Country Experts Research Articles

A global review of national guidelines of post-exposure prophylaxis for the prevention of HIV.

The World Health Organization (WHO) recommends the use of antiretroviral drugs as post-exposure prophylaxis (PEP) for preventing HIV acquisition for occupational and non-occupational exposures. To inform the development of global WHO recommendations on PEP, we reviewed national guidelines of PEP for their recommendations. Policies addressing PEP from 38 WHO HIV priority countries were obtained by searching governmental and non-governmental websites and consulting country and regional experts; these countries were selected based on HIV burden, new HIV acquisitions and the number of HIV-associated deaths. We reviewed national guidelines to collate data on where PEP can be offered, who can prescribe PEP, PEP eligibility, recommended drug regime, linkage to other interventions, recommended investigations prescribed with PEP, HIV self-test recommendation related to PEP and stopping rules for PEP. In total, 46 guidelines from January 2010 to May 2023 across 36 countries were included, with 70% of documents published during or after 2020. There was significant variation across national guidelines regarding where PEP can be accessed and who can provide or prescribe PEP. Six countries (17%) described being able to access PEP from a primary care facility, four countries (11%) from hospitals and two (6%) from community-based services. Only three countries (8%) specifically considered dispensing PEP by professionals other than doctors (e.g. nurses). None mentioned pharmacists as prescribers. We found a lack of consistency across countries regarding who is eligible for PEP, regimens used, interventions integrated into PEP provision and recommended investigations for PEP users. No country guidance provided considerations on using HIV self-tests for starting or stopping PEP. Despite PEP being recommended for more than three decades, many national policies were lacking in terms of PEP guidance. There are opportunities for countries to update and optimize guidance to consider ways to improve the accessibility of PEP. Greater efforts are needed to support the development of global consensus on how best to implement and integrate PEP, as well as how to include decentralization and task-sharing to achieve sufficient scale for impact. Improving timely access to PEP and promoting PEP adherence could help contribute to reducing the incidence of HIV globally.

5.L. Round table: Gaining or losing ground? Leveraging social innovation to improve abortion access in Europe

Abstract Sexual and reproductive health services are fundamental to ensuring a wide range of human rights, including the right to health. This includes guaranteeing access to abortion care, which international human rights bodies and the World Health Organization have recognised as a critical component of states’ obligation to respect and ensure human rights. Abortion regulation in Europe continues to evolve along a continuum from restrictive to liberal. For decades, the legislative trend across Europe has been towards the expansion of entitlements to abortion, and the repeal of legal and policy restrictions. In the last ten years, over 15 European countries have undertaken reforms to modernize their laws, including Belgium, France, Ireland, the Netherlands, and Spain. Currently, new progressive reforms are being considered in several countries. However, more restrictive reforms have also been adopted. Health system structures and sociopolitical, cultural, ethical, and moral dimensions shape access to abortion services, while abortion regulation often causes tensions in countries. The landscape is complex, with debates over legalisation and decriminalisation of abortion, and the procedural steps to ensure service provision. Differences in regulation across and within countries result in myriad access inequalities. Understanding abortion regulation in Europe is vital to assessing service equity and access. Exploring the sociopolitical contexts of abortion helps identify potential actions for ensuring access to abortion care. In exploring the range of potential actions, we focus on social innovation, i.e., new social practices to better meet social needs and the processes undertaken to get there. The country expert (HSPM) network of the European Observatory has launched a cross-country study of the state of abortion services in 19 high-income countries since 2018. This workshop will outline the legal, regulatory, service-delivery, and sociopolitical contexts of abortion in Europe, identifying challenges to access. It will take recent experiences in Germany, Ireland, and Portugal to examine differential access, ongoing political debates, and social positioning of abortion in Europe, and as a springboard to discuss the role of social innovation in shaping legal and regulatory changes. Lastly, this workshop will explore how the public health research community can contribute to evidence-based abortion policymaking and implementation. This interactive workshop will start with a presentation of findings from the European Observatory’s cross-country comparison. Then, country experts from the 3 case studies and a representative from the Center for Reproductive Rights will examine the sociopolitical environment of abortion policymaking in Europe. Discussion with audience interventions will reflect on opportunities for social innovation and movement building toward better access to abortion care in Europe and explore the role of the public health research community. Key messages • European abortion laws constantly evolve with a prevalent legislative trend towards expanding access and removing barriers; social innovation can be a lever to progressive law and policy reforms. • In all countries, those seeking abortion care continue to experience multiple access barriers, including those related to policy, regulation, financing, geography, and culture. Speakers/Panelists Katherine Polin Berlin University of Technology, Berlin, Germany Miriam Blümel Berlin University of Technology, Berlin, Germany Catherine Conlon Trinity College Dublin, Dublin, Ireland Ines Fronteira National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal Adriana Lamačková Center for Reproductive Rights, Geneva, Switzerland

