Formal Instruments Research Articles

Stakeholders' perspectives on internal accountability within a sub-national immunization program: A qualitative study in Enugu State, South-East Nigeria.

Weak accountability hinders the effectiveness of routine immunization (RI) systems in low- and middle-income countries, yet studies on accountability of immunization programs are scarce. Aim: The study explored stakeholders' perspectives on the functioning of internal accountability within the National Program on Immunization in Enugu State, southeast Nigeria. We used semi-structured in-depth interviews to collect data from RI officials at state government, local government, and health facility levels (n = 35) in Enugu State between June and July 2021. We adopted maximum variation sampling to purposively select individuals with roles in immunization. The interview guide was developed based on an accountability framework with three dimensions-the axes of power, ability, and justice. Data were analyzed thematically using NVivo software (version 11). The major themes were role clarity, performance standards, supervision, data use, human resources, funding, motivation, sanctions, political influence, and community engagement. Performance targets for immunization coverage and reporting timeline were not always met due to multiple accountability failures. Weaknesses in the formal rules that distribute roles among the immunization workforce comprise a lack of deployment letters, unavailability of job descriptions, and inadequate staff orientation. Local officials have a narrow decision space regarding staff posting, transfer, and discipline. Performance accountability was constrained by staff shortages, uneven staff distribution, absenteeism, infrequent supervision, weak data monitoring system, and underfunding. Despite being motivated by job recognition and accomplishments, low motivation from an insecure working environment and lack of financial incentives undermined the constructive agency of service delivery actors. The sanctions framework exists but is weakly enforced due to fear of victimization. Political commitment to the immunization program was low. Yet, political decision-makers interfered with staff recruitment, distribution, and discipline. Community engagement improved resource availability through paid volunteer health workers and maintenance of facilities. However, health facility committees were poorly resourced, non-functional, and lacked the power to sanction erring health workers. Immunization service delivery actors can be held accountable for program performance when there are sufficient formal instruments that provide roles and responsibilities, needed resources, motivated and supervised staff, an effective sanctions framework, genuine political participation, and strong community engagement.

Improving the socio-ecological fit in water governance by enhancing coordination of ecosystem services used

Water governance systems have evolved around the exploitation of provisioning ecosystem services. The overexploitation of provisioning and the degradation of regulating services have led to a decline in the capacity of ecosystems to provide any services at all. Decisions affecting water-related ecosystem services are often not made in the water sector. Governance that does not take into account ecological interdependencies lead to unsustainable use of resources. In such situations, one can speak of a misfit between interdependencies of ecosystem services and coordination processes that would allow addressing them. The article introduces an approach to identify such misfits and potential solutions to overcome them and applies the approach to case studies in Germany, South Africa and Iran. The context-sensitive analyses highlight factors that contribute to or even determine prevailing practices in water management. The fit with the pattern of ecosystem service uses was found to be higher for governance processes in practice (formal and informal) than for formal coordination instruments on paper. Actors may not lack opportunities to exchange but these are not translated into tangible coordination outcomes. To reduce trade-offs between the uses of ecosystem service, improved synergies are needed between formal and informal institutional settings. Instruments need to be tailored to local circumstances. Scope and effectiveness of local action may be limited by higher governance levels. The analyses have demonstrated that the path from improving social-ecological fit to achieving sustainability is long. Addressing institutional deficits requires transformational change rather than short-term measures for addressing isolated problems or crisis situations.

Water access disparity in Mumbai, India: Using spatial and structural attributes as formal conditionalities

ABSTRACT In order to investigate the role of spatiality in disparities in urban water access in the Indian city of Mumbai, this article uses the dual conceptual lens of “access-as-right” and “access-as-ability” based on the theory of access. The “access-as-right” lens allows for a focus on the role of formal policy and institutional regimes in determining disparity in water entitlements. This article argues that the spatial and structural conditionalities encoded in formal policy instruments in India, as well as the spatial and structural rationales underlying these conditionalities, are used to declare informal dwellings as spatially and structurally deficient. This “deficiency” leads to ineligibility of these dwellings for full water entitlement, creating access disparity that gravely impacts Mumbai’s vulnerable urban populations. This article relies on data from formal documents and semi-structured interviews of municipal engineers, experts, academics from related fields, and activists working on urban water access issues.

