Absence Of Monitoring Research Articles

A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention.

Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol. We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team. Ethical approval was obtained from NHS North West-Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.

Hip Instability in Children With Spinal Muscular Atrophy: A Retrospective Study.

Hip subluxation and dislocation are known problems for children with spinal muscular atrophy (SMA). Medical complexity of these children typically results in absence of monitoring and intervention for pathologic hips. Patterns of hip migration and acetabular morphology in SMA have not been described. This study examines the natural progression of hip instability across all types of SMA in a pediatric population. Following institutional review board approval, a retrospective chart review of all children with SMA at our institution was performed. All x-rays taken before the age of 18 years containing adequate projections of the pelvis were measured for Reimer migration index (MI), acetabular depth ratio (ADR), and acetabular index (AI). Demographics and clinical data were collected including use of nusinersen, ambulatory status, contractures, and hip pain. Linear mixed effects model was fit to serial MI measures of individual hips with fixed effects consisting of SMA type, age at x-ray, and their interaction. ADR and AI measures were similarly modeled following conversion of raw values to z-scores based on the model developed by Novais et al Slope indicated rate of measure change as a function of age. Forty-five children (22 males) with SMA types 1 to 3 were included in this retrospective study. Six children were classified as type 1, 25 were type 2, and 14 were type 3. The interaction of age by SMA type was statistically significant (P=0.01), indicating a difference in the rate of hip subluxation between the 3 SMA types as measured by MI. By age 4, MI values were different from one another across all 3 groups (P<0.01). ADR decreased with age across all SMA types. The slopes of ADR regression lines were negative and statistically significant between the 3 groups (P=0.002). AI values were higher for all types of SMA, which is the opposite of expected in normal hips. Hip subluxation occurs across all SMA types, most rapidly in SMA type 1. Regression lines of ADR and AI compared with those seen in unaffected populations suggest hips in children with SMA demonstrate a difference in morphology of the acetabulum and do not follow normal adaptive remodeling. As treatments advance and the population of SMA patients becomes more mobile, there is an increased need to monitor hip instability in children with SMA, thus making orthopaedic management an important consideration.

Agro-Silvo-Pastoral Heritage Conservation and Valorization—A Comparative Analysis of the Chinese Nationally Important Agricultural Heritage Systems and of the Italian Register of Historical Rural Landscapes

Agricultural heritage systems are receiving increasing attention due to their multifunctional role, their capability to provide ecosystem services, and for representing sustainable development models for rural areas. At the international level, the Food and Agriculture Organization (FAO) of the United Nations launched in 2002 the Globally Important Agricultural Heritage Systems (GIAHS) Program to identify and safeguard traditional agro-silvo-pastoral systems that are the result of the adaptation of rural communities to the surrounding environments. Following this approach, similar national programs have been developed, among which the Italian National Register of Historical Rural Landscapes and the China Nationally Important Agricultural Heritage Systems (China-NIAHS) initiative stand out. This research compares the China-NIAHS initiative and the Italian Register of Historical Rural Landscapes, highlighting similarities and differences and identifying strengths and weaknesses, to contribute to the development of proper tools for the conservation and valorization of agricultural heritage systems. Both initiatives were established in 2012 and share similar aims and inscription criteria, including historical and current significance, knowledge system and social structure, economic and productive framework, and causes of vulnerability. The main differences are related to the delimitation of the boundaries of the proposed sites and to the inscription process; in addition, while for the Italian National Register spatial analyses of land-use changes and landscape structure are mandatory according to a precise methodology, for the China-NIAHS no specific landscape analyses are required. The main critical issues are the lack of public participation and the lack of a monitoring plan after the inscription. The absence of monitoring is also the main vulnerability of the FAO GIAHS Programme. This research can offer important information for different stakeholders at the international, national, and local levels dealing with agricultural heritage conservation and valorization. In particular, it highlights the need of developing a multidisciplinary monitoring system with a standard methodology based on different indicators that can contribute to maximizing the impact of these initiatives. This research also provides useful information for the countries that are interested in developing a national initiative for agricultural heritage systems’ identification and valorization/conservation or for countries that intend to improve their national programs.

Neurofilament light protein as a biomarker for spinal muscular atrophy: a review and reference ranges.

