Management Unit Research Articles

The Effectiveness of The Case Manager in Managing Inhaled Patients in Single Schools, Using Indicators from The Network of Patient Service Management

The aim of this research is to find out the effectiveness of case managers in managing patient nursing in JIH Solo Hospital with quality indicators of patient service management. The study employs a variety of data collection techniques, including in-depth interviews, documents, and observations. Through a qualitative descriptive approach, which is research based on post-positivism that studies the state of things and nature, data validation is a very important technique used to determine the validity and reliability of the data obtained in this study. The findings of the study indicate that the role of the case manager in the JIH Solo Hospital's nursing room is adequate in terms of quality control of health services and cost management. The role of the case manager at JIH Solo Hospital is to coordinate, facilitate, and advocate with the PPA and other related management units in carrying out patient care evaluation, planning, management, monitoring, and evaluation to develop the effectiveness, cost efficiency, and quality of hospital services. However, due to some impediments, the case manager at JIH Solo Hospital has not been able to meet all the indicators in the quality management of patient service where in this study found on the structural indicators there are still shortcomings where the Case Manager who should not be PPA is active and serves only in the morning shift, but the facts in the field show 2 of the 3 case managers appointed are active PPA and assigned in 3 shifts, and on the process indicator in the case of screening that should be carried out directly by case manager, but is still implemented by the head of unit and team under the supervision of the nursing care supervisor to then be to Case Manager for follow-up

Monitoring emergency and urgent surgery: an improvement in a Healthcare Management Unit at a third-level hospital in Italy.

At San Martino IRCCS Hospital in Genoa, Italy, emergency and urgent surgery is classified according to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) classification, whereby cases are divided into two categories and colour-coded accordingly: - EMERGENCY - (Colour-code: RED) "Surgery to be performed within minutes"; - URGENCY - (colour-code: YELLOW) "Surgery to be performed within hours". In this context, it is essential that the emergency surgical team gets clear and complete information from the proposing surgeon, in order to complete the surgical list. Between 14th April 2023 and 23th July 2023, a new method of requesting urgent and emergency surgery by filling out an online form was tested. A total of 406 online requests were made, resulting in 367 E/U surgeries. The greatest number of emergency operations concerned thoracic-abdominal surgery (45%), followed by urology (19%). The requests analysed classified 18% of cases as red and 71% as yellow. The remaining 11% contained compilation errors. Moreover, 11% of the interventions were not performed within the time limits defined according to the severity code. By means of this new tool, San Martino IRCCS Hospital's Healthcare Management Unit can monitor requests for surgery in real time, thereby achieving greater efficiency and implementing corrective measures in the use of Operating Room resources.

Exploring presence practices: a study of unit managers in a selected Provincial Hospital in Free State Province

BackgroundNursing presence depends on an individual’s belief system, truths, sensory experience, professional skills, and active listening. Thus, one may assume that presence occurs when nurses care for patients in a kind and compassionate way. This study aimed to explore and describe presence practices amongst unit managers in a selected provincial hospital in Free State Province.MethodsA qualitative research approach with an exploratory descriptive contextual research design was employed in this study. A purposive nonprobability sampling technique was utilised to select participants. Data were collected through semi-structured interviews and analysed using the six steps of thematic qualitative data analysis. The study’s trustworthiness was ensured through ascertaining credibility, dependability, confirmability, transferability, and authenticity. Approval to conduct the study was obtained from the North-West University Health Research Ethics Committee (NWU-HREC), DoH in the Free State Province, and the CEO (the gatekeeper) of the selected hospital.ResultsFour themes were generated, namely, presence practices amongst unit managers in a selected provincial hospital in Free State, the impact of presence practices on hospital dynamics in a selected provincial hospital in Free State, unit managers’ practices of relational care and human connectedness in the unit, and the perceptions of unit managers on barriers to presence practices in a selected provincial hospital in Free State. Each of these themes presents categories and sub-categories. Unit managers actively foster supportive work cultures, effective management, human connectedness and relational care, and effective communication to yield team cohesion and positive impacts on patient care. Unit managers also display resilience and highlight the need for ongoing support from colleagues and top management.ConclusionUnit managers exhibit diverse presence practices which emphasise their commitment through visibility and accessibility despite staff shortages and resource constraints.

