Standard Policy Research Articles

Taking Shortcuts and Workarounds: Is it Ethical?

Current healthcare practices are geared toward standardized policies and procedures that are intended to guide the practice of all members of the healthcare professions, especially the practice of nurses. Instead of using predefined practices, nurses often choose shortcuts or workarounds to complete daily work in healthcare institutions. Are the shortcuts considered ethical for nurse practice or for members of the discipline of nursing? This article begins an ethical straight-thinking discussion on the conflicting values and implications for those who offer professional nurse services and those who receive these services.

Pricing, Procurement and Reimbursement Policies for Incentivizing Market Entry of Novel Antibiotics and Diagnostics: Learnings from 10 Countries Globally.

Fostering market entry of novel antibiotics and enhanced use of diagnostics to improve the quality of antibiotic prescribing are avenues to tackle antimicrobial resistance (AMR), which is a major public health threat. Pricing, procurement and reimbursement policies may work as AMR 'pull incentives' to support these objectives. This paper studies pull incentives in pricing, procurement and reimbursement policies (e.g., additions to, modifications of, and exemptions from standard policies) for novel antibiotics, diagnostics and health products with a similar profile in 10 study countries. It also explores whether incentives for non-AMR health products could be transferred to AMR health products. This research included a review of policies in 10 G20 countries based on literature and unpublished documents, and the production of country fact sheets that were validated by country experts. Initial research was conducted in 2020 and updated in 2023. Identified pull incentives in pricing policies include free pricing, higher prices at launch and price increases over time, managed-entry agreements, and waiving or reducing mandatory discounts. Incentives in procurement comprise value-based procurement, pooled procurement and models that delink prices from volumes (subscription-based schemes), whereas incentives in reimbursement include lower evidence requirements for inclusion in the reimbursement scheme, accelerated reimbursement processes, separate budgets that offer add-on funding, and adapted prescribing conditions. While a few pull incentives have been piloted or implemented for antibiotics in recent years, these mechanisms have been mainly used to incentivize launch of certain non-AMR health products, such as orphan medicines. Given similarities in their product characteristics, transferability of some of these pull incentives appears to be possible; however, it would be essential to conduct impact assessments of these incentives. Trade-offs between incentives to foster market entry and thus potentially improve access and the financial sustainability for payers need to be addressed.

The Plight of Syrian Refugees in the United States: Between Indifference and Dehumanization

Forced or voluntary migration worldwide and the quest for a safer and better life has not always resulted from armed conflicts or any form of political, ethnic, or religious persecution. Natural disasters have often enticed waves of deprived people across sovereign national borders. The present study investigates the plight of Syrian refugees in the aftermath of the 2011 upheavals which shook the Arab World, not as much because it poses unprecedented humanitarian and political challenges, but principally because it laid bare the double standard policy pursued by certain Western governments scapegoating Arab/Muslim stocks as a lingering menace to their security. To reconfigure the boundaries of decent debate and break down taboos over such a controversial issue, the paper raises a number of questions with regard to the essence of humanitarian work and how, over the past few decades, it has been politicized by ruthless politicians and unscrupulous technocrats to determine the resettlement of displaced masses or the allocation of funds to international relief organizations based on national, religious, and even racial standards. It takes the United States as a case in point to show how, despite being the largest donor of humanitarian assistance to Syrian refugees, it has resettled only a tiny fraction of such a group compared to poorer contiguous states. The paper posits, finally, to contribute survey-based argument to available literature which, to some degree, has not sufficiently explored the hypothetical connection between refugee flows and transnational terrorism to demonstrate, ultimately, that not every Arab/Muslim refugee is a terrorist-in-waiting.

Improving patient understanding of GEP test results (IMPARTER4): An RCT.

