Challenges in Creating a Critical Care Organization at Your Institution.

Radiographer role extension into image interpretation has gained global attention, particularly in low-resource settings where radiologist shortages hinder timely diagnosis. However, limited methodological guidance exists to support the design of complex, context-specific implementation research in this area. This paper outlines and reflects on a four-phase sequential mixed methods design employed to develop and validate a framework for Preliminary Image Evaluation (PIE) by radiographers in Ghana. This methodological paper presents a reflective account of the design decisions and integration strategies that guided a multi-phase mixed methods study on radiographer role extension. Rather than reporting new empirical data, the focus is on the philosophical positioning, analytical choices, and integration logic that shaped the study. Key methods included qualitative interviews, a validated online survey, performance-based image interpretation tests, curriculum document analysis, and a Delphi consensus process. Sequential integration of qualitative, quantitative, documentary, and performance-based data generated meta-inferences that supported cumulative knowledge building and iterative refinement of research tools. The design enabled alignment across data strands, enhanced interpretive trustworthiness, and culminated in a validated PIE framework tailored to resource-constrained environments. Stakeholder engagement throughout the process reinforced contextual relevance and legitimacy. This study demonstrates the methodological strength and contextual value of methodological diversity and purposeful method integration in addressing complex workforce issues. It shows how mixed methods designs can move beyond isolated findings to inform sustainable education reform, workforce development, and policy alignment in radiography. This work offers a methodological model that can guide educators, researchers, and policymakers in designing contextually responsive workforce research. By showcasing how integrated mixed methods can generate policy-relevant and actionable insights, it supports the development of strategic approaches to radiographer role extension.

Real-world laboratory functionality requirements and implementation considerations for fast phenotypic antimicrobial susceptibility testing.

In a time of dramatic change on multiple fronts, health systems must evolve with a mindset of persistent flexibility, where change is treated as normal rather than episodic or exceptional. At BJC Health (BJC), one of the nation's largest nonprofit health systems, treating patients in Illinois, Missouri, and Kansas, our change leadership approach emphasizes deliberate planning, leadership development, and communication to drive acceptance, ability, and accountability.This article describes two use cases that draw on this discipline: (1) the integration of employee benefits following the merger of BJC and Saint Luke's Health System, which required careful stakeholder engagement, extensive leader training, and transparent communication to address employee anxiety while maintaining operational stability; and (2) the implementation of artificial intelligence aimed at reducing administrative burden, improving provider well-being, and enhancing patient care. In both cases, success depended not only on the quality of solutions but on leaders' ability to guide people through change.By investing in change leadership capabilities, BJC has established a consistent and sustainable process for minimizing disruption, preserving our culture, and positioning ourselves to thrive amid continual transformation.

Prigi Bay presents a variety of appealing tourism attractions, including pristine sandy beaches, mangrove ecosystems, and turtle conservation efforts, hence providing a substantial chance to draw both domestic and foreign visitors. Tourists typically do not depart without acquiring distinctive gifts. A unique gift from this region is smoked fish, made by traditional methods, yielding a distinctive and delectable flavor. Nonetheless, the substantial demand for smoked fish must be reconciled with the appeal of the fish supplies within its waterways. This study aimed to evaluate the profitability and financial viability of the smoked fish processing industry, as well as to assess the availability of fish resources as raw materials for this process in Prigi Bay, Trenggalek. Prigi Bay is a region with high fish production and attractive coastal tourism, offering opportunities to develop local souvenirs, such as smoked fish. The profitability of the fish processing enterprise yields R/C, BEP, profit, and profitability that align with established profitability criteria. The viability of the smoked fish processing enterprise yields a favorable NPV, a Net Benefit-Cost ratio over 1, an IRR surpassing the 12% interest rate, and an expedited Payback Period. The investigation of the exploitation status indicated that five of the six primary commodities— blue mackerel, skipjack, squid, tuna, and rainbow runner— are undergoing biological overfishing, with tuna and blue mackerel facing the most pressure. The majority of species are in a state of full or moderate exploitation, whereas yellowfin tuna is nearing full exploitation but has not yet reached overfished status. A marketing strategy centered on high-value commodities, collaborative stakeholder engagement, and stringent fisheries management laws, including catch quotas and seasonal fishing limitations, to guarantee ecological and economic sustainability. These findings confirm the financial viability of a fish smoking enterprise in Prigi Bay by employing a fish stock-based adaptive quota model, which adjusts raw material allocation according to exploitation status, prioritizing fish resources that remain unsustainably harvested.

