Journal articles on the topic 'Multi-departmental evaluation'

The efficiency and effectiveness of a school's operations heavily depend on the quality of services provided by its office staff across various departments. This study seeks to fill this gap by evaluating the satisfaction of staff performance, offering a comprehensive analysis that identifies strengths and areas needing improvement. By providing actionable insights, the research aims to enhance service delivery and contribute to the overall success of the institution. The study employed a descriptive research design to evaluate student satisfaction with office staff performance using an adopted questionnaire at San Isidro College, using a convenience sampling technique to survey 705 college students. The results indicated that students at San Isidro College are generally satisfied with the respect shown by office staff but see room for improvement in staff eagerness and availability. The study underscores the importance of implementing strategies to enhance professional communication, streamline processes, ensure financial transparency, and cultivate a hospitable environment. These efforts will ultimately contribute to higher student satisfaction and a more supportive educational experience.

To address the complexity of the departmental coordination with others effectively, an approach for selecting emergency alternatives based on multi-granularity linguistic and multidivisional cooperation was presented. Firstly, multi-granularity linguistic phrases were employed to express the preference information, and some transformation functions were used to unify the multi-granular linguistic phrases into a uniform linguistic label set. Secondly, the evaluation indexes of key attributes with respect to each combination of alternations were determined considering multidivisional cooperation. Furthermore, according to the evaluation indexes and the weight vector of key attributes, the comprehensive value of each combination alternative was determined to obtain the best alternative. Finally, a case study of low-attitude airspace emergency rescue after an earthquake is presented to illustrate the validity of the approach.

This article draws on a 10-year institutional initiative and examines whether and how a strategic departmental Summative Peer Review of Teaching (SPRoT) Protocol was implemented at a Canadian research-intensive university. A peer review of teaching initiative (2010-12), led by a team of UBC national teaching fellows, was prompted by institutional concerns about the quality of student learning experiences and the effectiveness of teaching in a multi-disciplinary research-intensive university context. Canadian universities have long recognized the importance of attending to the evaluation of teaching practices in their particular contexts; however, the enactment of localized scholarship directed at these practices remains very much in its infancy. Traditional approaches to the evaluation of university teaching have often resulted in the over-reliance on student evaluation of teaching data and/or ad-hoc peer-review of teaching practices with numerous accounts of methodological shortcomings that tend to yield less useful and less authentic data. Using a case study research methodology, this paper examines the strategic development of a departmental SPRoT protocol at the University of British Columbia, Canada. Issues addressed in this article include contemporary approaches to the evaluation of teaching in higher education, faculty “buy-in” for the evaluation of teaching in a research intensive university, scholarly approaches to summative and formative Performance Reviews of Teaching (PRT), faculty-specific engagement in summative and formative (informal to formal) PRT training and implementation, and strategic institutional supports (funding, expertise, mentoring, technological resources).

This study examines human resource management strategies at Favehotel Rungkut Surabaya, focusing on operational efficiency improvement through effective workforce optimization. Using a qualitative case study approach, the research analyzes how a budget hotel manages 31 contract employees across 8 departments while maintaining service quality. The findings reveal that implementing work rotation systems, multi-skill training programs, and lean organizational structures contributed to a 27% increase in operational efficiency over two years. Key challenges identified include workload optimization, cross-departmental coordination, and employee competency development. This research provides practical implications for budget hotels in designing effective HR strategies, particularly in resource allocation, competency development, and performance evaluation systems

PurposeA lot is known about systemic barriers to broadening participation (BP) in STEM. Empirical research has demonstrated the existence and impact of implicit bias, stereotype threat, and micro-aggressions on a sense of belonging, organizational productivity and leadership opportunities. We also know that achieving greater participation of women and faculty of color in the STEM disciplines is complicated and depends on altering complex and multi-layered interactions between activities and actors. Further, because researcher and institutional goals vary as a function of target population and context, generalizable models can struggle in the face of larger BP efforts. Through the authors experience as an NSF ADVANCE-IT awardee, the authors believe that a dynamic, multi-scaled and organizational level approach is required to reflect the reciprocal dialogue among research questions, best practices, tailored applications and quantifiable goals. The authors describe several examples of research, programming activities and program evaluation that illustrate this approach. In particular, the authors describe both the programming successes and challenges, with the aim of helping others to avoid common mistakes by articulating very broad and, the authors’ hope, generalizable “lessons learned.” The paper aims to discuss these issues.Design/methodology/approachTo better understand the barriers for women in STEM, the authors utilized an iterative methodology. Specifically, the authors conducted a social network analysis, an exit survey of departed faculty, longitudinal analysis of career trajectories and research productivity, and a survey on the interaction between values and climate.FindingsThe analyses suggest three strategies better retain women in STEM: improve women’s professional networks; re-aling policy documents and departmental practices to better reflect faculty values; and improve departmental climate.Practical implicationsThe pay-off for using this more complex research approach to triangulate onto specific challenges is that the interventions are more likely to be successful, with a longer-lasting impact.Originality/valueWith continuous institutional research, metric refinement, and program evaluation the authors are better able to develop targeted programming, policy reform, and changes in institutional practice. The interventions should result in permanent institutional and systemic change by integrating multi-method qualitative and quantitative research into BP practices, which the authors couple with longitudinal analysis that can quantify success of the authors’ efforts.

In order to effectively evaluate the cooperative efficiency of intelligent transportation facilities, a structural model of four cooperative development elements, including functional cooperative, operational cooperative, information cooperative, and operation cooperative, is constructed with the guidance of system coordination and a cooperative efficiency evaluation system is established based on it. Then, a dynamic efficiency evaluation model based on variable weight and matter-element extension method was constructed to describe the cooperative efficiency of intelligent transportation facilities and analyze the cooperative efficiency of key road sections in the Jinan area as an example. The results show that of the ten sections, two are in poor performance status, three are in good performance status, and five are in excellent performance status. The four indexes of vertical cooperative construction, functional scheduling level, information element completeness, and multi-departmental information integration level have the most significant impact on facility cooperative efficiency and are the most sensitive; the three indexes of plan executability, functional ease of upgrading, and space–time alignment rate have the most negligible impact on facility cooperative efficiency and are the least sensitive.

В статье рассматривается результат исследования динамики личностного роста курсантов ведомственного вуза, а также необходимость изучения данной проблемы в рамках подготовки кадров для Федеральной службы исполнения наказаний. Анализируются исторические этапы формирования термина «личностный рост». Рассматриваются различные подходы к содержанию понятия. Дается современная интерпретация понятия «личностный рост». Определено, что профессиональный личностный рост курсанта вуза ФСИН России представляет собой динамический процесс профессионального становления. В статье описывается проведенное лонгитюдное исследование курсантов Академии ФСИН России. В исследовании использовался Многоуровневый личностный опросник (МЛО). Анализ полученных данных позволил прийти к выводу, что личностные изменения курсантов являются, с одной стороны, результатом взросления, которому способствуют условия обучения в вузе ФСИН России, а с другой стороны, результатом профессионального становления (освоение своей новой социальной роли). Также анализировались отдельные стимулы методики. В результате анализа было выявлено, что личностные изменения, происходящие с некоторыми курсантами в процессе обучения в специализированном вузе, носят негативный характер и схожи по симптоматике с синдромом «эмоционального выгорания». The article discusses the results of the study of the dynamics of personal growth of students of a departmental university, as well as the need to study this problem in the framework of training personnel for the Federal Penitentiary System. The historical stages of the formation of the term «personal growth» are analyzed. Various approaches to the content of the concept are considered. A modern interpretation of the concept of «Personal growth» is given. It is determined that the professional personal growth of a cadet of a departmental university of the Federal Penitentiary Service of Russia is a dynamic process of professional development. The article analyzes the statistics of the expelled cadets for 2017-2020, which may be a consequence of the lack of dynamics of personal growth. The article describes a longitudinal study of cadets of the Academy of the Federal Penitentiary Service of Russia in Ryazan. The study used a multi-level personal questionnaire. In the course of the study, data were obtained, the analysis of which can lead to the conclusion that the personal changes that occur in cadets are, on the one hand, the result of growing up, which is facilitated by the conditions of education in the departmental university of the Federal Penitentiary Service of Russia, and, on the other hand, the result of professional formation (mastering their new social role). Individual stimuli of the methodology were also analyzed. As a result of the analysis, it was revealed that the personal changes that occur with some cadets in the course of training at a specialized university are negative in nature and are similar in symptoms to the «emotional burnout syndrome»

The article is devoted to the system-based analysis of the definition and measurement of the professional position of the individual cadet of a departmental university. A basis is a set of elements that is characterized by completeness, orderliness, and measurability. The «set of elements» has the following «substrate characteristics» such as «relation», «mapping» and «transformation», which define the first level of «immersion» in the concept of «basis». In turn, at thesecond level of «immersion» in the concept of «basis», corresponding to three factors («completeness», «orderliness», «measurability»), there are corresponding triple characteristics that determine the third level of «immersion»: 1) «full» is «factorness», «multiply connected» and «integrity»; 2) «the order» is «symmetry», «dichotomy» and «adenomasness»; 3) «measurable» is a «measure», «projection» and «rating». At all three levels of «integration» into the concept of «basis» there is a single generalized dichotomy «external – internal», which in our article is projected on a separate personal dichotomy «social-individual». «Multi-connectivity» means the existence of many dichotomous factors for which there is no single dichotomy, i.e. there is no «node» with a single factor dichotomy (reminiscent of Kettell's factor strategy, consisting of 16 different factor dichotomies in his typology of personality qualities, where there is no single dichotomy). «Unconnectedness» means the existence of a set of factors for which there is a single dichotomy, i.e. there is a «node» with a single factor dichotomy. In the «dimension», the following triples are obtained: 1) measure the representation (image, word, number), 2) projection of data conversion (image to word, image number words number). The last conversion (words to numbers) will be used in this article, and it is, by the way, more common in measurement diagnostic practice. 3) the assessment of the level of measurement of information (low, medium, high) will be used in this article and, by the way, it is also more common in measuring diagnostic practice. In our article, «completeness» is defined by a factorial multi-connected integral set of types. «Orderliness» is defined by a symmetric-dichotomous unconnected factorial verbal structure of a set of types (a single dichotomous multi-factorial verbal structure of types or «verbal basis»). The «measurability»of types is associated with a single dichotomous verbal-numerical evaluation metric scale or with a «numerical basis». «Measurability» makes it possible to create dichotomous basic multifactorial methods based on a dichotomous symmetric verbal-numerical scale evaluation of types.

