Integrated Program Research Articles

Inpatient dialectical behavior therapy combined with trauma-focused therapy for PTSD and borderline personality disorder symptoms: study design of the naturalistic trauma therapy study

IntroductionChildhood traumatization can result in physical and mental health problems in adulthood, such as post-traumatic stress disorder (PTSD), which negatively influences quality of life and social functioning. Although evidence based trauma treatments benefit clients with PTSD after childhood abuse and comorbid personality disorders, they are less effective than in clients who were traumatized in adulthood, and drop-out is substantial. The current study aims to assess the effects of inpatient dialectical behavior therapy combined with prolonged exposure (DBT-PTSD) on severity of PTSD, dissociation, parasuicidal behavior and borderline personality disorder (BPD) in clients with severe PTSD and comorbid psychiatric disorders. Secondary outcomes are social functioning, quality of life, borderline and cluster C personality disorder symptoms as treatment predictors, treatment trajectories, clients’ experiences and health economic consequences.MethodsThe naturalistic, longitudinal Trauma Therapy Study is conducted from January 2019 until May 2025 in a mental healthcare center in the Netherlands. Clients with severe PTSD and comorbid conditions who are referred to inpatient DBT-PTSD are included into the study. Based on power analyses a total sample size of N=56 is needed. Measurements take place before the waiting list period, at pre- and posttreatment and at six- and twelve-months follow-up. Clients fill in a daily DBT-PTSD diary, which gives insight into individual symptom trajectories.ResultsStatistical analyses include two-sided paired samples t-tests, linear mixed model analyses and cost-effectiveness analyses. Qualitative interviews are conducted within two years posttreatment and analyzed using a phenomenological approach. We correct for chance capitalization by using a conservative α-level of.01. Multiple imputation is used to handle missing data.DiscussionResearch on the effects of integrated treatment programs for clients with severe PTSD and co-morbid conditions is scarce. This study extends current knowledge on the effects of inpatient DBT-PTSD on PTSD and BPD symptoms, clients’ social functioning and quality of life. In addition, it provides insight into individual symptom trajectories and experiences, inspiring future treatment improvements for clients with severe psychopathology.Trial registrationMedical Ethical Committee approval (NL669060018, RTPO1044/01.10.2018). Preregistration: Dutch registration database Centrale Commissie Mensgebonden Onderzoek and International Clinical Trials Registry Platform (NL-OMON46167/01.10.2018/https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON46167).

Enhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project: Améliorer les programmes de traitement intégré pour les troubles mentaux et les troubles liés à l'usage de substances psychoactives graves et concomitants : aperçu de la problématique des surdoses dans le cadre du projet ROAR CANADA.

This paper summarizes methods and initial overdose-related results from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal observational study of individuals with severe concurrent substance use and mental disorders (also called dual disorders or dual diagnosis). The study sampled patients treated at two tertiary treatment centres in British Columbia, Red Fish Healing Centre and Heartwood Centre, along with a concurrent treatment unit at St. Joseph's in Ontario. These facilities have implemented evidence-based integrated treatment programs. Our first analysis explores selected baseline characteristics as potential risk factors for drug overdose in this population. Sociodemographic factors, trauma history, and impulsivity were part of a more comprehensive longitudinal assessment. In this first investigation, we use bivariate analysis and logistic and linear regression modelling to examine these variables in relation to overdose history. Overall, 291 of 450 participants (64.7%) reported a history of ≥1 overdose. Across the three centres, patients had a lifetime average of 7.6 (SD = 12.9) overdoses. The prevalence and mean number of overdoses were somewhat higher among Red Fish patients (74.5% and 8.5, respectively). Adverse childhood events, lifetime trauma history, and impulsivity were all high, but only lifetime trauma history emerged as significantly associated with overdose across all treatment centres. Impulsivity indicators were selectively associated with overdose by site, but not consistently within the overall sample. These results highlight the importance of prioritizing trauma-informed care in the treatment of individuals with severe concurrent substance use and mental disorders, who are at high risk of overdose. The integration of trauma treatment into existing programs may enhance patient outcomes and contribute to the ongoing evolution of effective care strategies for this complex population. These findings are particularly relevant in light of the overdose crisis.

