Search results for: legal and finance staff

Authors: Mark Jackson

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Description: This paper is based on an theoretical analysis of the efficacy of the dominant model of policing in western jurisdictions. Those results are then compared with a similar analysis of a traditional reactive model. It is found that neither model provides for optimal delivery of services. Instead optimal service can be achieved by a synchronous hybrid model, termed the Convectory Policing approach. Methodology and Findings: For over three decades problem oriented policing (PO) has been the dominant model for western police agencies. Initially based on the work of Goldstein during the 1970s the problem oriented framework has spawned endless variants and approaches, most of which embrace a problem solving rather than a reactive approach to policing. This has included the Area Policing Concept (APC) applied in many smaller jurisdictions in the USA, the Scaled Response Policing Model (SRPM) currently under trial in Western Australia and the Proactive Pre-Response Approach (PPRA) which has also seen some success. All of these, in some way or another, are largely based on a model that eschews a traditional reactive model of policing. Convectory Policing (CP) is an alternative model which challenges the underpinning assumptions which have seen proliferation of the PO approach in the last three decades and commences by questioning the economics on which PO is based. It is argued that in essence, the PO relies on an unstated, and often unrecognised assumption that resources will be available to meet demand for policing services, while at the same time maintaining the capacity to deploy staff to develop solutions to the problems which were ultimately manifested in those same calls for service. The CP model relies on the observations from a numerous western jurisdictions to challenge the validity of that underpinning assumption, particularly in fiscally tight environment. In deploying staff to pursue and develop solutions to underpinning problems, there is clearly an opportunity cost. Those same staff cannot be allocated to alternative duties while engaged in a problem solution role. At the same time, resources in use responding to calls for service are unavailable, while committed to that role, to pursue solutions to the problems giving rise to those same calls for service. The two approaches, reactive and PO are therefore dichotomous. One cannot be optimised while the other is being pursued. Convectory Policing is a pragmatic response to the schism between the competing traditional and contemporary models. If it is not possible to serve either model with any real rigour, it becomes necessary to taper an approach to deliver specific outcomes against which success or otherwise might be measured. CP proposes that a structured roster-driven approach to calls for service, combined with the application of what is termed a resource-effect response capacity has the potential to resolve the inherent conflict between traditional and models of policing and the expectations of the community in terms of community policing based problem solving models.

Keywords: policing, reactive, proactive, models, efficacy

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Authors: Aman Guru, Chiron Singhi

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The Earth’s climate is being changed at an unrivalled rate since beginning of the evolution of the Earth, 4–5 billion years back, but presently it gained pace due to unintentional anthropogenic disturbances and also increased global warming since the mid-20th century, and these incessant changes in the climatic pattern may bring unpropitious effect on global health and security. Today, however, it is not only the air, or water that are polluted, but the whole atmosphere is prone to pollution and this resulted in other cascading ramification in the form of change in the pattern of rainfall, melting of ice, the rise in the sea level etc. Human activities like production, transport, burning of fuels are adding umpteen dangerous pollutants to the atmosphere which in turn gives rise to global warming. Agriculture plays an imperative part in India's economy. Agriculture, along with fisheries and forestry, is one of the largest contributors to the Gross Domestic Product in India. Research on the effect of climate change and vulnerability of agriculture is a high need in India. A steady increase of CO2 is a primary cause of climate change and global warming and which in turn have a great impact on Indian agriculture. The research focuses on the effect of climate change on Indian agriculture and the proceedings and legal control of legislative measures on such issues and the ways to implement such laws which can help to provide a solution to these problems which can prove beneficial to Indian farmers and their agricultural produce.

Keywords: agriculture, climate change, global warming, India laws, legislative measures

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Authors: Francis Jegede

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This paper examines essential issues relating to the rise and nature of violent extremism involving non-state actors and groups in the early 21^st century. The global trends in terrorism and violent extremism are examined in relation to Western governments’ counter terror operations. The paper analyses the existing legal framework for fighting violent extremism and terrorism and highlights the inherent limitations of the current International Law of War in dealing with the growing challenges posed by terrorists and violent extremist groups. The paper discusses how terrorist groups use civilians, women and children as tools and weapon of war to fuel their campaign of terror and suggests ways in which the international community could deal with the challenge of fighting terrorist groups without putting civilians, women and children in harm way. The paper emphasises the need to uphold human rights values and respect for the law of war in our response to global terrorism. The paper poses the question as to whether the current legal framework for dealing with terrorist groups is sufficient without contravening the essential provisions and ethos of the International Law of War and Human Rights. While the paper explains how terrorist groups flagrantly disregard the rule of law and disrespect human rights in their campaign of terror, it also notes instances in which the current Western strategy in fighting terrorism may be viewed or considered as conflicting with human rights and international law.

Keywords: terrorism, law of war, international law, violent extremism

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Authors: Wilfred Emmannuel Dzasu, Sani Usman Kunya, Inuwa Yusuf Mohammed, Moses Jonathan Gambo

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The research aimed at investigating and identifying the strategies for enhancing access to microfinance for housing provision in the informal sector of North East Nigeria, with a focus on addressing the critical issue of housing poverty and lack of access to affordable housing finance among low-income households in the informal sector. The study employed an exploratory sequential mixed method design, combining both qualitative and quantitative data collection and analysis techniques. In the qualitative phase, 12 participants from microfinance institutions (MFIs) in four selected states (Adamawa, Bauchi, Gombe, and Taraba) were interviewed. The interviews were conducted using an interview guide with open-ended questions and were recorded with the consent of the respondents. In the quantitative phase, a survey strategy was adopted to collect data from 500 questionnaires distributed to informal sector workers (ISWs) in the study area. A total of 350 questionnaires were returned, representing a 70.0% response rate. The most preferred strategy for improving access to housing microfinance among ISWs is aggressive awareness of housing financing options by MFIs, with a mean score of 4.213; the most important strategy for improving access to housing microfinance among MFIs is close monitoring and adequate supervision of housing loan beneficiaries by MFIs, with a mean score of 4.675. The study identified several government-related strategies that are necessary for enhancing access to housing microfinance, including the provision of grants and subsidized intervention funds for housing, improvement in infrastructures to aid housing developments, and adequate measures for checking inflation/price fluctuation of building materials. The study also identified several MFI-related strategies that are necessary for enhancing access to housing microfinance, including deliberate expansion in the capital bases of MFIs, adequate training and capacity development of MFIs staff on relevant skills in housing micro-financing, and introduction of loan products that suit the incremental building needs of informal sector workers. Overall, the study highlights the need for a combination of government-related and MFI-related strategies to enhance access to microfinance for housing provision in the informal sector of North East Nigeria.

