A Review of the Capability Options Development and Analysis System and the Role of Risk Management

DTIC Science & Technology

2006-08-01

Development Plan OF Objective Force SME Subject Matter Expertise S&T Science & Technology SWOT strengths, weaknesses, opportunities and threats...aircraft, or armoured vehicles. Rather it is the combination of people, organisation, equipment, systems and facilities to achieve a desired...Defence policy or Joint Service implications. They include ships, tanks, missile systems, armoured personnel carriers, major electronic systems, and

U.S. Support of Plan Colombia: Rethinking the Ends and Means

DTIC Science & Technology

2001-05-01

to thrive as long as there are dark corners of the international systems where traditional sovereign controls are weak or non -existent. The illicit...security debate involving U.S. policy in Colombia and the implementation of Plan Colombia. DOUGLAS C. LOVELACE, JR. Director Strategic Studies...crime more efficiently through effective international cooperation, which includes the press, judicial systems, and government officials on a broad

The Reemergence of the Arctic as a Strategic Location

DTIC Science & Technology

2008-05-22

opportunities, threats ( SWOT ) analysis for each instrument. The paper will conclude with Chapter 3, which will draw on American foreign policy traditions to...identifies strengths, weaknesses, opportunities, and threats ( SWOT ). Diplomacy Strengths. Relationships. As seen in the political system...around Oulu in northern Finland. It includes companies such as Nokia , and provides 3,000 jobs.242 Threats. Spiral into a “Downward Transitional

Education, Education and Indoctrination! Packaging Politics and the Three "Rs"

ERIC Educational Resources Information Center

Franklin, Bob

2004-01-01

This paper explores how recent Labour governments have tried systematically to package educational and other social policies for media presentation and public consumption. This concern has resulted in the criticism that Labour is concerned with policy presentation above content: strong on policy spin but weak on policy delivery. The first section…

Towards the implementation of malaria elimination policy in South Africa: the stakeholders' perspectives.

PubMed

Hlongwana, Khumbulani Welcome; Tsoka-Gwegweni, Joyce

2017-01-01

The past decade has seen substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight malaria. South Africa has been declared ready to institute malaria elimination. However, research on the factors that would affect this policy implementation is inadequate. To investigate the stakeholders' understanding of the malaria elimination policy in South Africa, including their perceived barriers and facilitators to effective policy implementation. The study followed a constructivist epistemological approach which manifests in phenomenological study design. Twelve purposively selected key informants from malaria researchers, provincial and national malaria programmes were interviewed using semi-structured interviews. Interview questions elicited interviewees' knowledge of the policy and its achievability, including any perceived barriers and facilitating factors to effective implementation. The hybrid approach was used to perform thematic data analysis. The dominant view was that malaria remains a problem in South Africa, exacerbated by staff attitudes and poor capacity, lack of resources, lack of new effective intervention tools, lack of intra- and inter-departmental collaboration, poor cross-border collaboration and weak stakeholder collaboration. Informants were concerned about the target year (2018) for elimination, and about the process followed in developing the policy, including the perceived malaria epidemiology shortfalls, regulatory issues and political context of the policy. Achievability of malaria elimination remains a subject of intense debate for a variety of reasons. These include the sporadic nature of malaria resurgence, raising questions about the contributions of malaria control interventions and climate to the transmission trends in South Africa. The shortage of resources, inadequate staff capacity, lack of any new effective intervention tools, and gaps in malaria epidemiology were key concerns, as was the superficially participative nature of the consultation process followed in developing the policy.

Citizens' Jury and Elder Care: Public Participation and Deliberation in Long-Term Care Policy in Thailand.

PubMed

Chuengsatiansup, Komatra; Tengrang, Kanisorn; Posayanonda, Tipicha; Sihapark, Siranee

2018-02-16

Health care policies for the elderly are complex, multidimensional, and contextually circumscribed. While engagement of health experts, economists, health care administrators, and political leaders is generally viewed as instrumental to the success and sustainability of eldercare programs, the elders themselves are often viewed as passive recipients of care and not included in the policy processes. Experiences and expectations from users' perspectives can be invaluable information for policy formulation and systems design. This paper examines a participatory policy process using a "citizens' jury" to promote public engagement in eldercare policy. The process was initiated by the National Health Commission Office in Thailand to explore how a citizens' jury as a model for civic deliberation can be utilized to provide sophisticated policy recommendations on long-term care policies for the elderly. The objectives of this paper are to (1) examine how public participation in health policy can be actualized through the citizens' jury as an operational model, (2) understand the strengths and weaknesses of the ways the idea was implemented, and (3) provide recommendations for further use of the model. Details of how a citizens' jury was deployed are discussed, with recommendations for further use provided at the end.

When Good Evidence Goes Bad: The Weak Evidence Effect in Judgment and Decision-Making

ERIC Educational Resources Information Center

Fernbach, Philip M.; Darlow, Adam; Sloman, Steven A.

2011-01-01

An indispensable principle of rational thought is that positive evidence should increase belief. In this paper, we demonstrate that people routinely violate this principle when predicting an outcome from a weak cause. In Experiment 1 participants given weak positive evidence judged outcomes of public policy initiatives to be less likely than…

From Santa Barbara to Washington: a person's and a nation's journey toward portable health information.

PubMed

Brailer, David J

2007-01-01

The Santa Barbara County Care Data Exchange recently decided to disband. Because I founded the Santa Barbara Project and went on to lead U.S. health information technology (IT) efforts, it has been suggested that federal health IT policy relied too heavily on the approach used in Santa Barbara. Concerns have been expressed that the U.S. health IT effort rests upon a weak foundation and may be unsustainable. Conversely, the lessons of Santa Barbara were evident to investigators, including myself, long before its termination. These lessons, not the original assumptions and methods used in Santa Barbara, were applied to federal policy.

The Effect of State Competitive Food and Beverage Regulations on Childhood Overweight and Obesity.

PubMed

Datar, Ashlesha; Nicosia, Nancy

2017-05-01

Policy efforts for combating childhood obesity have sought stronger state policies for regulating competitive foods and beverages (CF&Bs) available in schools. However, the evidence linking state policies to children's overall diet and body weight outcomes is limited and mixed, and experts have called for more rigorous studies that are able to address concerns about selection bias. The present study leverages a rare natural experiment where children in military families are "assigned" to different state policies, due to their military parent's periodic relocation, to examine whether state CF&B policies were associated with children's body mass index (BMI) and overweight or obesity. We analyzed data from 894 children (12-13 years old) in army families attending public schools located near 25 installations across 23 states in 2013. State CF&B policy measures from the Bridging the Gap project were linked to the child data. Primary outcomes included BMI z-scores and indicator for overweight or obesity. For a subsample of children with self-reported food frequency measures, we also examined the link between state CF&B policies and overall diet. All regression analyses adjusted for a rich set of child and family covariates. Having strong or weak policies was significantly associated with lower BMI z-scores, lower odds of overweight or obesity, and better dietary outcomes, relative to no policy. A portfolio of policies that includes multiple strong policies is likely needed to observe any meaningful changes in BMI and obesity. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Large-Scale Assessments and Educational Policies in Italy

ERIC Educational Resources Information Center

Damiani, Valeria

2016-01-01

Despite Italy's extensive participation in most large-scale assessments, their actual influence on Italian educational policies is less easy to identify. The present contribution aims at highlighting and explaining reasons for the weak and often inconsistent relationship between international surveys and policy-making processes in Italy.…

An Evaluation of the Policy Context on Psychosocial Risks and Mental Health in the Workplace in the European Union: Achievements, Challenges, and the Future.

PubMed

Leka, Stavroula; Jain, Aditya; Iavicoli, Sergio; Di Tecco, Cristina

2015-01-01

Despite the developments both in hard and soft law policies in the European Union in relation to mental health and psychosocial risks in the workplace, a review of these policies at EU level has not been conducted to identify strengths, weaknesses, and gaps to be addressed in the future. Keeping in mind that the aim should be to engage employers in good practice, ideally such policies should include key definitions and elements of the psychosocial risk management process, covering risk factors, mental health outcomes, risk assessment and preventive actions, or interventions. The current paper aims to fill this gap by reviewing hard and soft law policies on mental health in the workplace and psychosocial risks applicable at EU level and conducting a gap analysis according to a set of dimensions identified in models of good practice in this area. Our review of ninety-four policies in total revealed several gaps, especially in relation to binding in comparison to nonbinding policies. These are discussed in light of the context of policy-making in the EU, and recommendations are offered for future actions in this area.

An Evaluation of the Policy Context on Psychosocial Risks and Mental Health in the Workplace in the European Union: Achievements, Challenges, and the Future

PubMed Central

Leka, Stavroula; Jain, Aditya; Di Tecco, Cristina

2015-01-01

Despite the developments both in hard and soft law policies in the European Union in relation to mental health and psychosocial risks in the workplace, a review of these policies at EU level has not been conducted to identify strengths, weaknesses, and gaps to be addressed in the future. Keeping in mind that the aim should be to engage employers in good practice, ideally such policies should include key definitions and elements of the psychosocial risk management process, covering risk factors, mental health outcomes, risk assessment and preventive actions, or interventions. The current paper aims to fill this gap by reviewing hard and soft law policies on mental health in the workplace and psychosocial risks applicable at EU level and conducting a gap analysis according to a set of dimensions identified in models of good practice in this area. Our review of ninety-four policies in total revealed several gaps, especially in relation to binding in comparison to nonbinding policies. These are discussed in light of the context of policy-making in the EU, and recommendations are offered for future actions in this area. PMID:26557655

Dialectical thinking and fairness-based perspectives of affirmative action.

PubMed

Hideg, Ivona; Ferris, D Lance

2017-05-01

Affirmative action (AA) policies are among the most effective means for enhancing diversity and equality in the workplace, yet are also often viewed with scorn by the wider public. Fairness-based explanations for this scorn suggest AA policies provide preferential treatment to minorities, violating procedural fairness principles of consistent treatment. In other words, to promote equality in the workplace, effective AA policies promote inequality when selecting employees, and the broader public perceives this to be procedurally unfair. Given this inconsistency underlies negative reactions to AA policies, we argue that better preparing individuals to deal with inconsistencies can mitigate negative reactions to AA policies. Integrating theories from the fairness and cognitive styles literature, we demonstrate across 4 studies how dialectical thinking-a cognitive style associated with accepting inconsistencies in one's environment-increases support for AA policies via procedural fairness perceptions. Specifically, we found support for our propositions across a variety of AA policy types (i.e., strong and weak preference policies) and when conceptualizing dialectical thinking either as an individual difference or as a state that can be primed-including being primed by the framing of the AA policy itself. We discuss theoretical contributions and insights for policy-making at government and organizational levels. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

President Carter's Urban Policy: A Critique.

ERIC Educational Resources Information Center

Taylor, William L.

1978-01-01

The Carter Administration's urban policy is weak with respect to the targeting of Federal assistance to those communities most in need of help, and ignores the problem of restricted access to jobs, housing, and services. (Author/RLV)

Residual Inequity: Assessing the Unintended Consequences of New York City’s Clean Heat Transition

PubMed Central

Carrión, Daniel; Lee, W. Victoria; Hernández, Diana

2018-01-01

Energy policies and public health are intimately intertwined. In New York City, a series of policies, known as the Clean Heat Program (CHP), were designed to reduce air pollution by banning residual diesel fuel oils, #6 in 2015 and #4 by 2030. This measure is expected to yield environmental and public health benefits over time. While there is near-universal compliance with the #6 ban, a substantial number of buildings still use #4. In this paper, geographic analysis and qualitative interviews with stakeholders were used to interrogate the CHP’s policy implementation in Northern Manhattan and the Bronx. A total of 1724 (53%) of all residential residual fuel burning buildings are located in this region. Stakeholders reflected mostly on the need for the program, and overall reactions to its execution. Major findings include that government partnerships with non-governmental organizations were effectively employed. However, weaknesses with the policy were also identified, including missed opportunities for more rapid transitions away from residual fuels, unsuccessful outreach efforts, cost-prohibitive conversion opportunities, and (the perception of) a volatile energy market for clean fuels. Ultimately, this analysis serves as a case study of a unique and innovative urban policy initiative to improve air quality and, consequently, public health. PMID:29324717

Better Skills, Better Jobs, Better Lives: A Strategic Approach to Skills Policies

ERIC Educational Resources Information Center

OECD Publishing (NJ3), 2012

2012-01-01

Recognising both the complexity of skills policies and the potential for peer learning, the OECD has developed a global Skills Strategy that helps countries to identify the strengths and weaknesses of their national skills systems, benchmark them internationally, and develop policies that can transform better skills into better jobs, economic…

Child survival in England: Strengthening governance for health.

PubMed

Wolfe, Ingrid; Mandeville, Kate; Harrison, Katherine; Lingam, Raghu

2017-11-01

The United Kingdom, like all European countries, is struggling to strengthen health systems and improve conditions for child health and survival. Child mortality in the UK has failed to improve in line with other countries. Securing optimal conditions for child health requires a healthy society, strong health system, and effective health care. We examine inter-sectoral and intra-sectoral policy and governance for child health and survival in England. Literature reviews and universally applicable clinical scenarios were used to examine child health problems and English policy and governance responses for improving child health through integrating care and strengthening health systems, over the past 15 years. We applied the TAPIC framework for analysing policy governance: transparency, accountability, participation, integrity, and capacity. We identified strengths and weaknesses in child health governance in all the five domains. However there remain policy failures that are not fully explained by the TAPIC framework. Other problems with successfully translating policy to improved health that we identified include policy flux; policies insufficiently supported by delivery mechanisms, measurable targets, and sufficient budgets; and policies with unintended or contradictory aspects. We make recommendations for inter-sectoral and intra-sectoral child health governance, policy, and action to improve child health in England with relevant lessons for other countries. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

The Prevalence and Characteristics of E-Cigarette Users in the U.S.

PubMed Central

Levy, David T.; Yuan, Zhe; Li, Yameng

2017-01-01

Studies have examined the characteristics of individuals who use e-cigarettes, including sociodemographic and smoking characteristics, and the relationship of e-cigarette use to tobacco control policies. While most studies consider a subset of these characteristics with weak measures of regular e-cigarette use, this study uses a large, recent U.S. survey to simultaneously consider the association of each of these factors with different use measures. Data from the May 2014 Tobacco Use Supplement-Current Population Survey is supplemented with information on tobacco control policies. The prevalence of ever, current (at least 1 of the last 30 days), and regular (at least 20 of the last 30 days) e-cigarette use were 7.7%, 2.1% and 0.9%, implying that 27.0% of ever users were current users of which 45.3% were regular users. E-cigarette use varied by socio-demographic characteristics and by smoking status, and depended on the measure of use adopted. However, regardless of measures, e-cigarette use was higher among those smokers who smoked more cigarettes. The association with policies was generally weak, but we found more regular use by smokers in low tax and low tobacco control spending states. The results indicate that the user characteristics differ depending on the e-cigarette use measure. The measure of use should be carefully considered in analyzing how e-cigarette use affects cigarette use. PMID:29019917

Health care reform 2010: a fresh view on tort reform.

PubMed

Stimson, C J; Dmochowski, Roger; Penson, David F

2010-11-01

We reviewed the state of medical malpractice tort reform in the context of a new political climate and the current debate over comprehensive health care reform. Specifically we asked whether medical malpractice tort reform is necessary, and evaluated the strengths and weaknesses of contemporary reform proposals. The medical, legal and public policy literature related to medical malpractice tort reform was reviewed and synthesized. We include a primer for understanding the current structure of medical malpractice law, identify the goals of the current system and analyze whether these goals are presently being met. Finally, we describe and evaluate the strengths and weaknesses of the current reform proposals including caps on damages, safe harbors and health care courts. Medical malpractice tort law is designed to improve health care quality and appropriately compensate patients for medical malpractice injuries, but is failing on both fronts. Of the 3 proposed remedies, caps on damages do little to advance the quality and compensatory goals, while safe harbors and health care courts represent important advancements in tort reform. Tort reform should be included in the current health policy debate because the current medical malpractice system is not adequately achieving the basic goals of tort law. While safe harbors and health care courts both represent reasonable remedies, health care courts may be preferred because they do not rely on jury determination in the absence of strong medical evidence. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Fiscal Year 2010 U.S. Government Financial Statements: Federal Government Continues To Face Financial Management And Long-Term Fiscal Challenges

DTIC Science & Technology

2011-03-09

effective oversight of federal government programs and policies. Over the years, certain material weaknesses in internal control over...ineffective process for preparing the consolidated financial statements. In addition to the material weaknesses underlying these major impediments, GAO...noted material weaknesses involving billions of dollars in improper payments, information security, and tax collection activities. With regard to the

Moving forward with safety culture.

PubMed

Weber, Michael

2012-04-01

Radiation safety and protection of people are shared goals of the Health Physics Society (HPS) and the U.S. Nuclear Regulatory Commission (NRC). A positive safety culture contributes to achieving radiation safety and protection of people, which are important to both the HPS and the NRC. Through unprecedented collaboration and engagement with diverse stakeholders, the NRC and the stakeholders developed a Safety Culture Policy Statement. The policy statement defines safety culture and describes the traits of a positive safety culture. Consideration of both safety and security issues and the interface of safety and security are underlying principles that support the policy. Examination of significant events, both within the nuclear industry and in society at large, illustrates how weaknesses in these traits can contribute to the occurrence and consequences of safety incidents, including serious injury and loss of life. With the policy statement in place, the NRC is moving forward with outreach and education about safety culture. Health physicists and other radiation safety specialists play an essential role in enhancing safety culture.

[Hospital self-management policy in Chile: perceptions of decision-makers].

PubMed

Méndez, Claudio A; Miranda, Christian; Torres, M Cristina; Márquez, Myriam

2013-01-01

To learn the perceptions of decision-makers concerning the imple-men-t-ation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.

National Language Policy and Its Impacts on Second Language Reading Culture

ERIC Educational Resources Information Center

Azmi, Mohd Nazri Latiff

2013-01-01

This research concentrates on Malaysian language policy and its impacts on the development of English language (regarded as a second language in Malaysia) specifically on reading culture. The main objectives of this research are to investigate the weaknesses and strengths of the policy and also to come out with recommendations to improve the…

The Major Causes of Cost Growth in Defense Acquisition, Volume II: Main Body

DTIC Science & Technology

2009-12-01

confidence, it presents prima facie evidence not only of weaknesses in management oversight, including lax implementation of policies, but also in...responsibility to prepare independent estimates, and prompted a substantial increase in its staff.22 In the mid 1990s, OSD adopted the commercial business ...law, the authority to obligate funds for the program lapses if no certification is provided. In the case of one of the programs we studied, the Armed

Health Preemption Behind Closed Doors: Trade Agreements and Fast-Track Authority

PubMed Central

Crosbie, Eric; Gonzalez, Mariaelena

2014-01-01

Noncommunicable diseases result from consuming unhealthy products, including tobacco, which are promoted by transnational corporations. The tobacco industry uses preemption to block or reverse tobacco control policies. Preemption removes authority from jurisdictions where tobacco companies’ influence is weak and transfers it to jurisdictions where they have an advantage. International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate. Tobacco companies are using these agreements to preempt domestic authority over tobacco policy. Other transnational corporations that profit by promoting unhealthy foods could do the same. “Fast-track authority,” in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate. With international agreements binding governments to prioritize trade over health, transparency and public oversight of the trade negotiation process is necessary to safeguard public health interests. PMID:25033124

Health preemption behind closed doors: trade agreements and fast-track authority.

PubMed

Crosbie, Eric; Gonzalez, Mariaelena; Glantz, Stanton A

2014-09-01

Noncommunicable diseases result from consuming unhealthy products, including tobacco, which are promoted by transnational corporations. The tobacco industry uses preemption to block or reverse tobacco control policies. Preemption removes authority from jurisdictions where tobacco companies' influence is weak and transfers it to jurisdictions where they have an advantage. International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate. Tobacco companies are using these agreements to preempt domestic authority over tobacco policy. Other transnational corporations that profit by promoting unhealthy foods could do the same. "Fast-track authority," in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate. With international agreements binding governments to prioritize trade over health, transparency and public oversight of the trade negotiation process is necessary to safeguard public health interests.

Toward a New U.S. Chemicals Policy: Rebuilding the Foundation to Advance New Science, Green Chemistry, and Environmental Health

PubMed Central

Wilson, Michael P.; Schwarzman, Megan R.

2009-01-01

Objective We describe fundamental weaknesses in U.S. chemicals policy, present principles of chemicals policy reform, and articulate interdisciplinary research questions that should be addressed. With global chemical production projected to double over the next 24 years, federal policies that shape the priorities of the U.S. chemical enterprise will be a cornerstone of sustainability. To date, these policies have largely failed to adequately protect public health or the environment or motivate investment in or scientific exploration of cleaner chemical technologies, known collectively as green chemistry. On this trajectory, the United States will face growing health, environmental, and economic problems related to chemical exposures and pollution. Conclusions Existing policies have produced a U.S. chemicals market in which the safety of chemicals for human health and the environment is undervalued relative to chemical function, price, and performance. This market barrier to green chemistry is primarily a consequence of weaknesses in the Toxic Substances Control Act. These weaknesses have produced a chemical data gap, because producers are not required to investigate and disclose sufficient information on chemicals’ hazard traits to government, businesses that use chemicals, or the public; a safety gap, because government lacks the legal tools it needs to efficiently identify, prioritize, and take action to mitigate the potential health and environmental effects of hazardous chemicals; and a technology gap, because industry and government have invested only marginally in green chemistry research, development, and education. Policy reforms that close the three gaps—creating transparency and accountability in the market—are crucial for improving public and environmental health and reducing the barriers to green chemistry. The European Union’s REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation has opened an opportunity for the United States to take this step; doing so will present the nation with new research questions in science, policy, law, and technology. PMID:19672398

Toward a new U.S. chemicals policy: rebuilding the foundation to advance new science, green chemistry, and environmental health.

PubMed

Wilson, Michael P; Schwarzman, Megan R

2009-08-01

We describe fundamental weaknesses in U.S. chemicals policy, present principles of chemicals policy reform, and articulate interdisciplinary research questions that should be addressed. With global chemical production projected to double over the next 24 years, federal policies that shape the priorities of the U.S. chemical enterprise will be a cornerstone of sustainability. To date, these policies have largely failed to adequately protect public health or the environment or motivate investment in or scientific exploration of cleaner chemical technologies, known collectively as green chemistry. On this trajectory, the United States will face growing health, environmental, and economic problems related to chemical exposures and pollution. Existing policies have produced a U.S. chemicals market in which the safety of chemicals for human health and the environment is undervalued relative to chemical function, price, and performance. This market barrier to green chemistry is primarily a consequence of weaknesses in the Toxic Substances Control Act. These weaknesses have produced a chemical data gap, because producers are not required to investigate and disclose sufficient information on chemicals' hazard traits to government, businesses that use chemicals, or the public; a safety gap, because government lacks the legal tools it needs to efficiently identify, prioritize, and take action to mitigate the potential health and environmental effects of hazardous chemicals; and a technology gap, because industry and government have invested only marginally in green chemistry research, development, and education. Policy reforms that close the three gaps-creating transparency and accountability in the market-are crucial for improving public and environmental health and reducing the barriers to green chemistry. The European Union's REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation has opened an opportunity for the United States to take this step; doing so will present the nation with new research questions in science, policy, law, and technology.

The global health concept of the German government: strengths, weaknesses, and opportunities.

PubMed

Bozorgmehr, Kayvan; Bruchhausen, Walter; Hein, Wolfgang; Knipper, Michael; Korte, Rolf; Razum, Oliver; Tinnemann, Peter

2014-01-01

Recognising global health as a rapidly emerging policy field, the German federal government recently released a national concept note for global health politics (July 10, 2013). As the German government could have a significant impact on health globally by making a coherent, evidence-informed, and long-term commitment in this field, we offer an initial appraisal of the strengths, weaknesses, and opportunities for development recognised in this document. We conclude that the national concept is an important first step towards the implementation of a coherent global health policy. However, important gaps were identified in the areas of intellectual property rights and access to medicines. In addition, global health determinants such as trade, economic crises, and liberalisation as well as European Union issues such as the health of migrants, refugees, and asylum seekers are not adequately addressed. Furthermore, little information is provided about the establishment of instruments to ensure an effective inter-ministerial cooperation. Finally, because implementation aspects for the national concept are critical for the success of this initiative, we call upon the newly elected 2013 German government to formulate a global health strategy, which includes a concrete plan of action, a time scale, and measurable goals.

The global health concept of the German government: strengths, weaknesses, and opportunities

PubMed Central

Bozorgmehr, Kayvan; Bruchhausen, Walter; Hein, Wolfgang; Knipper, Michael; Korte, Rolf; Razum, Oliver; Tinnemann, Peter

2014-01-01

Recognising global health as a rapidly emerging policy field, the German federal government recently released a national concept note for global health politics (July 10, 2013). As the German government could have a significant impact on health globally by making a coherent, evidence-informed, and long-term commitment in this field, we offer an initial appraisal of the strengths, weaknesses, and opportunities for development recognised in this document. We conclude that the national concept is an important first step towards the implementation of a coherent global health policy. However, important gaps were identified in the areas of intellectual property rights and access to medicines. In addition, global health determinants such as trade, economic crises, and liberalisation as well as European Union issues such as the health of migrants, refugees, and asylum seekers are not adequately addressed. Furthermore, little information is provided about the establishment of instruments to ensure an effective inter-ministerial cooperation. Finally, because implementation aspects for the national concept are critical for the success of this initiative, we call upon the newly elected 2013 German government to formulate a global health strategy, which includes a concrete plan of action, a time scale, and measurable goals. PMID:24560258

Adaptation to Climatic Hazards in the Savannah Ecosystem: Improving Adaptation Policy and Action

NASA Astrophysics Data System (ADS)

Yiran, Gerald A. B.; Stringer, Lindsay C.

2017-10-01

People in Ghana's savannah ecosystem have historically experienced a range of climatic hazards that have affected their livelihoods. In view of current climate variability and change, and projected increases in extreme events, adaptation to climate risks is vital. Policies have been put in place to enhance adaptation across sub-Saharan Africa in accordance with international agreements. At the same time, local people, through experience, have learned to adapt. This paper examines current policy actions and their implementation alongside an assessment of barriers to local adaptation. In doing so it links adaptation policy and practice. Policy documents were analysed that covered key livelihood sectors, which were identified as climate sensitive. These included agriculture, water, housing and health policies, as well as the National Climate Change Policy. In-depth interviews and focus group discussions were also held with key stakeholders in the Upper East Region of Ghana. Analyses were carried using thematic content analysis. Although policies and actions complement each other, their integration is weak. Financial, institutional, social, and technological barriers hinder successful local implementation of some policy actions, while lack of local involvement in policy formulation also hinders adaptation practice. Integration of local perspectives into policy needs to be strengthened in order to enhance adaptation. Coupled with this is a need to consider adaptation to climate change in development policies and to pursue efforts to reduce or remove the key barriers to implementation at the local level.

White Paper Analysis of Human Resource Policy Considerations of Revitalization of Rural America. HRD & ALL Research Series.

ERIC Educational Resources Information Center

Geroy, Gary D.; Williams, Richard A.

The overall economic well-being of U.S. rural communities is on the decline. Rural America is now dependent on a highly diversified economy, and its problems will not be resolved through improved farm income alone. Various weaknesses in rural development policies must be addressed. The narrow policy focus on attracting manufacturing industries to…

Active Solidarity and Its Discontents.

PubMed

Trappenburg, M J

2015-09-01

Traditional welfare states were based on passive solidarity. Able bodied, healthy minded citizens paid taxes and social premiums, usually according to a progressive taxation logic following the ability to pay principle. Elderly, fragile, weak, unhealthy and disabled citizens were taken care of in institutions, usually in quiet parts of the country (hills, woods, sea side). During the nineteen eighties and nineties of the twentieth century, ideas changed. Professionals, patients and policy makers felt that it would be better for the weak and fragile to live in mainstream society, rather than be taken care of in institutions outside society. This might be cheaper too. Hence policy measures were taken to accomplish deinstitutionalization. This article discusses the implications of deinstitutionalization for distributive justice. It is argued that the weakest among the weak and fragile stand to lose from this operation. For able bodied citizens deinstitutionalization entails a move from passive to active solidarity. Rather than just pay taxes they have to actively care for and help the needy themselves. The move from passive to active solidarity tends to take advantage of benevolent citizens and burden the socioeconomically disadvantaged. This may be a reason to reconsider the policy move toward deinstitutionalization.

Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

PubMed Central

Griffiths, Karolina; Banjara, Megha Raj; O'Dempsey, T.; Munslow, B.; Kroeger, Axel

2013-01-01

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. PMID:23690789

Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries.

PubMed

Hawkins, Benjamin; Holden, Chris; Eckhardt, Jappe; Lee, Kelley

2018-01-01

Tobacco is widely considered to be a uniquely harmful product for human health. Since the mid-1990s, the strategies of transnational tobacco corporations to undermine effective tobacco control policy has been extensively documented through internal industry documents. Consequently, the sale, use and marketing of tobacco products are subject to extensive regulation and formal measures to exclude the industry from policy-making have been adopted in the Framework Convention on Tobacco Control. In contrast to tobacco, alcohol is subject to less stringent forms of regulation, and the alcohol industry continues to play a central role in policy-making in many countries and at the global level. This article examines whether there is a sufficient rationale for such different regulatory approaches, through a comparative analysis of the political economy of the tobacco and alcohol industries including the structure of the industries, and the market and political strategies they pursue. Despite some important differences, the extensive similarities which exist between the tobacco and alcohol industries in terms of market structure and strategy, and political strategy, call into question the rationale for both the relatively weak regulatory approach taken towards alcohol, and the continued participation of alcohol corporations in policy-making processes.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, Heidi, E-mail: heidi.mwalker@yahoo.ca; Sinclair, A. John, E-mail: john.sinclair@ad.umanitoba.ca; Spaling, Harry, E-mail: harry.spaling@kingsu.ca

Meaningful public engagement is a challenging, but promising, feature of strategic environmental assessment (SEA) due to its potential for integrating sustainability principles into policies, plans and programs in developing countries such as Kenya. This research examined two selected SEA case studies to identify the extent of participation, learning outcomes attributable to participation, and if any learning outcomes led to social action for sustainability at the community level. Strengths across the two cases were the inclusion of marginalized populations and consideration of socio-economic concerns. Consistent weaknesses included inadequate notice, document inaccessibility, lack of feedback and communication, and late analysis of alternatives.more » Despite some learning conditions being unfulfilled, examples of instrumental, communicative, and transformative learning were identified through a focus group and semi-structured interviews with community participants and public officials. Some of these learning outcomes led to individual and social actions that contribute to sustainability. -- Highlights: • The strengths and weaknesses of Kenyan SEA public participation processes were identified. • Multiple deficiencies in the SEA process likely frustrate meaningful public engagement. • Participant learning was observed despite process weaknesses. • Participant learning can lead to action for sustainability at the community level.« less

Kuwait: Security, Reform, and U.S. Policy

DTIC Science & Technology

2014-01-30

is a member of the Middle East North Africa Financial Action Task Force ( FATF ), but it has been identified by that body as having deficiencies in...Security, Reform, and U.S. Policy Congressional Research Service 24 has developed an action plan with the FATF to address the weaknesses. Some Kuwait

Time to refine key climate policy models

NASA Astrophysics Data System (ADS)

Barron, Alexander R.

2018-05-01

Ambition regarding climate change at the national level is critical but is often calibrated with the projected costs — as estimated by a small suite of energy-economic models. Weaknesses in several key areas in these models will continue to distort policy design unless collectively addressed by a diversity of researchers.

Candlestick and Faces: Aspects of Lifelong Learning.

ERIC Educational Resources Information Center

Hunt, Cheryl

1999-01-01

Government policies view lifelong learning in terms of economic development. A SWOT (strengths, weaknesses, opportunities, threats) analysis of the environment of British community education councils revealed other views of lifelong learning: it takes time and political expediency and national policy can adversely affect what and how people learn.…

Educational Needs on Palliative Care for Cancer Patients in Iran: A SWOT Analysis.

PubMed

Ansari, Mojgan; Rassouli, Maryam; Akbari, Mohamad Esmaiel; Abbaszadeh, Abbas; Akbari Sari, Ali

2018-04-01

By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder's educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran. This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes. A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included: "academic education planning", "workforce education", "public awareness", and "patient and caregiver empowerment" that contained our subcategories as follows: "strengths", "weaknesses", "opportunities" and "threats" (SWOT). Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced.

Framework for assessing the capacity of a health ministry to conduct health policy processes--a case study from Tajikistan.

PubMed

Mirzoev, Tolib N; Green, Andrew; Van Kalliecharan, Ricky

2015-01-01

An adequate capacity of ministries of health (MOH) to develop and implement policies is essential. However, no frameworks were found assessing MOH capacity to conduct health policy processes within developing countries. This paper presents a conceptual framework for assessing MOH capacity to conduct policy processes based on a study from Tajikistan, a former Soviet republic where independence highlighted capacity challenges. The data collection for this qualitative study included in-depth interviews, document reviews and observations of policy events. Framework approach for analysis was used. The conceptual framework was informed by existing literature, guided the data collection and analysis, and was subsequently refined following insights from the study. The Tajik MOH capacity, while gradually improving, remains weak. There is poor recognition of wider contextual influences, ineffective leadership and governance as reflected in centralised decision-making, limited use of evidence, inadequate actors' participation and ineffective use of resources to conduct policy processes. However, the question is whether this is a reflection of lack of MOH ability or evidence of constraining environment or both. The conceptual framework identifies five determinants of robust policy processes, each with specific capacity needs: policy context, MOH leadership and governance, involvement of policy actors, the role of evidence and effective resource use for policy processes. Three underlying considerations are important for applying the capacity to policy processes: the need for clear focus, recognition of capacity levels and elements, and both ability and enabling environment. The proposed framework can be used in assessing and strengthening of the capacity of different policy actors. Copyright © 2013 John Wiley & Sons, Ltd.

Automated survey of 8000 plan checks at eight facilities.

PubMed

Halabi, Tarek; Lu, Hsiao-Ming; Bernard, Damian A; Chu, James C H; Kirk, Michael C; Hamilton, Russell J; Lei, Yu; Driewer, Joseph

2016-09-01

To identify policy and system related weaknesses in treatment planning and plan check work-flows. The authors' web deployed plan check automation solution, PlanCheck, which works with all major planning and record and verify systems (demonstrated here for mosaiq only), allows them to compute violation rates for a large number of plan checks across many facilities without requiring the manual data entry involved with incident filings. Workflows and failure modes are heavily influenced by the type of record and verify system used. Rather than tackle multiple record and verify systems at once, the authors restricted the present survey to mosaiq facilities. Violations were investigated by sending inquiries to physicists running the program. Frequent violations included inadequate tracking in the record and verify system of total and prescription doses. Infrequent violations included incorrect setting of patient orientation in the record and verify system. Peaks in the distribution, over facilities, of violation frequencies pointed to suboptimal policies at some of these facilities. Correspondence with physicists often revealed incomplete knowledge of settings at their facility necessary to perform thorough plan checks. The survey leads to the identification of specific and important policy and system deficiencies that include: suboptimal timing of initial plan checks, lack of communication or agreement on conventions surrounding prescription definitions, and lack of automation in the transfer of some parameters.

A Business Of Security: Applying An Economic Model To Human Trafficking In Oregon

DTIC Science & Technology

2016-12-01

presents policy analysis under a qualitative cost - benefit lens to assess economic model variables applied to state level policies. The conclusion is...modern slavery, sex trafficking, labor trafficking, Oregon, supply and demand, cost - benefit analysis 15. NUMBER OF PAGES 129 16. PRICE CODE 17...analyzing weaknesses and gaps. The thesis presents policy analysis under a qualitative cost - benefit lens to assess economic model variables applied to

Controllability of control and mixture weakly dependent siphons in S3PR

NASA Astrophysics Data System (ADS)

Hong, Liang; Chao, Daniel Y.

