Measuring the sustainability of beef supply chain with rapid appraisal for beef supply chain

Background and Aim:

Nationally, there has always been a gap between the demand for beef and its supply, although supply growth is proportional with demand growth and even exceeds it in some regions in Indonesia. This research study aims to measure the sustainability status of the beef supply chain and applies the developed measurement system to a specific beef supply chain by identifying suitable indicators and their scale. Moreover, this research study provides some recommendations for the improvement of the sustainability status of the beef supply chain.

Materials and Methods:

In this research study, 11 and nine indicators were analyzed to assess the sustainability status of the beef supply chain at the farm and slaughterhouse chain levels. A rapid appraisal for beef supply chain was applied to rapidly assess the sustainability status of beef supply chains using Multidimensional Scaling (MDS). The Delphi method was utilized as an iterative process to collect data and obtain consensus of experts’ judgments regarding the policies that should be implemented to improve the most sensitive indicator affecting the economic, social, and environmental dimensions.

Results:

Analysis of ordination with MDS shows the regional sustainability index value for multidimensional approaches of beef cattle farms and beef slaughterhouses. The sustainability index value for beef cattle farms was 56.14 (moderately sustainable), 48.02 (fairly unsustainable), and 48.77 (fairly unsustainable) in Semarang, Sragen, and Boyolali, respectively. Moreover, the sustainability index value for beef slaughterhouses was 47.05 (fairly unsustainable), 54.83 (moderately sustainable), and 54.19 (moderately sustainable) in Semarang, Sragen, and Boyolali, respectively. Policy recommendation was focused on the basis of the results of leverage analysis, which highlighted the most indicative factor affecting sustainability for each dimension.

Conclusion:

Measurement results revealed that the achievement of beef supply chain sustainability requires targeted efforts through the deployment of several policies as the current status of sustainability in beef farms and beef slaughterhouses was only inclined toward moderately sustainable and fairly unsustainable. Although all the surveyed regions in this study can meet the regional needs of beef meat on their own and even distribute the excess to other regions, none of the beef supply chains of the surveyed region indicated good sustainability.

[THE QUALITY INDICATORS TO ASSESS THE PROSTATE CANCER RADIOTHERAPY PERFORMANCE (BRIEF REVIEW)]

INTRODUCTION

The radiation therapy (RT) plays a tremendous role in the consistent treatment of prostate cancer (PCa). The research ideas underpinning the wide implementation of innovative digitalized continuous (nonstop) dynamic auditing are coming true. Simultaneously, there are increasing challenges in selection of RT quality indicators.

OBJECTIVE

to study the pivotal indicators for RT quality assurance in treatment of PCa and to highlight the breaking through developments securing the delivery of top-quality cancer care in radiation oncology units.

MATERIALS AND METHODS

The literature search was performed in the PubMed database and the Google system. The inquiries included such terms as: "quality of care", "quality assessment criteria", "indicators", "prostate cancer" and "radiation therapy". A logical and semantic approaches were applicated to select the relevant scientific resources.

RESULTS

In most relevant studies, the variations of the Delphi technique are used to choose the quality assessment criteria. The targeted research papers describe the development of QIs for assessing the quality of radiation therapy in patients with locally advanced PCa; a hierarchical list of QIs has been generated. The adequate registration of information has huge impact on quality assessment to draw the definitive thorough conclusions.

DISCUSSION

The further improvement of Delphi technique may form one of pillars for the development of valuable RT quality measures. Considering the math aspects and the physical nature of RT, it seems being important to include the key opinion leaders in the field of clinical oncoinformatics, radiation informatics, and specialists from technical industries in the expert committees for the selection of RT QIs.

