Local Policy Research Articles

The Role of the Public Health Workforce in Securing Political Commitment for Tackling Childhood Obesity in Local Government

Local government is well placed to provide leadership for the national ambition in England to halve childhood obesity by 2030 and has delegated authority for many policies thought necessary for effective action. However, with currently constrained local government finances, resources may not be prioritized for the wide range of policies and interventions necessary. Thus, local political commitment is vital for directing local government investment to tackle the issue. This qualitative study investigated how political commitment has been demonstrated in local government, the strategies used to build such political commitment, and the role of the public health workforce. Public health staff from 13 local authorities participated in semi-structured telephone interviews using questions informed by a conceptual framework composed of five previously defined levels of political commitment: rhetorical, institutional, operational, embedded, and system-wide. Thematic analysis showed that public health officers secured a political commitment by framing childhood obesity in line with existing priorities to build support among councillors in a position to advocate for the issue. Public health officers also engaged with multiple stakeholders, gathering data and insights to develop operational and embedded commitment. The study shows that effective health promotion practice requires a skilled and committed public health workforce, acting as policy entrepreneurs to secure system-wide political commitment in local government by proactively navigating local governance and policy processes, to build in opportunities for feedback and accountability.

Tourism challenges within a high cost of living crisis

Living costs have been increasing at an unprecedented rate compared to average trends over the last decade due to increasing uncertainty from various global events, including the COVID-19 pandemic and geopolitical tensions. Previous research indicates that people prioritize essential consumption over leisure and tourism activities during high cost-of-living crises. However, prior studies have overlooked the spatially heterogeneous resilience of local tourism demand to the crisis, which differs by region with each possessing unique characteristics. This study aims to explore how the resilience of tourism demand shifted during the high cost-of-living crisis over space and time. Findings reveal spatially and temporally varied resilience in domestic and international tourism demand across regions. These findings offer crucial insights for developing localized tourism management policies amid high costs of living.

Local Governance and School-based Approaches to English Language Acquisition: A Comparative Analysis

In order to improve the effectiveness of English acquisition, it is necessary to discuss it in conjunction with local governance policies. Local governments should conduct an analysis of English acquisition from the aspects of policies, systems, and social participation. This paper puts forward three hypotheses: local policies and systems can improve the effectiveness of English learning, which are related. Public attention can promote the improvement of English acquisition effect and play a supervisory role; Laws and regulations can ensure the foundation of basic conditions for English acquisition and promote the improvement of school infrastructure. The results show that local policies and institutions are the conditions for improving English acquisition methods, social attention is the condition for verification, and school infrastructure is the key condition. Social issues, local policies and institutions all play an indirect role in promoting English language acquisition, while infrastructure plays a direct role. Therefore, local governments should improve English acquisition policies and systems, promote the introduction of English acquisition laws and regulations, and guide the public to supervise.

Integration of Teaching Resources for English Majors under Local Autonomy: Collaboration and Development

In the process of local social governance, educational resources are the basic conditions for social governance, so the integration of English education resources has become the main research aspect of local governments and educational institutions. The integration of key educational resources needs to be supported by local education policies, education systems and education laws, and the corresponding regulations and laws should be improved, and the English cognitive level of the public and the environmental governance of education need to be intervened by local governments, as well as the extensive participation of the public. Laws and regulations should be improved under the guidance of the government to provide support for the integration of English education resources, and the public should widely participate in the integration of educational resources of English majors under the publicity of educational resources, so as to form a good interactive relationship to provide support for local education governance. Therefore, the necessary conditions for the integration of local governments, legal institutions, education departments and the general public, military and local English education resources play a role in promoting the development level of English and the creation of a social environment.

Spanish Translation, Adaptation and Psychometric Analysis of a Short Version of the Intercultural Sensitivity Scale in Chilean Public Workers.

