Administrative Demands Research Articles

7560 Using a Single Pre-test Cortisol Level To Reduce The Need For Dynamic Testing For Adrenal Insufficiency In A Southeast Asian Population

Abstract Disclosure: V. Ramadoss: None. L. Tan: None. A.E. Teo: None. K. Lazarus: None. K. Meeran: None. D. Deepak: None. L. Ong: None. C. Khoo: None. P. Eng: None. Introduction: The Short Synacthen Test (SST) is widely used in clinical practice to assess Adrenal Insufficiency (AI). Despite its relative ease of administration, Synacthen use is limited by its availability and its administration demands supervision by experienced staff, resulting in increased testing cost. A single measurement of serum cortisol has been shown to predict AI, but the suggested threshold varies according to the patient cohort studied, assay variation and the prevalence of the condition relative to the size of population tested. This study aims to (a) identify a threshold cortisol level to screen for AI in a South-East Asian population and (b) to determine the utility of a stimulated 60-minute cortisol level in the diagnosis of AI. Methods: This is a retrospective analysis of SSTs (250 micrograms) performed in our institution between 28th February 2022 to 28th February 2023. Serum cortisol in our institution was measured by Abbott Alinity analysers. We defined a normal response as a stimulated cortisol value of ≥ 420nmol/L at either 30-minutes, 60-minutes, or at both time points. Logistic regression analysis was performed to predict normal responses based on baseline cortisol level. Results: Median cortisol level at baseline, 30-minutes, and 60-minutes after Synacthen stimulation were 254 (IQR 191-320) nmol/L, 499 (IQR 415 -585) nmol/L, 574 (IQR 476 -662) nmol/L respectively. A total of 785 SSTs were performed, out of which 83.1% were normal and 16.9% were abnormal. Of the 785 SSTs, 55 (7.0%) would have failed if only the 30-minute cortisol was assessed without the 60-minute value, whereas 10 (1.4%) would have failed if only the 60-minute cortisol was assessed without the 30-minutes value. An early morning basal cortisol (0800am to 1200pm) cut-off of <300nmol/L identified subnormal cortisol with 95.0% sensitivity and an afternoon cortisol (1200pm to 1700) of < 312nmol/L achieved 95.2% sensitivity. A basal cortisol level of < 100nmol/L will confirm AI with 97.3% specificity. Using a basal cortisol level of ≥ 300nmol/L, 94.8% of individuals go on to pass the SST. Use of this basal cortisol value would avoid 252 (32.1%) SSTs. Conclusion: A single measurement of basal cortisol of ≥ 300nmol/L has the potential to exclude AI with 95% sensitivity on Abbott Alinity platform in our cohort of patients. Using a threshold cortisol level of 300nmol/L, at least 32% of the SSTs could be avoided. This would have improved patients experience with cost savings implications. Furthermore, a stimulated 60-minute cortisol level identifies 55 (7%) of individuals who would otherwise be misclassified as AI, thereby avoiding unnecessary long-term glucocorticoid replacement. Presentation: 6/1/2024

Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis.

Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration. To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients. Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized. Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607). P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.

Adapting EFL materials and its influences on Indonesia secondary school students’ language learning

Educators encounter challenges in performing materials adaptation stemming from time limitations, institutional responsibilities, administrative demands, and a dearth of formal training in materials development resulting in improper adaptation and ineffective learning activities. This research investigated the process of adapting materials as a qualitative case study. The data were gathered from a senior high school teacher in Banda Aceh, Indonesia, by means of document analysis (e.g., teaching materials), observation, and interview. The results revealed that the instructor frequently added and modified educational resources to facilitate learning through several modalities. The act of deleting, simplifying, and rearranging was occasionally performed. Nevertheless, students’ reflection on course contents, inadequate level of difficulty, demanding tasks, and excessive reliance on first language remained as issues. This study emphasizes the role of adaptation in promoting meaningful learning experiences and urges the integration of culturally relevant themes with a variety of learning activities. Educators can use these findings to support professional developments focused on effective material adaption tactics, allowing them to reflect on their existing methods, try new approaches, and interact with colleagues to share successful practices.

