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BACKGROUND: The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self-care and multimodal approaches to improve pain, functioning, and quality of life. wHOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. DESIGN: wHOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC-GE); both will be compared to Usual VA Primary Care (UPC). The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, and a Whole Health coach, who collaborate with VA patients to create a Personalized Health Plan emphasizing CIH approaches to chronic pain management. The active comparator, PC-GE, is adapted group cognitive behavioral therapy for chronic pain. The first aim is to test whether the WHT approach is superior to PC-GE and whether both are superior to UPC in decreasing pain interference in functioning in 750 veterans with moderate to severe chronic pain (primary outcome). Secondary outcomes include changes in pain severity, quality of life, mental health symptoms, and use of nonpharmacological and pharmacological therapies for pain. Outcomes will be collected from the VA electronic health record and patient-reported data over 12 months of follow-up. Aim 2 consists of an implementation-focused process evaluation and budget impact analysis. SUMMARY: This trial is part of the Pain Management Collaboratory, which seeks to create national-level infrastructure to support evidence-based nonpharmacological pain management approaches for veterans and military service personnel.

Abstract. There are many opportunities for companies to promote gender equality in supply chains—through their own actions, by enabling business partners, and by influencing industry peers and the broader policy landscape. Taking any of these steps will help drive progress for women in supply chains. However, we believe that those companies looking to create real and lasting change for women should adopt holistic approaches that tackle inequality at every level. The methods used were qualitative and quantitative descriptive. A master data source was obtained from a key informant of the Sidoluhur Head, Secretary, 2 Hamlet Heads, and 1 Public Figure. The other master data was conducted by administering questionnaires to respondents and determining respondents using accidental sampling. Secondary data obtained from varieties of literature, previous research results, Laws, Government Regulations, and Village Performance Reports as well as other records (text files) associated with the research subject. Quantitative research results (presentation, distribution) examined by utilizing an interactive model through data aggregation, data compression, data display, and decision making or data verification. The effects indicated that the woman professionalism of the Sidoluhur Village Head was categorized Good, the Village Head already had 1) basic ability to cognize about the regulation and the primary tasks and functions (Tupoksi); 2) management capability in handling human resources, finance, village assets, and public service management; 3) technical capability to manage village administration, make village regulations, development planning and budgeting (APBDes) and be able to help the residential district. Results demonstrated that the women roles can be effective in the supply chain process for the SMEs as the management and effective chain roles.

International audience ; Background: Lymphomas are costly diseases that suffer from a lack of detailed economic information, notably in a real-world setting. Decision-makers are increasing the search for Real-World Evidence (RWE) to assess the impact, in real-life, of healthcare management and to support their public decisions. Thus, we aimed to assess the real-world net costs of the active treatment phases of adult Hodgkin Lymphoma (HL), Follicular Lymphoma (FL) and Diffuse Large B Cell Lymphoma (DLBCL).Methods: We performed a retrospective cohort study using population-based data from a national representative sample of the French population covered by the health insurance system. Cost analysis was performed from the French health insurance perspective and took into account direct and sick leave compensation costs (e2,018). Healthcare costs were studied over the active treatment phase. We used multivariate modeling to adjust cost differences between lymphoma subtypes.Results: Analyses were performed on 224 lymphoma patients and 896 controls. The mean additional monthly costs due to HL, FL and DLBCL patients were respectively e5,188, e3,242 and e7,659 for the active treatment phase. The main additional cost driver was principally inpatient stay (hospitalization costs and costly cancer-related drugs), followed by outpatient medication and productivity loss. When adjusted, DLBCL remains significantly the most costly lymphoma subtype.Conclusion: This study provides an accurate assessment of the main lymphoma subtypes related cost with high magnitude of details in a real-world setting. We underline where potential cost saving could be realized via the use of biosimilar medication, and where lymphoma management could be improved with the early management of adverse events.

