Independent Decisions Research Articles

Cognitive Reapportionment and the Art of Letting Go: A Theoretical Framework for the Allocation of Decision Rights

ABSTRACT We have entered an era where, in addition to us humans, systems can also think. It is imperative to decide how decision rights and authorities are allocated and distributed across interconnected co-cognitors: things that think. To address this question vital to the redesign of organizations, we reconceptualize cognitive reapportionment as the dynamic reallocation of decision rights and authorities across human and system co-cognitors capable of independent decision making. We articulate the Helix Model of Decision Journeys, wherein decision journeys, comprised of decision elements allocable to human or system co-cognitors, interweave and integrate business processes. The dynamic reapportionment of cognitive responsibilities across co-cognitors is dependent upon the type of scientific reasoning—deduction, induction, or abduction—at each decision element. We further propose two intertwined mechanisms for the art of letting go that facilitate the adoption of the Helix model. First, the nexus of omnipresent system co-cognitors collectively needs to evoke trust. Only when Technology Trust Thresholds are exceeded can decision making be reorganized and control relinquished to system co-cognitors. Second, the world of omnipresent cognitors will compel us to redesign, reprogram, and remix our workflow and business processes. Only through a purposeful effort to Redesign in the Remix Regime can the deduction-induction-abduction nature of decision tasks serve as the basis for their reapportionment.

Acceptance of Mass Drug Administration for Prophylaxis against Lymphatic Filariasis in a Tribal Endemic Area: A Descriptive Cross-sectional Study.

India is at a critical stage to eliminate filariasis. Uncovering the factors governing may help taking appropriate measures to achieve the goal. This study evaluated the acceptance of "mass drug administration" (MDA) for prophylaxis against filariasis and the factors facilitating and interfering with it. A cross-sectional study was conducted in a tribal endemic area of India from May 2022 to October 2022. A validated 29-item self-administered questionnaire was used to collect the data. Items were grouped under "knowledge," "social processes," "think and feel," "practical factors," and "motivation/hesitancy" domains. Of 101 participants, majority were aware of the disease (92.1%), its vector (74.3%), at least one disability caused (87.2%), and governmental scheme of MDA (69.3%). Two-thirds never received and 85.1% did not receive MDA within 1 year. 68.3% refused of distribution of MDA to their doorstep. Majority were concerned for getting MDA for self and their family/friends; however, 49.5% showed inability to take independent decision. More than 30% disagreed to get MDA had it been available. The region with the highest concerns for adverse drug effects showed minimum MDA consumption than others (P < 0.05). MDA acceptance/consumption was significantly associated with knowledge about disability caused, distribution of drugs by a health-care representative to doorstep, behavior of the representative, and concerns about potential adverse drug effects. MDA coverage was inadequate in the study population. Level of knowledge, practical difficulties in getting drugs, inapt thinking/concerns, motivation, awareness about disabilities caused, door-to-door drug distribution, and behavior of health-care representative(s), were identified as factors significantly affecting acceptance of MDA.

Daily ranging and den usage patterns structure the spatiotemporal properties of social encounters in spotted hyenas

Fission–fusion dynamics describe the tendency for members of some animal societies to associate in subgroups that change size and structure fluidly over time. These dynamics shape social complexity and social structure, but are difficult to study because they unfold simultaneously over large spatial scales. Here we use simultaneous, fine-scale GPS data from spotted hyenas to examine fission–fusion dynamics through a dyadic analysis of merge-split events between pairs of individuals. We introduce a species-agnostic framework for identifying merge-split events and discretizing them into three phases (merging, together, and splitting), enabling analysis of each phase as well as the connections among phases. Applying this framework to the hyena data, we examine the temporal and spatial properties of merges and splits between dyads and test the extent to which social encounters are driven by key locations. Specifically, we focus on communal dens—shelters for juvenile hyenas where classical observational studies often report large aggregations of adults. We find that overall, 62% of merges occurred at communal dens, supporting the idea that dens facilitate meet-ups and subsequent social behavior. Social encounters most commonly involved close approaches within a few meters between hyenas, while co-travel together occurred in only 11% of events. Comparison to permutation-based reference models suggests that independent movement decisions structure broad-scale patterns of social encounters but do not explain the fine-scale dynamics of interactions that unfold during these encounters. We reflect on how physical features such as dens can become social hotspots, causing social and spatial processes to become fundamentally intertwined.