This research study investigates critically the mechanisms employed to enhance accountability through the use of 'transparency' mechanisms, 'stakeholder engagement' mechanisms and 'quality assurance' mechanisms. The study is quantitative, cross-sectional survey employing a 30-item validated instrument and responses measured on a five-point Likert Scale for institutional accountability across ten different domains of focus regarding teacher education programs. A stratified random sample of 159 teachers were obtained from all four types of Teachers’ Education institutions. The data demonstrates a mean score of 3.25 for the average accountability implementation, demonstrating that substantial improvement is needed in this area. Correlation analyses suggested a positive correlation between accountability and training modules leading to systematic implementation of training integrated approach rather than treating them as separate training elements. This finding carries considerable implications for changing educational policies, promoting better institutional governance within schools to enhance quality assurance. Consequently, this research supports the current lack of empirical evidence regarding how accountability mechanisms work in global south.

The construction sector is under increasing pressure to enhance project performance, particularly through strengthening project manager competencies (PMC). Although the importance of managerial competencies has been widely acknowledged, limited research has examined how PMC influence project performance (PP) through underlying organizational mechanisms. This study addresses this gap by investigating the direct effect of PMC on PP and the mediating roles of team performance (TP) and stakeholder engagement (SE). A quantitative cross-sectional survey was conducted among 288 project team members in Pakistan’s construction sector. The data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results indicate that PMC have a significant positive effect on PP. Furthermore, TP and SE significantly mediate this relationship, highlighting the critical role of effective team dynamics and proactive stakeholder involvement in translating managerial competencies into improved project outcomes. This study contributes to the literature by integrating the Resource-Based View and stakeholder theory to explain the mechanisms linking managerial competencies to project performance. The findings provide practical implications for construction firms and policymakers by emphasizing the strategic importance of developing managerial competencies, strengthening team collaboration, and enhancing stakeholder engagement across the project lifecycle. Keywords: Project manager competencies; Project performance; Team performance; Stakeholder engagement; Resource-Based View; Stakeholder theory; Construction industry.

The purpose of this paper is to examine the extent of regulatory compliance regarding green zones in urban centers within a postcolonial context in promoting health and well-being in Lokoja metropolis and other developing countries while targeting all stakeholders and users. This study employs proportional random sampling to collect data by administering 140 structured questionnaires, yielding a valid response rate of 120 (72%). Additionally, physical observations of green zone areas were conducted for assessment, along with a review of published literature. SPSS was utilized for the descriptive and inferential analysis of the data, while thematic analysis was used for data collected through physical observations. The findings indicate that the lack of stronger regulatory control in postcolonial urban centers has led to the conversion of green-zone areas for alternative uses. This research was conducted in Lokoja municipality, one of the first administrative seats of the colonial governor-general. But the findings can be applied to similar cities and developing countries with post-colonial compliance regulatory issues. This study suggests that urban development control should establish stronger regulatory frameworks with penalties for non-compliance to preserve the original purpose of green zone areas, established during the colonial period. Moreover, the findings emphasize the necessity for robust legislation for urban control officials, building developers, and those involved in construction and city planning in developing countries, focusing on sustainable stakeholder engagement to ensure adequate compliance with green zone regulations.

This article examines the application of organizational innovation principles to address the challenges posed by local opposition to the siting of renewable energy facilities. Modern approaches to scenario planning emphasize continuous learning rather than one-time exercises. Recent advancements in scenario methodology encourage organizations to develop dynamic capabilities that allow for ongoing revisions to stakeholder engagement strategies. These capabilities enable renewable energy developers to adapt quickly to emerging community concerns. Drawing upon studies conducted during the Colorado Technical University course, MGMT 832, Organization Innovation and Scenario Thinking, and building upon findings from the renewable energy siting process delays due to opposition, this paper proposes innovative approaches to mitigate interruptions caused by opposition. Renewable energy developers who employ dynamic business model innovation can better navigate shifting stakeholder expectations and regulatory environments. The research demonstrates that effective communication, stakeholder engagement, and innovative organizational practices can significantly reduce delays in the implementation of renewable energy projects. Unlike contingency planning, which addresses specific risks, scenario planning generates diverse narratives of potential outcomes, allowing organizations to develop flexible strategies to address community concerns. Traditional risk assessment often overlooks unexpected events that can derail renewable energy projects. The concept of 'black swan' events highlights the importance of developing robust scenario plans that can withstand unpredictable opposition. Renewable energy developers must prepare for a range of possible futures rather than optimizing for a single expected outcome. By integrating organizational innovation theory with practical approaches to community engagement, this article offers a framework for renewable energy developers, policymakers, and stakeholders to navigate the complex landscape of renewable energy siting while addressing community concerns.