Chile has been facing socio-cognitive, affective and cultural tensions and changes due to the constant increase of the migrant population in Chile over the last two decades. This means that local public policy workers must interact and achieve effective communication with migrant users living in their territories. Intercultural sensitivity is understood as the affective dimension of intercultural communication. This dimension facilitates the awareness that people differ in their behaviors, perceptions and feelings during intercultural communication processes, promoting acceptance and respect towards these differences. The aim of this paper was to analyze the factor structure, psychometric properties and invariance of the Intercultural Sensitivity scale (Chen & Starosta, 2000) in a sample of Chilean workers. The sample consists of 337 workers from five municipalities in two regions of Chile. The sample has a mean age of 42.8years (SD = 10.4), and 62.9% report being female. To determine the factor structure, an unweighted least squares (ULS) parameter estimation method was used, which is recommended for relatively small sample sizes, as is the case in this study. The overall structure of the original scale, although showing adequate indicators in a confirmatory factor analysis, presented serious conflicts in the covariance matrix used. Therefore, the 5-factor structure seen in other studies is disconfirmed. Because of this, it was decided to construct an abbreviated version, but reducing the limitations encountered during the validation process. The final result is a 4-dimensional structure, corresponding to four of the original dimensions, with a total of 13 items. The goodness-of-fit indices (CFI, TLI, RMSEA and SRMR) had optimal levels. The Manifest and Subtle Prejudice scale was used for its divergent validity, presenting all the dimensions of the instrument, and its total score, inverse and significant correlations with manifest prejudice, subtle prejudice, and total prejudice, as expected.

Analysis of Local Governance and Legal Protection of Students' Information Security in the Context of Sustainable Development of Digital Education

Local governments are dealing with student information more and more frequently, resulting in the risk of student information being leaked, so it is necessary to introduce relevant policies, laws and regulations to standardize information collection activities and improve the level of social information governance. Therefore, this study proposes three hypotheses: on the one hand, whether the information policy issued by the local government can guide students' information collection activities, and on the other hand, whether the introduction of local laws and regulations can provide protection for students' information security; Finally, whether public participation can provide supervision for student information collection and governance, and create a good public management environment. The results show that local information laws and regulations can regulate the behavior of students' information collection and clarify the purpose and direction of students' information collection. At the same time, laws and regulations such as privacy protection and local codes of conduct can improve the security of student information and ensure the legal collection of information. The active participation of the public is conducive to the public information collection environment and ensures the overall security of student information. Therefore, local government policies, laws, and regulations can provide assurance and support for students' information security and promote the sustainable development of digital education.

Development of the implementability assessment tool for clinical practice guidelines based on the COSMIN framework and factorial experiment: a study protocol.

Clinical practice guidelines are essential tools for standardizing medical practices and improving healthcare quality. However, current guideline implementation is unsatisfactory. Barriers to guideline implementation include external environmental factors (e.g., medical personnel, medical institutions, local policies) and intrinsic characteristics (e.g., context, format, language etc.), with the latter being addressable by optimizing the guidelines themselves. This study aims to develop an appraisal tool to promote effective guideline implementation. Existing guideline implementability appraisal tools lack a clear theoretical basis, evidence of reliability and validity, and/or empirically-based guidance for effective implementation, all of which will be addressed in this study. The research is divided into four phases: (1) Generating a theoretical framework for guideline implementability (i.e., scoping review and concept analysis method); (2) Conducting a factorial experiment (i.e., guideline users simulate the use of different guideline versions to examine the relationship between constructs in the framework and implementability), and removing constructs with weak relationships to form the final implementability theoretical framework; (3) Generating dimensions and items for the guideline implementability appraisal tool based on the constructs in the theoretical framework, conducting comprehensive reliability and validity testing, usability testing, and iterative optimization according to the COSMIN guidelines; (4) Integrating the validated tool with the STAR guideline rating system for guideline appraisal and feedback to promote guideline implementability. STRENGTHS AND LIMITATIONS: (1) Our research will follow a standardized and rigorous process for developing measurement scales, ensuring that the resulting evaluation scale for the implementability of CPGs is theoretically grounded, internally consistent between theory and practice, and reliable and valid. (2) The theoretical framework developed in our study will strengthen the validity and rationality of constructs in the real world. (3) In the confirmatory factor analysis, this study will determine the dimensions and items' weight through factor loadings, allowing for the quantification of the implementability of CPGs and providing users of the guidelines with objective evaluative results. In addition, the clinical practice guideline implementability evaluation tool developed in this study can assist guideline developers in enhancing implementability before, during, and after guideline formulation.

