Poor Coordination Research Articles

Understanding contextual and practical factors to inform WHO recommendations on using chest imaging to monitor COVID-19 pulmonary sequelae: a qualitative study exploring stakeholders’ perspective

BackgroundA recommendation by the World Health Organization (WHO) was issued about the use of chest imaging to monitor pulmonary sequelae following recovery from COVID-19. This qualitative study aimed to explore the perspective of key stakeholders to understand their valuation of the outcome of the proposition, preferences for the modalities of chest imaging, acceptability, feasibility, impact on equity and practical considerations influencing the implementation of using chest imaging.MethodsA qualitative descriptive design using in-depth interviews approach. Key stakeholders included adult patients who recovered from the acute illness of COVID-19, and providers caring for those patients. The Evidence to Decision (EtD) conceptual framework was used to guide data collection of contextual and practical factors related to monitoring using imaging. Data analysis was based on the framework thematic analysis approach.Results33 respondents, including providers and patients, were recruited from 15 different countries. Participants highly valued the ability to monitor progression and resolution of long-term sequelae but recommended the avoidance of overuse of imaging. Their preferences for the imaging modalities were recorded along with pros and cons. Equity concerns were reported across countries (e.g., access to resources) and within countries (e.g., disadvantaged groups lacked access to insurance). Both providers and patients accepted the use of imaging, some patients were concerned about affordability of the test. Facilitators included post- recovery units and protocols. Barriers to feasibility included low number of specialists in some countries, access to imaging tests among elderly living in nursing homes, experience of poor coordination of care, emotional exhaustion, and transportation challenges driving to a monitoring site.ConclusionWe were able to demonstrate that there is a high value and acceptability using imaging but there were factors influencing feasibility, equity and some practical considerations associated with implementation. We had a few suggestions to be considered by the expert panel in the formulation of the guideline to facilitate its implementation such as using validated risk score predictive tools for lung complications to recommend the appropriate imaging modality and complementary pulmonary function test.

Physiotherapist and Patient Experiences of Team-Based Interprofessional Collaboration during the COVID-19 Pandemic in Canada

Purpose: To examine the perspectives of physiotherapists and physiotherapy patients regarding team-based interprofessional collaboration during the COVID-19 pandemic in Canada. Methods: This mixed methods study combined online surveys (physiotherapists, patients) and qualitative semi-structured interviews (patients). Descriptive statistics and thematic analysis summarized the quantitative and qualitative data before final data integration. Results: Physiotherapists (n = 334) and patients (n = 784) participated in the surveys, while 19 patients were interviewed. Less than half (48%) of physiotherapists reported delivering care as part of multidisciplinary teams and 38% of these individuals reported that the pandemic decreased their ability to deliver team-based, interprofessional care. Physiotherapists found that team-based care was negatively impacted by communication challenges, poor care coordination, and patients lacking access to other health professionals. While over one-third (38%) of patients reported poor care coordination between health professionals, qualitatively many patients reported that these challenges were similar pre-pandemic. They also experienced increased communication challenges and emphasized poor access to general practitioners and specialists. Both groups saw future opportunities for increased use of virtual care to improve team-based health care delivery. Conclusion: Physiotherapists and patients had varied experiences with aspects of team-based care during the pandemic that included challenges with communication, care coordination, and ability to access health professionals. Improved training and implementation of virtual care may enhance interprofessional collaboration and improve patient care in the future.

Health information management systems and practices in conflict-affected settings: the case of northwest Syria

