Search results for: critical evaluation of theoretical prospects

Authors: Aliyu Umar, Mohammed Yau, Faruruwa M. Dahiru, Saed Garba

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Evaluation of heavy metals in twelve commonly consumed herbal medicines/preparations in Kano State, Nigeria, was carried out. The samples comprised of five unregistered powdered medicines, namely, Zuwo, (ZW); Rai Dorai, (RD); Miyar Tsanya, (MTS); Bagaruwar Makka, (BM); and Madobiya, (M); five unregistered liquid herbal medicinal concussions for pile (MB), yellow fever (MS), typhoid (MT), stomach pain (MC), sexually transmitted diseases (STDs); and two registered herbal medicines; Alif Powder (AP) and Champion Leaf (CL). The heavy metals evaluation was carried out using Atomic Absorption Spectroscopy (AAS) and the result revealed the concentrations (ppm) ranges of the heavy metals as follows: Cadmium (0.0045 – 0.1601), Chromium (0.0418 – 0.2092), Cobalt (0.0038 – 0.0760), Copper (0.0547 – 0.2465), Iron (0.1197 – 0.3592), Manganese (0.0123 – 1.4462), Nickel (0.0073 – 0.0960), Lead (0.185 – 0.0927) and Zinc (0.0244 – 0.2444). Comparing the results obtained in this work with the standards of the World Health Organization (WHO), the Food and Agricultural Organization (FAO) and permissible limits of other countries, the concentrations of heavy metals in the herbal medicine/preparations are within the allowed permissible limits range in herbal medicines and their use could be safe.

Keywords: Kano state, herbal medicines, registered, unregistered

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Authors: Mustafa M. Donma, Orkide Donma

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A well-defined insulin resistance (IR) is one of the requirements for the good understanding and evaluation of metabolic syndrome (MetS). However, underlying causes for the development of IR are not clear. Endothelial dysfunction also participates in the pathogenesis of this disease. IR indices are being determined in various obesity groups and also in diagnosing MetS. Components of MetS have been well established and used in adult studies. However, there are some ambiguities particularly in the field of pediatrics. The aims of this study were to compare the performance of fasting blood glucose (FBG), one of MetS components, with some other IR indices and check whether FBG may be replaced by some other parameter or ratio for a better evaluation of pediatric MetS. Five-hundred and forty-nine children were involved in the study. Five groups were constituted. Groups 109, 40, 100, 166, 110, 24 children were included in normal-body mass index (N-BMI), overweight (OW), obese (OB), morbid obese (MO), MetS with two components (MetS2) and MetS with three components (MetS3) groups, respectively. Age and sex-adjusted BMI percentiles tabulated by World Health Organization were used for the classification of obesity groups. MetS components were determined. Aside from one of the MetS components-FBG, eight measures of IR [homeostatic model assessment of IR (HOMA-IR), homeostatic model assessment of beta cell function (HOMA-%β), alanine transaminase-to-aspartate transaminase ratio (ALT/AST), alanine transaminase (ALT), insulin (INS), insulin-to-FBG ratio (INS/FBG), the product of fasting triglyceride and glucose (TyG) index, McAuley index] were evaluated. Statistical analyses were performed. A p value less than 0.05 was accepted as the statistically significance degree. Mean values for BMI of the groups were 15.7 kg/m², 21.0 kg/m², 24.7 kg/m², 27.1 kg/m², 28.7 kg/m², 30.4 kg/m² for N-BMI, OW, OB, MO, MetS2, MetS3, respectively. Differences between the groups were significant (p < 0.001). The only exception was MetS2-MetS3 couple, in spite of an increase detected in MetS3 group. Waist-to-hip circumference ratios significantly differed only for N-BMI vs, OB, MO, MetS2; OW vs MO; OB vs MO, MetS2 couples. ALT and ALT/AST did not differ significantly among MO-MetS2-MetS3. HOMA-%β differed only between MO and MetS2. INS/FBG, McAuley index and TyG were not significant between MetS2 and MetS3. HOMA-IR and FBG were not significant between MO and MetS2. INS was the only parameter, which showed statistically significant differences between MO-MetS2, MO-MetS3, and MetS2-MetS3. In conclusion, these findings have suggested that FBG presently considered as one of the five MetS components, may be replaced by INS during the evaluation of pediatric morbid obesity and MetS.

Keywords: children, insulin resistance indices, metabolic syndrome, obesity

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Diabetic nephropathy (DN) is a major complication of diabetes, with fibrosis and propionate metabolism playing critical roles in its progression. Identifying biomarkers linked to these pathways may provide novel insights into DN diagnosis and treatment. This study aims to identify biomarkers associated with fibrosis and propionate metabolism in DN. Analyze the biological pathways and regulatory mechanisms of these biomarkers. Develop a machine learning model to predict DN-related biomarkers and validate their functional roles. Publicly available transcriptome datasets related to DN (GSE96804 and GSE104948) were obtained from the GEO database (https://www.ncbi.nlm.nih.gov/gds), and 924 propionate metabolism-related genes (PMRGs) and 656 fibrosis-related genes (FRGs) were identified. The analysis began with the extraction of DN-differentially expressed genes (DN-DEGs) and propionate metabolism-related DEGs (PM-DEGs), followed by the intersection of these with fibrosis-related genes to identify key intersected genes. Instead of relying on traditional models, we employed a combination of deep neural networks (DNNs) and ensemble methods such as Gradient Boosting Machines (GBM) and XGBoost to enhance feature selection and biomarker discovery. Recursive feature elimination (RFE) was coupled with these advanced algorithms to refine the selection of the most critical biomarkers. Functional validation was conducted using convolutional neural networks (CNN) for gene set enrichment and immunoinfiltration analysis, revealing seven significant biomarkers—SLC37A4, ACOX2, GPD1, ACE2, SLC9A3, AGT, and PLG. These biomarkers are involved in critical biological processes such as fatty acid metabolism and glomerular development, providing a mechanistic link to DN progression. Furthermore, a TF–miRNA–mRNA regulatory network was constructed using natural language processing models to identify 8 transcription factors and 60 miRNAs that regulate these biomarkers, while a drug–gene interaction network revealed potential therapeutic targets such as UROKINASE–PLG and ATENOLOL–AGT. This integrative approach, leveraging deep learning and ensemble models, not only enhances the accuracy of biomarker discovery but also offers new perspectives on DN diagnosis and treatment, specifically targeting fibrosis and propionate metabolism pathways.

