Access System Research Articles

Prioritizing Oral Health: Oral Health IS Health!

How did we let the mouth get separated from the rest of the body? And more importantly, how do we put oral health back into overall health? This issue of the NCMJ highlights recent efforts to develop strategies to create an accessible, sustainable, and equitable care delivery system in North Carolina.

Prospective per‐target analysis of the added value of the PrecisionPoint Transperineal Access System in cognitive prostate biopsy of MRI targets

AbstractObjectivesThe objective of this study is to evaluate the diagnostic performance of perineal access cannulas tethered to a biplanar ultrasound probe in cognitive transperineal prostate biopsies of targets identified by multiparametric magnetic resonance imaging (mpMRI) by comparing the results of the PrecisionPoint (PP) Transperineal Access System with the double‐freehand (DFH) technique.Patients and methodsAll patients who underwent cognitive transperineal prostate biopsy of mpMRI targets using the PP or DFH technique between November 2020 and September 2023 were enrolled. All data related to mpMRI target biopsies were stratified by technique, visibility in transrectal ultrasound and analysed by comparing PP versus DFH. A standardised anaesthesia protocol with 1% mepivacaine was used in all biopsies. The tolerability of the procedures was assessed using a visual analogue scale (VAS).ResultsThe number of mpMRI targets sampled was 166 in PP and 242 in DFH. In target biopsies, the PP system was associated with better diagnostic performance for clinically significant prostate cancer (Gleason score ≥3 + 4) compared to DFH for both ultrasound‐visible targets (61.4% vs. 48.0%) and non‐visible targets (41.4% vs. 14.9%) (p = 0.02). A higher rate of positive cores was obtained from targets sampled with PP (57.7% vs. 49.6%, p = 0.0002). The PP system was associated with the retrieval of significantly longer cores (p < 0.0001). There was no significant difference between the techniques regarding pain reported during the biopsy, with a median VAS of 2.7/10, although the PP device required a lower amount of anaesthetic in the periprostatic planes (4.3 ± 2.0 mL vs. 5.9 ± 1.9 mL, p < 0.0001).ConclusionThe PrecisionPoint Transperineal Access System enabled more precise and higher quality biopsies, resulting in improved histological characterisation of prostate cancer compared to the DFH approach. The use of a perineal cannula did not increase the pain perceived by patients and also required less local anaesthetic during the biopsy.

Resolving Disputes in International investment through Arbitration

This paper brings forth an extensive analysis of the role of arbitration in resolving disputes in international investment, providing a comparative study of the existing frameworks and emerging alternatives. As cross-border investments continue to grow, disputes between foreign investors and host states have become increasingly common. International arbitration has emerged as the preferred method for resolving such conflicts due to its neutrality, enforceability, and flexibility. The paper explores the key legal instruments governing international investment arbitration, including Bilateral Investment Treaties (BITs), Free Trade Agreements (FTAs), and multilateral agreements like the Energy Charter Treaty. It also examines the two most widely used procedural frameworks: the International Centre for Settlement of Investment Disputes (ICSID) and the United Nations Commission on International Trade Law (UNCITRAL), comparing their distinct approaches to arbitration. While arbitration has proven effective, it faces growing criticisms, including high costs, lengthy proceedings, and concerns about transparency and arbitrator impartiality. The research also highlights regional initiatives, particularly in Latin America and China, which reflect diverse approaches to investment dispute resolution. By comparing these frameworks and emerging trends, the paper sheds light on the strengths, weaknesses, and future direction of international investment arbitration, emphasizing the need for a more transparent, equitable, and accessible system to balance the interests of investors and host states. The analysis concludes by assessing the potential impact of these reforms on the future of international investment law.