BackgroundIn conflict settings, as it is the case in Syria, it is crucial to enhance health information management to facilitate an effective and sustainable approach to strengthening health systems in such contexts. In this study, we aim to provide a baseline understanding of the present state of health information management in Northwest Syria (NWS) to better plan for strengthening the health information system of the area that is transitioning to an early-recovery stage.MethodsA combination of questionnaires and subsequent interviews was used for data collection. Purposive sampling was used to select twenty-one respondents directly involved in managing and directing different domains of health information in the NWS who worked with local NGOs, INGOs, UN-agencies, or part of the Health Working Group. A scoring system for each public health domain was constructed based on the number and quality of the available datasets for these domains, which were established by Checci and others.Results & conclusionsReliable and aggregate health information in the NWS is limited, despite some improvements made over the past decade. The conflict restricted and challenged efforts to establish a concentrated and harmonized HIS in the NWS, which led to a lack of leadership, poor coordination, and duplication of key activities. Although the UN established the EWARN and HeRAMS as common data collection systems in the NWS, they are directed toward advocacy and managed by external experts with little participation or access from local stakeholders to these datasets.RecommendationsThere is a need for participatory approaches and the empowerment of local actors and local NGOs, cooperation between local and international stakeholders to increase access to data, and a central domain for planning, organization, and harmonizing the process. To enhance the humanitarian health response in Syria and other crisis areas, it is imperative to invest in data collection and utilisation, mHealth and eHealth technologies, capacity building, and robust technical and autonomous leadership.

Development and assessment of trajectory-based arterial through percent arrivals on red for arterial signal coordination performance evaluation

Efficient traffic signal system management plays a pivotal role in reducing traffic congestion and improving traffic mobility on urban roads. The applications of the Automated Traffic Signal Performance Measures (ATSPM) revolutionize the way of proactively managing and evaluating traffic signal systems through a suite of performance measures. The Percent Arrivals on Red (PAoR) is one of the commonly used progression performance measures in the ATSPM to characterize vehicle arrivals at the intersection. However, the accuracy of PAoR to assess arterial signal coordination is restricted by configuration limitations of advance detectors and remains to be further explored. To address this problem, this research proposes an easy-to-use trajectory-based performance measure, Arterial Through Percent Arrivals on Red (ATPAoR), for arterial signal coordination performance evaluation and presents the general procedures to calculate ATPAoR from connected vehicle data. A case study is carried out to implement the proposed ATPAoR and investigate the relationship between the ATPAoR and the PAoR. It is found that the combination of the time–space diagram (TSD) and arterial through-vehicle trajectories is effective in the actual arterial signal coordination performance visualization, ATPAoR result interpretation, and potential timing improvement recommendations. The PAoR is found to be greater than the ATPAoR in undersaturated conditions, and the PAoR above 60% is recommended to identify poor arterial signal coordination design. The historical TSD can be utilized to verify the accuracy of the PAoR to evaluate the actual arterial signal coordination when vehicle trajectory data is unavailable.

Spatial-Temporal Variations and Driving Factors of the Coupling and Coordination Level of the Digital Economy and Sustainable Rural Development: A Case Study of China

Sustainable rural development forms a robust foundation for economic and social sustainability. Moreover, the digital economy acts as a catalyst for advancing rural sustainable development by altering the distribution of production factors. Thus, this study concentrates on 30 provinces in China, constructing an evaluation index system for both the digital economy and rural sustainable development. The study employs various methods and models to analyze the spatiotemporal changes and driving factors affecting the coupling and coordination between these two aspects. The research findings are as follows: the coupling and coordination levels among provinces in China have been on the rise year by year. By 2022, the coupling and coordination levels of most provinces range between 0.5 and 0.6. Regional disparities are the primary determinant of the poor overall coupling and coordination level in China. In 2022, the coupling and coordination level in the eastern region is 0.6663, compared to 0.5420 in the central region and 0.5087 in the western region. Factors such as urbanization, industrial structure transformation, technological innovation, higher education, economic development, and government support significantly influence the coupling and coordination level. Nevertheless, their effects vary across regions, with a more pronounced impact in the eastern region than in the central and western regions. Therefore, this paper proposes policy recommendations, including infrastructure optimization, rural digitization promotion, regional resource allocation enhancement, cross-regional development mechanism exploration, and differentiated development strategy implementation.

