Poor Standards Research Articles

P-032 Sperm parameters can predict the success of assisted reproductive technology. Single-center and retrospective analysis of assisted reproductive technology cycles from 1992 to 2020

Abstract Study question Male parameters are largely underestimated in assisted reproductive technology (ART) success, so it was evaluated whether conventional semen parameters could predict assisted reproductive technology success Summary answer Sperm motility plays a role in predicting in vitro fertilization (IVF) success, while sperm morphology is the relevant parameter in intracytoplasmic sperm injection (ICSI) cycles. What is known already The detection of predictive markers would be very useful to choose the ART type and usually the male counterpart was relegated to a secondary role. Obviously, no convincing evidence that ART outcomes may be dependent on sperm parameters exists. The variation over the years of the reference values in semen analysis, together with the poor inter-laboratory standardization of sperm assessment, contributes to this very complex scenario. It remains undeniable that identifying thresholds of seminal parameters with prognostic significance in terms of pregnancy rate would have a considerable clinical impact in the assisted reproduction field. Study design, size, duration A single-center, retrospective, observational study was carried out including couples attending the Santa Maria Nuova Hospital-IRCCS of Reggio Emilia for infertility between January 1992 and December 2020. Only fresh ART cycles performed in a single third-level fertility center were considered for this study with a total of 22,013 cycles. Fertilization rate was the primary end-point, representing a parameter immediately dependent on male contribution. Pregnancy and live birth rates were considered in relation to semen variables. Participants/materials, setting, methods Both partners were aged over 18 years and satisfied national criteria to access ART procedures. The studies considering common sperm parameters obtained by conventional semen analysis, that is, sperm number, motility, and morphology. Semen analyses were performed according to the World Health Organization (WHO) manual available at the time of the ART cycle. Ovarian stimulation was performed applying different hormone stimulating protocols and ART approach used are IVF or the ICSI. Main results and the role of chance Considering the entire ART cohort, 5819 cycles were IVF (26.4%) and 16,194 were ICSI (73.6%). Considering strong ART outcomes, the overall pregnancy rate was 20.4% (4,368 cycles) for biochemical and 20.2% (4,314 cycles) for clinical pregnancies, respectively. Among the latter, the overall live birth rate was 63.3%. Interestingly, both biochemical (20.8% vs. 19.1%, p < 0.001) and clinical (20.7% vs. 18.5%, p < 0.001) pregnancy rates were significantly higher in ICSI than IVF cycles. On the contrary, the live birth rate was not significantly different between ART methodologies (64.0% in ICSI vs. 60.9% in IVF, p = 0.074). Only 610 cycles (2.8%) were interrupted since no oocytes were retrieved after gonadotropins stimulation. Considering only cycles with oocytes retrieved, the fertilization rate was significantly higher in ICSI (42.4±39.7%) compared to IVF cycles (38.4±49.2%) (F = 27.343, p < 0.001). In IVF setting, both progressive motility (p = 0.012) and motility after capacitation (p = 0.002) significantly predicted the fertilization rate (statistical accuracy = 71.1%). Sperm motilities also predicted pregnancy (p < 0.001) and live birth (p = 0.001) rates. In ICSI, sperm morphology predicted fertilization rate (p = 0.001, statistical accuracy = 90.3%). Limitations, reasons for caution These results, although statistically significant, show confidence intervals at the limits of significance. Therefore, this data must be carefully considered. From entering the ART path to its outcome, the variables encountered are numerous. The identification of a single parameter that influences, slightly, the final outcome, indicates a considerable clinical weight. Wider implications of the findings Interestingly, sperm motility plays a role in predicting in vitro fertilization success, while sperm morphology is the relevant parameter in ICSI. These parameters may be considered reliable tools to measure the male role on ART outcomes, potentially impacting the clinical management of infertile couples. Trial registration number not applicable

Барьеры телемедицины и пути их преодоления.

