Highest Priority Level Research Articles

Morphometric and Soil Erosion Characterization Based on Geospatial Analysis and Drainage Basin Prioritization of the Rabigh Area Along the Eastern Red Sea Coastal Plain, Saudi Arabia

Soil erosion is one of the most significant problems in global environmental development. Assigning, analyzing, and quantifying the main physical characteristics of drainage basins are powerful keys in identifying regions where there is a higher risk of soil erosion and where prompt mitigation actions are needed. Drainage basins and their drainage systems are ideally defined using the analysis morphometric parameters and their quantitative description. The present study aims to analyze morphometric parameters to prioritize drainage basins that are prone to erosion. Topographic sheets and remotely sensed digital elevation model (DEM) datasets have been prepared and analyzed using geospatial techniques to delineate drainage basins of different sizes and extract different ordered drainage systems. Based on the analysis of morphometric parameters, the Rabigh area was divided into 12 drainage basins, which significantly contribute to determining soil erosion priority levels. The present study selected and applied the most effective morphometric parameters to rank and prioritize the drainage basins of the study area after considering the crucial quantitative characteristics, such as linear, relief, and areal aspects. For each single basin, the compound factor was assigned from several morphometric parameters and applied to rank the Rabigh area. The results confirm that Basins 1, 4, 11, and 12 require a high level of soil erosion priority over an area of 2107 km2; however, Basins 3, 8, 9, and 10 have little degradation and a low level of soil erosion priority. Therefore, in the regions where high soil erosion is a factor, mitigation techniques such as terracing, filter strips, contouring, and other effective and useful structural and non-structural methods should be applied.

Technical efficiency analysis of advanced medical centers in Burkina Faso

IntroductionBurkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures.MethodWe first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC’s efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs’ internal and environmental factors were both considered.ResultsWe found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs’ efficiency.ConclusionOur results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

The priority of bacteria <i>Staphylococcus</i> spp. in the etiology of purulent septic infections through the prism of new diagnostic capabilities: A literature review

Representatives of the genus Staphylococcus spp. occupy a leading place in the etiology of infections caused by opportunistic bacteria. Staphylococcus spp., being symbionts of humans and/or animals, are constantly located on the surface of the skin and mucous membranes, which are their natural habitats. The importance of bacteria of the genus Staphylococcus spp. It is determined by their significant distribution in the population, as well as among patients and medical personnel, due to their transient and resident carrier, as well as their high adaptive potential, due to their ability to form biofilms and produce enzymes that provide them with protection from antimicrobial drugs. Modern molecular genetic methods for identifying Staphylococcus spp. and assessing their epidemic potential allow us to rethink their importance in the etiology of nosocomial purulent septic infections in a new way. It is no coincidence that they entered the group of ESCAPE pathogens with a high level of priority. The ability of staphylococci to form biofilms ensures their survival in various hospital/environmental facilities, which in the conditions of a medical organization become additional, or so-called “inanimate” sources of infection. In recent years, despite the increasing role of coagulase-negative staphylococci in the etiology of purulent septic infections, Staphylococcus aureus remains the most significant causative agent of purulent septic infections.

Characterization of ST-Elevation Myocardial Infarction cases: Association between specific dispatcher-assigned dispatch determinant codes and hospital-confirmed STEMI cases in Qatar