HPB SO48 - Evaluating the timeframe for the provision of laparoscopic cholecystectomy in acute cholecystitis patients at a regional hospital

Abstract Background Acute biliary disease comprised a substantial proportion of the general emergency surgical workload. AUGIS and NICE guidelines recommend early laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) patients as it is associated with reduced readmission rates, healthcare costs and faster recovery without notable complication risks. According to the local trust policy, it advocates early LC to be performed within 72 hours of admission for AC patients. If this is not possible a delayed LC should be performed within 8 weeks of admission. Our aim is to examine variations in the provision of LC between current practice and local trust/ NICE guidelines. Method This is a retrospective audit looking at the total number of surgical patients diagnosed with AC between Jan and Dec 2023. The number of patients who had LC in 2023, unfit for surgery and did not consent for the procedure were also included. This data was obtained from electronic patient records (investigative reports, discharge letters, outpatient letters) and then collated on a Microsoft Excel sheet for analysis. Surgical patients who were not diagnosed with AC such as those with biliary pancreatitis, cholelithiasis or cholangitis but subsequently underwent LC were excluded. Results The number of AC patients who were fit and consented to surgical intervention in 2023 was 88. The total number of delayed procedures done was 75 (85.2%). The number of patients who had early LC within 1 week was 13 (14.8%). Of the 75 patients who had delayed LC, 19 (25.3%) patients had delayed LC within 8 weeks from the diagnosis date. The remaining 56 (74.7%) patients had delayed LC after 8 weeks. For patients who had delayed LC, the readmission rate within 6 months of their discharge while waiting for their operative dates was 29 (38.7%). Conclusion One-third of AC patients were readmitted while waiting for LC, some had complications of gallstone disease such as perforation/ gallstone ileus. Therefore, the early provision of LC is crucial in minimising the readmission and complication rates. This data was highlighted in a departmental meeting and teaching session for consultants and junior doctors. We plan to liaise with stakeholders and theatre managers in implementing further solutions to improve compliance where possible. One critical area is auditing the condition of surgical patients in order to be put on the hospital’s twice-weekly hot gallbladder list to consider prioritising AC patient surgical time.

Feasibility Assessment of Hybrid Renewable Energy Based EV Charging Station in Libya

This study presents an assessment of the feasibility of implementing a hybrid renewable energy-based electric vehicle (EV) charging station at a residential building in Tripoli, Libya. Utilizing the advanced capabilities of HOMER Grid software, the research evaluates multiple scenarios involving combinations of solar and wind energy sources integrated with energy storage and the utility grid. This analysis provides a novel approach to enhancing urban energy systems with renewable technologies in a region traditionally reliant on fossil fuels. Key contributions of this study include the demonstration of an innovative integration strategy that combines solar and wind power with battery storage to ensure a reliable and efficient energy supply for EV charging. Furthermore, the study addresses the practical implications for local energy policy, suggesting that such hybrid systems can significantly enhance energy security and support sustainable urban development. The authors studied five scenarios using HOMER. The results reveals that the annual total costs and payback periods are as follows: for Scenario 1 (wind/utility grid), the expenditure totals US$1,554,416 and payback period of 4.8/5.8 years; for Scenario 2 (solar/wind/Utility grid), the amount is US$1,554,506 and payback period of 4.8/5.8 years; and for Scenario 3(solar/wind/storage/utility grid), it escalates slightly to US$1,554,731, all predicated on the utility grid tariffs and payback period of 4.8/5.8 years. Furthermore, in Scenario 4 (solar/utility grid), the annual total cost is significantly reduced to US$30,589 and a payback period of 8.1/14.3 years, while Scenario 5 (solar/storage/utility grid) incurs an even lower expenditure of US$28,572, again based on the utility grid tariffs and a payback period of 14.0 years. The findings contribute valuable insights into the scalability and adaptability of renewable energy solutions, providing a robust framework for policymakers and planners considering similar implementations in other regions. Overall, the research underscores the potential of integrated renewable energy systems to transform urban energy infrastructures, promoting a sustainable and resilient energy future. The HOMER Grid analysis shows that configurations with energy storage are more cost-effective in the long run, even though they require higher initial costs. It also offers important insights into the economic viability and optimization of hybrid renewable energy systems for an EV charging station in Tripoli, Libya. These results highlight the significance of making calculated investments in renewable energy infrastructure and supporting policies for the development of sustainable energy.

