Financial Restraints Research Articles

No one-size-fits-all solution to chronic absenteeism

As chronic absenteeism fails to ease from post-pandemic high levels, schools can turn to many reforms to promote school attendance. Commonly recommended strategies involve increasingly targeted and intensive tiers of interventions. Researcher Thomas S. Dee writes that the research base of many of these interventions is not strong. Schools facing financial and capacity restraints may have difficulty putting interventions in place. Dee suggests that educators obtain information on attendance barriers in their schools and base solutions on those data. Sharing information about attendance with families is one promising intervention.

Survey on the State, Potential, and Obstacles of the Digital Transformation in Human Milk Banks

Digitalization of human milk banking was examined in a survey among participants of the largest German-speaking symposium for human milk banks. Of the 100 participants, 47% were nurses, 23% were physicians, and 3% were midwives. The overwhelming majority (96%) desired more digitalization in their milk bank. The best-digitized processes were clinical results from donors, milk labeling, and milk orders. At the same time, a discrepancy between the maximum conceivable potential and the current implementation of digital transformation became evident. The survey revealed most participants use in-house digital solutions. Potential main advantages of digitalization were cited as efficiency gains, while implementation efforts and security concerns, particularly power outages and cyberattacks, were seen as disadvantages. Financial restraints, personnel shortage, resistance from local IT departments, and legal concerns were perceived as the biggest barriers. Despite these challenges and a critical examination of the disadvantages, the participants expressed strong optimism and a desire for further digitalization in the human milk bank sector.

Evidence-Based Strategies for Reforming the Medical Curriculum at the National Autonomous University of Honduras: A Systematic Literature Review.

Medical education worldwide has undergone numerous stages of reform. Cultural and financial restraints have decelerated progress in developing countries. Current reforms should focuson creating integrated, competency-based, and student-centered curricula that emphasize patient-centered care. The following review of literature published between 2014 and 2023 on global curricular reforms highlighted key components, challenges, and strategies for implementing or evaluating undergraduate medical programs that prioritize student-centered approaches and competency-based models. This review also compared the current curriculum at the National Autonomous University of Honduras (UNAH) with these international experiences to suggest strategies in order to encourage significant reform. The following review identified 47 articles that provided insights into ideal contexts for curricular reforms, while 15 publications detailed the current state of the UNAH medical curriculum and its potential weaknesses. Additionally, 25 articles discussed specific reforms in other countries, offering valuable results and conclusions for consideration. Drawing from these models and experiences, strategies were proposed for UNAH's curriculum reform, including identifying basic needs, defining project vision, training teaching staff and students, and integrating multidisciplinary teams of experts. Although training all teaching staff abroad may be financially unfeasible, selecting and training key individuals to train others could be a viable alternative. Successful reform requires a comprehensive, periodic, and systematic evaluation. Despite the challenges faced by developing countries, global experiences with alternative reform models offer promising solutions, providing an opportunity for the Faculty of Medical Sciences at UNAH to overcome local limitations and fulfill the primary task of training professionals who are clinically, ethically, and adaptively competent, with a focus on patient-centered and primary care approaches.

The Obstacles of Women Entrepreneurship on Empowerment in Rural Communities KwaZulu Natal, South Africa

This research aims to determine barriers to the expansion of women-owned businesses in rural communities of South Africa. To collect data for the research, a quantitative research approach was adopted. The research focused on 250 female business owners in the northern KZN rural regions of Umzinyakude, Uthukela, and Ugu. According to the survey, the primary barriers to developing women-owned businesses in rural communities are financial restraints, an absence of formal education, and inadequate facilities. These hurdles, however, may be overcome by women businesses being entrepreneurs in rural South African communities. Eliminating these barriers might empower women entrepreneurs and drive growth in the economy in rural communities, lowering poverty and improving rural people's living conditions. In light of these findings, the research suggests a variety of measures, including different financing methods, focused training and schooling programs, and the development of infrastructure to help women-owned businesses flourish in rural communities. Further research should investigate more issues like cultural as well as social barriers, an absence of accessibility to marketplaces and information, and legal and regulatory obstacles that prevent women from starting business entities in rural communities.