Keywords: diabetic nephropathy, deep neural networks, gradient boosting machines (GBM), XGBoost

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Authors: Etienne Mfoumou, Mo Shamma, Martin Tango, Michael Locke

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Water literacy is essential for addressing emerging water management challenges in southwest Nova Scotia (SWNS), where growing concerns over water scarcity and sustainability have highlighted the need for improved educational frameworks. Current approaches often fail to fully represent the complexity of water systems, focusing narrowly on the water cycle while neglecting critical aspects such as groundwater infiltration and the interconnectedness of surface and subsurface water systems. To address these gaps, this paper proposes a comprehensive framework for water literacy that integrates the physical dimensions of water systems with key aspects of understanding, including processes, energy, scale, and human dependency. Moreover, a suggested tool to enhance this framework is a real-time hydrometric data map supported by a network of water level monitoring devices deployed across the province. These devices, particularly for monitoring dug wells, would provide critical data on groundwater levels and trends, offering stakeholders actionable insights into water availability and sustainability. This real-time data would facilitate deeper understanding and engagement with local water issues, complementing the educational framework and empowering stakeholders to make informed decisions. By integrating this tool, the proposed framework offers a practical, interdisciplinary approach to improving water literacy and promoting sustainable water management in SWNS.

Keywords: water education, water literacy, water management, water systems, Southwest Nova Scotia

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Authors: A. G. Cunha, M. Inácio, M. C. Freitas, C. Antunes, T. Silva, C. Andrade, V. Lopes

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Saltmarshes are essential ecosystems both from an ecological and biological point of view. Furthermore, they constitute an important social niche, providing valuable economic and protection functions. Thus, understanding their rates and patterns of sedimentation is critical for functional management and rehabilitation, especially in an SLR scenario. The Sado estuary is located 40 km south of Lisbon. It is a bar built estuary, separated from the sea by a large sand spit: the Tróia barrier. Caldeira de Tróia is located on the free edge of this barrier, and encompasses a salt marsh with ca. 21,000 m². Sediment cores were collected in the high and low marshes and in the mudflat area of the North bank of Caldeira de Tróia. From the low marsh core, fifteen samples were chosen for ²¹⁰Pb and ¹³⁷Cs determination at University of Geneva. The cores from the high marsh and the mudflat are still being analyzed. A sedimentation rate of 2.96 mm/year was derived from ²¹⁰Pb using the Constant Flux Constant Sedimentation model. The ¹³⁷Cs profile shows a peak in activity (1963) between 15.50 and 18.50 cm, giving a 3.1 mm/year sedimentation rate for the past 53 years. The adopted sea level rise scenario was based on a model built with the initial rate of SLR of 2.1 mm/year in 2000 and an acceleration of 0.08 mm/year². Based on the harmonic analysis of Setubal-Tróia tide gauge of 2005 data, the tide model was estimated and used to build the tidal tables to the period 2000-2016. With these tables, the average mean water levels were determined for the same time span. A digital terrain model was created from LIDAR scanning with 2m horizontal resolution (APA-DGT, 2011) and validated with altimetric data obtained with a DGPS-RTK. The response model calculates a new elevation for each pixel of the DTM for 2050 and 2100 based on the sedimentation rates specific of each environment. At this stage, theoretical values were chosen for the high marsh and the mudflat (respectively, equal and double the low marsh rate – 2.92 mm/year). These values will be rectified once sedimentation rates are determined for the other environments. For both projections, the total surface of the marsh decreases: 2% in 2050 and 61% in 2100. Additionally, the high marsh coverage diminishes significantly, indicating a regression in terms of maturity.

Keywords: ¹³⁷Cs, ²¹⁰Pb, saltmarsh, sea level rise, response model

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Authors: S. Mezghani, E. Perrin, J. L. Bodnar, J. Marthe, B. Cauwe, V. Vrabie

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Non contact evaluation of the thickness of paint coatings can be attempted by different destructive and nondestructive methods such as cross-section microscopy, gravimetric mass measurement, magnetic gauges, Eddy current, ultrasound or terahertz. Infrared thermography is a nondestructive and non-invasive method that can be envisaged as a useful tool to measure the surface thickness variations by analyzing the temperature response. In this paper, the thermal quadrupole method for two layered samples heated up with a pulsed excitation is firstly used. By analyzing the thermal responses as a function of thermal properties and thicknesses of both layers, optimal parameters for the excitation source can be identified. Simulations show that a pulsed excitation with duration of ten milliseconds allows to obtain a substrate-independent thermal response. Based on this result, an experimental setup consisting of a near-infrared laser diode and an Infrared camera was next used to evaluate the variation of paint coating thickness between 60 µm and 130 µm on two samples. Results show that the parameters extracted for thermal images are correlated with the estimated thicknesses by the Eddy current methods. The laser pulsed thermography is thus an interesting alternative nondestructive method that can be moreover used for non conductive substrates.

Keywords: non destructive, paint coating, thickness, infrared thermography, laser, heterogeneity

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Authors: Gulbakhyt Sultanova

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Business education institutions assess the progress of their students by giving them grades for courses completed and calculating a Grade Point Average (GPA). Whether the participation in these courses has led to the development of competences enabling graduates to successfully compete in the labor market should be measured using a new index: Employment Readiness Assessment (ERA). The higher the ERA, the higher the quality of education at a business school. This is applied, empirical research conducted by using a method of linear optimization. The aim of research is to identify factors which lead to the minimization of the deviation of GPA from ERA as well as to the maximization of ERA. ERA is composed of three components resulting from testing proficiency in Business English, testing work and personal skills, and job interview simulation. The quality of education is improving if GPA approximates ERA and ERA increases. Factors which have had a positive effect on quality enhancement are academic mobility of students and staff, practical-oriented courses taught by staff with work experience, and research-based courses taught by staff with research experience. ERA is a better index to measure the quality of business education than traditional indexes such as GPA due to its greater accuracy in assessing the level of graduates’ competences demanded in the labor market. Optimizing the educational process in pursuit of quality enhancement, ERA has to be used in parallel with GPA to find out which changes worked and resulted in improvement.