Utilization and associated determinants of multi-sectoral approach in zoonotic disease surveillance among animal and human healthcare workers in Nakuru County, Kenya

Background Zoonoses are naturally transmissible between humans and animals. Globally, they account for more than 60% of human infections, 75% of emerging infections, 2.7 million human deaths, and 10% of the total DALYs lost yearly in Africa. In the last three decades, Kenya has had sporadic outbreaks of zoonoses. To increase the speed of reporting and efficiencies in detection and control, a multi-sectoral collaboration in zoonotic disease surveillance (MZDS) between human and animal health workers is essential. In an effort, Zoonotic disease unit (ZDU) in Kenya has been established at national and county levels. Methods A cross sectional study was carried out to determine the level of utilization of multisectoral collaboration and its associated determinants in zoonotic disease surveillance among animal and human healthcare workers in Nakuru County. Quantitative data was gathered from 102 participants and quantitative data from 5 key informants. To test for significant differences, Chi-square and independent t-test were used. Results MZDS utilization level was 16% and the factors associated with higher utilization include; knowing what MZDS entails, education level, sector affiliation, trainings, supportive infrastructure and data storage. Lack of financing and poor coordination are hindrances to MZDS. Conclusion There is need to finance MZDS activities, strengthen coordination mechanisms, carry out more sensitization and trainings among animal and human healthcare.

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions. Cases of cerebrovascular accidents (CVA), Parkinson's disease, dementia, and other intracranial lesions develop poor bladder control with or without urinary difficulty due to loss of cortical perception of bladder filling sensation and poor coordination of urethral sphincter relaxation during reflex micturition. Patients with CNS lesions usually have overactive bladder (OAB) symptoms, including urgency, frequency, incontinence, voiding symptoms of dysuria, large postvoid residual volume, and retention. In elderly patients with severe CNS disease the OAB symptoms are usually difficult to adequately relieve by medical treatment, and thus, their quality of life is greatly. Botulinum toxin A (BoNT-A) is currently licensed and has been applied in patients with idiopathic and neurogenic OAB due to spinal cord injury or multiple sclerosis. However, the application of BoNT-A in the treatment of urinary incontinence due to NLUTD in chronic CNS lesions has not been well-documented. Although cohort studies and case series support BoNT-A treatment for neurogenic OAB, chronic urine retention after intravesical BoNT-A injection for OAB and exacerbated urinary incontinence after urethral BoNT-A injection for voiding dysfunction have greatly limited its application among patients with NLUTD due to CNS lesions. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions and the clinical effects and adverse events of BoNT-A injection for patients with NLUTD. A flowchart was created to outline the patient selection and treatment strategy for neurogenic OAB.

A qualitative study of the experiences of insulin use by older people with type 2 diabetes mellitus.

There is a rising prevalence of type 2 diabetes among older people. This population also suffers from co-morbidity and a greater number of diabetes related complications, such as visual and cognitive impairment, which can potentially affect their ability to manage insulin regimens. Understanding the experiences of older people when they transition to insulin will help the development of healthcare interventions to enhance their diabetes outcomes, overall health and quality of life. The aims of this exploratory study were to (1) understand the experiences of older people with type 2 diabetes in relation to insulin treatment initiation and management and (2) use this understanding to consider how the insulin management support provided to older people by healthcare providers could be more tailored to their needs. A qualitative study using semi structured (remote) interviews with older people with diabetes (n = 10) and caregivers (n = 4) from the UK. Interviews were audio recorded and transcribed, and framework analysis was used to analyse the data. Three main themes, along with six subthemes, were generated from the study data. Participants generally felt at ease with insulin administration following training, yet some reported feelings of failure at transitioning to insulin use. Participants were also frustrated at what they perceived were insufficient resources for effective self-management, coupled with a lack of professional interest in optimising their health as older people. Some also expressed dissatisfaction regarding the brevity of their consultations, inconsistent information from different healthcare professionals and poor treatment coordination between primary and secondary care. Overall, the study emphasised that older people need better support, education and resources to help manage their insulin use. Healthcare professionals should be encouraged to adopt a more individualised approach to supporting older people that acknowledges their prior knowledge, physical and psychological capabilities and motivation for diabetes self-management. In addition, better communication between different services and greater access to specialist support is clearly needed for this older population. An integrated care pathway for insulin use in older people could be considered. This would include an assessment of the older person's needs and capacity on their initiation to insulin; targeted education and training in self-management; timely access to appropriate emotional and peer support resources; care plans developed collaboratively with patients; and individualised glucose targets that recognise the needs and preferences of the older person.

Parent-child sensorimotor coordination in toddlers with and without hearing loss.