In the social study of science, gender is a critical research site because relations of gender are hierarchical and inequality is a central feature of science. The focus here is on a key dimension of gender and scientific careers: academic rank, particularly that of full professor. This article concentrates on quantitative and qualitative approaches that have occurred in two focal problem areas related to gender, science, and rank: collaboration patterns and evaluative practices. The approaches encompass analyses of large and small groups and comparative cases, with surveys, bibliometrics, experiments, and interviews. This breadth of approaches reflects a search for explanations of the pervasive and persistent relationships between gender and academic rank. The analyses presented here point to the complexities of gender disparities in collaboration. These appear in team compositions, divisions of labor and power dynamics, integration into departmental units, and international coauthorship. The analyses also reveal ways that limited clarity in evaluation bears on gender disparities. Continuing understandings of gender, science, and rank will result in multi level analyses: those at organizational levels along with those of individual scientists.

408 Background: Disruptions in cancer care adversely affect clinical outcomes. The effect is magnified when treatments are not just protracted, but discontinued prematurely. The incidence of such treatment termination (TT) during radiation therapy has not been well studied. We herein present a single-institution cohort of TT at a large multi-center radiation oncology department over 10 years. Methods: As part of our ongoing departmental quality and safety monitoring program, TTs were prospectively tracked and assessed. A TT was defined as the premature discontinuation of therapy at any point following the initiation of radiation planning. The rate of TT was calculated as a percentage of all new patients who start radiation planning. Each TT between 1/2013 and 1/2023 was analyzed for a root cause, reviewed among multi-disciplinary Quality committee members, and presented monthly to the radiation department. Selected cases sparked discussion and efforts to identify interventions that may decrease the likelihood of similar TTs. Incremental departmental policy and procedure changes to critical pre-treatment evaluation, prospective contouring rounds, on-treatment management, and scheduling processes were implemented, collectively referred to as the “No-Fly” policy. Results: A total of 1,467 TTs were identified and analyzed. 688 (46.9%) involved patients treated with curative intent, 770 (52.5%) with palliative intent, and 9 (0.6%) for benign disease. The most common cause of TT was hospice and/or death (36.5%), 69.1% of which were in patients receiving palliative treatments. Other common causes identified are shown in Table 1. The overall 10-year rate of TT was 5.1% (1,467 of 28,707 planned treatment courses). The rate of TT decreased from 9.3% to 3.3% (2013 and 2022, respectively), with rates decreasing at each iteration of No-Fly from 8.8% (No-Fly 1, 2013-2014) to 5.2% (No-Fly 2, 2015-2018) to 4.0% (No-Fly 3, 2019-2022) (ANOVA p<0.001). Conclusions: Premature termination of radiation therapy can be deleterious for cancer patients. Determining the causes of TTs so that they may be mitigated is integral to effectively managing care and improving safety culture in radiation medicine departments. While some TTs may be unavoidable, open discourse and quality improvement changes are effective in reducing incidents over time. Understanding TTs is complimentary to other nationwide projects exploring how reducing missed radiation therapy appointment rates support access to high quality oncology care.[Table: see text]

Introduction: Process-supporting information technology holds the potential to increase efficiency, reduce errors, and alter professional roles and responsibilities in a manner which allows improvement in the delivery of patient care. However, clashes between the model of health care work inscribed in these tools with the actual nature of work has resulted in staff resistance and decreased organisational uptake of ICT, as well as the facilitation of unexpected and negative effects in efficiency and patient safety. Sociotechnical theory provides a paradigm against which workflow and transfusion of ICT in healthcare could be better explored and understood.Design: This paper will conceptualise a formative, multi-method longitudinal evaluation process to explore the impact of ICT with an appreciation of the relationship between the social and technical systems within a clinical department.Method: Departmental culture, including clinical work processes and communication patterns will be thoroughly explored before system implementation using both quantitative and qualitative research methods. Findings will be compared with post implementation data, which will incorporate measurement of safety and workflow efficiency indicators.Discussion: Sociotechnical theory provides a paradigm against which workflow and transfusion of ICT in healthcare could be better explored and understood. However, sociotechnical and multimethod approaches to evaluation do not exist without criticism. Inherent in the protocol are limitations of sociotechnical theory and criticism of the multimethod approach; testing of the methodology in real clinical settings will serve to verify efficacy and refine the process.

With the increasing adoption of digital governance and big data analytics, the quality of government hotline data significantly affects urban governance and public service efficiency. However, existing methods for assessing data record standards focus predominantly on structured data, exhibiting notable inadequacies in handling the complexities inherent in unstructured or semi-structured textual hotline records. To address these shortcomings, this study develops a comprehensive scoring method tailored for evaluating multi-dimensional data record standards in government hotline data. By integrating advanced deep learning models, we systematically analyze six evaluation indicators: classification predictability, dispatch accuracy, record correctness, address accuracy, adjacent sentence similarity, and full-text similarity. Empirical analysis reveals a significant positive correlation between improved data record standards and higher work order completion rates, particularly highlighting the crucial role of semantic-related indicators (classification predictability and adjacent sentence similarity). Furthermore, the results indicate that the work order field strengthens the positive impact of data standards on completion rates, whereas variations in departmental data-handling capabilities weaken this relationship. This study addresses existing inadequacies by proposing a novel scoring method emphasizing semantic measures and provides practical recommendations—including standardized language usage, intelligent analytic support, and targeted staff training—to effectively enhance urban governance.

Based on the records of people’s political inquiries, comments from public sources on the Internet and the data of the relevant departments’ responses to some people’s messages, this study uses text analysis, text feature extraction, model building, text mining, and other evaluation methods to study and evaluate the three aspects of government services: analysis of public comments, mining of hot issues and evaluation of replies, which aims to prompt the government to understand the needs of the people quickly and solve the relevant problems in a timely and effective manner. The results show that the final classification accuracy using BERT is 3.4% and 1.8% higher than that using TF-IDF and Word2vec, respectively. Multi-classification of message data was realized by BERT combined with the LinearSVC algorithm, and the crowd message was accurately divided into seven types of problems, with an accuracy of 96.7%. It is intended to be transferred to relevant departments for processing. For problems related to people’s livelihood, law, economy, and other aspects, different departments should take countermeasures to solve them and achieve systematic, departmental, and regional coordination. This will enhance the ability of government platforms to deal with problems. Through the definition of hot indexes, hot issues mining can timely find the outstanding problems reflected by the masses. At the same time, the feedback evaluation system can comprehensively evaluate the work of relevant departments from the perspectives of relevance, completeness, and interpretability. Big data analysis technology based on text mining is a feasible way to solve the difficulties of text data analysis. The analysis model constructed in this study is suitable for mining and analyzing unstructured data with short text features, and the results can provide guidance for government decision-making.

282 Background: The COVID-19 pandemic resulted in the use of telemedicine for evaluation and management visits in radiation oncology departments to decrease in-person interactions. The primary objective of this study is to evaluate the utility of telemedicine for patient consultation and its effect on radiotherapy simulation and treatment processes. Methods: A standardized simulation requisition directive was used for all consults (telemedicine and in-person) undergoing simulation for external beam radiation therapy at a single tertiary care institution from January to December 2020. These directives were reviewed at daily multi-disciplinary peer review meetings; modifications occurring as a result of this review were prospectively recorded in a departmental quality database. Descriptive statistics were used to identify characteristics associated with consultation type. Mann Whitney and Chi-square tests were used to compare continuous and categorical variables. Results: 1500 consecutive patients were reviewed in this prospective peer review process; 444 (29.6%) had telemedicine visits preceding simulation and 1056 (70.4%) had in-person consults. The median time between physician simulation order and date of simulation was 5 days (IQR: 2-11 days) for telemedicine visits and 4 days (IQR: 1-8 days) for in-person consults ( p<0.05). Significant differences were observed in telemedicine usage across months ( p<0.05) with the highest percentage in July, September, and August (50%, 45.9% and 45%, respectively). As a result of prospective multidisciplinary peer review, 397 modifications in 290 simulations were recorded in total; 101/444 (22.7%) telemedicine simulations had modifications compared to 189/1056 (17.9%) following in-person consultation ( p<0.05). The most common modifications for telemedicine visits resulted from immobilization device changes (n=32, 23.5%), arm positioning (n=19, 14.0%), and changes in the radiotherapy care path (n=17, 12.5%). For telemedicine consults, the median radiotherapy fraction dose was 2.66 Gy (2-4 Gy) and median fraction number was 16 (5-28). There was no difference for fractionation preference between telemedicine and in person consults ( p=0.084). Seven (1.6%) telemedicine visits and 7 (0.7%) in-person consults needed re-simulation during the entire study period ( p=0.136). Conclusions: Telemedicine is a powerful tool with the potential to revolutionize the radiation oncology daily practice. In the initial learning phase, it appears that there is a higher frequency of simulation modifications for patients evaluated by telemedicine. Therefore, as departmental processes incorporate telemedicine in the future, thorough attention is needed to encourage review of common modifications as well as identify patients at high risk of error at time of simulation who may also benefit from in-person evaluation prior to simulation.

Since the start of the industrial revolution, the manufacturing industry has been essential for economic growth but has also contributed to environmental pollution problems. The United Nations declared the 2030 Sustainable Development Goals (SDG) agenda to make sure that the well-being of the global environment is taken care of alongside the expansion of the world economies. As the leading manufacturing country worldwide, studying the evolution of China’s green development policies in manufacturing has significant implications for pollution management in manufacturing in other countries. This research analyzes China’s legal and policy documents on green development in the manufacturing industry based on planning objectives and actual effects with qualitative content analysis. It divides them into four periods: the exploring period (1949–1977), the formal establishment period (1978–2001), the improvement and strengthening period (2002–2011), and the comprehensive improvement period (2012 to present). Although the Chinese government has made progress in implementing green development policies, it still faces many challenges: (1) compatibility between economic development and environmental protection needs to be strengthened; (2) primarily command-and-control based policy structure needs to be reformed; (3) collaboration of multi-departmental management system needs to be enhanced. These challenges are the primary obstacles to China’s manufacturing industry achieving its environmental goals. The future policies for the green development of the manufacturing industry should focus on three aspects: (1) aligning environmental and manufacturing policies in setting strategic objectives and benchmarks; (2) concentrating on the systemic nature of policies and the interdependence of policy tools; (3) enhancing processes for policy creation, implementation, monitoring, and evaluation.

Abstract Introduction Junior doctors are increasingly encountering Advance Care Planning (ACP) when they look after frail, older or multi-morbid patients during their hospital rotations. However, there remains a lack of formal training and resources, particularly with DNACPR discussions and when engaging patients and their loved ones with Emergency Health Care Planning (EHCP). We aimed to assess the need for ACP, improve the infrastructure by which ACP is delivered, and better support junior doctors to have these difficult conversations. Method Discharges from the Geriatrics Department at Kettering General Hospital were reviewed initially in May 2019 and again in January 2020 following intervention. We introduced a focused communication skills training session delivered at departmental teaching, which included a combination of simulation training and lectures. We additionally designed and implemented an EHCP template to aid junior doctors’ discussions. This could also be copied to the discharge letter, to facilitate safe transfer of care to primary care. Results In May 2019 of 32 patients, 100% met at least one SPICTTM criterion, with median of 4 criteria, thus indicating a high need for ACP in this cohort. Despite this, only one discharge letter included an EHCP and two had a request for GP colleagues to complete one. Evaluation of discharges again in January of 2020 reconfirmed a similar need for ACP, but following our interventions, the number of EHCP’s performed had increased. Of 22 identified patients 4 had a completed EHCP and 3 were requested for completion by their GP. Qualitative questionnaires demonstrated an improvement in both knowledge and confidence amongst junior doctors following the training session. Conclusion We have shown that there is a necessity for ACP to be considered for Geriatrics inpatients, and that providing structure and training in this challenging area offers benefit to both patients and junior doctors.