527 Background: We developed two 8 min films to aid patients’ understanding about gene expression profiling (GEP) tests (Oncotype DX or Prosigna) in breast cancer. A previous study of 120 women without breast cancer demonstrated significantly better knowledge after film viewing compared to that after reading written materials (1). We present results of an RCT testing the films’ utility when given in clinics to women with early HR+ breast cancer for whom the benefit of chemotherapy was uncertain. Methods: Standard information policies about GEP testing differ, some clinics may provide patients with leaflets, others only verbal information. Patients who had consented to a GEP test were invited to join IMPARTER4. At baseline they completed anxiety trait/state and intolerance of uncertainty (IoU) questionnaires and were then randomized to Gp A (hospitals’ standard information alone) or Gp B (standard information plus the relevant GEP patient film). Prior to learning their risk of recurrence scores, researchers interviewed patients and probed their understanding and knowledge about GEP testing together with the role risk scores had in helping determine management options (hormone therapy plus or minus chemotherapy). Following test result discussions with oncologists, patients completed two further questionnaires measuring anxiety and decisional conflict. Treating physicians all completed IoU questionnaires once at baseline, Satisfaction with their clinical interviews conducted with patients about risk scores and management decisions was measured using a study specific questionnaire. Results: To date 225/230 patients from 18 UK hospitals (Gp A (standard information alone) n=103; Gp B (standard plus information film) n=122) were seen by 79 physicians. Socio-demographics, anxiety trait/state and IoU did not differ between groups. Prior to the results discussion, written information was given to 128/225 (56.9%), (66 in Gp A, and 62 in Gp B). Linear regression analyses (adjusted for age and education) showed that mean knowledge scores were higher in those receiving standard information plus the film (Gp B), (2.5 points (95% C.I:1.7-3.4) p<0.001). There was a trend for longer consultations in those patients having standard information alone (Gp A) (12.6% v 8.2%), who also asked more difficult questions (9.7% v 2.5%). Conclusions: Patient information films significantly improved knowledge about GEP tests and recurrence risk results compared to standard verbal and written information alone. Furthermore, the films appeared to enable shorter, more informed discussions between patients and their oncologists about the addition of chemotherapy to hormone therapy alone. Versions in Spanish, Italian, French, Urdu, Hindi, Gujarati, Punjabi, and Bengali are freely available. 1. Fallowfield et al, Br Ca Res & Tmt. 2022. Clinical trial information: 28497350.

A CASE STUDY ON THE OPERATION AND MARKETING STRATEGIES OF GROUP HOME IN JAPAN

This study uses the Sky Group Home case study method to understand the current status of the industrial environment where the case is located, and explore the development trends and business strategies of Japanese companies in the group home market. It also analyses the corresponding marketing strategies of the industry based on regional expansion points, so as to improve the competitiveness of the industry's regional channels and open up new markets for international group home development. In recent years, Taiwan's group homes have been gradually privatized, and Japan's implementation experience has a high degree of reference value for my country's policy construction and group homes. This study focuses on operating groups in Japan Company A of Home House is taken as the research object, and the standard policies and operating models for the establishment of Japanese group homes are discussed through literature. Company A is used to understand its operating model based on its service content and current operating conditions. Environmental analysis and marketing mix analysis are conducted to explore its market, management and Marketing strategy; Finally, use SWOT analysis to summarize A The current situation of the company and suggestions for the future development of the industry. The legal entity creates a daily life environment similar to home, adhering to the core concept of "serving users", focusing on personal uniqueness, and providing users with social care in a small unit. In Japan, group homes gather two major groups: the elderly and the physically and mentally disabled, living in a house the size of an average family. Or apartments, with nursing staff working around the clock to provide living assistance, giving customers a convenient and secure living space and a comfortable and barrier-free daily life. After a preliminary understanding, I realized that compared to Taiwan, the development of group housing in Japan is more prosperous, and because the government adopts a "government subsidy, private operation" approach in the implementation of group housing welfare policies, it not only provides operating subsidies to private operators , and also provide consulting services and other assistance to the industry to make this social welfare industry more common in the country, so it was decided to further explore this policy.

