Artigos de revistas sobre o tema "Bureau of Health Planning and Resources Development"

This paper relies on the “China Health and Family Planning Statistical Yearbook” published by the National Bureau of Statistics. Analyzing the current development status of ethnic medicine, the driving force of the national medicine industry chain is the national medicine industry, especially the development of grassroots national medical institutions, and the core problem of solving the grassroots development is the construction of national physicians and the accelerated cultivation of national medical talents. Providing sufficient human resources to grassroots medical institutions is an important guarantee for the development of national medicine industry. Finally, on the basis of research, the development model of the national industrial chain of ethnic medicine was established.

AbstractUnderstanding the structure and composition of landscapes can empower agencies to effectively manage public lands for multiple uses while sustaining land health. Many landscape metrics exist, but they are not often used in public land decision-making. Our objectives were to (1) develop and (2) apply a process for identifying a core set of indicators that public land managers can use to understand landscape-level resource patterns on and around public lands. We first developed a process for identifying indicators that are grounded in policy, feasible to quantify using existing data and resources, and useful for managers. We surveyed landscape monitoring efforts by other agencies, gathered science and agency input on monitoring goals, and quantified the prevalence of potential indicators in agency land health standards to identify five landscape indicators: amount, distribution, patch size, structural connectivity, and diversity of vegetation types. We then conducted pilot applications in four bureau of land management (BLM) field offices in Arizona, California, and Colorado to refine procedures for quantifying the indicators and assess the utility of the indicators for managers. Results highlighted the dominance of upland and the limited extent of riparian/wetland vegetation communities, moderate connectivity of priority vegetation patches, and lower diversity of native vegetation types on BLM compared to non-BLM lands. Agency staff can use the indicators to inform the development of quantitative resource management objectives in land use plans, evaluate progress in meeting those objectives, quantify potential impacts of proposed actions, and as a foundation for an all-lands approach to landscape-level management across public lands.

Health is an important aspect of human life. In general terms, better health status of individuals reflects reduced illnesses, low level of morbidity, and less burden of disease in a given population. It is widely recognised that improved health not only lowers mortality, morbidity and level of fertility, but also contributes to increased productivity and regular school attendance of children as a result of fewer work days lost due to illness, which in turn have implications for economic and social well-being of the population at large. Hence investing in health is vital for promoting human resource development and economic growth in a country [World Bank (1993)]. A view of Pakistan’s health profile indicates that the sector has expanded considerably in terms of physical infrastructure and its manpower in both the public and private sector. This has contributed to some improvement in selected health status indicators over the years. However, the public health care delivery system has been inadequate in meeting the needs of the fast growing population and in filtering down its benefits to the gross-root level. As such, Pakistan still has one of the highest rates of infant and child mortality, total fertility and maternal mortality when compared with many other countries in the Asian region [UNDP (2000)]. Due to low priority given to social sector development in the past and low budgetary allocations made to the health sector, the evidence shows that mortality and morbidity indices have not reduced to the desired level and large gaps remain in the quality of care indicators, especially in rural areas [Federal Bureau of Statistics (2000)].

(1) Background: The rational allocation of limited medical resources is the premise of safeguarding the public health. Especially since the outbreak of COVID-19, the evolution dynamics and spatial mismatch of medical resources have been a focal and frontier issue in academic discussions. (2) Methods: Based on the competitive state model and spatial mismatch index, this paper uses GIS and Geodetector spatial analysis methods and three typical indicators of hospitals, doctors, and beds to conduct an empirical study on the evolutionary characteristics and degree of mismatch in the geographic pattern of health resources in China from 2010 to 2020 (the data are from official publications issued by the National Bureau of statistics in China), in two dimensions of resource supply (economic carrying capacity) and demand (potential demand or need of residents). (3) Results: The spatial pattern of health resources at the provincial level in China has been firmly established for a long time, and the children and elderly population, health care government investment, and service industry added value are the key factors influencing the geographical distribution of health resources. The interaction between the different influence factors is dominated by bifactor enhancement, and about 30–40% of the factor pairs are in a nonlinear enhancement relationship. Hospital, doctor, and bed evolution trends and the magnitude and speed of their changes vary widely in spatial differentiation, but all are characterized by a high level of geographic agglomeration, heterogeneity, and gradient. Dynamic matching is the mainstream of development, while the geographical distribution of negative and positive mismatch shows strong spatial agglomeration and weak spatial autocorrelation. The cold and hot spots with evolution trend and space mismatch are highly clustered, shaping a center-periphery or gradient-varying spatial structure. (4) Conclusions: Despite the variability in the results of the analyses by different dimensions and indicators, the mismatch of health resources in China should not be ignored. According to the mismatch types and change trend, and following the geographic differentiation and spatial agglomeration patterns, this paper constructs a policy design framework of “regionalized governance-classified management”, in line with the concept of spatial adaptation and spatial justice, in order to provide a decision making basis for the government to optimize the allocation of health resources and carry out health spatial planning.

The origin of the federal-state partnership in Maternal and Child Health (MCH) can be traced from the Children's Bureau grants of 1912, through the Sheppard-Towner Act, to the creation of Title V and other programs of today that mandate planning, accountability, and systems development. In the past decade with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. This historical framework discusses two primary themes: the decades of evolution in the federal-state partnership, and the emergence in the last three decades of perinatal regional system policy, and suggests that the structure of the federal-state partnership has encouraged state variation. A survey of state MCH programs was undertaken to clarify their operational and perceived role in promoting quality improvement in perinatal care. Data and information from the survey, along with five illustrative state case studies, demonstrate great variation in how individual state agencies function. State efforts in quality improvement, a process to make things better, have four arenas of activity: policy development and implementation, definition and measurement of quality, data collection and analysis, and communication to affect change. Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes.

The COVID-19 pandemic, apart from having an impact on public health, has also caused the stagnation of travel-bureau businesses and the management of small and medium enterprises (SMEs) in the tourism sector. This study aims to analyze the COVID-19 pandemic as a determinant of travel-business stagnation and turbulence in small and medium enterprises (SMEs), the influence of human resources, business development, and product marketing on the productivity of the travel and SME business, the direct and indirect effects of business innovation, economic digitization, and the use of technology on business stability and economic-business sustainability. This study uses an explanatory sequential qualitative–quantitative approach. Data were obtained through observation, in-depth interviews, surveys, and documentation. This study is focused on assessing the efforts made by travel-agency-business actors and SMEs in responding and adapting to changes in the business environment, both internally and externally. Human resources, business development, and product marketing together affect the productivity of travel agents and SMEs with a coefficient of determination of 95.84%. Furthermore, business innovation, economic digitization, and the use of technology simultaneously affect business stability with a coefficient of determination of 63.8%, and business stability affects the sustainability of travel and SMEs with a coefficient of determination of 67.6%. This study recommends a strategy for travel-agency-business sustainability and the stability of SMEs’ economic-business management towards increasing economic growth in the North Toraja Regency, South Sulawesi, Indonesia.

At present, China has lost its demographic dividend. Meanwhile, in the face of the twin challenges of rising living costs and the uneven distribution of educational resources, the fertility intentions of ordinary people are rapidly declining. In the background, China’s latest birth incentive policy has not had the desired effect. Especially with the COVID-19 pandemic, these issues have become more complicated, making it more difficult to achieve policy goals. Analysis of changing characteristics and influencing mechanisms in China’s current stage of population growth is therefore significant. Such analysis can help improve China’s population structure and preserve the advantage of human resource endowment. In this paper, we use data from 2008, 2012, 2016, and 2020 as made available from the resources of China’s National Bureau of Statistics and National Health Commission. These included annual macro statistics, seventh census data, and COVID-19 pandemic data, allowing us to analyze the influencing mechanism of China’s population growth by using the Geographic Detector Model. The research revealed the dependency ratio as the primary factor influencing spatial differentiation of population growth in China, indicating that the dependency burden plays a role in inhibiting population growth. The secondary factor showed different changes in stages. At the same time, any two factors showed more substantial explanatory power after the interaction, meaning the spatial distribution of China’s population growth results from the joint influence of many factors. The strong interaction was mainly concentrated around the dependency ratio and were with women’s political participation and internet coverage. However, under the impact of the COVID-19 pandemic, the explanatory power of traditional factors was diluted, leading to a decline in the strength of interaction.

The Lower Santa Cruz River Basin Study (LSCRB Study) is a collaborative effort of regional and statewide water management stakeholders working with the US Bureau of Reclamation under the auspices of the 2009 SECURE Water Act. The impacts of climate change, land use, and population growth on projected water supply in the LSCRB were evaluated to (1) identify projected water supply and demand imbalances and (2) develop adaptation strategies to proactively respond over the next 40 years. A multi-step hydroclimate modeling and risk assessment process was conducted to assess a range of futures in terms of temperature, precipitation, runoff, soil moisture, and evapotranspiration, with a particular focus on implications for ecosystem health. Key hydroclimate modeling process decisions were informed by ongoing multi-stakeholder engagement. To incorporate the region’s highly variable precipitation pattern, the study used a numerical “weather generator” to develop ensembles of precipitation and temperature time series for input to surface hydrology modeling efforts. Hydroclimate modeling outcomes consistently included increasing temperatures, and generated information related to precipitation responses (season length and timing, precipitation amount) considered useful for evaluating potential ecosystem impacts. A range of risks was identified using the hydroclimate modeling outputs that allowed for development of potential adaptation strategies.

