Systematic Action Research Articles

Introducing A Conservation-Based Learning Model to Build Student Creativity Through Conservation Values as an Effort to Preserve Biodiversity In SDG's

Objective: This study aims to determine the implementation of the Conservation-Based Learning (CBL) model and its effect on creative behaviour through conservation values obtained by students through learning. Theoretical Framework: The CBL model is built on the premise that addressing the negative impacts of biodiversity loss requires behaviour change. While behaviour must be built through knowledge that fosters values. A learning model that is able to build Conservation Values (CV) and Conservation Behaviour (CB) will have a significant role in conserving biodiversity as specified in the SDG's. Method: The research involved 127 secondary school students used SmartPLS and PLS-Graph version 3.0 to analyse the relationships and effects of two syntaxes in the CBL model: Value Clarification (VC) and Systematic Action Planning (SAP). These syntaxes were tested for their impact on developing students' Conservation Values CV and Conservation Behaviour CB. Result and Discussion: The findings reveal that all variables examined in the study, including CV, CB, VC, and SAP, have positive and significant relationships. The implementation of the CBL model successfully enhances students' understanding of biodiversity and conservation values while promoting actionable conservation behaviour. Research Implication: The application of CBL model in learning successfully builds students' values and creative conservation behaviour. This has important implications for efforts to conserve biodiversity through the younger generation as expected in the SDG's. Originality/Value: This research introduces a new approach to achieve the SDG’s in conserving biodiversity (SDG-14, SDG-15) through quality education (SDG's-4). The CBL model has the potential to build the conservation values and behaviours of future generations.

Position paper on retinal arterial occlusion. SEMI-SERV

The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk.In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.

Addressing hardship and climate change: Citizens' perceptions of costs of living, social inequalities and priorities for policy

AbstractIn the wake of rising energy prices and the cost of living crisis, some have claimed that climate policies are at odds with citizens' more pressing everyday living concerns. Critics challenge these simplifying narratives that shorter term economic and social wellbeing priorities and ‘longer term’ decarbonization policies are in tension with one another and argue that effective policies must treat them as interconnected. Evidence regarding how citizens think about climate policy mostly focus on policy acceptability, highlighting the role of perceptions of effectiveness and fairness, but there is a quite limited conceptualization of contexts of social inequality, and even more limited engagement with the views of marginalized groups whose buy‐in is seen as crucial for effective net zero transitions. This paper reviews the evidence and analyses new data from a small exploratory study with citizens from low income and marginalized backgrounds. In group discussions several participants emphasized the importance of tackling both social hardships and climate priorities, seen by some as interlinked. Further, many described wider societal unfairness relating to experiences of poverty, exploitation, a lack of voice or even recognition and a keen sense of disconnect between politics and their own everyday concerns and lived experiences. I argue that climate policy making should engage more fully with contexts of social inequality and that social wellbeing and systematic action on climate change need to be treated by policy makers and politicians as profoundly interlinked challenges.

Urgensi Ratifikasi International Labour Organization 169 Sebagai Bentuk Perlindungan Hukum Terhadap Masyarakat Adat

Introduction: Judging from the cases of indigenous peoples disputes, the efforts of the Indonesian state to speed up the ratification of ILO convention 169 will minimize the occurrence of cases that occur in indigenous peoples because there is protection for the indigenous peoples themselves. This situation prompted the development and adoption of ILO Convention 169, which aims to protect indigenous peoples and their rights.Purposes of the Research: This writing aims to examine and find out about ILO Convention 169 which regulates legal protection for indigenous peoples and why it is important for ILO Convention 169 to be ratified as a form of legal protection for indigenous peoples.Methods of the Research: The type of research used in this paper is normative legal research. As for answering the problems in this study, the authors use three approaches to the problem, namely the statutory approach (statute approach), and conceptual approach (conceptual approach). The procedure for collecting legal materials carried out by the author is by searching for and collecting laws and regulations related to the legal issues at hand. Legislation in this case includes both legislation and regulation. Analysis of legal material uses qualitative methods, namely studies related to legal norms contained in international law legislation and legal norms that exist in society.Results of the Research: The results of this study indicate that the ILO Convention 169 which regulates the legal protection of indigenous peoples, to ensure the implementation of the contents of this Convention, the responsibility lies in the hands of the government (ILO member ratifying ILO Convention No.169) to develop, coordinate and take systematic action in order protect the rights of Indigenous Peoples and Indigenous Peoples, and ensure recognition of their integrity. ILO Convention 169 is important to ratify as a form of legal protection for indigenous peoples and to strengthen the legal rights of Indigenous Peoples who mostly live in forest areas, the human rights of minorities are very difficult to be able to enjoy their rights on their own land.