The ongoing discussion of telemedicine suggests that there are barriers to the widespread adoption of telemedicine technologies in clinical practice. The article is the first to classify the barriers of the introduction of telemedicine technologies into practice. There are 4 main barriers: technological, legal, economic and methodological. At the end of the description of each barrier, ways to overcome them are given. The technological barrier includes: the inconvenience of using existing tools, poor integration of telemedicine platforms with existing medical information systems (MIS), Poor standardization of information exchange protocols between sources (devices), information systems from different manufacturers, a small amount and low quality of digitized information about the state of human health and others. In the legal barrier, it is prohibited to make a diagnosis and prescribe treatment when providing medical care using telemedicine technologies, and also there are requirements for the workplace of a doctor providing TM-consultation. Financial barriers are represented by the difficulties of financing telemedicine - the lack of compulsory medical insurance tariffs, the erroneous opinion that telemedicine should reduce healthcare costs or does not require separate financing at all. The lack of methodological support for telemedicine - clinical studies, publications, methodological and clinical recommendations, training courses and programs on telemedicine for students, leads to a low commitment of doctors to use telemedicine in their work. The process of implementing telemedicine technologies is unavoidable. However, there is no doubt that telemedicine will eventually become a familiar and indispensable tool in the hands of doctors. Sooner or later, even without our active participation, these barriers will be overcome.

Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies.

To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US). Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies. In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) 'Escalation' is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward-'measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use. DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation.

Insights of School Water Consumption and Sanitation and Hygiene Practices among School Children in Dehiovita, Kegalle District, Sri Lanka

Developing access to safe drinking water, sanitation facilities and hygiene practices can reduce water borne diseases. The present study was carried out in the Dehiovita Zonal Educational zone under the Kegalle District from December 2018 to March 2019 to monitor existing facilities in schools, behavior among students, and for the sustainable development in water, sanitation, and hygiene at the schools. A semi-structured questionnaire was conducted covering students (n=500) from grade 7-13 in 15 schools through a random sampling technique. Data analysis was conducted using SPSS software to compare the responses using graphical presentation. In terms of water consumption behavior, about 73% of respondents use water bottles. Of these, 73%, 43% accounted for using unsafe plastic bottles and 28% accounted for aluminum bottles. Most of the respondents, 50% mentioned that they use water bottles twice daily. In relation to the water purification method used, 45% of students use chlorinated water, whereas 36% do not have purified water. Only 36% of respondents do have a water supply. Regarding the issues of water supply, 62% of respondents stated that they have broken taps, and 54% responded on less treated water. Most respondents, 78% mentioned, that they are unsatisfied with the existing water. With regards to the sanitation behavior among students, 48% of students use the latrine twice while 32% of respondents use the latrine once a day. Most of the respondents, 88% mentioned that they do not use soap after toilet use. 78% of respondents mentioned that the existing sanitation facilities are unsatisfied. Regarding the issues associated with sanitation facilities in schools, 92% of respondents showed the unavailability of soap and 73% of respondents stated that they have old latrines, while 67% stated that there is no cleaning equipment. Given the consideration on menstrual hygiene management (MHM), the usage of sanitation facilities by female students, 28% of respondents use once daily and 26% do not use the sanitation facility. Regarding the issues associated with MHM, 91% of respondents showed that no napkins discarding facility, and 84% mentioned lack of a place to wash, while 72% of students stated the lack of water. In conclusion, it reveals that there exists a higher demand on awareness of water consumption, sanitation and hygiene practices at schools and awareness on disease spreading as there exists poor quality standards of water consumption and sanitation. Thus, it needs careful monitoring of management steps to uplift water consumption, hygiene, and sanitation. The study suggests strengthening school water, sanitation, and hygiene clubs at schools and focus on government funding for utility development.
 Keywords: Water consumption, School sanitation, Hygiene practices, Dehiovita, Menstrual hygiene management

National health workforce accreditation and regulation in Palestine: a qualitative assessment