Infants experience the world through their actions with objects and their interactions with other people, especially their parents. Prior research has shown that school-age children with hearing loss experience poorer quality interactions with typically hearing parents, yet little is known about parent-child interactions between toddlers with hearing loss and their parents early in life. In the current study, we used mobile eye-tracking to investigate parent-child interactions in toddlers with and without hearing loss (mean ages: 19.42 months, SD = 3.41 months). Parents and toddlers engaged in a goal-directed, interactive task that involved inserting coins into a slot and required joint coordination between the parent and the child. Overall, findings revealed that deaf toddlers demonstrate typical action skills in line with their hearing peers and engage in similar interactions with their parents during social interactions. Findings also revealed that deaf toddlers explored objects more and showed more temporal stability in their motor movements (i.e. less variation in their timing across trials) than hearing peers, suggesting further adaptability of the deaf group to their atypical sensory environment rather than poorer coordination. In contrast to previous research, findings suggest an intact ability of deaf toddlers to coordinate their actions with their parents and highlight the adaptability within dyads who have atypical sensory experiences.

Achieving Sustainable Quality Education Targets: a Case Study in East Java, Indonesia

Objectives: This article aims to analyze the implementation of education policies designed to introduce quality education and identify barriers at the local level. The study focuses on an elementary school in Probolinggo City, East Java Province, Indonesia, to understand how these policies are being executed and the challenges faced. Methods: Interviews were conducted with various stakeholders, including school representatives, education office officials, and local government authorities. The study utilizes two types of data: primary data collected through interviews and secondary data from existing records and reports. Results: The findings reveal that the implementation of quality education policies at the primary school level is suboptimal in achieving the Sustainable Development Goals (SDGs) targets. This inadequacy is primarily due to weak coordination between education offices and schools. The study highlights that this poor coordination affects the ability to achieve inclusive and equitable quality education and support lifelong learning opportunities for all. Conclusion: The study concludes that the weak working relationship between schools and education offices significantly impacts the sensitivity of education office policies to school needs, thereby hindering the achievement of SDGs at the local level. The results emphasize the need for improved coordination and communication to ensure effective policy implementation. This study contributes to the development of policy implementation theory by providing insights into the sustainable strengthening of educational development strategies and expands theoretical and practical knowledge on local government policy implementation in the context of quality school education in Indonesia under the SDGs framework.

Precursor-Engineered Volatile Inks Enable Reliable Blade-Coating of Cesium-Formamidinium Perovskites Toward Fully Printed Solar Modules.

Reliable fabrication of large-area perovskite films with antisolvent-free printing techniques requires high-volatility solvents, such as 2-methoxyethanol (2ME), to formulate precursor inks. However, the fabrication of high-quality cesium-formamidinium (Cs-FA) perovskites has been hampered using volatile solvents due to their poor coordination with the perovskite precursors. Here, this issue is resolved by re-formulating a 2ME-based Cs0.05FA0.95PbI3 ink using pre-synthesized single crystals as the precursor instead of the conventional mixture of raw powders. The key to obtaining high-quality Cs-FA films lies in the removal of colloidal particles from the ink and hence the suppression of colloid-induced heterogeneous nucleation, which kinetically facilitates the growth of as-formed crystals toward larger grains and improved film crystallinity. Employing the precursor-engineered volatile ink in the vacuum-free, fully printing processing of solar cells (with carbon electrode), a power conversion efficiency (PCE) of 19.3%, a T80 (80% of initial PCE) of 1000h in ISOS-L-2I (85°C/1Sun) aging test and a substantially reduced bill of materials are obtained. The reliable coating methodology ultimately enables the fabrication of carbon-electrode mini solar modules with a stabilized PCE of 16.2% (average 15.6%) representing the record value among the fully printed counterparts and a key milestone toward meeting the objectives for a scalable photovoltaic technology.

