bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of lignocaine-dexamethasone periauricular injection on treating tinnitus
Authors: Adhikari Tika Ram , Dorji Sithar , Wangchuk Pelden , Khandu Pema , Jamtsho Sonam
Published: December 2020

Tinnitus is a highly prevalent disorder with no effective treatment. The various topical treatment used are ineffective and the benefits are mainly due to its placebo effect. A study on a series of twelve patients was carried out in a tertiary hospital in Bhutan to see the effectiveness of lignocaine-dexamethasone periauricular injection on treating tinnitus. To remove the bias in recording tinnitus by subjective response, we used a single patient as both case and control for the first time in such studies. The study found that there was no significant difference in reduction in tinnitus severity in both case and control ears even after eliminating the subjective response bias.
Improving healthcare performance by focusing on individual productivity of healthcare provider and system thinking: a strategy proposal
Authors: Wangmo Choni
Published: December 2020

Bhutan’s health system, despite its commendable achievements in past few decades, continues to face shortage of skilled healthcare professionals and quality issues in service delivery. While recruiting more professionals, advocating for population health, better patient experience and safety, healthcare provider wellness has been overlooked. As the recent pay revision receives warm welcome from the health fraternity, a sense of greater professionalism and responsibility will be expected. Yet, aforementioned challenges still remain. Life and aspirations of professionals, brought up and trained in society that provides free healthcare and education, will become more convoluted. Mentorship program for healthcare providers at the beginning of their career and institutionalizing enabling environment for their personal and professional development need to be looked into. Decisions to pursue specialization should be a result of genuine interest and not a presumed exit hallway from professional frustrations, nor a shortcut to hefty pay. A promising and congruous career pathway can improve job satisfaction among health care providers. Endeavors to improve healthcare service delivery are present at every level but lack of coordination hampers favorable outcome. Variation in healthcare is major cause of adverse healthcare outcome and it is also known that every system is perfectly designed to achieve the results it gets. After conceptualizing few desired outcomes, a strategy framework that leads to health system improvement through improved individual productivity and systemic reforms enhancing intra- and inter sectoral coordination, while using evidence-based practice and existing resources, is proposed.
Benefits of bloodletting procedure among Bad-mKhris-mGo-Nad patients: A prospective observational study
Authors: Ugyen Karma , Tenzin Karma , Gyeltshen Tempa
Published: December 2020

Introduction: Bad-mKhris-mGo-Nad is a type of headache caused by imbalance of bile and phlegm humor. In gSo-ba-Rig-pa, headache is categorized in two categories such as primary headaches and secondary headaches. In total there are 14 types of headaches and Bad-mKhris-mGoNad is one among the principal headaches. The gSo-ba-Rig-pa based bloodletting therapy for Bad-mKhris-mGo-Nad has been practiced by the traditional medicine practitioners since the inception of gSo-ba-Rig-pa more than 2500 years ago. Bloodletting is also believed to be one of the most important and effective therapy in the treatment regime of gSo-ba-Rig-pa. The Subsequent Tantra (last tantra) states that the bloodletting is the best remedy for all types of bile and blood-related disorders. This study was conducted to observe the effectiveness of bloodletting procedure among diagnosed cases of Bad-mKhris-mGo-Nad.
Methods: It was an observational prospective study conducted at the National Traditional Medicine Hospital, Kawangjansa, Thimphu. The three main parameters measured were frequency, duration, and severity of the headaches. The samples consisted of 31 patients with 23 females and 8 males. Data collection was carried out over the span of seven months (June - December, 2018)
Results: The association test between before and after 10 days, before and after 30 days of bloodletting was conducted on 30 patients by using Mid-Point test in Open Epi and the result was observed to be statistically significant at p< 0.05.
Conclusion: This study shows that the bloodletting therapy on Tshoksang reduces the pain duration and frequencies of headaches. Moreover, it was also established to be effective in reducing the severity of the headache caused by Bad-mKhrismGo-Nad.
How reliable are the current Blood Pressure Measuring devices in Health Facilities of Bhutan?
Authors: Tamang Soira , Gurung Mongal Singh , Lhaden Tshewang , Penjore Tashi , Tenzin Karma
Published: December 2020

Background: Accurate blood pressure measurement is vital before any inferences are made on the reading. Since device error is one of the potential causes of inaccurate results, blood pressure measuring (BPM) devices should be periodically assessed for its accuracy. This paper describes the types of BPM devices used in health facilities of Bhutan and the results of their performance verifications.
Method: This study assessed the pressure accuracy and leak rates of BPM devices in use at two regional referral hospitals, district hospitals and BHU I using calibrated Vital Signs Simulator (ProSimTM 8) from Fluke Biomedical as reference device. For pressure accuracy assessment, static pressures were simulated against which simultaneous readings of each of the devices were recorded (n=3). For the leak rate assessment, the simulator was set to a target pressure and leak rate (n=3) were recorded over 1 minute.
Result: A total of 395 devices of three types, viz., 135 aneroid, 125 electronic and 135 mercury were assessed. Deviations in readings of 64.72% of devices were found to be within acceptable range of ± 3 mmHg. The device-type specific pass percentages for pressure accuracy were 6.40 % for electronic, 88.81 % for aneroid and 94.81 % for mercury. A total of 71.85% of devices (aneroid and mercury) had acceptable leak rates of 15 mmHg per minute.
Conclusion: The study shows that not all the blood pressure measuring devices currently being used in the health facilities of Bhutan are accurate. Besides ensuring that only validated BPM devices enter the country, these devices should be verified for its performance periodically once they are in use.
Outcomes at the Neonatal Intensive Care Unit, Eastern Regional Referral Hospital, Monggar Bhutan: A Retrospective Cohort Study
Authors: Sharma Tulsi Ram , Erbele Phillip , Prasad Pokhrel Hari , Lethro Pema , Dhendup Tshering , Zangpo Tandin
Published: December 2020