Wie funktioniert Raumplanung? Umsetzung von Instrumenten zur Steuerung der Siedlungsentwicklung in Deutschland und der Schweiz

In Germany and Switzerland, land use and urban sprawl there has been a central topic of public debate for several years. Cantonal structure plans in Switzerland as well as state and regional plans in Germany contain binding regulations for managing settlement development. Studies that examine the implementation of these regulations are lacking. This paper analyses the implementation of selected instruments of supra-local spatial planning for managing settlement development in Germany and Switzerland using the Policy Arrangement Approach. The case study covers the regions Oberland (Bavaria), Südlicher Oberrhein (Baden-Württemberg) and the cantons of Zurich and St. Gallen. The results show that actors implement spatial-planning instruments in situative negotiation processes in which they exploremargins and alternatives. Central to these processes is a regional specific overlapping of (i) interlinkings of formal and informal instruments, (ii) the interplay between local autonomy, supra-local control and superordinate context factors, and (iii) the overlapping of supra-local and regional discourses. The results show that the Policy Arrangement Approach helps to better understand how spatial planning works.

Intelligence Instruments Applied to South African School Learners: A Critical Review

To establish reliability and validity of formal intelligence assessment instruments in a multicultural and multilingual society such as South Africa, context needs to be taken into consideration and existing psychological intelligence test instruments need to be surveyed carefully for cultural bias. The aim of this critical review of scientific literature was to critically appraise and synthesize data regarding intelligence instruments applied to South African school learners. The search initially yielded 405 studies of which 15 were finally included for thematic analysis. The following three main themes emerged from the included studies: Applicability of intelligence instruments administered to South African school learners; Contextual and demographic influences affecting performance on administered intelligence instruments; and Intellectual measuring instruments related to developmental and cognitive ability levels. It is recommended that the findings of this research study should be considered in the possible development of a strategic guideline to design an intelligence instrument applicable to South African school learners.

Association of frailty with clinical and financial outcomes of allogeneic hematopoietic stem cell transplant.

7046 Background: Considered the only curative therapy for many hematological conditions, allogeneic hematopoietic stem cell transplantation (alloHSCT) is increasingly used in older patients. Yet, chronological age alone has been found to be an inaccurate predictor of posttransplant sequelae. More recently, the concept of frailty has emerged as a better marker of physiologic reserve. While formal frailty instruments have not been widely adopted due to their resource intensive nature, we applied a previously-validated coding-based approach to examine the association of frailty with in-hospital outcomes of alloHSCT. Methods: All adults (≥ 18 years) undergoing alloHSCT for hematological malignancies were identified in the 2010-2019 Nationwide Readmissions Database. The previously-validated binary Johns Hopkins Adjusted Clinical Groups indicator was used to classify patients as frail. In this algorithm, the presence of diagnoses across various domains, including malnutrition, dementia, and decubitus ulcer, constitute frailty. Regression models were developed to evaluate the independent association of frailty with in-hospital mortality, periprocedural complications, length of stay, hospitalization costs, and 30-day non-elective readmissions. Results: Of an estimated 48,161 patients, 9.8% were considered frail. Frail patients were not significantly older (51.8 ± 15.0 vs 51.6 ± 14.2, p = 0.685), but had higher Elixhauser scores (2.8 ± 1.3 vs 2.0 ± 1.3, p < 0.001). After adjustment, frailty was associated with increased odds of in-hospital mortality (AOR 2.22; 95% CI 1.68-2.94; P < 0.001), as well as infectious (AOR 1.44, 95% CI 1.18-1.76; P < 0.001) and respiratory (AOR 1.69, 95% CI 1.41-2.02; P < 0.001) complications. Frailty was also associated with greater risk of acute graft-vs-host disease (AOR 1.39, 95% CI 1.12-1.72; P = 0.003) and CMV (AOR 1.72, 95% CI 1.27-2.33; P < 0.001) or invasive fungal infection (AOR 1.49, 95% CI 1.07-2.06; P = 0.017). Further, frailty was linked to increased likelihood of non-home discharge (AOR 1.29, 95% CI 1.03-1.61; P = 0.026), 30-day non-elective readmissions (AOR 1.29, 95% CI 1.11-1.50; P = 0.001), and significant increases in length of stay (+6.05 days, 95% CI 4.41-7.69; P < 0.001) and costs (+$36,660, 95% CI 27,413-45,907; P < 0.001). Conclusions: Among patients undergoing alloHSCT, frailty, as measured by an administrative tool, was independently associated with increased in-hospital mortality, complications and overall resource use. Inclusion of frailty in risk models may better aid benchmarking efforts and inform shared-decision making. [Table: see text]

