Improvement Strategies Research Articles

Real-World Survival Impact and Utilization of Adjuvant Radiation in Advanced Laryngeal Cancer.

Background: Optimal treatment of locally advanced cancer of the larynx is controversial. In this study, we aim to compare outcomes in patients with T3-4N0-1 cancer of the larynx who underwent surgery alone versus surgery followed by radiation therapy (RT). Materials and Methods: A total of 1820 patients with advanced laryngeal cancer were identified from the national Surveillance, Epidemiology, and End Results Database and stratified based on postoperative RT status, and clinical outcomes were compared between these 2 groups. Propensity score matching was conducted to balance baseline characteristics. Results: The majority of patients (53.4%) received adjuvant RT. N0 patients who received laryngectomy and who did not undergo adjuvant radiation had a 47% higher risk of cancer-specific death than patients receiving adjuvant RT (adj. HR 1.47, 95% CI 1.18-1.84). N1 patients who did not undergo adjuvant radiation had a 90% higher risk of cancer-specific death than patients receiving RT after surgery (adj. HR 1.90, 95% CI 1.27-2.84). After adjusting for propensity scores, adjuvant RT carried a significant overall survival benefit (HR 0.73, 95% CI 0.60-0.87). Conclusions: This study provides real-world support for adjuvant radiation in patients with T3-4N0-1 laryngeal carcinoma. Nearly half of patients did not receive RT, indicating a need for national provider education and process improvement strategies to improve utilization.

Strategies to develop an efficient feedback system in medical education and its outcome – An interventional study

Objective The main aim of this study is to know the loopholes in the feedback system, strategies to remove these loopholes, and to measure the effects of an efficient feedback system in an institution. Methods This research has three stages. In the first stage, we tried to find out the flaws in the feedback system of the institution based on published benchmarks. Then we tried to remove these flaws with the collaboration of different stakeholders. In the last stage of the study, we tried to measure the effectiveness of these corrective procedures by certain key performance indicators (KPIs). Results After improvement strategies, there was a significant improvement in the KPIs like, the knowledge and attitude toward the feedback improved from 3.1 to 4.23 in students, and from 3.46 to 4.34 in faculty members, on a five-point scale, and the teaching standards improved as measured by students’ performance in different courses in terms of learning objectives achievement, for example in internal medicine from 70.8% to 75.3%. Similar improvement was recorded in other KPIs as well. Conclusion An efficient feedback system is the backbone of education and by adopting effective feedback, individuals and institutions can excel in the field of medical education.

Transgressive segregation and generation mean analysis reveal the gene action underlying the inheritance of drought tolerance in rice

Climate change, an effective driver of unprecedented seasonal droughts, is greatly affecting rice production in Africa by threatening food security and safety. Rice, one of the major staple crops on the continent, can save the situation through the development of drought-tolerant cultivars, presenting a major challenge for future rice improvement programs as drought is regarded as a critical limitation in rain-fed ecosystems. This study sought to understand the genetic basis and inheritance behind the expression of tolerance of rice breeding lines to drought-stress through generation mean analysis. To achieve these objectives, two drought-sensitive genotypes (Jasmine 85 and CRI-Agrarice) were crossed with a drought-tolerant genotype (APO) to develop six populations (F1, F2, BC1, BC2, P1 and P2) under screenhouse drought-stress and non-stress evaluation. Data were collected on grain yield and yield-related traits among which the generation mean analysis was conducted. At least one transgressive phenotype was produced in the F2 population for each trait whether there is a significant difference or not among the parental lines under drought-stress. Under non-stress conditions, there was a significance for all six types of gene action for days to flowering in both crosses. Among both crosses and water-regimes, additive x additive gene interaction was significant for most of the traits even though the scaling tests were not significant indicating the effectiveness of selection in early generations. Therefore, either forward breeding or backcross breeding can be adopted as breeding strategies for rapid improvement for these lines to drought tolerance.