Mapping barriers to food, energy, and water systems equity in the United States

Barriers to affordable, accessible, high-quality food, energy, and water systems (FEWS) harm social equity. Connections within and across FEWS suggest that co-occurring barriers to equity can compound vulnerability. We hypothesized that barriers to FEW resources are strongly associated with geographic location, both within and across FEWS, as they rely heavily on localized sociopolitical and natural environments. This study explored the geographic relationships between FEWS barriers and social equity through a spatial analysis of census tracts within the United States. Cluster analyses showed that all FEWS barriers had a positive spatial autocorrelation (Moran's I = 0.12–0.94), with energy barriers being the most spatially clustered and affordability barriers being the least spatially clustered. In 54 % of census tracts, we observed the co-occurrence of low barriers to water quality and access. Barriers to FEWS affordability almost always co-occurred in parallel (e.g., high barriers to affordability in one system co-occurred with high barriers to affordability in another system). Finally, we developed a spatial index of the barriers to FEWS equity to determine vulnerability at the census tract scale, which had a positive spatial autocorrelation (Moran's I = 0.41). Clusters and intersections of FEWS equity barriers suggest that resources are interconnected, resulting in additional challenges for people living in these areas. The maps of barriers to equity in FEWS are useful tools that could help stakeholders (e.g., federal agencies, city planners, utilities) distribute FEWS resources fairly and begin engagement with communities about FEWS barriers in their local context.

Secrecy performance of D2D assisted cooperative uplink NOMA system with optimal power allocation strategy

This paper investigates the physical-layer security (PLS) aspects of the uplink cooperative non-orthogonal multiple access (NOMA) system in the context of two user scenario. More specifically, this work employs device-to-device (D2D) pair users (i.e., D1, and D2) to further improve the spectral efficiency (SE) of the proposed cooperative uplink NOMA (CU-NOMA) system. One D2D user acts as a decode-and-forward relay, improving the performance of both the cell-edge user (CU) and another D2D user i.e., (D2). We analyze the secrecy performance of CU and D2 under perfect and imperfect successive interference cancellation (SIC), and optimizes power allocation (PA) to boost the performance. The proposed CU-NOMA system is evaluated in terms of its performance metrics like ergodic secrecy capacity (ESC), ergodic secrecy sum capacity (ESSC), non-zero secrecy capacity (NSC), effective secrecy throughput (EST), and secrecy outage probability (SOP) under the presence of an external eavesdropper (Eav). In addition, this work derives the closed-form analytical expressions of ESC, NSC, EST, and SOP metrics for both CU and D2 under perfect SIC (pSIC) and imperfect (ipSIC) cases in order to characterize the secrecy performance of the proposed secure CU-NOMA network. Further, the outcomes of the simulations are shown as evidence for both the validation of the mathematical analysis and the performance of the method being suggested. The simulation result analysis of this work infers that the secrecy performance of CU-NOMA system with optimal PA exhibits superior performance than that of the fixed PA scheme.

Compact Plasma Ionization for Ion Mobility Spectrometry Using a 4.3 MHz Miniature Tesla Coil.

In this study, a low-cost 4.3 MHz plasma ionization source for ion mobility spectrometry (IMS), utilizing a miniaturized Tesla coil, is presented. This compact design, combined with a 3D printed cyclic olefin copolymer (COC) housing, delivers a stable and directed plasma suitable for ionization in IMS applications. The 3D printed housing ensures chemical resistance and low off-gassing, which are crucial for maintaining sample integrity. The Tesla coil produces a consistent sine wave at 4.3 MHz, and when connected to stainless steel screw electrodes it generates a stable plasma capable of ionizing analytes such as limonene, MTBE, nicotine, 2-octanone, and propofol. Measurements were conducted in both positive and negative ion modes. The results demonstrate the Tesla coil's effectiveness as a low-cost and reliable ionization source for IMS, offering comparable performance to traditional Ni63 β-emitters. This advancement in plasma ionization technology could facilitate more accessible and flexible IMS systems for diverse analytical applications. The integration of 3D printing in the development of this ionization source underscores the potential for customized, low-cost analytical instrumentation, promoting innovation in laboratory environments and commercial applications.

Neurosurgery in Pakistan: Past, Present, and Future.

Since its independence from India in 1947, Pakistan has struggled with economic crises such as global debt, corruption, constant regime change, and a decades-long war against terrorism. The resulting socioeconomic barriers have stymied efforts to develop a comprehensive and equitably accessible healthcare system, especially regarding safe, timely, and affordable surgical care. This article evaluates neurosurgery's development, current state, and prospects in Pakistan, a lower-middle-income country. We performed a literature search using PubMed and analyzed relevant articles to better understand the state and landscape of neurosurgery in Pakistan. Moreover, we conducted ecological research by querying the databases of the World Bank and the Institute of Health Metrics and Evaluation to evaluate the neurological and neurosurgical disease burden in the Pakistani population. The neurosurgical workforce in Pakistan has demonstrated rapid growth over the past two decades, with approximately 450 neurosurgeons and a neurosurgeon-per-100 000 population density of 0.114. Nonetheless, access to essential neurosurgical procedures for the treatment of diseases such as stroke has been difficult to ensure, which likely contributes to Pakistan's stroke burden, ie, stroke was still the third most common cause of death in 2019, causing 21.7% of all deaths. While Pakistan's political and economic instability has adversely affected the development of neurosurgery, the field has still made great strides and demonstrates a promising future in providing equitable neurosurgical care to all Pakistan's people.