Keywords: finanace, microfinance, housing, North East Nigeria

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Authors: Magda Olesiuk-Okomska

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Although international criminal law has grown significantly in the last decades, it still remains fragmented and lacks doctrinal cohesiveness. Its concept is described in the doctrine as highly disputable. There is no concrete definition of the term. In the domestic doctrine, the problem of criminal law issues that arise in the international setting, and international issues that arise within the national criminal law, is underdeveloped both theoretically and practically. To the best of author’s knowledge, there are no studies describing international aspects of criminal law in a comprehensive manner, taking a more expansive view of the subject. This paper presents results of a part of the doctoral research, undertaking a theoretical framework of the international criminal law. It aims at sorting out the existing terminology on international aspects of criminal law. It demonstrates differences between the notions of international criminal law, criminal law international and law international criminal. It confronts the notion of criminal law with related disciplines and shows their interplay. It specifies the scope of international criminal law. It diagnoses the current legal framework of international aspects of criminal law, referring to both criminal law issues that arise in the international setting, and international issues that arise in the context of national criminal law. Finally, de lege lata postulates were formulated and direction of changes in international criminal law was proposed. The adopted research hypothesis assumed that the notion of international criminal law was inconsistent, not understood uniformly, and there was no conformity as to its place within the system of law, objective and subjective scopes, while the domestic doctrine did not correspond with international standards and differed from the worldwide doctrine. Implemented research methods included inter alia a dogmatic and legal method, an analytical method, a comparative method, as well as desk research.

Keywords: criminal law, international crimes, international criminal law, international law

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Authors: Juliette MacDonald, Jun Li, Wenji Xiang, Mingwei Zhao

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Shanghai International College of Fashion and Innovation (SCF) was created as a result of a collaborative partnership agreement between the University of Edinburgh and Donghua University. The College provides two programmes: Fashion Innovation and Fashion Interior Design and the overarching curriculum has the intention of developing innovation and creativity within an international learning, teaching, knowledge exchange and research context. The research problem presented here focuses on the multi-national/cultural faculty in the team, the challenges arising from difficulties in communication and the associated limitations of management frameworks. The teaching faculty at SCF are drawn from China, Finland, Korea, Singapore and the UK with input from Flying Faculty from Fashion and Interior Design, Edinburgh College of Art (ECA), for 5 weeks each semester. Rather than fully replicating the administrative and pedagogical style of one or other of the institutions within this joint partnership the aim from the outset was to create a third way which acknowledges the quality assurance requirements of both Donghua and Edinburgh, the academic and technical needs of the students and provides relevant development and support for all the SCF-based staff and Flying Academics. It has been well acknowledged by those who are involved in teaching across cultures that there is often a culture shock associated with transnational education but that the experience of being involved in the delivery of a curriculum at a Joint Institution can also be very rewarding for staff and students. It became clear at SCF that if a third way might be achieved which encourages innovative approaches to fashion education whilst balancing the expectations of Chinese and western concepts of education and the aims of two institutions, then it was going to be necessary to construct a framework which developed close working relationships for the entire teaching team, so not only between academics and students but also between technicians and administrators at ECA and SCF. The attempts at co-construction and integration are built on the sharing of cultural and educational experiences and knowledge as well as provision of opportunities for reflection on the pedagogical purpose of the curriculum and its delivery. Methods on evaluating the effectiveness of these aims include a series of surveys and interviews and analysis of data drawn from teaching projects delivered to the students along with graduate successes from the last five years, since SCF first opened its doors. This paper will provide examples of best practice developed by SCF which have helped guide the faculty and embed common core values and aims of co-construction regulations and management, whilst building a pro-active TNE (Trans-National Education) team which enhances the learning experience for staff and students alike.

Keywords: cultural co-construction, educational team management, multi-cultural challenges, TNE integration for teaching teams

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Authors: Deike Janssen

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In the scenery of the Tyrolean mountains, at an altitude of 1300 meters, stands a building. Residents and activists call it a prison. However, it is not a prison -according to authorities, it is a 'Return Counseling Facility' where migrants and refugees should be "motivated" to return "voluntary" to their countries of origin. This paper argues that the geographical location of the camp functions as a site of exclusion, isolation, and coercion where no one can decide “voluntary” to return, but where people are brought to despair to leave Austria. Through a qualitative case study, this paper documents the heavy impact of offshore detention on the mental, physical and social state of the residents and a variety of human rights problems in the centre. Different developments at the Return Counselling Facility and the law that back up the centre uncover a worrying dynamic that deliberately accepts human rights problems in order to enforce borders, a policy that disregards humanitarian, legal, and ethical stands in order to deport people at all hazards. It, therefore, can be seen as a creative and ultimate exercise of state power, which uses isolated locations to control migration. While the analysis revises the micro and macro implications of the facility and, therefore, the legal and political facets, it also sheds light on the role of the civil society, which tries to increase through constant and collective efforts the human rights efforts of the government.