Water environment evaluation is the basis of water resource planning and sustainable utilization. As a successful case of the coordinated progress of ecological protection and economic development, the Xin’an River Basin is a model for exploring the green development model. However, there are still some problems in the synergistic cooperation between the two provinces. Exploring the differences within the basin is a key entry point for solving the dilemma of synergistic governance in the Xin’an River Basin, optimizing the allocation of resources, and improving the overall effectiveness of governance. Based on the DPSIR model, 21 water environment–related indicators were selected, and the entropy weight–TOPSIS method and gray correlation model were used to evaluate the temporal and spatial status of water resources in each county of the Xin’an River Basin. The results show that (1) The relative proximity of the water environment in Xin’an River Basin fluctuated in “M” shape during the ten years of the study period, and the relative proximity reached the optimal solution of 0.576 in 2020. (2) From the five subsystems, the state layer and the corresponding layer are the most important factors influencing the overall water environment of the Xin’an River Basin. In the future, it is intended to improve the departmental collaboration mechanism. (3) The mean values of relative proximity in Qimen County, Jiande City, and Chun’an County during the study period were 0.448, 0.445, and 0.439, respectively, and the three areas reached a moderate level. The water environment in Huizhou District and Jixi County, on the other hand, is relatively poor, and the mean values of proximity are 0.337 and 0.371, respectively, at the alert level. The poor effect of synergistic development requires a multi–factor exploration of reasonable ecological compensation standards. We give relevant suggestions for this situation.

<strong>Abstract:</strong> This study examined the predictive and operational value of bottleneck analysis for optimizing healthcare staff utilization through the integration of the Theory of Constraints (TOC) and predictive analytics. Using a quantitative, explanatory research design, data was collected from departmental workflows, performance metrics, and staff schedules in a mid-sized urban hospital over a 12-month period. Bottlenecks were identified and categorized into human, procedural, and technological constraints. To address the first research question, predictive models, including multiple linear regression and random forest algorithms were developed to assess the relationship between bottlenecks and staff utilization. The random forest model demonstrated higher predictive accuracy, indicating that identified constraints can meaningfully forecast staffing efficiency. To answer the second research question, descriptive statistics revealed that procedural and human bottlenecks were the most frequent and disruptive. One-way ANOVA showed significant differences in staff efficiency across departments based on constraint type and severity, while chi-square tests confirmed associations between bottleneck types and inefficiencies. For the third research question, TOC-informed interventions were implemented in departments with high constraint levels. Pre- and post-intervention analyses using paired t-tests showed significant improvements in staff efficiency, reduced idle time, and increased patient throughput, with effect sizes indicating meaningful practical changes. The study&rsquo;s findings have several implications. For practice, healthcare leaders should adopt TOC-driven bottleneck analysis combined with machine learning models to anticipate and alleviate staffing inefficiencies. Regular audits of workflow constraints can help in deploying staff more effectively and improving patient flow. For research, this study lays the groundwork for longitudinal and multi-site investigations to generalize findings across various healthcare settings. Future studies should explore real-time constraint detection using artificial intelligence tools. Theoretically, this study supports and extends the Theory of Constraints by demonstrating its compatibility with predictive modeling, contributing to a more data-driven approach to operational decision-making in healthcare. Recommendations include training healthcare managers in constraint identification and predictive analytics to enhance systemic responsiveness and sustainability in workforce management. <strong>Keywords:</strong> Predictive analytics, Operational value, Process flow mapping, Staff utilization, Theory of constraint. <strong>Title:</strong> Operational Bottlenecks and Workforce Efficiency: A Quantitative Evaluation Using the Theory of Constraints in Healthcare <strong>Author:</strong> Dr. David Augustine Bull <strong>International Journal of Interdisciplinary Research and Innovations</strong> <strong>ISSN 2348-1218 (print), ISSN 2348-1226 (online)</strong> <strong>Vol. 13, Issue 2, April 2025 - June 2025</strong> <strong>Page No: 60-78</strong> <strong>Research Publish Journals</strong> <strong>Website: www.researchpublish.com</strong> <strong>Published Date: 03-June-2025</strong> <strong>DOI: https://doi.org/10.5281/zenodo.15585196</strong> <strong>Paper Download Link (Source)</strong> <strong>https://www.researchpublish.com/papers/operational-bottlenecks-and-workforce-efficiency-a-quantitative-evaluation-using-the-theory-of-constraints-in-healthcare</strong>

The purpose of the study was to evaluate public participation in the policy making process in Makueni County. This was so because, despite the Makueni County Government generally accepted framework for public participation, there is limited information on how that framework has impacted or been used in the policy making process. Specifically, the study sought to assess the extent of awareness by the residents of Makueni of their democratic right and opportunities to participate in the policy making process; analyzed the levels of citizens involvement in policy making processes in Makueni County; established the perception towards public participation in policy making process by residents and management in Makueni County; and determined the barriers to public participation in policy making process by residents and management in Makueni County. The study was anchored on Stakeholder Theory, Arnstein’s Ladder and the Multi Streams Model. The study was hinged on descriptive survey research design and targeted the 884,527 residents of Makueni and the 217 County Public service Departmental staff in Makueni County. Stratified sampling was used to delineate 117 staff in terms of their positions, whether management or operations excluding the subordinate staff. Simple random sampling was used to get 396 residents. Focus Group Discussions and questionnaires were the primary data collection instruments. Quantitative data was analyzed using descriptive statistics in form of percentages and frequencies. Linear regression model analysis was also used to analyze data. The results established that the residents were unaware of their democratic right and opportunities for participation in policy making process in Makueni County. There were also low levels of citizens’ involvement in policy making processes in Makueni County. Further, perception about public participation by residents was both negative for those who felt let down by the county management and positive for those who mainly felt hopeful that despite those challenges, things improve for the better in terms of public participation in policy making process in Makueni County. Additionally, financial, physical resource, human resource and technological barriers were identified as having considerable negative impact on citizen participation in policy making process. The study thus recommends that Makueni County management should embark on renewed promotional strategies to create awareness among citizens of their democratic right and opportunities for participation in policy making process in Makueni County. Further, the citizens themselves should be proactive and employ necessary mechanisms of obtaining information from the county government and demand participation. The Makueni County management should on the other hand, formulate a framework that stipulates the measures to be applied towards fully involving the citizens. The Makueni County management should also be more transparent and accountable in order to help build a positive perception about public participation amongst the residents. Moreover, the Makueni County management should engage in robust resource mobilization of finances, physical, human and technological resources that advance public participation in policy making process. On a policy level, the County Assembly should amend existing public participation legislation to make it more responsive to the needs of citizens. The executive should on their part robustly implement public participation processes going forward.

AimsThe number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.MethodWe performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.ResultReferral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (&gt;65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.ConclusionTo plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.

6 Background: Disruptions in cancer care adversely affect patient clinical outcomes, particularly when a patient does not complete the prescribed course of treatment. Adverse outcomes include decreased overall survival and earlier/increased disease relapse or progression requiring additional salvage, palliative, and/or supportive therapies. We have reported on the incidence of treatment terminations (TT) in a large multi-center academic radiation medicine department. This study addresses the healthcare expenditure toward sub-optimal treatment associated with TT. Methods: TT of patients undergoing radiation treatment between 1/2013 and 1/2023 were prospectively tracked as part of departmental quality and safety monitoring. A TT was defined as the discontinuation of therapy at any point following informed consent and treatment simulation. The rate of TT was calculated as a percentage of all new patients who start radiation treatments. Cost of care was estimated using mean values from the 2023 Medicare Part B Fee schedule for New York, accounting for consultation, simulation and planning, treatment delivery, and weekly physician and physics treatment checks prior to TT. Cuts to the Medicare Physician Fee Schedule, Medicare reimbursement, and stagnant Medicare Conversion Factor relative to inflation over the 10 years were not accounted for. Results: There were a total of 1,467 TTs out of 28,707 planned treatment courses (5.1%). The average expenditure prior to TT was $8,584 per patient. Aggregated over the past decade, $12.59 million represents an underestimate of healthcare spend toward these situations at one institution. The rate of TT decreased from 9.3% in 2013 to 3.3% in 2022. As discussed separately, this TT rate was reduced via prospective analysis as part of our ongoing department quality and safety program, with incremental changes to pre-treatment evaluation, on-treatment management, and scheduling processes. Assuming stagnant clinical volume, this translates into decreased spend of $1.48 million annually toward incomplete (sub-optimal) treatments. Conclusions: Radiation TTs reflect major deviations from the original care plan. By understanding reasons for TT, we have more effectively selected optimal treatment paradigms and supported patients proactively through their treatment course. Avoiding divergence from intended cancer care decreases adverse outcomes, thereby improving value of the treatment course.

This paper attempts to employ the matrix of Strengths, Weaknesses, Opportunities, Threats (SWOT) to establish an evaluative index system for software enterprises in Jilin Province. The SWOT analysis is performed in combination with the Analytic Hierarchy Process (AHP) to determine the relative weights of various criteria in the analytic hierarchy as they are related to the overarching goal. The ultimate assessment of the developmental status of those provincial IT enterprises from the local (departmental/segmental) to the global (corporate/industrial) level will then be derived by applying a fuzzy comprehensive evaluation matrix in accordance with the principle of maximum associations. This approach promises to overcome drawbacks commonly found in conventional hierarchical analyses, where frequent adjustments and tests are often required to make results from judgmental matrix consistent. Examples with concrete analytic results have shown that this innovative, synthetic method is of promising guiding significance to corporate strategic formulations.

The efficiency and reliability of business processes in commercial banks are critical to financial stability and compliance. However, traditional evaluation methods that rely on retrospective qualitative assessments and static frameworks struggle to address the dynamic complexities inherent in modern banking operations. These approaches lack real-time monitoring, fail to leverage granular event log data, and overlook organizational interdependencies, hindering proactive risk management and optimization. To bridge these gaps, this study proposes a data-driven evaluation framework that integrates three core dimensions: efficiency, quality, and flexibility. We developed a hybrid analytical model by integrating process mining with DEMATEL-AHP to analyze a Chinese bank’s performance guarantee process, comparing pre- and post-centralization workflows. The analysis revealed that post-centralization processes exhibited improved flexibility but reductions in efficiency and quality. Moreover, the social network analysis highlighted structural shifts, including expanded audit participation and reduced departmental cohesion, contributing to inefficiencies. This study advances business process management by demonstrating that a data-driven process evaluation framework offers greater persuasiveness and methodological rigor than traditional qualitative approaches.

