Continuous Improvement Research Articles

A qualitative study of older adults: The difficulties and needs of returning home after hip fractures

BackgroundFalls and consequent fractures are an increasing problem among older adults, with low rates of return to previous functional condition and a substantial risk of subsequent falls. This scenario points to the need for an improved response to this population's needs. ObjectiveTo define the difficulties and needs felt by older adults with hip fractures when returning home. MethodsThis was a descriptive and exploratory qualitative study. Semi-structured interviews were conducted with hip fracture patients who had been submitted to surgery and who were treated at a hospital in the central region of Portugal. Bardin's content analysis was used to analyze the data. Content analysis was carried out with the support of MAXQDA® Analytic pro 2022 software. ResultsThe analysis of the results of the 15 interviews yielded three categories related to the difficulties perceived by hip fracture patients on returning home: functional limitations; pain; and emotional management. Regarding the needs felt, the following categories emerged: resources/help with activities of daily living; capacity-building for the return home; and information. ConclusionsThe needs and difficulties of older adults with hip fractures on returning home are multiple and variable. Knowledge of these aspects can significantly enhance the standardized actions of nurses in this area of intervention, contributing to the improvement of continuity of care and ensuring a safe transition.

TEACHER’S INNOVATION IN TEACHING LINGUISTIC KNOWLEDGE: EXPLORING STUDENTS’ REFLECTIONS IN LEARNING EFL WITH TECHNOLOGY

The foundation of competence for English teachers in the EFL context, as well as for any language teacher, lies in linguistic knowledge (Chang & Kanno, 2010; Kemaloglu-Er, 2017; Marfui, 2016; Medgyes, 1992). However, due to English being a foreign language in Indonesia, teachers who work with EFL learners require innovative strategies to achieve teaching goals and fulfill the profile of future EFL teachers (Chun et al., 2016; Hoopingarner, 2009; Kern, 2006; Kessler, 2018; Köksal, 2004; Salaberry, 2001). This study aims to explore EFL students' reflections on their experience of learning Linguistics with technology and its impact on their linguistic knowledge, which is valuable for their future. A total of 156 prospective teacher students participated in the study. They provided reflections on the learning process for Phonetics and Phonology courses at the end of the semester, using the Three What’s reflection writing concept guide: What, So What, Now What (Borton, 1969; Rolfe, 2014). Based on the reflection results, linguistic competence is acquired through a systematic learning process, both offline and online, which incorporates various technology-based learning resources (such as Google Classroom, Quizizz, YouTube, Padlet, etc.), with relevant linguistic content. The use of technology as a teaching strategy to aid student comprehension represents an innovation in language learning, as students become more creative in discussing and creating projects related to the course. Furthermore, they continue to utilize the technology they have experienced in other learning activities. By incorporating technology into the process of understanding essential linguistic concepts, teachers can model the target language being taught, demonstrating that teacher innovation is an integral part of professionalism and contributes to the improvement of learning continuity. In line with this notion of sustainability, it is recommended that further research be conducted to investigate the effectiveness of using technology in assisting and motivating students in assessment as learning, assessment for learning, and assessment of learning.

Beyond competence and retention: Developing a comprehensive evaluation framework for a rural primary care nurse practitioner residency program.

With the rise in nurse practitioner (NP) residency programs, evaluations have largely focused on retention and competency completion for residents. There is a need for expanded evaluation to ensure the sustainability of NP residency programs, to ensure timely adaptations to address resident satisfaction, and to solidify a long-term pathway of NPs well prepared for rural practice. We created a family nurse practitioner (FNP) residency program with a comprehensive evaluation framework to prepare residents for practice in rural settings. The evaluation framework was developed through collaborative engagement of an external evaluation team, program leadership, and clinical site representatives. The evaluation framework of the FNP residency program combined resident assessment and holistic program evaluation, using a rapid continuous quality improvement (QI) approach. The evaluation considered three distinct perspectives: the resident, the peer coach, and the clinical site. The rapid continuous QI approach allowed program leadership to respond swiftly to programmatic challenges, improve the residency program in response to residents' reported experiences, and emphasize sustainability for continued program impact, while assessing residents' learning and performance. The program's data-driven evaluation approach has demonstrated its success in meeting the goals of the Health Resources and Services Administration funding by increasing the number of primary care providers in rural settings. The program's expansion and continued success have further validated the efficacy of this evaluation framework in assessing, improving, and ensuring the sustainability of APRN residency programs. This article calls for the adoption of similar evaluation strategies in future residency programs to promote their long-term success and impact in rural health care settings.