Empowerment and gender norms among Yoruba women and men cassava producers

Yoruba women have gained a reputation as empowered traders, but their empowerment in agriculture has received less attention. This study examines the empowerment of Yoruba men and women cassava producers in Nigeria's Southwest geopolitical zone. It combines data from an Abbreviated Women Empowerment in Agriculture Index (A-WEAI) survey with results from focus group discussions and key informant interviews. An additional focus is on how norms that foster balanced household gender relations interact with those that produce inequalities. Yoruba men farmers appeared more empowered than their wives in all the domains measured by the A-WEAI in spite of women's high involvement in processing and trade. The fact that the same domains contributed most to men and women's disempowerment points to structural issues that affect men and women unevenly. The study finds signs of emerging shifts in gender norms: women demanded to be acknowledged as farmers and indicated first moves into land ownership. However, the most asymmetric effect of normative constraints experienced by women as a result of unpaid labor, alongside their own income-generating activities tend to neutralize these gains. Hence, the embeddedness of pockets of potentially symmetric institutions in a larger asymmetric patriarchal system of imbalanced resource access and agency does not produce equitable outcomes. Future research should address men's and women's participation in cassava trade and production and their benefits from it more holistically.

EMERGING TRENDS OF FUNDING SOURCES SMES WITH BIBLIOMETRIC ANALYSIS

The difficulty for SMEs is access to capital, which has been persistently tough; nonetheless, a solution is attainable. The paper presents an extensive bibliometric analysis of research trends and thematic development in funding sources for micro, small, and medium enterprises (SMEs), specifically concentrating on the timeframe from 2013 to 2024. It underscores the growing interest in innovative financing mechanisms such as equity crowdfunding, fintech, and digital finance, which are becoming essential for MSME funding. Traditional funding sources like bank loans and venture capital continue to be pertinent. However, there needs to be a discernible transition towards technology-enabled financing. The research highlights SMEs' difficulties in obtaining financing due to rigorous banking criteria, particularly in Indonesia. It proposes new study avenues centered on emergent subjects such as crowdfunding and the interaction between fintech and regulation. The results underscore the necessity for enhanced finance access and support systems to support SME growth and competitiveness.

Autonomous Vehicle Data Protection : A Review of Security Threats, Challenges and Protective Mechanism

The swift advancement of autonomous vehicle (AV) technology has presented notable obstacles with data security and privacy. This analysis examines major security threats that jeopardize user privacy and vehicle control, including data breaches, virus penetration, cyber attacks, illegal access, V2V and V2I system hacking, GPS spoofing, and data leaks. It also looks at the challenges developers have when putting strong security measures in place, considering how complicated AV infrastructures may be and how cloud, IoT, and AI are integrated. The paper outlines a number of defence tactics, such as blockchain technology, machine learning for anomaly detection, encryption, and secure communication protocols. In order to improve AV cyber security, it ends with suggestions for further study in fields like edge computing and quantum-resistant cryptography.

Update on Platelet-Rich Plasma and Platelet-Rich Fibrin for Dermatologic Surgery: Addressing Knowns and Unknowns.

Autologous and allogeneic platelet-rich plasma (PRP) in addition to its derivatives, such as platelet-rich fibrin (PRF), are broadly accepted therapeutic approaches in orthopedics, otolaryngology, sports medicine, plastic surgery, and oral and maxillofacial surgery. However, the absence of expert consensus, standardized protocols, and varying outcomes pose challenges to their broader acceptance in cosmetic dermatology and dermatologic surgery. To offer a contemporary literature overview of PRP and PRF, focusing on fundamental aspects of the technology, diversity of commercially accessible systems, and shed light on present-day controversies within the field. A systemic review of PRP and PRF literature was conducted, utilizing search engine databases: Cochrane Database of Systematic Reviews, Embase, Ovid MEDLINE, and PubMed. Emphasis was placed on scrutinizing higher level-of-evidence articles, specifically randomized control trials, systematic reviews, and meta-analyses (Level 1A-2A), with particular emphasis on recent data that have not been well reviewed in other publications from January 2022 to May 2024. An increasing body of literature affirms advantages of PRP products in dermatology, spanning wound care, facial rejuvenation, scar revision, and hair growth. A foundational understanding of variation in preparation protocol, outcomes, and timing of administration is needed to better comprehend market dynamics, patient demand, and strategies for integrating PRP into dermatologic practice.