Introduction: Globally, 2.6 million neonates die every year, with more than one third of these deaths occurring within 24 hours of birth. Most neonatal deaths are preventable. The scaling up of Neonatal Intensive Care Unit services in developing countries have shown to improve survival rates. This study aimed to determine the mortality rate, and correlate the general and clinical characteristics with the outcomes of neonates admitted in the NICU at the Eastern Regional Referral Hospital, Mongar, Bhutanfrom the year 2015 to 2017.
Methods: Demographic data, neonatal and maternal variables were extracted for all Neonatal Intensive Care Unit admissions from 2015 to 2017. Descriptive and analytical statistics were reported as frequencies, percentages, median, adjusted OR, 95% CI and p-values.
Results: The mortality rate was 12.31%. Neonatal jaundice (49.55%), neonatal sepsis (41.74%), and prematurity (32.43%) were the three most common diagnoses. The mortality among neonates with low birth weight (<2500 grams) was 3.68 times (adjusted OR 3.68; 95% CI: 1.39-9.77) higher than the mortality among the normal birth weight neonates and mechanically ventilated neonates were 35.85 times (adjusted OR 35.85; 95% CI: 13.12-97.87) more at riskof dying than those without mechanical ventilation. The main causes of mortality were neonatal sepsis (34.15%), prematurity (29.27%) and birth asphyxia (21.95%).
Conclusion: The mortality rate at the NICU, Eastern Regional Referral Hospital is 12.31%. The study recommends to establish intermediate phototherapy/Kangaroo Mother Care/special baby care unit in the hospital to improve the quality of new born care
Prevalence of Occupational noise induced hearing loss (ONIHL) among industrial workers in Bhutan.
Authors: Wangchuk Pelden , Dendup Phuntsho
Published: December 2020

Introduction: Exposure to any type of noise has a potential risk. Higher the level of noise and longer duration of exposure, the more the risk for the hearing sensitivity and health as a whole. The objective of the study is to determine the prevalence of Occupational Noise Induced Hearing Loss (ONIHL) among the industrial workers in Bhutan and to ascertain high risk establishment and vulnerable occupations.
Methods: The hearing assessment was conducted among 1638 workers considering different types of industries and occupations to ascertain the prevalence of occupational noise induced hearing loss and vulnerable group amongdifferent industries and occupations. Descriptive statistics and binary logistic regression were performed to test the significance of ONIHL among the various independent variables.
Results: The study found that the prevalence of ONIHL stands at 27.9% among industrial workers in Bhutan. 42.45% of candidates who had ONIHL reported with tinnitus in either or both ears. This study founda significant association between the exposure duration and the severity of ONIHL among the industrial workers. Considering the type of industry, wood based industry, hydro services, cement and polymer were found to have a higher prevalence of ONIHL and similarly, higher prevalence of ONIHL were found among occupations such as blaster, chipper, carpenters, dryer (knife grinder) and crusher operators.
Conclusions: This study conduces that prevalence of ONIHL among industrial workers is found to be at the higher side and some of the occupations and industries impose higher risk. The study suggests that there is need for intervention such as strict enforcement of the permissible exposure limit, monitor and evaluate hearing conservation programs, and providing advice and recommendation to address such issues by the relevant agencies and industries
Pterygium and associated factors among adults: a hospital-based prospective study
Authors: Wangmo Chhimi , Lepcha Nor Tshering
Published: December 2020

Introduction: The aim of this hospital-based study was to assess the prevalence and associated factors of pterygium among adult patients visiting the Ophthalmology Outpatient Department (OPD) in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu.
Methods: A cross sectional study was carried out in the ophthalmology OPD in the national referral hospital, Thimphu from 1st January, 2018 to 31st December, 2018, during which 1599 adult patients were selected through systematic random sampling.
Results: The prevalence of pterygium was 12.8% (95% CI: 11.2 -14.5). Among 271 eyes with pterygium, the distribution of grade 1, grade 2 and grade 3 pterygium was 34.7%, 56.1% and 9.2% respectively. Pterygium wasmost common in the age group of 36-55 years. The significant factors associated with pterygium were age group, occupation and usage of sunglasses. Individuals who were 36-55 years (adjusted OR 2.70, 95% CI 1.82-4.0) and >55 years (adjusted OR 2.17, 95% CI 1.34-3.50) had significantly higher risk than 18-35 years (p< 0.002), and not using sunglasses (adjusted OR 1.97, 95% CI1.17-3.33, p = 0.007) significantly increased the risk of pterygium. Indoor occupation, particularly being a student was protective against pterygium (OR 0.08, 95% CI 10.02-0.33, p< 0.001). Only 14.1% used sunglasses and among them, 27.6% were aware that sunglasses can protect from ultraviolet radiation.
Conclusion: This study found a high prevalence of pterygium among adults aged 18 years and above. Those aged 36-55 years and an occupation involving outdoor activities were affected more. Encouraging usage of sunglasses may reduce pterygium
Usefulness of Robson classification system to analyze caesarean section deliveries: a hospital based study
Authors: Tamang Tshering , Dema Jigme , Pelden Sonam , Choden Phuntsho
Published: December 2020

