External Evaluation Research Articles

School organisational trauma during student suicide crisis

ABSTRACT Recent qualitative research in Ireland illuminates the impact of student suicide on Irish school guidance counsellors and the school organisation. It exposes distinctive factors in the overall system contributing to their experience of organisational trauma when coping with suicide aftermath. A qualitative Interpretative Phenomenological Analysis study privileged the voices of this Irish cohort of first responders to student suicide. Much international literature highlights the often severe effects of suicide trauma on mental health professionals. Irish school guidance counsellors comprise some of this cohort who deal with suicide. As they are highly likely to encounter suicide due to the accelerating rate of youth suicide in Ireland, they are vulnerable to similar risks of adverse impact. This research helps fill a gap in the literature concerning the specific Irish school context. In this research, semi-structured interviews generated descriptions of what was indicative of vicarious and secondary trauma, moral injury, organisational trauma and lack of containment, systemic disconnect, ambiguity and organisational double-bind used as a defence strategy, which appears to have comprised crisis recovery for the entire system. This article draws on the research and argues for a review of the Irish school critical incident protocols and policy and the introduction of an external evaluation of their efficacy in containing trauma in Irish schools.

Predictive performance of multi-model approaches for model-informed precision dosing of piperacillin in critically ill patients

ObjectivesPiperacillin (PIP)/tazobactam is a frequently prescribed antibiotic; however, over- or underdosing may contribute to toxicity, therapeutic failure, and development of antimicrobial resistance. An external evaluation of 24 published PIP-models demonstrated that model-informed precision dosing (MIPD) can enhance target attainment. Employing various candidate models, this study aimed to assess the predictive performance of different MIPD-approaches comparing (i) a single-model approach, (ii) a model selection algorithm (MSA) and (iii) a model averaging algorithm (MAA). MethodsPrecision, accuracy and expected target attainment, considering either initial (B1) or initial and secondary (B2) therapeutic drug monitoring (TDM)-samples per patient, were assessed in a multicentre dataset (561 patients, 11 German centres, 3654 TDM-samples). ResultsThe results demonstrated a slight superiority in predictive performance using MAA in B1, regardless of the candidate models, compared to MSA and the best single models (MAA, MSA, best single models: inaccuracy ±3%, ±10%, ±8%; imprecision: <25%, <31%, <28%; expected target attainment >77%, >71%, >73%). The inclusion of a second TDM-sample notably improved precision and target attainment for all MIPD-approaches, particularly within the context of MSA and most of the single models. The expected target attainment is maximized (up to >90%) when the TDM-sample is integrated within 24 h. ConclusionsIn conclusion, MAA streamlines MIPD by reducing the risk of selecting an inappropriate model for specific patients. Therefore, MIPD of PIP using MAA implicates further optimisation of antibiotic exposure in critically ill patients, by improving predictive performance with only one sample available for Bayesian forecasting, safety, and usability in clinical practice.

Enhancing Professionalism in Nurse Anesthesia Education: A Randomized Controlled Trial of Multi-Source Feedback

Background: Professionalism is defined as a set of knowledge, skills, moral values, and personal and group identity that affect the quality of providing care to patients. Objectives: This study aimed to investigate the effect of Multi-Source Feedback (MSF) on the professionalism level of nurse anesthesia students. Methods: This study was a randomized controlled trial adopting a pre-test/post-test design and involved a sample of 46 third- and fourth-year nurse anesthesia students selected using the census method (27 females and 19 males with a mean age of 20.91). They were divided equally into two groups of 23 each. Students in the intervention group received MSF during the 3-month period of their academic semester. At the end of each month, they were evaluated by 3 external evaluators, including an anesthesiologist, a nurse anesthetist, and a nurse anesthesia instructor, using a researcher-made checklist. In addition to the mentioned evaluators, the students performed self-evaluation using the Professional Self-description Form (PSDF). Based on the scores of the evaluators, the necessary feedback was given to the students online and offline. Meanwhile, the students in the control group received routine training and feedback during the internship. The data were analyzed using the repeated measures MANOVA test. Results: The intervention group consistently scored higher in professionalism than the control group. Over time, the gap between the two groups increased, with the intervention group achieving significantly higher improvement (P &lt; 0.001). In the intervention group, the mean scores obtained from all evaluators including the nurse anesthesia instructor, the nurse anesthetist, the anesthesiologist, and self-evaluation were 62.43 ± 3.86, 63.13 ± 4.67, 61.26 ± 3.94 and 80.91 ± 6.86 at baseline, which rose to 87.52 ± 6.04, 88.69 ± 6.37, 83.00 ± 7.33 and 101.82 ± 5.59, respectively (P &lt; 0.001). Specifically, the two groups experienced an upward trend in terms of the MSF score, yet the control group displayed a slight increase, while the intervention group demonstrated a significantly steeper rise. Intergroup effect tests consistently revealed that across all evaluators, the intervention group outperformed the control group (P &lt; 0.001). Conclusions: The multi-source evaluation process had a statistically significant effect on the level of professionalism of nurse anesthesia students. It is possible to benefit from integrating this method with other evaluation methods in future studies.