Classroom Management in Improving the Quality of Learning in the Education Units

This study focuses on classroom management in education units as a basis to improve the quality of learning. This process relates to the instruments used for data collection. The instrument consisted of thirty-five related to classroom management. The sample was 142 people who were spread in the education unit of Riau Province, Indonesia. Sampling was undertaken by random sampling in accordance with the readiness of the respondent. Data were analysed by substituting the respondents’ results through descriptive statistics, then using the Product Moment correlation method, the contribution of indicators in realizing the success of implementing learning through ANOVA. The average demographic data of the respondents was 4.273 (very high); compile a lesson plan was 4.304 (very high); carry out learning was 4.352 (very high); assess achievement was 4.233 (very high); carry out follow-up the results of the assessment of learning achievement was 3.813 (high). Quality did not vary with a very high correlation value so that it contributed a role in building class management up to 100%.

Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection

Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease. To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection. A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed. A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia). Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.

Localised and tree total crop loads influence trunk growth, return fruit set, yield, and fruit quality in apples

Localised fruit thinning strategies must be investigated to improve precision crop load management in narrow-canopy, multileader apple trees. This study aimed to determine the effects of within-leader and tree total crop load on leaders’ and trunk’s growth, fruit set, yield, and fruit quality in ‘Ruby Matilda’ apples (marketed as Pink Lady®) over three years. Different crop loads were imposed on two leaders (primary and secondary) of bi-axis trees. Leader and trunk relative growth rate, return fruit set, yield, and fruit quality parameters at harvest were measured. High within-leader crop loads led to a significant increase in yield and reductions in trunk growth, return fruit set, and deterioration of fruit quality parameters except for flesh firmness and starch index. Similar trends were observed in whole-tree relationships. High crop load in secondary leaders had moderate negative effects on trunk growth, yield, and fruit mass of primary leaders; it only marginally affected their return fruit set and had no significant effect (p > 0.05) on their fruit quality. A crop load of 6.8 fruit no. cm−2 of leader cross-sectional area was estimated to achieve a relatively consistent return fruit set within the same leader. At a whole-tree level, a similar crop load (6.9 fruit no. cm−2 of trunk cross-sectional area) produced a consistent return fruit set despite its higher variability. These crop loads produced high yields (120 and 111 t ha−1, respectively) and good quality fruit. Using individual leaders as management units is recommended to simplify operations and reduce variability.

Hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand.

To describe the types of hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand, and to explore head of department (HOD) views on issues in current and future service provision. An electronic survey was sent to HODs of public geriatric medicine departments. Seventy-six (89%) of 85 identified HODs completed the survey. Seventy-one (93%) departments admit inpatients and 51 (67%) admit acute inpatients, with variable admission criteria. Sixty-four (84%) have hospitals with an inpatient general medicine service, and 58 (91%) of these admit older patients with acute geriatric issues. Sixty (79%) departments provide inpatient rehabilitation. Forty (53%) have beds for behavioural symptoms of dementia and/or delirium. Seventy (92%) provide a proactive orthogeriatric service. In terms of out-of-hospital services, 74 (97%) departments have outpatient clinics, 59 (78%) have telehealth and 68 (89%) perform home visits. Forty-five (59%) provide an inreach/outreach service to nursing homes. The most frequent gaps in service provision identified by HODs were acute geriatrics, surgical liaison, a designated dementia/delirium behavioural management unit, geriatricians in Emergency, outreach/inreach to residential care and shared care with some medical specialities. Increasing staff numbers and government policy change were the most frequently identified ways to address these gaps. Geriatric medicine service provision is variable across Australia and New Zealand, with key gaps identified. These findings will inform future directions in implementation of geriatric medicine models of care and discussions with various levels of government about the ongoing development of geriatric medicine services.

PLASMA DYNAMICS OF NEUTROPHIL EXTRACELLULAR TRAPS AND CELL-FREE DNA IN SEPTIC AND NONSEPTIC VASOPLEGIC SHOCK: A PROSPECTIVE COMPARATIVE OBSERVATIONAL COHORT STUDY.

