How Civil Society Organizations Works Politically to Promote Pro-Poor Policies in Decentralized Indonesian Cities

This paper examines how civil society organizations (CSOs) have taken advantage of the increased opportunities created by decentralization to influence the role and functions of local administrations in urban areas of Indonesia. The paper utilizes evidence from two cities in Central Java where policies were passed that expanded health insurance coverage for the poor: Semarang (pop. 1.5 million) and Pekalongan (pop. 300,000). The paper argues that CSOs are increasingly able to influence local policy outcomes -- regardless of the leadership qualities among elected officials -- by working politically. We describe the political context of each city, which varies greatly. We provide evidence of how pro-poor advocates expanded their capital by identifying allies, building coalitions and taking advantage of critical junctures in order to influence social policy. We demonstrate how developing constituent interest in public policy has helped CSOs hold government accountable to the poor. We present a fiscal analysis of municipal revenue and spending produced by CSO partners, which illustrates both the challenges of increasing allocations, as well as the outcomes in terms of expanded coverage of health services. In conclusion, we offer implications for development programming going forward

Risk Management Analysis Based on Supply Chain Business Process for Public Private Partnership Public Housing

Covid19 Pandemic has made many countries like Indonesia spent their budget heavily on health and economy recoveries, meaning that some allocated budget including for infrastructure has been cut. In contrast, number of backlogs which determine numbers of people that need shelters are still remain high especially for low income groups (LIG). To tackle the problem, government has an initiative to engage private sectors through public private partnership (PPP) in public housing. The process is quite complex and has taken so many stakeholders like government, private sectors, consultants, contractors, vendors, subcontractors and financial institutions like banks and insurance companies. The complexities in PPP business models which involving so many stakeholders can create potential risks. Therefore, besides calculating investment return in the feasibility study stage, it is also important to make a risk management analysis based on supply chain business process. The supply chain business process must start from mapping business process, i.e. planning stage, contract award stage, implementation and the phase of hand over the facilities once the concessional period would end, transfer the ownership back from private sectors to government. This study has an objective to conduct literature study about risk management analysis by using ISO 31000: 2018, the relative new concept in risk management that replaces the same standard but from year of 2009. The model then will be combined with supply chain business process so risk management can be mitigated in each business process. The model of the study use supply chain business process in establishing the context in risk analysis followed by risk identification, risk analysis, risk evaluation with the integrated process of communication and consultation, recording and reporting as well as reviewing and monitoring. Study has found that there are critical risks that must be mitigated namely design risk, land price risk, legal land status risk, political risk, contractual risk, market risk, business risk, material price risk, operational risk, legal risk in hand over and asset impairment risk. The model has proposed several new techniques to mitigate risk namely using value at risk (VaR) by monte carlo simulation to measure market risk, business risk and operational risk, developing digitalization for the process in communication communication, recording reporting as well reviewing monitoring. It is also recommended the using of supply chain financing to vendors and subcontractors as Banks have the accessed data from digitalization that consider government and private sectors’ guarantees

The dynamics of centralized procurement reform in a decentralized state : evidence and lessons from Indonesia

A central policy of the Government of Indonesia's strategy for enhancing its country's economic and social development is to develop infrastructure and expand service delivery. Public procurement reform is a key component of this policy. Despite the decentralization of financial responsibility and authority to relatively autonomous local level governments, procurement reform in Indonesia is a centrally-driven effort. In this paper, we examine the extent to which procurement reform is translating into improvements in sub-national performance. Data on local government procurement expenditures point to an overall decline in the volume of procurement, especially in poorer districts. This paper uses qualitative case studies of procurement reform in six local governments and finds that local government leadership is associated with the uptake of reform. There is little evidence to suggest that procurement reform has been "demand''-led, since neither the private sector nor Civil Society Organizations (CSOs) have been active in advocating for procurement reform

Bilateral Torsion of Intra-abdominal Seminoma Presenting with Acute Abdomen and Intra-peritoneal Bleeding: A Case Report

Seminoma is the most frequently reported tumor in patients with intra-abdominal testicles. In very rare cases, it might present with torsion or rupture. We report a 41-year-old man who presented with acute abdominal pain due to torsion of large bilateral intra-abdominal testicular tumors with rupture of the right-sided mass. Bilateral orchiectomy was performed and histopathological examination revealed bilateral seminoma. Postoperative staging imaging displayed no lymphadenopathy or metastatic lesions. No adjuvant treatment was required and the patient is clinically well and under regular follow-up. This case represents an extremely rare presentation of bilateral testicular cancer with a pleasant outcome

Potential Role of Plant Growth Regulators in Administering Crucial Processes Against Abiotic Stresses