Keywords: assessment and evaluation, competence evaluation, education quality, employment readiness

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Authors: Peter Ferguson

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In 2018, Japan’s Ministry of Education revised the public elementary school curriculum. As part of widespread reforms, the recent Course of Study established English as an academic subject in Grades 5 and 6 plus lowered the starting age of 'foreign language activities' to Grade 3. These changes were implemented in April 2020. This presentation will examine the process and effects that policy implementation had on schools and teachers. A critical analysis of the 2018 Course of Study policy documents revealed several discourses were expressed concerning not only English education and foreign language acquisition, but that larger political and socioeconomic ideological beliefs on globalization, language, nation, culture, and identity were also articulated. Using excerpts from document analysis, the presenter will demonstrate how competing discourses were expressed in policy texts. Data from interviews with national policymakers also exposed several challenges policymakers faced as they tried to balance competing discourses and articulate important pedagogical concepts while having their voices heard. Findings show that some stakeholders were marginalized during the processes of policy creation, transmission, and implementation. This presentation is part of a larger multiple case study that utilized ethnography of language policy and critical analysis of discourse to examine how English education language policy was implemented into the national elementary school curriculum in Japan, and how stakeholders at the various educational levels contended with the creation, interpretation, and appropriation of the language policy.

Keywords: ethnography of language policy, elementary school EFL, language ideologies, discourse analysis

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Authors: O. F. Elkommos

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Teaching English as a Second Language (TESL) has become a very rich area of research. Practitioners or teachers of English as a foreign or a second language are now promoting both collaborative learning and collaborative teaching. Students learning a language collaboratively and cooperatively are learning in a better environment of team work where they learn from each other. Further, teaching English collaboratively also creates an enriching environment that is also very enriching to students’ and teachers’ experiences of learning and teaching. Moreover, action research stems from actual teacher concerns and students’ needs. Reflection in turn, on the experience of the material taught and the delivery of material is becoming an integral part of the teaching and learning experience self- evaluation and self-development. In this case, the concern of the research field in the area of TESL will be the development of teaching delivery, material and quality of learning. In the present research, the TESL module taught to year two students in the Faculty of Arts and Humanities, British University in Egypt (BUE) will be evaluated reflexively by the students and teachers. The module was taught to students in two different specialisms. It was taught and delivered through collaborative teaching and was evaluated by both teachers and students as very successful and enjoyable. The reflections of both teachers and students as well as student results confirm that it was a success.

Keywords: action research, addressing differentiation, collaborative teaching, reflective teaching and learning, reflexive learning, reflexive teaching, self-development, self-evaluation, TESL

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Authors: S. K. Ashiquer Rahman

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The paper concentrates on the importance of Sustainable Campus Strategies, emphasizing the significance of mobilizing Innovative technological tools for constructing effectiveness of higher education strategy and institutional cooperation for sustainable campus at the university level and preparing the university’s authority to face the upcoming higher education strategy and institutional cooperation difficulties to the Sustainable Campus Plan. Within a framework of Sustainable Campus Strategies and institutional cooperation, the paper discusses the significance of a set of reference points that will lead to operational activities for multi-stakeholder multi-criteria evaluation of Higher Education and Research Institutions relative to the Sustainable Campus criteria and potential action plan for the University’s Strategy and Institutional Cooperation. It makes mention of the emergence of the effectiveness of Higher Education Strategy and Institutional Cooperation as well as the necessity of mobilizing innovative technological methods and tools for constructing the effectiveness of this Process. The paper outlines the conceptual framing of a Sustainable Campus Strategy, Institutional Cooperation and Action Plan for a sustainable campus. Optimistically, these will be a milestone in higher education, a pathway to meet the imminent Sustainable Campus Strategy and Institutional Cooperation of the completive world, and be able to manage the required criteria for a Sustainable University.

Keywords: higher education strategy, institutional cooperation, sustainable campus, multi-criteria evaluation, innovative method and tools

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Authors: Lorenzo Ciletti, Ed Baines, Matt Somerville

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Internationally, supporting staff with limited training (Teaching Assistants (TA)) has played a critical role in the education of children with special educational needs and/or disabilities (SEND). Researchers have notably illustrated that TAs support the children’s classroom tasks while teachers manage the whole class. Rarely have researchers investigated the TAs’ support for children’s participation in whole-class or peer-group talk, despite this type of “social support” playing a significant role in children’s whole-class integration and engagement with the classroom curriculum and learning. Social support seems particularly crucial for a large proportion of children with SEND, namely those with communication and interaction difficulties (e.g., autism spectrum conditions and speech impairments). This study explored TA practice and, particularly, TA social support in a rarely examined context (Italy). The Italian case was also selected as it provides TAs, known nationally as “support teachers,” with the most comprehensive training worldwide, thus potentially echoing (effective) nuanced practice internationally. Twelve hours of video recordings of a single TA and a child with communication and interaction difficulties (CID) were made. Video data was converted into frequencies of TA multidimensional support strategies, including TA social support and pedagogical assistance. TA-pupil talk oriented to children’s participation in classroom talk was also analysed into thematic patterns. These multi-method analyses were informed by social scaffolding principles: in particular, the extent to which the TA designs instruction contingently to the child’s communication and interaction difficulties and how their social support fosters the child’s highest responsibility in dealing with whole-class or peer-group talk by supplying the least help. The findings showed that the TA rarely supported the group or whole class participation of the child with CID. When doing so, the TA seemed to highly control the content and the timing of the child’s contributions to the classroom talk by a) interrupting the teacher’s whole class or group conversation to start an interaction between themselves and the child and b) reassuring the child about the correctness of their talk in private conversations and prompting them to raise their hand and intervene in the whole-class talk or c) stopping the child from contributing to the whole-class or peer-group talk when incorrect. The findings are interpreted in terms of their theoretical relation to scaffolding. They have significant implications for promoting social scaffolding in TA training in Italy and elsewhere.

