Impact of decentralized management on sickness absence in hospitals: a two-wave cohort study of frontline managers in Danish hospital wards.

BACKGROUND: This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees' wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied. METHODS: The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model. RESULTS: Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05-0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01-0.49). Overall, the results showed a clear data trend, although not all results were statistically significant. CONCLUSION: Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management.

Review of linear and circular approaches to on-site domestic wastewater treatment: Analysis of research achievements, trends and distance to target.

This comprehensive review critically assesses traditional and emerging technologies for domestic wastewater treatment and reuse, focusing on the transition from conventional centralised systems to innovative decentralised approaches. Through an extensive literature search on domestic wastewater systems serving a population equivalent of less than or equal to 10, the study juxtaposes linear and circular methods and highlights their impact on urban water management and the environment. The papers reviewed were classified into five categories: Environmental studies, economic studies, social studies, technological studies, and reviews and policy papers. The analysis was carried out separately for linear and circular approaches within each category. In addition, the maturity of the technology (lab/pilot or full-scale application) was taken into account in the analysis. The research landscape is shown to be evolving towards circular methods that promise sustainability through resource recovery, despite the dominance of linear perspectives. The lack of clear progress in decentralised technologies, the scarcity of circularity assessments and the challenges of urban integration are highlighted. Operational reliability, regulatory compliance and policy support are identified as key barriers to the adoption of decentralised systems. While conventional pollutants and their environmental impacts are well addressed for linear systems, the study of emerging pollutants is in its infancy. Conclusions on the impact of these hazardous pollutants are tentative and cautious. Social and economic studies are mainly based on virtual scenarios, which are useful research tools for achieving sustainability goals. The conceptual frameworks for assessing the social dimension need further refinement to be effective. The paper argues for a balanced integration of centralisation and decentralisation, proposing a dual strategy that emphasizes the development of interoperable technologies. It calls for further research, policy development and widespread implementation to promote decentralised solutions in urban water management and pave the way for sustainable urban ecosystems.

Reliability of organic and biogenic pollutant removal in selected technologies used in domestic wastewater treatment plants: A comparative analysis.

The results of a comparative study of two different technological solutions applicable to decentralised domestic wastewater treatment systems are presented. A hybrid reactor with activated sludge and mobile biofilm carriers moving in wastewater is one of them, and an innovative quasi-technical combination of a biological reactor with a sprinkled bed filled with sintered clay granules, followed in the process line by an innovative slope type filtration bed, is the other one. The study has shown a significant advantage of filter bed installations in functional quality, expressed in low values of indicators and pollutant concentrations. In the comparison of technological reliability and probability of exceeding the requirement values of BOD5 = 40 mg/L, Facility 1 achieved technological reliability of 70% and probability of exceeding was 23%. Technological reliability of Facility 2 in this component was 100% and P = 0%. Both facilities presented 100% technological reliability in the COD indicators, with zero probability of exceeding the required value of 150 mg/L. The reliability of TSS removal was similarly high in both facilities: 91% and 100%. The higher functional quality of Facility 2 was evident in TN and PO4-P parameters, where the period of its operation with exceeded values did not exceed 20% and 13%, respectively, with a low probability of exceeding the value of 18% and 2.5%, respectively. However, Facility 1 was unreliable in this regard in 90% and 84%, with a very high probability of exceeding the required values of these parameters: 88% and 72%. This facility does not meet the required criteria in this respect and may cause a risk to the aquatic environment if wastewater is discharged directly into open watercourses, or if it enters shallow groundwater. The use of a suitable, biologically active soil-plant receiver can eliminate this risk.

Registered nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics of eThekwini Municipality in KwaZulu-Natal.

BACKGROUND: Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). AIM: To explore and describe the nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. METHODS: Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. RESULTS: Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. CONCLUSION: Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs CONTRIBUTIONS: Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations.

Decentralised clinical trials in multiple sclerosis research.