Academic Leadership of Educational Institution Administrators under the Jurisdiction of Udon Thani Primary Educational Service Office Area 2

Background and Aims: Education plays a critical role in developing individuals, society, and the nation, serving as a driving force for sustainable national development and fostering harmonious living within communities. Administrators of educational institutions hold a key position in ensuring that education adapts to evolving economic, social, and technological landscapes. To meet these challenges, leaders must be skilled in managing change and enhancing academic quality. This research aims to: 1) examine the academic leadership level of school administrators under Udon Thani Primary Educational Service Office Area 2, 2) compare their leadership based on position, experience, and school size, and 3) explore strategies for developing their academic leadership. Methodology: The research sample consisted of 310 school administrators and teachers, selected based on Krejci and Morgan's table and randomly divided into groups. A 5-level rating scale questionnaire was used as the research instrument, with a consistency index ranging from 0.80 to 1.00 and an overall reliability score of 0.86. Statistical methods applied in the data analysis included frequency, percentage, mean, standard deviation, t-test, and F-test to evaluate and compare the findings. Results: The research findings are as follows: (1) The academic leadership of educational institution administrators under Udon Thani Primary Educational Service Office Area 2, both overall and in each specific area, is at a high level. (2) A comparison of opinions on academic leadership, classified by position, work experience, and school size, revealed no significant differences across these factors. (3) Guidelines for promoting academic leadership among school administrators include eight key areas: 1) raising awareness in meetings and setting high expectations for student academic achievement, 2) showing enthusiasm for implementing school improvement strategies, 3) providing incentives and rewards for academic efforts, 4) tracking academic progress, 5) creatively utilizing resources and personnel, 6) ensuring the school environment is pleasant, orderly, and safe, 7) monitoring teachers' instructional practices, and 8) observing teaching and giving constructive feedback. Conclusion: Overall, the study reveals that school administrators in Udon Thani Primary Educational Service Office Area 2 exhibit strong perceptions of academic leadership, which are consistent regardless of their position, experience, or the size of their institutions. To further enhance leadership effectiveness, the suggested guidelines emphasize the importance of fostering a supportive environment, implementing practical strategies for school improvement, and closely monitoring both students' academic progress and teaching practices. These measures are designed to ensure that academic leadership continues to positively impact educational outcomes.

Co-created improvement goals and strategies for implementing SBIRT and MAUDin primary care settings in a facilitator-supported, tailored implementation study.

Evidence-based approaches to screening and treatment for unhealthy alcohol use have the potential to reduce morbidity and mortality but are currently underutilized in primary care settings. To support implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) by identifying goals co-developed by clinics and practice facilitators in a flexible implementation study. In a pragmatic implementation study, we used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. Our study used a tailored approach, in which facilitators and clinics co-identified implementation goals based on clinic needs. We used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. With support from practice facilitators, clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g. data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree summarizes emergent findings into a tool to support future implementation of SBIRT in primary care settings. A facilitator-supported, tailored approach to SBIRT implementation enabled clinics to identify a variety of goals to improve SBIRT and MAUD implementation. These identified priorities, along with a decision tree describing the hierarchical structure of these goals, could support future implementation efforts.

Enhancing infection prevention and control through hand hygiene compliance in six Ugandan hospitals using quality improvement approaches