Death registration in Uganda remains extremely low, yet mortality statistics are vital in health policy, planning, resource allocation and decision-making. According to NIRA, only 1% of deaths are registered annually, while Uganda Bureau of Statistics estimates death registration at 24% for the period 2011–2016. The wide variation between the administrative and survey statistics can be attributed to the restriction to only certified death registration by NIRA while survey statistics relate to all forms of death notification and registration at the different sub-national levels. Registration of deaths is of critical importance to individuals and a country’s government. Legally, it grants administrative rights in management of a deceased’s estate, and access to social (insurance and pension) benefits of a deceased person. It is also essential for official statistics and planning purposes. There is an urgent need for continuous and real-time collection of mortality data or statistics in Uganda. These statistics are of significance in public health for identifying the magnitude and distribution of major disease problems, and are essential for the design, implementation, monitoring, and assessment of health programmes and policies. Lack of such continuous and timely data has negative consequences for the achievement of both national and Sustainable Development Goals 3, 11, 16, and 17. This study assessed the determinants of death registration and certification, using a survey of 2018–2019 deaths in 2,100 households across four administrative regions of Uganda and Kampala district. Multivariate–binary logistic regression was used to model factors associated with the likelihood of a death being registered or certified. We find that around one-third of deaths were registered while death certificates were obtained for less than 5% of the total deaths. Death registration and certification varied notably within Uganda. Uptake of death registration and certification was associated with knowledge on death registration, region, access to mass media, age of the deceased, place of death, occupation of the deceased, relationship to household head and request for death certificate. There is need for decentralization of death registration services; massive sensitization of communities and creating demand for death registration.

Land use is an important part of the human-land system, which can provide huge ecosystem services. Land use changes also lead to changes in the value of ecosystem services. Considering primary production, maintaining carbon dioxide and oxygen balance, nutrient cycling, water conservation, soil erosion and other main services functions, this study establishes a land use ecosystem services value (ESV) estimation method based on the terrestrial ecosystem simulator (TESim) implemented for regional scales (TESim-R model) coupled with the Land Use and Land Cover Change (LUCC) model (the TES-LUC model). This ESV estimation model facilitates understanding the true economic costs of land use projects as it considers ecosystem services. This model can be utilized to calculate the ecosystem data of different types of land use by substituting in data of meteorology, vegetation, soil, and control attribute, and then evaluate the ESVs of land use according to different ecosystems. Following Constanza et al. (2007), this study classifies the ESV of an area into five categories: primary production, climate regulation, nutrient cycling, water conservation, and erosion control. Using the net primary productivity (NPP) output value simulated by the TES-LUC model as the basis, the ESVs of five categories can be calculated, respectively. The sum of the five ESVs yields the total ESV. This study introduces the model through the example of China. To test the model, two cost benefit analysis, one on a land use development project of a small community, and the other one on a large national project, are conducted. The effectiveness of the model is evaluated for both projects. This study first investigates the “Grain-for-Green” Project in Long County, Sha’anxi Province, China based on the remote sensing image of the county and the data published by the local bureau of statistics from 2000 to 2015. Using the model, this study calculates and analyzes the change of ESV in Long County during the study period. The results demonstrate that the area of woodland, construction land, and grassland increased in different proportion, among which the area of grassland increased the most at 15.15%. The increase in land area mainly came from the decrease in farmland, the reduced area of which is up to 6,055.40hm2. During the study period, the total ESV increased by 1.670×107 yuan, an increase of 0.52%. This is mainly attributed to the increase in the ESV of woodland and grassland. However, due to the sharp decrease in the area of farmland and water body, the NPP and the nutrient cycling function of Long County were affected, exhibiting decreasing ESVs during the period. Therefore, based on the model and results, this study puts forward policy implications for land use projects from perspectives of water resources. The model is further tested by evaluating the environmental costs of a large national land use project, the “Rapid Urbanization” Project of Yangtze River Delta, which is in the Outline of China’s National Land Planning. Using data of land use gathered from six terms of remote sensing image interpretation data of Resource and Environmental Science Data Center of the Chinese Academy of Sciences from 1990 to 2015, the results derived from the model find that rapid urbanization leaded to unbalanced transition among different types of land, which caused a significant loss of ESV. From 1990 to 2015, the ESV of Yangtze River Delta decreased from 171.701 billion yuan to 168.267 billion yuan. Moreover,among five E5V components, the loss in the ESV of soil erosion was the highest, which decreased by 1.518 billion yuan due to the violent transformation between farmland and construction land. As a concluding remark, this study proposes a series of implications for large land use projects from the perspective of planning, implementation, and management.

Background:With the launch of The Swedish Young Rheumatics Report in April of 2018, we also presented new way of thinking and a tool called the Dreamscale, our complement to the traditional VAS scale used to assess pain. In October of 2018, we organized a workshop together with communication consults where we invited some of our members in different ages and health care professionals working with children, youths and young adults with rheumatic diseases, to try and reach a joint definition of what the Dreamscale is and could be, as we saw its huge potential. This is where the idea of the Dreamcatcher was born.Objectives:The objective is to create an innovative digital tool for young people with rheumatic disease. It takes its starting point in what is healthy and what is possible, rather than focusing on sickness and limitations. Using behavioral science, nudging and social functions, the Dreamcatcher has the potential to lower the barriers to living an active lifestyle, while also serving as a tool for dialogue with health care professionals, resulting in more efficient meetings, better resource planning and the gathering of valuable data to the national quality registers. It is also a digital tool with a big potential for development thanks to its open source code and its focus on enabling activity and participation, there is an obvious potential to develop its functions to also serve other actors and patient groups.Methods:We teamed up with communication bureau Gullers Grupp, pharmaceutical company Pfizer, and two health care clinics in Stockholm, one for children and youths with rheumatic disease and one for adults, and received funding for one year of development from Vinnova, the Swedish innovation authority, in April of 2019. We started the project by conducting a study to try and narrow down what focuses the Dreamcatcher should have. The pilot study contains both workshops with patients, both children, youths and young adults, and with teams of health care professionals, as well as more in-depth interviews with both patients and health care professionals. Based on the study, we will develop a prototype of what the Dreamcatcher could look like, and it will most likely be an application used for smartphones.Results:The study narrows down the Dreamcatcher into three things: the Dreamscale, Dream data, and the Dream collective.The Dreamscaleis as previously explained a complement to the traditional pain-scale and a tool for patients to set goals towards their dreams, and for patients and health care professionals to co-plan care and medical treatment based on what’s most important to the patient.Dream datais where patients can self-track their disease, data which is also available for the health care to view and therefore to be better prepared before meeting with the patient. It is also a goal to have the Dream data transferred to the national quality registers.The Dream collectiveis a social function where patients using the app can connect and get inspired by each other. It is a place to share your dreams and build a community to show that rheumatic disease isn’t something that should ever stop you from going after your dreams!Conclusion:The prototype of the Dreamcatcher will be presented in May of 2020 and we think this it has great potential to help shift focus withing health care, to not just focusing on sickness and limitations but rather on dreams, joy of life and possibilities!References:[1]https://ungareumatiker.se/nytt-digitalt-patientverktyg-unga-reumatiker-tar-fram-dromfangaren/[2]https://www.youtube.com/watch?v=zD6PwSKeb8IDisclosure of Interests:None declared

This study aims to determine and analyze the Implementation of Planning and Budgeting Process Policies at the Information Systems Bureau, Planning and Development of the University of North Sumatra Medan and to find out what factors are the obstacles / obstacles in the Implementation of the Planning and Budgeting Process Policy at the Bureau of Information Systems, Planning and Development, University of North Sumatra Medan. The research method used is a descriptive method with a qualitative approach, with research informants being the Head of Bureau, Head of Section, Head of Subdivision and Staff at the Bureau of Information Systems, Planning and Development, University of North Sumatra, Medan. The theory used is George C Edward III's public policy theory. The results of this study indicate that the Planning and Budgeting Process Policy Implementation at the Information Systems, Planning and Development Bureau has been implemented but has not achieved optimal results. The success of policy implementation needs to be supported by the authority and SOP for Planning and Budgeting at the Information Systems, Planning and Development Bureau at USU Medan. The factors that influence the Implementation of Planning and Budgeting Policies at the Bureau of Information Systems, Planning and Development of the University of North Sumatra are communication, disposition, resources, and bureaucratic structure. Good communication distribution and good coordination between leadership and staff are needed in order to produce a good implementation, therefore it is recommended to issue a Standard Operating Procedure (SOP) for planning and budgeting process policies in order to provide optimal results in the planning and budgeting process.

This study aims to determine and analyze the Implementation of Planning and Budgeting Process Policies at the Information Systems Bureau, Planning and Development of the University of North Sumatra Medan and to find out what factors are the obstacles / obstacles in the Implementation of the Planning and Budgeting Process Policy at the Bureau of Information Systems, Planning and Development, University of North Sumatra Medan. The research method used is a descriptive method with a qualitative approach, with research informants being the Head of Bureau, Head of Section, Head of Subdivision and Staff at the Bureau of Information Systems, Planning and Development, University of North Sumatra, Medan. The theory used is George C Edward III's public policy theory. The results of this study indicate that the Planning and Budgeting Process Policy Implementation at the Information Systems, Planning and Development Bureau has been implemented but has not achieved optimal results. The success of policy implementation needs to be supported by the authority and SOP for Planning and Budgeting at the Information Systems, Planning and Development Bureau at USU Medan. The factors that influence the Implementation of Planning and Budgeting Policies at the Bureau of Information Systems, Planning and Development of the University of North Sumatra are communication, disposition, resources, and bureaucratic structure. Good communication distribution and good coordination between leadership and staff are needed in order to produce a good implementation, therefore it is recommended to issue a Standard Operating Procedure (SOP) for planning and budgeting process policies in order to provide optimal results in the planning and budgeting process.