BackgroundThe Health Workforce Accreditation and Regulation (HWAR) is a set of policies and processes designed to improve the quality of health services and the performance of health professionals. Various efforts were implemented, mainly by WHO, to advance and strengthen practices and activities of HWAR. In Palestine, HWAR seems to be lagging and to require strengthening at both national policy and institutional levels, based on local evidence. HWAR is rarely investigated in Palestine and possibly also in the Eastern Mediterranean. We aimed to assess the current status of HWAR in Palestine, to identify the challenges, and to propose useful policy and technical actions for the effectiveness of HWAR. MethodsWe did a qualitative assessment with a purposive sampling strategy to identify key informants from health authorities and institutions in government institutions (Palestinian Ministry of Health and National Legislative Council), academia (universities), and private and non-governmental organisations. Ethical and administration approvals were obtained from the Helsinki Committee at the Palestinian Health Research Council. The study was implemented from mid-October to mid-November, 2019. 22 in-depth interviews were done with key personnel from leadership and policy levels, including health policy makers, experts, and academics (six female, 16 male). Open questions in the interviews covered HWAR domains: conceptual, governance and policy, technical practices, resource and capacity, and gaps and solutions. Triangulated qualitative methods (thematic and ground theory) were used for data analysis and management. FindingsWe found a lack of understanding of HWAR, and perceptions of HWAR were inconsistent. Despite the existence of a strong legal framework for HWAR and an abundance of untapped skillful health workers, graduates, and students in Palestine and abroad, the majority of participants had a negative view of HWAR, perceiving it as fragmented, poorly regulated, and poorly coordinated. The governing system for HWAR was described as having no specific body or no clear mechanisms of operation. Interviewees reported that some existing accreditation and regulatory standards are well applied but that most need to be updated, reviewed, and enforced at a larger scale. They also reported that HWAR regulatory, executive, and education stakeholders have no consensus on HWAR governance, which is driven by individual initiatives and capacity rather than a systematic evidence-based approach. Overall, the participants described HWAR practices and resources as of low quality. Benefits of a well-established HWAR system and mechanism were suggested, such as an increase in the quality of services, patient safety, trust, and satisfaction with the performance of health system, and a reduction in resource waste. Factors affecting HWAR and the challenges for its implementation were identified—eg, political instability, deficit of education and training, shortage of resources and capacities, and lack of governance and oversight. Actionable solutions at the level of the health system, institutions, and individuals were proposed, establishing a unified and effective HWAR governance structure, policy and regulations, and guidelines and standards for practices. InterpretationInterviewees emphasised the importance of HWAR as a key pillar of health system governance for improving health care and achieving universal health coverage. HWAR national policy and guidelines need substantial reform to tackle poor implementation, communication, standardisation, monitoring, and evaluation. Stakeholders, ministries, syndicates, and academic institutions should work together through an integrated national accreditation and regulation system. Interviewees suggested that system reform must be driven by a common vision, well-established guidelines, and an accreditation and regulation policy for better awareness, best practices, and effective mechanisms. FundingNone.

Factors Associated with Decisions of Arab Minority Parents in Israel to Vaccinate Their Children against COVID-19.

The Arab ethnic community in Israel is characterized by low social economic status and is at risk due to the typically crowded households. Understanding parents’ level of awareness is important to avoid new outbreaks. Objectives: This study seeks to identify predicting factors associated with perceived susceptibility to COVID-19, and barriers to COVID-19 vaccination. Materials and Methods: A survey was conducted through social media, using snowball sampling via social networks. Additionally, t-tests, Chi-square tests, and Z tests were used to evaluate differences between independent proportions. Pearson correlations were calculated for the study variables. Multiple logistic regression examined the extent to which the background variables were related to the intention to vaccinate the child. Results: A total of 2843 Arab parents participated in the study. Older parents, higher socioeconomic status, higher trust in the authorities, vaccinated parents, and low psychological and physical barriers were positively correlated with willingness to vaccinate children. Pandemic fatigue was associated with less positive attitudes and reduced perceived effectiveness toward vaccination. Conclusion: Addressing minorities’ poor standards of living and physical and psychological barriers posed by the authorities to minorities’ access to vaccination may increase compliance with COVID-19 vaccination and protect the health of the entire population.