Commentary: Visiting Nurses’ Knowledge, Attitudes, and Beliefs Regarding Telehealth to Promote Medication Compliance in the Older Adult Population: A Qualitative Study

As a Visiting Nurse working with the older adult population for the past 27yrs, I fully appreciate the use of Telehealth technology in the home care setting to assist with medication reconciliation, since nurses in the home health field are frequently unable to make desired visits based on financial restraints, limited nursing staff and the Covid pandemic that occurred during the above-mentioned study.

Clinical Effects of Yoga and Meditational Practices on the Holistic Health of Chronic Kidney Disease Patients: A Systematic Review.

As the world accelerates, sedentary and unhealthy lifestyles have an increasingly negative impact on human physical and emotional well-being.Millions ofpeople globallyare thought to have chronic kidney disease (CKD), which is frequently brought on by diabetes, hypertension, and glomerulonephritis. Over time, the illness gets worse and eventually results in irreversible renal failure. A person's life can be seriously affected by CKDin many different ways, including emotionally, socially, physically, and financially. Apart from physiological manifestations like anemia, discomfort, and exhaustion, CKDcan also result in psychological problems like anxiety and depression, which can impair one's overall standard of life.Numerous studies have demonstrated the beneficial effects of yoga and meditation on people with chronic renal disease, enhancing their general health and quality of life. Because of therapeutic limitations, familial pressures, financial restraints, and symptoms of end-stage kidney disease, people with CKD frequently experience stress and anxiety.By reducing stress and anxiety, yoga and meditation can help individuals with chronic conditions maintain their health and improve their overall well-being. Recent research has found that yoga can improve blood pressure, sympathetic activity, and basal metabolic rateas well as reduce blood pressure and blood sugar levels by balancing the autonomic nervous system. Furthermore, studies have demonstrated that yoga helps CKD patients live healthier lives by lowering stress, anxiety, and sadness. Healthcare professionals can help patients with chronic renal disease manage their symptoms and enhance their general health and well-being by adding yoga and meditation into their treatment regimens. Modifying lifestyle is essential for both the prevention and treatment of chronic renal disease. CKD often co-occurs with other age-related and sedentary lifestylesand poor diet-related chronic conditions. The dearth of targeted treatment for a large percentage of CKD patients led to the investigation of the therapeutic applications of yoga and meditation in this study. These affordable, non-invasivetherapies provide a comprehensive approach to controlling CKD, benefiting both healthy individuals and those with CKD in terms of their physical and mental well-being.

Pilot study exploring the presence of leadership curricula in undergraduate medical education

IntroductionThe physician’s role in the healthcare delivery system extends beyond patient care to include numerous critical leadership roles in healthcare. In addition to treating patients, physicians manage multidisciplinary teams and...

Identification of Social Determinants of Education Among Pharmacy Students: Results From a Single-Institution Survey

ObjectiveTo identify social determinants of education (SDOE) among pharmacy students enrolled in the entry-level Doctor of Pharmacy program at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. MethodsAn original 28-item survey was developed and disseminated to first through fourth year students enrolled in the entry-level Doctor of Pharmacy program at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences during the spring 2023 semester. The survey evaluated student demographics, educational performance, and SDOE in 6 categories: physical health, psychosocial health, economic stability, self-motivation, social environment/community, and physical environment/community. ResultsA total of 133 students responded to the survey. Over half of the respondents acknowledged difficulties completing errands or self-care tasks owing to their physical, mental, or emotional health. Over half of respondents also reported concerns about covering expenses at the end of the month. Respondents also reported eating less because of financial restraints (20.0%), worrying about housing (22.9%), feeling unsafe in their neighborhood (29.0%), and feeling lonely or isolated (63.4%). In the secondary analysis, the respondents who had concerns with covering expenses, affording food, or losing housing had significantly lower academic performance. ConclusionThis study identified several SDOE among pharmacy students at our institution, suggesting that students at even the highest levels of education may be subject to disparities. The identification of SDOE provides insight into barriers that are potentially hidden but are highly likely to impact student engagement and success. Efforts toward reducing disparities and promoting equitable opportunities for students are necessary to ensure continued growth and diversification of the pharmacy profession.