Finger millet (Eleusine coracana (L.) Gaertn) is a highly nutritious crop, predominantly grown in the semi-arid tropics of the world. Finger millet has a niche market opportunity due to its human health benefits and being rich in calcium, iron and dietary fiber and gluten-free. Ethiopia is the center of the genetic diversity of the crop. However, the productivity of finger millet in the country is low (<2.4 tons ha−1) compared with its potential yield (6 tons ha−1). The yield gap in Ethiopia is due to a range of biotic and abiotic stresses and socio-economic constraints that are yet to be systemically documented and prioritized to guide future production and improved variety development and release. The objective of this study was to document finger millet production opportunities, constraints and farmer-preferred traits in Ethiopia as a guide to variety design in improvement programs. A participatory rural appraisal (PRA) study was undertaken in six selected districts of the Southern Nation Nationalities People Region (SNNPR) and Oromia Region in Ethiopia. Data were collected from 240 and 180 participant farmers through a semi-structured questionnaire and focus group discussion, respectively. Finger millet was the most important crop in the study areas grown mainly for a combination of uses, including for food, feed and cash (reported by 38.8% of respondent farmers), food and feed (14.5%), food and cash (13.7%), food (11.5%) and food, cash, feed and construction material (9.7%). Hand weeding was used by 59.2% of the respondent farmers, followed by hand weeding and chemical herbicides (40.8%). Finger millet was mainly planted as a sole crop (reported by 97.0% respondents), mixed (1.7%) and sole and mixed (1.3%). About 75.6% of respondent farmers only practiced finger millet rotation with other crops. Respondent farmers indicated their source of fresh seed was from the Bureau of Agriculture (49.1%), farmer-to-farmer seed exchange (22.1%), own saved seed (7.5%), local producers (7.5%), research institutions (5.8%), unknown sources (4.1%), local market (3.5%) and cooperatives (0.42%). The total cost of finger millet production per hectare was calculated at 1249 USD with a total income of 2139 USD/ha, making a benefit to cost ratio of 1.71:1.00 and indicating the relatively low yield gains using the currently grown varieties. The main constraints to finger millet production in the study areas were drought stress (reported by 41.3% respondents), lack of improved varieties (12.9%), lack of financial resources (11.3%), small land holdings (10.8%), limited access to seed (10.0%), a shortage of fertilizers (5.4%), poor soil fertility (4.6%), shortage of draught power (1.3%), labour shortages (1.3%) and high labour costs (1.3%). The most important farmer-preferred traits in a finger millet variety were high grain yield, compact head shape, ‘enjera’-making quality, high marketability and early maturity, resolved through principal component analysis. The above-mentioned production constraints and farmer-preferred traits are strategic drivers to enhance finger millet productivity and need to be incorporated into Ethiopia’s finger millet breeding and technology development.