Keywords: deportation, human rights, migration, refugee detention, voluntary return

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Authors: Jawaad Saleem, Hannah Wright, Peter Sommerville, Adrian Hopper

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Introduction: Inpatient falls are the most commonly reported patient safety incidents, and carry a significant burden on resources, morbidity, and mortality. Ensuring adequate post falls management of patients by staff is therefore paramount to maintaining patient safety especially in out of hours and resource stretched settings. Aims: This quality improvement project aims to improve the current practice of falls management at Guys St Thomas Hospital, London as compared to our 2016 Quality Improvement Project findings. Furthermore, it looks to increase current junior doctors confidence in managing falls and their use of new guidance protocols. Methods: Multifaceted Interventions implemented included: the development of new trust wide guidelines detailing management pathways for patients post falls, available for intranet access. Furthermore, the production of 2000 lanyard cards distributed amongst junior doctors and staff which summarised these guidelines. Additionally, a ‘safety signal’ email was sent from the Trust chief medical officer to all staff raising awareness of falls and the guidelines. Formal falls teaching was also implemented for new doctors at induction. Using an established incident database, 189 consecutive falls in 2017were retrospectively analysed electronically to assess and compared to the variables measured in 2016 post interventions. A separate serious incident database was used to analyse 50 falls from May 2015 to March 2018 to ascertain the statistical significance of the impact of our interventions on serious incidents. A similar questionnaire for the 2017 cohort of foundation year one (FY1) doctors was performed and compared to 2016 results. Results: Questionnaire data demonstrated improved awareness and utility of guidelines and increased confidence as well as an increase in training. 97% of FY1 trainees felt that the interventions had increased their awareness of the impact of falls on patients in the trust. Data from the incident database demonstrated the time to review patients post fall had decreased from an average of 130 to 86 minutes. Improvement was also demonstrated in the reduced time to order and schedule X-ray and CT imaging, 3 and 5 hours respectively. Data from the serious incident database show that ‘the time from fall until harm was detected’ was statistically significantly lower (P = 0.044) post intervention. We also showed the incidence of significant delays in detecting harm ( > 10 hours) reduced post intervention. Conclusions: Our interventions have helped to significantly reduce the average time to assess, order and schedule appropriate imaging post falls. Delays of over ten hours to detect serious injuries after falls were commonplace; since the intervention, their frequency has markedly reduced. We suggest this will lead to identifying patient harm sooner, reduced clinical incidents relating to falls and thus improve overall patient safety. Our interventions have also helped increase clinical staff confidence, management, and awareness of falls in the trust. Next steps include expanding teaching sessions, improving multidisciplinary team involvement to aid this improvement.

Keywords: patient safety, quality improvement, serious incidents, falls, clinical care

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospitals Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre-EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors which are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality and the data were analysed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system which can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analysed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospitals staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: communication, emergency communication services, emergency medical teams, emergency physicians, emergency nursing, paramedics, information and communication technology, communication systems

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Authors: Mahmoud Meckawey

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This research is dealing with one of the most important aspects of maintenance fields, that is Maintenance Strategy. It's the branch which concerns the concepts and the schematic thoughts in how to manage maintenance and how to deal with the defects in the engineering products (buildings, machines, etc.) in general. Through the papers we will act with the followings: i) The Engineering Product & the Technical Systems: When we act with the maintenance process, in a strategic view, we act with an (engineering product) which consists of multi integrated systems. In fact, there is no engineering product with only one system. We will discuss and explain this topic, through which we will derivate a developed definition for the maintenance process. ii) The factors or basis of the functionality efficiency: That is the main factors affect the functional efficiency of the systems and the engineering products, then by this way we can give a technical definition of defects and how they occur. iii) The legality of occurrence of defects (Legal defects and Illegal defects): with which we assume that all the factors of the functionality efficiency been applied, and then we will discuss the results. iv) The Guarantee, the Functional Span Age and the Technical surplus concepts: In the complementation with the above topic, and associated with the Reliability theorems, where we act with the Probability of Failure state, with which we almost interest with the design stages, that is to check and adapt the design of the elements. But in Maintainability we act in a different way as we act with the actual state of the systems. So, we act with the rest of the story that means we have to act with the complementary part of the probability of failure term which refers to the actual surplus of the functionality for the systems.

Keywords: engineering product and technical systems, functional span age, legal and illegal defects, technical and functional surplus

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Authors: Oljana Hoxhaj

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The integration process of Albania into the European family carries many difficulties. In this context, the Albanian legislator is inclined to implement in the domestic legal framework models which have been successful in other countries. Our paper aims to present an analytical and comparative approach to the health system in Albania and France, mainly focusing on citizen’s access to these services. Different standards and cultures between states, in the context of an approximate model, will be the first challenge of our paper. Over the last few years, the Albanian government has undertaken concrete reforms in this sector, aiming to transform the vision on which the previous health system was structured. In this perspective, the state fulfills not only an obligation to its citizens, but also consolidates progressive steps toward alignment with European Union standards. The necessity to undertake a genuine reform in this area has come as an exigency of society, which has permanently identified problems within this sector, considering it ineffective, out of standards, and corrupt. The inclusion of health services on the Albanian government agenda reflects its will in the function of good governance, transparency, and broadening access to the provision of quality health services in the public and private sectors. The success of any initiative in the health system consists of giving priority to patient needs. Another objective that should be in the state's consideration is to create the premise to provide a comprehensive process on whose foundations partnership and broader co-operation with beneficiary entities are established in any decision-making that is directly related to their interests. Some other important and widespread impacts on the effective realization of citizens' access to the healthcare system coincide with the construction of appropriate infrastructure, increasing the professionalism and qualification of medical staff, and the allocation of a higher budget. France has one of the most effective healthcare models in Europe. That is why we have chosen to analyze this country, aiming to highlight the advantages of this system, as well as the commitment of the French state to drafting effective health policies. In the framework of the process of harmonization of the Albanian legislation with that of the European Union, through our work, we aim to identify the space to implement the whole of these legislative innovations in the Albanian legislation.