The Influence of Physical Education Lessons in the Practical Preparation of Students for Obtaining the Driving Licence

The purpose of this study is to explore the influence of physical education lessons in the practical preparation of students for obtaining a driving license. In this respect, the exercises used in physical education lessons, systematized and appropriately dosed, help to educate ambition, courage, distributive attention, calmness, tolerance, perseverance, fast thinking, capacity for anticipation, etc. To achieve the purpose of this paper, two questionnaires were developed. The first questionnaire, with 5 questions, was addressed to a number of 50 driving instructors. For the quantification of the answers, they had to refer to a number of 10 students and answer numerically the answer variants of the question, so that the total sum of the answers to be 10. The second questionnaire, with 4 questions, was addressed to students participating in physical education lessons. For all questions, the answers given had to include all answer variants, percentagewise, so that the total sum of the answers to a question to be 100%. The questionnaire was distributed to 50 students who attended the driving school. After analysing the highest percentages obtained from the students’ answers, it was found that the low results in the practical test for obtaining the driving license are due to poor motor coordination, due to the fact that students are not able to think fast and to find solutions in situations that arise and finally they are not able to cope with the traffic congestion, especially when there are drivers who do not follow the traffic rules. The analysis of the answers given by the driving instructors to the questions led to the conclusion that students are very rushed and do not have patience to listen to the whole explanation given by the instructor, they have poor distributive attention and poor coordination of motor and intellectual activities. Keywords: practical abilities, skills, distributive attention, physical education, driving license, practical preparation

Influence of BIM and Lean on mitigating delay factors in building projects

Building projects are affected by various phenomena that can affect their success and continuity and, in the worst cases, can lead to project abandonment. The delay has been identified as one of the phenomena with the most significant impact and recurrence; therefore, mitigation actions are required. BIM and Lean Construction are two approaches with great potential to mitigate delay-generating factors. However, more studies need to be conducted to analyze their influence on mitigating schedule delays. Considering this gap, this paper focuses on analyzing the influence of Lean Construction tools, and BIM uses that favor mitigating the main factors that generate variations in the construction schedules of residential buildings. The research method was divided into five main stages: (1) delay factors identification; (2) BIM uses identification; (3) Lean tools identification; (4) questionnaire design, validation, and application; and (5) influence quantitative analysis. A total of 20 delay factors, eight BIM uses, and eight Lean tools were selected. Next, a consultation was conducted with 50 building project managers and two residential building projects were analyzed. The findings show that implementing BIM and Lean tools greatly influences mitigating delay factors such as errors and deficiencies in design documents, inefficient project planning and scheduling, and poor communication and coordination with designers. BIM uses that have a strong influence on reducing delays include 4D construction planning and 4D construction analysis and optimization. In the Lean domain, the Last Planner System (LPS) and collaborative meetings have a high influence on mitigating delays. This study provides valuable insights for construction project managers to improve overall project efficiency by optimizing the implementation of BIM uses and Lean tools.

Drivers of district-level differences in outpatient antibiotic prescribing in Germany: a qualitative study with prescribers

BackgroundPrevious studies have identified substantial regional variations in outpatient antibiotic prescribing in Germany, both in the paediatric and adult population. This indicates inappropriate antibiotic prescribing in some regions, which should be avoided to reduce antimicrobial resistance and potential side effects. The reasons for regional variations in outpatient antibiotic prescribing are not yet completely understood; socioeconomic and health care density differences between regions do not fully explain such differences. Here, we apply a behavioural perspective by adapting the Theoretical Domains Framework (TDF) to examine regional factors deemed relevant for outpatient antibiotic prescriptions by paediatricians and general practitioners.MethodsQualitative study with guideline-based telephone interviews of 40 prescribers (paediatricians and general practitioners) in outpatient settings from regions with high and low rates of antibiotic prescriptions, stratified by urbanity. TDF domains formed the basis of an interview guide to assess region-level resources and barriers to rational antibiotic prescription behaviour. Interviews lasted 30–61 min (M = 45 min). Thematic analysis was used to identify thematic clusters, and relationships between themes were explored through proximity estimation.ResultsBoth paediatricians and general practitioners in low-prescribing regions reported supporting contextual factors (in particular good collegial networks, good collaboration with laboratories) and social factors (collegial support and low patient demand for antibiotics) as important resources. In high-prescribing regions, poor coordination between in-patient and ambulatory health services, lack of region-level information on antimicrobial resistance, few professional development opportunities, and regional variations in patient expectations were identified as barriers to rational prescribing behaviour.ConclusionsInterventions targeting professional development, better collaboration structures with laboratories and clearer and user-friendly guidelines could potentially support rational antibiotic prescribing behaviour. In addition, better networking and social support among physicians could support lower prescription rates.