Privacy, Data Sharing, and Data Security Policies of Women's mHealth Apps: Scoping Review and Content Analysis.

BackgroundWomen’s mobile health (mHealth) is a growing phenomenon in the mobile app global market. An increasing number of women worldwide use apps geared to female audiences (female technology). Given the often private and sensitive nature of the data collected by such apps, an ethical assessment from the perspective of data privacy, sharing, and security policies is warranted.ObjectiveThe purpose of this scoping review and content analysis was to assess the privacy policies, data sharing, and security policies of women’s mHealth apps on the current international market (the App Store on the Apple operating system [iOS] and Google Play on the Android system).MethodsWe reviewed the 23 most popular women’s mHealth apps on the market by focusing on publicly available apps on the App Store and Google Play. The 23 downloaded apps were assessed manually by 2 independent reviewers against a variety of user data privacy, data sharing, and security assessment criteria.ResultsAll 23 apps collected personal health-related data. All apps allowed behavioral tracking, and 61% (14/23) of the apps allowed location tracking. Of the 23 apps, only 16 (70%) displayed a privacy policy, 12 (52%) requested consent from users, and 1 (4%) had a pseudoconsent. In addition, 13% (3/23) of the apps collected data before obtaining consent. Most apps (20/23, 87%) shared user data with third parties, and data sharing information could not be obtained for the 13% (3/23) remaining apps. Of the 23 apps, only 13 (57%) provided users with information on data security.ConclusionsMany of the most popular women’s mHealth apps on the market have poor data privacy, sharing, and security standards. Although regulations exist, such as the European Union General Data Protection Regulation, current practices do not follow them. The failure of the assessed women’s mHealth apps to meet basic data privacy, sharing, and security standards is not ethically or legally acceptable.

Synthetic biology and bioelectrochemical tools for electrogenetic system engineering

Synthetic biology research and its industrial applications rely on deterministic spatiotemporal control of gene expression. Recently, electrochemical control of gene expression has been demonstrated in electrogenetic systems (redox-responsive promoters used alongside redox inducers and electrodes), allowing for the direct integration of electronics with biological processes. However, the use of electrogenetic systems is limited by poor activity, tunability, and standardization. In this work, we developed a strong, unidirectional, redox-responsive promoter before deriving a mutant promoter library with a spectrum of strengths. We constructed genetic circuits with these parts and demonstrated their activation by multiple classes of redox molecules. Last, we demonstrated electrochemical activation of gene expression under aerobic conditions using a novel, modular bioelectrochemical device. These genetic and electrochemical tools facilitate the design and improve the performance of electrogenetic systems. Furthermore, the genetic design strategies used can be applied to other redox-responsive promoters to further expand the available tools for electrogenetics.

Financial risk management in the construction projects

Construction risk can be described as the possibility of an incident that will harm the project’s feasibility. Different threats that impact businesses may be found in the construction industry as elsewhere. Moreover, construction projects face significant risks that put building projects at the risk of cost, over time, and poor standard of execution. In the last two years, Lebanon has been suffering from a severe economic crisis, which has affected a large number of businesses and industries, specifically the construction industry. Therefore, this article aims to identify, classify, and analyse the most significant risks inherent in the Lebanese construction industry with special emphasis on the financial and economic risk category and eventually establish a conclusion in this regard. To achieve the aims of this research, the data were collected by conducting a questionnaire survey among experts in the Lebanese construction industry. The results showed that the construction industry in Lebanon is exposed to many risk sources, internal and external, and the most important ones are financial risks such as fluctuation of the currency, inflation, and lack of solvency. Finally, the importance and benefits of implementing risk management are discussed in this research as well as the barriers to its effective implementation.