Prognostic Role and Diagnostic Power of Seven Indicators in COVID-19 Patients

The prognostic role and diagnostic ability of coronavirus disease 2019 (COVID-19) disease indicators are not elucidated, thus, the current study aimed to investigate the prognostic role and diagnostic ability of several COVID-19 disease indicators including the levels of oxygen saturation, leukocytes, lymphocytes, albumin, C-reactive protein (CRP), interleukin-6 (IL-6), and D-dimer in patients with COVID-19. The levels of oxygen saturation, lymphocytes, and albumin were significantly higher in the common and severe clinical type patients compared with those in critical type patients. However, levels of leukocytes, CRP, IL-6, and D-dimer were significantly lower in the common and severe type patients compared with those in critical type patients (P < 0.001). Moreover, the current study demonstrated that the seven indicators have good diagnostic and prognostic powers in patients with COVID-19. Furthermore, a two-indicator (CRP and D-dimer) prognostic signature in training and testing datasets was constructed and validated to better understand the prognostic role of the indicators in COVID-19 patients. The patients were classified into high-risk and low-risk groups based on the median-risk scores. The findings of the Kaplan–Meier curve analysis indicated a significant divergence between the high-risk and low-risk groups. The findings of the receiver operating curve (ROC) analysis indicated the good performance of the signature in the prognosis prediction of COVID-19. In addition, a nomogram was constructed to assist clinicians in developing clinical decision-making for COVID-19 patients. In conclusion, the findings of the current study demonstrated that the seven indicators are potential diagnostic markers for COVID-19 and a two-indicator prognostic signature identification may improve clinical management for COVID-19 patients.

Development of Policy-Relevant Indicators for Injury Prevention in British Columbia by the Key Decision-Makers

Indicators can help decision-makers evaluate interventions in a complex, multi-sectoral injury system. We aimed to create indicators for road safety, seniors falls, and ‘all-injuries’ to inform and evaluate injury prevention initiatives in British Columbia, Canada. The indicator development process involved a five-stage mixed methodology approach, including an environmental scan of existing indicators, generating expert consensus, selection of decision-makers and conducting a survey, selection of final indicators, and specification of indicators. An Indicator Reference Group (IRG) reviewed the list of indicators retrieved in the environmental scan and selected candidate indicators through expert consensus based on importance, modifiability, acceptance, and practicality. Key decision-makers (n = 561) were invited to rank each indicator in terms of importance and actionability (online survey). The IRG applied inclusion criteria and thresholds to survey responses from decision-makers, which resulted in the selection of 47 road safety, 18 seniors falls, and 33 all-injury indicators. After grouping “like” indicators, a final list of 23 road safety, 8 seniors falls, and 13 all-injury indicators were specified. By considering both decision-maker ranking and expert opinion, we anticipate improved injury system performance through advocacy, accountability, and evidence-based resource allocation in priority areas. Our indicators will inform a data management framework for whole-system reporting to drive policy and funding for provincial injury prevention improvement.

Human- and infrastructure-associated bacteria in greywater

Greywater, the wastewater from sinks, showers and laundry, is an understudied environment for bacterial communities. Most greywater studies focus on quantifying pathogens, often via proxies used in other wastewater, like faecal indicator bacteria; there is a need to identify more greywater-appropriate surrogates, like Staphylococcus sp. Sequencing-based studies have revealed distinct communities in different types of greywater as well as in different parts of greywater infrastructure, including biofilms on pipes, holding tanks and filtration systems. The use of metagenomic sequencing provides high resolution on both the taxa and genes present, which may be of interest in cases like identifying pathogens and surrogates relevant to different matrices, monitoring antibiotic resistance genes and understanding metabolic processes occurring in the system. Here, we review what is known about bacterial communities in different types of greywater and its infrastructure. We suggest that wider adoption of environmental sequencing in greywater research is important because it can describe the entire bacterial community along with its metabolic capabilities, including pathways for removal of nutrients and organic materials. We briefly describe a metagenomic dataset comparing different types of greywater samples in a college dormitory building to highlight the type of questions these methods can address. Metagenomic sequencing can help further the understanding of greywater treatment for reuse because it allows for identification of new pathogens or genes of concern.

Community-Based Rehabilitation Indicators: Validation and Preliminary Evidence for Disability in Italy

