Administrative Coordination Research Articles

Sustainable Urban Design Approach for Public Spaces Using an Analytical Hierarchy Process (AHP)

Urban public spaces hold significant importance in societal life, playing crucial roles in the development and sustainability of urban environments. These spaces face numerous challenges in the contemporary era. This study examines how sustainable public space design should be structured within the framework of the United Nations Sustainable Development Goals (SDGs), specifically Goal 11, and the parameters set forth by Project for Public Spaces Inc. (PPS), a highly influential non-profit organization based in the United States that provides research, training, technical assistance, planning, and design recommendations. Qualitative data collection methods, including literature review, expert interviews, and the Analytic Hierarchy Process (AHP), are employed to evaluate various sustainability criteria. AHP is used to prioritize the criteria and sub-criteria derived from SDG and PPS frameworks. Through this method, the necessary parameters for a sustainable public space design model are identified based on expert opinions. The findings indicate that physical structure is the top priority criterion for public space sustainability. Historical value, green infrastructure, and ecological efficiency emerge as the highest priority parameters. Among social criteria, security and control, comfort, active and passive interaction, continuity, detectability, and meaning are significant. Economic vitality criteria include contributions to the local and urban economy, increasing local employment, contributions to tourism, and service diversity. Administrative coordination criteria encompass protection, investment incentives, and effective coordination. The study proposes a comprehensive model for sustainable public space design that integrates physical, social, economic, and administrative dimensions. The model emphasizes the importance of multidisciplinary approaches and stakeholder involvement in ensuring urban areas are resilient, inclusive, and sustainable. Key priorities include the protection of historical values, the development of green infrastructure, and the enhancement of ecological efficiency. Future research should explore the application of this model in different urban contexts to validate and refine its effectiveness.

Analysis and spatial mapping of antimicrobial prescription completeness and legibility in a public community pharmacy

Objective The phenomenon of resistance of antimicrobials is associated with inappropriate use. The analysis of antimicrobial prescriptions, evaluating their legibility and completeness, is interesting because it aims to identify possible errors that may compromise the proper use. This study aims to evaluate the completeness and legibility of antimicrobial prescriptions in a municipality in southeastern Brazil. Methods The antimicrobial prescriptions retained at the Community Pharmacy in the municipality of Alegre, from March 2018 to February 2019, underwent a simple random sampling process to obtain the sample for analysis. In addition, data on the origin of the prescription were georeferenced, generating a map correlating the evaluation of the legibility of the prescriptions with the health units of the municipality. This study was approved by the Research Ethics Committee of the Administrative Coordination of Southern Espírito Santo (CASES) with the CAAE number: 13586319.6.0000.8151. Results The sample comprised 359 prescriptions containing 373 antimicrobials. The majority of prescriptions (97.2%) contained complete data from the prescribing professional, and 70.2% presented the patient’s identification without abbreviations, although 44% showed legibility problems in this parameter. In 35.4% of the prescriptions, there were legibility problems and no data in the joint evaluation of the prescribed antimicrobial, concentration, quantity, pharmaceutical form, dose, frequency, and duration of treatment. In the evaluation of the posology (dose and frequency) and duration of treatment, complete data were found in 82.3% and 71.8%, respectively. Most of the antimicrobials prescribed, 95.4% and 93% respectively, were listed in the National List of Essential Medicines (Rename) and were in the Brazilian Common Denomination (DCB) format. The most prescribed antimicrobial was Cephalexin 500mg. Conclusion The study indicated the presence of antimicrobial prescriptions that do not comply with legislation and may compromise patient safety. These findings highlight the need for targeted interventions to improve prescription legibility and adherence to the regulatory standards in public health settings.