High-Level Isolation: A Landscape Analysis of Global Capabilities and Opportunities to Advance the Field.

High-level isolation units (HLIUs) have been established by countries to provide safe and optimal medical care for patients with high-consequence infectious diseases. We aimed to identify global high-level isolation capabilities and determine gaps and priorities of global HLIUs, using a multiple method approach that included a systematic review of published and gray literature and a review of Joint External Evaluations and Global Health Security Index reports from 112 countries. A follow-up electronic survey was distributed to identified HLIUs. The landscape analysis found 44 previously designated/self-described HLIUs in 19 countries. An additional 33 countries had potential HLIUs; however, there were not enough details on capabilities to determine if they fit the HLIU definition. An electronic survey was distributed to 36 HLIUs to validate landscape analysis findings and to understand challenges, best practices, and priorities for increased networking with a global HLIU cohort; 31 (86%) HLIUs responded. Responses revealed an additional 30 confirmed HLIUs that were not identified in the landscape analysis. To our knowledge, this was the first mapping and the largest ever survey of global HLIUs. Survey findings identified major gaps in visibility of HLIUs: while our landscape analysis initially identified 44 units, the survey unveiled an additional 30 HLIUs that had not been previously identified or confirmed. The lack of formalized regional or global coordinating organizations exacerbates these visibility gaps. The unique characteristics and capabilities of these facilities, coupled with the likelihood these units serve as core components of national health security plans, provides an opportunity for increased connection and networking to advance the field of high-level isolation and address identified gaps in coordination, build an evidence base for HLIU approaches, and inform HLIU definitions and key components.

Can global health security frameworks measure One Health implementation in West Africa?A mixed-methods study

BackgroundThe 2014 outbreak of the Ebola virus disease highlighted the importance of overhauling and transforming healthcare systems in West Africa to improve the ability of individual countries to deal with infectious diseases. As part of this effort, in November 2016 the West African Health Organization (WAHO) began the process of institutionalizing the One Health (OH) approach to health security across the Economic Community of West African States (ECOWAS). The lack of clear metrics and evaluation frameworks to measure the progress of OH implementation in West Africa has been reported as a challenge. Therefore, this study sought to assess and explore whether the existing metrics of global health security frameworks can measure the successful implementation of OH activities, evaluate the progress made since 2016, and identify key areas for improvement in the region.MethodThe study employed predetermined keywords to select indicators from the International Health Regulations (IHR) Monitoring Frameworks, specifically the State Party Self-Assessment Annual Report (SPAR) and Joint External Evaluation (JEE), deemed relevant to the OH approach. In addition, the COVID-19 performance index scores (severity and recovery) for June 2022 were extracted from the Global COVID-19 Index (GCI). The GCI Recovery Index evaluated the major recovery parameters reported daily to indicate how a country performed on the path to recovery from the COVID-19 pandemic compared to other countries. National documents were also analyzed using categorical variables to assess the performance status of OH platforms across implementing countries. A quantitative analysis of these indicators was conducted and supplemented with qualitative data gathered through interviews with key stakeholders. Between March and April 2022, we conducted 18 key informant interviews with purposively selected representatives from regional governmental agencies and international multilateral agencies, including ECOWAS member states. Interviews were conducted online, transcribed, and analysed following the tenets of thematic analysis.ResultsOur quantitative analysis revealed no significant association between the implementation status of OH activities and any of the selected indicators from SPAR and JEE. The descriptive analysis of the JEE scores at the country level revealed that countries with existing OH platforms scored relatively higher on the selected JEE indicators than other countries in the pre-implementation stage. OH implementation status did not significantly affect COVID-19 recovery and severity indices. The qualitative findings with relevant stakeholders revealed noteworthy challenges related to insufficient human capacity, inadequate coordination, and a lack of government funding for the sustainability of OH initiatives. Nonetheless, countries in the ECOWAS region are making progress toward the integration of OH into their health security systems.ConclusionStandardized metrics were used to assess the implementation and efficacy of OH systems in the ECOWAS region. Current indicators for monitoring global health security frameworks lack specificity and fail to comprehensively capture essential OH components, particularly at the sub-national level. To ensure consistency and effectiveness across countries, OH implementation metrics that align with global frameworks such as IHR should be developed.