Keywords: effective service, harmonization level, innovation, reform

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Authors: Poteet Frances, Glovinski Ira

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INTRODUCTION: The interoceptive nervous system continuously senses chemical and anatomical changes and helps you recognize, understand, and feel what’s going on inside your body so it is important for energy regulation, memory, affect, and sense of self. A newborn needs predictable routines rather than confusion/chaos to make connections between internal experiences and emotions. AIM: Current legal protocols of removing babies from drug-addicted mothers impact the critical window of bonding. The newborn’s brain is social and the attachment process influences a child’s development which begins immediately after birth through nourishment, comfort, and protection. DESCRIPTION: Our project aims to educate drug-addicted mothers, and medical, nursing, and social work professionals on interoceptive concepts and practices to sustain the mother/newborn relationship. A mother’s interoceptive knowledge predicts children’s emotion regulation and social skills in middle childhood. CONCLUSION: When mothers develop an awareness of their inner bodily sensations, they can self-regulate and be emotionally available to co-regulate (support their newborn during distressing emotions and sensations). Our project has enhanced relationship preservation (mothers understand how their presence matters) and the overall mother/newborn connection.

Keywords: drug-addiction, interoception, legal, mothers, newborn, self-regulation

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Authors: Nur Inayah Ismaniar, Sukri Palutturi, Ansariadi, Atjo Wahyu

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Background: In various countries in the world, the problem of smoking is now considered something serious because of the effects of smoking which can not only lead to addiction but also have the potential to harm health. Public health authorities have concluded that one solution that can be done to protect the public from active smokers is to issue a policy that requires public facilities to be completely smoke-free. The hospital is one of the public facilities that has been designated as a smoke-free area. However, the implementation and maintenance of a successful program based on a smoke-free hospital are still considered an ongoing challenge worldwide due to the very low level of adherence. The low level of compliance with this smoke-free policy is also seen in other public facilities. The purpose of the literature review is to review the level of compliance with the application of the Non-Smoking Area policy, how this policy has succeeded in reducing smoking activity in hospitals, and what factors lead to such compliance in each country in the world. Methods: A literature review of articles was carried out on all types of research methods, both qualitative and quantitative. The sample is all subjects who are in the research location, which includes patients, staff and hospital visitors. Results: Various variations in the level of compliance were found in various kinds of literature. The literature with the highest level of compliance is 88.4%. Furthermore, several determinants that are known to affect the compliance of the Non-Smoking Area policies in hospitals include communication, information, knowledge, perceptions, interventions, attitudes and support. Obstacles to its enforcement are the absence of sanctions against violators of the Non-Smoking Area policy, the ineffectiveness of the function of policymakers in hospitals, and negative perceptions of smoking related to mental health. Conclusion: Violations of the Non-Smoking Area policy are often committed by the hospital staff themselves, which makes it difficult for this policy to be fully enforced at various points in the hospital.

Keywords: health policy, non-smoking area, hospital, implementation

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Authors: Laila Khawaja

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In recent years, an increasing emphasis has been placed on measuring program implementation, in part because of the great variability in how complex interventions are delivered in real-life settings. There is an increased awareness that while conducting process evaluations, one should aim to identify and understand the complexities of intervention if they are to be used for future intervention development or the strategies needed to implement the same intervention in a different setting. Complex interventions are public health interventions that are not drugs or surgical procedures but have many potential active aspects of intervention. In this paper, process evaluations are aligned with MRC guidelines to identify contextual factors related to outcomes to assess the quality of implementation. This paper briefly discusses the perceptions of research team on the implementation of the intervention of ‘Engaging Adolescents in Changing Behaviour’ (EACH-B), a school-based complex intervention study aiming to improve diet and physical activity among adolescents aged 12-13 years. Through qualitative interviews and focus groups with 10 staff members, we aimed to understand their experiences and reflections on implementing the EACH-B trial delivered in 49 Schools around Hampshire, England. Data were uploaded into NVivo, and analysis was conducted using thematic analysis. The investigation revealed two overarching themes: (a) how the communication patterns with teachers were impacted during the delivery of implementation and (b) what were the team’s strategies to keep logistics aligned with the research process that impacted the overall implementation of the trial. The paper informs adaptation strategies used by the research team to establish and maintain effective communication with the teachers as well as the thoughtfulness of the team’s logistic strategy for the successful delivery of the trial.

Keywords: complex interventions, process evaluation, adaptation strategies, randomised controlled trial

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Authors: N. Tal-Alon, O. Shapira-Lishchinsky

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Disability disclosure is one of the most complicated dilemmas that people with invisible disabilities face. There are only a few research studies that have focused on the difficulties and dilemmas of teachers who have different disabilities. In addition, there are currently no research studies focusing specifically on the different aspects of disability disclosure, which are unique to teachers. This research has, therefore, broadened the knowledge base and understanding of the dilemma of disability disclosure among teachers with invisible physical disabilities. In addition, it has shed light on the ways this issue is perceived by different groups: the perspective of school principals, the perspective of colleagues, and the perspective of teachers with physical disabilities themselves. The study sample included 12 teachers with invisible physical disabilities, 10 school principals who employ at least one teacher with an invisible physical disability, and 10 professional colleagues of at least one teacher with an invisible physical disability. This particular research study was conducted using a qualitative approach through the Narralizer computer program based on a series of in-depth interviews. The data analysis was carried out by grouping major points of interest into specific categories and sub-categories. The findings of this research suggest that teachers with disabilities struggle with the dilemma of whether or not to reveal their disability to the school staff and to their students. It was found that there were considerable differences between the issues that faculty members considered regarding this dilemma and the ones that teachers with disabilities considered. While the principals and professional colleagues focused solely on their own interests, the teachers with a disability emphasized more on the ways that they might have a positive influence on their students, as well as their own individual interests. In addition, school principals on a whole tended to view negatively the option of disclosing the disability to the students and were often critical towards teachers who concealed their disability from the school staff. The importance of this research is in its potential to influence policy decisions that can be implemented by the Ministry of Education regarding the support system for teachers with invisible physical disabilities.