Blue carbon ecosystem (BCE) initiatives in the Coral Triangle Region (CTR) are increasing due to their amplified recognition in mitigating global climate change. Although transdisciplinary approaches in the "blue carbon" discourse and collaborative actions are gaining momentum in the international and national arenas, more work is still needed at the local level. The study pursues how BCE initiatives permeate through the local communities in the Philippines and Indonesia, as part of CTR. Using perception surveys, the coastal residents from Busuanga, Philippines, and Karimunjawa, Indonesia were interviewed on their awareness, utilization, perceived threats, and management strategies for BCEs. Potential factors affecting residents' perceptions were explored using multivariate regression and correlation analyses. Also, a comparative analysis was done to determine distinctions and commonalities in perceptions as influenced by site-specific scenarios. Results show that, despite respondents presenting relatively high awareness of BCE services, levels of utilization are low with 42.9–92.9% and 23.4–85.1% respondents in Busuanga and Karimunjawa, respectively, not directly utilizing BCE resources. Regression analysis showed that respondents' occupation significantly influenced their utilization rate and observed opposite correlations in Busuanga (positive) and Karimunjawa (negative). Perceived threats are found to be driven by personal experiences—occurrence of natural disasters in Busuanga whereas discerned anthropogenic activities (i.e., land-use conversion) in Karimunjawa. Meanwhile, recognized management strategies are influenced by the strong presence of relevant agencies like non-government and people's organizations in Busuanga and the local government in Karimunjawa. These results can be translated as useful metrics in contextualizing and/or enhancing BCE management plans specifically in strategizing advocacy campaigns and engagement of local stakeholders across the CTR.

To prevent chemical accidents, the United States (US), the European Union (EU), and the Republic of Korea operate legal systems, such as risk management plans (RMP) and process safety management (PSM), to prevent chemical accidents inside and outside the workplace. The duty to implement chemical accident prevention systems and the criteria for being a target workplace are dependent on the designated quantities of chemicals handled. A chemical accident prevention system is obligatory for storage and handling of legally declared chemicals in the workplace. Benzene, toluene, xylene, methyl ethyl ketone, and ethyl acetate are all flammable materials that are commonly used as solvents in the chemical industry. These substances are grouped into flammable substances groups in the US and the EU, and are managed with the same designated quantities. However, in Korea, the designated quantities are: benzene, 10,000 kg; toluene, xylene, and methyl ethyl ketone, 200,000 kg; and ethyl acetate, 20,000 kg. In order to evaluate the validity of the chemical quantities, fire explosion scenarios during chemical accidents were modeled using two modeling programs, Areal Location of Hazardous Atmosphere (ALOHA) and Korea Off-Site Risk Assessment Supporting Tool (KORA) software, under the same conditions. Similar damage radii were found for the five flammable materials with both pool fires and vapor cloud explosions (VCE). Based on these damage radii, the designated quantities of five substances were calculated and included in the range (10,000 to 13,500 kg). The results show that current designated quantities underestimate chemical substances, and for the prevention of accidents and post-management after chemical accidents, it is necessary to manage flammable substances under one grouping.

BACKGROUND: Throughout China, during the recent epidemic in Hubei province, frontline medical staff have been responsible for tracing contacts of patients infected with coronavirus disease 2019 (COVID-19). This study aimed to investigate the psychological impact and coping strategies of frontline medical staff in Hunan province, adjacent to Hubei province, during the COVID-19 outbreak between January and March 2020. MATERIAL/METHODS: A cross-sectional observational study included doctors, nurses, and other hospital staff throughout Hunan province between January and March 2020. The study questionnaire included five sections and 67 questions (scores, 0–3). The chi-squared χ(2) test was used to compare the responses between professional groups, age-groups, and gender. RESULTS: Study questionnaires were completed by 534 frontline medical staff. The responses showed that they believed they had a social and professional obligation to continue working long hours. Medical staff were anxious regarding their safety and the safety of their families and reported psychological effects from reports of mortality from COVID-19 infection. The availability of strict infection control guidelines, specialized equipment, recognition of their efforts by hospital management and the government, and reduction in reported cases of COVID-19 provided psychological benefit. CONCLUSIONS: The COVID-19 outbreak in Hubei resulted in increased stress for medical staff in adjacent Hunan province. Continued acknowledgment of the medical staff by hospital management and the government, provision of infection control guidelines, specialized equipment and facilities for the management of COVID-19 infection should be recognized as factors that may encourage medical staff to work during future epidemics.