The Role of Strategic Leadership on Quality Public Service Delivery: A Study of Federal Medical Centre, Yenagoa

The concept of leadership dates back to the inception of human civilization. Accordingly, there has been a significant shift from conventional leadership approaches to strategic leadership. This research evaluated the impact of strategic leadership on enhancing service quality within Federal Medical Centre Yenagoa. The study aimed to gauge how strategic leadership contributes to enhancing public service quality in this medical centre, posing two research inquiries. A survey involving 203 participants was conducted using Taro Yamani’s statistical formula. Upon scrutinizing the data collected from 193 individuals, it was evident that strategic leadership has effectively enhanced public service quality in Federal Medical Centre Yenagoa. This can be ascribed to its ability to modify institutional trajectories, as demonstrated by the adoption of the New Public Management theoretical framework (NPM) in 1991, established by Christopher Cropper Hood, the Gladstone Professor of Government. The study stressed that unlike traditional leadership, which heavily depends on personal attributes, strategic leadership is more objective, focusing on the interactions between the external environment and the organization’s mission. The study, amongst others, recommended that the Federal Medical Centre Yenagoa and similar establishments in Nigeria reassess their leadership approaches and embrace strategic leadership. These institutions should proactively establish an environment and mechanisms conducive to strategic thinking and systematic action to achieve sustainable growth goals.

Sense and Shoot: Multifunctional CaO2-loaded Cu-MOF nanosheets for integrated fluorescence detection and fenton-like degradation of tetracycline

Simultaneous accomplishment of sensitive detection and efficient degradation of antibiotics residues exposed in the aqueous environments has proved to be a difficult endeavor. Here, multifunctional composite CaO2-loaded Cu-MOF nanosheets (CaO2@Cu-MOF NSs) was elaborately designed and synthesized. Triggered by H+, the composite is not only capable of producing Ca2+ as the signal factor for tetracycline (TC) detection by activating the fluorescence emission of calcein, but also capable of self-supplying H2O2 and Cu2+ to construct a novel Fenton-like oxidation and O2 activation system for TC degradation based on Cu2+/Cu+ cycle. Under the synergy of target cycling and nano-enhancement, the sensing system exhibited great TC detection performance with a linear range of 0.001 to 100 ng mL−1 and detection limit of 11.8 fg mL−1. At the same time, the degradation system exhibited favorable degradation performance under the systematic action of Fenton-like and O2-activated oxidation. Nearly 80 % of the TC residues could be degraded within 10 min, and more than 95 % within 60 min. The constructed system was successfully applied to detect and degrade exposed TC in actual water samples in an integrated manner, demonstrating great promise for practical applications.

Innovations in the Russian School: Categorical Analysis, Social Realities and Barriers, Prospects

The purpose of the article is to identify social barriers to innovation in modern Russian schools based on the analysis of empirical sociological material, to interpret them in the context of risks and consequences for the innovative development of the general education system. Preliminary to the analysis of empirical data, the authors conduct a categorical analysis of educational innovation. The need for significant improvement and expediency are emphasised as key characteristics of innovation. The innovativeness of education is considered in conjunction with the social functions of education and the professional activities of the teacher. The fetishisation of innovation and bureaucratic practices of managing it are justifiably pointed out as a source of social barriers to the development of innovative activity in a modern school. A relatively new contradiction in the sociology of education is identified between the need for innovative development of the general education system and the presence of social barriers to the innovative activity of all participants in educational relations. Based on the analysis of the results of a sociological study conducted by online questioning, the following barriers are identified: notional, conceptual, organisational, content-managerial, blurred perception of obstacles, professional overload, competence and information. It has been revealed that all the subjects of innovation activities at school act as social sources and carriers of barriers to innovation: teachers, the administration of an educational organisation, specialists from educational authorities. It has been determined that the impact of these factors on the innovative development of the general education system is complex and systemic.
 Taking into account the high risk of their negative impact on the innovative development of the general education system, specific areas of activity for researchers and managers are formulated on a local, regional and federal scale. They concern the elaboration of the problem of innovation in the interdisciplinary synthesis of scientific disciplines studying education; development of targets, planning technology, determination of content and performance indicators of innovative development of the general education system in Russia; increasing the professional level of teachers and education managers for innovative activities; changes in the principles of innovation management in education. Systematic actions in these directions can minimise the negative manifestations of barriers to innovation and ensure a sustainable perspective for the innovative development of the education system.