Community-based rehabilitation (CBR) is a multi-sectorial community strategy for guaranteeing that people with disabilities enjoy the same rights and opportunities as all other community members. CBR is organized in a five-component matrix—namely, health, education, social, livelihood, and empowerment. To measure the effectiveness of CBR, the World Health Organization (WHO) has developed standardized indicators. The objective of the present study is to translate and validate the CBR indicators (CBR-Is), providing preliminary evidence of their use for disability in Italy. After obtaining permission from the WHO, the CBR-Is followed a process of translation and cross-cultural adaptation according to international guidelines. An examination of internal consistency and reliability was than performed. The intra-rater reliability was estimated using the Intraclass Correlation Coefficient with a 95% confidence interval. In order to measures the differences between people with and without disabilities, an independent sample t-test was used for quantitative indicators. The Italian version of the CBR-Is (IT-CBR-Is) was administered to 234 people. The internal consistency showed a good value, with a Cronbach’s alpha coefficient of 0.862, and the intra-rater reliability analysis showed solid values for each domain (range: 0.723–0.882). Statistically significant differences between people with and without disabilities were found for each domain of the CBR matrix—namely, health, social, education, livelihood, and empowerment. The IT-CBR-Is are consistent and reliable measures when used to investigate disability in a community-based inclusive development perspective. National stakeholders can now have specific indicators to implement services and actions for people with disabilities.

Evaluation of the Strategies to Control COVID-19 Pandemic in Four European Countries

On March 11, 2020, the World Health Organization (WHO) has officially declared the novel coronavirus outbreak a pandemic. The national governments deployed a series of severe control measures and a set of public health policies in order to stop the spread of COVID-19 pandemic. The aim of this study is to investigate the correlation between specific interventions and incident cases during the second wave in multiple and specific countries. The observational study was based on data from the Oxford COVID-19 Government Response Tracker (OxCGRT) source retrieved from October 1st, 2020 to January 10, 2021. Thirteen specific indicators related to measures adopted were considered. Four European countries were taken into account: Italy, German, Spain and UK. A vector autoregression (VAR) model and the Granger Causality test were performed to allow for an assessment of any possible effect induced by each control measure against the overall pandemic growth. Wald test was conducted to compute p-values. No correlation between the applied measures and incident cases in the four countries was shown by the Granger causality test. Only closings of workplaces (C2) and limits on private gatherings showed (C4) a significant correlation with incident cases in UK and restrictions on internal movement between cities/regions in Germany. The Granger causality also tested that C2 and C4 forecasted the decrease of incident cases after a time lag of 6–30 days in UK and Germany, respectively. Policy makers must analyze the context in which policies are set because of effectiveness of interventions can be influenced by local context and, especially, by socio-economic and demographic characteristics, and make a proper communication to support the resilience of the population capable of guaranteeing adherence to the interventions implemented.

An Analysis of an Inventory of Community Resilience Frameworks

This data article provides details of an analysis of an inventory of 56 community resilience frameworks. In this article, a description of how the inventory data was catalogued is presented. Section 3 outlines the categories used to analyze the frameworks as well as the categories used to bin the indicators and measures used in each. Section 3.1 describes the results of the categorization process for the 56 resilience frameworks. Section 3.2 outlines the results of the categorization of the 3,298 indicators used in each framework. Section 3.3 describes the 7,165 measures used in the 56 frameworks.

Missing cases of injury death: use of quantitative methods and case reviews to inform future improvements in case definition

BACKGROUND

Knowledge of fatal injuries is required to inform prevention activities. Where hospital patients with an injury principal diagnosis (PDx) died and were certified to a medical underlying cause of death (UCoD), there is the potential to underestimate injury mortality. We sought to characterise injury/non-injury (NI) mismatches between PDx and UCoD by identifying which subgroups had small/large mismatches, and to understand why mismatches had occurred using informative examples.

METHOD

Hospital records (n=10 234) with a PDx of injury were linked to the mortality collection using a unique personal identifier. Percentages UCoD coded to a NI were tabulated, for three follow-up periods and by selected variables. Additionally, we reviewed a sample of 70 records for which there was a mismatch.

RESULTS

%NIs were 39%, 66% and 77% for time from injury to death of <1 week, <90 days and <1 year, respectively. Variations in %NI were found for all variables. Illustrative examples of 70 medical UCoD deaths showed that for 12 cases the injury event was unequivocally judged to have resulted in premature death. A further 16 were judged as injury deaths using balance of probability arguments.

CONCLUSION

There is variation in rates of mismatch between PDx of injury and UCoD of NI. While legitimate reasons exist for mismatches in certain groups, a material number of injury deaths are not captured using UCoD alone; a new operational definition of injury death is needed. Early solutions are proposed. Further work is needed to investigate operational definitions with acceptable false positive and negative detection rates.