Prediction of Stunting in Toddlers Using Bagging and Random Forest Algorithms

Stunting is a condition of failure to thrive in toddlers. This is caused by lack of nutrition over a long period of time, exposure to repeated infections, and lack of stimulation. This malnutrition condition is influenced by the mother's health during pregnancy, the health status of adolescents, as well as the economy and culture and the environment, such as sanitation and access to health services. To find out predictions of stunting, currently we still use a common method, namely Secondary Data Analysis, namely by conducting surveys and research to collect data regarding stunting. This data includes risk factors related to stunting, such as maternal nutritional status, child nutritional intake, access to health services, sanitation, and other socioeconomic factors. This secondary data analysis can provide an overview of the prevalence of stunting and the contributing factors. To overcome this, the right solution is needed, one solution that can be used is data mining techniques, where data mining can be used to carry out analysis and predictions for the future, and provide useful information for business or health needs. Based on this analysis, this research will use the Bagging method and Random Forest Algorithm to obtain the accuracy level of stunting predictions in toddlers. Bagging or Bootstrap Aggregation is an ensemble method that can improve classification by randomly combining classifications on the training dataset which can reduce variation and avoid overfitting. Random Forest is a powerful algorithm in machine learning that combines decisions from many independent decision trees to improve prediction performance and model stability. By combining the Bagging method and the Random Forest algorithm, it is hoped that it will be able to provide better stunting prediction results in toddlers. This research uses a dataset with a total of 10,001 data records, 7 attributes and 1 attribute class. Based on the test results using the Bagging method and the Random Forest algorithm in this research, the results obtained were class precision yes 91.72%, class recall yes 98.84%, class precision no 93.55%, class recall no 65.28%, and accuracy of 91.98%.

Theorizing the governance of direct and indirect transactions in multi‐tier supply chains

AbstractAn outsourcing decision does not equate to the outsourcing of a sourcing decision. Many indirect transactions with lower tier suppliers are embedded in transactions with first‐tier suppliers. Building on the identification of a transaction as the fundamental unit of analysis, this study proposes that transactions comprise bundles of intertwined direct transactions at the firm level and indirect transactions at the supply chain level. These indirect transactions require separate but not independent sourcing decisions. Using a buyer's decision to control or delegate the governance of indirect transactions for an externally sourced product, this study demonstrates that disaggregating the transaction advances theory by extending the range of outcomes, refining the calculus of the make‐or‐buy decision, and providing a coherent theoretical framework for multi‐tier supply chain management. This study considers the theoretical, managerial, and societal implications across various contingencies involving inter‐firm relationships.

Towards smarter cyberthreats detection model for industrial internet of things (IIoT) 4.0

Recently, Artificial Intelligence (AI) has been applied to the Internet of Things (IoT) as well as Industrial IoT 4.0 (IIoT). This has improved the autonomous behavior of smart things in terms of making independent and smart decisions. However, AI techniques are the target of many attacks like the poisoning of training data and the evasion attack. In this context, blockchain can be joined to AI methods to protect their execution. In this paper, we propose SmarterChain to safely detect cyberthreats in IoT. First, we train and generate machine learning models for cyberthreats detection. Next, we protect these models by embedding them on the blockchain. Fi- nally, the models are used by intelligent devices anywhere to facilitate safe decision-making regarding cyberthreats. In addition to identifying the type of attack, our proposed solution outperforms previous detection methods, using the same dataset, in terms of safety ensured by smart contracts, with low overhead due to deployment and runtime.

OPC UA DRIVEN AUTONOMOU DECISION MAKING IN INDUSTRIAL IOT

The creation of autonomous and intelligent devices for manufacturing firms has been made possible by the Industrial Internet of Things and the progress made in machine-to-machine communication. These autonomous machines are able to collect data from various sensing devices and other related machine systems by using communication protocols such as OPC UA. Here we perform machine to machine communication through an Arduino microcontroller. Any board or computer with a full-size USB A host connector can be connected to the Arduino with the help of a USB-A to USB-B cable. The communication takes place over the serial port (USART/UART). Machines can currently send and receive enough data to enable independent decision-making. Existing low-level machine-to-machine communication only involves data processing, and higher-level decision-making processes are limited to a single machine system rather than communications amongst networked machines. The goal of this effort is to employ OPC UA protocols to improve these limitations in machine-to-machine communication. This could mean deciding how to respond to receiving information and directing both horizontally (same level machines) and vertically (higher level machines) connected equipment. Proactive machine-to-machine communication improves factory intelligence in this way. Keywords: M2M,OPC UA,IIOT

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria

BackgroundThe global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear.MethodsThis cross-sectional study surveyed medical students’ and residents’ attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice.ResultsThe study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes.ConclusionsAccording to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services.Trial registrationThe study has not been registered as it did not include a direct medical intervention on human participants.