2013-08-01

Deadlocks in a flexible manufacturing system modelled by Petri nets arise from insufficiently marked siphons. Monitors are added to control these siphons to avoid deadlocks rendering the system too complicated since the total number of monitors grows exponentially. Li and Zhou propose to add monitors only to elementary siphons while controlling the other (strongly or weakly) dependent siphons by adjusting control depth variables. To avoid generating new siphons, the control arcs are ended at source transitions of process nets. This disturbs the original model more and hence loses more live states. Negative terms in the controllability make the control policy for weakly dependent siphons rather conservative. We studied earlier on the controllability of strongly dependent siphons and proposed to add monitors in the order of basic, compound, control, partial mixture and full mixture (strongly dependent) siphons to reduce the number of mixed integer programming iterations and redundant monitors. This article further investigates the controllability of siphons derived from weakly 2-compound siphons. We discover that the controllability for weakly and strongly compound siphons is similar. It no longer holds for control and mixture siphons. Some control and mixture siphons, derived from strongly 2-compound siphons are not redundant - no longer so for those derived from weakly 2-compound siphons; that is all control and mixture siphons are redundant. They do not need to be the conservative one as proposed by Li and Zhou. Thus, we can adopt the maximally permissive control policy even though new siphons are generated.

The politics of nursing: a case study--clinical grading.

PubMed

Gavin, J N

1995-08-01

This paper is a study of the clinical grading policy for nurses in the United Kingdom and the extent to which the participating groups in the policy development process realized their objectives. The study is based on the literature available at the time of the research and the results of structured interviews with a range of individuals involved in the policy process. The results expose the cleavages between the different representative groups on the staff side. They also shed light on the differing power bases of the groups involved. In particular, they expose the weakness of nursing as a professional pressure group and the strength of the state and its agents in determining the outcomes of policy in the public arena. It is suggested that this weakness vis-à-vis the state is responsible for the failure of nurses to achieve a reward system which recognizes the value of clinical nursing expertise, and that the 'clinical grading' system, in practice, is having the opposite effect. The policy is explored from its origins, its acceptance on to the political agenda, its negotiation and agreement, its contentious implementation, the final outcomes, and its failure to establish a valid 'clinical' pay structure.

Monitoring HIV and AIDS Related Policy Reforms: A Road Map to Strengthen Policy Monitoring and Implementation in PEPFAR Partner Countries

PubMed Central

2016-01-01

Achieving an AIDS-free generation will require the adoption and implementation of critical health policy reforms. However, countries with high HIV burden often have low policy development, advocacy, and monitoring capacity. This lack of capacity may be a significant barrier to achieving the AIDS-free generation goals. This manuscript describes the increased focus on policy development and implementation by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It evaluates the curriculum and learning modalities used for two regional policy capacity building workshops organized around the PEPFAR Partnership Framework agreements and the Road Map for Monitoring and Implementing Policy Reforms. A total of 64 participants representing the U.S. Government, partner country governments, and civil society organizations attended the workshops. On average, participants responded that their policy monitoring skills improved and that they felt they were better prepared to monitor policy reforms three months after the workshop. When followed-up regarding utilization of the Road Map action plan, responses were mixed. Reasons cited for not making progress included an inability to meet or a lack of time, personnel, or governmental support. This lack of progress may point to a need for building policy monitoring systems in high HIV burden countries. Because the success of policy reforms cannot be measured by the mere adoption of written policy documents, monitoring the implementation of policy reforms and evaluating their public health impact is essential. In many high HIV burden countries, policy development and monitoring capacity remains weak. This lack of capacity could hinder efforts to achieve the ambitious AIDS-free generation treatment, care and prevention goals. The Road Map appears to be a useful tool for strengthening these critical capacities. PMID:26914708

Medicines for the mind: policy-based "pull" incentives for creating breakthrough CNS drugs.

PubMed

Choi, Dennis W; Armitage, Robert; Brady, Linda S; Coetzee, Timothy; Fisher, William; Hyman, Steven; Pande, Atul; Paul, Steven; Potter, William; Roin, Benjamin; Sherer, Todd

2014-11-05

Several large pharmaceutical companies have selectively downsized their neuroscience research divisions, reflecting a growing view that developing drugs to treat brain diseases is more difficult and often more time-consuming and expensive than developing drugs for other therapeutic areas, and thus represents a weak area for investment. These withdrawals reduce global neuroscience translational capabilities and pose a serious challenge to society's interests in ameliorating the impact of nervous system diseases. While the path forward ultimately lies in improving understandings of disease mechanisms, many promising therapeutic approaches have already been identified, and rebalancing the underlying risk/reward calculus could help keep companies engaged in making CNS drugs. One way to do this that would not require upfront funding is to change the policies that regulate market returns for the most-needed breakthrough drugs. The broader neuroscience community including clinicians and patients should convene to develop and advocate for such policy changes. Copyright © 2014 Elsevier Inc. All rights reserved.

Diverse policy implications for future ozone and surface UV in a changing climate

NASA Astrophysics Data System (ADS)

Butler, A. H.; Daniel, J. S.; Portmann, R. W.; Ravishankara, A. R.; Young, P. J.; Fahey, D. W.; Rosenlof, K. H.

2016-06-01

Due to the success of the Montreal Protocol in limiting emissions of ozone-depleting substances, concentrations of atmospheric carbon dioxide, nitrous oxide, and methane will control the evolution of total column and stratospheric ozone by the latter half of the 21st century. As the world proceeds down the path of reducing climate forcing set forth by the 2015 Conference of the Parties to the United Nations Framework Convention on Climate Change (COP 21), a broad range of ozone changes are possible depending on future policies enacted. While decreases in tropical stratospheric ozone will likely persist regardless of the future emissions scenario, extratropical ozone could either remain weakly depleted or even increase well above historical levels, with diverse implication for ultraviolet (UV) radiation. The ozone layer’s dependence on future emissions of these gases creates a complex policy decision space for protecting humans and ecosystems, which includes unexpected options such as accepting nitrous oxide emissions in order to maintain historical column ozone and surface UV levels.

Policy Analysis of Road Traffic Injury Prevention in Iran

PubMed Central

Azami-Aghdash, Saber; Gorji, Hassan Abolghasem; Shabaninejad, Hosein; Sadeghi-Bazargani, Homayoun

2017-01-01

Introduction Due to the large number of Road Traffic Injuries (RTIs) in Iran, authorities have implemented a number of policies for the prevention of RTIs. However, a scientific analysis of these policies has thus far been neglected. Therefore, this study was conducted for policy analysis of RTIs prevention in Iran. Methods This qualitative study with a case study approach was conducted in Iran during 2016 in two phases: First, by reviewing literature and documents of the past ten years, policies that have been executed to prevent RTIs in Iran were identified. In the second phase of the study, the identified policies were ranked by prioritization matrices. The two policies with the highest scores were selected. ‘Policy triangle framework’ was used for Policy analyzing. Stakeholders of these policies (42 people) were interviewed. Data were analyzed manually by implementing Content-Analysis methods. Results The policies of “pupil liaisons” and “safety belt” were selected for analysis from thirteen potential identified polices. The results of some studies revealed that safety belts had not been properly used in Iran (less than 80%). There was an eight-year hiatus between the approval of the safety belts policy and implementation of this policy. Eight actors were identified for safety belts policy. Lack of diligence in implementation of the policy, failing to pay adequate attention to education and the culture of driving, and failing to select an organization for the implementation of the policy, were identified as the main weaknesses of this policy. For ‘pupil liaisons’ policy, five actors were identified. Following the implementation of this policy, the number of penalties was reduced (17.9%). Neglecting scientific findings and individual-based nature of the policy were identified as the primary weaknesses of this policy. Conclusions Taking serious measures to properly execute the policy, educating people, selecting an efficient organization that is responsible for the implementation of the policies, and using international experience are the measures that can be taken to reduce the number of RTIs in the country. PMID:28243417

Guest Commentary: Fat and other taxes, lessons for the implementation of preventive policies.

PubMed

Caraher, Martin; Cowburn, Gill

2015-08-01

Fat, sugar or sweetened beverage taxes are part of an overall public health nutrition approach to healthy eating. They are not approaches that on their own are likely to bring about change. Policy evidence from existing food tax implementation suggest that taxes need to be paralleled by subsidies and other interventions to encourage healthy eating. Such dual methods help not only contribute to nutrition outcomes but also ensure political support for food taxes. Politicians and policy makers are suspicious of taxes, using subsidies and revenue monies from taxes to support healthy eating is more likely to encourage both political and public support. Building support for policies is never just a matter of academic evidence. Public health advocates need to show more ambition by developing skills in implementing pricing policies to support healthy eating. Key opponents to taxes are the food industry who use a range of arguments to prevent taxation being implemented. Public health advocates are weak in tackling the issues of corporate power and providing evidence to maintain policy and political support. The public health movement needs to continue to develop the political will among politicians and the public for taxes on food. A new way of looking at policy formation is required and this includes addressing the power of corporate interests and the role of professionals in shaping or combating these influences. Copyright © 2015 Elsevier Inc. All rights reserved.

Arab EFL Learners' Writing Dilemma at Tertiary Level

ERIC Educational Resources Information Center

Ezza, El-Sadig

2010-01-01

There is a general belief among researchers and speakers at conferences and symposia that Arab EFL Learners are primarily responsible for their weak writing performance. Educational policies usually evade criticism. This study is an attempt to show that educational policies can have their role in the learner's writing problems. Viz. it posits that…

West Virginia Department of Transportation (WVDOT) hosted a peer exchange from October 19 \\0x2010 October 22, 2010.

DOT National Transportation Integrated Search

2010-10-01

The expressed objectives of the Peer Exchange were to discuss : 1) A draft revised policy manual for the RSS Section that in its final form is clear, concise, : and a standalone document. : 2) Strengths and weaknesses of the outlined policies. : 3...

Opting Out: Parents Creating Contested Spaces to Challenge Standardized Tests

ERIC Educational Resources Information Center

Mitra, Dana; Mann, Bryan; Hlavacik, Mark

2016-01-01

We explore how the opt-out movement has responded to the combination of a stringent federal policy with weak and often variable implementation among the states. Gaps between federal expectations and states' understandings of just how to make NCLB's demands a reality have created policy ambiguity. Parents who oppose standardized testing have…

Pulmonary Metastasectomy: A Common Practice Based on Weak Evidence

PubMed Central

Treasure, Tom

2007-01-01

The resection of secondary metastases from the lungs is a wide-spread surgical practice. Patients are referred from coloproctology teams to thoracic surgeons specifically for this surgery. What is the expected benefit? I have explored the rationale and searched the literature in order to present these patients with a well-informed opinion for their consideration. I find only weak evidence based on uncontrolled retrospective series which have been interpreted as showing a survival benefit. This has been extrapolated to policy and practice that do not stand up to scrutiny. The practice has never been subjected to randomised trial and I will argue that the present evidence is insufficient to justify the uncontrolled use of an intervention with inescapable short-term morbidity, permanent loss of function, and major cost implications. I propose ways in which the evidence may be improved, including a trial in the areas of most uncertainty. PMID:17999813

Policy and Technology Readiness: Engaging the User and Developer Community to Develop a Research Roadmap

DOE Office of Scientific and Technical Information (OSTI.GOV)

Olson, Jarrod; Barr, Jonathan L.; Burtner, Edwin R.

A key challenge for research roadmapping in the crisis response and management domain is articulation of a shared vision that describes what the future can and should include. Visioning allows for far-reaching stakeholder engagement that can properly align research with stakeholders needs. Engagement includes feedback from researchers, policy makers, general public, and end-users on technical and non-technical factors. This work articulates a process and framework for the construction and maintenance of a stakeholder-centric research vision and roadmap in the emergency management domain. This novel roadmapping process integrates three pieces: analysis of the research and technology landscape, visioning, and stakeholder engagement.more » Our structured engagement process elicits research foci for the roadmap based on relevance to stakeholder mission, identifies collaborators, and builds consensus around the roadmap priorities. We find that the vision process and vision storyboard helps SMEs conceptualize and discuss a technology's strengths, weaknesses, and alignment with needs« less

How to buy a medical home? Policy options and practical questions.

PubMed

Berenson, Robert A; Rich, Eugene C

2010-06-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for "new" PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations.

How to Buy a Medical Home? Policy Options and Practical Questions

PubMed Central

Berenson, Robert A.

2010-01-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for “new” PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations. PMID:20467911

Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco.

PubMed

Witter, S; Boukhalfa, C; Cresswell, J A; Daou, Z; Filippi, V; Ganaba, R; Goufodji, S; Lange, I L; Marchal, B; Richard, F

2016-08-02

Across the Africa region and beyond, the last decade has seen many countries introducing policies aimed at reducing financial barriers to obstetric care. This article provides evidence of the cost and effects of national policies focussed on improving financial access to caesarean and facility deliveries in Benin, Burkina Faso, Mali and Morocco. The study uses a comparative case study design with mixed methods, including realist evaluation components. This article presents results across 14 different data collection tools, used in 4-6 research sites in each of the four study countries over 2011-13. The methods included: document review; interviews with key informants; analysis of secondary data; structured extraction from medical files; cross-sectional surveys of patients and staff; interviews with patients and observation of care processes. The article finds that the policies have contributed to continued increases in skilled birth attendance and caesarean sections and a narrowing of inequalities in all four countries, but these trends were already occurring so a shift cannot be attributed solely to the policies. It finds a significant reduction in financial burdens on households after the policy, suggesting that the financial protection objectives may have been met, at least in the short term, although none achieved total exemption of targeted costs. Policies are domestically financed and are potentially sustainable and efficient, and were relatively thoroughly implemented. Further, we find no evidence of negative effects on technical quality of care, or of unintended negative effects on untargeted services. We conclude that the policies were effective in meeting financial protection goals and probably health and equity goals, at sustainable cost, but that a range of measures could increase their effectiveness and equity. These include broadening the exempted package (especially for those countries which focused on caesarean sections alone), better calibrated payments, clearer information on policies, better stewardship of the local health system to deal with underlying systemic weaknesses, more robust implementation of exemptions for indigents, and paying more attention to quality of care, especially for newborns.

An Empirical Exploration of Selected Policy Options in Organ Donation.

ERIC Educational Resources Information Center

Klenow, Daniel J.; Youngs, George A., Jr.

1995-01-01

Presents findings from a mail survey of 414 persons regarding organ transplantation and donation policy issues. Gauged three measures of support for organ donation: donor card commitment, required request of next-of-kin support, and weak presumed consent support. High levels of support exist for organ donor cards and the next-of-kin law. Little…

Applying the School Health Index to a Nationally Representative Sample of Schools

ERIC Educational Resources Information Center

Brener, Nancy D.; Pejavara, Anu; Barrios, Lisa C.; Crossett, Linda; Lee, Sarah M.; McKenna, Mary; Michael, Shannon; Wechsler, Howell

2006-01-01

The School Health Index (SHI) is a self-assessment and planning tool that helps individual schools identify the strengths and weaknesses of their health policies and programs. To determine the percentage of US schools meeting the recommendations in the SHI, the present study analyzed data from the School Health Policies and Programs Study (SHPPS)…

Policies to Create and Destroy Human Capital in Europe. NBER Working Paper No. 15742

ERIC Educational Resources Information Center

Heckman, James J.; Jacobs, Bas

2010-01-01

Trends in skill bias and greater turbulence in modern labor markets put wages and employment prospects of unskilled workers under pressure. Weak incentives to utilize and maintain skills over the life-cycle become manifest with the ageing of the population. Policies to promote human capital formation reduce welfare state dependency among the…

Overview. Good Policy and Practice in HIV & AIDS and Education. Booklet 1

ERIC Educational Resources Information Center

Attawell, Kathy; Elder, Katharine

2006-01-01

This booklet is the first in a series of publications that address key themes of UNESCO's work on HIV & AIDS and the education sector. It provides an overview of why HIV and AIDS are important issues for the education sector, identifies weaknesses in current policy and programming responses, and highlights evidence gaps. Intended mainly for…

Simulation: The Effects of Simulation on High Stakes Testing in Undergradute Nursing Education

ERIC Educational Resources Information Center

Walters, Linda

2014-01-01

Many nursing programs use standardized testing packages in order to evaluate students' content mastery as well as predict probability of passing the National Council Licensure for Registered Nurses (NCLEX-RN). Instead of a diagnosis for weak content areas, programs implement testing policies in the belief that such policies ensure student success…

History and challenges of Brazilian social movements for the achievement of the right to adequate food.

PubMed

da Silva, Ana Carolina Feldenheimer; Recine, Elisabetta; Johns, Paula; Gomes, Fabio da Silva; Ferraz, Mariana de Araújo; Faerstein, Eduardo

2018-03-01

The historical struggles that Brazil faced to overcome malnutrition coincided with the empowerment of civil society and social movements which played a crucial role in the affirmation of health and food as social rights. After two decades under military dictatorship, Brazil went through a redemocratization process in the 1980s when activism emerged to demand spaces to participate in policy-making regarding the social agenda, including food and nutrition security (FNS). From 1988 onward institutional structures were established: the National Council of FNS (CONSEA) convenes government and civil society sectors to develop and monitor the implementation of policies, systems and actions. Social participation has been at the heart of structural changes achieved since then. Nevertheless, the country faces multiple challenges regarding FNS such as the double burden of disease, increasing use of pesticides and genetically modified seeds, weak regulation of ultra-processed products, and marketing practices that affect the environment, population health, and food sovereignty. This article aims at examining the development of the participatory political system and the role played by Brazilian social movements in the country's policies on FNS, in addition to outlining challenges faced by those policies.

Population-level interventions to reduce alcohol-related harm: an overview of systematic reviews.

PubMed

Martineau, Fred; Tyner, Elizabeth; Lorenc, Theo; Petticrew, Mark; Lock, Karen

2013-10-01

To analyse available review-level evidence on the effectiveness of population-level interventions in non-clinical settings to reduce alcohol consumption or related health or social harm. Health, social policy and specialist review databases between 2002 and 2012 were searched for systematic reviews of the effectiveness of population-level alcohol interventions on consumption or alcohol-related health or social outcomes. Data were extracted on review research aim, inclusion criteria, outcome indicators, results, conclusions and limitations. Reviews were quality-assessed using AMSTAR criteria. A narrative synthesis was conducted overall and by policy area. Fifty-two reviews were included from ten policy areas. There is good evidence for policies and interventions to limit alcohol sale availability, to reduce drink-driving, to increase alcohol price or taxation. There is mixed evidence for family- and community-level interventions, school-based interventions, and interventions in the alcohol server setting and the mass media. There is weak evidence for workplace interventions and for interventions targeting illicit alcohol sales. There is evidence of the ineffectiveness of interventions in higher education settings. There is a pattern of support from the evidence base for regulatory or statutory enforcement interventions over local non-regulatory approaches targeting specific population groups. © 2013.

Implementation of the free maternity services policy and its implications for health system governance in Kenya

PubMed Central

Smith, Helen

2017-01-01

Introduction To move towards universal health coverage, the government of Kenya introduced free maternity services in all public health facilities in June 2013. User fees are, however, important sources of income for health facilities and their removal has implications for the way in which health facilities are governed. Objective To explore how implementation of Kenya’s financing policy has affected the way in which the rules governing health facilities are made, changed, monitored and enforced. Methods Qualitative research was carried out using semistructured interviews with 39 key stakeholders from six counties in Kenya: 10 national level policy makers, 10 county level policy makers and 19 implementers at health facilities. Participants were purposively selected using maximum variation sampling. Data analysis was informed by the institutional analysis framework, in which governance is defined by the rules that distribute roles among key players and shape their actions, decisions and interactions. Results Lack of clarity about the new policy (eg, it was unclear which services were free, leading to instances of service user exploitation), weak enforcement mechanisms (eg, delayed reimbursement to health facilities, which led to continued levying of service charges) and misaligned incentives (eg, the policy led to increased uptake of services thereby increasing the workload for health workers and health facilities losing control of their ability to generate and manage their own resources) led to weak policy implementation, further complicated by the concurrent devolution of the health system. Conclusion The findings show the consequences of discrepancies between formal institutions and informal arrangements. In introducing new policies, policy makers should ensure that corresponding institutional (re)arrangements, enforcement mechanisms and incentives are aligned with the objectives of the implementers. PMID:29177098

Is research keeping up with changes in landscape policy? A review of the literature.

PubMed

Conrad, Elisabeth; Christie, Mike; Fazey, Ioan

2011-09-01

Several innovative directions for landscape policy development and implementation have emerged over recent years. These include: (i) an expansion of scope to include all landscape aspects and landscape types, (ii) an increased emphasis on public participation, (iii) a focus on designing measures appropriate for different contexts and scales, and (iv) encouraging support for capacity-building. In this paper, we evaluate the extent to which these policy directions are reflected in the practice of academic landscape research. We evaluate all research papers published in three leading landscape journals over six years, as well as published research papers relating directly to the European Landscape Convention. The latter, which was adopted in 2000, establishes a framework for landscape protection, planning and management in Europe and is to date the only international legal instrument of its kind. Results indicate that whilst policy innovations do not appear to be a major stimulus for academic research, studies nevertheless address a range of landscape aspects, types and scales (albeit with a slight bias towards bio-physical landscape aspects). However, geographical representativeness of research is weak and dominated by the United States and northern/western Europe, and research capacity likewise appears to be unevenly distributed. Landscape research is also limited in the extent to which it involves stakeholders or develops innovative methods for doing so, notwithstanding that this remains a key challenge for policy-makers. Results point to the potential for landscape research to address areas (topical and geographical) which have received little attention to date, as well as suggesting mutual benefits of stronger links between policy and academia. Copyright © 2011 Elsevier Ltd. All rights reserved.

How to Motivate Adults with Low Literacy and Numeracy Skills to Engage and Persist in Learning: A Literature Review of Policy Interventions

ERIC Educational Resources Information Center

Windisch, Hendrickje Catriona

2016-01-01

Low basic skills levels of adults are a complex policy problem which has neither straightforward causes nor solutions, and successful interventions are still relatively rare. Tackling serious literacy and numeracy weaknesses among adults is challenging, partly because the task itself is difficult, and partly because even if accomplished…

Space, place and (waiting) time: reflections on health policy and politics.

PubMed

Sheard, Sally

2018-02-19

Health systems have repeatedly addressed concerns about efficiency and equity by employing trans-national comparisons to draw out the strengths and weaknesses of specific policy initiatives. This paper demonstrates the potential for explicit historical analysis of waiting times for hospital treatment to add value to spatial comparative methodologies. Waiting times and the size of the lists of waiting patients have become key operational indicators. In the United Kingdom, as National Health Service (NHS) financial pressures intensified from the 1970s, waiting times have become a topic for regular public and political debate. Various explanations for waiting times include the following: hospital consultants manipulate NHS waiting lists to maintain their private practice; there is under-investment in the NHS; and available (and adequate) resources are being used inefficiently. Other countries have also experienced ongoing tensions between the public and private delivery of universal health care in which national and trans-national comparisons of waiting times have been regularly used. The paper discusses the development of key UK policies, and provides a limited Canadian comparative perspective, to explore wider issues, including whether 'waiting crises' were consciously used by policymakers, especially those brought into government to implement new economic and managerial strategies, to diminish the autonomy and authority of the medical professional in the hospital environment.

Biotic indices for assessing the status of coastal waters: a review of strengths and weaknesses.

PubMed

Martínez-Crego, Begoña; Alcoverro, Teresa; Romero, Javier

2010-05-01

Biotic indices have become key assessment tools in most recent national and trans-national policies aimed at improving the quality of coastal waters and the integrity of their associated ecosystems. In this study we analyzed 90 published biotic indices, classified them into four types, and analyzed the strengths and weaknesses of each type in relation to the requirements of these policies. We identified three main type-specific weaknesses. First, the problems of applicability, due to practical and conceptual difficulties, which affect most indices related to ecosystem function. Second, the failure of many indices based on structural attributes of the community (e.g. taxonomic composition) to link deterioration with causative stressors, or to provide an early-detection capacity. Third, the poor relevance to the ecological integrity of indices based on attributes at the sub-individual level (e.g. multi-biomarkers). Additionally, most indices still fail on two further aspects: the broad-scale applicability and the definition of reference conditions. Nowadays, the most promising approach seems to be the aggregation of indices with complementary strengths, and obtained from different biological communities.

Food terrorism and food defense on the Web.

PubMed

Taylor, Mary Kay

2008-01-01

Global food supplies are at risk of both accidental and deliberate contamination. As past incidents have demonstrated, food terrorism may cause social, economic, and political disruption. The United States increased its efforts to protect its food after 9/11 by broadening the roles of existing agencies, including the U.S. Department of Agriculture and the Food and Drug Administration, and by making coordination of food defense the responsibility of the Department of Homeland Security. However, weaknesses in the system remain. This article presents background information and Web sites useful for consumers, industry representatives, students, researchers, policy makers, and the librarians that serve them.

Childhood Asthma Disparities in Chicago: Developing Approaches to Health Inequities.

PubMed

Martin, Molly A; Kapheim, Melissa Gutierrez; Erwin, Kim; Ignoffo, Stacy; McMahon, Kate; OʼRourke, Amy; Gerald, Lynn B; Barrett, Meredith; Press, Valerie G; Darabi, Houshang; Krishnan, Jerry A

We conducted a needs assessment to develop an evidence-based, locally tailored asthma care implementation plan for high-risk children with asthma in Chicago. Our team of health policy experts, clinicians, researchers, and designers included extensive stakeholder engagement (N = 162) in a mixed-methods community needs assessment. Results showed the lines of communication and collaboration across sectors were weak; caregivers were the only consistent force and could not always manage this burden. A series of recommendations for interventions and how to implement and measure them were generated. Cooperative, multidisciplinary efforts grounded in the community can target wicked problems such as asthma.

Stakeholder perceptions of job stress in an industrialized country: implications for policy and practice.

PubMed

Page, Kathryn M; LaMontagne, Anthony D; Louie, Amber M; Ostry, Aleck S; Shaw, Andrea; Shoveller, Jeannie A

2013-08-01

We used a secondary, qualitative analysis of stakeholder perceptions of work stress in Australia to characterize the context for policy and practice intervention. Themes included: Individual versus contextual descriptions of stress; perceived 'gender' differences in manifesting and reporting of stress; the work/home interface; and perceived sectoral and occupational differences in compensation claim rates. We found that people often still perceive stress as an individual rather than organizational problem and view work stress as a stereotypically feminine weakness that affects only certain people. Organizations downplay and overlook risks, increasing worker reluctance to report stressors, creating barriers to job stress interventions. Our study may be relevant to other industrial countries where researchers currently study job stress interventions to improve their effectiveness. Comprehensive approaches can increase knowledge and decrease stigma about job stress and mental illness, and target both work- and non-work-related influences on mental health.

Foundation for the Future. 2013-2015 Strategic Plan. FY13 Organizational Performance Plan

DTIC Science & Technology

2013-01-01

Strengths, Weaknesses, Opportunities, and Threats ( SWOT ) Analysis 192013–2015 Strategic Plan tr t ic l The Planning, Policy, and Leadership Support (PPLS...participation of faculty and staff from across the University in this review. The review process begins with an analysis of organizational strengths...weaknesses, opportunities, and threats ( SWOT ). (The results of the SWOT are shown on page 18.) This is based on an environmental scan which identifi

Managing Strategic Change: An Executive Overview

DTIC Science & Technology

2003-06-01

strategic plan and policies based on the results of the environmental scan in comparison with the strengths and weaknesses of the organization...DISCLAIMER The views expressed in this report are those of the author and do not necessarily reflect official policy or position of...management echelon and has a time horizon consistent with the scanning abilities of the organization and set at the risk level (comfort zone) that

[Using SWOT to analyze breastfeeding education results in a medical center].

PubMed

Lee, Pei-Shan; Huang, Chiu-Mieh

2005-08-01

The breastfeeding rate within the first month after postpartum dropped from 95% in 1962 to 25% in 1989. As a result, the Department of Health, Executive Yuan, has made a lot of effort to promote a baby-friendly hospital policy since 2001, with the aim of increasing the breastfeeding rate. However, many studies have pointed out that the Department of Health is encountering difficulties when implementing this policy. This study is designed to use the Strengths, Weakness, Opportunities, and Threats (SWOT) Analysis to evaluate the development of breastfeeding education in a certain medical center. We divide those factors that influence the effect of this policy into extrinsic environmental factors and intrinsic environmental factors. The intrinsic environmental factors are the strengths and weaknesses of the baby-friendly hospital policy. The extrinsic environmental factors are the opportunities and threats. The SWOT Matrix is also applied to develop appropriate strategies to take the greatest possible advantage of opportunities available. With the SWOT approach, managers can not only readily extinguish intrinsic advantages from intrinsic disadvantages, but also recognize external opportunities and threats. Furthermore, it assists managers in resolving problems and turning adversity into opportunity. In providing the SWOT analysis, we hope clinical nursing staff will gain a better understanding of the baby-friendly hospital policy and deliver higher quality of health care for postpartum mothers, thus increasing the breastfeeding rate.

The SAZA study: implementing health financing reform in South Africa and Zambia.

PubMed

Gilson, Lucy; Doherty, Jane; Lake, Sally; McIntyre, Di; Mwikisa, Chris; Thomas, Stephen

2003-03-01

This paper explores the policy-making process in the 1990s in two countries, South Africa and Zambia, in relation to health care financing reforms. While much of the analysis of health reform programmes has looked at design issues, assuming that a technically sound design is the primary requirement of effective policy change, this paper explores the political and bureaucratic realities shaping the pattern of policy change and its impacts. Through a case study approach, it provides a picture of the policy environment and processes in the two countries, specifically considering the extent to which technical analysts and technical knowledge were able to shape policy change. The two countries' experiences indicate the strong influence of political factors and actors over which health care financing policies were implemented, and which not, as well as over the details of policy design. Moments of political transition in both countries provided political leaders, specifically Ministers of Health, with windows of opportunity in which to introduce new policies. However, these transitions, and the changes in administrative structures introduced with them, also created environments that constrained the processes of reform design and implementation and limited the equity and sustainability gains achieved by the policies. Technical analysts, working either inside or outside government, had varying and often limited influence. In part, this reflected the limits of their own capacity as well as weaknesses in the way they were used in policy development. In addition, the analysts were constrained by the fact that their preferred policies often received only weak political support. Focusing almost exclusively on designing policy reforms, these analysts gave little attention to generating adequate support for the policy options they proposed. Finally, the country experiences showed that front-line health workers, middle level managers and the public had important influences over policy implementation and its impacts. The limited attention given to communicating policy changes to, or consulting with, these actors only heightened the potential for reforms to result in unanticipated and unwanted impacts. The strength of the paper lies in its 'thick description' of the policy process in each country, an empirical case study approach to policy that is under-represented in the literature. While such an approach allows only a cautious drawing of general conclusions, it suggests a number of ways in which to strengthen the implementation of financing policies in each country.

Ethical issues in the translation of social neuroscience: a policy analysis of current guidelines for public dialogue in human research.

PubMed

Zimmerman, Emma; Racine, Eric

2012-01-01

Social neuroscience and its potential implications create an interesting case study for examining human research ethics policies on the topic of public communication of research. We reviewed mainstream national and international human research ethics guidelines and policies on issues of public communication of research. Our analysis relied on five thematic nets to capture the interactions between research and the public: public understanding, knowledge translation, public participation, social outcomes, and dual use. Coverage of these topics is sparse and inconsistent in mainstream policies and guidelines. We identify three options to address these gaps and analyze their strengths and weaknesses.

Bridging gaps in health information systems: a case study from Somaliland, Somalia.

PubMed

Askar, Ahmed; Ardakani, Malekafzali; Majdzade, Reza

2018-01-02

Reliable and timely health information is fundamental for health information systems (HIS) to work effectively. This case study aims to assess Somaliland HIS in terms of its contextual situation, major weaknesses and proposes key evidence-based recommendations. Data were collected through national level key informants' interviews, observations, group discussion and scoring using the HIS framework and assessment tool developed by World Health Organization Health Metrics Network (WHO/HMN). The study found major weaknesses including: no policy, strategic plan and legal framework in place; fragmented sub-information systems; Poor information and communications technology (ICT) infrastructure; poorly motivated and under-skilled personnel; dependence on unsustainable external funds; no census or civil registration in place; data from private health sector not captured; insufficient technical capacity to analyse data collected by HIS; and information is not widely shared, disseminated or utilized for decision-making. We recommend developing a national HIS strategic plan that harmonizes and directs collective efforts to become a more integrated, cost-effective and sustainable HIS.

Treatment for Myasthenia Gravis (MG)

MedlinePlus

... years. In some people the weakness may completely disappear. This is called a remission. The degree to ... Boards Site Map Privacy Policy Community Leaders Press/Media Contact Us Site Created by Kellen Interactive Web ...

The tobacco industry’s thwarting of marketing restrictions and health warnings in Lebanon

PubMed Central

Nakkash, R; Lee, K

2009-01-01

Aims: This article outlines how the tobacco industry has undermined tobacco control efforts in Lebanon since the early 1970s. Methods: An analysis of online and on-site tobacco industry documents, reviews of newspapers, policy and other documents, and interviews with key policy makers were conducted. Results: Findings reveal how the weakness of tobacco control legislation in Lebanon has been the product of an effective tobacco industry strategy to weaken the content and scope of regulation, and delay adoption and implementation. Conclusions: The tobacco industry has built and maintained strong alliances that were and are regularly mobilised to effectively oppose regulation. Despite ratification of the World Health Organization Framework Convention on Tobacco Control in 2005, Lebanon's tobacco control track remains weak. Public health professionals and the government should work hard to oppose such tobacco industry tactics. PMID:19633145

Quantum Barro-Gordon game in monetary economics

NASA Astrophysics Data System (ADS)

Samadi, Ali Hussein; Montakhab, Afshin; Marzban, Hussein; Owjimehr, Sakine

2018-01-01

Classical game theory addresses decision problems in multi-agent environment where one rational agent's decision affects other agents' payoffs. Game theory has widespread application in economic, social and biological sciences. In recent years quantum versions of classical games have been proposed and studied. In this paper, we consider a quantum version of the classical Barro-Gordon game which captures the problem of time inconsistency in monetary economics. Such time inconsistency refers to the temptation of weak policy maker to implement high inflation when the public expects low inflation. The inconsistency arises when the public punishes the weak policy maker in the next cycle. We first present a quantum version of the Barro-Gordon game. Next, we show that in a particular case of the quantum game, time-consistent Nash equilibrium could be achieved when public expects low inflation, thus resolving the game.

A systematic analysis of influenza vaccine shortage policies.

PubMed

Uscher-Pines, Lori; Barnett, Daniel J; Sapsin, Jason W; Bishai, David M; Balicer, Ran D

2008-02-01

The aim of this study was to apply SWOT analysis (strengths, weaknesses, opportunities, threats) to a domestic shortage of influenza vaccine, to identify lessons learned, and to generate effective solutions for future public health rationing emergencies. SWOT and TOWS techniques were employed to characterize the vulnerability of the USA to disruptions in the supply of influenza vaccine. A group of five researchers reviewed relevant literature, engaged in group brainstorming, and categorized elements according to the SWOT framework. Three strengths, five weaknesses, five threats and seven opportunities were identified in the areas of vaccine production, purchasing and distribution, and provision. Four future recommendations emerged with respect to government investment, communications, sanctioning of physicians, and incident command. Application of the SWOT technique is highly relevant to the health policy realm and can assist public health planners in planning for future resource scarcity.

The tobacco industry's thwarting of marketing restrictions and health warnings in Lebanon.

PubMed

Nakkash, R; Lee, K

2009-08-01

This article outlines how the tobacco industry has undermined tobacco control efforts in Lebanon since the early 1970s. An analysis of online and on-site tobacco industry documents, reviews of newspapers, policy and other documents, and interviews with key policy makers were conducted. Findings reveal how the weakness of tobacco control legislation in Lebanon has been the product of an effective tobacco industry strategy to weaken the content and scope of regulation, and delay adoption and implementation. The tobacco industry has built and maintained strong alliances that were and are regularly mobilised to effectively oppose regulation. Despite ratification of the World Health Organization Framework Convention on Tobacco Control in 2005, Lebanon's tobacco control track remains weak. Public health professionals and the government should work hard to oppose such tobacco industry tactics.

Model-Based Policymaking: A Framework to Promote Ethical "Good Practice" in Mathematical Modeling for Public Health Policymaking.

PubMed

Boden, Lisa A; McKendrick, Iain J

2017-01-01

Mathematical models are increasingly relied upon as decision support tools, which estimate risks and generate recommendations to underpin public health policies. However, there are no formal agreements about what constitutes professional competencies or duties in mathematical modeling for public health. In this article, we propose a framework to evaluate whether mathematical models that assess human and animal disease risks and control strategies meet standards consistent with ethical "good practice" and are thus "fit for purpose" as evidence in support of policy. This framework is derived from principles of biomedical ethics: independence, transparency (autonomy), beneficence/non-maleficence, and justice. We identify ethical risks associated with model development and implementation and consider the extent to which scientists are accountable for the translation and communication of model results to policymakers so that the strengths and weaknesses of the scientific evidence base and any socioeconomic and ethical impacts of biased or uncertain predictions are clearly understood. We propose principles to operationalize a framework for ethically sound model development and risk communication between scientists and policymakers. These include the creation of science-policy partnerships to mutually define policy questions and communicate results; development of harmonized international standards for model development; and data stewardship and improvement of the traceability and transparency of models via a searchable archive of policy-relevant models. Finally, we suggest that bespoke ethical advisory groups, with relevant expertise and access to these resources, would be beneficial as a bridge between science and policy, advising modelers of potential ethical risks and providing overview of the translation of modeling advice into policy.