Animal-Based Indicators for On-Farm Welfare Assessment in Sheep

Simple Summary

As we keep and use sheep, we need to be able to assess their welfare and deal with welfare problems as they arise. To assess welfare, a comprehensive protocol based on valid and feasible indicators is needed. The aim of this study was to review the scientific literature and identify protocols and indicators for assessing the welfare of sheep. We identified promising protocols, well-known and established indicators, such as lameness or body condition score, as well as novel indicators that still need to be evaluated to prove their validity, such as pruritic behaviour or resting time. This review provides a starting point for the development of valid and feasible on-farm protocols using animal-based indicators to assess sheep welfare.

Abstract

The value society assigns to animal welfare in agricultural productions is increasing, resulting in ever-enhancing methods to assess the well-being of farm animals. The aim of this study was to review the scientific literature to obtain an overview of the current knowledge on welfare assessments for sheep and to extract animal-based welfare indicators as well as welfare protocols with animal-based indicators. By title and abstract screening, we identified five protocols and 53 potential indicators from 55 references. Three out of the five protocols include animal-based as well as resource-based indicators. All of them were assessed as being practicable on-farm but lacking reliability. Some of the single indicators are endorsed by the literature and widely used in the field like assessment of behaviour, lameness or body condition score. Others (e.g., Faffa Malan Chart FAMACHA©, dag score or pain assessment) are regularly mentioned in the literature, but their reliability and usefulness are still subject of discussion. Several indicators, such as pruritic behaviour, eye condition, lying time or tooth loss are relatively new in the literature and still lack evidence for their validity and usefulness. This literature review serves as a starting point for the development of valid and practicable welfare protocols for sheep.

[Long-term Changes and Drivers of Ecological Security in Shahe Reservoir, China]

Monthly datasets of ecological indicators from 2010 to 2020 in Shahe Reservoir, Tianmuhu, China, were examined to reveal the long-term variations in water ecological security and its driving factors. The results of Secchi disk depth(SD) measurements revealed significantly spatial variation(P<0.05) within the reservoir. The highest SD was recorded in the downstream-linked reservoir, and the lowest SD was recorded in the upstream tributaries. In contrast, the values of other water ecological indicators were higher in the upstream tributaries than in the transition region and the downstream-linked reservoir area. In summer and autumn, the SD was low, while the concentrations of total phosphorous(TP), chlorophyll a(Chl-a), the permanganate index, and cyanobacterial biomass(BM_c) were high. During the thermal stratification period from May to September, the concentrations of 2-methylisoborneol(MIB) and Chl-a were highest at a depth of 4 m, while diatom biomass(BM_b) and BM_c reached their maximum at depths of 2 m and 0.5 m, respectively. Therefore, spatial and temporal variations should be fully considered when evaluating aquatic ecological security. Focusing on spring and summer, when the risk of water ecological security was high, Chl-a combined with SD and MIB along with their correlation with other water quality indexes, was used to evaluate and optimize the ecological security of Shahe Reservoir. The evaluation results showed that the aquatic ecological security of the reservoir was excellent over the last 10 years; however, annual fluctuations have been large and the evaluation scores were spatially variable. While seasonal sampling strategies focusing on three layers depths are economical and reliable for lake regions with thermal stratification, our results indicate that tailored monitoring may be required to determine the aquatic ecological security of lakes and reservoirs. In Shahe Reservoir, the decrease in the SD and the increase in MIB caused by high TP and algal blooms were the most important drivers of ecological service function in the reservoir. Furthermore, hydrometeorological factors may also play important roles in the aquatic ecological security of reservoirs.