Introduction: World Health Organization recommends using the Ten-group Robson classification as a standard for assessing and reducing caesarean section (CS) rates. Our study aimed at analyzing CS deliveries using this system with the primary objective of examining the driving factors of increased risk for caesarean delivery.
Methods: A retrospective observational study was conducted in Mongar Regional Referral Hospital from 1st January 2016 to 31st December, 2018 recruiting all institutional deliveries and classifying each of them into 10 groups of Robson classification system based on six obstetric variables.
Results: There were 2337 deliveries, of which 804 were CS, contributing to a rate of 34.4%. More than three fourth (78.9%) of caesarean deliveries occurred in Groups 5, 4, 2 and 1. Previous CS was the highest contributor of CS rate and the most common indication.
Conclusion: Higher CS rate has been observed in our referral hospital, contributed largely by women with previous CS, induced labour and pre-labour CS. There is a need for implementation of Robson classification system in all tertiary hospitals.
Fast and Texture-Structure Preservable Inpainting and Its Application for Creating Virtualized-Reality Indoor Models
Authors: Thangamani Kalaivani , Ishikawa Tomoya , Makita Koji , Kurata Takeshi
Published: December 2020

This paper discusses the new inpainting algorithm for handling the images in the virtualized-reality indoor models. The untextured regions in the indoor model are textured by this proposed inpainting method which guarantees the texture and the structure propagation. We call this as a hybrid method because it combines the effectiveness of the two popular inpainting algorithms namely, the Exemplar-Based method and the Edge-Based image restoration method and rectifies the drawbacks in these two methods. The tedious patch search in the Exemplar-Based method is simplified by the usage of the hash table which holds the classified textures. The Edge-Based method can handle the structures only in the form of lines and circles whereas the proposed method can handle any type of curves by using the combination of superpixels and spline curves.
Groundwater Fluctuations in Sub Basin of Krishna River, Western Maharashtra, India
Authors: Zende Abhijit M. , Nagarajan R.
Published: December 2020

Water is the most important resource of a country and of the entire society as a whole since no life is possible without water. Water may occur in nature in liquid, solid as well as in gaseous form. All these forms of water are very useful to mankind. About 97% of the total available water on earth is contained in oceans, and is, hence, saline or salty in nature. The amount of fresh (sweet) water actually available is only about 3 % of the total quantity of water on the earth. Looking to the above, the reality is that there is essentially very less fresh water on the planet today and with development and population increase need for water increases day by day, so planning should be done for restoring the available water for the need of future generation. The proper conservation, maintenance, and careful use of water resources, along with developing additional storages, may considerably reduce the chances of water famines for future generations to come. In addition to these measures, we may have to find out means and ways for increasing the available usable water by developing artificial rain technology, easier ways to desalt sea water at cheaper rates, recharging the unconfined aquifers by constructing small check dams on small rivulets. Here, an attempt is made to study the ground water fluctuations in the Yerala river basin, located in Sangli and Satara district situated in Maharashtra state, India. Ground water table in the Yerala river basin decrease from 8 to 1.5 m Below Ground Level (BGL) during period of 2001 to 2010.
Architecture of Artificial Neural Network in Identification of Internal Dynamics and Prediction of Dynamic System Rainfall Data Time Series
Authors: Karmakar Sanjeev , Kowar Manoj Kumar , Guhathakurta Pulak
Published: December 2020

The objective of this study is to expand and evaluate the back-propagation artificial neural network (BPANN) and to apply in the identification of internal dynamics of very high dynamic system such long-range total rainfall data time series. This objective is considered via comprehensive review of literature (1978-2011). It is found that, detail of discussion concerning the architecture of ANN for the same is rarely visible in the literature; however various applications of ANN are available. The detail architecture of BPANN with its parameters, i.e., learning rate, number of hidden layers, number of neurons in hidden layers, number of input vectors in input layer, initial and optimized weights etc., designed learning algorithm, observations of local and global minima, and results have been discussed. It is observed that obtaining global minima is almost complicated and always a temporal nervousness. However, achievement of global minima for the period of the training has been discussed. It is found that, the application of the BPANN on identification for internal dynamics and prediction for the long-range total annual rainfall has produced good results. The results are explained through the strong association between rainfall predictors i.e., climate parameter (independent parameter) and total annual rainfall (dependent parameter) are presented in this paper as well.
Defending Against Modern Threats in Web Applications
Authors: Kumar Mohit , Gupta Abhishek , Shadab Azhar , Kumar Lokesh , Tiwari Vikas Kumar
Published: December 2020