Keywords: education, employment, invisible disabilities, teachers

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Authors: Andrew Anis Fakhrey Mosaad

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Objectives: Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers to applying physiotherapy in ICUs. Materials and Methods: A 54-item survey for determining the characteristics physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through the Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23–52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. Results: The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapists (low level of employment and practice, lack of shift); patients (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. Conclusion: The most common interventions were positioning, active, passive, breathing exercises, and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, teams, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Keywords: intensive care units, physical therapy, physiotherapy, exercises

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Authors: Tamir Michal

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The subject of Bedouin dispersion has accompanied the State of Israel from the day of its establishment. From a legal point of view, this subject has offered a launchpad for creative judicial decisions. Thus, for example, the first court decision in Israel to recognize affirmative action (Avitan), dealt with a petition submitted by a Jew appealing the refusal of the State to recognize the Petitioner’s entitlement to the long-term lease of a plot designated for Bedouins. The Supreme Court dismissed the petition, holding that there existed a public interest in assisting Bedouin to establish permanent urban settlements, an interest which justifies giving them preference by selling them plots at subsidized prices. In another case (The Forum for Coexistence in the Negev) the Supreme Court extended equitable relief for the purpose of constructing a bridge, even though the construction infringed the Law, in order to allow the children of dispersed Bedouin to reach school. Against this background, the recent verdict, delivered during the Protective Edge military campaign, which dismissed a petition aimed at forcing the State to spread out Protective Structures in Bedouin villages in the Negev against the risk of being hit from missiles launched from Gaza (Abu Afash) is disappointing. Even if, in arguendo, no selective discrimination was involved in the State’s decision not to provide such protection, the decision, and its affirmation by the Court, is problematic when examined through the prism of the Theory of Recognition. The article analyses the issue by tools of theory of Recognition, according to which people develop their identities through mutual relations of recognition in different fields. In the social context, the path to recognition is cognitive respect, which is provided by means of legal rights. By seeing other participants in Society as bearers of rights and obligations, the individual develops an understanding of his legal condition as reflected in the attitude to others. Consequently, even if the Court’s decision may be justified on strict legal grounds, the fact that Jewish settlements were protected during the military operation, whereas Bedouin villages were not, is a setback in the struggle to make the Bedouin citizens with equal rights in Israeli society. As the Court held, ‘Beyond their protective function, the Migunit [Protective Structures] may make a moral and psychological contribution that should not be undervalued’. This contribution is one that the Bedouin did not receive in the Abu Afash verdict. The basic thesis is that the Court’s verdict analyzed above clearly demonstrates that the reliance on classical liberal instruments (e.g., equality) cannot secure full appreciation of all aspects of Bedouin life, and hence it can in fact prejudice them. Therefore, elements of the recognition theory should be added, in order to find the channel for cognitive dignity, thereby advancing the Bedouins’ ability to perceive themselves as equal human beings in the Israeli society.

Keywords: bedouin dispersion, cognitive respect, recognition theory, sustainable development

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Authors: Mohd Bahroddin Badri, Ridzuan Masri

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Despite the existence of large volume of waqf assets, it is argued that the potential of these assets not fully unleashed. There are many waqf assets especially in the form of land waqf that are idle and undeveloped mainly because of the insufficient fund and lack of investment expertise. This paper attempts to explore few cases on the innovation of waqf development in Malaysia and some countries that demonstrate synergistic collaboration between stakeholders, e.g., the government, nazir, Islamic religious councils, corporate entities and Islamic financial institutions for waqf development. This paper shows that cash waqf, corporate waqf, Build-Operate-Transfer (BOT) and Sukuk are found to be contemporary mechanisms within Islamic finance ecosystem that drive and rejuvenate the development of waqf to the next level. It further highlights few samples of waqf Sukuk that were successfully issued in selected countries. This paper also demonstrates that the benefit of waqf is beyond religious matters, which may also include education, healthcare, social care, infrastructure and corporate social responsibility (CSR) activities. This research is qualitative in nature, whereby the researcher employs descriptive method on the collected data. The researcher applies case study and library research method to collect and analyse data from journal articles, research papers, conference paper and annual reports. In a nutshell, the potential of contemporary models as demonstrated in this paper is very promising, in which the practical application of those instruments should be expanded for the rejuvenation of waqf asset.

Keywords: cash waqf, corporate waqf, Sukuk waqf, build-operate-transfer

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Authors: Muhammad Muhammad Suleiman

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The Nigerian political system has witnessed rising occurrences of election malpractice in the last decade. This has been due to election rigging and other forms of electoral fraud. In order to find a sustainable solution to this malpractice, the introduction of electronic voting (e-voting) has been suggested. This paper reviews the challenges, benefits, and issues associated with e-voting as a panacea for election malpractice in Nigeria. The review of existing literature revealed that e-voting can reduce the cost of conducting elections and reduce the opportunity for electoral fraud. The review suggests that the introduction of e-voting in the Nigerian political system would require adequate cybersecurity measures, trust-building initiatives, and proper legal frameworks to ensure its successful implementation. It is recommended that there should be an effective policy that would ensure the security of the system as well as the credibility of the results. Furthermore, a comprehensive awareness campaign needs to be conducted to ensure that voters understand the process and are comfortable using the system. In conclusion, e-voting has the potential to reduce the occurrence of election malpractice in the Nigerian political system. However, the successful implementation of e-voting will require effective policy interventions and trust-building initiatives. Additionally, the costs of acquiring the necessary infrastructure and equipment and implementing proper legal frameworks need to be considered.