Randomised controlled trials (RCTs) play an important role in multiple sclerosis (MS) research, ensuring that new interventions are safe and efficacious before their introduction into clinical practice. Trials have been evolving to improve the robustness of their designs and the efficiency of their conduct. Advances in digital and mobile technologies in recent years have facilitated this process and the first RCTs with decentralised elements became possible. Decentralised clinical trials (DCTs) are conducted remotely, enabling participation of a more heterogeneous population who can participate in research activities from different locations and at their convenience. DCTs also rely on digital and mobile technologies which allows for more flexible and frequent assessments. While hospitals quickly adapted to e-health and telehealth assessments during the COVID-19 pandemic, the conduct of conventional RCTs was profoundly disrupted. In this paper, we review the existing evidence and gaps in knowledge in the design and conduct of DCTs in MS.

Federated analyses of multiple data sources in drug safety studies.

PURPOSE: Studies of rare side effects of new drugs with limited exposure may require pooling of multiple data sources. Federated Analyses (FA) allow real-time, interactive, centralized statistical processing of individual-level data from different data sets without transfer of sensitive personal data. METHODS: We review IT-architecture, legal considerations, and statistical methods in FA, based on a Swedish Medical Products Agency methodological development project. RESULTS: In a review of all post-authorisation safety studies assessed by the EMA during 2019, 74% (20/27 studies) reported issues with lack of precision in spite of mean study periods of 9.3 years. FA could potentially improve precision in such studies. Depending on the statistical model, the federated approach can generate identical results to a standard analysis. FA may be particularly attractive for repeated collaborative projects where data is regularly updated. There are also important limitations. Detailed agreements between involved parties are strongly recommended to anticipate potential issues and conflicts, document a shared understanding of the project, and fully comply with legal obligations regarding ethics and data protection. FA do not remove the data harmonisation step, which remains essential and often cumbersome. Reliable support for technical integration with the local server architecture and security solutions is required. Common statistical methods are available, but adaptations may be required. CONCLUSIONS: Federated Analyses require competent and active involvement of all collaborating parties but have the potential to facilitate collaboration across institutional and national borders and improve the precision of postmarketing drug safety studies.

A survey on constructed wetland publications in the past three decades.

Decentralised wastewater treatment systems, such as constructed wetlands, are becoming increasingly popular these days because they are more economical and cost-effective than conventional plants. The primary objective of this review paper is to determine the number of studies that have been conducted on constructed wetlands, specifically 'free water surface flow constructed wetlands', 'horizontal subsurface flow constructed wetlands', 'vertical subsurface flow constructed wetlands', and 'hybrid constructed wetlands'. In addition, the paper examines the status of research publications on constructed wetlands by country, author, and journal. Based on the review, it has been found that although constructed wetland technology is economical and cost-effective, it is still not among the top 10 effluent treatment methods. Compared to other constructed wetland systems, 'hybrid constructed wetlands' have received minimal attention. Based on the search results, 4639 documents published between 1989 and 2021 have been extracted from the online edition of SCI-EXPANDED, Web of Science. The documents associated with constructed wetlands are divided into eight main document types. Articles and proceedings papers are the most common document type, accounting for 93% of all publications, followed by reviews (4%), meeting abstracts (1.3%), corrections (0.56%), editorial materials (0.38%), news items (0.2%), letters (0.04%), and book reviews (0.02%).

Sustainable application of electrocatalytic and photo-electrocatalytic oxidation systems for water and wastewater treatment: a review.

