Successful Implementation Research Articles

Successful Implementation of the AIUM Standardized 4-Year Residency Ultrasound Curriculum in Obstetrics and Gynecology: Lessons Learned and Way Forward.

Significant disparities in sonographic education exist in Obstetrics and Gynecology programs in the United States. To address the lack of standardization in ultrasound teaching, the American Institute of Ultrasound in Medicine (AIUM) assembled a multi-society task force in 2018 that resulted in the publication of a Consensus Report outlining a standardized ultrasound curriculum and competency assessment. The primary objective of the study was to implement the AUIM standardized curriculum within an Obstetrics and Gynecology residency program at a tertiary medical center, and report on the early implementation experience. The secondary objective was to assess current national practices in ultrasound training in Obstetrics and Gynecology residency programs. Study design was an effectiveness-implementation hybrid study of a structured ultrasound educational program based on the 2018 AIUM Consensus Report. The theoretical portion of the curriculum consisted of 26 hours of didactic lectures distributed over 4 years. For the practical component, residents received instruction from faculty and sonographers and independently acquired the required images as part of their regular clinical work. Simulator app access was also provided for additional opportunities to practice and acquire images. Deidentified images for the required competencies were uploaded to a WhatsApp group for review. Theoretical knowledge was assessed with a series of multiple-choice exams. Practical skills were assessed through grading of images submitted through WhatsApp as well as direct observations of resident scans. At the completion of 4 years, the assessment of both theoretical knowledge and practical skills was carried out using the ISUOG Basic Training Examination. National patterns in the area of ultrasound education were assessed with a four-question electronic survey of Obstetrics and Gynecology program directors in the United States. Analysis of both portions of the study was primarily descriptive. Four Obstetrics and Gynecology residents completed the curriculum spanning postgraduate years 1 through 4. The number of competencies completed ranged from 7 to 19 out of 41. All of the residents passed the theoretical and practical components of the ISUOG Basic Training Examination. For the residency program director survey portion of the study, response rate was 20% (59 of 290). Among the respondents, 55.9% reported having a structured curriculum and 34.4% reported implementing the AIUM curriculum. The two most commonly cited obstacles to implementation of structured ultrasound teaching were uncertainty with how to start the process (49.2%) and lack of faculty engagement (49.2%). Implementation of the AIUM Curriculum within the framework of an Obstetrics and Gynecology residency program at a tertiary medical center is feasible. In our experimental group, completion of the curriculum resulted in passing of an internationally recognized validated assessment. Obstacles to implementation in our program included a wide range of engagement and participation among residents, and limited opportunities to obtain some of the required competencies. Identification of obstacles to implementation from the perspective of residency program directors is critical for developing targeted approaches to ensure widespread implementation. Successful standardized validated sonographic training of graduating Obstetrics and Gynecology residents is crucial for this operator-dependent modality that has tremendous implications on patient safety and clinical care.

Countless Joy: The Lived Experiences of Elementary School Teachers in the Implementation of School Feeding Program Analysis

The well-being of the school children is a topic of growing concerns, which focuses on this study to sought and investigate the experiences of elementary school teachers engaged in executing the school feeding program at elementary school. Maslow’s Hierarchy of needs offers a useful framework for understanding how teacher’s implementation of feeding programs aligns with the fundamental needs of students. Utilizinga qualitative- phenomenological approach, researcher formulated a focused research question to unravel the nuanced experiences in emplementing the “ Countless Joy” school feeding program. The study involved a group of ten ( 10 ) elementary school teachers. Thematic analysis was a commonly used in this context. Lived experiences of elementary school teachers in the implementation of the school feeding program were: navigating success in school feeding implementation, tailoring impactful to the children through comprehensive assessment,collaborating with the stakeholders, ensuring nutrition in meal plans, engaging in monitoring and evaluation for conti

Technical Assistance for Systemic Change: Lessons Learned From a National Technical Assistance Center.

