Small Institutions Research Articles

Costing the outpatient rehabilitation services: time-driven activity-based costing approach

BackgroundConsidering the importance of healthcare services costing in resource allocation, the aim of this study is to calculate the cost of rehabilitation services in an outpatient rehabilitation clinic in Tehran, Iran.MethodsThe data for this study were categorised as financial data and information about the process of rehabilitation services. The first category was extracted from the financial documents and the second was obtained by observation of patient flow and interviews with the clinic staff in 2016. The cost of rehabilitation services has been estimated using the time-driven activity-based costing approach.ResultsThe findings show that the cost of physical occupational therapy in the Asma rehabilitation center was $18.79 per unit of service. This amount for speech therapy services was $17.23 to $19.40, taking into account the difference in the quality of the service delivered. The cost of mental health occupational therapy service was between $19.46 and $23.57. Comparing the cost of these services with the government’s tariffs makes it clear that there is a huge gap.ConclusionThe limited number of patients referred to the center makes the cost of one unit of rehabilitation services much higher than the official tariffs. This is true for almost all similar institutions and makes the profitability of small rehabilitation institutions extremely unstable. Therefore, proper marketing for rehabilitation services by promoting patient referral links with larger healthcare centers and reallocation of resources to the formation of integrated rehabilitation complexes can play a significant role in their profitability.

Author Response: Effect of Levetiracetam Use Duration on Overall Survival of Isocitrate Dehydrogenase Wild-Type Glioblastoma in Adults: An Observational Study.

Average leverage is often used as a measure of risk. However, average leverage in a limited liability context should not be computed as a simple arithmetic average of the underlying constituents. In fact, using a simple arithmetic average can give misleading results. For example, the simple arithmetic average leverage may give results which run counter to the actual risk exposure for certain portfolios. This article introduces a new measure, Limited Liability Leverage (<i>L</i>³), which corrects the simple average for the limited liability framework. This new measure is discussed in the context of a portfolio of hedge funds and compared to a multi-strategy hedge fund structure, where trading units do not have limited liability. This perspective can also be extended to reflect the lower risk of a financial system with many small institutions relative to a system with large, “too-big-to-fail” institutions. <b>TOPICS:</b>Real assets/alternative investments/private equity, legal/regulatory/public policy, risk management, portfolio construction

The Medical Metropolis: Health Care and Economic Transformation in Pittsburgh and Houston

The Medical Metropolis: Health Care and Economic Transformation in Pittsburgh and Houston

Pandemic Scholars Circle: Deepening Community during Isolation

Pandemic Scholars Circle: Deepening Community during Isolation

What Makes Small Industries Apply for Loan?

Banking sectors have allocated funds for micro and small-scale enterprises’ financing needs. However, the absorption of this fund is still considered low, particularly among the micro- and smallscale processing industries. The present study hence applied the multinomial logistic regression to understand the small industries’ loan decisions. The data were obtained from the 2019 Micro and Small Industry Survey and Financial Institution Statistics. It was found that income and profit did not exhibit a significant effect in both models and regions. However, the interest rate was found to have a positive effect in both models and regions, contradicting the Loanable Fund Theory. Collateral exhibited a positive effect in each region only in the first model. Meanwhile, other variables like age, financial record, business course, cooperative membership, business assistance (i.e., cooperative, noncooperative, and subsidized credit), internet access, and partnership exhibited different effects on small industries’ loan decisions in each model and region.

Are European commercial banks more profitable than cooperative banks? Evidence from a low interest rate environment

AbstractOur aim is to compare empirically the profitability of European cooperative and commercial banks in a low interest rate environment. We employ dynamic panel data methods on a data set of nearly 1000 banks from 11 European countries where both ownership structures compete on the same market. We observed different banking strategies during the 2009–2015 period, when market interest rates reached an all‐time low. Our analysis produced four main conclusions. First, we find that commercial banks maintain superior profitability over cooperative banks in an environment of low interest rates. Second, commercial banks unjustifiably decreased their loan loss provisioning in a low interest rate environment in order to maintain their profitability. This trend is not present in cooperative banks. Third, decreased provisioning is present mainly in smaller institutions. Fourth, cooperative banks are significantly more stable than commercial banks in terms of their Z‐score in a low interest rate environment. This finding is in line with existing findings during normal interest rates. In addition, the Z‐score of cooperative banks increased during the observation period, whereas the Z‐score of commercial banks remained stable. Our findings survive a battery of robustness checks. Our results also show differences in the strategies and priorities of both competing ownership types in a low interest rate environment: commercial banks focus on maintaining their profitability by decreasing loan loss provisions, whereas cooperative banks seek to increase their stability. Therefore, regulators pursuing stability in a low interest rate environment should focus on the credit risk management of small commercial banks.