Wastewater treatment and reuse have risen as a solution to the water crisis plaguing the world. Global warming-induced climate change, population explosion and fast depletion of groundwater resources are going to exacerbate the present global water problems for the forthcoming future. In this scenario, advanced electrochemical oxidation process (EAOP) utilising electrocatalytic (EC) and photoelectrocatalytic (PEC) technologies have caught hold of the interest of the scientific community. The interest stems from the global water management plans to scale down centralised water and wastewater treatment systems to decentralised and semicentralised treatment systems for better usage efficiency and less resource wastage. In an age of rising water pollution caused by contaminants of emerging concern (CECs), EC and PEC systems were found to be capable of optimal mineralisation of these pollutants rendering them environmentally benign. The present review treads into the conventional electrochemical treatment systems to identify their drawbacks and analyses the scope of the EC and PEC to mitigate them. Probable electrode materials, potential catalysts and optimal operational conditions for such applications were also examined. The review also discusses the possible retrospective application of EC and PEC as point-of-use and point-of-entry treatment systems during the transition from conventional centralised systems to decentralised and semi-centralised water and wastewater treatment systems.

A systematic review of methods used to conduct decentralised clinical trials.

AIMS: To evaluate, using quantitative and qualitative approaches, published data on the design and conduct of decentralised clinical trials (DCTs). METHODS: We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, ProQuest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and Google Scholar for publications reporting, discussing, or evaluating decentralised clinical research methods. Reports of randomised clinical trials using decentralised methods were included in a focused quantitative analysis with a primary outcome of number of randomised participants. All publications discussing or evaluating DCTs were included in a wider qualitative analysis to identify advantages, disadvantages, facilitators, barriers and stakeholder opinions of decentralised clinical trials. Quantitative data were summarised using descriptive statistics, and qualitative data analysed using a thematic approach. RESULTS: Initial searches identified 19 704 articles. After removal of duplicates, 18 553 were screened, resulting in 237 eligible for full-text assessment. Forty-five trials were included in the quantitative analysis; 117 documents were included in the qualitative analysis. Trials were widely heterogeneous in design and reporting, precluding meta-analysis of the effect of DCT methods on the primary recruitment outcome. Qualitative analysis formulated 4 broad themes: value, burden, safety and equity. Participant and stakeholder experiences of DCTs were incompletely represented. CONCLUSION: DCTs are developing rapidly. However, there is insufficient evidence to confirm which methods are most effective in trial recruitment, retention, or overall cost. The identified advantages, disadvantages, facilitators and barriers should inform the development of DCT methods. We recommend further research on how DCTs are experienced and perceived by participants and stakeholders to maximise potential benefits.

Learning from remote decentralised clinical trial experiences: A qualitative analysis of interviews with trial personnel, patient representatives and other stakeholders.

AIMS: The aim of the study was to identify actionable learning points from stakeholders in remote decentralised clinical trials (RDCTs) to inform their future design and conduct. METHODS: Semistructured interviews were carried out with a purposive sample of stakeholders, including senior managers, trial managers, technology experts, principal investigators, clinical investigators, research scientists, research nurses, vendors, patient representatives and project assistants. The interview data were coded using a thematic approach, identifying similarities, differences and clustering to generate descriptive themes. Further refinement of themes was guided by empirical phenomenology, grounding explanation in the meanings that interviewees gave to their experiences. RESULTS: Forty-eight stakeholders were interviewed. Actionable learning points were generated from the thematic analysis. Patient involvement and participant engagement were seen as critical to the success of RDCTs where in-person contact is minimal or nonexistent. Involving patients in identifying the research question, creating recruitment materials, apps and websites, and providing ongoing feedback to trial participants were regarded as facilitating recruitment and engagement. Building strong relationships early with trial partners was thought to support RDCT conduct. Multiple modes of capturing information, including patient-reported outcomes (PROs) and routinely collected data, were felt to contribute to data completeness. However, RDCTs may transfer trial activity burden onto participants and remote-working research staff, therefore additional support may be needed. CONCLUSION: RDCTs will continue to face challenges in implementing novel technologies. However, maximising patient and partner involvement, reducing participant and staff burden, and simplifying how participants and staff interact with the RDCT may facilitate their implementation.

How (not) to promote sub-national ownership of national initiatives in decentralised health systems: The free maternal and child health programme in Nigeria, 2008-2015.

