurses, paramedical staff, and clinicians. The leader of the Quality Movement is critical in propelling and building momentum. Leaders need to recognize skepticism and resistance and consider ways in which staff can become positively engaged. Involvement of all the functional owners is the start point towards building ownership and accountability for standards compliance. Creativity plays a very valuable role. Communication by Mail Series, WhatsApp groups, Quizzes, Events, and any and every form helps. Leaders must be able to generate interest and commitment without burdening clinical and administrative staff with an activity they neither understand nor believe in.

Keywords: NABH, reaccreditation, quality assurance, quality indicators

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Authors: Drashti G. Daraji, Rosa E. Moo-Puc, Hitesh D. Patel

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Substituted 2-Thioimidazole analogues have been synthesized and confirmed by advanced spectroscopic techniques. Among them, ten compounds have been selected and evaluated for their in vitro anti-cancer activity at the National Cancer Institute (NCI) for testing against a panel of 60 different human tumor cell lines derived from nine neoplastic cancer types. Furthermore, synthesized compounds were tested for their in vitro antiprotozoal activity, and none of them exhibited significant potency against antiprotozoans. It was observed that the tested all compounds seem effective on the UACC-62 melanoma cancer cell line as compared to other cancer cell lines and also exhibited the least potent in the Non-Small Cell Lung Cancer cell line in one-dose screening. In silico studies of these derivatives were carried out by molecular docking techniques and Absorption, Distribution, Metabolism, and Excretion (ADME) using Schrödinger software to find potent B-Raf kinase inhibitor (PDB ID: 3OG7). All the compounds have been performed for docking study; Compound D4 has a good docking score for melanoma cancer as compared with other.

Keywords: anticancer activity, cancer cell line, 2-thio imidazole, one-dose assay, molecular docking

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Authors: C. Bamrungbutr, J. Sillitoe

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Maritime transportation has been a crucial part of world economics. Recently, researchers have put effort into studying the mechanisms of how a regional port, in the shadow of a nearby predominant port, can compete and grow. However, limited research has focused on the competition issues for a shadow port which is a capital city port. This study will thus focus on this question of the growth of a capital city port which is under the shadow of the adjacent capital city port by using the two capital city ports of Thailand; Bangkok port (the former main port) and Laem Chabang port (the current main port). For this work, a framework of opportunity capture will be used, and five groups of port development experts (government, council, logistics provider, academia and industry) will be interviewed. The responses will be analysed using the noticing, collecting and thinking model. The resulting analysis will be appropriate for use in developing guidelines for the future management of a range of shadow ports established in a capital city, enabling them to operate in a competitive environment more effectively. The resultant growth of these ports will be a significant factor in increasing the competitiveness of a nation’s maritime transport industry and eventually lead to a boost in the national economy.

Keywords: shadow port, Bangkok Port, Laem Chabang Port, port competition

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Authors: Peregrine James Dalziel, Philip Vu Tran

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Objective / Introduction: Demand for radiology services from Emergency Departments (ED) continues to increase with greater demands placed on radiology staff providing reports for the management of complex cases. Queuing theory indicates that wide variability of process time with the random nature of request arrival increases the probability of significant queues. This can lead to delays in the time-to-availability of radiology reports (TTA-RR) and potentially impaired ED patient flow. In addition, greater “cognitive workload” of greater volume may lead to reduced productivity and increased errors. We sought to quantify the potential ED flow improvements obtainable from increased radiology providers serving 3 public hospitals in Melbourne Australia. We sought to assess the potential productivity gains, quality improvement and the cost-effectiveness of increased labor inputs. Methods & Materials: The Western Health Medical Imaging Department moved from single resident coverage on weekend days 8:30 am-10:30 pm to a limited period of 2 resident coverage 1 pm-6 pm on both weekend days. The TTA-RR for weekend CT scans was calculated from the PACs database for the 8 month period symmetrically around the date of staffing change. A multivariate linear regression model was developed to isolate the improvement in TTA-RR, between the two 4-months periods. Daily and hourly scan volume at the time of each CT scan was calculated to assess the impact of varying department workload. To assess any improvement in report quality/errors a random sample of 200 studies was assessed to compare the average number of clinically significant over-read addendums to reports between the 2 periods. Cost-effectiveness was assessed by comparing the marginal cost of additional staffing against a conservative estimate of the economic benefit of improved ED patient throughput using the Australian national insurance rebate for private ED attendance as a revenue proxy. Results: The primary resident on call and the type of scan accounted for most of the explained variability in time to report availability (R2=0.29). Increasing daily volume and hourly volume was associated with increased TTA-RR (1.5m (p<0.01) and 4.8m (p<0.01) respectively per additional scan ordered within each time frame. Reports were available 25.9 minutes sooner on average in the 4 months post-implementation of double coverage (p<0.01) with additional 23.6 minutes improvement when 2 residents were on-site concomitantly (p<0.01). The aggregate average improvement in TTA-RR was 24.8 hours per weekend day This represents the increased decision-making time available to ED physicians and potential improvement in ED bed utilisation. 5% of reports from the intervention period contained clinically significant addendums vs 7% in the single resident period but this was not statistically significant (p=0.7). The marginal cost was less than the anticipated economic benefit based assuming a 50% capture of improved TTA-RR inpatient disposition and using the lowest available national insurance rebate as a proxy for economic benefit. Conclusion: TTA-RR improved significantly during the period of increased staff availability, both during the specific period of increased staffing and throughout the day. Increased labor utilisation is cost-effective compared with the potential improved productivity for ED cases requiring CT imaging.