Spinal muscular atrophy (SMA) is the leading genetic cause of infant mortality, characterized by progressive neuromuscular degeneration resulting from mutations in the survival motor neuron (SMN1) gene. The availability of disease-modifying therapies for SMA therapies highlights the pressing need for easily accessible and cost-effective blood biomarkers to monitor treatment response and for better disease management. Additionally, the wide implementation of newborn genetic screening programs in Western countries enables presymptomatic diagnosis of SMA and immediate treatment administration. However, the absence of monitoring and prognostic blood biomarkers for neurodegeneration in SMA hinders effective disease management. Neurofilament light protein (NfL) is a promising biomarker of neuroaxonal damage in SMA and reflects disease progression in children with SMA undergoing treatment. Recently, the European Medicines Agency issued a letter of support endorsing the potential utilization of NfL as a biomarker of pediatric neurological diseases, including SMA. Within this review, we comprehensively assess the potential applications of NfL as a monitoring biomarker for disease severity and treatment response in pediatric-onset SMA. We provide reference ranges for normal levels of serum based NfL in neurologically healthy children aged 0-18 years. These reference ranges enable accurate interpretation of NfL levels in children and can accelerate the implementation of NfL into clinical practice.

Challenges of Ta Providers in Lac Implemention: Basis for Localized Lac Framework

Learning Action Cell (LAC) is a session conducted by group of teachers who engage in collaborative learning sessions to solve shared challenges encountered in school. Though LAC projects a promising result for teachers in improving Teaching and Learning Strategies, it is somehow, not being maximized in the school. This challenge of maximizing (LAC) brings life to Continuous Improvement CI Project BILLS, Boosting and Improving LAC Leaders and Strategies. And this, proposed research is anchored to the on going CI Project BILLS. This study in particular, tried to determine the challenges encountered by TA providers or LAC leaders in LAC implementation. This study aimed to analyze the experiences and challenges, most especially, of the TA providers, 8 Head Teachers, and 18 Master Teachers towards LAC implemantation. This action research was plainly qualitative in nature and made used of interview as the research instrument. Consequently, coding and theming were used for data analysis. This research revealed that TA providers 1. have difficulty in crafting the proposals and securing necessary attachments, 2. due to challenges encountered in LAC implementation by LAC leaders, the monitoring of teachers’ performance was taken for granted, 3. the absence of monitoring and evaluation team was found as another reason on the low success rate of LAC implementation. TA providers also observed that 4. teacher-participants demonstrated less motivation and participation in the LAC session, 5. through the TA’s initiative, they have found out that teachers’ schedule have conflict with the LAC activity and the LAC topics are no longer new to the teacher-participants. Meanwhile, the newly introduced LAC process through CI Project, was observed to have a more detailed, organized and systematic conduct of LAC. The most evident improvements are the following: 1. Presence of Monitoring and Evaluation (M&amp;E) all throughout the process, 2. Intervention of Learning and Development (L&amp;D) Coordinator, 3. Posting of QATAME flow chart, 4. Proper conduct of LAC, 5. Presentation of LAC outputs and outcomes.

Healthcare facility water, sanitation, and hygiene service status and barriers in Addis Ababa, Ethiopia

Abstract Inadequate water, sanitation, and hygiene (WASH) practices within healthcare facilities heighten the likelihood of hospital-acquired infections. Therefore, this study aimed to assess the status of WASH services and barriers at public healthcare facilities in Addis Ababa. A converging parallel mixed design was conducted among 86 public health care facilities and 16 key informants. A stratified sampling technique was used to select health care facilities. Quantitative data was collected using a semi-structured checklist, and qualitative data was collected using key informant interviews. Thematic data analysis was done to identify the barriers. Independent analysis of the healthcare WASH domain revealed that 86% and 14% of healthcare facilities had access to basic and limited water services, respectively; 100% had limited access to sanitation services; and 88.4% had limited hand hygiene services. While 97.7% and 29% did not have environmental cleaning or waste management services, respectively. Lack of WASH service infrastructure, resource availability, governance and collaborative work, capacity and awareness building, and a framework for monitoring and evaluation were found to be barriers to WASH services. Lack of basic WASH service access and existing challenges at healthcare facilities hinder efforts towards infection prevention and control.

