Offers a commentary on the Report 'A Fair Path to Universal Health Coverage' from the perspective of the Director of the Ethiopian Ministry of Health.

The future of health research will be characterised by three continuing trends: rising demand for health data; increasing impracticability of obtaining specific consent for secondary research; and decreasing capacity to effectively anonymise data. In this context, governments, clinicians and the research community must demonstrate that they can be responsible stewards of health data. IRBs and RECs sit at heart of this process because in many jurisdictions they have the capacity to grant consent waivers when research is judged (...) to be of particular value. However, several different terms are used to refer to this value, indicating a lack of conceptual clarity regarding the appropriate test for access to health data for research without consent. In this paper we do three things. First we describe the current confusion and instability in terminology relating to public interest in the context of consent waivers. Second we argue for harmonisation of terminology on the grounds of clarity, transparency and consistency. Third we argue that the term ‘public interest’ best reflects the normative work required to justify consent waivers because it is the broadest of the competing terms. ‘Public interest’ contains within its scope positive and negative implications of a study, as well as welfare, justice and rights considerations. In making this argument, we explain the normative basis for consent waivers, and provide a starting place for further discussion about the precise conditions in which a given study can be said to advance the public interest. Ipsos MORI study found that: … the public would be broadly happy with administrative data linking for research projects provided Those projects have social value, broadly defined. Data are de-identified. Data are kept secure. Businesses are not able to access the data for profit. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

The primary responsibility of the US Food and Drug Administration is to protect public health by ensuring the safety of the food supply. To that end, it sometimes conducts risk assessments of novel food products, such as genetically modified food. The FDA describes its regulatory review of GM food as a purely scientific activity, untainted by any normative considerations. This paper provides evidence that the regulatory agency is not justified in making that claim. It is argued that the (...) FDA’s policy stance on GM food is shaped by neoliberal considerations. The agency’s review of a genetically engineered animal, the AquAdvantage salmon, is used as a case study to track the influence of neoliberalism on its regulatory review protocol. After that, an epistemic argument justifying public engagement in the risk assessment of new GM food is outlined. It is because risk evaluations involve normative judgments, in a democracy, layperson representatives of informal epistemic communities that could be affected by a new GM food should have the opportunity to decide the ethical, political or other normative questions that arise during the regulatory review of that entity. (shrink)

The study aimed to identify the delegation of authority for the performance of the medical staff and its relationship to improving the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. Administrators, and technicians) with a total of 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was the existence of (...) a statistically significant relationship between delegation of authority and the quality of health care. One of the most important recommendations of the study was to strengthen the direction of senior management towards excellence in patient service, because the patient represents a fundamental focus in health services. (shrink)

The study aimed to identify the delegation of authority for the performance of the medical staff and its relationship to improving the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. Administrators, and technicians) with a total of 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was the existence of (...) a statistically significant relationship between delegation of authority and the quality of health care. One of the most important recommendations of the study was to strengthen the direction of senior management towards excellence in patient service, because the patient represents a fundamental focus in health services. (shrink)

There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. (...) In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all (...) three subjects combined comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

Normative political theorists have been growing more and more aware of the many difficult questions raised by the discretionary power inevitably left to public administrators. This article aims to advance a novel normative principle, called ‘principle of restraint’, regulating reform of established administrative agencies. I argue that the ability of public administrators to exercise their power in accordance with the requirements of public reason is protected by an attitude of restraint on the part of potential reformers. Specifically, they should refrain (...) from any reform of an administrative agency that involves a switch to a considerably more loosely interconnected system of values underlying the work of that agency. To illustrate the importance of the principle of restraint, I examine a case from British health policy, showing that a recent reform of the National Institute for Health and Care Excellence well exemplifies the serious problems brought by any violation of that principle. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

Lack of physical activity is one of the main cause of obesity. Currently, scientists proposed that teenagers and women are overweight or obese than men in Bangladesh. Furthermore, non-communicable diseases (NCDs) are becoming more prevalent in Bangladesh. By 2050, the illness burden of non-communicable diseases will have a significant impact on the health budget. To reduce non-communicable diseases, physical activity is one of the options. However, the lack of public facilities for physical activities in each community is a concern. (...) According to the Department of Military Estate Administration, Central Circle, DOHS (Defense Officers' Housing Scheme) has a total of 2966 plots and 396.6327 acres of area (640 acres =1 square mile) including 5 DOSH in Bangladesh. However, each DOHS has all the public facilities including structures streets, parks, walking paths, squares, gyms, cultural and sports grounds, walkways, waterfronts, lakes, mosques, cafeterias, public toilets, sitting areas for elderly or passersby, etc for physical activities specially for women, children, and the disabled people. Gulshan, Baridhara, Banani, and Dhanmondi areas are other good examples from Bangladesh where dwellers specially, women and children have facilities for physical activities. Sangmoo Kim, urban specialist said, “it is not over-ambitious thinking to have public facilities; it is a basic need for each city dweller for a healthy life”. This report aims to explore what are the policy drawbacks of the Government of Bangladesh not providing public facilities to perform physical activities in each area. (shrink)

