Future Implementation Research Articles

Assessing the health literacy of caregivers in the pediatric intensive care unit: a mixed-methods study.

Limited health literacy is associated with increased hospitalizations, emergency visits, health care costs, and mortality. The health literacy levels of caregivers of critically ill children are unknown. This mixed-methods study aims to quantitatively assess the health literacy of caregivers of children admitted to the pediatric intensive care unit (PICU) and qualitatively describe facilitators and barriers to implementing health literacy screening from the provider perspective. Caregivers of patients admitted to our large, academic PICU (between August 12, 2022 and March 31, 2023) were approached to complete a survey with the Newest Vital Sign (NVS), which is a validated health literacy screener offered in English and Spanish. We additionally conducted focus groups of interdisciplinary PICU providers to identify factors which may influence implementation of health literacy screening using the Consolidated Framework for Implementation Research (CFIR) framework. Among 48 surveyed caregivers, 79% demonstrated adequate health literacy using the Newest Vital Sign screener. The majority of caregivers spoke English (96%), were mothers (85%), and identified as White (75%). 83% of caregivers were able to attend rounds at least once and 98% believed attending rounds was helpful. Within the PICU provider focus groups, there were 11 participants (3 attendings, 3 fellows, 2 nurse practitioners, 1 hospitalist, 2 research assistants). Focus group participants described facilitators and barriers to implementation, which were mapped to CFIR domains. Timing of screening and person administering screening were identified as modifiable factors to improve future implementation. We found the health literacy levels of PICU caregivers in our setting is similar to prior assessments of parental health literacy. Participation in morning rounds was helpful for developing understanding of their child's illness, regardless of health literacy status. Qualitative feedback from providers identified barriers across all CFIR domains, with timing of screening and person administering screening as modifiable factors to improve future implementation.

Alignment of workplace wellbeing initiatives with WHO’s “Guidelines for mental health at work”

The workplace offers an ideal setting for promoting health and well-being. The World Health Organisation (WHO) has recently published guidelines and recommendations for promoting mental health and well-being in the workplace based on the latest empirical evidence. However, little is known regarding its alignment with current practices within organisations. The purpose of this paper is to explore the extent to which mental health and well-being initiatives implemented in organisations outside the context of a formal research evaluation align with the WHO Guidelines for Mental Health at Work. Other objectives of the study are to identify trends within current initiatives and to explore whether the number or types of initiatives align with the WHO Guidelines, depending on the size of the organisation. The study used a secondary data analysis approach for a series of case studies collected over a three-year period (2020 to 2022). A total of 333 well-being initiatives from 52 Polish and international organisations were described. The results show a wide variety of initiatives undertaken by organisations, most of which are universal individual intervention types and are implemented by large organisations. A discussion of the strengths, gaps, and opportunities for future implementation and subsequent alignment with the latest evidence-based recommendations is provided.

A Survey of Blockchain in Governance: Framework Selection and Future Implementation in Indonesian Government

Blockchain technology enables users to connect without the need for a third party or central server. This is achieved through the use of a decentralized system, ensuring that all data and information transacted are encrypted, verified, validated, and stored using mathematical consensus algorithms. This leads to blockchain being recognized as a technology characterized by decentralization, security, anonymity, transparency, immutable data, and trust. Blockchain is frequently associated with digital currency, although digital currency is just one of the outcomes of applying blockchain technology, resulting in cryptocurrencies. Currently, blockchain technology is a trend among academics and practitioners who are researching and developing blockchain technology for application in various domains, including government. Government systems and public servants often encounter issues related to data security. Hence, the research has the purpose to offer comprehension and perspectives on implementing blockchain technology within the government sector to enhance public service information security. The research was carried out by reviewing Scopus-indexed international articles published between 2019 and 2023, which are relevant to frameworks, consensus algorithms, and applications employed in the governmental domain. The research outcomes revealed that the Hyperledger Fabric framework, coupled with the Practical Byzantine Fault Tolerance (PBFT) algorithm, is the most suitable option for potentially developing blockchain-based government or public service applications for future implementation. Regarding this research, there are future challenges in the form of constructing prototypes and evaluating their effectiveness and efficiency. Therefore, further research and development efforts are essential to ensure that the application of blockchain technology in the government sector can be realized as required in the future.