Keywords: electronic voting, general election, candidate, INEC, cyberattack

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Authors: Samuel Mwangi, Josephine K. Mule

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Access control as a security technique regulates who or what can access resources. It is a fundamental concept in security that minimizes risks to the institutions that use access control. Regulating access to institutions of higher learning is key to ensure only authorized personnel and students are allowed into the institutions. The use of biometrics has been criticized due to the setup and maintenance costs, hygiene concerns, and trepidations regarding data privacy, among other apprehensions. Facial recognition is arguably a fast and accurate way of validating identity in order to guard protected areas. It guarantees that only authorized individuals gain access to secure locations while requiring far less personal information whilst providing an additional layer of security beyond keys, fobs, or identity cards. This exploratory study sought to investigate the use of facial recognition in controlling access in institutions of higher learning in Kenya. The sample population was drawn from both private and public higher learning institutions. The data is based on responses from staff and students. Questionnaires were used for data collection and follow up interviews conducted to understand responses from the questionnaires. 80% of the sampled population indicated that there were many security breaches by unauthorized people, with some resulting in terror attacks. These security breaches were attributed to stolen identity cases, where staff or student identity cards were stolen and used by criminals to access the institutions. These unauthorized accesses have resulted in losses to the institutions, including reputational damages. The findings indicate that security breaches are a major problem in institutions of higher learning in Kenya. Consequently, access control would be beneficial if employed to curb security breaches. We suggest the use of facial recognition technology, given its uniqueness in identifying users and its non-repudiation capabilities.

Keywords: facial recognition, access control, technology, learning

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Authors: Lelika Lazarus, Reshma Sookrajh, Kapil S. Satyapal

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Reflecting on teaching is commonly cited as a fundamental practice for personal and professional development. Educational research into the scholarship of teaching and learning anatomy includes engaging in discipline specific literature on teaching, reflecting on individual teaching methods and communicating these findings to peers. The aim of this paper is to formally assess the opinions of senior anatomy instructors regarding the state of anatomical knowledge at their respective institutions. The context of the paper derives from ongoing debates about the perceived decline in standards of anatomical knowledge of medical students and postgraduate learners. An open ended questionnaire was devised consisting of eight direct questions seeking opinions on anatomy teaching, knowledge, and potential educational developments and general thoughts on the teaching of anatomy to medical students. These were distributed to senior anatomy Faculty (identified by the author by their affiliation with the Anatomical Society of Southern Africa) based at the eight national medical schools within the country. A number of key themes emerged. Most senior faculty felt that the standard of medical education at their respective institutions was ‘good.’. However, emphasis was also placed on the ‘quality of teaching’ incorporating clinical scenarios. There were also indications that staff are split into those that are keen to do research and those that are happy to provide teaching to medical students as their primary function. Several challenges were also highlighted such as time constraints within the medical curriculum, the lack of cadavers to reinforce knowledge and gain depth perception and lack of appropriately qualified staff. Recommendations included fostering partnerships with both clinicians and medical scientists into the anatomy curriculum thus improving teaching and research.

Keywords: anatomy, education, reflection, teaching

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Authors: Turki Adnan Kamal, Abdulmajeed Ahmad Alsofiany, Nemer Khidhran Husain Alghamdi, Ali Eissa Hassan Al-Rajhi

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Background:- Health care workers are ranked as one of the most vulnerable groups experiencing violence and aggressive behavior compared to other occupational groups. Objectives:- To estimate the prevalence rate and characteristics and assess the avoidance measures, and notification of the violence among medical staff working in primary health care centers in Taif city. Subject and methods:- A cross-sectional study design was applied among all physicians and a representative sample of nurses working in primary health care centers affiliated with the Ministry of Health (MOH) in Taif city. A predesigned Arabic/English validated self-administered questionnaire was used. Results:- In this study, 56 physicians and 145 nurses responded, giving a response rate of 77.6%. Their age ranged from 25 and 60 years (36.2±8.2), with 59.7% of them aged between 25 and 35 years. Males represent 55.7% of them. More than half of them (52.2%) were Saudis. The prevalence of workplace violence was 30.3%. Verbal abuse was the commonest reported type (86.9%). The absence of security, training on the procedures that must be followed and special uniforms at the workplace were significantly associated with workplace violence. We concluded that workplace violence is a significant problem facing a considerable proportion of HCWs in primary health care centers in Taif, Saudi Arabia. Most violence incidents were verbal. Conclusion:- Findings of this study revealed that HCWs who were dealing with male patients only were at high risk of workplace violence and the absence of measures to avoid workplace violence, particularly security, training on the procedures that must be followed and special uniform at the workplace was significantly associated with workplace violence.

Keywords: violence, workplace, primary health care, prevalence, avoidance

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Authors: Gerhard Grebe, Johan Marx

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The aim of the study is to assess the state of operational risk management and the adoption of an appropriate risk culture in Ghanaian banks. The Bank of Ghana (BoG) joined the Basel Consultative Group (BCG) of the Basel Committee on Bank Supervision (BCBS) in 2021 and is proceeding with the implementation of the Basel III international regulatory framework for banks. The BoG’s Directive about risk management encourages, inter alia, the creation of an appropriate risk culture by Ghanaian banks. However, it is not evident how the risk management staff of Ghanaian banks experience the risk culture and the implementation of operational risk management in the banks where they are employed. Ghana is a developing economy, and it is addressing challenges with its organisational culture. According to Transparency International, successive Ghanaian governments claim to be fighting corruption, but little success has been achieved so far. This points to a possible lack of accountability, transparency, and integrity in the environment in which Ghanaian banks operate and which could influence their risk culture negatively. Purposive sampling was used for the survey, and the questionnaire was completed byGhanaian bank personnel who specializesin operational risk management, risk governance, and compliance, bank supervision, risk analyses, as well as the implementation of the operational risk management requirements of the Basel regulatory frameworks. The respondents indicated that they are fostering a risk culture and implementing monitoring and reporting procedures; the three lines of defence (3LOD); compliance; internal auditing; disclosure of operational risk information; and receiving guidance from the bank supervisor in an attempt to improve their operational risk management practices. However, the respondents reported the following challenges with staff members who are not inside the risk management departments(in order of priority), namelydemonstrating a risk culture, training and development; communication; reporting and disclosure; roles and responsibilities; performance appraisal; and technological and environmental barriers. Recommendations to address these challenges are provided