Individualized Benefits and Access to Active Labor Market Programs Boost Refugee Women's Economic Integration

Individualized Benefits and Access to Active Labor Market Programs Boost Refugee Women's Economic Integration

FAMILY PSYCHOEDUCATION FOR SCHIZOPHRENIA PATIENTS: A LITERATURE REVIEW

Family psychoeducation provides in-depth information about schizophrenia, enabling families to better understand the patient's condition while alleviating their emotional distress. This intervention benefits not only patients but also their families by enhancing their understanding and skills in supporting the treatment process. Objective: To identify and summarize key findings from studies examining the effectiveness of family psychoeducation as an intervention for schizophrenia patients. Methods: This review employed a literature review methodology, with data collected from databases including PubMed, ScienceDirect, ProQuest, and Google Scholar. The search utilized relevant keywords, and the extracted data were analysed using the PICO framework, focusing on study characteristics, types of interventions, and outcomes. Reporting adhered to the PRISMA-SR guidelines. Included studies were English language randomized controlled trials (RCTs) that specifically addressed family psychoeducation for caregivers of schizophrenia patients and reported outcomes such as reduced caregiver burden, improved caregiving knowledge, and skills. Results: There were 17 articles containing 8 types of psychoeducational program that can be caried out on families of schizophrenia patients, namely Multifamily Psychoeducational Program, WeChat-based integrative family intervention program, Telehealth-Based Psychoeducation for Caregivers, Behavioral Family Psychoeducational Program, Mindfulness-Based Psychoeducation, Structured Psychoeducation, Family Psychoeducation, Group Psychoeducation. The intervention was given for a minimum of 4 sessions, and a maximum of 16 sessions. Conclusion: Family psychoeducation is an effective approach for improving family understanding, caregiving skills, and the quality of life for patients and families.

Efficacy of integrated cultural practices for dollar spot disease management on creeping bentgrass and bermudagrass

AbstractDollar spot, caused by Clarireedia spp., is one of the major challenges in golf course management. While individual cultural practices such as adequate nitrogen fertilization, thatch removal, aeration, and dew removal (DR) can reduce dollar spot severity, there are limited reports across multiple locations on the effectiveness of integrating multiple cultural practices for improved dollar spot suppression. Field studies were conducted in Wisconsin, Ohio, Pennsylvania, and Virginia to evaluate the efficacy of urea fertilizer, DR, and a plant growth regulator (PGR) in dollar spot management on golf course greens and fairways. Each of the three treatments had two levels including applied or not applied. Urea and early DR reduced dollar spot severity across several locations, while PGR did not affect disease suppression. In some locations, the two‐way and three‐way interaction effects were significant, where combining the treatments reduced disease severity compared to non‐treated plots or when only one treatment was applied. Overall, the urea application had the most notable and consistent impact on reducing disease severity, while the effectiveness of DR and PGR varied depending on the location and year. Results from this study provide insights into the development of an effective integrated management program for dollar spot.

Randomized clinical trial of a digital integrative medicine intervention among patients undergoing active cancer treatment

Exercise and mindfulness-based interventions have growing evidence for managing fatigue and comorbid symptoms; however, packaging them in a cohesive digital way for patients undergoing cancer treatment has not been evaluated. We conducted a randomized controlled trial to assess the impact of a 12 week digital integrative medicine program, Integrative Medicine at Home (IM@Home), versus enhanced usual care on fatigue severity (primary outcome), comorbid symptoms and acute healthcare utilization (secondary outcomes), in 200 patients with solid tumors experiencing fatigue during treatment. Fatigue severity decreased more in IM@Home than in the control (1.99 vs. 1.51 points; p = 0.04). IM@Home participants also had reduced symptom distress (p = 0.003), anxiety (p = 0.03), and depression (p = 0.02). Acute healthcare utilization was lower with IM@Home, with fewer emergency department visits (rate ratio 0.49; p = 0.04), hospitalizations (4% vs. 12.9%; p = 0.03), and shorter hospital stays (4.25 vs. 10 days; p < 0.001). These promising findings should be confirmed in phase III clinical trials. “Study registered at clinicaltrials.gov (NCT05053230) on 09-20-2021”.