Exploring the Feasibility of Opportunistic Diabetic Retinopathy Screening with Handheld Fundus Cameras in Primary Care: Insights from Doctors and Nurses

Aims: This study aims to assess the perspective of doctors and nurses regarding the clinical settings and barriers to implementing opportunistic diabetic retinopathy screening with handheld fundus cameras. Design: This study was a cross-sectional, online questionnaire study. Methods: An online survey was distributed to doctors and nurses working in Portuguese primary care units and hospitals between October and November 2021. The survey assessed current fundus observation practices, potential contexts, and barriers to using handheld fundus cameras. Results: We received 299 eligible responses. About 87% of respondents (n = 255) believe in the clinical utility of handheld fundus cameras to increase patients’ access to diabetes-related retinopathy screening, and 74% (n = 218) attribute utility to identify other eye or systemic diseases. More than a third of participants (37%, n = 111) envisioned using such devices multiple times per week. The main potential barriers identified included limited time (n = 90), equipment cost (n = 48), or the lack of skills in retinal image acquisition (n = 47). Most respondents (94%, n = 275) expected a follow-up recommendation to accompany the telemedicine diagnosis. Conclusions: Doctors and nurses support the use of handheld fundus cameras. However, to optimize their implementation, some strategies should be considered, including training, telemedicine-based diagnosis, and support for follow-up through accessible, user-friendly, and efficient information systems.

The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action

Abstract Background The HEROES (HEalth woRkfOrcE to meet health challengeS) Joint Action aims to advance health workforce planning across the EU, addressing the pressing need for a resilient, sustainable, and accessible health service systems. Given the evident strain on health systems demonstrated during the COVID-19 pandemic, this initiative seeks to address the critical need for strategic HWF planning. Building on previous projects, HEROES will foster the capacity of EU states in workforce planning, preparing the health systems to meet future challenges. Methods The study adopts a collaborative framework involving 19 EU countries, segmented into clusters based on health system characteristics. A stepwise approach (‘AS IS,’ ‘TO BE,’ ‘TO DO’) characterizes the methodology, incorporating extensive data collection, stakeholder engagement, and scenario forecasting. Country-level information on HWF Data and Planning will be compared both across countries in clusters and across clusters. Results Initial findings indicate significant disparities in health workforce data quality, availability, and planning methodologies among the states. Identified methodologies also involve real-world data applications and predictive analytics to refine health workforce planning. Efforts are underway to define an Advanced Minimum Dataset (AMDS) to synchronize health workforce data and define planning tools across the clusters, as country-level AS IS reports have been finalized and cross-country comparisons are ongoing. Conclusions Collaborative, data-driven health workforce planning can significantly enhance health system resilience and responsiveness. Recommended public health actions include enhancing HWF data integration, forecasting capabilities, and stakeholder participation, with the aim of shaping national health policies and practices. The public health impact is profound, as it allows to improve health service delivery and workforce adaptability in response to dynamic health demands. Key messages • The HEROES Joint Action advances EU health workforce planning, with the aim of enhancing the resilience and responsiveness of health systems. • Strategic data-driven approaches in health workforce planning are pivotal for resilient, accessible and sustainable healthcare systems.

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.