Comprehensive understanding of stroke risk, prognosis, and preventive strategies for type 2 diabetes

Stroke is a serious and disabling disease with a high mortality rate that is becoming increasingly common worldwide, posing a serious threat to the health and quality of life of patients. Type 2 diabetes plays a special role in increasing the risk of stroke, which not only increases the risk of developing a stroke, but also negatively affects the outcome and the possibility of recurrent strokes.In order to prevent stroke, systematic action is necessary, including the correction of risk factors and the use of effective medications. One such drug is pioglitazone. Many studies support its effectiveness in reducing the risk of cardiovascular events, including stroke, for both secondary and primary prevention.Pioglitazone may be particularly beneficial for patients at high risk of cardiovascular disease and those with a history of ischemic brain damage. Despite the known side effects, its benefits in preventing stroke outweigh the possible disadvantages.This review provides important aspects of the role of type 2 diabetes mellitus in increasing the risk of stroke and discusses the prospects for the use of pioglitazone as a drug therapy affecting stroke risk and prognosis.

Towards A Scientific Methodology for Arab Investigative Journalism: An in-depth Analysis of Interviews with Ten Arab Journalists

This study aimed to build an applied model on the methodology of investigative journalism in the Arab world. To achieve this goal, this study followed the methodology of in-depth analysis of interviews via e-mail with ten Arab journalists interested in investigative journalism, whether those who practiced investigative reporting or received training in this field. This study is significant because it draws the attention of researchers and academics to the need for adopting a scientific methodology for investigative journalism. In addition, it could be turned into a part of a broader research track to develop Arab investigative journalism methodology. Based on the analysis of the interviewees’ answers, these steps can be listed as follows: Finding an original idea, writing the hypothesis, preparing a solid systematic action plan to prove the hypothesis of the investigation, conducting field work, producing the investigative report whether written or televised, and finally publishing the report.

Guiding Mothers About Early Detection and Addressing Speech Delay and Disorders Among Children in a Rural Setup.

Introduction Speech is one of the most important milestones to be achieved by a growing child. The significance of being informed about different pediatric speech abnormalities, especially to mothers, allows them to help their children in cases of irregularities in the maturation in this domain. Aim and objectives The study aimed to assess and educate mothers on the important milestones of speech delay in children and make them address the issue and be aware of various corrective measures to treat the underlying conditions of speech disorders in children.The objectives of the study includeunderstanding the pre-acquired knowledge of the mothers regarding the delay in speech in children, imparting knowledge regarding different speech disorders and their management, spreading awareness on how to seek help for various underlying causes of speech irregularities or delay, and to train the mothers into approaching the challenges in an orderly manner. Methods A study was conducted to guide rural mothers visiting the Obstetrics and Gynecology and Pediatric out-patient departments and Neonatal wards in a rural tertiary care hospital situated in the Sawangi Meghe village of Wardha City, Maharashtra, India, about the detection and treatment of children with disabilities of speech as early as possible. The mothers' knowledge was assessed before and after the study with the help of questionnaires, and basic understandable information on different types, causes, symptomatology, and management of speech delay and disorders among children was explained with the help of group discussions and posters. Results The motive behind this study was to be aware of facts known by the rural mothers, their actions on coming across such presentations by their children, cues that they would pick up, and the need to ask for help at the appropriate time were assessed and elaborated if not known by them. The Relative Learning Gain and Normalized Gain were calculated to be 76.43% and 0.74 (high gain), respectively, and out of the total subjects, 97.16% of mothers voted that this study proved helpful, and six mothers (4.23%) benefited with the intervention and were referred to experts for evaluation of their children. Conclusion Awareness in this field is necessary to manage children's development, especially by their mothers. Knowing the prevalence of knowledge in mothers may build an association with the prevalence of the recognized cases of speech disorders in children. Evaluation at different community levels may be conducted to gauge the need to impart required knowledge about speech disabilities in children to the maternal population. Future research and the impartation of knowledge to caregivers are vital to promote vigilant and systematic action to be taken regarding the proper growth of their children.