BACKGROUND: Promoting the sub-national ownership of national health initiatives is essential for efforts to achieve national health goals in federal systems where sub-national governments are semi-autonomous. Between 2008 and 2015, Nigerian government implemented a pilot free maternal and child health (MCH) programme in selected states to improve MCH by reducing physical and financial barriers of access to services. This study was conducted to better understand why the programme was neither adopted nor scaled-up by sub-national governments after pilot phase. METHODS: We conducted a qualitative evaluation of the programme in Imo and Niger States, with data from programme documents, in-depth interviews (45) and focus group discussions (16) at State and community levels. Data was analysed using manual thematic coding approach. RESULT: Our analysis indicates that the programme design had two mutually dependent goals, which were also in tension with one another: 1. To ensure programme performance, the designers sought to shield its implementation from sub-national government politics and bureaucracy; and 2. To gain the buy-in of the same sub-national government politicians and bureaucrats, the designers sought to demonstrate programme performance. The potential for community advocacy for sub-national adoption and scale-up was not considered in the design. Therefore, limited involvement of sub-national governments in the programme design limited sub-national ownership during implementation. And limited oversight of implementation by sub-national government policymakers limited programme performance. CONCLUSION: Efforts to promote sub-national ownership of national initiatives in decentralised health systems should prioritise inclusiveness in design, implementation, and oversight, and well-resourced community advocacy to sub-national governments for adoption and scale-up.

Real-Time Anomaly Detection for an ADMM-Based Optimal Transmission Frequency Management System for IoT Devices.

In this paper, we investigate different scenarios of anomaly detection on decentralised Internet of Things (IoT) applications. Specifically, an anomaly detector is devised to detect different types of anomalies for an IoT data management system, based on the decentralised alternating direction method of multipliers (ADMM), which was proposed in our previous work. The anomaly detector only requires limited information from the IoT system, and can be operated using both a mathematical-rule-based approach and the deep learning approach proposed in the paper. Our experimental results show that detection based on mathematical approach is simple to implement, but it also comes with lower detection accuracy (78.88%). In contrast, the deep-learning-enabled approach can easily achieve a higher detection accuracy (96.28%) in the real world working environment.

The Structural Role of Smart Contracts and Exchanges in the Centralisation of Ethereum-Based Cryptoassets.

In this paper, we use the methods of networks science to analyse the transaction networks of tokens running on the Ethereum blockchain. We start with a deep dive on four of them: Ampleforth (AMP), Basic Attention Token (BAT), Dai (DAI) and Uniswap (UNI). We study two types of blockchain addresses, smart contracts (SC), which run code, and externally owned accounts (EOA), run by human users, or off-chain code, with the corresponding private keys. We use preferential attachment and network dismantling strategies to evaluate their importance for the network structure. Subsequently, we expand our view to all ERC-20 tokens issued on the Ethereum network. We first study multilayered networks composed of Ether (ETH) and individual tokens using a dismantling approach to assess how the deconstruction starting from one network affects the other. Finally, we analyse the Ether network and Ethereum-based token networks to find similarities between sets of high-degree nodes. For this purpose, we use both the traditional Jaccard Index and a new metric that we introduce, the Ordered Jaccard Index (OJI), which considers the order of the elements in the two sets that are compared. Our findings suggest that smart contracts and exchange-related addresses play a structural role in transaction networks both in DeFi and Ethereum. The presence in the network of nodes associated to addresses of smart contracts and exchanges is positively correlated with the success of the token network measured in terms of network size and market capitalisation. These nodes play a fundamental role in the centralisation of the supposedly decentralised finance (DeFi) ecosystem: without them, their networks would quickly collapse.

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa.

