Inconsistent Practices Research Articles

The double-edged sword of transparency: ESG disclosure's effect on competitive dynamics in manufacturing

This study explores the role and impact of Environmental, Social, and Governance (ESG) information on investor decision-making, focusing on the lack of standardized ESG reporting among companies. Although ESG disclosures can enhance a company’s legitimacy and attract investor interest, the voluntary nature of reporting has led to inconsistent practices and limited information quality. The research aims to develop a standardized ESG reporting model that meets investor needs while assessing the effects of ESG performance on corporate outcomes. Using a mixed-methods approach, the study combines qualitative research to formulate an ESG reporting model and quantitative methods to evaluate its impact on company performance. Data were collected from 167 manufacturing companies in Indonesia, selected based on their consistent publication of sustainability reports over four consecutive years. The findings reveal that ESG shows consistent high significance across all three models (Sig = 0.000 for Model-1, Model-2, and Model-3 regression). This uniform high significance underscores the growing importance of ESG factors in various aspects of corporate performance and perception. It suggests that ESG considerations are integral not only to stock returns and firm valuation but also to a company's competitive positioning. The study concludes that while ESG reporting is essential for corporate transparency, it may not always align with positive financial outcomes. This suggests the need for more comprehensive ESG frameworks to balance investor expectations and corporate performance.

Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study

Hypertension poses a critical threat to health in India, being the predominant risk factor for mortality and disability. With over 70% of outpatient care being provided by the private sector, our study investigated the practices and incentives of private health providers in screening, diagnosing, treating, monitoring, and counseling hypertension patients in rural and peri-urban India. Conducted from April 2020 to February 2021, the qualitative study involved 46 participants, including various healthcare professionals and patients in three Telangana state districts. Analysis revealed a lack of recognition of hypertension’s gravity among private providers in these areas, leading to inconsistent screening practices and varied diagnostic thresholds, particularly among rural medical practitioners. Both formal and informal providers lacked standardized protocols and follow-up mechanisms, with limited technical knowledge about hypertension observed, especially among rural practitioners who were often the first point of contact. Drug effectiveness, and incentives from pharmaceutical sales representatives influenced prescribing practices. Diagnostic labs also offered financial incentives for patient referrals. Thus, aligning providers’ objectives with patient preferences and public health goals is crucial. To encourage evidence-based hypertension care, the government and NGOs could implement strategies such as tailored incentives, financial rewards, tax benefits, accreditation, and recognition for private healthcare providers. Professional bodies in the private sector should establish programs emphasizing quality assurance and certifications. Future research should focus on designing and testing new models for private sector hypertension service delivery, coupled with targeted interventions to enhance care in rural and peri-urban settings.

Research on Human Exposure to Transport-Induced Vibration in Buildings

The analysis of human perception of vibrations in buildings is a critical aspect of structural engineering, particularly as urbanization intensifies and the proximity of vibration sources to buildings increases. This paper addresses the frequent errors in the assessment and diagnosis of the impact of vibrations on building occupants. Despite stringent standards and detailed methodologies, misinterpretations and incorrect implementations of these guidelines are common, leading to flawed diagnostic studies. These errors often stem from the misuse of measurement equipment, inappropriate selection of measurement points, and a general lack of comprehensive education on vibration analysis. National guidelines, although largely based on ISO standards, vary significantly, contributing to inconsistent practices across Europe. The dominant sources of urban vibrations include vehicle traffic, particularly heavy trucks and rail vehicles, which significantly impact both building structures and human comfort. This paper reviews the methodologies for measuring and interpreting vibrations, emphasizing the importance of correct sensor placement and data analysis. It highlights the necessity of integrating vibrational comfort into building design, considering both external and internal vibration sources. The study also explores the effectiveness of different evaluation methods, such as the RMS and VDV methods, and the impact of various weighting functions on the analysis results. The findings underscore the need for improved education and standardization in the field to ensure accurate assessments and enhance the vibrational comfort of building occupants.