Background: The association between neutrophil extracellular traps (NETs) and the requirement for vasopressor and inotropic support in vasoplegic shock is unclear. This study aimed to investigate the dynamics of plasma levels of NETs and cell-free DNA (cfDNA) up to 48 h after the admission to the intensive care unit (ICU) for management of vasoplegic shock of infectious (SEPSIS) or noninfectious (following cardiac surgery, CARDIAC) origin. Methods: This is a prospective, observational study of NETs and cfDNA plasma levels at 0H (admission) and then at 12H, 24H, and 48H in SEPSIS and CARDIAC patients. The vasopressor inotropic score (VIS), the Sequential Organ Failure Assessment (SOFA) score, and time spent with invasive ventilation, in ICU and in hospital, were recorded. Associations between NETs/cfDNA and VIS and SOFA were analyzed by Spearman's correlation (rho), and between NETs/cfDNA and ventilation/ICU/hospitalization times by generalized linear regression. Results: Both NETs and cfDNA remained elevated over 48 h in SEPSIS (n = 46) and CARDIAC (n = 30) patients, with time-weighted average concentrations greatest in SEPSIS (NETs median difference 0.06 [0.02-0.11], P = 0.005; cfDNA median difference 0.48 [0.20-1.02], P < 0.001). The VIS correlated to NETs (rho = 0.3-0.60 in SEPSIS, P < 0.01, rho = 0.36-0.57 in CARDIAC, P ≤ 0.01) and cfDNA (rho = 0.40-0.56 in SEPSIS, P < 0.01, rho = 0.38-0.47 in CARDIAC, P < 0.05). NETs correlated with SOFA. Neither NETs nor cfDNA were independently associated with ventilator/ICU/hospitalization times. Conclusion: Plasma levels of NETs and cfDNA correlated with the dose of vasopressors and inotropes administered over 48 h in patients with vasoplegic shock from sepsis or following cardiac surgery. NETs levels also correlated with organ dysfunction. These findings suggest that similar mechanisms involving release of NETs are involved in the pathophysiology of vasoplegic shock irrespective of an infectious or noninfectious etiology.

The Portuguese NHS 2024 reform: transformation through vertical integration

Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers’ vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care.

A Study on Waste Disposal Management at Government Hospital in Up

The management of waste disposal in government hospitals across Uttar Pradesh (UP) is a critical issue that significantly impacts public health and environmental sustainability. This research paper aims to explore the current state of waste disposal practices in these facilities, identifying challenges, and proposing sustainable solutions. The study employs a mixed-methods approach, combining quantitative data analysis with qualitative interviews to gather insights from hospital staff, waste management professionals, and local community members. Key findings reveal significant gaps in waste segregation, collection, transportation, and treatment processes, leading to improper waste disposal and potential health risks. The research also highlights the lack of awareness among hospital staff about the importance of waste segregation and the absence of effective policies to manage biomedical waste. Recommendations include the implementation of comprehensive waste management training programs for hospital staff, the establishment of dedicated waste management units within hospitals, and the promotion of community-based waste segregation initiatives. This study underscores the urgent need for improved waste disposal management in government hospitals in UP to safeguard public health and the environment.