Proposal for an Integrity Program Adapted to the Context of CISAN Municipalities

Este estudo propõe um programa de integridade adaptado às particularidades e capacidades institucionais dos municípios integrantes do Consórcio Intermunicipal do Semiárido Nordeste II da Bahia (CISAN), investigando os fatores institucionais que influenciam essa implementação e examinando as expectativas dos gestores de controle interno quanto aos impactos na governança municipal. Este estudo adotou uma abordagem qualitativa e exploratória, por meio de um estudo de caso múltiplo. Para isso, utilizou-se de duas fontes de dados: i) realização de entrevistas semiestruturadas com sete gestores de controle interno de municípios membros do CISAN, e, ii) análise de documentos oficiais. Os dados foram analisados por meio da técnica de análise de conteúdo, utilizando o software ATLAS.ti., agrupados em categorias e temas que possibilitaram a sistematização dos achados. Os resultados indicaram que a capacidade administrativa limitada, devido à escassez de recursos humanos qualificados e infraestrutura tecnológica insuficiente, é um dos principais obstáculos à implementação eficaz de programas de integridade. A estrutura organizacional centralizada e a resistência cultural interna também foram identificadas como barreiras significativas.

Refugee Integration and Peaceful Coexistence in Kenya: A Case of Kakuma Municipality, Turkana County, Kenya

An important and relevant research area was the integration of refugees and their peaceful living with the host community in Kakuma Municipality of Kenya. Kakauma is host to over 283, 969 refugees of different nationalities, the study aimed at evaluating the effectiveness of refugee integration programs in promoting peaceful coexistence between host and refugee communities in Kakuma, Kenya. Of the other concern of the study is to understanding the perception of the host community towards refugee integration and peaceful coexistence and assessing the efficiency in implementing the concept of refugee integration in concern to peaceful coexistence among groups. The study was anchored on Intergroup Contact Theory, the theory claims that people of different groups might reduce prejudice and harmony among the groups and favorable interface through contact. A mixed-methodologies approach to was the study was used, whereby both qualitative and quantitative data collection methods were used. The target population includes the Kakuma Municipality citizens and the Kakuma refugee camp residents that are approximately 439,708 people. The sample size of 400 was used for quantitative part by using Yamane‟s formula and the participants were selected purposively. The qualitative component comprised of 20 key informant interviews. For the quantitative component, data was obtained using structured questionnaires, while the qualitative component was acquired using semi-structured interviews. Quantitative data was examined using SPSS version 28.0, which included descriptive and inferential statistics such as Pearson’s correlation and multiple regression. Thematic analysis was used to examine qualitative data. The study’s goal was to give thorough insights on refugee integration and peaceful coexistence in Kakuma Municipality, which will help to influence refugee management policy and practice. The results revealed that perceptions of refugee integration, efficacy of integration programs were significantly and positively correlated with peaceful coexistence, with regression analysis showing that these factors explained 75.6% of the variance in peaceful coexistence. Key findings based on the objectives included: generally positive host community perceptions towards refugee integration and peaceful coexistence, with daily interactions, cultural exchange, and economic integration being important factors; the crucial role of access to healthcare services in promoting peaceful coexistence, with equal access, quality care, and addressing language barriers being key issues; the effectiveness of refugee integration programs in promoting peaceful coexistence, particularly when addressing diverse needs and involving local government support. Based on these findings, recommendations were made to engage the public in promoting positive perceptions and intensify efforts towards implementing effective integration strategies.

Azelaic Acid Induces Resistance in Coffea arabica Against Infection by Hemileia vastatrix, the Causal Agent of Coffee Leaf Rust