A-181 The Effectiveness Module to Reduce Laboratory Error Reporting Rates

Abstract Background In a hospital in central Taiwan, the number of tests conducted in 2022 was 1.88 million, there were 26 cases of laboratory error reports, with an error rate of 14 cases per million. Error reports may lead to diagnostic errors, posing a significant risk to patient safety. Therefore, our team aims to establish a simple and universal module that can be applicable to various laboratory operations to minimize errors. Methods Initially, we conducted an analysis of error causes, identifying 25 cases of human error and 1 case of computer system error. Human errors were categorized according to the laboratory process, including 4 specimen identification errors, 3 procedural errors, 9 typing errors, 7 validation of analytical data errors, and 2 instances of failure to communicate issues during handover. The proximate cause of human error was non-compliance with SOPs, and the root cause was inadequate SOPs leading to inconsistent practices. We reviewed the workflow, implemented corrective actions, revised SOPs, and provided training for personnel. Additionally, three important strategies were introduced: 1.High-Frequency Audits: Corrective actions were included in the internal audit checklist, initially increasing the frequency to at least once a month for the first 3 months, followed by at least once every 6 months within the next 6 months. If no further occurrences were noted, audits could be conducted annually or not. Each audit should be completed within 20 minutes to avoid excessive burden, with direct observation of operations and random questioning being the preferred audit methods. 2. Audit deficiencies should be documented: Personnel were requested to conduct cause analysis and improvements. This not only expressed the supervisor's commitment to improvement but also provided an opportunity to discover reasons why countermeasures cannot not be implemented, allowing for strategic adjustments until successful implementation. 3.Case-Based Training: Benchmark cases were developed into teaching materials, and compiled errors regularly for looking for patterns or trends to identity key steps. Make these key steps the focus of your educational training. Results In 2023, 1.94 million tests were conducted, there were 4 error reports, with an error rate of 3 cases per million, all were attributed to human error. In another hospital in southern Taiwan, laboratory error reports were primarily due to human error. From June 2022 to July 2023, a total of 3.46 million tests were conducted, there were 14 error reports and an error rate of 5 cases per million. After implementing the same improvement module from August to December 2023, a total of 1.56 million tests were conducted, there were 2 error reports and an error rate of 2 cases per million, all were attributed to human error. Conclusions We applied this improvement module to two hospitals in central and southern Taiwan, resulting in a significant reduction in error rate. The key factors of effectiveness were utilizing high-frequency audits to ensure sustained results, and demonstrating the positive attitude of supervisors during the process. This motivated personnel to demand higher standards from themselves, ultimately showcasing remarkable improvements.

Standardization through education of molecular pathology: a spotlight on the European Masters in Molecular Pathology.

Despite advancements in precision medicine, many cancer patients globally, particularly those in resource-constrained environments, face significant challenges in accessing high-quality molecular testing and targeted therapies. The considerable heterogeneity in molecular testing highlights the urgent need to harmonize practices across Europe and beyond, establishing a more standardized and consistent approach in MP laboratories. Professionals, especially molecular pathologists, must move beyond traditional education to cope with this heterogeneity. This perspective addresses critical issues in molecular pathology (MP), such as limited access to high-quality molecular testing, leading to disparities in cancer treatment, and the consequences of inconsistent practices. Recognizing the necessity for a standardized framework for education to address these issues, educational programs play a pivotal role in updating professionals' skills to achieve standardization in MP. European experts from the Steering Committee, the Pathology Section of the European Union of Medical Specialists, and the European Society of Pathology have proposed creating a comprehensive Master's degree program called the "European Masters in Molecular Pathology" (EMMP). This program emerges as a strategic response to the demand for a specialized and standardized framework for education in MP, catering to professionals who concurrently work and study. The program's design aligns with evidence-based education methods, ensuring effective learning and engagement while integrating computational pathology to analyze complex molecular data, enhance diagnostic accuracy, and improve treatment outcomes. EMMP's structured curriculum, strategic partnerships, and regular updates underscore its significance in standardizing MP practices. Exploring future developments, this perspective delves into technology integration and interdisciplinary collaboration, anticipating ongoing advances and harmonization. Challenges and future directions in MP education are discussed, emphasizing the necessity for dynamic curriculum updates, seamless technology integration, and interdisciplinary cooperation. This perspective underscores EMMP's pivotal role in preparing pathologists for this dynamic field, advocating continuous advancements in education and training to uphold excellence in MP practices and maintain the highest patient care standards.