Supervision Impact on Rehabilitation Counselor Job Satisfaction and Intent-to-Quit

In the public vocational rehabilitation (VR) program, recruitment and retention of rehabilitation counselors remains a persistent concern that has broad implications for employee working conditions and the capacity to effectively serve individuals with disabilities. Rehabilitation counselor supervision models have commonly included clinical supervision, administrative supervision, and supervisory working alliance (SWA) variables, though there is limited empirical research exploring how these factors relate to counselor outcomes. A sample of 192 practicing rehabilitation counselors from state VR agencies were surveyed to investigate how these factors contribute to counselors’ job satisfaction and intent-to-quit. Results showed that clinical supervision practices contributed to higher job satisfaction and lower intent-to-quit, with evidence that this effect was mediated through the SWA. Administrative supervision was not a significant contributor to outcomes in multivariate models. Findings suggest that regular supervision sessions that incorporate clinical concerns and balance administrative demands may support counselor retention.

Establishment and Organization of Public Administration in Bosnia and Herzegovina during the Austrian-Hungarian rule (1878-1918)

The subject of this paper is the analysis of the process of establishment and organization of public administration during the Austro-Hungarian rule. At the Berlin Congress in 1878, Austria-Hungary was given a mandate by the great powers, with the consent of the Ottoman Empire, to occupy Bosnia and Herzegovina. The occupation brought about various social, military, political, and legal issues that needed to be resolved. In fact, these issues that arose represented the classical domains of state administration, such as the army, police, foreign affairs, justice, and finance. The new authority, represented by the Joint Ministry of Finance, maintained the existing administrative-territorial structure with certain necessary adjustments. Operationally, these tasks were handled by the Bosnian Office, which was superior to the Provincial Government of Bosnia and Herzegovina. The administrative-territorial organization was defined by the decree of the Provincial Government of Bosnia and Herzegovina in 1882, which prescribed that all administrative tasks be carried out in district offices with broad and diverse jurisdiction. It is important to note that the inhabitants of Bosnia and Herzegovina, within the Austro-Hungarian monarchy, had territorial affiliation instead of citizenship, which represented a special legal relationship between individuals and the state. The state administration functioned based on a hierarchical principle of subordination and responsibility, where lower organs were subordinate to higher ones. All general acts of the Provincial Government were previously submitted to the Joint Minister of Finance for approval and only came into force after obtaining such approval. The Provincial Government consisted of four departments: the political-administrative department, the financial department, the judicial department, and the civil department. The departments were headed by heads of departments. The challenges set by Austria-Hungary in the context of establishing a new administrative structure required a state administration with loyal and capable officials. A significant challenge in achieving this goal was the problem of the lack of suitable personnel, both due to the lack of professional qualifications and the departure of a significant number of educated individuals. Considering the demands of modern state administration, good education was required from officials, which, among other things, led to a significant number of officials in both central and local administrative structures being foreigners. They were mostly Austrians, Hungarians, Poles, Czechs, and Slovaks. Many of them stayed in Bosnia and Herzegovina for only a short period, but there were also those who permanently remained. The districts were divided into district offices led by district heads. A special characteristic of the administrative organization was that district offices, to a large extent during the Austro-Hungarian rule, also performed judicial functions. After the occupation, the Austro-Hungarian administration began establishing local self-government. Urban and rural municipalities were formed, and local people participated in their organs. Although municipalities were conceived as units of local self-government, analyzing their scope of authority, it can be determined that they mostly performed delegated tasks of the state administration with a very low degree of autonomy. The public administration operated on a hierarchical principle of subordination and responsibility, within which lower administrative organs were subordinate to higher ones. This paper aims to provide insight into the complexity of administrative organization and structure in Bosnia and Herzegovina during the Austro-Hungarian period. This is significant because during that period, the foundations of modern public administration in Bosnia and Herzegovina were established, encompassing not only state administration but also local self-government and public services.