ABSTRACT With the increasing ageing population, many older adults still live in the generally designed housing stock, which could be ‘unsuitable’ for them. One effective way to enhance their quality of life and independence is to renovate existing housing. The development of innovative technologies (e.g. virtual reality) and design approaches (e.g. co-design) can provide new strategies for housing renovation practices. However, the knowledge of synergising these technologies with design approaches remains limited, with the potential value yet to be fully recognised. This study explores and validates a method that synergises co-design, empathic design, and virtual reality within a senior social housing renovation project in the Netherlands, which focuses on three phases: a) translating the design ideas, empathic elements, and requirements of senior residents into digital models, b) developing virtual scenarios to illustrate design variations, and c) evaluating and modifying the design variations with stakeholders using virtual reality devices. Through data analysis of the semi-structured interviews, questionnaires, co-designed sketches, and communication transcriptions, the results reveal that customised renovation design enhances stakeholder engagement and improves the effectiveness of the design process, especially for the residents. This study provides a reference for future design research involving the use of VR with older adults.

ABSTRACT The North American 2026 FIFA Men’s World Cup (FWC) is the first tournament in which human rights policies and plans have been in place for the awarding body and host nation from the bid stage. This paper examines the FWC human rights governance arrangements, through an analysis of strategic documents, observations of three host cities and semi-structured interviews with key stakeholders. Drawing on institutional theory, we argue that human rights institutional logic formation, via stakeholder engagement and isomorphic pressures, influences FIFA. However, we also demonstrate that this influence is limited due to the primacy of business agendas at the executive level. We conclude that while positive steps have been made, with human rights structures, policies and processes now in place at FIFA, host nation(s) and host cities; issues of implementation remain throughout each level of the FWC institutional field.

Purpose The purpose of this study is to investigate the efficacy of the pre-packaged insolvency resolution process (PPIRP) introduced specifically for micro, small and medium enterprises (MSMEs) in India under the Insolvency and Bankruptcy Code (IBC), 2016. The study aims to address the gap in literature with respect to the real-world impact of the PPIRP by evaluating whether it achieves its intended goals of being a timely, cost-effective and stakeholder-friendly process for resolution of insolvency of MSMEs. The research has been motivated by the need to understand the practical challenges of PPIRP and compare it with the corporate insolvency resolution process (CIRP) to propose reforms for boosting its effectiveness. Design/methodology/approach This study adopts a qualitative, doctrinal methodology to assess the efficacy of the PPIRP under the IBC. The study involves a systematic interpretation of the statutory provisions and case laws as primary sources. The study is complemented by secondary sources such as articles, commentaries from leading firms and reports from IBBI. Because the PPIRP is a relatively new mechanism that was introduced in 2021, the research has emphasized on examining the legal and practical implications of the same in India. Apart from the regulatory analysis, the research also incorporates a comparative approach by evaluating the PPIRP process against the CIRP process to highlight the strengths, limitations and the scope of improvements in both. The study also incorporates case analysis method to provide insights into the ground reality of the successful or unsuccessful implementation of the PPIRP. The study also incorporates comparisons with similar processes adopted by jurisdictions such as the USA, the UK and Singapore to understand the distinctiveness of the Indian process. This multifaceted methodology ensures that there is a balanced and comprehensive assessment of the role of PPIRP in the insolvency resolution landscape in India. Findings The findings of this study reveal that though the PPIRP was anticipated to be a cost-effective, time-bound and debtor-in-control alternative for the MSMEs as against the traditional insolvency resolution mechanism, it has had limited practical impact. The rate of adoption of the PPIRP mechanism remains low with several structural and procedural challenges, which hinder the applicability of the PPIRP. These include a high default threshold, stringent eligibility criteria and a requirement for substantial approvals from creditors before the initiation of the process. Though the PPIRP process has been designed to expedite resolution and minimize the judicial intervention, the same is not achieved, and there are delays because of procedural complexities and hesitancy of stakeholders. The case studies present mixed outcomes, where, in some cases, the PPIRP enabled timely resolution of insolvency, while in the others, the process was either converted to CIRP or withdrawn as the creditors failed to achieve a consensus. While the PPIRP offers advantages in terms of a hybrid process that allows debtor control with creditor oversight and reduced costs, in comparison with the international pre-packaged systems, it lacks methods for stakeholder buy-in and flexibility. The research highlights the need for reforms to enhance stakeholder engagement, lower the entry barriers and align the PPIRP to global best practices to meet its full potential. Originality/value The study is, to the best of the authors’ knowledge, among the first few comprehensive doctrinal analyses into the effectiveness of the PPIRP in India. It offers a balanced view on the PPIRP process, highlighting both its strengths and weaknesses. The research provides a basis for suggesting changes for improving the PPIRP process and its implementation. The findings are valuable for insolvency professionals, policymakers and MSME stakeholders and lay the groundwork for any future empirical research to be conducted on PPIRP.