Persistent pain, long-term opioids, and restoring trust in the patient-clinician relationship

The erosion of trust in the patient-clinician relationship is an underappreciated, and vital, component of the prescription opioid crisis. Drawing from lived experience of patients and clinicians, and a narrative evidence review, this report discusses how opioid use for persistent pain can impact the patient-clinician relationship from the vantage points of the patient and the family physician. For patients, the stress of dealing with persistent pain, misalignment with clinicians regarding goals of care, experiences of disrespect and stigma, fear of abrupt tapers, and frustration with a fragmented health system, all combine to breed a lack of trust. Clinicians, for their part, experience challenges due to inadequate resources for pain management and opioid safety, pressure to deprescribe opioids rapidly, inconsistent prescribing practices of colleagues, ‘policing’ opioid prescriptions when concern arises for opioid use disorder and adversarial relationships with frustrated patients wary of clinician intentions. As a result, many clinicians struggle to maintain a therapeutic relationship with patients in great need of empathy and healing. To support implementation of evidence-based guidelines and achieve public health goals of safer prescribing and reducing harm from prescription opioids, we recommend steps health systems and clinicians can take to rebuild trust in the patient-clinician relationship, enable patient-centered pain care, and embed patient perspectives into opioid safety processes. PerspectiveErosion of patient-clinician trust is a barrier to implementing evidence-based guidelines that aim to improve opioid safety. This paper explores lived patient and clinician experiences and recommends steps for health systems and clinicians to rebuild this trust as a strategy to actualize the benefits of adherence to these guidelines.

A comparative model for financial advisory standardization in Nigeria and sub-Saharan Africa

The development of a theoretical model for harmonizing local and international product standards for Nigerian exports Financial inclusion remains a significant challenge in Nigeria and across Sub-Saharan Africa, with millions of individuals, particularly in rural areas, lacking access to formal financial systems. Financial advisory services play a critical role in addressing this challenge by helping individuals understand and effectively use financial products such as savings, credit, and investments. However, the lack of standardization in the delivery of these advisory services has hindered their effectiveness, resulting in inconsistent practices and limited reach, especially among the unbanked population. This review proposes a comparative model for the standardization of financial advisory services in Nigeria and other Sub-Saharan African countries. It seeks to examine the current landscape of financial advisory services, comparing Nigeria’s approach with successful models in countries such as Kenya, Ghana, and South Africa. The model emphasizes key components of standardization, including financial literacy programs, digital advisory platforms, and microfinance initiatives, which are critical to reaching underserved communities. By analyzing case studies, such as Kenya’s M-Pesa platform, which has significantly advanced financial inclusion through mobile money and advisory services, the review identifies best practices that can be adapted to Nigeria’s context. The comparative analysis highlights the importance of leveraging technology, particularly mobile platforms, to provide accessible and scalable financial advisory services. It also underscores the need for public-private partnerships, regulatory support, and tailored programs that address the unique socioeconomic and cultural characteristics of Nigeria and other Sub-Saharan countries. While digital infrastructure remains a challenge in rural areas, the success of mobile banking and advisory platforms in countries like Ghana demonstrates that technology can play a transformative role in financial inclusion. Challenges such as cultural resistance, economic disparities, and infrastructure gaps are discussed, emphasizing the need for a flexible yet standardized approach to advisory services. Additionally, the review outlines the critical role of regulatory frameworks in ensuring that financial advisory services are consistent, transparent, and accessible to all segments of the population. The review advocates for a standardized advisory model tailored to Nigeria’s specific needs, drawing lessons from successful models across Sub-Saharan Africa. Such standardization, supported by regulatory reforms and technology integration, has the potential to bridge the financial inclusion gap, empowering individuals and fostering economic growth. The review also calls for regional collaboration in Sub-Saharan Africa to promote knowledge-sharing and create unified strategies for advancing financial inclusion across the continent.