Evaluation of the AFIAS-1 thyroid-stimulating hormone point of care test and comparison with laboratory-based devices.

Thyroid-stimulating hormone (TSH) is the routine primary screening test to assess thyroid function and rapid measurement of TSH levels is highly desirable especially in emergency situations. In the present study, we compared the analytical performance of a commercially available point-of-care test (AFIAS-1) and five laboratory-based systems. Left over material of 60 patient plasma samples was collected from patient care and used in the respective assay. For statistical analysis of the produced data Bland-Altman and Passing-Bablok regression analysis were applied. Good correlation (r=0.982 or higher) was found between all devices. Slopes from regression analysis ranged from 0.972 (95% CI: 0.927-1.013) to 1.276 (95% CI: 1.210-1.315). Among the compared devices, imprecision was high in terms of coefficient of variation (CV=10.3%) for low TSH concentrations and lower (CV=7.3%) for high TSH concentrations. Independent of the method used, we demonstrated a poor standardization of TSH assays, which might impact clinical diagnosis e.g. of hyperthyreosis. This study shows that the point-of-care (POC) test AFIAS-1 can serve as an alternative to laboratory-based assays. In addition the data imply that better standardization of TSH measurements is needed.

A Review on Machine Learning, Artificial Intelligence, and Smart Technology in Water Treatment and Monitoring

Artificial-intelligence methods and machine-learning models have demonstrated their ability to optimize, model, and automate critical water- and wastewater-treatment applications, natural-systems monitoring and management, and water-based agriculture such as hydroponics and aquaponics. In addition to providing computer-assisted aid to complex issues surrounding water chemistry and physical/biological processes, artificial intelligence and machine-learning (AI/ML) applications are anticipated to further optimize water-based applications and decrease capital expenses. This review offers a cross-section of peer reviewed, critical water-based applications that have been coupled with AI or ML, including chlorination, adsorption, membrane filtration, water-quality-index monitoring, water-quality-parameter modeling, river-level monitoring, and aquaponics/hydroponics automation/monitoring. Although success in control, optimization, and modeling has been achieved with the AI methods, ML models, and smart technologies (including the Internet of Things (IoT), sensors, and systems based on these technologies) that are reviewed herein, key challenges and limitations were common and pervasive throughout. Poor data management, low explainability, poor model reproducibility and standardization, as well as a lack of academic transparency are all important hurdles to overcome in order to successfully implement these intelligent applications. Recommendations to aid explainability, data management, reproducibility, and model causality are offered in order to overcome these hurdles and continue the successful implementation of these powerful tools.

A legal-realist assessment of the Zimbabwean correctional system response to COVID-19 during state disaster measures

PurposeThe first prison system case in Zimbabwe was notified in July 2020 shortly after State declaration of disaster. A legal-realist assessment was conducted of the Zimbabwean correctional system response to COVID-19 during state disaster measures, with a focus on assessing right to health, infectious disease mitigation and the extent to which minimum state obligations complied with human and health rights standards.Design/methodology/approachThe Zimbabwean correctional system operations during COVID-19 disaster measures are scrutinized using a range of international, African and domestic human rights instruments in relation to the right to health of prisoners. This study focused particularly on standards of care, environmental conditions of detention and right of access to health care.FindingsSystemic poor standards of detention are observed, where prisoners experience power outages, water shortages and a lack of access to clean drinking water and water for ablution purposes, a severe lack of safe space and adequate ventilation, poor quality food and malnutrition and a lack of sufficient supply of food, medicines, clothing and bedding. Whilst access to health care of prisoners in Zimbabwe has greatly improved in recent times, the standard of care was severely stretched during COVID-19 due to lack of government resourcing and reliance on non-governmental organisation and faith-based organisations to support demand for personal protective equipment, disinfection products and medicines.Originality/valuePrison conditions in Zimbabwe are conducive to chronic ill health and the spread of many transmissible diseases, not limited to COVID-19. The developed legal-realist account considers whether Zimbabwe had a culture of respect for the rule of law pertinent to human and health rights of those detained during COVID-19 disaster measures, and whether minimum standards of care were upheld.