Web applications have become critical part of business. They hold a treasure trove of data behind their front ends. Now-adays attackers are well aware of the valuable information accessible through web applications, so website security has become a major problem today. The number of vulnerabilities have multiplied in recent years. Vulnerabilities like cross site scripting(XSS),sql injection and cross site request forgery(CSRF) has emerged as a major threat to web applications. So, in order to protect web applications from these modern threats, at first vulnerability assessment should be carried out from time to time and also some preventive techniques should be followed to prevent these threats. The motivation of this paper is to promote the use of automated tools for vulnerability assessment and to follow preventive techniques in order to make web applications secure.
Choosing a Technique for Digital Signatures From the Customers’ Perspective
Authors: Rakshit Pushpendu
Published: December 2020

One way to secure identity over the Internet and other channels is to use digital signatures. Since this area is often used in contact with banks, we have during our work co-operated with Nordea IT. In order for customers to use a digital signature whenever they wish to, a way of making them mobile is required. In our thesis we give an overall understanding of digital signatures and how they can be used. Our main goal is trying to find out what technique customers want to use for carrying their digital signature and if information positively affects customers’ will to use the new service. We have found theories about the customers from literature, articles and Nordea IT. The most important theories state the importance of listening to customers and the importance of creating a trust between bank and customer. The main method used for the investigation is a questionnaire. This questionnaire is used to find out public opinions regarding the use of digital signatures. As seen from the result of our investigation most theories about the customers are confirmed. The answers from the questionnaire showed that it is important that the technique fulfils the customers’ desire. Every other person could consider using digital signatures, if the number of uncertain can be convinced. From those who are negative or uncertain, one fifth are affected by information from the bank. The importance of information about security and bank policies is thus also confirmed. Both the choices of technique and the information positively affects customers’ will to use digital signature. So we find through a study that how customer accepts such technological enhancement.
International Grid: New Way to Prevent Blackouts
Authors: Shaikh Fouzul Azim , Gautam Dhananjay , Pandey Neelotpal , Singh Deepak
Published: December 2020

Nowadays the conventional grids are facing lots of problems like poor efficiency, unaffordable maintenance, high power loss, overloads and blackout or power outages. The main objective of this paper is to present the new concept of International Grid and to root out the problems which are prominent in conventional grids. The evolution of International Grid is a smart way to ensure the prevention of blackouts which are drastically increasing even with the advent of new technologies. The International Grid concept is introduced to highlight alternative, automated technologies that may bring significant benefits to the transmission and distribution networks. The real time application of International Grid is not only easily feasible but also requires less number of components for installation. We are presenting the structure and efficient working along with synchronization of International Grid with various components.
PERFORMANCE EVALUATION OF RELAYING SCHEMES FOR WIRELESS COMMUNICATION SYSTEMS
Authors: BRAGANC MANISHA CRASTO , VIRANI HASANALI G. , KHANOLKAR SHAILESH
Published: December 2020

The evaluation of MIMO (multiple-input multiple-output) Relay wireless system is carried out and compared against the performance of a SISO (single-input single-output) Relay wireless system. The encoding scheme used in MIMO is Alamouti coding and decoding is done by the Maximum Likelihood (ML) detector. A comparison is made between the SISO non-regenerative amplify-and-forward (AF) and regenerative decode-and-forward (DF) relaying schemes. The plots of bit error rate (BER) versus signal to noise ratio (SNR) are simulated by incorporating Rayleigh fading condition in the presence of additive white Gaussian noise(AWGN) using MATLAB.
A FUZZY BASED APPROACH IN MULTI HOP NETWORK
Authors: NARENDRAKUMAR A. , THIGARAJAN K.
Published: December 2020

The proposed system utilizes the concept of multi hop communication in Wireless Sensor Networks(WSNs). On the other hand , the single hop communication leads to more power dissipation in the nodes at the time of transmitting sensed data. The proposed system rectifies the above mentioned problem with the multi hop communication among the finite
number of nodes to determine the distance for transferring information from source node to base station using the Fuzzy logical method. In a nutshell, the multi hop communication leads the better solution for saving the transmission energy in the wireless environment.
NOVEL DEFENCE MECHANISM AGAINST ON DEMAND ADHOC ROUTING PROTOCOL FOR MOBILE ADHOC NETWORKS
Authors: RAO K. SUBBA , PRAGINA N.
Published: December 2020

To access multimedia data mobile users like to use their own consumer electronic devices anywhere and at anytime . Hence, we expect that wireless ad hoc networks will be widely used in the near future since these networks form the topology with low cost on the fly. However, consumer electronic devices generally operate on limited battery power and
therefore are vulnerable to security threats like data flooding attacks. The data flooding attack causes Denial of Service (DoS) attacks by flooding many data packets. However, there are a few existing defense systems against data flooding attacks. Moreover, the existing schemes may not guarantee the Quality of Service (QoS) of burst traffic since multimedia data are usually burst. Therefore, we propose a novel defense mechanism against data flooding attacks with the aim of enhancing the throughput. The simulation results show that the proposed scheme enhances the throughput of burst traffic.
GROUP MOBILITY MODEL BASED PROACTIVE AND REACTIVE ROUTING PROTOCOL IN MANET
Authors: PATEL ANKUR , Dubey Shivendu , VERMA ASHOK , PATEL SHARDA PD.
Published: December 2020