Mental health support for healthcare workers: what is it about governance and policy implementation

Abstract Background We adopt a health system and governance perspective to address the mental health needs of healthcare workers, considering the nature of interventions and the levels and actors involved in governance. The aim is to move the debate forward by identifying governance gaps hampering the implementation of health workforce policies and exploring strategies to effectively increase mental health support. Methods A qualitative comparative methodology is applied based on a case study design utilising a multi-level intersectoral governance matrix. The assessment matrix comprises four key categories: health policy and data, social policy and psycho-social conditions, organisation of work, and job and professional conditions. We conducted a rapid assessment of healthcare workforce developments in the European context, drawing on secondary sources and country experts. The country sample comprises Germany, Portugal, Romania, Switzerland and the United Kingdom. Results Awareness of mental health threats among healthcare workers increased, but policy discourse is driven by service delivery and labour market demands. The attention to healthcare workers’ needs is stronger on the international level especially supported by WHO action, and weakest at national/regional levels. Although organisations and professions demonstrate varying degrees of activity, their efforts are scattered and lack sustainability. Similar challenges were identified across healthcare systems, including limited action, disconnected actors, missing coordination, and a lack of attention to governance gaps and system weaknesses. Conclusions There are similar problems across countries. Mental health policy is driven by labour market needs and ignores research evidence and the individual needs. Successful mental health policy implementation needs multi-level governance and coherent coordination mechanisms, and generally greater attention to the ‘human side’ of the healthcare workforce. Speakers/Panelists Sara Alidina Central Administration of the Health System, Lisbon, Portugal Tomas Zapata WHO/Europe, Copenhagen, Denmark

Different approaches to regulate digital health applications in seven European countries

Abstract Background Demographic ageing, shortages in health workforce and increased use of digital tools in daily life kindle decision makers’ interest to utilize digital health applications (DHA). While there are several reviews that provide an overview across remuneration frameworks, no synthesis between additional regulatory aspects and frequency of remuneration approval has been conducted. Methods European countries with either strong status in digital health in general or regulation for health apps in particular were chosen for analysis (BE, DK, DE, EE, EN, FR, NL). Country specific information was collected from scientific and grey literature, legal and stakeholder webpages. Semi-structured interviews were conducted with country experts via video call or e-mail and analyzed using Mayring’s structured, qualitative content analysis. Preliminary results We find three approaches concerning DHT-definitions: For BE, DE, FR, specific regulations define national remuneration requirements. EN and NL define only minimum requirements while decentralized payors make financing decisions. DK and EE fit DHTs into existing financing schemes. Among countries with a national financing framework, DE achieved the largest number of approvals, followed by FR, while BE has not yet issued a (lasting) financing approval. Evaluation requirements focus on clinical and economic outcomes, largely ignoring non-clinical improvements for patients. Conclusions The German regulation stands out with a peculiar definition that might help clarify evaluation criteria, increase the number of financing approvals but also empower patients while reducing the role of health workforce in their application. BE and NL regulations necessitate involvement of health workers, thus addressing structurally different applications. Key messages • Drawing lessons for DHT regulations across countries needs to address differences in national definitions and evaluation criteria. • A standardization system for DHT may help to speed utilization of effective tools and clarify evaluation requirements.