Keywords: children with communication and interaction difficulties, children with special educational needs and/or disabilities, social scaffolding, teaching assistants, teaching practice, whole-class talk participation

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Authors: Elsayed Elmiligy, Dzolkhifili Omar, Norhayu Asib

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Sitophilus oryzae is a primary destructive insect pest. A study on nanoemulsion formulation of C. hystrix peel oil and evaluation of its insecticidal effect on the adults of S. oryzae was held in toxicology laboratory at Faculty of Agriculture, Universiti Putra Malaysia (UPM). Three nanoemulsion formulations (F1, F2, and F3) were prepared using C. hystrix peel oil (a.i), Tween 80 (surfactant), AMD 810 (carrier) and deionized water. The selected formulations have undergone stability tests, surface tension, zeta potential and particle size measurements. The formulations were tested for their contact and fumigant activity against the adults of S. oryzae. LC₅₀ values were obtained from Probit regressions using the Polo-PC program. All the formulations showed stability under storage temperature and centrifugation. They were characterized as nanoemulsions as they remained in the range of nanoscale 200 nm. The formulations revealed lower surface tension in the range of 29.5 to 30.4 mN/m. They showed stable of zeta potential values. The formulations showed the highest toxicity against the adults of S. oryzae. The order of decreasing toxicity was F1 > F2 > F3 with LC₅₀ values of 52.1, 58.5, and 61.7 µl/l for contact toxicity, and 71, 75.5, and 76.7 µl/l air for fumigant bioassay after 72 hours. Formulation of C. hystrix peel oil in a nanoemulsion enhance its effectiveness and reduce the amount of applied essential oil.

Keywords: Citrus hystrix peel oil, Sitophilus oryzae, nanoemulsion, contact toxicity, Fumigant bioassay

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Authors: Naritphol Boonjyakiat

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This research attempts to investigate the effects of corporate social responsibility and knowledge management factors on students’ job performance of the Silpakorn University’s internship program within various organizations. The goal of this study is to fill the literature gap by gaining an understanding of corporate social responsibility and the knowledge management factors that fundamentally relate to students’ job performance within the organizations. Thus, this study will focus on the outcomes that were derived from a set of secondary data that were obtained using a Silpakorn university’s data base of 200 students and selected employer assessment and evaluation forms from the companies. The results represent the perceptions of students towards the corporate social responsibility aspects and knowledge management factors within the university and their job performance evaluation from the employers in various organizations. The findings indicate that corporate social responsibility and knowledge management have significant effects on students’ job performance. This study may assist us in gaining a better understanding of the integrated aspects of university and workplace environments to discover how to optimally allocate university’s resources and management approaches to gain benefits from corporate social responsibility and knowledge management practices toward students’ job performance within an organizational experience settings. Therefore, there is a sufficient reason to believe that the findings can contribute to research in the area of CSR, KM, and job performance as essential aspect of involved stakeholder.

Keywords: corporate social responsibility, knowledge management, job performance, internship program

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Authors: William Ceurvels, Dong-Di Zhang

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The true nature of the mechanism by which the pharmaceuticals of the Shang-Han Lun act has been a topic of debate since Wuji Cheng published the first commentary during the Northern Song. Subsequent commentaries employed a number of methodologies in their analysis of pharmaceutical mechanisms, but no commentator was able to garner universal acceptance. During the Qing Dynasty, the proliferation and development of Neo-Confucian scholarship produced a new generation of scholars possessed of rigorous and inventive research methods, one of whom was the famed materia medica scholar, Run-an Zou. Run-an Zou and his successor Zhou Yan advocated analyzing the mechanism of Treatise pharmaceuticals based upon the understanding of those pharmaceuticals during the time period in which the Treatise was written and thereby focused on the Han Dynasty materia medica tract Shen-nong Ben-cao Jing (The Divine Husbandman’s Herbal Foundation Canon). Zou Run-an’s commentary, Ben-jing Shu-zheng won nearly universal praise among materia medica scholars for its scholastic rigor and innovative research methods. However, because Ben-jing Shu-zheng only focuses on individual herbs, as opposed to formulas, its value in analyzing the Shang-Han Lun has limitations. The purpose of this study is to combine Zou Run-an’s single-pharmaceutical commentaries to generate theoretical full formula analyses to gain a fuller picture of Zou’s understanding of the healing mechanism of Shang-Han Lun formulas. Commentaries were gathered from Ben-jing Shu-zheng and Zhou Yan’s Ben-cao Si-bian Lun and combined to produce theoretical full formula model mechanisms of Treatise formulas. Through this study, a new picture of the mechanistic basis of Shang-han formulas emerges, which is based on qi-xue changes as opposed to organ or meridian theory. The author hopes that this modest research study will be of service to scholars of the Shang-han and clinical doctors alike in their pursuit of the true pharmacomechanisms of this great Han dynasty tome.

Keywords: Materia medica, Shang-han Lun, Shen-nong Ben-cao Jing, neo-Confucian scholarship

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Authors: Henry Nicholas Lee, George Thomas, Juliana Johari, Carmilla Freddie, Caroline Val Madin

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Research in comparative and international education often provides value-laden views of an education system within and in between other countries. These views are frequently used by policy makers or educators to explore similarities and differences for, among others, benchmarking purposes. In this study, a comparison is made between Malaysia and England, focusing on the process of writing children went through to create a text, using a multimodal theoretical framework to analyse this comparison. The main purpose is political in nature as it served as an answer to Malaysia’s call for benchmarking of best practices for language learning. Furthermore, the focus on writing in this study adds into more empirical findings about early writers’ writing development and writing improvement, especially for children at the ages of 5-9. In research, comparative studies in English as a Second Language (ESL) writing pedagogy – particularly in Malaysia since the introduction of the Standard- based English Language Curriculum (KSSR) in 2011 as a draft and its full implementation in 2017; reviewed 2018 KSSR-CEFR aligned – has not been done comparatively. In theory, a multimodal theoretical framework somehow allows a logical comparison between first language and ESL which would provide useful insights to illuminate the writing process between Malaysia and England. The comparisons are not representative because of the different school systems in both countries. So far, the literature informs us that the curriculum for language learning is very much emphasised on children’s linguistic abilities, which include their proficiency and mastery of the language, its conventions, and technicalities. However, recent empirical findings suggested that literacy in its concepts and characters need change. In view of this suggestion, the comparison will look at how the process of writing is implemented through the five modes of communication: linguistic, visual, aural, spatial, and gestural. This project draws on data from Malaysia and England, involving 10 teachers, 26 classroom observations, 20 lesson plans, 20 interviews, and 20 brief conversations with teachers. The research focused upon 20 primary children of different genders aged 5-9, and in addition to primary data descriptions, 40 children’s works, 40 brief classroom conversations, 30 classroom photographs, and 30 school compound photographs were undertaken to investigate teachers and children’s use of modes and semiotic resources to design a text. The data were analysed by means of within-case analysis, cross-case analysis, and constant comparative analysis, with an initial stage of data categorisation, followed by general and specific coding, which clustered the data into thematic groups. The study highlights the importance of teachers’ and children’s engagement and interaction with various modes of communication, an adaptation from the English approaches to teaching writing within the KSSR framework and providing ‘voice’ to ESL writers to ensure that both have access to the knowledge and skills required to make decisions in developing multimodal texts and artefacts.