Architectural Support for Sharing, Isolating and Virtualizing FPGA Resources

FPGAs are increasingly popular in cloud environments for their ability to offer on-demand acceleration and improved compute efficiency. Providers would like to increase utilization, by multiplexing customers on a single device, similar to how processing cores and memory are shared. Nonetheless, multi-tenancy still faces major architectural limitations including: (a) inefficient sharing of memory interfaces across hardware tasks (HT) exacerbated by technological limitations and peculiarities, (b) insufficient solutions for performance and data isolation and high quality of service, and (c) absent or simplistic allocation strategies to effectively distribute external FPGA memory across HT. This article presents a full-stack solution for enabling multi-tenancy on FPGAs. Specifically, our work proposes an intra-fpga virtualization layer to share FPGA interfaces and its resources across tenants. To achieve efficient inter-connectivity between virtual FPGAs (vFGPAs) and external interfaces, we employ a compact network-on-chip architecture to optimize resource utilization. Dedicated memory management units implement the concept of virtual memory in FPGAs, providing mechanisms to isolate the address space and enable memory protection. We also introduce a memory segmentation scheme to effectively allocate FPGA address space and enhance isolation through hardware-software support, while preserving the efficacy of memory transactions. We assess our solution on an Alveo U250 Data Center FPGA Card, employing 10 real-world benchmarks from the Rodinia and Rosetta suites. Our framework preserves the performance of HT from a non-virtualized environment, while enhancing the device aggregate throughput through resource sharing; up to 3.96x in isolated and up to 2.31x in highly congested settings, where an external interface is shared across four vFPGAs. Finally, our work ensures high-quality of service, with HT achieving up to 0.95x of their native performance, even when resource sharing introduces interference from other accelerators.

Towards a Greener Future: Scaling Up Agroforestry for Global Sustainability

The current world faces several challenges, including climate change, an exponentially increasing population, the loss of biodiversity and environmental concerns which necessities the adoption of the sustainable nature-based solutions such as agroforestry. Agroforestry is the intricate integration of trees, crops, and livestock on the same piece of land management unit that helps to restore the ecosystem, improve soil health, thus combating the environmental degradation. Moreover, agroforestry has also emerged as a potential tool that bridges the ecological preservation, while increasing or at least maintaining the productivity of the whole agroecosystem. Agroforestry is a contemporary food system that relies primarily on natural inputs, leading to the creation of more sustainable and resilient landscapes. Simultaneously, agroforestry systems reduce the soil erosion, and increases the accumulation of organic matter, hence established a closed nutrient cycling which sustain the agricultural production for longer duration. Simultaneously, agroforestry systems are effective in enhancing food security, diversifying farm income and strengthening the resilience of community to climate change thus empower the farmers and provide an opportunity to combat poverty. However, there are numerous constraints including clear land tenure rights, market infrastructure and linkage, and lack of the traditional knowledge which influenced the adoption of agroforestry systems at global level. This immediately need to be addressed by implementing flexible legislation (such as National Agroforestry Policy 2014 adopted by India), capacity building and community involvement, value chain development and payment for ecosystem services. Overall, it is crucial to adopt low-carbon perennial agroecological practices like agroforestry in order to increase the CO2 abatement rate, improve the food, nutritional and livelihood security of smallholder farmers and contribute to a more environmental friendly and sustainable future.

Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province

BackgroundResearch on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses’ knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses’ knowledge and attitudes.MethodsThis study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder.ResultsThe results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit.ConclusionThe study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

Educational Policies During the Pandemic and Pedagogical Practice in Secondary Educational Institutions

The pandemic altered global education with the closure of institutions and the adaptation of teaching methods, prompting the implementation of policies to ensure continuity of learning to meet challenges. The purpose was to identify the relationship between educational policies during Covid-19 and pedagogical practice in the Secondary Educational Institutions (IES) of the Local Educational Management Unit (UGEL) San Roman, Puno. The methodology was the quantitative approach, non-experimental cross-sectional correlational design. The population and sample consisted of 33 directors of the UGEL - San Román. The technique was the survey, whose instruments were the questionnaire of educational policies and pedagogical practice. The results were that the existence of correlation between the study variables was determined, with r=0.355 revealing a low positive correlation between the study variables. Concluding that the effects of educational policies are significant with pedagogical practice.

Estilos de aprendizaje y desarrollo de pensamiento formal en estudiantes peruanos de Educación Básica

The aim of this study was to establish the relationship between Learning Styles (LS) and the level of Formal Thought Development (FTD) in fourth-year students of Regular Basic Education in the Tacna Region, 2022. From a methodological standpoint, this research adopts a descriptive correlational design. The sample consisted of 738 fourth-year secondary education students, randomly and repre-sentatively selected from the four Local Educational Management Units in the Tacna Region. Two instruments were administered: the CHAEA questionnaire by Honey and Alonso, comprising 80 items to identify LS, and the TOLT Test by To-bin and Capie, consisting of 10 items, to determine the FTD level in participants. The findings revealed a significant relationship between LS and FTD level in Regu-lar Basic Education students in the Tacna Region, 2022. Reflective, theoretical, and pragmatic learning styles showed significant relationships (bilateral signifi-cance of 0.003&lt;0.05, 0.040&lt;0.05, and 0.010&lt;0.05, respectively) with FTD. Thus, effect sizes are around the medium level with high statistical power. Only the ac-tive learning style did not show a significant relationship (bilateral significance of 0.133 &gt; 0.05). It is concluded that the active learning style is not related to the FTD level, whereas the reflective, theoretical, and pragmatic styles are.