ABSTRACT Introduction: Malnutrition, resulting from insufficient nutritional intake or poor dietary choices, significantly affects hospitalized patients, leading to longer hospital stays and increased health care costs. The European Nutrition for Health Alliance and subsequent initiatives have emphasized the importance of nutritional screening. Objectives: This study aimed to improve nutritional screening among patients aged over 75 years admitted to internal medicine wards by assessing compliance with best practices and identifying and addressing barriers to effective implementation of recommended practices. Methods: Using the JBI Evidence Implementation Framework, the project involved a structured audit and feedback process across seven phases. Baseline audit data were collected from all patients aged over 75 years admitted to internal medicine wards over 1 month. The JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit and feedback tools were used to identify barriers and develop strategies to address them. A follow-up audit was conducted 6 months post-implementation to measure changes in compliance with recommended practices. Results: The follow-up audit showed a significant improvement in compliance with best practices, which increased from 22.62% at baseline to 48.26%, reflecting the effectiveness of the targeted interventions. Nurses reported enhanced knowledge and confidence in conducting screenings, although gaps in documentation practices remained. Conclusion: This project successfully improved compliance with nutritional screening practices, highlighting the importance of stakeholder engagement, training, and support. Future efforts should focus on sustaining these improvements through enhanced training and interdisciplinary collaboration, with the aim of improving the outcomes of patients at risk of malnutrition. Spanish abstract: http://links.lww.com/IJEBH/A521

This paper examines the socio-legal implications of recent reforms to UK nuclear planning law facilitating the deployment of small modular reactors (SMRs) across England and Wales. The reforms extend planning permissions beyond traditional nuclear sites. These changes create a distinct consent process compared to large nuclear facilities, notably through accelerated timelines and a dedicated regulatory taskforce to expedite approvals and early stakeholder engagement. Applying the energy justice framework, the key issue addressed is whether these reduced-consent reforms compromise procedural fairness, equitable distribution of benefits and burdens, and recognition of environmental risks within affected communities.

When coastal habitats fail: Transitioning from adaptation to vulnerability under habitat degradation.