Operationalising the water-energy-food nexus through the theory of change

The water-energy-food (WEF) nexus facilitates understanding of the intricate and dynamic interlinkages among the three resources. Its implementation can enhance resource securities and sustainable development. Despite its potential, full adoption of the approach has been hindered by a lack of actionable strategies to guide its practical application. This is attributed to (i) poor data (ii) lack of empirical evidence, (iii) inadequate analytical tools, and (iv) lack of clarity on applicable spatial scale. This study undertook a literature review, coupled with systemic analyses of a WEF nexus analytical model, whose outputs were used as a basis to develop a Theory of Change, an iterative outline for operationalising the approach in the context of southern Africa. The consultative and iterative Theory of Change culminated with the formulation of pathways to (i) overcome the barriers impeding WEF nexus operationalisation, (ii) mitigation of trade-offs while enhancing synergies towards attaining simultaneous resource securities, (iii) poverty alleviation and reduction of inequalities, and (iv) reconciling policy with implementation scale. The WEF nexus operationalisation outcomes are linked to Sustainable Development Goals 2 (zero hunger), 6 (clean water and sanitation), and 7 (affordable and clean energy), with synergies to SDGs 1 (no poverty), 5 (gender equality), 8 (decent work and economic growth), 12 (responsible consumption and production), 13 (climate action), 14 (life below water), and 15 (life on land). Operationalising the WEF nexus through an interactive process can inform sustainable pathways towards resource security, job and wealth creation, improved livelihoods and well-being, and regional integration.

Rethinking the design of resilience and adaptation indicators supporting coastal communities

As resilience and adaptation considerations become mainstreamed into public policy, there is an overarching desire to measure and quantify metrics and indicators that seek to evaluate the efficiency, effectiveness, and justness associated with outcomes of such processes. While much research has sought to develop specific indicators that may serve as proxies for these considerations, less research has focused on those normative aspects of indicator design that support a variety of goals associated with the accuracy, reproducibility, proxy value and multi-stakeholder translation of indicators, among various other goals and values. This perspective article sets forth a range of potential considerations that may be useful for those who seek to design and develop novel resilience and adaptation indicators ("RAIs"). These considerations are explored through a range of hypothetical examples that may be applicable to coastal communities that seek to address the practical challenges facing the design, execution, management and modification of RAIs.

The indicators and methods used for measuring urban liveability: a scoping review

OBJECTIVES

Liveability is a multi-dimensional and hierarchical concept which consists of various criteria and sub-criteria and may be evaluated in different ways. The aim of this study was to systematically review indicators and methods used for the evaluation of urban liveability in literature.

CONTENT

The five-stage methodological framework of Arksey and O'Malley was used to conduct this scoping review. A systematic search of electronic databases, including Scopus, Medline (via PubMed), Embase, Web of Science and EBSCO was done until May 29, 2019. Web searching, searching reference lists and hand searching was also conducted to retrieve more relevant articles. Two reviewers screened the papers for eligibility based on the inclusion criteria and extracted their key data and reported them descriptively.

SUMMARY

Sixty seven (67) out of 3,599 papers met the selection criteria. This review showed five distinct domains considered to be important components of liveability. These were Economical, Environmental, Institutional, Social, and Governance (Political) domains. The most important subdomains (indices) which were frequently applied in various studies were Environmental friendliness and Sustainability, Socio-Cultural Conditions and Economic Vibrancy and Competitiveness. We also identified seven different methodologies and six ranking tools used for assessing urban liveability. Among the quantitative methods, three methods accounted for 89.6% of the articles. These methods were the Analytical hierarchy process and entropy (AHP; n=24; 50%), Factor analysis & Principle Component Analysis (FA & PCA; n=12; 25%) and Spatial Multi-criteria Decision-making Method (Spatial; n=7; 14.6%). Among the ranking tools used, three ranking tools accounted for 65.4% of the articles. These tools were the Livable City Scientific Evaluation Standards (LCSES; n=9; 34.6%), The Global Liveable Cities Index (GLCI; n=4; 15.4%) and the Economist Intelligence Unit (EIU; n=4; 15.4%).

OUTLOOK

This paper discusses and summarizes the latest indicators and methods used for determining urban liveability. The information offered in the review can help future investigators to decide which method suits their purpose and situation better and measure urban liveability more systematically than before.

Comparison of HIV Indicators after the Implementation of a New Model for TB and HIV Management in an Iranian Prison

OBJECTIVES

A new national clinical guideline for the management of tuberculosis and HIV in Iranian prisons was released in 2011. The aim of this study was to compare HIV indicators in the case and control prisons after implementation of the new guideline.

METHODS

This report examines outcomes observed during the pilot phase of its implementation at a case prison from October 2013 to June 2014 compared to a control prison that had not yet implemented the guideline. The case prison included incarcerated individuals in the Great Tehran Prison. A prison in Alborz province was considered as a control group. Pearson's Chi-squared, two-sample t-test, paired t-test and Kruskal-Wallis were used for the analysis.