Promoting research integrity in Africa: an African voice of concern on research misconduct and the way forward.

PubMed

Kombe, Francis; Anunobi, Eucharia Nkechinyere; Tshifugula, Nyanyukweni Pandeni; Wassenaar, Douglas; Njadingwe, Dimpho; Mwalukore, Salim; Chinyama, Jonathan; Randrianasolo, Bodo; Akindeh, Perpetua; Dlamini, Priscilla S; Ramiandrisoa, Felasoa Noroseheno; Ranaivo, Naina

2014-12-01

African researchers and their collaborators have been making significant contributions to useful research findings and discoveries in Africa. Despite evidence of scientific misconduct even in heavily regulated research environments, there is little documented information that supports prevalence of research misconduct in Africa. Available literature on research misconduct has focused on the developed world, where credible research integrity systems are already in place. Public attention to research misconduct has lately increased, calling for attention to weaknesses in current research policies and regulatory frameworks. Africa needs policies, structural and governance systems that promote responsible conduct of research. To begin to offset this relative lack of documented evidence of research misconduct, contributors working in various research institutions from nine African countries agreed to share their experiences to highlight problems and explore the need to identify strategies to promote research integrity in the African continent. The experiences shared include anecdotal but reliable accounts of previously undocumented research misconduct, including some 'normal misbehavior' of frontline staff in those countries. Two broad approaches to foster greater research integrity are proposed including promotion of institutional and individual capacity building to instil a culture of responsible research conduct in existing and upcoming research scientist and developing deterrent and corrective policies to minimize research misconduct and other questionable research practices. By sharing these experiences and through the strategies proposed, the authors hope to limit the level of research misconduct and promote research integrity in Africa. © 2013 John Wiley & Sons Ltd.

PROMOTING RESEARCH INTEGRITY IN AFRICA: AN AFRICAN VOICE OF CONCERN ON RESEARCH MISCONDUCT AND THE WAY FORWARD

PubMed Central

Kombe, Francis; Anunobi, Eucharia Nkechinyere; Tshifugula, Nyanyukweni Pandeni; Wassenaar, Douglas; Njadingwe, Dimpho; Mwalukore, Salim; Chinyama, Jonathan; Randrianasolo, Bodo; Akindeh, Perpetua; Dlamini, Priscilla S.; Ramiandrisoa, Felasoa Noroseheno; Ranaivo, Naina

2013-01-01

African researchers and their collaborators have been making significant contributions to useful research findings and discoveries in Africa. Despite evidence of scientific misconduct even in heavily regulated research environments, there is little documented information that supports prevalence of research misconduct in Africa. Available literature on research misconduct has focused on the developed world, where credible research integrity systems are already in place. Public attention to research misconduct has lately increased, calling for attention to weaknesses in current research policies and regulatory frameworks. Africa needs policies, structural and governance systems that promote responsible conduct of research. To begin to offset this relative lack of documented evidence of research misconduct, contributors working in various research institutions from nine African countries agreed to share their experiences to highlight problems and explore the need to identify strategies to promote research integrity in the African continent. The experiences shared include anecdotal but reliable accounts of previously undocumented research misconduct, including some ‘normal misbehavior’ of frontline staff in those countries. Two broad approaches to foster greater research integrity are proposed including promotion of institutional and individual capacity building to instil a culture of responsible research conduct in existing and upcoming research scientist and developing deterrent and corrective policies to minimize research misconduct and other questionable research practices. By sharing these experiences and through the strategies proposed, the authors hope to limit the level of research misconduct and promote research integrity in Africa. PMID:23594261

Vaccine vial monitor availability and use in low- and middle-income countries: A systematic review.

PubMed

Eriksson, Pär; Gessner, Bradford D; Jaillard, Philippe; Morgan, Christopher; Le Gargasson, Jean Bernard

2017-04-19

The vaccine vial monitor (VVM) registers cumulative heat exposure on vaccines over time. As low- and lower-middle-income countries transition beyond support from the Global Alliance for Vaccines and Immunization (Gavi), they will assume full responsibility for vaccine financing and procurement. It is unclear to what extent countries transitioning out of Gavi support will continue to include VVMs on their vaccines. This paper aims to systematically review evidence on VVM availability and use in low- and middle-income countries to document factors behind global access to and country demand for VVMs. Such results could help identify actions needed to ensure continued use of VVMs in countries that transition out of Gavi support. We performed a systematic review of electronic databases, reference lists, and grey literature in English and French languages with publication dates from 2005 onwards. The studies included were analyzed for the following outcomes: (1) availability and deployment of VVM-labeled vaccines; (2) VVM practices and perceptions in the immunization system; (3) vaccine introduction and decision-making processes; (4) Gavi graduation and vaccine program sustainability. The study found that VVM availability and use was affected by multiple sourcing of vaccines and the extent to which VVM was included in the vaccine specification in the tendering documents when procuring vaccines. Knowledge about VVM and its impact on the EPI program was found to be high among health workers as well as decision-makers. However, the study also found that weak capacity in key national institutions such as NRA and NPA might impact on demand for VVM. As countries take decisions regarding the adoption of new vaccines, factors such as disease burden and vaccine price may assume greater importance than vaccine characteristics and presentation. Finally, the study found that countries rely largely on the advice and recommendations from technical partners such as WHO and PAHO. The study concludes that global access to and country demand for VVM are dependent on policy statements and recommendations about VVM by key policy institutions such as WHO and UNICEF. The study also concludes that despite Gavi-eligible countries having access to VVM-labeled vaccines, inclusion is often below 100%. Weak institutional capacity in key national agencies such as NRA and NPA seems to be a contributing factor, while other factors include the procurement of clear national policies on the inclusion of VVM on vaccines, along with the capacity to enforce the policy. Finally, the study concludes that knowledge about VVM and its impact on vaccine program efficiency, safety, and cost is critical for transitioning countries' continuous demand for VVM. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Weak surveillance and policy attention to cancer in global health: the example of Mozambique

PubMed Central

Carrilho, Carla; Ismail, Mamudo R; Castillo, Paola; Augusto, Orvalho; Sidat, Mohsin; Menéndez, Clara; Garcia-Basteiro, Alberto L; Ordi, Jaume

2018-01-01

Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention. PMID:29607101

The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

PubMed Central

Gilson, Lucy; Raphaely, Nika

2008-01-01

This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern to support policy change. PMID:18650209

The influence of formal and informal policies and practices on health care innovation implementation: A mixed-methods analysis.

PubMed

DiMartino, Lisa D; Birken, Sarah A; Hanson, Laura C; Trogdon, Justin G; Clary, Alecia S; Weinberger, Morris; Reeder-Hayes, Katherine; Weiner, Bryan J

The implementation science literature has contributed important insights regarding the influence of formal policies and practices on health care innovation implementation, whereas informal implementation policies and practices have garnered little attention. The broader literature suggests that informal implementation policies and practices could also influence innovation use. We used the Organizational Theory of Innovation Implementation to further understand the role of formal and informal implementation policies and practices as determinants of implementation effectiveness. We examined their role within the context of initiatives to increase palliative care consultation in inpatient oncology. We used a case study design in two organizational settings within one academic medical center: medical and gynecologic oncology. We completed semistructured interviews with medical (n = 12) and gynecologic (n = 10) oncology clinicians using questions based on organizational theory. Quantitative data assessed implementation effectiveness, defined as aggregated palliative care consult rates within oncology services from 2010 to 2016. Four palliative care clinicians were interviewed to gain additional implementation context insights. Medical oncology employed multiple formal policies and practices including training and clinician prompting to support palliative care consultation and a top-down approach, yet most clinicians were unaware of the policies and practices, contributing to a weak implementation climate. In contrast, gynecologic oncology employed one formal policy (written guideline of criteria for initiating a consult) but also relied on informal policies and practices, such as spontaneous feedback and communication; they adopted a bottom-up approach, contributing to broader clinician awareness and strong implementation climate. Both services exhibited variable, increasing consult rates over time. Informal policies and practices may compensate or substitute for formal policies and practices under certain conditions (e.g., smaller health care organizations). Further research is needed to investigate the role of formal and informal policies and practices in shaping a strong and sustainable implementation climate and subsequent effective innovation implementation.

Meeting the Need for State-Level Estimates of Health Insurance Coverage: Use of State and Federal Survey Data

PubMed Central

Blewett, Lynn A; Davern, Michael

2006-01-01

Objective Critically review estimates of health insurance coverage available from different sources, including the federal government, state survey initiatives, and foundation-sponsored surveys for use in state policy research. Study Setting and Design We review the surveys in an attempt to flesh out the current weaknesses of survey data for state policy uses. The main data sources assessed in this analysis are federal government surveys (such as the Current Population Survey's Annual Social and Economic Supplement, and the National Health Interview Survey), foundation-supported surveys (National Survey of America's Families, and the Community Tracking Survey), and state-sponsored surveys. Principal Findings Despite information on estimates of health insurance coverage from six federal surveys, states find the data lacking for state policy purposes. We document the need for state representative data on the uninsured and the recent history of state data collection efforts spurred in part by the Health Resources Services Administration State Planning Grant program. We assess the state estimates of uninsurance from the Current Population Survey and make recommendations for a new consolidated federal survey with better state representative data. Conclusions We think there are several options to consider for coordinating a federal and state data collection strategy to inform state and national policy on coverage and access. PMID:16704521

Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

PubMed

Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

2007-10-06

The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

Alcohol industry influence on UK alcohol policy: A new research agenda for public health

PubMed Central

Hawkins, Benjamin; Holden, Chris; McCambridge, Jim

2012-01-01

The British government has been criticised for according industry interests too much weight in alcohol policy-making. Consequently, it has been argued that alcohol strategy in the UK is built around policies for which the evidence base is weak. This has clear implications for public health. The purpose of this commentary is to map recent developments in UK alcohol policy and related debates within the alcohol policy literature, thus laying the foundations for a systematic examination of the influence of the alcohol industry on alcohol policy. It highlights the changing structure of the industry and summarises what is known about the positions and strategies of industry actors towards alcohol policy. In so doing, it aims to contribute not just to debates about alcohol policy, but to a broader understanding of health policy processes and the relationships between government and other stakeholders. It advances a new research agenda focused on the role of corporate actors in the field of alcohol policy and public health more broadly. PMID:22815594

Alcohol industry influence on UK alcohol policy: A new research agenda for public health.

PubMed

Hawkins, Benjamin; Holden, Chris; McCambridge, Jim

2012-09-01

The British government has been criticised for according industry interests too much weight in alcohol policy-making. Consequently, it has been argued that alcohol strategy in the UK is built around policies for which the evidence base is weak. This has clear implications for public health. The purpose of this commentary is to map recent developments in UK alcohol policy and related debates within the alcohol policy literature, thus laying the foundations for a systematic examination of the influence of the alcohol industry on alcohol policy. It highlights the changing structure of the industry and summarises what is known about the positions and strategies of industry actors towards alcohol policy. In so doing, it aims to contribute not just to debates about alcohol policy, but to a broader understanding of health policy processes and the relationships between government and other stakeholders. It advances a new research agenda focused on the role of corporate actors in the field of alcohol policy and public health more broadly.

Coordination of the health policy dialogue process in Guinea: pre- and post-Ebola.

PubMed

Ade, Nadege; Réne, Adzodo; Khalifa, Mara; Babila, Kevin Ousman; Monono, Martin Ekeke; Tarcisse, Elongo; Nabyonga-Orem, Juliet

2016-07-18

Policy dialogue can be defined as an iterative process that involves a broad range of stakeholders discussing a particular issue with a concrete purpose in mind. Policy dialogue in health is increasingly being recognised by health stakeholders in developing countries, as an important process or mechanism for improving collaboration and harmonization in health and for developing comprehensive and evidence-based health sector strategies and plans. It is with this perspective in mind that Guinea, in 2013, started a policy dialogue process, engaging a plethora of actors to revise the country's national health policy and develop a new national health development plan (2015-2024). This study examines the coordination of the policy dialogue process in developing these key strategic governance documents of the Guinean health sector from the actors' perspective. A qualitative case study approach was undertaken, comprising of interviews with key stakeholders who participated in the policy dialogue process. A review of the literature informed the development of a conceptual framework and the data collection survey questionnaire. The results were analysed both inductively and deductively. A total of 22 out of 32 individuals were interviewed. The results suggest both areas of strengths and weaknesses in the coordination of the policy dialogue process in Guinea. The aspects of good coordination observed were the iterative nature of the dialogue and the availability of neutral and well-experienced facilitators. Weak coordination was perceived through the unavailability of supporting documentation, time and financial constraints experienced during the dialogue process. The onset of the Ebola epidemic in Guinea impacted on coordination dynamics by causing a slowdown of its activities and then its virtual halt. The findings herein highlight the need for policy dialogue coordination structures to have the necessary administrative and institutional support to facilitate their effective functioning. The findings also point to the need for further research on the practical and operational aspects of national dialogue coordination structures to determine how to best strengthen their capacities.

Barriers to breastfeeding in Lebanon: A policy analysis.

PubMed

Akik, Chaza; Ghattas, Hala; Filteau, Suzanne; Knai, Cecile

2017-08-01

Although the issue of breastfeeding in Lebanon has risen on the political agenda, the country does not meet international recommendations for early breastfeeding practices. This study analysed barriers to dissemination, implementation, and enforcement of key policies to improve early breastfeeding practices. We conducted interviews with stakeholders in breastfeeding policy in Lebanon and used a framework approach for analysing data. We found a disconnect between policy endorsement and translation on the ground, weak engagement of professional associations and governmental institutions, undue influence by the breast milk substitute industry, and competing priorities-most notably the current refugee crisis. This study highlights the potential policy opportunities to counter these barriers and points to the role of international organisations and grassroots advocacy in pushing, monitoring, and implementing policies that protect breastfeeding, where government capacity is limited, and the private sector is strong.

Appearing like a state: Oil companies and local violence in the Niger Delta

NASA Astrophysics Data System (ADS)

Mattner, Mark

What determines the extent to which communities in the Niger Delta experience violence? The dissertation addresses this question by focusing on the role of multinational oil companies in local governance, where state institutions are weak. The available literature often overlooks this important dimension. Specifically, the dissertation evaluates whether the choice of community relation policies by oil companies accounts for variations in local violence. These policies often include community development projects and attempts at strengthening local institutions. The main hypothesis is that where projects are allocated and implemented through participatory processes, informal institutions are created which substitute for weak local governments and reduce violence. The dissertation tests this contention by comparing four cases which were selected according to differences in their levels of violence. It concludes that the hypothesis is valid only in highly specific circumstances. In most cases, levels of repression and the relationship between companies and local elites are more significant explanations for violence. This is because oil companies and the state continue to rely primarily on repression and co-optation in their relationship with local communities. Community development and corporate social responsibility are secondary concerns. The central implication of this analysis is that a solution to the crisis in the Niger Delta is unlikely to lie in self-regulation and non-binding commitments by corporate actors. More promising approaches are strengthening local governments by ensuring the integrity of local elections and more stringent regulation of oil company conduct.

Design and application of a technologically explicit hybrid energy-economy policy model with micro and macro economic dynamics

NASA Astrophysics Data System (ADS)

Bataille, Christopher G. F.

2005-11-01

Are further energy efficiency gains, or more recently greenhouse gas reductions, expensive or cheap? Analysts provide conflicting advice to policy makers based on divergent modelling perspectives, a 'top-down/bottom-up debate' in which economists use equation based models that equilibrate markets by maximizing consumer welfare, and technologists use technology simulation models that minimize the financial cost of providing energy services. This thesis summarizes a long term research project to find a middle ground between these two positions that is more useful to policy makers. Starting with the individual components of a behaviourally realistic and technologically explicit simulation model (ISTUM---Inter Sectoral Technology Use Model), or "hybrid", the individual sectors of the economy are linked using a framework of micro and macro economic feedbacks. These feedbacks are taken from the economic theory that informs the computable general equilibrium (CGE) family of models. Speaking in the languages of both economists and engineers, the resulting "physical" equilibrium model of Canada (CIMS---Canadian Integrated Modeling System), equilibrates energy and end-product markets, including imports and exports, for seven regions and 15 economic sectors, including primary industry, manufacturing, transportation, commerce, residences, governmental infrastructure and the energy supply sectors. Several different policy experiments demonstrate the value-added of the model and how its results compare to top-down and bottom-up practice. In general, the results show that technical adjustments make up about half the response to simulated energy policy, and macroeconomic demand adjustments the other half. Induced technical adjustments predominate with minor policies, while the importance of macroeconomic demand adjustment increases with the strength of the policy. Results are also shown for an experiment to derive estimates of future elasticity of substitution (ESUB) and autonomous energy efficiency indices (AEEI) from the model, parameters that could be used in long-run computable general equilibrium (CGE) analysis. The thesis concludes with a summary of the strengths and weakness of the new model as a policy tool, a work plan for its further improvement, and a discussion of the general potential for technologically explicit general equilibrium modelling.

Policy-driven tobacco control.

PubMed

Francis, John A; Abramsohn, Erin M; Park, Hye-Youn

2010-04-01

Since the passage of Proposition 99, California's comprehensive tobacco control programme has benefited from a localised policy adoption process that allows for the innovation and diffusion of strong local tobacco control policies throughout the state. The policy adoption continuum is described in the context of California's smoke-free workplace movement, and the influence of policy-driven tobacco control initiatives on social norms, behaviour and the public's health was examined. The Smoke-free California policy adoption continuum reflects a general approach for policy innovation and diffusion that builds social acceptance and influences social norms, while minimising unintended consequences and creating best practices in tobacco control. California's local smoke-free workplace policies have reduced secondhand smoke exposure and supported attitude and behaviour changes. The effects of local policy adoption led to the nation's first statewide smoke-free workplace law. Proposition 99 created an unprecedented tobacco control infrastructure that supported local policy innovation and diffusion to influence social norms and behaviours. Tobacco control policy efforts should address campaign challenges, oppose pre-emption and confront tobacco industry influence. Advocates must be cautious of pursuing a statewide policy prematurely, as it may result in a weak and/or pre-emptive policy that can stymie local policy efforts and prolong the adoption of a meaningful statewide policy.

Outcome of Guillain–Barre syndrome patients with respiratory paralysis

PubMed Central

Kalita, J.; Ranjan, A.

2016-01-01

Background and Aims: To evaluate the outcome of patients with Guillain–Barre syndrome (GBS) having respiratory failure treated with modified intubation policy. Design and Methods: Consecutive patients with GBS having single breath count below 12 and respiratory rate >30/min were included and their clinical details noted. The patients were intubated and mechanically ventilated (MV) if their PaO2 was <60 mmHg on venturi mask, PaCo2 > 50 mmHg or pH < 7.3. Their electrophysiological subtypes and complications were noted. The hospital mortality and 3 months outcome were compared in MV and those could be managed without MV even with respiratory compromise. Results: Out of 369 patients, 102 (27.6%) patients had respiratory compromise who were included in this study. Of the patients with respiratory compromise, 44 (43.1%) were intubated and mechanically ventilated after a median of 4 days of hospitalization. The median duration of MV was 21 (range 1–88) days. The patients with autonomic dysfunction (56.8% vs. 19%), facial weakness (78% vs. 36.2%), bulbar weakness (81.8% vs. 31%), severe weakness (63.8% vs. 31%) and high transaminase level (47.7% vs. 25.9%) needed MV more frequently. In our study, 6.8% patients died and 26.6% had poor outcome which was similar between MV and non-MV patients. The MV patients had longer hospitalization and more complications compared with non-MV group. Conclusion: In GBS patients with respiratory compromise, conservative intubation does not increase mortality and disability. PMID:26475599

Institutional development and policy frameworks for pastoralism: from local to regional perspectives.

PubMed

Bonfoh, B; Fokou, G; Crump, L; Zinsstag, J; Schelling, E

2016-11-01

Pastoralists are among the most politically and economically marginalised communities in the world. They have less and less access to the natural resources on which their livelihoods depend and very limited access to basic socio-economic services and infrastructure. This paper builds on a number of studies carried out in the Sahel, the Horn of Africa, Central Asia and the Swiss Alps to address the institutional dynamics required for sustainable pastoralism. Specifically, the authors question the way in which institutions and policies are currently shaped and suggest that reforming these could contribute to new avenues for pastoralism. Among the main drivers of pastoralist marginalisation are poor public and private institutional arrangements. The consequences are violent conflict and increased mobility and relocation. Responses to the current weaknesses of pastoralism must encompass inclusive, comprehensive institutions which allow access to resources, economic viability and integration in the new socio-ecological space. The authors argue that those involved in pastoral development in national as well as international arenas, including pastoralist groups, states and agencies, are creatively engaged in a process of innovation for pastoralism, and this will contribute towards new forms of governance and improved institutional and policy frameworks.

Why it's time for a national health program in the United States.

PubMed Central

Waitzkin, H

1989-01-01

The United States lacks a coherent national health program. Current programs leave major gaps in coverage and recently have become more restrictive. Influential policies that have failed to correct crucial problems of the health-care system include competitive strategies, corporate intervention, and public-sector cutbacks with bureaucratic expansion. A national health program that combines elements of national health insurance and a national health service is a policy that would help solve current health-care problems. Previous proposals for national health insurance contained weaknesses that would need correction under a national program. Based on the experiences of other economically advanced countries, a national health program could provide universal entitlement to health care while controlling costs and improving the health-care system through structural reorganization. Current proposals for a national health program contain several basic principles dealing with the scope of services, copayments, financing, cost controls, physician and professional associations, personnel and distribution, prevention, and participation in policy making. Support for a national health program is growing rapidly. Such a program would help protect all people who live in this country from unnecessary illness, suffering, and early death. PMID:2735021

Developing government policies for distance education: Lessons learnt from two Sri Lankan case studies

NASA Astrophysics Data System (ADS)

Liyanagunawardena, Tharindu Rekha; Adams, Andrew A.; Rassool, Naz; Williams, Shirley A.

2014-12-01

Education, especially higher education, is considered vital for maintaining national and individual competitiveness in the global knowledge economy. Following the introduction of its "Free Education Policy" as early as 1947, Sri Lanka is now the best performer in basic education in the South Asian region, with a remarkable record in terms of high literacy rates and the achievement of universal primary education. However, access to tertiary education is a bottleneck, due to an acute shortage of university places. In an attempt to address this problem, the government of Sri Lanka has invested heavily in information and communications technologies (ICTs) for distance education. Although this has resulted in some improvement, the authors of this article identify several barriers which are still impeding successful participation for the majority of Sri Lankans wanting to study at tertiary level. These impediments include the lack of infrastructure/resources, low English language proficiency, weak digital literacy, poor quality of materials and insufficient provision of student support. In the hope that future implementations of ICT-enabled education programmes can avoid repeating the mistakes identified by their research in this Sri Lankan case, the authors conclude their paper with a list of suggested policy options.

Advancing the theory and practice of impact assessment: Setting the research agenda

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pope, Jenny, E-mail: jenny@integral-sustainability.net; School of Geo and Spatial Sciences, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520; Curtin University Sustainability Policy Institute, GPO Box U1987, Perth WA 6845

2013-07-15

Impact assessment has been in place for over 40 years and is now practised in some form in all but two of the world's nations. In this paper we reflect on the state of the art of impact assessment theory and practice, focusing on six well-established forms: EIA, SEA, policy assessment, SIA, HIA and sustainability assessment. We note that although the fundamentals of impact assessment have their roots in the US National Environmental Policy Act 1969 (NEPA) each branch of the field is distinct in also drawing on other theoretical and conceptual bases that in turn shape the prevailing discoursemore » in each case, generating increasing degrees of specialisation within each sub-field. Against this backdrop, we consider the strengths and weaknesses of collective impact assessment practice, concluding that although there are substantial strengths, the plethora of specialist branches is generating a somewhat confusing picture and lack of clarity regarding how the pieces of the impact assessment jigsaw puzzle fit together. We use this review to suggest an overarching research agenda that will enable impact assessment to evolve in line with changing expectations for what it should deliver. -- Highlights: ► Strengths, weakness, opportunities and threats for IA are explored in this paper ► EIA, SEA, policy assessment, SIA, HIA and sustainability assessment are reviewed ► Diversity of practice is both a strength and weakness in the current economic climate ► There are opportunities to simplify IA by focusing on common and fundamental elements ► Continued research into theory related to IA effectiveness is also essential.« less

Stakeholder perspectives on the use of pig meat inspection as a health and welfare diagnostic tool in the Republic of Ireland and Northern Ireland; a SWOT analysis.

PubMed

Devitt, C; Boyle, L; Teixeira, D L; O'Connell, N E; Hawe, M; Hanlon, A

2016-01-01

A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis is a strategic management tool applied to policy planning and decision-making. This short report presents the results of a SWOT analysis, carried out with n  = 16 stakeholders i) involved in the pig industry in the Republic of Ireland and Northern Ireland, and ii) in general animal welfare and food safety policy areas. As part of a larger study called PIGWELFIND, the analysis sought to explore the potential development of pig meat inspection as an animal welfare and diagnostic tool. The final SWOT framework comprised two strengths, three opportunities, six weaknesses, and five threats. Issues around relationships and communication between producers and their veterinary practitioner, processors and producers were common to both the strengths and weakness clusters. Practical challenges within the processing plant were also named. Overall, the SWOT framework complements results reported in Devitt et al. (Ir Vet J 69:2, 2016) regarding problematic issues within the current system of information feedback on meat inspection especially within the Republic of Ireland, and the wider challenges of communication and problems of distrust. The results of the SWOT analysis support the conclusions from Devitt et al. (Ir Vet J 69:2, 2016), that trust between all stakeholders across the supply chain will be essential for the development of an effective environment in which to realise the full diagnostic potential of MI data. Further stakeholder engagement could seek to apply the findings of the SWOT analysis to a policy Delphi methodology, as used elsewhere.

Why Do White Americans Oppose Race-Targeted Policies? Clarifying the Impact of Symbolic Racism

PubMed Central

Rabinowitz, Joshua L.; Sears, David O.; Sidanius, Jim; Krosnick, Jon A.

2009-01-01

Measures of symbolic racism (SR) have often been used to tap racial prejudice toward Blacks. However, given the wording of questions used for this purpose, some of the apparent effects on attitudes toward policies to help Blacks may instead be due to political conservatism, attitudes toward government, and/or attitudes toward redistributive government policies in general. Using data from national probability sample surveys and an experiment, we explored whether SR has effects even when controlling for these potential confounds and whether its effects are specific to policies involving Blacks. Holding constant conservatism and attitudes toward limited government, SR predicted Whites' opposition to policies designed to help Blacks and more weakly predicted attitudes toward social programs whose beneficiaries were racially ambiguous. An experimental manipulation of policy beneficiaries revealed that SR predicted policy attitudes when Blacks were the beneficiary but not when women were. These findings are consistent with the claim that SR's association with racial policy preferences is not due to these confounds. PMID:20161542

Limiting the consumption of sugar sweetened beverages in Mexico's obesogenic environment: a qualitative policy review and stakeholder analysis.

PubMed

Moise, Nathalie; Cifuentes, Enrique; Orozco, Emanuel; Willett, Walter

2011-11-01

Mexico is building a legal framework to address its childhood obesity epidemic. Sugar sweetened beverages (SSB) in the school environment represent a major policy challenge. We addressed the following questions: What barriers inhibit political attention to SSB and childhood obesity? What political instruments, international and national, exist to guide agenda setting in Mexico? What opportunities exist for policy adoption? We conducted a systematic review of international and national legal instruments concerned with SSB consumption. We traced process, conducting interviews with key informants. Thematic analysis helped us identify barriers and opportunities for public health interventions. We found 11 national policy instruments, but detected implementation gaps and weak fiscal policies on SSB consumption in schools: limited drinking water infrastructure, SSB industry interests, and regulatory ambiguities addressing reduction of sugar in beverages. Public policy should target marketing practices and taxation. The school environment remains a promising target for policy. Access to safe drinking water must complement comprehensive and multi-sector policy approaches to reduce access to SSB.

Health inequities in the age of austerity: The need for social protection policies.

PubMed

Ruckert, Arne; Labonté, Ronald

2017-08-01

This commentary assesses the impacts of the global austerity drive on health inequities in the aftermath of the global financial crisis of 2008. In doing so, it first locates the origins of austerity within the 40 year history of neoliberal economic orthodoxy. It then describes the global diffusion of austerity since 2008, and its key policy tenets. It next describes the already visible impacts of austerity-driven welfare reform on trends in health equity, and documents how austerity has exacerbated health inequities in countries with weak social protection policies. We finally identify the components of an alternative policy response to the financial crisis than that of austerity, with specific reference to the need for shifts in national and global taxation policies and public social protection policies and spending. We conclude with a call for a reorientation of public policy towards making human health an overarching global policy goal, and how this aligns with the multilaterally agreed upon Sustainable Development Goals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perspectives on health policy dialogue: definition, perceived importance and coordination.

PubMed

Nabyonga-Orem, Juliet; Ousman, Kevin; Estrelli, Yolanda; Rene, Adzodo K M; Yakouba, Zina; Gebrikidane, Mesfin; Mamoud, Drave; Kwamie, Aku

2016-07-18

Countries in the World Health Organization African Region have witnessed an increase in global health initiatives in the recent past. Although these have provided opportunities for expanding coverage of health interventions; their poor alignment with the countries' priorities and weak coordination, are among the challenges that have affected their impact. A well-coordinated health policy dialogue provides an opportunity to address these challenges, but calls for common understanding among stakeholders of what policy dialogue entails. This paper seeks to assess stakeholders' understanding and perceived importance of health policy dialogue and of policy dialogue coordination. This was a cross-sectional descriptive study using qualitative methods. Interviews were conducted with 90 key informants from the national and sub-national levels in Lusophone Cabo Verde, Francophone Chad, Guinea and Togo, and Anglophone Liberia using an open-ended interview guide. The interviews were transcribed verbatim, coded and then put through inductive thematic content analysis using QRS software Version 10. There were variations in the definition of policy dialogue that were not necessarily linked to the linguistic leaning of respondents' countries or whether the dialogue took place at the national or sub-national level. The definitions were grouped into five categories based on whether they had an outcome, operational, process, forum or platform, or interactive and evidence-sharing orientation. The stakeholders highlighted multiple benefits of policy dialogue including ensuring stakeholder participation, improving stakeholder harmonisation and alignment, supporting implementation of health policies, fostering continued institutional learning, providing a guiding framework and facilitating stakeholder analysis. Policy dialogue offers the opportunity to improve stakeholder participation in policy development and promote aid effectiveness. However, conceptual clarity is needed to ensure pursuance of common objectives. While it is clear that stakeholder involvement is an important component of policy dialogue, numbers must be manageable for meaningful dialogue. Ownership and coordination of the policy dialogue are important aspects of the process, and building the institutional capacity of the ministry of health requires a comprehensive approach as opposed to strengthening selected departments within it. Likewise, capacity for policy dialogue needs to be built at the sub-national level, alongside improving the bottom-up approach in policy processes.

Model-Based Policymaking: A Framework to Promote Ethical “Good Practice” in Mathematical Modeling for Public Health Policymaking

PubMed Central

Boden, Lisa A.; McKendrick, Iain J.

2017-01-01

Mathematical models are increasingly relied upon as decision support tools, which estimate risks and generate recommendations to underpin public health policies. However, there are no formal agreements about what constitutes professional competencies or duties in mathematical modeling for public health. In this article, we propose a framework to evaluate whether mathematical models that assess human and animal disease risks and control strategies meet standards consistent with ethical “good practice” and are thus “fit for purpose” as evidence in support of policy. This framework is derived from principles of biomedical ethics: independence, transparency (autonomy), beneficence/non-maleficence, and justice. We identify ethical risks associated with model development and implementation and consider the extent to which scientists are accountable for the translation and communication of model results to policymakers so that the strengths and weaknesses of the scientific evidence base and any socioeconomic and ethical impacts of biased or uncertain predictions are clearly understood. We propose principles to operationalize a framework for ethically sound model development and risk communication between scientists and policymakers. These include the creation of science–policy partnerships to mutually define policy questions and communicate results; development of harmonized international standards for model development; and data stewardship and improvement of the traceability and transparency of models via a searchable archive of policy-relevant models. Finally, we suggest that bespoke ethical advisory groups, with relevant expertise and access to these resources, would be beneficial as a bridge between science and policy, advising modelers of potential ethical risks and providing overview of the translation of modeling advice into policy. PMID:28424768

Linking Research, Extension and Education: Why Is the Problem So Persistent and Pervasive?

ERIC Educational Resources Information Center

Van Crowder, L.; Anderson, J.

1997-01-01

Weak links among research, education, and extension often result from their informal nature, national agriculture policy environment, and funding shortages. An integrative systems approach can strengthen links to improve agriculture technology systems. (SK)

Student Freedom in the Classroom.

ERIC Educational Resources Information Center

Rich, John Martin

1986-01-01

Analyzes the concept of freedom. Evaluates progressive, libertarian, and essentialist views of student freedom and discusses their weaknesses. Attempts to resolve the problems raised by placing freedom within the context of authority and considers implications for educational policy and practice. (AYC)

Report: Audit of EPA’s Fiscal 2007 and 2006 (Restated) Consolidated Financial Statements

EPA Pesticide Factsheets

Report #08-1-0032, November 15, 2007. We noted one material weakness with EPA’s Implementation of the “Currently Not Collectible” policy for accounts receivable that caused a Material Understatement of Asset Value.

On a stochastic control method for weakly coupled linear systems. M.S. Thesis

NASA Technical Reports Server (NTRS)

Kwong, R. H.

1972-01-01

The stochastic control of two weakly coupled linear systems with different controllers is considered. Each controller only makes measurements about his own system; no information about the other system is assumed to be available. Based on the noisy measurements, the controllers are to generate independently suitable control policies which minimize a quadratic cost functional. To account for the effects of weak coupling directly, an approximate model, which involves replacing the influence of one system on the other by a white noise process is proposed. Simple suboptimal control problem for calculating the covariances of these noises is solved using the matrix minimum principle. The overall system performance based on this scheme is analyzed as a function of the degree of intersystem coupling.

The evolution of health-policy making in Italy.

PubMed

France, George; Taroni, Francesco

2005-01-01

An analysis of the dynamics of health care policy in Italy suggests that in recent years the pace of change in the health care system has accelerated. Although the basic features of universalism, comprehensiveness, and funding from general taxation have remained remarkably constant, the capacity to innovate policy tools and their settings and to take account of domestic and international experience seems to have increased. The political will and capacity to combat entrenched interests may also have increased, although implementation is still weak. The imperative to contain public expenditure has heavily conditioned health policy and will continue to do so. This has occurred mainly at the national level, but as the principal locus of health-policy making progressively shifts to the regions, so too will the constraining effect of this imperative move downward. If the decentralization process continues, problems could arise due to interregional differences in capacities to formulate and implement appropriate policies and to tackle special interest groups.

The impact of the International Monetary Fund's macroeconomic policies on the AIDS pandemic.

PubMed

Baker, Brook K

2010-01-01

Expansion of funding for HIV/AIDS, especially treatment, is under attack over concerns about cost effectiveness and financial constraints. The International Monetary Fund is deeply implicated in the history of the AIDS pandemic, the underlying weakness of health systems, and the ideology of constrained resources that underlies most attacks on AIDS funding. The IMF imposed structural violence on developing countries in the 1980s and 1990s through neoliberal and macroeconomic reforms that intensified individual and communal vulnerability to infection and dismantled already weak health systems. This same macroeconomic fundamentalism has recently been repackaged and renamed. IMF fundamentalist policies continue to prioritize low inflation, constricted government spending, robust foreign currency reserves, and prompt repayment of debt at the expense of investments in health and more expansionary, pro-growth and job-creation policies. Several recent surveys have concluded that the IMF reluctantly relaxed overly restrictive policy prescriptions in response to the global economic crisis, but this relaxation was temporary at best and only extended to countries previously acceding to IMF orthodoxy. AIDS activists are campaigning for billions of dollars to fulfill the promise of universal access. If IMF pressures persist, developing countries will continue to undermine the additionality of donor health financing by substituting donor for domestic financing, refusing to invest in recurrent costs for medicines and health workers, and neglecting needed investments in health infrastructure and health system strengthening.