Mitigation of Inpatient Standard Class Risk at Hospital X

Background: The Standard Inpatient Class Policy (KRIS) in Indonesia aims to provide equitable healthcare services, ensuring the same standards in inpatient wards across all hospitals in Indonesia. This policy has been issued since 2021 and is mandatory for all hospitals to implement by December 2024. The implementation of the KRIS policy impacts hospitals, necessitating analysis and mitigation of risks arising from its implementation. This study aims to provide an overview of the analysis and mitigation of risks in the standard inpatient class implemented by Hospital X. Method: Qualitative research using Focus Group Discussions (FGDs) in November 2023 involving 7 key informants, including Hospital Directors and Department Heads, regarding the mitigation of risks in the standard inpatient class using risk analysis matrices. Results: There are two criteria for the standard inpatient class that pose a very high level of risk, namely the building components lacking high porosity and the density of ward spaces and bed spacing. Conclusion: Hospital X implements risk mitigation by taking actions to reduce the impact of risks through room improvement based on related room reports, risk reduction mitigation by planning inpatient building renovations, and risk acceptance mitigation by allowing ward areas to be 9.8 square meters per bed.

#1245 Standard or personalized policy of peritoneal catheter removal at kidney transplantation?

Abstract Background and Aims The presence of peritoneal dialysis (PD) catheter in an immunosuppressed kidney transplant recipient can increment the risk of infectious complications after transplant. For this reason, it is thought that management of PD catheters at the time of transplant can have an impact on patient and graft outcomes. However, there is no agreement when to remove peritoneal dialysis catheter after transplantation. According to European Guidelines, the catheter can be left in situ for 3-4 months despite a functional graft. Our aim was to review the data from our center regarding infectious PD associated complications after kidney transplant. Method We retrospectively reviewed all 132 patients that were previously on PD and were admitted to our center for renal transplantation between January of 2013 and June of 2023, and had information regarding timing of removal of PD access. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Our main outcome was to assess the PD infectious catheter-associated complications. Our secondary outcomes were the timing of removal of PD catheter after renal transplantation, number of episodes of dialysis post transplantation, and kidney replacement therapy (KRT) used. Our follow up included the time from kidney transplantation (KT) until they removed PD catheter. Those who removed PD catheter at the timing of renal transplantation were excluded when evaluating the infectious complications. Results From the 132 kidney transplant recipients eight patients removed PD catheter at the time of the transplant due to ongoing PD associated infection. Sixty-nine patients were men (52.3%), with a median (IQR) age at transplantation of 48.4 years (41-57). Regarding donors’ characteristics, 88 (33.3%) were deceased, 21 of which were expanded criteria donors, and 44 (66.7%) were living donors. A total of 19 (14.4%) patients had history of PD infectious complications in the three months before transplantation. From the 124 patients that remained with the PD catheter after KT the adverse event infection occurred in 19 (15.3%) patients and two of these had previous access related infection in the 3 months interval before transplantation. The adverse events were: exit-site infection (ESI) 10.4% (n = 19), peritonitis 3% (n = 4) and tunnel infection 1.6% (n = 2). Half required hospitalization mainly due to center logistics for catheter removal. No deaths were registered. The identified microorganisms are present in Table 1. The median (IQR) time of removal of the PD catheter was 4 (3-5) months. Sixteen patients (12.9%) required KRT due to delayed graft function: ten patients used the Tenckhoff catheter and the rest performed haemodialysis (four using central venous catheter and two using arteriovenous fistula). Three patients remained dialysis dependent. When analysing the living donor group the rate of KRT was even lower, with three (6.8%) patients requiring dialysis, and only one used the PD catheter. Conclusion Despite the timing of PD catheter removal was according to the European Guidelines, the risk of PD catheter associated infections is not negligible (15.3%), not to mention the burden for the patient to keep an abdominal device demanding routinely care of the exit site. Peritonitis rate was low and comparable to previous studies. Considering the utility of remaining with the catheter, the risk of needing KRT, namely in living donor KT, was low. We postulate whether PD catheter removal at the time of KT should be considered, especially when the risk of late graft function is low, as in living donors, and/or the risk of PD catheter related infections is high. For this reason, we call for an individualized policy regarding catheter removal in the transition to KT.