RESULTS

The intervention significantly increased the total number of inmates tested for HIV and of diagnoses of HIV-positive inmates in the case prison compared to the control prison (P<0.001). Moreover, coverage of antiretroviral therapy was higher in the case prison compared to the control prison (P=0.015).

CONCLUSION

We recommend the implementation of this guideline in all Iranian prisons.

Global Commitments to Conserving and Monitoring Genetic Diversity Are Now Necessary and Feasible

Global conservation policy and action have largely neglected protecting and monitoring genetic diversity—one of the three main pillars of biodiversity. Genetic diversity (diversity within species) underlies species’ adaptation and survival, ecosystem resilience, and societal innovation. The low priority given to genetic diversity has largely been due to knowledge gaps in key areas, including the importance of genetic diversity and the trends in genetic diversity change; the perceived high expense and low availability and the scattered nature of genetic data; and complicated concepts and information that are inaccessible to policymakers. However, numerous recent advances in knowledge, technology, databases, practice, and capacity have now set the stage for better integration of genetic diversity in policy instruments and conservation efforts. We review these developments and explore how they can support improved consideration of genetic diversity in global conservation policy commitments and enable countries to monitor, report on, and take action to maintain or restore genetic diversity.

Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria, Australia

The United Nations Sustainable Development Goals, New Urban Agenda and Paris Agreement on Climate Change are blueprints for health promotion action that mandate human health is linked inextricably to the health of the environment. In the Anthropocene, new indicators are required to promote community engagement with, and measurement of, healthy and sustainable wellbeing for people and planet. This study explored the need for a metric such as the Happy Planet Index that explicitly links human health to health of the environment for a local level scale in Australia. The project arose from an international coalition of health promoters advocating for 'planetary health' approaches. Qualitative description methods guided the study design involving key informant interviews (n = 17) and four focus groups (n = 27 participants) with health and/or sustainability academics, practitioners and policy-makers. Document analysis of health and environment indices and policy mandates augmented the analysis. Qualitative content analysis techniques were used to analyse the findings. There was strong interest for a local level composite indicator, such as a rescaled Happy Planet Index (life expectancy × life satisfaction × equity adjustment/ecological footprint) for use at a local level. The value of a composite index was: its ability to promote community engagement with planetary health thinking; an advocacy tool for joint health and sustainability policy; to justify programs on health and environmental co-benefits; and to provide a mechanism for correlative comparisons between local governments and national comparisons. However, disciplinary silos currently limit partnerships for health promotion and planetary health and a local composite index could help bridge these divides.

Substantiation of Methods for Predicting Success in Artistic Swimming

To develop a methodology for predicting success in artistic swimming based on a set of morphofunctional indicators and indices, 30 schoolgirls, average age (12.00 ± 0.22), were divided into two groups. Group 1: 15 athletes, training experience 4–5 years. Group 2: 15 schoolgirls without training experience. For each participant, we determined the length and weight of the body, the circumference of the chest, vital lung capacity, and the circumference of the biceps in a tense and at rest. The Erisman index, biceps index, and the ratio of proper and actual vital lung capacity was calculated. Them, we conducted the Stange and Genchi hypoxic tests, and flexibility tests for “Split”, “Crab position”, and “Forward bend”. Prediction was conducted using the Wald test with the calculation of predictive coefficients and their informativeness. A predictive table containing results of functional tests and indices of artistic swimming athletes is developed. It includes nine criteria, which informativeness varied in the range of 395.70–31.98. The content of the prediction consists of evaluating the results, determining the appropriate predictive coefficient, and summing these coefficients before reaching one of the predictive thresholds. The conducted research allowed us to substantiate and develop a method for predicting the success of female athletes with the use of morphofunctional indicators and indices.

Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings

Objective

Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach.

Methods

This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019.

Results

Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators.

Conclusion

Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention.

Juridification of maternal deaths in Ethiopia: a study of the Maternal and Perinatal Death Surveillance and Response (MPDSR) system

Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services.