Professional architects’ design trade-offs in reinforcement learning-powered agent-based simulation

While emphasising play-based approaches in early childhood education, there is a deficiency in the practical understanding of play integration into children’s learning environment design. To support methodological limitations, this study developed a play behaviour model using reinforcement learning agents to generate children’s unpredictable behavioural responses during physical and social play, including unforeseen injuries. In comparative laboratory experiments, 14 professional architects engaged in design tasks before and after using the simulation. The design results were assessed through external expert evaluations, with a focus on the optimal trade-offs between facilitating play behaviours while ensuring safety considerations and on the level of effective design decision making and completeness. The statistical analysis demonstrated that the simulation facilitated optimal trade-offs, enhanced decision making and improved the overall completeness of children’s learning environment design. This research addressed the capabilities of simulation to support a child-centric design, with potential implications for improving early childhood education environments.

CoCoNest: A Continuous Structural Connectivity-based Nested Parcellation of the Human Cerebral Cortex

Abstract Despite the widespread exploration and availability of parcellations for the functional connectome, parcellations designed for the structural connectome are comparatively limited. Current research suggests that there may be no single ‘correct’ parcellation and that the human brain is intrinsically a multi-resolution entity. In this work, we propose the CoCoNest family of parcellations - a fully data-driven, multi-resolution family of parcellations constructed from structural connectome data. The CoCoNest family is constructed using agglomerative (bottom-up) clustering and error-complexity pruning, which strikes a balance between the complexity of the parcellation and how well it preserves patterns in vertex-level, high-resolution connectivity data. We draw on a comprehensive battery of internal and external evaluation metrics to show that the CoCoNest family is competitive with or outperforms widely used parcellations in the literature. Additionally, we show how the CoCoNest family can serve as an exploratory tool for researchers to investigate the multi-resolution organization of the structural connectome.

Survey on caregiver competency and retraining needs.

This study investigated caregivers' job image, abilities, and educational needs, which are rapidly increasing owing to an aging society. A self-administered written survey was conducted at 12 general hospitals in Korea from February 1, 2022 to March 15, 2023. A total of 451 caregivers participated in the survey as subjects of analysis, and 560 nurses participated as external observers. The caregivers' self-assessment results regarding job performance, educational needs, and retraining needs were compared with those of external observers. Caregivers evaluated themselves significantly higher in all areas of job performance compared to the evaluations of external observers. In particular, the caregivers' self-evaluation of their abilities in "Recording and Reporting," "Basic Resuscitation," "Safety and Infection Control," and "Understanding Major Illnesses" was different from the evaluation of nurses. Both the caregivers and external observers agreed on the need for caregiver retraining, with 1-2 hoursof supplementary training every 12 months being the most preferred amount of retraining. There was a significant difference between caregivers' self-evaluations of their capabilities and the external observers' evaluations. Therefore, systematic professional caregiver retraining is necessary.

Artificial intelligence for surgical safety during laparoscopic gastrectomy for gastric cancer: Indication of anatomical landmarks related to postoperative pancreatic fistula using deep learning.