Integrated care in the Baltic states over a 5-year period: progress, challenges and future directions

Abstract Person-centered, multidisciplinary care is key to addressing evolving complex health needs. In Estonia, Latvia, and Lithuania, this pursuit of integrated care has gained momentum as an innovative approach to allocate resources more efficiently and improve patient outcomes. This study investigates the progress of integrating care in the Baltic countries from 2019 to 2024. It details key learnings, particularly for small European countries with limited resources. The Health Systems and Policy Monitor Network of the European Observatory on Health Systems and Policies undertook a cross-country study to better understand the progress in care integration in the Baltics. The Network’s Baltic country experts completed a 21-item questionnaire on the adoption of integrated care reforms. Responses were analyzed to capture reform characteristics and commonalities, countries’ political environments and their conduciveness to the uptake of integrated care. Country-specific experiences with the implementation of integrated care were further explored via case studies of pilot programs over the five years. The pace of implementing integrating care reforms varied in each country. Existing regulatory barriers, workforce challenges and payment schemes have impeded integration efforts across health and social care. Despite these obstacles, the political commitment to new and innovative service delivery and collaboration for chronic care management underscores an important prerequisite toward achieving more integrated and person-centered healthcare. The three case studies illustrate the hurdles that come with shifting care settings and expanding roles for some workers. Findings stress the role for integrated care to address organisational challenges in the Baltics. This study highlights innovative approaches and long-running efforts to provide multidisciplinary care for complex-needs patients and the implications of their results for broader health system adoption. Key messages • Small countries like the Baltics face structural challenges in integrating care to improve outcomes and efficiency. • Investment and innovative care approaches are key to further advancements.

The dissemination and implementation of trauma-focused cognitive behavioural therapy for children and adolescents in seven European countries

BackgroundThere is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as “trauma-focused cognitive behavioural therapy” (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries.MethodsFor this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden).ResultsCommon modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe.ConclusionsThe results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.

Leveraging HIV self-testing to achieve the UNAIDS 2025 targets in the South and Southeast Asia region.

The South and Southeast Asia region has the second-highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS-related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95-95-95 HIV testing, treatment and viral suppression targets. HIV self-testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia. There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow-up HIV services among key populations. Key factors influencing the implementation and scale-up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost-effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended. It is crucial to accelerate the implementation and scale-up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial-and-error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95-95-95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic.

The prevalence of polypharmacy in older Europeans: A multi-national database study of general practitioner prescribing.

The aims of this study were to measure the prevalence of polypharmacy and describe the prescribing of selected medications known for overuse in older people with polypharmacy in primary care. This was a multinational retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain and the UK. We used anonymized longitudinal patient-level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5-9 and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6-month period. Selected medications were: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the healthcare context to interpret findings. Age and gender distribution was similar across the six countries (mean age 75-76 years; 54-56% female). The prevalence of polypharmacy of 5-9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The healthcare context information explained possible underreporting for selected medications. We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worryingly high usage of PPIs and benzodiazepines supports current efforts to improve polypharmacy management across Europe.

The effect of environmental control course on architectural design projects (Case study environmental control course - Canadian International Collage – Egypt)

It is a global strategy to save the environment through sustainable designs; this approach must begin throughout the college phase and progress through their professional career. During their academic journey, undergraduate architecture students take many courses, including a chain of Design courses and an Environmental Control (EC) course. The main aim of this paper is to discuss the importance of EC courses and how they affect design courses' outcomes. The research methodology starts with secondary data through a literature review about environmental studies and their impact on design, what the topics that the EC course has covered, and when it should be taught to be able to design a framework that helped the instructors in developing their courses' plan, then collect the data from the instructors of both courses EC and design to develop the EC course plan by adding new assignment asking students to apply what they learn during EC course in one of their previous design projects which submitted before registered the EC course and gained a knowledge of different environmental techniques. Finally, test the application of the suggested Framework by comparing the results of design projects before and after EC study and validate the results by publishing an online survey targeting the experts in different countries to demonstrate the importance of EC courses as a powerful learning tool in architecture education, as well as to be a comprehensive approach that reflects the relationship between design and environmental studies to improve both architects and building design performance.

Problems Encountered in Humanitarian Aid Logistics and Solution Suggestions by Integrated QFD Method: The Case of Hatay