Cognitive impairment is present in the majority of individuals with first-episode psychosis (FEP) and is a strong predictor of long-term functional disability. Despite this, evidence-based cognitive interventions are rarely available in routine mental healthcare in low-income and middle-income countries, where most young people with psychosis reside. This protocol describes the CognIFied study, a pilot randomised controlled trial evaluating the feasibility and acceptability of a culturally adapted, task-shifted compensatory cognitive training (CCT) intervention for young adults with FEP in Nigeria. CognIFied is a multicentre, assessor-blind, parallel-group pilot randomised controlled trial with an embedded mixed-methods process evaluation. The study will recruit 180 young adults aged 18-30 years with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-defined FEP (onset within the past 5 years) and objective cognitive impairment from three public psychiatric hospitals in Nigeria. Participants will be randomised 1:1 to receive either culturally adapted CCT or an active control condition, Enhanced Recreational Therapy. Both interventions comprise 12 weekly group sessions lasting 60-90 min. CCT is delivered by trained psychiatric social workers using a manualised curriculum co-designed with young people with lived experience. Primary outcomes assess feasibility (recruitment, retention, intervention adherence), acceptability (Client Satisfaction Questionnaire-8) and intervention fidelity. Secondary outcomes include preliminary signals of effectiveness on global cognitive functioning (Brief Assessment of Cognition in Schizophrenia) and functional capacity (University of California, San Diego [UCSD] Performance-Based Skills Assessment), assessed at baseline and at 3, 6 and 12 months. Quantitative analyses will be descriptive and exploratory, supplemented by qualitative inquiry guided by Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Consolidated Framework for Implementation Research frameworks and an exploratory economic evaluation. Ethical approval has been obtained from relevant institutional review boards. Findings will be disseminated through open-access publications, policy-focused stakeholder engagement and community dissemination co-led by a Youth Research Team. ISRCTN44794154.

Guest editorial: Special issue on digitalization and stakeholder engagement in Asian cultural heritage

Newborn bloodspot screening (NBS) is freely and universally available to babies born in Australia, with nearly 300 000 newborns screened each year. The NBS programme screens for approximately 30 conditions; however, there are hundreds of childhood conditions that could be treated if identified earlier and asymptomatically. Contemporary screening platforms have relied on mass spectrometry-based technologies, limiting surveillance to conditions with validated biomarkers detectable within the neonatal period. Advancements in metabolic techniques and genomics have expanded the range of conditions that could be detected. The NewbornsInSA research study will develop, validate and evaluate a novel multi-omic model of newborn screening, integrating metabolomic and genomic newborn screening as complementary methodologies. Parents can opt in to additional NBS through NewbornsInSA during pregnancy or shortly after birth. One thousand prospectively recruited families will be offered genomic NBS by whole-genome sequencing, including analysis of a virtual gene panel of over 600 genes, and concurrent metabolomic screening. Clinically actionable pathogenic or likely pathogenic genetic variants will be reported to parents and whole genome sequencing data will be available on request for diagnostic reanalysis, if required later in life.Acceptability of the NewbornsInSA programme will be evaluated through stakeholder engagement activities with healthcare professionals, members of the public and patient advocacy groups. Family experiences will be assessed using online surveys. The diagnostic yield, accuracy and the costs and consequences of the multi-omic NBS model will be assessed by comparison to standard-of-care NBS.NewbornsInSA will investigate the acceptability, feasibility and cost-effectiveness of a multi-omic newborn screening model in a prospectively recruited South Australian population. We hypothesise that this approach will increase the number of conditions identified, reduce the time to diagnosis and facilitate earlier care with better outcomes for newborns with genetic conditions. This research study has been ethically approved by the Women's and Children's Health Network Human Research Ethics Committee (2022/HRE00258 and 2023/HRE00236). Findings will be disseminated through peer-reviewed publication and conferences.

Artificial Intelligence (AI) is increasingly shaping agribusiness transformation in Nepal by improving productivity, sustainability, and market integration within a largely smallholder-based agricultural economy. This article examines the current status, applications, opportunities, and constraints of AI adoption in Nepal’s agribusiness sector using a comprehensive secondary desk review of academic literature, policy documents, and development reports. Key AI applications include precision farming, satellite-based crop classification, predictive analytics, and digital advisory services across crop, livestock, and supply chain management. Initiatives such as GeoKrishi, Connect Kisan AI, and the Omdena-UNWFP collaboration illustrate AI’s potential to enhance resource efficiency and climate resilience. However, adoption remains limited due to infrastructure gaps, high costs for smallholders, data scarcity and localization challenges, low digital literacy, and evolving policy and regulatory frameworks. Drawing on insights from other emerging markets, the study adapts the extended Technology Acceptance Model-Technology-Organization-Environment (TAM-TOE) framework to contextualize AI adoption in Nepal. The article concludes that inclusive and scalable AI-driven agribusiness transformation will require coordinated stakeholder engagement, targeted investments in digital infrastructure, skills development, and robust data governance mechanisms.

European policies on child obesity prevention, health promotion and responsive parenthood within Joint Action Health4EUKids.