Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Indian Solar Panel Initiatives in Reducing Carbon Dioxide Emissions

Environmental degradation and the emission of greenhouse gases particularly carbon dioxide have expanded problems to human wellness and to the atmosphere. The second-most populated country in the globe, India, is among the primary users of conventional resources, which leads to global warming. The growth rate is anticipated to raise more before 2050, which will cause the brisk industrial expansion and rising energy demand to both increases. In order to reduce carbon emissions and meet energy requirements, many countries use alternate usage of renewable energy particularly solar energy. In this review we aim to study solar panel schemes initiated by India, mainly focusing on National Solar Mission. This study also reviews the present solar installed capacity, solar panel scheme 2022, and initiatives and outcomes of solar panels in residences and offices. This study reviewed that by using solar panel resources, the (MNRE) Ministry of New and Renewable Energy hopes to help the Indian Government reach its purpose of 100 GW solar installed capacity by end of 2022. Despite having an amazing 40 GW of solar power installed capacity till December 2021, India is still far from reaching its own goal of 100 GW by March 2023 as per NSM. In essence, this means that India will need to change a few of its ongoing plans further.

Preliminary discussion on the ignition mechanism of exploding foil initiators igniting boron potassium nitrate

Exploding foil initiator(EFI)is a kind of advanced device for initiating explosives,but its function is unstable when it comes to directly igniting pyrotechnics.To solve the problem,this research aims to reveal the ignition mechanism of EFIs directly igniting pyrotechnics.An oscilloscope,a photon Doppler velocimetry,and a plasma spectrum measurement system were employed to obtain information of electric characteristics,impact pressure,and plasma temperature.The results of the electric characteristics and the impact pressure were inconsistent with ignition results.The only thing that the ignition success tests had in common was that their plasma all had a relatively long period of high-temperature duration(HTD).It eventually concludes that the ignition mechanism in this research is the microconvection heat transfer rather than the shock initiation,which differs from that of exploding foil initiators detonating explosives.Furthermore,the methods for evaluating the ignition success of semiconductor bridge initiators are not entirely applicable to the tests mentioned in this paper.The HTD is the critical parameter for judging the ignition success,and it is influenced by two factors:the late time discharge and the energy of the electric explosion.The longer time of the late time discharge and the more energy of the electric explosion,the easier it is to expand the HTD,which improves the probability of the ignition success.

Risk assessment of oil and gas investment environment in countries along the Belt and Road Initiative

With the implementation of the Belt and Road Initiative, China is deepening its cooperation in oil and gas resources with countries along the Initiative. In order to better mitigate risks and enhance the safety of investments, it is of significant importance to research the oil and gas investment environment in these countries for China's overseas investment macro-layout. This paper proposes an indicator system including 27 indicators from 6 dimensions. On this basis, game theory models combined with global entropy method and analytic hierarchy process are applied to determine the combined weights, and the TOPSIS-GRA model is utilized to assess the risks of oil and gas investment in 76 countries along the Initiative from 2014 to 2021. Finally, the GM(1,1) model is employed to predict risk values for 2022-2025. In conclusion, oil and gas resources and political factors have the greatest impact on investment environment risk, and 12 countries with greater investment potential are selected through cluster analysis in conjunction with the predicted results. The research findings may provide scientific decisionmaking recommendations for the Chinese government and oil enterprises to strengthen oil and gas investment cooperation with countries along the Belt and Road Initiative.

Influence of initial check, information exchange, final accuracy check, reaction information nursing on the psychology of elderly with lung cancer

BACKGROUND As one of the fatal diseases with high incidence,lung cancer has seriously endangered public health and safety.Elderly patients usually have poor self-care and are more likely to show a series of psychological problems.AIM To investigate the effectiveness of the initial check,information exchange,final accuracy check,reaction(IIFAR)information care model on the mental health status of elderly patients with lung cancer.METHODS This study is a single-centre study.We randomly recruited 60 elderly patients with lung cancer who attended our hospital from January 2021 to January 2022.These elderly patients with lung cancer were randomly divided into two groups,with the control group taking the conventional propaganda and education and the observation group taking the IIFAR information care model based on the conventional care protocol.The differences in psychological distress,anxiety and depression,life quality,fatigue,and the locus of control in psychology were compared between these two groups,and the causes of psychological distress were analyzed.RESULTS After the intervention,Distress Thermometer,Hospital Anxiety and Depression Scale(HADS)for anxiety and the HADS for depression,Revised Piper’s Fatigue Scale,and Chance Health Locus of Control scores were lower in the observation group compared to the pre-intervention period in the same group and were significantly lower in the observation group compared to those of the control group(P<0.05).After the intervention,Quality of Life Questionnaire Core 30(QLQ-C30),Internal Health Locus of Control,and Powerful Others Health Locus of Control scores were significantly higher in the observation and the control groups compared to the pre-intervention period in their same group,and QLQ-C30 scores were significantly higher in the observation group compared to those of the control group(P<0.05).CONCLUSION The IIFAR information care model can help elderly patients with lung cancer by reducing their anxiety and depression,psychological distress,and fatigue,improving their tendencies on the locus of control in psychology,and enhancing their life qualities.