IntroductionHand hygiene (HH) plays a crucial role in mitigating healthcare-associated infections. Improving HH compliance in healthcare facilities in resource-limited settings is urgently needed.MethodsWe implemented the World Health Organization (WHO) HH improvement strategy using a continuous quality improvement (CQI) approach targeting improvement in HH compliance by healthcare workers (HCWs). An intervention was implemented in six hospitals using a longitudinal study design between May 2019 and April 2023. We set up and monitored infection prevention and control (IPC) and HH programs using WHO’s infection prevention and control assessment framework at the facility level (IPCAF) and hand hygiene self-assessment framework (HHSAF) tools. We implemented HH interventions using CQI techniques while targeting HCW HH knowledge and compliance with the WHO’s Five Moments of HH.Results and discussionBy the end of the intervention, IPC and HH capacity improved in all six hospitals, from a median score of 547.0 and 252.5 on IPCAF and HHSAF tools at baseline to an advanced score of 635.0 and 350.0 at endline assessment, respectively. Similarly, HCWs’ HH knowledge improved in all hospitals, from a mean score of 45.0% at baseline to 76.0% at endline assessment, most notably among nurses. HH compliance, as assessed using WHO’s HH observation tool, at least doubled in all hospitals, rising from 19.9% to 53.8%, with before touching a patient registering the highest (22-fold) improvement. On linear regression analysis, no significant association was observed between HH compliance and IPCAF b = -0.0004 (95% CI -0.093, 0.93) p = 0.990, HHSAF b = 0.009 (95% CI -.0127, 0.145) p = 0.842 and HCW knowledge on HH/IPC b = -0.165 (95% CI 0.815, 0.485) p = 0.519. This is the first documented comprehensive utilization of CQI approaches to implement HH as an entry point for the development of hospital IPC programs, and evaluation of WHO tools and approaches for IPC and HH improvement in Uganda.ConclusionImplementation of the WHO HH improvement strategy using a CQI approach can lead to remarkable improvement in HH capacity, and HCW compliance and knowledge in hospitals within resource-limited settings.

Outlook on nutritional importance and breeding strategies for oil and quality improvement in sesame (Sesamum indicum L.)

Sesame (Sesamum indicum L.), is a pivotal crop in global agriculture due to its high oil content (50-60 %), rich in quality unsaturated fatty acids and an array of bioactive compounds like sesamin and sesamol. This review is a compilation of information on sesame nutrition, mechanism of action of bioactive principles, health benefits in terms of unsaturated fats, antioxidants and essential nutrients to combat health disorders. The genetic resources are the base for any crop improvement programs. The genetic wealth of this crop as ex-situ conservation world-wide, traits of importance from its wild relatives, studies on genetic diversity through agronomic and molecular techniques for quality traits are focused. Both conventional and molecular breeding methods are examined. Conventional breeding efforts covers trait variability, correlations, gene action, combining ability studies, breeding methods and varieties released. The insights into molecular biology probes the novel QTLs, discovery of candidate genes, molecular markers for quality traits, genome sequencing, advancements in gene expression studies, genetic maps and pangemone. Despite the significant progress, the lacuna and future prospects in these areas are highlighted. Integrating the information from modern genomic technologies with conventional methods is the key to maximize the crop's potential for oil and nutritional security.

High Expression of Immune Checkpoint Molecules in Different Types of Thyroid Cancer

This study aimed to investigate the expression of programmed cell death protein-1 (PD-1) and its ligand (PD-L1) immune checkpoint molecules in thyroid carcinomas and determine their association with the clinicopathological characteristics of patients. Thyroid tissue specimens from 100 patients diagnosed with primary thyroid carcinomas including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC) were collected. Sections were prepared from formalin-fixed paraffin-embedded samples, and PD-1 and PD-L1 expressions were examined using immunohistochemistry. PD-1 was detected in tumor-infiltrating lymphocytes (TILs) in 88% of the patients and tumor cells in 28% of the patients with 10% in PTC, 5% in FTC, 5% in MTC, and 8% in ATC). PD-L1 was found in tumor cells and TILs in 30% and 79% of the patients, respectively. Moreover, a significant difference was observed in PD-1 and PD-L1 expression between tumor cells and TILs across different tumor types. However, their expression in tumor cells and TILs was significantly higher in ATC compared to other tumor types. Additionally, the expression of PD-1 and PD-L1 was significantly associated with an advanced stage, higher tumor size, tumor necrosis, and mitosis. A significant positive correlation was also observed between the expression of PD-1 and PD-L1 in tumor cells and TILs. The higher expression of PD-1 and PD-L1 may contribute to tumor progression. Therefore, combinational immunotherapy by these immune checkpoint inhibitors might be a promising strategy for clinical improvement in patients with thyroid cancer, especially those with ATC.