The possibilities of individualization of the educational trajectory for persons with secondary vocational education while continuing their studies at the university

The reform of the modern education system involves a paradigm shift in education, where the focus is on the development of personal creative abilities. Special attention is given to the search for individual self-determination of students, creating conditions for their full development and self-realization, and organizing the learning process according to their needs and abilities. In this context, educational organizations need to change the organization of the educational process and implement innovative personal-oriented technologies and tools for managing the educational process.The goal of this article is to examine approaches to managing the personalization of the educational process through the development and implementation of individual educational trajectories. The authors are present arguments in favor of the necessity of personalization in the educational process, as well as its essence and characteristics. Personalization is considered as a way of designing an educational environment that meets the interests, values, motivations, and needs of each learner and is based on their personal resources and individual characteristic, as well as ensuring the optimal choice of forms and methods of learning.The article is discussing methods of individualizing the educational trajectory of a graduate of vocational education, identifi es and describes a set of organizational and substantive measures aimed at managing the personalization of the educational process through the creation of individual educational trajectories in mixed groups.From the information presented, it can be concluded that the management of the personalization of the educational process is a sequential process, which results in a change in the personality of the student. The personalization is contributing to the eff ectiveness of educational activities and requires special complex and systematic actions on the part of the educational organization and all participants in educational relations.

A weapon to fight against pervasive Omicron: systematic actions transiting to pre-COVID normal.

The Coronavirus Disease-2019 (COVID-19) pandemic is not just a health crisis but also a social crisis. Confronted with the resurgence of variants with massive infections, the triggered activities from personal needs may promote the spread, which should be considered in risk management. Meanwhile, it is important to ensure that the policy responses on citizen life to a lower level. In the face of Omicron mutations, we need to sum up the control experience accumulated, adapting strategies in the dynamic coevolution process while balancing life resumption and pandemic control, to meet challenges of future crises. We collected 46 cases occurring between 2021 and 2022, mainly from China, but also including five relevant cases from other countries around the world. Based on case studies, we combine micro-view individual needs/behaviors with macro-view management measures linking Maslow's hierarchy of needs with the transmission chain of Omicron clusters. The proposed loophole chain could help identify both individual and management loopholes in the spread of the virus. The systematic actions that were taken have effectively combated these ubiquitous vulnerabilities at lower costs and lesser time. In the dynamic coevolution process, the Chinese government has made effective and more socially acceptable prevention policies while meeting the divergent needs of the entire society at the minimum costs. Systematic actions do help maintain the balance between individuals' satisfaction and pandemic containment. This implies that risk management policies should reasonably consider individual needs and improve the cooperation of various stakeholders with targeted flexible measures, securing both public health and life resumption.

Reflections on Building a Multi-Country AAC Implementation Guide.

Augmentative and Alternative Communication (AAC) implementation at any level is a multifaceted process that requires selection of relevant and appropriate systems to suit individual users who may have complex communication needs and other co-occurring difficulties. Careful and systematic action may be required to develop skills and abilities in the use of chosen technologies with suitable ongoing support within a wide range of settings. The wider milieu in which services are provided must also be considered in order to provide a firm foundation for capacity building alongside considerations for multilingual and multicultural factors. UNICEF with the Global Symbols team supported by local professionals working with AAC users, their families and carers set out to collaboratively provide an implementation guide based on their experiences in several Eastern European countries. The aim of the guide was to illustrate work already being undertaken in the area and to ensure the sharing of knowledge and resources where gaps were discovered. The result became a series of linked webpages in an online framework that covered practical aspects for the development of policies and procedures to support early intervention for those with severe speech, language and communication needs across countries of differing cultures and languages. The actual AAC implementation required ingenuity on all sides with translations for pictographic symbol and software adaptations with Cyrillic and Latin alphabets, new synthetic voices alongside deployment and capacity development. Considerable local support was forthcoming and captured with interviews by those working with AAC users as technology was introduced and outcomes measured. As the guide was completed several videos were shared publicly by carers with examples of AAC and assistive technology use. Policies and procedures were also shared in the form of tables, charts, symbol sets, communication boards and software that illustrated not only the occurrence of knowledge transfer and the use of open licenses, but also differences in strategies and the way they were adapted to suit the range of settings in the various countries.