Introduction: Significant variation exists in the perceived indications for balloon atrial septostomy in children with tricuspid atresia (TA). Many units advocate early, elective balloon atrial septostomy due to potential progressive narrowing of the interatrial opening, especially after the insertion of an arterial shunt. Our practice is to perform an atrial septostomy only in children with clinical and/or echocardiographic features of a restrictive interatrial communication. The aim of the study was to assess our practice by retrospective evaluation of patients born with tricuspid atresia with particular reference to the clinical fate of the atrial septum. More specifically the frequency of emergency atrial septostomy, the complication rate, the need for delayed septostomy or surgical resection and the longer term outcome were evaluated. Materials and methods: The study was a retrospective review (1980–2005) of the data on 49 live-born patients in our departmental database with a diagnosis of TA. One patient was excluded from the study due to referral to another centre and subsequent loss to follow up. By reviewing the medical notes of the remaining 48 patients we collected data on indications for, and timing of balloon atrial septostomy and subsequent complications and long term outcome. Results: The median time to follow up was 9.5 years (0.7–23.7). The diagnosis group was heterogeneous with 38 (79%) patients diagnosed with TA and normally related great arteries with or without pulmonary stenosis or atresia. The remaining 10 patients had more complex anatomy. Of the 48 patients, 5 (10%) were deemed to require balloon atrial septostomy for a clinically and/or echocardiographically restrictive atrial septum. Three procedures were performed within the first 24 hrs of life and 2 within the first month. One of the patients developed NEC following the septostomy and subsequently died of overwhelming sepsis. One patient required delayed surgical septectomy at 6 years of age, during a bidirectional Glenn operation. Of the remaining 42 patients there were 7 deaths (16%) but none were attributed to a restrictive atrial septum (1–at birth, severe acidosis and multi organ failure due to interrupted aortic arch and poor response to IV Prostin; 1–5 days with Group B streptococcal sepsis; 1–post operative sepsis following insertion of a BT shunt; 1–9 years, acute shunt obstruction; 1–withdrawal of care due to complex anatomy deemed to have a poor prognosis; 2-sudden death at home at 3½ years and 11 years). 26 patients required palliation with an arterial shunt (19–modified BT shunt, 6–Waterston Shunt, 1–ductal stent). None of the patients developed a clinically and/or echocardiographically restrictive atrial septum post procedure or during long term follow-up. Conclusions: We conclude that elective balloon atrial septostomy at presentation may not be necessary in patients born with tricuspid atresia. Accepting the limitations of retrospective data collection we also conclude that progressive narrowing of the interatrial septum at a later date is an unusual occurrence, even after an arterial shunt operation. We recommend that atrial septostomy should only be performed in patients who show obvious clinical and/or echocardiographic evidence of restrictive interatrial communication.

Engineers ultimately work in multi-disciplinary workplaces, yet degree structures and siloing of subjects typically prevent students from interacting with those outside of their own discipline. As products and technology become increasingly complex, engineers can no longer do design in isolation. Learning designs need to mirror real world complex team projects. In this project we provide an example of how Design-Based Research can be used as a meta methodology to design a learning experience that is implemented through a design-based collaborative student team project. An important part of the design process is to understand the interface with other disciplines of engineering and be able to specify appropriate requirements and verify that those requirements are being met. If these groups of students do not interact while at university, they are ill-prepared to do such design across disciplinary boundaries in the workplace. Moreover, if they are incapable of being able to formally specify what they require from other engineers, then they would not be able to verify that the design meets those specifications. This capstone project seeks to address these issues through the following objectives:&#x0D; &#x0D; &#x0D; Develop a multi-disciplinary team design project that can be rolled out to two core, candidate subjects in different departments in the Faculty of Engineering and Information Technology (FEIT);&#x0D; Develop appropriate learning activities that support the project and promote cohort interaction outside of traditional discipline / departmental boundaries;&#x0D; Design relevant feedback and evaluation mechanisms in order to monitor student team progress and gauge the effectiveness of the approach in building cohort, enhancing student graduate outcomes and employability skills;&#x0D; Enhance students’ communication and project management skills;&#x0D; Expose students to real-world engineering practices through the involvement of an industry partner in the scoping and design process.&#x0D; &#x0D; &#x0D; The project takes a Design-based Research (DBR) (McKenney and Reeves, 2019) approach that aligns&#x0D; with the four stages of DBR that is mirrored in both the design of the learning experience and in the student design project itself:&#x0D; &#x0D; Analysis – problem identification (Threshold Concepts: transdisciplinary collaboration, authentic learning), literature review, establishment of a collaborative learning design team&#x0D; Design prototype intervention (design of authentic learning environment)&#x0D; Evaluation (implementation of prototype with stakeholders – students/industry partner) - Re-Design / Evaluation Iterative Loop&#x0D; Development of Transferable Design Principles for designing authentic (real world) transdisciplinary learning environments in collaboration with industry&#x0D; &#x0D; &#x0D; Designing a speaker system, which contains electrical and mechanical systems that interact in a complex transfer of energy from electrical to mechanical to acoustic energy, is an inherently multidisciplinary endeavour consisting of both electrical and mechanical engineering concepts. This project will be completed by two capstone teams, one with a mechanical engineering focus and one with an electrical engineering focus, that will closely interact with each other in order to produce a working speaker system that will be tested and evaluated by an industry partner, creating an authentic learning experience (Herrington et al., 2014). &#x0D; &#x0D; A particular speaker application will first be chosen by the project teams (e.g. PA speaker, bookshelf speaker, instrument speaker, studio monitor), with corresponding design goals to be determined by the team. Teams will be required to select appropriate speaker drivers, supplied by the industry partner, to form the basis of electrical and mechanical design of the (minimum) two-driver speaker system utilising established design principles (Theile, 1971a, 1971b; Small, 1972, 1973a, 1973b). &#x0D; &#x0D; The Speaker System Design (Electrical) project team will focus on designing the electrical / electronic side of the speaker system, including modelling, building and testing both passive and active types of crossovers in order to achieve the required performance for the chosen application and consider aspects such as frequency domain performance, power, heat and cost. The electrical project team must interface with the mechanical project team to understand the mechanical characteristics of the enclosure that the speaker is being placed in to design their crossovers. &#x0D; &#x0D; The Speaker System Design (Mechanical) project team will focus on designing the mechanical / acoustic side of the speaker system, including designing, modelling low frequency response, building and testing a suitable enclosure to minimise vibrations and diffraction and ensure suitable performance characteristics for the chosen application consider aspects such as exterior construction materials, geometry of the design, high frequency diffusion patterns, venting and interior absorption materials to minimise resonances. The mechanical project team must interface with the electrical project team to understand the characteristics of the speaker-driving circuitry to design a suitable enclosure.&#x0D; &#x0D; The main pedagogical outcomes of the project are to give electrical and mechanical engineering students a real world experience of transdisciplinary collaboration. We will use pre/post student questionnaires and post project focus groups to evaluate the impact of the project on the student learning experience. University ethics consent will be applied for, involving participant consent and information forms, and anonymous data collection.&#x0D; &#x0D; This presentation will introduce the first two phases of the Design-Based Research project as an example of implementing DBR to design authentic learning – the pedagogical problem analysis, and the proposed prototype educational design capstone project.&#x0D; &#x0D; References&#x0D; &#x0D; Herrington, J., Reeves, T. C., &amp; Oliver, R. (2014). Authentic Learning Environments. In J. M. Spector, M. D. Merrill, J. Elen, &amp; M. J. Bishop (Eds.), Handbook of Research on Educational Communications and Technology (pp. 401-412). Springer New York. https://doi.org/10.1007/978-1-4614-3185-5_32 &#x0D; McKenney, S., &amp; Reeves, T. (2019). Conducting educational design research (2nd ed.). Routledge. https://doi.org/10.4324/9781315105642 &#x0D; Small, R. H. (1973). Vented-Box Loudspeaker Systems--Part 1: Small-Signal Analysis. Journal of the Audio Engineering Society, 21(5), 363-372.&#x0D; Small, R. H. (1973). Closed-box loudspeaker systems-part 2: Synthesis. Journal of the Audio Engineering Society, 21(1), 11-18.&#x0D; Small, R. H. (1972). Closed-box loudspeaker systems-part 1: analysis. Journal of the Audio Engineering Society, 20(10), 798-808.&#x0D; Thiele, N. (1971a). Loudspeakers in vented boxes: Part 1. Journal of the Audio Engineering Society, 19(5), 382-392.&#x0D; Thiele, N. (1971b). Loudspeakers in vented boxes: Part 2. Journal of the Audio Engineering Society, 19(6), 471-483.