Keywords: workflow, quality, administration, CT, staffing

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Authors: Aneri Mehta, Krunal Mehta

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A doctrine, any doctrine, incorporates a set of beliefs or principles held by a body of persons. A national nuclear doctrine represents, therefore, the collective set of beliefs or principles held by the nation in regard to the utility of its nuclear weapons. India’s foreign policy has been profoundly affected by the nuclear explosions conducted in May 1998. The departure from the professed peaceful nuclear policies has had several implications for India’s defense and foreign policies. The explosions in Pokhran have aggravated tensions in south Asia by disrupting diplomatic initiatives with Pak and China. Diplomacy has been reduced to damage control. The object of India’s nuclear deterrence is to persuade an adversary that the costs to him of seeking a military solution to his political problems with India will far outweigh the benefits. The paper focuses on India’s guidelines governing nuclear policy, development of nuclear materials for effective deterrence as well as civil development purpose. The paper finds that security concerns and technological capabilities are important determinants of whether India develops a nuclear weapons programs, while security concerns, economic capabilities, and domestic politics help to explain the possession of nuclear weapons.

Keywords: foreign policy, nuclear deterrence, nuclear policy, development

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Authors: Margareth S. Zanchetta, Kateryna Metersky, Valerie Tan, Charissa Cordon, Stephanie Lucchese, Yana Siganevich, Prasha Sivasundaram, Truong Binh Nguyen, Imran Qureshi

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Due to a new area of practice, Canadian nurses possess knowledge gaps regarding the use of cannabis-based therapies by clients/patients. Education related to medical cannabis (MC) and recreational cannabis (RC) is required to promote nurses’ competency and confidence in supporting clients/patients using MC/RC toward the improvement of health outcomes. A team composed of nursing researchers and undergraduate/graduate students implemented a national survey to explore this theme with the population of undergraduate, graduate (MN and NP), and Post-Diploma (RN Bridging) nursing students enrolled in Canadian Universities Nursing Programs. Upon Research Ethics Board approval, survey recruitment was supported by major nursing stakeholders. The research questions were : (a) Which are the most preferred sources of information on MC/RC for nursing students? (b) Which are the factors and preferred learning modalities that could increase interest in learning about MC/RC, and (c) What are the future career plans among nursing students, and how would they consider the prospective use of cannabis in their practice? The survey was available from Sept. 2022 to Feb. 2023, hosted by a remote platform. An original questionnaire (English-French) was composed of 18 multiple choice questions and 2 open-ended questions. Sociodemographic information and closed-ended responses were compiled as descriptive statistics, while narrative accounts will be analysed through thematic analysis. Respondents (n=153) were from 7 Canadian provinces, national (99%) and international students (1%); the majority of respondents (61%) were in the age range of 21-30 years old. Results indicated that respondents perceive a gap in the undergraduate curriculum on the topics of MC/RC (91%) and that their learning needs include regulations (90%), data on effectiveness (88%), dosing best practices (86%), contraindications (83%), and clinical and medical indications (76%). Respondents reported motivation to learn more about MC/RC through online lectures/videos (65%), e-learning modules or online interactive training (61%), workshops (51%), webinars (36%), and social media (35%). Their primary career-related motivations regarding MC/RC knowledge include enhancing nursing practice (76%), learning about this growing scope of practice (61%), keeping up-to-date responding to scientific curiosity (59%), learning about evidence-based practice (59%), and utilizing alternative forms of medical treatment (37%). Respondents indicated that the integration of topics on cannabis in any course in the undergraduate and/or graduate curriculum would increase their desire to learn about MC/RC as equally as exposure within a clinical setting (75%). The emerging trend in the set of narrative responses (n=130) suggests that respondents believe educational MC/RC content should be integrated into core nursing courses. Respondents also urged educators to be well-informed about evidence-based practice related to MC/RC and to reflect upon stigma and biases surrounding its use. Future knowledge dissemination and translation activities include scholarly products and presentations to stimulate discussion amongst nursing faculty and students, as well as nurses in clinical settings. The goal is to mobilise talents and build collaboration for the development of a socially responsive curriculum on MC/RC competency to address the education-related expectations of all these social actors.