Accessibility of digital healthcare in 2023: insights from a Dutch national survey study

Abstract Background Digital technology is reshaping healthcare, offering potential improvements in accessibility, efficiency and quality. However, to realize potential benefits, ensuring equal access for all is crucial. We investigated digital healthcare usage and studied differences in use across age groups and educational backgrounds in the Netherlands. Methods Surveys were conducted among general healthcare users (n = 837, any citizen living in the Netherlands with access to healthcare) and healthcare users with chronic conditions (n = 1437). We studied their digital skills (can you independently use a computer, tablet or smartphone; digital applications; email and apps?) and their use of digital selfcare (did you use websites for health-related information or treatment?). Findings are stratified for educational level (low/medium/high) and age (15 -39, 40-64, over 65 years). Data collection occurred between April and August 2023, focusing on the twelve months preceding the survey. Results The majority of respondents use digital devices independently (range: 78-91%), but these percentages vary between subgroups, from 48-65% for users with lower education vs 86-99% for users with higher education. Similar differences exist across age groups: 98-100% of users aged 15-39 use a computer, tablet or smartphone, in contrast with 59-78% in the over 65 years age group. Similarly, the use of websites for health information is 22-31% among lower educated users to 68-70% among higher educated users; and 36-48% among those ≥65 years to 73-75% among respondents aged 15-39. Conclusions Substantial variation exists in the use of digital tools and digital selfcare across ages and educational levels. These findings underscore the urgency of addressing inequalities in access to digital healthcare, serving as a call to action for policymakers, healthcare providers, and developers to collectively strive for an accessible (digital) healthcare system for all. Key messages • Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation. • Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.

Mindful Transportation: A Conceptual Framework for Enhancing Accessibility for People with Disabilities in Malaysia

This conceptual paper explores the integration of mindfulness principles into the development of transportation services for people with disabilities (PWDs) in Malaysia. Transportation plays a critical role in promoting inclusivity and enhancing the quality of life for PWDs, yet accessibility remains a significant challenge due to infrastructural barriers, lack of awareness, and limited empathy from service providers. Drawing on the concepts of mindfulness, which are rooted in awareness, empathy, and responsiveness, this paper proposes a framework that emphasizes inclusivity, respect, and collaboration among key stakeholders. The proposed framework emphasizes the need for a holistic approach that incorporates physical accessibility, staff training, and policy reforms. Inclusivity involves modifying infrastructure to meet universal design standards, while empathy requires transport providers to understand the unique challenges faced by PWDs and offer compassionate, tailored services. Responsiveness, a key element of mindfulness, calls for flexible and adaptive transport services that cater to the real-time needs of PWDs, ensuring that they can access public transportation with ease and dignity. By applying this mindful approach, the transportation system can become more accommodating and respectful toward PWDs, thereby reducing social exclusion and improving their mobility. This paper contributes to the growing body of literature on disability inclusion and provides actionable strategies for policymakers, transport providers, and disability organizations to work together in creating a more accessible public transportation system. Future research should investigate the practical application of this framework and its potential to drive policy changes that benefit PWDs across Malaysia.

Comparative Bladder Cancer Tissues Prediction Using Vision Transformer.

Bladder cancer, often asymptomatic in the early stages, is a type of cancer where early detection is crucial. Herein, endoscopic images are meticulously evaluated by experts, and sometimes even by different disciplines, to identify tissue types. It is believed that the time spent by experts can be utilized for patient treatment with the creation of a computer-aided decision support system. For this purpose, in this study, it is evaluated that the performances of three models proposed using the bladder tissue dataset. The first model is a convolutional neural network (CNN)-based deep learning (DL) network, and the second is a model named hybrid cnn-machine learning (ML) or DL + ML, which involves classifying deep features obtained from a CNN-based network with ML. The last one, and the one that achieved the best performance metrics, is a vision transformer (ViT) architecture. Furthermore, a graphical user interface (GUI) is provided for an accessible decision support system. As a result, accuracy and F1 score values for DL, DL + ML, and ViT models are 0.9086-0.8971-0.9257 and 0.8884-0.8496-0.8931, respectively.

FEATURES OF THE MODERN HEALTHCARE MANAGEMENT SYSTEM

The article examines different approaches to the essence of the concepts of «management», «health care management», etc., based on which the interpretation of the concept of «health care management» is proposed. Conceptualization of the content of the terms «management» and «administration» is of great importance for the development of the conceptual and categorical apparatus not only of the theory of management and science in general, but also of modern branch theories. The variety of approaches is caused by the conditions of functioning of modern management systems in the field of health care, which is caused by the continuation of the reformation of the management system of the industry, the addition of the legal framework, the search for sources of financing, personnel support, and the development of infrastructure in most modern states. The article analyzes the object and subject of health care management as mandatory components of the structure of the health care system. The content of the main functions and methods of management in the field of health care is revealed. The interrelationship of functions and methods depending on the level of management and the applied model of organization of the health care system is analyzed. It is emphasized that the presence of different types of health care models depends not only on the method of financing and management, but also on the conformity of this model to the cultural, economic and social characteristics of the nation and the state. It is indicated that modern states, which continue the process of reforming the health care sector, can use the best practices of each of the presented models to create an effective and accessible system of medical care, capable of responding to modern challenges, with an effective management system. It has been established that the management system of the health care sector should be based on a number of scientific approaches that will allow taking into account all factors of the internal and external environment. It has been proven that the need to form an optimal management system is an important element of transformational processes in the field of health care. Today, the field of health care should be aimed at developing the capacity of health care institutions to meet the established quality standards, offer a favorable environment for the activities of medical workers, and meet the existing needs of citizens.