Multidrug-Resistant Staphylococcus aureus Strains Thrive in Dairy and Beef Production, Processing, and Supply Lines in Five Geographical Areas in Ethiopia.

Livestock, farms, abattoirs, and food supply systems can become the source of foodborne pathogens, including S. aureus, in the absence of monitoring, general hygienic practices, and control. Studies are scarce on reservoirs (hiding places) and routes of entry of S. aureus into the food supply chain in Ethiopia. To fill these gaps, we evaluated the role of cows (milk), meat, equipment, and food handlers on the abundance and AMR of S. aureus in five geographical areas in central Oromia, Ethiopia. We isolated S. aureus from 10 different ecologies per area in 5 areas and tested their sensitivity to 14 antimicrobials of 9 different classes. We ranked the 5 areas and 10 ecologies by computing their multiple AMR index (MARI) at a cut-off value of 0.2 to determine 'high-risk' ecologies for AMR. We recorded as MDR if an isolate had resistance to ≥3 antimicrobial classes. We used a circos diagram to analyze if isolates with identical AMR patterns were shared between different ecologies. S. aureus is prevalent in central Oromia (16.1-18.3%), higher in dairy farms than in abattoirs, and varied among 10 ecologies (p < 0.001) but not among 5 areas (p > 0.05). Of the 92 isolates, 94.6% were penicillin-resistant. Their AMR prevalence was above 40% for 9 of 14 antimicrobials. All isolates (100%) had AMR in at least one antimicrobial class (range = 1-9; median = 5), indicating MDR was prevalent. The prevalence of MDR S. aureus varied (p < 0.05) among areas and 10 ecologies; the highest was in slaughter lines. All isolates had a MARI of >0.2, indicating drug overuse, and S. aureus's AMR burden is high in central Oromia. Dairy farms had higher MARI values (0.44) than abattoirs (0.39). Of 10 ecologies, the highest and lowest MARI values were in the beef supply chain, i.e., slaughter line (0.67) and butcher's hand (0.25). Of the 68 different AMR patterns by 92 isolates against 14 antimicrobials, 53 patterns (77.9%) were unique to individual isolates, indicating they were phenotypically dissimilar. MDR S. aureus was widespread in central Oromia in dairy and meat supply chains, contaminating milk, meat, equipment, and workers in farm and abattoir settings. In the absence of strict regulations and interventions, MDR S. aureus can be disseminated from these epicenters to the public.

Open Educational Resources (OERs) at European Higher Education Institutions in the Field of Library and Information Science during COVID-19 Pandemic

The purpose of this study is to map the practices regarding open educational resources’ (OERs) development and implementation at European higher education institutions (HEIs) in the field of library and information science (LIS) during the COVID-19 pandemic and to identify the challenges and obstacles to their full and optimal utilization, both during crisis situations and beyond. A systematic literature review and questionnaire-based survey yielded results from 56 European LIS schools/departments (n = 56). Statistical analysis was performed using the R programming language, and descriptive statistics were used to quantify the data sets. The results have shown that the COVID-19 pandemic served as an impetus for the adoption of OERs, particularly in the context of digital education (DE) and remote learning. However, there is still a lack of awareness of the many benefits and opportunities they provide to higher education, as evidenced by the fact than less than half LIS schools/departments used OERs. Certain issues were identified, such as the lack of institutional policies regarding OERs, inadequate peer-review of OERs, and, in most cases, the absence of monitoring and evaluation practices for OERs. The results and insights from this study can be used to improve all aspects of OERs’ implementation and thus accelerate their adoption, both with regard to LIS schools/departments and other fields. Further research into the topic through interviews and focus groups should provide a deeper understanding of opportunities, challenges and practices surrounding the adoption of OERs in the field of LIS education.