Keywords: Canada, medical cannabis, nursing education, nursing graduate student, nursing undergraduate student, online survey, recreational cannabis

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Authors: C. L. Wu, W. W. Tseng

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From the National Health Insurance (NHI) system was introduced in Taiwan in 2000, there have been some problems in transformed small-scale hospitals, such as mobility of patients, shortage of nursing staff, medical pipelines breaking fire compartments and insufficient fire protection systems. Due to shrinking of the funding scale and the aging society, fire safety in small-scale hospitals has recently given cause for concern. The aim of this study is to determine fire risk index for small-scale hospital through a systematic approach The selection of fire safety mitigation methods can be regarded as a multi-attribute decision making process which must be guaranteed by expert groups. First of all, identify and select safety related factors and identify evaluation criteria through literature reviews and experts group. Secondly, application of the Fuzzy Analytic Hierarchy Process method is used to ascertain a weighted value which enables rating of the importance each of the selected factors. Overall, Sprinkler type and Compartmentation are the most crucial indices in mitigating fire, that is to say, structural approach play an important role to decrease losses in fire events.

Keywords: Fuzzy Delphi Method, fuzzy analytic hierarchy, process risk assessment, fire events

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Authors: M. Nasri Nasrabadi, A. A. Hassani

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Karoon is one of the greatest and longest rivers of Iran, which because of the existence of numerous industrial, agricultural centers and drinking usage, has a strategic situation in the west and southwest parts of Iran, and the optimal monitoring of its water quality is an essential and indispensable national issue. Due to financial constraints, water quality monitoring network design is an efficient way to manage water quality. The most crucial part is to find appropriate locations for monitoring stations. Considering the objectives of water usage, we evaluate existing water quality sampling stations of this river. There are several methods for assessment of existing monitoring stations such as Sanders method, multiple criteria decision making and dynamic programming approach (DPA) which DPA opted in this study. The results showed that due to the drinking water quality index out of 20 existing monitoring stations, nine stations should be retained on the river, that include of Gorgor-Band-Ghir of A zone, Dez-Band-Ghir of B zone, Teir, Pole Panjom and Zargan of C zone, Darkhoein, Hafar, Chobade, and Sabonsazi of D zone. In additional, stations of Dez river have the best conditions.

Keywords: DPA, karoon river, network monitoring, water quality, sampling site

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Authors: Eduardo Cabrera-Rode, Janet Rodriguez, Aimee Alvarez, Ragmila Echevarria, Antonio D. Reyes, Ileana Cubas-Duenas, Silvia E. Turcios, Oscar Diaz-Diaz