BACKGROUND: The South African government is implementing National Health Insurance (NHI) as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage (UHC). Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans Contracting Units for Primary healthcare (PHC) Services (CUPS) to function as either independent sub-district purchasers or public providers and District Health Management Offices (DHMOs) to support and monitor these CUPS. This decentralised operational unit of PHC, the heartbeat of NHI, is critical to the success of NHI. The views of district-level managers, who are responsible for these units, are fundamental to this NHI implementation. This qualitative study aimed to explore district and sub-district managerial views on NHI and their role in its implementation. METHODS: Purposive sampling was used to identify key respondents from a major urban district in Gauteng, South Africa, for participation in in-depth interviews. This study used framework analysis methodology within MaxQDA software. RESULTS: Three main themes were identified: managerial engagement in NHI policy development (with two sub-themes), managerial views on NHI (with three sub-themes) and perceptions of current NHI implementation (with six sub-themes). The managers viewed NHI as a social and moral imperative but lacked clarity and insight into the NHI Bill as well as the associated implementation strategies. The majority of respondents had not had the opportunity to engage in NHI policy formulation. Managers cited several pitfalls in current organisational operations. The respondents felt that national and provincial governments continue to function in a detached and rigid top-down hierarchy. Managers highlighted the need for their inclusion in NHI policy formulation and training and development for them to oversee the implementation strategies. CONCLUSIONS: It appears that strategic purchasing is not being operationalised in PHC. NHI policy implementation appears to function in a rigid top-down hierarchy that excludes key stakeholders in the NHI implementation strategy. The findings of this study suggest an inadequate decentralisation of healthcare governance within the public sector necessary to attain UHC. District managers need to be engaged and capacitated to operationalise the planned decentralised purchasing-provision function of the DHS within the NHI Bill.

Health workforce response to Covid-19: What pandemic preparedness planning and action at the federal and state levels in Germany?: Germany's health workforce responses to Covid-19.

INTRODUCTION: The Covid-19 pandemic has required countries to prepare their health workforce for a rapid increase of patients. This research aims to analyse the planning and health workforce policies in Germany, a country with a largely decentralised workforce governance mechanism. METHODS: Systematic search between 18 and 31 May 2020 at federal and 16 states on health workforce action and planning (websites of ministries of health, public health authorities), including pandemic preparedness plans and policies. The search followed World Health Organisation (WHO) Europe's health workforce guidance on Covid-19. Content analysis was performed, informed by the themes of WHO. RESULTS: The pandemic preparedness plans consisted of no or limited information on how to expand and prepare the health workforce during pandemics. The 16 states varied considerably regarding implementing strategies to expand health workforce capacities. Only one state adopted a policy on task-shifting despite a federal law on task-shifting during pandemics. CONCLUSIONS: Planning on the health workforce, its capacity and skill-mix during pandemics was limited in the pandemic response plans. Actions during the peak of the pandemic varied considerably across states, were implemented ad hoc and with limited planning. Future action should focus on integrated planning and evaluation of workforce policies.

Blockchain-Based Access Control Scheme for Secure Shared Personal Health Records over Decentralised Storage.

Blockchain technology provides a tremendous opportunity to transform current personal health record (PHR) systems into a decentralised network infrastructure. However, such technology possesses some drawbacks, such as issues in privacy and storage capacity. Given its transparency and decentralised features, medical data are visible to everyone on the network and are inappropriate for certain medical applications. By contrast, storing vast medical data, such as patient medical history, laboratory tests, X-rays, and MRIs, significantly affect the repository storage of blockchain. This study bridges the gap between PHRs and blockchain technology by offloading the vast medical data into the InterPlanetary File System (IPFS) storage and establishing an enforced cryptographic authorisation and access control scheme for outsourced encrypted medical data. The access control scheme is constructed on the basis of the new lightweight cryptographic concept named smart contract-based attribute-based searchable encryption (SC-ABSE). This newly cryptographic primitive is developed by extending ciphertext-policy attribute-based encryption (CP-ABE) and searchable symmetric encryption (SSE) and by leveraging the technology of smart contracts to achieve the following: (1) efficient and secure fine-grained access control of outsourced encrypted data, (2) confidentiality of data by eliminating trusted private key generators, and (3) multikeyword searchable mechanism. Based on decisional bilinear Diffie-Hellman hardness assumptions (DBDH) and discrete logarithm (DL) problems, the rigorous security indistinguishability analysis indicates that SC-ABSE is secure against the chosen-keyword attack (CKA) and keyword secrecy (KS) in the standard model. In addition, user collusion attacks are prevented, and the tamper-proof resistance of data is ensured. Furthermore, security validation is verified by simulating a formal verification scenario using Automated Validation of Internet Security Protocols and Applications (AVISPA), thereby unveiling that SC-ABSE is resistant to man-in-the-middle (MIM) and replay attacks. The experimental analysis utilised real-world datasets to demonstrate the efficiency and utility of SC-ABSE in terms of computation overhead, storage cost and communication overhead. The proposed scheme is also designed and developed to evaluate throughput and latency transactions using a standard benchmark tool known as Caliper. Lastly, simulation results show that SC-ABSE has high throughput and low latency, with an ultimate increase in network life compared with traditional healthcare systems.