Tantangan Pelaksanaan Program Bantuan Pangan Non Tunai (BPNT) di Kelurahan Barengkok Kecamatan Leuwiliang Kabupaten Bogor

The Non-Cash Food Assistance Program (BPNT) is assistance provided by the government to Beneficiary Families (KPM) in the form of non-cash every month. Initially, the Non-Cash Food Assistance (BPNT) program was a replacement program for the Prosperous Rice Program (Rastra) which had several problems. Presidential Regulation of the Republic of Indonesia Number 63 of 2017. This BPNT uses an electronic account mechanism, so it can only be used to buy food from traders or e-warongs that have collaborated with Himbara banks, but now BPNT assistance has changed to being in the form of money that is withdrawn at Bank link. This study aims to identify and analyze the obstacles faced in the implementation of the Non-Cash Food Assistance Program (BPNT) in Barengkok Village, Leuwiliang District, Bogor Regency. This study uses a qualitative approach with in-depth interview and observation methods. Data were collected from various sources, including beneficiaries, program implementers, and other related parties. The analysis was carried out to identify and group the main obstacles that affect the implementation of BPNT. The study identified several major obstacles in the implementation of BPNT, which were grouped into three categories: (1) Technical obstacles, including problems with infrastructure such as internet networks and EDC machines; (2) Administrative obstacles, including inaccuracies in data verification and lack of socialization about BPNT mechanisms; and (3) Socio-Economic obstacles, such as difficult access to e-warongs and low financial literacy among beneficiaries. These obstacles indicate that the implementation of BPNT in Barengkok Village faces various challenges that affect the effectiveness of the program. To improve the results and impact of BPNT, improvements need to be made in technical, administrative, and socio-economic aspects. Recommendations include improving infrastructure, improving administrative coordination, and improving education for the community.

Microstructure, Charge Transport and Interfaces in All-Solid-State Batteries

Objective: Despite recent global efforts to establish all-solid-state batteries (ASSB) as potentially safe and stable high-energy and high-speed storage technology, long-term performance, specific power, and economic viability remain challenging. However, efficient and short ionic and electronic transport pathways and optimized interfacial contacts between the cell materials and compounds are essential. This poses a significant challenge for the microstructure of cathodes and a careful design and tailoring of anodes and separators in ASSB, which rely solely on solid-state contacts. Here, we present our recent work on ASSB with thiophosphate electrolytes conducted within the German Competence Cluster for Solid-State Batteries (FestBatt). Our work aims to investigate relevant parameters in different cell components on material, electrode, and cell level, such as the importance of particle size distributions, microstructures, and kinetic factors to optimize ASSB cathodes, separators, and anodes. Methodology: The work will be presented in four sections, which showcase key challenges as well as optimization strategies mainly focusing on cathode composites, but also discussing selected examples for separators and anodes in ASSB with thiophosphate electrolytes. Further, an outlook for relevant production steps of ASSB electrodes and cells will be given. For these studies, we mainly conducted focused ion beam scanning electron microscopy tomography, electrochemical impedance spectroscopy, cycling experiments on ASSB cells with thiophosphate solid electrolytes. Results: Fast conducting solid electrolytes are necessary to ensure sufficient transport in composite cathodes but does not represent the only key factor for high-quality cathode composites in ASSB. In our studies, we aimed to optimize the microstructure of composite cathodes consisting of intercalation-type active material and a thiophosphate-based solid electrolyte. We varied the particle size distribution of the solid electrolyte to create various cathode microstructures and assessed the effectiveness of electronic and ionic conduction pathways using partial conductivities. We used both electronically and ionically blocking electrodes for electrochemical impedance spectroscopy measurements to quantify the respective partial conductivities. Our analysis revealed that the particle size of the solid electrolyte significantly influences the charge transport and electrochemical performance of the cathodes. Additionally, using FIB-SEM tomography, we created detailed 3D reconstructions of the cathode microstructure and correlated the obtained partial conductivities with microstructural descriptors such as tortuosity factors, identifying possible kinetic bottlenecks. We found that minimizing residual porosity, which blocks ion and electron transport, is necessary to optimize cathode microstructures and enhance ASSB performance. Moreover, high-performance anodes, along with protective concepts, are crucial for establishing dense, high-energy ASSB cells. Lithium metal anodes may not be the ultimate solution, and silicon anodes can pose advantages, e. g. in terms of electrochemical stability for thiophosphate separators. Discussion: Our studies demonstrate the importance of optimizing the microstructure of cathodes and carefully designing Si anodes for improved ASSB cells. By manipulating the particle size distribution of the solid electrolyte, we achieved more efficient electronic and ionic transport pathways, leading to improved battery performance. The presented work is primarily published in references 1-5, detailing key challenges and showcasing optimization strategies for these topics. Beyond that, diversity in materials, research teams, and approaches is crucial for long-term successful development of ASSB. Acknowledgement: Scientific and administrative coordination of the BMBF Competence Cluster for Solid-State Batteries (FestBatt), FB2-Koord (03XP0431), and cell platform Thiophosphates, FB2-Thio (03XP0430A).