<strong>Original Research Paper</strong> <strong>Neurological Etiologies Necessitating Elective Tracheostomy in Pediatric Age Group: A 100 Patient Experience</strong> <strong>Authors:</strong> <strong>¹</strong><strong>Anju Benny, ²Muhammad Faraz Shamshad, ³Soumyadeep Sikdar, ⁴Shreshtha Singh, ⁵Amir Hassan, ⁶Yi Sin Leong, ⁷Areeba Siddiqui, ⁸Fazila Imtiaz,⁹ Hafsa Ashraf, ¹⁰Misha Anam</strong> <em>¹</em><em>ACS Medical College and Hospital(India)</em> <em>²</em><em>Karachi Medical &amp; Dental College, Karachi (Pakistan)</em> <em>³</em><em>Institute of Medical Sciences, Benaras Hindu University (India)</em> <em>⁴</em><em>Synergy Hospital, Dehradun, Uttarakhand (India)</em> <em>⁵</em><em>Rehamn Medical Institute (RMI), Peshawar (Pakistan)</em> <em>⁶</em><em>Universiti Kebangsaan Malaysia Medical Centre (Malaysia)</em> <em>⁷</em><em>Dow Medical College (Pakistan)</em> <em>⁸</em><em>Lahore Medical &amp; Dental College, Lahore (Pakistan)</em> <em>⁹</em><em>Shalamar Hospital, Lahore (Pakistan)</em> <em>¹⁰</em><em>Children Hospital &amp; The Institute of Child Health, Lahore (Pakistan)</em> Corresponding Author: Misha Anam, Children Hospital &amp; The Institute of Child Health, Lahore (Pakistan) <strong>Article Received:</strong>&nbsp; 10-08-2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Revised:</strong>&nbsp; 31-08-2022&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>Accepted:</strong> 21-09-2022 <strong>ABSTRACT</strong><strong>:</strong> <strong>Background: </strong>Tracheostomy is a life-saving procedure and is indicated in a variety of peripheral or central conditions leading to respiratory compromise. Mainly, tracheostomy is done for three reasons; to bypass obstructed upper airway, to remove secretions and keep the airway patent; and to effectively ventilate the patient.<strong> Objective:</strong> The aim of this study is to quantify the frequency of different neurological disorders which indicate elective tracheostomy to avoid respiratory compromise and its associated complications.<strong> Materials and Methods:</strong> In this Prospective, observational study, 100 pediatric patients with confirmed neurological diagnosis and associated severe respiratory impairment requiring invasive mechanical ventilation were enrolled. The study was conducted over the period of 3 months, from May 2022 to July 2022, at Children Hospital and Institute of Child Health, Lahore.<strong> Results: </strong>According to the collected data, prevalence of male patients was almost twice as that of females (2.9:1). The main indication of tracheostomy was the requirement of prolonged mechanical ventilation due to neurological condition (n= 36, p&lt;0.02). Among all the neurological etiologies, the CNS infections with serious respiratory manifestations were most common including Guillain Barre Syndrome (n=26, p=&lt;0.01), Diphtheria Polyneuropathy (n=8, p=0.06), Hypoxic-Ischemic Encephalopathy (n=5, p&lt;0.08), Varicella Zoster Infection (n=3, p=0.09), Poliomyelitis / Post-Polio Syndrome (n=2, p&lt;0.1), and Tetanus (n=1, p=0.15).<strong> Conclusion: </strong>Infectious neurological diseases such as GBS, Diphtheria, and polio, causing respiratory failure are still prevalent in developing countries like Pakistan &amp; India and are the main causes of tracheostomy in pediatric age group. Prolonged mechanical ventilation was the main indication for tracheostomy. <strong><em>Keywords: tracheostomy, pediatrics, infections, GBS, ETT, neurological intensive care</em></strong> &nbsp; &nbsp; <strong>INTRODUCTION</strong><strong>:</strong> Tracheostomy is one of the ancient surgical procedures to bypass upper airway tract obstructions. About 40 years ago, pediatric tracheostomy was only indicated in the cases of infectious diseases of upper airway such as Diphtheria, Epiglottitis etc. [1]. Over the time, the indications and applications of tracheostomy were revised and evolved, considerably. With the administration of vaccines, the incidence of infectious diseases caused by <em>Cornybacterium Diphtheria</em> and <em>Hemophillus Influenzae</em> has decreased dramatically [2]. Hence, the number of pediatric emergency tracheostomies has fallen, globally. However, with the introduction of other indications of tracheostomy, the overall number of tracheostomies has increased over time [3]. Worldwide, the pediatric tracheostomy is performed in tertiary care facilities only, in children with acute or chronic, congenital, or acquired respiratory and/or neurological impairment, and in children with long term dependency on invasive mechanical ventilation [4]. There are a number of neurological etiologies that can result in severe respiratory impairments. Emergent Endotracheal Tube Placement with mechanical ventilation can save the patient temporarily but if the long term invasive mechanical ventilation is required, ETT must be replaced by tracheostomy [5]. According to the experts, if patient needs ETT and mechanical ventilation for 7 days or more, then tracheostomy should be performed for sustainable and secured airway [6]. Although in some cases of severe neurological impairment, patients need ETT assisted mechanical ventilation for a longer period of time, for example in case of a brain injury with poor GCS and unconsciousness, tracheostomy cannot protect the airway against secretions and gastric aspiration as ETT does [7]. Tracheostomy decreases the work required for breathing but that is not an issue for the patients with brain injury. Prolonged ETT intubation is associated with high risk of nosocomial pneumonia and prolonged ventilator dependency which can be significantly reduced by tracheostomy. Prolonged ETT intubation is also associated with a number of tracheal complications especially in the patients with severe brain trauma. If patient is intubated for more than 14 days, there is a high risk of development of serious complications such as laryngeal injury including laryngeal edema and inflammation, vocal cord injury, ulceration, paresis, paralysis, granuloma, and stenosis. So, it is important to weigh the pros and cons after regular and careful clinical evaluations of the patients [8]. There are a variety of neurological disorders which require tracheostomy as a part of an active or long-term management plan. These diseases/disorders include congenital/chromosomal/neurometabolic, idiopathic, traumatic, infective, autoimmune, and inflammatory disorders [9]. The incidence of infective neurological causes has decreased worldwide over the time, by the virtue of effective immunization. Nevertheless, these are still prevalent in developing countries due to poor vaccination coverage and healthcare provision. There are several neurological infections that cause acute flaccid paralysis and hence the respiratory compromise. The mechanism of respiratory disability may vary slightly, but the ones that are mentioned in the article required tracheostomy at some point in the management of the disease [9, 10]. Among all the acute neurological infections, Guillian Barre Syndrome (GBS) is the most common cause of peripheral, motor neuropathy with presumed antecedent infection and autoimmune etiology. Usually, the infection caused by <em>Campylobacter Jejuni</em> precedes the GBS with rapidly progressive axonal injury, ascending paralysis, respiratory failure, severe residual disability and slow recovery [11]. Globally, the incidence of GBS ranges from 1.1 to 1.8 per 100,000 people, annually [12]. The overall incidence of GBS increases with the age; peaks after 50 years. In Pakistan, the exact incidence and prevalence is not known. Electrophysiological studies for early detection, definitive diagnosis, and classification of GBS play an important role in significant reduction of morbidity and disability [13]. Poliomyelitis or Post Polio Syndrome is caused by highly infective, Enterovirus via feco-oral route [14]. It is a type of acute flaccid paralysis associated with prolonged or permanent flaccid muscle paralysis, respiratory failure, and death. Due to combined efforts, this sporadic, highly contagious infection is successfully eradicated from the world, except some areas of Sub-Saharan Africa and South Asia where it is still an endemic. In 95% of the infectious cases, the patients either remain asymptomatic or have a flu-like illness [15]. Despite effective preventive and management policies, some patients develop late functional complications after a long period of complete stability and recovery. This condition is called Post-Polio Syndrome. The bulbar form of Poliomyelitis involves high morbidity and mortality due to vasomotor, circulatory, and autonomic dysfunction along with respiratory failure. The acute respiratory failure needs emergent intubation and prolonged mechanical ventilation which can later indicate elective tracheostomy [16]. Diphtheritic Polyneuropathy (DP) is a serious bulbar, respiratory, and circulatory complication. It is a direct and acute indication for intubation and tracheostomy [17]. The etiology causes a decrease in lung&rsquo;s vital capacity (&lt;16mL/kg body weight), paralytic collapse of layrngeal muscles, and multiple cranial nerves impairment causing peripheral motor disturbances. Diphtheritic Polyneuropathy is also a late complication of diphtheria infection, so special attention should be given from the fourth to seventh week of DP [18]. The objective of this study is to determine the current neurological indications of tracheostomy in the pediatric age group and to assess the burden of infectious causes with central involvement in developing countries like Pakistan, despite the discovery and implementation of effective immunization all around the globe. <strong>MATERIAL &amp; METHODS</strong><strong>:</strong> In this prospective, observational study, 100 patients were recruited by following the inclusion and exclusion criteria. The study was conducted over the period of 3 months, from May 2022 to July 2022 at a tertiary care hospital. The Qualitative and Quantitative data was collected for 100 selected patients who were registered through the CH &amp; ICH, Lahore. Multi-departmental Collaboration was ensured. Verbally explained, written informed consent was taken from the guardians, mostly from the parents of the children. The whole purpose and procedure of this study was explained to the attendants. Few parents refused to take part in the study, their rights were respected, and they were not included in our study. By any means, this study does not adversely affect the rights and welfare of the subjects. All the patients had some neurological manifestation as a primary cause for elective tracheostomy. Those patients were also not included in the study which needed tracheostomy due to some other primary cause while the neurological condition co-existed. <strong>INCLUSION CRITERIA:</strong> Patients diagnosed with neurological impairments that were compromising the respiration by any means, i.e. Upper airway obstruction, Vocal cord paralysis/paresis, respiratory muscle paralysis/paresis, altered sensorium, skeletal/laryngeal muscle weakness, prolonged mechanical ventilation, etc. Patients who were on mechanical ventilation for &gt; 7 days Patients who required prolonged mechanical ventilation or on whom, ventilator weaning off attempts were performed but failed <strong>EXCLUSION CRITERIA:</strong> Patients of age more than 14 years Patients who needed tracheostomy for causes other than neurological anomaly Patients with incomplete previous medical record Patients with underlying diseases (other than neurological issues) such as hypothyroidism, diabetes, hepatic or renal dysfunction, vasculitis, metastasis, intoxication, etc. <strong>RESULTS</strong><strong>:</strong> According to the collected data, there were 67 males (p &lt;0.02) and 23 females (&lt;0.04) with male to female ratio of 2.9:1. The peak incidence of tracheostomy is seen at the ages of 2-5 years (n=29, p &lt;0.05) and 6-12 months (n=21, p&lt;0.05). P value less than 0.05 is considered significant. The demographic characteristics including age group and gender are described in Table 1. &nbsp; <strong>Demographic Characteristics</strong> <strong>Frequency (%age)</strong> <strong>P-value</strong> <strong>Age</strong> 0-6 months 16 (16%) Not Significant 6-12 months 21 (21%) &lt;0.05 1-2 years 11 (11%) Not Significant 2-5 years 29 (29%) &lt;0.05 5-10 years 10 (10%) Not Significant 10-14 years 13 (13%) Not Significant <strong>Gender</strong> Male 67 (67%) &lt;0.02 Female 23 (23%) &lt;0.04 <strong>Table 1 Demographic Characteristics of selected children (n=100)</strong> &nbsp; Eight different indications of elective tracheostomy in pediatric population were documented in this study. In descending order, the 3 main indications are prolonged invasive mechanical ventilation (n=36, p=&lt;0.02), Upper airway