Modern sociology has a special look at the three associated variables of environment, water and energy. The three variables are not in a harmonial state in many parts of the globe. Some have access to two, or not sufficient to one. Only a few countries are in an equilibrium state of the three. For example, many African countries are in short fall of water and energy. What sociologists suggest is to bring about resources enough as far as the three parts are concerned. In the past, the threefold relationship was less considered and measured, but currently with the heavy weight of population over 7.8 billion world over (WPDS, 2020), balance between the three is inevitable. While population all over the world has increased considerably, water resources have not increased in the same way. Moreover, in the past, population dependency on energy was not that much. But, in the industrial age of today, man is highly in need of energy of different types to maintain life. However, waste and wastewater have become problematic in current age and in most parts of the world. The emerging situation is polluting environment, seas and water streams. It is more observable in less developed world than the developed world. Therefore, the water and energy crisis is wide and ongoing. It is discussed elaborately in the present article. However, national security could be accessible only if water-energy policies are there (Bauer et el. 2014). Introduction The threefold relationship of environment, water and energy is very important from a sociological point of view. Although in the past these three variables were less considered, and their relationship with each other has been less measured, at the same time, following the comprehensive development of modern societies, the tripartite relationship of these variables is inevitable today. To have a healthy environment, enough water resources and enough energy, you must always invest in it. While energy is highly dependent on water, the supply and transfer of water, and the disposal and transfer of wastewater also require energy. Therefore, water and energy, while being necessary for each other, also ensure the health and safety of individuals. Existence of lakes, dams and other similar sources generate energy through and with the power of these elements. At the same time, energy itself transports water resources from one region to another. It also happens with the energy power of the waste disposal system or system. Otherwise, the health of individuals and the health of society in general will face irreparable risks. In the past, when such facilities were less available, many health problems arose that eventually led to an increase in mortality. Therefore, in order to have a healthy environment, providing water and energy resources is very vital and inevitable. Likewise, drinking water itself needs energy for purification and purification operations, and re-pumping to consumers. This means that any interaction regarding the sanitation of water, its purification, its displacement, etc., is itself highly dependent on energy. These conditions ultimately lead to greater well-being, health and security. While developed societies have more or less achieved these possibilities over the last century or so, non-industrial societies have recently been able to implement such schemes; That is, a strategy that leads to better health for them. Where there is a shortage of clean drinking water, and water has to be transported over long distances, having energy is extremely important. Countries generally do not have the same amount of water resources for different uses. As a result, in many cases they have to move water from long distances to other places. This kind of movement requires sufficient and sustainable energy, and this makes agricultural exploitation, agricultural prosperity, access to more resources and products, and the like, more practical and achievable. One of the most significant challenges in this regard is within African countries; That is, areas that are generally short of energy, and the aforementioned losses have made it impossible for such communities to make good use of their potential resources (agricultural land); As a result, poverty and scarcity are widespread in such societies. Method of ResearchMethodology used in the present article is of qualitative type. In that, various paradigms have been used to find out about the facts regarding pandemics during the history. Qualitative research usually studies people, events or areas in their natural settings. In finding facts for the research, the researcher engaged in careful data collection and thoughtful analysis of what was relevant. In the documentary research applied for the present research, printed and written materials were widely regarded. The research was performed as a qualitative library-type in which the researcher had to refer to the relevant and related sources. In the current research, various documents were thoroughly investigated, and the needful inferences were made. The data fed by the investigator in the present article is hopefully reliable. Though literature on pandemics is very limited, yet the author tried to investigate many different resources in order to elicit the necessary information to build up the text. Energy and waterMany of the problems of the society will be reduced if all the people of a society have adequate access to energy and water. It means the safety of water for drinking and sanitary consumption (UNDP: 2015). Access to water and energy also greatly contributes to improving the quality of life. At the same time, access to these resources greatly contributes to the health of the environment, its preservation and maintenance. Today, many less developed communities face increasing population, population density, and mass migration to urban areas. They face water and energy constraints. This has caused the environment to be directly and indirectly affected, and in a negative way. Overpopulation in urban areas, on the one hand, and water scarcity, on the other, put many green space resources at risk of extinction. Therefore, urban environmental planners must always adjust and consider the relocation and resettlement of the population in accordance with water and energy resources. This statement can be applied to all human societies, and it means that energy and water are inseparable. For example, energy is inevitably needed to cool biofuels (hydropower) or water-based power plants, and so on, to access water sources or safe water. In other words, to transfer water from one area to another, or to pump water for change or desalination, we need sufficient and appropriate energy. Therefore, countries should always pay enough attention to these two sources in their planning path. However, many traditional water sources such as springs, aqueducts and the like are being destroyed in many communities. Likewise, following the general warming of the earth, water scarcity is felt more than ever in different communities. On the other hand, following the consumption of more and more population, the need for water directly and indirectly is always increasing. Given this scenario, environmental planners must always take new practical measures to meet the growing needs of their citizens. From a sociological point of view, basic human needs cannot be met without energy and water. That is, it provided food for the growing population, and sustained economic growth. Many societies today need more food, even than in previous years. In other words, more per capita should be considered for them in terms of food, services, agricultural resources and the like. This means that as the quality of life improves, so does the expectation of consumption. In such circumstances, the community in question needs more water resources. While many societies are in such a situation. Future consumption needs are less predictable. Rising prices for food and consumables around the world in recent years are evidence of this claim. That is, many societies around the world over the past decades have not paid attention to the current years (decades) of the 21st century. At the same time (today) (1.3 billion) 1.3 billion people in the world do not have access to electricity, and about 800 million people get their water from unhealthy sources. These conditions lead to many diseases, health problems, personal and social threats and other deprivations. Therefore, considering the natural trend of population growth, which is generally 2% per year or more in developing countries, the forecast and increase of water and energy resources is of crucial importance. As noted, nearly one-seventh of the world's population is now forced to use polluted water resources, which threatens the health of current and even future generations. Therefore, environmental sociologists must always measure and predict population growth index and water resources index together. Many African countries today are in such a situation. That is, a situation whose unhealthy conditions can be transferred to other communities. It's about the same billion people suffering from poverty, hunger and deprivation, and over the next thirty years the demand for food and energy will increase at an unprecedented rate. However, a high proportion of the population, or in other words one-seventh of the world's population, faces food deprivation. While by 2050 the world population will increase from the current 7.2 billion (2013) to more than 9.2 billion, during this time the expectations of individuals, their way of life and the different needs of citizens in different societies will also increase. . These conditions will further exacerbate food and energy problems. Therefore, social planners should distribute their urban and rural population in proportion to their water and energy resources. If more population pressure is applied to urban areas, it will put additional pressure on water and energy resources. However, many human societies today still rely on the same water resources to sustain their lives, economic growth and their environment. In a situation where the share of the population is increasing, effective and productive sources of agricultural and food production. That is, water and energy resources must also increase, otherwise many products. Food production, agricultural production and the like are more or less failing. Under such circumstances, more migration will inevitably occur, which in itself has a negative impact on the environment. This trend is more related to less developed countries than industrialized and developed countries. Improving communities and ecosystemsPutting water and energy on the agenda (from a systemic point of view). How it was developed and managed must be pursued at the local, national, regional and global levels. Water and energy as two influential and vital factors today should be regularly included in development plans, sufficient budgets should be allocated to them, and as mentioned, they should be pursued at different levels and in a participatory manner. In this way, water and energy supply can be achieved to some extent. Likewise, specialized departments, in partnership with other institutions, must make the necessary predictions in proportion to time and place. Therefore, water, energy and food supply will play a central role in the importance and environmental health of communities. Due to increasing population, urban population density, population growth, and changing lifestyles, the need for water, energy and food is felt more than ever in the past. Today, however, a significant portion of the world's population cannot easily meet these needs. Therefore, countries, both independently and in partnership with other communities, must meet the growing needs for water, energy and food as much as possible. In this way, the quality of life in these communities also improves. Many Third World countries, and African countries in general, face severe restrictions in the water, energy and food sectors. The issue of energy and water in general is important in two ways. That is, in terms of the opportunities and challenges of society, and the elimination of many of the growing needs in different societies. Water and energy, while creating opportunities, on the other hand, and in conditions of scarcity or scarcity, water inevitably brings challenges and limitations. Opportunities mean that in the conditions of having sufficient water and energy, economic-agricultural development takes place in its desired form. That is, a movement that itself provides more added value. With the opportunity in question, this situation will lead to more investment, more income, and ultimately more per capita GDP. That is, what leads to an improvement in the quality of life. Few countries have achieved this today. However, many developing societies today and in the years to come will face a water and energy crisis. The problem itself requires more studies, more investment and more international cooperation. Population, economy and energy and water demandThe production and use of energy and water in its national form is a significant necessity in order to meet the basic needs and develop opportunities for the people. Energy supply means access to clean, reliable and revenue-generating energy services for cooking, heating, lighting, communications and productive uses (United Nations: 2010). The supply of water resources and the production of energy required due to the growing needs, today is the first level of importance in different countries. The provision of these resources in its national and global form must be considered, otherwise uncontrolled migration from places without water and energy to other places will inevitably take place. That is, the flow that ultimately leads to environmental problems in various forms. This process leads to housing constraints, transportation problems, and many socio-economic disadvantages. Therefore, social planners, environmental sociologists, and economists must always have adequate oversight and effective forecasting in the water and energy sectors. Water and energy themselves provide food security. It means providing and accessing adequate, healthy and nutritious food that meets the daily nutritional needs and nutritional preferences for a healthy and active life (FAO: 1996). In any case, both energy and water cross national borders in some cases, thereby facilitating international cooperation. Today, following the need of countries for these two factors, new relations have emerged between countries. Whereas in the distant past, water currents flowed easily from one country to another, today for this movement. Contracts and treaties are concluded. Similarly, while countries today need more energy (for example, electricity), cooperation and areas of trade and transmission of electricity between countries are taking place. In this way, the fields of economic cooperation between countries have increased. That is, it provides conditions that improve agriculture, improve the environment, and provide more food, and so on. Cooperation between neighbors in this way provides benefits sharing, profitability, access to more food and water-related products. As the population of countries has increased in recent decades, and on the other hand, the need for food has increased, this has made the connection between countries more and more in terms of water and energy transmission. Is. Improved global water, energy and food supply conditions can be achieved through a cohesive policy. It means adopting a method in terms of management and administration, integrated in all sections and scales (WWF Retrieved). At the international level, ongoing crises such as energy, food, financial issues, and the like indicate systemic interdependence. If the needs related to the mentioned indicators such as energy, water and food are not met in an adequate level, the society will face various crises. Under such circumstances, the standard of living declines. That is, comfort, access to the required material goods, income, employment, domestic products, and inflation are all affected by the declining trend in living standards (Retrieved: 2011). For example, in the absence of energy and water, many villagers migrate to urban areas. That is, a movement that itself leads to crises such as environmental pollution, transportation, population density, destruction of the urban environment and the like. Such crises also lead to greater challenges to personal and social health. Therefore, the water and energy crisis poses many and ongoing challenges. Sociologists in general and environmental sociologists in particular evaluate and predict these conditions. Developing countries face serious challenges in achieving their Millennium Development Goals by 2015, and their close and intimate relationships with water, energy and food need to be re-examined to achieve the Millennium Development Goals. Developing countries must always anticipate their coming years by turning to water and energy resources. That is, such facilities that lead to the provision of food. However, such countries face unforeseen challenges and problems due to their increasing population on the one hand, and their extensive migration to urban areas on the other hand. Sociologists have always advised that greater individual and social health be achieved through access to adequate sources of water and energy, otherwise there will be many challenges in the lives of different strata. Likewise, the emergence of new injuries endangers individual and social health in various forms. Energy and water balanceEnergy and water are two important factors in urban development. Any industrial development and access to more industrial products, and more processing itself requires more energy and water resources. In the absence of these two sources, urban communities are largely exposed to economic stagnation, unemployment, and consequently economic inflation. This also leads to a decline in quality of life. Therefore, in proportion to the capacities related to their water and energy resources, they should welcome urban development. Today, many developing communities are facing this problem (restrictions on water and energy resources) in urban areas due to the general increase in their population, and migration from rural to urban areas. Fast-growing cities are heavily dependent on energy and water supply. But at the same time, they must reduce water demand, manage relevant trade, and make good use of their water resources. That is, through the reuse of water, the recycling of water and the production of energy from waste and the like. In a coherent and coordinated manner for industrial development, the use and reuse of energy and water is essential, in order to increase scarce resources and save costs. That is, during the production and management of waste, the motivation for social-environmental responsibility should be strengthened as much as possible through sustainable production. The relationship between energy and water is not only quantitative, but also water quality, water pollution, water pollution and the like must be considered. Different countries and societies, given their growing needs on the one hand, and the scarcity of water resources on the other hand, must always make multiple uses of the available water resources. It means recycling a lot of used water and reusing it in other fields and the like. Otherwise, the limitation and shortage of water resources will lead to food shortages. Therefore, continuous monitoring of its water resources to a large extent ensures the health and quality of life in urban and rural areas as much as possible. The connection between water and energy is inseparable, especially in urban areas. That is, city life depends on these two elements (Sustainca: 2015). Disseminate information on water and energyAccess to information and dissemination of data in the field of energy and water resources, or in other words, management of water resources, etc., is itself a major challenge in most societies today. Many countries, especially in less developed societies, do not have enough information about their water resources, water needs, future water resources, and water management in general. Therefore, based on estimates, such communities will sooner or later face challenges and problems due to water shortages. Therefore, from the sociological point of view of the environment, these communities should prioritize studies and information gathering in this regard as part of their plans, given the increase in their population and water consumption. Green infrastructure facilities, and nature conservation, provide significant services in protecting communities from floods and overheating, dust control, etc. It means strengthening green infrastructure (Benedict: 1947). The complexity of energy and water development decisions often requires some kind of modeling (or hybrid model), based on which an integrated support system is developed and maintained. To meet their water needs, countries must use newer and more advanced methods and models. Likewise, the link between less developed and more developed countries, in order to benefit from their experiences, can itself help in making decisions about energy and water development in less developed societies. Otherwise, the scope of the crisis will expand further in the coming years. Such developments include water and energy economics, their ecological impacts, social criteria, and economic tools that can be measured through choices. In other words, calculating and measuring their water and energy resources as effective methods help these countries in providing water resources. In general, today water and energy resources in its scientific form should be evaluated, measured and predicted. The bridge between science, politics and peopleDialogue or science, politics and people in the field of energy and water based on knowledge and education (literacy), indicates that energy and water need improvement and development. That is, effective efforts must be made in this regard. Innovations in technology, management and the like. In this way, a bridge between science, politics and people can be created. By creating such a tripartite relationship, energy and water resources can be fundamentally managed. At the same time, science and technology must be aligned with, and aligned with, energy and water policy.Otherwise, the challenges and shortcomings of energy and water constraints will become more and more widespread. In a situation where the global population has increased to more than 7.2 billion people today, and at the same time social, economic, service and similar needs have increased more than ever in the past, the use of science and technology to Providing as much energy and water as possible is inevitable. This connection can also be explained by the fact that human beings are inseparable from nature. As any damage to nature by man, man himself is subsequently harmed (Rights of Mother Earth: 2011). As far as developing countries are concerned, such efforts should be made to expand capacities at all levels. By creating such connections or putting them on the agenda, the necessary coordination between the environment, water and energy is achieved. Therefore, capacity building at different levels, including urban and rural areas, industrial and agricultural capacity, human capacity, both men and women, each play a role in providing resources related to water, energy and a healthy environment. ConclusionSociologically speaking, basic human needs cannot be met without energy and water. Currently, over 1.3 billion people in the world do not have access to electricity, and over 800 million people get their water from unhealthy sources. Such conditions lead to many diseases, health problems, personal and social threats, and other deprivations. As noted earlier, one-seventh of world's population is currently forced to use polluted water resources which threatens the health of generations. Therefore, environmental sociologists must always measure and predict the population growth index and water resources index together. However, many human societies still rely on the same water resources to sustain their lives, their economic growth and their environment. Water and energy as two influential and vital factors should be regularly included in development plans, and sufficient budgets need to be allocated to them. Eventually, it must be noted that water, energy and food supply play a central role in the environmental health of communities. References: Bauer, D.; et al. "The Water-Energy Nexus: Challenges and Opportunities". US Department of Energy. 2014. Benedict, M.A.; et al. Green Infrastructure: Linking Landscapes and Communities. 1947. California Sustainability Alliance, Cynthia, Truelove, Senior Water Policy Analyst, California Public Utilities Commission. FAO. Rome Declaration on World Food Security and World Food Summit Plan of Action, World Food Summit 13-17, November 1996, Rome. Nexus Resource. Right of Mother Earth, Bolivia UN, Bolovian.net, Retrieved 2011. Standard of Living Definition, Investopedia.com, Retrieved 2011. UNDP: Millennium Development Goals, Goal 7: Ensure Environmental Sustainability. 2015. UN Secretary General's Advisory Group on Energy and Climate Change (AGECC), Summary Report and Recommendations, 28 April 2010, P.13. World Population Data Sheet, Population Reference Bureau, Washington DC. 2020.