ABSTRACTCoffee leaf rust (CLR), caused by the fungus Hemileia vastatrix, is a very devastating disease affecting coffee production in many countries worldwide and causing yield losses that range from 15% to 50%. High CLR intensity on coffee trees impairs photosynthesis and causes intense defoliation resulting in fewer and smaller fruit berries on trees. New control methods for CLR that will reduce the use of fungicides and production costs need to be investigated and used in an integrated disease management program. In this study, it was hypothesised that azelaic acid (AzA), a C9 dicarboxylic acid (oxylipin) known to be involved in systemic acquired resistance, could boost defence reactions on the leaves of coffee (Coffea arabica, cultivar Catuaí Vermelho—IAC44) against infection by H. vastatrix. In the in vitro assay, urediniospores germination was significantly reduced (81%–86%) by AzA with concentrations from 1 to 20 mM. Fungal sporulation was much more intense on the leaves from water‐sprayed plants compared to leaves from AzA‐sprayed plants at both 22 and 30 days after inoculation (dai). The area under CLR progress curve and the intensity of fungal sporulation were significantly lower by 82% and 83%, respectively, and the incubation period was higher by 31% for AzA‐sprayed plants compared to water‐sprayed ones. The AzA‐sprayed plants infected by H. vastatrix displayed less photosynthetic impairments considering the greater values for rate of net CO2 assimilation, internal CO2 concentration, transpiration rate, and maximum photochemical efficiency of photosystem II compared to water‐sprayed and infected ones. On top of that, these plants displayed higher concentrations of chlorophyll a + b and carotenoids and a more robust antioxidative metabolism (increased ascorbate peroxidase, catalase, and glutathione reductase activities at 12 dai). Interestingly, activities of chitinase, β‐1,3‐glucanase, phenylalanine ammonia‐lyase, peroxidase, and polyphenoloxidase were lower for AzA‐sprayed plants as a result of reduced colonisation and sporulation of H. vastatrix in contrast to water‐sprayed and infected ones. Higher concentration of superoxide anion radical for AzA‐sprayed plants and infected by H. vastatrix at 12, 22, and 30 dai may have helped to reduce the colonisation of coffee leaf tissues by H. vastatrix besides having a citotoxic fungistatic effect against the fungus. These results strongly support the potential of AzA to negatively affect the germination of urediniospores from H. vastatrix as well as to hamper the infection process of H. vastatrix on coffee leaves.

Post-Acute Care Interventions in Patients Hospitalized Due to COPD Exacerbation Before and After Implementation of an Integrated Care Program.

In Switzerland, while the quality of acute inpatient care for patients with AECOPD is high, a lack of post-acute care interventions has been identified. To correct this shortfall, an integrated care program for patients with AECOPD was initiated at University Hospital Zurich. The study's aim was to compare defined post-acute care intervention implementation rates before and after the new program's implementation. A retrospective medical chart review was performed regarding patients hospitalized due to AECOPD between July 2019 and March 2023. The control group (CG) had received usual care, while the intervention group (IG) received the newly implemented program. Implementation rates were compared with Pearson's chi-squared-test or Fisher's exact test. Charts of 107 participants (IG: 55, CG: 52) were evaluated. Implementation rates increased significantly in the IG for exacerbation management, dyspnea management, recommendation for rehabilitation, smoking cessation advice, evaluation of inhalation technique and recommendation of vaccination (p < 0.05) but not for physical activity, post-discharge medical follow-up or nutrition. This study provides promising evidence that the introduction of a hospital-initiated integrated care program can significantly increase the implementation rate of post-acute care interventions in patients hospitalized due to AECOPD.

Developing and Implementing an Integrated Family Education Program (IPMD-F) for Parents of Children With Reading Difficulties: Insights From an Action Research Study.

This research aims to identify the problems and needs of families of children with reading difficulties, develop an Integrated Process-Based Family Education Program (IPMD-F) to address these needs, and implement it. The study used a community-based participatory action research approach, following a four-stage process: general information collection, needs identification and action plan creation, development and implementation of the IPMD-F, and evaluation. Conducted during the 2023-2024 academic year in Ankara, Turkey, with 16 volunteer parents of children diagnosed with learning disabilities, data were collected using qualitative and quantitative tools. Qualitative data were analyzed using thematic reflexive analysis, while quantitative data were analyzed using the Wilcoxon signed-rank test to determine pre-test and post-test score differences. Findings derived from a synthesis of personal development theory, a holistic approach, and a neurodiversity perspective revealed that the program assisted parents in attaining a holistic outlook, reinforcing parent-child communication, and cultivating coping strategies. Our assessment also substantiated the program's efficacy in practice. This study highlights that the IPMD-F can be a significant resource for families of children with reading difficulties and suggests broader implementation of such programs.

Prevalence, management, health-care burden, and 90-day outcomes of prolonged mechanical ventilation in the paediatric intensive care unit (LongVentKids): an international, prospective, cross-sectional cohort study.