Fungsi Camat Dalam Mengkoordinasikan Kegiatan Pemberdayaan Masyarakat di Wilayah Kecamatan Golewa Barat Kabupaten Ngada

The function of the sub-district in coordinating community empowerment activities in the sub-district area, the position of the sub-district is explained in article 221 of Law Number 23 of 2014, namely the district/city area forms a sub-district in order to improve the coordination of government administration, public services, and empowerment of the village/sub-district community. This research is a Normative-Empirical Law research, where this research is carried out in Ngada Regency. The data obtained in this study is qualitative data, using the guidelines of the law with interviews and respondents then processed into qualitative descriptive. The results of this study are an illustration that; (1) The West Golewa Sub-district according to the regulation of its function has not been maximized in coordinating community empowerment activities, as explained in article 221 of Law Number 23 of 2014 (2) the inhibiting factor in carrying out the function of regulating the sub-district in coordinating community empowerment activities periodically and optimally, it is necessary to play a role in coaching and supervising the sub-district so that it is more active in carrying it out, the function of the sub-district, so that it plays an active role.

Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?

To evaluate the value of enhanced optometric services for managing neovascular age-related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed-methods approach: three for nAMD and four for glaucoma. The methods were a patient-related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Patient-related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4-5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care-based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%-16% for nAMD services and from 48% to 22%-23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co-ordination and effective interprofessional communication.

Development of a novel cancer diagnostic center to facilitate care coordination for patients with new or suspected diagnoses of cancer.

81 Background: Navigating a cancer diagnosis is a multifaceted challenge, characterized by intricate care coordination that creates potential for workup and treatment delays, lapses in care, and potentially negatively affecting clinical outcomes. We have developed a novel physician and advanced practitioner-led cancer diagnostic program (CDP) to help navigate patients with a suspected cancer through the diagnostic and staging workup, discussion of results, and linkage to oncologic care. Patients are referred to the CDP, an administrative intake coordinator creates a medical chart, verifies insurance, gathers records, and schedules appointments. An intake nurse reaches out within 24 hours to obtain clinical information and review of systems. Patients are offered an in-person or video visit with the advanced practitioner for history and physical, labs, and further coordination of testing. Here, we aim to describe the demographic and clinical patterns of referral and clinical outcomes of patients who were referred to a CDP over one calendar year. Methods: We retrospectively analyzed 154 patients with a new cancer diagnosis to have at least 1 encounter at the Johns Hopkins CDP between January 1, 2022, and December 31, 2022. Data were retrospectively collected from medical records and stored within Johns Hopkins REDCap. Descriptive analyses were used to describe the data. Results: Among the 154 total patients included in this analysis, 65.6% were White, 24.7% were Black, 3.2% were Asian, and 1.9% were of Hispanic, Latino, or Spanish origin. Insurance coverage was most frequently (46.8%), Medicare (40.3%), and Medicaid (8.4%). Referral distribution shows 50 inpatient and 104 outpatient referrals. Primary cancer diagnoses were most often gastrointestinal (39.6%), upper airway and lung (26.6%), and genitourinary (9.1%). Conclusions: The Johns Hopkins CDP exemplifies the potential for dedicated diagnostic and treatment initiation programs to improve oncologic care, particularly for vulnerable populations. The center facilitates expedited diagnostic resolution, to increased ease of workup for patients and providers, and potentially improve clinical outcomes such as linkage to care and time to treatment. Accepting referrals from inpatient and outpatient settings captures a broad patient pool, including those who may otherwise experience lapses in care owing to complex care navigation needs. In conclusion, we describe a novel care delivery model to potentially optimize healthcare delivery in oncologic care. Inpatient Referral Outpatient Referral Percent minority populations 34% 23.1% Stage 4 at diagnosis 74% 52.9% Patients initiating treatment with curative intent 42.3% 30% Median length of hospitalization 7 days N/A Median time from pathology results to discharge -2.5 days N/A Median time from pathology results to treatment initiation 20 days 16.5 days

Drivers of transnational administrative coordination on super‐wicked policy issues: The role of institutional homophily

Drivers of transnational administrative coordination on super‐wicked policy issues: The role of institutional homophily