Numerical simulation for the initial state of avalanche in polydisperse particle systems

Numerical simulation is employed to investigate the initial state of avalanche in polydisperse particle systems.Nucleation and propagation processes are illustrated for pentadisperse and triadisperse particle systems,respectively.In these processes,particles involved in the avalanche grow slowly in the early stage and explosively in the later stage,which is clearly different from the continuous and steady growth trend in the monodisperse system.By examining the avalanche propagation,the number growth of particles involved in the avalanche and the slope of the number growth,the initial state can be divided into three stages:T1(nucleation stage),T2(propagation stage),T3(overall avalanche stage).We focus on the characteristics of the avalanche in the T2 stage,and find that propagation distances increase almost linearly in both axial and radial directions in polydisperse systems.We also consider the distribution characteristics of the average coordination number and average velocity for the moving particles.The results support that the polydisperse particle systems are more stable in the T2 stage.

Actors of Psychoactive Drug Initiation among Adolescents in Yaoundé-Cameroon

Introduction: Actors of psychoactive drug initiation refer to those who introduce others to psychoactive drug use (initiators) and those who are introduced to psychoactive drugs (users). By identifying their features, better prevention and intervention programs can be developed to reduce psychoactive drug use among adolescents. This article describes the role of actors of psychoactive drug initiation among teenagers in secondary schools in Yaoundé (Cameroon). Methodology: A cross sectional study was carried out in twelve secondary schools in Yaoundé from October 2022 to May 2023. Adolescents from Form four to upper sixth, who assented to participate in the study and received parental consent were included. Data were collected in a structured self-reported questionnaire and analyzed using SPSS 23. Quantitative variables were expressed using means, standard deviations, median and interquartile ranges depending on the distribution of data. Qualitative variables were expressed in the form of frequency and percentages. Results: Drug use was more prevalent among male adolescents (55.3%) from nuclear families (91.4%) who received relatively high pocket money. The main sources of drug exposure were non-family members (49.7%), especially friends outside school. The most frequent place of initiation was snack bars (33.1%). Conclusion: The study revealed the importance of the family, friends and leisure places in the initiation process of drug use in teenagers. Based on these results, parents and school authorities should work together to create a safe and supportive environment that fosters communication, education to prevent drug abuse among adolescents in Yaoundé.

UNEP welcomes China to international decarbonization initiative

An official with the United Nations Environment Programme has welcomed China’s participation in an international initiative that aims to decarbonize the building sector,saying it offers the opportunity for China to share its valuable experiences and insight on promoting green buildings.Jonathan Duwyn,program officer of UNEP’s buildings and construction cities unit,made the remarks in a recent interview with China Daily,following the launch of the Buildings Breakthrough on Dec.6at COP28United Nations climate change conference in Dubai,the United Arab Emirates.

Neurocognitive Profile of People Living with Human Immunodeficiency Virus Initiating Treatment in Kinshasa in the Dolutegravir Era, Democratic Republic of Congo

Context: Antiretroviral therapies improve the prognosis of NeuroAIDS contrasting with a high frequency of Minor Neurocognitive Disorders (MND) even in aviremic subjects. Objective: The objective of this study is to present the neurological and cognitive profile of People Living with HIV (PLHIV) initiating antiretroviral treatment in Kinshasa in the era of Dolutegravir (DTG). Methods: This is a multicenter, cross-sectional study with a descriptive aim carried out in 16 HIV Outpatient Treatment Centers (OTC) in Kinshasa from October 4, 2021 to February 15, 2022. The International HIV Dementia Scale (IHDS) correlated with the Activities of Daily Living (IADL) scale facilitated the categorization of NeuroCognitive Disorders (NCD) of PLHIV evaluated after carrying out a summary neurological examination. Results: Of the 96 patients recruited, 56.3% were women with a sex ratio of 0.68. The average age was 40.1 ± 12.1 years. The secondary education level was the majority at 64.6%. Malaria (44.8%) and tuberculosis (32.3%) were more common as opportunistic infections. They were alcoholics in (30.2%). Their history was heart disease (15.6%), high blood pressure (18.8%);drug abuse (10.4%). The IHDS score was light in 55.2% of cases. The correlation between IHDS/IADL watches asymptomatic neurocognitive impairments (ANI) in 77.1%, almost all of subjects are found with normal overall functioning (94.8%) and a disturbed neurological examination in 53.1% of cases with a predominance of motor impairments in 79.1%. Conclusion: In view of these results, early and systematic screening of NCD and associated factors remains necessary in our context. .