The number of children requiring prolonged mechanical ventilation (PMV) has increased with the advancement of medical care. We aimed to estimate the prevalence of PMV worldwide, document demographic and clinical characteristics of children requiring PMV in paediatric intensive care units (PICUs), and to understand variation in clinical practice and health-care burden. This international, multicentre, cross-sectional cohort study screened participating PICUs in 28 countries for children aged >37 postgestational weeks to 17 years who had been receiving mechanical ventilation (MV; invasive or non-invasive) for at least 14 consecutive days. Screening days took place every 90 days for 3 years. Patients were eligible for inclusion in the analysis if they had been receiving MV (invasive or non-invasive) for at least 14 consecutive days by their first day of screening. Eligible patients were followed up on the subsequent screening day 90 days later or at time of hospital discharge, whichever came first. Outcome data were recorded in a validated web-based case report file. The primary outcome was the prevalence of PMV. Secondary outcomes were mortality, duration of MV, tracheostomy, and number of complications. All outcomes were assessed at 90 days post-screening. The study was registered with ClinicalTrials.gov, NCT04112459. Between Sept 4, 2019 and Dec 7, 2022, 14 595 children were screened on four separate screening days in 158 PICUs, and 2773 patients had been receiving MV for at least 14 days and were included in the analysis. The point prevalence of PMV was 25·8% (IQR 24·1-28·5). Median age was 0·4 years (IQR 0·2-5·3) and median weight was 8·1 kg (IQR 4·7-19·1). 625 (24·0%) of 2610 patients had a history of prematurity (<37 weeks gestational age at birth). 90-day outcome data were collected for 2430 patients. 441 (18·2%) of 2430 patients had died within 90 days. 649 (29·8%) of 2176 patients who initiated ventilation support upon hospital admission had a tracheostomy placed after the first 14 days of MV. The median time to tracheostomy placement after MV initiation was 26 days (IQR 18-52). 462 (21·2%) of 2176 patients had at least one failed extubation between MV initiation and their first screening date. 556 (25·6%) of 2174 patients who started MV upon hospital admission required MV for 21 days or less, whereas 1618 (74·4%) patients required MV for 22 days or more; 90-day mortality did not differ between these groups (18·2% vs 20·30%, p=0·288). Complications were recorded for 810 (38·4%) 2109 patients who initiated MV upon hospital admission; of these 539 (67%) had ventilator-associated pneumonia, and 212 (39%) of 539 patients had multiple episodes of ventilator-associated pneumonia. Timing of tracheostomy was variable, and duration of MV was longer than previously reported. The large variability in patients requiring MV and the associated health-care burden and outcomes across PICUs suggest that further investigation of the factors influencing the care of children with MV is warranted. Réseau en Santé Respiratoire du Québec (Respiratory Research Network of Quebec), Fonds de la recherche en santé du Québec, Women and Children Health Research Institute-Clinical/Community Research Integration and Support Program, Réseau mère-enfant de la francophonie. For the French and Spanish translations of the abstract see Supplementary Materials section.

The Effectiveness of an Integrative Coaching Psychology Intervention Program on the Well-Being of Parent with Preadolescent with Symptoms of Externalizing Disorders

The Effectiveness of an Integrative Coaching Psychology Intervention Program on the Well-Being of Parent with Preadolescent with Symptoms of Externalizing Disorders

Zn-doped CaP coating equips Ti implants with corrosion resistance, biomineralization, antibacterial and immunotolerant activities.