Riau Province’s land and forest governance: The tendency of budget information transparency among Riau’s 12 regencies

Information transparency is a basic principle of good governance that few studies in the literature have thoroughly examined. Riau Province in particular has a high record of land and forest conflicts that needs urgent response, yet environmental policies have mostly been scrutinized for its resource extraction and regulation aspects, not their aspect of information transparency. Low proactive disclosure of information from local governments is a recurring issue in Riau Province, so FITRA Riau initiated the Public Information Openness Index (IKIP) to cover the Riau Province and 12 regencies/cities. To address this research gap of governmental public bodies’ information transparency, this study conducted the novel substantive approach critical review to see the extent of local government’s transparency regarding their budgeting for one of Riau’s most prevalent issues, namely land and forest governance (TKHL). From March to September 2019, this study used a triangulation of data collected from information access tests, IKIP evaluation, and focus group discussion involving the Riau Information Commission, the Information Management and Documentation Officers (PPID) of the 12 regencies, and the Governor of Riau Province. After analyzing the four aspects of regulation, institution, budget, and TKHL information, results determined that the most open region in Riau Province is Indragiri Hulu, and the least open region is Kuantan Singingi. Information transparency is still limited in procedural terms, in which all regions have more or less fulfilled the administrative regulation demands but the substance of the public information across all aspects is too generic to truly inform the public of the regions’ TKHL.

Challenges and opportunities in achieving secure hospital clinical mobility management: An illustrative use case

Objective: To qualitatively describe a use case at Yale New Haven Health System (YNHHS) illustrating the need for and effective deployment of innovative technologies to manage an enterprise-owned shared device (EOSD) management program. EOSD management provides clinicians with secure, rapid access to enterprise mobile devices and applications, maintains devices in functional, use ready condition for clinicians, and enables enterprise tracking and reduced loss of devices.Methods: Executive leaders in clinical information technology and informatics management at YNHHS were interviewed through written and telephonic communication. Qualitative data was gathered through communications between clinical and information technology executives and the implementation support team of a leading identity and access management (IAM) solutions and EOSD management solution provider. Use case information was gathered, integrated and shared with health system executives and health IT/informatics leaders to verify the description of unmet needs, solution objectives and impact/value delivered after implementation of the EOSD management solution.Results: Benefits realized from implementation of an enterprise-shared mobility management solution included establishment of a cohesive and comprehensive enterprise-owned, shared device management strategy. This included effective monitoring and dynamic management of the system’s mobile device fleet, and better IT resource management with reduced mobile device loss. The IT administrative burden was reduced. While not surveyed systematically, improved clinician experience and satisfaction were reported to IT leaders anecdotally. EOSD management solution deployment was rapid, as was the time to improved clinician mobile experience and clear demonstration of value.Conclusions: A leading US health system was able to rapidly deploy a shared mobile device management solution that enabled effective monitoring and dynamic management of the enterprise mobile device fleet, with easier and faster clinician device access and workflows, and reduced IT administrative demand and costs. While the complexities associated with increased clinical mobility in healthcare will likely continue to grow, issuing future device and mobile management challenges that require effective hospital system response, technologies have emerged that enable more effective, efficient and satisfactory organizational mobility performance.

Not to throw the baby out with the bath water… On the approach to assessing research output

The need for evaluating scientific research demands adjusting methodology. Today, the two existing approaches, namely bibliometrical analysis and expert opinion, will not meet the demands of researchers and administrators if used separately. Based on the reviews, reports and personal practical experience, the author examines the pros and cons of these two approaches and concludes on the need to integrate them so they complement one another. The bibliometrical studies related to scholarly publications processing and quantitative analysis enable to identify the most globally important works while the expert opinion enables to distinguish radically new themes at the early stage.The author argues that the methodology of three components will be the most efficient for science advance; they are: bibliometrical analysis, expert review, and opinion of the professional who would browse the publications in his/her specialty searching for promising themes. Properly synchronized, these three approaches would enable to make economically efficient and informative foundation for rating research activities and to identify the newest vectors in science at the early stage of their emergence.