Keywords: comparative education, early writers, KSSR, multimodal theoretical framework, writing development

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Authors: Josiah O. Carter, Charlotte Hayden, Elizabeth Arthurs

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Background: During the COVID-19 pandemic, hospital management policies have changed frequently and rapidly. This has created novel challenges in keeping the workforce abreast of these changes to enable them to deliver safe and effective care. Traditional communication methods, e.g. email, do not keep pace with the rapidly changing environment in the hospital, resulting in inaccurate, irrelevant, or outdated information being communicated, resulting in inefficiencies in patient care. Methods: The creation of a WhatsApp messaging group within the medical division at the Bristol Royal Infirmary has enabled senior clinicians and the hospital management team to update the medical workforce in real-time. It has two primary functions: (1) To enable dissemination of a concise, important operational summary. This comprises information on bed status and infection control procedural changes. It is fed directly from a daily critical incident briefing (2) To facilitate a monthly scheduled question and answer (Q&A) session for junior doctors to clarify issues with clinical directors, rota, and management staff. Additional ad-hoc updates are sent out for time-critical information; otherwise, it mainly functions as a broadcast-only group to prevent important information from being lost amongst other communication. All junior doctors within the medical division were invited to join the group. At present, the group comprises 131 participants, of which 10 are administrative staff (rota coordinators, management staff & clinical directors); the remaining 121 are junior clinicians working within the medical division. An electronic survey via Microsoft forms was sent out to junior doctors via the WhatsApp group and via email to assess its utilisation and effectiveness with the aim of quality improvements. Results: Of the 121 group participants, 19 completed the questionnaire (response rate 15.7%). Of these, 16/19 (84.2%) used it regularly, and 12/19 (63.2%) rated it as the most useful source for reliable updates relating to the hospital response to the COVID-19 pandemic, whereas only 2/19 (10.5%) found the trust intranet and the trust COVID-19 operational email update most useful. Respondents rated the WhatsApp group more useful as an information source (mean score 7.7/10) than as a means of providing feedback to management staff (mean score 6.3/10). Qualitative feedback suggested information around ward closures and changes to COVID cohorting, along with updates on staffing issues, were most useful. Respondents also noted the Q&A sessions were an efficient way of relaying feedback about management decisions but that it would be preferable if these sessions could be delivered more frequently. Discussion: During the current global COVID-19 pandemic, there is an increased need for rapid dissemination of critical information within NHS trusts; this includes communication between junior doctors, managers, and senior clinicians. The versatility of WhatsApp permits a variety of functions allowing for regular updates, the dissemination of time-critical information, and enables conversing and feedback. The project has demonstrated that reserved and well-managed use of a WhatsApp group is a welcome, efficient and practical means of communication between the senior management team and the junior medical workforce.

Keywords: communication, COVID-19, hospital management, WhatsApp

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Authors: Mohammed Wadi, Bedri Kekezoglu, Mustafa Baysal, Mehmet Rida Tur, Abdulfetah Shobole

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This paper investigates the technical evaluation of the wind potential for present and future investments in Turkey taking into account the feasibility of sites, installments, operation, and maintenance. This evaluation based on the hourly measured wind speed data for the three years 2008–2010 at 30 m height for Çatalca district. These data were obtained from national meteorology station in Istanbul–Republic of Turkey are analyzed in order to evaluate the feasibility of wind power potential and to assure supreme assortment of wind turbines installing for the area of interest. Furthermore, the data are extrapolated and analyzed at 60 m and 80 m regarding the variability of roughness factor. Weibull bi-parameter probability function is used to approximate monthly and annually wind potential and power density based on three calculation methods namely, the approximated, the graphical and the energy pattern factor methods. The annual mean wind power densities were to be 400.31, 540.08 and 611.02 W/m² for 30, 60, and 80 m heights respectively. Simulation results prove that the analyzed area is an appropriate place for constructing large-scale wind farms.

Keywords: wind potential in Turkey, Weibull bi-parameter probability function, the approximated method, the graphical method, the energy pattern factor method, capacity factor

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Authors: Fitih Ademe, Kibebew Kibret, Sheleme Beyene, Mezgebu Getnet, Gashaw Meteke

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Pressing demands for agricultural products and its associated pressure on water availability in the semi-arid areas demanded information for strategic decision-making in the changing climate conditions of Ethiopia. Availing such information through traditional agronomic research methods is not sufficient unless supported through the application of decision-support tools. The CERES (Crop Environmental Resource Synthesis) model in DSSAT-CSM was evaluated for estimating yield and water productivity of maize under two soil types (Andosol and Luvisol) of the Central Rift Valley of Ethiopia. A six-year data (2010 – 2017) obtained from national fertilizer determination experiments were used for model evaluation. Pertinent statistical indices were employed to evaluate model performance. Following model evaluation, yield and rain-water productivity of maize was assessed for the baseline (1981-2010) and future climate (2050’s and 2080’s) scenario. The model performed well in predicting phenology, growth, and yield of maize for the different seasons and phosphorous rates. A good agreement between simulated and observed grain yield was indicated by low values of the RMSE (0.15 - 0.37 Mg/ha) and other indices for the two soil types. The evaluated model predicted a decline in the potential (23.8 to 26.7% at Melkassa and from 21.7 to 26.1% at Ziway under RCP4.5 and RCP8.5 climate change scenarios, respectively) and water-limited yield (15 to 18.3% at Melkassa and by 6.5 to 10.5% at Ziway) in the mid-century due to climate change. Consequently, a decline in water productivity was projected in the future periods that necessitate availing options to improve water productivity in the region. In conclusion, the DSSAT-CERES-maize model can be used to simulate maize (Melkassa-2) phenology, growth and grain yield, as well as simulate water productivity under different management scenarios that can help to identify options to improve water productivity in the changing climate of the semi-arid central Rift valley of Ethiopia.