Chronic inflammation leading to implant failure present major challenges in orthopedics, dentistry, and reconstructive surgery. Titanium alloys, while widely used, often provoke inflammatory complications. Zinc-doped calcium phosphate (CaP) coatings offer potential to enhance implant integration by improving corrosion resistance, bioactivity, and immunocompatibility. The objective of the study was to develope novel coating composition based on zinc-doped CaP coatings on Ti64 alloy implants that for the first time combines improved corrosion resistance, antibacterial properties and principally improved compatibly with the innate immunity primarily due to the proper programming of resident tissue macrophages to promote long-term implant acceptance. Ti64 substrates were coated with CaP and Zn-doped CaP using the microarc oxidation (MAO) technique. The adhesion between substrate and coatings are investigated by the progressive scratch test. The corrosion resistance and bioactivity were evaluated through electrochemical tests and simulated body fluid immersion. RNA sequencing was used to assess inflammatory responses in human primary macrophages. Antibacterial efficacy was tested against Escherichia coli and Staphylococcus aureus. Zn addition significantly increased the adhesion of the coatings to Ti64 alloy, doubling up the critical load (from 4 N to 11 N). Zn-doped CaP coatings demonstrated enhanced corrosion resistance and increased biomineralization. RNA sequencing revealed that Zn addition suppressed inflammatory and promoted tolerogenic macrophage programming. Most pronounced effects was compensatory effect Zi on the CaP-supressed oxidative phosphorylation and lysosomal pathways in healing macrophages, and by upregulation of metallothioneins. Zn-doped coatings also exhibited superior antibacterial efficacy, reducing E. coli and S. aureus colonization by 99 % and 90 %, respectively. Zinc-doped CaP coatings on Ti64 implants significantly improved corrosion resistance, bioactivity, and antibacterial performance. We developed advanced multifunctional biomaterial equipped with beneficial anti-inflammatory and tissue integrative programming of innate immunity providing principal advantages for the long-term implant integration and reducing the implant failure risks.

A evolução dos programas de integridade sob a ótica do Empresa Pró-Ética

The Empresa Pró-Ética is an initiative aimed at promoting the voluntary adoption of integrity prac­tices through the assessment of specific requirements, whether they are legal or best practices. This study’s main objective is to address its historical evolution and implemented modifications, in order to evaluate what an ideal integrity program would look like from this perspective. To achieve this, a comparative study of the main pillars, requirements, and documents demanded throughout its editions is conducted. There is a noticeable continuous improvement in the required criteria, as well as adaptations made over time, which reflect expectations regarding what constitutes an effective integrity program.

국내 통합시뮬레이션 간호교육에 대한 통합적 문헌고찰

Objectives This study aimed to identify trends in research on integrated simulation nursing education in Korea and to comprehensively examine its effects. Methods Literature up to June 2024 was searched using Korean and English keywords. RISS, KISS, DBpia, and PubMed were used for literature searches. The study followed the five steps suggested by Whittemore and Knafl: problem identification, literature search, data evaluation, data analysis, and data presentation. Results The 19 selected studies were published between 2012 and 2024. Nine studies employed a one-group quasi-experimental design, and 16 studies focused on fourth-year nursing students. A human patient simulator was used in 13 studies. Fourteen studies integrated scenarios from various nursing majors within a single course, while four studies used scenarios integrating two or more nursing majors. One study combined nursing major-specific scenarios with integrated scenarios. Among the cognitive domains, problem-solving ability was the most frequently measured variable, with all five studies reporting significant results. In the affective domains, self-efficacy was the most commonly measured variable, with seven studies, four of which reported significant results. Clinical competence was measured in the psychomotor domain, with all eight studies reporting significant results. Conclusions The findings of this study suggest that integrated simulation nursing education effectively enhances cognitive, affective, and psychomotor skills in nursing students. Future efforts should focus on developing stage- and grade-specific integrated simulation education programs, as well as integrated simulation education that connects various nursing majors.

Nigeria's Sugar Industry: Challenges, Opportunities, and Prospects for Self-Sufficiency

The sugar industry in Nigeria is relatively young, having been established in the 1960s. However, it has not yet reached its full potential, as it currently only supplies about 5% of the country's sugar demand. This lack of performance has led to the loss of foreign exchange earnings and hundreds of thousands of employment opportunities. The Nigerian Sugar Master Plan (NSMP) predicts that the country's sugar demand will exceed 1.7 million metric tonnes by 2020, and to meet this demand, the country needs to establish 28 sugar factories and cultivate 250,000 hectares of land for sugarcane over the next 10 years. Private investors will provide most of the investment capital. The government has enacted various policy instruments, including fiscal incentives, tariffs, and the Backward Integration Program (BIP), to create a conducive policy environment for the sugar industry's development. The Sugar Levy will also fund research and development studies and essential infrastructure. These policies aim to attract new investors and protect existing and new investments in the sugar sector. The approval of the NSMP and the adoption of the conducive policy environment demonstrate the government's commitment to revitalizing the sugar industry and making it a crucial part of the nation's industrial landscape. This paper highlights the progress made in the first ten years of the NSMP's BIP, the establishment of the Nigeria Sugar Institute, and the expected increase in sugar production in NSMP phase II.