A dual dynamically cross-linked hydrogel promotes rheumatoid arthritis repair through ROS initiative regulation and microenvironment modulation-independent triptolide release

High oxidative stress and inflammatory cell infiltration are major causes of the persistent bone erosion and difficult tissue regeneration in rheumatoid arthritis (RA). Triptolide (TPL) has become a highly anticipated anti-rheumatic drug due to its excellent immunomodulatory and anti-inflammatory effects. However, the sudden drug accumulation caused by the binding of “stimulus-response” and “drug release” in a general smart delivery system is difficult to meet the shortcoming of extreme toxicity and the demand for long-term administration of TPL. Herein, we developed a dual dynamically cross-linked hydrogel (SPT@TPL), which demonstrated sensitive RA microenvironment regulation and microenvironment modulation-independent TPL release for 30 days. The abundant borate ester/tea polyphenol units in SPT@TPL possessed the capability to respond and regulate high reactive oxygen species (ROS) levels on-demand. Meanwhile, based on its dense dual crosslinked structure as well as the spontaneous healing behavior of numerous intermolecular hydrogen bonds formed after the breakage of borate ester, TPL could remain stable and slowly release under high ROS environments of RA, which dramatically reduced the risk of TPL exerting toxicity while maximized its long-term efficacy. Through the dual effects of ROS regulation and TPL sustained-release, SPT@TPL alleviated oxidative stress and reprogrammed macrophages into M2 phenotype, showing marked inhibition of inflammation and optimal regeneration of articular cartilage in RA rat model. In conclusion, this hydrogel platform with both microenvironment initiative regulation and TPL long-term sustained release provides a potential scheme for rheumatoid arthritis.

The strength of Frontline Practice Leadership in Australian supported accommodation services: Challenges confronting service providers.

The strength of practice leadership predicts the quality of Active Support but it can be compromised by other demands on frontline managers. The study aimed to identify and understand differences in practice leadership over time and between organisations. Data collected in 2022 in 96 services from 11 organisations using the Observed Measure of Practice Leadership were compared to similar data from 2013 and 2018. Qualitative fieldnotes were analysed thematically. Practice leadership scores increased significantly between 2013 and 2018 but declined significantly between 2018 and 2022. Scores were significantly higher in organisations that had implemented Active Support since 2013 compared to later adopters. Higher scoring organisations had structures that supported frontline managers with practice leadership and that countered increasing administrative demands. Establishment of support structures for practice leadership by organisations warrants further investigation together with the relative importance of each task of practice leadership.

Considering Burnout and Well-Being: Emergency Medicine Resident Shift Scheduling Platform and Satisfaction Insights from a Quality Improvement Project.

Few studies explore emergency medicine (EM) residency shift scheduling software as a mechanism to reduce administrative demands and broader resident burnout. A local needs assessment demonstrated a learning curve for chief resident schedulers and several areas for improvement. In an institutional quality improvement project, we utilized an external online cross-sectional convenience sampling pilot survey of United States EM residency programs to collect information on manual versus software-based resident shift scheduling practices and associated scheduler and scheduler-perceived resident satisfaction. Our external survey response rate was 19/253 (8%), with all United States regions (i.e., northeast, southeast, midwest, west, and southwest) represented. Two programs (11%) reported manual scheduling without any software. ShiftAdmin was the most popularly reported scheduling software (53%). Although not statistically significant, manual scheduling had the lowest satisfaction score and programs with ≤30 residents reported the highest levels of satisfaction. Our data suggest that improvements in existing software-based technologies are needed. Artificial intelligence technologies may prove useful for reducing administrative scheduling demands and optimizing resident scheduling satisfaction.