Effects of the initiation position on the damage and fracture characteristics of linear-charge blasting in rock

To study the effects of the initiation position on the damage and fracture characteristics of linear-charge blasting, blasting model experiments were conducted in this study using computed tomography scanning and three-dimensional reconstruction methods. The fractal damage theory was used to quantify the crack distribution and damage degree of sandstone specimens after blasting. The results showed that regardless of an inverse or top initiation, due to compression deformation and sliding frictional resistance, the plugging medium of the borehole is effective. The energy of the explosive gas near the top of the borehole is consumed. This affects the effective crushing of rocks near the top of the borehole, where the extent of damage to Sections Ⅰ and Ⅱ is less than that of Sections Ⅲ and Ⅳ. In addition, the analysis revealed that under conditions of top initiation, the reflected tensile damage of the rock at the free face of the top of the borehole and the compression deformation of the plug and friction consume more blasting energy, resulting in lower blasting energy efficiency for top initiation. As a result, the overall damage degree of the specimens in the top-initiation group was significantly smaller than that in the inverse-initiation group. Under conditions of inverse initiation, the blasting energy efficiency is greater, causing the specimen to experience greater damage. Therefore, in the engineering practice of rock tunnel cut blasting, to utilize blasting energy effectively and enhance the effects of rock fragmentation, using the inverse-initiation method is recommended. In addition, in three-dimensional(3D) rock blasting, the bottom of the borehole has obvious end effects under the conditions of inverse initiation, and the crack distribution at the bottom of the borehole is trumpet-shaped. The occurrence of an end effect in the 3D linear-charge blasting model experiment is related to the initiation position and the blocking condition.

Impact of initial fluctuations and nuclear deformations in isobar collisions

Relativistic isobar^(96)_(44)Ru+^(96)_(44)Ru and^(96)_(40)Zr+^(96)_(40)Zrcollisions have revealed intricate differences in their nuclear size and shape,inspiring unconventional studies of nuclear structure using relativistic heavy ion collisions.In this study,we investigate the relative differences in the mean multiplicityR_(<Nch>)and the secondR_(ε2)and third-order eccentricityR_(ε3)between isobar collisions using initial state Glauber models.It is found that initial fluctuations and nuclear deformations have negligible effects on R_(<Nch>)in most central collisions,while both are important for the R_(ε2)and R_(ε3),the degree of which is sensitive to the underlying nucleonic or sub-nucleonic degree of freedom.These features,compared to real data,may probe the particle production mechanism and the physics underlying nuclear structure.

Mg-doped,carbon-coated,and prelithiated SiO_(x) as anode materials with improved initial Coulombic efficiency for lithium-ion batteries

Silicon suboxide(SiO_(x),x≈1)is promising in serving as an anode material for lithium-ion batteries with high capacity,but it has a low initial Coulombic efficiency(ICE)due to the irreversible formation of lithium silicates during the first cycle.In this work,we modify SiO_(x) by solid-phase Mg doping reaction using low-cost Mg powder as a reducing agent.We show that Mg reduces SiO_(2) in SiO_(x) to Si and forms MgSiO_(3) or Mg_(2)SiO_(4).The MgSiO_(3) or Mg_(2)SiO_(4) are mainly distributed on the surface of SiO_(x),which suppresses the irreversible lithium-ion loss and enhances the ICE of SiO_(x).However,the formation of MgSiO_(3) or Mg_(2)SiO_(4) also sacrifices the capacity of SiO_(x).Therefore,by controlling the reaction process between Mg and SiO_(x),we can tune the phase composition,proportion,and morphology of the Mg-doped SiO_(x) and manipulate the performance.We obtain samples with a capacity of 1226 mAh g^(–1) and an ICE of 84.12%,which show significant improvement over carbon-coated SiO_(x) without Mg doping.By the synergistical modification of both Mg doping and prelithiation,the capacity of SiO_(x) is further increased to 1477 mAh g^(–1) with a minimal compromise in the ICE(83.77%).