obstruction (n=20, p=&lt;0.04), and Metabolic/ Genetic/ Chromosomal anomalies (n=16. p=&lt;0.05). &nbsp; &nbsp; &nbsp; <strong>Indications of Tracheostomy</strong> <strong>Frequency (%age)</strong> <strong>P-value</strong> Upper Airway Obstruction 20 (20%) &lt;0.04 Prolonged Invasive Mechanical Ventilation 36 (36%) &lt;0.02 Hypoxic Brain Injury 8 (8%) Not Significant Metabolic / Genetic / Chromosomal 16 (16%) &lt;0.05 Cerebral Hemorrhage 4 (4%) Not Significant CNS Infection 9 (9%) Not Significant Demyelinating Disorder 5 (5%) Not Significant Brain Tumor 2 (2%) Not Significant <strong>Table 2 Indications of Elective Tracheostomy in children with neurological disease associated respiratory compromise</strong> &nbsp; Among the 100 selected patients, 16 different neurological conditions were documented, all leading to the respiratory failure by different mechanisms. Surprisingly, 45% of the total patients had neurological manifestation due to infectious etiology. The infectious causes of neurological conditions include (in descending order) Guillain Barre Syndrome (n=26, p=&lt;0.01), Diphtheria Polyneuropathy (n=8, p=0.06), Hypoxic-Ischemic Encephalopathy (n=5, p&lt;0.08), Varicella Zoster Infection (n=3, p=0.09), Poliomyelitis / Post-Polio Syndrome (n=2, p&lt;0.1), and Tetanus (n=1, p=0.15). &nbsp; <strong>Neurological Conditions</strong> <strong>Frequency (%age)</strong> <strong>P- value</strong> Poliomyelitis / Post-Polio Syndrome 2 (2%) Not Significant Guillain Barre Syndrome 26 (26%) &lt;0.01 Myasthenia Gravis 14 (14%) &lt;0.03 Diphtheria Polyneuropathy 8 (8%) Not Significant Varicella Zoster Infection 3 (3%) Not Significant Duchenne Muscular Dystrophy &nbsp;5 (5%) Not Significant Hypoxic-Ischemic Encephalopathy 5 (5%) Not Significant Cerebral Palsy 8 (8%) &lt;0.05 Spinal Muscular Atrophy (SMA) 3 (3%) Not Significant Neurofibromatosis 4 (4%) Not Significant Brain Tumors 6 (6%) Not Significant Kernicterus 5 (5%) Not Significant Leukodystrophy 2 (2%) Not Significant Amyotrophic Lateral Sclerosis 3 (3%) Not Significant Traumatic Brain Injury 5 (5%) Not Significant Tetanus 1 (1%) Not Significant <strong>Table 3 Spectrum and frequency of various neurological conditions necessitating elective tracheostomy</strong> &nbsp; During the period of 3 months of this study, no tracheostomy related mortality was documented. None of the patients underwent decannulation. The limitations of this study are that the duration of three months period did not allow the proper follow up of the patient and the prognosis, duration, and late complications of tracheostomy could not be assessed. <strong>DISCUSSION</strong><strong>:</strong> Tracheostomy is an operative procedure that creates a surgical opening on the anterior aspect of cervical trachea, mainly for effective ventilation [1, 2]. Patients with tracheostomy are a heterogeneous group of population with various indications and associated conditions. In this study, we only included the patients from pediatric age group requiring elective tracheostomy due to any congenital or acquired neurological condition [3, 4]. Children with congenital or acquired neurological disorders are prone to have respiratory co-morbidities [5]. There are multiple neurological manifestations that cause respiratory compromise such as pharyngeal/ laryngeal muscle weakness leading to Vocal cords dysfunction, respiratory muscle weakness or paralysis causing hypoventilation, skeletal muscle weakness i.e. SMA associated with prolonged immobility, pooling of respiratory secretions in respiratory tract, recurrent lung infections, and irreversible destruction of lung parenchyma [6, 7]. In patients with Cerebral Palsy and other neuromuscular disorders, pharyngeal and laryngeal muscles fail to maintain the patency of upper airway tract against inspiratory negative pressure [8, 9]. The hypotonic pharynx tends to remain collapsed causing upper airway narrowing or obstruction. Whenever, the patient develops acute upper or lower respiratory tract infection, the condition worsens with additional mucosal swelling and pooling of respiratory secretions due to ineffective clearing of sputum [10]. Moreover, the muscular weakness also results in disrupted swallowing mechanism causing GERD (Gastro-Esophageal Reflux Disease) and micro aspirations due to prolonged immobility and loss of protective cough reflex. All these factors make the patient prone to develop permanent lung damage via recurrent bronchitis, bronchiectasis, and pneumonia [11]. Tracheostomy has several therapeutic as well as palliative applications in patients with neurological diseases. As discussed in this article, tracheostomy provides secure and sustainable pathway for short or long-term invasive mechanical ventilation. It secures the breathing pathway in case of upper respiratory tract obstruction. It reduces the physiological dead space and significantly reduces the work required for breathing [12]. It provides effective, less traumatic and easily accessible route for airway toileting via sputum suctioning which is essential, especially during acute respiratory tract infections. In the case of emergency positive pressure ventilation, tracheostomy provides a quick, accessible route and significantly decreases the morbidity and mortality caused by delayed or unsuccessful attempts of endotracheal tube placement. Although noninvasive ventilation is an alternative emergency maneuver, but in the patients with neurological diseases, the invasive ventilation is preferred due to the high risks of secretions and gastric content aspiration. It also provides a safe route for diagnostic as well as therapeutic endoscopy, reduces the duration of procedure, and significantly minimizes the procedure associated risks [13, 14]. In most of the conditions, early tracheostomy proves to be highly beneficial in terms of decreasing morbidity and disability [23]. For example, in GBS, early tracheostomy can end the dependency on mechanical ventilator, providing more comfort and a chance of commencement of early oral nutrition with adequate oral hygiene that can speed up the weaning process [24]. It also adds to the parent&rsquo;s satisfaction and patient&rsquo;s motivation for the quick recovery. But the decision of tracheostomy is often critical, and it needs expert&rsquo;s opinion and evaluation to assess the pros and cons of tracheostomy. In the neurological cases where there is an increased risk of aspiration, ETT intubation with inflated cuff provides more protection and safer airway. However, ETT is not a sustainable way to maintain airway and is associated with various early and late complications [25-27]. In the literature, the indications of tracheostomy are not found consistent throughout the world. In developed countries, tracheostomy is mainly indicated in traumatic, chromosomal, autoimmune, or inflammatory conditions [15-18]. Whereas, in developing countries, the major causes requiring tracheostomy are infections and their peripheral and central ramifications. In Pakistan, the vaccination rate in children is considerably lower than that of developing countries due to ineffective surveillance and lack of general public awareness [19, 20]. However, the unvaccinated or partially vaccinated are not the only ones susceptible to infectious diseases. The severe neurological infectious diseases such as GBS, Diphtheria etc., are also found common in fully immunized children. In that case, there are multiple reasons to consider, but the experts speculate that the main reason for this poor coverage is low quality vaccination. In developing countries like Pakistan, less immunogenic vaccinations are prevalent because of limited resources and cost effectiveness [21, 22] <strong>CONCLUSION</strong> This study demonstrates the frequency of different neurological conditions with significant respiratory complications that necessitate surgical tracheostomy. All over the world, the infectious causes of tracheostomy have almost diminished but these are still prevalent in our setup. According to this study, prolonged mechanical ventilation was the most common indication and GBS was the most common neurological condition requiring elective tracheostomy for better prognosis in children. <strong>REFERENCES</strong><strong>:</strong> Monteiro S, Farias TP, Camargo Millen MD, Locio RV. The History of Tracheostomy. InTracheostomy 2018 (pp. 1-9). Springer, Cham. Noorulla KA, Kumar MK, Talat M, Rajesh P. EVALUATION OF THE INDICATIONS AND OUTCOMES OF TRACHEOSTOMY DONE IN ICU: A CLINICO-OBSERVATION STUDY. McGrath BA, Wallace S, Lynch J, Bonvento B, Coe B, Owen A, Firn M, Brenner MJ, Edwards E, Finch TL, Cameron T. Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals. British journal of anaesthesia. 2020 Jul 1;125(1):e119-29. Muller RG, Mamidala MP, Smith SH, Smith A, Sheyn A. Incidence, epidemiology, and outcomes of pediatric tracheostomy in the United States from 2000 to 2012. Otolaryngology&ndash;Head and Neck Surgery. 2019 Feb;160(2):332-8. Abe T, Madotto F, Pham T, Nagata I, Uchida M, Tamiya N, Kurahashi K, Bellani G, Laffey JG. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Critical care. 2018 Dec;22(1):1-6. Volsko TA, Parker SW, Deakins K, Walsh BK, Fedor KL, Valika T, Ginier E, Strickland SL. AARC Clinical Practice Guideline: management of pediatric patients with tracheostomy in the acute care setting. Respiratory care. 2021 Jan 1;66(1):144-55. Swain SK, Sahu MC, Choudhury J, Bhattacharyya B. Tracheostomy among paediatric patients: Our experiences at a tertiary care teaching hospital in Eastern India. Pediatria Polska-Polish Journal of Paediatrics. 2018;93(4):312-7. Bontempo LJ, Manning SL. Tracheostomy emergencies. Emergency Medicine Clinics. 2019 Feb 1;37(1):109-19. Chia AZ, Ng ZM, Pang YX, Ang AH, Chow CC, Teoh OH, Lee JH. Epidemiology of pediatric tracheostomy and risk factors for poor outcomes: an 11-year single-center experience. Otolaryngology&ndash;Head and Neck Surgery. 2020 Jan;162(1):121-8. Veder LL, Joosten KF, Zondag MD, Pullens B. Indications and clinical outcome in pediatric tracheostomy: Lessons learned. International Journal of Pediatric Otorhinolaryngology. 2021 Dec 1;151:110927. Rees JH, Soudain SE, Gregson NA, et al. Campylobacter jejuni infection and Guillain&ndash;Barr&eacute; syndrome. New Engl J Med. 1995;333:1374-9. McGrogan A, Madle GC, Seaman HE, et al. The epidemiology of Guillain-Barr&eacute; syndrome worldwide. Neuroepidemiology. 2009;32:150-63. Yakoob MY, Rahman A, Jamil B, et al. Characteristics of patients with Guillain Barre Syndrome at a tertiary care centre in Pakistan during 1995-2003. J Pakistan Med Assoc. 2005;55:493. World Health Organization.&nbsp;<em>Geneva declaration for the eradication of poliomyelitis</em>. Geneva: WHO, 2004. Lancet T. Poliomyelitis-eradication initiative&#39;s wider lessons. The Lancet. 2004 Jan 10;363(9403):93. Sejvar JJ. West Nile virus and &ldquo;poliomyelitis&rdquo;. Neurology. 2004 Jul 27;63(2):206-7. Piradov MA, Pirogov VN, Popova LM, Avdunina IA. Diphtheritic Polyneuropathy:&nbsp;Clinical Analysis of Severe Forms.&nbsp;<em>Arch Neurol.</em>&nbsp;2001;58(9):1438&ndash;1442. doi:10.1001/archneur.58.9.1438 Gampa M, Karna PN, Reddy KV, Priyadarshini T. Study of Diphtheria and Its Complications: A Retrospective Study from a Tertiary Care Hospital. Pediatric Infectious Disease. 2021 Oct;3(4):141. Lancet T. Poliomyelitis-eradication initiative&#39;s wider lessons. The Lancet. 2004 Jan 10;363(9403):93. Iqbal W, Sayed TM, Wali W, Ahmed N, Butt AW, Gill ZA. Is Guillain-Barr&eacute; syndrome different in Pakistan?. PAFMJ. 2018 Feb 28;68(1):119-24. Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain&ndash;Barr&eacute; syndrome in low-income and middle-income countries: challenges and prospects. Nature Reviews Neurology. 2021 May;17(5):285-96. Samar SS, Ahmed SI, Bareeqa SB. Guillain&ndash;Barr&eacute; syndrome in Pakistan: A short review of literature. J Neurol Neurorehabil Res. 2018; 3 (1): 34-35. J Neurol Neurorehabil Res 2018 Volume 3 Issue. 2018;1. Sachdev A, Chaudhari ND, Singh BP, Sharma N, Gupta D, Gupta N, Gupta S, Chugh P. Tracheostomy in Pediatric Intensive Care Unit&mdash;A Two Decades of Experience. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine. 2021 Jul;25(7):803. Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, Melro L, Park M, Malbouisson LM. Comparison between ultrasound-and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: a retrospective cohort study. Journal of Critical Care. 2015 Feb 1;30(1):220-e13. Chew JY, Cantrell RW. Tracheostomy: complications and their management. Archives of Otolaryngology. 1972 Dec 1;96(6):538-45. McClelland RM. Complications of tracheostomy. British Medical Journal. 1965 Sep 9;2(5461):567. Dane TE, King EG. A prospective study of complications after tracheostomy for assisted ventilation. Chest. 1975 Apr 1;67(4):398-404.