Despite the millions of dollars awarded annually by the United States Department of Education to build implementation capacity through technical assistance (TA), data on TA effectiveness are severely lacking. Foundational to the operationalization and consistent research on TA effectiveness is the development and use of standardized TA core competencies, practices, and structures. Despite advances toward a consistent definition of TA, a gap still exists in understanding how these competencies are used within an operationalized set of TA practices to produce targeted outcomes at both individual and organizational levels to facilitate implementation of evidence-based practices. The current article describes key insights derived from the evaluation of an operationalized set of TA practices used by a nationally funded TA center, the State Implementation & Scaling Up of Evidence Based Practices (SISEP) Center. The TA provided by the Center supports the uptake of evidence-based practices in K-12 education for students with disabilities. Lessons learned include: (1) the need to understand the complexities and dependencies of operationalizing TA both longitudinally and at multiple levels of the system (state, regional, local); (2) the relative importance of building general and innovation-specific capacity for implementation success; (3) the value of using a co-design and participatory approach for effective TA delivery; (4) the need to develop TA providers' educational and implementation fluency across areas and levels of the system receiving TA; and (5) the need to ensure coordination and alignment of TA providers from different centers. Gaining an understanding into optimal TA practices will not only provide clarity of definition fundamental to TA research, but it will also inform the conceptual framing and practice of TA.

Understanding the benefits and challenges of Content and Language Integrated Learning (CLIL) in English education: a literature synthesis

Content and Language Integrated Learning (CLIL) is a dynamic educational approach that holds the potential to enhance language proficiency, content knowledge acquisition, and academic achievement among students. By integrating language learning with subject content, CLIL provides students with immersive and meaningful learning experiences that facilitate communicative competence, critical thinking skills, and intercultural awareness. Discussions surrounding CLIL implementation have emphasized its potential to transform language education and promote multilingualism in diverse educational contexts. Key findings from research on CLIL suggest that participation in CLIL programs can lead to improvements in students' language proficiency across various linguistic skills, including listening, speaking, reading, and writing. Additionally, CLIL facilitates deeper comprehension and retention of subject matter by providing authentic contexts for learning and promoting interdisciplinary connections. Students participating in CLIL programs demonstrate comparable or even superior levels of content knowledge acquisition compared to those in traditional subject-based instruction, highlighting the effectiveness of CLIL in promoting academic success and critical thinking skills. However, the success of CLIL implementation hinges on various factors, including teacher preparation, institutional support, and resource allocation. Educators play a central role in the success of CLIL programs, requiring specialized training and ongoing professional development to effectively integrate language and content instruction. Institutional support is essential for creating conducive environments for CLIL implementation, while adequate resources are critical for optimizing learning experiences and addressing the diverse needs of learners.

Conceptualisation of the Regulatory Framework of Green Infrastructure for Urban Development: Identifying Barriers and Drivers

Urban green infrastructure plays a crucial role in sustainable city development by offering a multitude of benefits, including improved environmental quality, increased social well-being, and enhanced economic prosperity. Evaluation and monitoring of regulatory implementation stand as essential components in the advancement of urban green infrastructure (GI) as they indicate the efficacy of regulatory acts and enable the assessment of their implementation success and adaptability to identified needs. This study identifies barriers and drivers based on the views of 352 professionals surveyed between 2018 and 2023 in Serbia. The primary data collection method employed questionnaire surveys. This study identified a range of barriers within existing legal frameworks, foremost of which include the lack of coordination and coherence between relevant ministries and governmental agencies, insufficient financial and human resources, the lack of transparency in the regulation development process, the need for strengthening technical capacities, and the absence of an adequate urban GI strategy. This research serves as a foundation for conceptualising GI regulatory elements that enhance urban GI development. Addressing these barriers necessitates efforts to improve coordination and collaboration among stakeholders, increase public participation, and enhance transparency in the regulatory process.

Implementation of an electronic health record system during global surgical outreach: A prospective evaluation of success and sustainability.