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Obex is a nutritional supplement to help weight loss naturally. In addition, this supplement has a satiating effect that helps control the craving to eat between meals. The purpose of this study was to evaluate the effect of Obex in the metabolic syndrome (MS). This was an open label pilot study conducted in 30 patients with MS and ages between 29 and 60 years old. Participants received Obex, at a dose of one sachet before (30 to 45 minutes) the two main meals (lunch and dinner) daily (mean two sachets per day) for 3 months. The content of the sachets was dissolved in a glass of water or fruit juice. Obex ingredients: Açai (Euterpe oleracea Mart.) berry, inulin, Phaseolus vulgaris, Caralluma fimbriata, inositol, choline, arginine, ornitine, zinc sulfate, carnitine fumarate, methionine, calcium pantothenate, pyridoxine and folic acid. In addition to anthropometric measures and blood pressure, fasting plasma glucose, total cholesterol, triglycerides and HDL-cholesterol and insulin were determined. Insulin resistance was assessed by HOMA-IR index. Three indirect indexes were used to calculate insulin sensitivity [QUICKI index (Quantitative insulin sensitivity check index), Bennett index and Raynaud index]. Metabolic syndrome was defined according to the Joint Interim Statement (JIS) criteria. The JIS criteria require at least three of the following components: (1) abdominal obesity (waist circumference major or equal major or equal 94 cm for men or 80 cm for women), (2) triglycerides major or equal 1.7 mmol/L, (3) HDL cholesterol minor 1.03 mmol/L for men or minor 1.30 mmol/L for women, (4) systolic/diastolic blood pressure major or equal 130/85mmHg or use antihypertensive drugs, and (5) fasting plasma glucose major or equal 5.6 mmol/L or known treatment for diabetes. This study was approved by the Ethical and Research Committee of the National Institute of Endocrinology, Cuba and conducted according to the Declaration of Helsinki. Obex is registered as a food supplement in the National Institute of Nutrition and Food, Havana, Cuba. Written consent was obtained from all patients before the study. The clinical trial had been registered at ClinicalTrials.gov. After three months of treatment, 43.3% (13/30) of participants decreased the frequency of MS. Compared to baseline, Obex significantly reduced body weight, BMI, waist circumference, and waist/hip ratio and improved HDL-c (p<0.0001) and in addition to lowering blood pressure (p<0.05). After Obex intake, subjects also have shown a reduction in fasting plasma glucose (p<0.0001) and insulin sensitivity was enhanced (p=0.001). No adverse effects were seen in any of the participants during the study. In this pilot study, consumption of Obex decreased the prevalence of MS due to the improved selected components of the metabolic syndrome, indicating that further studies are warranted. Obex emerges as an effective and well tolerated treatment for preventing or delaying MS and therefore potential reduction of cardiovascular risk.

Keywords: nutritional supplement, metabolic syndrome, weight loss, insulin resistance

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Authors: Fauzia Dianawati, Riska W. Purnomo

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Food and agricultural sector become the biggest sector contributing to inflation in Indonesia. Especially in Wonogiri district, red cayenne pepper was the biggest sector contributing to inflation on 2016. A national statistic proved that in recent five years red cayenne pepper has the highest average level of fluctuation among all commodities. Some factors, like supply chain, price disparity, production quantity, crop failure, and oil price become the possible factor causes high volatility level in red cayenne pepper price. Therefore, this research tries to find the key factor causing fluctuation on red cayenne pepper by using ARCH/GARCH method. The method could accommodate the presence of heteroscedasticity in time series data. At the end of the research, it is statistically found that the second level of supply chain becomes the biggest part contributing to inflation with 3,35 of coefficient in fluctuation forecasting model of red cayenne pepper price. This model could become a reference to the government to determine the appropriate policy in maintaining the price stability of red cayenne pepper.

Keywords: ARCH/GARCH, forecasting, red cayenne pepper, volatility, supply chain

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Authors: Lucyna Kapka-Skrzypczak, Barbara Sochanowicz, Magdalena Matysiak-Kucharek, Magdalena Czajka, Krzysztof Sawicki, Marcin Kruszewski

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Due to the strong antimicrobial activity silver nanoparticles (AgNPs) are widely used in various medical and general applications, among others, in cosmetics, odour resistant textiles, etc. The aim of this study was to compare effect of AgNPs and gold NPs (AuNPs) on histones posttranslational modifications. Histone molecule posttranscriptional modifications are responsible for chromatin compaction and repackaging. In this study, BALB/c mice were inoculated with murine mammary carcinoma 4T1 cells and treated with AgNPs coated with citrate (AgNPs(cit) or PEG (AgNPs(PEG), or AuNPs. Thereafter the histone H3 acetylation on Lys9 and H3 methylation on Lys4, Lys9, Lys29 was investigated. All NPs tested decreased H3 methylation, while no effect was observed for H3 acetylation. Modification of histone H3 methylation dependent on type of NPs used its coating, site of methylation and treatment used. Conclusion, epigenetic effects of nanomaterials depend on nanomaterial composition, its coating, and way of application. This work was supported by National Science Centre grant No. 2014/15/B/NZ7/01036 (MK, LKS, MMK, MC, KS), statutory funding for INTC (BS).