A Review on Malicious URLs Detection Using Machine Learning Methods

Malicious URLs are a serious threat to cybersecurity because they can compromise user security and inflict large financial losses. The extensiveness and adaptability of traditional detection approaches which rely on blacklists are limited when it comes to rapidly emerging threats. In response, machine learning methods have become more popular as a means of improving the detection efficiency of malicious URLs. This paper provides a thorough analysis providing a structured understanding of all aspects and formal formulation of the machine learning job of malicious URL detection. It covers feature representation and algorithm design, classifying and reviewing contributions from literature studies. The survey aims to provide a state-of-the-art understanding and support future research and practical implementations. It targets a diverse audience, including experts, cybersecurity professionals and machine learning researchers. The article provides a comprehensive overview of the field discussing practical system design considerations, ongoing research challenges and future research directions.

Reenvisioning Patient Education with Smart Hospital Patient Rooms

Smart hospital patient rooms incorporate various smart devices to allow digital control of the entertainment --- such as TV and soundbar --- and the environment --- including lights, blinds, and thermostat. This technology can benefit patients by providing a more accessible, engaging, and personalized approach to their care. Many patients arrive at a rehabilitation hospital because they suffered a life-changing event such as a spinal cord injury or stroke. It can be challenging for patients to learn to cope with the changed abilities that are the new norm in their lives. This study explores ways smart patient rooms can support rehabilitation education to prepare patients for life outside the hospital's care. We conducted 20 contextual inquiries and four interviews with rehabilitation educators as they performed education sessions with patients and informal caregivers. Using thematic analysis, our findings offer insights into how smart patient rooms could revolutionize patient education by fostering better engagement with educational content, reducing interruptions during sessions, providing more agile education content management, and customizing therapy elements for each patient's unique needs. Lastly, we discuss design opportunities for future smart patient room implementations for a better educational experience in any healthcare context.

Stakeholder perspectives on short-stay joint replacement programs: results from a national cross-sectional study

BackgroundThe capacity to meet anticipated growth in joint replacement demand requires safe, efficient models of care. While short-stay joint replacement programs are being used internationally, they have not been widely implemented in many countries. Importantly, the critical challenges that need to be addressed ahead of large-scale program implementation remain unclear. This study aimed to investigate stakeholder perspectives on short-stay joint replacement programs, including perceived barriers and enablers to implementation and sustainability, and understand current practices in Australia.MethodsFour key stakeholder groups were invited to participate in this national study: (1) health professionals who provide joint replacement care; (2) hospital administrators involved in joint replacement provision; (3) patients with recent joint replacement; and (4) carers of people with recent joint replacement. Data on perceived feasibility (0 (not at all feasible) − 10 (highly feasible), appeal (0 (not at all appealing) − 10 (highly appealing), current practices, and barriers and enablers were collected using visual analogue scales, multiple response option and open-ended questions, via an online platform. Descriptive analysis and free-text content analysis was undertaken.ResultsData were available from 1,445 participants including 360 health professionals, 20 hospital administrators, 1,034 patients, and 31 carers. Short-stay program implementation was considered moderately feasible by health professionals (median 6, interquartile range (IQR) 3–8) and hospital administrators (median 5, IQR 5–6). Short-stay programs were moderately appealing to patients (median 7, IQR 2–9) but of little appeal to carers (median 3, IQR 1–7). Prominent implementation barriers included perceived limited appropriateness of short-stay programs, inadequate home supports, and issues around reimbursement models or program funding. Not having daily physiotherapy access and concerns about pain and mobility at home were common barriers for patients. Concern about patients’ ability to manage daily activities was the most common barrier for carers. Access to post-discharge services, better funding models, improved staffing, and consistent protocols and national care standards were prominent enablers.ConclusionsThis national study has uniquely captured multiple stakeholder perspectives on short-stay joint replacement programs. The findings can guide future quality improvement and implementation initiatives and the development of resources to best support patients, carers, clinicians, and hospitals.

Recurrent multi-stressor floc treatments with sulphide and free ammonia enabled mainstream partial nitritation/anammox