Peningkatan Kapasitas Bisnis AgroEcofarm pada Kelompok P4S Tani Makmur Jaya

Gogodeso Village consists of settlements, moorland, people's plantations, rice fields with a village area of 383 Ha. In general, livelihoods are identified into several sectors, namely agriculture (mostly), services/trade, industry and others. One of the farmer empowerment programs is the Tani Makmur Jaya Self-Help Agricultural and Rural Training Center (P4S). In its activities, P4S consistently and routinely develops organic farming, one of which is making organic fertilizer and carrying out healthy cultivation practices. However, they experienced problems with production, management and human resources and marketing. The implementation methods used are: (1) Planning (2) Administrative preparation and team coordination (3) Socialization of Organic Fertilizer (4) Training in Making Organic Fertilizer (5) Management and marketing training (6) Mentoring (7) Supervising related production activities and post-production (8) Evaluation (9) Program sustainability. Community-based empowerment activities in increasing the capacity of AgroEcofarm-based businesses at P4S Tani Makmur Jaya can run smoothly, including the transfer of organic fertilizer technology, transfer of business management and human resources and transfer of marketing branding. In making fertilizer, production can be increased by 2000 bottles of POC/year and 2000 sacks/year of solid organic fertilizer respectively. Apart from that, there are new brands for P4S fertilizer, namely POC Orchomi and Biokosh for solid organic fertilizer.

Research and Development Collaborations Within the Context of a South African Developmental State

The article explores the significance of research and development (R&D) collaborations and partnerships between government and academia as a strategy to be employed in shaping the developmental agenda in states. The authors provide both a conceptual view and findings from primary data which interrogated the notion that a ‘research community’ should be anchored on its collaborative efforts and continuously strive for partnership creations with the aim of transforming societies and serving the public. An observation is made on the prospects of South Africa’s provincial governments and academia forging collaborations and partnerships with an open approach and common goals in order for the collaborations to have a purposeful meaning to the public. The current state of affairs in South Africa as alluded to in the National Development Plan (NDP) warrants for a developmental agenda that is dominated by knowledge production, dissemination and its uptake thereof. This context therefore enjoins different role players such as government and academia/research institutions and the private sector to work together and solve developmental problems such as poverty, inequality, unemployment and service delivery challenges. It is through initiatives such as R&D collaborations and partnerships that these aforementioned challenges can be curbed; however, this requires these sectors to do things differently. The Public Management Reform Theory provided the theoretical framework in this article as it advocates for an improved public sector’s administrative structures, coordination, management and operations. In addition, this theory envisages a better and modernized public service that delivers services in an effective and efficient manner. The theory points out to a paradigm shift in terms of how the public sector is traditionally perceived to one that is modernized, decentralized, customer friendly and economically and socially reformed. The methodology adopted in this article includes a qualitative research method, desktop research and document analysis. There is substantial primary data and secondary literature in the public domain that was used to substantiate arguments advanced in this article. It should be noted that over the years, there has been on-going academic conversations on research collaborations between academia and the public sector as a prerequisite for socio-economic development; therefore, this article is further contributing to this debate.

The clinical trial activation process: a case study of an Italian public hospital

Background/aimsIn order to make the centers more attractive to trial sponsors, in recent years, some research institutions around the world have pursued projects to reorganize the pathway of trial activation, developing new organizational models to improve the activation process and reduce its times.This study aims at analyzing and reorganizing the start-up phase of trials conducted at the Research and Innovation Department (DAIRI) of the Public Hospital of Alessandria (Italy).MethodsA project was carried out to reorganize the trial authorization process at DAIRI by involving the three facilities responsible for this pathway: clinical trial center (CTC), ethics committee secretariat (ESC), and administrative coordination (AC).Lean Thinking methodology was used with the A3 report tool, and the analysis was carried out by monitoring specific key performance indicators, derived from variables representing highlights of the trials’ activation pathway.The project involved phases of analysis, implementation of identified countermeasures, and monitoring of timelines in eight 4-month periods.The overall mean and median values of studies activation times were calculated as well as the average times for each facility involved in the process.ResultsIn this study, 298 studies both sponsored by research associations and industry with both observational and interventional study design were monitored.The mean trial activation time was reduced from 218 days before the project to 56 days in the last period monitored.From the first to the last monitoring period, each facility involved achieved at least a halving of the average time required to carry out its activities in the clinical trials’ activation pathway (CTC: 55 days vs 23, ECS: 25 days vs 8, AC 29 days vs 10).Average activation time for studies with agreement remains longer than those without agreement (100 days vs. 46).ConclusionsThe reorganization project emphasized the importance of having clinical and administrative staff specifically trained on the trial activation process.This reorganization led to the development of a standard operating procedure and a tool to monitor the time (KPIs of the process) that can also be implemented in other clinical centers.