Autonomous Navigation of a Team of Unmanned Surface Vehicles for Intercepting Intruders on a Region Boundary.

We study problems of intercepting single and multiple invasive intruders on a boundary of a planar region by employing a team of autonomous unmanned surface vehicles. First, the problem of intercepting a single intruder has been studied and then the proposed strategy has been applied to intercepting multiple intruders on the region boundary. Based on the proposed decentralised motion control algorithm and decision making strategy, each autonomous vehicle intercepts any intruder, which tends to leave the region by detecting the most vulnerable point of the boundary. An efficient and simple mathematical rules based control algorithm for navigating the autonomous vehicles on the boundary of the see region is developed. The proposed algorithm is computationally simple and easily implementable in real life intruder interception applications. In this paper, we obtain necessary and sufficient conditions for the existence of a real-time solution to the considered problem of intruder interception. The effectiveness of the proposed method is confirmed by computer simulations with both single and multiple intruders.

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit.

BACKGROUND: Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited. OBJECTIVES: The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU). METHODS: Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data. RESULTS: A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction. CONCLUSIONS: Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.

A Challenge-Response Assisted Authorisation Scheme for Data Access in Permissioned Blockchains.

Permissioned blockchains can be applied for sharing data among permitted users to authorise the data access requests in a permissioned blockchain. A consensus network constructed using pre-selected nodes should verify a data requester's credentials to determine if he or she have the correct permissions to access the queried data. However, current studies do not consider how to protect users' privacy for data authorisation if the pre-selected nodes become untrusted, e.g., the pre-selected nodes are manipulated by attackers. When a user's credentials are exposed to pre-selected nodes in the consensus network during authorisation, the untrusted (or even malicious) pre-selected nodes may collect a user's credentials and other private information without the user's right to know. Therefore, the private data exposed to the consensus network should be tightly restricted. In this paper, we propose a challenge-response based authorisation scheme for permissioned blockchain networks named Challenge-Response Assisted Access Authorisation (CRA3) to protect users' credentials during authorisation. In CRA3, the pre-selected nodes in the consensus network do not require users' credentials to authorise data access requests to prevent privacy leakage when these nodes are compromised or manipulated by attackers. Furthermore, the computational burden on the consensus network for authorisation is reduced because the major computing work of the authorisation is executed by the data requester and provider in CRA3.

Intermittent Information-Driven Multi-Agent Area-Restricted Search.

The problem is a two-dimensional area-restricted search for a target using a coordinated team of autonomous mobile sensing platforms (agents). Sensing is characterised by a range-dependent probability of detection, with a non-zero probability of false alarms. The context is underwater surveillance using a swarm of amphibious drones equipped with active sonars. The paper develops an intermittent information-driven search strategy, which alternates between two phases: the fast and non-receptive displacement phase (called the ballistic phase) with a slow displacement and sensing phase (called the diffusive phase). The proposed multi-agent search strategy is carried out in a decentralised manner, which means that all computations (estimation and motion control) are done locally. Coordination of agents is achieved by exchanging the data with the neighbours only, in a manner which does not require global knowledge of the communication network topology.