A mobile ad hoc network (MANET) is a collection of wireless mobile nodes forming a dynamic network Topology without the aid of any existing network infrastructure or centralized administration. Each node participating in the network acts as a host and as a router , means they have to forward packets and identify route as well. Random way point is the most common mobility model in most of the simulation based studies of various MANET routing protocols.The Group Mobility Model has been generated by Impact of Mobility Patterns on Routing in Ad-hoc Network(IMPORTANT). In the present communication, we have analyzed the Packet Delivery Ratio (PDR), Average End to End
delay, Average Throughput, Normalized Routing Load (NRL) and number of Drop packets in CBR and TCP traffic models using routing protocols namely AODV and DSDV. Research efforts have focused much in evaluating their performance with same number of nodes but divided in different number of groups. Simulations has been carried out using NS-2 simulator.
HIERARCHICAL ROUTING PROTOCOLS FOR WIRELESS SENSOR NETWORK–A SURVEY
Authors: G RENGUGADEVI , G SUMITHRA M.
Published: December 2020

Wireless sensor networks are a web of sensor nodes with a set of processor and limited memory unit embedded in it. Reliable routing of packets from the sensor node to its base station is the most important task for the networks. The routing protocols applied for the other networks cannot be used here due to its battery powered nodes. This paper gives an
overview of the different hierarchical routing strategies used in wireless sensor networks and gives a brief working model of energy efficient routing protocols in WSN. In this paper performance of different routing protocols are compared based on metrics such as mobility support, stability, energy efficiency.
ULTRA WIDE BAND PLANER ANTENNA FOR WIRELESS NETWORK APPLICATION
Authors: MAULIK P PATEL , KUNAL K MODH , RAKESH L SHELIYA , RAKESH B PATEL
Published: December 2020

This paper presents a planar Antenna for Ultra Wide Band frequency for cover a large bandwidth of 3.1 GHz and 13.1 GHz for the resonance frequency of 6.5 and its wide application like WLAN, Wi-MAX, Medical Application, radar imaging technology, PC Peripherals, Wireless USB. The gain and directivity of the proposed antenna are presented
at different UWB band frequencies. for HFSS is used to design and simulation of antenna.
ANT COLONY OPTIMIZED ROUTING FOR MOBILE ADHOC NETWORKS (MANET)
Authors: GARG DWEEPNA , GOHIL PARTH
Published: December 2020

A Mobile Ad-Hoc Network (MANET) is a collection of wireless mobile nodes forming a temporary network without using centralized access points, infrastructure, or centralized administration. Routing means the act of moving information across an internet work from a source to a destination. The biggest challenge in this kind of networks is to find a path between the communication end points, what is aggravated through the node mobility. In this paper we present a new routing algorithm for mobile, multi-hop ad-hoc networks. The protocol is based on swarm intelligence. Ant colony algorithms are a subset of swarm intelligence and consider the ability of simple ants to solve complex problems by cooperation. The introduced routing protocol is well adaptive, efficient and scalable. The main goal in the design of the protocol is to reduce the overhead for routing. We refer to the protocol as the Ant Colony Optimization Routing (ACOR).
Contracting Out of Health Services for Province-level Integration of Healthcare System: Effect on Equity
Authors: Capeding Theo Prudencio Juhani Z. , Zarsuelo Ma-Ann M. , Lam Hilton Y. , Silva Ma. Esmeralda C. , Mendoza Michael Antonio F.
Published: December 2020

Background. The recently enacted Universal Health Care (UHC) Act prioritizes the provision of a comprehensive set of quality and accessible services. However, the devolution of health services has led to inequitable investments in healthcare resulting to disparities in health outcomes between areas. One of the strategies considered that could minimize these differences is the contracting out of health services to the private sector. This review focuses on mapping equity-related issues and concerns with regard to contracting out health services.

Methods. A modified systematic search of literature using published journal articles through PubMed and Google Scholar and other pertinent reports and manuals was conducted on issues of equity and health service contracting.

Results and Discussion. There is currently a dearth of literature on the effect of contracting services on health equity outcomes, particularly on the impact of contracting out on equity. Limited studies showed that contracting out can potentially improve equity by increasing service utilization. Mechanisms on how contracting out could potentially affect equity were also found.

Results mainly suggest that concrete steps should be taken to ensure equitable access and improvement in health outcomes among population subgroups. To provide a framework in applying possible insights from the review, discussion of the literature review was framed in the context of establishing performance-based contracting. It was emphasized that including representatives from the underserved populations and patient groups during stakeholder consultations were crucial to provide localized context for the inclusive development of contracting arrangements. Other strategies that were highlighted included: establishing monitoring systems that disaggregate data between groups, selecting contractors that have the capacity to reach and provide services to the underserved, and making sure that these contractors are also open to data sharing for economic evaluation of services.