How Summer Students Perceive the Closed Summer Program: In the Case of Jimma University

The purpose of this study was to explore how the summer students perceived the closed summer education program at Jimma University. The research study was a phenomenological case study approach. Eleven participants were selected using purposeful sampling among the summer students. The information was gathered using a semi-structured, in-depth interview that was recorded. Data were transcribed, translated, coded, categorized, and thematically analyzed. Data quality was used as a code book. The study of summer education programs for in-service training found that they were not sufficient to acquaint teachers with subject matter knowledge, and summer programs were blamed for affecting the quality of education due to the lack of in-depth teaching. The absence of monitoring and control of summer education programs leads to additional factors directly affecting the quality of summer education, with students being overcrowded and experiencing content overload. Policy implementation gap that affects the process of implementing summer education programs within the given time. It was also stated that the problems with the summer education program started with the registration period and that the scope of content and lesson time are disproportionate. It was difficult to assess all students and have enough time to practice with the shortness of time and the large number of students in the class. As a result of the summer graduates, primary and secondary teachers struggle to express themselves in English and lack of ICT abilities, which impacts summer students. The results confirmed that it can be saved to card games and completely blocked the game of figures. That’s why summer education turns into a regular program. The research also analyzed the trustworthiness of the data using phenomenological incense. Finally, the study's findings addressed the conceptual framework of the diagram from the findings of the study's discussion, conclusions, and implications, which were investigated.

Participatory budgeting practices and governance effectiveness

Purpose: This study examines the effectiveness of public participation in budgeting practice at the local rural level in Bangladesh. Methodology: This study uses a mixed-methods research design (social survey method and in-depth interview) as data collection instruments. Simple random sampling method has been used to collect survey data from 180 respondents from two Union Parishads (e.g., Karimgonj &amp; Jafrabad) under Karimgonj Upazila in the Kishoregonj district. In this study, the data has been collected from both primary and secondary sources. The primary data has been collected using a semi-structured questionnaire under the quantitative approach and an in-depth interview under the qualitative approach. Thematic analysis was used to assess qualitative data, while the SPSS was used to study quantitative data. On the other side, the study’s secondary data and information included a variety of published sources. Findings: The major findings revealed that participatory budgeting at the rural-local level is moderately effective, as some of the study respondents were somewhat satisfied. However, most of the respondents wanted more from the budget-making process. The result shows that several factors negatively influence the participatory budgeting practices in Bangladesh. Negative factors include corruption, undue interference of local political leaders, absence of monitoring &amp; supervision, lack of public awareness, lack of access to information, the dominant role of elected representatives, lack of proper leadership training, the influence of elite people, and lack of civic education. Practical implications: The study recommends several policy recommendations to ensure effective and participatory budgeting practices in rural areas of Bangladesh. Keywords: Participation budgeting, governance effectiveness, rural local level, local government institutions.

Digital traceability to enhance circular food systems and reach agriculture emissions targets

How can digital tools increase national circularity measures in agriculture towards GHG reduction and other national goals? During the 26th Conference of Parties (COP) held in November 2021, it was clear that circularity will play a role in meeting important international targets but that the global community and national governments lack the tools to measure the contribution of circular actions in the agriculture sector towards meeting these commitments. In the absence of monitoring and decision-support tools, governments will not know the full impact of their actions towards meeting commitments. This perspective looks at the way that digital agricultural traceability systems can form the building blocks for government action to incentivize enhanced circularity in the agriculture sector and track progress towards international targets. Among the many countries working on digital traceability systems, Uruguay stands out an example of a country pushing towards systemic traceability in multiple aspects of the food system. We examine Uruguay's use of digital traceability systems for sustainable production and redefinition of green markets as an example of a rapidly modernizing digital food system and a beacon for other countries to follow. The case of Uruguay shows that digital tools can create transparency in productive systems and allow the government to target sustainability policies. By using digital traceability systems for livestock, dairy effluents, soil rotations, agricultural chemicals, and forests Uruguay is creating a replicable framework for circularity and long-term sustainable production in the agriculture sector, one policy at a time. This framework serves as a benchmark for other countries in Latin America to reach their traceability, circularity, and emissions reductions targets.