Strategies for Enhancing Co-existence in Diverse Social Groups

Co-existence is a pleasing word to converse, but an intricate word to believe and follow in a real-life situation. This article aims to suggest effective strategies for enhancing co-existence in diverse social groups. To attain these objectives, the secondary data were congregated through a comprehensive review on co-existence and the strategies for enhancing co-existence from books, journal articles, and website materials published from the year 1971 to 2024. The article employed exploratory research and operated thematic analysis as its qualitative research design. It identifies. promoting inclusive education, encouraging intercultural dialogue, supporting community engagement initiatives, implementing anti-discrimination policies, promoting social integration programs, facilitating interfaith initiatives, encouraging multicultural policies, supporting civil society organizations, and promoting economic inclusion as the effective strategies for enhancing co-existence in diverse social groups. This article provides exquisite insights for leaders, policymakers and citizens, emphasizing that the feeling of co-existence is essential for the overall well-being of a nations and its citizens.

Who works! from fragmentation to coherence through collaborative, constructive communication

PurposeThe paper seeks to assist public sector leaders to take a balanced and impactful approach to transformation programmes which aim to deliver integrated healthcare. The paper highlights the balance of attention paid in these programmes across elements of leadership, strategy, structure and people, and aims to highlight where this balance can sit to encourage more successful and sustainable transformations, with an increased focus on interpersonal and inter-professional engagement and interaction across workforce and service users.Design/methodology/approachThe project involved a literature review which identified themes that were in turn used to inform an approach to a desk review of journal articles written about past integration programmes in healthcare. A coding framework was developed to assess the articles in the desk review to identify where the focus of attention lay in the approaches to integration.FindingsThere is a spread of activity across all four themes (leadership, strategy, structure and people) in the assessed cases, but the emphasis tends to be towards static, short-term approaches, with a noticeable lack of focus on the aspects required to deliver long-term sustained transformation. There is a need for improved balance between structural and relational approaches to transformation.Research limitations/implicationsThe paper focuses on nine examples of transformation programmes and would benefit from further development and use of the coding framework.Practical implicationsThe framework that emerges from this project can contribute to the development of a proactive model to assist transformation leads and decision makers bring a more balanced, thoughtful and impactful approach to integrating health and care services. In particular, the findings point to an overuse of structural approaches to change and transformation, which could include project management methods, for example, which become the product of the initiatives, rather than enablers of leaders’ visions and people’s interpersonal and interprofessional engagement and interactions.Originality/valueBuilding on existing research, this paper makes a valuable contribution to the discourse on how to deliver the required health and care integration agenda in a more accessible way and sustainably, moving away from short-term, quick-fix approaches and considers how to accommodate the role of interpersonal interaction as the vehicle for change.

International Medical Graduate Integration into the Sunshine Coast Hospital and Health Service (SCHHS): A practice note

Australia’s healthcare workforce shortage demands innovative solutions to ensure the delivery of high-quality healthcare. International Medical Graduates (IMGs), particularly those on the standard pathway—doctors whose primary medical qualifications are obtained in non-comparable healthcare systems such as those outside the UK, USA, Canada, Ireland, or New Zealand—play a crucial role in bridging workforce gaps. However, transitioning into the Australian healthcare system presents significant challenges for these IMGs, including adapting to clinical practices, communication styles, and cultural norms. This practice note outlines the Sunshine Coast Hospital and Health Service’s (SCHHS) comprehensive IMG integration program, specifically designed to address the unique needs of standard pathway IMGs. The program, structured into three phases—robust selection, structured orientation and onboarding, and ongoing mentorship—has demonstrated high retention rates, enhanced IMG confidence, and positive feedback from both participants and supervisors. Key findings from the SCHHS initiative underscore the importance of early, structured support in mitigating the difficulties faced by IMGs during their transition. This model provides a scalable approach to improving IMG integration, enhancing patient safety, and addressing critical healthcare workforce shortages across Australia.