In a context of imperfect risk protection, households may protect against the impact of a health shock by employing various financial and non-financial coping mechanisms, such as foregoing or reducing needed medical care, labor substitution, consumption reduction, borrowing money, dissaving, and selling assets. However, leveraging certain coping mechanisms may reduce future productivity, potentially trapping households in chronic or persistent poverty. Resources and risk are not necessarily shared equitably within a household; the ability and willingness of the household to leverage (...) coping mechanisms, or the choice of coping mechanism may depend on the social protection policy context, household socioeconomic status, and type of intrahousehold risk sharing. Vietnam has been making policy changes aimed towards achieving Universal Health Coverage for the past several decades, culminating in a 2015 change mandating universal insurance coverage. This can potentially influence both providers in making decisions around service delivery and households around financing care. This research aims to contribute to the literature exploring the relationships among direct and indirect health care costs, potentially maladaptive coping mechanisms, and household living standards, within the particular health financing and social protection environment in Vietnam. (shrink)

The study aimed to identify training for the performance of the medical staff and its role in developing the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. , and technicians) of 2150 employees, a stratified random sample of 330 employees was selected, the questionnaire was distributed to them, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was the existence of a statistically significant effect (...) of training on the development of health care quality. One of the most important recommendations of the study was to provide more suitable opportunities to create a climate for the professional growth of employees, and pay more attention to the expansion of programs and training courses that are in line with the requirements of administrative empowerment. (shrink)

The study aimed to identify training for the performance of the medical staff and its role in developing the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. , and technicians) of 2150 employees, a stratified random sample of 330 employees was selected, the questionnaire was distributed to them, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was the existence of a statistically significant effect (...) of training on the development of health care quality. One of the most important recommendations of the study was to provide more suitable opportunities to create a climate for the professional growth of employees, and pay more attention to the expansion of programs and training courses that are in line with the requirements of administrative empowerment. (shrink)

The study aimed to study the reality of applying standards of administrative excellence in major hospitals in the southern governorates of Palestine. The research was applied to all employees working in hospitals: (Al-Shifa Medical Complex, the Indonesian Hospital, and the European Gaza Hospital). The study sample consisted of (320) employees, as the researchers prepared A questionnaire to achieve the purpose of the study on the reality of administrative excellence (leading change, applying continuous improvement strategy, achieving efficiency, orienting customers (beneficiaries), and (...) spreading organizational culture. The most important findings of the researchers were the multiplicity of approaches used to achieve administrative excellence, such as the European model of excellence, the American model of excellence, and the Japanese model of excellence. Administrative excellence based on human resources. The study recommended taking advantage of different experiences in leading change, developing policies that support orientation towards beneficiaries, and establishing an organizational culture that supports administrative excellence, and that organizational culture shows interest in social and national responsibility because of its impact on the behavior of employees in general. (shrink)

Since March of 2020, the world has been brought to its knees by unscientific and unethical mandates. These mandates have destroyed the world economy and the lives of countless innocent individuals. The “cure” that has been offered by medical bureaucrats and politicians has been more deadly than the disease (COVID-19). The imposition of ludicrous lockdowns, mask-wearing, coerced vaccination, and vaccine passports have not only proved to be ineffective, but also much more harmful than SARS-CoV-2 and all its variants. COVID-19 has (...) a recovery rate of close to 99% for most of the world’s population, however, despite this, institutions and power-hungry individuals have trampled upon our civil liberties and ignored our inalienable human rights. It is precisely as Thomas Paine famously stated: “The greatest tyrannies are always perpetrated in the name of the noblest causes.” -/- Many lives have been gratuitously lost because of the administration of deadly medical treatments, and the rejection of effective treatments that follow genuine science. In the process, informed consent has been disparaged and desecrated. For over two years, we were instructed to “trust the science,” but the “science” advocated by medical bureaucrats and greedy politicians was the reason why the world was turned upside-down. In the face of these crimes against humanity, justice will only be brought by real courts and real judges, but this will require the awakening of a critical mass. This book serves as an instrument for this awakening. (shrink)

I applaud recent improvements upon previous guidelines for the assessment of pain in non-human species and the application of their framework towards decapod crustaceans. Rather than constituting a mere intermediate solution between the scientific difficulty of settling questions of animal consciousness and the need for a framework for the purposes of animal welfare legislation, I will argue that the longer lists of criteria for animal sentience should make us realize that animal sentience is a multi-dimensional phenomenon that must be studied (...) with a plethora of methods in order to assess its diversity across the tree of life. (shrink)

Post-mortem reproduction is a complex and contested matter attracting attention from a diverse group of scholars and resulting in various responses from a range of countries. Vietnam has been reluctant to deal directly with this matter and has, accordingly, permitted post-mortem reproduction implicitly. First, by analysing Vietnam’s post-mortem reproduction cases, this paper reflects on the manner in which Vietnamese authorities have handled each case in the context of the contemporary legal framework, and it reveals the moral questions arising therefrom. The (...) article then offers an account of Vietnamese social norms as an explanation for the tendency to conduct post-mortem reproduction. In arguing that a deeper and more thorough examination of the moral and ethical reasoning is required, the paper advocates in favour of supportive post-mortem reproduction regulation. In doing so, the paper seeks to reconcile the Vietnamese legal framework and post-mortem reproduction experiences of other countries. The article concludes that Vietnam and countries sharing the similar cultural traits should permit post-mortem reproduction explicitly. This would require full engagement with the ethical and legal issues arising, and careful promulgation of regulations and guidelines based on comparative experiences of a range of countries in handling this matter. (shrink)

Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is (...) a matter of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program. (shrink)

What is the role of lay deliberation – if any – in health-care rationing, and administration more generally? Two potential answers are suggested by recent debates on the subject. The one, which I will call the technocratic answer, suggests that there is no distinctive role for lay participation once ordinary democratic politics have set the goals and priorities which reform should implement. Determining how best to achieve those ends, and then actually achieving them, this view suggests, is a (...) matter for experts, armed with the best evidence available to them, both of the subject area involved, and of management and administrative excellence. -/- By contrast, the second, deliberative, view holds that lay deliberation has an important role in the administration and execution of government policy, both because these latter inevitably have a political element which needs to reflect democratic norms and values, and because lay people are, themselves, a source of information, even of wisdom, that experts will want to use in fulfilling their professional responsibilities. Recent debates on the value of lay participation in healthcare provision can illuminate the strengths and weaknesses of both approaches, as can the experience of NICE. So, I will start by examining two articles by Albert Weale, which attempt to clarify the role that lay deliberation should have in healthcare, before turning to the dilemmas for both the technocratic and deliberative views which emerge from the experience of NICE. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared (...) with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

This paper pays attention to colonial strategies that were deployed to fight against the influenza pandemic among the Asante of Ghana. It does a comparative analysis of the outbreak and mode of spread of COVID-19 and influenza pandemics in Ghana and Asante, in particular. Based on the theory of lesson-drawing, the authors aimed to ascertain whether the strategies adopted to fight the current COVID-19 pandemic reminisce the earlier strategies deployed during the influenza pandemic of 1918. Based on primary and secondary (...) data, the authors have constructed a history that proffers some insights into the fight against COVID-19. Authors conclude that the various health interventions toward the prevention and control of influenza in Asante during the colonial period were skewed in favor of Europeans and natives who worked within the colonial civil service. This did not support relevant strategies and efforts to reduce the spread of the disease at a faster pace. Despite several efforts made to curtail the spread of the disease, the colonial administration together with traditional authorities encountered challenges of inadequate health personnel, culture conflict ad financial challenges. The role of security agencies and the collaboration between the colonial administration and traditional authorities offer a very significant lesson for confronting the COVID-19 pandemic in Ghana. (shrink)

Upon Brexit & Trade War, the research took a supply-side analysis in macroeconomic paradigm for the purpose and cause of the actions. In the geopolitical competitions on crude oil resources between the allied powers & the Russian hegemony, the latter of which has effective control over P. R. China’s multilateral behaviors, the external research induced that trade war, either by complete information in intelligence or an unintended result, was a supply chain attack in prohibiting the antisatellite weapon supplies in the (...) Northern regions of mainland China in relation to Russia. Although no substantive change to international relations, the Trade War’s prohibitive effect on the high frequency trading in the monetary domain of CNY was observed, which had been the source of economic bubbles in the import-export control regime with centralized banking. The paper argues that by realism in economy & military strategy, trade war was ineffective in deterring the covert operations of the People’s Liberation Army by their territorial strategies and raises questions in humanitarianism in conflict situations. Moreover, with gross privacy breaches by mass surveillance in domain politics, totalitarianism with coercions, and counterfeit of drone strikes, traditional methods of threat elimination are rendered less pragmatic apart from the adversaries’ cyber security breaches. With the scientific approach, I offer an ecological paradigm with historic analysis of the Chinese military’s conducts in terms economics. The territorial methods of the PLA are contextualized into the ecological paradigm in regionalism & public administration. Electronic combats of the Chinese regime with the Great Firewall and Denial-of-Service attacks not only contribute to the diminishing natural freedoms of the population, but also transgress the fundamental right to health along with non-traditional nuclear threats to P.R.C. itself. (shrink)

Since the outbreak of the Coronavirus disease 2019 (Covid-19), tremendous efforts have been made by scientists, health professionals, business people, politicians, and laypeople around the world. Covid-19 vaccines are one of the most crucial innovations that help fight against the virus. This paper attempts to revisit the Covid-19 vaccines production process by employing the serendipity-mindsponge-3D creativity management theory. Vaccine production can be considered an information process and classified into three main stages. The first stage involved the processes of absorbing (...) information (e.g., digital data and open science) and rejecting unhelpful information (e.g., misinformation and fake news) for effectively acquiring useful insights. Useful insights were later employed by experts, enterprises, governments, and international organizations through interdisciplinary coordinated efforts for developing vaccines within a short period. Finally, the appearance of multiple types of vaccines enabled more strategic options for vaccine distribution and administration. Findings from this vaccine creativity management process could be used as critical lessons for further improvements of vaccination programs. (shrink)