Intelligent Robust Controllers Applied to an Auxiliary Energy System for Electric Vehicles

This paper presents two intelligent robust control strategies applied to manage the dynamics of a DC-DC bidirectional buck–boost converter, which is used in conjunction with a supercapacitor as an auxiliary energy system (AES) for regenerative braking in electric vehicles. The Neural Inverse Optimal Controller (NIOC) and the Neural Sliding Mode Controller (NSMC) utilize identifiers based on Recurrent High-Order Neural Networks (RHONNs) trained with the Extended Kalman Filter (EKF) to track voltage and current references from the converter circuit. Additionally, a driving cycle test tailored specifically for typical urban driving in electric vehicles (EVs) is implemented to validate the efficacy of the proposed controller and energy improvement strategy. The proposed NSMC and NIOC are compared with a PI controller; furthermore, an induction motor and its corresponding three-phase inverter are incorporated into the EV control scheme which is implemented in Matlab/Simulink using the “Simscape Electrical” toolbox. The Mean Squared Error (MSE) is computed to validate the performance of the neural controllers. Additionally, the improvement in the State of Charge (SOC) for an electric vehicle battery through the control of buck–boost converter dynamics is addressed. Finally, several robustness tests against parameter changes in the converter are conducted, along with their corresponding performance indices.

A Study Of Accreditation Status Synchronization And Regional Public Service Agency As A Model Of Public Health Service (Puskesmas) Management Improvement

Indonesia still has public health centre (Puskesmas) health care issues. The data from Bengkulu is comparable to those from the national level. It shows that Puskesmas has not maximised gatekeeping. We need responsible Puskesmas management and high-quality, sustainable health care to address these problems. Pushesmas' accreditation and Regional Public Service Agency status help the government improve Puskesmas administration. We need a synchronization model because we implement accreditation and BLUD separately. Given the current situation, this study explores potential synchronization strategies between accreditation and BLUD to enhance Puskesmas management. The study describes the condition of accredited and BLUD Puskesmas, identifies the problems, investigates the role capabilities of the parties involved, seeks to synchronise Puskesmas management, and formulates a strategy to improve management. This qualitative descriptive research uses a case study approach with purposive sampling to examine Puskesmas, an accredited and BLUD school in Bengkulu Province. Researchers conduct in-depth interviews, observations, library studies, and documentation. Researchers analyse data through collection, reduction, presentation, and verification or conclusion. They also triangulate data, sources, and procedures for data validity analysis. This research created a Puskesmas Management Improvement Strategy Model as a Novelty

Digital Literacy Education: A New Approach to Cultivating 21st Century Key Competencies

This study delves into the theoretical foundations, practical explorations, strategic methods, and evaluation improvements of digital literacy education aimed specifically at vocational institutions and their stakeholders. It begins with a detailed analysis of the definitions and connotations of "digital literacy" and "digital literacy education," clarifying their distinctions and importance within the context of vocational training. Through an examination of typical case studies both domestically and internationally, the research identifies the problems and challenges in the implementation of digital literacy education, exploring their underlying causes. Subsequently, the paper proposes principles for curriculum design, content selection, and implementation strategies tailored to the needs of vocational students. It also analyzes the characteristics, application scenarios, and practical effects of various teaching models. Finally, an assessment system for digital literacy education is constructed, alongside targeted improvement strategies and future development trends. This research aims to provide valuable references for educators, policymakers, and practitioners in the field of vocational education, thereby continuously enhancing the effectiveness and relevance of digital literacy education.