ABSTRACT OBJECTIVES ST-elevation myocardial infarction (STEMI) is an Acute Myocardial Infarction (AMI) with the greatest risk of death and disability. Getting diagnosed patients rapid definitive treatment at the correct facility is crucial in improving their outcome. Using a Question-and-Answer algorithm (Mobile Priority Dispatch System (MPDS®)), trained Emergency Medical Dispatchers (EMDs) can help identifying STEMI at the time of dispatch. This can assist Emergency Medical Services (EMS) pre-planning transport to potential STEMI-receiving hospitals. The study aimed to determine whether hospital-confirmed STEMI cases transported by ambulance are associated with certain dispatch determinant codes and identify the treatments performed. METHODS The retrospective study analyzed deidentified dispatch and hospital data of STEMI patients who were transported by Qatar’s Ambulance Service between January 2018 and May 2021. Data analysis compared patient demographics with dispatch measures, considering chief complaint and determinant codes, and Percutaneous Coronary Intervention (PCI) treatment received. RESULTS A total of 3,724 STEMI cases with MPDS® dispatch codes were retrieved. After excluding patient transfer and pandemic-related cases, a final sample of 2,607 cases was analyzed. Most STEMI patients (86.0%) were classified as high priority levels at dispatch, had chest pain as chief complaint (62.9%), and were male (90.8%). Approximately, 99.0% of the STEMI patients received PCI treatment. Distributions of STEMI cases and PCI treatment did not significantly differ by patient demographics and dispatch measures. CONCLUSIONS Qatar’s STEMI patients are more likely to be male and to receive adequate acute care irrespective of any demographic factor and despite potential language issues. This study highlights that the chief complaint may be described or interpreted differently when the questioning language is not their mother tongue, or when there is a language barrier between the caller, call taker, or when using the MPDS® protocols language or when self-translating questions instantly in another language. Therefore, EMDs should be made aware of the language differences and be encouraged to further clarify the chief complaint when appropriate. There may be a need for potential refinements of the MPDS® questioning algorithm and EMD training with AMI symptoms reinforcement. This could help improve their early identification of STEMI cases with non-classic chest pain symptoms.

Priority Intervention Evaluation of Community Regeneration in Megacities Based on the Business Improvement District (BID) Model: A Case Study of Tianjin, China

This study aims to start from the macroscale of the megacity, explore a top-down operational technical path from the identification of community regeneration units as the evaluation objects to the BID priority intervention evaluation, and then propose differentiated community regeneration strategies based on the BID model. In the post-epidemic era, it is necessary for global megacities to take new measures in urban regeneration to respond to worldwide changes and challenges. As an innovative tool to promote central city revitalization, the BID model has played an important role in community transformation. In the context of the continuous decentralization of population and industry in China’s megacities, it is urgent to explore the technical path to apply the BID model to local community regeneration. Given the shortcomings of existing studies in the method to identify the scope of BID implementation and evaluate intervention priorities, this study takes Tianjin, a megacity in China, as an example and uses DBSCAN (density-based spatial clustering of applications with noise) and service area analysis to define the community regeneration units with commercial agglomeration characteristics as the objects. Then, the BID priority intervention evaluation system is constructed from the two measurement aspects of the intervention potential and the necessity of community regeneration to classify the BID intervention priorities of community regeneration units. The main conclusions are as follows: 1. When the DBSCAN analysis parameters take the minimum number of elements as 30 and the search distance as 120 m, the result is most suitable for identifying community units with commercial agglomeration of the study area; 2. Population vitality, especially working and residential population density, is the key factor affecting BID intervention potential, while road network density is an important indicator for determining the necessity of community regeneration; 3. Community regeneration units with high BID priority levels need to develop differentiated regeneration strategies combining their BID intervention potential, regeneration necessity characteristics, and location attributes. These conclusions can provide references for the governments of megacities to screen and establish BIDs.

The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems’ Response to the Covid-19 Pandemic