Background: The complexity of diagnostic presentations of an inpatient psychiatry population requires an integrative approach to health and well-being. In this sense, the primary need of this research aims at developing clinical strategies and healthier coping skills for anger, anxiety, and depression; promoting self-esteem, healthier sleep, and anxiety reduction; as well as enhancing mood and emotional–behavioral regulation via exercise and nutrition education. Objectives: The primary objective is to promote exercise, fitness, and physical health in inpatient psychiatry patients. The (...) secondary objective includes therapeutic management of depressive symptoms and patient-centered approach to mania, angry outbursts, and generalized disruptive behavior. The tertiary objective is promoting research in the psychophysiological effectors of exercise and nutrition education in combination with psychotherapy. Method: Monitoring self-reported changes in mood and general well-being via administration of surveys and questionnaires pre- and postexercise sessions. Results: The research yielded positive outcomes in all areas investigated, suggesting the positive effects of exercise and mind–body strategies in the context of psychotherapy in inpatient psychiatry. Conclusion: Physical exercise may be a helpful way to reduce mental health disorders in the context of inpatient psychiatry by targeting anxiety, depression, anger, psychomotor agitation, and muscle tension and addressing stressors and triggers and to develop a more balanced and integrated sense of self. (shrink)

Abstract: The study aimed to determine the strategic flexibility and its relationship to the level of quality of services provided, from the viewpoint of the internal beneficiary in non-governmental hospitals in Gaza Strip. The study relied on the descriptive and analytical approach, and the questionnaire was designed as a tool to collect data and consisted of (39) items, and the researchers used the comprehensive survey method, and the number of the study population was (536) individuals, where (434) questionnaires were retrieved, (...) and the recovery rate was (80.97%). The study revealed many results, the most important of which were: the existence of a moderate degree of approval by the study sample individuals on strategic flexibility, as it was evident through the area of strategic flexibility as a whole having a relative weight (60.44%). The study is on the quality of services, as it became clear through the field of service quality obtaining a relative weight (79.90%). The results of the study revealed a statistically significant relationship between strategic flexibility and the quality of services in non-governmental hospitals in Gaza Strip, with a correlation coefficient of 0.490. The study reached many recommendations, the most important of which were: the need to work on appointing young people and those with potentials, because jobs are vacant in the hospitals under study, and the need to seek the help of an administrative staff with scientific and practical qualifications, and to work on updating information systems, archiving and networks through which data and information are transferred between departments And the creation of mechanisms by which stored information can be used to enhance the decision-making process, and an effective system to receive patients' complaints in a manner that ensures rapid response and treatment, to achieve continuous communication between patients and the hospital management, and to notify patients of dealing with the complaints they submit, and work to provide all Medical and health specialties in the hospitals under study, by making use of the medical delegations that visit Gaza Strip, involving them in the treatment processes, bringing in doctors and specialists from abroad, updating the standards related to measuring the services provided to patients on an ongoing basis, based on the suggestions and complaints of patients, and developing facilities in hospitals As well as updating the medical devices and equipment used in hospitals periodically. (shrink)

This study aimed to determine the experiences of male and female students on Flexible Learning (FL) during the COVID-19. A qualitative method using a phenomenological approach was used to ascertain the students' experiences, while written questionnaires were utilized to gather the information. The 24 students taking Development Communication and Public Administration were chosen based on set criteria. Both male and female flexible learning participants appreciated its benefits, including convenience and reduced academic stress. They both faced technology-related challenges and suggested (...) improvements. However, differences emerged in their experiences. Males found FL fun, emphasizing family time, while females highlighted skill development and concerns about teaching methods. Females also mentioned practical skill development not emphasized by males. These variations may stem from differing learning preferences and experiences. Variations in male and female experiences in Flexible Learning highlight the need for teachers to tailor instruction, offer mental health support, and incorporate skill development. Improved teacher training and clear guidelines are crucial, as are gender-inclusive program design and regular feedback mechanisms to create equitable and effective educational experiences. (shrink)

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design. Traditional counter-measures to drink driving such as policing and punishment and information campaigns have proven insufficient. Extensive policing is expensive and intrusive. Severe punishment is disproportionate to the risks created in most single cases. If the interlock becomes inexpensive and convenient enough, and if there are no convincing moral objections to the device, it may prove the only feasible as well as (...) the only justifiable solution to the problem of drink driving. A policy of universal alcohol interlocks, in all cars, has been proposed by several political parties in Sweden and is supported by the National Road Administration and the 2006 Alcohol Interlock Commission. This article assesses two possible moral objections to a policy of universal interlocks: (i) that it displaces the responsibility of individual drivers and (ii) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second has only limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. Given the expected technological development, the proposed policy seems a commendable health promotion measure for the near future. (shrink)

his article develops a set of recommendations for the psychiatric and medical community in the treatment of mental disorders in response to the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, DSM-5. We focus primarily on the limitations of the DSM-5 in its individuation of Complicated Grief, which can be diagnosed as Major Depression under its new criteria, and Post-Traumatic Stress Disorder (PTSD). We argue that the hyponarrativity of the descriptions of these disorders (...) in the DSM-5, defined as the abstraction of the illness categories from the particular life contingencies and personal identity of the patient (e.g., age, race, gender, socio-economic status), constrains the DSM-5's usefulness in the development of psychotherapeutic approaches in the treatment of mental disorders. While the DSM-5 is useful in some scientific and administrative contexts, the DSM's hyponarrativity is problematic, we argue, given that the DSMs are designed to be useful guides for not only scientific research, but also for the education of medical practitioners and for treatment development. our goal therefore is to offer suggestions for mental health practitioners in using the DSM-5, so that they can avoid or eliminate the problems that may stem from the limitations of hyponarrativity. When such problems are eliminated, we believe that effective psychotherapeutic strategies can be developed, which would be successful in repairing the very relationships that are strained in mental disorder: the patient's relationship to herself, her physical environment, and her social environment. (shrink)