Keywords: ghana, operational risk, risk culture, risk management

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Authors: Rose Hattab

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Women have been an important dynamic in religious context and the state-building process of Arab countries throughout history. During the 1970s as the movement for women’s activism and rights developed, the Iraqi state under the Ba’ath Party began to provide Iraqi women with legal and civil rights. This was done to liberate women from the grasps of social traditions and was a tangible espousing of equality between men and women in the process of nation-building. Whereas women’s rights were stronger and more supported throughout the earliest years of the Ba’ath Regime (1970-1990), the aftermath of the Gulf War and economic sanctions on the conditions of Iraqi society laid the foundation for a division of women’s rights between civil and religious authorities. Personal status codes that were secured in 1959 were being pushed back by amendments made in coordination with religious leaders. Civil laws were present on paper, but religious authority took prominence in practice. The written legal codes were inclusive of women’s rights, but there is not an active or ensured practice of these rights within Iraqi society. This is due to many different factors, such as religious, sectarian, political and conservative reasons that hold back or limit the ability for Iraqi women to have autonomy in aspects such as participation in the workforce, getting married, and ensuring social justice. This paper argues that the Personal Status Code introduced in 1959 – which replaced Sharia-run courts with personal status courts – provided Iraqi women with equality and increased mobility in social and economic dynamics. The statewide crisis felt after the Gulf War and the economic sanctions imposed by the United Nations led to a stark shift in the Ba’ath party’s political ideology. This ideological turn guided the social system to the embracement of social conservatism and religious traditions in the 1990s. The effect of this implementation continued after the establishment of a new Iraqi government during 2003-2005. Consequently, Iraqi women's rights in employment, marriage, and family became divided into paper and practice by religious authorities and civil law from that period to the present day. This paper also contributes to the literature by expanding on the gap between legal codes on paper and in practice, through providing an analysis of Iraqi women’s rights in the Iraqi Constitution of 2005 and Iraq’s Penal Code. The turn to conservative and religious traditions is derived from the multiplicity of identities that make up the Iraqi social fabric. In the aftermath of a totalitarian regime, active wars, and economic sanctions, the Iraqi people attempted to unite together through their different identities to create a sense of security in the midst of violence and chaos. This is not an excuse to diminish the importance of women’s rights, but in the process of building a new nation-state, women were lost from the narrative. Thus, the presence of gender equity is found in the written text but is not practiced and upheld in the social context.

Keywords: civil rights, Iraqi women, nation building, religion and conflict

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Authors: R. M. Kilonzo, S. Bedingfield, K. Smith, K. Hudgins Smith, K. Couper, R. Ratley, Z. Taylor, A. Engelman, M. Renne

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Introduction: The mental health needs of university students continue to evolve, necessitating a strategic approach to service delivery. The East Tennessee State University (ETSU) Counseling Center developed its inaugural Strategic Plan (2024-2028) to enhance student mental health services. The plan focuses on improving access, quality of care, and service visibility, aligning with the university’s mission to support academic success and student well-being. Aim: This strategic plan aims to establish a comprehensive framework for delivering high-quality, evidence-based mental health services to ETSU students, addressing current challenges, and anticipating future needs. Methods: The development of the strategic plan was a collaborative effort involving the Counseling Center’s leadership, staff, with technical support from Doctor of Public Health-community and behavioral health intern. Multiple workshops, online/offline reviews, and stakeholder consultations were held to ensure a robust and inclusive process. A SWOT analysis and stakeholder mapping were conducted to identify strengths, weaknesses, opportunities, and challenges. Key performance indicators (KPIs) were set to measure service utilization, satisfaction, and outcomes. Results: The plan resulted in four strategic priorities: service application, visibility/accessibility, safety and satisfaction, and training programs. Key objectives include expanding counseling services, improving service access through outreach, reducing stigma, and increasing peer support programs. The plan also focuses on continuous quality improvement through data-driven assessments and research initiatives. Immediate outcomes include expanded group therapy, enhanced staff training, and increased mental health literacy across campus. Conclusion and Recommendation: The strategic plan provides a roadmap for addressing the mental health needs of ETSU students, with a clear focus on accessibility, inclusivity, and evidence-based practices. Implementing the plan will strengthen the Counseling Center’s capacity to meet the diverse needs of the student population. To ensure sustainability, it is recommended that the center continuously assess student needs, foster partnerships with university and external stakeholders, and advocate for increased funding to expand services and staff capacity.

Keywords: strategic plan, university counseling center, mental health, students

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Authors: Haidy Weliam Megaly Gouda

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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification

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Authors: Bency Ann Massinello, Nancy Day, Janet Fellini