‘Social defence’ and the resilience of the domestic war on terror: A genealogy of social security, national security, and defence

Abstract Russia’s invasion of Ukraine has moved attention within International Security back to Great Power Politics and interstate war, and away from phenomena like ‘foreign terrorist fighters’ and lone actor terrorism. Is the War on Terror paradigm receding? This paper argues that counter-radicalisation imaginaries and counter-extremism programming will all remain stubbornly present despite the shift back to interstate war. The resilience of domestic War on Terror policies will stem from their integration within local municipality activity and social policy during the second decade of the 21st century. These policy areas and levels are detached from the international security community, meaning that shifts in attention at the global level will have little effect upon localised national security practices. The paper then interrogates how counterterrorism agendas have so successfully entered the world of social policy and local public administration, using genealogical methods to trace how social security and crime prevention were historically prefaced upon defence. The paper traces the policy paradigm of ‘social defence’ which dominated mid-20th century international organisations, targeting non-criminal juveniles with pre-emptive interventions to prevent ‘dangerous persons’ imperilling society. Effectively, this untold history of crime prevention in Europe demonstrates the profound interlocking of national security, social policy and defence across the 20th century, with implications for the resilience of this triad.

Effectively managing area-based management tools: A new toolkit for the conservation of marine mammals

Marine mammals play crucial roles in marine ecosystem function yet are threatened by increasing pressures from anthropogenic activities within marine ecosystems. Area-based Management Tools (ABMT) are key for their conservation and protection, yet their effectiveness is often hindered by lack of resources, technical capacity and political support. Yet, ABMTs are grounded in local, national, regional, and international agreements and policy frameworks including the Kunming-Montreal Global Biodiversity Framework (GBF). To support marine managers, the “Marine Mammals Management Toolkit” was developed and is composed of three core components, including the Self-Assessment Tool (SAT), founded on the Protected Area Management Effectiveness (PAME) framework, and is a multiple-choice tool that enables managers to evaluate the effectiveness of management plans regarding marine mammals through the production of a Management Effectiveness Score (MES). The SAT has been utilised across 24 MPAs in 18 countries. Two case studies are provided on its application. The Stellwagen Bank National Marine Sanctuary (SBNMS) evaluated their existing management plan, and scored an MES value of 7.8 with the Bermuda Marine Mammal Sanctuary (BMMS) scoring 4.7. The results of the SAT enabled the Bermudian Government to make informed decisions in developing a Marine Spatial Plan for the BMMS, and enables SBNMS to set a baseline to track effectiveness over the life-time of SBNMS and respective management plans; guiding local and national policy, as well as enabling Bermuda and the United States of America to contribute to their international commitments.

Fibrinogen concentrate use in the operating theatre at a quaternary hospital in Australia

AbstractAt our quaternary teaching hospital in Queensland, Australia, there has been a rapid increase from 2019 to 2022 in the usage of fibrinogen concentrate (FC) in preference to cryoprecipitate for cardiac surgery. FC is indicated for patients having major trauma requiring haemostatic resuscitation, major intraoperative haemorrhage, or liver transplant patients with major intraoperative haemorrhage. These patients must exhibit severe hypofibrinogenaemia, which is assessed using assay cut‐offs of thromboelastogram (TEG) (citrated functional fibrinogen [CFF] ≤ 10 mm) or rotational thromboelastometry (ROTEM) (FIBTEM A5 ≤ 8 mm). FC usage over cryoprecipitate for cardiac surgery is an ongoing debate due to advantages such as dose predictability, rapid reconstitution, viral inactivation, and minimal transfusion‐related adverse events; however, it is expensive. The aim of this study was to capture prescribing patterns of FC and appropriateness against local guidelines. Retrospective data were analysed, and the practice was compared to hospital guidelines. Data from 52 patients over a 4‐year period (2019–2022) showed intraoperative haemorrhage was the leading indication for FC use (65%, n = 34), followed by liver transplantation (27%, n = 14), and major trauma (8%, n = 4). When breaking down the cause of intraoperative haemorrhage, cardiothoracic surgery, both elective (50%, n = 17) and emergency procedures (41%, n = 14), accounted for 91% of all operative bleeding requiring FC. There were 34 (65%) of 52 patients who received a differing dose of FC compared to what was recommended in the hospital guideline, with 50% (n = 17) receiving a higher than recommended dose and 50% (n = 17) receiving lower than recommended doses. This project was exempt due to the local policy requirements that constitute research by the Metro South Human Research Ethics Committee (Reference no: CM2305202303). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of standard care involved the use of existing non‐identifiable patient records.