A medical intervention is a medical procedure or application intended to relieve or prevent illness or injury. Examples of medical interventions include vaccination and drug administration. After a medical intervention, adverse events (AEs) may occur which lie outside the intended consequences of the intervention. The representation and analysis of AEs are critical to the improvement of public health. Description: The Ontology of Adverse Events (OAE), previously named Adverse Event Ontology (AEO), is a community-driven ontology developed to standardize and (...) integrate data relating to AEs arising subsequent to medical interventions, as well as to support computer-assisted reasoning. OAE has over 3,000 terms with unique identifiers, including terms imported from existing ontologies and more than 1,800 OAE-specific terms. In OAE, the term ‘adverse event’ denotes a pathological bodily process in a patient that occurs after a medical intervention. Causal adverse events are defined by OAE as those events that are causal consequences of a medical intervention. OAE represents various adverse events based on patient anatomic regions and clinical outcomes, including symptoms, signs, and abnormal processes. OAE has been used in the analysis of several different sorts of vaccine and drug adverse event data. (shrink)

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the Department (...) of Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

Cattle farming is a traditional agricultural system that contributes to the rural economic, social, and cultural values of the communities. Cattle as common with other livestock, are affected by many diseases that cause mortality and economic losses. In many rural households, the use of plants and associated knowledge are popular for managing cattle diseases, especially in areas experiencing challenges with conventional veterinary medicine. Evidence on the documentation of indigenous knowledge and biological evaluation of plants used against cattle diseases remain understudied (...) and fragmented. The aim of the review is to collate and analyze the ethnoveterinary knowledge and biological evaluation of plants used against cattle diseases in South Africa. Different scientific databases were systematically explored to extract data from 37 eligible studies. A total of 310 medicinal plants from 81 families were used to treat 10 categories of cattle diseases across seven (7) provinces in South Africa. Leguminosae (Fabaceae), Compositae (Asteraceae), Asparagaceae, and Xanthorrhoeaceae were the most frequently used plant families. Common plant parts used were leaves and roots. Twenty-seven (27) combination remedies involving 2–6 plants were identified as treatment regimes against cattle diseases. Common preparation methods were infusion and decoction while the administration mode was predominantly unspecified (52%) while oral and topical contributed 26 and 22%, respectively. In terms of diseases, the most treated ones were general systems infection, reproduction disorders, and gastrointestinal problems. Currently, an estimated 21% of the 310 plants have been evaluated for diverse biological activities using relevant bioassays related to cattle diseases. Antibacterial activity remained the most studied biological activity. Evidence from the review revealed the significance of ethnoveterinary medicine against cattle diseases especially in rural areas of South Africa. Nevertheless, the use of plants for cattle diseases among other ethnic groups, particularly in the Northern Cape and Western Cape, remains understudied. (shrink)

William Smith’s recent article criticises the so-called orthodox approaches to the normative analysis of healthcare resource allocation, associated to the requirement that decision-makers should abide by strictly procedural principles of legitimacy defining a deliberative democratic process. Much of the appeal of Smith’s argument goes down to his awareness of real-world processes and, in particular, to the large gap he identifies between well-led democratic deliberation and the messiness of the process through which the intuitively legitimate Affordable Care Act (ACA) was created. (...) This reply aims to demonstrate that the ACA provides no counterexample to orthodox views, seizing this opportunity to explore the specific space that the procedural principles populating orthodox accounts are meant to regulate. Neither general questions of healthcare justice concerning, for example, universal access nor, relatedly, the activity of elected politicians falls within the natural scope of application of such principles, revealing a much more complex picture of the interactions between justice and legitimacy as well as substantive and procedural considerations than acknowledged by Smith. In the end, orthodox accounts of healthcare resource allocation turn out to provide a precious fund of theoretical resources for the normative study of administrators, which might be useful well beyond bioethics and health policy. (shrink)

Police killings of individuals with mental illness have prompted calls for greater funding of mental health services to shift responsibilities away from the police. Such investments can reduce police interactions with vulnerable populations but are unlikely to eliminate them entirely, particularly in cases where individuals with mental illness have a weapon or are otherwise dangerous. It remains a pressing question, then, how police should respond to these and other vulnerable aggressors with diminished culpability (VADCs). This article considers and ultimately (...) rejects three potential approaches from the ethics of defensive force literature. It looks to improve on them by developing what I call the fusion account, which explains how vulnerability and diminished culpability fit together to provide moral grounds for extra protections from deadly force. The article’s final sections explore the policy implications of the fusion account for police administrators, officers, and the law. (shrink)