High-Impact Teaching Practices in Higher Education: Understanding Barriers, Concerns, and Obstacles to Their Adoption

This research explores the barriers, concerns, and obstacles undergraduate STEM educators face when implementing high-impact teaching practices (HIPs), the application of which may improve student learning outcomes. Because our study took place during the COVID-19 pandemic, our results also shed light on the unique challenges of utilizing HIPs in asynchronous online-learning environments. Thirteen undergraduate instructors were interviewed about their current teaching practices in order to identify barriers to or support for adopting HIPs. Data collected through semi-structured interviews revealed administrative and financial restraints as barriers to effective teaching which have been found in previous research. A number of new and unique obstacles emerged out of teaching remotely or online during the pandemic, including a heightened concern over the instructor’s ability to connect with students and engage in the best teaching practices. This research extends our current understanding of barriers and concerns about adopting HIPs in undergraduate STEM courses because of the unique perceived threats that emerged during the pandemic. We identify strategies to equip faculty with the support they need to provide equitable learning experiences, including access to consultants who support curriculum development and implementation in the classroom, ongoing educational coaching, and increased access to professional-development opportunities and a community of inquiry to discuss teaching strategies.

Sharing results with participants (and community) in malaria related research: Perspectives and experience from researchers.

Results-sharing with participants or their communities after the completion of research is an essential element of ethical research. The main objective of this study was to identify and document current practice of trial result dissemination, to explore attitudes among trialists towards result dissemination and to better understand previous experiences and barriers to returning results to participants. This mixed-methods study used a sequential exploratory design with two phases: i) an initial qualitative phase to explore the topic and to inform the quantitative data collection, ii) a quantitative survey. Findings from the survey and interviews were triangulated and presented to a network of clinical malaria researchers for validation. A total of 11 semi-structured interviews (SSIs) were conducted using an interview guide. The quantitative survey had a response rate of 19.9% (42/211). Disseminating results to participants after clinical trials was deemed critical for ethical malaria related research, with 38.1% indicating it as extremely important and 45.2% rating it as mostly important. Most respondents referred to the dissemination of results to policymakers and wider stakeholders as important aspects of research translation. The practice of patient or community engagement was prioritized in the pre-trial period and during the trial for obvious instrumental goals of improving retention, coverage and adherence, but much less priority was given to the post-trial period. The main reason for poor dissemination practice was the notion that the time lag between study participation and the availability of results was too long (42.4%). Other reasons included the assumption that the community was not interested (36.4%), and financial restraints (9.1%). The rich qualitative data revealed detailed accounts of operational, cultural, educational and economic aspects that pose further barriers to results-sharing, including limited knowledge about best practice. Better planning which includes adequate financial resourcing is required for meaningful dissemination of results to study participants. Improved institutional guidance and more stringent requirements by funders could support researchers who are generally interested and willing to complete the process. Best practice methods to conduct such dissemination remains to be explored.

Has financial fair play changed European football?

In 2011 UEFA, the governing body of European football, introduced the Financial Fair Play Regulation (FFPR), consisting of a set of financial restraints to be met by clubs as a prerequisite for participation to its competitions. The aim of the FFPR was to introduce financial discipline into the clubs’ decision-making processes, and ultimately protect the long-term viability of the European football industry. The reform was criticized because of possible unintended detrimental consequences. In particular, Peeters and Szymanski (2014) provided a model-based ex-ante simulation analysis showing that the reform would increase the profitability of clubs, but also tilt the competitive balance in favor of the top teams, thus reducing the interest of fans and investors as one of the main attractions in sports is precisely that the best team does not always win. Exploiting an original dataset between the seasons 2007–2008 and 2019–2020, we provide an ex-post econometric evaluation of the effects of the introduction of the FFPR revealing causal evidence that largely vindicates those ex-ante predictions.