The Covid-19 pandemic challenged health care delivery systems worldwide. Many acute care hospitals in communities that experienced surges in cases and hospitalizations had to make decisions such as rationing scarce resources. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges. However, cross-institutional collaborations within jurisdictions offer unique opportunities to prevent or mitigate health disparities in resource utilization and access to care. In January 2020, in response to the emerging coronavirus epidemic, the San Francisco Department of Public Health (SFDPH) and local hospital and health systems partners convened to align and coordinate medical surge planning and response. Adopting a governance structure of mutual accountability and transparency, the San Francisco Health Systems Collaborative guided local medical and public health response in the areas of medical surge, vaccination administration, testing, and therapeutics. Four principles guided the collaborative response: (1) shared priorities, (2) clear governance and accountability, (3) data transparency, and (4) operational coordination. High-level priorities established included protecting vulnerable people, protecting health care workers, and maintaining health system capacity. The governance structure consisted of three layers: local hospital and health systems’ CEOs coordinating with SFDPH executives; hospital chief medical and nursing officers coordinating high-level surge capacity assessments and mitigation plans; and local clinical operational managers working with public health response operational leaders to coordinate scarce resource utilization. Fluctuating with the tempo of the disease indicators and medical surge, governance and coordination were maintained through a tiered meeting and reporting system. Data visibility and transparency were key principles facilitating operational decision-making and executive-level coordination of resources, including identifying additional surge bed capacity for use systemwide, as well as ensuring efficient and equitable vaccine distribution through implementation of five mass-vaccination sites with prioritized access for vulnerable communities. Applying these four principles of shared priorities, accountability, transparency, and operational coordination and pragmatism helped the public health and individual hospital systems make contributions to the overall response that were aligned with their unique strengths and resources. Publication here represents the first official public use of the name San Francisco Health Systems Collaborative (which had served as the term used internally to refer to the group) and the first time codifying this structure. Through this coordination, San Francisco achieved one of the lowest Covid-19 death rates and had one of the highest vaccination and booster rates, compared with rates across California or the United States. Similar principles and implementation methods can be adopted by other health jurisdictions for future emergency outbreak response.

Identification and Prioritization of Thermal Environment Regulation Hotspots in Chengdu

Temperature condition in urban areas has a substantial impact on the well-being and safety of both urban residents and the ecosystems. Green spaces are crucial for mitigating urban heat impacts, and hence, their balanced supply and demand is essential. Due to rapid urbanization, Chengdu has had a significant increase in population, which has had an impact on the dynamic changes in its green space environment, making it a suitable case for our study. This study employs the high-temperature vulnerability framework to classify urban green spaces as entities that regulate the thermal environment. This classification is based on the analysis of ecosystem service supply and demand. The approach creates an assessment framework for managing the balance between the need for and availability of thermal environment regulation in urban green spaces. The study utilizes matching and a priority index to identify places in Chengdu where there are imbalances between supply and demand for services. Our findings suggest: (1) The demand for regulating the thermal environment in Chengdu’s green spaces is defined by three indices: thermal exposure, thermal sensitivity, and thermal adaptability. High-demand areas account for a relatively small proportion and exhibit a pattern of “global diffusion and local concentration”. (2) The supply capacity in Chengdu is determined by both the size of green spaces and the surface temperature. High-supply capacity areas are mainly located in the southeastern part of the city, and their distribution pattern is similar to that of green spaces. (3) The level of correspondence between the supply and demand in Chengdu varies significantly and can be classified into three categories: “insufficient supply and high demand”, “insufficient supply and low demand”, and “abundant supply and low demand”. Out of these, 32 units are located in the area with a shortage of supply, while 6 units are in the area with a significant imbalance of low supply and high demand. (4) The green space thermal environment regulation in Chengdu is categorized into four priority intervention levels: priority I, II, III, and IV zones. The priority IV zone, which has a high intervention priority level, consists of two units primarily located in the Inner Ring Qingyang, Inner Ring Jinjiang, Cuijiadian, Caotang, and Donghu, which are deemed crucial for needing prioritized regulation.

Setting research and extension priorities for agronomic crops in California

Agronomic crop production in California, including grains and animal feed, faces multiple challenges that could be addressed by extension support. This means that extension services need to understand priorities for using their limited resources. Until now, a statewide assessment of the most important topics for research and extension was lacking. A survey was conducted by the University of California Cooperative Extension (UCCE) to identify high-priority needs and inform extension programming based on grower, consultant, and allied industry input. Our goal was to compare the importance of different topics with the level of satisfaction regarding UCCE’s delivery of information on these topics. Survey respondents identified integrated pest management, nutrient and irrigation management, and variety testing as high-priority needs, with overall high satisfaction regarding UCCE’s program delivery on these topics. Topics needing more focus (high priority but below-average level of satisfaction) included testing new products, soil health management, and water conservation and storage. Areas of low priority and low satisfaction included niche marketing, emerging crops, organic production, harvest/post-harvest technology, salinity management, compost and manure management, and greenhouse gas emission reductions. To address stakeholder challenges, results from this study suggest that research and extension efforts should prioritize issues directly impacting on-farm crop production. At the same time, areas of low interest reflect a need for more support to engage farmers on these topics, particularly those concerning state environmental regulations and challenges to local and global food production and security.