The burden of musculoskeletal conditions continues to grow in low- and middle-income countries. Among thousands of surgical outreach trips each year, few organizations electronically track patient data to inform real-time care decisions and assess trip impact. We report the implementation of an electronic health record (EHR) system utilized at point of care during an orthopedic surgical outreach trip. In March 2023, we implemented an EHR on an orthopedic outreach trip to guide real-time care decisions. We utilized an effectiveness-implementation hybrid type 3 design to evaluate implementation success. Success was measured using outcomes adopted by the World Health Organization, including acceptability, appropriateness, feasibility, adoption, fidelity, and sustainability. Clinical outcome measures included adherence to essential quality measures and follow-up numerical rating system (NRS) pain scores. During the 5-day outreach trip, 76 patients were evaluated, 25 of which underwent surgery beforehand. The EHR implementation was successful as defined by: mean questionnaire ratings of acceptability (4.26), appropriateness (4.12), feasibility (4.19), and adoption (4.33) at least 4.00, WHO behaviorally anchored rating scale ratings of fidelity (6.8) at least 5.00, and sustainability (80%) at least 60% follow-up at 6months. All clinical quality measures were reported in greater than 80% of cases with all measures reported in 92% of cases. NRS pain scores improved by an average of 2.4 points. We demonstrate successful implementation of an EHR for real-time clinical use on a surgical outreach trip. Benefits of EHR utilization on surgical outreach trips may include improved documentation, minimization of medical errors, and ultimately improved quality of care.

Determining the stationary digital twins implementation barriers for sustainable construction projects

PurposePrevious research has demonstrated that Digital Twins (DT) are extensively employed to improve sustainable construction methods. Nonetheless, their uptake in numerous nations is still constrained. This study seeks to identify and examine the digital twin’s implementation barriers in construction building projects to augment operational performance and sustainability.Design/methodology/approachAn iterative two-stage approach was adopted to explore the phenomena under investigation. General DT Implementation Barriers were first identified from extant literature and subsequently explored using primary questionnaire survey data from Hong Kong building industry professionals.FindingsSurvey results illustrated that Lack of methodologies and tools, Difficulty in ensuring a high level of performance in real-time communication, Impossibility of directly measuring all data relevant to the DT, need to share the DT among multiple application systems involving multiple stakeholders and Uncertainties in the quality and reliability of data are the main barriers for adopting digital twins' technology. Moreover, Ginni’s mean difference measure of dispersion showed that the stationary digital twin’s barriers adoption is needed to share the DT among multiple application systems involving multiple stakeholders.Practical implicationsThe study’s findings offer valuable guidance to the construction industry. They help stakeholders adopt digital twins' technology, which, in turn, improves cost efficiency and sustainability. This adoption reduces project expenses and enhances environmental responsibility, providing companies a competitive edge in the industry.Originality/valueThis research rigorously explores barriers to Digital Twin (DT) implementation in the Hong Kong construction industry, employing a systematic approach that includes a comprehensive literature review, Ranking Analysis (RII) and Ginni’s coefficient of mean difference (GM). With a tailored focus on Hong Kong, the study aims to identify, analyze and provide novel insights into DT implementation challenges. Emphasizing practical relevance, the research bridges the gap between academic understanding and real-world application, offering actionable solutions for industry professionals, policymakers and researchers. This multifaceted contribution enhances the feasibility and success of DT implementation in construction projects within the Architecture, Engineering and Construction (AEC) sector.