The need for environmental horizon scanning.

PubMed

Sutherland, William J; Woodroof, Harry J

2009-10-01

Policymakers and practitioners in most fields, including conservation and the environment, often make decisions based on insufficient evidence. One reason for this is that issues appear unexpectedly, when with hindsight, many of them were foreseeable. A solution to the problem of being insufficiently prepared is routine horizon scanning, which we describe as the systematic search for potential threats and opportunities that are currently poorly recognized. Researchers can then decide which issues might be most worthwhile to study. Practitioners can also use horizon scanning to ensure timely policy development and research procurement. Here, we suggest that horizon scanning is an underused tool that should become a standard element of environmental and conservation practice. We make recommendations for its incorporation into research, policy and practice. We argue that, as an ecological and conservation community, we are failing to provide timely advice owing to a weakness in identifying forthcoming issues. We outline possible horizon-scanning methods, and also make recommendations as to how horizon scanning could have a more central role in environmental and conservation practice.

Assessing a cross-border logistics policy using a performance measurement system framework: the case of Hong Kong and the Pearl River Delta region

NASA Astrophysics Data System (ADS)

Wong, David W. C.; Choy, K. L.; Chow, Harry K. H.; Lin, Canhong

2014-06-01

For the most rapidly growing economic entity in the world, China, a new logistics operation called the indirect cross-border supply chain model has recently emerged. The primary idea of this model is to reduce logistics costs by storing goods at a bonded warehouse with low storage cost in certain Chinese regions, such as the Pearl River Delta (PRD). This research proposes a performance measurement system (PMS) framework to assess the direct and indirect cross-border supply chain models. The PMS covers four categories including cost, time, quality and flexibility in the assessment of the performance of direct and indirect models. Furthermore, a survey was conducted to investigate the logistics performance of third party logistics (3PLs) at the PRD regions, including Guangzhou, Shenzhen and Hong Kong. The significance of the proposed PMS framework allows 3PLs accurately pinpoint the weakness and strengths of it current operations policy at four major performance measurement categories. Hence, this helps 3PLs further enhance the competitiveness and operations efficiency through better resources allocation at the area of warehousing and transportation.

Vector control programs in Saint Johns County, Florida and Guayas, Ecuador: successes and barriers to integrated vector management.

PubMed

Naranjo, Diana P; Qualls, Whitney A; Jurado, Hugo; Perez, Juan C; Xue, Rui-De; Gomez, Eduardo; Beier, John C

2014-07-02

Vector-borne diseases (VBDs) and mosquito control programs (MCPs) diverge in settings and countries, and lead control specialists need to be aware of the most effective control strategies. Integrated Vector Management (IVM) strategies, once implemented in MCPs, aim to reduce cost and optimize protection of the populations against VBDs. This study presents a strengths, weaknesses, opportunities, and threats (SWOT) analysis to compare IVM strategies used by MCPs in Saint Johns County, Florida and Guayas, Ecuador. This research evaluates MCPs strategies to improve vector control activities. Methods included descriptive findings of the MCP operations. Information was obtained from vector control specialists, directors, and residents through field trips, surveys, and questionnaires. Evaluations of the strategies and assets of the control programs where obtained through SWOT analysis and within an IVM approach. Organizationally, the Floridian MCP is a tax-based District able to make decisions independently from county government officials, with the oversight of an elected board of commissioners. The Guayas program is directed by the country government and assessed by non-governmental organizations like the World health Organization. Operationally, the Floridian MCP conducts entomological surveillance and the Ecuadorian MCP focuses on epidemiological monitoring of human disease cases. Strengths of both MCPs were their community participation and educational programs. Weaknesses for both MCPs included limitations in budgets and technical capabilities. Opportunities, for both MCPs, are additional funding and partnerships with private, non-governmental, and governmental organizations. Threats experienced by both MCPs included political constraints and changes in the social and ecological environment that affect mosquito densities and control efforts. IVM pillars for policy making were used to compare the information among the programs. Differences included how the Ecuadorian MCP relies heavily on the community for vector control while the American MCP relies on technologies and research. IVM based recommendations direct health policy leaders toward improving surveillance systems both entomologically and epidemiologically, improving community risk perceptions by integrating components of community participation, maximizing resources though the use of applied research, and protecting the environment by selecting low-risk pesticides. Outcomes of the research revealed that inter-sectorial and multidisciplinary interventions are critical to improve public health.

Resistance to agricultural biotechnology: the importance of distinguishing between weak and strong public attitudes.

PubMed

Aerni, Philipp

2013-10-01

Empirical research shows that European governments and retailers are unlikely to be directly punished by taxpayers and consumers if they move away from their anti-GMO positions and policies. However, it is ultimately not the weak attitudes of taxpayers and consumers that matter to governments and retailers but the strong attitudes of the noisy anti-biotech movement. (Image: Highway signs: ©maxmitzu - Fotolia.com; woman and balance: ©lassedesignen - Fotolia.com). Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Evidence-based practice of transfusion medicine: is it possible and what do the words mean?

PubMed

Vamvakas, Eleftherios C

2004-10-01

Evidence-based medicine (EBM) optimizes clinical decision making by dictating that clinical decisions be based on the best available research evidence and by integrating best research evidence with clinical expertise and patient values. Several rankings of the strength of the evidence generated from different types of clinical research designs have been presented, and, in addressing a particular problem, clinicians can base their decision making on the types of clinical reports that have been published, along with an assessment of the strengths and weaknesses of each study. At a policy level, the concept of EBM would dictate that policy decisions also be made based on the best available research evidence. In transfusion medicine, however, decisions are based on a broader range of inputs, and the criteria for evaluating the efficacy and/or cost-effectiveness of proposed interventions differ from those used in other areas. Reasons why policy decisions are often based on considerations other than the best research evidence include public expectations about transfusion safety and proposals for applying the precautionary principle to transfusion medicine. Using the debate over the appropriateness of introducing universal white-cell reduction as an example, this review describes 2 perspectives for assessing evidence and/or making clinical or policy decisions: the evidence-based approach and the precautionary-principle approach; and also considers whether decisions in transfusion medicine can be truly evidence based.

Public trust in vaccination: an analytical framework.

PubMed

Gopichandran, Vijayaprasad

2017-01-01

While vaccination is one of the most successful public health interventions, there has always been a parallel movement against vaccines. Apart from scientific factors, the uptake of vaccinations is influenced by historical, political, sociocultural and economic factors. In India, the health system is struggling with logistical weaknesses in taking vaccination to the remotest corners; while on the other hand, some people in places where vaccination is available resist it. Unwillingness to be vaccinated is a growing problem in the developed world. This trend is gradually emerging in several parts of India as well. Other factors, such as heightened awareness of the profit motives of the vaccine industry, conflicts of interest among policy-makers, and social, cultural and religious considerations have eroded the people's trust in vaccination. This paper develops an analytical framework to assess trust in vaccination. The framework considers trust in vaccination from four perspectives - trust in the health system, the vaccine policy, vaccination providers and specific vaccines. The framework considers specific issues involved in vaccination trust, including the increasing scepticism towards medical technology, perceptions of conflicts of interest in the vaccine policy, and of lack of transparency and openness, the presence of strong alternative schools of thought, influence of the social media. The paper will conclude by arguing that engaging with communities and having a dialogue about the vaccination policy is an ethical imperative.

International trade and carbon emissions: The role of Chinese institutional and policy reforms.

PubMed

Andersson, Fredrik N G

2018-01-01

The carbon dioxide embodied in Chinese exports to developed countries increased rapidly from 1995 to 2008. We test the extent to which institutional reforms in China can explain this increase. We focus on five areas of reforms: trade liberalization, environmental institutions, legal and property rights, institutional risk and exchange rate policy. Our results show that trade liberalization, weak environmental institutions, exchange rate policy, and legal and property rights affect emissions. Our results also indicate that the lack of reform in the utilities sector is an important factor in the rapid increase in embodied emissions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Policies, Practices, and the Effect of Gender Discrimination on the Integration of Women Officers in the Department of the Navy

DTIC Science & Technology

1994-03-01

controls productivity by regulating lunch and toilet breaks as well as physical movement within the workplace . Researchers have observed that women are more...Weak Link. The Feminization of the American Military, that "the presence of women in the military inhibits male bonding, corrupts allegiance to the...assignment policies that restrict most women to "traditional" clerical and fleet- support occupational fields. I. M&SCULINE HEQGONY Then-Commandant of the

A Psychobiographical and Psycho-Political Comparison of Clinton and Trump.

PubMed

Elovitz, Paul H

2016-01-01

A comparison of the family backgrounds, childhoods, personal lives, personalities, and political views of the Republican and Democratic nominees in the 2016 presidential election. The author is a presidential psychobiographer who has been presenting and publishing on candidates and presidents since 1976. He uses his training in child development and psychoanalysis to demonstrate some of the influences of early development on the candidates’ subsequent lives and careers. The strengths and weaknesses of Hillary Clinton and Donald Trump are discussed. Included in the analysis are family background, childhood, character, coping mechanisms, temperament, role models, foreign policy, health, interpersonal relations, marriage, parenting, and religious views, as well as the appeal and obstacles to election faced by each candidate.

An overview of Japanese occupational health.

PubMed Central

Reich, M R; Frumkin, H

1988-01-01

This paper provides an overview of Japanese occupational health and evaluates the current situation from three perspectives. Major occupational health hazards are assessed using four sources of data, showing patterns similar to those found in other advanced industrial societies. Institutional structures for occupational health policy are then examined, illustrating strengths and weaknesses of the Japanese legal and administrative systems. Trade union activities are presented, indicating the constraints of enterprise unions, and the tendency for a greater orientation toward compensation than prevention. Significant occupational health problems persist among marginal workers in Japan, including women and various minority groups. The analysis demonstrates a record for occupational health in Japan considerably more mixed than the conventional view. PMID:2968056

The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers.

PubMed

Cooper, Diane; Mantell, Joanne E; Moodley, Jennifer; Mall, Sumaya

2015-03-04

Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa's prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH's SRH and combatting the global HIV epidemic. This paper explores South African policymakers' perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008-2009 and 2011-2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH's childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. The past decade's HIV policy changes have increased opportunities for SRH-HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.

Nursing education reform in South Africa – lessons from a policy analysis study

PubMed Central

Blaauw, Duane; Ditlopo, Prudence; Rispel, Laetitia C.

2014-01-01

Background Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013. Objective We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa. Design We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software. Results The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa. Conclusions The study found significant weaknesses in the policy capacity of the main institutions responsible for the leadership and governance of nursing in South Africa, which will need to be addressed if important nursing education reforms are to be realised. PMID:25537941

Nursing education reform in South Africa--lessons from a policy analysis study.

PubMed

Blaauw, Duane; Ditlopo, Prudence; Rispel, Laetitia C

2014-01-01

Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013. We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa. We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software. The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa. The study found significant weaknesses in the policy capacity of the main institutions responsible for the leadership and governance of nursing in South Africa, which will need to be addressed if important nursing education reforms are to be realised.

Responsible Internet Use.

ERIC Educational Resources Information Center

Truett, Carol; And Others

1997-01-01

Provides advice for making school Internet-use guidelines. Outlines responsible proactive use of the Internet for educators and librarians, discusses strengths and weaknesses of Internet blocking software and rating systems, and describes acceptable-use policies (AUP). Lists resources for creating your own AUP, Internet filtering software, and…

A Critical Review of Methods to Evaluate the Impact of FDA Regulatory Actions

PubMed Central

Briesacher, Becky A.; Soumerai, Stephen B.; Zhang, Fang; Toh, Sengwee; Andrade, Susan E.; Wagner, Joann L.; Shoaibi, Azadeh; Gurwitz, Jerry H.

2013-01-01

Purpose To conduct a synthesis of the literature on methods to evaluate the impacts of FDA regulatory actions, and identify best practices for future evaluations. Methods We searched MEDLINE for manuscripts published between January 1948 and August 2011 that included terms related to FDA, regulatory actions, and empirical evaluation; the review additionally included FDA-identified literature. We used a modified Delphi method to identify preferred methodologies. We included studies with explicit methods to address threats to validity, and identified designs and analytic methods with strong internal validity that have been applied to other policy evaluations. Results We included 18 studies out of 243 abstracts and papers screened. Overall, analytic rigor in prior evaluations of FDA regulatory actions varied considerably; less than a quarter of studies (22%) included control groups. Only 56% assessed changes in the use of substitute products/services, and 11% examined patient health outcomes. Among studies meeting minimal criteria of rigor, 50% found no impact or weak/modest impacts of FDA actions and 33% detected unintended consequences. Among those studies finding significant intended effects of FDA actions, all cited the importance of intensive communication efforts. There are preferred methods with strong internal validity that have yet to be applied to evaluations of FDA regulatory actions. Conclusions Rigorous evaluations of the impact of FDA regulatory actions have been limited and infrequent. Several methods with strong internal validity are available to improve trustworthiness of future evaluations of FDA policies. PMID:23847020

Same sex marriage and the perceived assault on opposite sex marriage.

PubMed

Dinno, Alexis; Whitney, Chelsea

2013-01-01

Marriage benefits both individuals and societies, and is a fundamental determinant of health. Until recently same sex couples have been excluded from legally recognized marriage in the United States. Recent debate around legalization of same sex marriage has highlighted for anti-same sex marriage advocates and policy makers a concern that allowing same sex couples to marry will lead to a decrease in opposite sex marriages. Our objective is to model state trends in opposite sex marriage rates by implementation of same sex marriages and other same sex unions. Marriage data were obtained for all fifty states plus the District of Columbia from 1989 through 2009. As these marriage rates are non-stationary, a generalized error correction model was used to estimate long run and short run effects of same sex marriages and strong and weak same sex unions on rates of opposite sex marriage. We found that there were no significant long-run or short run effects of same sex marriages or of strong or weak same sex unions on rates of opposite sex marriage. A deleterious effect on rates of opposite sex marriage has been argued to be a motivating factor for both the withholding and the elimination of existing rights of same sex couples to marry by policy makers-including presiding justices of current litigation over the rights of same sex couples to legally marry. Such claims do not appear credible in the face of the existing evidence, and we conclude that rates of opposite sex marriages are not affected by legalization of same sex civil unions or same sex marriages.

How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps.

PubMed

Hartmann, Miriam; Khosla, Rajat; Krishnan, Suneeta; George, Asha; Gruskin, Sofia; Amin, Avni

2016-01-01

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994-2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations.

How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps

PubMed Central

Khosla, Rajat; Krishnan, Suneeta; George, Asha; Gruskin, Sofia; Amin, Avni

2016-01-01

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994–2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations. PMID:28002440

Drug Policy in Bulgaria.

PubMed

Dimova, Antoniya; Rohova, Maria; Atanasova, Elka; Kawalec, Paweł; Czok, Katarzyna

2017-09-01

Bulgaria has a mixed public-private health care financing system. Health care is financed mainly from compulsory health insurance contributions and out-of-pocket payments. Out-of-pocket payments constitute a large share of the total health care expenditure (44.14% in 2014). The share of drugs expenditure for outpatient treatment was 42.3% of the total health care expenditure in 2014, covered mainly by private payments (78.6% of the total pharmaceutical expenditure). The drug policy is run by the Ministry of Health (MoH), the National Council on Prices and Reimbursement of Medicinal Products, and the Health Technology Assessment Commission. The MoH defines diseases for which the National Health Insurance Fund (NHIF) pays for medicines. The National Council on Prices and Reimbursement of Medicinal Products maintains a positive drug list (PDL) and sets drug prices. Health technology assessment was introduced in 2015 for medicinal products belonging to a new international nonproprietary name group. The PDL defines prescription medicines that are paid for by the NHIF, the MoH, and the health care establishments; exact patient co-payments and reimbursement levels; as well as the ceiling prices for drugs not covered by the NHIF, including over-the-counter medicines. The reimbursement level can be 100%, 75%, or up to 50%. The PDL is revised monthly in all cases except for price increase. Physicians are not assigned with pharmaceutical budgets, there is a brand prescribing practice, and the substitution of prescribed medicines by pharmacists is prohibited. Policies toward cost containment and effectiveness increase include introduction of a reference pricing system, obligation to the NHIF to conduct mandatory centralized bargaining of discounts for medicinal products included in the PDL, public tendering for medicines for hospital treatment, reduction of markup margins of wholesalers and retailers, patient co-payment, and the introduction of health technology assessment. Although most of the policies have been introduced since 2011, there is still weak evidence for improvement regarding cost containment and effectiveness. Copyright © 2017. Published by Elsevier Inc.

The Weakness of Stern Alcohol Control Policies.

PubMed

Poikolainen, Kari

2016-01-01

To test the total consumption model claiming that alcohol-related ill health can best be diminished by a policy of severe restrictions and high price. The associations between an index measuring the severity of the alcohol policy, total alcohol consumption and number of disability-adjusted life years (DALYs) lost due to alcohol were compared in 30 OECD countries in 2005. No significant correlations were found between alcohol policy index, alcohol consumption and the number of DALYs due to alcohol use. In regression analysis, alcohol policy index and alcohol consumption were not related to alcohol-related DALYs. Excise tax rate was not related to alcohol-related DALYs (25 countries with tax rate data). These findings suggest that the total consumption model fails. Alcohol-related ill health seems to be mainly due to alcohol dependence, both clinical and subclinical, not to moderate drinking. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Kuwait: Governance, Security, and U.S. Policy

DTIC Science & Technology

2016-12-01

financing and money laundering . In May 2014, the Ministry of Social Affairs warned Kuwaiti citizens that the fundraising campaigns for Syrian...Kuwait developed with the broader FATF to address Kuwait’s weaknesses on anti- money laundering and counterterrorism financing (AML/CTF). As of mid-2014

The Black Hole of Education Research.

ERIC Educational Resources Information Center

Miller, D. W.

1999-01-01

Critics feel education scholarship lacks rigor and a practical focus on achievement, wasting substantial resources. Research on effectiveness of educational reforms is often weak, inconclusive, or simply inadequate, and good scholarship may have little influence on classroom practice. Popular policies often persist despite strong research evidence…

SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program.

PubMed

Huerta, Michael; Balicer, Ran D; Leventhal, Alex

2003-01-01

During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.

Are root cause analyses recommendations effective and sustainable? An observational study.

PubMed

Hibbert, Peter D; Thomas, Matthew J W; Deakin, Anita; Runciman, William B; Braithwaite, Jeffrey; Lomax, Stephanie; Prescott, Jonathan; Gorrie, Glenda; Szczygielski, Amy; Surwald, Tanja; Fraser, Catherine

2018-03-01

To assess the strength of root cause analysis (RCA) recommendations and their perceived levels of effectiveness and sustainability. All RCAs related to sentinel events (SEs) undertaken between the years 2010 and 2015 in the public health system in Victoria, Australia were analysed. The type and strength of each recommendation in the RCA reports were coded by an expert patient safety classifier using the US Department of Veteran Affairs type and strength criteria. Thirty-six public health services. The proportion of RCA recommendations which were classified as 'strong' (more likely to be effective and sustainable), 'medium' (possibly effective and sustainable) or 'weak' (less likely to be effective and sustainable). There were 227 RCAs in the period of study. In these RCAs, 1137 recommendations were made. Of these 8% were 'strong', 44% 'medium' and 48% were 'weak'. In 31 RCAs, or nearly 15%, only weak recommendations were made. In 24 (11%) RCAs five or more weak recommendations were made. In 165 (72%) RCAs no strong recommendations were made. The most frequent recommendation types were reviewing or enhancing a policy/guideline/documentation, and training and education. Only a small proportion of recommendations arising from RCAs in Victoria are 'strong'. This suggests that insights from the majority of RCAs are not likely to inform practice or process improvements. Suggested improvements include more human factors expertise and independence in investigations, more extensive application of existing tools that assist teams to prioritize recommendations that are likely to be effective, and greater use of observational and simulation techniques to understand the underlying systems factors. Time spent in repeatedly investigating similar incidents may be better spent aggregating and thematically analysing existing sources of information about patient safety.

How Do Medical Schools Identify and Remediate Professionalism Lapses in Medical Students? A Study of U.S. and Canadian Medical Schools.

PubMed

Ziring, Deborah; Danoff, Deborah; Grosseman, Suely; Langer, Debra; Esposito, Amanda; Jan, Mian Kouresch; Rosenzweig, Steven; Novack, Dennis

2015-07-01

Teaching and assessing professionalism is an essential element of medical education, mandated by accrediting bodies. Responding to a call for comprehensive research on remediation of student professionalism lapses, the authors explored current medical school policies and practices. In 2012-2013, key administrators at U.S. and Canadian medical schools accredited by the Liaison Committee on Medical Education were interviewed via telephone or e-mail. The structured interview questionnaire contained open-ended and closed questions about practices for monitoring student professionalism, strategies for remediating lapses, and strengths and limitations of current systems. The authors employed a mixed-methods approach, using descriptive statistics and qualitative analysis based on grounded theory. Ninety-three (60.8%) of 153 eligible schools participated. Most (74/93; 79.6%) had specific policies and processes regarding professionalism lapses. Student affairs deans and course/clerkship directors were typically responsible for remediation oversight. Approaches for identifying lapses included incident-based reporting and routine student evaluations. The most common remediation strategies reported by schools that had remediated lapses were mandated mental health evaluation (74/90; 82.2%), remediation assignments (66/90; 73.3%), and professionalism mentoring (66/90; 73.3%). System strengths included catching minor offenses early, emphasizing professionalism schoolwide, focusing on helping rather than punishing students, and assuring transparency and good communication. System weaknesses included reluctance to report (by students and faculty), lack of faculty training, unclear policies, and ineffective remediation. In addition, considerable variability in feedforward processes existed between schools. The identified strengths can be used in developing best practices until studies of the strategies' effectiveness are conducted.

Evaluating WIC.

ERIC Educational Resources Information Center

Germanis, Peter; Besharov, Douglas J.

2000-01-01

Describes the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and reviews and assesses research on its impact. Recommends policy reforms and randomized experiments to evaluate the program and any changes made to it. Weaknesses in research to date make the real impacts of WIC unclear. (Contains 79 references.) (SLD)

In Praise of Monetary Motivation.

ERIC Educational Resources Information Center

Piamonte, John S.

1979-01-01

Although management has built remuneration policies on the belief that money does not motivate personnel, the author states that the best way to encourage high performance is still money if administered correctly. He discusses behavior theories, incentive/contingency principles, the weaknesses of many merit pay schemes, and factors in employee…

The Dairy Technology System in Venezuela. Summary of Research 79.

ERIC Educational Resources Information Center

Nieto, Ruben D.; Henderson, Janet L.

A study examined the agricultural technology system in Venezuela with emphasis on the dairy industry. An analytical framework was used to identify the strengths and weaknesses of the following components of Venezuela's agricultural technology system: policy, technology development, technology transfer, and technology use. Selected government…

Application of theory-based evaluation for the critical analysis of national biofuel policy: A case study in Malaysia.

PubMed

Abdul-Manan, Amir F N; Baharuddin, Azizan; Chang, Lee Wei

2015-10-01

Theory-based evaluation (TBE) is an effectiveness assessment technique that critically analyses the theory underlying an intervention. Whilst its use has been widely reported in the area of social programmes, it is less applied in the field of energy and climate change policy evaluations. This paper reports a recent study that has evaluated the effectiveness of the national biofuel policy (NBP) for the transport sector in Malaysia by adapting a TBE approach. Three evaluation criteria were derived from the official goals of the NBP, those are (i) improve sustainability and environmental friendliness, (ii) reduce fossil fuel dependency, and (iii) enhance stakeholders' welfare. The policy theory underlying the NBP has been reconstructed through critical examination of the policy and regulatory documents followed by a rigorous appraisal of the causal link within the policy theory through the application of scientific knowledge. This study has identified several weaknesses in the policy framework that may engender the policy to be ineffective. Experiences with the use of a TBE approach for policy evaluations are also shared in this report. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anti-tobacco policy in schools: upcoming preventive strategy or prevention myth? A review of 31 studies.

PubMed

Galanti, Maria Rosaria; Coppo, Alessandro; Jonsson, Elin; Bremberg, Sven; Faggiano, Fabrizio

2014-07-01

To summarise the evidence on effectiveness of school anti-tobacco policies (exposure) in preventing tobacco use (outcome) among high school students. The search was conducted between 1 September and 30 November 2011 on six electronic databases with keywords: 'policy', 'ban', 'restriction' and 'environment' in combination with 'adolescent' or 'student', 'school' and 'smoking' in titles, abstracts or keywords. Restrictions were made to articles published in English. Studies were included if they targeted the relevant grades/age; reported at least one outcome measure of students' ever or current tobacco use; reported on the effects of exposure to policy separately from other interventions. Inclusion criteria were assessed independently by two of the coauthors. Of 2723 articles initially identified, 31 articles met the inclusion criteria (1.1%). Independent multiple observers extracted the data following the GRADE system guidelines to classify the level of evidence in relation to the review objective. Studies were very heterogeneous in the definitions of exposure to school anti-tobacco policy and of tobacco use, adjustment for potential confounders and reporting of results, therefore summary quantitative measures of effect were not calculated. Qualitative summary statements were derived by reviewing the results reported in text and tables for distinct policy constructs. Evidence could be classified as low or very low, resting on cross-sectional studies with high risk of bias. Studies were rather consistent in indicating that comprehensive smoking bans, clear rules, strict policy enforcement, availability of education and prevention were associated with decreased smoking prevalence. Formally adopted and written policies, surveillance of students' behaviour and presence/severity of sanctions were not consistently associated to students' tobacco use. The evidence concerning the effectiveness of a school policy alone in preventing youth tobacco use is weak and inconclusive. Experimental studies or observational studies with longitudinal design are warranted, employing clear definitions of policy components and careful control for confounding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evidence-based medicine - an appropriate tool for evidence-based health policy? A case study from Norway.

PubMed

Malterud, Kirsti; Bjelland, Anne Karen; Elvbakken, Kari Tove

2016-03-05

Evidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP. In a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools. From a total sample of 151 SRs published by the NOKC in the period 2004-2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making. The case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using strategies that seem too confined. Policymaking in healthcare should be based on relevant and transparent knowledge, taking due account of the context of the intervention. However, we do not share the belief that the complex and messy nature of policy processes in general is compatible with the standards of EBM.

Policy for Research and Innovation in Latin America

NASA Astrophysics Data System (ADS)

Aguirre-Bastos, Carlos

2010-02-01

Latin America (LAC) is renewing efforts to build-up research and innovation (R&I) capacities, guided by policies that consider the need to transform the traditional science system into a more dynamic entity. Policies permitted the generation of new spaces to develop science, strengthen scientific communities, improve university-enterprise linkages, establish common agendas between public and private sectors, earmark special budgets, build new infrastructure, and improve the number and quality of scientific publications. In spite of much progress, LAC lags much behind developed countries, their universities rank lower than their international counterparts, the number of researchers is small and funding is below an appropriate threshold. Some countries have innovated in few economic sectors, while others remain technologically underdeveloped and much of the countries' innovative capacities remain untapped. It is believed that policies still have little influence on social and economic development and there exists dissatisfaction in the academic and entrepreneurial sectors with their quality and relevance or with the political will of governments to execute them. On the other hand, in the past decades, the complexity of innovation systems has increased considerably, and has yet to be taken fully into account in LAC policy definitions. The situation calls for decision makers to shape new framework conditions for R&I in a way that both processes co-evolve and are stimulated and guided on solutions to the major problems of society. Considering the main features of complex systems, self- organization, emergence and non-linearity, R&I policy measures need to be seen as interventions in such a system, as the use of traditional leverage effects used in the past for policy decisions are more and more obsolete. Policies must now use ``weak coordination mechanisms,'' foresight, mission statements, and visions. It is obvious that due to nonlinearities in the system, adaptive political requirements and governance have to replace master plans and long term fixed targets. Policies must include incentives for networking, pilot projects, simulation models, etc. International cooperation is absolutely necessary to generate the new policy framework needed by LAC. )

Use and effectiveness of behavioural economics in interventions for lifestyle risk factors of non-communicable diseases: a systematic review with policy implications.

PubMed

Blaga, Oana M; Vasilescu, Livia; Chereches, Razvan M

2018-03-01

There is limited evidence on what behavioural economics strategies are effective and can be used to inform non-communicable diseases (NCDs) public health policies designed to reduce overeating, excessive drinking, smoking, and physical inactivity. The aim of the review is to examine the evidence on the use and effectiveness of behavioural economics insights on reducing NCDs lifestyle risk factors. Medline, Embase, PsycINFO, and EconLit were searched for studies published between January 2002 and July 2016 and reporting empirical, non-pharmacological, interventional research focusing on reducing at least one NCDs lifestyle risk factor by employing a behavioural economics perspective. We included 117 studies in the review; 67 studies had a low risk of bias and were classified as strong or very strong, 37 were moderate, and 13 were weak. We grouped studies by NCDs risk factors and conducted a narrative synthesis. The most frequent behavioural economics precepts used were incentives, framing, and choice architecture. We found inconclusive evidence regarding the success of behavioural economics strategies to reduce alcohol consumption, but we identified several strategies with policy-level implications which could be used to reduce smoking, improve nutrition, and increase physical activity. Most studies targeting tobacco consumption, physical activity levels, and eating behaviours from a behavioural economics perspective had promising results with potential impact on NCDs health policies. We recommend future studies to be implemented in real-life settings and on large samples from diverse populations.

Did the strong get stronger and the weak get weaker? Examining changes in hospital financial condition.

PubMed

Bazzoli, Gloria J; Lindrooth, Richard C; Clement, Jan P; Zhao, Mei; Chukmaitov, Askar

2006-01-01

In the late 1990s and early 2000s, many industry observers expressed the view that there was a growing dichotomy in the hospital industry in which financially weak hospitals were getting weaker and financially strong hospitals were getting stronger. Although existing analysis of cross-sectional financial data concur with this view, our analysis of 1993 to 2000 longitudinal data provides only partial support. We find that about one half of general acute care hospitals classified as financially strong in 1993-95 continued to be strong in 1998-00. More persistence was found for hospitals in weak financial position in 1993-95 with about 60 to 70 percent of them continuing to be weak in 1998-00. Persistently weak hospitals did experience deteriorating financial condition whereas persistently strong hospitals appeared at best to hold their ground financially. Although many Medicare payment policies appear well-targeted to hospitals that would otherwise have financial problems (for example, isolated rural institutions and teaching hospitals), policymakers may need to consider the development of temporary loan or grant programs to assist hospitals that experience transitory financial problems during difficult times.

Collaboration: a SWOT analysis of the process of conducting a review of nursing workforce policies in five European countries.

PubMed

Uhrenfeldt, Lisbeth; Lakanmaa, Riitta-Liisa; Flinkman, Mervi; Basto, Marta Lima; Attree, Moira

2014-05-01

This paper critically reviews the literature on international collaboration and analyses the collaborative process involved in producing a nursing workforce policy analysis. Collaboration is increasingly promoted as a means of solving shared problems and achieving common goals; however, collaboration creates its own opportunities and challenges. Evidence about the collaboration process, its outcomes and critical success factors is lacking. A literature review and content analysis of data collected from six participants (from five European countries) members of the European Academy of Nursing Science Scholar Collaborative Workforce Workgroup, using a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis template. Two major factors affecting scholarly collaboration were identified: Facilitators, which incorporated personal attributes and enabling contexts/mechanisms, including individual commitment, responsibility and teamwork, facilitative supportive structures and processes. The second, Barriers, incorporated unmet needs for funding; time; communication and impeding contexts/mechanisms, including workload and insufficient support/mentorship. The literature review identified a low level of evidence on collaboration processes, outcomes, opportunities and challenges. The SWOT analysis identified critical success factors, planning strategies and resources of effective international collaboration. Collaboration is an important concept for management. Evidence-based knowledge of the critical success factors facilitating and impeding collaboration could help managers make collaboration more effective. © 2012 John Wiley & Sons Ltd.

Environmental health risks of toxic waste site exposures--an epidemiological perspective.

PubMed

von Schirnding, Y E; Ehrlich, R I

1992-06-06

A general account is given of the problems of assessing the impact of human exposure to toxic waste sites, including the identification of truly exposed populations and of exposure pathways. Epidemiological studies of populations at risk are briefly reviewed and methodological problems summarised. These include the use of relatively weak study designs, inadequate exposure assessment and recall biases associated with symptom reporting among anxious residents living in the vicinity of waste sites. In South Africa, health risks associated with exposure to toxic waste sites need to be viewed in the context of current community health concerns, competing causes of disease and ill-health, and the relative lack of knowledge about environmental contamination and associated health effects. A nonspecific deterioration of health and well-being is more likely to result from waste site exposures than is overt clinical disease. Socially acceptable policies and controls may have to be based on criteria other than demonstrable ill-health. Detailed inventories and registries of the nature of disposed materials need to be maintained, sites of poorly controlled disposal in the past identified and selective environmental monitoring conducted. Epidemiological studies may be justified in situations where exposures well in excess of acceptable norms are demonstrated. An integrated national waste management policy for the country is urgently needed.

Seeing the NICE side of cost-effectiveness analysis: a qualitative investigation of the use of CEA in NICE technology appraisals.

PubMed

Bryan, Stirling; Williams, Iestyn; McIver, Shirley

2007-02-01

Resource scarcity is the raison d'être for the discipline of economics. Thus, the primary purpose of economic analysis is to help decision-makers when addressing problems arising due to the scarcity problem. The research reported here was concerned with how cost-effectiveness information is used by the National Institute for Health & Clinical Excellence (NICE) in national technology coverage decisions in the UK, and how its impact might be increased. The research followed a qualitative case study methodology with semi-structured interviews, supported by observation and analysis of secondary sources. Our research highlights that the technology appraisal function of NICE represents an important progression for the UK health economics community: new cost-effectiveness work is commissioned for each technology and that work directly informs national health policy. However, accountability in policy decisions necessitates that the information upon which decisions are based (including cost-effectiveness analysis, CEA) is accessible. This was found to be a serious problem and represents one of the main ongoing challenges. Other issues highlighted include perceived weaknesses in analysis methods and the poor alignment between the health maximisation objectives assumed in economic analyses and the range of other objectives facing decision-makers in reality. Copyright (c) 2006 John Wiley & Sons, Ltd.

Lessons from the removal of lead from gasoline for controlling other environmental pollutants: A case study from New Zealand

PubMed Central

Wilson, Nick; Horrocks, John

2008-01-01

Background It took over two decades to achieve the removal of leaded gasoline in this country. This was despite international evidence and original research conducted in New Zealand on the harm to child cognitive function and behaviour from lead exposure. Objective To identify lessons from the New Zealand experience of removing leaded gasoline that are potentially relevant to the control of other environmental pollutants. Discussion From the available documentation, we suggest a number of reasons for the slow policy response to the leaded gasoline hazard. These include: (1) industry power in the form of successful lobbying by the lead additive supplier, Associated Octel; (2) the absence of the precautionary principle as part of risk management policy; and (3) weak policymaking machinery that included: (a) the poor use of health research evidence (from both NZ and internationally), as well as limited use of expertise in academic and non-governmental organisations; (b) lack of personnel competent in addressing technically complex issues; and (c) diffusion of responsibility among government agencies. Conclusion There is a need for a stronger precautionary approach by policymakers when considering environmental pollutants. Politicians, officials and health workers need to strengthen policymaking processes and effectively counter the industry tactics used to delay regulatory responses. PMID:18179712

The World Hypertension League: where now and where to in salt reduction

PubMed Central

Lackland, Daniel T.; Lisheng, Liu; Zhang, Xin-Hua; Nilsson, Peter M.; Niebylski, Mark L.

2015-01-01

High dietary salt is a leading risk for death and disability largely by causing increased blood pressure. Other associated health risks include gastric and renal cell cancers, osteoporosis, renal stones, and increased disease activity in multiple sclerosis, headache, increased body fat and Meniere’s disease. The World Hypertension League (WHL) has prioritized advocacy for salt reduction. WHL resources and actions include a non-governmental organization policy statement, dietary salt fact sheet, development of standardized nomenclature, call for quality research, collaboration in a weekly salt science update, development of a process to set recommended dietary salt research standards and regular literature reviews, development of adoptable power point slide sets to support WHL positions and resources, and critic of weak research studies on dietary salt. The WHL plans to continue to work with multiple governmental and non-governmental organizations to promote dietary salt reduction towards the World Health Organization (WHO) recommendations. PMID:26090335

Special Education Teacher Education Research: Current Status and Future Directions

ERIC Educational Resources Information Center

Sindelar, Paul T.; Brownell, Mary T.; Billingsley, Bonnie

2010-01-01

In this article, the authors propose an agenda for special education teacher education researchers, with particular attention to policy work and studies of innovations in pre-service preparation, induction and mentoring, and professional development. Because previous research is limited and unfocused, the foundation for future research is weak,…

University Autonomy: Two Fault-Lines

ERIC Educational Resources Information Center

Evans, G. R.