Public Policy Innovation: Analyzing the Implementation and Outcomes of Progressive Initiatives

Public policy innovation plays a pivotal role in addressing contemporary societal challenges, and this journal article scrutinizes the implementation and outcomes of progressive initiatives in the realm of public policy. The study delves into the dynamics of policy innovation, examining the factors influencing successful implementation and evaluating the resultant outcomes. The article begins by elucidating the significance of public policy innovation in responding to the evolving needs of societies. It explores various forms of innovation, including technological, procedural, and institutional innovations, and their impact on the policy landscape. A comprehensive analysis of the implementation process follows, encompassing stakeholder engagement, regulatory frameworks, and the role of leadership in fostering innovation-friendly environments. Case studies and real-world examples illustrate instances of successful policy innovation, highlighting best practices and lessons learned. Furthermore, the study assesses the outcomes of progressive policy initiatives, considering their effectiveness in achieving intended goals and addressing societal challenges. It also explores the potential unintended consequences and challenges associated with policy innovation. The findings underscore the importance of a dynamic and adaptive policy framework that encourages experimentation, learning, and continuous improvement. Recommendations include the establishment of innovation labs, cross-sector collaboration, and mechanisms for ongoing evaluation and feedback. In conclusion, this article contributes to the discourse on public policy innovation, offering insights into the complexities of implementation and the multifaceted outcomes of progressive initiatives. As societies navigate unprecedented challenges, fostering a culture of innovation in public policy emerges as a key strategy for building responsive and effective governance systems.

Topology Optimization of Anisotropic Materials with Smooth Fiber Orientation

In the concurrent optimization of topology and fiber orientation, the design of smooth fiber helps to maintain the stability of numerical calculation and the compatibility of the manufacturing process. However, the improvement of fiber continuity is often accompanied by a significant decrease in the overall structural stiffness. Aiming at this problem, this paper proposes a topology optimization method for anisotropic materials with smooth fiber orientation. This method improves the smoothness of fiber orientation and reduces stiffness loss by introducing a fiber angle constraint strategy and adaptive filtering technology. The fiber angle constraint strategy integrates the created angle constraint function into the Method of Moving Asymptotes (MMA) to complete the strong constraint of the angle. This strategy quantifies the continuity of the fiber and effectively improves the continuity of the fiber. At the same time, the application of adaptive filtering technology can adjust a reasonable fiber angle distribution on the basis of smoothing fibers, thereby enhancing the stiffness of the overall structure. In addition, this paper shows the complete optimization process and MATLAB code implementation and verifies the effectiveness of the method through a series of numerical examples, that is, on the basis of improving fiber continuity, the stiffness of the whole structure is guaranteed, and then the effective balance between the two is realized.

Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators.

Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.

Performance Evaluation of M30 Grade Concrete Using Silica Sand as Partial Replacement of Cement in Concrete

Abstract: This study explores the improvement of concrete parcels, particularly strength and continuity, through the partial substitute of cement with silica fume (SF). The exploration addresses the environmental and health issues caused by artificial waste disposal, similar to covering ash and copper slag, by incorporating silica sand into concrete. A literature review reveals that SF significantly improves the mechanical and continuity characteristics of concrete, enabling the product of highperformance concrete suitable for these soundings. This paper investigates the strength parameters of concrete with 0 –15% SF relief in increment of 5%, comparing the results with conventional concrete. Findings indicate that the optimal compressive strength and split tens are achieved at 10% SF relief, beyond which strength decreases. This study aims to inform civil masterminds about the benefits of SF- modified concrete composites.