Information consumption city and carbon emission efficiency: Evidence from China's quasi-natural experiment

The transformation of public consumption patterns has become a burning question, but there are few studies on public consumption patterns. Therefore, evaluating the impact of Information consumption city (ICC) policy on carbon emission efficiency holds significant implications. This study settles on 104 pilot cities in China from 2006 to 2020 to assess the impact and the response mechanism of ICC policy on carbon emission efficiency through the time-vary Difference-in-Difference (DID) model. The result shows that: (1) ICC policy significantly promotes the local carbon emission efficiency, which remains robust after a battery of sensitivity tests. (2) It improves carbon emission efficiency through production factors agglomeration effect, industrial structural changing effect, innovation promotion effect, and environmental attention effect; (3) The direct impact of ICC policy on carbon emission efficiency varies across regions with different information consumption and carbon emission base. (4) ICC can improve carbon emission efficiency through the joint implementation of smart city (SC), new urbanization (NU), ecological civilization city construction (EC), Belt and Road Initiative (BR), Broadband China (BC), low-carbon city pilot policy (LCC), and air quality standards (AQS) policy.

Assessing the tradeoffs in emissions, air quality and health benefits from excess power generation due to climate-related policies for the transportation sector

As the transportation sector continues to decarbonize through electrification, there is growing interest in quantifying potential tradeoffs in air pollution and health impacts due to potential excess emissions from the power sector. This study investigates air pollution and health impacts of policy-driven changes in the transportation sector and the associated power generation demand in the Northeast and Mid-Atlantic United States. Five illustrative scenarios were designed to capture the effects of different policies under the first mandatory market-based program to reduce greenhouse gases in the US power sector (Regional Greenhouse Gas Initiative—RGGI) and the Transportation and Climate Initiative (TCI). Considering future power generation with new renewable energy investments to meet demands from decarbonized transportation, the scenarios were framed using: 1. 2030 reference cases for both sectors and a hybrid TCI portfolio, 2. Departure from the reference cases defined by Pennsylvania included or not in RGGI, and 3. Power grid emissions estimated under clean energy standard (CES) policy and hybrid TCI portfolio. While the cross-sectoral policy effect on domain-wide concentrations is modest (max ΔPM2.5 ∼ 0.06 μg m3, ΔNO2 ∼ 0.3 ppbv, ΔO3 ∼ 0.15 ppbv), substantial increases in Ohio and West Virginia were attributed to Pennsylvania joining RGGI. With CES enacted and Pennsylvania in RGGI, significant reductions are seen in average concentrations (max ΔPM2.5 ∼ 1.2 μg m3, ΔNO2 ∼ 1.1 ppbv, ΔO3 ∼ 1.7 ppbv) except for Louisiana and Mississippi with corresponding disbenefits. When focusing exclusively on emissions reductions from transportation, the hybrid TCI portfolio had health benefits of 530 avoided adult deaths, and 46 000 avoided asthma exacerbations. With a ‘business as usual’ power grid, these benefits remain comparable and are mainly driven by NO2, followed by PM2.5 and O3. However, if Pennsylvania joins RGGI, total health benefits and spatial distribution change substantially, with a large portion of adverse health impacts moving from TCI states to Ohio and West Virginia. The overall monetized impact of a CES scenario can substantially exceed the estimated average range of 66–69 Billion US$, depending on the interaction with transportation decarbonization strategies and other drivers of exposure.

