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This paper aims to understand the clinical practice of physiotherapists and occupational therapists in the Republic of Ireland in the assessment and treatment of spasticity in adults, to inform and improve spasticity management practice. This study also aims to describe therapists’ knowledge, confidence and perceived barriers in the management of spasticity.

A cross sectional survey design study was completed, and respondents were recruited through an online survey.

In total, 92 respondents from a wide range of clinical settings revealed there is considerable variation in services available nationally for adults presenting with spasticity. There were significant inconsistencies across all areas of practice. The majority of respondents (94%) did provide intervention to patients with spasticity, yet three quarters did not have access to a specialist spasticity clinic, and the majority (82%) did not feel they were providing sufficient treatment intensity for spasticity.

These findings provide a unique insight into the assessment and treatment practices of Irish physiotherapists and occupational therapists. These results demonstrate the need for further upskilling and specialist high-quality spasticity services nationally.

The primary objective of this paper is to show a systematic and methodological approach for the digitalization of critical clinical pathways (CPs) within the healthcare domain.

The methodology entails the integration of service design (SD) and action research (AR) methodologies, characterized by iterative phases that systematically alternate between action and reflective processes, fostering cycles of change and learning. Within this framework, stakeholders are engaged through semi-structured interviews, while the existing and envisioned processes are delineated and represented using BPMN 2.0. These methodological steps emphasize the development of an autonomous, patient-centric web application alongside the implementation of an adaptable and patient-oriented scheduling system. Also, business processes simulation is employed to measure key performance indicators of processes and test for potential improvements. This method is implemented in the context of the CP addressing transient loss of consciousness (TLOC), within a publicly funded hospital setting.

The methodology integrating SD and AR enables the detection of pivotal bottlenecks within diagnostic CPs and proposes optimal corrective measures to ensure uninterrupted patient care, all the while advancing the digitalization of diagnostic CP management. This study contributes to theoretical discussions by emphasizing the criticality of process optimization, the transformative potential of digitalization in healthcare and the paramount importance of user-centric design principles, and offers valuable insights into healthcare management implications.

The study’s relevance lies in its ability to enhance healthcare practices without necessitating disruptive and resource-intensive process overhauls. This pragmatic approach aligns with the imperative for healthcare organizations to improve their operations efficiently and cost-effectively, making the study’s findings relevant.

The present study is performed to identify the propagation mechanism of the ripple effect as well as examine the simultaneous impact of risks on supply chain (SC) performance.

A theoretical framework with many hypotheses regarding the relationships between SC risk types and performance is established. The data are collected from a large-scale survey supported by a project of the Japanese government to promote sustainable socioeconomic development for the Association of Southeast Asian Nations (ASEAN) region, with the participation of 207 firms. Structural equation modeling (SEM) is used to test the hypotheses of the theoretical framework.

It is indicated that human-made risk causes operational risk, while natural risk causes both supply risk and operational risk. Furthermore, the impacts of human-made risk and natural risk on performance are amplified through operational risk.

This study is one of the first attempts that identifies the propagation mechanism of the ripple effect and examines the simultaneous impact of risks on performance in construction SCs.

Although many studies on risk management in construction SCs have been carried out, they mainly focus on risk identification or quantification of risk impact. It is observed that research on the ripple effect of disruptions has been very scarce.

Acknowledging, on the one hand, the increasing fragility of supply chains and the number of risks involved in supply chain operations and, on the other hand, the role of small- and medium-sized enterprises (SMEs) in supply chains and the high exposure of these firms to risks of different types, this study aims to examine the relationship between supply chain risk management (SCRM) and innovation performance in SMEs. Furthermore, the impact of technological turbulence on this relationship was studied to take into account recent technological changes.

Structural equation modelling was carried out on a sample of Turkish SMEs to test the hypotheses developed.

The findings presented allow the authors to better understand the link between SCRM and innovation performance in SMEs. More precisely, empirical evidence is provided about the impact of SCRM components such as maturity and ability on innovation performance. Furthermore, the findings show the impact of technological turbulence on both SCRM and innovation performance.

By focusing on SCRM in SMEs, this paper contributes to the body of knowledge with regard to SCRM in general and with regard to SMEs in particular; research on the latter has only started recently. Moreover, by having studied SMEs from a developing country (other than China), this paper helps to develop a broader and more diverse perspective of SCRM.

The purpose of this study was to examine how beginning teachers’ participation in a microcredential based on trauma-informed classroom management and restorative discipline (TIMRD) practices might enhance their self-efficacy (SE), through an understanding of their own trauma response, its neurobiological basis and classroom interventions that focus on student wellness and teacher self-care.

Using a single case study design, participants completed a pre- and post-assessment before and after completion of a TIMRD microcredential.

A total of seven teaching fellows completed the microcredential process. Results indicate that the use of a microcredential for professional learning assisted with decreasing sense of burnout while increasing professional SE, SE related to classroom management and instructional strategies (ISs).

New teachers commonly struggle with a lack of professional efficacy for a variety of reasons, yet all teachers present with their own personal trauma. Increasing new teachers’ sense of resilience through addressing their own trauma and the impact of student trauma is integral to increasing teaching SE and reducing rates of burnout.

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these challenges, providing insights into healthcare investments, policy analysis and patient care pathways.