GaN HEMT for High-performance Applications: A Revolutionary Technology

Background: The upsurge in the field of radio frequency power electronics has led to the involvement of wide bandgap semiconductor materials because of their potential characteristics in achieving high breakdown voltage, output power density, and frequency. III-V group materials of the periodic table have proven to be the best candidates for achieving this goal. Among all the available combinations of group III-V semiconductor materials, gallium nitride (GaN), having a band gap of 3.4eV, has gradually started gaining the confidence to become the next-generation material to fulfill these requirements. Objective: Considering the various advantages provided by GaN, it is widely used in AlGaN/GaN HEMTs (High Electron Mobility Transistors) as their fundamental materials. This work aimed to review the structure, operation, and polarization mechanisms influencing the HEMT device, different types of GaN HEMT, and the various process technologies for developing the device. Methods: Various available methods to obtain an enhancement type GaN HEMT are discussed in the study. It also covers the recent developments and various techniques to improve the performance and device linearity of GaN HEMT. Conclusion: Despite the advantages and continuous improvement exhibited by the GaN HEMT technology, it faces several reliability issues, leading to degradation of device performance. In this study, we review various reliability issues and ways to mitigate them. Moreover, several application domains are also discussed, where GaN HEMTs have proven their capability. It also focuses on reviewing and compiling the various aspects related to the GaN HEMT, thus providing all necessary information.

Review of Patents Analysis on Floor Robot Vacuum

Background: As the pace of life gets faster, and with the development and progress of society and the continuous improvement of people's pursuit of a convenient and comfortable life, it has become a growing desire for people to get rid of tedious housework. Hygienic automatic cleaning has also become the main demand of people. Objective: Through review, analysis, and discussion of the patents on existing floor robot vacuums, it is expected to find out the development process and main outcomes, along with the main technologies involved, and provide a valuable prediction basis for future research and development directions. Methods: This study aimed to summarize a number of representative patents related to floor robot vacuums and their main components and analyze them in depth to study their technical points and development laws. Results: By summarizing a large number of patents on floor robot vacuums and further analyzing and comparing the characteristics of the patents, the future development trend of floor robot vacuums was further discussed. Conclusion: Through a detailed analysis of the mechanical structure, intelligent control technology, and sensor technology of the existing floor robot vacuums as a whole and the main work unit, this study discussed the ideas and methods of improving the new floor robot vacuum, which is of great significance to its operation and more convenient and intelligent.

Modes of Variability in E3SM and CESM Large Ensembles

Abstract An adequate characterization of internal modes of climate variability (MoV) is a prerequisite for both accurate seasonal predictions and climate change detection and attribution. Assessing the fidelity of climate models in simulating MoV is therefore essential; however, doing so is complicated by the large intrinsic variations in MoV and the limited span of the observational record. Large ensembles (LEs) provide a unique opportunity to assess model fidelity in simulating MoV and quantify intermodel contrasts. In this work, these goals are pursued in four recently produced LEs: the Energy Exascale Earth System Model (E3SM) versions 1 and 2 LEs, and the Community Earth System Model (CESM) versions 1 and 2 LEs. In general, the representation of global coupled modes is found to improve across successive E3SM and CESM versions in conjunction with the fidelity of the base state climate while the patterns of extratropical modes are well simulated across the ensembles. Various persistent shortcomings for all MoV are however identified and discussed. The results both demonstrate the successes of these recent model versions and suggest the potential for continued improvement in the representation of MoV with advances in model physics. Significance Statement Modes of variability play a critical role in prediction of seasonal to decadal climate variability and detection of forced climate change, but historically many modes have been poorly simulated by coupled climate models. Using recently produced large ensembles, this work demonstrates the improved simulation of a broad range of internal modes in successive versions of the E3SM and CESM and discusses opportunities for further advances.

Continuous Refinement-based Digital Pathology Image Assistance Scheme in Medical Decision-Making Systems.

Digital pathology images' extensive cellular information provide a trustworthy foundation for tumor diagnosis. With the aid of computer-aided diagnostics, pathologists can locate crucial information more quickly. The cascade structure refines the segmentation results by utilizing its multi-task and multi-stage characteristics. However, cascade-based models require downsampling and cropping of patches during the inference process due to the ultra-high resolution and complex structure of pathology images. This not only increases the cost and computation time but also results in the loss of cellular details and corrupts the global contextual information. This study proposes a Digital Pathology Image Assistance Program (CRSDPI) for medical decision-making systems that is based on continuous improvement. After locating the region of interest using the maximum inter-class variance method, the pictures are preprocessed to account for the impacts of staining inconsistencies and sensitivity variations on the model's performance. Ultimately, we create a two-phase continuously refined segmentation network (TCRNet) by combining an enhanced continuous refinement model with a coarse segmentation network built on a pyramid scene parsing network. The coarse segmentation network introduces an auxiliary loss term to speed up convergence, and the refined model introduces an implicit function to reduce computational cost and reconstruct more details. The TCRNet model refines the target by successively aligning the features without the need to take cascading decoder operations after encoder. Experiments conducted on digital pathology images of breast cancer and osteosarcoma demonstrate the superior prediction accuracy and computational speed of our strategy.