In recent years, extraordinary situations and humanitarian crises have increased the number of studies in the field of humanitarian aid logistics. Although various solutions have been tried to be produced for the problems experienced in humanitarian aid logistics in disasters occurring worldwide and, in our country, these solutions have generally not been suitable for regional needs. The aim of this study is to identify the problems encountered in humanitarian aid activities carried out in Hatay province and to develop solutions to these problems. Humanitarian logistics is a complex process involving many actors. This complexity requires a combination of both requirements and decision criteria to be evaluated. In this study, a model that can provide flexible yet effective solutions to the problems encountered in the humanitarian logistics planning process is proposed. This model involves combining qualitative and quantitative data using the Quality Function Deployment (QFD) method. In this study, a model that integrates Delphi and Analytical Network Process (ANP) methods with Quality Function Deployment (QFD) technique has been developed to identify the problems encountered in humanitarian aid logistics in Hatay province and to develop solutions to these problems. In line with the developed model, the study generally consisted of three stages. In the first stage, the Delphi method was used to identify the problems in humanitarian aid logistics by taking into account the relevant literature and the opinions of the representatives of the institutions/organizations providing humanitarian aid services in Hatay. Then, the priority values (weights) of these problems were determined by Analytic Network Process (ANP) method. In the last stage, solution proposals were developed through the Quality Function Deployment (QFD) relationship matrices. In humanitarian aid logistics, 14 problems were identified by Delphi technique. With the prioritisation of the results obtained with ANP, ‘Problems Arising from Lack of Continuity-Sustainability’ emerged as the most important problem. Then, among the 13 solution suggestions determined by expert opinions, ‘Establishing a system to monitor humanitarian aid’ was determined as the most effective solution suggestion in eliminating the problems in humanitarian aid logistics. In the future, it would be useful to conduct similar research with the participation of more experts in different regions or countries. In addition, the findings of the study can be compared with different multi-criteria decision-making methods to provide a broader perspective. In this context, the use of integrated methodologies in the field of humanitarian aid logistics will allow for a more comprehensive approach to the problems.

Transfer of internationally qualified nurses' specialty skills to developed countries after immigration: A multicentre policy review.

Internationally qualified nurses are highly sought after as a labour source due to continued shortages in the nursing profession in most developed countries. However, the lack of clear policies and procedures for nurses in the host country to use specialty nursing skills can result in the underutilisation of their expertise. To review the registration processes of internationally qualified nurses in 20 developed countries, with a focus on the transferability of specialised skills gained overseas. A multicentre policy review design was used, using the STROBE reporting guidelines. The study sourced policy information from nurse registration bodies in developed countries and reviewed and removed redundant policies. Out of 34 policies initially identified, 26 were used to show the registration process of nurses after immigration to developed countries. Only four of the 20 countries reviewed indicated the option of specialised nurse registration on their website for internationally qualified nurses, with a university qualification required before years of experience. All other countries indicated the general registration pathway only. More attention is needed to address the lack of well-defined policies that guide the utilisation of internationally qualified nurses' specialised skills. Transparent procedures are essential to fully benefit from their expertise in the host country's health workforce.

Constitutional Conventions in Central Europe: Insights from Experts

ABSTRACT Besides a legal framework, the political processes of modern polities are affected by other rules, commonly referred to as constitutional conventions. However, constitutional conventions in Central European states have not received particular attention despite growing evidence of their existence. This research note aims to help fill in this gap. We have conducted semi-structured interviews with 46 country experts and delivered comprehensive information about intra-field, inter-field, and cross-national variations. Interviews show that among the experts, both theoretical and empirical knowledge of constitutional conventions vary significantly and that conventions are still largely marginalised, notably in political science research.

Defining change: Exploring expert views about the regulatory challenges in adaptive artificial intelligence for healthcare

ObjectiveContinuously learning or adaptive artificial intelligence (AI) applications for screening, diagnostic and other clinical services are yet to be widely deployed. This is partly due to existing device regulation mechanisms that are not fit for purpose regarding the adaptive features of AI. This study aims to identify the challenges in and opportunities for the regulation of adaptive features of AI. Materials and MethodsWe performed in-depth qualitative, semi-structured interviews with a diverse group of 72 experts in high-income countries (Australia, Canada, New Zealand, US, and UK) who are involved in the development, acquisition, deployment and regulation of healthcare AI systems. ResultsOur findings revealed perceived challenges in the regulation of adaptive features of machine learning (ML) systems. These challenges include the complexity of AI applications as products subject to regulation; lack of accepted definitions of adaptive changes; diverse approaches to defining significant adaptive change; and lack of clarity about regulation of adaptive change. Our findings reflect potentially competing interests among different stakeholders and diversity of approaches from regulatory bodies and legislators in different jurisdictions across the globe. In addition, our findings highlight the complex regulatory implications of adaptive AI that differ from traditional medical products, drugs or devices. ConclusionThe perceived regulatory challenges raised by adaptive features of AI applications require high-level coordination within a complex regulatory ecosystem that consists of medical device regulators, professional accreditation agencies, professional medical organisations, and healthcare service providers. Regulatory approaches should complement existing safety protocols with new governance mechanisms that specifically take into account the variety of roles and responsibilities that will be required to monitor, evaluate and oversee adaptive changes.