Do adolescents use choice to learn about their preferences? Development of value refinement and its associations with depressive symptoms in adolescence.

Independent decision making requires forming stable estimates of one's preferences. We assessed whether adolescents learn about their preferences through choice deliberation and whether depressive symptoms disrupt this process. Adolescents aged 11-18 (N = 214; participated 2021-22; Female: 53.9%; White/Black/Asian/Mixed/Arab or Latin American: 26/21/19/9/8%) rated multiple activities, chose between pairs of activities and re-rated those activities. As expected, overall, participants uprated chosen and downrated unchosen activities (dz = .20). This value refinement through choice was not evident in younger participants but emerged across adolescence. Contrary to our predictions, depressive symptoms were associated with greater value refinement. Despite this, more depressed adolescents reported lower value certainty and choice confidence. The cognitive processes through which choice deliberation shapes preference develop over adolescence, and are disrupted in depression.

Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study.

To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles. In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis. Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches. The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making. The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

Dynamic strategy for low-carbon supply chain considering retailers competition and technological innovation

This paper discusses how managers adjust their strategies to allocate relevant resources more effectively and maximize economic benefits when major technological changes are predicted for the future. For a supply chain system consisting of a single manufacturer and two competing retailers as the research object. First, random stop model is applied to portray the impact of technological innovation on the decision-making of supply chain members. On this basis, differential game models for supply chain members are constructed based on different cooperation modes, including centralized, decentralized, and retailers alliance. Second, we solve and compare the optimal decision-making, emissions reduction, low-carbon goodwill, and profit levels before and after technological innovation in different modes. Finally, we design a bilateral cost-sharing contract to achieve coordination. Results demonstrate that: (1) Before the success of technological innovation, when a higher probability of success and uplift rate is predicted can incentivize supply chain members' emissions reduction and low-carbon promotion inputs; (2) In the presuccess period of technological innovation, members' independent decision-making (decentralized decision-making) can optimize the retailer's low-carbon promotional inputs under certain conditions. In contrast, the optimality of decentralized decision-making after technological innovation depends only on the influence of competition intensity. (3) The bilateral cost-sharing contract designed in this paper can optimize supply chain-related inputs and performance levels to achieve perfect coordination within the supply chain system, given that specific preconditions are satisfied.

Experiences of Intersubjectivity and Agency in Human–Horse Relationships Differ Between Box- and Open-Shed-Stable Environments

ABSTRACT Human–horse relationships can be experienced in many ways and the horse companion can be given various roles, from a partner in action to a tool or commodity. How humans experience connection with horses and what kinds of roles are assigned to them may reflect or even depend on the real-life co-actions and environments. In this study, we assessed experiences of intersubjectivity in human–horse relationships, focusing particularly on whether and how agency and emotional and embodied intersubjectivity with the horse were discussed by horse owners. We conducted the study in two different stable environments, namely box stables and open-shed stables, that differ particularly in the horses’ possibilities to execute independent decision-making in their daily lives. We conducted semi-structured interviews of 25 horse owners and analyzed them using theory-guided qualitative content analysis for notions of agency and intersubjectivity. Overall, while there were only a few explicit accounts of embodied intersubjectivity in action, it was most explicitly apparent in descriptions of hacking and doing other things than riding. Additionally, intersubjectivity was apparent in descriptions of horse emotions. There were several differences in the horse owners’ accounts at the different stable environments. Respondents at the open-shed stables assigned agency more often to the horse or simultaneously themselves and the horse, discussed more often horse emotions, and emphasized hacking, playing, or just being with the horse as meaningful co-actions. At the box stables, accounts emphasizing competing, self-evidence of riding as the main activity, and human agency in co-action were more common. These results show that the management environment and forms of co-action are connected to the thoughts and views equestrians have on agency and experiences of intersubjectivity in horse–human relationships.

An Empirical Study on the Dynamic Impact of Monetary and Fiscal Policies on the Herding Behavior among Manufacturing Companies