Keywords: andosol, CERES-maize, luvisol, model evaluation, water productivity

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Authors: Yazidu Saidi Mbalamula

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Free Basic Education (FBE) policy implementation in Secondary Schools has been one of thrilled undertaking both to the government and household in Tanzania. On the one hand, the government has achieved citizenry acceptance to responsibility and accountability, and on the other hand, the household has been relieved from social costs that were unbearable and deprived many Tanzanians access to basic education and secondary education in particular. Specifically, this study presents a descriptive survey conducted in two districts of Kagera region located at the northern part of Tanzania. Three objectives were pursued to identify achievements realized and challenges in the FBE implementation, and also stakeholders’ proposals were explored on how to improve FBE implementation. A sample of 91 respondents, including school managers, teachers, students, and parents, were involved in the study. Both questionnaires and interviews were used whereby the quantitative data were analyzed using Statistical Package for Social Sciences (SPSS), and content analysis was used to analyze the qualitative data. The results show that implementation of free education policy in secondary schools had far positive impact on the improvement of school management, school attendance, reduced school drop-out, reduced parents-school managers conflicts, and increased enrollment rates. Notwithstanding that, the political machinery remains instrumental to instigate policy reforms in education sector. Nevertheless, the alienating interests of politibureau, often top-down and blanketed by superficial government redness, can hardly be feasible to wield such huge programme given staggering stakeholders’ awareness of the actual requirements and unlatching resources to back up policy implementation. The study recommends that further studies on stakeholders’ conceptions on the FBE and equity of financing of basic education in Tanzania.

Keywords: capitation grant, CCM, free basic education, kagera, education policy

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Authors: Timothy E. Frank, Josh R. Aldred, Sophie B. Boulware, Michelle K. Cabonce, Justin H. White

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Materials degrade at different rates in different environments depending on factors such as temperature, aridity, salinity, and solar radiation. Therefore, predicting asset longevity depends, in part, on the environmental conditions to which the asset is exposed. Heating, ventilation, and air conditioning (HVAC) systems are critical to building operations yet are responsible for a significant proportion of their energy consumption. HVAC energy use increases substantially with slight operational inefficiencies. Understanding the environmental influences on HVAC degradation in detail will inform maintenance schedules and capital investment, reduce energy use, and increase lifecycle management efficiency. HVAC inspection records spanning 14 years from 21 locations across the United States were compiled and associated with the climate conditions to which they were exposed. Three environmental features were explored in this study: average high temperature, average low temperature, and annual precipitation, as well as four non-environmental features. Initial insights showed no correlations between individual features and the rate of HVAC component degradation. Using neighborhood component analysis, however, the most critical features related to degradation were identified. Two models were considered, and results varied between them. However, longitude and latitude emerged as potentially the best predictors of average HVAC component degradation. Further research is needed to evaluate additional environmental features, increase the resolution of the environmental data, and develop more robust models to achieve more conclusive results.

Keywords: climate, degradation, HVAC, neighborhood component analysis

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Authors: Dana A. Thal, Heike Kahlert, Fritz Scholz

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Thiol molecules are known to easily form self-assembled monolayers (SAM) on Au surfaces. Depending on the thiol’s structure, surface modifications via SAM can be used for electrode sensor development. In the presented work, 1-decanethiol coated polycrystalline Au electrodes were applied to indirectly assess the radical scavenging potential of plant compounds and extracts. Different plant compounds with reported antioxidant properties as well as an extract from the plant Gynostemma pentaphyllum were tested for their effectiveness to prevent SAM degradation on the sensor electrodes via photolytically generated radicals in aqueous media. The SAM degradation was monitored over time by differential pulse voltammetry (DPV) measurements. The results were compared to established antioxidant assays. The obtained data showed an exposure time and concentration dependent degradation process of the SAM at the electrode’s surfaces. The tested substances differed in their capacity to prevent SAM degradation. Calculated radical scavenging activities of the tested plant compounds were different for different assays. The presented method poses a simple system for radical scavenging evaluation and, considering the importance of the test system in antioxidant activity evaluation, might be taken as a bridging tool between in-vivo and in-vitro antioxidant assay in order to obtain more biologically relevant results in antioxidant research.

Keywords: alkanethiol SAM, plant antioxidant, polycrystalline Au, radical scavenger

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Authors: Shamshuddin K., Nagaraj Vannal, Diwakar Kulkarni, Raghavendra Nakod

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In most of the universities and colleges Operating System (OS) course is treated as theoretical and usually taught in a classroom using conventional teaching methods. In this paper we are presenting a new approach of teaching OS through experiential learning, the course is designed to suit the requirement of undergraduate engineering program of Instrumentation Technology. This new approach has benefited us to improve our student’s programming skills, presentation skills and understanding of the operating system concepts.