Institutional Proxy Representatives of Future Generations: A Comparative Analysis of Types and Design Features

Future generations will be strongly affected by political decisions made today (e.g., by the long-term consequences of climate change). According to the democratic all-affected principle, the interests of everyone affected by political decisions should be considered in the political decision-making process. Future generations cannot influence democratic decision-making, since they do not yet exist. Election-based democratic incentive systems are said to make it difficult to consider the needs of future generations today. Surprisingly, however, since the early 1990s, an increasing number of democracies have established what could be called institutional proxy representatives of future generations (proxies), i.e., public bodies with institutionalized access to government and/or parliament that introduce the construed interests of future generations into the political decision-making process. Proxies help to consider future generations’ interests alongside the interests of current constituencies. After concept building, this comparative study searches all liberal democracies and identifies 25 proxies, with heterogeneous institutional designs. By employing membership criteria, three types are distinguished: (a) expertise-driven independent guardians (type I), (b) political or administrative advisory and coordination bodies (type II), and (c) sustainability stakeholder councils or committees (type III). They vary considerably in their formal capacity to influence political decision-making (i.e., on what legal basis they were provided with what instruments to address which phases of the policy process and which branches of government). Overall, they should not be overburdened with expectations. While they are usually equipped with the tools to voice the (construed) interests of future generations, they often lack the capacity to act as watchdogs with teeth when ignored.

Patologi Birokrasi Pelayanan Bansos Di Bagian Kesra Kantor Sekretariat Daerah Kabupaten Pekalongan

The Pekalongan Regency Regional Secretariat Office is a very vital government agency because it has the task of assisting the Regent in formulating policies and administrative coordination for the implementation of regional apparatus duties and administrative services. With this task, SETDA is the "Qibla" for other regional apparatus organizations in the Pekalongan Regency Government. However, what happened was that several employees at the Regional Secretariat Office actually committed violations that today are called bureaucratic pathologies. This research uses a qualitative descriptive research type. Descriptive understanding is a discussion in the form of exposure to words and language, in a special natural context and by utilizing various natural methods. Qualitative research is research that intends to understand the phenomenon of what is experienced by research subjects. The purpose of this study was to find out about the procedures for providing grants and social assistance sourced from the Regional Revenue and Expenditure Budget of Pekalongan Regency, namely to find out the procedures or stages of applying for grants and social assistance, knowing local government policies and regulations and their implementation The results of this study indicate the existence of bureaucratic pathology in the activities of grant services and social assistance in the welfare division of the Pekalongan regional secretariat. Guidelines for the management of grants and social assistance sourced from the regional income and expenditure budget as outlined in the district head's regulations seem to have been ignored. In this study, the types of pathology that occur are explained. Most types of pathology that occur are caused by the bureaucracy itself. Bureaucratic culture since ancient times has not been able to be changed by the bureaucracy itself. In carrying out daily tasks, many of the bureaucracy have not been maximal in carrying it out, especially bureaucracy related to service. A paradigm shift is still very much needed within the bureaucracy itself. Efforts to overcome it are still not optimal, the support and commitment of the leadership is the main thing to change the existing bureaucratic paradigm.

Legal Analysis of Regional Leader Coordination Forums to Support the Implementation of Regional Government Duties and Functions by Government Regulation Number 12 of 2022 in Indonesia

This investigation points to discovering out and analyze the lawful investigation of territorial authority coordination gatherings to bolster the usage of territorial government obligations and capacities in agreement with government control number 12 of 2022 in Indonesia, to discover out and analyze the supporting and repressing variables for the advancement of the Territorial Administration Coordination Gathering organization. in supporting the usage of the obligations and capacities of regulating common government issues, to recognize and analyze endeavors to overcome the variables hindering the Organizational Advancement of the Territorial Administration Coordination Gathering in supporting the execution of the obligations and capacities of regulating common government undertakings in Indonesia. This inquiry is a subjective inquiry about utilizing an inductive approach. The investigative strategies utilized are perception, documentation and interviews. Based on the results of the field examination, it can be concluded that there has been no improvement in the Territorial Administration Coordination Gathering in Indonesia, but the usage of the obligations and capacities of regulating common government undertakings is still being carried out in a few locales. Within the advancement handle, the existing restraining components did not become an issue within the Organizational Improvement of the Territorial Authority Coordination Gathering in Indonesia.