A Study on the Relationship between Parental Parenting Styles and Adolescent Attachment Decision Making Styles

This study investigates the associations between perceived parenting styles, attachment orientations, and decision - making styles among adolescents. Employing a cross - sectional, correlation research design, data were collected from 197 eighth - grade students (111 boys and 86 girls) Participants completed self - reported scales measuring perceived parenting styles, attachment styles, and decision - making styles. The results revealed a significant positive correlation between parental responsiveness and secure attachment, highlighting the crucial role of parental warmth and support in fostering secure attachments during adolescence. Conversely, a significant correlation was found between parental control and fearful attachments, indicating the adverse effects of harsh and inconsistent parenting practices on attachment patterns. . These findings underscore the importance of responsive parenting in nurturing secure attachment bonds and advocate for culturally sensitive approaches to understanding parenting styles. Further research is warranted to explore parental influences on adolescent decision - making across diverse cultural contexts, with implications for tailored interventions aimed at promoting positive outcomes in adolescents' development.

Reconstruction of Law Enforcement Rule for Employers of Medical Practitioner without Practice Licenses Based on Restorative Justice

In Indonesia, current constructive law lacks clear regulation regarding the enforcement of laws against employers who hire medical practitioner without practice licenses. As a result, law enforcement often relies on general statutes such as the Penal Code or Civil Code, treating offenders similarly to criminals. This situation emphasizes the urgent need for specific rule that adhere to principles of restorative justice. This study aims to study the absences in current law enforcement rule pertaining to employers of unlicensed medical practitioner, explore these issues from a restorative justice perspective, and propose a reconstructed regulatory framework grounded in restorative justice principles. The research employs a constructivist paradigm with a descriptive-analytical approach, utilizing socio-legal methods within a qualitative research design. Data consist of primary, secondary, and tertiary legal materials gathered through literature review, observation, and interviews, and are studied qualitatively. The findings reveal that existing rule do not follow to principles of restorative justice. Enforcement lacks consistency, hindering the equitable access of the public to law enforcement, justice, and benefits. Weaknesses include the absence of specific legal provisions and insufficient knowledge among law enforcement officials regarding healthcare law, resulting in inconsistent enforcement practices. Illustration on international and national legal insights, the study proposes a reconstructed legal framework that ensures balanced protection for employers, medical practitioner, and patients, promoting dignified and high-quality healthcare services free from stigma, and showed with fairness and professionalism. Reconstructing legal norms such as Article 442 and healthcare legislation could create a balanced law enforcement regulation that upholds legal enforcement, legal utility, and societal justice perceptions.

Enhancing Street Food Safety in Kampala: Current Challenges and Future Directions

Street food vending in Kampala is a vibrant component of the city’s cultural and economic fabric, providing affordable, diverse food options and supporting local agriculture. However, the informal nature of street food vending introduces significant food safety challenges, including regulatory constraints, inconsistent sanitary practices, and risks of microbiological contamination. This review examines the current state of street food vending in Kampala, focusing on regulatory frameworks, hygiene standards, and vendor knowledge. It explores the health implications of street food consumption, including case studies of foodborne illnesses, and evaluates successful interventions aimed at improving safety. The review also draws comparative insights from practices in other cities and identifies emerging trends and research needs. Key findings highlight the need for strengthened enforcement mechanisms, enhanced vendor training, and improved public awareness to address food safety challenges. Recommendations include adopting best practices from successful cities, leveraging emerging technologies for real-time monitoring, and improving infrastructure to support safe street food practices. This comprehensive overview offers actionable insights for stakeholders to enhance the safety and sustainability of street food vending in Kampala. Keywords: Street Food, Kampala, Current Challenges, Future Directions

Antennal Transcriptome Screening and Identification of Chemosensory Proteins in the Double-Spine European Spruce Bark Beetle, Ips duplicatus (Coleoptera: Scolytinae).