AbstractDepartments are assessed using performance evaluation systems (PES) based on their important performance criteria. The sum of the weighted KPIs’ actualization scores creates the departments' performance ratings, which are used to rank departments from highest to lowest performing. However, this strategy does not account for departmental variances. We used multi-attribute decision-making (MADM) techniques in this study to ascertain the performance of several divisions inside a business. Our study's structure is divided into two distinct parts. In the first stage, pair-wise evaluation matrices are built and attribute weights are established using the Analytic Hierarchical Process (AHP) to determine attribute precedence. The second step employs the Elimination and Choice Expressing the Reality (ELECTRE) methodology to rank the departments using the attribute weights generated in the first stage using the AHP method. At the conclusion of the paper, a case study is presented to demonstrate how departments are organized in accordance with performance management principles within a corporation that use the balance-scorecard program for performance evaluation.

ObjectiveTo design and assess a visual genomic explainer focusing on plain language and engaging imagery. The explainer aimed to support doctors’ comprehension of complex genomic concepts and results and act as a resource promoting the integration of genomic testing into mainstream care.DesignProspective genomic resource development and questionnaire.SettingRegional and tertiary hospitals in Australia and Ireland, private and community-based clinicians in Australia.ParticipantsRecruitment of paediatricians and nephrologists in Australia and paediatricians in Ireland was multi-faceted. Emails with survey links were circulated through training bodies, advanced trainee networks, departmental heads, and professional societies.Main outcome measuresComprehension, engagement and perception of the visual explainer.ResultsMost clinicians surveyed (95% (53) Australian group, 100% (29) Irish group) felt that genomics would be a useful tool in their practice. 77% of Australian paediatric respondents and 73% of Irish paediatric respondents felt that genomics was underutilised. Challenges encountered with genomic testing included poor patient comprehension of the testing process and results along with difficulties perceived by clinicians in explaining complex results. 89% of Australian paediatricians and 100% of Irish paediatricians surveyed would recommend the use of the explainer to other professionals in their field.ConclusionThis genomic resource was acceptable to clinicians and could be a useful tool to support paediatricians integrating genomic testing into mainstream care.

Abstract Background During the outbreak of new coronavirus pneumonia, many hospitals in China became the designated hospitals for the treatment of new coronavirus pneumonia. The goal was to develop rapid and effective prevention and control methods for blood purification centers. Research design and methods The medical department, hospital department, nursing department, and blood purification center jointly set up a multi-department integrated COVID-19 prevention and control management team to manage the blood purification center. The efforts included the establishment of the continuous renal replacement therapy (CRRT) team for COVID-19, the integrated training and assessment of medical personnel, the integrated education of patients and their families, and the integrated management of the workflow of the hemodialysis room. Results No infected persons, including medical staff, patients, and their families, have been found in the dialysis center. After multi-departmental integrated training, the theoretical performance of medical staff in our dialysis center has increased from 82.36 ± 8.10 to 95.29 ± 4.95 (p &lt; 0.05), and the unqualified rate dropped from 23.21 to 1.78% (p &lt; 0.05). In addition, the three operational skills evaluation scores have also been significantly improved, from 86.00 ± 4.02, 88.01 ± 6.20, 92.01 ± 2.46 to 95.90 ± 0.30, 97.21 ± 0.87, 96.00 ± 1.00 (p &lt; 0.01), and the passing rate from 80.36 to 100% (p &lt; 0.05). Conclusion Medical staff’s knowledge of novel coronavirus pneumonia prevention and control can be improved by multi-sectoral integrated management, and CRRT treatment of COVID-19 patients is effective.

The thrust of this study was to assess students’ perceptions of the Bachelor of Education (Accounting) programme at the University of Cape Coast. The study adopted the descriptive survey design in which data were collected within the overarching framework of the Context Input Process Product evaluation model. A sample size of 349 Bachelor of Education (Accounting) students participated in the study. Multi-stage sampling, employing stratified sampling, proportionate random sampling and simple random techniques, was used in selecting the respondents for the study. Descriptive statistics (means and standard deviation) and inferential statistics (Mann-Whitney U-test and Kruskal-Wallis test) were used to analyse the research questions / hypotheses. The study found that students perceived the Bachelor of Education (Accounting) programme to be satisfactory to the context rubric of the CIPP model. However, it was found that the programme was not satisfactory with respect to the input rubric of the CIPP model. It was also revealed that students were satisfied with the process rubric of the programme. The study recommended that the programme designers should include courses that will expose students to the use of current accounting software used in Ghana such as Tally Accounting, and the Head of the Department should ensure that departmental library resources and facilities, current journals in Accounting for the use of both students and lecturers, and teaching and learning materials are adequately available and in right conditions.

The thrust of this study was to assess students’ perceptions of the Bachelor of Education (Accounting) programme at the University of Cape Coast. The study adopted the descriptive survey design in which data were collected within the overarching framework of the Context Input Process Product evaluation model. A sample size of 349 Bachelor of Education (Accounting) students participated in the study. Multi-stage sampling, employing stratified sampling, proportionate random sampling and simple random techniques, was used in selecting the respondents for the study. Descriptive statistics (means and standard deviation) and inferential statistics (Mann-Whitney U-test and Kruskal-Wallis test) were used to analyse the research questions / hypotheses. The study found that students perceived the Bachelor of Education (Accounting) programme to be satisfactory to the context rubric of the CIPP model. However, it was found that the programme was not satisfactory with respect to the input rubric of the CIPP model. It was also revealed that students were satisfied with the process rubric of the programme. The study recommended that the programme designers should include courses that will expose students to the use of current accounting software used in Ghana such as Tally Accounting, and the Head of the Department should ensure that departmental library resources and facilities, current journals in Accounting for the use of both students and lecturers, and teaching and learning materials are adequately available and in right conditions.

Today healthcare globally is growing at a rapid pace and despite the huge technological advancement, healthcare still faces primitive challenges and hence results in the poor service and facility to the needy. Layout planning acts as one major reason which requires improvements for the effective and efficient working of the healthcare facilities. This research aims at optimizing several quantitative criteria related to economic, technology and society which are taken into consideration for the decision-making during the evaluation, analysing and selection of the best layout for an existing healthcare facility. Critical areas for the improvement were found out using statistical analysis based on a survey questionnaire and Apple’s layout procedure is utilised to design the different possible layouts for an efficient facility. The seven criteria namely inter-departmental satisfactory level, the average distance travelled and the average time required for staff flow, the average distance travelled and the average time required for patient flow, the average distance travelled and the average time required for material flow were taken into consideration. The ELECTRE methodology was used as multi-criteria decision making based on decided seven criteria for comparing the different layout by methodical and orderly thinking.

In recent years, the Chinese central government and coastal provincial governments have promulgated a series of Coastal Ocean Pollution Prevention and Control Programs (COPPCP). Whether the government’s COPPCP can achieve policy synergy will affect the level of marine pollution governance. This study constructs a two-dimensional assessment framework of policy “subject department”–”content theme” and conducts a comprehensive evolution of policy synergy from objective, process, and state perspectives. From the subject department dimension, the study used social network analysis to find that interdepartmental collaboration was not done well overall. The policy synergy process is difficult to be guaranteed. Meanwhile, the structure of departmental synergy networks in different provinces shows differences and can be divided into three types of governments with single-core, multi-core, and vertical synergy. In the content synergy dimension, it was found by the Chinese Bidirectional Encoder Representations from Transformers-Whole Word Masking (BERT-WWM) model that the policy content is mainly focused on four themes of marine ecological protection (MEP), marine pollution control (MPC), land-based pollution reduction (LPR), and safeguard measures (SAM). The three types of governments show different performances on the four theme synergies. The governments perform well in the objective synergy; however, it is difficult for them to agree on the policy tool synergy, and the status of policy synergy is difficult to maintain. This paper adopts the BERT-WWM model instead of the manual coding method in the previous policy content analysis, enhancing the evaluation’s objectivity. The study results will provide a reference for further improving marine pollution governance systems in developing countries.

Abstract Background Coaching programs in graduate medical education have the potential to impact trainee development across multiple core competencies but require rigorous program evaluation to ensure effectiveness. We sought to qualitatively evaluate the implementation of a multi-departmental, faculty-led communication coaching program using a logic model framework. Methods Study participants were selected from four key stakeholder groups: resident coachees, faculty coaches, medical education leaders, and programmatic sponsors. 30–45 min semi-structured interviews were conducted via Zoom, transcribed, and de-identified for the analysis. Interviews captured stakeholders' perspectives on physicians' communication training needs, stakeholders perceived and actual roles, stakeholders’ involvement in the program, factors influencing the implementation process, and strategies for programmatic improvement, sustainment, and spread. The Consolidated Framework of Implementation Research (CFIR) guided the codebook development and data analysis. A combined inductive/deductive approach was used to develop a 20-item codebook, followed by a team-based thematic analysis. A strong intercoder agreement (Cohen’s kappa coefficient κ = 0.83) ensured coding consistency. The emerging themes were then mapped onto four domains of a logic model: Context, Inputs and Outputs, Outcomes, and Evaluation. Results 35 interviews were conducted between November 2021 and April 2022 with representation from all stakeholder groups, including 10 resident coachees (who received coaching), 10 faculty coaches (who served as coaches and underwent coaching-specific faculty development), 9 medical education leaders (who designed and implemented program), and programmatic sponsors (who provided financial support). We mapped 8 emergent themes onto the critical domains of a logic model for program evaluation. For the domain of Context, themes included (1) gap in communication education and (2) patient-centeredness. For the domain of Inputs/Outputs, themes included (1) investment in the program and (2) perceived program value. For the domain of Outcomes, themes included (1) learning-focused outcomes and (2) patient-related outcomes. For the domain of Evaluation, themes included (1) defining success and (2) challenges with evaluation. Conclusions Mapping CFIR-informed themes onto a logic model for program evaluation presents a novel strategy for integrating program implementation and evaluation, both of which are essential to effective educational programming. These findings can be used to guide future programmatic modifications to better meet the needs of key stakeholders.