Postoperative pancreatic fistula (POPF) is a critical complication of laparoscopic gastrectomy (LG). However, there are no widely recognized anatomical landmarks to prevent POPF during LG. This study aimed to identify anatomical landmarks related to POPF occurrence during LG for gastric cancer and to develop an artificial intelligence (AI) navigation system for indicating these landmarks. Dimpling lines (DLs)-depressions formed between the pancreas and surrounding organs-were defined as anatomical landmarks related to POPF. The DLs for the mesogastrium, intestine, and transverse mesocolon were named DMP, DIP, and DTP, respectively. We included 50 LG cases to develop the AI system (45/50 were used for training and 5/50 for adjusting the hyperparameters of the employed system). Regarding the validation of the AI system, DLs were assessed by an external evaluation committee using a Likert scale, and the pancreas was assessed using the Dice coefficient, with 10 prospectively registered cases. Six expert surgeons confirmed the efficacy of DLs as anatomical landmarks related to POPF in LG. An AI system was developed using a semantic segmentation model that indicated DLs in real-time when this system was synchronized during surgery. Additionally, the distribution of scores for DMP was significantly higher than that of the other DLs (p < 0.001), indicating the relatively high accuracy of this landmark. In addition, the Dice coefficient of the pancreas was 0.70. The DLs may be used as anatomical landmarks related to POPF occurrence. The developed AI navigation system can help visualize the DLs in real-time during LG.

A Multi-Modal Machine Learning Methodology for Predicting Solitary Pulmonary Nodule Malignancy in Patients Undergoing PET/CT Examination

This study explores a multi-modal machine-learning-based approach to classify solitary pulmonary nodules (SPNs). Non-small cell lung cancer (NSCLC), presenting primarily as SPNs, is the leading cause of cancer-related deaths worldwide. Early detection and appropriate management of SPNs are critical to improving patient outcomes, necessitating efficient diagnostic methodologies. While CT and PET scans are pivotal in the diagnostic process, their interpretation remains prone to human error and delays in treatment implementation. This study proposes a machine-learning-based network to mitigate these concerns, integrating CT, PET, and manually extracted features in a multi-modal manner by integrating multiple image modalities and tabular features). CT and PET images are classified by a VGG19 network, while additional SPN features in combination with the outputs of VGG19 are processed by an XGBoost model to perform the ultimate diagnosis. The proposed methodology is evaluated using patient data from the Department of Nuclear Medicine of the University Hospital of Patras in Greece. We used 402 patient cases with human annotations to internally validate the model and 96 histopathological-confirmed cases for external evaluation. The model exhibited 97% agreement with the human readers and 85% diagnostic performance in the external set. It also identified the VGG19 predictions from CT and PET images, SUVmax, and diameter as key malignancy predictors. The study suggests that combining all available image modalities and SPN characteristics improves the agreement of the model with the human readers and the diagnostic efficiency.

Knowledge tensions and decision-making challenges in open innovation: Standardization as a de-biasing mechanism

Complexities in external knowledge evaluation present significant “limits” to open innovation (OI), challenging decision making in the processes of searching, accessing, and using external knowledge for recombination, which are central to the OI paradigm. Grounded in the theory of attitudes, this study investigates the role of standardization in preventing the negative behavioral influence of “not invented here” (NIH) and “not-shared-here” (NSH) attitudes on knowledge search and sourcing decisions by debiasing decisional paths associated with reluctance to adopt OI. Using hurdle model estimations on 600 small-and medium-sized enterprises, the results of the study reveal that NIH and NSH attitudes are the origin of decision-making biases at different stages of OI implementation, where external knowledge is the focus of evaluation. Proactive standardization efforts are shown to be effective in countering the impact of NIH and NSH attitudes on knowledge sourcing decisions and on the intensity of knowledge sourcing, typically leading to bounded search, inward decisions, and anticipated termination of projects. This study provides insights into the influence of standardization efforts specifically addressing challenges related to the evaluation of external knowledge, where the likelihood of failure is higher and associated costs are significant.

The strategic architecture of “BPDPKS” – Oil Palm Plantation Fund Management Agency

Abstract The Oil Palm Plantation Fund Management Agency, Badan Pengelola Dana Perkebunan Kelapa Sawit, is a government institution that manages funds for oil palm plantations using export levies from crude palm oil (CPO) products and their derivatives. However, there is a dichotomy between supporting conglomerates and smallholders. To address this issue, an analysis is required to determine the agency’s position as a strategic organization capable of implementing sustainable oil palm development programs. The strategic architecture outlines the future and business outlook of the agency. Hence, this study uses IPA analysis to analyze the current planning needs and what is required in the agency’s strategic architecture. The core competencies were identified using VRIO frameworks and external analysis using PESTEL. Result from that analysis as a parameter to create a strategic architecture for 2024-2028. The strategic architecture has been developed based on internal and external evaluation matrices, employing strengths, weaknesses, opportunities, and threats (SWOT) analysis. Additionally, this research was followed by preparing an action plan as a guideline for implementation programs.