How does the war affect breast cancer quality of care? The Syrian experience.

e18724 Background: The Syrian decade-long war has severely affected the healthcare system, including almost vanishing cancer screening practices, war-destroyed medical facilities, and lack of continuous medical education. This study aims to present data on the affected breast cancer screening practices, methods of diagnosis, and stages distribution in Syria. Methods: Medical records of breast cancer patients treated at Albairouni University Hospital between 2019 and 2022 were retrospectively reviewed. Eligible patients were women diagnosed with primary breast cancer. Exclusion criteria included male gender, females receiving neoadjuvant chemotherapy, and incomplete charts. Data regarding the patient's age, city of residence, marital status, number of children, smoking habits, method of diagnosis, tumor size (T), lymph nodes (N), and distal metastasis (M) were collected. We used Microsoft Excel and Statistical Package for the Social Sciences (SPSS) to analyze data. Descriptive methodology (frequency [n], percentage) was used. Results: The number of included patients after applying the exclusion criteria was 2,367. The mean age was 51.8 (SD = 11.3). More than half of the patients (58.3%) came from outside Damascus -where the hospital is located- and its suburbs. Less than 5% of the population detected cancer by screening mammography. Only 32.4% of patients were diagnosed by a biopsy, while surgical procedures were used to diagnose 64.8% of the population. At the time of diagnosis, only 8% of patients presented with local-stage disease (stages 0 & I), 73% had a regional disease (stages II & III), and 19% had metastatic breast cancer (stage IV). Conclusions: Our retrospective chart review analysis is the first comprehensive review in Syria for female breast cancer patients. We found a chocking low percentage of patients diagnosed based on a screening mammogram, much higher surgical biopsies rather than a simple imaging-guided biopsy, and much lower than the national average of early-stage disease. Factors that might explain our results include lack of appropriate education, restricted access to medical facilities, and financial restraints. Our alarming findings can serve as the base for future strategies to improve breast cancer care in Syria by detecting the disease earlier and avoiding surgical diagnostic procedures.

Opportunities and challenges in lifelong learning and continuing professional development among nurses at a cancer hospital in Sri Lanka

Background: Continuing Professional Development (CPD) and lifelong learning are essential for nurses to keep up to date with innovations, technological enhancements, and development in the healthcare sector to improve patient outcomes and safety. Objective: The study aimed to identify platforms, awareness, and barriers to CPD and lifelong learning of nursing professionals at Cancer Hospital (Apeksha), Maharagama, Sri Lanka. Methods: A quantitative survey was conducted, and a self-administered questionnaire was used to collect samples from April 2022 to February 2023. Random sampling techniques were used to select the samples from the population of nurses. The study sample size was 235, and only 200 nurses responded. Results: Descriptive statistics were calculated, and cross-tabulations were also employed. The nursing professionals in the study setting are characterized by a significant gender imbalance, with most nurses being female (86.5%) and males comprising a minority (13.5%). Most nurses have one to five years of experience, with just over a third (37.5%) having between one to ten years of experience. Family responsibilities, poor physical health, and financial constraints were identified as the most common barriers to engaging in CPD. Workplace stress, lack of financial aid, lack of opportunities, leave issues, inflexible work hours, and workload at the ward/unit were the most commonly agreed-upon organizational barriers in CPD. Despite various channels for accessing CPD activities, including colleagues and the workplace, a significant proportion of respondents were not aware of opportunities and platforms through these channels, highlighting the need for increased awareness and accessibility of CPD opportunities. Conclusion: CPD is crucial for nurses to grow their careers and improve their knowledge and abilities. Main obstacles such as family obligations, financial restraints, and occupational stress must be overcome to motivate nurses to engage in CPD activities and foster professional progress. There should be a proper mechanism to increase the awareness of CPD among nurses.