Plant growth regulators are naturally biosynthesized chemicals in plants that influence physiological processes. Their synthetic analogous trigger numerous biochemical and physiological processes involved in the growth and development of plants. Nowadays, due to changing climatic scenario, numerous biotic and abiotic stresses hamper seed germination, seedling growth, and plant development leading to a decline in biological and economic yields. However, plant growth regulators (PGRs) can potentially play a fundamental role in regulating plant responses to various abiotic stresses and hence, contribute to plant adaptation under adverse environments. The major effects of abiotic stresses are growth and yield disturbance, and both these effects are directly overseen by the PGRs. Different types of PGRs such as abscisic acid (ABA), salicylic acid (SA), ethylene (ET), and jasmonates (JAs) are connected to boosting the response of plants to multiple stresses. In contrast, PGRs including cytokinins (CKs), gibberellins (GAs), auxin, and relatively novel PGRs such as strigolactones (SLs), and brassinosteroids (BRs) are involved in plant growth and development under normal and stressful environmental conditions. Besides, polyamines and nitric oxide (NO), although not considered as phytohormones, have been included in the current review due to their involvement in the regulation of several plant processes and stress responses. These PGRs are crucial for regulating stress adaptation through the modulates physiological, biochemical, and molecular processes and activation of the defense system, upregulating of transcript levels, transcription factors, metabolism genes, and stress proteins at cellular levels. The current review presents an acumen of the recent progress made on different PGRs to improve plant tolerance to abiotic stress such as heat, drought, salinity, and flood. Moreover, it highlights the research gaps on underlying mechanisms of PGRs biosynthesis under stressed conditions and their potential roles in imparting tolerance against adverse effects of suboptimal growth conditions.Fil: Sabagh, Ayman EL. Kafrelsheikh University; EgiptoFil: Mbarki, Sonia. National Institute Of Research In Rural Engineering; TúnezFil: Hossain, Akbar. Bangladesh Agricultural Research Institute; BangladeshFil: Iqbal, Muhammad Aamir. University Of Poonch Rawalakot; PakistánFil: Islam, Mohammad Sohidul. Hajee Mohammad Danesh And Technology University; BangladeshFil: Raza, Ali. Fujian Agriculture And Forestry University; ChinaFil: Llanes, Analia Susana. Universidad Nacional de Rio Cuarto. Facultad de Cs.exactas Fisicoquimicas y Naturales. Instituto de Investigaciones Agrobiotecnologicas. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Cordoba. Instituto de Investigaciones Agrobiotecnologicas.; ArgentinaFil: Reginato, Mariana Andrea. Universidad Nacional de Rio Cuarto. Facultad de Cs.exactas Fisicoquimicas y Naturales. Instituto de Investigaciones Agrobiotecnologicas. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Cordoba. Instituto de Investigaciones Agrobiotecnologicas.; ArgentinaFil: Rahman, Md Atikur. Grassland And Forage Division National Institute; Corea del SurFil: Mahboob, Wajid. Nuclear Institute Of Agriculture,; PakistánFil: Singhal, Rajesh Kumar. Indian Council Of Agricultural Research; IndiaFil: Kumari, Arpna. Guru Nanak Dev University; IndiaFil: Rajendran, Arvind. Vellore Institute Of Technology; IndiaFil: Wasaya, Allah. Bahauddin Zakariya University; PakistánFil: Javed, Talha. Fujian Agriculture And Forestry University; JapónFil: Shabbir, Rubab. University Of Poonch Rawalakot; PakistánFil: Rahim, Junaid. University Of Çukurova; PakistánFil: Barutçular, Celaleddin. Institute Of Crop Science And Resource Conservation; AlemaniaFil: Habib Ur Rahman, Muhammad. Sichuan Agricultural University; ChinaFil: Raza, Muhammad Ali. Sichuan Agricultural University; ChinaFil: Ratnasekera, Disna. University Of Ruhuna; Sri LankaFil: Konuskan l, Ömer. Mustafa Kemal University; TurquíaFil: Hossain, Mohammad Anwar. Bangladesh Agricultural Research Institute; BangladeshFil: Meena, Vijay Singh. Indian Council Of Agricultural Research; IndiaFil: Ahmed, Sharif. Bangladesh Agricultural Research Institute; BangladeshFil: Ahmad, Zahoor. Bangladesh Wheat And Maize Research Institute; BangladeshFil: Mubeen, Muhammad. Sichuan Agricultural University; ChinaFil: Singh, Kulvir. Punjab Agricultural University; IndiaFil: Skalicky, Milan. Czech University Of Life Sciences Prague; República ChecaFil: Brestic, Marian. Slovak University Of Agriculture; EslovaquiaFil: Sytar, Oksana. Slovak University Of Agriculture; EsloveniaFil: Karademir, Emine. Siirt University; TurquíaFil: Karademir, Cetin. Siirt University; TurquíaFil: Erman, Murat. Siirt University; TurquíaFil: Farooq, Muhammad. College Of Agricultural And Marine Sciences Sultan; Omá

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries