Technological Advancement and Public Service Motivation: Insights from the Lebanese Public Service

The 1950s and 1960s witnessed the rise of a new anti-bureaucratic philosophy, namely public choice theory. The advocates of this theory, like Anthony Downs and William Niskanen, called for downsizing, trimming the size of the bureaucracy, contracting out and privatizing public sector services. The 1980s and 1990s witnessed the rise of a new paradigm, namely new public management (NPM), which has its origins in public choice theory. The supporters of NPM, like political rulers in Western democratic countries and international donors, called for downsizing the public sector, privatizing its services, and introducing pro-market and business management techniques to the public service out of the belief that private sector firms are superior to public organizations. The widespread adoption of these business management principles in the public sector has blocked the performance of public servants who are motivated by intrinsic motives along with causing real threats to the existence and identity of public sector values and norms like equity, accountability, fairness and merit. This led to the revival of public service motivation which was a reaction against the widespread use of market principles in the public sector. Public management scholars studied public service motivation from different sides; however, no one has studied the effect of technology, as part of the external environment, on public service motivation. This study will fill this gap in public service motivation literature. Keywords: Public service motivation, technology, electronic government, civil service,  transparency, accountability, equity

The effects of socio-cultural factors on public service motivation: Insights from the Lebanese public service

The infusion of market and business management principles into the public sector has impeded the behaviour of public service motivated employees who are motivated by intrinsic motives. Besides, the infusion of such principles caused great threats to basic values of the civil service, like equity, fairness, justice, accountability, impartiality, public welfare and other values related to the public sector. From here, public service motivation (PSM) emanates as a reaction against these principles/techniques in the civil service. Public management scholars have studied PSM from different angles and perspectives; however, no one has studied the effects of socio-cultural factors on PSM. This study will fill this gap in PSM literature by studying how socio-cultural factors impede/block the development of this construct with lessons learnt from the Lebanese civil service

CENTELLA ASIATICA (LINN.) URBAN AMELIORATES OXIDATIVE STRESS ON ERYTHROCYTE MEMBRANE

The effect of Centella asiatica on erythrocyte membrane under normal and oxidative stressed condition was investigated in the present study. 100% ethanol, 50% ethanol and water extract of Centella asiatica were screened for in vivo study by in vitro hypotonia-induced and time dependant H2O2-induced antihemolytic activity assay. During in vivo study, test group rats (n=7) were orally administered with 50% ethanol extract of Centella asiatica at a dose of 250 mg/kg/day for 6 weeks while control group rats were administered with normal saline. Then, levels of lipid peroxide (LPO) of erythrocyte ghost membrane from control and test group rats were estimated under normal and in vitro H2O2-induced oxidative stressed condition. All of the three extract prevent hypotonic solution induced hemolysis while 50% ethanol extract showed highest H2O2-induced antihemolytic activity in a time dependant manner. The LPO levels of the erythrocyte ghost membrane under H2O2-induced oxidative stressed condition were significantly decreased as a result of C. asiatica administration but not in normal condition. Therefore, the extract of C. asiatica has the ability to ameliorate oxidative stress on erythrocytes membrane at least upon oxidative challenge

Public Service Motivation in an International Context: Evidence from the Lebanese Civil Service

Public service motivation has been developed partly as a reaction to the failures of new public management in reforming the civil service, and partly as a reaction to the negative effects that this model has on public service ethics. In 1990, the United States of America witnessed an attempt with the aim of reviving and developing the concept of public service ethics, also known as public service motivation (PSM) or public service ethos (PSE) in order to improve the performance of the American civil servants. PSM has been studied in different developed countries; however, it was almost ignored in developing countries. This study focuses on the conceptualization of PSM in Lebanon with a particular focus on civil service. This study shows that PSM is an international concept, which is present in the Lebanese context as well. However, other value-laden elements appeared to surface, where they yield additional information on the content of PSM. Keywords: Public service motivation, new public management, public sector motivation, legality, objectivity, ethics, neutrality and meri

Overall survival of patients with recurrent pancreatic cancer treated with systemic therapy: a retrospective study

BACKGROUND: Only a few patients with pancreatic ductal adenocarcinoma (PDAC) recurring after curative resection and peri-operative (neoadjuvant and adjuvant) therapy are included in clinical trials of metastatic PDAC. As such, there is a paucity of data to guide treatment after relapse, and patients are treated similarly to those with de novo metastatic PDAC (mPDAC). We evaluated the patterns of chemotherapy use and over-all survival (OS) in patients with recurrent PDAC (rPDAC) following curative therapy. METHODS: In this retrospective study, the Indiana University pancreatic cancer database was used to identify patients with PDAC who underwent curative resection and subsequently developed recurrence. Demographics, tumor and treatment characteristics were collected. Patients were broadly divided into those who received chemotherapy for rPDAC and those who did not. Patients in the former category were further subdivided into those who received single agent therapy, any standard combination therapy (5-fluorouracil/irinotecan/oxaliplatin combination or gemcitabine/nab-paclitaxel) and those who received non-standard combinations. Survival analysis was performed by the Kaplan-Meier method. Log rank tests were used to determine differences in survival between treated rPDAC patients and those not treated. Cox regression analysis was employed to evaluate factors associated with OS. RESULTS: We identified 435 patients with resected PDAC treated between 2008 and 2014. Two hundred and twenty-three patients (51.2%) were diagnosed with rPDAC. Of these, 140 patients (63%) received chemotherapy whereas 71 patients (32%) did not receive chemotherapy. The 74 patients (53%) who received any standard, approved multiagent combination regimen had a median OS of 14 months compared to 8 months for the 47 patents (34%) who received other non-standard combinations and the 19 (13%) who received single agent therapy (P = 0.029). Multivariate cox regression analysis showed that margin negative resection, peri-operative therapy, radiotherapy and the use of any chemotherapy for rPDAC were associated with improved OS. CONCLUSION: Our findings support the use of standard approved multi-agent therapy in rPDAC. Patients derive significant benefit from these standard combination therapies with median OS that is comparable to what is observed with treatment for de novo mPDAC

Germline and Somatic DNA Damage Repair Gene Mutations and Overall Survival in Metastatic Pancreatic Adenocarcinoma Patients Treated with FOLFIRINOX

Purpose: Pancreatic ductal adenocarcinoma (PDAC) is a lethal cancer with lack of predictive biomarkers. We conducted a study to assess DNA damage repair (DDR) gene mutations as a predictive biomarker in PDAC patients treated with FOLFIRINOX. Experimental Design: Indiana University Simon Cancer Center pancreatic cancer database was used to identify patients with metastatic PDAC, treated with FOLFIRINOX and had tissue available for DNA sequencing. Baseline demographic, clinical, and pathologic information was gathered. DNA isolation and targeted sequencing was performed using the Ion AmpliSeq protocol. Overall survival (OS) analysis was conducted using Kaplan–Meier, logistic regression and Cox proportional hazard methods. Multivariate models were adjusted for age, gender, margin status, CA 19-9, adjuvant chemotherapy, tumor and nodal stage. Results: Overall, 36 patients were sequenced. DDR gene mutations were found in 12 patients. Mutations were seen in BRCA1 (N = 7), BRCA2 (N = 5), PALB2 (N = 3), MSH2 (N = 1), and FANCF (N = 1) of all the DDR genes sequenced. Median age was 65.5 years, 58% were male, 97.2% were Caucasian and 51.4% had any family history of cancer. The median OS was near significantly superior in those with DDR gene mutations present vs. absent [14 vs. 5 months; HR, 0.58; 95% confidence interval (CI), 0.29–1.14; log-rank P = 0.08]. Multivariate logistic (OR, 1.47; 95% CI, 1.04–2.06; P = 0.04) and Cox regression (HR, 0.37; 95% CI, 0.15–0.94; P = 0.04) showed presence of DDR gene mutations was associated with improved OS. Conclusions: In a single institution, retrospective study, we found that the presence of DDR gene mutations are associated with improved OS in PDAC patients treated with FOLFIRINOX

Knowledge of medical workers about the impact of climate change: a narrative synthesis

Introducere. Schimbările climatice reprezintă una dintre cele mai mari provocări globale de sănătate ale secolului 21. Republica Moldova este deosebit de vulnerabilă la schimbările climatice datorită mijloacelor de trai sensibile la climă, multiplelor activități realizate în aer liber, preocupărilor predominante de sănătate. Scopul lucrării. Evidențierea particularităților conștientizării schimbărilor climatice de către lucrătorii medicali. Material și metode. S-a realizat o sinteză bibliografică narativă pentru anul 2022 cu evaluarea a 23 de articole științifice cu rezultatele cercetărilor în domeniu din Romania, Ungaria, Portugalia, Germania, SUA. A fost realizată o căutare avansată pe motorul de căutare Google și examinate primele 10 pagini. Cuvintele-cheie căutate au fost: „conștientizarea schimbărilor climatice”, „lucrători medicali” scrise în limba engleză. Rezultate. Forța de muncă din domeniul sănătății joacă un rol esențial în abordarea schimbărilor climatice și a efectelor sale asupra sănătății. Cercetarea publicațiilor despre înțelegerea, atitudinea și interesul lucrătorilor medicali față de impactul schimbărilor climatice a evidențiat unele particularități. A fost constatat că, deși cunoștințele despre schimbările climatice și efectele sale imediate asupra sănătății datorate expunerii la căldură (76,8-87,2%), frig (77,6-83,4%) și vectorii bolilor (75,1-87,5%) au fost cunoscute de respondenții implicați în diverse cercetări, conștientizarea cu privire la efectele întârziate sau indirecte asupra sănătății, cum ar fi malnutriția a fost relativ scăzută (51,4-58,7%). Mulți participanți au manifestat interesul de a afla mai multe despre schimbările climatice, de exemplu, despre legăturile dintre focarele de boli infecțioase și schimbările climatice (66,7-78,1%) și rolul profesioniștilor din domeniul sănătății în conștientizarea schimbărilor climatice și acțiunile necesare de întreprins (40,4-53,2%). Concluzii. Asemenea cercetări sunt necesare și în Republica Moldova pentru a înțelege rolurile și motivațiile diferiților actori din domeniul sănătății în abordarea acestei provocări. Constatările sunt încurajatoare pentru intervenții ulterioare în acest domeniu.Background. Climate change represents one of the biggest global health challenges of the 21st century. The Republic of Moldova is particularly vulnerable to climate change due to climate-sensitive livelihoods, multiple outdoor activities, and prevailing health concerns. The purpose of the work. Highlighting the particularities of climate change awareness by medical workers. Material and methods. A narrative bibliographic synthesis was made for the year 2022 with the evaluation of 23 scientific articles with the results of research in the field from Romania, Hungary, Portugal, Germany, USA. An advanced search was performed on the Google search engine and the first 10 pages were examined. The keywords searched were „climate change awareness”, „medical workers” written in English. Results. The health workforce plays a critical role in addressing climate change and its effects on health. The research of publications on the understanding, attitude, and interest of health workers towards the impact of climate change highlighted some peculiarities. It was found that although knowledge of climate change and its immediate health effects due to exposure to heat (76.8-87.2%), cold (77.6-83.4%) and disease vectors (75.1- 87.5%) were known by respondents involved in various researches, awareness of delayed or indirect health effects such as malnutrition was relatively low (51.4-58.7%). Many participants expressed an interest in learning more about climate change, for example, the links between infectious disease outbreaks and climate change (66.7-78.1%) and the role of health professionals in climate change awareness and action to undertake (40.4-53.2%). Conclusions. Such research is also needed in the Republic of Moldova to understand the roles and motivations of different actors in the field of health in addressing this challenge. The findings are encouraging for further interventions in this area

Impact of Nab–Paclitaxel-based Second-line Chemotherapy in Metastatic Pancreatic Cancer

Background: Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with median survival of 20% at 1 year. We conducted a retrospective study to assess the efficacy and tolerability of nab-paclitaxel (NP)-based second-line chemotherapy in metastatic PDAC. Patients and Methods: The Indiana University Simon Cancer Center pancreatic cancer program was used to identify patients with metastatic PDAC who received any second-line chemotherapy. Demographic, clinical and outcomes data were collected by manual chart abstraction. Patients were divided into two groups: a NP-based treatment group and a non- NP-based treatment group. Overall (OS) and progression-free (PFS) survival were estimated using Kaplan–Meier method. Cox proportional hazards regression was used for multivariate analyses. Results: A total of 120 patients received second-line chemotherapy. There were 47 (39%) patients in the NP group and 73 (61%) in the non-NP group. As compared to the non-NP group, the NP group showed improved median PFS [2.8 vs. 2.1 months; hazard ratio (HR)=0.62, 95% confidence interval (CI)=0.38-1.02; p=0.06] and median OS (7.5 vs. 4.7 months; HR=0.67, 95% CI=0.45-1.00; p=0.05). Multivariate analyses adjusted for age showed a significantly improved PFS (adjusted HR=0.60, 95% CI=0.36-0.98; p=0.04) and a suggestion of improved OS (adjusted HR=0.67, 95% CI=0.44-1.01, p=0.05) in the NP group as compared to non-NP group. Serious adverse events were seen in 13.3% of patients in the non-NP group and 17.1% patients in the NP group. Conclusion: In a single-institution retrospective cohort study, we report a significant improvement in the PFS and suggestion of improvement in the OS with NP-based second-line chemotherapy with an acceptable toxicity rate