Selective suppression of nitrite-oxidising bacteria (NOB) over aerobic and anoxic ammonium-oxidising bacteria (AerAOB and AnAOB) remains a major challenge for mainstream partial nitritation/anammox implementation, a resource-efficient nitrogen removal pathway. A unique multi-stressor floc treatment was therefore designed and validated for the first time under lab-scale conditions while staying true to full-scale design principles. Two hybrid (suspended + biofilm growth) reactors were operated continuously at 20.2 ± 0.6 °C. Recurrent multi-stressor floc treatments were applied, consisting of a sulphide-spiked deoxygenated starvation followed by a free ammonia shock. A good microbial activity balance with high AnAOB (71 ± 21 mg N L−1 d−1) and low NOB (4 ± 17 % of AerAOB) activity was achieved by combining multiple operational strategies: recurrent multi-stressor floc treatments, hybrid sludge (flocs & biofilm), short floc age control, intermittent aeration, and residual ammonium control. The multi-stressor treatment was shown to be the most important control tool and should be continuously applied to maintain this balance. Excessive NOB growth on the biofilm was avoided despite only treating the flocs to safeguard the AnAOB activity on the biofilm. Additionally, no signs of NOB adaptation were observed over 142 days. Elevated effluent ammonium concentrations (25 ± 6 mg N L−1) limited the TN removal efficiency to 39 ± 9 %, complicating a future full-scale implementation. Operating at higher sludge concentrations or reducing the volumetric loading rate could overcome this issue. The obtained results ease the implementation of mainstream PN/A by providing and additional control tool to steer the microbial activity with the multi-stressor treatment, thus advancing the concept of energy neutrality in sewage treatment plants.

The genetics of Graves' disease.

Graves' disease (GD) is the commonest cause of hyperthyroidism and has a strong female preponderance. Everyday clinical practice suggests strong aggregation within families and twin studies demonstrate that genetic factors account for 60-80% of risk of developing GD. In this review, we collate numerous genetic studies and outline the discoveries over the years, starting with historic candidate gene studies and then exploring more recent genome-wide linkage and association studies, which have involved substantial cohorts of East Asian patients as well as those of European descent. Variants in genes including HLA, CTLA4, and PTPN22 have been shown to have substantial individual effects on disease susceptibility. In addition, we examine emerging evidence concerning the possibility that genetic variants may correlate with relevant clinical phenotypes including age of onset of GD, severity of thyrotoxicosis, goitre size and relapse of hyperthyroidism following antithyroid drug therapy, as well as thyroid eye disease. This review supports the inheritance of GD as a complex genetic trait, with a growing number of more than 80 susceptibility loci identified so far. Future implementation of more targeted clinical therapies requires larger studies investigating the influence of these genetic variants on the various phenotypes and different outcomes of conventional treatments.

Lessons From the Field. Chronic disease: Action for post‐pandemic wellness and health

ABSTRACTObjectiveWe aim to share practical insight acquired while implementing the Chronic Disease Self‐Management Program (CDSMP), offering strategies to reach and support diverse individuals with chronic diseases.BackgroundIn light of a global rise in chronic diseases, existing health disparities, and increasingly limited health care access, exacerbated by COVID‐19, empowering individuals through self‐management becomes important to alleviate burdens for families, individuals, and healthcare systems.MethodsUptake and effectiveness of CDSMP were quantified via enrollment data and evaluation instruments. Qualitative exploration of instructor feedback provided lessons learned.ResultsParticipation in CDSMP courses increased during the pandemic with participants reporting greater confidence and frequency of engagement in self‐management activities. Strategic efforts including partnership‐building, targeted marketing, and innovative delivery methods played a pivotal role in recruitment success. Inclusivity measures, such as use of electronic platforms and varied engagement options, broadened program accessibility. Addressing social isolation emerged as a key factor, both as an end in itself and as a motivator for course engagement and retention.ConclusionReducing barriers related to program accessibility, inclusivity, and social isolation are important factors influencing program enrollment both in total number and in diversity of participants, course engagement and retention, and program effectiveness.ImplicationsLessons learned can inform future implementation as family educators seek to uplift and improve the well‐being and health of diverse families coping with chronic diseases.

Experiential learning in engineering education: A systematic literature review

AbstractBackgroundThe evolving transformations of our society at large, academic institutions, and engineering discipline in the 21st century have profound implications for the nature of experiential learning being offered in engineering education. However, what is experiential learning in the context of engineering education?PurposeThe introduction and evaluation of experiential learning in undergraduate engineering education between 1995 and 2020, as well as the essential elements for consideration in its future implementation, have been analyzed and synthesized.Design/MethodA population–intervention–comparison–outcome framework and PRISMA flow diagram were used to outline a systematic literature review on how experiential learning was introduced into undergraduate engineering curricula, how it was evaluated, and the essential elements for consideration in its future implementation.FindingsA total of 220 studies were synthesized. These studies offered a new lens of seeing experiential learning, which were interpreted as “paradigm shifts.” More than one‐half of the total studies were conducted between 1995 and 2005. These studies were strongly directed at measuring student performance and occurred in a decade when many North American engineering curricula were being restructured. The review indicated that experiential learning has been successfully carried out via diverse methodologies. However, there is a strong need to enrich it with a theoretical basis.ConclusionsExperiential learning introduced into engineering education appeared to be an interdependent self–school–community entity. In the changing work environment of the 21st century, heightened by the impacts of the COVID‐19 pandemic, invoking the inseparability of self, school, and community would provide unique perspectives to our evolving understanding of experiential learning and its relevance in engineering discipline.