ABSTRACTAimTo improve delayed cord clamping (DCC) rates for preterm infants (≤ 34 + 0 weeks' gestation) and establish DCC as standard practice using quality improvement (QI) methods.MethodsA multi‐departmental initiative was undertaken. An audit of DCC for preterm infants born at or before 34 + 0 weeks was performed. Using this data and feedback from multidisciplinary staff meetings, barriers to DCC implementation were identified and targeted QI interventions were introduced. Ongoing data surveillance monitored the effects of these interventions.ResultsDCC rates were evaluated for 862 preterm infants from January 2014 to August 2022. This QI project commenced in February 2018, with a detailed audit of 225 preterm infants across three time periods: epoch 1 (immediately prior to QI initiative), epoch 2 (QI implementation phase), and epoch 3 (immediate post‐implementation surveillance). Inconsistent documentation of cord clamp time and admission hypothermia were identified as potential barriers to implementation of DCC. Over the course of the initiative, the documentation rate increased from 16% to 92.6%. Hypothermia at admission decreased from 76% in epoch 1 to 43.2% in epoch 3. The baseline rate of DCC was low in epoch 1 (12%), but improved to 70% in epoch 3, with this change sustained in ongoing DCC rate evaluation to August 2022.ConclusionsThere has been a significant and sustained improvement in DCC for preterm infants at our centre. A structured approach to QI and collaboration between multiple departments were each integral in effecting this improvement in clinical care.

Abstract Aims Traditionally, bleeps have been integral to the role of a doctor. A pre-pandemic study estimated that more than 10% of the world’s bleeps are currently being used by the NHS. However, in response to the 2021 directive by the health secretary to phase out bleeps within NHS England, new approaches to communication in healthcare are being implemented. One of these is Alertive, a WhatsApp-style messaging system. This study utilises a quality improvement approach to determine the efficacy of Alertive in conveying messages as a replacement for bleeps, and to investigate the reasons behind its perceived poor uptake. Methods A ten-day evaluation of the uptake of 15 distinct Alertive roles within the surgical department, accompanied by a satisfaction survey circulated among departmental juniors. Results The survey findings revealed a prevailing consensus among users endorsing the efficacy and superiority of Alertive as a concept over the previous bleep system. However, user-reported constraints related to functionality and application logistics. These have been identified as sources of frustration and thereby impeding the broader utilisation and efficacy of Alertive. Conclusion Effective multi-disciplinary communication is imperative in a hospital setting. While Alertive presents a potential alternative to traditional bleeps, challenges such as poor role uptake and communication appropriateness persist and represent significant barriers to full integration and staff satisfaction. Role uptake is variable with some surgical teams having better compliance than others. While users report that the concept of Alertive is beneficial, no single communication system has been identified as being superior, emphasising the ongoing need for solutions in healthcare communication.

AbstractI-cell disease is rare autosomal recessive lysosomal storage disease which is characterized by accumulation of innumerable intracytoplasmatic inclusions in connective tissue cells. It has multisystemic involvement and often leads to a fatal outcome by early childhood. Craniosynostosis can be present in many cases of I-cell disease and can be even the presenting complaint of the patient. This case report emphasizes the importance of multi-departmental collaboration, extensive preoperative workup, and technical nuances in intraoperative and postoperative management of the child.We present a case of a 3-year-old child with mucolipidosis type 2 (I-cell disease) with multisutural craniosynostosis managed with fronto-orbital advancement and anterior cranial vault reconstruction. The patient was undertaken for Operative procedure electively with support from neuroanesthesia and ENT (ear, nose, and throat) teams. The patient could not be intubated despite repeated attempts from the neuroanesthesia team owing to complicated oropharyngeal anatomy. So, decision was taken to tracheostomize the patient by the ENT team. After tracheostomy, the patient underwent fronto-orbital advancement and anterior two–third cranial vault remodeling. There was significant improvement in cosmesis of the patient along with cranial vault expansion. However, in the postoperative period, the child developed ARDS (acute respiratory distress syndrome) and wound infection, for which he received intravenous antibiotics and tracheostomy support. The child was discharged after 2 months of hospitalization under stable conditions.I-cell disease is an autosomal recessive fatal lysosomal storage disorder, with multiple organ system involvement. Craniosynostosis with I-cell disease can also be managed surgically, after judicious evaluation of risks and benefits involved with active involvement of the caretakers.

Introduction: Diffusion weighted MR imaging (DWI) is the most accurate method to confirm or exclude acute ischemic stroke, however due to logistics is not widely used in the emergent setting. While many patients with stroke symptoms will get an MRI during their hospitalization, it may occur only after hours of care in the ER or after admission. Hypothesis: Providing emergent MR imaging in Stroke Code patients avoids unnecessary admission and associated costs for work-up of stroke mimics which otherwise would not be rapidly identified. Methods: IRB-approved retrospective review of the first year of expedited acute stroke MR imaging availability at a TJC Comprehensive Stroke Center. Imaging included immediate non-contrast head CT on arrival with CT Angiography at discretion of Stroke Code Leader. Emergent MR was then performed in patients without MRI contraindications who had unclear diagnosis, or to clarify extent of infarct. Demographic, clinical and imaging data were analyzed with time from triage to imaging, tPA decision, and discharge. Results: MRI was performed prospectively in 68/456 patients presenting with possible acute stroke symptoms from 7/1/2014-7/1/2015 (44 male, 26 female, age 60+/-15 years). Symptom onset was within 3 hours in 34 (49%), 3-6 hours in 12 (17%) and &gt;6 hours or awoke with symptoms in 22 (31%); NIHSS of 4 or less in 40 (59%). Median time from arrival to completion of non-contrast head CT was 16 minutes; median time from CT imaging to completion of DWI was 39 minutes. Twenty-nine patients were discharged directly from the ER after MRI, with median ER stay of 5 hours, 15 minutes. Conclusions: Through multi-departmental collaboration, expediting MR imaging in the setting of acute stroke evaluation can avoid unnecessarily prolonged ER observation and admission in patients with stroke mimics.

Context As new athletic trainers (ATs) transition into their roles, some employers provide orientation and onboarding to assist with the transition to practice. There is a lack of research outlining the ideal onboarding process for new ATs transitioning to practice. Objective Examine the onboarding process for new ATs. Design Grounded theory. Setting College/university, secondary school, hospital/clinic. Patients or Other Participants Seventeen newly credentialed, employed ATs who recently graduated from professional masters' programs (11 female, 6 male; 25.6±2.2 years) and twelve employers (6 female, 6 male, years in role supervising new ATs: 8.5±4.9) participated in this study. Data Collection and Analysis Participants were recruited via purposive sampling. Each participant was interviewed via phone using a semi-structured interview guide. Employees were interviewed approximately 3, 6, 9, and 13-15 months after beginning employment. Employers were interviewed one time. Data saturation guided the number of participants. Data were analyzed through grounded theory, with data coded for common themes and subthemes. Trustworthiness was established via peer review, member checks, and multi-analyst triangulation. Results Two themes emerged: initial orientation and continued onboarding. Participants reported receiving organizational, departmental, and site-specific orientations for initial orientation. For continued onboarding, participants reported mentoring, site visits, feedback and evaluation, regular meetings, and continuing education and professional development. Conclusions Onboarding is vital in transitioning to practice for newly credentialed ATs, as it provides support and helps new employees understand and adapt to their roles. Onboarding should go beyond initial orientation and include regular meetings with supervisors, other ATs, and site visits to provide feedback and ensure new ATs adapt to their roles. New ATs should seek support from supervisors and local ATs to help better understand their role.

Aims: To classify and find out the incidence of ocular injury effects and extraocular associates. Methods and Materials: This eight-month observational study was conducted between 2017 and 2018 recruiting 111 eyes of 101 patients reporting to ophthalmology outpatient and emergency medicine departments. Results: The demographic profile is composed of 82 (81.18%) males and 19 (18.81%) females with a mean presenting age of 33.45 and 33.57 years in males and females respectively ranging from 3 to 82 years. Sixty four (57.65%) right and 47 (42.34%) left eyes studied. Closed globe injuries accounted for 95 (85.56%) and open globe injuries were found in 16 (14.41%) eyes. Mode of injuries classified as RTA 37 (33.33%), RTA Self fall 26 (23.42%), metal-induced trauma in 9 (8.10%) and exposure to vegetative matter in 9 (8.10%), self fall at home/work in 6 (5.40%), assault in 4 (2.6%), sports-related injuries in 3 (2.7%), bull gore injuries in 3 (2.7%) and explosion injuries in 3 (2.7%) eyes. RTA and RTA self fall showed the highest relative risk and odds ratio among males compared to females. The relative risk ratio and odds ratio for RTA in males showed 0.63 and 0.31 respectively. Anterior segment injury effects were observed in all eyes and 21 (18.91%) eyes with posterior segment involvement. The associated facio-maxillary injury was seen in 58 (52.25%) eyes, orbital wall fractures in 52 (46.85%), and head injury in 26 (23.42%) eyes. Thirty (35.14%) eyes required imaging for further evaluation, of which 32 (31.68%) underwent computed tomography and 2 (1.99%) eyes subjected to magnetic resonance imaging. Fifty-three (52.47%) eyes were managed surgically, 25 (24.75%) conservatively and 23 (22.77%) medically. Conclusion: This study analysis concludes that closed globe injury is the most common ocular trauma. In middle-aged male patients, RTA-induced injuries were commonly prevalent. The most frequently associated co-morbidities were facio-maxillary trauma, lateral orbital wall fractures, and subconjunctival hemorrhage. Maximum eyes required surgical management while computed tomography provided a conventional mode of imaging. The multi-departmental management approach is essential for achieving a good medical and surgical outcome.

Abstract Background Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers. Methods We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a ‘hybrid’ GMB format combining online and in person facilitation to reduce travel and associated climate impact. Results Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The ‘hybrid’ GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process. Conclusions Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The ‘hybrid’ GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF.

Despite the increasing number of racially and ethnically minoritized (REM) individuals earning PhDs and the substantial investment in diversity initiatives within higher education, the relative lack of diversity among faculty in tenure-track positions reveals a persistent systemic challenge. This study used an adaptation of the Community Readiness Tool to evaluate readiness for faculty diversification efforts in five biomedical departments. Interviews with 31 key informants were transcribed and coded manually and using NVIVO 12 in order to assign scores to each department in the six domains of readiness. The results revealed no meaningful differences in overall scores across institutional types, but did show differences within specific domains of readiness. These findings indicate that readiness is multi-faceted and academic departments can benefit by identifying priority areas in need of additional faculty buy-in and resources to enhance the success of diversification efforts.