The northern bark beetle, Ips duplicatus, is an emerging economic pest, reportedly infesting various species of spruce (Picea spp.), pine (Pinus spp.), and larch (Larix spp.) in Central Europe. Recent climate changes and inconsistent forest management practices have led to the rapid spread of this species, leaving the current monitoring strategies inefficient. As understanding the molecular components of pheromone detection is key to developing novel control strategies, we generated antennal transcriptomes from males and females of this species and annotated the chemosensory proteins. We identified putative candidates for 69 odorant receptors (ORs), 50 ionotropic receptors (IRs), 25 gustatory receptors (GRs), 27 odorant-binding proteins (OBPs), including a tetramer-OBP, 9 chemosensory proteins (CSPs), and 6 sensory neuron membrane proteins (SNMPs). However, no sex-specific chemosensory genes were detected. The phylogenetic analysis revealed conserved orthology in bark beetle chemosensory proteins, especially with a major forest pest and co-habitant, Ips typographus. Recent large-scale functional studies in I. typographus chemoreceptors add greater significance to the orthologous sequences reported here. Nevertheless, identifying chemosensory genes in I. duplicatus is valuable to understanding the chemosensory system and its evolution in bark beetles (Coleoptera) and, generally, insects.

Enhancing organizational attractiveness through CSR consistency: Examining the impact of corporate hypocrisy, conceptual fluency, and proactive communication in HR recruitment

AbstractIncorporating corporate social responsibility (CSR) into organizational strategies has become essential, demonstrating a dedication to ethical conduct and sustainable practices. This paper investigates how consistency in CSR practices impacts organizational attractiveness. Drawing upon the theory of the continuum model of impression formation, two separate studies were undertaken to investigate the influence of CSR consistency (both consistent and inconsistent CSR) on the appeal of organizations. Besides, these studies aimed to evaluate the mediating roles of conceptual fluency and perceived corporate hypocrisy in this relationship, as well as the moderating effect of two corporate communication strategies (proactive and passive). The study found that perceptions of corporate hypocrisy played a significant mediating role in the link between inconsistent CSR practices and the appeal of an organization. This mediating effect was diminished by the use of proactive communication strategies. In contrast, conceptual fluency was identified as a key mediator in the relationship between consistent CSR practices and organizational attractiveness, with its mediating effect being enhanced by proactive communication strategies. This study makes a novel contribution by focusing on the temporal stability of CSR initiatives and broadens the understanding of whether sustained engagement in CSR activities over time confers greater organizational attractiveness than occasional or random initiatives. This study extends the theory of the relationship between perceived CSR and job seekers and provides guidance and recommendations for CSR activities and HR recruitment practices for companies in the post‐epidemic era.

Paving the way to establishing the digital-friendly health and care information model in Kazakhstan