A GIS-Based Approach for Shallow Landslides Risk Assessment in the Giampilieri and Briga Catchments Areas (Sicily, Italy)

Shallow landslides pose a widely growing hazard and risk, globally and particularly in Mediterranean areas. The implementation of adequate adaptation and mitigation measures necessarily requires the development of practical and affordable methodologies and technologies for assessing the shallow landslides hazard and its territorial impact. The assessment of shallow landslide hazard maps involves two different and sequential steps: the susceptibility and the runout analysis, respectively, aimed at the identification of the initiation and the propagation areas. This paper describes the application in the Giampilieri and Briga Villages area (Sicily, Italy) of a shallow landslide risk process at a basin scale with an innovative approach in the runout assessment segment. The runout analysis was conducted using specific GIS tools employing an empirical–geometric approach at a basin scale. The exposure and vulnerability values of the elements at risk were assigned using a qualitative and semi-quantitative approach, respectively. The results highlight the effectiveness of the procedure in producing consistent runout hazard and risk assessments in the valley areas where the more important and vulnerable exposed elements are located. This study contributes to addressing the public administration demand for valuable and user-friendly tools to manage and drive regional planning.

The Framework of the Natural Resources Report—Improvements Based on the Natural Resource Accounting Administration Demands of China

The Framework of the Natural Resources Report—Improvements Based on the Natural Resource Accounting Administration Demands of China

Pencarian Rekognisi dan Legalitas Perkawinan Secara Adat Pada Suku Asli Anak Rawa di Siak Provinsi Riau

This article deals with the search for the recognition and legality of customary marriages on believers of the Suku Asli Anak Rawa in Siak, Riau. The article argued that although the Constitutional Court ordered the writing of identity credentials on the residence documents of citizens of trust holders, it could not be realized because they did not have a trust organizations or holders of trusts. This resulted in a number of Suku Asli Anak Rawa convert to one of the state-recognized religions in order to obtain a document of identity. Ethnographic data was collected through in-depth interviews, semi-structured observations as well as document studies. First, the author explores the indigenous population of the Anak Rawa who still embrace their beliefs and compares them to citizens who have converted to one of the official religions. Second, the researchers explored patterns of strengthening the external social networks of Suku Asli Anak Rawa, both government agencies and relevant social organizations as part of identity strengthening and search for recognition over indigenous marriages. Third, the researchers explored the efforts made by the Suku Asli Rawa in filing a registered status application to have the legality of issuing a marriage certificate. In conclusion, this paper indicates that policy on religious minority groups cannot be implemented immediately because of the limited capacity of citizens to meet administrative demands and bureaucratic processes in government.

The Phenomenon of Teachers’ Burnout: Its Implication for Job Satisfaction

Teachers play an indispensable role in the lives of children; however, in recent years, the demands of teaching have increased significantly. This study aims to determine the feelings of burnout among secondary public-school teachers in the District of Aloran, Division of Misamis Occidental. It examines the elements contributing to teacher burnout, its impact on job satisfaction, and the coping mechanisms teachers use to mitigate it. Informant teachers, who participated in one-on-one interviews, were employed during the 2023–2024 academic year and were identified as experiencing burnout based on the results of the Maslach Burnout Inventory. A transcendental phenomenological approach and a qualitative study design were employed. The findings reveal that concerns about academics, administration, and workload demands significantly contribute to teacher burnout, affecting their well-being and hindering their professional growth. To manage burnout, teachers utilize coping strategies such as seeking social support and engaging in self-care practices. The study proposes program interventions, including upgrading and continuing current programs that support and enhance teacher well-being, along with offering competitive compensation and benefits. These findings suggest that a holistic approach addressing equity and inclusion, enhancing teacher professional development, and promoting cooperation among stakeholders will transform the school system, providing high-quality, relevant, and inclusive education.