Artificial Intelligence – Qualification and Competence Development Requirements for Executives

When companies increasingly use artificial intelligence (AI), this changes the world of work and, in particular, the way people and technology work together and divide up their work. Because with the help of AI systems, even cognitively demanding activities can be automated. For example, AI can support executives in their leadership tasks and partially take over administrative coordination and control tasks. Workflows and processes must be redesigned or at least adapted accordingly. This scientific article provides an overview of the necessary changes and presents suitable tools for well-structured change management that is oriented toward human-centered work design and takes AI-specific design criteria into account. Furthermore, the article presents a qualification concept, which helps executives to develop, implement and establish AI applications in a socio-technical and human-oriented manner. With the help of this concept, executives and users of AI, for example, will be able to acquire the necessary competencies. In this context, the results of the practical evaluation of the concept will also be presented.

TRANSFORMATION OF POLITICAL AND ADMINISTRATIVE COORDINATION STRATEGIES IN THE STRUCTURE OF PUBLIC RISK MANAGEMENT

The article problematizes a range of issues related to the transformation of coordination relations in the structure of public administration when making decisions under conditions of uncertainty. The main substantive objective of the study is to analyze the conceptual model of strategies and political-administrative coordination mechanisms of interaction in risk situations, the features of management influences that ensure enhanced functionality of prevention and distribution of threats, especially in the context of digitalization. The research methodology is based on classical and modern concepts of public management, risk and its perception, and theories of political coordination of various forms of algorithmic threat management. The article argues that coordination in the structure of public administration is a political form of coordination and correction of political interests, rules of interaction between producers and consumers of risks, their beneficiaries and those most exposed to risks. The article proves that political and administrative coordination in the field of risk management is aimed at minimizing the results of conflicts of interest, deformation of the perception of threats and dangers into riskophobia or riskophilia. The authors argue that government monopolization of the right to information about risks reduces the possibilities for joint coordination and the effectiveness of political strategies to address threats. The analysis made it possible to come to the conclusion that the discoordination of functions, tasks and risk management processes does not allow the preferences and perceptions of risk of social actors to be aggregated into the overall interest of preventing and forecasting threats, and forms points of blockade of the structural-organizational and institutional-regulatory mechanism for controlling hazards in the social system. The study identifies and describes dysfunctions in the field of public administration associated with discoordination of political risk management, highlights institutional, distributional, behavioral and paternalistic management failures in situations of uncertainty, threats and dangers, identifies and describes mechanisms of political-administrative coordination risk management.

Evaluation of the Performance of a Primary Care Hospital’s Emergency Department in Tunisia

Background: Performance is a complex and multidimensional concept that fundamentally refers to the achievement of continuous improvement in health. Its application to the context of emergency departments allows us to assess how well these services are able to respond effectively to patients’ needs and those they serve. The aim of this study was to evaluate the performance of an emergency department at a primary care hospital in Tunisia. Methods: We conducted our study at the Emergency Department of Kesra District Hospital. We used the EGIPSS model to evaluate the department’s performance. We collected qualitative data through questionnaires and interviews with key actors from the hospital and emergency department, and we extracted quantitative data from annual reports. Results: In terms of adaptation to the environment, several shortcomings were identified, such as centralized resource acquisition systems limiting the ability to meet needs and the absence of feedback mechanisms requiring formal administrative and clinical coordination processes. In regard to values and culture, human resource management is not well developed with a lack of continuous training programs and no clear statement of values for the emergency department and the hospital. As for production, incentives to improve efficiency and quality are lacking, and quality management within the emergency department and the hospital in general do not exist due to the absence of a quality management system. Conclusion: The performance of the emergency department at the primary care hospital level is still deficient and may require setting up systems and processes for improving quality.