Keywords: pedagogy, interactive learning, experiential learning, OS, C, UNIX

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Authors: Aamina B. Hudaa, Rehana Akhtera, Massarat Hassana, Mir Monisab

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Mutton nuggets produced with the addition of apple pomace at the levels of 0% (Control), 5% (Treatment 1), 10% (Treatment 2), and 15% (Treatment 3) were evaluated for emulsion stability, cooking yield, pH, proximate composition, texture analysis and sensory properties. Apple pomace addition resulted in significantly higher (p ≤ 0.05) emulsion stability and cooking yield of treatments in comparison to control and pH values were significantly higher (p ≤ 0.05) for the control as compared to treatments. Among the treatments, the product with 15% apple pomace had significantly (p ≤ 0.05) highest moisture content, and protein, ash and fat contents were significantly (p ≤ 0.05) higher in control than treatment groups. Crude fiber content of control was found significantly (p ≤ 0.05) lower in comparison to nuggets formulated with 5%, 10% and 15% apple pomace and was found to increase significantly (p ≤ 0.05) with the increasing levels of apple pomace. Hardness of the products significantly (p ≤ 0.05) decreased with addition of apple pomace, whereas springiness, cohesiveness, chewiness and gumminess showed a non-significant (p ≥ 0.05) decrease with the levels of apple pomace. Sensory evaluation showed significant (p ≤ 0.05) reduction in texture, flavour and overall acceptability scores of treatment products; however the scores were in the range of acceptability and T-1 showed better acceptability among apple pomace incorporated treatments.

Keywords: Mutton nuggets, apple pomace, textural properties, sensory evaluation

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Authors: Ebim Matthew Abua

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In Chinua Achebe’s Things Fall Apart (henceforth, TFA), the character Unoka is portrayed as a weakling and indolent person even when he was a creative artist, a talented musician, and a mathematician. His lack of achievement becomes the barometer for measuring his success. Right from time, music is considered to be of great significance because of its capacity to recreate and retell social events. To this end, music is both a social act and a creative art. As a social act, music is a discursive medium that exploits the dynamics of art in its evaluation of society. Music is so much a part of human existence that its presence in literature can help readers relate to fictional situations and characters. In this paper, the character Unoka is examined against the backdrop of his musical proclivities and his contributions to the overall development of TFA. Unfortunately, Achebe’s Things Fall Apart, a product of artistic creativity, portrays the personality of Unoka as lazy and uninspiring because he (Unoka) is a musician who is busy playing his flute and hardly doing anything productive. This paper is significant because it examines the literary and or linguistic depiction of Unoka and the aftermath of that depiction on the entire novel and, by extension, the larger society. Methodologically, this paper adopted the qualitative approach from the ethnography of communication (EOC), which is the analysis of communication within the wider context of the social and cultural practices and beliefs of the members of a particular culture or speech community. The aim of this qualitative research method includes the ability to discern which communication acts and/or codes are important to different groups, what types of meanings groups apply to different communication events, and how group members learn these codes to provide insight into particular communities. The study reveals that the people of Umuofia were mono-directional in their economy, and there was no room for diversification. One was either a farmer, or such a person was relegated to the background. Unoka, taking up a new challenge of diversifying the economy from the perspective of entertainment, was viewed as a misnomer. This study opens the door to other areas of studying Achebe’s epic novel apart from the critical works of literary artists that have been dished out over time.

Keywords: literature, popular culture, unoka, things fall apart

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Authors: Maryvone Cunha de Morais, Lilian Cristine Hübner

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Based on a translanguaging theoretical approach, which considers language not as separate entities but as an entire repertoire available to bilingual individuals, this systematic review aimed at analyzing the methods (aims, samples investigated, type of stimuli, and analyses) adopted by studies on translanguaging practices associated with written and oral tasks (separately or integrated) in bilingual education. The PRISMA criteria for systematic reviews were adopted, with the descriptors "translanguaging", "bilingual education" and/or “written and oral tasks" to search in Pubmed/Medline, Lilacs, Eric, Scopus, PsycINFO, and Web of Science databases for articles published between 2017 and 2021. 280 registers were found, and after following the inclusion/exclusion criteria, 24 articles were considered for this analysis. The results showed that translanguaging practices were investigated on four studies focused on written production analyses, ten focused on oral production analysis, whereas ten studies focused on both written and oral production analyses. The majority of the studies followed a qualitative approach, while five studies have attempted to study translanguaging with quantitative statistical measures. Several types of methods were used to investigate translanguaging practices in written and oral production, with different approaches and tools indicating that the methods are still in development. Moreover, the findings showed that students’ interactions have received significant attention, and studies have been developed not just in language classes in bilingual education, but also including diverse educational and theoretical contexts such as Content and Language Integrated Learning, task repetition, Science classes, collaborative writing, storytelling, peer feedback, Speech Act theory and collective thinking, language ideologies, conversational analysis, and discourse analyses. The studies, whether focused either on writing or oral tasks or in both, have portrayed significant research and pedagogical implications, grounded on the view of integrated languages in bi-and multilinguals.

Keywords: bilingual education, oral production, translanguaging, written production

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Authors: Joshi Manisha, Shivaram, Anand Vinekar, Tanya Susan Mathews, Yeshaswini Nagaraj

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Retinopathy of prematurity (ROP) is abnormal blood vessel development in the retina of the eye in a premature infant. The principal object of the invention is to provide a technique for detecting demarcation line and ridge detection for a given ROP image that facilitates early detection of ROP in stage 1 and stage 2. The demarcation line is an indicator of Stage 1 of the ROP and the ridge is the hallmark of typically Stage 2 ROP. Thirty Retcam images of Asian Indian infants obtained during routine ROP screening have been used for the analysis. A graphical user interface has been developed to detect demarcation line/ridge and to extract ground truth. This novel algorithm uses multilevel vessel enhancement to enhance tubular structures in the digital ROP images. It has been observed that the orientation of the demarcation line/ridge is normal to the direction of the blood vessels, which is used for the identification of the ridge/ demarcation line. Quantitative analysis has been presented based on gold standard images marked by expert ophthalmologist. Image based analysis has been based on the length and the position of the detected ridge. In image based evaluation, average sensitivity and positive predictive value was found to be 92.30% and 85.71% respectively. In pixel based evaluation, average sensitivity, specificity, positive predictive value and negative predictive value achieved were 60.38%, 99.66%, 52.77% and 99.75% respectively.