Effectiveness of the UK AML System and Strategies for Improvement

As the cost of anti-money laundering (AML) compliance in the UK continues to rise, financial crime rates have not fallen. This study assesses the effectiveness of the UK’s anti-money laundering (AML) system and proposes strategies for improvement. The research examines the current legal framework, including the Proceeds of Crime Act (POCA) and the Money Laundering Regulations 2017 (MLR2017), assessing their role in preventing and combating financial crime. Analyzing case studies and statistical data, the findings suggest that while the UK AML system has been effective in identifying and deterring money laundering, significant challenges remain. Insufficient sharing of information between agencies, uneven allocation of resources, and inconsistent regulatory enforcement hinder overall effectiveness. To address these shortcomings, the study makes several strategic recommendations: strengthening inter-agency cooperation, leveraging advanced technological solutions for data analysis and reporting, improving training and awareness programmes for financial institutions, and improving the legal framework to adapt to emerging threats. Implementing these recommendations could strengthen the UK’s anti-money laundering (AML) efforts, making them more robust and responsive to the evolving financial crime landscape. Ultimately, this study aims to contribute to the current debate on the effectiveness of AML and to make recommendations for improving the AML system’s response to the complexities of money laundering in order to strengthen the UK’s position in the global fight against money laundering.

Innovation and Entrepreneurship Education Based on University Student Academic Competitions: Pathways, Challenges, and Strategies

Against the backdrop of accelerated globalization and technological innovation, innovation and entrepreneurship education has become a central issue in higher education. Purpose: This study aims to evaluate the effectiveness of innovation and entrepreneurship education in academic competitions and explore the challenges and strategies for improvement; Methods: Through a literature review, this study analyzes cases of educational reforms and evaluates the effectiveness of various strategies in academic competitions. Results: The research indicates that interdisciplinary learning and project-based learning effectively enhance students' innovation and problem-solving skills, but uneven resource distribution and competitive pressure remain significant challenges. Conclusion: To fully leverage the potential of academic competitions in innovation and entrepreneurship education, it is necessary to optimize educational strategies and provide balanced resource support.

THE IMPORTANCE OF A CONTINGENCY PLAN

The dissertation titled “The Importance of a Contingency Plan: For the Residents of Vila Bom Jesus in the Municipality of Canaã dos Carajás-PA in Cases of Dam Rupture” addresses the urgent need for an effective contingency plan for this vulnerable community. The social relevance of the topic is unquestionable, given the increasing incidence of natural and technological disasters. The Brumadinho tragedy in 2019 highlighted the devastating consequences of dam failures, underscoring the importance of preventive measures. This study aims to examine the effectiveness of current contingency plans and propose recommendations to improve the preparedness and resilience of Vila Bom Jesus residents. Specific objectives include analyzing the structure of existing plans, assessing community perception, and proposing strategies for continuous improvement. The methodology used is based on a literature review, with strict inclusion and exclusion criteria to ensure the relevance and quality of the analyzed articles. The thematic analysis of the data facilitates the identification of patterns and critical elements for the development of effective plans. The results reveal that although contingency plans exist, the lack of knowledge and adequate preparation among residents compromises their effectiveness. Anderson Vasconcellos Amaral’s research highlights the transformation of Canaã dos Carajás landscapes due to mining and agriculture, and the social and environmental implications of these activities. The dissertation concludes that contingency plans need to be continuously reviewed and updated, incorporating new information and best practices. The contributions of this study are significant for the protection of vulnerable communities, providing practical guidelines that can be adapted to different contexts.

Determinants of patient nonattendance in HIV/AIDS suburban clinics: A case study in clinic staff perceptions

ABSTRACT The purpose of this study is to analyze HIV/AIDS clinic staff perceptions of patient nonattendance to develop location-specific strategies for attendance rate improvement. People living with HIV may provide incomplete information regarding their behavior given the culture of secrecy, history of mental illness, and illegal nature of intravenous drug use. Staff perspectives offer insights that the patients may not recognize or be willing to admit. The investigation examined 32 staff interviews, a perspective yet to be explored in depth, at four suburban Midwestern and Southern HIV/AIDS clinics. Thematic analysis revealed five nonattendance determinants: social, cultural, physical, psychological, and logistical. Subthemes not found in previous studies emerged across clinics, including religious and language barriers in the local Hispanic, Burmese, and Haitian Creole populations. The qualitative study yielded previously unknown explanations for patterns in data common in the literature. For example, the staff more often associated the younger generation with feelings of invincibility, but the older generation with limited access to future care due to physical mobility issues. Clinic administration identified a new trend of patients taking temporary holidays from care. Given the differing subthemes, location-specific attendance intervention strategies are proposed.