Conclusion and Recommendations. Despite the paucity of data on the impact of contracting out services on equity, mechanisms explaining the effect of contracting on equity were put forward and illustrated. These findings can be considered by policy makers and program developers in the operationalization of service agreements between the public and private sectors.
Policy Analysis on Financing Roles for Population- and Individual-based Health Services in Light of the Universal Health Care Act
Authors: Estacio, Jr. Leonardo R. , Avila Christine Mae S. , Zarsuelo Ma-Ann M. , Silva Ma. Esmeralda C. , Mendoza Michael Antonio F. , Padilla Carmencita D.
Published: December 2020

Objectives. The health financing scheme brought by the Universal Health Care Act has a significant change in the landscape of allocating funds for health services, as well as in the delineation of roles among the key actors. Consistent with the law, the protection from the health financial risks of Filipinos must be guaranteed. This study aimed to determine the roles of the government and other key agencies in financing population-based and individual-based health services in the Philippines.

Methods. A systematic review of literature was done to generate evidence for the policy brief and proposed policy alternatives. The UP Manila Health Policy Development Hub organized a roundtable discussion in collaboration with the Department of Health participated by key stakeholders from various sectors involved in the policy issue. Systematic review and insights from the discussion were analyzed to produce consensus policy recommendations.

Results. Given the current procurement and financing, the DOH should fund population-based services while PhilHealth, with the assistance of Health Maintenance Organizations (HMO) for premium holders, should fund individual-based services. Health programs with grey areas (i.e. with both individual- and population-based services) need further technical discussions. It is imperative to have clear-cut specific guidelines on the managerial and financial roles of the provincial health board and the scope of financing service delivery.

Conclusion. Delineating the roles of DOH, PhilHealth, and HMOs in financing health services is not without risks. The utilization of the special health fund at the provincial level should be carefully implemented and monitored to minimize inefficiencies and fraud.
Policy Analysis on Province-level Integration of Healthcare System in Light of the Universal Health Care Act
Authors: Lam Hilton Y. , Zarsuelo Ma-Ann M. , Capeding Theo Prudencio Juhani Z. , Silva Ma. Esmeralda C. , Mendoza Michael Antonio F. , Padilla Carmencita D.
Published: December 2020

Background. The enactment of the Universal Healthcare (UHC) Act affirms the commitment of the State to safeguard the health of all Filipinos. One of the objectives of the Act is to integrate the different local health systems at the provincial level in order to minimize fragmentation in the delivery of health services. This significant undertaking needs effective inter-sectoral collaborations of various stakeholders both at the local and national levels.

Methods. A systematic review of literature was conducted to generate evidence-based policy tools. A roundtable discussion (RTD) was organized in collaboration with the Department of Health (DOH) to frame the current issues of the devolved health system and the anticipated challenges surrounding the integration to the provincial level. Policy discussion was guided by specific operational concerns put forth by the DOH such as the roles and functions of key local actors, organizational models, and metrics of integration.

Results. Inputs in the proposed organogram for the province-level integrated health system and assessment tool for identifying readiness of provinces were discussed and agreed upon. Critical issues in the composition of the members of the Provincial Health Board (PHB) and the line of command among constituents were raised.

Conclusion and Recommendations. Eight consensus key policy recommendations have been identified. These could be translated into operational guidelines for the DOH, local government units (LGUs), and other related national government agencies (NGAs) in implementing the local health systems integration as prescribed in the UHC Act.
Development on Third Party Accreditation of Healthcare Facilities in Light of the Universal Health Care Act: Policy Analysis
Authors: Mendoza Michael Antonio F. , Zarsuelo Ma-Ann M. , Borlongan Gabriel R. , Silva Ma. Esmeralda C. , Lam Hilton Y. , Padilla Carmencita D.
Published: December 2020

Background. The Universal Health Care (UHC) Act seeks to delineate the roles of key agencies and stakeholders towards equity in access to quality and affordable health care. Under the pillar of health regulation, the Philippine Health Insurance Corporation is mandated to recognize third party accreditation mechanisms as a basis for granting incentives to health facilities that provide better service quality, efficiency, and equity.

Methods. A systematic review of literature was conducted to generate a policy brief that outlined the strengths and weaknesses of the current accreditation system, and how to address arising fragmentation issues in implementation based on international and local evidence. To generate recommendations from a multi-stakeholder approach, a roundtable discussion enjoined by all major stakeholders of the policy issue was conducted by the University of the Philippines Manila Health Policy Development Hub in collaboration with the Department of Health. Thematic analysis of the RTD and the literature review were utilized in crafting the position statement with the general aim of producing consensus policy recommendations, as inputs in the Implementing Rules and Regulations of the Act.

Results. Policy analysis using results of literature review and policy discussion was crafted, with thematically arranged recommendations in the domains of leadership and governance, financing and sustainability, standards development, program development, and continuing quality improvement that could help the national health system in determining third party accreditation mechanisms set forth by the UHC Act. Significant issues raised was the composition and requirements of the third party accreditor and the risks in transition.