An Analytical Model for Estimating Ship-Related Emissions in Port Areas

Intensive shipping activity in port areas is considered one of the leading problems in the maritime sector, which has a negative effect on climate change and local air quality. The compilation of detailed inventories of combustion gases released by ships should therefore provide a more accurate overview of emission levels, which can serve as a basis for analysing impacts on the port community and lead to the establishment of better environmental measures. Thus, the aim of this study was to develop an adaptable and relevant analytical model capable of integrating a comprehensive methodology with large databases of ship movements and technical details to provide clear ship-related emission estimates in large port areas. Considering the lack of research in Croatia that includes the mentioned approach and the insufficient monitoring of air pollutants in ports, the model was used to produce an initial overall emissions inventory for the Port of Split, the busiest passenger port in Croatia. In the model, bottom-up logic with an energy-based method was applied to detailed technical and near-real-time shipping data from AIS, creating the first high-density spatial and temporal overview of shipping emissions in the City port basin. The results showed strong seasonal fluctuations and large discrepancies in the quantities emitted between different ship types and operating modes. The analysis therefore raised the question of the need for the future development and implementation of a scalable system that would provide a more transparent and efficient overview of the important characteristics of air pollution from ships and port areas.

Bird diversity in Aketajawe Lolobata National Park

Research on richness and bird species diversity are important for conservation efforts in National Park. Currently, the Aketajawe Lolobata National Park (ALNP) is a habitat patch among industrial areas on Halmahera Island, so that it is important to carry out periodic bird inventories in the national park. Therefore, the need to study the current bird diversity and the status of bird species as a basis for future monitoring and implementation of appropriate conservation measures are important. Bird diversity research needs to be carried out because. Observation plots are placed at primary and secondary forest in Akejawi resort. The research was conducted on January to February 2022. Total observation point is 20 plots. The method was used by point count. The distance between the observation plot is 200 m and the radius of observation is 50 m. The observation were made in the morning (06.00-09.00 am). Repetition of observation on each habitat was carried out 10 times. Data were analyzed by using Shannon-Wiener Index Diversity. Based on findings, There were 345 individuals of 39 species from 19 families inhabited Akejawi Resort. Secondary forest had the highest diversity index when compared to primary forest. This study revealed that there were 9 birds originated from North Maluku and there were 15 species categorized as protected species. The latest data can provide opportunities for further research to reveal patterns of bird distribution and various protection measures due to the loss of forest areas around national parks.

Physical activity promotion in the community pharmacy: An opportunity for an expanded role?

BackgroundPhysical inactivity is a major risk factor for the development of chronic diseases, and it is increasingly prevalent in the Portuguese population. Pharmacists’ role in promoting physical activity (PA) is still not well established, although health promotion is foreseen by law in Portugal. Competing tasks and location where the pharmacy is embedded can hinder this promotion in their daily practice. ObjectiveThe aim of this study was to identify the main barriers and facilitators of physical activity promotion (PAP) in Portuguese community pharmacies and explore possible pathways for future implementation of physical activity promotion. MethodsIn-depth, semi-structured interviews were conducted with purposively enrolled community pharmacists. Participant recruitment was aligned with data saturation. Data analysis comprised a mixed model of a deductive theme mapping strategy using the Theoretical Domains Framework (TDF) for the behaviour of promoting physical activity and an inductive approach for any other relevant themes and which might influence PA promotion. ResultsData saturation was reached at eleven interviews. Barriers and facilitators for the behaviour of promoting PA were identified from 11 out of the 14 TDF domains. Following an inductive approach, other emerging codes were clustered in additional seven major themes. Highlighted barriers focused on domains #1 – Knowledge, #10 – Memory, Attention and Decision Processes and #13 – Environmental Context and Resources. Community mapping, establishment of remuneration models and the use of digital technologies were suggested as additional potential contributors to scale up PAP. ConclusionCommunity pharmacists are well placed inside their communities to serve as a focal point for signposting, engagement with other healthcare professionals and community resources and activities organized by the pharmacy itself. Pharmacists should be supported in being knowledgeable, aware, and available when promoting PA in their daily counseling.

Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Background People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. Methods A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. Findings The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. Conclusion This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.

Rational design of a multivalent vaccine targeting arthropod-borne viruses using reverse vaccinology strategies

Viruses transmitted by arthropods, such as Dengue, Zika, and Chikungunya, represent substantial worldwide health threats, particularly in countries like India. The lack of approved vaccines and effective antiviral therapies calls for developing innovative strategies to tackle these arboviruses. In this study, we employed immunoinformatics methodologies, incorporating reverse vaccinology, to design a multivalent vaccine targeting the predominant arboviruses. Epitopes of B and T cells were recognized within the non-structural proteins of Dengue, Zika, and Chikungunya viruses. The predicted epitopes were enhanced with adjuvants β-defensin and RS-09 to boost the vaccine's immunogenicity. Sixteen distinct vaccine candidates were constructed, each incorporating epitopes from all three viruses. FUVAC-11 emerged as the most promising vaccine candidate through molecular docking and molecular dynamics simulations, demonstrating favorable binding interactions and stability. Its effectiveness was further evaluated using computational immunological studies confirming strong immune responses. The in silico cloning performed using the pET-28a(+) plasmid facilitates the future experimental implementation of this vaccine candidate, paving the way for potential advancements in combating these significant arboviral threats. However, further in vitro and in vivo studies are warranted to confirm the results obtained in this computational study, which highlights the effectiveness of immunoinformatics and reverse vaccinology in creating vaccines against major Arboviruses, offering a promising model for developing vaccines for other vector-borne diseases and enhancing global health security.

How is the halal certification policy implemented? Perspective analysis of small and medium enterprises (SMEs) in Indonesia

Purpose This study aims to explore small and medium enterprises (SMEs) acceptance of the halal certification policy in Indonesia, aiming to understand their perspectives and characteristics, as well as the primary considerations of business actors in implementing the policy. This study seeks to provide a comprehensive understanding of SME actors’ views toward halal certification policies, which is crucial for strengthening the government’s efforts in building a robust halal system and creating awareness in the community. Design/methodology/approach This study uses a mixed method. This study uses a random sampling technique on SMEs in Bandung, Indonesia. A total of 400 respondents participated in filling out the study questionnaire. Meanwhile, five SME actors were interviewed to gain deeper insight into the topic of this study. The data analysis technique used descriptive analysis and verification with confirmatory factor analysis. Findings The results of the study indicate that the halal certification policy is generally accepted by business actors, but there are criticisms regarding knowledge and information about halal certification. Halal awareness and perceived effectivity have the highest acceptance scores, while halal knowledge and information, religious behavior, individual background, and personal and social aims have the lowest scores. All acceptance indicators meet the criteria of a good fit model, with system indicators having a greater impact. Acceptance is based not only on theological–religious considerations but also on pragmatic considerations related to business operations. Research limitations/implications This study has several limitations that should be considered. First, the topics and variables studied are focused only on the dimensions of acceptance of the halal certification policy. It would be more comprehensive if integrated with other variables in correlational and implicative studies. Second, the measurement model used in this study is modified from the policy acceptance model, which focuses on normative and systemic aspects of the policy without considering theological values of the halal certification policy. A more complex model is required to measure the acceptance of a comprehensive halal certification policy that considers both normative and theological aspects. Practical implications The implications of this study are as follows: First, the implementation of the halal certification policy must take into account the various indicators of policy acceptance, particularly from the business actors who are responsible for implementing the policy. Second, the implementation of the halal certification policy must also take into account the heterogeneous characteristics of the business actors. Third, the certification policy should focus on two critical indicators, namely, halal awareness and the perceived effectivity of policy implementation, which can be reinforced by other indicators. Social implications The results of this study confirm that the government must take into account the response of business actors to ensure the effectiveness of implementing the halal certification policy. The government can take an important step in this regard by conducting a survey of business actors who have participated in the halal certification program to understand the benefits and satisfaction they receive from the policy and identify the factors that hinder them from accepting the halal certification policy. Originality/value This study highlights the response of SME actors regarding the acceptance of the halal certification policy. This study provides a new perspective regarding the acceptance of SMEs toward halal certification policies that are important for future implementation.

Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants

Introduction In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers. Methods This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist. Results Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging. Conclusion Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.

A pragmatic dialogue amongst stakeholders on the impact of COVID-19 on Irish cancer patients and healthcare services and lessons learned.