2010-01-01

The doctrine of university autonomy in the UK contains a least two major "fault-lines" where the structure is inherently weak and there is danger of functional breakdown. The first occurs at the junction between the institution and the state, the second within the institution, where the unity in policy-making between academic and…

UNIX Systems in Higher Education: A Paradoxical Success.

ERIC Educational Resources Information Center

McCredie, John W.

1983-01-01

Bell Laboratories' much acclaimed UNIX operating system is widely used in educational computing environments. Discusses history of the system, system features and weaknesses, and policy issues. Also discusses some ways UNIX systems are used and recent developments at American Telephone and Telegraph (AT&T) impacting UNIX systems. (JN)

Checklist for the Safety and Security of Buildings and Grounds.

ERIC Educational Resources Information Center

Virginia State Dept. of Education, Richmond.

An evaluation checklist is provided for assessing a school's strengths and weaknesses relative to the safety and security of buildings and grounds, as well as assessing development and enforcement of policies, the presence of intervention and prevention plans, staff development, parent and community involvement, opportunities for student…

Retail E-Commerce Security Status among Fortune 500 Corporations

ERIC Educational Resources Information Center

Zhao, Jensen J.; Zhao, Sherry Y.

2012-01-01

The authors assessed the "Fortune 500" corporations' retail e-commerce security to identify their strengths and weaknesses for improvement. They used online content analysis, information security auditing, and network security mapping for data collection and analysis. The findings indicate that most sites posted security policies; however, only…

Education Policy in Greece: A Preliminary Assessment

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

The future of Greece's well-being will depend on improving educational performance to raise employment and social outcomes. The challenges are significant, as public education expenditure in Greece has declined in recent years and learning outcomes are weak. To help the Greek government address these challenges, this report proposes a set of…

The performance of health workers in Ethiopia: results from qualitative research.

PubMed

Lindelow, Magnus; Serneels, Pieter

2006-05-01

Insufficient attention has been paid to understanding what determines the performance of health workers. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia, a country with some of the poorest health outcomes in the world. We describe performance problems identified by both health users and health workers participating in the focus group discussions, including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption. In the second part of the paper we present four structural reasons why these problems arise: (i) the ongoing transition from health sector dominated by the public sector, towards a more mixed model; (ii) the failure of government policies to keep pace with the transition towards a mixed model of service delivery; (iii) weak accountability mechanisms and the erosion of professional norms in the health sector; and (iv) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.

Impact of the health insurance scheme for stateless people on inpatient utilization in Kraburi Hospital, Thailand

PubMed Central

Suphanchaimat, Rapeepong; Prakongsai, Phusit; Limwattananon, Supon; Mills, Anne

2016-01-01

Objectives This study sought to investigate the impact of the Thai “Health Insurance for People with Citizenship Problems” (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. Methods Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. Results The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients’ characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. Conclusion A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended. PMID:27942240

A situational review of infant and young child feeding practices and interventions in Viet Nam.

PubMed

Nguyen, Phuong Hong; Menon, Purnima; Ruel, Mariel; Hajeebhoy, Nemat

2011-01-01

Sub-optimal infant and young child feeding (IYCF) practices are likely a significant contributor to high undernutrition rates in Viet Nam. To date, however, there has been no comprehensive review of IYCF practices in Viet Nam. The objectives of this paper were to review: 1) patterns/trends in IYCF in Viet Nam; 2) the barriers and facilitators to IYCF practices; and 3) interventions and policies and their effectiveness. Methods used include reviewing and analyzing existing data, summarizing and organizing the evidence into broad themes based on a pre-defined conceptual framework. Findings show that the proportion of children ever breastfed is almost universal and the median duration of breastfeeding is 13-18 months. However, exclusive breastfeeding for the first six months is low (8-17%) and appears to be declining over time. Information on complementary feeding is limited, but two key challenges are: early introduction, and low nutrient quality of complementary foods. Facilitators of optimal IYCF were support from 1) government progressive policies, 2) non-profit organizations and 3) family members. Barriers to optimal IYCF included 1) the lack of enforcement of, and compliance with the code of marketing breast milk substitutes, 2) inadequate knowledge among health care providers; and 3) maternal poor knowledge. These findings indicate that the evidence base on complementary feeding is weak in Viet Nam and needs to be strengthened. The review also reinforces that program and policy actions to improve IYCF in Viet Nam must target multiple stakeholders at different levels: the family, the health system and the private sector.

An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana

PubMed Central

2013-01-01

Background Pregnant women were offered free access to health care through National Health Insurance (NHIS) membership in Ghana in 2008, in the latest phase of policy reforms to ensure universal access to maternal health care. During the same year, free membership was made available to all children (under-18). This article presents an exploratory qualitative analysis of how the policy of free maternal membership was developed and how it is being implemented. Methods The study was based on a review of existing literature – grey and published – and on a key informant interviews (n = 13) carried out in March-June 2012. The key informants included representatives of the key stakeholders in the health system and public administration, largely at national level but also including two districts. Results The introduction of the new policy for pregnant women was seen as primarily a political initiative, with limited stakeholder consultation. No costing was done prior to introduction, and no additional funds provided to the NHIS to support the policy after the first year. Guidelines had been issued but beyond collecting numbers of women registered, no additional monitoring and evaluation have yet been put in place to monitor its implementation. Awareness of the under-18 s policy amongst informants was so low that this component had to be removed from the final study. Initial barriers to access, such as pregnancy tests, were cited, but many appear to have been resolved now. Providers are concerned about the workload related to services and claims management but have benefited from increased financial resources. Users still face informal charges, and are reported to have responded differentially, with rises in antenatal care and in urban areas highlighted. Policy sustainability is linked to the survival of the NHIS as a whole. Conclusions Ghana has to be congratulated for its persistence in trying to address financial barriers. However, many themes from previous evaluations of exemptions policies in Ghana have recurred in this study – particularly, the difficulties of getting timely reimbursement to facilities, of controlling charging of patients, and of reaching the poorest. This suggests that providing free care through a national health insurance system has not solved systemic weaknesses. The wider concerns about raising the quality of care, and ensuring that all supply-side and demand-side elements are in place to make the policy effective will also take a longer term and bigger commitment. PMID:23446355

An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana.

PubMed

Witter, Sophie; Garshong, Bertha; Ridde, Valéry

2013-02-27

Pregnant women were offered free access to health care through National Health Insurance (NHIS) membership in Ghana in 2008, in the latest phase of policy reforms to ensure universal access to maternal health care. During the same year, free membership was made available to all children (under-18). This article presents an exploratory qualitative analysis of how the policy of free maternal membership was developed and how it is being implemented. The study was based on a review of existing literature - grey and published - and on a key informant interviews (n = 13) carried out in March-June 2012. The key informants included representatives of the key stakeholders in the health system and public administration, largely at national level but also including two districts. The introduction of the new policy for pregnant women was seen as primarily a political initiative, with limited stakeholder consultation. No costing was done prior to introduction, and no additional funds provided to the NHIS to support the policy after the first year. Guidelines had been issued but beyond collecting numbers of women registered, no additional monitoring and evaluation have yet been put in place to monitor its implementation. Awareness of the under-18 s policy amongst informants was so low that this component had to be removed from the final study. Initial barriers to access, such as pregnancy tests, were cited, but many appear to have been resolved now. Providers are concerned about the workload related to services and claims management but have benefited from increased financial resources. Users still face informal charges, and are reported to have responded differentially, with rises in antenatal care and in urban areas highlighted. Policy sustainability is linked to the survival of the NHIS as a whole. Ghana has to be congratulated for its persistence in trying to address financial barriers. However, many themes from previous evaluations of exemptions policies in Ghana have recurred in this study - particularly, the difficulties of getting timely reimbursement to facilities, of controlling charging of patients, and of reaching the poorest. This suggests that providing free care through a national health insurance system has not solved systemic weaknesses. The wider concerns about raising the quality of care, and ensuring that all supply-side and demand-side elements are in place to make the policy effective will also take a longer term and bigger commitment.

Same Sex Marriage and the Perceived Assault on Opposite Sex Marriage

PubMed Central

Dinno, Alexis; Whitney, Chelsea

2013-01-01

Background Marriage benefits both individuals and societies, and is a fundamental determinant of health. Until recently same sex couples have been excluded from legally recognized marriage in the United States. Recent debate around legalization of same sex marriage has highlighted for anti-same sex marriage advocates and policy makers a concern that allowing same sex couples to marry will lead to a decrease in opposite sex marriages. Our objective is to model state trends in opposite sex marriage rates by implementation of same sex marriages and other same sex unions. Methods and Findings Marriage data were obtained for all fifty states plus the District of Columbia from 1989 through 2009. As these marriage rates are non-stationary, a generalized error correction model was used to estimate long run and short run effects of same sex marriages and strong and weak same sex unions on rates of opposite sex marriage. We found that there were no significant long-run or short run effects of same sex marriages or of strong or weak same sex unions on rates of opposite sex marriage. Conclusion A deleterious effect on rates of opposite sex marriage has been argued to be a motivating factor for both the withholding and the elimination of existing rights of same sex couples to marry by policy makers–including presiding justices of current litigation over the rights of same sex couples to legally marry. Such claims do not appear credible in the face of the existing evidence, and we conclude that rates of opposite sex marriages are not affected by legalization of same sex civil unions or same sex marriages. PMID:23776536

Addressing policy needs for prevention and control of type 2 diabetes in India.

PubMed

Atre, Sachin

2015-09-01

India carries nearly one-fifth of the global burden of diabetes cases, the majority of which are of type 2 diabetes. Recognising the need for controlling diabetes, the Government of India has initiated a national level programme for prevention and control of diabetes along with other non-communicable diseases in 2008. Despite being piloted and implemented, there is hardly any published literature about the national level situation of diabetes and its control efforts. The present article is written with the aim to fill this gap to some extent and to provide a situational analysis of the diabetes problem in India in a holistic way, addressing policy needs for the national programme. It focuses on three main areas, namely, awareness of diabetes, costs of drugs for its treatment and healthcare-system related issues. It argues that poor coverage and weak implementation of the national level programme are major forces that push patients to seek help in the weakly regulated private sector. Approaching the private sector is likely to increase the cost of care, which in turn can lead to an increased financial burden for patients and their families due to factors such as patients' lack of awareness about diabetes, poor drug price regulation and prescriptions including combinations and/or patented products of medicines used for treating diabetes by the private sector. This article addresses several needs such as strengthening the national programme and increasing its reach to unreached districts, exerting drug price regulation and implementing community-based participatory programmes for prevention and management of type 2 diabetes. It also underscores a need for piloting and implementing a robust national level electronic reporting system for diabetes programmes. © Royal Society for Public Health 2015.

Decision support framework for evaluating the operational environment of forest bioenergy production and use: Case of four European countries.

PubMed

Pezdevšek Malovrh, Špela; Kurttila, Mikko; Hujala, Teppo; Kärkkäinen, Leena; Leban, Vasja; Lindstad, Berit H; Peters, Dörte Marie; Rhodius, Regina; Solberg, Birger; Wirth, Kristina; Zadnik Stirn, Lidija; Krč, Janez

2016-09-15

Complex policy-making situations around bioenergy production and use require examination of the operational environment of the society and a participatory approach. This paper presents and demonstrates a three-phase decision-making framework for analysing the operational environment of strategies related to increased forest bioenergy targets. The framework is based on SWOT (strengths, weaknesses, opportunities and threats) analysis and the Simple Multi-Attribute Rating Technique (SMART). Stakeholders of four case countries (Finland, Germany, Norway and Slovenia) defined the factors that affect the operational environments, classified in four pre-set categories (Forest Characteristics and Management, Policy Framework, Technology and Science, and Consumers and Society). The stakeholders participated in weighting of SWOT items for two future scenarios with SMART technique. The first scenario reflected the current 2020 targets (the Business-as-Usual scenario), and the second scenario contained a further increase in the targets (the Increase scenario). This framework can be applied to various problems of environmental management and also to other fields where public decision-making is combined with stakeholders' engagement. The case results show that the greatest differences between the scenarios appear in Germany, indicating a notably negative outlook for the Increase scenario, while the smallest differences were found in Finland. Policy Framework was a highly rated category across the countries, mainly with respect to weaknesses and threats. Intensified forest bioenergy harvesting and utilization has potentially wide country-specific impacts which need to be anticipated and considered in national policies and public dialogue. Copyright © 2016 Elsevier Ltd. All rights reserved.

Learning from Evidence in a Complex World

PubMed Central

Sterman, John D.

2006-01-01

Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended “side effects.” Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies. Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond. PMID:16449579

[Austerity and healthcare privatization in times of crisis: are there any differences among autonomous communities?].

PubMed

Bacigalupe, Amaia; Martín, Unai; Font, Raquel; González-Rábago, Yolanda; Bergantiños, Noemi

2016-01-01

To analyse the differences between autonomous communities in Spain according to their policies of austerity and healthcare privatization during the economic crisis. Changes in the application of legal reforms, healthcare privatization and healthcare financing/resources in the autonomous communities were analysed, and a summary indicator of each dimension was constructed. The Basque Country showed the clearest behaviour towards a weak policy of austerity and privatization, as opposed to La Rioja, Madrid, and the Balearic Islands. The three classifications will enable analysis of the mediating effect of policies of austerity and privatization in the relationship between the economic crisis and health in the Spanish context. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Vector control programs in Saint Johns County, Florida and Guayas, Ecuador: successes and barriers to integrated vector management

PubMed Central

2014-01-01

Background Vector-borne diseases (VBDs) and mosquito control programs (MCPs) diverge in settings and countries, and lead control specialists need to be aware of the most effective control strategies. Integrated Vector Management (IVM) strategies, once implemented in MCPs, aim to reduce cost and optimize protection of the populations against VBDs. This study presents a strengths, weaknesses, opportunities, and threats (SWOT) analysis to compare IVM strategies used by MCPs in Saint Johns County, Florida and Guayas, Ecuador. This research evaluates MCPs strategies to improve vector control activities. Methods Methods included descriptive findings of the MCP operations. Information was obtained from vector control specialists, directors, and residents through field trips, surveys, and questionnaires. Evaluations of the strategies and assets of the control programs where obtained through SWOT analysis and within an IVM approach. Results Organizationally, the Floridian MCP is a tax-based District able to make decisions independently from county government officials, with the oversight of an elected board of commissioners. The Guayas program is directed by the country government and assessed by non-governmental organizations like the World health Organization. Operationally, the Floridian MCP conducts entomological surveillance and the Ecuadorian MCP focuses on epidemiological monitoring of human disease cases. Strengths of both MCPs were their community participation and educational programs. Weaknesses for both MCPs included limitations in budgets and technical capabilities. Opportunities, for both MCPs, are additional funding and partnerships with private, non-governmental, and governmental organizations. Threats experienced by both MCPs included political constraints and changes in the social and ecological environment that affect mosquito densities and control efforts. IVM pillars for policy making were used to compare the information among the programs. Differences included how the Ecuadorian MCP relies heavily on the community for vector control while the American MCP relies on technologies and research. Conclusion IVM based recommendations direct health policy leaders toward improving surveillance systems both entomologically and epidemiologically, improving community risk perceptions by integrating components of community participation, maximizing resources though the use of applied research, and protecting the environment by selecting low-risk pesticides. Outcomes of the research revealed that inter-sectorial and multidisciplinary interventions are critical to improve public health. PMID:24990155

Incentives to improve farm management: EMS, supply-chains and civil society.

PubMed

Gunningham, Neil

2007-02-01

This paper focuses on impediments to environmentally sound management practices and how these might be overcome, with an emphasis on the role of environmental management systems, supply chains and civil society. It argues that: Farmers are under increased pressure to cut costs and improve production but with little opportunity to increase prices. Commonly short-term economic interest has damaging environmental implications. Current government policy, in Australia and in many other jurisdictions, relies heavily on voluntary arrangements, education and information, as the main policy instruments through which to persuade farmers to adopt better environmental farm management - e.g. the recent push to encourage the use of voluntary environmental management systems. However, there is good evidence to suggest that these can only make a valuable contribution when combined with a range of other policy instruments, including positive and negative incentives, intervention by third parties and in some cases, an underpinning of regulation. Arguably, what is needed is a strategy that builds on the strengths of voluntary environmental management arrangements while compensating for their weaknesses by combining them with other, complementary policy instruments. If so, we must engage with a range of questions that have not so far figured substantially in the policy debate. Although the principal focus has been on the role of government in bringing about on-farm change in management practices, supply chain pressure (at least in respect of agricultural chemicals and practices which threaten food safety) and civil society action are also potentially powerful mechanisms for bringing about change. Government can and should play a role in harnessing such forces in the interests of improved environmental on-farm practices.

Alcohol and alcohol-related harm in China: policy changes needed

PubMed Central

Tang, Yi-lang; Xiang, Xiao-jun; Wang, Xu-yi; Cubells, Joseph F; Babor, Thomas F

2013-01-01

Abstract In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China’s policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China’s current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization’s global strategy to reduce the harmful use of alcohol. PMID:23599550

China’s Rapidly Aging Population Creates Policy Challenges In Shaping A Viable Long-Term Care System

PubMed Central

Feng, Zhanlian; Liu, Chang; Guan, Xinping; Mor, Vincent

2013-01-01

In China, formal long-term care services for the large aging population have increased to meet escalating demands as demographic shifts and socioeconomic changes have eroded traditional elder care. We analyze China’s evolving long-term care landscape and trace major government policies and private-sector initiatives shaping it. Although home and community-based services remain spotty, institutional care is booming with little regulatory oversight. Chinese policy makers face mounting challenges overseeing the rapidly growing residential care sector, given the tension arising from policy inducements to further institutional growth, a weak regulatory framework, and the lack of enforcement capacity. We recommend addressing the following pressing policy issues: building a balanced system of services and avoiding an “institutional bias” that promotes rapid growth of elder care institutions over home or community-based care; strengthening regulatory oversight and quality assurance with information systems; and prioritizing education and training initiatives to grow a professionalized long-term care workforce. PMID:23213161

A qualitative study of the determinants of HIV guidelines implementation in two south-eastern districts of Tanzania

PubMed Central

Geubbels, Eveline; Wringe, Alison; Todd, Jim; Klatser, Paul; Dieleman, Marjolein

2017-01-01

Abstract Current HIV policies in Tanzania have adopted the three long-term impact results of zero new infections, zero HIV deaths and zero stigma and discrimination. Strategies to reach these results include scaling-up HIV Testing and Counselling (HTC); Preventing Mother-To-Child Transmission (PMTCT); and strengthening Care and Treatment Clinic (CTC) services. Previous studies showed that HIV policy and guideline recommendations were not always implemented in rural South Tanzania. This study aims to identify the determinants of HIV guideline implementation. A qualitative study of 23 semi-structured interviews with facility in-charges; healthcare workers; district, regional and national HIV coordinators was conducted. Five health facilities were purposively selected by level, ownership and proximity to district headquarters. Interviews were analysed according to Fleuren’s five determinants of innovation uptake related to: strategies used in guideline development and dissemination; guideline characteristics; the guideline implementing organization; guideline users; and the socio-cultural and regulatory context. None of the facilities had the HTC national guideline document. Non-involvement of providers in revisions and weak planning for guideline dissemination impeded their implementation. Lengthy guidelines and those written in English were under-used, and activities perceived to be complicated, like WHO-staging, were avoided. Availability of staff and lack of supplies like test kits and medication impeded implementation. Collaboration between facilities enhanced implementation, as did peer-support among providers. Provider characteristics including education level, knowledge of, and commitment to the guideline influenced implementation. According to providers, determinants of clients’ service use included gender norms, stigma, trust and perceived benefits. The regulatory context prohibited private hospitals from buying HIV supplies. Being tools for bringing policies to practice, national guidelines are crucial in the efforts towards the three zeros. Strategies to improve providers’ adherence to guidelines should include development of clearer guideline dissemination plans, strengthening of the health system, and possibly addressing of provider-perceived patient-level barriers to utilizing HIV services. PMID:28369374

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice

PubMed Central

Rozel, John S.; Mulvey, Edward P.

2018-01-01

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk. PMID:28375722

The Link Between Mental Illness and Firearm Violence: Implications for Social Policy and Clinical Practice.

PubMed

Rozel, John S; Mulvey, Edward P

2017-05-08

The United States has substantially higher levels of firearm violence than most other developed countries. Firearm violence is a significant and preventable public health crisis. Mental illness is a weak risk factor for violence despite popular misconceptions reflected in the media and policy. That said, mental health professionals play a critical role in assessing their patients for violence risk, counseling about firearm safety, and guiding the creation of rational and evidence-based public policy that can be effective in mitigating violence risk without unnecessarily stigmatizing people with mental illness. This article summarizes existing evidence about the interplay among mental illness, violence, and firearms, with particular attention paid to the role of active symptoms, addiction, victimization, and psychosocial risk factors. The social and legal context of firearm ownership is discussed as a preface to exploring practical, evidence-driven, and behaviorally informed policy recommendations for mitigating firearm violence risk.

A Proposed Strategy for Research Misconduct Policy: A Review on Misconduct Management in Health Research System

PubMed Central

Djalalinia, Shirin; Owlia, Parviz; Malek Afzali, Hossein; Ghanei, Mostafa; Peykari, Niloofar

2016-01-01

Background: Today, with the rapid growth of scientific production, research misconduct has become a worldwide problem. This article is intended to introduce the successful experience on the management of research paper misconducts in the field of health research. Methods: Our aim was to design and develop the strategy for research misconduct policy. Focusing on the national regulatory system, we developed a hierarchical model for paper misconduct policy in all the medical sciences universities and their affiliated research units. Results: Through our regulatory policy for paper misconduct management, specific protocol was followed in the field of health research publications through which the capabilities of covering the four main elements of prevention, investigation, punishment, and correction have come together. Conclusions: Considering the proposed strategy, regarding the strengths and weaknesses, utilization of evaluation tool can be one of the best strategies to achieving the prospective of health research papers by 2025. PMID:27512558

A Proposed Strategy for Research Misconduct Policy: A Review on Misconduct Management in Health Research System.

PubMed

Djalalinia, Shirin; Owlia, Parviz; Malek Afzali, Hossein; Ghanei, Mostafa; Peykari, Niloofar

2016-01-01

Today, with the rapid growth of scientific production, research misconduct has become a worldwide problem. This article is intended to introduce the successful experience on the management of research paper misconducts in the field of health research. Our aim was to design and develop the strategy for research misconduct policy. Focusing on the national regulatory system, we developed a hierarchical model for paper misconduct policy in all the medical sciences universities and their affiliated research units. Through our regulatory policy for paper misconduct management, specific protocol was followed in the field of health research publications through which the capabilities of covering the four main elements of prevention, investigation, punishment, and correction have come together. Considering the proposed strategy, regarding the strengths and weaknesses, utilization of evaluation tool can be one of the best strategies to achieving the prospective of health research papers by 2025.

[Welfare policies on the fringe of capitalism: the recent situation in Brazil].

PubMed

Pochmann, Marcio

2007-01-01

Located on the fringe of global capitalism, lacking an international currency and endowed with weak technology production and dissemination capacities, Brazil is developing its own very specific approach to social welfare policies. Its 1988 Constitution ushered in acknowledged progress in these policies during the past two decades, despite constraints due to the general behavior of its lackluster economy, with rising unemployment and a shrinking job pool. In parallel, the semi-stagnation of its per capita income has been paced by a steady stream of tax adjustments, hobbling more recent developments in social spending. All these efforts often achieve little more than upholding the wealth financialization cycle, mainly for the tiny portion of society holding public debt papers. An analysis of this specifically Brazilian situation leads to a better understanding of missed opportunities for cutting away many of Brazil's social shackles, as welfare policies have significant impacts on lower-income segments of the population.

The potential of health sector non-governmental organizations: policy options.

PubMed

Gilson, L; Sen, P D; Mohammed, S; Mujinja, P

1994-03-01

Non-governmental organizations (NGOs) have increasingly been promoted as alternative health care providers to the state, furthering the same goals but less hampered by government inefficiencies and resource constraints. However, the reality of NGO health care provision is more complex. Not only is the distinction between government and NGO providers sometimes difficult to determine because of their operational integration, but NGOs may also suffer from resource constraionts and management inefficiencies similar to those of government providers. Some registered NGOs operate as for-profit providers in practice. Policy development must reflect the strengths and weaknesses of NGOs in particular settings and should be built on NGO advantages over government in terms of resource mobilization, efficiency and/or quality. Policy development will always require a strong government presence in co-ordinating and regulating health care provision, and an NGO sector responsive to the policy goals of government.

Demographic Trends, Policy Influences, and Economic Effects in China and India Through 2025

DTIC Science & Technology

2011-04-01

see Bardhan (2003). 42 over four children per woman. These northern states are poor and have weak infrastructure, educational systems, and...www.hsph.harvard.edu/pgda/WorkingPapers/2010/PGDA_WP_53.pdf Bardhan , Pranab, “Crouching Tiger, Lumbering Elephant: A China-India Comparison,” in Kaushik

Through Deming's Eyes: A Cross-National Analysis of Quality Assurance Policies in Higher Education.

ERIC Educational Resources Information Center

Dill, David D.

1995-01-01

Efforts to improve the quality of academic programs in the United Kingdom, United States, and Netherlands have followed three general approaches: the logic of competitive markets; application of incentives; and professional self-regulation. Strengths and weaknesses of these approaches for improving academic quality are examined through the lens of…

Report: Internal Control Weaknesses under EPA Grant Nos. I004802070 and BG96483308, Awarded to the Eastern Band of Cherokee Indians, Cherokee, North Carolina

EPA Pesticide Factsheets

Report #10-4-0001, October 5, 2009. EBCI does not have a conflict of interest and its SF 272s are correct and prepared in compliance with federal requirements, EPA policies, and grant terms and conditions.

Review: The birds of Hispaniola: Haiti and the Dominican Republic

Treesearch

Wayne J. Arendt

2005-01-01

The following critiques express the opinions of the individual evaluators regarding the strengths, weaknesses, and value of the books they review. As such, the appraisals are subjective assessments and do not necessarily refl ect the opinions of the editors or any offi cial policy of the American Ornithologists’ Union.

Optimal birth control of age-dependent competitive species III. Overtaking problem

NASA Astrophysics Data System (ADS)

He, Ze-Rong; Cheng, Ji-Shu; Zhang, Chun-Guo

2008-01-01

A study is made of an overtaking optimal problem for a population system consisting of two competing species, which is controlled by fertilities. The existence of optimal policy is proved and a maximum principle is carefully derived under less restrictive conditions. Weak and strong turnpike properties of optimal trajectories are established.

Effective School District Management: A Self-Review Instrument and Guide.

ERIC Educational Resources Information Center

Dembowski, Fred

This guide describes the school administrator's managerial role. It is designed to help readers gain additional insights into this role by explaining how to conduct a self-review of the strengths and weaknesses of educational-management-related policies and procedures in school districts. It begins with a discussion of a school administrators'…

Educational Standards, Accountability, and Student Assessment: Legal and Administrative Considerations for Competency Testing.

ERIC Educational Resources Information Center

Hoegl, Juergen K.

Minimal competency testing of students can be an effective tool for improving educational quality if applied appropriately with adequate safeguards. The failure of academic standards through grade inflation, a policy of social promotion rather than academic promotion, and weak curricula has reduced public confidence in education and encouraged…

Education and Its Limitations in the Maintenance of Peace in El Salvador.

ERIC Educational Resources Information Center

Moncada-Davidson, Lillian

1995-01-01

Points out weaknesses in Salvadoran government policies, which seek to reform public education and build human capital in the interests of long-term economic development but fail to address extreme poverty and social inequality. Suggests that support for existing grass-roots economic and educational projects would help the poor and thereby…

Education in Costa Rica. Reviews of National Policies for Education

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

As Costa Rica's economy has developed in recent decades, the education system that helped propel the country to upper middle-income status now needs reform to respond to rising expectations and changing demands for skills. New challenges are emerging: economic growth has recently slowed, inequality is widening and productivity growth is weak. How…

Facing the Challenges of E-Learning Initiatives in African Universities

ERIC Educational Resources Information Center

Gunga, Samson O.; Ricketts, Ian W.

2007-01-01

This paper explores the possibility of bringing e-learning to African universities through collaborative networks of public-private partnerships. It is envisaged that this approach will solve the dual problem of infrastructural barriers and weak ICT policies. As technology is used more in education, the teachers' roles are increasingly integrated…

Policies and Practices in the Bibliographic Control of United States Government Publications.

ERIC Educational Resources Information Center

Crowers, Clifford P., Ed.

1974-01-01

In an attempt to clarify the indexing and announcing controls for government documents, this issue of the Drexel Library Quarterly presents background information on several of the information controlling and access agencies, describes their operations, and points out their inherent problems and weaknesses. The agencies covered are the Government…

Career Education for Mentally Handicapped Adults. Discussion Paper 01/83.

ERIC Educational Resources Information Center

Lindsay, Janis

A study examined the career education opportunities available to mentally handicapped adults in British Columbia. The primary objectives of the study were to assess the effectiveness of various methods and models in meeting the needs of mentally handicapped adults, to explore the policy implications of the program strengths and weaknesses, to…

Whose Evidence Is It Anyway?

ERIC Educational Resources Information Center

Gorard, Stephen

2008-01-01

When governments and pressure groups attend only to research that suits their political purposes, it makes a mockery of the idea of evidence-informed policy and practice. In this article, the author cites examples of research that picked up weak and misleading evidence for political purposes. The author argues that researchers are tied in to the…

Data-based Organizational Change: The Use of Administrative Data To Improve Child Welfare Programs and Policy.

ERIC Educational Resources Information Center

English, Diana J.; Brandford, Carol C.; Coghlan, Laura

2000-01-01

Discusses the strengths and weaknesses of administrative databases, issues with their implementation and data analysis, and effective presentation of their data at different levels in child welfare organizations. Focuses on the development and implementation of Washington state's Children's Administration's administrative database, the Case and…

Immaculate Consummation: Learning Meets Leadership

ERIC Educational Resources Information Center

Gronn, Peter

2009-01-01

As a policy-making elite, the Organization for Economic Cooperation and Development (OECD), according to this author, is susceptible to one of the fatal weaknesses of all elites: an inclination to be inwardly self-referential in their views of the world and to seek confirmation of the positions to which they are already predisposed or committed.…

Sexuality education in a representative sample of Portuguese schools: examining the impact of legislation.

PubMed

Rocha, Ana Cristina; Duarte, Cidália

2015-02-01

To share Portugal's experience with school-based sexuality education, and to describe its implementation at a local level, following an ecological model and using a mixed methodology approach. The study also examines the impact of the latest policies put into effect, identifying potential weaknesses and strengths affecting the effectiveness of sexuality education enforcement. A representative sample of 296 schools in Portugal was analysed. Teachers representing the school completed a questionnaire and were asked to share any kind of official document from their sexuality education project (such as curriculum content). A subsample of these documents was analysed by two coders. Quantitative analysis was carried out using descriptive statistics. The majority of Portuguese schools delivered sexuality education, in line with Portuguese technical guidelines and international recommendations. There were common procedures in planning, implementation and evaluation of sexuality education. Some strengths and weaknesses were identified. Results highlighted the impact of the various systems on the planning, enforcement and evaluation of sexuality education in school. The latest policies introduced valuable changes in school-based sexuality education. A way of assessing effectiveness of sexuality education is still needed.

Public and private sector in the health care system of the Federation bosnia and herzegovina: policy and strategy.

PubMed

Slipicevic, Osman; Malicbegovic, Adisa

2012-01-01

In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other.

Public and Private Sector in the Health Care System of the Federation Bosnia and Herzegovina: Policy and Strategy

PubMed Central

Slipicevic, Osman; Malicbegovic, Adisa

2012-01-01

In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other. PMID:23678309

Strength and Comprehensiveness of School Wellness Policies in Southeastern US School Districts.

PubMed

Cox, Melissa J; Ennett, Susan T; Ringwalt, Christopher L; Hanley, Sean M; Bowling, James M

2016-09-01

In 2004, Congress passed legislation mandating that all public school districts participating in federal school meal programs develop a school wellness policy (SWP) to direct efforts related to nutrition and physical activity. We examined the extent to which SWPs varied in comprehensiveness and strength in a representative sample of school districts in the southeastern United States, the area of the country with the highest rates of childhood obesity. Policies were assessed using an established 96-item coding tool by 2 raters to ascertain the comprehensiveness and strength of the policies as a whole, and across distinct subsections specified by federal legislation. In addition, variability in SWP comprehensiveness and strength was assessed based on district sociodemographic characteristics. Overall, SWPs in the southeastern states are weakly written, fragmented, and lack requirements necessary for healthy school environments. District size, which was the only sociodemographic factor related to policy characteristics, yielded an inverse association. To encourage continued promotion of healthy school environments, school districts will require technical support to improve the quality of their school wellness policies. © 2016, American School Health Association.

The challenges of nutrition policymaking.

PubMed

Slavin, Joanne L

2015-02-07

In my over three decades of work in the field of food and nutrition, I have participated in many efforts that seek new policy initiatives in the hopes that these programs can curb rates of obesity and chronic disease and help consumers make healthier dietary choices. Because of the profound effect that many of these policies have on consumers, the food environment, federal nutrition assistance programs and subsequent policy and regulatory recommendations, it is imperative that only the strongest, best available evidence is used to set policy. This review evaluates methods by which current nutrition policies use scientific research as well as provides recommendations for how best to ensure future nutrition policies are truly science-based and likely to have a meaningful impact on public health. Specifically, this review will: Describe the current food and nutrition policy environment in the US Examine how science is used in federal food and nutrition policymaking efforts, using the Dietary Guidelines for Americans (DGA) as an example Describe strong versus weak science as well as what types of studies are most appropriate for use in policymaking Discuss the potential effects and consequences of making policy recommendations in the absence of scientific consensus or agreement Make recommendations to support the present and ongoing development of science-based policy likely to positively impact public health.

State policies targeting junk food in schools: racial/ethnic differences in the effect of policy change on soda consumption.

PubMed

Taber, Daniel R; Stevens, June; Evenson, Kelly R; Ward, Dianne S; Poole, Charles; Maciejewski, Matthew L; Murray, David M; Brownson, Ross C

2011-09-01

We estimated the association between state policy changes and adolescent soda consumption and body mass index (BMI) percentile, overall and by race/ethnicity. We obtained data on whether states required or recommended that schools prohibit junk food in vending machines, snack bars, concession stands, and parties from the 2000 and 2006 School Health Policies and Programs Study. We used linear mixed models to estimate the association between 2000-2006 policy changes and 2007 soda consumption and BMI percentile, as reported by 90 730 students in 33 states and the District of Columbia in the Youth Risk Behavior Survey, and to test for racial/ethnic differences in the associations. Policy changes targeting concession stands were associated with 0.09 fewer servings of soda per day among students (95% confidence interval [CI] = -0.17, -0.01); the association was more pronounced among non-Hispanic Blacks (0.19 fewer servings per day). Policy changes targeting parties were associated with 0.07 fewer servings per day (95% CI = -0.13, 0.00). Policy changes were not associated with BMI percentile in any group. State policies targeting junk food in schools may reduce racial/ethnic disparities in adolescent soda consumption, but their impact appears to be too weak to reduce adolescent BMI percentile.

Strengthening health systems by health sector reforms.

PubMed

Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

2014-01-01

The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.

Access to antiretroviral treatment, issues of well-being and public health governance in Chad: what justifies the limited success of the universal access policy?

PubMed Central

2013-01-01

Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country’s budget and external donors’ financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems. PMID:23902732

Rehabilitation in practice: management of lower motor neuron weakness.

PubMed

Ramdharry, Gita M

2010-05-01

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'The trainee consistently demonstrates a knowledge of the pathophysiology of various specific impairments including lower motor neuron weakness' and 'management approaches for specific impairments including lower motor neuron weakness'.This article explores weakness as a lower motor symptom. Weakness as a primary impairment of neuromuscular diseases is addressed, with recognition of the phenomenon of disuse atrophy, and how weakness impacts on the functional abilities of people with myopathy and neuropathy. Interventions to reduce weakness or address the functional consequences of weakness are evaluated with consideration of safety and clinical application. This paper will allow readers to: (1) appraise the contribution of research in rehabilitation of lower motor neuron weakness to clinical decision making and (2) engage with the issues that arise when researching rehabilitation interventions for lower motor neuron weakness. Impairments associated with neuromuscular conditions can lead to significant functional difficulties that can impact on a person's daily participation. This article focuses on the primary impairment of weakness and explores the research evidence for rehabilitation interventions that directly influence weakness or address the impact of weakness on function.