Availability of health resources and unmet needs: a provincial level analysisPurposeThis study aimed to analyze the association between the availability of health and percentage of unmet needs in every province in Indonesia.MethodsThis study used secondary data of the Indonesian demographic and health survey 2012, health facilities research report 2011, Board of Population and Family Planning contraceptive services report 2012 and reports from Indonesian Central Bureau of Statistics 2012. The sample was all provinces in Indonesia. Linear regression tests were used to examine the correlation between the availability of health resources and unmet needs.ResultsStatistically, there was no association between the ratio of health resources by 10,000 population with unmet needs for family planning. But, there was an association between the ratio of health resources based on the area with unmet needs for family planning. The higher ratio of health resources by 1000 km2, the lower unmet need percentage for family planning.ConclusionsAvailability (quantity and distribution) of health resources based on the area plays an important role in family planning programs especially unmet needs for family planning. Planning of health resources provision should not be only based on the ratio by 10,000 population, but also consider the area of services.

Recruitment and career development of educational staff at private universities sometimes face challenges. The public's impression of the quality of human resources in private universities is influenced by these phenomena. The purpose of this research is to show the model of recruiting and career development of educational staff at private universities, namely De La Salle Catholic University of Manado (UKDLSM), as well as to make recommendations for improving educational staff quality. The research method employed is qualitative, with data collected through observation, interviews, and documentation. Interviews were held with the Head of the Human Resources Development Bureau (PSDM), educational staff at the PSDM bureau, educational staff in three work units, and three job applicant candidates for education staff. The study's results show that (1) UKDLSM already has a recruitment model for education staff, which is contained in the UKDLSM Organizational and Administrative Documents; (2) UKDLSM already has a career development model for educational staff, such as educational staff orientation, skills and capacity building training, and further studies to take the specific positions; (3) Recommendations: the requirement of manpower planning, the implementation of an open recruiting model with internal and external candidates, and implementing frequent and transparent quality audits of education staff

Background. Critical care medicine is a branch of medical science that deals with the characteristics and regularity of life-threatening processes initiated by any injury or disease and, accordingly, relevant treatment for patients with critical illness. Conceptions of critical care medicine in China stemmed in the early 1970s. Ever since the establishment of the first intensive care unit (ICU) along with the increasingly incomparable role of ICU in medical practices, critical care medicine has become an indispensable part of the Chinese medical and health system. Currently, critical care medicine as a secondary clinical discipline and a well-constructed science is in sustainable development on the way towards systematization and standardization. Methods. The gross domestic product (GDP) and population data were obtained from the National Bureau of Statistics. The number of ICUs, ICU beds, and hospital beds and other data regarding ICU staffing and facility resources were obtained from the Yearbook of Health in the People’s Republic of China and National Bureau of Statistics. The mortality rates of SARS and COVID-19 and the number of health workers aiding Hubei amid COVID-19 pandemic were obtained from the National Health Commission. Findings. Critical care medicine in mainland China has made significant strides: both quantity and quality are progressing at a fast pace after SARS in 2003. Although there exist some disparities in healthcare personnel and medical resources, they have not hindered the country from mobilizing its healthcare workers and resources against a public health emergency.

Introduction: According to the U.S. Census Bureau, 17% of the U.S. population is Latino, with an expected increase to 31% by 2060. It is imperative that we prepare students who will be future health care providers with the resources needed to care for the Latino population, specifically increasing the number of Spanish-speaking health care providers who have some understanding of the Latino culture. There is a lack of health care providers who are educated about the Latino culture and lack mentorship in the development of medical conversational Spanish. Method: The Nicaragua Clinical Experience is a service learning abroad program embedded in an academic setting through the scholarship of cultural immersion, language development, health care, and leadership development of students. Conclusion: The Nicaragua Clinical Experience is a unique academic program that prepares pre–health care majors to provide culturally congruent health care for the Latino population. Clinical Implications: Students are prepared to care for Latino patients through the cultural immersion program and are also introduced to working in “team-based care” multidisciplinary groups to improve health care outcomes.

Regulation Government Number 12 of 2019 Concerning Management Regional Finance also mentions management finance area is whole activities that include planning and budgeting, implementation and administration, reporting and accountability, as well supervision finance area. The purpose of this research is to analyze and describe management administration finance at the General Bureau Regional Secretariat of North Sulawesi Province. The type of research used in this study is descriptive qualitative and the collection technique is by observation, interviews and documentation. Informants in this study are a) Head of the General Bureau Regional Secretariat of North Sulawesi Province, b) Head of Sub-Division of Accounting and Administration of Regional Assets of the General Bureau Regional Secretariat North Sulawesi Province, c) Head Field Planning, Control and Evaluation of Regional Development Bapeda of North Sulawesi Province, and d) Treasurer expenditure General Bureau Regional Secretariat North Sulawesi Province. In general, the results of this research are 1) The management of financial administration at the General Bureau of the Regional Secretariat of North Sulawesi Province has not been effective in accordance with Government Regulation Number 12 of 2019 Concerning Regional Financial Management, this is based on research results that it is known that out of 4 (four) aspects of management financial administration is only the reporting and accountability aspects that have been running effectively while the other 3 (three) aspects are a) Planning and budgeting, b) Implementation and administration , and c) Supervision has not been running effectively , 2) Inhibiting factors management of financial administration at the General Bureau of the Regional Secretariat of North Sulawesi Province are: a) Lack of knowledge of the Head of Finance and Verification Subdivision and lack of accuracy and thoroughness of TAPD b) Limited HR of the Regional Government Budget Team, namely from the North Sulawesi Province Regional Finance and Assets Agency and the North Sulawesi Provincial Bappeda, as well as limited human resources working at the North Sulawesi Provincial Inspectorate (PPUD and Auditor) c) Inadequate financial administration management facilities where the internet connection network system is weak in SIMDA North Sulawesi Province, d) The last inhibiting factor is the low performance of human resources, namely slowness in collecting worksheets , inaccuracy of spending treasurers and PPK, low time discipline of financial managers in issuance, SPD and SP2D finalization

The research examines the field of Health Management Information Systems (HMIS) which are created and used in existing healthcare systems. It highlights the significance of HMIS as well as its advantages and drawbacks. Critical phases in the development of an HMIS are described in the methodology section. The existing findings support data-driven decision-making, improved patient care, cost savings, and higher data security. Among the difficulties include interoperability, data security, and workforce issues. In conclusion, HMIS is necessary for healthcare, requiring careful planning and investment to improve patient care, make the most of available resources, and ensure data security in a constantly evolving healthcare environment.

Abstract Background The management of HIV infection requires extensive, longitudinal information record-keeping and coordination to ensure optimal monitoring and outcomes of care and treatment. Objective Agencies funded by The Ryan White HIV/AIDS Treatment Modernization Act are increasingly required to monitor the quality of their HIV care and generate reports for funding agencies. To assist in their data collection and reporting capacity, the HIV/AIDS Bureau in the Health Resources and Services Administration released its first version of a software application called CAREWare in 2000. Methods This report describes the development of the application, the agencies that use it, how it is used, and overall satisfaction. The role of CAREWare in the larger health information technology landscape affecting HIV primary care providers is also discussed. Results and Conclusion CAREWare has evolved significantly in functionality and use, including the capacity to run in a real-time network connecting multiple service providers, generate performance measures, and import data in multiple formats. The application is the source of over half of the Bureau s data, is used regularly by most providers and is installed in nearly every state. Ongoing enhancements will be essential to ensure that CAREWare stays current in a rapidly-changing environment of health information technology and data exchange.