Short Training Significantly Improves Ganglion Cell Detection Using an Algorithm-Assisted Approach.

Medical education in pathology relies on the accumulation of experience gained through inspection of numerous samples from each entity. Acquiring sufficient teaching material for rare diseases, such as Hirschsprung disease (HSCR), may be difficult, especially in smaller institutes. The current study makes use of a previously developed decision support system using a decision support algorithm meant to aid pathologists in the diagnosis of HSCR. To assess the effect of a short training session on algorithm-assisted HSCR diagnosis. Five pathologists reviewed a data set of 568 image sets (1704 images in total) selected from 50 cases by the decision support algorithm and were tasked with scoring the images for the presence or absence of ganglion cells. The task was repeated a total of 3 times. Each pathologist had to complete a short educational presentation between the second and third iterations. The training resulted in a significantly increased rate of correct diagnoses (true positive/negative) and a decreased need for referrals for expert consultation. No statistically significant changes in the rate of false positives/negatives were detected. A very short (<10 minutes) training session can greatly improve the pathologist's performance in the algorithm-assisted diagnosis of HSCR. The same approach may be feasible in training for the diagnosis of other rare diseases.

#31 Bloodstream Infections and Microbiology during Induction Chemotherapy over a Decade at a Community Pediatric Cancer Center

Abstract Background Bloodstream infections (BSIs) remain a significant cause of morbidity and mortality in children with leukemia. They are at an increased risk of infectious complications secondary to intense chemotherapeutic regimens during induction resulting in prolonged and profound neutropenia. To our knowledge, there is limited literature regarding pathogens and antibiotic resistance from smaller institutions similar to ours. The primary objective of this review was to describe the microbiology of BSIs, and second to evaluate our rates of BSIs during induction chemotherapy as compared to larger institutions. Method Retrospective chart review of 82 eligible patients between the age of 1 and 21 years with newly diagnosed leukemia between May 1, 2010 and May 31, 2020. Patients who did not complete the entirety of induction chemotherapy at our hospital were excluded. A microbiologically documented infection was defined as a causative pathogen isolated from the blood in the setting of fever and/or neutropenia. Neutropenia was defined as an absolute neutrophil count (ANC) of less than 0.5x109 cells/L. Results Of the 82 patients, 12 (14.6%) patients had a BSI during induction chemotherapy. The most common organisms identified were Gram-positive cocci (75%), Gram-negative bacilli (16.6%), and Gram-negative cocci (8.3%). Methicillin-susceptible Staphylococcus aureus (MSSA) was the most frequently isolated organism (42%) overall. No methicillin-resistant Staphylococcus aureus (MRSA) was identified. Of the Gram-negative bacteria isolated, Escherichia coli (8%) and Pseudomonas aeruginosa (8%) were identified. No extended spectrum beta-lactamase (ESBL) or multi-drug resistant organisms were identified. No fungi were isolated. Conclusion The incidence of BSIs in children during induction chemotherapy at our institution is similar to what is reported from larger, academic centers. Gram-positive cocci comprise 75% of BSIs with no MRSA isolates in 10 years. Our antibiogram shows no resistant Gram-negative bacteria. This is in contrast to what is reported to larger pediatric cancer centers. Therefore, current empiric monotherapy with a fourth generation cephalosporin at the onset of febrile neutropenia remains adequate for our pediatric oncology patients.

Pre-Marriage Course Based on Religious Moderation in Sadd Al-Żarī'ah Perspective

This study intends to investigate pre-marital course practices based on religious moderation as an effort to oppose extremism. This is founded on the concept that the family is the smallest institution in a country, so it is very vital to develop a balanced attitude. The Ministry of Religious Affairs as the spearhead of this strategy has its own purpose in fulfilling this policy. One of the goals is how to genuinely avoid mafsadat early on. The concept of averting this mafsadat in the study of ushul fiqh and fiqh (Islamic law) is known as the sadd al-żarī'ah approach. This study is a literature review based on primary data from rules addressing the implementation of pre-marital courses. Meanwhile, secondary data were obtained from studies linked to the issue of this study. The content analysis method is used to derive findings. The findings in this study indicate that a pre-marital course focused on religious moderation as an effort to fight radicalism is a course model that provides training for future married couples to be moderate. Meanwhile, in the sadd al-żarī’ahperspective, a pre-marital course focused on religious moderation is a measure to prevent mafsadat.