Senior manager leadership competencies for quality residential aged care: an Australian industry perspective

BackgroundDocumented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills and personal qualities are necessary to deliver and strengthen the quality of RAC, with the aim of improving understanding of the professional development needs of leaders in the sector.MethodsWe conducted 12 in-depth interviews with Australian aged care industry experts, including academics, and representatives from the primary health network, consumer, and provider advocate groups. Abductive, thematic analysis incorporated coding derived from existing leadership skills frameworks as well as inductively identified themes.ResultsIdentified leadership skills were grouped into five domains including i) workforce development and retention, ii) governance and business acumen; iii) health systems knowledge; iv) stewardship and v) responding to regulatory and political contexts. Skills particularly emphasised by participants were those required to recruit and retain a skilled workforce, manage relationships, and promote a positive organisational culture and employee wellbeing.ConclusionsRAC senior managers require a complex mix of business, human resource management, and clinical skills to deliver quality care in Australia’s complex RAC setting. The lack of any professional development framework to guide the acquisition or updating of those skills is a concern.

Perceptions of people with motor neurone disease, families and HSCPs: a literature review

Motor neurone disease or amyotrophic lateral sclerosis is a rapidly progressive terminal neurodegenerative condition caused by degeneration of the upper and lower motor neurones in the central nervous system of the brain. The effects of motor neurone disease are multifaceted, leading to many adjustments in everyday life. This literature review asked what the experiences of people living with motor neurone disease was before and during the COVID-19 pandemic and during the COVID-19 pandemic, especially in terms of their condition and the support they received from health and social care services. A key theme identified was lack of knowledge among professionals when they cared for people living with motor neurone disease and their families. This lack of knowledge often resulted in delayed diagnosis and poor standards of care. COVID-19 impacted on the care of people living with motor neurone disease and their families, and there is a paucity of evidence on how services were perceived by these groups during the COVID-19 pandemic. The experiences of people living with motor neurone disease and their families are currently missing in the literature. In conclusion, further studies are required to include care of people living with motor neurone disease and their families.

Corporate Social Responsibility in the Niger Delta: Past, Present and Future Challenges

ABSTRACTMultinational oil companies adopted corporate social responsibility as a means of addressing the challenges of their relationship with the Niger Delta communities, which had been turbulent for several decades as a result of the ecological devastation of the Niger Delta region. This article analyses the challenges of implementing corporate social responsibility in the Niger Delta, from the inception of the Nigerian oil industry to the present day. Using the experiences of multinational oil companies in the Niger Delta as a case study, the article explores the extent to which multinational oil companies operating in developing countries are increasingly assuming roles that are not traditional corporate roles, to compensate for the bad governance and poor regulatory standards in these countries. The article also provides recommendations for what the Nigerian government can do to develop corporate social responsibility and make it more effective.

Radiomics in medical imaging: pitfalls and challenges in clinical management.

Radiomics and radiogenomics are two words that recur often in language of radiologists, nuclear doctors and medical physicists especially in oncology field. Radiomics is the technique of medical images analysis to extract quantitative data that are not detected by human eye. This article is a narrative review on Radiomics in Medical Imaging. In particular, the review exposes the process, the limitations related to radiomics, and future prospects are discussed. Several studies showed that radiomics is very promising. However, there were some critical issues: poor standardization and generalization of radiomics results, data-quality control, repeatability, reproducibility, database balancing and issues related to model overfitting. Radiomics procedure should made considered all pitfalls and challenges to obtain robust and reproducible results that could be generalized in other patients cohort.

Taking Systems Thinking to the Global Level: Using the WHO Building Blocks to Describe and Appraise the Global Health System in Relation to COVID-19.