Pricing, Procurement and Reimbursement Policies for Incentivizing Market Entry of Novel Antibiotics and Diagnostics: Learnings from 10 Countries Globally.

Fostering market entry of novel antibiotics and enhanced use of diagnostics to improve the quality of antibiotic prescribing are avenues to tackle antimicrobial resistance (AMR), which is a major public health threat. Pricing, procurement and reimbursement policies may work as AMR 'pull incentives' to support these objectives. This paper studies pull incentives in pricing, procurement and reimbursement policies (e.g., additions to, modifications of, and exemptions from standard policies) for novel antibiotics, diagnostics and health products with a similar profile in 10 study countries. It also explores whether incentives for non-AMR health products could be transferred to AMR health products. This research included a review of policies in 10 G20 countries based on literature and unpublished documents, and the production of country fact sheets that were validated by country experts. Initial research was conducted in 2020 and updated in 2023. Identified pull incentives in pricing policies include free pricing, higher prices at launch and price increases over time, managed-entry agreements, and waiving or reducing mandatory discounts. Incentives in procurement comprise value-based procurement, pooled procurement and models that delink prices from volumes (subscription-based schemes), whereas incentives in reimbursement include lower evidence requirements for inclusion in the reimbursement scheme, accelerated reimbursement processes, separate budgets that offer add-on funding, and adapted prescribing conditions. While a few pull incentives have been piloted or implemented for antibiotics in recent years, these mechanisms have been mainly used to incentivize launch of certain non-AMR health products, such as orphan medicines. Given similarities in their product characteristics, transferability of some of these pull incentives appears to be possible; however, it would be essential to conduct impact assessments of these incentives. Trade-offs between incentives to foster market entry and thus potentially improve access and the financial sustainability for payers need to be addressed.

TEMPORARY REMOVAL: Drivers of Anemia Reduction among Women of Reproductive Age in the Philippines: A Country Case Study

BackgroundAnemia prevalence among women of reproductive age (WRA) in the Philippines was 25% in 2000, decreasing to 13% in 2018. To date, an in-depth assessment of the determinants associated with this decline has not been conducted. ObjectiveTo conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in the Philippines between 2008 and 2018. MethodsEmploying standard Exemplars methodology, we conducted quantitative analyses using the Philippines’ National Nutrition Survey, the Expanded National Nutrition Survey, and the Philippines National Demographic and Health Surveys. Qualitative analyses included a comprehnsive literature review, program/policy analysis, and interviews with stakeholders to understand country-level enablers and barriers to WRA anemia decline in the Philippines. A final Oaxaca-Blinder decomposition analysis (OBDA) evaluated the relative contribution of direct and indirect factors. ResultsAmong non-pregnant women (NPW), mean hemoglobin (Hb) increased from 12.7 g/dL in 2008 to 13.1 g/dL in 2018 (p<0.01), corresponding to an 11%-point decline in anemia prevalence (23% to 12%). Inequities by geographical region, household wealth, and women’s educational attainment narrowed considerably during this time. Important direct and indirect nutrition programs were introduced during our study period, including universal healthcare and food fortification. Country experts interviewed credited programs focused on alleviating micronutrient deficiencies and poverty, and improvements in women’s health and well-being, for the country's extraordinary success. OBDA explained ∼50% of the observed change in mean Hb among NPW, with family planning (35%), household socio-demographics (29%), and improvement in women’s nutrition (23%) emerging as critical drivers of anemia decline, corroborating our qualitative and policy analyses. ConclusionsTo protect these gains, WRA anemia prevention efforts in the Philippines should continue to focus on universal healthcare access, women’s empowerment, and poverty alleviation.