Raspberry Pi based Smart Classroom Architecture with Local Network

Classrooms are important building blocks of a school campus. Therefore, a feasible architecture for building and running smart classrooms is essential. Today all online education system is based on the browser/server structure or client/server structure and for this system required the computer to every student. As the number of student increases cost of education also increases. In small schools and institutes could not able to afford a computer to every student. Instead, we aim to design an embedded device with only one master computer and number of slave units. Raspberry Pi has the capability of being configured as an access point and as a web server, so it can be used for creating applications reachable from mobile devices without needing an Internet connection. The proposal is based on the possibility for students to Answer questionnaires from their mobile devices. The teacher can observe answers in real time. This solution adds dynamism integrating the existing mobile devices in the classroom. It eliminates the use of computers or laptops to each student which reduces size and cost of the project. Programming language used in this project would be HTML alongwith Python, Operating System will be Raspbian and Questionnaire Software will be Node-Red. This paper explains the proposal features in terms of used hardware and software, as well as the functional tests performed and their implementation allowing replication.

Peran Keluarga dalam Mewujudkan Takaful Ijtima’i (Studi Kajian Hukum Keluarga dan Ekonomi Islam)

as the smallest institution in society, the family has the potential for enormous influence on common prosperity. This is closely related to the function of the family as a container for the formation of quality human resources. If accordingly mentioned, then for the first step, every family must pay attention to the welfare of their own families afterwards to take a pay attention to other families in the surrounding environment. This attention is none other than the form of mu’amalah which is based on a sense of mutual assistance. Therefore, it is only natural that all components of society are obliged to build the welfare of their respective families. This is implemented in order to create a social balance in the form of welfare. Focus point in this study of the writer lies on the role of the family to realize the balance of welfare, especially in the economic field, through the concept of takaful. This research was conducted using qualitative-descriptive methods that contain primary and secondary data about family welfare and takaful which can be applied as a whole to the community sector. theory development in this study uses the theory of construction where the role of the deconstruction of family welfare can realize takaful ijtima’i.

Construction of a Research Requirement Participant Pool Using Open-Source Software

Introduction Recruiting undergraduate students to participate in research has long been an established practice within psychology. Although this data source has weaknesses, this involvement in the research process has considerable pedagogical value in teaching students research methodology. Statement of the Problem Most common software packages used to manage participant pools tend to be expensive, to the extent that it prohibits access for small institutions and departments. Literature Review Highlighting the problem, we cite research related to using undergraduates as participants, pedagogical value of these experiences, and current trends in software distribution. We then provide evidence of successful implementation of open-source software (OSS) in educational settings, and conclude with OSS options capable of addressing the problem of access. Teaching Implications By providing students research experiences, both as a researcher and as a participant, we enhance their understanding of this process. Secondary to this, we can foster within them a skill set that is valuable to disciplines outside of academia. Conclusion The implementation of an OSS system to manage research participants provides a cost-effective means to expand the learning and research opportunities of available to students.

Effectiveness of Microfinance in Poverty Alleviation and Entrepreneurship Opportunities

Poverty continues to affect billions of lives worldwide. Microfinance is one of the many tools that strive to end poverty. In particular, microfinance meets the poor need for financial services. The poor have traditionally been excluded from legitimate financial services, but with new financial products, such as group lending, small financial institutions have been able to meet the challenges of lending to the poor. Today micro finance plays a key role in the financial market. The study focuses on the success of small investments in the fight against poverty and entrepreneurial opportunities. This study was made up of baseline data with a sample size of 110 small-scale users selected in a simple random random sample. The study was conducted at ESAF Small Finance Bank in the Trissur region. Identifying awareness of microfinance and its services among its customers. Identifying challenges in obtaining microfinance. Evaluating the effectiveness of small incomes in the fight against poverty Identifying the effectiveness of small incomes in business opportunities. Mathematical tools used in this data collection to analyze simple percentages, Chi-square and ANOVA. The findings of this study revealed the popularity of small amounts of money for its customers and most of the women borrowed from microfinance. Awareness among customers about microfinance and ESAF is very high.