Microbial community composition and co-occurrence network analysis of the rhizosphere soil of the main constructive tree species in Helan Mountain of Northwest China

To understand the microbial diversity and community composition within the main constructive tree species, Picea crassifolia, Betula platyphylla, and Pinus tabuliformis, in Helan Mountain and their response to changes in soil physicochemical factors, a high throughput sequencing technology was used to analyze the bacterial and fungal diversity and community structure. RDA (Redundancy Analysis) and Pearson correlation analysis were used to explore the influence of soil physicochemical factors on microbial community construction, and co-occurrence network analysis was conducted on the microbial communities. The results showed that the fungal and bacterial diversity was highest in B. platyphylla, and lowest in P. crassifolia. Additionally, the fungal/bacterial richness was greatest in the rhizosphere soils of P. tabuliformis and B. platyphylla. RDA and Pearson correlation analysis revealed that NN (nitrate nitrogen) and AP (available phosphorus) were the main determining factors of the bacterial community, while NN and SOC (soil water content) were the main determining factors of the fungal community. Pearson correlation analysis between soil physicochemical factors and the alpha diversity of the microbial communities revealed a significant positive correlation between pH and the bacterial and fungal diversity, while SOC, TN (total nitrogen), AP, and AN (available nitrogen) were significantly negatively correlated with the bacterial and fungal diversity. Co-occurrence network analysis revealed that the soil bacterial communities exhibit richer network nodes, edges, greater diversity, and greater network connectivity. Indicating that bacterial communities exhibit more complex and stable interaction patterns in soil. This study reveals the complex interactive relationship between microbial communities and soil physicochemical factors in forest ecosystems. By analyzing the response of rhizosphere microbial communities of major tree species in Helan Mountain to nutrient dynamics and pH changes, we can deepen our understanding of the role of microorganisms in regulating ecosystem functions and provide theoretical basis for soil improvement and ecological restoration strategies.

Add-on perceptual learning on refractive amblyopia in children.

To evaluate the visual outcomes of standard amblyopic treatment add-on training via perceptual learning in refractive amblyopic children and to identify the risk factors for treatment failure. Retrospective charts were reviewed in children with refractive amblyopia who received standard treatment and add-on Cambridge Visual Stimulator (CAM) training. The add-on CAM group that was enrolled had worn full-corrected glasses for at least 2mo before training. A control group received only the standard treatment. Treatment success was defined as best-corrected visual acuity (BCVA) ≥20/25. The age, sex, initial BCVA, refractive errors, sessions and duration of training, and final BCVA were recorded. A total of 209 children (129 children in add-on CAM group and 80 children in control group) were enrolled. Seventy-six percent of unilateral and 87% of bilateral amblyopic children achieved treatment success. In children with unilateral or bilateral moderate amblyopia, the duration to reach BCVA ≥20/25 was significantly shorter in add-on CAM group than in control group. Poor initial BCVA (P<0.001) and high astigmatism (P=0.007) were risk factors for treatment failure after add-on CAM training. Age, sex, and types of refractive error were not associated with treatment success. Add-on CAM training is an effective strategy for visual improvement and can shorten the treatment course when the effect of standard treatment is limited in amblyopic children.