Climate Information as A Support for Optimizing Agricultural Public Policies: A Comparative Analysis Among Peasant Communities in The Middle Couffo (Benin) And Kpékplémé In the Middle Mono in The South-East of Togo

Responses to climate change often take the form of strengthening the resilience and adaptive capacities of communities vulnerable to hazards. To this end, climate information is very crucial and must constitute an essential element of local public agricultural policies. In this perspective, how do local communities participate in the popularization of climate information in order to establish sustainable strategies for climate resilience? This involves analyzing the role of local communities in agricultural extension through the dissemination of climate information. The methodological approach taken is based on the observation of the agrarian landscape and the modification of the finage, the techniques of resilience of the peasant communities and semi-structured interviews carried out with 221 targeted actors in three agricultural communes of Moyen-Couffo in Benin. and in Kpékplémé and Aklakou in southern Togo. The analytical approach oriented from the perspective of local agricultural public policies has made it possible to bring climate information closer to a competence of local communities. This article, based on a corpus of resilience itineraries, sheds light on the role of local authorities in anticipating and adapting to climate change. It appears from the cases studied that the promotion of sustainable adaptation strategies depends on a local public agricultural policy supported by planning and agricultural innovations based on climate information and their popularization by decentralized territorial entities.

From Trash to Treasure: Assessing the Effectiveness of the Green@Community Recycling Network in Hong Kong

Municipal solid waste (MSW) is a growing problem worldwide posing a variety of environmental and human health impacts. Despite recycling being one major strategy to alleviate MSW production, the effectiveness of recycling has been equivocally dependent on local policy implementation and citizen environmental behavior. To enhance recycling effectiveness in Hong Kong, the government has established Green@Community, a unified community-based network for recycling and public environmental education. Since its establishment, the number of visitors to and the amount of recyclable materials collected at the network increased steadily over time. Our study is the very first to investigate the effectiveness of this territory-wide recycling network. Through a questionnaire survey, we found that respondents’ recycling traits were stronger if they have accrued gift tokens through participating in recycling activities. Visiting a Green@Community facility could also enhance knowledge of the types of acceptable recyclables, and respondents who had visited a Green@Community facility agreed that education and publicity could increase the recycling rate in Hong Kong. These findings highlighted the effectiveness and uniqueness of this community-based recycling network, its role in raising recycling knowledge, and its implications for policymakers and urban planners of densely populated cities to leverage society’s recycling participation, but also called for more efforts on developing, promoting, and incentivizing the usage of such a network to further enhance recycling and alleviate MSW production in Hong Kong.

Exploring facilitators and barriers to scope of practice expansion with Pharmacist independent prescribers in North Wales: a qualitative study