IntroductionKazakhstan has made significant strides in digital health implementation since 2013, transitioning from paper-based systems to wide implementation of digital solutions. However, challenges persist, notably the misalignment between existing data collection requirements and ongoing digital transformations. To address this obstacle, the development of a new digital-friendly requirements for health data collection at provider levels was initiated. Material and methodsA comparative analysis of all existing requirements on health and care data collection set a foundation for further actions. A dedicated technical working group, established by the Ministry of Healthcare, oversaw this process, while several specialized expert groups participated in detailed discussions to ensure alignment with healthcare needs. We took as a basis the legislative act enforcing use of data forms inherited from pre-digital era. Data elements from most used forms were cataloged, checked for consistency, and standardized. ISO 13940 standard guided transformation of rigid paper-based forms into flexible digital-friendly data sets. ResultsAnalysis of the healthcare legislation reveals significant optimization opportunities. We categorized 157 forms into four groups by their content and role and focusing on clinical and administrative records for transformation. Data elements’ analysis led to developing 209 standardized classifications with data values. 83 data sets, encompassing clinical and administrative domains, were developed to substitute 63 (out of 157) forms. Therefore, the foundation for better data and structure interoperability was set. DiscussionThe top-down approach to digital health standardization, combined with open market policies, results in inconsistent data collection practices. Developed data sets align with the goal of developing the national Electronic Health Records system as enabler for interoperability and adds a bottom-up perspective to digital health standardization. This effort addresses the lack of guidance for digital data model development, however additional efforts required to change the current practice and finalize the national legislation transformation into digital-friendly mode.

Assessment of record keeping management in General Hospital, Ikot Abasi, Akwa Ibom State

Introduction: This study examines records management at Ikot Abasi General Hospital. Four specific objectives were established and four research questions were formulated to guide the development of the study. The research focused on current records management practices at the hospital, assessing the existing infrastructure and technology used to maintain these records.Methods: A descriptive survey design with a qualitative approach was used. Data collection was conducted by interviewing a total of 11 participants, which included 2 physicians, 5 nurses, and 4 records managers at Ikot Abasi General Hospital. An interview guide was designed to elicit information on the participants' perspectives on records management practices in the hospital. The data collected were analyzed using thematic analysis.Results: The study revealed a varying level of understanding among respondents about current records management practices, with concerns about accuracy and completeness of documentation. Despite these challenges, evaluation of existing infrastructure and technology showed a positive impact, particularly with the implementation of electronic health record (EHR) systems, which has streamlined processes and reduced reliance on paper documentation.Conclusions: The study identified several challenges faced by healthcare professionals and administrators, including inconsistent documentation practices, lack of adequate storage facilities, limited access to technology and resources, and regulatory compliance issues. It was recommended that healthcare and related organizations implement standardized documentation protocols and provide regular training sessions for healthcare professionals to ensure consistency, accuracy, and completeness in records management. In addition, it was suggested that governments at all levels allocate resources to improve records management infrastructure and invest in modern technological solutions, such as electronic health record (EHR) systems.

Interpolation of microbiome composition in longitudinal data sets.

Since missing samples are common in longitudinal microbiome dataset due to inconsistent collection practices, it is important to evaluate and benchmark different interpolation methods for predicting microbiome composition in such samples and facilitate downstream analysis. Our study rigorously evaluated several such methods and identified the K-nearest neighbors approach as particularly effective for this task. The study also notes significant variability in interpolation accuracy among individuals, influenced by factors such as age, sample size, and sampling frequency. Furthermore, we developed a predictive model for estimating interpolation accuracy at a specific time point, enhancing the reliability of such analyses in future studies. Combined, our study, thus, provides critical insights and tools that enhance the accuracy and reliability of data interpolation methods in the growing field of longitudinal microbiome research.

Consistency of alerts generated by, and implementation of, the NHS England acute kidney injury detection algorithm in English laboratories.