Transforming Governance in Indonesia: Exploring New Frontiers in Public Sector Management

Indonesia's recent governmental reforms, focusing on the need for enhanced public sector management to cope with modern administrative demands and societal expectations. The primary objective of the research is to evaluate the effectiveness of these reforms and to identify areas for further improvement in Indonesian governance. The methodology employed in this study includes a comprehensive review of existing literature, qualitative analysis of policy documents, and interviews with key stakeholders in the Indonesian government. This multi-faceted approach allows for a thorough understanding of the complexities involved in public sector management reform. The findings reveal significant advancements in transparency, accountability, and public engagement within Indonesia's governance structures. However, challenges such as bureaucratic inertia, inadequate resource allocation, and resistance to change remain prevalent. The study concludes with recommendations for enhancing governance practices, emphasizing the need for continuous innovation and stakeholder engagement in the public sector. This research contributes to the broader discourse on governance reform in developing countries, offering valuable insights for policymakers and practitioners involved in public sector transformation.

AAV-Mediated Expression of a Single-Chain FVIII Mimetic Antibody Efficiently Corrects Bleeding in Haemophilia a Mice

Background: The recent approval of gene therapy for haemophilia A (HA) using adeno-associated viruses (AAVs) marks an important and long-awaited landmark as it is associated with markedly reduced bleeding events whilst overcoming the demands of regular life-long administration of factor concentrates or antibodies with FVIII mimetic activity. However, the benefits of AAV gene therapy in severely affected HA patients are likely to be short-lived as clinical data from most of the advanced trials show a gradual decline in transgenic Factor VIII (FVIII) levels over time. The reasons for this decline in expression remain unexplained but may be due in part to the packaging of an oversized FVIII expression cassette into AAV vectors. This hypothesis is supported by the fact that such decline in transgene expression has not been observed in other gene therapy approaches in clinic where the transgene expression cassette is within the packaging limits of AAV vectors. Therefore, we explored an alternative therapy approach for HA that utilises an expression cassette encoding a novel FVIII mimetic bispecific antibody (Bi8) that remains within the packaging constrains of AAV vectors, thus potentially improving the prospects of long-term control of the bleeding diathesis in severely affected HA subjects. . Methods: Bi8, is a small 54kDa single-chain bispecific antibody designed as a tandem of single-chain fragment variables (scFvs) targeting Factors IXa (FIXa) and X (FX). FVIII mimetic activity of recombinant Bi8 protein was evaluated in vitro using (1) the catalytic conversion of purified FX into FXa in a chromogenic assay, and (2) factor XIa (FXIa)-triggered thrombin generation assay (TGA) and activated partial thromboplastin time (aPTT) using spiked human HA plasma. Bi8 sequences were cloned in an AAV expression cassette downstream of a strong liver-specific promoter, pseudotyped with AAV serotype 8 capsid and evaluated in vitro as well as in vivo, including in FVIIIKO mice to assess potency in a tail vein transection assay, kinetics of Bi8 expression and the occurrence of anti-drug antibodies (ADAs). Results: In preliminary experiments, we demonstrated that the single-chain format used for Bi8 retained haemostatic functions. When tested in a chromogenic assay, recombinant Bi8 protein showed kinetics of FXa formation identical to that of emicizumab. Furthermore, Bi8 spiked in human HA plasma at 350nM corrected the clotting time (17.2 sec) in an aPTT assay to levels observed with emicizumab (22.7 sec). TGA with recombinant Bi8 and emicizumab showed comparable efficacy with peaks of thrombin generation at 354.2 and 358.4nM respectively. Next, human hepatocyte HuH7 cells were transduced with AAV8 encoding Bi8 (AAV8_Bi8) vectors in vitro, leading to the expression of a fully functional bispecific antibody with an activity/antigen ratio of 0.99 when compared to the recombinant Bi8 protein. Three doses of AAV8_Bi8 vector were then evaluated in 6-8 weeks old, male FVIIIKO mice, with a single intravenous infusion of 4e 11; 4e 12 and 1.2e 13 vector genome (vg) per kilo. Expression of the bispecific antibody was detectable in plasma for all 3 doses and peaked 2 weeks post-infusion with respective concentrations of 4.5; 47.4 and 178.8nM (Panel A). Transgenic expression was then stably maintained for 12 weeks and ADAs were not detected in any of the treated animals. When challenged in a bleeding assay, haemostasis was secured in all cohorts of mice infused with AAV-Bi8 vectors, including at the lowest dose of 4e 11 vg/kg where the average total blood loss was reduced to 401.2μL (median 406.2μL) compared to 760.4μL (median 773.1μL) in non-treated FVIIIKO mice (Panel B). Conclusion: This study establishes the feasibility of using AAV vectors to deliver an expression cassette encoding Bi8, a novel FVIII mimetic antibody formatted as a single-chain tandem-scFv, leading to circulating concentrations of bispecific antibody at levels that can secure haemostasis and reduce blood loss in a murine model of HA. This non FVIII-based expression cassette meets the packaging capacity of AAVs and therefore provides an alternative approach for AAV-mediated gene therapy for HA that may be better suited for stable long-term expression than FVIII transgenes.