Independent external evaluation of pediatric HCM Risk Scores in predicting severe ventricular arrhythmias

Independent external evaluation of pediatric HCM Risk Scores in predicting severe ventricular arrhythmias

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.

Analisis SWOT Pemasaran Cabai pada Koperasi Primadona Situbondo

This research aims to find out what marketing strategies are used by the Primadona Cooperative. The informants in this research were 30 people consisting of chairman, deputy, secretary, staff, members and consumers of the prima donna cooperative. The formulation of alternative strategies was analyzed by creating an Internal Factor Evaluation (IFE) and External Factor Evaluation (EFE) matrix, then continued with a grand strategy and SWOT analysis. SWOT analysis is an analysis used to evaluate the strengths and weaknesses in the internal environment as well as the opportunities and threats in the company's external environment. From the results of the analysis, it was concluded that the competitive position of red chili agribusiness is in quadrant I (high market growth and strong competitive position).

Implementing Self-Measured Blood Pressure Monitoring With Clinical Support: A Qualitative Study of Federally Qualified Health Centers.

Self-measured blood pressure monitoring (SMBP) with clinical support is effective at reducing blood pressure for people with hypertension. Although strengths and challenges around SMBP are well-documented, few studies describe the complexities of real-world implementation of SMBP with clinical support in the Federally Qualified Health Center (FQHC) setting. Between 2019 and 2023, the Ohio Department of Health funded the Ohio Association of Community Health Centers to manage a multiyear quality improvement (QI) project with 21 FQHCs. The project aimed to improve the identification and management of patients with hypertension, diabetes, and prediabetes. This study focuses on the activities implemented to provide SMBP support to patients with hypertension. FQHCs implemented clinical SMBP support using multiple roles, approaches, and resources. FQHCs established a process to identify patients eligible for SMBP support, provide blood pressure monitors, train patients on SMBP, track blood pressure readings, follow up with patients, and connect patients to resources. External evaluators interviewed 13 staff members within seven FQHCs from the QI project. Interviewed FQHCs were located across Ohio and represented urban, rural, suburban, and Appalachian areas. Clinical activities to support SMBP, facilitators, and barriers were identified with thematic analysis. The National Association of Community Health Centers SMBP Implementation Toolkit was used as a framework to assess SMBP activities. Facilitators included team-based care, health information technology capacity, funding for blood pressure monitors and staff time, leadership and staff support, and external support. Barriers included technology challenges, staffing shortages, low patient engagement, sustainability, and the COVID-19 pandemic. This study demonstrates how FQHCs can use a variety of staff, processes, and resources to implement clinical SMBP support across a range of geographic regions. To facilitate this, FQHCs and patients may need more comprehensive insurance coverage of blood pressure monitors, reimbursement for staff time, and technology support.

In Silico Design and In Vitro Assessment of Bicyclic Trifluoromethylated Pyrroles as New Antibacterial and Antifungal Agents.

QSAR studies on the number of compounds tested as S. aureus inhibitors were performed using an interactive Online Chemical Database and Modeling Environment (OCHEM) web platform. The predictive ability of the developed consensus QSAR model was q2=0.79±0.02. The consensus prediction for the external evaluation set afforded high predictive power (q2=0.82±0.03). The models were applied to screen a virtual chemical library with anti-S. aureus activity. Six promising new bicyclic trifluoromethylated pyrroles were identified, synthesized and evaluated in vitro against S. aureus, E. coli, and A. baumannii for their antibacterial activity and against C. albicans, C. krusei and C. glabrata for their antifungal activity. The synthesized compounds were characterized by 1H, 19F, and 13C NMR and elemental analysis. The antimicrobial activity assessment indicated that trifluoromethylated pyrroles 9 and 11 demonstrated the greatest antibacterial and antifungal effects against all the tested pathogens, especially against multidrug-resistant strains. The acute toxicity of the compounds to Daphnia magna ranged from 1.21 to 33.39 mg/L (moderately and slightly toxic). Based on the docking results, it can be suggested that the antibacterial and antifungal effects of the compounds can be explained by the inhibition of bacterial wall component synthesis.