Abstract Introduction Independent non-medical prescribing allows qualified nurses, pharmacists and other healthcare professionals to prescribe within their competence, which is initially narrow in scope. Previous research identified that this competence requirement has potential to limit pharmacist independent prescribers’ (PIPs) ability to expand their prescribing scope1. The Royal Pharmaceutical Society has published guidance for PIPs on expanding scope of practice after qualification2. Research asking how, why and what factors affect the process of scope expansion is lacking. Aim To explore the reasons why PIPs may or may not expand their prescribing scope of practice after qualification and what factors may prevent or enable this. Methods A qualitative semi-structured interview study was utilised. Participants were PIPs working within North Wales who self-reported at least 2 years’ experience as a prescriber, prescribing at least monthly and had expanded their scope of practice since qualification. Recruitment was via gatekeepers. The study obtained ethical approval from Cardiff University School of Pharmacy Research Ethics Committee (Reference 2324-03) and was registered with Betsi Cadwaladr University Health Board. Purposive sampling ensured inclusion of pharmacists from multiple pharmacy sectors. Interviews were face-to-face or online and recorded on MSTeams®. Deidentified verbatim transcripts were analysed via inductive thematic analysis. Results Ten participants were interviewed, from a mixture of hospital, primary care, out of hours and community pharmacy sectors. Themes identified included intrinsic factors (experience and attitude) and extrinsic factors (support, service factors, governance and workplace social context). Experience sub-themes included confidence, a holistic approach and awareness of professional boundaries as facilitators for scope expansion. Attitude included being motivated and fulfilment in the role. Support was a key factor including time, funding, mentorship, peer and managerial support – all identified as facilitators and lack of each as a barrier. Other support sub-themes included structured training programmes, such as the All Wales 111 competency framework, easy access to experienced colleagues for advice on cases and space for reflective thinking, either as a team or with a mentor. Governance was identified as both a barrier and facilitator, with some appreciating the structure of local prescribing policies whilst others found it restrictive. Service factors included new roles, an expectation of the role to prescribe for multiple conditions, such as in 111 or the community pharmacy independent prescribing service, changes in team skill mix, service review and patient requests. Workplace social context that facilitated scope expansion included independent prescriber role models, nurturing teams and working within a multidisciplinary team. A lack of multidisciplinary working, such as lone working in community pharmacy, was seen as a barrier. Discussion / Conclusion Themes identified align with previously published literature and models on expertise development in independent prescribing(4), suggesting that expanding scope of prescribing aligns with expert practice development needs. This exploratory study highlights factors that PIPs found both helpful and a hindrance for expanding their prescribing scope of practice, although limited by the small sample size. Further research is needed to corroborate these findings with other professions and in other parts of the UK before incorporating into future guidance.

Daily pro-environment behavior in a Pakistani sample: Self and collective efficacy, individual and social norms and environmental concerns

The aim of this study was to analyze the perceived self and collective efficacy, individual and social norms and feelings related to environmental health concern among a sample of Pakistanis who are (or are not) engage in pro- environment behaviors in their daily lives. An ad hoc questionnaire with scales on pro-environmental behavior, self and collective efficacy, individual and social norms, and environmental health concerns was administered to adults in Lahore, Pakistan, and 833 respondents (62% males and 38% females) responded. Analysis of our research data shows that among those who engaged in daily pro-environmental behaviors, perceptions of individual and social norms and individual and collective efficacy were positively associated with concern for the environment and health. This study offers some interesting ideas that could be useful in developing federal, regional, local and community policies to promote daily pro-environmental behaviors. For example, in addition to advocating for environmental health and reducing one’s ecological footprint, social communication could explain that caring about environmental health (and thus adopting daily pro-environmental behaviors) is a way to manage one’s mental health. In this way, circular behavior is encouraged, which not only benefits the environment and the community, but also brings personal benefits.

Partisan political staff at the local level: A self‐assessment of the policymaking role of the chief of cabinet

AbstractThis study explores the policymaking role of the chief of cabinet, as head of the partisan political staff and a central actor within politico‐administrative relations. We focus on the local government level, where the role of political staff is understudied. While the added value of partisan political staff can be diverse and comprise advisory and non‐advisory activities, we do assume an active policymaking role for the chiefs of cabinet within the local policy advisory system. The research question is: “How do chiefs of cabinet conceive their own policymaking role at the local government level?” Adopting an actor‐centered approach, this research studies 20 chiefs of cabinet in cities in the Belgian region Flanders, where the amount of political staff has risen sharply. Q methodology is used for self‐assessment of the policymaking role (Van Exel & De Graaf, 2005), with statements based on Maley's three arenas (Maley, 2015). The results show that multiple types of chief of cabinet exist, revealing variation within one single institutional system. The resulting taxonomy consists of three types of chiefs of cabinet, each with a different role and impact on both policymaking and the civil service: “The Whip,” “The Negotiator,” and “The Streamliner.”