Lean process mining: adopting process mining in lean manufacturing for dynamic process mapping and avoiding waste occurrence in real time

Purpose This paper aims to recommend a method entitled “lean process mining (LPM)” for mapping, analyzing and improving the material/information flows in the value stream of manufacturing processes. Design/methodology/approach The method is developed based on literature review and in-depth explorative research in value stream mapping and process mining approaches. The proposed LPM framework consists of three phases including as-realized process state, improvement strategies and reengineered process state. Hence, firstly, extracts the as-realized model, measures the identified wastes and identifies the sources of wastes. Secondly, implements prediction-recommendation-prevention strategies. Thirdly, reengineers the process model and measures the improved wastes. Findings It presents the applicability of the proposed approach in (1) online observation of manufacturing process behavior and tracing the process deviations dynamically in real time to identify the sources of waste; (2) avoiding defective products occurring during the production and eliminating the relevant derived wastes including wasted material, wasted energy, waste of labor, excess inventory, increased production lead time and wasted operational costs. Originality/value The practical application of LPM is illustrated through implementing it in a real-life manufacturing case. The outcomes prove the remarkable applicability of this method in lean manufacturing to avoid waste occurrence in the value stream.

How Well Are Surgical Quality Improvement Projects Planned? Review of 242 Surgical Improvement Efforts Across Five American College of Surgeons Quality Programs.

Structured preparation is necessary to conduct quality improvement (QI) strategies that are relevant to the problem, feasible, appropriately resourced, and potentially effective. Recent work suggests improvement efforts are sub-optimally conducted. Our goal was to determine how well preparation for surgical QI is undertaken, including detailing the problem, setting project goals, and planning an intervention. This retrospective cross-sectional study included QI efforts submitted in 2019 to the American College of Surgeons (ACS) during review for accreditation across five ACS Quality Programs: Children's Surgery Verification (CSV), the Commission on Cancer (CoC), the Metabolic and Bariatric Surgical Accreditation and Quality Improvement Program (MBSAQIP), the National Accreditation Program for Breast Centers (NAPBC), and the Trauma Verification Program. Projects were scored for alignment with three components of the pre-conduct phase of the ACS Quality Framework: problem detailing, goal specification, and strategic planning. 242 projects satisfied inclusion criteria and were scored. Most projects in the final cohort were from MBSAQIP (36%), CoC (31%), or NAPBC (29%) programs. The average overall pre-conduct score was 52% (Standard Deviation (SD)=17). On average, projects performed best in the 'Goal Specification' component (65% SD=27), followed by 'Problem Detailing' (52% SD=16), and 'Strategic Planning' (44% SD=25). Within these components, identification of possible limitations (5%) and consideration of contextual issues (12%) were among the least frequently reported items. Thorough planning is a critical component of effective QI, and our study reflects significant opportunity for its improvement. The ACS Quality Framework may serve as a guide to improve QI planning, thereby promoting efficiency and effectiveness of these efforts.

Strengthening Collaborative Governance in the Department of Transportation: Implementation and Enforcement Levies

This article explores the strengthening of collaborative governance within Indonesia's Department of Transportation, focusing on the implementation and enforcement of levies. It highlights the integration of diverse stakeholders, including government bodies, private sector entities, and civil society, to create a more effective levy management system. However, a lack of collaboration between the Palembang city government and the local community has hindered the effectiveness of levies. Key strategies for improvement include promoting transparency, shared decision-making, and the use of innovative technologies. The study underscores the importance of trust and accountability among stakeholders to enhance compliance and enforcement. In Palembang, the capital of South Sumatra Province, transportation and traffic management challenges necessitate the effective implementation of levies. Employing a qualitative approach through in-depth interviews, observations, and documentation, the research reveals that collaborative efforts between local governments, the private sector, and the community are essential, despite challenges such as limited resources and community resistance. The findings suggest that while collaborative governance can improve the effectiveness of levy enforcement, it requires commitment and active participation from all parties. Recommendations include enhancing human resource capacity, strengthening regulatory frameworks, and raising public awareness of the importance of levies for regional revenue. This study also aligns with the Sustainable Development Goals (SDGs), particularly in improving infrastructure, fostering sustainable cities (SDG 11), and promoting effective partnerships (SDG 17).