[Evaluative designs in public health: methodological considerations].

PubMed

López, Ma José; Marí-Dell'Olmo, Marc; Pérez-Giménez, Anna; Nebot, Manel

2011-06-01

Evaluation of public health interventions poses numerous methodological challenges. Randomization of individuals is not always feasible and interventions are usually composed of multiple factors. To face these challenges, certain elements, such as the selection of the most appropriate design and the use of a statistical analysis that includes potential confounders, are essential. The objective of this article was to describe the most frequently used designs in the evaluation of public health interventions (policies, programs or campaigns). The characteristics, strengths and weaknesses of each of these evaluative designs are described. Additionally, a brief explanation of the most commonly used statistical analysis in each of these designs is provided. Copyright © 2011 Sociedad Española de Salud Pública y Administración Sanitaria. Published by Elsevier Espana. All rights reserved.

The PI-Mode of Project Management

NASA Technical Reports Server (NTRS)

Isaac, Dan

1997-01-01

The PI-Mode is NASA's new approach to project management. It responds to the Agency's new policy to develop scientific missions that deliver the highest quality science for a fixed cost. It also attempts to provide more research opportunities by reducing project development times and increasing the number of launches per year. In order to accomplish this, the Principal Investigator is placed at the helm of the project with full responsibility over all aspects of the mission, including instrument and spacecraft development, as well as mission operations and data analysis. This paper intends to study the PI-Mode to determine the strengths and weaknesses of such a new project management technique. It also presents an analysis of its possible impact on the scientific community and its relations with industry, NASA, and other institutions.

[Model-based biofuels system analysis: a review].

PubMed

Chang, Shiyan; Zhang, Xiliang; Zhao, Lili; Ou, Xunmin

2011-03-01

Model-based system analysis is an important tool for evaluating the potential and impacts of biofuels, and for drafting biofuels technology roadmaps and targets. The broad reach of the biofuels supply chain requires that biofuels system analyses span a range of disciplines, including agriculture/forestry, energy, economics, and the environment. Here we reviewed various models developed for or applied to modeling biofuels, and presented a critical analysis of Agriculture/Forestry System Models, Energy System Models, Integrated Assessment Models, Micro-level Cost, Energy and Emission Calculation Models, and Specific Macro-level Biofuel Models. We focused on the models' strengths, weaknesses, and applicability, facilitating the selection of a suitable type of model for specific issues. Such an analysis was a prerequisite for future biofuels system modeling, and represented a valuable resource for researchers and policy makers.

CORRELATES OF INTERORGANIZATIONAL SERVICE COORDINATION IN COMMUNITY CORRECTIONS

PubMed Central

Welsh, Wayne N.; Prendergast, Michael; Knight, Kevin; Knudsen, Hannah; Monico, Laura; Gray, Julie; Abdel-Salam, Sami; Redden, Shawna Malvini; Link, Nathan; Hamilton, Leah; Shafer, Michael S.; Friedmann, Peter D.

2016-01-01

Because weak interagency coordination between community correctional agencies (e.g., probation and parole) and community-based treatment providers has been identified as a major barrier to the use of evidence-based practices (EBPs) for treating druginvolved offenders, this study sought to examine how key organizational (e.g., leadership, support, staffing) and individual (e.g., burnout, satisfaction) factors influence interagency relationships between these agencies. At each of 20 sites, probation/parole officials (n = 366) and community treatment providers (n = 204) were surveyed about characteristics of their agencies, themselves, and interorganizational relationships with each other. Key organizational and individual correlates of interagency relationships were examined using hierarchical linear models (HLM) analyses, supplemented by interview data. The strongest correlates included Adaptability, Efficacy, and Burnout. Implications for policy and practice are discussed. PMID:27546925

The impact of federal policy on teachers' use of science manipulatives: A survey of teacher philosophy and practices

NASA Astrophysics Data System (ADS)

Helgoe, Catherine A.

Recently, educators in public K-12 schools have added testing of science knowledge to the measures of Adequate Yearly Progress required by the federal No Child Left Behind (NCLB) legislation. Research of the impact of NCLB policy on general teaching practices had credited the policy with improving instruction; however, negative impacts noted included the concern that teachers "teach to the test," narrowing the curriculum. Testing as an assessment strategy was not advocated by the professional educators and scientists responsible for the National Science Education Standards (NSES). Results from previous studies pointed to a potential conflict between the NCLB reforms and the National Science Education Standards science standards, in which teachers might reduce or eliminate hands-on activities and other constructivist practices in order to focus class time on other topics and tasks. Most research on NCLB policy, however, had not evaluated instructional practices regarding science education. This study examined the relationship among teacher beliefs, specifically the strength of their constructivist versus traditional beliefs, teachers' responses to NCLB policy, and teachers' use of constructivist practices in the form of manipulatives. This study showed that national policy did have an impact on teachers; however, that impact was not specific to the hands-on practices in science education. Teachers who responded to this survey had found many benefits in student learning using manipulatives and those positive impacts on their students justified the increased use of manipulatives in the classroom. The strength of teachers' constructivist beliefs showed a weak positive correlation to choices related to curriculum priorities, learning goals and advantages in using manipulatives. However, a relationship to beliefs was not found in the changes teachers made to various instructional practices, or in how they viewed certain manipulative materials, or in how they viewed federal policies. The impact of the federal policies was related more to school climate and teacher motivation than instructional choices. Most teachers reported positive impacts on student learning using manipulatives and these results, more than the pressure they felt to "cover the curriculum" or prepare students for standardized tests, provided reasons to continue using the practice.

Community-Based Participatory Research and Policy Advocacy to Reduce Diesel Exposure in West Oakland, California

PubMed Central

Gonzalez, Priscilla A.; Garcia, Analilia P.; Gordon, Margaret; Garzón, Catalina; Palaniappan, Meena; Prakash, Swati; Beveridge, Brian

2011-01-01

We conducted a multimethod case study analysis of a community-based participatory research partnership in West Oakland, California, and its efforts to study and address the neighborhood's disproportionate exposure to diesel air pollution. We employed 10 interviews with partners and policymakers, participant observation, and a review of documents. Results of the partnership's truck count and truck idling studies suggested substantial exposure to diesel pollution and were used by the partners and their allies to make the case for a truck route ordinance. Despite weak enforcement, the partnership's increased political visibility helped change the policy environment, with the community partner now heavily engaged in environmental decision-making on the local and regional levels. Finally, we discussed implications for research, policy, and practice. PMID:21551381

Opening the black box of transfer systems in public sector health services in a Western state in India.

PubMed

Purohit, Bhaskar; Martineau, Tim; Sheikh, Kabir

2016-08-22

Limited research on Posting and Transfer (P&T) policies and systems in the public sector health services and the reluctance for an open debate on the issue makes P&T as a black box. Limited research on P&T in India suggests that P&T policies and systems are either non-existent, weak, poorly implemented or characterized by corruption. Hence the current study aimed at opening the "black box" of P&T systems in public sector health services in India by assessing the implementation gaps between P&T policies and their actual implementation. This was a qualitative study carried out in Department of Health, in a Western State in India. To understand the extant P&T policies, a systems map was first developed with the help of document review and Key Informant (KI) Interviews. Next systems audit was carried out to assess the actual implementation of transfer policies by interviewing Medical Officers (MOs), the group mainly affected by the P&T policies. Job histories were constructed from the interviews to understand transfer processes like frequencies of transfers and to assess if transfer rules were adhered. The analysis is based on a synthesis of document review, 19 in-depth interviews with MOs working with state health department and five in-depth interviews with Key Informants (KIs). Framework analysis approach was used to analyze data using NVIVO. The state has a generic transfer guideline applicable to all government officers but there is no specific transfer policy or guideline for government health personnel. The generic transfer guidelines are weakly implemented indicating a significant gap between policy and actual implementation. The formal transfer guidelines are undermined by a parallel system in which desirable posts are attained, retained or sometimes given up by the use of political connections and money. MOs' experiences of transfers were marked by perceptions of unfairness and irregularities reflected through interviews as well as the job histories. The generic transfer rules and ambiguity in how transfers are treated may explain the discrepancy between policy and implementation leading to systems abuse. This discrepancy could have negative influence on MOs' morale which could in turn affect distribution of MOs. Where possible, ambiguity in the rules should be avoided and a greater transparency on implementation of the transfer rules is needed. However, it may not be possible to make any significant improvements to P&T policies and how they are implemented until the external pressure that creates parallel systems is greatly reduced in translating HR policy into HR practice. Effective P&T policies and implementation may have important implications for organizational performance and may help to improve Human Resource (HR) policy and HR expertise. Also there is a greater need for transparency on implementation of the rules. However, it may not be possible to make any significant improvements to P&T policies and how they are implemented until the external pressure that creates parallel systems is greatly reduced.

Health equity and migrants in the Greater Mekong Subregion

PubMed Central

McMichael, Celia; Healy, Judith

2017-01-01

ABSTRACT Background: Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries. Methods: A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants. Results: There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers – and irregular migrants in particular – face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services. Conclusions: UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require deliberate policy decisions to include migrants. The emergence of the UHC agenda, and the focus on migrant health among policy makers and partners, present an opportunity to tackle barriers to health service access, extend coverage, and strengthen partnerships in order to improve migrant health. This is an opportune time for GMS countries to develop migrant-inclusive health systems. PMID:28452652

Promoting transparency, accountability, and access through a multi-stakeholder initiative: lessons from the medicines transparency alliance.

PubMed

Vian, Taryn; Kohler, Jillian C; Forte, Gilles; Dimancesco, Deirdre

2017-01-01

Barriers to expanding access to medicines include weak pharmaceutical sector governance, lack of transparency and accountability, inadequate attention to social services on the political agenda, and financing challenges. Multi-stakeholder initiatives such as the Medicines Transparency Alliance (MeTA) may help overcome these barriers. Between 2008 and 2015, MeTA engaged stakeholders in the pharmaceutical sectors of seven countries (Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda, and Zambia) to promote access goals through greater transparency. We reviewed archival data to document MeTA activities and results related to transparency and accountability in the seven countries where it was implemented. We identified common themes and content areas, noting specific activities used to make information transparent and accessible, how data were used to inform discussions, and the purpose and timing of meetings and advocacy activities to help set priorities and influence governance decisions. The cross-case analysis looked for pathways which might link the MeTA strategies to results such as better policies or program improvements. Countries used evidence gathering, open meetings, and proactive information dissemination to increase transparency. MeTA fostered policy dialogue to bring together the many government, civil society and private company stakeholders concerned with access issues, and provided them with information to understand barriers to access at policy, organizational, and community levels. We found strong evidence that transparency was enhanced. Some evidence suggests that MeTA efforts contributed to new policies and civil society capacity strengthening although the impact on government accountability is not clear. MeTA appears to have achieved its goal of creating a multi-stakeholder shared policy space in which government, civil society, and private sector players can come together and have a voice in the national pharmaceutical policy making process. Assuming that transparency is in place to leverage accountability, the success of MeTA's efforts to promote accountability by the government as well as other stakeholders in the pharmaceutical sector will depend on how well efforts are sustained over time.

Challenges with implementing malaria rapid diagnostic tests at primary care facilities in a Ghanaian district: a qualitative study.

PubMed

Boadu, Nana Yaa; Amuasi, John; Ansong, Daniel; Einsiedel, Edna; Menon, Devidas; Yanow, Stephanie K

2016-02-27

Rapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resource-limited settings, where weak infrastructure limits the use of microscopy. In 2010, Ghana adopted a test-before-treat guideline for malaria, with RDT use promoted to facilitate diagnosis. Yet healthcare practitioners still treat febrile patients without testing, or despite negative malaria test results. Few studies have explored RDT implementation beyond the notions of provider or patient acceptability. The aim of this study was to identify the factors directly influencing malaria RDT implementation at primary care facilities in a Ghanaian district. Qualitative interviews, focus groups and direct observations were conducted with 50 providers at six purposively selected primary care facilities in the Atwima-Nwabiagya district. Data were analysed thematically. RDT implementation was hampered by: (1) healthcare delivery constraints (weak supply chain, limited quality assurance and control, inadequate guideline emphasis, staffing limitations); (2) provider perceptions (entrenched case-management paradigms, limited preparedness for change); (3) social dynamics of care delivery (expected norms of provider-patient interaction, test affordability); and (4) limited provider engagement in policy processes leading to fragmented implementation of health sector reform. Limited health system capacity, socio-economic, political, and historical factors hampered malaria RDT implementation at primary care facilities in the study district. For effective RDT implementation providers must be: (1) adequately enabled through efficient allocation and management of essential healthcare commodities; (2) appropriately empowered with the requisite knowledge and skill through ongoing, effective professional development; and (3) actively engaged in policy dialogue to demystify socio-political misconceptions that hinder health sector reform policies from improving care delivery. Clear, consistent guideline emphasis, with complementary action to address deep-rooted provider concerns will build their confidence in, and promote uptake of recommended policies, practices, and technology for diagnosing malaria.

Situational analysis of antibiotic use and resistance in Ghana: policy and regulation.

PubMed

Yevutsey, Saviour Kwame; Buabeng, Kwame Ohene; Aikins, Moses; Anto, Berko Panyin; Biritwum, Richard B; Frimodt-Møller, Niels; Gyansa-Lutterodt, Martha

2017-11-23

Antibiotics have played an essential role in decreasing morbidity and mortality from infectious diseases. However, indiscriminate use and unrestricted access is contributing to the emergence of bacterial resistance. This paper reports on a situational analysis of antimicrobial use and resistance in Ghana, with focus on policy and regulation. Relevant policy documents, reports, regulations and enactments were reviewed. PubMed and Google search engines were used to extract relevant published papers. Websites of stakeholders such as Ministry of Health (MOH) and its agencies were also reviewed. An interview guide was used to elicit responses from selected officials from these sectors. Laws and guidelines to control the use of antimicrobials in humans were available but not for animals. There was no National Antimicrobial Policy (NAP). A health practice regulatory law mandates Physicians, Physician Assistants, Midwives and trained Nurses to prescribe antimicrobials. However, antibiotics are widely prescribed and dispensed by unauthorised persons, suggesting weak enforcement of the laws. Antibiotics were also supplied to and from unapproved medicine outlets. The Standard Treatment Guidelines (STG), Essential Medicines List (EML) and the National Health Insurance Scheme Medicines List (NHISML) provide restrictions regarding levels of prescribing of antimicrobials. However, existing guidelines on antibiotic use are mostly not adhered to. The use of Automatic Stop Orders to avoid wastage in the hospitals is also not practiced. Data on use of antibiotics for individuals are not readily available in most facilities. Again, there are no standards or guidelines on veterinary use of antibiotics. Surveillance systems for consumption of antibiotics and resistance monitoring were not in place in most health facilities. However, there is an ongoing national action to create awareness on bacteria resistance, strengthening knowledge through research and surveillance and development of NAP in line with global action plan on antimicrobial resistance. Absence of national antimicrobial policy, weak regulatory environment and non-adherence to practice standards may have contributed to increased and unregulated access to antimicrobials in Ghana, a catalyst for development and spread of antimicrobial resistance.

The Development of Japanese Educational Policy, 1945-85.

ERIC Educational Resources Information Center

Beauchamp, Edward R.

1987-01-01

Reviews Japan's educational system in terms of three major time periods: the Meiji Period 1868-80, Occupation Period 1945-52, and from 1978 to the present. Discusses strengths and weaknesses of education in each time frame. Concludes that Japan's educational system is in need of reform once again, but questions whether it has the ability to reform…

The Organisation of 14-19 Education and Training in England: Beyond Weakly Collaborative Arrangements

ERIC Educational Resources Information Center

Hodgson, Ann; Spours, Ken

2006-01-01

As a result of reforms over the past two decades, institutional arrangements for upper secondary education in England are both marketised and competitive compared with other European systems. Since 1997, the Labour Government has broadly sustained this position. However, recent policy documents recognise that 14-19 education and training will…

Single Mothers, the Underclass, and Social Policy. CDE Working Paper 88-30.

ERIC Educational Resources Information Center

McLanahan, Sara; Garfinkel, Irv

Although the vast majority of single mothers do not fit the description of an underclass, there is a small group of predominantly black single mothers concentrated in northern urban ghettos that is persistently weakly attached to the labor force, socially isolated, and reproducing itself. Although welfare programs are necessary for those who are…

A Study of Policy for Providing Feedback to Students on College English

ERIC Educational Resources Information Center

Chen, Liping

2009-01-01

Feedback is central to the development of effective learning in college English. This article presents a study on feedback to students on college English. The purpose of providing feedback to the students is to help teachers and students to identify their strengths and weaknesses. The author offers different kinds of feedback in her teaching.…

Planning, Plumbing, or Posturing? Explaining the Weakness of Human Resource Development Structures and Policies in South Africa

ERIC Educational Resources Information Center

Allais, Stephanie; Marock, Carmel; Ngcwangu, Siphelo

2017-01-01

In South Africa, a national peak structure, the Human Resource Development Council, led by the Deputy President and consisting of key Cabinet Ministers, senior leaders from organised labour and business, community representatives, professional bodies and experts from research and higher education, was established to enable high-level coordination…

The New Regionalism in Sub-Saharan Africa: More Than Meets the Eye? Policy Brief No. 20

ERIC Educational Resources Information Center

Goldstein, Andrea

2002-01-01

Following independence in sub-Saharan Africa in the 1960s, traditional integration strategies produced disappointing results in most instances, as they started with very modest levels of intra-regional trade, marked differences in income and industrialisation levels and diffuse fiscal weakness. They also had a strong protectionist bias, trying to…

School Health Index: A Self-Assessment and Planning Guide. Middle School/High School.

ERIC Educational Resources Information Center

Barrios, Lisa C.; Burgeson, Charlene R.; Crossett, Linda; Harrykissoon, Samantha D.; Pritzl, Jane; Wechsler, Howell; Kuester, Sarah A.; Pederson, Linda; Graffunder, Corinne; Rainford, Neil; Sleet, David

2004-01-01

The "School Health Index" is a self-assessment and planning guide that will enable schools to: (1) identify the strengths and weaknesses of school policies and programs for promoting health and safety; (2) develop an action plan for improving student health and safety, and (3) involve teachers, parents, students, and the community in improving…

Caution Ahead: Overdue Investments for New York's Aging Infrastructure

ERIC Educational Resources Information Center

Forman, Adam

2014-01-01

Following the devastation of Superstorm Sandy in October 2012, New York City's essential infrastructure needs were made a top policy priority for the first time in decades. The scale and severity of the storm prompted numerous studies to assess the damage and led policymakers to take steps to shore up the city's coastal infrastructure weaknesses.…

The Pedagogy of Confidence: Inspiring High Intellectual Performance in Urban Schools

ERIC Educational Resources Information Center

Jackson, Yvette

2011-01-01

In her new book, Yvette Jackson shows educators how to focus on students' strengths to inspire learning and high intellectual performance. Jackson asserts that the myth that the route to increasing achievement by focusing on weaknesses (promoted by policies such as NCLB) has blinded us to the strengths and intellectual potential of urban…

Grades of Evidence: Variability in Quality of Findings in Effectiveness Studies of Complex Field Interventions

ERIC Educational Resources Information Center

Chatterji, Madhabi

2007-01-01

This article argues with a literature review that a simplistic distinction between strong and weak evidence hinged on the use of randomized controlled trials (RCTs), the federal "gold standard" for generating rigorous evidence on social programs and policies, is not tenable with evaluative studies of complex, field interventions such as…

Approaches in Health Human Resource Forecasting: A Roadmap for Improvement.

PubMed

Rafiei, Sima; Mohebbifar, Rafat; Hashemi, Fariba; Ezzatabadi, Mohammad Ranjbar; Farzianpour, Fereshteh

2016-09-01

Forecasting the demand and supply of health manpower in an accurate manner makes appropriate planning possible. The aim of this paper was to review approaches and methods for health manpower forecasting and consequently propose the features that improve the effectiveness of this important process of health manpower planning. A literature review was conducted for studies published in English from 1990-2014 using Pub Med, Science Direct, Pro Quest, and Google Scholar databases. Review articles, qualitative studies, retrospective and prospective studies describing or applying various types of forecasting approaches and methods in health manpower forecasting were included in the review. The authors designed an extraction data sheet based on study questions to collect data on studies' references, designs, and types of forecasting approaches, whether discussed or applied, with their strengths and weaknesses. Forty studies were included in the review. As a result, two main categories of approaches (conceptual and analytical) for health manpower forecasting were identified. Each approach had several strengths and weaknesses. As a whole, most of them were faced with some challenges, such as being static and unable to capture dynamic variables in manpower forecasting and causal relationships. They also lacked the capacity to benefit from scenario making to assist policy makers in effective decision making. An effective forecasting approach is supposed to resolve all the deficits that exist in current approaches and meet the key features found in the literature in order to develop an open system and a dynamic and comprehensive method necessary for today complex health care systems.

The alcohol policy environment, enforcement and consumption in the United States.

PubMed

Erickson, Darin J; Lenk, Kathleen M; Toomey, Traci L; Nelson, Toben F; Jones-Webb, Rhonda

2016-01-01

Many studies of alcohol policies examine the presence or absence of a single policy without considering policy strength or enforcement. We developed measures for the strength of 18 policies (from Alcohol Policy Information System) and levels of enforcement of those policies for the 50 US states, and examined their associations with alcohol consumption. We grouped policies into four domains (underage alcohol use, provision of alcohol to underage, alcohol serving, general availability) and used latent class analysis to assign states to one of four classes based on the configuration of policies-weak except serving policies (6 states), average (29 states), strong for underage use (11 states) and strong policies overall (4 states). We surveyed 1082 local enforcement agencies regarding alcohol enforcement across five domains. We used multilevel latent class analysis to assign states to classes in each domain and assigned each state to an overall low (15 states), moderate (19 states) or high (16 states) enforcement group. Consumption outcomes (past month, binge and heavy) came from the Behavioral Risk Factor Surveillance System. Regression models show inverse associations between alcohol consumption and policy class, with past month alcohol consumption at 54% in the weakest policy class and 34% in the strongest. In adjusted models, the strong underage use policy class was consistently associated with lower consumption. Enforcement group did not affect the policy class and consumption associations. Results suggest strong alcohol policies, particularly underage use policies, may help to reduce alcohol consumption and related consequences. [Erickson DJ, Lenk KM, Toomey TL, Nelson TF, Jones-Webb R. The alcohol policy environment, enforcement, and consumption in the United States. Drug Alcohol Rev 2015;●●:●●-●●]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

“…still waiting for chloroquine”: the challenge of communicating changes in first-line treatment policy for uncomplicated malaria in a remote Kenyan district

PubMed Central

2014-01-01

Background Widespread parasite resistance to first-line treatment for uncomplicated malaria leads to introduction of new drug interventions. Introducing such interventions is complex and sensitive because of stakeholder interests and public resistance. To enhance take up of such interventions, health policy communication strategies need to deliver accurate and accessible information to empower communities with necessary information and address problems of cultural acceptance of new interventions. Objectives To explore community understanding of policy changes in first-line treatment for uncomplicated malaria in Kenya; to evaluate the potential role of policy communication in influencing responses to changes in first-line treatment policy. Methods Data collection involved qualitative strategies in a remote district in the Kenyan Coast: in-depth interviews (n = 29), focus group discussions (n = 14), informal conversations (n = 11) and patient narratives (n = 8). Constant comparative method was used in the analysis. Being malaria-prone and remotely located, the district offered an ideal area to investigate whether or not and how policy communication about a matter as critical as change of treatment policy reaches vulnerable populations. Results Three years after initial implementation (2009), there was limited knowledge or understanding regarding change of first-line treatment from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in the study district. The print and electronic media used to create awareness about the drug change appeared to have had little impact. Although respondents were aware of the existence of AL, the drug was known neither by name nor as the official first-line treatment. Depending on individuals or groups, AL was largely viewed negatively. The weaknesses in communication strategy surrounding the change to AL included poor choice of communication tools, confusing advertisements of other drugs and conflicts between patients and providers. Conclusion Effective health policy communication is important for the uptake of new drug interventions and adherence to treatment regimens. Besides, prompt access to effective treatment may not be achieved if beneficiaries are not adequately informed about treatment policy changes. Future changes in treatment policy should ensure that the communication strategy is designed to pass sustained, accurate and effective messages that account for local contexts. PMID:25005337

"…still waiting for chloroquine": the challenge of communicating changes in first-line treatment policy for uncomplicated malaria in a remote Kenyan district.

PubMed

Okungu, Vincent; Gilson, Lucy

2014-07-08

Widespread parasite resistance to first-line treatment for uncomplicated malaria leads to introduction of new drug interventions. Introducing such interventions is complex and sensitive because of stakeholder interests and public resistance. To enhance take up of such interventions, health policy communication strategies need to deliver accurate and accessible information to empower communities with necessary information and address problems of cultural acceptance of new interventions. To explore community understanding of policy changes in first-line treatment for uncomplicated malaria in Kenya; to evaluate the potential role of policy communication in influencing responses to changes in first-line treatment policy. Data collection involved qualitative strategies in a remote district in the Kenyan Coast: in-depth interviews (n = 29), focus group discussions (n = 14), informal conversations (n = 11) and patient narratives (n = 8). Constant comparative method was used in the analysis. Being malaria-prone and remotely located, the district offered an ideal area to investigate whether or not and how policy communication about a matter as critical as change of treatment policy reaches vulnerable populations. Three years after initial implementation (2009), there was limited knowledge or understanding regarding change of first-line treatment from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in the study district. The print and electronic media used to create awareness about the drug change appeared to have had little impact. Although respondents were aware of the existence of AL, the drug was known neither by name nor as the official first-line treatment. Depending on individuals or groups, AL was largely viewed negatively. The weaknesses in communication strategy surrounding the change to AL included poor choice of communication tools, confusing advertisements of other drugs and conflicts between patients and providers. Effective health policy communication is important for the uptake of new drug interventions and adherence to treatment regimens. Besides, prompt access to effective treatment may not be achieved if beneficiaries are not adequately informed about treatment policy changes. Future changes in treatment policy should ensure that the communication strategy is designed to pass sustained, accurate and effective messages that account for local contexts.

Conceptions of systemic reform: California science education as an investigative example

NASA Astrophysics Data System (ADS)

Sachse, Thomas Paul

This study explored three perspectives of systemic reform in the context of the California state strategies for improving science education. The three perspectives are those of conceptualizers, implementers, and government administrators. The California case study is examined during the ten-year period from 1983 to 1993. This study is of particular significance, because it examines science education reforms during the ten-year period of Bill Honig's state superintendency in the largest and most diverse state. By examining the facets of state science reforms from three rather different perspectives, the study contrasts how systemic reform definitions vary with role. This qualitative study employs document analysis, archival reviews, and participant interviews as the primary data collection methods. Document analysis included key curriculum frameworks, project proposals and reports, relevant legislation, and professional correspondence. Archival reviews included databases (such as the California Basic Educational Data System), assessment reports (such as the California Assessment Program---Rationale and Content), and policy analyses (such as the Policy Analysis for California Education---Conditions of Education). Interviews were conducted for each of the three perspectives across five segments of the reform strategy for a total of fifteen interviews. Data analysis consisted of combining detailed reviews of documents, archives, and interview information with an examination of perspectives, by role group. The study concludes with an analysis of how each role group perceived the facets of systemic reform in the context of the California case study of science education reform. In addition, the research points to "lessons learned", the strengths and weaknesses of systemic reform strategies at the state level. The study offers recommendations to other large-scale (state level) policy reformers interested in creating, sustaining, and maintaining lasting change.

Contestations and complexities of nurses' participation in policy-making in South Africa.

PubMed

Ditlopo, Prudence; Blaauw, Duane; Penn-Kekana, Loveday; Rispel, Laetitia C

2014-01-01

There has been increased emphasis globally on nurses' involvement in health policy and systems development. However, there has been limited scholarly attention on nurses' participation in policy-making in South Africa. This paper analyses the dynamics, strengths, and weaknesses of nurses' participation in four national health workforce policies: the 2008 Nursing Strategy, revision of the Scope of Practice for nurses, the new Framework for Nursing Qualifications, and the Occupation-Specific Dispensation (OSD) remuneration policy. Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 frontline nurses in four South African provinces. Thematic content analysis was done using the Atlas.ti software. The study found that nurses' participation in policy-making is both contested and complex. The contestation relates to the extent and nature of nurses' participation in nursing policies. There was a disjuncture between nursing leadership and frontline nurses in their levels of awareness of the four policies. The latter group was generally unaware of these policies with the exception of the OSD remuneration policy as it affected them directly. There was also limited consensus on which nursing group legitimately represented nursing issues in the policy arena. Shifting power relationships influenced who participated, how the participation happened, and the degree to which nurses' views and inputs were considered and incorporated. The South African health system presents major opportunities for nurses to influence and direct policies that affect them. This will require a combination of proactive leadership, health policy capacity and skills development among nurses, and strong support from the national nursing association.

Contestations and complexities of nurses’ participation in policy-making in South Africa

PubMed Central

Ditlopo, Prudence; Blaauw, Duane; Penn-Kekana, Loveday; Rispel, Laetitia C.

2014-01-01

Background There has been increased emphasis globally on nurses’ involvement in health policy and systems development. However, there has been limited scholarly attention on nurses’ participation in policy-making in South Africa. Objective This paper analyses the dynamics, strengths, and weaknesses of nurses’ participation in four national health workforce policies: the 2008 Nursing Strategy, revision of the Scope of Practice for nurses, the new Framework for Nursing Qualifications, and the Occupation-Specific Dispensation (OSD) remuneration policy. Design Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 frontline nurses in four South African provinces. Thematic content analysis was done using the Atlas.ti software. Results The study found that nurses’ participation in policy-making is both contested and complex. The contestation relates to the extent and nature of nurses’ participation in nursing policies. There was a disjuncture between nursing leadership and frontline nurses in their levels of awareness of the four policies. The latter group was generally unaware of these policies with the exception of the OSD remuneration policy as it affected them directly. There was also limited consensus on which nursing group legitimately represented nursing issues in the policy arena. Shifting power relationships influenced who participated, how the participation happened, and the degree to which nurses’ views and inputs were considered and incorporated. Conclusions The South African health system presents major opportunities for nurses to influence and direct policies that affect them. This will require a combination of proactive leadership, health policy capacity and skills development among nurses, and strong support from the national nursing association. PMID:25537938

Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.

PubMed

Kundu, Debashish; Sharma, Nandini; Chadha, Sarabjit; Laokri, Samia; Awungafac, George; Jiang, Lai; Asaria, Miqdad

2018-01-27

There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers - both public and private health facilities empanelled under the insurance scheme was the key intervention. To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of 'Kingdon's multiple streams for policy implementation framework' to explain the implementation gap between policy and practice of the MDR-TB benefit packages. The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Our findings suggest that there may be an implementation gap due to weak coupling between the problem and the policy streams, reflecting weak coordination between state nodal agency and the state TB department. There is a pressing need to build strong institutional capacity of the public and private sector for improving service delivery to MDR-TB patients through this new health insurance mechanism.

The U.S. experience in promoting sustainable chemistry.

PubMed

Tickner, Joel A; Geiser, Ken; Coffin, Melissa

2005-01-01

Recent developments in European chemicals policy, including the Registration, Evaluation and Authorization of Chemicals (REACH) proposal, provide a unique opportunity to examine the U.S. experience in promoting sustainable chemistry as well as the strengths and weaknesses of existing policies. Indeed, the problems of industrial chemicals and limitations in current regulatory approaches to address chemical risks are strikingly similar on both sides of the Atlantic. We provide an overview of the U.S. regulatory system for chemicals management and its relationship to efforts promoting sustainable chemistry. We examine federal and state initiatives and examine lessons learned from this system that can be applied to developing more integrated, sustainable approaches to chemicals management. There is truly no one U.S. chemicals policy, but rather a series of different un-integrated policies at the federal, regional, state and local levels. While centerpiece U.S. Chemicals Policy, the Toxic Substances Control Act of 1976, has resulted in the development of a comprehensive, efficient rapid screening process for new chemicals, agency action to manage existing chemicals has been very limited. The agency, however, has engaged in a number of successful, though highly underfunded, voluntary data collection, pollution prevention, and sustainable design programs that have been important motivators for sustainable chemistry. Policy innovation in the establishment of numerous state level initiatives on persistent and bioaccumulative toxics, chemical restrictions and toxics use reduction have resulted in pressure on the federal government to augment its efforts. It is clear that data collection on chemical risks and phase-outs of the most egregious chemicals alone will not achieve the goals of sustainable chemistry. These alone will also not internalize the cultural and institutional changes needed to ensure that design and implementation of safer chemicals, processes, and products are the focus of the future. Thus, a more holistic approach of 'carrots and sticks'--that involves not just chemical producers but those who use and purchase chemicals is necessary. Some important lessons of the US experience in chemicals management include: (1) the need for good information on chemicals flows, toxic risks, and safer substances.; (2) the need for comprehensive planning processes for chemical substitution and reduction to avoid risk trade-offs and ensure product quality; (3) the need for technical and research support to firms for innovation in safer chemistry; and (4) the need for rapid screening processes and tools for comparison of alternative chemicals, materials, and products.

Applying a framework for assessing the health system challenges to scaling up mHealth in South Africa

PubMed Central

2012-01-01

Background Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings. PMID:23126370

National policy development for cotrimoxazole prophylaxis in Malawi, Uganda and Zambia: the relationship between Context, Evidence and Links

PubMed Central

2011-01-01

Background Several frameworks have been constructed to analyse the factors which influence and shape the uptake of evidence into policy processes in resource poor settings, yet empirical analyses of health policy making in these settings are relatively rare. National policy making for cotrimoxazole (trimethoprim-sulfamethoxazole) preventive therapy in developing countries offers a pertinent case for the application of a policy analysis lens. The provision of cotrimoxazole as a prophylaxis is an inexpensive and highly efficacious preventative intervention in HIV infected individuals, reducing both morbidity and mortality among adults and children with HIV/AIDS, yet evidence suggests that it has not been quickly or evenly scaled-up in resource poor settings. Methods Comparative analysis was conducted in Malawi, Uganda and Zambia, using the case study approach. We applied the ‘RAPID’ framework developed by the Overseas Development Institute (ODI), and conducted a total of 47 in-depth interviews across the three countries to examine the influence of context (including the influence of donor agencies), evidence (both local and international), and the links between researcher, policy makers and those seeking to influence the policy process. Results Each area of analysis was found to have an influence on the creation of national policy on cotrimoxazole preventive therapy (CPT) in all three countries. In relation to context, the following were found to be influential: government structures and their focus, donor interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, we found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Further, local operational research results seem to have been taken up more quickly, while randomised controlled trials (the gold standard of clinical research) was not necessarily translated into policy so swiftly. Finally the links between different research and policy actors were of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get cotrimoxazole preventive therapy onto the policy agenda. Conclusions This analysis underscores the importance of considering national level variables in the explanation of the uptake of evidence into national policy settings, and recognising how local policy makers interpret international evidence. Local priorities, the ways in which evidence was interpreted, and the nature of the links between policy makers and researchers could either drive or stall the policy process. Developing the understanding of these processes enables the explanation of the use (or non-use) of evidence in policy making, and potentially may help to shape future strategies to bridge the research-policy gaps and ultimately improve the uptake of evidence in decision making. PMID:21679387

State Policies Targeting Junk Food in Schools: Racial/Ethnic Differences in the Effect of Policy Change on Soda Consumption

PubMed Central

Stevens, June; Evenson, Kelly R.; Ward, Dianne S.; Poole, Charles; Maciejewski, Matthew L.; Murray, David M.; Brownson, Ross C.