Precision Education and Equity: A Participatory Framework to Advance Equitable Assessment.

Precision education (PE) may hold promise for the future of the field. Leveraging data and learning analytics to foster continuous improvement of individuals, programs, and organizations seems like a potential mechanism to advance both medical education and health care delivery systems toward a more equitable future. However, PE initiatives may also have unintended consequences and perpetuate inequities instead of ameliorating them. Although there have been some principles, ideas, and suggestions on how PE implementation may promote equity-particularly for the field of assessment-there is a lack of practical and evidence-informed guidance to support a more equitable and participatory approach to PE implementation. This paper provides actionable recommendations on how PE may advance equitable assessment. First, PE implementation must include democratizing access and ownership while enhancing literacy and transparency. Open and transparent access to both data and PE technology has the potential to enhance PE by fostering greater participation, rigor, and potential innovation. Transparency may also safeguard the use of assessment data for equitable purposes. Second, PE implementation must be cocreated with diverse learners. PE has the potential to empower learners if they are given an opportunity to participate in the development, application, and implementation of PE. Overall, a participatory approach to PE implementation has the potential to improve equitable assessment.

Environmental stewardship and corporate social responsibility: A review of case studies from the oil and gas sector

This review presents a comprehensive review of case studies focusing on environmental stewardship and corporate social responsibility (CSR) within the oil and gas sector. The oil and gas industry plays a pivotal role in global energy production, yet its operations often pose significant environmental and social challenges. In response, companies in this sector are increasingly embracing environmental stewardship and CSR principles to mitigate negative impacts and foster sustainable practices. The review examines a diverse range of case studies from various regions and contexts, highlighting both successful initiatives and notable challenges faced by oil and gas companies in integrating environmental stewardship and CSR into their operations. Key themes explored include environmental conservation efforts, community engagement, stakeholder collaboration, regulatory compliance, and technological innovation. Several case studies demonstrate innovative approaches adopted by oil and gas companies to minimize environmental degradation, such as implementing advanced technologies for emission reduction, investing in renewable energy projects, and restoring ecosystems affected by exploration and extraction activities. Moreover, successful CSR programs are showcased, emphasizing community development initiatives, education, healthcare, and infrastructure improvement projects aimed at enhancing the quality of life for local populations impacted by oil and gas operations. However, challenges persist, including balancing economic interests with environmental and social responsibilities, navigating complex regulatory landscapes, and addressing stakeholder concerns effectively. Despite these challenges, the case studies underscore the importance of proactive engagement, transparent communication, and continuous improvement in fostering environmental stewardship and CSR within the oil and gas sector. The review offers insights into best practices, lessons learned, and future directions for promoting sustainability and responsible business practices in the oil and gas industry, thereby contributing to the broader discourse on corporate environmental responsibility and societal impact mitigation.

The evolution of CSR reporting in the oil and gas industry and its future direction: A conceptual review

Corporate Social Responsibility (CSR) reporting has become increasingly important for industries worldwide, particularly in sectors with significant environmental and social impacts such as the oil and gas industry. This paper presents a conceptual review of the evolution of CSR reporting within the oil and gas sector, examining its historical development, current practices, and future directions. The evolution of CSR reporting in the oil and gas industry can be traced back to growing societal and stakeholder pressures for transparency and accountability. Initially, CSR reporting focused primarily on philanthropic activities and compliance with regulations. However, with mounting concerns over environmental degradation, climate change, and social justice issues, stakeholders demanded more comprehensive reporting practices. In response, oil and gas companies have adopted various frameworks and standards, such as the Global Reporting Initiative (GRI) and the United Nations Sustainable Development Goals (SDGs), to guide their CSR reporting efforts. These frameworks help companies disclose their environmental, social, and governance (ESG) performance in a systematic and comparable manner, enhancing accountability and facilitating stakeholder engagement. Looking ahead, the future direction of CSR reporting in the oil and gas industry is likely to be shaped by emerging trends such as increased emphasis on climate-related disclosures, integration of ESG factors into corporate strategy and decision-making, and the rise of digital technologies for data collection and reporting. Moreover, there is a growing recognition of the need for industry-wide collaboration and standardization to improve the credibility and effectiveness of CSR reporting. This conceptual review highlights the evolving landscape of CSR reporting in the oil and gas industry and underscores the importance of continuous improvement and innovation in meeting the evolving expectations of stakeholders and society.