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Background: The use of an appropriate mode of communication among the multidisciplinary care team members regarding coordination of care is an extremely complicated yet important patient safety initiative. Effective communication among the team members(nursing staff, medical staff, respiratory therapists, rehabilitation therapists, patient-family services team…) become essential to develop a culture of trust and collaboration to deliver the highest quality care to patients are their families. The inpatient post-acute pediatrics, where children and their caregivers come for continuity of care, is no exceptions to the increasing use of text messages as a means to communication among clinicians. One such platform is the Vocera Communications (Vocera Smart Mobile App called Vocera Edge) allows the teams to use the application and share sensitive patient information through an encrypted platform using IOS company provided shared and assigned mobile devices. Objective: This paper discusses the quality initiative of implementing the transition from Vocera Smartbage to Vocera Edge Mobile App, technology advantage, use case expansion, and lessons learned about a secure alternative modality that allows sending and receiving secure text messages in a pediatric post-acute setting using an IOS device. This implementation process included all direct care staff, ancillary teams, and administrative teams on the clinical units. Methods: Our institution launched this transition from voice prompted hands-free Vocera Smartbage to Vocera Edge mobile based app for secure care team texting using a big bang approach during the first PDSA cycle. The pre and post implementation data was gathered using a qualitative survey of about 500 multidisciplinary team members to determine the ease of use of the application and its efficiency in care coordination. The technology was further expanded in its use by implementing clinical alerts and alarms notification using middleware integration with patient monitoring (Masimo) and life safety (Nurse call) systems. Additional use of the smart mobile iPhone use include pushing out apps like Lexicomp and Up to Date to have it readily available for users for evident-based practice in medication and disease management. Results: Successful implementation of the communication system in a shared and assigned model with all of the multidisciplinary teams in our pediatric post-acute setting. In just a 3-monthperiod post implementation, we noticed a 14% increase from 7,993 messages in 6 days in December 2020 to 9,116messages in March 2021. This confirmed that all clinical and non-clinical teams were using this mode of communication for coordinating the care for their patients. System generated data analytics used in addition to the pre and post implementation staff survey for process evaluation. Conclusion: A secure texting option using a mobile device is a safe and efficient mode for care team communication and collaboration using technology in real time. This allows for the settings like post-acute pediatric care areas to be in line with the widespread use of mobile apps and technology in our mainstream healthcare.

Keywords: nursing informatics, mobile secure texting, multidisciplinary communication, pediatrics post acute care

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Authors: Ikechukwu Ogeze Ukeje, Chinyere Ori Elom, Chukwudum Collins Umoke

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This study explores the challenges in the integration of Artificial Intelligence (AI) and Information and Communication Technology (ICT) practices in enhancing governance and sustainable solution modeling in higher education, focusing on Alex Ekwueme Federal University Ndufu-Alike (AE-FUNAI), Nigeria. In the context of a developing country like Nigeria, leveraging AI and ICT tools presents a unique opportunity to improve teaching, learning, administrative processes, and governance. The research aims to evaluate how AI and ICT technologies can contribute to sustainable educational practices, enhance decision-making processes, and improve engagement among key stakeholders: students, lecturers, and administrative staff. Students are involved to provide insights into their interactions with AI and ICT tools, particularly in learning and participation in governance. Lecturers’ perspectives will offer a view into how these technologies influence teaching, research, and curriculum development. Administrative staff will provide a crucial understanding of how AI and ICT tools can streamline operations, support data-driven governance, and enhance institutional efficiency. This study will use a mixed-method approach to collect both qualitative and quantitative data. The finding of this study is geared towards shaping the future of education in Nigeria and beyond by developing an Inclusive AI-governance Integration Framework (I-AIGiF) for enhanced performance in the system. Examining the roles of these stakeholder groups, this research could guide the development of policies for more effective AI and ICT integration, leading to sustainable educational innovation and governance.

Keywords: university administration, AI, higher education governance, education sustainability, ICT challenges

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Authors: Nisha Harry, Keshia Sing

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Orientation: The Multifactor Leadership Questionnaire (MLF) and the sense of coherence-29 (SCS) is an effective tools to assess the prevalence and underlying structures of empirically based taxonomies related to leadership and wellbeing. Research purpose: The purpose of the study was to test the psychometric properties of the SCS and Multifactor Leadership Questionnaire (MLQ) to screen for psychological wellness indices within the banking industry in South Africa. Motivation for the study: The contribution of these two instruments for the purpose of determining psychological wellness in a banking work environment is unique. Research design, approach, or method: The sample consisted of (N = 150) financial staff employed in a South African banking organisation. The age of the sample was: 37% (30 -40 yrs), 31% (20-30 yrs), 26% (40- 50 yrs), and 6% (50+yrs), of which 52% were males, 48% were females. The white race group was the majority at 29%, African at 26%, Coloured at 23%, and Indian was 22%. Main findings: Results from the exploratory factor analysis revealed a two-factor structure as the most satisfactory. Confirmatory factor analyses revealed the two-factor model displayed better good of-fit indices. Practical implications: The factor structure of the Sense of Coherence-29 scale (SCS), and the Multifactor Leadership Questionnaire (MLQ), have a value-added focus to determine psychological wellness within banking staff. It is essential to take into account these constructs when developing employee wellness interventions. Contribution/value add: Understanding the psychometric properties of the SCS, the self-reported form, and the MLQ questionnaire contributes to screening psychological wellness indices such as coping within the banking industry in a developing country like South Africa. Leaders are an important part of the implementation process of organisational employee wellness practices.

Keywords: factorial structure, leadership, measurement invariance, psychological wellness, sense of coherence

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Authors: R. K. Yadav, S. Baral, H. R. Paudel, R. Basnet

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The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public healthcare providers in the fight against tuberculosis using international healthcare standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. A total of 20 respondents participated in the study. Barriers to PPM were identified in the following three themes: 1) Obstacles related to TB case detection, 2) Obstacles related to patients, and 3) Obstacles related to the healthcare system. PPM implementation was challenged by following subthemes that included staff turnover, low private sector participation in workshops, a lack of training, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. The study concludes that numerous barriers exist in the way of effective implementation of the PPM approach, including TB cases detection barriers such as knowledge of TB diagnosis and treatment, HW attitude, workload, patient-related barriers such as knowledge of TB, self-medication practice, stigma and discrimination, financial status, and health system-related barriers such as staff turnover and poor engagement of the private sector in workshops, training, recording, and re-evaluation. Government stakeholders must work together with private sector stakeholders to perform joint monitoring and supervision. Private practitioners should receive training and orientation, and presumptive TB patients should be given adequate time and counseling as well as motivation to visit a government health facility.

Keywords: barrier, tuberculosis, case finding, PPM, nepal

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