Integration of LST and NDVI for adjusted night light index (ILNANLI): a novel index to reduce the effect of saturation and blooming of DMSP-OLS data

ABSTRACT DMSP-OLS night-light images have provided an effective way to monitor cities on a global scale. These images can separate urban areas and other human activities from the background without light with correct spatial measurement. However, due to saturation and blooming problems, the ability of these images to describe urban features is limited, especially in urban cores. Therefore, in this research, a new index, ILNANLI, has been developed and presented by integrating LST and NDVI for the adjusted night-light index. This index has two general goals: reducing the effects of saturation in the city centres, increasing the variety of brightness pixel values of night-light images, and reducing the blooming in the surrounding areas. The ILNANLI has been developed in such a way that it has put the indicators and relationships together, taking into account the characteristics of different regions of the city (such as buildings, vegetation, and soil) in such a way that in every urban environment (temperate and dry and semi-desert) to be successful. Another feature is its easy implementation and high success. In fact, the prominent feature of this index, which distinguishes it from the rest of the indices, is that it has been able to work successfully in arid and semi-desert areas in addition to temperate regions. The evaluation results showed that the average overall accuracy of ILNANLI in mapping and extracting built-up areas with automatic thresholds in cities with different climates has effectively increased by 8% compared to other indexes. Also, the examination of transects shows that the proposed index is more effective than the other four indexes in increasing the diversity of values and reducing blooming. Therefore, as a favourable option with easy implementation, the proposed index can be used to reduce the effect of saturation and blooming and study the urban structure at local scales.

Revolutionizing decision support: asystematic literature review of contextual implementation models for electronic health records systems.

This study aims to assess previously developed Electronic Health Records System (EHRS) implementation models and identify successful models for decision support. A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources used were Scopus, PubMed and Google Scholar. The review identified peer-reviewed papers published in the English Language from January 2010 to April 2023, targeting well-defined implementation of EHRS with decision-support capabilities in healthcare. To comprehensively address the research question, we ensured that all potential sources of evidence were considered, and quantitative and qualitative studies reporting primary data and systematic review studies that directly addressed the research question were included in the review. By including these studies in our analysis, we aimed to provide a more thorough and reliable evaluation of the available evidence. The findings suggest that the success of EHRS implementation is determined by organizational and human factors rather than technical factors alone. Successful implementation is dependent on a suitable implementation framework and management of EHRS. The review identified the capabilities of Clinical Decision Support (CDS) tools as essential in the effectiveness of EHRS in supporting decision-making. This study contributes to the existing literature on EHRS implementation models and identifies successful models for decision support. The findings can inform future implementations and guide decision-making in healthcare facilities.

Promoting a thriving school community: Investigating the effectiveness of positive psychology interventions for improved teacher-student and staff relationships: A critical review

Promoting a thriving school community: Investigating the effectiveness of positive psychology interventions for improved teacher-student and staff relationships: A critical review

Fidelity and acceptability of implementation strategies developed for adherence to a clinical pathway for screening, assessment and management of anxiety and depression in adults with cancer

BackgroundImplementation strategies are crucial to facilitate implementation success. To prepare and support implementation of a clinical pathway for screening, assessment and management of anxiety and depression in cancer patients (the ADAPT CP), six broad categories of implementation strategies; (1) Awareness campaigns, (2) Champions, (3) Education, (4) Academic Detailing and Support, (5) Reporting, (6) Technological Support, were developed. The aim of this paper is to describe the fidelity and acceptability of six categories of implementation strategies and any subsequent changes/adaptations made to those strategies.MethodsThe ADAPT CP was implemented in twelve cancer services in NSW, Australia, as part of a cluster randomised controlled trial of core versus enhanced implementation strategies. Fidelity to and any subsequent changes to the delivery of the planned six categories of implementation strategies were captured using the ADAPT contact log, which recorded the contacts made between the ADAPT research team and services, engagement meetings and monthly meetings. To explore acceptability and awareness/engagement with the implementation strategies, interviews with a purposively selected staff sample across both study arms were held prior to implementation (T0), six months into implementation (T1) and at the end of the 12-month implementation period (T2). Interviews were thematically analysed across the six categories of strategies.ResultsDelivery of all six categories of implementation strategies as planned was moderated by service context and resources and staff engagement. As such, for some implementation strategies, subsequent changes or adaptations to the content, mode of delivery, frequency and duration such as abbreviated training sessions, were made to optimise fidelity to and engagement with the strategies. Most strategies were perceived to be acceptable by service staff. Use of strategies prior to implementation of the ADAPT CP such as the engagement meetings and training sessions, positively impacted on ownership and preparedness to implement the ADAPT CP. Furthermore, ongoing support such as provision of additional training or monthly meetings facilitated increased awareness and engagement with the ADAPT program.ConclusionFlexibility in delivering implementation strategies, and ensuring staff engagement with, and acceptability of those strategies, can support implementation of interventions within healthcare settings.Trial registrationThe ADAPT CRCT was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true