Sustainable development goals, natural resources and economic growth: Evidence from China

Using a sample of Chinese listed companies between 2000 and 2020, this study uses the econometric method to examines the influence of financial restrictions on development of green economic growth and sustainable development goals. We also examine how natural resources development rules help businesses overcome financial barriers to green finance and promotes sustainable development goals. Economic recovery is proven less capable when businesses face more financial restraints, and privately held businesses are often more at risk than state-owned ones in this respect. Particularly after 2016, the financing efficiency of businesses in the center and western areas dramatically increases, demonstrating the synergistic effects of green finance regulations and economic policies that promote undeveloped regions. The combination of green financial investment, insurance, and credit shows the greatest positive supportive impact. Insurance serves a bridging function in this combination by better ensuring that clean energy performance matches clean energy projected performance and encouraging clean energy to get green credit financing. The findings also suggest that the existing green financing sector is still following a pattern dictated by the government. The effectiveness of finance is influenced by both elements at the corporate and national levels, such as formal institutions and financial oversight. These results have significant ramifications for policymakers who are considering clean energy policies to assist renewable energy development via a successful financial sector structure, which ultimately aids in realizing the energy sector transformation.

Reflections on the Infant Mental Health Endorsement® process in Virginia.

This study was conducted to gather information to inform key stakeholders in Virginia's Early Childhood Mental Health workforce who are involved in the Infant Mental Health Endorsement® . An "Endorsement® indicates an individual's efforts to specialize in the promotion and practice of infant or early childhood mental health within his/her own chosen discipline" (Virginia Association for Infant Mental Health, 2021). The following research questions guided this study: (1) who is part of the infant mental health endorsed workforce in Virginia; (2) what are the benefits and barriers to the Endorsement® process. A total of 115 individuals who were or are involved in the Endorsement® as endorsees or advisors were participants in the study. Participants cited many benefits of obtaining their Infant Mental Health Endorsement® , including general professional development and connecting to other professionals in the field. Barriers to obtaining the Endorsement® included time and financial restraints related to obtaining reflective supervision from a qualified Reflective Supervisor. Results from the study will be used to inform the Infant Mental Health Endorsement® process, and applied to the Early Childhood Mental Health Endorsement® in 2023.

The attraction of public-private partnerships for road construction in India, as affected by both positive and negative factors

The paper aims to pinpoint and assess the perceived advantages and disadvantages of the Public-Private Partnership (PPP) for road development in India. Main PPP project contributors in Indian PPP road projects were polled via questionnaire. A literature review was used to select fifteen favourable characteristics and thirteen unfavourable factors for the questionnaire. Descriptive statistical analysis is used to analyze the data that was collected. The elimination of government financial restraints, project cost and time management, the reduction of government funds committed to capital investment, improved maintainability and accelerated project development are the key positive characteristics that draw PPP in Indian road projects. Excessive participation restrictions, protracted negotiating delays, ambiguity surrounding government objectives and evaluation standards, a lack of employment possibilities, and a lack of experience and the necessary skills make PPP undesirable. Both the public and private sectors can benefit from PPP in various ways. All sectors must make decisions based on proper assessment criteria during the project development stage. The decision-makers of PPP projects benefit early on from thoroughly understanding both positive and negative elements.