Prioritizing plants for conservation in forests over limestone in Guiuan Marine Resource Protected Landscapes and Seascapes (GMRPLS), Samar Island, Philippines using a localized conservation priority index (LCPI)

Philippine landscapes and seascapes have been undergoing massive degradation especially with the onset of the Anthropocene epoch. The unique forests over limestone in Guiuan Marine Resource Protected Landscapes and Seascapes in Eastern Samar have never been exempted from ongoing deteriorating conditions leading to the diminishing ecosystem services for the nearby villages. Conservation plan and action are urgent. The current paper determines top-priority plants for conservation using the localized conservation priority index (LCPI), which considers the contexts of the locality. LCPI follows a point scoring procedure recognizing holistic social, cultural, ecological and biophysical variables, such as cultural use, frequency value of occurrences in study plots, species distribution, harvesting risk, and economic use. Research findings indicated Caryota rumphiana Mart., Saribus rotundifolius (Lam.) Blume Artocarpus blancoi (Elmer) Merr., Shorea negrosensis Foxw., Alstonia scholaris (L.) R. Br., Calophyllum soulattri Burm.f., Artocarpus rubrovenius Warb., Nothaphoebe leytensis (Elmer) Merr., Shorea astylosa Foxw., Palaquium sp., Heterospathe intermedia (Becc.) Fernando, Hancea wenzeliana (Slik) S.E.C.Sierra, Kulju & Welzen, Aquilaria cumingiana (Decne.) Ridl., Wallaceodendron celebicum Koord., Palaquium luzoniense (Fern.-Vill.) Vidal, Mastixia sp., Wrightia sp., Lubi-lubi, Kuyakya and Neonauclea formicaria (Elmer) Merr. The leaves, stems, fruits, and flowers are the most-commonly harvested plant parts in high-priority level species, most of which are primarily used for housing and construction. The identified plants were geotagged to intensify onsite protection. The findings are of extreme relevance in providing guidance to protected area staff, local people organizations, and community residents in embarking on urgent conservation action in conserving locally vulnerable biodiversity in order to sustain ecosystem services.

Testing a Prioritization Tool to Identify Older Adults in Need of Home-Delivered Meals and Nutrition-Related Services

The Expanded Food Security Screener (FSS-Exp) determines food insecurity risk based on physical, economic, and social access to food. It categorizes individuals into 5 priorities based on need for a home-delivered meal. Concurrent and construct validity were applied to the tool. For concurrent validity, partial correlations between FSS-Exp and health- and food-related measures were significant and ranged between 0.20 and 0.33. For construct validity, analysis of variance was used to examine scores of the health- and food-related tools by priority level. The 2 highest priority levels had significantly lower mean scores for all the health variables except for dietary intake. The FSS-Exp tool effectively identifies those most in need of meal services.

One-Pot Microfluidics to Engineer Chitosan Nanoparticles Conjugated with Antimicrobial Peptides Using "Photoclick" Chemistry: Validation Using the Gastric Bacterium Helicobacter pylori.