Effects of Table Banking on Socio-Economic Empowerment of Households in Turkana County, Kenya.

Table banking is a concept that has gained popularity in the recent past in Kenya. The aim of this type of informal banking is to enhance the socio-economic status of citizens, particularly those from poor areas of the country. However, measuring and tracking changes in the levels of socio-economic empowerment of households through table banking is not well documented, although it is becoming popular, especially among women groups in Kenya. The main objective of this study was to investigate the effects of table banking on the socio-economic empowerment of households in Turkana County, Kenya. The specific objectives were: to establish the effect of table banking financial accessibility, table banking awareness, table banking group participation, table banking group credit risks management strategies on socio-economic empowerment in Turkana County. The study is guided by the theory of change by Loiseau and Walsh 2015, vulnerable group theory of financial inclusion and public good theory of financial inclusion. The study adopted descriptive survey design where questionnaires were used to get primary data. Secondary data was used to validate the primary data collection. The study involved a sample of 398 members drawn using simple random sampling method from a population of 60,500 Table banking members from Kalobeyei ward, Kakuma ward in Turkana West Subcounty in Turkana County. A total of 398 questionnaires were administered with a return rate of 97.0%. The data collected was analysed using descriptive statistics. The study relied on Pearson’s correlation, linear regression and factor analysis to draw inferences from the responses. Statistical analysis was done with the aid of statistical package of social sciences (SPSS) software version 24. The findings of the study revealed a strong, positive and statistically significant relationship between access to finance and socio-economic empowerment of households. The findings of the study also showed a fairly, strong, positive and statistically significant relationship between table banking awareness on socio-economic of households. Besides, the findings revealed a very strong, positive and statistically significant relationship between Table banking and active group participation on socio-economic empowerment of women. The results of the study also revealed a very strong, positive and statistically significant relationship between table banking credit risk management strategies and socio-economic empowerment of women. According to the findings, this study recommends continuous, operative and thorough training of all groups involved in table banking to enhance their capacity in leading the groups and enhancing financial management capability and performance. Additionally, the study recommends creating a functional system for financial access through the use of several financial products at affordable prices, this focuses on government considering increasing the avenues and mechanisms for socioeconomic empowerment of women and special interest groups, especially in the rural areas. As shown in this study, findings provide evidence of active participating of women in the table banking compared to men involvement, based on this it will also be pivotal to further research the basis of men’s involvement in table banking and how affects their contribution to socio -economic empowerment at the household level.

An Animal Ex Vivo Model Comparing Two Different Methods of Sinus Floor Elevation with Great Elevation Heights: Macroscopic, Microscopic and Radiological Analysis

Introduction: Maxillary sinus pneumatization increases with age and tooth loss, leading to a reduction in the maxillary alveolar ridge, which often results in insufficient bone height for the proper placement of dental implants. This study focused on performing maxillary sinus elevations in ex vivo bisected pig heads using novel access and elevation devices, comparing these with the osteotome sinus floor elevation (OSFE) technique. Materials and Methods:An experimental study was conducted using 20 ex vivo adult pig heads. The sinus elevations were divided into two groups: 10 heads were treated using the osteotome technique, and 10 heads were treated using a new device, which consists of a syringe with latex and saline solution, as well as a burr system for membrane access and control. Results: In the osteotome technique, perforations of the Schneiderian membrane were observed, whereas the inflatable balloon device did not cause any lacerations. Conclusions: OSFE resulted in sinus membrane perforations at greater elevation heights, while the new balloon device successfully elevated the membrane without tearing it. Within the limitations of this study, maxillary sinus lifts using the new balloon technique proved to be minimally invasive procedures.