Implementation and use of the Safewards model in healthcare services: A scoping review.

Safewards is a multi-intervention mental health nursing model of practice improvement aimed at preventing and reducing conflict and containment. The use of Safewards has now extended beyond mental health settings. Implementation of Safewards has been reported to be challenging and therefore requires an evidence-informed and structured approach. This review's objectives were to: (i) Comprehensively map approaches used to implement Safewards interventions; (ii) Characterise the outcomes measured in Safewards implementation studies; and (iii) Identify the facilitators and barriers to Safewards training and its implementation in practice. All quantitative, qualitative and mixed-methods publications of Safewards, the interventions, evaluations, barriers and facilitators from all healthcare services internationally were included. The Joanna Briggs Institute scoping review and Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews were used to guide methodology. Data were reported according to the 12 items of the TIDieR. Twenty-seven publications reported the implementation of Safewards. Descriptions were limited for reporting items such as intervention descriptions, materials, resources, specific procedures and processes, modifications made to interventions and delivery of interventions and training. No consistent theoretical implementation framework was reported. Collaboration, leadership, feedback and co-design were strong drivers for staff buy-in, engagement and success for implementation in mental health and acute settings. Transparency, replicability and generalisation require a detailed description of all elements of an intervention being implemented. Without adequate information, only assumptions can be drawn about the clinical governance and process of the implementation and training, and it is difficult to conclude when attempting to replicate the interventions.

Project ECHO®: a global cross-sectional examination of implementation success

BackgroundOrganizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation– Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation.MethodsAn empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics.ResultsThe 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12–18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams.ConclusionsThese findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.

Evaluation of The Success of Using a SAP-Based ERP System With Theory of Planned Behavior (TPB) Model

PT. XYZ has implemented System Application and Product in data processing (SAP) software to support business processes in the company. The success or failure of system implementation can be assessed from non-technical aspects, namely that users can accept and use the SAP system well. The aim of this research is to evaluate the use of SAP software through Theory of Planned Behavior (TPB) modeling. Attitudes, subjective norms, perceived behavioral control, behavioral intentions, and behavior are the variables used in this modeling. This TPB modeling explains the factors that influence an individual's interest and behavior in using SAP software. An individual's intention to use SAP software is influenced by attitudinal variables, perceived behavioral control, and subjective norms, while a person's influence to use SAP software is influenced by intention. This type of research is quantitative research through data collection using a questionnaire with 30 respondents coming from SAP users at PT. XYZ. Data analysis was carried out using the SmartPLS application. The results obtained are that attitudes have a positive and significant effect on behavioral intentions, behavioral intentions have a positive and significant effect on behavior, subjective norms have a positive and significant effect on behavioral intentions, and perceived behavioral control has a negative effect on behavioral intentions in using SAP software.

Approximate Dynamic Programming for Control of Wave Energy Converters With Implementation and Validation on a Point Absorber Prototype

It is recognized that the application of constrained optimal control for wave energy converters (WECs), represented by model predictive control (MPC), is hindered by its computation burden resulting from online optimization, especially when the model contains nonlinearities. In this article, a novel control solution based on approximate dynamic programming (ADP) is proposed, in which an explicit controller is solved by model sampling and neural network training. In this way, the major computation load is moved offline to enable fast online execution, and the need for wave prediction is eliminated. The effectiveness of ADP is verified by a simulation case study based on a nonlinear WEC system. Using nonlinear MPC as the performance benchmark, over 90% energy efficiency is achieved by ADP under various sea states with constraint satisfaction and dramatically faster computation. The ADP controller is further experimentally validated on a newly constructed WEC prototype through wave tank testing, where successful implementation and satisfactory performance are demonstrated.