An Initial Perturbation Method for the Multiscale Singular Vector in Global Ensemble Prediction

Ensemble prediction is widely used to represent the uncertainty of single deterministic Numerical Weather Prediction(NWP) caused by errors in initial conditions(ICs). The traditional Singular Vector(SV) initial perturbation method tends only to capture synoptic scale initial uncertainty rather than mesoscale uncertainty in global ensemble prediction. To address this issue, a multiscale SV initial perturbation method based on the China Meteorological Administration Global Ensemble Prediction System(CMA-GEPS) is proposed to quantify multiscale initial uncertainty. The multiscale SV initial perturbation approach entails calculating multiscale SVs at different resolutions with multiple linearized physical processes to capture fast-growing perturbations from mesoscale to synoptic scale in target areas and combining these SVs by using a Gaussian sampling method with amplitude coefficients to generate initial perturbations. Following that, the energy norm,energy spectrum, and structure of multiscale SVs and their impact on GEPS are analyzed based on a batch experiment in different seasons. The results show that the multiscale SV initial perturbations can possess more energy and capture more mesoscale uncertainties than the traditional single-SV method. Meanwhile, multiscale SV initial perturbations can reflect the strongest dynamical instability in target areas. Their performances in global ensemble prediction when compared to single-scale SVs are shown to(i) improve the relationship between the ensemble spread and the root-mean-square error and(ii) provide a better probability forecast skill for atmospheric circulation during the late forecast period and for short-to medium-range precipitation. This study provides scientific evidence and application foundations for the design and development of a multiscale SV initial perturbation method for the GEPS.

Selenga River human dispersal path in Initial Upper Paleolithic

Here,we consider earlier Upper Paleolithic sites in the Selenga River Basin,the main fluvial input of Lake Baikal that flows through northern Mongolia and the southwestern Transbaikal region of Russia.Lithic industries from these sites can be attributed to the laminar Initial Upper Paleolithic(IUP)technocomplex,widespread in southern Siberia and Central Asia.IUP industries appear in the Selenga Basin about 45 kaBP cal.Aspects of regional typological variability and the transport of exotic raw materials over long distances indicate that these populations participated in developed exchange networks and employed high mobility targeting the acquisition of necessary raw materials.Two site types are present:quarry-workshops in northern Mongolia and generalized activity settlements in the southwestern Transbaikal.Although faunal data are limited,we interpret available information as indicating a specialization on hunting,focusing on migrating steppe game species.The distribution of sites in the mid-altitudes and landscapes of the Selenga-Orkhon geographical region and the geomorphological homogeneity of this territory also supported interregional human moves during the IUP.

Irregular initial solidification by mold thermal monitoring in the continuous casting of steels:A review

Occasional irregular initial solidification phenomena,including stickers,deep oscillation marks,depressions,and surface cracks of strand shells in continuous casting molds,are important limitations for developing the high-efficiency continuous casting of steels.The application of mold thermal monitoring(MTM) systems,which use thermocouples to detect and respond to temperature variations in molds,has become an effective method to address irregular initial solidification phenomena.Such systems are widely applied in numerous steel companies for sticker breakout prediction.However,monitoring the surface defects of strands remains immature.Hence,indepth research is necessary to utilize the potential advantages and comprehensive monitoring of MTM systems.This paper summarizes what is included in the irregular initial solidification phenomena and systematically reviews the current state of research on these phenomena by the MTM systems.Furthermore,the influences of mold slag behavior on monitoring these phenomena are analyzed.Finally,the remaining problems of the formation mechanisms and investigations of irregular initial solidification phenomena are discussed,and future research directions are proposed.

An improved initial rotor position estimation method using high-frequency pulsating voltage injection for PMSM

High frequency pulsating voltage injection method is a good candidate for detecting the initial rotor position of permanent magnet synchronous motor.However,traditional methods require a large number of filters,which leads to the deterioration of system stability and dynamic performance.In order to solve these problems,a new signal demodulation method is proposed in this paper.The proposed new method can directly obtain the amplitude of high-frequency current,thus eliminating the use of filters,improving system stability and dynamic performance and saving the work of adjusting filter parameters.In addition,a new magnetic polarity detection method is proposed,which is robust to current measurement noise.Finally,experiments verify the effectiveness of the method.

Multi-Level Image Segmentation Combining Chaotic Initialized Chimp Optimization Algorithm and Cauchy Mutation

To enhance the diversity and distribution uniformity of initial population,as well as to avoid local extrema in the Chimp Optimization Algorithm(CHOA),this paper improves the CHOA based on chaos initialization and Cauchy mutation.First,Sin chaos is introduced to improve the random population initialization scheme of the CHOA,which not only guarantees the diversity of the population,but also enhances the distribution uniformity of the initial population.Next,Cauchy mutation is added to optimize the global search ability of the CHOA in the process of position(threshold)updating to avoid the CHOA falling into local optima.Finally,an improved CHOA was formed through the combination of chaos initialization and Cauchy mutation(CICMCHOA),then taking fuzzy Kapur as the objective function,this paper applied CICMCHOA to natural and medical image segmentation,and compared it with four algorithms,including the improved Satin Bowerbird optimizer(ISBO),Cuckoo Search(ICS),etc.The experimental results deriving from visual and specific indicators demonstrate that CICMCHOA delivers superior segmentation effects in image segmentation.