Keywords: ROP, ridge, multilevel vessel enhancement, biomedical

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Authors: Francesco Lubrano, Fabrizio Bertone, Federico Stirano

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

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

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Authors: Yumei Han, Naiqing Song, Xiaoping Yang, Yuping Han

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This study explores the conceptualization of key competencies that children are expected to develop in three year preschools (age 3-6) and the assessment practices of such key competencies in China. Assessment of children development has been put into the central place of early childhood education quality evaluation system in China. In the context of students key competencies development centered education reform in China, defining and selecting key competencies of children in preschools are of great significance in that they would lay a solid foundation for children’s lifelong learning path, and they would lead to curriculum and instruction reform, teacher development reform as well as quality evaluation reform in the early childhood education area. Based on sense making theory and framework, this study adopted multiple stakeholders’ (early childhood educators, parents, evaluation administrators, scholars in the early childhood education field) perspectives and grass root voices to conceptualize and operationalize key competencies for children in preschools in Southwest China. On the ground of children development theories, Chinese and international literature related to children development and key competencies, and key competencies frameworks by UNESCO, OECD and other nations, the authors designed a two-phase sequential mixed method study to address three main questions: (a) How is early childhood key competency defined or labeled from literature and from different stakeholders’ views? (b) Based on the definitions explicated in the literature and the surveys on different stakeholders, what domains and components are regarded to constitute the key competency framework of children in three-year preschools in China? (c) How have early childhood key competencies been assessed and measured, and how such assessment and measurement contribute to enhancing early childhood development quality? On the first phase, a series of focus group surveys were conducted among different types of stakeholders around the research questions. Moreover, on the second phase, based on the coding of the participants’ answers, together with literature synthesis findings, a questionnaire survey was designed and conducted to select most commonly expected components of preschool children’s key competencies. Semi-structured open questions were also included in the questionnaire for the participants to add on competencies beyond the checklist. Rudimentary findings show agreeable concerns on the significance and necessity of conceptualization and assessment of key competencies for children in preschools, and a key competencies framework composed of 7 domains and 25 indicators was constructed. Meanwhile, the findings also show issues in the current assessment practices of children’s competencies, such as lack of effective assessment tools, lack of teacher capacity in applying the tools to evaluating children and advancing children development accordingly. Finally, the authors put forth suggestions and implications for China and international communities in terms of restructuring early childhood key competencies framework, and promoting child development centered reform in early childhood education quality evaluation and development.

Keywords: assessment, conceptualization, early childhood education quality in China, key competencies

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Authors: L. Musak, J. Valachova, T. Vasicko, O. Osina

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Introduction: Stainless steel is resistant to electrochemical corrosion by passivation. Welders are greatly exposed to welding fumes of toxic metals, which added to this steel. The content of chromium (Cr) in steel was above 11.5%, Ni and Mo from 2 to 6.5%. The aim of the study was the evaluation of occupational exposure to Cr, chromosome analysis and valuation of individual susceptibility polymorphism of gene CCND1 c.870 G>A. Materials and Methods: The exposed group was consisted from 117 welders of stainless steels. The average age was 38.43 years and average exposure time 7.14 years. Smokers represented 40.17%. The control group consisted of 123 non-exposed workers with an average age of 39.74 years and time employment 16.67 years. Smokers accounted for 22.76%. Analysis of Cr in blood and urine was performed by atomic absorption spectrophotometry (AAS Varian SpectraAA 30P) with electrothermal decomposition of the sample in the graphite furnace. For the evaluation of chromosomal aberrations (CA) was used cytogenetic analysis of peripheral blood lymphocytes, gene polymorphism was determined by PCR-RFLP reaction using appropriate primers and restriction enzymes. For statistical analysis was used the Mann-Whitney U-test. Results: The mean Cr level in exposed group was 0.095 mmol/l (0.019 min-max 0.504). No value does exceed the average normal value. The average value Cr in urine was 7.9 mmol/mol creatinine (min 0.026 to max 19.26). The total number of CA was 1.86% in compared to 1.70% controls. (CTA-type 0.90% vs 0.80% and CSA-type 0.96% vs 0.90%). In the number of total CA was observed statistical difference between smokers and non-smokers of exposed group (S-1.57% vs. NS-2.04%, P<0.05). In CCND1 gene polymorphisms was observed the increasing of the total CA with wild-type allele (WT) via heterozygous to the VAR genotype (1.44%<1.82%<2.13%). There was observed a statistically higher incidence of CTA-type aberrations in variant genotypes between exposed and control groups (1.22% vs. 0.59%, P<0.05). Discussion and conclusions: The work place is usually higher source of exposure to harmful factors. Workers need consistently and checked frequently health control. In assessing the risk of adverse effects of metals is important to consider their persistence, behavior and bioavailability. Prolonged exposure to carcinogens may not manifest symptoms of poisoning, but delayed effects may occur, which resulted in a higher incidence of malignant tumors.

Keywords: genotoxicity, chromium, stainless steels, welders

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Authors: Nur A. Azmi, Suseela D. Chandran, Fadilah Puteh, Azizan Zainuddin

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Medical tourism has been associated as a global phenomenon in developed and developing countries in the 21st century. Medical tourism is defined as an activity in which individuals who travel from one country to another country to seek or receive medical healthcare. Based on the global trend, the number of medical tourists is increasing annually, especially in the Southeast Asia (SEA) region. Since the establishment of Association of Southeast Asian Nations (ASEAN) in 1967, the SEA nations have worked towards regional integration in medical tourism. The medical tourism in the SEA has become the third-largest sector that contributes towards economic development. Previous research has demonstrated several factors that affect the development of medical tourism. However, despite the already published literature on SEA's medical tourism in the last ten years there continues to be a scarcity of research on niche areas each of the SEA countries. Hence, this paper is significant in enriching the literature in the field of medical tourism particularly in showcasing the niche market of medical tourism among the SEA best players namely Singapore, Thailand, Malaysia and Indonesia. This paper also contributes in offering a comparative analysis between the said nations whether they are complementing or competing with each other in the medical tourism sector. This then, will increase the availability of information in SEA region on medical tourism. The data was collected through an in-depth interview with various stakeholders and private hospitals. The data was then analyzed using two approaches namely thematic analysis (interview data) and document analysis (secondary data). The paper concludes by arguing that the ASEAN countries have specific niche market to promote their medical tourism industry. This paper also concludes that these key nations complement each other in the industry. In addition, the medical tourism sector in SEA region offers greater prospects for market development and expansion that witnessed the emerging of new key players from other nations.

Keywords: healthcare services, medical tourism, medical tourists, SEA region, comparative analysis

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