COVID-19 disrupted cancer care services in Ireland, from screening and diagnostics to treatments, possibly impacting physical health outcomes owing to delayed diagnosis and treatment changes. This study explores how cancer care and patients in Ireland were affected by COVID-19 from the perspective of Irish policy, clinical and patient stakeholders using a qualitative approach. The findings could inform future strategic and implementation plans forthe current challengesfaced and lessons learned will be identified. A thematic analysis of a multi-stakeholder online workshop representing policy and clinical and patient stakeholders was completed. The pandemic exasperated prior challenges including under-resourced services, access barriers, staff shortages and lack of interoperability in information technology (IT) systems. Overall, the measures implemented protected cancer patients from COVID-19; however, some groups were more vulnerable, with apparent demographic and socio-economic inequalities. Many hard-fought gains from the previous decade, in terms of cancer screening, diagnosis and survivorship, were eroded. As we transition to the peri-COVID-19 period, staff burnout, poor IT infrastructure and lack of good quality data must be addressed to minimise further disruptions and restore and enhance cancer services. Overall, innovations and measures adopted during the pandemic protected cancer patients; however, some groups were particularly vulnerable, and inequalities may have widened further. Only proven effective and efficient innovations introduced during the pandemic should be retained and enhanced. Good quality data is needed to inform such decisions when choosing amongst them.

Impact analysis of a construction and demolition waste dumping quota trading scheme in uncertain, cooperative, and non-cooperative scenarios

Construction and demolition waste (C&DW) has emerged as a significant environmental challenge, demanding urgent attention and innovative solutions. In response, this paper introduces a novel approach, the C&DW Dumping Quota Trading Scheme (CDWTS), and presents an optimization model to gauge its deep-seated implications on construction project investments and environmental pollution mitigation. This model considers both collaborative and non-collaborative interactions among decision-makers and effectively addresses the uncertainties inherent in the evaluation process through a proposed Hybrid Defuzzification Strategy (HDS). The HDS integrates distributed robust optimization, fuzzy set theory with risk-oriented, and sensitivity analysis to attain risk hedging that balances economy and robustness in the assessment and analysis of the CDWTS. Numerical testing of the model using data from Nanjing, China offers valuable perspectives for CDWTS stakeholders. Specifically, the CDWTS serves as a powerful tool for encouraging enterprises to internalize the external costs of pollution, resulting in significant environmental improvements and the promotion of cleaner production processes within the construction industry. Notably, the allotment and pricing of quotas are identified as pivotal factors in optimizing environmental benefits. Future implementations of the CDWTS should prioritize the development of equitable and efficient quota allocation methods while ensuring stability in quota pricing. Furthermore, it's vital to recognize the potential environmental risks associated with collusion among enterprises and the utilization of rudimentary recycling technologies. Thus, it is recommended to augment subsidies for technological investments in the recycling process and to enhance supervision and management of enterprise alliances. In conclusion, unlike prior studies that mainly delved into dissecting CDWTS concepts and designing its framework, this paper conducts a comprehensive analysis of CDWTS's economic and environmental benefits while addressing uncertainties. Policymakers should consider adopting the CDWTS and HDS into their waste management toolkits, as well as fully assessing the potential concerns identified in this study. These tools and insights not only assist the construction industry in moving toward cleaner production on its own, but they also address potential barriers for policymakers on a path to "waste-free cities".

Analysis of Forecasting Techniques for the Growth of Vehicular Population in Nepal

Forecasting of vehicular population is a critical process that entails predicting future values based on analyzing past trends and considering explanatory variables, such as economic and demographic factors. This becomes especially vital in the context of Nepal, where the accurate prediction of the future growth of the vehicular population is paramount for achieving sustainable transportation systems. This study employs three distinct forecasting methods: trend line analysis, econometric analysis, and time series analysis. These methods have been rigorously evaluated to assess their respective levels of accuracy in predicting Nepal's vehicular population. Notably, the results from time series analysis, particularly the ARIMA model, have demonstrated a remarkable level of precision compared to the traditional trend line and econometric analysis approaches. The superiority of the ARIMA model underscores its efficacy as the preferred method for accurate vehicular population forecasting, providing a reliable foundation for future planning and policy implementation. The forecasted figures for Nepal's vehicular population indicate anticipated counts of 8,914,793 for 2030 AD, 1,482,842,6 for 2040 AD, and 2,203,801,2 for 2050 AD. These predictions offer transportation planners invaluable insights for the effective implementation of new projects, ensuring that resources are optimally allocated and transportation sustainability is realized.