This study emphasizes the importance of enhancing food safety and hygiene practices among sidewalk vendors to safeguard public health in Balayan Public Market. Employing a mixed-methods approach, with both quantitative and qualitative components, a diverse sample of 55 consumers, 5 sidewalk vendors, and 5 market administrators was selected using a combination of purposive and random sampling techniques under non-probability sampling. Microbial investigations were conducted during both the initial sampling and testing phase (A) and subsequent sampling and testing phase (B) (...) on popular street food items at Lipa Quality Control Inc., including chicken nuggets, chicken nugget sauce (sweet and vinegar), Isaw, Isaw sauce, Proben, Proben sauce, Calamares, Calamares Vinegar Sauce, Kwek- Kwek, and Kwek-Kwek sauce. The findings reveal that “Isaw and Chicken Nuggets Sauce (Sweet)” had a result of “Too Numerous To Count (TNTC),” indicating an extraordinarily high bacteria count. This underscores the imperative need to raise awareness and provide targeted guidance to sidewalk vendors regarding essential food handling, storage, and sanitation practices. Therefore, a sanitary action plan is developed to promote community engagement, educational initiatives, and regulatory support, enhancing food safety practices among sidewalk vendors and ensuring a safer and healthier food environment. (shrink)

Abstract: The study aimed to determine the quality of services and its role in enhancing strategic flexibility, from the point of view of the internal beneficiary in non-governmental hospitals in Gaza Strip. The study relied on the descriptive and analytical approach, and the questionnaire was designed as a tool to collect data and consisted of (39) items, and the researchers used the comprehensive survey method, and the number of the study population was (536) individuals, where (434) questionnaires were retrieved, and (...) the recovery rate was (80.97%). The study revealed many results, the most important of which were: the existence of a high degree of approval by the study sample regarding the quality of services, as it was evident through the field of service quality obtaining a relative weight (79.90%), and the results of the study indicated that there is a moderate degree of approval by the members of the study sample. On the strategic flexibility, as it was evident by obtaining the area of strategic flexibility as a whole on a relative weight (60.44%). The results of the study revealed a statistically significant relationship between the quality of services and the strategic flexibility in non-governmental hospitals in Gaza Strip, with a correlation coefficient of 0.490). The results of the study also revealed a statistically significant effect of the quality of services on the strategic flexibility in non-governmental hospitals in Gaza Strip. The study reached many recommendations, the most important of which were: Establishing an effective system to receive patients' complaints in a manner that ensures rapid response and treatment, to achieve continuous communication between patients and the hospital administration, to notify patients of dealing with the complaints they submit, and to work to provide all medical and health specialties in hospitals in place. The study, by making use of medical delegations visiting Gaza Strip, involving them in therapeutic operations, bringing in doctors and specialists from abroad, updating the criteria for measuring services provided to patients on an ongoing basis, based on patients' suggestions and complaints, developing facilities in hospitals, as well as updating medical devices and equipment Used in hospitals periodically and the need to work on appointing young people and people of energy, for vacancies in the hospitals under study, and the need to seek the help of an administrative staff that is distinguished by scientific and practical qualifications, and to work on updating information systems, archiving and networks through which data and information are transferred between departments, and finding mechanisms to be done from During which the information stored can be used to enhance the decision-making process. (shrink)

The article aims to investigate and analyze the social impact of industrialization on Badli. Badli is one of the largest industrial zones in Delhi which also bears large slums neighboring to the industries. The literature available on the area is also limited to news articles and government reports, thus further research on Badli is required. The social implications were examined through naturalistic observational research and unstructured interviews of 10 individuals from Badli. Using thematic analysis and secondary data analysis the data (...) was interpreted into common themes and key ideas. The analysis showed most Industries in Badli are unauthorized and have issues such as unemployment, child labor, hazardous working conditions, nominal wages, producing illegal substances and lack of healthcare management. People living in the neighboring slum areas suffer from issues such as poor health care facilities, below par educational infrastructure, high crime rates, harmful drainage and ventilation services, congested housing structures, economic disparity, and toxic family environment. Thus Industrialization has deeper implications on the society of Badli which can be attributed to the influx of migrants, industries and poor governance by the administrative authorities to control and manage the industrial process in Badli. It can be concluded that there is a huge correlation between social change and industrialization. Further studies are required to create socio-economic policies catering to the situation in Badli for a long-lasting sustainable effect on the area. (shrink)

The author reviews the planned withdrawal of healthcare from the primary public hospital, Grady Memorial Hospital, of Atlanta, Georgia. Prior to passage of the Affordable Care Act of 2010, at least half of the patients had no public or private health insurance and their care was financially supported by State and County funding as well as supplementation from Emory University. New administration in the elected positions of the State and County and at the University reached agreement to decrease (...) care. The University President stated that the Hippocratic Oath was no longer valid for salaried physicians who must follow the direction of their business manager. The author, a tenured Professor, was forcibly transferred to the Veterans Hospital, which also was withholding standard medical care, including life-saving medications. Organizing multiple concerned organizations including members of the King Center, the Carter Center, the Open Door Community Center, Gay Rights, etc., (Grady Coalition) multiple public protests were successful in raising the necessary funds to continue adequate care at Grady and begin an investigation of the Veterans Affairs Hospital. (shrink)

This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and life (...) insurance institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

Investigating an actual case that occurred in a New York state hospital where an Orthodox Jewish patient’s legal proxy demands that the clinicians and hospital administrators should provide aggressive treatment with all available technological resources for the seemingly brain-dead patient with a medically futile condition. The authors argue that a health care policy or regulation should be developed to limit patient’s access to technology in critical care. Otherwise, we will be allowing society to issue a carte blanche to religious (...) autonomy by technology abuse. It is argued that religious autonomy should be restricted when its demand exhibits apparent logical absurdity and/or goes against the common survival of the entire population. (shrink)