Comparative Analysis of Costing Methods for Magnetic Resonance Imaging in a Tertiary Care Teaching Hospital: An Observational Study

Abstract Background: Health-care costs, often determined through outdated methods, fail to capture the true costs of care delivery. Traditional costing methods in the health-care sector have proven insufficient, leading to potential revenue losses and increased patient out-of-pocket expenses. Activity-based costing (ABC) and time-driven ABC (TDABC) offer alternative approaches to cost calculation, aiming for a more accurate reflection of resource consumption. Methodology: This descriptive observational study was conducted in the magnetic resonance imaging (MRI) center of a tertiary care teaching hospital, focusing on a single noncontrast MRI scan costing. Direct observations and record reviews, including standard operating procedures, policy letters, financial documents, and miscellaneous records, were employed. Results: Using traditional costing, the unit cost of an MRI scan was calculated at INR 1291.51. ABC yielded a unit cost of INR 3613.77, while TDABC resulted in a unit cost of INR 2764.39. A comparison between the three costing methods revealed potential revenue losses with traditional costing. In contrast, TDABC appeared to strike a balance between financial prudence and reduced patient out-of-pocket expenses. Conclusion: The study emphasizes the significance of understanding true costs in health-care delivery. The results advocate for the adoption of TDABC as a favorable compromise, enabling the hospital to retain revenue without burdening patients with additional costs. Notably, the study highlights the necessity for a granular understanding of true costs for successful transitions from volume to value in health care.

Integrating few-shot personalized thermal comfort model and reinforcement learning for HVAC demand response optimization

Heating, ventilation, and air conditioning (HVAC) is the most common equipment to maintain personalized thermal comfort (PTC), and a valuable demand response (DR) resource. The challenges to be addressed in HVAC DR optimization include uncertainties of environment, PTC varying by users and rapid decision-making. This paper proposed a fast HVAC DR optimization method that integrates deep reinforcement learning (DRL) and few-shot PTC model. Firstly, we established an HVAC DR optimization framework integrating few-shot PTC model and DRL, in which the few-shot PTC model was utilized to generate user's PTC temperature range served as the constraint and state variable of DRL. Secondly, we proposed a few-shot PTC model, which only required several field samples and had excellent engineering usability. Thirdly, we designed the HVAC DR optimization algorithm considering user's PTC based on proximal policy optimization, which automatically dealt with the uncertainties and made rapid decisions for setting HVAC setpoints of temperature dynamically. Simulation results show that the few-shot PTC model only requires 9 field samples, which is less than 1 % of existing advanced methods. Furthermore, the proposed method converges within 12.6 min under uncertainties on an i7-12700 processor, which is only about 1/2 of the standard deep deterministic policy gradient.

CHARGES FOR THE USE OF RAW WATER: AN ANALYSIS OF THE PERFORMANCE OF MODELS APPLIED IN WATERS UNDER FEDERAL DOMAIN IN THE CUREMA-MÃE D'ÁGUA WATER SYSTEM

Aiming to explore the potential fundraising, models used for charging the raw waters of São Francisco, Paraíba do Sul, and Doce rivers were applied and evaluated in the Curema-Mãe D'Água water system, located in semiarid Brazil. The methodology consisted of a bibliographical review, documentary research, system operation modeling, application of models, and critical analysis of operations and collections results, comprising a total of 240 months from 2002 to 2021. When applying the Standard Operational Policy (SOP), the water system did not meet the demands 35.4% of the time. The model with the highest collection was the one used in Paraíba do Sul River (R$ 12.71 million/year). The models applied in São Francisco (R$ 1.37 million/year) and Doce Rivers (R$ 3.58 million/year) presented the lowest collections. The Paraíba do Sul River model provided the highest charging with water abstract and consumption elements. The Doce River model, conversely, delivered the highest values through the effluent discharge element. The analysis of charging results indicates that each model has specific applications and outcomes. None of the models consider eventual water scarcity conditions in their formulations.

Current Health Data Standardization Project and Future Directions to Ensure Interoperability in Korea.

