Hospital organizational structures, culture, change and effectiveness: The case of Hamad Medical Corporation in Qatar

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis presents health care organizations as heterogenic and highly complex in nature with particular normative structures underpinning their formal rational structures. It seeks to explore the evolution of organization structure as applied to a medical corporation in Qatar and to examine the nature of organizational culture and multi professional cohesiveness. In doing so it assesses a range of models on organizational design and change. The three hospitals that compose the corporation are investigated through triangulated interpretative qualitative and quantitative methodologies and the application of the Competing Values Framework. The comprehensive approach of the investigation resulted in a series of conclusions on the evolution of hospital organizational structures, the link between life cycle and structure, forms of organizing health services, characertistics of professional structures, the nature and success of change management strategies, coordination mechanisms, organizational and professional cultures, and health service, organizational and team effectiveness assessment. Findings demonstrated that autonomous and sometimes conflicting professions worked in harmony and cohesiveness as a consequence of shared core values and the human relations focus of health organizations. In examining organizational design it showed that coordination mechanisms were preferred to integration mechanisms with the former playing an important role in conflict resolution and human relations. Finally, findings indicated that when organizational design has shortcomings, the organization substitutes through other mechanisms.Government of the State of Qatar; Ministry of Education, Qatar; Hamad Medical Corporatio

The Impact of Foreign Direct Investment on Real Wages in Egypt: A Sectoral Empirical Analysis

This research seeks to empirically examine the impact of Foreign Direct Investment )FDI( on real wages in Egypt. First, we test the effect of FDI on real wages on the whole economy, and then special attention is given to the basic sectors in the economy. For this purpose, we make use of time-series Autoregressive Distributed Lag (ARDL) models utilizing annual data covering the period 1985-2014. Our results reveal that FDI positively affects the average wages in the long-run in almost all conducted models. According to the sectoral models, the highest long-run effect of FDI on wages is detected in the manufacturing sector, while it is insignificant in the tourism sector. Attracting more FDI in general and manufacturing FDI in particular is recommended as this will have a positive effect on average wages and consequently raise the economy’s output and overall income

GAS CHROMATOGRAPHY-MASS SPECTROMETRY ANALYSIS AND ANTIOXIDANT ACTIVITY OF PUNICA GRANATUM L. PEELS AND ITS ROLE AS IMMUNOSTIMULANT AGAINST SCHISTOSOMA MANSONI INFECTION IN BIOMPHALARIA ALEXANDRINA

Objective: To evaluate the antioxidant activity and chemical composition of Punica granatum L. and test it as immunostimulants against Schistosoma mansoni infection to Biomphalaria alexandrina snails.Methods: Antioxidant activity was evaluated by measuring the free radical scavenging activity of the 90% defatted methanol extract (90% DM) of P. granatum peels and its sub-derived fractions was evaluated via 2,2'-diphenyl-1-picrylhydrazyl and its chemical constituents were identified via gas chromatography-mass spectrometry (GC-MS) analysis. B. alexandrina snails were exposed to pomegranate extracts (PEs) for 1 month before their challenging with S. mansoni miracidia. Infection rates, immunological and histological parameters were, then, evaluated in PE-exposed snails and compared to controls.Results: The antioxidants activities of PE, expressed as scavenging concentration at 50%, were in the following order; 90% DM (12.45) ˃n-butanol(15.59) ˃ethyl acetate (21.36) ˃water (49.16) µg/ml, compared to 7.50 µg/ml for ascorbic acid. The infection rates of PE-exposed snails were 20%,50%, 60%, 70%, and 80%, respectively, for 90% DM, n-butanol, ethyl acetate, water, and dichloromethane extracts compared to 95% in control snails. The number of amoebocytes showed a significant increase, clear differentiation, and size increment in exposed snails compared to controls. Moreover, hermaphrodite glands histology shows a full maturity in the formation of reproductive cells in PE-exposed snails. The GC-MS analysis of the 90% DM extract revealed the presence of 36 compounds representing 93.1% of the total composition. Piperidin-4-ol, 1,3-dimethyl-2,4,6-triphenyl (19.87%), and 6,11-dihydroxy-5,12 naphthacenequinone-1-carboxylic acid (7.80%) were the major components.Conclusion: The identified compounds in 90% DM extract of P. granatum may be responsible for the high antioxidant activity of the fruit and it may account for its immunostimulatory effect against S. mansoni infection in B. alexandrina.Keywords: Punica granatum L., Antioxidant activity, Biomphalaria alexandrina, Schistosoma mansoni, Infection rate, Gas chromatography-mass spectrometry