Embryo-fetal developmental toxicity of carbamazepine administered orally in wistar rat

Carbamazepine is an anticonvulsant medication commonly used to treat epilepsy and other neurological disorders. The purpose of this study was to assess the impact of carbamazepine on prenatal development, including maternal-fetal, external, visceral, and skeletal toxicity. Additionally, the study aimed to investigate the effects of orally administered Carbamazepine at a lower dose range in Wistar rats. Pregnant female rats were randomly distributed into control (G1) group administered with distilled water orally (n=8), low dose (G2) group administered at 25 mg/kg, intermediate dose (G3) group at 50 mg/kg, and high dose (G4) group at 100 mg/kg through oral gavage from gestation day (GD) 5–19. Pregnant female rats were scheduled to necropsy on gestation day (GD) 20. During the evaluation, the uterus was observed for number of live or viable fetuses, dead fetuses, early resorptions, late resorptions, number of corpora lutea and the sex ratio (m/f) per litter. Further, fetuses were subjected to materno-fetal examination which included observation for placenta, amniotic fluid, and umbilical cord followed by external evaluation. Additionally, half of the fetuses were subjected to visceral, craniofacial evaluation and other half of the fetuses were subjected to skeletal evaluation by double staining method using Alcian Blue for cartilages and Alizarin Red S for bones. It was observed that there was a significant decrease in the rate of pregnancy in the intermediate dose (G3) group and in high dose (G4) group when compared with the control group. Moreover, treatment with the Carbamazepine caused significant increase in fetal malformations such as dilation of lateral and third ventricle in brain, in intermediate dose (G3) group and high dose (G4) group when compared with the control (G1) group, dilation of ureters in high dose (G4) group. Fetal skeletal malformations like bent and nodulated ribs were also observed in intermediate dose (G3) group. Existing research substantially supports the claim that carbamazepine can cause teratogenic effects and prenatal development toxicity even at a lower dose range.

Performance Power: Boosting Saudi Arabia’s Health System Disaster Readiness (2017–2023)

Introduction: The 2016 self-assessment based on joint external evaluation (JEE) identified certain gaps, which prompted the need for additional improvement. This study attempted to address an approach to enhance preparedness using the performance management system’s components focusing on related areas in the JEE tool by the International Health Regulations (IHR). Methods: This was an observational cross-sectional study including all hospitals and regional health directorates within the Ministry of Health, Saudi Arabia. Entities preparedness was calculated using the JEE tool. Moreover, the implementation of the performance management system was also assessed for Saudi Arabia from the year 2017 to 2022. Additionally, the feedback was collected using the survey from the 11 National Preparedness Index (NPI) coordinators. Results: Total readiness was found to be 52% only, which was far less than the planned value of 75%. While regarding the implementation of the performance management system, it was noted that there was a progressive increase in the implementation from 10% in the year 2017 to 81.25% in the year 2022. Considering the feedback responses of NPI coordinators, it was found that 100% of coordinators agreed that the NPI has supported enhancing Health emergency preparedness and that the follow-up and support from the NPI team played an important role in NPI score improvement. Conclusion: The analysis indicated that while there are areas of progress, Saudi Arabia is still working on strengthening fundamental public health functions and emergency preparedness. This is evident when comparing a range of indicators with those of many countries under the purview of the World Health Organization (WHO).

Management strengthening strategies for transport cooperatives: a case study in Riobamba

Transport cooperatives face administrative challenges that affect their efficiency and competitiveness. This study focuses on the Interprovincial Transport Cooperative "Transvencedores" of Riobamba, Ecuador, with the objective of designing an administrative strengthening plan to improve its management and service. The research, with a qualitative and descriptive approach, used surveys and interviews with 25 staff members and 384 users, applying tools such as the SWOT matrix and the internal (EFI) and external factor evaluation (EFE) matrices to identify strengths, weaknesses, opportunities and threats. The results revealed significant administrative problems, such as the lack of process automation, poor internal communication and the absence of a clear organizational philosophy. It was concluded that the cooperative requires ongoing staff training strategies, implementation of new technologies to control activities, and improved internal communication. These measures are essential to improve operational efficiency and customer satisfaction, positioning the cooperative as a leader in interprovincial transportation in Riobamba.