Marie Oldfield, Pro Bono Economics & Refugee Council. Over half the total applications for asylum the UK receives each year are initially rejected, yet nearly a third of these initial rejections are subsequently overturned on appeal. This process that fails to get decisions right first time imposes significant costs, not just on the applicants themselves, but also more widely on UK taxpayers. Asylum seekers are not entitled to welfare benefits nor employment except in some limited cases, and are often placed (...) in unsuitable conditions with lack of appropriate support to prepare their case for asylum. These unfortunate circumstances mean that they are unable to gather and present all the required evidence first time, even when the case for asylum is legitimate. As a result, the application is rejected and thus begins a cycle of appeals that might eventually lead to a successful outcome for the asylum seeker but will, in the process, burden the taxpayer with unnecessary administrative cost and cause the asylum seeker needless distress and prevent them from accessing suitable economic opportunities. • Our study estimates that there are approximately 4,000 initial rejections that are successfully appealed each year and, with each appeal incurring direct administrative costs of around £1,000, the price tag of incorrect initial decisions adds up to a hefty £4 million per year in unnecessary administrative costs alone. • There are other costs, too, that negatively impact asylum seekers and taxpayers, albeit in a more indirect manner. The longer the appeals process is dragged out, the more delay there is to successful asylum seekers entering the labour market which means lost economic activity and forgone tax revenue for the Exchequer. Long periods of unemployment also result in skills attrition and lower the probability of the asylum seeker successfully entering the labour market in the future. • A lengthy appeals process heightens stress and worsens mental health in asylum seekers, a group arguably already more vulnerable on this front. Unnecessary human suffering aside, there is also a monetary cost borne by the taxpayer should NHS mental health services become involved. Thus, there is a pressing and viable case for providing asylum seekers a stable environment in which to complete their applications for asylum. This would increase the likelihood of reaching correct decisions in the first instance, avoid unnecessary administrative costs of an arduous appeals process, enable successful asylum seekers to access the labour market and contribute to the Exchequer, and avoid placing extra demands on already strained NHS mental health services. (shrink)

Termination in international contracts is considered a harsh sanction that harms international trade for each breach of contract or its provisions. The interest of international trade is fulfilled in maintaining and completing performance of contract, even if with a breach rectifiable by remedy. The termination destroys the contract and results in returning goods after their dispatch in addition to the accompanying new freight and insurance expenses and administrative and health procedures necessary for the entry and exit of goods and (...) to pay then refund the price. Moreover, the goods are exposed again to damage and perishing risks. Furthermore, the international sale contract is inherently associated with other international contracts such as goods transport contract, insurance contract and documentary credit through which the price is paid. If the sale contract is terminated, its effect will apply to all other associated contracts, if not performed, which produces many issues and hardships. (shrink)

Abstract: Public procurement is the acquisition of right goods, works and services required to satisfy certain needs at the right time, from the right supplier, in the right quantities, in the right quality, and at the right price. Worldwide it accounts 10% – 30 % of GNP while in Tanzania it accounts for about more 45% of the total budget. Appropriate procurement system in the public sector is a tool for achieving political, economic and social goals. The research examined the (...) impact of the capacity building on the performance of LGAs procurement function, was conducted in Tanzania to the four regions in 2018, comprised a sample size of 224 respondents from eight Local Government Authorities (LGAs). Qualitative and quantitative data were collected, employed the case study method intended to the Evaluate Assessment of Capacity Building Programme on the Performance of LGAs procurement functions. The study revealed that procurement functions have improved because of the intervention of capacity building such as the improvement of the; Use and application of PPA and PPR, use and application of Procurement Planning, use and application of Contract Management and Administration, use procurement record keeping and reporting, use and application of PMIS & Other Procurement Systems, appropriate Tendering Process. Also, the researchers have revealed challenges hindering LGAs procurement system such as; lack training, unpredictable funds flow and political interference. Moreover, based on the contributions attributed by the capacity building further research can be undertaking to measure the impact of capacity building in the other areas apart from procurement field such as; health, agriculture, good governance and so on. In addition to that, another research can be undertaken to assess the factors hindering the performance of LGAs procurement system. (shrink)