The correlation of in vitro antioxidant potentials with the various biochemical responses of salinized basil leaves

One of the environmental sustainability issues is salinity. Basil seedlings (Ocimum basilicum L.) were treated using NaCl solutions of three different concentrations prepared using irrigation (40, 80, and 130 mM), and various biochemical analyses were performed on basil leaves. The number of leaves, leaf area, moisture, weights, and MDA content of basil decreased significantly as salinity levels increased from 40 to 130 mM; however, dry matter increased. As well, the current study investigated a significant increase in osmolytes (including total soluble sugars and proline) and Na+ contents. The highest activities of CAT and SOD in the leaf tissues of basil were recorded after treatment with 130 mM NaCl, whereas the polyphenol and total flavonoid contents were negatively influenced.  On the other hand, the highest ABTS scavenging activity was observed in the 40 mM-treated leaves at a concentration of 1000 µg/mL; however, the DPPH scavenging potential increased significantly in the 80 mM-treated leaves at 3000 µg/mL. Furthermore, the correlation between in vitro antioxidant potentials and biochemical responses was described. A strong correlation was identified between the in vitro antioxidant capacities of salinized O. basilicum leaves and SOD activity, total flavonoids, and the presence of phenolic acids, particularly p-hydroxybenzoic and o-coumaric acids at various concentrations. As a result, this is the first study to explain how basil may resist salinity by producing specific antioxidant compounds; therefore, our research recommends use of salinity issue to obtain a better plant material for producing dietary supplements or herbal drugs

Students' and teachers' perceptions of clinical assessment program: A qualitative study in a PBL curriculum

<p>Abstract</p> <p>Background</p> <p>"Examinations drive students' learning." This statement refers to what is assumed to be one of the strongest relationships in education. We explored in this research how and why students differ in their approaches to learning, how assessment affects deep learning, and which barriers stand in the way of good assessment and learning in the clinical years of a Problem Based Learning (PBL) graduate entry medical curriculum.</p> <p>Findings</p> <p><b>Method: </b>We conducted a qualitative, phenomenological study using semi-structured group interviews with students and semi-structured individual interviews with teachers and students. The transcripts were analyzed, and themes were identified.</p> <p><b>Setting</b>: The research was conducted at the King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia from November 2007 to March 2008.</p> <p><b>Results: </b>A total of 28 students participated in 7 focus group interviews. Semi-structured individual interviews were conducted with 12 teachers and 12 students. The analysis yielded four themes: summative assessment, formative assessment, continuous assessment of clinical attachments, and learning objectives.</p> <p>Conclusions</p> <p>The results of this study confirm that assessment affects students' perceptions of learning and how they learn. These effects are not uniformly positive. According to the students, the predominantly summative assessment program offers little inducement to engage in deep learning. They express a clear preference for formative assessment, which may foster a deeper approach to learning. Efforts to achieve more clinically relevant assessment with adequate balance between the various types of assessment are required. Research is needed to decide this balance.</p

Intralesional Injection of Botulinum Toxin for Post-Herpetic Neuralgia: A Pilot Study

Background: When someone has herpes zoster and the rash goes away in spite of persistence of pain, they are defined to have post-herpetic neuralgia (PHN). Herpes zoster is frequently accompanied by post-herpetic neuralgia. Clostridium botulinum produces botulinum toxin (BTX-A), a neurotoxic protein that is used to treat various ailments. Objective: Intralesional botulinum toxin injections were tested for their efficacy in the treatment of post herpetic neuralgia. Patients and methods: An intralesional BTX-A injections pilot trial including 19 patients with PHN was carried out. Quality of life scale (QLS), neuropathy pains scale (NPS), and pain analyses by visual analogue scale (VAS) were used for all patients after comprehensive history-taking process.Results: After a six-months therapy follow-up period, we found significant differences comparing before and after treatment in the neuropathy pain scale, VAS score, and the QLS (SF-36). Pain at site of injection was found in all patients while redness or erythema was found in 13 patients. Conclusion: Treatment with botulinum toxin via local injection is beneficial for post-herpetic neuralgia (PHN). BTX could be alternative therapeutic modality in treating PHN in the future