The Possibility of adoption Lean Supply Chain Management (LSCM) activities in the food beverage industry : Exploratory study

The study aims to determine the extent of the possibility of adopting lean supply chain management activities, represented by the activities (lean purchasing, lean supplier, lean production, lean transportation, lean warehousing, and lean customer) in the Coca-Cola and Pepsi-Cola companies for the production of food beverages in the Kurdistan Region / Iraq, based on two hypotheses. They stipulate the respondents' awareness and possibility of adopting these activities. The questionnaire form was used as a main tool for collecting data. (90) questionnaires were distributed to the managers of departments and units in the two surveyed companies. The number of questionnaires suitable for analysis reached (80) forms. The results of the statistical analysis supported the study hypotheses and showed the possibility of adopting all activities. The researchers suggested adopting all activities and starting with the lean production activity.

MSPA-based green space morphological pattern and its spatiotemporal influence on land surface temperature

The frequent occurrence of extreme heat events has notably affected human's living environment, and a considerable number of studies have reported that green space is an efficient measure by investigating the correlation between green space and land surface temperature (LST). However, spatiotemporal effects of green space on LST still remain unclear. In this study, green space patterns (e.g., core, islet, perforation, edge, loop, bridge, and branch) were identified through morphological spatial pattern analysis (MSPA). Moreover, the effects of green space pattern on LST in three periods were investigated through three kinds of models. As indicated by the results: (1) the geographically and temporally weighted regression model exhibited the optimal performance compared with other two models. (2) in general, the core, the edge, the bridge, and the branch significantly contributed to cooling, and the islet hindered cooling. However, the perforation and the loop exerted significant dual nature effects with the similar quantity of the negative and positive coefficients, showing relatively complex impact mechanism. (3) the intensity of the effect of the respective MSPA class varied across the study area. The core had the most substantial effect, which distributed in the south and middle corners. (4) the result suggested that a neighborhood scale in China, which was 960 m in this study, served as a basic unit in green space management. The spatiotemporal non-stationarity of the effects of green space morphological patterns on LST provided important insights into urban thermal environment improvement through urban green space planning and design.

Genomic evaluation of mud sunfish in the atlantic slope drainage

Mud Sunfish (Acantharchus pomotis, Baird), a cryptic species native to the Atlantic and Gulf slope drainages of North America, have experienced a documented reduction in their geographic range. Atlantic Slope populations of Mud Sunfish were evaluated to determine the population structure, assess genetic diversity, and to identify presence of evolutionary significant units (ESU) in order to develop fundamental understandings of its occurrence. Tissue samples were collected from across the Atlantic Slope for genomic comparison. Restriction site Associated DNA Sequencing (RAD-Seq) was performed on 95 individuals from 14 populations. Mantel test provided evidence of a correlation between genetic and geographical distances, suggesting a pattern of isolation-by-distance. Differences among populations of Mud Sunfish largely occur along a north-south latitudinal gradient. Bayesian clustering of putatively outlier SNP loci, suggests that regional adaptive pressure is occurring. Despite a large geographic distance and significant differences between the majority of the populations of Mud Sunfish, Bayesian clustering analysis suggests that two unresolved clades are persisting within the Atlantic Slope Drainage: a northern clade of Mud Sunfish ranging from New Jersey to North Carolina and a southern clade ranging from South Carolina to Florida. A population of Mud Sunfish in Florida appears distinct from all others in the Atlantic Coastal plain and likely represents a distinct management unit.