The growth of Pakistan’s agriculture-based economy depends on elevating agriculture production and raising the per-capita income of rural communities. This paper evaluates the value of two simultaneous initiatives for the economic development of Pakistan, i.e., (i) reforming and modernization of the cadastre system, and (ii) the implementation of national spatial data infrastructure (NSDI). Both can provide crucial frameworks to assemble geographic information necessary for effective agriculture policies in the country. Their execution at the national level requires substantial technical, human, and finical resources. These mega initiatives may become highly challenging, due to the already shrinking economy of the country from COVID-19. The study makes use of an evaluation framework, official documents, such as project proposals, minutes of meetings, in addition to data collected through questionnaire and from ministries, such as the ministry of planning, development, and reforms (commonly known as planning commission), as well as Pakistan bureau of statistics. Our findings indicate that both the projects share some commonalities in terms of benefits, problems, and resources. However, the economic benefits of the NSDI project are high compared to the cadastre for the country, especially for effective agricultural policy-making. The results output will help practitioners from both systems to reduce the overlapping value, cost, and scope of the work involved.

Abstract Abstract 254 Clinical experience and research with sickle cell patients and those with other genetic diseases suggests that the period of “transition,” in which patients move from pediatric care to adult-centered clinical care, is a period of high health services utilization. Young adult patients may not have learned to effectively manage disease symptoms and may not be connected to a “medical home” or have established a relationship with a primary care physician or adult hematologist. Further, these patients may not have insurance coverage previously provided by parents or by public pediatric insurance programs. As part of a collaborative agreement through the Centers for Disease Control and Prevention (CDC) and the National Heart, Lung & Blood Institute (NHLBI), California and five other states are conducting epidemiologic surveillance to determine the prevalence of hemoglobinopathies as well as health services utilization. Such data are essential to inform allocation of resources to meet the medical and social service needs of patients. Within the state, this project is a collaborative effort among the CA Dept. of Public Health Genetic Disease Screening Program, Children's Hospital Los Angeles and Children's Hospital & Research Center Oakland. Using administrative data obtained as a part of this effort, we describe emergency room (ER) utilization patterns among young adults with sickle cell disease. The CA Office of Statewide Health Planning and Development has collected data on ER utilization for the years 2005 – 2008. Using ICD 9 codes beginning with 282.6 to identify sickle cell-related ER visits during those years, we report usage patterns by patient age, gender, and payer type. To calculate risk of repeat ER visits, we used a negative binomial regression model (with 1 visit as the baseline for analysis, rather than 0 visits, due to the limitations of the data set). The following means and counts are adjusted to account for this shift. Analyses were conducted using SAS 9.1. The mean number of ER visits among sickle cell patients in the data set was 3.36 per year and 54% of visits were made by women, but gender differences in average visits per year per patient (3.18 female, 3.60 male) were not statistically significant. Medi-Cal (Medicaid) was the primary payer for 47% of visits during this time frame, and patients with Medi-Cal averaged nearly one additional visit per year (3.82 visits) compared to patients with other forms of payment (3.04 visits). Among patients seen at any time during the four years and controlling for gender and payer type, we found a 78% increase (IRR 1.78, 95% CI 1.59, 2.00) in risk of visiting the ER a second or subsequent time in a given year among the 20 to 30 year old group compared to all other age groups, a four fold increase (IRR 4.22, 95% CI 3.61, 4.93) in risk of a second or subsequent visit in a year compared to the group aged 10 to 20 years, and a 30% increase (IRR 1.34, 95% CI 1.16, 1.55) compared to the group 30 to 40 years of age. Average number of visits in the transition age group was 4.53 per year, compared to 1.93 per year in the 10 to 20y group and 3.56 in the 30 to 40y age group. The number of individuals visiting the ER per year was higher in this age group compared to the two adjoining age groups (520 individuals on average per year for 20 – 30y, vs. 311 per year for 10 – 20y and 355 for 30 to 40y). The increase in visits per year of age can be seen (Figure 1) to begin at age 18 or 19 and continue to approximately age 30. The proportion of patients with no insurance coverage increased from 8% in the 10 to 20y age category to 19% of patients in the 20 to 30y age category, and remains high for the subsequent age categories (11 to 17%). The transition period from pediatric care to adult care in California sickle cell patients is marked by a dramatic increase in emergency room visits (both more patients visiting and more visits per patient) compared to other age groups. ERs are also visited significantly more often by uninsured sickle cell patients in this age group than other age groups. Patients in this age group would likely benefit from access to a medical home model of care.Figure 1.Mean Annual Number of Visits by Age of Patient among Those Seen in ER with SCD-related ICD 9 Codes, California, 2005–2008Figure 1. Mean Annual Number of Visits by Age of Patient among Those Seen in ER with SCD-related ICD 9 Codes, California, 2005–2008 Disclosures: Coates: Novartis: Research Funding, Speakers Bureau.

This study aims to examine the effect of human resource competence, government internal control system and the use of information technology on the quality of financial statements of Central Bureau of Statistics in the Maluku Region.The population in this study are employees who handle accounting / financial reports on all accounting entities within the Central Bureau of Statistics in the Maluku Region.The research sample is the financial statements stylist includes PPK , PPSPM, financial staff, equipment, program development (planning) or administration as well as employees in the technical field who make financial reports. The data analyzed are primary data obtained through questionnaires. Total questionnaires distributed amounted to 57 and processed as many as 50 questionnaires (87.72%). The analytical method used is the multiple regression analysis method.Hypothesis testing results indicate that the competence of human resources and government internal control systems has a positive and significant effect on the quality of financial statements while the use of information technology has no effect on the quality of financial statements.

The quality of human resources has an important contribution to the success of development in the context of increasing people's welfare. This research aims to identify the factors that make a major contribution to the increase in the HDI and examine the effect of poverty and unemployment on the achievement of quality human resource development. By using secondary data sources sourced from the Central Bureau of Statistics and the Directorate General of Fiscal Balance as well as the EViews analysis tool, the research results show that life expectancy, expected length of schooling, average length of schooling, spending per capita have a significant effect on the development of the quality of human resources on the island of Java. Meanwhile, poverty and unemployment have a negative impact on the development of the quality of human resources on the island of Java. The results of this research might be become a foundation for policy makers to explore education spending and health spending instruments to improve the quality of human resources. The results of the research also show that quality human resources are able to improve people's welfare through economic development, reducing poverty and unemployment. Keywords: Human development; economic development; education; health; poverty; unemployment

Recognizing the health impact of timing and spacing of pregnancies, the Sustainable Development Goals call for increased access to family planning globally. While faith-based organizations in Africa provide a significant proportion of health services, family planning service delivery has been limited. This evaluation sought to assess the effectiveness of implementing a systems approach in strengthening the capacity of Christian Health Associations to provide family planning and increase uptake in their communities. From January 2014 to September 2015, the capacity of three Christian Health Associations in East Africa—Caritas Rwanda, Uganda Catholic Medical Bureau, and Uganda Protestant Medical Bureau—was strengthened in key components of a systems approach to family planning—training, supervision, commodity availability, family planning promotion, data collection, and creating a supportive environment—with the aim of improving access to women with unmet need and harmonizing faith-based service delivery contributions with the national family planning program. Community-based provision of family planning, including fertility awareness methods, was introduced across intervention sites for the first time. 547 facility- and community-based providers were trained in family planning, and 393,964 people were reached with family planning information. 32,176 clients took up a method, and 43% of clients received this service at the community level. According to a provider competency checklist, facility- and community-based providers were able to adequately counsel clients on new fertility awareness methods. Integration of Christian Health Associations into the national family planning strategy improved through participation in routine technical working group meetings, and the Ministries of Health in Rwanda and Uganda recognized them as credible family planning partners. Findings suggest that by strengthening capacity using a systems approach, Christian Health Associations can meaningfully contribute to national and international family planning goals. Increased attention to mainstreaming family planning service delivery across Christian Health Associations is recommended.

Open spaces, including waterfront areas, are critical to coastal communities and provide many benefits, including recreation opportunities, economic development, ecological benefits, and other ecosystem services. However, it is not clear how values of waterfront ecosystem services vary across geographical areas which prevents development and adoption of site-specific natural resource conservation plans and suitable long-term land management strategies. This study estimated the monetary value of distance to different waterfront types in coastal counties of Mississippi and Alabama (U.S.) using a geographically weighted regression (GWR) approach as an extension to a traditional hedonic pricing method (HPM). In addition, the study utilized publicly available data from the U.S. Census Bureau instead of certified rolls of county property assessors and Multiple Listing Service (MLS) data which can be costly and difficult to obtain. Residents valued most waterfront types which was reflected in greater assessed prices for houses in proximity to these waterfronts. However, the value of ecosystem services associated with waterfronts differed geospatially. The marginal implicit prices ranged from −$6343 to $6773 per km depending on a waterfront type. These estimates will be useful to city developers, land-use planners, and other stakeholders to make more informed and balanced decisions related to natural resource preservation associated with coastal areas, land-use planning, and zoning. In addition, information from this study can be used in developing healthy living environments where local economy can benefit from increased property tax revenues associated with waterfronts and their ecosystem services.