RETRACTED: Conciliation procedures in civil proceedings: Comparative legal aspect

AbstractNowadays, the system of judicial settlement of disputes by means of conciliation correlates with the rule of law, has fundamental disagreements with extrajudicial and, accordingly, less formal instruments for resolving disputes—mediation, negotiations. Moreover, the advantage of the judicial conciliation procedure lies in the ability to ensure the implementation of the decision and its compliance with generally accepted values, and the interpretation of legal provisions is the business of officially authorized officials, and not specialists who act privately. The purpose of the paper is to conduct a comparative analysis of the legal regulation of approbation of conciliation procedures in civil proceedings. In the process of writing the paper, scientific and legal approaches to the essence of the procedure for conciliation in civil proceedings were identified; a comparative legal analysis of the specific features of legal regulation of conciliation procedures in civil proceedings in the territory of the European Union and in the post‐Soviet space was carried out; the prospects for improving the investigated procedure were outlined. It can be concluded that the comparative study of the foundations of legal regulation of conciliation procedures in civil proceedings in the territory of the European Union and in the post‐Soviet space showed the flexibility of the procedure under study, the multivariance of approaches to its implementation, and unity in supporting this method of resolving disputes.

Patient-Reported Measures of the Effects of Vision Impairments and Low Vision Rehabilitation on Functioning in Daily Life.

The quantification of vision impairments dates to the mid-nineteenth century with standardization of visual acuity and visual field measures in the eye clinic. Attempts to quantify the impact of vision impairments on patients' lives did not receive clinical attention until the close of the twentieth century. Although formal psychometric theories and measurement instruments were well developed and commonplace in educational testing, as well as in various areas in psychology and rehabilitation medicine, the late start applying them to clinical vision research created a vacuum that invited poorly developed and poorly functioning instruments and analytic methods. Although this research is still burdened with legacy instruments, mandates by regulatory agencies to include the patients' perspectives and preferences in the evaluation of clinical outcomes have stimulated the development and validation of self-report instruments grounded in modern psychometric theory and methods. Here I review the progress and accomplishments of applying modern psychometrics to clinical vision research.

Neighbourhood Revitalisation and Heritage Conservation through Adaptive Reuse: Assessing Instruments for Commoning

ABSTRACT This contribution discusses experiences of civic initiatives with adaptive reuse in urban and rural settings. The contribution aims at understanding the implications of formal ownership instruments of commoning projects to address social needs and conserve heritage. In particular, we examine cases in which Heritable Building Lease (HBL), Community Land Trusts (CLT), and Community Ownership (CO) have been used as instruments for such commoning processes. These instruments are increasingly implemented for adaptive reuse projects with heritage buildings and sites to promote a long-term perspective of use. The case studies have an explicit ambition in opening up the site’s heritage to community engagement and to contribute to positive impacts on equitable and participatory neighbourhood development. The paper argues that the instruments play an important role in institutionalising commoning initiatives, but that formal tools are not enough as they have to mesh with informal processes. Moreover, professional expertise, time resources for volunteer engagement and idealistic motivations, are necessary preconditions for the use of these tools, yet they also show a selective bias towards the involvement of middle-class activists.