A Review on Indias Urban Transportation

Abstract: Traffic congestion, pollution, and road accidents are all challenges that have arisen as a result of India's growing population and vehicle ownership. The transportation industry is an important part of the nation's economy, but also contributes significantly to climate change. Many transportation plans ultimately lead to fixing the climate change problem in order to attain sustainable mobility since climate change is a global hazard. India, like other nations across the world, is investing greater effort into sustainable mobility through different governmental measures.This article examines the major transportation issues that India faces, as well as how the Indian government's transport industry policy initiatives for cities have developed since independence. Motorisation is inextricably linked to urbanisation. Both motorisation and urbanisation complement each other. The influence of NMT on urban transportation is likewise directly related to its growing pace. The difficulties and inadequacies in existing policies are explored, as well as potential policy frameworks. According to this survey, most government policy efforts have yet to achieve the desired degree of success. The absence of monitoring, complicated institutional capacity and urban governance, uneven land allocation, and ineffective overall growth and movement plans are all contributing factors.Due to the continuing COVID-19 situation, the urban transportation scene is expected to shift dramatically. Travellers' mobility preferences are likely to be affected by increasing risks that come with congested settings paired with social distancing techniques in public and shared transportation. With the increased usage of e-services, urban freight demands may also shift.

Building A Rural Economic Area Through Cooperation Between Villages: A Case Study of Agrotourism-Based Rural Area Development in Banyumas, Indonesia

This study aims to evaluate the implementation of cooperation between villages based on agrotourism in the Kendeng Mountains, Somagede District, Banyumas Regency as a model for developing rural areas in Banyumas Regency. The research was conducted in three villages in Somagede District, i.e., Tanggeran, Klinting, and Kemawi, and served as a pilot project for rural area development. Qualitative method is conducted through meetings with informants from all village officials and tourism business actors in the three collaborating villages and members of the Rural Area Development Coordination Team. This study employs qualitative method utilizing in-depth interviews, observations, documentation, and focus group discussion (FGD), while the findings were analyzed using an interactive analysis model. The results showed that the cooperation between the villages of Kemawi, Klinting, and Tanggeran in developing agrotourism-based rural areas did not yield the expected results. The failure is due to the absence of cooperation norms among members, the identification of common needs that must be resolved through inter-village collaboration, and the low commitment of the village heads to prioritize and carry out all program plans. The cooperation also fails because of the lack of support from the local government during program implementation and the absence of monitoring and evaluation activities at each stage of the implementation of inter-village cooperation.

What’s Wrong with the Policy of Releasing Patient Medical Information at Regional Public Hospital X

Background: The release of medical information to third parties is the responsibility of the health facility to protect the health information contained in it from being damaged, lost, falsified data, and illegal access. Therefore, health facilities must have policies that regulate the system for releasing patient medical information to third parties. This study aims to analyze the policy of the patient's medical information release system in RSUD X. Method: This research is a descriptive study with a qualitative approach, through in-depth interviews and observation techniques. The informants in this study amounted to 12 people, namely the leadership of the hospital, the manager of medical services, the head of the medical record section, and the DPJP. Results: The results of this study indicate that RSUD X already has a policy regarding the system of releasing medical information to third parties but the release activities in the field it is not following the policy. This is because communication such as socialization from the leadership is still lacking so policy actors still do not know about the policy. The leadership has also never carried out monitoring and evaluation related to the release activity so the leadership does not know that other factors cause the policy not to work. Conclusion: The release of medical information to third parties already has a policy set out in the sop, but in its implementation, it is not following the existing sop due to the lack of socialization related to the sop to the discharge officers, the absence of monitoring and evaluation of the discharge activities that have been running at RSUD X. Also, the social attitudes of the community that are considered to have the most influence on the activities of releasing patient medical information in RSUD X.

Remnant vegetation in farmland - its significance in ethnobotany and local ecosystem

This paper evaluated the structure of remnant vegetation (RV) in and around the farmlands of Kancheepuram District, Tamil Nadu of Southern India, to understand its significance in the local ecosystem. Stratified quadrats along nine randomly selected transects were used for sampling vegetation. The study recorded 2495 specimens of 96 plant species under 43 families in 1848 quadrats (88 of 10 m × 10 m, 352 of 5 m × 5 m and 1408 of 1 m × 1 m dimensions) while there was a possibility of recording more species with better sampling efforts. To know the ethnobotanical uses of plants, interviews were conducted with local villagers and people belonging to the Irula tribe, and later the data were collated with published information. Sixty -six plant species were recorded with traditional uses in food, fodder, fuel, condiment and medicine. Prosopis juliflora, an alien invasive species, was a serious threat to the native flora since higher P. juliflora abundance was associated with declining diversity of other plants. The study found that the absence of monitoring and management protocols leading to uncontrolled propagation of invasive species could cause potential damage to the region’s dry evergreen forests, which were often located near the farmlands.