National Health Services (NHS) England mandates that an acute kidney injury (AKI) detection algorithmbe embedded in laboratories. We evaluated the implementation of the algorithm and the consistency of alerts submitted to the United Kingdom Renal Registry (UKRR). Code was developed to simulate the syntax of the AKI detection algorithm, executed on data from local laboratories submitted to the UKRR, including alerts and serum creatinine (SCr) results spanning 15months before and after the alert submission. Acute kidney injury alerts were categorized into stages 0/1/2/3. Inter-rater agreement (Gwet's AC1) was used to compare local and centrally derived alerts at individual laboratory and commercial laboratory information management system (LIMS) levels, penalizing extreme disagreements. The analysis included 9,096,667 SCr results from 29 labs (475,634 patients; median age 72years, 47% female) between algorithm activation and data extraction (September 30, 2020). Laboratories and the central simulation generated 1,579,633 and 1,646,850 non-zero AKI alerts, respectively. Agreement was high within known laboratory information management system providers (0.97-0.98) but varied across individual laboratories (overall range 0.17-0.98, 0.17-0.23 in three). Agreement tended to be lower (Gwet's AC1 0.88) with the highest baseline SCr quartile (median 164μmol/L). Overall, alerts submitted to the UKRR are a valid source of AKI surveillance but there are concerns about inconsistent laboratory practices, incomplete adoption of the NHSE algorithm code, alert suppression, and variable interpretation of guidelines. Future efforts should audit and support laboratories with low agreement rates, and explore reasons for lower agreement in individuals with pre-existing CKD.

Visiting Contested Terrain: Archiving, Auditing, and Reforming Commemorative Place Names on US Marine Corps Bases

In recent years, commemorative naming has been discussed and called into question in the U.S. military, and with the establishment of the Confederate Naming Commission by Congress in 2021, representatives for branches of the US military and Department of Defense were tasked with evaluating commemorative practices associated with valorizing Confederate history. In this paper, we focus specifically on place naming patterns on US Marine Corps bases through an engagement with military archives. These archives are part of a hegemonic control of memory that sits uncomfortably at the intersection of the racialized history of the Armed Forces and its growing reliance on a multi-cultural America. We argue and find early evidence that the archives constitute contested terrain and the commemorative audits conducted by military institutions are a potentially fraught practice given possible self-interest and potential lack of a critical perspective on the past and place. We encountered many of the difficulties that complicate name reform and the commemorative audits, such as negotiated access to the physical archives and data, inconsistent practices and documentation which contributed to an incomplete audit, and conflicts with institutional interest. Even with the Confederate Naming Commission’s recent reports and recommendations for renaming some military bases and structures, there remains a demand for greater attention to the audits of commemorative place names utilized to make such recommendations. This demand necessitates a recognition that the legacy of racism and racial violence goes far beyond the years of the Confederacy, particularly regarding the landscapes of the United States military.

Labour Migration and Human Trafficking in Andhra Pradesh, India: A ‘Determinants of Migrant Vulnerability’ Perspective

Labour migration, other than being a key driver of economic growth and development, is also associated with inconsistent human rights practices. This paper furthers the understanding of links between migration and human trafficking in Andhra Pradesh, India. It applies IOM’s Determinants of Vulnerability Framework to assess and analyse the various ways in which vulnerabilities of the migrant unorganised and casual labourers are constructed as they are forced to migrate for livelihood security. The study employed a mixed-methods approach which included a survey of 5888 individuals, seven case studies, five focus group discussions and 121 key informant interviews. The paper confirms that migration, by itself, does not lead to trafficking. A number of intersecting, inter-related factors at individual, household, community, and structural levels add to risks or provide protection against trafficking to a migrant before, during or after the process of migration. Relatedly, the paper argues that the process of migration is a continuum between vulnerability, unsafe migration, and trafficking.

The role of laryngeal hypersensitivity in dysphagia: A scoping review with embedded stakeholder involvement