Urban Security Challenges: A Review of Crime Prevention Strategies Adopted by Residents in Greater Port Harcourt City, Rivers State, Nigeria

The vulnerability to the insecurity of cities, and how best to address them, have been subject to considerable discussions. With the rising crime rate in cities in Nigeria, households have provided for their security, particularly with structures in the building, streets and neighbourhoods. Observation of streets and houses in Greater Port Harcourt City Area show high fences (some with the addition of razor wires), gates to streets manned by security personnel, use of CCTV, electrified gates and fences, burglary proofing of windows, doors and even roofs. This research reviews strategy adopted by residents in curbing crime across different neighbourhoods of Greater Port Harcourt City. The study utilizes a survey research methodology based on data obtained from four hundred and ninety–eight (498) respondents drawn from four neighbourhoods selected purposively (three from planned neighbourhoods in the inner city and one large neighbourhood in the peri-urban area). The study followed a multi-stage framework. Five streets in the inner city and fifteen streets in the peri-urban area were randomly selected in the study neighbourhoods. This was followed by the selection of twenty houses on each street using the systematic sampling method. In each house, one household head was randomly picked for questionnaire administration. The results revealed that the use of urban design elements to control crime between the inner-city neighbourhoods and the neighbourhoods in the urban periphery of the city differed significantly. The inner-city made greater use of natural surveillance to control crime whereas the peri-urban area utilized target hardening. State actors and non-state actors were used for crime control across the neighbourhoods; however, income status was a key determinant of preference. The high income was favourable to the formal instrument of state power, the police while the low income preferred the non-state actors, the local vigilante. This study recommends an integrated crime prevention strategy for the entire city; adequate funding of security by the Government, the provision of amenities and street furniture, the use of neighbourhood plans that promotes defensible space in emerging areas, the introduction of technology and community policing in crime prevention will achieve far greater long-term security for the Greater Port Harcourt metropolis. Keywords: Urban security, Crime prevention, Neighbourhood, Greater Port Harcourt City.

Ansätze zur Integration von Ökosystemleistungen in die formelle räumliche Planung

Due to global changes and changes in land use, ecosystems and their services are increasingly affected. Against this background, it is questionable how ecosystems and the services they provide can be better and sufficiently taken into account in land-use planning as well as spatial development in Germany. Currently little chance is seen to establish new ecosystem service-based processes that would be comprehensively integrated in the spatial planning practice in Germany. However, modernisation of formal and informal planning instruments is conceived in a long-term perspective. The ecosystem service approach can essentially contribute to this modernisa[1]tion methodically as well as conceptually. Therefore, this paper discusses possibilities how to integrate the ecosystem service approach in formal spatial planning in a short to medium term and which societal and ecological added value can be generated. Chances and risks of different implementation options will be discussed and specific approaches outlined.

Impact of the b-Learning Model on University Teaching

In this work, the impact of the implementation of B-Learning and traditional face-to-face models is analyzed, by comparing the academic results achieved by four groups of university students in the electronics course, by using objective and subjective measurements. Analysis of the results based on objective data demonstrated a lower student dropout rate and an improvement in the general grade point average under the B-Learning model. The subjective comparison collects student’s opinions through a formal evaluation instrument. This analysis concluded that students perceive the teaching-learning process under the B-Learning model more motivating, more useful and that it meets their expectations in a better way. Finally, the Student's t test is carried out to demonstrate that the analyzed research variables present statistically significant differences.