Conclusion and Recommendation. With the PhilHealth Benchbook setting the standards and with the expressed commitment of stakeholders for third party accreditation, it is an opportune time for the UHC Act to institutionalize the accreditation mechanisms that will address existing challenges of PhilHealth accreditation. The literature review and discussion bring forth the proposed tool for the criteria in selecting third party accreditors.
The Symbolic Relationship between ‘Ulamā’ and ‘Umarā’ in Contemporary Saudi Arabia
Authors: YAKAR Emine Enise , YAKAR Sumeyra
Published: December 2020

The research can be considered in the framework of legal and political anthropology and the study topic centres around the effects of an alliance between Saudi ‘ulamā’ (the religious scholars) and ’umarā’ (the political leaders) in contemporary Saudi Arabia. The objective of paper is to investigate to what extend the Wahhabī interpreted religious discourses are used to shape the political atmosphere of todays’ Kingdom. The paper will explain in more detail the continuing relationship between the ’ulamā’ and ’umarā’ in the light of the Wahhābī doctrine of siyāsa shar‘iyya (a fundamental legal doctrine that establishes the relationship between the regime and its subjects in an Islamic state), while focusing on the historical ebbs and flows between the ’ulamā’ and ’umarā’.
Fen Lisesi Öğrencilerinin Bilgisayara Yönelik Tutumları
Authors: ÖNAL Nezih
Published: December 2020

Dijital çağın yaşandığı günümüz dünyasına bilim ve teknolojide yaşanan hızlı gelişmelerin damga vurduğu bilinmektedir. Söz konusu gelişmeler her alanda kendini hissettirirken eğitimi de derinden etkilemiş ve hatta eğitimde dönüşüme yol açmıştır. Bu bağlamda teknoloji, eğitim sistemi içerisinde eğitimin niteliğini ve gücünü artırmak amacıyla kullanılmaya başlanmıştır. Eğitim teknolojileri olarak isimlendirilen bu teknolojilerin en önemlilerinden biri bilgisayarlardır. Dolayısıyla öğrenenlerin bilgisayara yönelik tutumları etkili bir öğretim için önem arz etmektedir. Buradan hareketle gerçekleştirilen bu çalışmanın amacı fen lisesi öğrencilerinin bilgisayara yönelik tutumlarını incelemektir. Araştırma nicel araştırma yöntemi tarama desenine dayalı olarak gerçekleştirilmiştir. Araştırmaya İç Anadolu Bölgesi’nde bir fen lisesinde öğrenim gören 269 fen lisesi öğrencisi katılmıştır. Araştırmada veri toplama aracı olarak Teo (2008) tarafından geliştirilen ve Demir ve Yurdugül (2014) tarafından Türkçe’ye uyarlanmış olan Bilgisayara Yönelik Tutum Ölçeği kullanılmıştır. Veriler SPSS 21.0 paket programında farklara dayalı istatiksel teknikler kullanılarak çözümlenmiştir. Verilerin analizi sonucunda, fen lisesi öğrencilerinin bilgisayara yönelik tutumlarının erkek öğrenciler lehine anlamlı fark gösterdiği ancak sınıf seviyesi ve bilgisayara sahip olma süresi değişkenlerine göre anlamlı fark göstermediği tespit edilmiştir. Sonuçlar doğrultusunda bilgisayar temelli etkinliklerde kız ve erkek öğrencilerin bir arada yer aldığı işbirlikli öğrenme gruplarının oluşturulması ve yine okul dışı öğrenme etkinliklerinde de sınıf seviyesi gözetilmeden karma gruplar oluşturulması gibi öneriler getirilmiştir
To Solve Problems in Economics-Maxima and Minima Approach
Authors: Madhukar Kulkarni Dr. Aruna
Published: December 2020

Thomas Simpson is still an icon for maxima and minima. The purpose of this article is just to provide additional information about the concepts of maxima and minima in business economics. Companies often want to minimize production cost or maximize revenue. It is often desirable to minimize the amount of material used to package a product with a certain volume. The basic idea of the
optimization problems that follow is the same we have a particular quantity that we are interested in maximizing or minimizing. Here some problems are solved.
Comparative evaluation of efficacy of ferrous ascorbate and ferrous calcium citrate prepared in multidrug delivery system on haemoglobin status in anaemic pregnant women
Authors:   Professor and Head, Department of Pharmacology, S.S Institute of Medical Sciences and Research Centre, Davangere, Karnataka, Kiran L J
Published: December 2020