This research employs the real options theory, a financial concept, to delve into health economics challenges. Through a systematic approach, three distinct models rooted in this theory are crafted and analyzed. Firstly, the study examines the value of investing in emerging health technology, factoring in future advantages, associated costs and unpredictability. The second model is patient-centric, evaluating the choice between immediate treatment switch and waiting for more clarity, while also weighing the associated risks. Lastly, the research assesses pandemic-related government policies, emphasizing the importance of delaying decisions in the face of uncertainties, thereby promoting data-driven policymaking.

Three different real options models are presented in this study to illustrate their applicability and value in aiding decision-makers. (1) The first evaluates investments in new technology, analyzing future benefits, discount rates and benefit volatility to determine investment value. (2) In the second model, a patient has the option of switching treatments now or waiting for more information before optimally switching treatments. However, waiting has its risks, such as disease progression. By modeling the potential benefits and risks of both options, and factoring in the time value, this model aids doctors and patients in making informed decisions based on a quantified assessment of potential outcomes. (3) The third model concerns pandemic policy: governments can end or prolong lockdowns. While awaiting more data on the virus might lead to economic and societal strain, the model emphasizes the economic value of deferring decisions under uncertainty.

This research provides a quantified perspective on various decisions in healthcare, from investments in new technology to treatment choices for patients to government decisions regarding pandemics. By applying real options theory, stakeholders can make more evidence-driven decisions.

Decisions about patient care pathways and pandemic policies have direct societal implications. For instance, choices regarding the prolongation or ending of lockdowns can lead to economic and societal strain.

The originality of this study lies in its application of real options theory, a concept from finance, to the realm of health economics, offering novel insights and analytical tools for decision-makers in the healthcare sector.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

A debate on whether new ventures should be supported with public funding is taking place. Adopting a position on this discussion requires rigorous assessments of implemented programs. However, the few existing efforts have mostly focused on regional cases in developed countries. To fill this gap, this paper aims to measure the effects of a regional acceleration program in a developing country (Medellin, Colombia).

The economic notion of capabilities is used to frame the analysis of firm characteristics and productivity, which are hypothesized to be heterogeneous within the program. To test these relationships, propensity score matching is used in a sample of 60 treatment and 16,994 control firms.

This paper finds that treated firms had higher revenue than propensity score-matched controls on average, confirming a positive impact on growth measures. However, such financial growth is mostly observed in service firms rather than other economic sectors.

Further evaluations, with a longer period and using more outcome variables, are suggested in the context of similar publicly funded programs in developing countries.

These findings tip the balance in favor of the literature suggesting supportive programs for high-growth firms as opposed to everyday entrepreneurship. This is an insight, especially under the context of an emerging economy, which has scarce funding to support entrepreneurship.

This paper aims to examine prospective graduate students' attitudes toward educational loan borrowing in an experimental setting.

Participants were randomly assigned to two treatment groups and one control group. Subjects in experimental group 1 received financial education: a short online course on the economic viability of getting a master's degree and how to finance it with a graduate student loan, while subjects in experimental group 2 received financial education along with information on the availability bias.

Relying on a control group in the assessment of financial literacy education intervention impacts, this research finds positive causal treatment effects on individuals’ attitudes toward debt-financed graduate education. In comparison to the control group, experimental subjects perceived the possibility of going into debt with a graduate loan to complete a master’s degree as less stressful and worrying.

This study has important educational policy implications to prevent students from stopping investing in human capital by perceiving educational loan debt as something stressful or worrying. The results can help potential (and current) grad students develop a feasible financial plan for graduate school by encouraging higher education institutions to implement educational loan information and financial education into university seminar courses for better graduate student loan decision-making.

Student attitudes toward debt have been analyzed in the context of higher education, but only a few researchers internationally have used an experimental design to study personal financial decision-making.

Renal failure is an end-stage consequence after persistent hyperglycemia during diabetic nephropathy (DN), and the etiology of DN has been linked to oxidative stress. The purpose of this research was to determine the beneficial synergistic effects of S-Allyl Cysteine (SAC) and Taurine (TAU) on oxidative damage in the kidneys of type 2 diabetic rats induced by hyperglycemia.

Experimental diabetes was developed by administering intraperitoneal single dose of streptozotocin (STZ; 65 mg/kg) with nicotinamide (NA; 230 mg/kg) in adult rats. Diabetic and control rats were treated with SAC (150 mg/kg), TAU (200 mg/kg) or SAC and TAU combination (75 + 100 mg/kg) for four weeks. The estimation of body weight, fasting blood glucose (FBG), oral glucose tolerance test (OGTT), oxidative stress markers along with kidney histopathology was done to investigate the antidiabetic potential of SAC/TAU in the NA/STZ diabetic group.

The following results were obtained for the therapeutic efficacy of SAC/TAU: decrease in blood glucose level, decreased level of thiobarbituric acid reactive substances (TBARS) and increased levels of GSH, glutathione-s-transferase (GST) and catalase (CAT). SAC/TAU significantly modulated diabetes-induced histological changes in the kidney of rats.

SAC/TAU combination therapy modulated the oxidative stress markers in the kidney in diabetic rat model and also prevented oxidative damage as observed through histopathological findings.