This paper investigates the dynamic interplay between monetary and fiscal policies and their influence on herding behavior among manufacturing companies in China. Herding behavior, characterized by the tendency of firms to mimic the actions of others rather than making independent decisions, can significantly affect market stability and efficiency. The study employs a comprehensive dataset spanning a period that encompasses various monetary and fiscal policy interventions, alongside fluctuations in market conditions. Using advanced econometric techniques, including Vector Autoregression (VAR) models and Granger causality tests, we analyze the short-term and long-term effects of monetary and fiscal policies on herding behavior within the manufacturing sector. The study also examines the moderating role of firm-specific characteristics such as size, industry, and financial health on the relationship between policies and herding behavior. Preliminary findings suggest a complex and dynamic relationship between policy interventions and herding behavior. Monetary policy tools, such as interest rate adjustments and open market operations, exhibit significant short-term effects on herding behavior, influencing firms' decisions to follow prevailing market trends. Similarly, fiscal policy measures, including tax incentives and government spending, demonstrate varying degrees of impact on herding behavior, contingent upon the economic context and firms' financial positions. Furthermore, the study explores the transmission channels through which monetary and fiscal policies influence herding behavior, including their effects on market liquidity, risk perceptions, and investor sentiment. Understanding these mechanisms is crucial for policymakers and market participants to anticipate and mitigate the adverse effects of herd behavior on market stability and efficiency. In conclusion, this empirical study contributes to the existing literature by providing insights into the dynamic relationship between monetary and fiscal policies and herding behavior among manufacturing companies in China. The findings have important implications for policymakers aiming to design effective policy interventions to foster a more resilient and stable market environment, ultimately promoting sustainable economic growth and development.

THE PEDAGOGICAL INFLUENCE OF RELIGIOUS EDUCATION ON THE LEGAL CONSCIOUSNESS OF A STUDENT

Purpose. The article is devoted to the problem of the influence of religious consciousness on the legal students’ consciousness. The purpose of this work is to study the influence of religious education on the formation of legal consciousness of schoolchildren and students in the modern Russian sociocultural situation. The work is aimed at identifying the role of religiosity and traditional values in maintaining high moral principles, the unity of society, as well as determining the effectiveness of the pedagogical impact of religious education on the legal consciousness of young people. Methodology. The work analyzes domestic and foreign research on the influence of religious education on legal consciousness. At the same time, attention is focused on research that is related to the pedagogical impact of religious education on legal consciousness. Results. The author comes to the conclusion that it will be effective to introduce into teaching activities a block of subjects related to religious education of a supra-confessional nature, promoting unity and education of citizens based on common values. The effectiveness of modern education is associated not only with knowledge, but also with internal comprehension, which requires independent decisions of students. Religious education and its pedagogical method, based on love and care, taking into account the priority of spirituality, is capable of shaping civic identity. The role of dialogue, creativity and project work is important for deep understanding and value development, promoting the creation of a society based on mutual understanding and respect. Religious education in such a context acts as a basis for dialogue and mutual understanding, which provides the basis for mutual respect and peaceful coexistence between different religious traditions. Practical implications. Research can be used to update the educational system, introducing new approaches to learning based on mutual understanding, respect and dialogue. This includes the development and implementation of modules related to religious education, of a supra-confessional nature, which can promote unity and the education of citizens on the basis of common values. The results of this work can be applied both in the training of teachers and directly within the framework of the organization of legal education in educational organizations.

«Україні потрібні генералісти»: розмисли про роль та призначення сучасної освіти

In his exclusive interview with our magazine, the Estonian sociologist, philosopher, expert in the field of education reform, professor emeritus of the University of Tartu, Ülo Vooglide, reflects on the role and purpose of education in educating a generalist of his own ideas, and not an executor of someone else’s decisions. The researcher believes that educational institutions should focus on creating an environment in which the child’s inner potential will be revealed, nurturing his individuality, taking into account dreams and needs. A person and his talents are the main asset of the people. The scientist draws attention to the fact that the result of education is not the amount of acquired knowledge, but the ability and ability of a person to use the knowledge resource in solving practical tasks and life situations. The ability to make independent decisions, effectively solve practical situations and calculate the consequences of one’s actions, etc., is much more important than “filling the head” with ready-made information. Quality education becomes a global value and a categorical condition for competitive strategic development of society. At the same time, the creation and construction of quality education will contribute to the development of Ukrainian society, will allow education to be at the forefront of new social changes.

"What Works" to Support LGBTQ+ Young People's Mental Health: An Intersectional Youth Rights Approach.

Despite overwhelming international evidence of elevated rates of poor mental health in LGBTQ+ youth compared to their cis-heterosexual peers, we know relatively little about effective mental health services for this population group. This study aims to produce the first early intervention model of "what works" to support LGBTQ+ youth with emerging mental health problems. Utilizing a mixed method case study, we collected data across 12 UK mental health service case study sites that involved: (a) interviews with young people, parents, and mental health practitioners (n = 93); (b) documentary analysis; (c) nonparticipant observation. The data analysis strategy was theoretical using the "explanation-building" analytical technique. Our analysis suggests an intersectional youth rights approach with 13 principles that must be enacted to provide good mental health services as advocated by the United Nations Convention on the Rights of the Child and World Health Organization. This approach should address the multiple forms of marginalization and stigmatization that LGBTQ+ youth may experience, enable informed independent decision-making, and uphold the right to freedom of safe self-expression. A rights-based approach to mental health services for LGBTQ+ young people is not prominent. This needs to change if we are to tackle this mental health inequality and improve the mental well-being of LGBTQ+ youth worldwide.