Iron deficiency anaemia (IDA), the most prevalent nutritional deficiency leading to mortality globally. Oral ferrous salts are effectively used to treat iron deficiency in pregnancy. For the present study, no direct comparison demonstrating the efficacy of ferrous ascorbate and ferrous calcium citrate was considered. An open-label, observational study was designed and conducted for two months. Subjects were randomly allocated to two groups (Group A and Group B). The medication followed in Group A was, ferrous calcium citrate with elemental iron 50 mg; In Group B ferrous ascorbate containing elemental iron 100 mg orally for two months at bedtime. Haemoglobin levels, other hematological parameters, weight changes, side effects, conjunctival colour and general wellbeing were assessed in every visit (i.e. 0, 30th and 60th day) for clinical efficacy assessment. There was an increase in the mean serum haemoglobin and ferritin levels (p<0.05). In Group A and Group B, the mean values of all the assessment parameters increased significantly (p<0.05) in follow-up visits (i.e. 1st month and 2nd month) when compared to baseline values. Out of 69 adverse drug events, 29 (42%) were reported from Group A and 40 (58%) from Group B. Ferrous calcium citrate showed considerable efficacy and safety profiles. Keywords: Iron deficiency; anaemia; haemoglobin; ferrous calcium citrate; ferrous ascorbate
Distribution of ABO and Rhesus Blood groups among Type-2 Diabetic subjects
Authors:   Post graduate, Kannur University, Kannur, Kerala, Akshaya C K
Published: December 2020

ABO and Rh blood group systems have been associated with a number of diseases including type-2 diabetes mellitus (T2DM). Epidemiological studies have inconsistently associated ABO and Rhesus (Rh) blood groups with T2DM risk. To assess the distribution of ABO and Rh blood groups among type-2 diabetic subjects and to check the potential association between ABO and Rh blood groups with T2DM. This small retrospective case-control study was conducted at DM WIMS Hospital, Wayanad. One-year data (from Jan-18 to Jan-19) of fasting, postprandial or random plasma/serum glucose, HbA1c, ABO and Rh blood groups of Non- diabetic and type -2 diabetic subjects were collected from the Hospital Clinical Laboratory Medicine department. Among 280 randomly selected data, 147 are non-diabetic subjects, and 133 are confirmed and known cases of type 2 diabetic mellitus. Subjects with Blood group B has the highest distribution percentage among group-2 (59.39%) in comparison with group-1 (34.02%), followed by A (19.55%), O (18.79%), AB (2.27%). Statistical analysis using Chi-square test among ABO and Rh blood groups between group-1 and group-2 showed a significant (p< 0.001) association of blood group “B +ve” and least association of blood group “O +ve” with T2DM. However, the Rh Blood groups evaluation for T2DM showed no clear association, as both Rh +ve and Rh -ve were uniformly distributed in the groups. The ABO and Rh blood groups may have a possible role to play in the development of T2DM. The subjects with B + ve blood group are at greater risk for T2DM and O + ve blood group individuals are at lower risk for T2DM. Keywords: Blood groups; ABO blood groups; Rh blood groups; Type 2 Diabetes Mellitus; distribution; association REFERENCES
Assessment of birth spacing among married women in Southern Karnataka
Authors:   Senior Resident, Department of Community Medicine, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Harohalli, Ramanagara, Karnataka, India, Sushma J
Published: December 2020

Several factors influence maternal and child health, one among which is adequate birth spacing. Studies have shown that a recommended duration of birth spacing is not being observed among a larger population of women of childbearing age. The objective of the current study is to assess the pattern of birth spacing among married women of reproductive age group. A cross-sectional study was conducted in Tilaknagar, Mysore with a sample size of 180. Descriptive statistics like frequency and proportions for data analysis were calculated using R software. Among 180 subjects, only 36.1% of respondents had adequate birth spacing (≥36months) between the first two consecutive children. Among women having a third child, 52.9% had adequate spacing between the second and the third child. Keywords: Birth interval; Spacing
Balanced Scorecard Application and its Challenges
Authors: Deghash Hani
Published: December 2020

Institutions seek to obtain a comprehensive picture of their financial and managerial performance by providing indicators and measures for evaluating internal and external performance in the short and long term based on their strategic needs. Institutions' performance is measured through managerial measurement tools to improve decision-making process and achieve the institutions’ strategic objectives. Among tools used in measuring performance, there are traditional tools rely on financial measures and other tools rely on financial and non-financial performance measures, such as the balanced scorecard. This study focuses on the balanced scorecard as one of the tools used to measure performance, the reasons that led to its emergence, its dimensions, the axes contained in each dimension, its basic characteristics, advantages, the success drivers of applying the balanced scorecard, the challenges facing its application, and the steps of implementing the balanced scorecard.
Climate Change, Vulnerability, Social Conflicts and Human Displacement in the Andes: The case of Huaytapallana Glacier
Authors: Altamirano Téofilo
Published: December 2020

The objective of this review was to identify the links between Climate Change, Vulnerability, Social Conflicts and Human Displacement in the Andes. The different factors that influence the vulnerability of people and communities are analyzed, such as the diversity of the impacts of climate change, the retreat of glaciers, the loss of biological diversity, health, agricultural production and scenarios with the presence of water scarcity. Adaptive behaviors are observed in the inhabitants of Andean communities, but they are not sufficient, because in many occasions people are forced to migrate to other cities. Five ways of responding to climate risks or hazards are suggested: 1) reduction and control of global warming, 2) adaptation to conditions resulting from climate change, 3) resistance, 4) mitigation, and 5) involuntary displacement. Finally, it concludes by stating that there is an intricate link between global warming, climate change, vulnerability and social conflicts, and that migration is a product of climate change.