All Creatures Safe and Sound: The Social Landscape of Pets in Disasters

All Creatures Safe and Sound: The Social Landscape of Pets in Disasters

Work opportunity for International Medical Graduates

Pursuing residency beyond a certain period would be hard for International medical graduates due to inevitable financial restraints. Hence, International Medical Graduates seek work opportunities. which could help them earn money and gain clinical experience at the same time. I have searched through various websites in different search engines for a work opportunity for myself as an International Medical Graduate (IMG). This article is a consolidation of contents from more than ten websites. The conclusion is that-there are health care job opportunities for ECFMG-certified (the Educational Commission for Foreign Medical Graduates -certified) international medical graduates and it would be easier for non-visa requiring candidates. An entry-level job opportunity may lead to another clinical job opportunity during which the candidate could build on strong clinical background in the United States of America and be financially sufficient. Persistence is the key to success.

P303 An unusual case of isolated gluteal abscess

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMBackgroundMucormycosis is an invasive infection caused by fungi belonging to the order Mucorales. The angioinvasive disease caused by these fungi can prove to be fatal despite appropriate treatment. We report an unusual case of a gluteal abscess caused by a probable mucormycosis in an apparently immunocompetent individual.Case DescriptionA 68-year-old gentleman hailing from a rural area of Bihar, India presented with a painful swelling over the left buttock region for 4 weeks. He was a known hypertensive and had ischemic heart disease. He denied any history of fever. The lump had gradually increased in size. He was a retired school teacher with a farmland and reared livestock at home. He was a non-vegetarian and denied any addictions. He had a history of intermittent lower backache for which he used to take occasional intramuscular analgesic injections over his buttocks from a local medical practitioner.On examination, the swelling was about 4 cm X 4 cm in size, fluctuant, with ill-defined margins over the lateral region of the left buttock. The swelling was tender, warm, and not fixed to underlying structures. Systemic examination was unremarkable. Ultrasound examination revealed an ∼7.2 × 4.2 × 7.8 cm cystic lesion with a volume of 126cC. It was located predominantly in subcutaneous fat extending into muscular plane with septa and solid components in the left gluteal region (Fig. 1). It had thick walls and fine internal echoes within. Other investigations were unremarkable except for glycosylated Hb, which was 6.2%. Incision and drainage were done.During the procedure, it was seen as a cyst with a thick wall that was removed in toto. The contents were explored after removal and were found to be yellowish black with mucoid consistency. Histopathological examination revealed numerous broad, ribbon-like, aseptate fungal hyphae with right-angled branching infiltrating the inflamed tissue (Fig.2). There were numerous epithelioid granulomas surrounding the fungal elements in the soft tissue of the wall. The findings were consistent with a fungal abscess caused by mucormycosis. Culture of the fluid/pus was negative. Thus, a diagnosis of mucormycotic gluteal abscess was made and patient was commenced on 50 mg of amphotericin B deoxycholate in view of financial restraints. High resolution computed tomography of chest was done which was unremarkable.He developed an acute kidney injury after 2 doses of amphotericin B deoxycholate which was then stopped. Oral posaconazole was started. He has developed bilateral leg swelling post-oral posaconazole and is commenced on oral spironolactone for the same. The postoperative wound has healed well and there is no new swelling or tenderness over the area. He is planned for further follow-up.ConclusionsIsolated gluteal abscess caused by mucormycosis is rare in an apparently immunocompetent host.We assume that repeated intramuscular injections might have caused traumatic inoculation of fungus into the host which led to this outcome.

Work opportunity for International Medical Graduates

Pursuing residency beyond a certain period would behard for International medical graduates due toinevitable financial restraints. Hence, InternationalMedical Graduates seek work opportunities. which couldhelp them earn money and gain clinical experience atthe same time. I have searched through variouswebsites in different search engines for a workopportunity for myself as an International MedicalGraduate (IMG). This article is a consolidation ofcontents from more than ten websites. The conclusionis that-there are health care job opportunities forECFMG-certified (the Educational Commission forForeign Medical Graduates -certified) internationalmedical graduates and it would be easier for non-visarequiring candidates. An entry-level job opportunitymay lead to another clinical job opportunity duringwhich the candidate could build on strong clinicalbackground in the United States of America and befinancially sufficient. Persistence is the key to success.