Implications of Canadian youth views for measuring youth mental health from a socio-economic perspective

Developing meaningful indicators to track youth mental health (MH) is important to support the development and evaluation of responsive mental health promotion (MHP) initiatives that address the socio-economic determinants of youth MH. Development of relevant indicators is challenged, however, by the lack of knowledge regarding the relations among socio-economic factors and youth MH. Thirty diverse young people from a Canadian metropolitan area were engaged within a process of social praxis to explore their experiences of the inter-relationship between their socio-economic environments and their MH and their processes of seeking to realize their MH. Participants emphasized 'needs' as foundational to MH, whereas 'wants', driven by materialistic and wealth-oriented values and social norms, constrained their MH. Their reflections on the inter-relations among their MH and socio-economic processes highlight eight inter-related MH needs within the Canadian socio-economic context. In this paper, we present these needs and show how these needs, young people's affective states, and their access to resources within co-evolving socio-economic processes (to enable their needs) illustrate the fundamental inter-relation between young people's MH and socio-economic processes. We identify implications for measuring youth MH within MHP practice, including the importance of iterative indicator frameworks that include measures of young people's access to resources to enable their MH needs and their degree of distress.

Investigating Indicators of Waiting Time and Length of Stay in Emergency Departments

Purpose

To investigate potential indicators of patients' waiting time and length of stay in emergency departments (ED) at the Ministry of Health (MOH) hospitals in order to determine the causes of delayed patient care and to recommend clinical implications to achieve a better ED system.

Materials and Methods

This exploratory study was conducted in the EDs at four tertiary hospitals of MOH. A random sample of 1360 people was tested from December 2019 to February 2020. Data included patient Canadian Triage Acuity and System (CTAS) level, registration time, triage time, physician examination time, decision time, and disposition time. Descriptive statistics, multivariate analysis, multiple linear regression analysis and Pearson correlation were used according to SPSS (version 24).

Results

The findings showed that 89.6% of total emergency patients were categorized as levels 3, 4 and 5. Around 73.5% of emergency patients stayed less than 4 hours due to registration or triage to disposition, while 26.5% of those patients stayed more than 4 hours.

Conclusion

The majority of patients' total stay in EDs was less than 4 hours. According to ED international standard of length of stay, this is appropriate. The highest effective indicator in total length of stay was the decision to disposition time in EDs.

Assessment of Meat-Type Sheep Welfare Using Animal-Based Measures

Simple Summary

There was every indication that animal welfare will continue to be a major issue affecting livestock farming in the future. The main welfare issues affecting sheep were feeding strategies, health, and diseases. The health problems of sheep are avoidable with good grazing, breeding, and stockmanship. However, sheep must be given adequate supervision to ensure that any welfare issues are quickly noticed and addressed. Assessing animal welfare can be used as management tools by farmers to identify welfare issues and recognize poor welfare.

Abstract

This study aimed to assess the welfare of Tunisian sheep in extensive sheep production systems using animal-based measures of ewe welfare. This study encompasses the first national survey of sheep welfare in which animal-based outcomes were tested. Animal-based welfare measures were derived from previous welfare protocols. Fifty-two Tunisian farms were studied and a number from 20 to 100 animals by flock were examinated. The whole flock was also observed to detect clinical diseases, lameness, and coughing. The human-animal relationship was selected as welfare indicators. It was evaluated through the avoidance distance test. The average avoidance distance was 10.47 ± 1.23 and 8.12 ± 0.97 m for a novel person and farmer, respectively. The global mean of body condition score (BCS) was 2.4 with 47% of ewes having a BCS of two, which may be associated with an increased risk of nutritional stress, disease, and low productivity. Ten farms had more than 7% of lambs with a low body condition score, which may be an indication of a welfare problem. The results obtained in the present study suggest that the used animal-based measures were the most reliable indicators that can be included in welfare protocols for extensive sheep production systems.

A warning about measurement and methodological issues associated with coronavirus tracking and evaluation across jurisdictions

As people around the world experience a devastating pandemic, it is critical that policy-makers consider the methodological and measurement issues that might be associated with coronavirus disease 2019 (COVID-19) public health indicators. This commentary uses four primary variables to illustrate measurement and methodological issues that can complicate comparisons between jurisdictions. Jurisdiction refers to a variety of geographic areas, such as a country, a state, or a province/territory. These variables play a critical role in determining how we understand the trajectory of disease spread. These variables also contribute to our understanding of prevention strategies and their associated efficacy, reflecting the impact of COVID-19 on hospitals. It is critical for public health stakeholders and the public to recognize that these four simple variables can vary substantially across jurisdictions.