The association of interlimb coordination and temporal symmetry with walking function and motor impairment after stroke.

Interlimb coordination during walking is impaired after stroke, with unknown effects on walking function. This cross-sectional study determined associations of interlimb coordination and temporal symmetry with walking function and motor impairment. During walking, participants wore wireless sensors to detect heel strikes. We calculated interlimb coordination as the phase coordination index and temporal symmetry as the ratio of contralesional (i.e., paretic) to ipsilesional (i.e., non-paretic) stance times. Associations with walking speed (10-meter walk test), walking endurance (6-minute walk test), dynamic balance (Mini Balance Evaluation Systems Test), and motor impairment (Fugl Meyer Lower Extremity assessment) were assessed. 56 individuals with chronic stroke were tested. Worse interlimb coordination was correlated with slower comfortable (R = -0.38, p = 0.004) and maximal (R = -0.36, p = 0.006) walking speed and worse motor function (R = -0.45, p = 0.001). Worse temporal symmetry was correlated with worse motor function (R = 0.39, p = 0.004). Interlimb coordination had stronger associations than temporal symmetry with comfortable (R: -0.38 vs. 0.08) and maximal walking speeds (R: -0.36 vs. 0.12). Poor interlimb coordination was associated with slow walking and motor impairment and had stronger associations with walking speeds than temporal symmetry did. Interlimb coordination may provide unique insights into walking function and a target for walking rehabilitation after stroke.

Impact of geographical cohorting, multidisciplinary rounding and incremental case management support on hospital length of stay and readmission rates: a propensity weighted analysis

Hospital length of stay (LOS) in the USA has been increasing since the start of the COVID-19 pandemic, with numerous negative outcomes, including decreased quality of care, worsened patient satisfaction...

An Empirical Analysis of the Moderating Effect of Organizational Context on the Relationship between Leadership Process and Effectiveness of Freight Forwarding Firms in Nairobi City County, Kenya

Highly competitive and fast shifting market conditions require business enterprises to possess superior organizational capabilities for success. Previous studies have identified persistent challenges including leadership processes and complex work environments as constraints to organizational success. The freight forwarding sector in Kenya grapples with challenges related to high operational costs, poor co-ordination, and rapid developments in information technology and related insecurity. Literature on organizational leadership has neither addressed nor empirically tested the dimensions of gauging effectiveness of freight forwarding firms. Specifically, there is lack of empirical investigation linking organizational context with leadership process and effectiveness of freight forwarding firms. This study sought to investigate the moderating effect of organizational context on the relationship between leadership process (tactical, strategic, and situational influence) and effectiveness of freight forwarding firms in Nairobi City County, Kenya. Through a mixed methods approach, the study adopted explanatory sequential design anchored on the Balanced Score Card model, Institutional Theory and Structuralism Theory. Target population was 400 freight forwarding firms practicing in Nairobi City County, from which 276 respondents were selected through stratified random sampling. Quantitative data was collected through questionnaires with a response rate of 84% while qualitative data was collected from 10 key informants through in-depth interviews. Descriptive statistics used were frequencies, means and standard deviation, while regression analysis was used to test the study hypotheses. Qualitative data was subjected to thematic analysis. Results established that organizational context has a significant moderating effect on the relationship between leadership process and firm effectiveness. With leadership process viewed through input > processing > output logic, the external environment provides streams of opportunities in terms of inputs, which firms can harness to create competitive advantage and effectiveness. Findings demonstrated the link between leadership process, organizational context, and effectiveness. Management should entrench effective leadership process through active deployment of appropriate influence strategies to generate key capabilities and conducive work contexts. Government policies should promote collaborative approaches among supply chain partners. The study recommends future research to expand the conceptual, methodological, and contextual scope for more representative conclusions. Keywords: Freight Forwarding Firms, Leadership Process, Organizational Effectiveness, Organizational Context

A mixed methods study on continuity and care coordination based on the obstetric near miss approach.