Incidental findings and safety events from magnetic resonance imaging simulation for head and neck radiation treatment planning: A single institution experience

PurposeHaving dedicated MRI scanners within radiation oncology departments may present unexpected challenges since radiation oncologists and radiation therapists are generally not trained in this modality and there are potential patient safety concerns. This study retrospectively reviews the incidental findings and safety events that were observed at a single institution during introduction of MRI sim for head and neck radiotherapy planning. MethodsConsecutive patients from March 1, 2020, to May 31, 2022, who were scheduled for MRI sim after having completed CT simulation for head and neck radiotherapy were included for analysis. Patients first underwent a CT simulation with a thermoplastic mask and in most cases with an intraoral stent. The same setup was then reproduced in the MRI simulator. Safety events were instances where scheduled MRI sims were not completed due to the MRI technologist identifying MRI-incompatible devices or objects at the time of sim. Incidental findings were identified during weekly quality assurance rounds as a joint enterprise of head and neck radiation oncology and neuroradiology. Categorical variables between completed and not completed MRI sims were compared using the Chi-Square test and continuous variables were compared using the Mann-Whitney U test with a p-value of < 0.05 considered to be statistically significant. Results148 of 169 MRI sims (88 %) were completed as scheduled and 21 (12 %) were not completed (Table 1). Among the 21 aborted MRI sims, the most common reason was due to safety events flagged by the MRI technologist (n = 8, 38 %) because of the presence of metal or a medical device that was not noted at the time of initial screening by the administrative coordinator. Patients who did not complete MRI sim were more likely to be treated for non-squamous head and neck primary tumor (p = 0.016) and were being treated post-operatively (p < 0.001). CT and MRI sim scans each had 17 incidental findings. CT simulation detected 3 cases of new metastases in lungs, which were outside the scan parameters of MRI sim. MRI sim detected one case of dural venous thrombosis and one case of cervical spine epidural abscess, which were not detected by CT simulation. ConclusionsRadiation oncology departments with dedicated MRI simulation scanners would benefit from diagnostic radiology review for incidental findings and having therapists with MRI safety credentialing to catch near-miss events.

Borders, cross-border cooperation and depopulation: the case of the Spanish-Portuguese North-Central Border.

Cross-border cooperation has been (and still is) one of the main assets of the acquis communitiare in everything that refers to cross-border development. In fact, development initiatives aimed at addressing the problems of intra-European border areas could have better results if they were concerted (horizontally coordinated) and executed jointly by the governments, national, and local actors from both border sides, to improve their populations' quality of life. The study goal is to provide new contributions that enrich critical reflection and debate on the issue of depopulation, in order to propose economic policy recommendations within a framework of cross-border institutional cooperation and inter- and intra-governmental coordination of political actors involved. We prepared a descriptive analysis of its evolution during the period 1960-2020, with three essential variables: a) population evolution border based on the losses or gains verified with respect to 1960; b) critical population mass existing in 2020 based on the indicator of population density (inhabitants per square kilometer), and c) level of population aging based on the indicator percentage of population over 65 years of age over total population. Our descriptive analysis exclusively covers the border municipalities located along the both sides of the Spanish-Portuguese north-central border line, a total of 49 border municipalities (nine Portuguese and 40 spanish). The results show the existence of this recessive demographic continuum, which extends to both sides of the border, causes the need to face the depopulating phenomenon from a transnational and European perspective, in the sense that 'national' solutions to the phenomenon will not be able to offer answers common and consistent to a phenomenon as complex as depopulation. It is necessary to reinforce the existing cross-border cooperation, providing it with greater operability at the level of institutional and administrative coordination, deepening the multilevel governance of the territory.

Geographical, social, and political contexts of tuberculosis control and intervention, as reported by mid-level health managers in Uganda: ‘The activity around town’

Training district-level health officers and other mid-level health system managers revealed multiple contextual factors across political, administrative, and social axes affecting tuberculosis (TB) and TB control in Uganda. Individual relationships between local health, political, and media leaders affect efforts to inform the public and provide services, yet greater administrative coordination between national-level logistics, implementing partner funding, and local needs is required. Social challenges to TB control include high population mobility, local industries, poverty with high-density living and social venues, and misinformation about TB. Capitalizing on implementation knowledge and sharing data can overcome social geographic challenges to TB-prevention planning through strategic healthcare capacity-building at the district level.