Keywords: gold nanoparticles, histone, methylation, silver nanoparticles

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Authors: Bakhrouri Sarah

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The city of Algiers constitutes the first commercial pole of the country; 56.3% of its economic entities come from the commercial sector. Shopping centers are the new form of commerce that has emerged in the city since the 2000s. They are considered to be commercial and leisure poles and major generators of travel. However, shopping centers in the capital Algiers are poorly served by public transport, and their choice of location is mainly conditioned by the availability of land; accessibility by public transport does not appear to be an important criterion in the choice of their location. As a result, travel to and from these commercial centers is mainly by car, which breaks with the sustainability objectives of national transportation policy. Our study attempts to examine the impact of public transport accessibility of shopping centers on consumers' travel behaviour. The main objective of this research is to determine the link between the accessibility of these facilities, the use of private cars, and public transport modes. To this end, we analyze the choice of travel mode of consumers and the different factors that determine it by focusing on the influence of accessibility. The results showed a considerable influence of the accessibility on the travel behavior of the consumer in Algiers, so it is recommended to improve the accessibility of shopping centers by public transport in order to contribute to a modal shift.

Keywords: accessibility, shopping centers trips, public transportation, Algiers

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Authors: Seo-Hee Kim, Kee-Won Kim, Seung-Hoon Kim

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The most important elements of a novel are the characters, events and background. The background represents the time, place and situation that character appears, and conveys event and atmosphere more realistically. If readers have the proper knowledge about background of novels, it may be helpful for understanding the atmosphere of a novel and choosing a novel that readers want to read. In this paper, we are targeting Korean historical novels because spatio-temporal background especially performs an important role in historical novels among the genre of Korean novels. To the best of our knowledge, we could not find previous study that was aimed at Korean novels. In this paper, we build a Korean historical national dictionary. Our dictionary has historical places and temple names of kings over many generations as well as currently existing spatial words or temporal words in Korean history. We also present a method for recognizing spatio-temporal background based on patterns of phrasal words in Korean sentences. Our rules utilize postposition for spatial background recognition and temple names for temporal background recognition. The knowledge of the recognized background can help readers to understand the flow of events and atmosphere, and can use to visualize the elements of novels.

Keywords: data mining, Korean historical novels, Korean linguistic feature, spatio-temporal background

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Authors: Jiri Barta

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At the present time, awareness, education, computer simulation and information systems protection are very serious and relevant topics. The article deals with perspectives and possibilities of implementation of emergence or natural hazard threats into the system which is developed for communication among members of crisis management staffs. The Czech Hydro-Meteorological Institute with its System of Integrated Warning Service resents the largest usable base of information. National information systems are connected to foreign systems, especially to flooding emergency systems of neighboring countries, systems of European Union and international organizations where the Czech Republic is a member. Use of outputs of particular information systems and computer simulations on a single communication interface of information system for communication among members of crisis management staff and setting the site interoperability in the net will lead to time savings in decision-making processes in solving extraordinary events and crisis situations. Faster managing of an extraordinary event or a crisis situation will bring positive effects and minimize the impact of negative effects on the environment.

Keywords: computer simulation, communication, continuity, critical infrastructure, information systems, safety

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Authors: Etta Conteh, Tracy Macintosh

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Introduction: Restraints are often used in the Emergency Department when it is necessary for a patient to be restrained in order to decrease their agitation and better treat them. Chemical and physical restraints may be used on these patients at the discretion of the medical provider. Racism and injustice are rampant within our country, and medicine and healthcare are not spared. While racism and racial bias in medicine and healthcare have been studied, information on the differences in the use of restraints by race are scarce. Objective: The objective of this study is to determine if African Americans and Hispanic-American patients are restrained at higher rates compared to their White counterparts. Methods: This study will be carried out through a retrospective analysis utilizing the Hospital Corporation of America (HCA) national Emergency Department (ED) and inpatient database with patient visits from 2016-2019. All patient visits, with patients aged 18 years or older, will be reviewed, looking specifically for the race and the use and type of restraints. Other factors, such a pre-existing psychiatric condition, will be used for sub-analysis. Rationale: The outcome of this project will demonstrate the absence or presence of a racial disparity in the use of restraints in the Emergency Department. These results can be used as a foundation for improving racial equity in healthcare treatment.