In modern conditions, the most important tools of state regulation in carrying out evaluations of the effectiveness of the reforms carried out are forecasting and planning of long-term results taking into account the level of influence of socio-economic and other factors. This is due to the market economy’s inability to regulate itself, especially in crisis situations. Forecasting is closely linked to planning and is the necessary methodological and information basis for the development of plans and programs. Health system reform should be based on addressing systemic health challenges, taking into account socio–economic, demographic and technological trends, and assessment of the effectiveness of reform should capture changes in dynamics. Integrated program and targeted planning provides for the development of medical and social programs, taking into account certain priorities of public health, which makes it possible to concentrate resources on priority areas of health development on the basis of an integrated inter-agency approach to achieving the goals set. With the transition to a market economy, there are signs of indicative planning in health care as a way of consciously, purposefully managing health and economic processes, both in the public, municipal and private health sectors. Indicative planning has proved to be highly effective as a means of public regulation of a market economy. A characteristic feature of indicative planning is the rejection of directionality, command and distribution functions in favor of indicative. Targeted Health Development Programs should use as achievements indicators of resource provision and efficiency of its use, indicators of availability and quality of health care, its safety, timeliness and efficiency, continuity in its provision, satisfaction of consumers, quality of document circulation, etc., which may be influenced by the health management system.

ABSTRACTBackground: To assess the state of health center integration into community preparedness, we undertook a national study of linkages between health centers and the emergency preparedness and response planning initiatives in their communities. The key objectives of this project were to gain a better understanding of existing linkages in a nationally representative sample of health centers, and identify health center demographic and experience factors that were associated with strong linkages.Methods: The objectives of the study were to gain a baseline understanding of existing health center linkages to community emergency preparedness and response systems and to identify factors that were associated with strong linkages. A 60-item questionnaire was mailed to the population of health centers supported by the Health Resources and Services Administration’s Bureau of Primary Health Care in February 2005. Results were aggregated and a chi square analysis identified factors associated with stronger linkages.Results: Overall performance on study-defined indicators of strong linkages was low: 34% had completed a hazard vulnerability analysis in collaboration with the community emergency management agency, 30% had their role documented in the community plan, and 24% participated in community-wide exercises. Stronger linkages were associated with experience responding to a disaster and a perception of high risk for experiencing a disaster.Conclusions: The potential for health centers to participate in an integrated response is not fully realized, and their absence from community-based planning leaves an already vulnerable population at greater risk. Community planners should be encouraged to include health centers in planning and response and centers should receive more targeted resources for community integration. (Disaster Med Public Health Preparedness. 2007;1:96–105)

Objective: This study aims to explore and establish a set of information system for health law enforcement and management using information engineering technology, and apply the system into both administration and law enforcement managements in health inspection agencies in Qingdao. Methods: Using information engineering technology to establish a set of information platforms for health law enforcement and administration management, then combine the data resources from all the national, provincial and municipal information platforms and develop a set of data analysis and Early warning mechanisms. Results: The municipal information platform was established and put into use successfully in Qingdao health inspection bureau. Conclusion: The application of the information system improved work efficiency greatly, reduce administrative cost, and helps the authorities to comprehensive grasp of the health law enforcement situation, scientifically assess, early warn, timely and effectively intervene and correct the health law enforcement works in the health inspection agencies.

Since May 2009 the first National Health Accounts (NHA) for Pakistan have been finalised and published by Federal Bureau of Statistics (FBS) in cooperation with German Technical Cooperation (GTZ). This paper goes one step ahead the report and analyses in more detail the regional differences in health expenditure structures in Pakistan. The further analyses can be divided into four parts: health expenditures in provinces (Provincial Health Accounts, PHA),2 Punjab provincial and district governments health expenditures and its comparison with ADB figures, all districts of Pakistan and comparison between total district government and provincial government expenditure for each province; the latter calculation is applied as indication for the degree of fiscal autonomy of the districts in each province. Consequently we first analyse the provincial health expenditures by Financial Agents and compare them between the provinces which leads to very heterogeneous results (Section 2); the per capita health expenditures differ from 16 to 23 USD. Secondly, we compare NHA results on Punjab district government with available ADB results and present differences in methods as possible reasons for different results (Section 3). Third, we analyse district data of all district governments in all four Pakistani provinces on the level of detailed function codes in Section 4; the aim is to discover regional differences between districts of the same as well as of different provinces. Fourth, we analyse in Section 5 the degree of fiscal autonomy on health of the districts in each province; therefore we review the ordinance description and compare total district government with total provincial government expenditures per province. Finally we give recommendations for future rounds of NHA in Pakistan regarding formats and necessities of detailed health expenditure data collection to ensure evidence based decision-making not only on federal, but also on provincial and district level. JEL classification: H51, I1, O18, R1 Keywords: National Health Accounts, Health Expenditures, Regional Comparison, Regional Accounts, Fiscal Autonomy, Pakistan

Data from the Australian Bureau of Statistics, Household Expenditure Survey for 1998/99, are used to investigate the characteristics of households with a high per capita water use in Canberra, Australia's capital city. The results indicate that higher per capita water use is a function of household size (with large households achieving economies of size by sharing water consuming resources) and household income (with wealthy individuals using more water per capita). Linking these findings to Australian Bureau of Statistics projections of shrinking household size, the authors conclude that the resultant decline in household efficiency will drive up the demand for water, unless offset by demand management policies that focus not just on consumer behaviour (e.g. water restrictions) but also on the water efficiency of housing and domestic water-using appliances.

This study aims to analyze the determinants of human resources reflected by the Human Development Index (HDI) in West Kalimantan Province, Indonesia. In this study, 14 regencies/cities in West Kalimantan Province served as the research object. The data were secondary from the Central Bureau of Statistics of West Kalimantan Province from 2017-2021. The analysis tool combined the panel data method with a fixed-effect model approach. Based on the analysis, while the poverty variable negatively and significantly affected HDI, HDI was favorably and strongly impacted by the variables per capita expenditure, unemployment, and gross regional product (GDP). For the government, it is recommended to make policies, such as providing capital to MSME actors, farmers, fishermen, and others, to develop their businesses and boost productivity and people's welfare

Telemedicine may be a useful technique for delivering health care in the developing world. However, there is little practical experience to draw on and real concerns that if additional resources were to become available telemedicine might not be the most appropriate use for them. The logical steps to determine the place of telemedicine in the developing world therefore appear to be: 1 to identify potential telemedicine projectsthe Telecommunication Development Bureau of the International Telecommunication Union is trying to do this and has recently sponsored missions to various countries in Africa and Asia; 2 to carry out properly controlled pilot projects in order to demonstrate technical feasibility and to quantify the benefits to the healthcare system; 3 to calculate the costs of large-scale deployment. Assuming that telemedicine is shown to be beneficial, it is only at this final stage that a rational decision can be made about whether telemedicine would be an appropriate use of additional resources in a developing country, as opposed to alternative uses of those resources to solve other important problems of health care.

This study aims to analyze indigenous agriculture from economic resources in East Java Province as an existing economic resource of strategy and development that evolve into the primary source. This research employed survey and action research methods and secondary data sourced from the central bureau of statistics on 17 economic sectors in Pasuruan and Probolinggo regencies. This research applied survey and action research methods as it attempts to identify the resource potential in each sector setting as the basic strategy for sustainable resources to be the leading sector and as the basis to empower economic resources to reach sustainable food security. This research methodology uses three analysis devices: Location Quotient, Growth Ratio Model and finally describes how to combine LQ and Growth Ratio Model. The result showed that Probolinggo Regency was categorized as rapid advance but left behind. In other words, the economic growth of Probolinggo Regency has weakened. Meanwhile, the food security in Pasuruan Regency was weak. This regency had focused on increasing its economic growth rather than sustainability. The research found that sectors with a positive Growth Ratio Model might move the local economy through regional development innovations.

The purpose of the study is to analyze the state of the rural territory of Kazakhstan and the Akmola region. The study is classified as a desk (marketing) study, the collection and analysis of secondary (preliminary) information was carried out, in particular, data from the FAO statistical yearbook and the website of the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan of the Ministry of National Economy of the Republic were used to review and analyze the indicators Kazakhstan. Based on official statistics, an analysis of the state of the rural territory of Kazakhstan and the Akmola region was carried out. The indicators are considered as the gross regional product per capita of the Republic of Kazakhstan, the structure of the gross regional product of the Akmola region, the level of self-sufficiency in agricultural products of the Akmola region, the leading indicators of the development of rural areas of the Akmola region, the harvested area of maagrarianral crops by types of the EAEU countries. The results of the above study - the current relevance of ensuring the sustainable development of rural areas is due, on the one hand, to the growing economic and social lag of the rural regions, and on the other hand, their exceptional importance for the nation in such matters as food security, conservation of soil and environmental resources, the use of agricultural, industrial and labour resources, and their potential.