Influence of resource gradients and habitat edges on density variation in tiger populations in a multi-use landscape

Spatial heterogeneity in the local densities of terrestrial carnivores is driven by multiple interacting biotic and abiotic factors. Space-use patterns of large carnivores reflect the competing demands of resource selection (e.g., exploitation of habitats with abundant prey) and minimization of risks arising from human interactions. Estimating the relative strength of these drivers is essential to understand spatial variation in densities of large carnivores and there are still key knowledge gaps for many large carnivore populations. To better understand the relative roles of environmental and human drivers of spatial variation in tiger (Panthera tigris) densities, we surveyed a 3000 km2 landscape in North India using camera trap data. Over two years, we photo-captured 92 unique adult tigers. Associating spatial covariates with patterns of detection allowed us to test hypotheses about the relative influence of prey abundance, habitat structure and extent, and proximity to habitat edges on spatial variation in tiger densities across a gradient of anthropogenic disturbance. We documented extensive variation in tiger density within and across management units and protected areas. Spatial variation in prey abundance and proximity to grassland habitats, rather than human use (e.g. extent of human-dominated edge habitat and protection status), explained most of the spatial variation in tiger density in two of the five surveyed sites. The region’s largest tiger population occurred in a multi-use forest beyond protected area boundaries, where wild ungulates were abundant. Our results suggest that tigers can occur at high densities in areas with extensive human use, provided sufficiently high prey densities, and tracts of refuge habitats (eg. areas with dense vegetation with low human use). We argue that tiger conservation portfolio can be expanded across multi-use landscapes with a focus on areas that are adaptively managed as “zones of coexistence” and “refuge habitats”. Advancing this conservation strategy is contingent on greatly strengthening systems to effectively and equitably redress human–wildlife conflict and leveraging existing policies to strengthen local participation in conservation planning and forest stewardship. Our insights into the environmental drivers of spatial heterogeneity in tiger populations can inform both local management and guide to species recovery in working landscapes.

Nurturing transformative local structures of multisectoral collaboration for primary health care: qualitative insights from select states in India

BackgroundMultisectoral collaboration is essential for advancing primary health care (PHC). In low- and middle-income countries (LMICs), limited institutional capacities, governance issues, and inadequate stakeholder engagement impede multisectoral collaboration. India faces similar challenges, especially at the meso-level (districts and subdistricts). Owing to its dependence on context, and insufficient evidence, understanding “How” to improve multisectoral collaboration remains challenging. This study aims to elicit specific recommendations to strengthen meso-level stewardship in India for multisectoral collaboration. The findings from this study may offer lessons for other LMICs.MethodsUsing purposive, maximum variation sampling, the study team conducted semi-structured interviews with 20 diverse participants, including policymakers, implementers, development agency representatives, and academics experienced in multisectoral initiatives. The interviews delved into participants’ experiences, the current situation, enablers, and recommendations for enhancing stakeholder engagement and capacities at the meso-level for multisectoral collaboration.ResultsContext and power are critical elements to consider in fostering effective collaboration. Multisectoral collaboration was particularly successful in three distinct governance contexts: the social-democratic context as in Kerala, the social governance context in Chhattisgarh, and the public health governance context in Tamil Nadu. Adequate health system input and timely guidance instil confidence among local implementers to collaborate. While power plays a role through local leadership’s influence in setting agendas, convening stakeholders, and ensuring accountability. To nurture transformative local leaders for collaboration, holistic, equity-driven, community-informed approaches are essential. The study participants proposed several concrete steps: at the state level, establish “central management units” for supervising local implementers and ensuring bottom-up feedback; at the district level, rationalise committees and assign deliverables to stakeholders; and at the block level, expand convergence structures and involve local self-governments. Development partners can support data-driven priority setting, but local implementers with contextual familiarity should develop decentralised plans collaboratively, articulating rationales, activities, and resources. Finally, innovative training programs are required at all levels, fostering humility, motivation, equity awareness, leadership, problem- solving, and data use proficiency.ConclusionThis study offers multiple solutions to enhance local implementers’ engagement in multisectoral efforts, advocating for the development, piloting, and evaluation of innovative approaches such as the block convergence model, locally-led collaboration efforts, and novel training methods for local implementers.