Innovative Approach and Model for Arabic Curriculum Development in The Society 5.0 Era

This study aims to describe approaches and models of Arabic curriculum development relevant to the era of Society 5.0. This research uses a qualitative-descriptive system with a literature study method. The results of this study found that the use of the STEAM approach and SAR (Systematic Action Research) development model are relevant to be used in developing the Arabic curriculum in the era of Society 5.0. Integrating an innovative Arabic curriculum through the STEAM approach and the SAR development model can actively motivate students, increase their interest in learning, and produce skills relevant to the demands of an increasingly technologically advanced society. These findings contribute to developing an Arabic curriculum that is more relevant to the needs of learners in the era of Society 5.0. This STEAM-based SAR model can guide educators in facing the challenges and opportunities that exist in developing Arabic learning that is adaptive and responsive to social and technological changes

Aquinas, Geach, and the Inner Acts of the Will

In the paper I discuss Geach’s rejection of volitions (inner acts of the will) both in the exegesis of Aquinas and in systematic action theory – a rejection followed by some analytical commentators of Aquinas (like Davies and Kenny). I claim that Geach’s interpretation of Aquinas’s action theory in terms of tendencies (treating the will as a special kind of tendency) enables – pace Geach – a sound defense of volitionism both in the exegesis of Aquinas and in the action theory. In other words, I offer arguments in favour of volitions (inner acts of the will) starting from some insights to be found in Geach, and I response to some standard objections against volitionism. Moreover, I try to sketch a framework (based on an ontology of tendencies suggested by Geach) suitable to discuss some other volitionist claims. I proceed in four steps: first I introduce the definition of a volition or inner act of the will that may be ascribed to various camps in the volitionism debate; then I discuss three main arguments of Geach against volitionism – the argument from trying, the argument from voluntary omissions, and the argument from natural theology. I pay special attention to the issue of the timing of volitions.

THE PRACTICE OF «ORGANIZING THE CHURCH NETWORK» BY PARTY-STATE STRUCTURES OF THE UKRAINIAN SSR IN THE SECOND HALF OF THE 1960S

The rethinking of the events of the Soviet past largely concerns the sphere of church-state relations. The significant losses of cultural and architectural heritage during the Soviet period make it expedient to study the mechanisms of liquidation of church buildings in the second half of the 1960s. The purpose and objectives of the article. To determine the principles of state policy in the field of religion and methods of its implementation by party-state structures concerning the church network of the Russian Orthodox Church in the Ukrainian SSR. The research methodology. The research methodology is based on a set of philosophical, general scientific, and historical methods and principles. To solve the specific tasks of the study, the principles of objectivity, historicism, systematicity, and comprehensiveness were also used. Research results. The period of the second half of the 1960s was marked by the liberalization of official views on the religious sphere, the abandonment of repressive methods of fighting religion and the Church, the beginning of the latent destruction of sacred buildings, and the dominance of the Soviet state’s nihilistic attitude toward cultural heritage. The Russian Orthodox Church remained entirely subordinate to the Soviet state, which disregarded its legitimate rights and interests. Discussion. The repressions of the “Thaw“ period and the failure of building a communist society led to a loss of public confidence in the possibility of a just welfare state. It became clear that by practicing persecution, restricting the rights of priests, and banning them from studying in theological schools, the Soviet government was undermining its authority. Therefore, in the 1970s, ideologues of the CPSU Central Committee proposed a new model of churchstate relations — the adaptation to communism. There were no fundamental changes in party policy, as it was based on the Marxist doctrine of religion as the opium of the people. The anti-church orientation of state policy remained, only its forms and methods were transformed. The period of massive closure of Orthodox churches was replaced by a new long-term period, called the period of “streamlining the religious network”. Conclusions. One of the directions of the state’s policy towards religion in the mid-1960s was the targeted liquidation of religious buildings of the Russian Orthodox Church. The main reasons for it were the ideological and political priorities of the state leadership. The closure and destruction of religious buildings were systematic actions of the party-state structures in the process of implementing their policy in the field of religion in the Ukrainian SSR.