Surface bioconjugation of antimicrobial peptides (AMP) onto nanoparticles (AMP-NP) is a complex, multistep, and time-consuming task. Herein, a microfluidic system for the one-pot production of AMP-NP was developed. Norbornene-modified chitosan was used for NP production (NorChit-NP), and thiolated-AMP was grafted on their surface via thiol-norbornene "photoclick" chemistry over exposure of two parallel UV LEDs. The MSI-78A was the AMP selected due to its high activity against a high priority (level 2) antibiotic-resistant gastric pathogen: Helicobacter pylori (H. pylori). AMP-NP (113 ± 43 nm; zeta potential 14.3 ± 7 mV) were stable in gastric settings without a cross-linker (up to 5 days in pH 1.2) and bactericidal against two highly pathogenic H. pylori strains (1011 NP/mL with 96 μg/mL MSI-78A). Eradication was faster for H. pylori 26695 (30 min) than for H. pylori J99 (24 h), which was explained by the lower minimum bactericidal concentration of soluble MSI-78A for H. pylori 26695 (32 μg/mL) than for H. pylori J99 (128 μg/mL). AMP-NP was bactericidal by inducing H. pylori cell membrane alterations, intracellular reorganization, generation of extracellular vesicles, and leakage of cytoplasmic contents (transmission electron microscopy). Moreover, NP were not cytotoxic against two gastric cell lines (AGS and MKN74, ATCC) at bactericidal concentrations. Overall, the designed microfluidic setup is a greener, simpler, and faster approach than the conventional methods to obtain AMP-NP. This technology can be further explored for the bioconjugation of other thiolated-compounds.

ANALISIS GAP BIDANG SUMBER DAYA MANUSIA (SDM) RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA UNIT II MENUJU RS TIPE B

Background : Issues of ASEAN Free Trade Area ( AFTA ) and globalization of the world economy demands which is every profit and non-profit organizations to compete in marketing and resource. The changes, requires hospitals to survive among competitors that would appear at any moment. Therefore , Human Resources (HR) hospitals must be able to respond it. HR needs proper planning in accordance with the service requirements of each unit in accordance with the classification of hospitals based on the Regulation of the Minister of Health ( Permenkes ) number 56 of 2014 as well as national accreditation standard version of the Commission on Accreditation of Hospitals 2012 ( KARS ). So the RS PKU Muhammadiyah Yogyakarta Unit II will head the hospital type B and accreditation .Methods: The study design was qualitative used in-depth interviews and quantitative method for analyzing a plan about between condition HR today and the need for hospital accreditation of type B and KARS version 2012. While quantitative data obtained through questionnaires Need Assessment journal guidelines on Managerial Competency Development at Provincial and District HospitalsResults : Based on the research results, there is a shortage of human resources about the type and number according to hospital type B and for the accreditation of 99 elements document ratings are 96 % complete . As for performance assessment PKU Muhammadiyah Yogyakarta Unit II responsibility for the examination and treatment, training, science and research, issues of hospital management which is indispensable. To support the referral level, in terms of both treatment and prevention. As well as for international cooperation needs to be improved. While the assessment of training needs at the level of priority on the entire item, respondents give a high priority level assessment.Conclusion : There is a shortage of the type and quantity of human resources between the condition of human resources today and the provisions of hospital type B and there are some completeness of documents for the accreditation of qualifications assessment and education staff KARS 2012 version. Keywords : hospital type B, Permenkes 56/2014, accreditation of KARS version 2012, human resources.

Penerapan Metode Simple Additive Weighting dalam Penentuan Prioritas Program Pembangunan Daerah

Regional governments and institutions related to preparing regional development programs experience several obstacles in determining regional development work plans, one of which is difficulty in determining development priorities that are in line with regional regulations. The effectiveness and efficiency of implementing regional development programs depends on the accuracy of the data collected. One of the challenges faced by the Medan City Regional Development Planning Agency is the lack of consideration of the priority scale and fairness in the regional development stages, as well as the absence of a system that can help determine the priority scale. Therefore, this research requires a decision support system (DSS). In the SPK, there are many solution methods that can be used according to the needs of each problem. In this research, to determine regional development program priorities, the SAW method will be used. Of the 10 proposed regional programs, only one will be a priority development program. After applying the SAW method in making decisions, the development program that has the highest priority level is the highway construction program with the final result obtained, namely 0.77705.