Development of a learning disabilities test: a case study at elementary school

Development of a learning disabilities test: a case study at elementary school

How Do Supranational Regulators Keep Companies in Line? An Analysis of the Enforcement Styles of EU Agencies

AbstractNational governments have increasingly transferred enforcement powers to EU agencies that monitor and penalize non‐compliance by private actors. How do EU agencies apply enforcement competences in practice? Based on the Eurolegalism thesis, pressures for deeper integration have led to the emergence of a more adversarial enforcement style in Europe. Consequently, supranational regulators are expected to employ formal and coercive enforcement instruments. Conversely, studies of EU enforcement suggest that EU agencies may be reluctant to antagonize national governments by prosecuting private actors. In this study, we analyze the enforcement practices of supranational agencies with direct enforcement powers: the EU Aviation Safety Agency (EASA), European Securities and Markets Authority (ESMA) and European Medicines Agency (EMA). We find that EU agencies apply a legalistic approach, but they vary in coerciveness of enforcement. Whereas EU agencies tend to apply more coercive measures against non‐conform products, they are generally not adversarial toward non‐compliant organizations.

Assessing the Potential of Real Estate Investment Trust in Financing Real Estate Development Projects

One of the crucial challenges facing real estate development in Nigeria is finance. The informal sources of finance are grossly inadequate, and access to formal finance instruments is difficult. This study aimed at investigating the potential of REIT structure as an option for financing real estate development in Nigeria. The specific objectives of the study were to; evaluate the external factors influencing the performance, future growth and development of N-REITs as it affects funding of real estate development projects; and appraise the future prospects of N-REITs as a viable option in financing real estate development projects. A survey research design was adopted for the study. A sample of 275 stakeholders comprising 221 real estate developers, and 54 senior staff members of Securities and Exchange Commission (SEC), all in Abuja, were conveniently selected for the study. Frequency, percentage, mean, and standard deviation were used to analyse the data. Findings show that equity capital (47.8%), commercial banks (26.2%), and mortgage banks (16.5%) are the major sources of real estate development finance in Nigeria. The key external factors influencing N-REITs performance were strategic property locations (4.43 ± 0.82), tax treatment (4.34 ± 0.78), and political risks (4.10 ± 1.12); while the most important prospects of N-REITs in financing real estate development projects include; increase in supply of real properties (4.1 ± 1.02), portfolio diversification (3.88 ± 1.10), and liquidity in real estate sector (3.69 ± 1.22). The study concludes that, in implementing high level sensitisation, transparency, infrastructure provision and review of regulations guiding REIT’s operation, N-REIT most probably becomes a viable option for financing real estate development.

Beeinflusst die Trägerschaft der Regionalplanung die Inhalte der Regionalpläne und die regionale Siedlungsentwicklung? Theoretische Überlegungen und eine empirische Analyse für Deutschland

This paper deals with the question of whether the responsible body of regional planning has an influence on the regulatory intensity of regional plans on the one hand and on regional settlement development on the other hand. Seven hypotheses are formulated for this purpose. Based on a nationwide evaluation of regional plans and data on settlement development in Germany, these hypotheses are tested. The presumed clear correlations between the degree of centralization of responsible bodies and the regulatory intensity cannot be confirmed. However, a final hypothesis for further research can be stated. The effect of regulatory intensity on land take varies between different responsible bodies. The effectiveness of the formal spatial planning instruments depends on the implementation competencies of the responsible body.

370 Evaluating Knowledge of Common Surgical Instruments During Early Surgical Training in the United Kingdom: A Call for Formalised Training?

Abstract Aim Knowledge of surgical instruments and their use is essential to effective surgical practice, enabling efficient task-specific utilisation and promoting clear intraoperative communication; thus, reducing the risk of error. However, variations in surgical instruments across different specialities and eponymous names can pose barriers to learning for early surgical trainees. There is a paucity of data on surgical instrument knowledge among early surgical trainees, and their knowledge acquisition route. Method questionnaire was distributed among early surgical trainees (ST3 and below) between 18 August 2020 and 18 November 2020 across various UK regions. Respondents were asked to answer ten multiple-choice questions to assess their surgical instrument knowledge levels. Respondents were also asked about their training level, experience, and opinion regarding formal surgical instrument teaching. Results Thirty-seven trainees responded to the questionnaire. The majority (81%) received no formal surgical instrument training. Most respondents (96%) feel they would benefit from formal training. The average test score was 50%. There was no evidence of improved performance with formal training, though the formal training received averaged less than one hour. Higher scores were associated with increased seniority and training years, indicating most trainees are learning ‘on-the-job‘. Conclusions There is generally an unsatisfactory level of knowledge in surgical instruments in early surgical trainees. Trainees have also overwhelmingly indicated a desire for formalised training on surgical instruments. The authors believe the lack of formal training may contribute to this knowledge gap and intend to design a new short course to address this.