Activities of the Internal Affairs Bodies for the Prevention of Domestic Crimes

The problem of domestic crime continues to be one of the urgent problems affecting the welfare of the nation . As a result of the implementation of the Concept of the Development of state Family Policy in the Russian Federation for the period up to 2025, a system of measures has been formed aimed at creating conditions for meeting the interests and needs of families, increasing their economic independence, their role in the self-realization of the individual, educating new generations, strengthening the prestige of marriage and family lifestyle . Experts point out the negative impact of family problems on the development of civil society, socio-economic, political stability of the state . Solving this problem is one of the main tasks of the internal affairs bodies of the Russian Federation . Domestic violence is a crime that occurs in the private sphere of life, characterized by systematic actions against family members in order to gain physical, emotional and material control . The article analyzes the provisions of regulatory legal acts of the Russian Federation, materials of law enforcement practice and scientific positions related to the activities of the internal affairs bodies of the Russian Federation on the prevention of domestic crimes, and also suggests measures to improve them .

Creating 'wellbeing societies': moving from rhetoric to action.

Several global challenges have emerged and coalesced in recent times, including climate change and environmental crises; growing health and social inequalities; geopolitical conflicts; and increasing rates of both communicable and noncommunicable and mental health diseases. The urgency and need for change has never been greater. In response, governments are paying increasing attention to the notion of wellbeing as an integrating concept to drive action to address these challenges. They are beginning to take action by introducing wellbeing indexes; wellbeing budgets; joined-up 'triple bottom line' approaches to policy making, and the inclusion of civil society in the decision-making processes. To date, these steps have been sporadic and localised; yet if these multiple social, environmental and economic crises are to be averted, coherent and systematic actions at the global, national and local levels are needed. The World Health Organization (WHO) and its 194 Member States have come together to map a path forward through the Geneva Charter for Well-being and the Well-being Framework. These aim to set the foundation and direction for action. They map the pathway towards a 'wellbeing society', a concept WHO brought to attention in the Geneva Charter. The intention is to support and galvanise nations to build on their nascent efforts to adopt a welbeing agenda, and move beyond rhetoric to take concerted action. To achieve the promise of 'wellbeing societies' will require developing new governance models,bringing all sectors together to define the problems and solutions, adopting new economic levers, and reorienting financing systems to focus on what is truly important. In this paper we describe the background and context for these initiatives, the concept of wellbeing societies and how WHO is advancing this global agenda.

Challenges and opportunities for teaching Italian as a second language: A case study at the University of Toronto Mississauga

This article analyses the current condition of teaching Italian abroad and the ways in which second-language programmes can engage learners and meet their educational goals. While we are aware of the need for systematic action amongst various actors to ensure the future of Italian-language teaching, we choose to focus on the concept of Experiential Learning (EL). EL is a didactic action (i.e. a linguistic policy) which can be directly implemented into university courses or programmes and represents an innovative method of teaching Italian as a second language. Research on the theme of EL was conducted on Italian L2 courses at the University of Toronto Mississauga and involved instructors and students from various departments. These results lay the foundation for the creation of concrete educational policies, consistent with international literature on the action-oriented approach (CEFR, ACTFL), and for the ‘power of feasibility’ of individual classes (and individual teachers) of L2.

Preventing Falls in the Elderly: More Years of Quality Life

The aging of Finland’s population at an accelerating rate has brought about unprecedented challenges to its social welfare and healthcare. The proportion of people over 65 is estimated to be as high as 26% in 2030. Falls in the elderly have long been a concern, as they result in serious consequences, including suffering, disability, and even death. In Finland, the mortality and disability-adjusted life years (DALYs) due to falls in people aged 70 and above have shown a steady increase from 1990 to 2019. The disease burden of falls and DALYs remain significant in Finland. Although national systematic actions have been implemented in Finland for the prevention of falls, continuous efforts should be made. Fall prevention is the responsibility of every professional, and this work must involve the patients and their relatives.