The need for interoperability at the national level was highlighted in Korea, leading to a consensus on the importance of establishing national standards that align with international technological standards and reflect contemporary needs. This article aims to share insights into the background of the recent national health data standardization policy, the activities of the Health Data Standardization Taskforce, and the future direction of health data standardization in Korea. To ensure health data interoperability, the Health Data Standardization Taskforce was jointly organized by the public and private sectors in December 2022. The taskforce operated three working groups. It reviewed international trends in interoperability standardization, assessed the current status of health data standardization, discussed its vision, mission, and strategies, engaged in short-term standardization activities, and established a governance system for standardization. On September 15, 2023, the notice of "Health Data Terminology and Transmission Standards" in Korea was thoroughly revised to improve the exchange of health information between information systems and ensure interoperability. This notice includes the Korea Core Data for Interoperability (KR CDI) and the Korea Core Data Transmission Standard (HL7 FHIR KR Core), which are outcomes of the taskforce's efforts. Additionally, to reinforce the standardized governance system, the Health-Data Standardization Promotion Committee was established. Active interest and support from medical informatics experts are needed for the development and widespread adoption of health data standards in Korea.

Implementation Of Quality Audit In Realizing Good University Governance At The University Muhammadiyah Parepare

Education Quality is the level of conformity between the implementation of higher education with Higher Education Standards consisting of National Higher Education Standards and Higher Education Standards set by universities. The objectives in this study are: To determine the adequacy of regulations owned as guidelines for the implementation of Higher Education operational activities, To find out the existence of national standards used as a reference in carrying out Higher Education operational activities, To find out the existence of Higher Education standards as a reference for the implementation of operational activities adapted from local, national and international and to find out the quality audit process carried out by UMPAR thus guarantees that the implementation of PT operational activities is in accordance with the regulations owned. The research approach used is a qualitative approach, the data analysis technique used is qualitative data analysis with three lines of analysis such as data reduction, data presentation, and conclusions. The results in this study are 1) The implementation of education at the University of Muhammadiyah Parepare still refers to the policies of the central government and the Muhammadiyah organization. 2) The University of Muhammadiyah Parepare needs to prepare itself well by developing a strategic plan to support the implementation of operational activities in facing future challenges Implementation of a program and activity for the next 5 years. 3) Internal Quality Assurance Standard Policy of the University of Muhammadiyah Parepare covers all aspects of higher education implementation with the main focus on aspects of education, research, community service, and Al Islam-Kemuhamadiyahan, The results of the implementation of the internal quality assurance system with the form of evaluation of the PPEPPP model are readiness to implement accreditation for study programs within the University of Muhammadiyah Parepare.

A review of distributed ledger technologies application in medical systems interoperability

This study of the literature delves into the complex area of medical systems interoperability, focusing on mitigating variables that impact security and data transfer at the structural and semantic levels. In the era of digital healthcare, the secure sharing of medical data is crucial, and this study looks at how Distributed Ledger Technologies (DLTs) can play a major role in addressing these challenges. Complex interoperability issues that come from differences in communication protocols, data formats, established data structures, data models, and data meaning and codification methodologies face the healthcare industry. These problems typically impede the seamless transmission of electronic medical records between healthcare systems. Because of their decentralized structure and cryptographic foundation, DLTs offer a workable solution to these issues. By critically evaluating previous research and case studies, DLTs may be able to lessen these interoperability issues, as this literature review illustrates. Since DLTs provide an immutable and secure platform for the transmission of medical data, guaranteeing data integrity and confidentiality, they are a natural fit for the sensitive nature of healthcare data. Their importance in creating safe communication protocols, enhancing the meaning of data, and defining models and formats for data is emphasized in this review. A comprehensive architecture for DLT interoperability in healthcare is also recommended by the research. This framework encourages the development of DLT integration, shared data models, standardized data formats, and governance and policy. By implementing this strategy and strengthening secure medical data sharing, healthcare organizations and governments may increase the efficiency, precision, and speed of healthcare delivery. The crucial role that DLTs play in removing the structural and semantic barriers to safe medical systems interoperability is highlighted in the conclusion of this literature review. By adopting DLTs, the healthcare sector may usher in a new era of standardized, safe, and efficient medical data transmission, which will ultimately benefit both patients and healthcare providers. This study shows how distributed ledger technologies (DLTs) have the potential to revolutionize the healthcare industry by enabling the secure and meaningful exchange of medical data between different systems, thereby improving patient care and healthcare outcomes.