Narratives of School Leadership to Support the Well-Being of Teachers in Karachi Pakistan

The teaching profession is one of the professions that leads to challenges, and these challenges impact teachers’ well-being. School leaders play a pivotal role in supporting and brightening teachers’ well-being. This research project which is based on qualitative phenomenological research, seeks to explore the narratives of primary school leaders to foster their teachers' well-being through structured interviews. School leaders belonging to various educational settings were engaged. Structured interviews were used to collect the primary data collection, for a comprehensive exploration of eight primary school leaders of District Korangi Karachi’s perceptions, experiences, challenges, and strategies to support in improve their teachers’ well-being. The main findings divulge extraordinary roles and multifaceted responsibilities of primary school leaders in nurturing the well-being of their educators. School leaders expressed and shared their experiences in providing opportunities for professional development, creating healthy positive organizational cultures, managing workloads and time management, and addressing psychological concerns. School leaders' narratives also enlighten on the ramifications of leadership in administrative challenges and demands. These narratives provide a nuanced understanding of the strategies and initiatives that support teacher well-being. Such insights are instrumental in informing policy.

Identification of Dynamic Capability and Personal Competency to Develop Innovative Performance

The New Public Management Paradigm required the management of public sector organizations to transform by prioritizing the principles of competition, performance, and responsiveness in every bureaucratic behavior so that it could stimulate an increase in organizational performance results to become more effective and efficient. Seeing the demands for public administration reform, of course, the desires and demands of the community for the creation of public sector organizations that had high governance performance was increasing where this indicated the low performance of public sector management as an effort to achieve increased flexibility of public sector organizations in facing global challenges. This study aimed to identify dynamic management capability and personal competency to develop innovative performance. This study used a qualitative approach with a literature study method, a literature study consisting of detailed investigations, data collection of certain period of time, phenomena, and contexts to analyze the context and processes related to the theoretical issues being studied intrinsically from the literature used. This study concluded that there were cognitive dynamic capability and personal competence that must be possessed by public organizations to increase innovative performance in effective governance, namely thinking again, thinking ahead, and thinking across. These three factors encouraged transformational changes in governance that led to the formation of dynamic capabilities of Government/public sector organizations facing global challenges.

Teachers’ demand and supply for effective junior secondary school administration in Rivers State from 2017 – 2021

This paper investigated teachers’ demand and supply for effective secondary school’s administration in Rivers State. Two research questions guided the study. Descriptive survey design was adopted for the study. The population of the study was 230 UBE Board Staff of Rivers State. The sample of the study was 115 staff of UBE Board drawn from the population using simple random sampling technique which represents 50% of the staff. The instrument for the data collection was document analysis (Teacher's data). The percentage of teachers demand and supply was used in answering the question. The findings revealed that there are shortages of teachers in the junior secondary schools in Rivers State. Based on the findings, the study recommends among others, that government should recruit more qualified teachers to correspond with the increased in students’ enrollment. Conclusively, teachers’ welfare package should be made more attractive to motivate teachers and to encourage young graduates to join the teaching profession.