Effects of Initial and Boundary Conditions on Heavy Rainfall Simulation over the Yellow Sea and the Korean Peninsula:Comparison of ECMWF and NCEP Analysis Data Effects and Verification with Dropsonde Observation

This study evaluated the simulation performance of mesoscale convective system(MCS)-induced precipitation,focusing on three selected cases that originated from the Yellow Sea and propagated toward the Korean Peninsula.The evaluation was conducted for the European Centre for Medium-Range Weather Forecasts(ECMWF)and National Centers for Environmental Prediction(NCEP)analysis data,as well as the simulation result using them as initial and lateral boundary conditions for the Weather Research and Forecasting model.Particularly,temperature and humidity profiles from 3D dropsonde observations from the National Center for Meteorological Science of the Korea Meteorological Administration served as validation data.Results showed that the ECMWF analysis consistently had smaller errors compared to the NCEP analysis,which exhibited a cold and dry bias in the lower levels below 850 hPa.The model,in terms of the precipitation simulations,particularly for high-intensity precipitation over the Yellow Sea,demonstrated higher accuracy when applying ECMWF analysis data as the initial condition.This advantage also positively influenced the simulation of rainfall events on the Korean Peninsula by reasonably inducing convective-favorable thermodynamic features(i.e.,warm and humid lower-level atmosphere)over the Yellow Sea.In conclusion,this study provides specific information about two global analysis datasets and their impacts on MCS-induced heavy rainfall simulation by employing dropsonde observation data.Furthermore,it suggests the need to enhance the initial field for MCS-induced heavy rainfall simulation and the applicability of assimilating dropsonde data for this purpose in the future.

Frost heaving and crack initiation characteristics of tunnel rock mass in cold regions under low-temperature degradation

Water freezing in rock fractures causes volumetric expansion and fracture development through frost heaving.This study introduces a novel analytical model to investigate how uneven freezing force and surrounding rock pressure influence fracture initiation,based on mass conservation,elasticity,and water-ice phase transition principles.A model for rock fracture initiation considering freezing temperature,uneven freezing expansion,in-situ stress,and lateral pressure was proposed based on fracture mechanics.Equations for stress intensity factors were developed and validated using the phase field method.The effects of rock elastic modulus anisotropy and critical fracture energy density on fracture initiation were also discussed.The results show that the values of KI and KII exhibit an upward trend as the freezing temperature,uneven expansion,in-situ stress,and lateral pressure increase.The uneven freezing expansion has the most significant influence on KI and KII values among these parameters.As the uneven freezing expansion coefficient increases to 0.5,the fracture initiation mode shifts from tensile fracture to shear fracture.As the lateral pressure coefficient increases to 1,the fracture initiation mode shifts from tensile fracture to shear fracture.Rock elastic modulus anisotropy causes fractures to propagate in a clockwise direction,forming a'butterfly'pattern.Critical fracture energy density an isotropy causes counterclockwise deviation in propagation direction,resulting in branching paths and an'H'-shaped pattern.

Innovation Analysis of Rural Agricultural Economic Management Model in the Context of the Belt and Road Initiative

[Objectives]To explore innovative strategies for rural agricultural economic development in the context of the Belt and Road Initiative.[Methods]This research adopts the method of literature review and field research,systematically combs the research results related to the Belt and Road Initiative and rural agricultural economic management,and deeply understands the actual situation of rural agricultural economic management.[Results]The research shows that in the context of the Belt and Road Initiative,the rural agricultural economy is facing new development opportunities and challenges,but there are also some problems.In the new period,we should accelerate the innovative development of rural agricultural economy by promoting market-oriented reform,strengthening scientific and technological innovation,optimizing the industrial structure,deepening international cooperation and other measures.The Belt and Road Initiative provides an important opportunity for the innovation of rural agricultural economic management.Rural agricultural economic management should be actively integrated into the Belt and Road construction to improve the level of rural agricultural economic management.[Conclusions]This study provides useful exploration and reference for the innovation of rural agricultural economic management models,which helps to promote the healthy development of rural agricultural economy and achieve the goal of rural revitalization.