Rescue and recovery: The COVID and post-COVID responses of apprenticeship systems

ABSTRACT Few changes have been so abruptly disruptive to apprenticeships worldwide as the global COVID outbreak from early 2020 onwards. Because apprenticeships involve experience in workplaces (normally via employment), as well as participation in education systems, the effects were especially serious. There was extra urgency to policy responses because apprenticeships are disproportionately, and in some countries, exclusively, undertaken by young people. There were no worldwide ‘answers’ as to what to do, as apprenticeship systems vary greatly among countries. The paper examines the development of apprenticeship-related measures in several countries worldwide, with a particular focus on Australia and England. The paper uses statistical data, government announcements, guidance from stakeholders and officials, and also a systematic analysis of presentations by leading country experts at an online international apprenticeship conference in May 2021. Reflecting on common concerns on apprenticeship system, the paper critiques and analyses the effects and potential effects of COVID and post-COVID measures on apprenticeship systems.

Mapping the scientific knowledge and approaches to defining and measuring hate crime, hate speech, and hate incidents: A systematic review.

Mapping the scientific knowledge and approaches to defining and measuring hate crime, hate speech, and hate incidents: A systematic review.

A Regression Model for Predicting the Cost of Laterite- Quarry Dust Cement Blocks

This is part of a study investigating the structural properties of blocks produced from using different combination of laterite and quarry dust as full replacement for conventional river sand as aggregate. The use of alternative materials in blocks production and other concrete works is becoming increasingly popular across most developing countries. This work developed a mathematical model using Osadebe Regression Theory (ORT) for the prediction of cost/cum of laterite- quarry dust cement block. The lack of fit of the model was carried out using statistical tool (excel) and found to be adequate. The model will be very useful especially for commercial blocks producers and built experts in Nigeria and sub-Sahara African countries for construction cost estimation and profit projection.

Profiling national institutional archetypes for climate change technology implementation: application in small islands and least developed countries

In developing countries, when the implementation success of new climate adaptation and mitigation technologies fall short of expectations, the typical “suspects” cited are lack of funding or country expertise and allusions to “lack of institutional capacity.” The premise of this study is that the national institutional environment is the fundamental prerequisite for successful technology implementation, and despite much effort, a diagnostic approach to assessing this prerequisite is missing. Here, I propose an approach to do this, based on an understanding of the dynamics that interconnect country-level legal, regulatory and market mechanisms, societal norms, and inter/intra governmental structures. I estimate levels of country structural and systems supports, operating environment, implementer acceptance and country tractability. A preliminary test of the approach was completed through a survey of experts involved in the United Nations Technology Needs Assessment programs in Least Developed and Small Island Developing Countries. It was found that countries fall into four fundamental archetypes. A country’s archetype suggests characteristics of the institutional environment that help to explain the potential for technology implementation success. A further implication is that some countries that typically would not be considered very similar may possess similar country institutional environments. One consequence of this is that archetype-based groups could work together and learn from each other more effectively.

Clinical practice guideline: Interventions for Developmental Language Delay and Disorders.

Approximately 9.9 % of children present with difficulties in language development (DLD), 7.6 % without serious additional impairments and 2.3 % associated with languagerelevant comorbidities, e.g., hearing loss. Notably, in a consensus statement by experts in German-speaking countries, in the guideline presented here, and further in this article, all of these disorders are referred to as "developmental language disorders" (DLD), whereas the international consortium CATALISE only refers to those without comorbidities as DLD. DLDs are among the most commonly treated childhood disorders and, if persistent, often reduce educational and socio-economic outcome. Children in their third year of life with developmental language delay (late talkers, LT) are at risk of a later DLD. This German interdisciplinary clinical practice guideline reflects current knowledge regarding evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the effectiveness of interventions for DLD. The guideline recommends parent training (Hedges g = 0.38 to 0.82) for LTs with expressive language delay, language therapy (Cohen's d = -0.20 to 0.90) for LTs with additional receptive language delay or further DLD risk factors, phonological or integrated phonological treatment methods (Cohen's d = 0.89 to 1.04) for phonological speech sound disorders (SSDs), a motor approach for isolated phonetic SSDs (non-DLD), and for lexical-semantic and morpho-syntactic impairments combinations of implicit and explicit intervention approaches (including input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalinguistic- approaches, visualizations; Cohen's d = 0.89-1.04). Recom mendations were also made for DLD associated with pragmatic-communicative impairment, bi-/ multilingualism, hearing loss, intellectual disability, autism-spectrum disorders, selective mutism, language- relevant syndromes or multiple disabilities, and for intensive inpatient language rehabilitation. Early parent- and child-centered speech and language intervention implementing evidence-based intervention approaches, frequency, and settings, combined with educational language support, can improve the effectiveness of management of developmental language delay and disorders.