Defect Analysis of Ceramic Products with Statistical Quality Control (SQC) and Failure Mode Effect Analysis (FMEA) Methods at PT. XYZ

Ceramic product company is one of the companies engaged in the ceramic industry. Ceramic product company produces various types of floor tiles with various sizes including sizes 40x40 cm, 50x50 cm, and 60x60 cm. Problems that arise at ceramic product company is that there are still defects in the 50x50 cm ceramic production line which is quite high, this certainly cannot be separated from the company's losses. Therefore, to reduce the level of defects in products, it needs to be supported by maintenance management and employee expertise. The purpose of this study is to determine product defects and propose improvements to reduce product defects. This research uses the Statistical Quality Control (SQC) method to control quality from the initial process to the finished product and Failure Mode Effect Analysis (FMEA) is used to identify and prevent problems that occur in products and processes. Based on the results of the analysis from October 2022 to March 2023, with a total production of 327,600 products, there are 56,543 defective products. Based on the results of the Pareto diagram for chipping before firing with a percentage of (34.3%), crack defects of (25.6%), chipping before vela of (21.2%), and ink drop defects of (18.9%). The calculation of RPN for ceramic production measuring 50x50 cm obtained several risks with the highest priority level, obtained the highest RPN of 288 from the type of crack defect with a proposed improvement, which emphasizes the operator to always pay attention to the running machine settings.

Towards automated homomorphic encryption parameter selection with fuzzy logic and linear programming

Homomorphic Encryption (HE) is a set of powerful properties of certain cryptosystems that allow privacy-preserving operation over the encrypted text. Still, HE is not widespread due to limitations in terms of efficiency and usability. Among the challenges of HE, scheme parametrization (i.e., the selection of appropriate parameters within the algorithms) is a relevant multi-faced problem. First, the parametrization needs to comply with a set of properties to guarantee the security of the underlying scheme. Second, parametrization requires a deep understanding of the low-level primitives since the parameters have a confronting impact on the scheme’s precision, performance, and security. Finally, the circuit to be executed influences, and it is influenced by, the parametrization. Thus, there is no general optimal selection of parameters, and this selection depends on the circuit and the scenario of the application. Currently, most existing HE frameworks require cryptographers to address these considerations manually. It requires a minimum of expertise acquired through a steep learning curve. In this paper, we propose a unified solution for the aforementioned challenges. Concretely, we present an expert system combining Fuzzy Logic and Linear Programming. The Fuzzy Logic Modules receive a user selection of high-level priorities for the security, efficiency, and performance of the cryptosystem. Based on these preferences, the expert system generates a Linear Programming Model that obtains optimal combinations of parameters by considering those priorities while preserving a minimum level of security for the cryptosystem. We conduct an extended evaluation showing that an expert system generates optimal parameter selections that maintain user preferences without undergoing the inherent complexity of analyzing the circuit.

A wormhole attack detection method for tactical wireless sensor networks.

Wireless sensor networks (WSNs) are networks formed by organizing and combining tens of thousands of sensor nodes freely through wireless communication technology. WSNs are commonly affected by various attacks, such as identity theft, black holes, wormholes, protocol spoofing, etc. As one of the more severe threats, wormholes create passive attacks that are hard to detect and eliminate. Since WSN is often used in the tactical network field, a planned secure network is essential for military applications with high security. Guard nodes are traffic monitoring nodes used to supervise neighbors' data communication around the tactical networks. Therefore, this work proposes a Quality of Service (QoS) security mechanism to select multiple dual-layer guard nodes at different paths of the WSN based on the path qualities to detect wormholes. The entire network's links are categorized into high, normal, and low priority levels. As such, this study aimed to confirm the security of high priority nodes and links in the tactical network, avoid excessive overhead, and provide random security facilities to all nodes. The proposed measures of the QoS-based security provision, including link cluster formation, guard node selection, authenticated guard node identification, and intrusion detection, ensure economic and efficient network communication with different quality levels.

What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey.