Adequately preparing for and containing global shocks, such as COVID‐19, is a key challenge facing health systems globally. COVID‐19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system—the global health actors and the governance, finance, and delivery arrangements within which they operate—is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID‐19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non‐transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.

The life-cycle assessment of greenhouse gas emissions and life-cycle costs of e-waste management in Thailand

There is no clear direction in the management of electrical and electronic waste products (e-waste), as there are no regulations on ways to do so. This research attempts to understand the trade-off between the economic value and the environmental effects of the current disposal of e-waste to find ways to optimize waste management, focusing on cellphones, television cathode ray tubes, desktop computers, and air conditioners. A life cycle greenhouse gas and life cycle costs were conducted. Under the e-waste management status quo, most household e-waste is kept in houses because owners do not know where to discard it. In addition, informal sectors, such as domestic farmers or workers, have been actively involved in collecting and dismantling e-waste for more than a decade, leading to poor management standards for both health and the environment. Without e-waste management regulations, informal dismantlers of products gain slight profits by collecting and selling parts and discarding all non-recyclable waste in municipal garbage dumps. The current practice actually adds greenhouse gas to the atmosphere mainly due to improper logistics management and discarding of refrigerants. The logistics are inefficient because the dismantling communities and recycling locations are far apart. Most e-waste is generated, and most recycling industries are located in the central region (the richest areas), while the dismantling communities are located in the northeastern region (the poorest areas). Furthermore, the life cycle of greenhouse gas and the life cycle costs of e-waste are affected by transportation, and not all e-waste parts can be recycled within the country. High-tech mineral extraction cannot be practiced in the country, and thus, circuit boards and batteries are exported for recycling. To promote a circular economy, e-waste management regulations should be implemented, the costs of proper e-waste management should be internalized, and a full recycling industry should be established in the country.

Financial Performance before and during the Covid-19 Pandemic on Islamic Microfinance Institutions (Case Study Btm Kaliwungu)

Islamic banking in Indonesia is facing a number of challenges in the midst of the Covid-19 pandemic, and impacting Sharia Micro Finance Institutions will face several potential risks to financial performance. For this reason, research is needed to analyze the impact of Covid-19 on sharia microfinance performance. In this case, BTM Kaliwungu analyzes financial statements using financial ratios, namely Return On Asset (ROA), Capital Adequacy Ratio (CAR), Non-Performing Finance (NPF) and Financing Deposit to Ratio (FDR). This is a quantitative study with trend analysis in Microsoft Excel. The data were collected three years (December 31, 2017- December 31, 2019) before and one year (December 31, 2020) after the announcement of the first case of Covid-19 on March 2, 2020. The financial statements demonstrate the overall impact of Covid-19 on sharia microfinance performance (BTM Kaliwungu). During the existence of covid-19, the CAR ratio has no effect. ROA displays the results of criterion calculation quite well before or during the Covid-19 pandemic. The NPF calculation results show that the poor standard is still within the acceptable standardized range. Furthermore, in the case of FDR, it necessitates a greater reliance on third-party funding.

O potrzebie zreformowania mechanizmów odpowiedzialności za naruszenia Zasad Etyki Poselskiej

Considering the poor standards of public life, the existence and functioning of the Deputies’ Ethics Committee constitute essential elements of the Polish parliamentarism. Although not the only one, the principal task of the Deputies’ Ethics Committee is to react to the actions of deputies that violate the rules of ethics of deputies adopted in 1997. After more than 20 years of the Committee’s operation, we can identify areas where there are noticeable dysfunctions, e.g. the composition of the Committee, the mechanism of imposing penalties and their type. With the 2018 amendment to the Standing Orders of the Sejm, a new mechanism was also introduced to hold deputies accountable for actions violating ethical standards occurring during sessions of the chamber as well as on the premises under the authority of the Chancellery of the Sejm, effectively allowing us to speak of a duality of accountability.