External debts are one of the major sources of revenue to developing nations that normally do not have an enough industrial support and is illustrated by a small Human Development Index (HDI). The aim of this paper is to test if external debts promote sustainable economic development in developing countries or not. The study opted a time series data research design where by secondary data were used. The population applied on the financial records from 1999/2000 -2019/2020 financial years (Quarterly Data). The sample size of the study was 80 quarterly observations. Kenya was purposively sampled to be used as research area of this study. The data collected from different reliable sources which included the International Financial Statistics (IFS), World Bank’s Statistical Database (WBSDs), The Treasury of Kenya (TK), Ministry of Devolution and Planning (MDP and the Kenya National Bureau of Statistics (KNBS). The results of the study revealed that there is long -term associations between external debts and sustainable economic development with P-Value of 0.0001. Also, explained significantly by all the other macro-economic variables in the predictable direction with P-Value of 0.0011, except broad inflation and money that have vague signs. In short-run revealed that external debts affect statistically significance economic development with a negative direction P-Value of 0.0064. The study recommends that the government should think about adopting other sources of finance articulate via taxation and reduce borrowing outside to minimize assistance from developed nations. The government should also assign extra resources to savings in human capital education as efficiently labor has the effect of promoting sustainable economic development crosswise all models in the short run. Particularly population expansion rate should be proscribed through increasing utilize of social services such as family planning or sensitization to reduce support pressure on imperfect resources which deject economic development

Three colleges—STII Darunnajah Jakarta, STAI Darunnajah Bogor, and STAI Darunnajah Jakarta—that were part of the Darunnajah Foundation gave birth to Darunnajah University. Following their 2022 merger to form Darunnajah University, the first thing to be mapped and designed is the Lecturer Resources. This is looking at the state of existing lecturers, and then the birth of five new study programs. This study used a case study methodology, employing a qualitative approach through observation, interviews, and documentation. Data were collected, reduced, presented, and conclusions drawn. The study's findings demonstrated Darunnajah University's seriousness in planning its teaching workforce for 2023–2031. Where the HR bureau is guided by the strategic plan and renovation; 1) Development of existing lecturers by encouraging them to continue their studies, providing scholarships, and providing recommendations for scholarships. 2) Cultivating the values of panca jiwa, panca bina, panca jangka, and panca dharma towards lecturers 3) Recruitment of linear lecturers. 4) Benchmarking good practices of HR development for lecturers to UNIDA Gontor. 5) Targeted in 2031, there are 13 professors.

The Secretariat General of the MPR RI synergistically carries out anticipation to try to increase work productivity by preparing reliable human resources and conditions like this are faced with very basic problems such as not optimal work skills, lack of knowledge development and self-concept in being honest is still not in accordance with expertise as well as job analysis and job specifications that are still not optimal. This study aims to explain the competence of the employees of the Bureau of Planning and Finance of the Secretariat General of the MPR RI in supporting the implementation of MPR tasks and to explain the efforts of the Secretariat General of the MPR RI in developing employee competencies so that they can provide the level of support expected in carrying out MPR constitutional tasks. This research method uses a qualitative approach, with a descriptive study paradigm and an ethnographic approach. The technique used in data collection is through in-depth interviews with key informants, document review and activity observation. The results of the competency research to observe the correctness of the signatures authorized for accountability receipts have been carried out quite well, this is measured from the results of observations of activities described by carrying out tasks, applying standard operating procedures (SOP), causal factors and improvement efforts.

One of the manifestations of underdevelopment is malnutrition and unhygienic living conditions. These contribute to lowering productivity levels of labour thereby affecting both industrial and agricultural output. This gives rise to other problems such as unemployment, and underemployment which leads to falls in family income and a consequent decline in living standards. The cycle is then repeated. However, till the early 1970s most LDCs did not give due weightage to the improvement of health conditions as they felt that resources would be better utilised in the directly productive sectors of the economy, for example, agriculture and industry to name two. However, the last twenty years has seen, through the basic needs approach, the role that health can play in promoting development. Expenditures in the health sector came to be seen as investments in human capital. The benefits of such investment became apparent from the improvement in the quality of human resources which was reflected by increases. in productivity of the labour force as well as by increasing the length of the expected working life of labour. Thus the provision of better health facilities has a two-fold effect: first it increases the productivity of the existing labour force and, second it increases the quantity of human resources available in the future by increasing the length of working life. Keeping this in view, the Government of Pakistan's policy with regard to the provision of health can be summarised in a five-point agenda:

This study aims to determine the application of human resource management in BIAS Yogyakarta Junior and Senior High School, especially in the realm of boarding schools or Islamic boarding schools. This type of research is a field study using observation, interview, and documentation techniques. The results of the study can be seen that in the implementation of human resources carried out, HR planning is carried out by the HR management bureau by analyzing report data from school principals and cottages. Second, HR recruitment is carried out in steps including determining vacant positions, determining position requirements, and determining recruitment sources and methods. Third, the selection process for job applicants is carried out by the stages of receiving a cover letter and organizing selection tests (administration and interview). Fourth, the placement of human resources in BIAS boarding school junior and senior high schools by the intended work, knowledge, abilities, skills, and expertise possessed and mastered. Fifth, training and human resource development. Sixth, compensation and provision of incentives.

The paper evaluates the anticipated benefits and the perceived host community support for ethno-cultural tourism resource development in Kaduna State, Nigeria. Multi-stage sampling technique was adopted for this study. Six local governments’ areas were chosen purposively because they accommodate different ethnic and cultural diversity within the state, representing about 33% of the total number of 23 LGAs in the state and have an estimated population of 1,639,621. The selected LGAs are also heterogeneous in terms of ethnicity, culture and religion. Semi-structured interview were administered to 316 respondents selected in the study area. Survey data were obtained through focus group discussion (FGD) in each ethnic community. FGD”s were held with youths, elders and aged. The sampled communities are Ham, Fulani, Hausa, Kagoro, Adara and Gbagyi, field observations were also carried out for holistic resource inventory in the ethnic communities. Documentary data were obtained from desk review method; information on tourism resources available in each ethnic community. The study reveals that the anticipated benefits of ethno-cultural tourism expected by the host communities are basically in terms of infrastructural development (road, water, electricity and communication services) and essential amenities (accommodation, restaurant, Tourist Travel Services, banking and bureau de change). The study recommends that lack of financial capital is a great hindrance for local communities to invest in the tourism industry. A mechanism for financial assistance, including provision of soft loans, needs to be in place in order to encourage host communities to invest in the industry. In turn, this would

The crucial problem of Health Human Resources currently facing is the number, distribution, and quality of health workers. Therefore, it is necessary to take concrete steps in addressing the challenges of this problem by meeting the availability of quality Health Human Resources according to needs, distributed fairly and evenly, and utilized efficiently and effectively. The focus of this research is how the planning of needs, realization and optimization of health human resources at the UPT Puskesmas in Blitar district. This type of research is quantitative qualitative with a case study approach. The results of this study illustrate that in running the public health center program still varies Adequacy of availability of health human resources that are less than ideal, both strategic and non-medical personnel. The planning mechanism for health human resource needs is carried out periodically once a year and used as a proposal report to the Health Office. Development planning still has obstacles due to lack of understanding of the manager program and there is no standard format yet. As an effort to optimize health human resources at the UPT Puskesmas, efforts were made to maximize the existing health human resources by giving multiple assignments and several strategies carried out by the head of the UPT Puskesmas in Blitar district. The realization of the planning for calculating the need for health Human Resources made annually from the UPT Puskesmas as a report to the Health Office has been realized, although not yet fully.

Kosovo aims to revitalize its agricultural sector by modernizing and boosting irrigation development, which is vital for the economic growth and to overcome the ongoing rural desertification. The Kosovo Irrigation Master Plan (KIMP) establishes a national strategy for developing irrigation across the country. Following a systematic analysis of the land, water, agriculture, environment and economic sectors, the planning of the irrigation development has been done with the use of a GIS based analytical tool. The assessment of the water resources conducted both in the current and in the future climate change impacted situations have evidenced an exposed situation for the future foreseen development. Currently, the gross irrigation area is 20,000 Ha, but the plan has evidenced a potential of 280,000 Ha. With limited existing storage capacities and a predicted increased hydrologic variability, investing in irrigation infrastructures without a secured access to water resources appears to be hazardous and calls for the development of storage capacities. The economic and institutional sustainability of this development appears to be found only through a multipurpose management of the planned infrastructures. This article presents the studies conducted within the Kosovo national irrigation master plan.

The Local Government Ordinance (LGO), formulated by the National Reconstruction Bureau (NRB) in 2000 and promulgated by provincial governments in August 2001, assigns powers, responsibilities, and service delivery functions to three levels of local governments: district, tehsil, and union. Responsibilities for the delivery of social and human development services, such as primary and basic health, education and social welfare, are delegated to the district level, whereas municipal services, such as water, sanitation and urban services are assigned to the tehsil level. The LGO does not only deal with the delivery of public services in its plan but also stresses the need for fiscal decentralisation, claiming that “Fiscal decentralisation is the heart of any devolution exercise. Without fiscal decentralisation no authority is devolved.”

This study aims to determine the Implementation of the Pre-DIPA e-tender for Procurement of Goods/Services at the General Bureau of the Secretariat General of the Ministry of Health so that it is hoped that appropriate steps can be formulated in implementing the Pre-DIPA e-tender, problems and efforts made by Presidential Regulation Number 16 of 2018 concerning Government Procurement of Goods/Services. The research method used in this research is quantitative research. The sampling technique uses data sources from 5 informants. Data collection techniques in this study used observation, interview, and documentation techniques. This research procedure includes the stages before in the field, while in the field, and data analysis. Data analysis was carried out by collecting data, reducing data, presenting data, and drawing conclusions. Based on the results of the research, leadership factors, quality of human resources, planning and management, policies and regulations, system integration, and infrastructure and standardization it can be concluded that the implementation of the e-tender pre-DIPA Procurement of Goods/Services at the General Bureau has been going quite well, there are still problems with server down due to frequent maintenance or updating of the system from LKPP. The suggestion is to communicate more intensively with LKPP to reduce server disturbances.

This report is organized around a set of topics that have dominated much of the recent literature in health geography: the importance of neighbourhoods, green spaces/blue spaces, density, walkability, and vulnerable populations. These topics are discussed in terms of the need to shift to new ideas and to avoid creating new determinisms in health geography. A second critical argument to the report is that health geographers also need to focus more of their efforts on those who are truly in need and have the fewest resources to effect change to their health and their lives.