INTRODUCTION: The European Reference Network (ERN) ReCONNET is the ERN aimed at improving the management of rare and complex connective tissue and musculoskeletal diseases (rCTDs) across the European Union (EU). In the mission of ERN ReCONNET, clinical practice guidelines (CPGs) play a crucial role, representing a valid tool towards the harmonisation of the management of rCTDs while improving effectiveness and quality of care delivered to patients. METHODS: ERN ReCONNET developed two surveys to map the adherence to rCTDs CPGs among healthcare providers and to assess the knowledge and awareness of CPGs for their diseases among patients, family members and caregivers. RESULTS: The results of the surveys highlighted that healthcare professionals find it useful to apply CPGs in clinical practice (93%), while 62% of them experience difficulties and barriers in the application in their centres. Healthcare professionals also highlighted the need to develop CPGs for all rCTDs and to implement the use of the existing CPGs in clinical practice. On the other hand, patients, families and caregivers are relatively aware of the purpose of CPGs (51%) and 62% of them were aware of the existence of CPGs for their disease. Patient-friendly versions of CPGs and patients' lifestyle guidelines should be systematically developed contributing to the empowerment of patients in the disease management. CONCLUSION: ERN ReCONNET is addressing the main issues identified in the results of the survey, promoting practical actions for the local adaptation of CPGs across Europe, improving their routine clinical use and increasing the awareness on CPGs among rCTDs patients, family members and caregivers.

BACKGROUND: Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. METHODS: The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. RESULTS: Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. CONCLUSION: Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

Currently, there are no harmonized guidelines which govern skin banking in the Asia Pacific region. Therefore, skin banks are either unregulated or rely on their nation's legislation or international accreditation to uphold their quality standards. A new set of skin banking guidelines was developed through a comprehensive review and collation of best international practices for the Asia Pacific Burn Association (APBA) members, from donor screening and testing, to skin recovery, processing, storage and distribution, and quality assurance. National regulatory requirements reviewed include the European directives, Australia's Therapeutic Goods Administration and Singapore's tissue banking standards. Further technical and quality management recommendations are referenced from the American Association of Tissue Banks (AATB), the United States Food and Drug Administration standards and guidance documents, various relevant European guides, Japanese Society of Tissue Transplantation guidelines and the Asia Pacific Association of Surgical Tissue Banking. Adapted mainly from the AATB standards, the new Asia Pacific Burn Association Guidelines for Skin Banking in Therapeutic Applications offer a comprehensive manual, addressing: governance and contracts; staff responsibilities; quality management; facilities, equipment and supplies management; donor consent and testing; and recommendations of good practices pertaining to skin recovery, processing, storage and distribution. Besides complementing current generic regulations, they provide technical specifications of major aspects unaddressed in most legislations. This inaugural set of new regional skin banking guidelines would be a start for regional members of the APBA to adopt, and will hopefully culminate in a set of standards so that, in the long run, skin allografts from this region can be of similar quality, which can simplify import process and facilitate the exchange of allografts between members.

The government has a function to protect its people, including managing the disaster. The purpose of government in natural disaster management is a function that is expected to be carried out with full commitment. Disaster management is an activity carried out comprehensively, and there is a need for active stakeholder involvement. Pangandaran Regency is a disaster-prone area in West Java Province. This article aims to describe the mitigation launched by the Pangandaran Regency government to reduce disaster risk. The method used is qualitative, which uses observation data collection techniques, literature studies, and interviews with informants consisting of government and community elements. Pangandaran Regency has been stretched to get out of the tsunami disaster that had occurred. Even mitigation efforts have been carried out with the involvement of various stakeholders in the Pangandaran Regency. With mitigation, disaster risk reduction can be made. Therefore the government should make efforts to overcome disaster risk through the Mitigation Program by the Regional Disaster Management Agency (BPBD/Badan Penanggulanan Bencana Daerah). Disaster mitigation in Pangandaran Regency consists of two types: Mitigation with a Structural approach and Non-Structural approach. A structural approach is focusing on physical development, such as the construction of temporary evacuation sites or the construction of an early warning system (EAS). Non-structural mitigation carried out in the form of non-physical development, such as disaster education to school children and also to the community through activities carried out by mothers. Disaster training is given to private parties so that they can understand their role when disaster strikes.

In many countries, policies regarding reduction of unwanted catch and discards are crafted in response to concerns regarding accountability, conservation, and waste as well as scientific needs to fully account for all sources of fishing mortality. It is important to note, however, that unwanted catch is minimal and most, or all, of the catch has value in some fisheries. Utilisation rates are very high, and discarding is generally not of concern in such fisheries which occur primarily, but not entirely, in developing countries. Where unwanted catch and discards are a concern, legislation may be prescriptive, as can be seen in the EU Landing Obligation (LO), and programmes established in e.g. Norway, Iceland, Argentina, Chile and New Zealand. Elsewhere, legislative language is intended to minimize unwanted catch but allows for some flexibility in developing strategies and solutions, as in the USA. The effectiveness of these approaches depends on many factors and all require effective cross-sectoral collaboration. Also essential is a comprehensive monitoring and control system which insures regulatory compliance and collection of adequate data to address scientific and management information needs. In this chapter, we evaluate the effectiveness of discard and unwanted catch reduction approaches under diverse legislative systems in different parts of the world, with reference to emerging practices under the LO. We consider the importance of finding the balance between top-down and bottom-up processes and look carefully at different governance/regulatory frameworks (e.g. input controls, output controls, quota management and transferability, cooperative/collaborative management), factors which encourage or discourage innovation and collaborative problem solving, monitoring and accountability. This is accomplished through case studies from selected fisheries around the world. ; publishedVersion

INTRODUCTION: The European Reference Network (ERN) ReCONNET is the ERN aimed at improving the management of rare and complex connective tissue and musculoskeletal diseases (rCTDs) across the European Union (EU). In the mission of ERN ReCONNET, clinical practice guidelines (CPGs) play a crucial role, representing a valid tool towards the harmonisation of the management of rCTDs while improving effectiveness and quality of care delivered to patients. METHODS: ERN ReCONNET developed two surveys to map the adherence to rCTDs CPGs among healthcare providers and to assess the knowledge and awareness of CPGs for their diseases among patients, family members and caregivers. RESULTS: The results of the surveys highlighted that healthcare professionals find it useful to apply CPGs in clinical practice (93%), while 62% of them experience difficulties and barriers in the application in their centres. Healthcare professionals also highlighted the need to develop CPGs for all rCTDs and to implement the use of the existing CPGs in clinical practice. On the other hand, patients, families and caregivers are relatively aware of the purpose of CPGs (51%) and 62% of them were aware of the existence of CPGs for their disease. Patient-friendly versions of CPGs and patients' lifestyle guidelines should be systematically developed contributing to the empowerment of patients in the disease management. CONCLUSION: ERN ReCONNET is addressing the main issues identified in the results of the survey, promoting practical actions for the local adaptation of CPGs across Europe, improving their routine clinical use and increasing the awareness on CPGs among rCTDs patients, family members and caregivers.

The aim of this research is to find out how the regulation policy (formulation) of the use of the allocation of funds for tobacco excise revenue sharing (DBHCHT) is related to the social environmental development program. The results showed that the regulatory policy (formulation) on poverty alleviation through DBHCHT management in each region was different. This can lead to optimal management of DBHCHT because it is strong enough to involve all stakeholders in poverty alleviation while still relying on how the work of SKPD-SKPD, community and private sector to be actively involved. The role of the DBHCHT management policy formulation in poverty alleviation programs can actually be said to have a qualitatively significant role proven to be able to direct local government through empowering SKPDs to jointly implement poverty alleviation programs. Keywords: Law, Means of poverty alleviation, DBHCHT Abstrak Penelitian bertujuan utnuk mengetahui bagaimanakah kebijakan pengaturan (formulasi) penggunaan alokasi dana bagi hasil cukai hasil tembakau (DBHCHT) terkait dengan program pembinaan lingkungan sosial. Hasil penelitian menunjukkan bahwa kebijakan pengaturan (formulasi) tentang pengentasan kemiskinan melalui pengelolaan DBHCHT pada masing-masing daerah berbeda-beda. Hal ini dapat menyebabkan pengelolaan DBHCHT cukup optimal karena cukup kuat untuk melibatkan seluruh stakeholders dalam pengentasan kemiskinan meskipun tetap mengandalkan bagaimana kiprah SKPD-SKPD, masyarakat dan swasta untuk terlibat secara aktif. Peran formulasi kebijakan pengelolaan DBHCHT dalam program pengentasan kemiskinan sebenarnya dapat dikatakan memiliki peran yang secara kualitatif signifikan terbukti mampu mengarahkan pemeritnah setempat melalui pemberdayaan SKPD-SKPD untuk secara bersama-sama melaksanakan program pengentasan kemiskinan. Kata kunci: Hukum, Sarana pengentasan kemiskinan, DBHCHT.

The 2020 issue of the Bulletin is devoted almost exclusively to Switzerland's corona crisis management during the first wave in the first half of 2020. The first contribution is an interview with the Chief of the Swiss Armed Forces Thomas Süssli. In the subsequent six articles, our authors deal with recommendations for the development of the legal and planning framework for coping with pandemics, pandemic preparedness in Switzerland (Andrin Hauri, Kevin Kohler, Benjamin Scharte, Andreas Wenger), a chronology of crisis management in the corona pandemic's first phase (Kevin Kohler, Andrin Hauri, Benjamin Scharte, Jan Thiel, Andreas Wenger), the pandemic as a learning opportunity (Andreas Wenger, Andrin Hauri, Kevin Kohler, Benjamin Scharte, Jan Thiel), Switzerland in the European crisis management (Julian Kamasa, Jan Thiel), the Swiss Armed Forces on corona deployment (Michael Haas, Annabelle Vuille) and the new CSS project on the future of nuclear arms control (Oliver Thränert). ; Das Bulletin 2020 befasst sich erneut mit aktuellen Themen der schweizerischen Aussen- und Sicherheitspolitik. Diese Ausgabe widmet sich nahezu ausschliesslich dem Corona-Krisenmanagement der Schweiz während der ersten Pandemie-Welle im ersten Halbjahr 2020. Es wird eröffnet von einem Interview mit dem Schweizer Armeechef Thomas Süssli. In den darauffolgenden sechs Beiträgen beschäftigen sich unsere Autoren mit Handlungsempfehlungen zur Weiterentwicklung des gesetzlichen und planerischen Rahmens zur Bewältigung von Pandemien, der Pandemievorbereitung in der Schweiz (Andrin Hauri, Kevin Kohler, Benjamin Scharte, Andreas Wenger), einer Chronologie des Krisenmanagements während der ersten Phase der Corona-Pandemie (Kevin Kohler, Andrin Hauri, Benjamin Scharte, Jan Thiel, Andreas Wenger), der Pandemie als fachliche und politische Lernchance (Andreas Wenger, Andrin Hauri, Kevin Kohler, Benjamin Scharte, Jan Thiel), der Schweiz im europäischen Krisenmanagement (Julian Kamasa, Jan Thiel), der Schweizer Armee im Corona-Einsatz (Michael Haas, Annabelle Vuille) und dem neuen CSS Projekt zur Zukunft der (nuklearen) Rüstungskontrolle (Oliver Thränert). ; ISSN:1024-0608

At the current stage of Ukrainian state integration into European community, country leaders face new challenges that require improving efficiency of public management and public administration based on democracy and human-centeredness. Urgency of public leadership development in Ukraine is closely related to the foreign countries' experience study on the mechanisms of formation and development of public leadership, characterized by a high level of moral values, responsibility, communication, modesty. The new management paradigm, being introduced in public administration and public management in Ukraine, also requires introduction of new qualities in public leadership, manifested through establishment of moral values in the leader's personality, leader's behavior in public service reform. According to the author, such qualities of leadership as delegation of powers in public authorities, intersectoral cooperation in public administration determine development of leadership in the context of educational trends in foreign countries. The article reveals priority models of public leadership of Western European countries as a prerequisite for formation of successful personality, successful leadership qualities, the trend of which is such an important factor as publicity, because before the 90s of the twentieth century not all government officials in European countries were public.The author of the article proposes to consider the features of the development of public leadership in Germany and Poland. Leadership qualities such as the ability to educate themselves, delegation of authority, transparent (transparency, openness and activation) and transformational cooperation. They determine a new style of leadership development in Western European countries, which will be useful for implementation in Ukraine. Therefore, the relevance of the article is beyond doubt. ; На современном этапе интеграции Украинского государства в европейское сообщество перед отечественными лидерами возникают новые задачи, которые требуют ...