Teachers’ Experiences in Piloting the Integrated Curriculum in Lesotho: Constraints and Prospects

This study aimed to investigate the challenges and opportunities experienced by teachers in piloting the integrated curriculum in Lesotho. Moreover, this research was underpinned by a Constructivist paradigm which concedes that peoples’ views of the world are influenced by their experiences. The qualitative case study research design was employed and data were generated through the semi-structured interviews. In particular, purposive sampling technique was deployed to obtain sufficient and useful data. For this reason, three teachers with ten years teaching experience were selected from three departments in a chosen school. The departments included; Commercial studies, Science and Mathematics as well as Languages respectively. Overall, findings from this study affirm that constraints experienced while piloting the integrated curriculum outweigh the prospects. The opportunities raised included the following; development of creative skills and nurturing of the students’ talent while the challenges highlighted were; content overload, lack of CPD, absence of monitoring and supervision among others. Therefore, the implications of these findings are that a successful implementation of the reformed curriculum is under threat. In order to reprimand this threat, provision of regular workshops, monitoring and evaluation of the CPD programmes, reliable internet coverage, free data bundles for both teachers and students, as well as frequent follow ups by curriculum developers may address the issues of concern hence improve the quality of education as intended by the Lesotho Curriculum and Assessment Policy of 2009.

Implementing a formative assessment model at the secondary schools: attitudes and challenges

This paper aims at exploring the issues related to implementing a formative assessment model namely School-Based Assessment (SBA) at secondary schools in Bangladesh. A qualitative study employing interviews with English teachers of grade 8 and the head teachers and FGDs with students from twelve secondary schools was conducted. Moreover, field notes and document analysis provided valuable data. The findings from the qualitative content analysis showed a dismal condition of implementing SBA in Bangladesh. Some distinct reasons posed challenges to implementing SBA. These are teachers’ insufficient orientation towards SBA, teachers’ negative attitude towards SBA, teachers’ heavy workloads, large class size, large contents of syllabus, no reflection of the marks of SBA in public examinations, lack of honesty and fairness in teachers, lack of validity and reliability of SBA as an assessment tool, poor socio-economic conditions of teachers, and the absence of monitoring and supervision by concerned authorities. This study also provides a comprehensive understanding of how teachers conceptualize and apply strategies of SBA in their classrooms, along with some recommendations and, hence, bears implications for the policy makers, teacher trainers, and other stakeholders involved in the Bangladeshi school education system and elsewhere.

Identifying potential pollution hazards to the ecological well‐being of Lake Hayq and Lake Hardibo and related threats in Ethiopia: Advocating development of decision‐support tools and policy options

AbstractThe present study focuses on the pollutants draining into two closely related lakes in northcentral Ethiopia and related policy issues at a national scale. Observational interviews were conducted in the catchments of the lakes, and related published scientific and policy papers were examined. The susceptibility of the lakes to degradation was investigated on the basis of a set of related attributes and associated questions. The hydrological, morphometric features, chemical and biological characteristics, land uses and socio‐economic activities within the catchments of the lakes were assessed. Soil erosion, nutrients and plastic and organic wastes are identified as likely pollutants posing risks to the lake aquatic ecosystems. A better understanding of the sources, distribution and dynamics of the pollution vectors within the catchments is important in order to protect the lakes from further degradation. Based on a national perspective, the absence of monitoring and emission controls in catchments is hindering the development and application of protection measures in the lake catchments. Legal enforcement directed to controlling point source pollutants is poor, with regulation of diffuse source pollution being urgently needed to protect the lakes. Accordingly, commitment on the part of the federal, regional and local governments is clearly required to enhance assessment and enforcement capacities and to authorize regulating institutions.