Keywords: emergency medicine, public health, racism, restraint use

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Authors: B. Urban

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International entrepreneurship represents the process of discovering and creatively exploiting opportunities that exist outside a firm’s national borders in order to obtain a competitive advantage. Firms in emerging economies are increasingly looking towards internationalisation since they are faced with rising competition in their domestic markets and attracted to opportunities in foreign markets. This article investigates international entrepreneurship by examining how the influence of entrepreneurial intensity and capabilities at the firm level influence performance, while at the same time considering environmental influences on this relationship. Based on past theoretical and empirical findings, hypotheses are formulated and then tested using correlational and regression analysis. Generally, the results support the hypotheses where both entrepreneurial intensity and capabilities are positively related to internationalisation and firm performance, while weak evidence is found for environmental hostility as a moderating influence. Several recommendations are made in light of the findings, where it is suggested that firms foster higher levels of innovativeness, risk-taking and proactiveness while developing human, social and technology related capabilities in order to enhance their performance and increase their levels of internationalisation.

Keywords: international entrepreneurship, entrepreneurial intensity, capabilities, firm performance, exporting, South Africa

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Authors: Izabela P. Vatanabe, Rafaela Peron, Patricia Manzine, Marcia R. Cominetti

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Introduction: Considering the increase in life expectancy of world population, there is an emerging concern in health services to allocate better care and care to elderly, through promotion, prevention and treatment of health. It has been observed that frailty syndrome is prevalent in elderly people worldwide and this complex and heterogeneous clinical syndrome consist of the presence of physical frailty associated with cognitive dysfunction, though in absence of dementia. This can be characterized by exhaustion, unintentional weight loss, decreased walking speed, weakness and low level of physical activity, in addition, each of these symptoms may be a predictor of adverse outcomes such as hospitalization, falls, functional decline, institutionalization, and death. Cognitive frailty is a recent concept in literature, which is defined as the presence of physical frailty associated with mild cognitive impairment (MCI) however in absence of dementia. This new concept has been considered as a subtype of frailty, which along with aging process and its interaction with physical frailty, accelerates functional declines and can result in poor quality of life of the elderly. MCI represents a risk factor for Alzheimer's disease (AD) in view of high conversion rate for this disease. Comorbidities and physical frailty are frequently found in AD patients and are closely related to heterogeneity and clinical manifestations of the disease. The decreased platelets ADAM10 levels in AD patients, compared to cognitively healthy subjects, matched by sex, age and education. Objective: Based on these previous results, this study aims to evaluate whether ADAM10 platelet levels of could act as a biomarker of cognitive frailty. Methods: The study was approved by Ethics Committee of Federal University of São Carlos (UFSCar) and conducted in the municipality of São Carlos, headquarters of Federal University of São Carlos (UFSCar). Biological samples of subjects were collected, analyzed and then stored in a biorepository. ADAM10 platelet levels were analyzed by western blotting technique in subjects with MCI and compared to subjects without cognitive impairment, both with and without presence of frailty. Statistical tests of association, regression and diagnostic accuracy were performed. Results: The results have shown that ADAM10/β-actin ratio is decreased in elderly individuals with cognitive frailty compared to non-frail and cognitively healthy controls. Previous studies performed by this research group, already mentioned above, demonstrated that this reduction is still higher in AD patients. Therefore, the ADAM10/β-actin ratio appears to be a potential biomarker for cognitive frailty. The results bring important contributions to an accurate diagnosis of cognitive frailty from the perspective of ADAM10 as a biomarker for this condition, however, more experiments are being conducted, using a high number of subjects, and will help to understand the role of ADAM10 as biomarker of cognitive frailty and contribute to the implementation of tools that work in the diagnosis of cognitive frailty. Such tools can be used in public policies for the diagnosis of cognitive frailty in the elderly, resulting in a more adequate planning for health teams and better quality of life for the elderly.

Keywords: ADAM10, biomarkers, cognitive frailty, elderly

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