Agent-based simulation model to evaluate government policies for farmers’ adoption and synergy in improving irrigation systems: A case study of Lake Urmia basin

The complexities of water issues, in which human factors directly affect the qualitative and quantitative indicators of water resources in a variable, extensive, and undefined manner, make social interactions necessary for the water resources sustainable development. In this situation, local government admins (local divisions of the Water Institutions and Ministry of Agriculture) (LGA) can play a fundamental role in attracting the participation of independent farmers in sustainable agriculture and preserving water resources by modifying support policies. In this study, an agent-based simulation model of social interactions and economic interests of farmers is presented along with different scenarios of support policies as well as random supervision and training by LGA agents to evaluate its impact on the independent decision making of farmers in the form of a complex adaptive system. Questionnaires and expert interviews were used to determine the data and scenarios. Farmers’ adaptation for development technology in irrigation management (DTIM), simulated output of WP, field application efficiency (FAE), and their adaptation speed are influenced by input factors such as assumed cost of sustainable water supply (SWS), mean government expenditure (subsidy count), and the level of supervision and training by LGA. The results showed that the assumed cost of SWS and government supervision and training are the most influential indicators of the farmer agent’s propensity to DTIM with F-value=4375.59 and F-value=1055.10, respectively. The results confirm that appropriate policies in strengthening LGA supervision and training and increasing farmers’ awareness of the importance of long-term water resource sustainability can help achieve more adaptability.

Three-phase multi-criteria ranking considering three-way decision framework and criterion fuzzy concept

The criterion fuzzy concept refers to a fuzzy set that represents the decision-maker's subjective preference for each criterion within the universe of criteria. Addressing the challenge of ranking all alternatives based on a given criterion fuzzy concept is a novel research direction in the field of fuzzy multi-criteria ranking issues. This paper proposes a three-phase approach for multi-criteria ranking in fuzzy environments, which combines the criterion fuzzy concept and three-way decision thinking. The proposed approach not only analyzes the decision-making characteristics of all alternatives but also facilitates their ranking. During the first phase, a qualitative classification method based on the criterion fuzzy concept and ideal solutions is defined, which divides all alternatives into three independent decision sub-regions. During the second phase, by analyzing the priority relationships among the alternatives within every sub-region, three local ranking rules for alternatives are proposed to determine the ranking of alternatives in each classification region. During the third phase, the semantic relations among three classification regions are considered to give an overall ranking of all alternatives. Finally, combined with two existing quantitative ranking indicators, multiple data sets are employed to verify the feasibility and superiority of the proposed three-phase multi-criteria ranking approach.

What motivates independent directors to join or leave boards? The interplay between director incentives, director decisions, and firm outcomes

AbstractReputation, monetary, risk, and workload incentives affect independent directors' decisions to join new or leave existing board of directors' seats, impacting their directorship portfolios. Using a director's perspective and relative incentive proxies, we find that directors strategically relinquish less prestigious board seats to increase their reputation. Similarly, we hypothesize and find that accepting an additional board nomination is incentivized by a director's goal to achieve higher reputation growth. Lastly, by taking on a firm's perspective, we find a positive association between the board's aggregated portfolio reputation and risk propensity with firm performance and earnings management.

The Effect of the COVID-19 Pandemic on Palestinian Patients Attending Selected Governmental Hospitals: An Analysis of Hospital Records.

Confronting the COVID-19 epidemic forced the closure or relocation of the majority of health facilities. It is likely that non-COVID-19 patients suffered collateral effects. The clinic and operating room records were analyzed at selected Palestinian government hospitals in the West Bank region. The reduction in patient clinic visits varied from 49% to 90%, with Ear-Nose-Throat (ENT), urology, and pediatric clinics being the most affected. The reduction in operation numbers in the center (which had independent decision-making) ranged from 7.1% to 23.4%, but in the north and south (which followed centralized choices), the reduction ranged from 19.6% to 91.8%. COVID-19 affected outpatient visits. The pandemic affected some services, but West Bank hospitals were able to provide normal obstetric and gynecological treatments and help patients who needed primary or intermediate surgery.