Predictive factors for nutritional behavior among pregnant women attending antenatal care clinic in 6th of October City

Background: Good maternal nutrition during pregnancy is important to ensure health for the mother and the fetus. This study aimed to assess nutritional knowledge and behavior among a group of Egyptian pregnant women in addition to identify the factors influencing their nutritional behavior. Methods: This comparative cross sectional study included 300 pregnant women attending the antenatal care clinics in 6th of October University private hospital and El-Hosary primary healthcare (PHC) unit. The data was collected through a modified nutritional survey that was translated from Spanish to Arabic and revised by language experts for clarity. &nbsp;Results: Almost all of the women attending the private hospital were university educated while about half of the women attending the PHC unit were graduated from technical education. In general, the level of knowledge about food requirements of both groups was satisfactory good; however, neither of them fulfilled the WHO recommendations of food intake during pregnancy or the optimum number of meals per day. The average random blood glucose was higher among the women attending the PHC unit; the BMI, mid arm circumference and subcutaneous fat were higher among the same group as well. In regard to fulfilling the WHO recommended servings per day, only starch and fat items were fulfilled by both groups, whereas the other three items (vegetables, fruits, meat and dairy products) were merely included in the diets of both groups. Conclusion: Healthy behavior among pregnant women in both group were influenced by their educational level, occupation as well as their pre-gestational BMI. Those were the only three significant predictive factors, where women with higher education showed an active lifestyle. In addition, women starting with normal BMI before pregnancy had better healthy behaviors including the choice of healthy diets

Alternative technique using dual source CT imaging for assessment of myocardial perfusion

AbstractPurposeTo elucidate the diagnostic role of multidetector DSCT for the assessment of myocardial perfusion in correlation with coronary luminal integrity in a single CT scan while both tubes were operated in single energy mode.Methods and materialThirty-five patients were subjected to single acquisition contrast-enhanced, ECG-gated DSCT of the heart at rest. Postprocessing was performed generating two image sets: coronary CT angiographic images (cCTA) and myocardial perfusion images (CTP) for respective correlative assessment of coronary luminal integrity and myocardial perfusion. Perfusion defect was detected subjectively using gray scale images and the color coded first pass and color overlaid late enhancement (color attenuation) images were used for semi-objective evaluation and final objective and quantitative confirmation by density measurement.ResultsSignificant correlation and good agreement between the findings of DSCT myocardial perfusion and the findings of stenosis and its degree on cCTA on a segmental basis is noted with Cohen’s Kappa=0.67 and prevalence and bias adjusted Kappa=0.71 emphasizing the high diagnostic value of DSCT myocardial perfusion as compared to cCTA as the gold reference standard.ConclusionWe propose that comprehensive evaluation of coronary artery morphology and myocardial perfusion in patients with CAD could be achieved by single reproducible non-invasive contrast enhanced CT acquisition using DSCT scanners while operated in single energy mode with high sensitivity, specificity and diagnostic accuracy, it also has the potential to be the first, independent and stand out imaging choice in such field

Application of Nanometal Oxides In Situ in Nonwoven Polyester Fabric for the Removal of Bacterial Indicators of Pollution from Wastewater

The objective of this study is to investigate and assess the use of in situ deposit nanosilver (nAg2O) or nanocopper oxides (nCuO) into nonwoven polyester fabric (NWPF) as a safe and effective antibacterial filter of pollution from domestic wastewater. The bactericidal effect of both nAg2O and nCuO was examined against Gram-negative bacteria (Escherichia coli, Salmonella typhi) and Gram-positive bacteria (Enterococcus faecalis, Staphylococcus aureus) using agar diffusion disk method. In addition, the capability of nAg2O and nCuO as disinfectants for secondary treated domestic wastewater was investigated as a case study. Transmission electron microscope (TEM) confirmed the formation of nAg2O and nCuO particles with average particle sizes of 15 and 41 nm, respectively. Disk diffusion results showed that nAg2O had a higher bactericidal effect than nCuO. Moreover, the disinfection of secondary treated wastewater using 1.27 mg/cm3 of nAg2O in the nonwoven fabric was capable of hindering 99.6% and 91.7% of total and fecal coliforms within 10 minutes with a residual value of 18 and 15 MPN-index/100 mL, respectively. The residual total and fecal coliform concentrations were far less than that stated in the national and international limits for wastewater reuse in agriculture purpose