An audit to review compliance to cisplatin hydration guidelines within the royal Marsden NHS hospital

Abstract Introduction Cisplatin is a cytotoxic agent that forms the backbone of many cancer regimens.1 Cisplatin exhibits good anti-tumour activity however it can accumulate in the renal proximal tubules, leading to nephrotoxicity. It is therefore essential that adequate hydration with diuretics and fluids alongside is administered prior, during and after cisplatin infusion to promote renal perfusion.2 The local policy for intravenous hydration for cisplatin-based regimens states that adult patients are to be weighed prior to treatment and weighed again after treatment to ensure they have not developed fluid retention.3 This audit was necessary following the implementation of the new electronic prescribing system, where nurses no longer got prompted to weigh patients in the same way they did before. Aim To assess the level of compliance with current locally approved guidelines for cisplatin hydration administration since the launch of the new electronic prescribing system (EPIC). Methods Ethics approval was not required for this audit as retrospective use of anonymous data. Compiled records of 262 patients who were prescribed cisplatin-containing regimens from 17th March 2023 until 31st November 2023 were used to identify patients for inclusion in the audit. Data collection was performed retrospectively using a data collection form and a pilot study was carried out on 20 patients. A sample size of 144 patients was obtained using the Raosoft sample size calculator to achieve a 95% confidence interval with a 5% margin of error accepted.3 All data were collected by the auditor. Patients’ hospital numbers were then individually searched on EPIC to identify if weights were recorded pre- and post-administration of cisplatin. Treatment plans and medical notes on EPR were checked to identify if escalation was appropriately followed where patients gained >2 kg and, in this case to see if furosemide 20mg tablet was given. In addition, laboratory test results and structured notes were reviewed to ascertain if an increase in serum creatinine occurred and if patients were admitted to hospital as a consequence. Data was directly input into Microsoft excel for data analysis. Results The majority of cisplatin administration episodes (72%) did have the patient’s weight recorded before and after treatment. Of the remaining 28% where the weight was missing or incomplete, 4 episodes resulted in a documented AKI and 3 of these episodes were severe enough to warrant hospital admission. Discussion and conclusion The results demonstrate a lack of documentation of patient’s weights across RMH. Only 72% of patients who were administered IV cisplatin at RMH between 17th March 2023 and 31st November 2023 were recorded. This falls below the local guidance, which recommends all patients (100%) should be weighed pre- and post- cisplatin administration. Documentation is critical to ensure a clear audit trail and to enable identification pf patients who may be at higher risk of developing fluid retention. This therefore needs improvement. A limitation of the audit is the increased potential for human error due to the way data was collected. The requirement to search through all structured notes and observations flowsheet was time consuming and intensive, increasing the likelihood documentation may have been missed.

Health Equity in AI Development and Policy: An AI-enabled Study of International, National and Intra-national AI Infrastructures

This study examines how concerns related to equity in AI for health are reflected at the international, national, and sub-national level. Utilizing unsupervised learning over corpora of published AI policy documents and graph structurization and analysis, the research identifies and visualizes the presence and variation of these concerns across different geopolitical contexts. The findings reveal interesting differences in how these issues are prioritized and addressed, highlighting the influence of local policies and cultural factors. The study underscores the importance of tailored approaches to AI governance in healthcare, advocating for increased global collaboration and knowledge sharing to ensure equitable and ethical AI deployment. By providing a comprehensive analysis of policy documents, this research contributes to a deeper understanding of the global landscape of AI in health, potentially offering insights for policymakers and stakeholders.

The Impact of Urbanization on the Socio-Economic Status of Rural Migrants in China - A Comparison and Analysis for the Pearl River Delta and Yangtze River Delta Regions

The Pearl River Delta and Yangtze River Delta regions in China are two key areas of rapid economic development, and research has found that a large number of migrants from rural areas have been formed as a result of the rapid development of the urban agglomerations in the region, however, there is still a certain research gap on the comparison of the rural labour force populations of the two regions due to the different attractiveness of the rural transfer population in the two regions as well as the differences in the various local policies. Therefore, this paper reads the literature to compare the impact of the progress of urbanization in the Pearl River Delta and Yangtze River Delta on the economic status of rural migrants in China. The study finds that the Yangtze River Delta mainly attracts high-end technical talents while the Pearl River Delta attracts more migrant workers. Therefore, the governments of the two regions need to implement practical policies to provide migrants with corresponding protection.