Policy brief: Optimising antimicrobial usage in paediatric inpatient hospital settings.

Antimicrobial resistance (AMR) poses a global threat, partly fueled by antimicrobial overuse. Paediatric inpatients are particularly vulnerable to infections, leading to high antimicrobial consumption. In low-to-middle income countries (LMICs) like South Africa, research on antimicrobial usage for neonatal and paediatric healthcare-associated infections (HAI) is limited. This cross-sectional study evaluated antimicrobial usage in three academic public sector hospitals in South Africa to improve appropriateness. 22.9% of hospitalised children received at least one prescribed antimicrobial, with neonates, infants, and adolescents having higher prescription rates for HAIs. Common antimicrobials prescribed included beta-lactamase sensitive penicillin, aminoglycosides, and carbapenems. Antimicrobial selection aligned with the WHO AWaRe classification system. HIV infection did not emerge as a risk factor for HAIs or excessive antimicrobial usage. The policy brief recommends several strategies, summarized by the acronym 'PRACTICE,' to optimize antimicrobial prescribing practices. These include implementing standardized policies for empiric antimicrobial use, routine review of antimicrobial therapy, age-specific antimicrobial stewardship programs, and continued collaborative efforts and research. Individualized treatment plans, improved infection prevention and control measures, ongoing surveillance, and exploring electronic technology for antimicrobial stewardship are also crucial. Addressing antimicrobial usage is imperative to combat the growing threat of AMR and improve patient outcomes in LMICs like South Africa.

MACROECONOMIC STRATEGY FOR THE RESTORATION OF THE GAS DISTRIBUTION MARKET ON THE EXAMPLE OF THE MARSHALL PLAN

Ukraine suffered giant human, material, and resource losses from the war. This led to a change in the Strategy and Tactics for the future allocation of resources and strategies for the macroeconomic recovery of the energy sector. A sharp decline in Ukraine's energy intensity in all sectors of the economy resulted in a general decline in the country's gross domestic product. As a result of the military intervention, Ukraine's energy sector is characterized by high import dependence, low energy efficiency, and financial illiquidity. In addition, the subsequent market transformation has led to chaotic pricing of gas resources and utilities and low household income. The article discusses the main aspects of the famous Marshall Plan for the post-war reconstruction of the Ukrainian economic and energy systems. The study pays special attention to the macroeconomic Strategy for the energy sector's recovery. The article considers the existing developments of researchers and practitioners in analyzing the impact of the Marshall Plan on the recovery of European countries after World War II. When implementing this plan in the context of current national realities, the author outlines certain aspects that could be taken into account in the necessary implementation of a standard European policy of Ukraine's reconstruction, intensification of the business legal and competitive environment, and implementation of integrity issues about the focus and priority of individual industries and areas. It is particularly urgent to address the combination of renewable features in the context of European environmental, climate, and economic policies. Considering Ukraine's energy balance in wartime, the existing Energy Strategy should summarize the growth that will be implemented slowly. Gas resources will continue to play an essential role in domestic energy consumption. Therefore, in analyzing existing approaches, trends, and our beliefs, we modeled a possible macroeconomic Strategy for restoring Ukraine's gas distribution sector in the postwar period based on approaches specific to the Marshall Plan. The macroeconomic Strategy for restoring gas distribution companies in postwar Ukraine is a complex concept and consists of several government measures. This Strategy should consider the Marshall Plan, which has already positively affected some countries after World War II. The basis of this recovery plan is access to fuel and energy resources in a technically reliable, safe, cost-effective, and environmentally acceptable manner in the interests of consumers and society. Ukraine suffered giant human, material, and resource losses from the war. This has led to a change in the Strategy and Tactics for the future allocation of resources and macroeconomic recovery strategies for the energy sector. A sharp decline in Ukraine's energy intensity in all sectors of the economy resulted in a general decline in the country's gross domestic product. As a result of the military intervention, Ukraine's energy sector is characterized by high import dependence, low energy efficiency, and financial illiquidity. In addition, the resulting market transformation has led to chaotic pricing for gas resources and utilities.

