Rise to Power

This chapter offers a reconstruction of Jovian’s rise to imperial power after Julian died in the Persian heartland. A few hours after Julian’s death, the army generals, the commanders of the legions and cavalry squadrons, as well as high civil officials assembled at the dawn of June 27, 363, to elect a successor. After the praetorian prefect Salutius had declined the emperorship and no agreement could be reached on a suitable candidate, the imperial guardsmen (protectores) put their commander (primicerius domesticorum) Jovian forward as the new emperor. He was soon accepted by the generals, high officials, and the complete army as their new ruler. Although sometimes argued otherwise, Jovian’s elevation to the throne was legitimate according to the primary sources. According to the Christian sources, Jovian initially refused to became emperor (recusatio imperii). Although Ammianus Marcellinus mentions that he was unfit for the emperorship, it is argued that Jovian’s background, his family connections (his own father Varronianus and his father-in-law Lucillianus), as well as his own military career, made him eligible for the emperorship. Nevertheless, Jovian was a compromise candidate and was made emperor not for his dynamic leadership, but in the expectation that he would work in collaboration with the senior staff (the men who had elected him) to get the army out of Persia and to lead the soldiers back to Roman territory.

Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia

Background Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics. Methods We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility. Results The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels. Conclusions HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.

Challenging the deficit discourse in medical schools through reverse mentoring—using discourse analysis to explore staff perceptions of under-represented medical students

IntroductionDespite the increasing diversity of UK medical students, students from low-socioeconomic backgrounds, some minority groups and members of communities with protected identities remain under-represented in medicine. In trying to ascertain why this under-representation persists, literature focuses on the barriers and challenges faced by under-represented students as opposed to the institution’s responsibility to remove or mitigate these obstacles. One UK University created a reverse mentoring scheme enabling students to mentor senior members of the medical faculty to help them understand the perspectives and experiences of students from minority backgrounds. This paper explores whether changes in staff perceptions of under-represented students resulted from engaging with reverse mentoring.MethodsThis qualitative study explored the impact of the reverse mentoring scheme. Staff mentees were required to write a narrative text about the Higher Education journey of an under-represented medical student before and after the reverse mentoring intervention. These texts were compared using discourse analysis to identify shifts in language use that demonstrated a change in perceptions.ResultsThe key themes from five senior staff members indicate a positive change in staff characterisation of the students and an acceptance of institutional responsibility for challenges faced. Initial texts revealed a superficial understanding of the student journey that focused on individual deficit but had fairy tale endings depicting the medical school as benevolent. The follow-up texts revealed a deeper understanding reflected by the portrayal of students as capable agents and containing pragmatic endings acknowledging the responsibility of the medical school.ConclusionThese findings highlight how removed senior staff can be from the reality of the student experience and that engaging with reverse mentoring helps to raise awareness and challenges the students face. This suggests a route for constructive change in medical schools and endorses the benefits of facilitating open discussion around educational inequity.

Examining Information System’s Usage and Performance Indicators Using Technology Utilization, Satisfaction and Performance

While the development of information systems in workplaces with the aim of achieving cost-effectiveness, efficiency and quality of service delivery remain sacrosanct, issues of effective utilization and its resultant implications on organizational performance remain critical from one context to another. Unfortunately, few studies had considered focusing on these causal relationships among information system deployments in the construction industry especially in developing countries like Nigeria. This work modelled the interactions causal relationships associated with task technology fit, system usage and performance variables using the TUSPEM model. Through convenience and stratified sampling techniques, the views of 136 senior staff including top level management staff, sectional heads and other senior staff of a construction firm in Nigeria were sought. Smart PLS structural equation modeling software was used for the analysis of the dataset. The result showed significant relationships between causal variables in the TUSPEM model such as Application utilization to performance (t-value 2.44, P< 0.02), utilization to user satisfaction (t-value 2.87, P< 0.01). TTF to performance (t-value 2.86, P< 0.06), satisfaction (t-value 4.40, P< 0.00), User attitude to utilization (t-value 5.40, P< 0.00). Computer 2self-efficacy to utilization (t-value 4.47, P< 0.00). User satisfaction to performance (t-value 2.47, P< 0.01). Critical appraisal and integration of quality feedback on information system usage and its resultant effects on the numerous information systems being deployed must not be sideline if the sustainability of information system is anything to go by. Other implications are discussed.