A Proposed Costing System for Agile Just-In-Time Supply Chains with Back-Flush and throughput Accounting

According to the new advances in the form of new firms, including JIT and Agile, further advances in technologies, computer programs, and the systems of official accounting all become necessary to be modified. Also, the considerations of kaizen costing systems, in addition to the new movements towards the concern of the customer, should come first as a result of the new movements towards the customer profit analysis. In a JIT supply chain, suppliers are responsible for informing their cus-tomers of their products. Within the context of the current research, it was suggested to use the sys-tems of Back-flush costing as well as throughput accounting systems to simplify the application of just-in time systems and agile systems to satisfy the requirements of achieving the policy of continu-ous improvement. Furthermore, the continuous debate between the different parties of the game supposed here will be realized and considered. The integration of competitors into various aspects of the supply chain has been made possible by the emergence of intelligent supply chains. Additionally, the rapid advancements in the industrial and technological landscape have placed a significant bur-den on the movement of goods and information, requiring efficient and cost-effective solutions to meet time-sensitive requirements and customer demands. It is even more promising to consider the potential for surpassing competitors in terms of achievements and capabilities. The continuous advancements in artificial intelligence have further emphasized the need for progress in both production quality and cost optimization. The rapid progress in both the just-in-time/agile and resilient systems has led to additional requirements for the implemented accounting system and the selected level of automated accounting system. Extensive analysis of various arguments within the scope of the present study has been conducted, promoting the adoption of a more reality-sensitive model for the application.

Quality Improvement of Floor Cleaner Packaging Using Six Sigma and Continuous Improvement

There was a product defect in the 700 ML Lemongrass Refill Floor Cleaner packaging, which was 26,236 units from June to December 2021. The cost overrun was Rp. 15,085,700. This study aimed to improve the quality of the 700 ML Lemongrass Floor Cleaner packaging. The research method used was quantitative, and examined the quality of product packaging with Six Sigma and Continuous Improvement methods. The results of research conducted for the DPMO value before any improvement was 65,121 with a sigma level of 4.51. Then improvements were made so that the DPMO value became 12,517 with a sigma level of 5.26, resulting in a decrease in waste in the production process. So it can be concluded that we can provide solutions by replacing spare parts that are no longer suitable for use, making sure the machine is set correctly, making the standard materials used without defects and maintaining their shape, arranging the pouch arrangement as neatly and efficiently as possible, checking the pouch at the supplier, adjusting the machine settings, making sure it is neatly organized and performing regular machine maintenance according to the SOP.
 Keywords: continuous improvement, floor cleaner packaging, six sigma, quality

Insights from a community of practice: Integrating human rights in fisheries improvement

A recent article authored by Williams and Sparks suggests that fishery improvement projects (FIPs) “as currently constituted and reported, will not be an effective part of the fight against labour exploitation and abuses in global industrial fisheries.” We wish to reinforce their argument that driving social responsibility improvements in global fisheries requires a systemic approach combining genuine worker representation, mandatory human rights due diligence, enforceable and legally binding agreements, changes to purchasing practices, and the ratification and implementation of international labor and human rights conventions, and we acknowledge that the FIP model alone will fall short of this. Based on our collective experience working towards social improvements in fisheries, we wish to bring a slightly more nuanced perspective to bear to demonstrate the critical importance of using a human rights-based approach in fisheries’ sustainability efforts across industrial and artisanal contexts. We structure this response by revisiting each of the main points Williams and Sparks raise, bringing in our own experiences and additional evidence to build upon their original remarks, suggesting: there is a need for continuous monitoring and improvements in dynamic risk environments; voluntary measures can lead to and buttress mandatory and legally binding measures; diverse fisheries require diverse approaches; and humans are inextricably linked to fisheries, thus effective and enduring solutions must consider human wellbeing and environmental sustainability in tandem. We end with a call to action with explicit roles and responsibilities for different actors inside and outside of the Fishery Improvement Project context to support binding and enforceable agreements between buyers and fishworker representative organizations, advancing human and labor rights protections in seafood supply chains.