Faculty Awareness and Use of an Institutional Repository at a Master’s Granting University

Introduction: Assessment plays a significant role in managing a successful institutional repository (IR). This study combined the results of a faculty survey that measured faculty awareness of and participation in the IR of a single, state masters-granting institution with information regarding content type and downloads to draw conclusions regarding the composition and usage of the IR at this institution. Method: A survey was sent to 856 faculty members at Fort Hays State University (FHSU) that asked questions regarding awareness of the IR and participation in the IR demonstrated through deposit and access of materials. Statistics regarding content type and full-text downloads were collected from the repository platform. Collected data were compared with previous studies at other similar institutions to determine similitude or difference between this IR and other IRs at masters and baccalaureate institutions. Results &amp;amp; Discussion: Faculty awareness of and participation in the IR at FHSU is higher than that of other institutions, as shown in previous surveys, even though overall faculty participation remains low. The content of the IR is largely consistent with other similar institutions. Conclusion: The faculty survey combined with information regarding repository usage demonstrates that the FHSU Scholars Repository serves a different purpose for both faculty and users than designers envisioned. Efforts to force the IR to resemble that of a research institution may be misplaced. Further research on the content makeup of IRs at masters and baccalaureate institutions is needed to establish commonalities among smaller institutions.

Student Counseling Centers in Europe: A Retrospective Analysis.

ObjectiveTertiary education can be stressful for many young people, who consistently report high levels of distress. The issue has major implications for campus health services and mental health policymaking more widely. The present study proposes to map student counseling services in Europe.MethodsThe sample of institutions was sourced, using standardized data extraction, from the European Tertiary Education Register (ETER). Then, each institution’s website was analyzed for information about the availability of student counseling centers and the services provided. Data extracted from the ETER database were: ETER ID, national identifier, institution name, English institution name, number of students, legal status (in English), institution category (in English), and institutional website. Data extracted from institutions’ websites concerned the availability of students’ psychological centers and the services provided. Analyses were carried out using the SPSS Statistics software package (IBM Corp., Armonk, NY, United States), version 26.ResultsOverall, it was found that most institutions do not provide mental health counseling services for their students. Institutions of medium dimensions showed a higher probability of reporting students’ psychological centers than small institutions. Moreover, private institutions and public institutions were more likely to report having such centers, while private government-dependent institutions were less likely. Universities of applied sciences and universities were more likely to report having them, while other institutions were less likely. Regarding provision according to geographic area, compared to Northern Europe, every other European region was less likely to report featuring such centers. Most institutions reported offering counseling, career counseling, or not otherwise specified psychological services, but only a small number reported providing services such as psychotherapy, psychiatric services, or counseling for learning-specific disabilities.ConclusionIt is critically important to catalog European data on student counseling centers and services, to encourage tertiary education institutions to invest in such services as key sites for mental health promotion. Indeed, professionally trained staff and the possibility of long-term treatment options would go a long way in supporting students who might not otherwise have access to treatment.

Sara Kidina in Buton: The Perspective of History, Culture and Quality of Life

This article aimed to explain the existence of ‘Sara Kidina’, a traditional institution that has survived to this day in Buton. Sara Kidina means a government or small institution that deals with legal and religious issues. This study used a descriptive qualitative model. Data were collected through a literature search and in-depth interviews with key informants. According to the results, the Sara Kidina institution has survived for approximately 423 years. Since its formation during the reign of the fourth Sultan of Buton, DayanuIkhsanuddin, Sara Kidina’s duties and functions have not significantly changed, even though the Buton sultanate system has ended. Sara Kidina functions to take care of the Butonese people, both now and in the hereafter. In carrying out these customary, legal and religious processions, Sara Kidina has an organizational structure with assigned duties. During the Sultanate of Buton, four Bhisa were included in the Sara Kidina structure because of their extensive knowledge of legal, religious and mysticism issues. At present, Sara Kidina is still functioning well in serving the needs of the community. This shows the strong influence of these institutions in the social and cultural life of the Butonese people. Therefore, government policy alignments are expected to support the existence of the Sara Kidina institution.&#x0D; Keywords: institutional existence, Sara Kidina, History, Buton culture, quality of life

A Faculty-Led, Community-Building Program That Enhances Student-Faculty Connections within Biology.

ABSTRACTConnections between students and faculty on campus may influence students’ sense of belonging, and a greater sense of belonging has a positive effect on student success. We developed a low-cost, faculty-led program of community-building events and implemented the program in the biology department at a small liberal-arts institution with the goal of improving students’ sense of community. Student responses to surveys indicated that the majority of students felt connected to faculty and students in the department; however, Black or African American students initially felt a lower level of connection to faculty than did white students. After implementing our series of community-building events, students surveyed reported high levels of satisfaction with the events. Furthermore, there was a trend toward a higher percentage of Black or African American students than white students reporting that they were more likely to reach out to faculty after participating in the community-building events. Thus, our low-cost program improved connections between students and faculty in the biology department. Collectively, our results suggest that academic departments can implement community-building programs to improve students’ sense of belonging.