AbstractBackgroundBased on stakeholder conversations, speech and language therapists have anecdotally observed cases of dysphagia with suspected laryngeal hypersensitivity. These presentations have been coined as ‘muscle tension dysphagia’ often with concurrent laryngeal sensitivity symptoms. However, the role of laryngeal hypersensitivity in dysphagia is not fully understood. Knowledge user engagement highlights a lack of clarity around diagnosis and investigative approaches, limited clinical guidance and inconsistent practice, which leads to inequity in service delivery and care.AimTo identify and present the published literature regarding the definitions and clinical identification tools used during the management of laryngeal hypersensitivity related dysphagia.Methods & ProceduresA scoping review was conducted following Joanna Briggs Institute methodology and EQUATOR PRISMA‐ScR guidance. Patient and stakeholder engagement was embedded at each review stage. The protocol was registered with the Open Science Framework: DOI 10.17605/OSF.IO/CUXYN. A multidatabase search strategy identified literature published between 2012 and 2022. A narrative description was used to report the study findings.Outcomes & ResultsThe search identified 2590 citations. The full paper screening was completed on 88 studies, with 17 studies included in data extraction. There was a wide range of terminology and assessment approaches which varied across different clinical settings. The most cited term was ‘muscle tension dysphagia’. The most common assessments tools were videofluoroscopy, fibreoptic endoscopic evaluation of swallowing and videostroboscopy, predominantly used in speech and language therapy and/or Ear, Nose and Throat settings. Gastroesophageal and respiratory investigations were less frequently cited.Main ContributionThis review details the current evidence related to the terminology and assessment tools cited in laryngeal hypersensitivity related dysphagia to improve clinician knowledge and understanding. Patient and stakeholder involvement indicated that future research needs to: optimize consensus of terminology, and improve consistent identification methods, service provision and treatment approaches.Conclusions & ImplicationsThis review highlights the lack of consistent terminology across the literature. A wide range of assessment tools report nonspecific positive clinical features and a lack of significant instrumental assessment findings. Patients and stakeholders identify the research priorities should improve clinician awareness, knowledge, guidance and evidence to support patient care.WHAT THIS PAPER ADDSWhat is already known on the subject Swallowing difficulties can occur in adults for a number of different reasons, such as neurological, respiratory or physiological conditions. Swallowing difficulties with no evidence of biomechanical or structural impairment on instrumental assessment and of unknown cause (termed idiopathic functional dysphagia or medically unexplained dysphagia) is a poorly understood phenomenon. More recently, concurrent oropharyngeal dysphagia and laryngeal hypersensitivity and/or muscle tension have been posited as a potential underlying mechanism.What this study adds to the existing knowledge This scoping review contributes to our expanding knowledge of the role of laryngeal hypersensitivity in dysphagia by providing an overview of the current evidence related to the terminology and assessment tools reported in the literature. Embedded patient and stakeholder involvement further deepens real‐world insights into the increased referrals for these individuals with increasing uncertainty in how to best assess, manage and support patients. Patients equally have reported that reduced professional awareness and inequalities in service delivery pathways result in poor patient experience and quality of life, and healthcare economic burden.What are the potential or actual clinical implications of this work? This scoping review draws our attention to an area of practice which has received little attention in both clinical practice and academic research. First, the study raises awareness of this population and the impact for services, speech and language therapists and clinicians; and second, highlights evidence–practice gaps with seldom consistency in the use of terminology and assessment approaches. The study provides priority research themes to expand our knowledge and understanding, as guided by the literature and patient and stakeholder input.

Parents' Perceptions of Schools' COVID-19 Mitigation Strategies: A Phenomenological Study.

At the onset of the COVID-19 pandemic, schools closed across the United States. Given the impact of virtual learning and lost access to school resources, schools eventually reopened with COVID-19 mitigation protocols in place. This qualitative study sought to understand parental perceptions of school-based COVID-19 mitigation strategies. Using a phenomenology approach, nine focus groups were completed with 40 parents of children in grades K-8 representing eight Maryland counties. Based on acceptance of masking policies (as indicated on a survey), parents were sorted into 2 groups-lower and higher masking acceptance. A thematic analysis was conducted for each group and themes were compared between the 2 groups. The main themes were related to parents' general sentiments regarding COVID-19, compliance, pandemic-related changes over time, changes in personal opinions, and in-person learning. Both groups described challenges related to inconsistent COVID-19 mitigation policies and practices, the challenges of rapid and frequent changes in guidelines during the pandemic, and the benefits of in-person learning. Parents of elementary and middle school children, regardless of general acceptance of masking policies, shared concerns about implementation and guidance regarding school-based mitigation strategies.