Examining Peer Observation Practices of Online Teaching and Learning Through Analysis of Existing Instruments

ABSTRACT As online teaching gains increasing popularity in higher education, the need for valid and reliable measures to assess course quality and instructional effectiveness has become paramount. Peer observation of teaching has served as a valuable tool in evaluating online courses and facilitating continuous improvement. This study is intended to identify and analyze existing peer observation instruments used in higher education institutions in the U.S. specifically focusing on R1 and R2 institutions according to the Carnegie classification. Using the Online Teaching Competencies (OTC) framework developed by Farmer and Ramsdale (2016) as a coding basis, a total of 34 instruments were collected and examined. Coding results based on OTC revealed three highly observed competencies, including a prevalent emphasis on alignment between course activities and learning objectives, instructor availability for learners, and the provision of clear and consistent instructions. However, a substantial number of competencies in the OTC framework were never utilized by any of the collected instruments. Likewise, a large number of competencies measured by the collected instruments were not included in the OTC framework, suggesting potential gaps in the evaluation of course design and accessibility for students with disabilities. This study offers insight into the current state of peer observation practices for online teaching and highlights areas for improvement and refinement of evaluation frameworks.

Effectiveness of project COUNTS in improving students’ numeracy skills

Students with learning difficulties benefit from intervention programs. Hence, this experimental research examined the effectiveness of Project COUNTS (Capacitating, Optimizing and Upgrading the Numeracy skills of The Students), a mathematics intervention program, and a continuous improvement venture in a public school in the Philippines during the academic year 2020–2021. It specifically investigated the numeracy skills pretest and posttest performances and its difference, and the difference in the pretest and posttest according to profiles. This experimental study utilized the data from 175 randomly selected grade 8 (91) and grade 9 (84) students under the low-numerate and non-numerate categories through multi-stage sampling. The study utilized the mean, standard deviation, dependent samples z-test, independent samples z-test, and one-way ANOVA. The results showed that the participants’ numeracy skills pretest and posttest performance reached low-numerate (x̄=15.95, SD=3.30) and numerate (x̄=23.27, SD=3.21) levels, respectively. There is a significant difference in the participants’ posttest performance when grouped according to their sex (z=2.84, p=0.00); females (x̄=24.04, SD=3.22) have better performance than males (x̄=22.57, SD=3.04). There was a statistically significant difference in the pretest and posttest performances (z=-11.38, p<0.001), thus confirming the intervention program’s effectiveness (large effect size) in improving the numeracy skills of students. Teachers, school heads and superiors, students and parents/guardians, and future researchers can replicate or apply the intervention program to other sets of learners.

Reflections on the strategy of hospital development based on the characteristics of new hospitals.

The disease spectrum is constantly changing, meaning patients' medical characteristics are complex and varied, and hospital operations are facing great challenges. To provide a basis for formulating relevant policies, promoting the continuous improvement of medical quality, improving the efficiency of medical services and proposing corresponding countermeasures. Information on the first page of the medical cases of patients discharged from 2020-2021 in the case management system of The Second People's Hospital of Zhangye City was collected, and statistical analysis was performed in terms of the origin, age, gender, occupation and main diagnosis of the patients. The database was established using Excel software, and statistical description was performed using SPSS 23.0 software, in which the main indicators were the number of cases and relative numbers (%). The total number of inpatients in the hospital exhibited an overall upward trend, with the number in 2021 increasing by 40.53% compared with the previous year. Among them, 0.75% of the inpatients resided outside the province and 99.25% resided within the province. The proportion of inpatients within the city was 98.86%, including 85.50% in Ganzhou District and 14.5% in the five surrounding counties (districts). In 2021, the number of inpatients in the five surrounding districts increased by 60.67% compared with the previous year. The occupational structure of the inpatients was mainly farmers, accounting for 64.68%, which was higher than all other occupational groups, while public employees accounted for 17.9%. Inpatients aged 60 years and above accounted for 37.75%. In terms of disease spectrum ranking, circulatory, digestive, respiratory, injury and oncological system diseases ranked in the top five of the presented diseases, accounting for 64.47% of the total number of inpatients. The patients of the new hospital are mainly elderly patients and local farmers. The hospital development should be based on the disease characteristics of this group, improving the diagnosis and treatment capacity of the departments and strengthening the capacity building of the hospital and the level of the medical services.