Synchronous Diagnosis of Diabetic Retinopathy by a Handheld Retinal Camera, Artificial Intelligence, and Simultaneous Specialist Confirmation

PurposeDiabetic retinopathy (DR) is a leading cause of preventable blindness, particularly in underserved regions where access to ophthalmic care is limited. This study presents a proof of concept for utilizing a portable handheld retinal camera with an embedded artificial intelligence (AI) platform, complemented by a synchronous remote confirmation by retina specialists, for DR screening in an underserved rural area. DesignRetrospective cohort study Subjects1,115 individuals with diabetes. MethodsA retrospective analysis of a screening initiative conducted in four municipalities in Northeastern Brazil, targeting the diabetic population. A portable handheld retinal camera captured macula-centered and disc-centered images, which were analyzed by the AI system. Immediate push notifications were sent out to retina specialists upon the detection of significant abnormalities, enabling synchronous verification and confirmation, with on-site patient feedback within minutes. Referral criteria were established, and all referred patients underwent a complete ophthalmic work-up and subsequent treatment. Main outcome measuresProof-of-concept implementation success. ResultsOut of 2,052 invited individuals, 1,115 participated, with a mean age of 60.93 years and diabetes duration of 7.52 years, of whom 66.03% were women. The screening covered 2,222 eyes, revealing various retinal conditions. Referable eyes for DR were 11.84%, with an additional 13% for other conditions (diagnoses included various stages of DR, media opacity, nevus, drusen, enlarged cup-to-disc ratio, pigmentary changes, and other). AI performance for overall detection of referable cases (both DR and other conditions) was: sensitivity- 84.23% (95% CI- 82.63-85.84), specificity- 80.79% (95% CI- 79.05- 82.53). When we assessed whether AI matched any clinical diagnosis, be it referable or not, sensitivity was 85.67% (95% CI- 84.12-87.22), specificity was 98.86 (95% CI- 98.39-99.33), and AUC was 0.92 (95% CI- 0.91-0.94). ConclusionsThe integration of a portable device, AI analysis, and synchronous medical validation has the potential to play a crucial role in preventing blindness from DR, especially in socially unequal scenarios.

IT’S NEVER TOO LATE TO START: A CASE FOR PREVENTATIVE OUTPATIENT GERIATRIC SERVICES

INTRODUCTION & AIMS The population is ageing and the chronic disease burden growing, seeing more older adults present to hospital with preventable non-communicable diseases. Multidisciplinary outpatient teams are well placed to manage modifiable risk factors to prevent disease progression and hospitalisations. A preventative service was launched at Concord Hospital integrating geriatrician, exercise physiologist and dietitian care to optimise the physical and mental health of older adults with chronic disease and frailty. This evaluation aims to determine the success of service implementation and feasibility of the model. METHODS Between November 2022 and June 2023, 59 patients (mean age 80.2 years (SD 6.2), 47.5% female) completed 12-weeks of concurrent exercise and diet interventions with medical oversight. Patients were assessed pre- and post-interventions. Exercise was individualised and multimodal, performed twice weekly in a supervised group. Diet was individualised with a protein supplement prescribed as appropriate. The outcomes measured were Fried Frailty Phenotype (FFP), leg strength (one repetition maximum leg press), Short Physical Performance Battery (SPPB), Geriatric Depression Scale Short Form (GDS), and Mini Nutritional Assessment Long Form (MNA). Service activity was measured monthly via rate of referral and occasions of service (OOS). Data were analysed using JASP (v.0.18.1). RESULTS Monthly rate of referral and OOS increased from 18 to 51 patients and 49 to 479 occasions respectively, indicating service demand. After 12-weeks there were significant improvements in FFP (mean difference [95%CI] -0.4 [-0.7, -0.2] points), leg strength (34.0 [27.1, 40.8] kilograms), SPPB (1.1 [0.8, 1.5] points), GDS (-1.4 [-2.2, -0.6] points) and MNA (2.6 [1.6, 3.5] points), with no effect of sex observed. CONCLUSION Initial implementation of a preventative outpatient geriatric service was successful with increasing service demand and significant physical and mental health improvements. The service model is feasible; however, further evaluation is required to determine outcomes after continued service provision.