Out of Their Shells: Digitisation of Endangered Diversity in Orphaned Collections Spurs Access and Discovery

AbstractNatural history collections assembled before modern‐day, anthropogenic declines in species occurrence and abundance can provide essential data for conservation and biogeographic research. Digitizing old, commonly ‘orphaned’ collections in small institutions without professional curators increases local community access to specimens, as well as global access to digitized data. We present a case study, documenting a 19th century freshwater mussel (Order: Unionoida) collection, which is part of the 'orphaned' natural history collections at Wesleyan University (Middletown, CT, USA). We curated this collection by identifying specimens according to present taxonomic practices, and using archival documents to recover metadata. Nearly 1900 specimens in 402 ‘lots’, representing 155 species, were photographed and catalogued. Three primary type specimens were identified; 64 species are on the IUCN Red List, with 4 extinct, and 28 Critically‐Endangered to Endangered. We created and publicly host online 3D models of imperiled species. These models enabled us to organize an exhibit of 3D prints of fragile specimens, and to study ecophenotypic variation of freshwater mussels along a river gradient. Our project documents the challenges and achievements of a case study illuminating the potential scientific value of, and revival strategies for, orphaned natural history collections.

Complications of Intraoperative ECMO During Lung Transplantation

<h3>Purpose</h3> Routine intraoperative (IO) ECMO has been proposed as the preferred strategy for lung transplantation (LTX). We reviewed the clinical outcomes and complications of patients who underwent LTX with IO ECMO support at a low-volume center. <h3>Methods</h3> All consecutive patients who underwent LTX between 2008 and 2020 were included in the study. Demographics, the type and duration of supports, and patient outcomes were retrospectively reviewed. Uni-and multivariate analysis was performed as appropriate. <h3>Results</h3> Out of 201 lung transplants, 95 (47.2%) were performed on intraoperative support, of which 55 (27,3%) with IO ECMO. The indications for support were switch from preoperative in 28 cases (50.9%) and IO respiratory or hemodynamic instability in 24 (43.6%). The predominant baseline disease was IPF (45.4%). IO support was VA in 41 (74,5%), VV in 13 (23.6%), VAV in 1 (1.8%). ECMO configuration was peripheral in 49 cases (89%). Most supports were placed with a cut-down approach (69.1%). The average duration of support was 472 min±32,2. In 23 patients (41.8%) the IO support was extended postoperatively. The median ICU and hospital LOS were 12 (2-137) and 42 days (2-204) respectively and were significantly longer compared to patients who did not receive IO support. At least one complication occurred in 22 patients (40%), while 7 (10.9%) had more than one. The most frequent complications were postoperative hemothorax (23%), limb ischemia (9%), lymphocele (5.1%), IO harlequin syndrome (3.6%). Complications required surgical revision in 79.3% of cases. 1-yr (77.1% vs 83.3%) but not 5-yr (66.9% vs 70.1%) Kaplan-Meier survival of patients supported with IO ECMO was less favourable compared to non-supported patients, with borderline statistical significance (p=0.05%). On univariate analysis, no pre-operative or IO parameter was significantly associated with the development of complications. On multivariate analysis, the development of at least one complication was significantly associated with hospital stay (p=003), ICU stay (=.0002), duration of postoperative intubation (p=0.03). <h3>Conclusion</h3> IO ECMO during LTX has a relevant impact on the development of early complications after LTX at a small volume Institution, increases the length of intubation and hospital stay, and decreases 1-yr survival. These results may support the local policy to attempt transplantation off support if tolerated.

Time of transformation: Research, resources, and access at SALT

This article evaluates the transformation of a library in a small contemporary art institution into a large-scale organization, providing the essential infrastructure for research in Istanbul, Turkey, from 2001 onwards. It explains how Platform Garanti Contemporary Art Center's (2001-2010) library and archive collection were established and became part of SALT Research with other cultural entities in 2011. Focusing on the motivations behind SALT's founding, the article discusses the formation of SALT Research, which comprises a library, archive and learning platform. It presents the changing positions of the institution regarding developing library tools, user needs, and the pandemic.