Job satisfaction of senior staff nurses in selected Upazila health complexes

A descriptive type of cross-sectional study was conducted with the objective to determine the status of job satisfaction of senior staff nurses working at Upazila Health Complex. A total of 152 senior staff nurses were selected purposively from 16 upazila health complex where data collection instrument was self- administered semi-structured questionnaire. Results revealed that the mean age of the respondents was 44.05±7.01 years. In education, majority of the respondents (72.4%, n=110) were diploma in nursing and 20.4% (n=31) BSc in nursing. Among them, 30.9% (n=47) respondents had monthly income from Tk. 21000-25000. Majority of the respondents (61.8%, n=94) had permanent job and 23.7% (n=36) respondents had temporary job. Majority of the respondents (60.6%, n=92) were working as senior stuff nurse for above eight years. Majority of the respondents (73.7%, n=112) had working experience above four years. Most of the respondents (86.2%, n=131) had national training. 36.8% (n=56) respondents were satisfied with the salary they got. Few of the respondents (8.6%, n=13) were satisfied with the working environment. 23.0% (n=35) respondents were dissatisfied with the freedom to choose own work. 22.4% (n=34) respondents were satisfied with recognition of performance at work. Most of the respondents (86.2%, n=131) respondents were neither satisfactory nor dissatisfactory with cooperation from superior. 18.4% (n=28) respondents were satisfied with relation with colleague. 28.9% (n=44) respondents were dissatisfied with job security. Majority of the respondents (64.8%, n=104) were neither satisfactory nor dissatisfactory with fringe benefit from service. Majority of the respondents (57.9%, n=88) respondents were dissatisfied with promotional scope. 39.5% (n=60) respondents were satisfied with the place of posting.16.4% (n=25) respondents were dissatisfied with opportunity for career advancement. Majority of the respondents (72.4%, n=110) were satisfied with their jobs. 17.8% (n=27) respondents had poor satisfaction level regarding their jobs. Majority of the respondents (51.3%, n=78) said that political influence affect their job satisfaction. 13.2% (n=20) respondents said that communication barrier affect their job satisfaction. Respondent’s age (p=0.004), educational status (p=0.030) and monthly family income (p=0.052) was significantly associated with level of job satisfaction. Special attention should be given for their promotional opportunity to increase their level of job satisfaction.

Fees of senior staff of Medical Service of the navy

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Factors determining the Knowledge of Nurses Towards COVID-19 at Tertiary Hospital, Sylhet

Introduction: COVID-19 virus has become a highly contagious disease as pandemic in the current situation over the world. As a communicable disease, COVID-19 can be transmitted so rapidly from nurse to nurse, patient to nurse and nurse to other group of people. Health care workers should know knowledge about this communicable disease. This is why we have done this study. Methods: The cross sectional study was conducted in Sylhet Women’s Medical College Hospital, Sylhet, Bangladesh; from January to June 2021. Face to face data was collected. Data was collected by researcher themselves. Collected data were checked, coded and transferred into the SPSS V22.0 for analyzing data. Frequency, percentages, mean and t-test statistics were calculated. Results: Among the participants, the age mean of senior staff nurse and junior staff nurse is 24.34 year and 33.66 year. The result shows that among senior staff nurse 25.74% was male and 74.26% was female, on the other hand among junior staff nurse, there was 100% female and no male junior staff nurse in this study. Among 134 participants of SSN, 86.77% and 96.32% were answered “yes” against “COVID-19 is communicable disease” and “COVID-19 is virus” where among 64 participants of JSN, 59.38% and 89.06% were answered “yes” against same questions. In case of “Yes” result, SSN is answer better than JSN which is statistically significant (p value is 0.006366). Conclusion: There is comparably better knowledge about COVID-19 disease to SSN than JSN. Health care workers must gain knowledge about such pandemic disease. By gaining well knowledge; everybody can stop spreading infection of COVID-19 disease.

Reimagining the World Bank: Global Public Goods in an Age of Crisis

For some time now, there has been a push for the World Bank to shift its focus toward global public goods (GPGs). These are goods that, once delivered, can be unrestrictedly consumed by most—if not all—countries on the planet. Nor are their benefits rivalrous. Moreover, the production of GPGs cannot be left to markets or individual countries, as these have suboptimal incentives to act. In the wake of the COVID-19 outbreak, the concept of GPGs has seen a revival of sorts, with the pandemic not only striking just as multilateralism was at its lowest ebb, but also serving as irrefutable proof that the world needs international collaboration now more than ever. Multilateral institutions, and in particular the World Bank—a leading global institution with global membership—can rightfully be regarded as a possible solution to many global challenges. Based on interviews conducted with World Bank senior staff, as well as numerous experts, this article discusses arguments in favor of such a strategic shift. While there are legitimate claims for the Bank becoming a full-fledged provider of GPGs, the institution’s historical roots and operational constraints make this an unlikely prospect.

714 Venous Thromboembolism Risk Re-Assessment Within 24 and 72 Hours After Admission (Closed-Loop Audit)

Introduction NICE and Poole Hospital guideline state venous thromboprophylaxis (VTE) risk assessment must be done on admission and at consultant review (within 24hr and 72hr after admission) Changing from paper to electronic patient records(EPR) system omits some mandatory protocols. Although VTE risk assessment on admission remains mandatory on EPR, records of re-assessment within 24 and 72hr becomes optional. Method 100 random patients admitted to the orthopaedic department, before and after implementation of change. Results The initial data indicates 0% of recording for re-assessment after admission. This action led to incorrect dosage and duration of chemical VTE prophylaxis in 20% of the patients. After presenting the data to stakeholders, an instruction of entering VTE re-assessment on EPR was done by a teaching session and by putting up posters. A discussion with the IT department resulted in setting up a dropdown-box for VTE re-assessment on EPR. Re-audit shows a slight improvement in the recording from 0% to 3% for within 24hr and 22% for within 72hr. Feedbacks indicates an insufficient time, a lack of senior staff member involvement and established workplace culture. Conclusions Despite some improvement, more junior and senior staff engagement, including cultural changes, are needed to achieve the national standard.