The study aimed to identify the effect of Total Quality Management in achieving the requirements of the quality of job life among university college employees, and the researchers used the descriptive and analytical approach, and used a main tool to collect information, which is: the questionnaire. The study population reached (596) academic and administrative employees distributed among (5) University colleges in Gaza Strip, and a stratified random sample of (240) employees was selected, approximately (40.3%) of the study population. SPSS software (...) was used to analyze the data. The study concluded that the application of the requirements of total quality management in university colleges in Gaza Strip is appropriate in general in terms of: (the commitment of the top management to total quality management, organizational structure, management with facts, focus on beneficiaries, staff empowerment, and continuous improvement). The sample on the dimensions of total quality management with a relative weight is (69.93%). And that the elements of job quality in university colleges in Gaza Strip are generally adequate in terms of: (moral working conditions, wages and rewards, participation in decision-making, handling of complaints and grievances, benefits provided to employees), where the response of the sample respondents was about the dimensions of job quality with a relative weight (63.30%), and the existence of a strong positive relationship between Total Quality Management in university colleges in Gaza Strip. And that there is a statistically significant effect of the variables of comprehensive quality management and quality of career in university colleges in Gaza Strip at a significance level (α = 0.05). And that the dimensions of total quality management most influencing the dimensions of job quality are: (empowering employees; continuous improvement; focusing on beneficiaries; managing with facts). The absence of differences between the answers of the sample members about the impact of Total Quality Management in achieving the requirements of the quality of the job life of the employees in university colleges due to the variable (academic qualification, years of service). And the existence of differences attributed to a variable (gender in favor of the male category, the college in favor of the university college of applied sciences category, and the nature of work attributed to an academic category with an administrative position). Among the most important recommendations of the study is the necessity for university colleges to be keen on: (achieving job satisfaction, employee participation when setting regulations and policies and making important decisions, adhering to scientific research requirements and encouraging scientific achievements and career creativity among employees, while providing material and moral facilities for scientific research and development, developing mechanisms and patterns of electronic work). University colleges must provide benefits to employees such as: (providing health care, organizing leisure trips, contributing to solving economic problems, providing club subscriptions). And the necessity for university colleges to pay attention to handling complaints and grievances through: (Assigning an efficient and competent committee to handle complaints and grievances in all fairness and transparency, adopting and following up the results of the application of handling complaints and grievances, protecting complainants from any arbitrary action against them). And the need for the Ministry of Education and Higher Education to develop the evaluation role of the National Authority for Accreditation, Quality and Quality of Higher Education Institutions to evaluate the performance of university colleges, to ensure the application of academic and administrative quality standards in colleges, and to seek the help of quality and excellence experts in evaluating the application of Total Quality Management in the academic and administrative f ield in accordance with regional performance standards And global. (shrink)

The pandemic disrupted educational systems globally, prompting the need for alternative learning modalities like online, modular, and blended learning. The SLCP, particularly within the context of a school in Region 8, integrates these modalities to address essential learning competencies. This research paper aimed to evaluate the school Learning Continuity Plan (LCP) through its School Continuity Learning Plan Program using (CIPP) model of evaluation. Employing a qualitative design, data were gathered through purposive interviews with 1 non-teaching personnel, 1 department head, and (...) 3 teachers and an analysis of the approved LCP road-map. Findings revealed comprehensive alignment with the evaluation model domains, though certain areas required revisiting for improvement. The study advocated for the administration's holistic consideration, especially recognizing teachers as front line contributors to the LCP. Their pivotal role in the design and planning phases was emphasized for the effective mechanization of the school LCP. Hence, it was concluded that educational administrators should prioritize collaboration with teachers and consider their perspectives to enhance the overall quality and functionality of the LCP. Moreover, the study recommended organizational consideration, valued teachers in school LCP, prioritized health, integrated modalities, and emphasized quality learning with metrics in LCP. (shrink)

Background: As part of a consistent effort to examine and provide integrative medical approaches to the therapeutic offering for psychophysical health, this study investigates the utilization of Olfactory Virtual Reality (OVR) in an inpatient psychiatry unit, more specifically in the Shepardson 3 Inpatient Psychiatry Unit at the University of Vermont Medical Center, in Burlington, VT, USA. Objectives: The purpose of this protocol is to explore the therapeutic value of olfactory virtual reality (OVR) in the above described population, and to (...) collect statistically significant data to determine the feasibility of potential future OVR studies. Method: Direct subject observation and monitoring in the context of Olfactory Virtual Reality (OVR) sessions and Qualitative data collection via the administration of subject surveys, subdivided in: a) Pre-OVR experience, b) Immediate post-OVR experience, and c) 1-to-3-hour post-OVR experience questionnaires. Results: The research yielded positive outcomes in all areas investigated, despite challenges related to the utilization of the device itself, issues in individual olfactory threshold, and COVID-19 restrictions and limitations. Conclusion: The outcome of this study indicates that the utilization of olfactory virtual reality technologies is a safe and effective integrative approach to target several aspects of psychological and physical health such as anxiety, stress, and pain, in combination with the psychotherapeutic and pharmacological standards of care in inpatient psychiatry. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, (...) for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

Abstract: As Nigeria’s Central Bank marks its 60th anniversary, it has become necessary to assess its performance. Consequently in this paper, we provide a comprehensive, unbiased review of the Central bank of Nigeria (CBN). The paper starts with a discussion on the role and activities of the West African Currency Board, which was the precursor of the CBN and subsequently analyzes how the Board led to the emergence of the CBN. We look at the functions, mandate and organizational structure of (...) the CBN. Second, we assess how the CBN has responded to the changing financial landscape over the years. Third, noting that the CBN has over time promoted financial reforms and played a key regulatory role, we discuss the sufficiency of the financial reforms it has promoted as well as the regulatory tools that it has deployed over the years. In this regard, we specifically highlight the role of the CBN in the global financial crises of 2007-2009 as well as the European debt crises of 2010 to 2013. Fourth, given that the primary mandate of the CBN revolves around price and exchange rate stability, we analyze its performance thus far noting the numerous challenges it has faced. Summarily, we find that the CBN has operated a multi-pronged approach by utilizing a combination of policy instruments including price-based, quantity-based and administrative policy measures. Going forward, we recommend that the CBN needs to continue to adopt avant garde mechanisms to further strengthen the Nigerian banking industry with a view to maintaining the stability and health of the economy. (shrink)