The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests. A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform. Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks. This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

Prioritization of patients for surgery in Canada: The case of hip and knee replacement surgeries in Newfoundland

AbstractBackgroundSingle‐entry models (SEM) improve wait times for hip and knee replacement, but little is known whether prioritization implemented in SEM can help meet the benchmarks for consolation/surgery. This study aimed to determine the impact of prioritization on receiving consultation and surgery within the benchmarks.MethodsThis is a retrospective cohort study for which two administration databases were linked. Logistic regression was used to investigate the impact of prioritization on receiving consultations and surgery within the benchmarks of 90 and 182 days, respectively, adjusting for patients’ characteristics and preference for surgeon.Results1,967 patients were included in this study. The odds ratios of having consultation within 90 days for hip replacement patients in priorities 1 and 2 (high priority) were 57.24 (CI: 23.16–141.47) and 14.63 (CI: 6.44–33.25), respectively, compared with those in priority 3. For knee replacement, patients with higher priority were more likely to have consultation within 90 days. Although priority levels were not related to having surgery within 182 days for knee replacement, hip replacement patients with priority 1 (CI: 0.2–0.75) and 2 (CI: 0.16–0.54) were less likely to have surgery within 182 days, compared with those with priority 3.ConclusionPatients with high priority levels were more likely to have consultation within 90 days for hip and knee replacements. SEM may not help have surgery within 182 days. Prioritization has no impact on receiving surgery within 182 days for knee replacement, but hip replacement patients with high priority were less likely to have surgery within 182 days.

Business Strategies and Firm Profitability of Selected Mobile Operating Firms in Nigeria

Purpose: Firms economic and financial growth are the major goals of organizations across the globe to beat competition and survive in the unfriendly business environment. However, despite the positive impact of the mobile telecommunication sector to social and economic development, the mobile operating firms are plagued with challenges militating against the expected growth rate. This is evident in decline in market growth, dwindling profitability and decline in productivity. This study examined business strategies and firm profitability of mobile operating firms in Nigeria.
 Methodology: The study adopted survey research design. The population of the study was 436 management staff of the selected mobile operating firms in Nigeria. The enumeration sampling method was used. A structured adapted and validated questionnaire was administered. Cronbach’s alpha reliability coefficients for the constructs ranged from 0.71- 0.79. The response rate was 83.3%. Data were analyzed using descriptive and inferential (multiple regression) statistics.
 Findings: The study revealed business strategies have significant effect on profitability (Adj. R2 = 0.469; F (4, 358) = 81.082, P < 0.05). The study concluded that business strategies (cost leadership, product differentiation, product leadership and service delivery) influenced market growth, firm profitability and productivity of selected mobile operating firms in Nigeria.
 Recommendation: The study recommended that for mobile operator’s companies to achieve targeted profitability, business strategies measures such as cost leadership, product differentiation, product leadership and service delivery should be given high level of priority.

Significant Indicators of Precarious Employment and Their Priority

The article is devoted to the problem of identifying significant indicators of precarious employment and their priority, the solution of which was based on the authors: 1) checking indicators for multicollinearity, for which, based on the processing of data from the Federal State Statistics Service and The Russia Longitudinal Monitoring Survey - Higher School of Economics (RLMS-HSE), an array of data was generated for the period 2010-2020; 2) checking indicators based on expert assessments of Russian specialists collected in 2022 during a survey specially organized by the authors. Taking into account the integration of the verification results by two methods, the indicators of the initial list proposed by the authors were clarified and verified and the final list of indicators of precarious employment was formed. The final list includes indicators that make it possible to identify objective (taking into account the assessment of the type of registration of employment and employment conditions) and subjective (taking intoaccount the assessment of the presence of instability of the labor situation and dissatisfaction with employment and its conditions) manifestations of precarious employment in relation to Russian conditions. The prioritization of indicators of precarious employment was carried out and three groups of indicators were identified by priority level to characterize its manifestations: with a high (key indicators), medium and below medium priority level. The boundary for the indicator of the level of income from basic employment, which does not ensure the stability of the financial situation of households, has been clarified. It was revealed that precarious employment, regardless of the type of employed households, is identified by income from basic employment, which does not allow per capita income to be brought to the level of standards that form middle and higher material security (3.1 of subsistence minimum and higher).