2011-01-01

Objectives. We estimated the association between state policy changes and adolescent soda consumption and body mass index (BMI) percentile, overall and by race/ethnicity. Methods. We obtained data on whether states required or recommended that schools prohibit junk food in vending machines, snack bars, concession stands, and parties from the 2000 and 2006 School Health Policies and Programs Study. We used linear mixed models to estimate the association between 2000–2006 policy changes and 2007 soda consumption and BMI percentile, as reported by 90 730 students in 33 states and the District of Columbia in the Youth Risk Behavior Survey, and to test for racial/ethnic differences in the associations. Results. Policy changes targeting concession stands were associated with 0.09 fewer servings of soda per day among students (95% confidence interval [CI] = −0.17, −0.01); the association was more pronounced among non-Hispanic Blacks (0.19 fewer servings per day). Policy changes targeting parties were associated with 0.07 fewer servings per day (95% CI = −0.13, 0.00). Policy changes were not associated with BMI percentile in any group. Conclusions. State policies targeting junk food in schools may reduce racial/ethnic disparities in adolescent soda consumption, but their impact appears to be too weak to reduce adolescent BMI percentile. PMID:21778484

Mind your "smoking manners": the tobacco industry tactics to normalize smoking in Japan.

PubMed

Kashiwabara, Mina; Armada, Francisco

2013-11-09

The tobacco industry has adapted its promotional strategies as tobacco-control measures have increased. This paper describes the tobacco industry's strategies on smoking manners and illustrates how these interfere with tobacco-control policy in Japan where tobacco control remains weak. Information on the tobacco industry's promotional strategies in Japan was collected through direct observation, a review of tobacco industry documents and a literature review. The limitation of the study would be a lack of industry documents from Japan as we relied on a database of a U.S. institution to collect internal documents from the tobacco industry. Japan Tobacco began using the manners strategies in the early 1960s. Collaborating with wide range of actors -including local governments and companies- the tobacco industry has promoted smoking manners to wider audiences through its advertising and corporate social responsibility activities. The tobacco industry in Japan has taken advantage of the cultural value placed on manners in Japan to increase the social acceptability of smoking, eventually aiming to diminish public support for smoke-free policies that threatens the industry's business. A stronger enforcement of the WHO Framework Convention on Tobacco Control is critical to counteracting such strategies.

The health professions and the performance of future health systems in low-income countries: support or obstacle?

PubMed

Dussault, Gilles

2008-05-01

This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

Evidence-based medicine and the governance of pandemic influenza.

PubMed

Kamradt-Scott, Adam

2012-01-01

The conventional response of governments to protect their populations against the threat of influenza has been to ensure adequate vaccine production and/or access to supplies of vaccines and antiviral medications. This focus has, in turn, shaped the global governance structures around pandemic influenza, with collective efforts centred on facilitating virus sharing, maintaining and increasing vaccine production, and ensuring access to pharmaceuticals - responses that remain unattainable for many low- and middle-income countries (LMICs) in the short to medium term. This paper argues that this emphasis on pharmacological responses reflects a particular view of biomedicine that pays inadequate attention to the weak capacity of many health systems. In more recent years, this dynamic has been further exacerbated by the influence of evidence-based medicine (EBM) that preferences certain types of biomedical knowledge and practice. This paper explores the role that EBM has played in shaping the global governance of pandemic influenza, and how it has served to reinforce and reify the authority of particular groups of actors, including policy-makers, elected officials and the medical community. The paper concludes that only by unpacking these structures and revealing the political authority in play can alternative policy responses more appropriate to LMICs be considered.

The GMOS cyber(e)-infrastructure: advanced services for supporting science and policy.

PubMed

Cinnirella, S; D'Amore, F; Bencardino, M; Sprovieri, F; Pirrone, N

2014-03-01

The need for coordinated, systematized and catalogued databases on mercury in the environment is of paramount importance as improved information can help the assessment of the effectiveness of measures established to phase out and ban mercury. Long-term monitoring sites have been established in a number of regions and countries for the measurement of mercury in ambient air and wet deposition. Long term measurements of mercury concentration in biota also produced a huge amount of information, but such initiatives are far from being within a global, systematic and interoperable approach. To address these weaknesses the on-going Global Mercury Observation System (GMOS) project ( www.gmos.eu ) established a coordinated global observation system for mercury as well it retrieved historical data ( www.gmos.eu/sdi ). To manage such large amount of information a technological infrastructure was planned. This high-performance back-end resource associated with sophisticated client applications enables data storage, computing services, telecommunications networks and all services necessary to support the activity. This paper reports the architecture definition of the GMOS Cyber(e)-Infrastructure and the services developed to support science and policy, including the United Nation Environmental Program. It finally describes new possibilities in data analysis and data management through client applications.

Translating tuberculosis research into global policies: the example of an international collaboration on diagnostics.

PubMed

Ramsay, A; Steingart, K R; Cunningham, J; Pai, M

2011-10-01

Using the example of an international collaboration on tuberculosis (TB) diagnostics, we mapped the key stages and stakeholders involved in translating research into global policies. In our experience, the process begins with advocacy for high-quality, policy-relevant research and appropriate funding. Following the assessment of current policy and the identification of key study areas, policy-relevant research questions need to be formulated and prioritised. It is important that a framework for translating evidence into policy at the target policymaking level, in this case global, is available to researchers. This ensures that research questions, study designs and research standards are appropriate to the type and quality of evidence required. The framework may evolve during the period of research and, as evidence requirements may change, vigilance is required. Formal and informal multi-stakeholder partnerships, as well as information sharing through extensive networking, facilitate efficient building of a broad evidence base. Coordination of activities by an international, neutral body with strong convening powers is important, as is regular interaction with policy makers. It is recognised that studies on diagnostic accuracy provide weak evidence that a new diagnostic will improve patient care when implemented to scale in routine settings. This may be one reason why there has been poor uptake of new tools by national TB control programmes despite global policy recommendations. Stronger engagement with national policy makers and donors during the research-intopolicy process may be needed to ensure that their evidence requirements are met and that global policies translate into national policies. National policies are central to translating global policies into practice.

Implementation of deinstitutionalization of child care institutions in post-soviet countries: The case of Azerbaijan.

PubMed

Huseynli, Aytakin

2018-02-01

Institutional care has proven to be detrimental for child development. This study examined the status of the State Program on Deinstitutionalization and Alternative Care (SPDAC), a public policy aimed at transforming 55 institutions covering 14,500 children during 2006-2016 in Azerbaijan. The success of this public policy was crucial for the country's entire child welfare system. The study used a crosssectional, descriptive, exploratory, and qualitative method. Data were collected through in-depth, semistructured interviews and archival resources. Twenty key informants were selected through a purposive sampling strategy. They led projects or were heads of departments related to implementing the SPDAC at government agencies, national or international nongovernmental organizations, UNICEF, or as social workers in newly established alternative services. Interviews were analyzed in TAMSAnalyzer. Themes supporting possible explanations such as lack of political will, weak child protection systems, weak civil society, illequipped human resources, absence of alternative services, and low levels of knowledge of children's rights emerged in the analysis. The findings could contribute to research on child welfare reform and reflect hidden factors behind policies to guide practice in former Soviet Union states and countries rich in natural resources such oil, gas, and minerals. The primary finding of a lack of political will raises the question of how to create political will and how to motivate government officials to invest in the welfare of children. Copyright © 2017 Elsevier Ltd. All rights reserved.

PROFILE: Integrating Stressor and Response Monitoring into a Resource-Based Water-Quality Assessment Framework.

PubMed

ROUX; KEMPSTER; KLEYNHANS; VAN; DU

1999-01-01

/ South African water law as well as the country's water resource management policies are currently under review. The Water Law Principles, which were established as part of this review process, indicate a commitment to sustainable development of water resources and the protection of an ecological "reserve." Such policy goals highlight the limitations of traditional and current water-quality management strategies, which rely on stressor monitoring and associated regulation of pollution. The concept of an assimilative capacity is central to the implementation of the current water-quality management approach. Weaknesses inherent in basing water management on the concept of assimilative capacity are discussed. Response monitoring is proposed as a way of addressing some of the weaknesses. Following a global trend, the new policy goals emphasize the need to protect rather than to use the ability of ecosystems to recover from disturbances. This necessitates the adoption of response measurements to quantify ecological condition and monitor ecological change. Response monitoring focuses on properties that are essential to the sustainability of the ecosystem. These monitoring tools can be used to establish natural ranges of ecological change within ecosystems, as well as to quantify conceptually acceptable and unacceptable ranges of change. Through a framework of biological criteria and biological impairment standards, the results of response monitoring can become an integral part of future water resource management strategies in South Africa. KEY WORDS: Stressor monitoring; Response monitoring; Assimilative capacity; Ecosystem stability; Resilience; Biocriteria

'A preferred consultant and partner to the Royal Government, NGOs, and the community': British American Tobacco's access to policy-makers in Cambodia.

PubMed

MacKenzie, Ross; Collin, Jeff

2017-04-01

British American Tobacco Cambodia (BATC) has dominated the country's tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC's in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia's increasingly controversial political and business leadership that is centred around the Cambodian People's Party with the aim of gaining access to policy-makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company's ostensible contribution to Cambodia's economic and social development and, more significantly, provided BATC with opportunities to petition policy-makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia's economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia's compliance with the Framework Convention on Tobacco Control.

Hybrid nuclear reactor grey rod to obtain required reactivity worth

DOEpatents

Miller, John V.; Carlson, William R.; Yarbrough, Michael B.

1991-01-01

Hybrid nuclear reactor grey rods are described, wherein geometric combinations of relatively weak neutron absorber materials such as stainless steel, zirconium or INCONEL, and relatively strong neutron absorber materials, such as hafnium, silver-indium cadmium and boron carbide, are used to obtain the reactivity worths required to reach zero boron change load follow. One embodiment includes a grey rod which has combinations of weak and strong neutron absorber pellets in a stainless steel cladding. The respective pellets can be of differing heights. A second embodiment includes a grey rod with a relatively thick stainless steel cladding receiving relatively strong neutron absorber pellets only. A third embodiment includes annular relatively weak netron absorber pellets with a smaller diameter pellet of relatively strong absorber material contained within the aperture of each relatively weak absorber pellet. The fourth embodiment includes pellets made of a homogeneous alloy of hafnium and a relatively weak absorber material, with the percentage of hafnium chosen to obtain the desired reactivity worth.

Multiple streams approach to tobacco control policymaking in a tobacco-growing state.

PubMed

Mamudu, Hadii M; Dadkar, Sumati; Veeranki, Sreenivas P; He, Yi; Barnes, Richard; Glantz, Stanton A

2014-08-01

Smokefree policies (SFPs) have diffused throughout the US and worldwide. However, the development of SFPs in the difficult policy environment of tobacco-producing states and economies worldwide has not been well-explored. In 2007, Tennessee, the third largest tobacco producer in the US, enacted the Non-Smoker Protection Act (NSPA). This study utilizes the multiple streams model to provide understanding of why and how this policy was developed by triangulating interviews with key stakeholders and legislative debates with archival documents. In June 2006, the Governor unexpectedly announced support for SFP, which created a window of opportunity for policy change. The Campaign for Healthy and Responsible Tennessee, a health coalition, seized this opportunity and worked with the administration and the Tennessee Restaurant Association to negotiate a comprehensive SFP, however, a weaker bill was used by the legislative leadership to develop the NSPA. Although the Governor and the Tennessee Restaurant Association's support generated an environment for 100% SFP, health groups did not fully capitalize on this environmental change and settled for a weak policy with several exemptions. This study suggests the importance for proponents of policy change to understand changes in their environment and be willing and able to capitalize on these changes.

How to Assess Quality of Research in Iran, From Input to Impact? Introduction of Peer-Based Research Evaluation Model in Iran.

PubMed

Ebadifar, Asghar; Baradaran Eftekhari, Monir; Owlia, Parviz; Habibi, Elham; Ghalenoee, Elham; Bagheri, Mohammad Reza; Falahat, Katayoun; Eltemasi, Masoumeh; Sobhani, Zahra; Akhondzadeh, Shahin

2017-11-01

Research evaluation is a systematic and objective process to measure relevance, efficiency and effectiveness of research activities, and peer review is one of the most important tools for assessing quality of research. The aim of this study was introducing research evaluation indicators based on peer reviewing. This study was implemented in 4 stages. A list of objective-oriented evaluation indicators were designed in 4 axes, including; governance and leadership, structure, knowledge production and research impact. The top 10% medical sciences research centers (RCs) were evaluated based on peer review. Adequate equipment and laboratory instruments, high quality research publication and national or international cooperation were the main strengths in medical sciences RCs and the most important weaknesses included failure to adhere to strategic plans, parallel actions in similar fields, problems in manpower recruitment, knowledge translation & exchange (KTE) in service providers and policy makers' levels. Peer review evaluation can improve the quality of research.

Robotic Billiards: Understanding Humans in Order to Counter Them.

PubMed

Nierhoff, Thomas; Leibrandt, Konrad; Lorenz, Tamara; Hirche, Sandra

2016-08-01

Ongoing technological advances in the areas of computation, sensing, and mechatronics enable robotic-based systems to interact with humans in the real world. To succeed against a human in a competitive scenario, a robot must anticipate the human behavior and include it in its own planning framework. Then it can predict the next human move and counter it accordingly, thus not only achieving overall better performance but also systematically exploiting the opponent's weak spots. Pool is used as a representative scenario to derive a model-based planning and control framework where not only the physics of the environment but also a model of the opponent is considered. By representing the game of pool as a Markov decision process and incorporating a model of the human decision-making based on studies, an optimized policy is derived. This enables the robot to include the opponent's typical game style into its tactical considerations when planning a stroke. The results are validated in simulations and real-life experiments with an anthropomorphic robot playing pool against a human.

Science and policy applicability of the transient climate response to cumulative emissions of carbon

NASA Astrophysics Data System (ADS)

Rogelj, J.

2014-12-01

The Transient Climate Response to cumulative Carbon Emissions (TCRE) provides a quantification of the near-linear relationship between cumulative emissions of carbon and global-mean temperature increase. For its most recent report, the Intergovernmental Panel on Climate Change bases its assessment on a large body of literature which encompasses multiple lines of evidence. In this session I will look at the literature basis that was available for TCRE at the time of the IPCC Fifth Assessment Report, providing an easy-to-access introduction into the TCRE concept. Building on this basis and summarizing my own recent work on this, I will discuss the strengths and weaknesses of the use of TCRE for climate policy. While the TCRE concept provides a clear long-term view of what is required to stabilize global-mean temperature increase, I will explore how TCRE uncertainties might pose problems for using TCRE as the only policy guidance in near-term policy decisions.

Divestment prevails over the green paradox when anticipating strong future climate policies

NASA Astrophysics Data System (ADS)

Bauer, Nico; McGlade, Christophe; Hilaire, Jérôme; Ekins, Paul

2018-01-01

Fossil fuel market dynamics will have a significant impact on the effectiveness of climate policies1. Both fossil fuel owners and investors in fossil fuel infrastructure are sensitive to climate policies that threaten their natural resource endowments and production capacities2-4, which will consequently affect their near-term behaviour. Although weak in near-term policy commitments5,6, the Paris Agreement on climate7 signalled strong ambitions in climate change stabilization. Many studies emphasize that the 2 °C target can still be achieved even if strong climate policies are delayed until 20308-10. However, sudden implementation will have severe consequences for fossil fuel markets and beyond and these studies ignore the anticipation effects of owners and investors. Here we use two energy-economy models to study the collective influence of the two central but opposing anticipation arguments, the green paradox11 and the divestment effect12, which have, to date, been discussed only separately. For a wide range of future climate policies, we find that anticipation effects, on balance, reduce CO2 emissions during the implementation lag. This is because of strong divestment in coal power plants starting ten years ahead of policy implementation. The green paradox effect is identified, but is small under reasonable assumptions.

New Deal Policies and the Persistence of the Great Depression: A General Equilibrium Analysis.

ERIC Educational Resources Information Center

Cole, Harold L.; Ohanian, Lee E.

2004-01-01

There are two striking aspects of the recovery from the Great Depression in the United States: the recovery was very weak, and real wages in several sectors rose significantly above trend. These data contrast sharply with neoclassical theory, which predicts a strong recovery with low real wages. We evaluate the contribution to the persistence of…

The Challenge of the Age and Competency Structure in Industry for Innovations and Human Resource Policy.

ERIC Educational Resources Information Center

Kroll, Martin

2003-01-01

Analyzes the weaknesses of current structural options in Germany that allow older workers to keep on working. Points out that data do not indicate older workers are reluctant to participate in training. Suggests that management of competency development is unsuitable for the further employment of older adults. (Contains 56 references and 36…

Policy Dialogue and Target Setting: Do Current Indicators of Education for All Signify Progress?

ERIC Educational Resources Information Center

Lewin, Keith M.

2011-01-01

Governments and development agencies met at Jomtien in 1990 and Dakar in 2000 and committed themselves to achieve "Education for All" (EFA). Most aid to education is now the umbrella of EFA and its associated goals, targets and indicators. This paper selects some of the indicators used for EFA and analyses their strengths and weaknesses. Gross and…

Evaluating the Impact of Teacher Professional Development: An Evidence-Based Framework

ERIC Educational Resources Information Center

King, Fiona

2014-01-01

Does teacher professional development make a difference? How do we know? While researchers and policy-makers acknowledge that teacher professional development (PD) needs to be assessed and evaluated, there is often little clarity as to how this can be achieved. Evaluation of teacher PD by schools has been described as the weak link in the PD chain…

Comprehensive Academic Library Preservation and Conservation Activities Survey for Fiscal Year 1988-1989. (A Sabbatical Leave Project).

ERIC Educational Resources Information Center

Lamb, Robert Scott, II

This report describes and presents the results of a survey designed to obtain information on the preservation and conservation policies and procedures, staff, facilities, and expenditures of 18 academic libraries in Illinois, Indiana, and Ohio. The goals of the survey were to inform each library surveyed of its strengths and weaknesses in the…

Nanoscience and nanotechnology in Venezuela

NASA Astrophysics Data System (ADS)

López Cadenas, María Sonsiré; Hasmy, Anwar; Vessuri, Hebe

2011-08-01

Nanoscale research in Venezuela is briefly reviewed, with emphasis on research groups, research lines, and institutions involved. A summary exploration is made of international collaboration through scientific co-authorship, as well of the efforts to build nano capacities, available infrastructure, relationships to the productive sector and a weak presence in Venezuelan public policies, although there is some expectation that the situation may soon begin to change.

"It's making contacts": notions of social capital and implications for widening access to medical education.

PubMed

Nicholson, S; Cleland, J A

2017-05-01

In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a discourse that portrays WA applicants and students as lacking the essential skills or attributes to be successful in medical education. Much of the research in this area to date has been weak and it is critical to better understand how WA applicants and students negotiate medical admissions and education to inform change. To address this gap we amalgamated a larger dataset from three qualitative studies of student experiences of WA to medicine (48 participants in total). Inductively analysing the findings using social capital as a theoretical lens we created and clustered codes into categories, informed by the concepts of "weak ties" and "bridging and linking capital", terms used by previous workers in this field, to better understand student journeys in medical education. Successful applicants from lower socio-economic groups recognise and mobilise weak ties to create linking capital. However once in medical school these students seem less aware of the need for, or how to create, capital effectively. We argue WA activities should support increasing the social capital of under-represented applicants and students, and future selection policy needs to take into account the varying social capital of students, so as to not overtly disadvantage some social groups.

[Health governance and social protection indicators in Latin-America: strengths, weaknesses and lessons-learned from six Mexican states].

PubMed

Arredondo-López, Armando; Orozco-Núñez, Emanuel

2014-01-01

Evaluative research projects for identifying good practice have been postponed regarding health system reform. This study was thus aimed at identifying health governance and social protection indicators. This study involved evaluative research regarding the health system for the uninsured part of the population in six Mexican states. The primary data was obtained from in-depth interviews with key players from the participating states; official statistics and the results of a macro-project concerned with Mexican health and governance reform and policy was used for secondary. Atlas Ti and Policy Maker software were used for processing and analysing the data. A list of strengths and weaknesses was presented as evidence of health system governance. Accountability at federal level (even though not lacking) was of a prescriptive nature and a system of accountability and transparency regarding the assignment of resources and strategies for the democratisation of health in the states and municipalities was still lacking. All six states had low levels of governance and experienced difficulty in conducting effective reform programmes and strategies involving a lack of precision regarding the rules and roles adopted by different health system actors.

Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward.

PubMed

Kurji, Zohra; Premani, Zahra Shaheen; Mithani, Yasmin

2016-01-01

Pakistani health care system is in progress and since last year, Pakistan has tried to make much improvement in its health care delivery system and has brought out many reforms. A systematic search of national and international literature was looked from peerreviewed databases form MEDLINE, CINAHL, and PubMed. There is little strength in health care delivery system in Pakistan like making health policies, participating in Millennium Development Goals program, initiating vertical programs and introducing Public Private Partnership, improving human resource development and infrastructure by making Basic Health Unit and Rural Health Centres. However, these all programs are very limited in its scope and that is the reason that Pakistan's healthcare system is still not very efficient. There are numerous weaknesses like poor governance, lack of access and unequal resources, poor quality of Health Information Management System, corruption in health system, lack of monitoring in health policy and health planning and lack of trained staff. Pakistan is improving very slowly in the health sector for the last five decades as is evident by its health indicators and above mentioned strengths and weaknesses. Therefore, the Government needs to take strong initiatives to change the current health care system.

The effect of tobacco control policies on smoking prevalence and smoking-attributable deaths. Findings from the Netherlands SimSmoke Tobacco Control Policy Simulation Model.

PubMed

Nagelhout, Gera E; Levy, David T; Blackman, Kenneth; Currie, Laura; Clancy, Luke; Willemsen, Marc C

2012-02-01

To develop a simulation model projecting the effect of tobacco control policies in the Netherlands on smoking prevalence and smoking-attributable deaths. Netherlands SimSmoke-an adapted version of the SimSmoke simulation model of tobacco control policy-uses population, smoking rates and tobacco control policy data for the Netherlands to predict the effect of seven types of policies: taxes, smoke-free legislation, mass media, advertising bans, health warnings, cessation treatment and youth access policies. Outcome measures were smoking prevalence and smoking-attributable deaths. With a comprehensive set of policies, as recommended by MPOWER, smoking prevalence can be decreased by as much as 21% in the first year, increasing to a 35% reduction in the next 20 years and almost 40% by 30 years. By 2040, 7706 deaths can be averted in that year alone with the stronger set of policies. Without effective tobacco control policies, almost a million lives will be lost to tobacco-related diseases between 2011 and 2040. Of those, 145,000 can be saved with a comprehensive tobacco control package. Smoking prevalence and smoking-attributable deaths in the Netherlands can be reduced substantially through tax increases, smoke-free legislation, high-intensity media campaigns, stronger advertising bans and health warnings, comprehensive cessation treatment and youth access laws. The implementation of these FCTC/MPOWER recommended policies could be expected to show similar or even larger relative reductions in smoking prevalence in other countries which currently have weak policies. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Are personal health records safe? A review of free web-accessible personal health record privacy policies.

PubMed

Carrión Señor, Inmaculada; Fernández-Alemán, José Luis; Toval, Ambrosio

2012-08-23

Several obstacles prevent the adoption and use of personal health record (PHR) systems, including users' concerns regarding the privacy and security of their personal health information. To analyze the privacy and security characteristics of PHR privacy policies. It is hoped that identification of the strengths and weaknesses of the PHR systems will be useful for PHR users, health care professionals, decision makers, and designers. We conducted a systematic review using the principal databases related to health and computer science to discover the Web-based and free PHR systems mentioned in published articles. The privacy policy of each PHR system selected was reviewed to extract its main privacy and security characteristics. The search of databases and the myPHR website provided a total of 52 PHR systems, of which 24 met our inclusion criteria. Of these, 17 (71%) allowed users to manage their data and to control access to their health care information. Only 9 (38%) PHR systems permitted users to check who had accessed their data. The majority of PHR systems used information related to the users' accesses to monitor and analyze system use, 12 (50%) of them aggregated user information to publish trends, and 20 (83%) used diverse types of security measures. Finally, 15 (63%) PHR systems were based on regulations or principles such as the US Health Insurance Portability and Accountability Act (HIPAA) and the Health on the Net Foundation Code of Conduct (HONcode). Most privacy policies of PHR systems do not provide an in-depth description of the security measures that they use. Moreover, compliance with standards and regulations in PHR systems is still low.

Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice.

PubMed

Sheehan, Mary C; Lam, Juleen; Navas-Acien, Ana; Chang, Howard H

2016-01-01

Systematic review and meta-analysis (SRMA) are increasingly employed in environmental health (EH) epidemiology and, provided methods and reporting are sound, contribute to translating science evidence to policy. Ambient air pollution (AAP) is both among the leading environmental causes of mortality and morbidity worldwide, and of growing policy relevance due to health co-benefits associated with greenhouse gas emissions reductions. We reviewed the published AAP SRMA literature (2009 to mid-2015), and evaluated the consistency of methods, reporting and evidence evaluation using a 22-point questionnaire developed from available best-practice consensus guidelines and emerging recommendations for EH. Our goal was to contribute to enhancing the utility of AAP SRMAs to EH policy. We identified 43 studies that used both SR and MA techniques to examine associations between the AAPs PM2.5, PM10, NO2, SO2, CO and O3, and various health outcomes. On average AAP SRMAs partially or thoroughly addressed 16 of 22 questions (range 10-21), and thoroughly addressed 13 of 22 (range 5-19). We found evidence of an improving trend over the period. However, we observed some weaknesses, particularly infrequent formal reviews of underlying study quality and risk-of-bias that correlated with lower frequency of thorough evaluation for key study quality parameters. Several other areas for enhanced reporting are highlighted. The AAP SRMA literature, in particular more recent studies, indicate broad concordance with current and emerging best practice guidance. Development of an EH-specific SRMA consensus statement including a risk-of-bias evaluation tool, would be a contribution to enhanced reliability and robustness as well as policy utility. Copyright © 2016 Elsevier Ltd. All rights reserved.

Are Personal Health Records Safe? A Review of Free Web-Accessible Personal Health Record Privacy Policies

PubMed Central

Fernández-Alemán, José Luis; Toval, Ambrosio

2012-01-01

Background Several obstacles prevent the adoption and use of personal health record (PHR) systems, including users’ concerns regarding the privacy and security of their personal health information. Objective To analyze the privacy and security characteristics of PHR privacy policies. It is hoped that identification of the strengths and weaknesses of the PHR systems will be useful for PHR users, health care professionals, decision makers, and designers. Methods We conducted a systematic review using the principal databases related to health and computer science to discover the Web-based and free PHR systems mentioned in published articles. The privacy policy of each PHR system selected was reviewed to extract its main privacy and security characteristics. Results The search of databases and the myPHR website provided a total of 52 PHR systems, of which 24 met our inclusion criteria. Of these, 17 (71%) allowed users to manage their data and to control access to their health care information. Only 9 (38%) PHR systems permitted users to check who had accessed their data. The majority of PHR systems used information related to the users’ accesses to monitor and analyze system use, 12 (50%) of them aggregated user information to publish trends, and 20 (83%) used diverse types of security measures. Finally, 15 (63%) PHR systems were based on regulations or principles such as the US Health Insurance Portability and Accountability Act (HIPAA) and the Health on the Net Foundation Code of Conduct (HONcode). Conclusions Most privacy policies of PHR systems do not provide an in-depth description of the security measures that they use. Moreover, compliance with standards and regulations in PHR systems is still low. PMID:22917868

Monitoring the inputs required to extend and sustain hygiene promotion: findings from the GLAAS 2013/2014 survey.

PubMed

Moreland, Leslie D; Gore, Fiona M; Andre, Nathalie; Cairncross, Sandy; Ensink, Jeroen H J

2016-08-01

There are significant gaps in information about the inputs required to effectively extend and sustain hygiene promotion activities to improve people's health outcomes through water, sanitation and hygiene (WASH) interventions. We sought to analyse current country and global trends in the use of key inputs required for effective and sustainable implementation of hygiene promotion to help guide hygiene promotion policy and decision-making after 2015. Data collected in response to the GLAAS 2013/2014 survey from 93 countries of 94 were included, and responses were analysed for 12 questions assessing the inputs and enabling environment for hygiene promotion under four thematic areas. Data were included and analysed from 20 External Support Agencies (ESA) of 23 collected through self-administered surveys. Firstly, the data showed a large variation in the way in which hygiene promotion is defined and what constitutes key activities in this area. Secondly, challenges to implement hygiene promotion are considerable: include poor implementation of policies and plans, weak coordination mechanisms, human resource limitations and a lack of available hygiene promotion budget data. Despite the proven benefits of hand washing with soap, a critical hygiene-related factor in minimising infection, GLAAS 2013/2014 survey data showed that hygiene promotion remains a neglected component of WASH. Additional research to identify the context-specific strategies and inputs required to enhance the effectiveness of hygiene promotion at scale are needed. Improved data collection methods are also necessary to advance the availability and reliability of hygiene-specific information. © 2016 John Wiley & Sons Ltd.

Malaria control aimed at the entire population in KwaZulu-Natal negates the need for policies to prevent malaria in pregnancy.

PubMed

Tsoka-Gwegweni, J M; Kleinschmidt, I

2013-01-24

South Africa has no policy to prevent malaria in pregnancy, despite the adverse effects of the disease in pregnancy. However, malaria control measures consisting of indoor residual spraying and specific antimalarial treatment have been in place since the 1970s. Information on the burden of malaria in pregnancy in South Africa is needed to indicate whether a specific policy for malaria prevention in pregnancy is necessary. To determine the burden of malaria in pregnancy in KwaZulu-Natal (KZN) province, South Africa. Pregnant women were enrolled at their first antenatal care visit to three health facilities in Umkhanyakude health district in northern KZN during May 2004 - September 2005 and followed up until delivery. Data collection included demographic details, current and previous malaria infection during pregnancy, haemoglobin concentrations and birth outcomes. Of the 1 406 study participants, more than a quarter were younger than 20 years of age, and more than 90% were unemployed and unmarried. Although 33.2% of the women were anaemic, this was not related to malaria. The prevalence and incidence of malaria were very low, and low birth weight was only weakly associated with malaria (1/10). The low burden of malaria in these pregnant women suggests that they have benefited from malaria control strategies in the study area. The implication is that additional measures specific for malaria prevention in pregnancy are not required. However, ongoing monitoring is needed to ensure that malaria prevalence remains low.

Methodological considerations for economic modelling of latent tuberculous infection screening in migrants.

PubMed

Shedrawy, J; Siroka, A; Oxlade, O; Matteelli, A; Lönnroth, K

2017-09-01

Tuberculosis (TB) in migrants from endemic to low-incidence countries results mainly from the reactivation of latent tuberculous infection (LTBI). LTBI screening policies for migrants vary greatly between countries, and the evidence on the cost-effectiveness of the different approaches is weak and heterogeneous. The aim of this review was to assess the methodology used in published economic evaluations of LTBI screening among migrants to identify critical methodological options that must be considered when using modelling to determine value for money from different economic perspectives. Three electronic databases were searched and 10 articles were included. There was considerable variation across this small number of studies with regard to economic perspective, main outcomes, modelling technique, screening options and target populations considered, as well as in parameterisation of the epidemiological situation, test accuracy, efficacy, safety and programme performance. Only one study adopted a societal perspective; others adopted a health care or wider government perspective. Parameters representing the cascade of screening and treating LTBI varied widely, with some studies using highly aspirational scenarios. This review emphasises the need for a more harmonised approach for economic analysis, and better transparency in how policy options and economic perspectives influence methodological choices. Variability is justifiable for some parameters. However, sufficient data are available to standardise others. A societal perspective is ideal, but can be challenging due to limited data. Assumptions about programme performance should be based on empirical data or at least realistic assumptions. Results should be interpreted within specific contexts and policy options, with cautious generalisations.

Strengthening health systems by health sector reforms

PubMed Central

Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

2014-01-01

Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261

The effect of smoke-free policies on hospitality industry revenues in Cyprus: an econometric approach.

PubMed

Talias, Michael A; Savva, Christos S; Soteriades, Elpidoforos S; Lazuras, Lambros

2015-10-01

Smoke-free policies aiming to improve quality of indoor air and significantly reduce exposure to secondhand smoke in the hospitality industry are faced with strong opposition from the tobacco industry and hospitality venue owners claiming that they lead to reductions of revenues. The objective of our study was to examine the impact of a recently introduced smoke-free legislation on the revenues of the hospitality industry in Cyprus. Anonymous information on revenues was obtained from the Cyprus government value added tax office for the entire hospitality industry in Cyprus including hotels, bars, restaurants and cafeterias between 2005 and 2011. Panel data methodology was used to examine the effect of a smoke-free legislation, on tourism, businesses' revenues adjusting for gross domestic product, inflation, unemployment rate, tourists' arrivals, seasonal variation and the economic crisis. Our study showed that the implementation of the smoke-free policy did not have negative effects on the hospitality industry profitability. We conclude that even in regions with relatively high smoking rates, pro-smoking societal attitudes and weak social norms against tobacco control, and even during periods of economic crisis, smoke-free legislation does not impact negatively on hospitality industry revenues and if anything may lead to a small positive increase. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cooperative Drought Adaptation: Integrating Infrastructure Development, Conservation, and Water Transfers into Adaptive Policy Pathways

NASA Astrophysics Data System (ADS)

Zeff, H. B.; Characklis, G. W.; Reed, P. M.; Herman, J. D.

2015-12-01

Water supply policies that integrate portfolios of short-term management decisions with long-term infrastructure development enable utilities to adapt to a range of future scenarios. An effective mix of short-term management actions can augment existing infrastructure, potentially forestalling new development. Likewise, coordinated expansion of infrastructure such as regional interconnections and shared treatment capacity can increase the effectiveness of some management actions like water transfers. Highly adaptable decision pathways that mix long-term infrastructure options and short-term management actions require decision triggers capable of incorporating the impact of these time-evolving decisions on growing water supply needs. Here, we adapt risk-based triggers to sequence a set of potential infrastructure options in combination with utility-specific conservation actions and inter-utility water transfers. Individual infrastructure pathways can be augmented with conservation or water transfers to reduce the cost of meeting utility objectives, but they can also include cooperatively developed, shared infrastructure that expands regional capacity to transfer water. This analysis explores the role of cooperation among four water utilities in the 'Research Triangle' region of North Carolina by formulating three distinct categories of adaptive policy pathways: independent action (utility-specific conservation and supply infrastructure only), weak cooperation (utility-specific conservation and infrastructure development with regional transfers), and strong cooperation (utility specific conservation and jointly developed of regional infrastructure that supports transfers). Results suggest that strong cooperation aids the utilities in meeting their individual objections at substantially lower costs and with fewer irreversible infrastructure options.

Too Few, Too Weak: Conflict of Interest Policies at Canadian Medical Schools

PubMed Central

Shnier, Adrienne; Lexchin, Joel; Mintzes, Barbara; Jutel, Annemarie; Holloway, Kelly

2013-01-01

Introduction The education of medical students should be based on the best clinical information available, rather than on commercial interests. Previous research looking at university-wide conflict of interest (COI) policies used in Canadian medical schools has shown very poor regulation. An analysis of COI policies was undertaken to document the current policy environment in all 17 Canadian medical schools. Methods A web search was used to initially locate COI policies supplemented by additional information from the deans of each medical school. Strength of policies was rated on a scale of 0 to 2 in 12 categories and also on the presence of enforcement measures. For each school, we report scores for all 12 categories, enforcement measures, and summative scores. Results COI policies received summative scores that ranged from 0 to 19, with 0 the lowest possible score obtainable and 24 the maximum. The highest mean scores per category were for disclosure and ghostwriting (0.9) and for gifts and scholarships (0.8). Discussion This study provides the first comprehensive evaluation of all 17 Canadian medical school-specific COI policies. Our results suggest that the COI policy environment at Canadian medical schools is generally permissive. Policy development is a dynamic process. We therefore encourage all Canadian medical schools to develop restrictive COI policies to ensure that their medical students are educated based on the best clinical evidence available, free of industry biases and COI relationships that may influence the future medical thinking and prescribing practices of medical students in Canada once they graduate. PMID:23861928

Children in difficulties.

PubMed

Pairojkul, Srivieng; Limratana, Napa

2012-07-01

Children in difficulties are characterized by: chronic neglect; disability; physical, emotional or sexual abuse; HIV or one/both parents with HIV and/or limited socio-economic opportunities. To review the current situation by reviewing the incidence of problems affecting children and exploring both potential short-/long-term strategies, including the role of pediatricians. The authors reviewed the incidence and situations of children in difficulties, did a synthesis of guidelines and made recommendations. The fundamental causes of difficulties include: failed macro-economic policies; inadequate and inaccessible education system; and weakness of the family unit, which is associated with: separation and divorce; violence between partners and/or toward their children; neglect and abandonment; inappropriate child-rearing; and child exploitation, including trafficking. GOs and NGOs need to work collaboratively for child protection. Pediatricians can play a vital role in strengthening the family (a) by providing timely strategic, informal education for parents on healthy child-rearing (b) by being attuned to signs, symptoms and attitudes of children in difficulties from childhood through adolescence and (c) by working interactively with children/teens, their families, teachers and communities. Medical schools need to revise the curricula to include these crucial roles for pediatricians in child and family advocacy.