The near-miss approach assumes that mothers facing life-threatening conditions such as severe pre-eclampsia and postpartum haemorrhage share common risk factors. Among these women, those who survive (near-miss cases) can offer insights into the determinants, providing valuable lessons for understanding underlying factors. To investigate elements of continuity and coordination leading to obstetric near misses. A major referral hospital and its referral pathway in Kenya. Explanatory sequential mixed-methods design. Near-miss survivors had lower continuity and coordination of care indices during antenatal visits (COCI = 0.80, p = 0.0026), (modified continuity of care index [MCCI] = 0.62, p = 0.034), and those with non-life-threatening morbidity in the first trimester were more likely to experience a near miss (aOR = 4.34, p = 0.001). Facilities in the western region had a higher burden of near misses compared to the Eastern region. Qualitatively, three deductive themes were identified: sequential coordination, parallel coordination and continuity, along with factors classified as access. In mixed integration, poor continuity indices were explained by quality of interpersonal relationships and woman centredness. Poor coordination was explained by inadequate teamwork between providers in referring and referral facilities and between primary health facilities and the community. Higher near-miss rates in the western region resulted from differences in human and physical resources. Promoting woman-centred care, teamwork, improving communication and introducing innovative coordination roles like case and care managers can enhance continuity and coordination of maternal healthcare. This study contributes to our understanding of the challenges of continuity and coordination in maternal healthcare in resource-poor settings by applying the WHO operationalisation of continuity and coordination using mixed methodology.

SCOT analysis of implementing One Health Approach from the stakeholders’ perspective in Puducherry, South India

BackgroundThe implementation of the One Health (OH) approach improves the prevention and control of zoonotic diseases and ensures a better understanding of the emergence of infectious diseases. ObjectiveThis study aimed to identify the key stakeholders’ knowledge of the One Health concept and assess attitudes toward the need for collaboration and explore the viewpoints of stakeholders regarding One Health Collaboration. MethodsIt is an explanatory mixed-method study conducted in the Puducherry district, South India. The study involved quantitative data collection among 70 stakeholders from various departments using quota sampling. Followed by qualitative data exploration of the viewpoints of stakeholders on One Health Collaboration through key informant interviews among 10 key stakeholders selected using purposive sampling. Knowledge of the stakeholders on One Health was assessed by using a self-administered semi-structured questionnaire. Knowledge and attitudes were summarized as frequency and percentage. A manual content analysis of the transcripts of the interviews was done. ResultA total of 70 (Male-55.7 % & female-44.3 %) stakeholders were included in the study. 57.1 % of the stakeholders heard about One Health and the rest did not know. A few numbers of stakeholders (18.8 %) were aware of the formal connection between various departments. 86%of stakeholders suggested that intersectoral coordination is very much needed at the grass root level. The interviews found that a lack of standard guidelines, weak political commitment, poor departmental coordination, and a lack of community awareness were the most frequent challenges encountered. ConclusionThe operationalization of OH could be enhanced by providing standard guidelines and ensuring the coordination between the stakeholders.

Automated systems for diagnosis of dysgraphia in children: a survey and novel framework

Learning disabilities, which primarily interfere with basic learning skills such as reading, writing, and math, are known to affect around 10% of children in the world. The poor motor skills and motor coordination as part of the neurodevelopmental disorder can become a causative factor for the difficulty in learning to write (dysgraphia), hindering the academic track of an individual. The signs and symptoms of dysgraphia include but are not limited to irregular handwriting, improper handling of writing medium, slow or labored writing, unusual hand position, etc. The widely accepted assessment criterion for all types of learning disabilities including dysgraphia has traditionally relied on examinations conducted by medical expert. However, in recent years, artificial intelligence has been employed to develop diagnostic systems for learning disabilities, utilizing diverse modalities of data, including handwriting analysis. This work presents a review of the existing automated dysgraphia diagnosis systems for children in the literature. The main focus of the work is to review artificial intelligence-based systems for dysgraphia diagnosis in children. This work discusses the data collection method, important handwriting features, and machine learning algorithms employed in the literature for the diagnosis of dysgraphia. Apart from that, this article discusses some of the non-artificial intelligence-based automated systems. Furthermore, this article discusses the drawbacks of existing systems and proposes a novel framework for dysgraphia diagnosis and assistance evaluation.