Implementation of the policy of equalizing the position of administrator into functional in Gorontalo City Government

The implementation of PermenPAN-RB policy number 17 of 2021 concerning the equalization of administrative positions into functional positions has been implemented by the Gorontalo City Government. This study aims to determine how the implementation of this policy and the factors that determine the success of policy implementation within the Gorontalo City Government. This research is a qualitative descriptive with research locations at the Gorontalo City Staffing, Education and Training Agency (BKPP) and the Organization and Governance Section of the Gorontalo City Regional Secretariat from September to November 2023. Data collection techniques in the form of observation, interviews and documentation. The results of the study found that policy implementation has been running at the planning, supervision and policy evaluation stages, but has not been optimal at the policy implementation stage. The determining factors for the success of policy implementation based on aspects of communication, resources, disposition (attitude of implementers) and bureaucratic structure are still not optimal. The communication aspect has not been effective both in the aspects of transmission, clarity and consistency. The resource aspect has not been effective on human resources, budget resources, equipment resources. The disposition/attitude aspect of the executor has been effective. The aspect of bureaucratic structure is influenced by other factors, namely communication factors, making this factor less efficient.

Implementasi Program Keluarga Harapan Di Desa Ciwangi Kecamatan Balubur Limbangan Kabupaten Garut

This research was conducted with the aim of understanding the implementation of the Family Hope Program (PKH) in the Ciwangi Village, Balubur Limbangan District, Garut Regency. Several issues were identified in the implementation process, causing it to not run smoothly. This was due to various factors related to policy substance, the behavior of implementers, network interaction, target group participation, and resources in the implementation in Ciwangi Village, Balubur Limbangan Subdistrict, Garut Regency. The theory used in this research is the policy implementation theory proposed by Muchlis Hamdi (2014), which consists of policy substance, the behavior of implementers, network interaction, target group participation, and resources. This research utilized a qualitative research method with data collection techniques through observation, interviews, and documentation. The informant selection technique employed was purposive sampling, with a total of 8 informants. The findings indicate that the implementation of the Family Hope Program in Ciwangi Village, Balubur Limbangan District, Garut Regency, has not fulfilled several factors crucial for the success of policy implementation. However, there are also factors that have been fully met, such as policy substance and network interaction.

Exploratory Factor Analysis for Items Measuring of The Tax Auditors’ Performance

Tax auditors play an essential role in tax audits to ensure governments can overcome non-tax compliance issues and protect tax revenues for the nation. Tax auditors are expected to perform their tasks efficiently and effectively in examining the taxpayer’s declaration. The tax auditors' performance determines the success of tax audit implementation. Several factors can influence the tax auditors’ performance, including auditors’ effort, professional skepticism and task complexity. Therefore, this study aims to develop a valid and reliable research instrument to measure tax auditors’ performance using the Exploratory Factor Analysis and internal reliability test (Cronbach’s Alpha). A total of 100 tax auditors from the Inland Revenue Board of Malaysia and the Royal Malaysian Customs Department were selected as respondents to participate in this study. The data was collected using the online Google Forms with 5 Likert scales and was analysed using IBM-SPSS Version 27. The results show that out of 34 developed items, only 30 remained as constructed items. The remaining items were deleted due to the low loading factor of less than 0.40. Thus, this study validated the research instrument to proceed with the Confirmatory Factor Analysis (CFA) in the following step using the validated research instrument.