Assessment of the surveillance system for adverse events following immunisation in the Gaza Strip: a cross-sectional study

BackgroundIn the occupied Palestinian territory, the expanded programme on immunisation (EPI) has successfully targeted 13 diseases through vaccination and achieved high population coverage. However, surveillance of adverse events following immunisation (AEFI) is inadequate in the Gaza Strip, as only post-BCG lymphadenitis is reported. This study assessed the adherence of health-care workers (HCWs) to the AEFI surveillance system in the Gaza Strip. MethodsData were collected by four methods: 105 HCWs answered a questionnaire; 24 health facilities completed a checklist enquiry; 17 medical health officers and information system managers from Ministry of Health (MOH) and UNRWA health centres and hospitals underwent in-depth interviews; and a focus group was held with 22 epidemiologists, stakeholders, consultants, and managers of the EPI. The 24 health facilities comprised seven MOH primary health-care centres (PHCs) providing vaccination, five MOH PHCs not providing vaccination, seven UNRWA PHCs, and the five hospitals of the Gaza Strip with paediatric departments. Data collected from June, 2015, to August, 2015, were analysed with SPSS version 19. Relationships among variables were assessed by independent t tests, chi squared tests and one-way ANOVA. Verbal informed consent was obtained from all participants, and written approval for the study was obtained from MOH and UNWRA directorates. FindingsAEFI are reported infrequently; approximately half of the 105 HCWs (51%; 53) report AEFI, but there were conflicting views as to whom they should report. 65% (68) thought that they should report all AEFI. Participants’ educational background, participation in workshops, and number of years of employment affected AEFI recognition and reporting. The majority (74%; 78) participate in immunisation workshops. There is an ineffective structure in MOH centres, and the UNRWA has a well-established internal system for reporting AEFI but a poor system for external reporting to the MOH epidemiology department. A lack of HCW awareness of responsibilities may also have a role. The majority of HCWs (95%; 100) reported a need for further training, and all reported a lack of cooperation or coordination between hospitals and PHCs regarding AEFI notification. All individuals (17) who were interviewed knew that they must report AEFI. A majority (65%; 11) stated no difficulties, whereas some (35%; six) reported difficulties due to absence of guidelines, protocols, or notification forms, and to fear of punishment. Focus group participants felt that all AEFI should be reported. They agreed that HCWs face obstacles such as fear of consequences, lack of knowledge and training, high workloads, not considering AEFI as related to immunisation, and absence or shortage of notification forms, protocols, and guidelines. Some felt that certain AEFI should be reported only to treating doctors, but all agreed that there is no cooperation or coordination among PHCs and between hospitals and PHCs regarding AEFI reporting. InterpretationCommon themes may explain poor adherence of HCWs to AEFI surveillance. The system is ineffective in MOH centres, and UNRWA PHCs have well-established internal but poor external reporting systems. Absence of monitoring may have a role, and a lack of guidelines, protocols, and forms for reporting were mentioned by HCWs, medical health officers and information system managers, and the focus group. Some HCWs may not know their responsibilities (eg, to whom AEFI should be reported). Many other obstacles face HCWs, including fear of punishment and accountability. Therefore, HCWs must be encouraged to report adverse events without fear of penalty. In addition, lack of education on AEFI and lack of experience in identifying AEFI may affect reporting. Training of HCWs, development of guidelines and protocols, database construction and design, and monitoring of the AEFI surveillance system are highly recommended. FundingWHO EMRO.

Implementasi Keamanan Jaringan Menggunakan Intrusion Detection System (IDS) Pada PT. Mega Esa Farma

In the current global era, Information Technology (IT) has developed rapidly, especially with the existence of an internet network that makes it easy to communicate and exchange data with other parties. Because of the easy access to this information, security issues have become a major focus in the world of computer networks. This causes a new problem that is important information or data can be used by parties who are not responsible for their own benefits. So that a network security system becomes an important aspect. PT. Mega Esa Farma is an industrial company engaged in the field of Pharmacy. This company is one of the many companies in Indonesian that has obstacles in network security, the absence of monitoring on a company’s computer network is very bad for data security. Therefore, we need a system that can be used to monitor and proctect the network from threats that will occur. By using the Intrusion Detection System (IDS) with snort to follow up on the generated snort alerts. A DDOS attack and port scanning attempt has been conducted on a computer that has a snort installed and the results are obtained that the snort is able to detect the attack and directly send alert to the administrator.