Strengthening Generic Skills in Undergraduate Students in Physical Education. Perception of University Professors

Purpose: Demonstrate the effectiveness of the proposal for strengthening generic and specific competencies, which are evaluated in the Saber Pro tests in students of the Bachelor's program in Physical Education at a Colombian university, through the perception of participating teachers. said proposal. Methodology: A qualitative methodology was implemented, with the purpose of trying to understand the reality and behaviors of individuals who belong to a certain social context (Vílchez, 2022), in addition to understanding and identifying various characteristics associated with the qualities and descriptions of a social phenomenon without resorting to the collection of specific numerical data (Morenos, 2021). Results and Conclusions: They indicate the development of innovative teaching strategies in academic spaces in order to strengthen competencies. Likewise, it demonstrates the viability of the proposal in relation to the teaching strategies that make a theoretical and practical approach, since they adjust to the focus and thematic contents of the subjects, therefore, they facilitate the assimilation and appropriation of the knowledge that requires a future graduate, thus concluding the need to incorporate innovative tools that promote the appropriation of knowledge to train better professionals in the area of Physical Education. Implications: This research provides implications for educational and government policy to continue to strengthen standardized testing policies in higher education. Originality/value: This research offers novelty by glimpsing the impact of the formation of the pedagogical model in higher education.

Development of quality indicators for pregnancy and childbirth in patients with systemic lupus erythematosus.

A quality indicator (QI) for the treatment of systemic lupus erythematosus (SLE) during pregnancy and childbirth that is useful for sharing standard treatment policies has not yet been developed. This study aimed to develop a QI for SLE associated with pregnancy and childbirth. To identify candidate QIs, we conducted a systematic literature review on the development of QIs for SLE related to pregnancy and childbirth and on clinical practice guidelines. Candidate QI items were extracted from the final selected articles, and a first evaluation, panel meeting, and second evaluation were conducted to determine whether the candidate items were appropriate as QIs. Items for which all panel members reached a consensus were designated pregnancy and childbirth-related SLE QIs. Four articles on SLE QI development and 28 practice guidelines were listed through abstract/text screening. Based on these studies, 52 candidate QIs were extracted that were limited to items related to pregnancy and childbirth and 41 items were selected on which all panel members agreed. We developed pregnancy-related SLE QIs using the RAND/UCLA method and selected 41 items, which could be used clinically.

Constrained minimum variance and covariance steering based on affine disturbance feedback control parameterization

AbstractThis paper deals with finite‐horizon minimum‐variance and covariance steering problems subject to constraints. The goal of the minimum variance problem is to steer the state mean of an uncertain system to a prescribed vector while minimizing the trace of its terminal state covariance whereas the goal in the covariance steering problem is to steer the covariance matrix of the terminal state to a prescribed positive definite matrix. The paper proposes a solution approach that relies on a stochastic version of the affine disturbance feedback control parametrization. In this control policy parametrization, the control input at each stage is expressed as an affine function of the history of disturbances that have acted upon the system. It is shown that this particular parametrization reduces the stochastic optimal control problems considered in this paper into tractable convex programs or difference of convex functions programs with essentially the same decision variables. In addition, the paper proposes a variation of this control parametrization that relies on truncated histories of past disturbances, which allows for sub‐optimal controllers to be designed that strike a balance between performance and computational cost. The suboptimality of the truncated policies is formally analyzed and closed form expressions are provided for the performance loss due to the use of the truncation scheme. Finally, the paper concludes with a comparative analysis of the truncated versions of the proposed policy parametrization and other standard policy parametrizations through numerical simulations.