Stepping Into the Same River Twice? Judicial Independence in Old and New Authoritarianism

AbstractThe study seeks to answer the question of whether there are similarities between the methods used to limit judicial independence in Hungary during the last phase of the communist regime, i.e. before the democratic transition, and today, when many scholars believe that an authoritarian transition is taking place in this country. For this purpose, I argue that despite the undeniable fundamental differences between the political and legal system of these two periods, the mechanisms and ways as the independence of judiciary were and are influenced by the government can plausibly be compared. The analysis seems to support this presumption: both the formal instruments and the informal channels of influence in the hands of the ruling political forces show a number of similarities. Thus, even if there are differences in the degree of their application and result, from centralizing the system of judicial administration to replacing court leaders with politically loyal people there are a number of instruments that enable central government to influence the judiciary, while maintaining the appearance of judicial independence.

Assessing diagnosis disclosure and concealment in multiple sclerosis: Development and initial validation of the DISCO-MS survey

Background: Individuals with multiple sclerosis (MS) regularly report making strategic decisions about whether to share their diagnosis or keep it a secret; for many, this represents a key stressor. Surprisingly, the impact of disclosure and concealment are understudied in MS and a formal measurement instrument is lacking. We developed the Diagnosis Disclosure and Concealment in MS (DISCO-MS) survey, a self-assessment tool evaluating (1) frequency of concealment behaviors and (2) expected consequences of diagnosis disclosure in persons with MS. Methods: A systematic mixed-methods process was used for the design and initial validation of the DISCO-MS. Associations of DISCO-MS responses to demographics, clinical variables, and mood were examined in 204 participants with MS. Results: The 39-item DISCO-MS shows good psychometric characteristics. Approximately 25% of respondents conceal their diagnosis, particularly in professional settings. Higher concealment behaviors were associated with younger age, shorter disease duration, and lower physical disability. Nearly 50% of respondents believed that talking openly about their diagnosis might have undesirable professional and interpersonal consequences. Younger age, higher depression, and higher anxiety were associated with greater expectations of negative consequences. Conclusion: Development and validation of the DISCO-MS presents the first step toward systematic study of the impact of DISCO on people with MS.

Ecosystem-based adaptation in cities: Use of formal and informal planning instruments

Extreme weather events like heavy rainfall and heat waves will likely increase in intensity and frequency due to climate change. As the impacts of these extremes are particularly prominent in urban agglomerations, cities face an urgent need to develop adaptation strategies. Ecosystem-based Adaptation (EbA) provides helpful strategies that harness ecological processes in addition to technical interventions. EbA has been addressed in informal adaptation planning. Formal municipality planning, namely landscape planning, is supposed to include traditionally some EbA measures, although adaptation has not been their explicit focus. Our research aims to investigate how landscape plans incorporate climate-related extremes and EbA as well as to discuss the potential to enhance EbA uptake in formal planning. We conducted a document analysis of informal planning documents from 85 German cities and the analysis of formal landscape plans of 61 of these cities. The results suggest that city size does affect the extent of informal planning instruments and the comprehensiveness of formal landscape plans. Climate-related extremes and EbA measures have traditionally been part of landscape planning. Almost all landscape plans address heat stress, while climate change and heavy rain have been addressed less often, though more frequently since 2008. Greening of walls and roofs, on-site infiltration and water retention reveal significant potential for better integration in landscape plans. Landscape planning offers an entry point for effective climate adaptation through EbA in cities. Informal and formal planning instruments should be closely combined for robust, spatially explicit, legally binding implementation of EbA measures in the future.