Subjective wellbeing, suicide and socioeconomic factors: an ecological analysis in Hong Kong.

PubMed

Hsu, C-Y; Chang, S-S; Yip, P S F

2018-04-10

There has recently been an increased interest in mental health indicators for the monitoring of population wellbeing, which is among the targets of Sustainable Development Goals adopted by the United Nations. Levels of subjective wellbeing and suicide rates have been proposed as indicators of population mental health, but prior research is limited. Data on individual happiness and life satisfaction were sourced from a population-based survey in Hong Kong (2011). Suicide data were extracted from Coroner's Court files (2005-2013). Area characteristic variables included local poverty rate and four factors derived from a factor analysis of 21 variables extracted from the 2011 census. The associations between mean happiness and life satisfaction scores and suicide rates were assessed using Pearson correlation coefficient at two area levels: 18 districts and 30 quantiles of large street blocks (LSBs; n = 1620). LSB is a small area unit with a higher level of within-unit homogeneity compared with districts. Partial correlations were used to control for area characteristics. Happiness and life satisfaction demonstrated weak inverse associations with suicide rate at the district level (r = -0.32 and -0.36, respectively) but very strong associations at the LSB quantile level (r = -0.83 and -0.84, respectively). There were generally very weak or weak negative correlations across sex/age groups at the district level but generally moderate to strong correlations at the LSB quantile level. The associations were markedly attenuated or became null after controlling for area characteristics. Subjective wellbeing is strongly associated with suicide at a small area level; socioeconomic factors can largely explain this association. Socioeconomic factors could play an important role in determining the wellbeing of the population, and this could inform policies aimed at enhancing population wellbeing.

A qualitative study of the determinants of HIV guidelines implementation in two south-eastern districts of Tanzania.

PubMed

Mwangome, Mary N; Geubbels, Eveline; Wringe, Alison; Todd, Jim; Klatser, Paul; Dieleman, Marjolein

2017-07-01

Current HIV policies in Tanzania have adopted the three long-term impact results of zero new infections, zero HIV deaths and zero stigma and discrimination. Strategies to reach these results include scaling-up HIV Testing and Counselling (HTC); Preventing Mother-To-Child Transmission (PMTCT); and strengthening Care and Treatment Clinic (CTC) services. Previous studies showed that HIV policy and guideline recommendations were not always implemented in rural South Tanzania. This study aims to identify the determinants of HIV guideline implementation. A qualitative study of 23 semi-structured interviews with facility in-charges; healthcare workers; district, regional and national HIV coordinators was conducted. Five health facilities were purposively selected by level, ownership and proximity to district headquarters. Interviews were analysed according to Fleuren's five determinants of innovation uptake related to: strategies used in guideline development and dissemination; guideline characteristics; the guideline implementing organization; guideline users; and the socio-cultural and regulatory context. None of the facilities had the HTC national guideline document. Non-involvement of providers in revisions and weak planning for guideline dissemination impeded their implementation. Lengthy guidelines and those written in English were under-used, and activities perceived to be complicated, like WHO-staging, were avoided. Availability of staff and lack of supplies like test kits and medication impeded implementation. Collaboration between facilities enhanced implementation, as did peer-support among providers. Provider characteristics including education level, knowledge of, and commitment to the guideline influenced implementation. According to providers, determinants of clients' service use included gender norms, stigma, trust and perceived benefits. The regulatory context prohibited private hospitals from buying HIV supplies. Being tools for bringing policies to practice, national guidelines are crucial in the efforts towards the three zeros. Strategies to improve providers' adherence to guidelines should include development of clearer guideline dissemination plans, strengthening of the health system, and possibly addressing of provider-perceived patient-level barriers to utilizing HIV services. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

JPRS Report China.

DTIC Science & Technology

1988-07-28

Recognition’ [Yi Hao; Hong Kong LIAOWANG, 30 May 88] 57 Impact of NT Dollar Appreciation on Country’s Industry 58 JPRS-CAR-88-040 26 July 1988... industrial departments, our large and middle-size enterprises are, from policy to organization, very weak in technical innovation . The leadership of...of the Provi- sional Regulations on Control of Individual Urban and Rural Industrial and Commercial Entreprises (5 Septem- ber 1987) 14. Joint

Protecting Defense Technologies: DOD Assessment Needed to Determine Requirement for Critical Technologies List

DTIC Science & Technology

2013-01-01

Service DTSA Defense Technology Security Administration MCTL Militarily Critical Technologies List This is a work of the U.S. government and is not...Respond to MCTL Weaknesses Page 8 GAO-13-157 Protecting Defense Technologies Administration ( DTSA ), military services, and DOD...implementation of technology security policies on international transfers of defense- related goods, services, and technologies; • directed DTSA to

Court-Led Educational Reforms in Political Third Rails: Lessons from the Litigation over Ultra-Religious Jewish Schools in Israel

ERIC Educational Resources Information Center

Perry-Hazan, Lotem

2015-01-01

This paper offers a model for evaluating the strengths and weaknesses of judicial involvement in educational reforms. It uses the model to analyze two case studies of court-led educational reforms in the third rail of Israeli politics--the curricula and the admission policies of ultra-Othodox (Haredi) schools. These case studies are located at the…

English Teachers in the Digital Age--A Case Study of Policy and Expert Practice from England

ERIC Educational Resources Information Center

Goodwyn, Andy

2011-01-01

This article is a case study of how English teachers in England have coped with the paradigm shift from print to digital literacy. It reviews a large scale national initiative that was intended to upskill all teachers, considers its weak impact and explores the author's involvement in the evaluation of the project's direct value to English…

Marine Corps Intelligence Forecasting: A Way Forward

DTIC Science & Technology

2012-04-30

highly-nuanced understanding of the world. The global threat that al-Qaida and likeminded networks posed is greatly reduced; in the meantime, powerful ...the policymaker and military intelligence pointed toward the operational leader is important, since policy influences often lie at the root of any...Albert Humphrey developed a mechanism known as SWOT - strengths, weaknesses, opportunities, and threats - at the behest of several Fortune 500

The Quadratic Relationship between Socioeconomic Status and Learning Performance in China by Multilevel Analysis: Implications for Policies to Foster Education Equity

ERIC Educational Resources Information Center

Zhao, Ningning; Valcke, Martin; Desoete, Annemie; Verhaeghe, JeanPierre

2012-01-01

The purpose of the present study is to explore the relationship between family socioeconomic status and mathematics performance on the base of a multi-level analysis involving a large sample of Chinese primary school students. A weak relationship is found between socioeconomic status and performance in the Chinese context. The relationship does…

Infrastructural requirements for local implementation of safety policies: the discordance between top-down and bottom-up systems of action.

PubMed

Timpka, Toomas; Nordqvist, Cecilia; Lindqvist, Kent

2009-03-09

Safety promotion is planned and practised not only by public health organizations, but also by other welfare state agencies, private companies and non-governmental organizations. The term 'infrastructure' originally denoted the underlying resources needed for warfare, e.g. roads, industries, and an industrial workforce. Today, 'infrastructure' refers to the physical elements, organizations and people needed to run projects in different societal arenas. The aim of this study was to examine associations between infrastructure and local implementation of safety policies in injury prevention and safety promotion programs. Qualitative data on municipalities in Sweden designated as Safe Communities were collected from focus group interviews with municipal politicians and administrators, as well as from policy documents, and materials published on the Internet. Actor network theory was used to identify weaknesses in the present infrastructure and determine strategies that can be used to resolve these. The weakness identification analysis revealed that the factual infrastructure available for effectuating national strategies varied between safety areas and approaches, basically reflecting differences between bureaucratic and network-based organizational models. At the local level, a contradiction between safety promotion and the existence of quasi-markets for local public service providers was found to predispose for a poor local infrastructure diminishing the interest in integrated inter-agency activities. The weakness resolution analysis showed that development of an adequate infrastructure for safety promotion would require adjustment of the legal framework regulating injury data exchange, and would also require rational financial models for multi-party investments in local infrastructures. We found that the "silo" structure of government organization and assignment of resources was a barrier to collaborative action for safety at a community level. It may therefore be overly optimistic to take for granted that different approaches to injury control, such as injury prevention and safety promotion, can share infrastructure. Similarly, it may be unrealistic to presuppose that safety promotion can reach its potential in terms of injury rate reductions unless the critical infrastructure for this is in place. Such an alignment of the infrastructure to organizational processes requires more than financial investments.

Doubly illegal: Qualitative accounts of underage alcohol access through theft

PubMed Central

Jennings, Vanessa K.; Friese, Bettina; Moore, Roland S.; Grube, Joel W.

2012-01-01

This study investigated sources of alcohol for underage drinkers. In-depth, semi-structured interviews were individually conducted with 47 youths, ages 15–18, who reported drinking within the last 12 months, to explore alcohol access. Theft was one method that some youths reported using to obtain alcohol. In addition to 9% of respondents who reported stealing alcohol from commercial outlets themselves, a total of 26% respondents reported occasions when their close friends stole alcohol. Our findings unveiled that teens had a body of knowledge that some drew upon for stealing alcohol. Youths revealed detailed knowledge about store layout, theft protection devices and store policies. In particular, respondents disclosed knowledge about which aisles have blind spots, how to remove security tops on bottles, and no-chase policies. Theft of alcohol from commercial sources may be reduced by examining the weaknesses of existing theft prevention practices, and revising store policies. PMID:22303285

A change in behaviour: getting the balance right for research and policy.

PubMed

O'Sullivan, Maureen; Ryan, Cristín; Downey, Damian G; Hughes, Carmel M

2016-10-01

Behaviour change interventions offer clinical pharmacists many opportunities to optimise the use of medicines. 'MINDSPACE' is a framework used by a Government-affiliated organisation in the United Kingdom to communicate an approach to changing behaviour through policy. The Theoretical Domains Framework (TDF) organises constructs of psychological theories that are most relevant to behaviour change into 14 domains. Both frameworks offer a way of identifying what drives a change in behaviour, providing a target for an intervention. This article aims to compare and contrast MINDSPACE and the TDF, and serves to inform pharmacy practitioners about the potential strengths and weaknesses of using either framework in a clinical pharmacy context. It appears that neither framework can deliver evidence-based interventions that can be developed and implemented with the pace demanded by policy and practice-based settings. A collaborative approach would ensure timely development of acceptable behaviour change interventions that are grounded in evidence.

Approaches in Health Human Resource Forecasting: A Roadmap for Improvement

PubMed Central

Rafiei, Sima; Mohebbifar, Rafat; Hashemi, Fariba; Ezzatabadi, Mohammad Ranjbar; Farzianpour, Fereshteh

2016-01-01

Introduction Forecasting the demand and supply of health manpower in an accurate manner makes appropriate planning possible. The aim of this paper was to review approaches and methods for health manpower forecasting and consequently propose the features that improve the effectiveness of this important process of health manpower planning. Methods A literature review was conducted for studies published in English from 1990–2014 using Pub Med, Science Direct, Pro Quest, and Google Scholar databases. Review articles, qualitative studies, retrospective and prospective studies describing or applying various types of forecasting approaches and methods in health manpower forecasting were included in the review. The authors designed an extraction data sheet based on study questions to collect data on studies’ references, designs, and types of forecasting approaches, whether discussed or applied, with their strengths and weaknesses Results Forty studies were included in the review. As a result, two main categories of approaches (conceptual and analytical) for health manpower forecasting were identified. Each approach had several strengths and weaknesses. As a whole, most of them were faced with some challenges, such as being static and unable to capture dynamic variables in manpower forecasting and causal relationships. They also lacked the capacity to benefit from scenario making to assist policy makers in effective decision making. Conclusions An effective forecasting approach is supposed to resolve all the deficits that exist in current approaches and meet the key features found in the literature in order to develop an open system and a dynamic and comprehensive method necessary for today complex health care systems. PMID:27790343

Should we expect population thresholds for wildlife disease?

USGS Publications Warehouse

Lloyd-Smith, James O.; Cross, P.C.; Briggs, C.J.; Daugherty, M.; Getz, W.M.; Latto, J.; Sanchez, M.; Smith, A.; Swei, A.

2005-01-01

Host population thresholds for invasion or persistence of infectious disease are core concepts of disease ecology, and underlie on-going and controversial disease control policies based on culling and vaccination. Empirical evidence for these thresholds in wildlife populations has been sparse, however, though recent studies have narrowed this gap. Here we review the theoretical bases for population thresholds for disease, revealing why they are difficult to measure and sometimes are not even expected, and identifying important facets of wildlife ecology left out of current theories. We discuss strengths and weaknesses of selected empirical studies that have reported disease thresholds for wildlife, identify recurring obstacles, and discuss implications of our imperfect understanding of wildlife thresholds for disease control policy.

Greek's health, waiting for the 'deus ex machina'.

PubMed

Fanourgiakis, John; Kanoupakis, Emmanuel

2014-10-01

Greece from May 2010 has been following Troika's (European Commission, European Central Bank and International Monetary Fund) austere policies in all over the public finance sector. Troika's instructions which are adopted by the politicians resulted to depressed and weak citizens. The consequences in health care sector are becoming visible across the society. A big part of Greek's society is uninsured without any access to public health care system. The vulnerable social groups confront catastrophic health care expenditures and impoverishment with no social net protection. Greeks are paying the price of their irrational way of living. The current paper has gathered from the literature the early effects of the implementation of these policies on public health and healthcare.

The Vagaries Of Public Support For Government Actions In Case Of A Pandemic

PubMed Central

Hilyard, Karen M.; Freimuth, Vicki S.; Musa, Donald; Kumar, Supriya; Quinn, Sandra Crouse

2011-01-01

Government health measures in a pandemic are effective only with strong support and compliance from the public. A survey of 1,583 US adults early in the 2009 H1N1 (swine influenza) pandemic shows surprisingly mixed support for possible government efforts to control the spread of the disease, with strong support for more extreme measures such as closing borders and weak support for more basic, and potentially more effective, policies such as encouraging sick people to stay home from work. The results highlight challenges that public health officials and policy makers must address in formulating strategies to respond to a pandemic before a more severe outbreak occurs. PMID:21134932

Enhancing the use of research in health-promoting, anti-racism policy.

PubMed

Ferdinand, Angeline S; Paradies, Yin; Kelaher, Margaret

2017-07-11

The Localities Embracing and Accepting Diversity (LEAD) programme was established to improve the health of ethnic minority communities through the reduction of racial discrimination. Local governments in the state of Victoria, Australia, were at the forefront of LEAD implementation in collaboration with leading state and national organisations. Key aims included expanding the available evidence regarding effective anti-racism interventions and facilitating the uptake of this evidence in organisational policies and practices. One rural and one metropolitan local government areas were selected to participate in LEAD. Key informant interviews and discussions were conducted with individuals who had participated in LEAD implementation and members of LEAD governance structures. Data were also collected on programme processes and implementation, partnership formation and organisational assessments. The LEAD model demonstrated both strengths and weaknesses in terms of facilitating the use of evidence in a complex, community-based health promotion initiative. Representation of implementing, funding and advisory bodies at different levels of governance enabled the input of technical advice and guidance alongside design and implementation. The representation structure assisted in ensuring the development of a programme that was acceptable to all partners and informed by the best available evidence. Simultaneous evaluation also enhanced perceived validity of the intervention, allowed for strategy correction when necessary and supported the process of double-loop organisational learning. However, due to the model's demand for simultaneous and intensive effort by various organisations, when particular elements of the intervention were not functional, there was a considerable loss of time and resources across the partner organisations. The complexity of the model also presented a challenge in ensuring clarity regarding roles, functions and the direction of the programme. The example of LEAD provides guidance on mechanisms to strengthen the entry of evidence into complex community-based health promotion programmes. The paper highlights some of the strengths and weaknesses of the LEAD model and implications for practical collaboration between policymakers, implementers and researchers.

Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision.

PubMed

Frisch, Morten; Aigrain, Yves; Barauskas, Vidmantas; Bjarnason, Ragnar; Boddy, Su-Anna; Czauderna, Piotr; de Gier, Robert P E; de Jong, Tom P V M; Fasching, Günter; Fetter, Willem; Gahr, Manfred; Graugaard, Christian; Greisen, Gorm; Gunnarsdottir, Anna; Hartmann, Wolfram; Havranek, Petr; Hitchcock, Rowena; Huddart, Simon; Janson, Staffan; Jaszczak, Poul; Kupferschmid, Christoph; Lahdes-Vasama, Tuija; Lindahl, Harry; MacDonald, Noni; Markestad, Trond; Märtson, Matis; Nordhov, Solveig Marianne; Pälve, Heikki; Petersons, Aigars; Quinn, Feargal; Qvist, Niels; Rosmundsson, Thrainn; Saxen, Harri; Söder, Olle; Stehr, Maximilian; von Loewenich, Volker C H; Wallander, Johan; Wijnen, Rene

2013-04-01

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

Smoke-free policies and the social acceptability of smoking in Uruguay and Mexico: Findings from the International Tobacco Control Policy Evaluation Project

PubMed Central

Boado, Marcelo; Sebrié, Ernesto M.; Bianco, Eduardo

2009-01-01

Introduction Little research has been conducted to determine the psychosocial and behavioral impacts of smoke-free policies in middle-income countries. Methods Cross-sectional data were analyzed from the 2006 waves of the International Tobacco Control Policy Evaluation. Survey comparing adult smokers in Mexico (n = 1,080), where smoke-free legislation at that time was weak, and Uruguay (n = 1,002), where comprehensive smoke-free legislation was implemented. Analyses aimed to determine whether exposure to smoke-free policies and perceived antismoking social norms were associated with smokers’ receiving cues about the bothersome nature of secondhand smoke (SHS), with smokers’ reactance against such cues, and with smokers’ level of support for smoke-free policies in different venues. Results In bivariate analyses, Uruguayan smokers were more likely than Mexican smokers to experience verbal anti-SHS cues, lower reactance against anti-SHS cues, stronger antismoking societal norms, and stronger support for 100% smoke-free policies in enclosed workplaces, restaurants, and bars. In multivariate models for both countries, the strength of voluntary smoke-free policies at home was independently associated with support for smoke-free policies across all venues queried, except for in bars among Uruguayans. Perceived strength of familial antismoking norms was consistently associated with all indicators of the social acceptability of smoking in Uruguay but only with the frequency of receiving anti-SHS verbal cues in Mexico. Discussion These results are generally consistent with previous research indicating that comprehensive smoke-free policies are likely to increase the social unacceptability of smoking and that resistance against such policies is likely to diminish once such policies are in place. PMID:19380383

Turning the tide: national policy approaches to increasing physical activity in seven European countries.

PubMed

Bull, Fiona; Milton, Karen; Kahlmeier, Sonja; Arlotti, Alberto; Juričan, Andrea Backović; Belander, Olov; Martin, Brian; Martin-Diener, Eva; Marques, Ana; Mota, Jorge; Vasankari, Tommi; Vlasveld, Anita

2015-06-01

Physical inactivity is one of the four leading behavioural risk factors for non-communicable disease (NCD). Like tobacco control, increasing levels of health-enhancing physical activity (HEPA) will require a national policy framework providing direction and a clear set of actions. Despite frequent calls, there has been insufficient progress on policy development in the majority of countries around the world. This study sought and summarised national HEPA policy in seven European countries (Finland, Italy, the Netherlands, Norway, Portugal, Slovenia and Switzerland). Data collection used a policy audit tool (PAT), a 27-item instrument structured into four sections. All countries reported some legislation or policy across the sectors of education, sport and health. Only some countries reported supportive policy in the transport and environment sectors. Five countries reported a stand-alone HEPA policy and six countries reported national recommendations. HEPA prevalence targets varied in magnitude and specificity and the presence of other relevant goals from different sectors highlighted the opportunity for joint action. Evaluation and the use of scientific evidence were endorsed but described as weak in practice. Only two countries reported a national multisector coordinating committee and most countries reported challenges with partnerships on different levels of policy implementation. Bringing together the key components for success within a national HEPA policy framework is not simple. This in-depth policy audit and country comparison highlighted similarities and differences and revealed new opportunities for consideration by other countries. These examples can inform countries within and beyond Europe and guide the development of national HEPA policy within the NCD prevention agenda. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Smoke-free policies and the social acceptability of smoking in Uruguay and Mexico: findings from the International Tobacco Control Policy Evaluation Project.

PubMed

Thrasher, James F; Boado, Marcelo; Sebrié, Ernesto M; Bianco, Eduardo

2009-06-01

Little research has been conducted to determine the psychosocial and behavioral impacts of smoke-free policies in middle-income countries. Cross-sectional data were analyzed from the 2006 waves of the International Tobacco Control Policy Evaluation. Survey comparing adult smokers in Mexico (n = 1,080), where smoke-free legislation at that time was weak, and Uruguay (n = 1,002), where comprehensive smoke-free legislation was implemented. Analyses aimed to determine whether exposure to smoke-free policies and perceived antismoking social norms were associated with smokers' receiving cues about the bothersome nature of secondhand smoke (SHS), with smokers' reactance against such cues, and with smokers' level of support for smoke-free policies in different venues. In bivariate analyses, Uruguayan smokers were more likely than Mexican smokers to experience verbal anti-SHS cues, lower reactance against anti-SHS cues, stronger antismoking societal norms, and stronger support for 100% smoke-free policies in enclosed workplaces, restaurants, and bars. In multivariate models for both countries, the strength of voluntary smoke-free policies at home was independently associated with support for smoke-free policies across all venues queried, except for in bars among Uruguayans. Perceived strength of familial antismoking norms was consistently associated with all indicators of the social acceptability of smoking in Uruguay but only with the frequency of receiving anti-SHS verbal cues in Mexico. These results are generally consistent with previous research indicating that comprehensive smoke-free policies are likely to increase the social unacceptability of smoking and that resistance against such policies is likely to diminish once such policies are in place.

Multiple Streams Approach to Tobacco Control Policymaking in a Tobacco-Growing State

PubMed Central

Mamudu, Hadii M.; Dadkar, Sumati; Veeranki, Sreenivas P.; He, Yi; Barnes, Richard; Glantz, Stanton A.

2014-01-01

Smokefree policies (SFPs) have diffused throughout the US and worldwide. However, the development of SFPs in the difficult policy environment of tobacco-producing states and economies worldwide has not been well-explored. In 2007, Tennessee, the third largest tobacco producer in the US, enacted the Non-Smoker Protection Act (NSPA). This study utilizes the multiple streams model to provide understanding of why and how this policy was developed by triangulating interviews with key stakeholders and legislative debates with archival documents. In June 2006, the Governor unexpectedly announced support for SFP, which created a window of opportunity for policy change. The Campaign for Healthy and Responsible Tennessee, a health coalition, seized this opportunity and worked with the administration and the Tennessee Restaurant Association to negotiate a comprehensive SFP, however, a weaker bill was used by the legislative leadership to develop the NSPA. Although the Governor and the Tennessee Restaurant Association’s support generated an environment for 100 % SFP, health groups did not fully capitalize on this environmental change and settled for a weak policy with several exemptions. This study suggests the importance for proponents of policy change to understand changes in their environment and be willing and able to capitalize on these changes. PMID:24370600

Economic and technological aspects of the market introduction of renewable power technologies

NASA Astrophysics Data System (ADS)

Worlen, Christine M.

Renewable energy, if developed and delivered with appropriate technologies, is cleaner, more evenly distributed, and safer than conventional energy systems. Many countries and several states in the United States promote the development and introduction of technologies for "green" electricity production. This dissertation investigates economic and technological aspects of this process for wind energy. In liberalized electricity markets, policy makers use economic incentives to encourage the adoption of renewables. Choosing from a large range of possible policies and instruments is a multi-criteria decision process. This dissertation evaluates the criteria used and the trade-offs among the criteria, and develops a hierarchical flow scheme that policy makers can use to choose the most appropriate policy for a given situation. Economic incentives and market transformation programs seek to reduce costs through mass deployment in order to make renewable technologies competitive. Cost reduction is measured in "experience curves" that posit negative exponential relationships between cumulative deployment and production cost. This analysis reveals the weaknesses in conventional experience curve analyses for wind turbines, and concludes that the concept is limited by data availability, a weak conceptual foundation, and inappropriate statistical estimation. A revised model specifies a more complete set of economic and technological forces that determine the cost of wind power. Econometric results indicate that experience and upscaling of turbine sizes accounted for the observed cost reduction in wind turbines in the United States, Denmark and Germany between 1983 and 2001. These trends are likely to continue. In addition, future cost reductions will result from economies of scale in production. Observed differences in the performance of theoretically equivalent policy instruments could arise from economic uncertainty. To test this hypothesis, a methodology for the quantitative comparison of economic incentive schemes and their effect on uncertainty and investor behavior in renewable power markets is developed using option value theory of investment. Critical investment thresholds compared with actual benefit-cost ratios for several case studies in Germany indicate that uncertainty in prices for wind power and green certificates would delay investment. In Germany, the fixed-tariff system effectively removes this barrier.

Mobilizing women at the grassroots to shape health policy: a case study of the Global Campaign for Microbicides.

PubMed

Forbes, Anna

2013-11-01

Competition to advance issues on public policy agendas is constant. Political scientists agree that professional "policy entrepreneurs" (researchers, academics, and bureaucrats) serve as conduits in this process. Grassroots advocacy has always been part of the political landscape as non-professional people also take on the role of policy advocates or activists, to get specific problems and preferred solutions onto public and policy agendas and motivate policymakers to take action. The contribution of grassroots advocacy to significant policy changes is often under-funded because its impacts are hard to isolate and quantify, and are often most evident in retrospect. This paper examines the contribution of the Global Campaign for Microbicides to the movement to expand the range of HIV prevention options for women and describes how it mobilized hundreds of grassroots policy activists around the world to take coordinated action on this issue. It reviews the Campaign's accomplishments and highlights some of its strengths and weaknesses. Finally, the paper considers the value of similar efforts on the part of grassroots advocates seeking to influence the post-ICPD and post-2015 development agendas as they are being negotiated. Decisions regarding what kind of advocacy work is carried out during this process, and by whom and how, will inevitably shape the content of these new frameworks. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Reinforcement Learning for Weakly-Coupled MDPs and an Application to Planetary Rover Control

NASA Technical Reports Server (NTRS)

Bernstein, Daniel S.; Zilberstein, Shlomo

2003-01-01

Weakly-coupled Markov decision processes can be decomposed into subprocesses that interact only through a small set of bottleneck states. We study a hierarchical reinforcement learning algorithm designed to take advantage of this particular type of decomposability. To test our algorithm, we use a decision-making problem faced by autonomous planetary rovers. In this problem, a Mars rover must decide which activities to perform and when to traverse between science sites in order to make the best use of its limited resources. In our experiments, the hierarchical algorithm performs better than Q-learning in the early stages of learning, but unlike Q-learning it converges to a suboptimal policy. This suggests that it may be advantageous to use the hierarchical algorithm when training time is limited.

The intervention effect of local alcohol licensing policies on hospital admission and crime: a natural experiment using a novel Bayesian synthetictime-series method.

PubMed

de Vocht, Frank; Tilling, Kate; Pliakas, Triantafyllos; Angus, Colin; Egan, Matt; Brennan, Alan; Campbell, Rona; Hickman, Matthew

2017-09-01

Control of alcohol licensing at local government level is a key component of alcohol policy in England. There is, however, only weak evidence of any public health improvement. We used a novel natural experiment design to estimate the impact of new local alcohol licensing policies on hospital admissions and crime. We used Home Office licensing data (2007-2012) to identify (1) interventions: local areas where both a cumulative impact zone and increased licensing enforcement were introduced in 2011; and (2) controls: local areas with neither. Outcomes were 2009-2015 alcohol-related hospital admissions, violent and sexual crimes, and antisocial behaviour. Bayesian structural time series were used to create postintervention synthetic time series (counterfactuals) based on weighted time series in control areas. Intervention effects were calculated from differences between measured and expected trends. Validation analyses were conducted using randomly selected controls. 5 intervention and 86 control areas were identified. Intervention was associated with an average reduction in alcohol-related hospital admissions of 6.3% (95% credible intervals (CI) -12.8% to 0.2%) and to lesser extent with a reduced in violent crimes, especially up to 2013 (-4.6%, 95% CI -10.7% to 1.4%). There was weak evidence of an effect on sexual crimes up 2013 (-8.4%, 95% CI -21.4% to 4.6%) and insufficient evidence of an effect on antisocial behaviour as a result of a change in reporting. Moderate reductions in alcohol-related hospital admissions and violent and sexual crimes were associated with introduction of local alcohol licensing policies. This novel methodology holds promise for use in other natural experiments in public health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Protecting food security when facing uncertain climate: Opportunities for Afghan communities

NASA Astrophysics Data System (ADS)

Salman, Dina; Amer, Saud A.; Ward, Frank A.

2017-11-01

Climate change, population growth, and weakly developed water management institutions in many of the world's dry communities have raised the importance of designing innovative water allocation methods that adapt to water supply fluctuations while respecting cultural sensitivities. For example, Afghanistan faces an ancient history of water supply fluctuations that have contributed to periodic food shortage and famine. Poorly designed and weakly enforced water allocation methods continue to result in agriculture sector underperformance and periodic food shortages when water shortfalls occur. To date, little research has examined alternative water sharing rules on a multi-basin scale to protect food security for a subsistence irrigation society when the community faces water shortage. This paper's contribution examines the economic performance of three water-sharing mechanisms for three basins in Afghanistan with the goal of protecting food security for crop irrigation under ongoing threats of drought, while meeting growing demands for food in the face of anticipated population growth. We achieved this by formulating an integrated empirical optimization model to identify water-sharing measures that minimize economic losses while protecting food security when water shortages occur. Findings show that implementation of either a water trading policy or a proportional shortage policy that respects cultural sensitivities has the potential to raise economic welfare in each basin. Such a policy can reduce food insecurity risks for all trading provinces within each basin, thus being a productive institution for adapting to water shortage when it occurs. Total economic welfare gains are highest when drought is the most severe for which suffering would otherwise be greatest. Gains would be considerably higher if water storage reservoirs were built to store wet year flows for use in dry years. Our results light a path for policy makers, donors, water administrators, and farm managers, who shoulder the burden of protecting food security and rural livelihoods in the world's poor dry communities.

A qualitative examination of the health workforce needs during climate change disaster response in Pacific Island Countries

PubMed Central

2014-01-01

Background There is a growing body of evidence that the impacts of climate change are affecting population health negatively. The Pacific region is particularly vulnerable to climate change; a strong health-care system is required to respond during times of disaster. This paper examines the capacity of the health sector in Pacific Island Countries to adapt to changing disaster response needs, in terms of: (i) health workforce governance, management, policy and involvement; (ii) health-care capacity and skills; and (iii) human resources for health training and workforce development. Methods Key stakeholder interviews informed the assessment of the capacity of the health sector and disaster response organizations in Pacific Island Countries to adapt to disaster response needs under a changing climate. The research specifically drew upon and examined the adaptive capacity of individual organizations and the broader system of disaster response in four case study countries (Fiji, Cook Islands, Vanuatu and Samoa). Results ‘Capacity’ including health-care capacity was one of the objective determinants identified as most significant in influencing the adaptive capacity of disaster response systems in the Pacific. The research identified several elements that could support the adaptive capacity of the health sector such as: inclusive involvement in disaster coordination; policies in place for health workforce coordination; belief in their abilities; and strong donor support. Factors constraining adaptive capacity included: weak coordination of international health personnel; lack of policies to address health worker welfare; limited human resources and material resources; shortages of personnel to deal with psychosocial needs; inadequate skills in field triage and counselling; and limited capacity for training. Conclusion Findings from this study can be used to inform the development of human resources for health policies and strategic plans, and to support the development of a coordinated and collaborative approach to disaster response training across the Pacific and other developing contexts. This study also provides an overview of health-care capacity and some of the challenges and strengths that can inform future development work by humanitarian organizations, regional and international donors involved in climate change adaptation, and disaster risk reduction in the Pacific region. PMID:24521057

Protocol for the process evaluation of a complex intervention designed to increase the use of research in health policy and program organisations (the SPIRIT study).

PubMed

Haynes, Abby; Brennan, Sue; Carter, Stacy; O'Connor, Denise; Schneider, Carmen Huckel; Turner, Tari; Gallego, Gisselle

2014-09-27

Process evaluation is vital for understanding how interventions function in different settings, including if and why they have different effects or do not work at all. This is particularly important in trials of complex interventions in 'real world' organisational settings where causality is difficult to determine. Complexity presents challenges for process evaluation, and process evaluations that tackle complexity are rarely reported. This paper presents the detailed protocol for a process evaluation embedded in a randomised trial of a complex intervention known as SPIRIT (Supporting Policy In health with Research: an Intervention Trial). SPIRIT aims to build capacity for using research in health policy and program agencies. We describe the flexible and pragmatic methods used for capturing, managing and analysing data across three domains: (a) the intervention as it was implemented; (b) how people participated in and responded to the intervention; and (c) the contextual characteristics that mediated this relationship and may influence outcomes. Qualitative and quantitative data collection methods include purposively sampled semi-structured interviews at two time points, direct observation and coding of intervention activities, and participant feedback forms. We provide examples of the data collection and data management tools developed. This protocol provides a worked example of how to embed process evaluation in the design and evaluation of a complex intervention trial. It tackles complexity in the intervention and its implementation settings. To our knowledge, it is the only detailed example of the methods for a process evaluation of an intervention conducted as part of a randomised trial in policy organisations. We identify strengths and weaknesses, and discuss how the methods are functioning during early implementation. Using 'insider' consultation to develop methods is enabling us to optimise data collection while minimising discomfort and burden for participants. Embedding the process evaluation within the trial design is facilitating access to data, but may impair participants' willingness to talk openly in interviews. While it is challenging to evaluate the process of conducting a randomised trial of a complex intervention, our experience so far suggests that it is feasible and can add considerably to the knowledge generated.

Public participation GIS: a method for identifying ecosystems services

USGS Publications Warehouse

Brown, Greg; Montag, Jessica; Lyon, Katie

2012-01-01

This study evaluated the use of an Internet-based public participation geographic information system (PPGIS) to identify ecosystem services in Grand County, Colorado. Specific research objectives were to examine the distribution of ecosystem services, identify the characteristics of participants in the study, explore potential relationships between ecosystem services and land use and land cover (LULC) classifications, and assess the methodological strengths and weakness of the PPGIS approach for identifying ecosystem services. Key findings include: (1) Cultural ecosystem service opportunities were easiest to identify while supporting and regulatory services most challenging, (2) participants were highly educated, knowledgeable about nature and science, and have a strong connection to the outdoors, (3) some LULC classifications were logically and spatially associated with ecosystem services, and (4) despite limitations, the PPGIS method demonstrates potential for identifying ecosystem services to augment expert judgment and to inform public or environmental policy decisions regarding land use trade-offs.

Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research.

PubMed

Yakoob, Mohammad Yawar; Lo, Clifford W

2017-10-01

An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.

Teaching and assessing professionalism in medicine.

PubMed

Duff, Patrick

2004-12-01

Professionalism is the single most important of the clinical competencies. Lack of professional behavior, in turn, is the single most common cause for disciplinary action against third and fourth-year medical students, residents, fellows, and clinical practitioners. Desirable professional attributes include humility, honesty, responsibility, reliability, and accountability. The ability to preserve an appropriate balance between patient care responsibilities and personal commitments also is an important feature of professional behavior. Altruism, respectfulness, loyalty, compassion, sensitivity, and tactfulness are other desirable professional attributes. In addition, professionalism requires a heightened sense of intellectual curiosity, insight into personal strengths and weaknesses, maturity, and commitment to clinical excellence and self-directed learning. Professionalism can be taught and assessed through lectures, small-group seminars, role-playing exercises, directed reading, and one-on-one observation and counseling. However, the most effective way of teaching professionalism is for instructors to model appropriate behavior and to impose a consistent policy of zero tolerance for unprofessional behavior.

Laboratory challenges in the scaling up of HIV, TB, and malaria programs: The interaction of health and laboratory systems, clinical research, and service delivery.

PubMed

Birx, Deborah; de Souza, Mark; Nkengasong, John N

2009-06-01

Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals. Despite strong commitment from the international community to fight major infectious diseases, weak laboratory infrastructure remains a huge rate-limiting step. Some major challenges facing laboratory systems in resource-poor settings include dilapidated infrastructure; lack of human capacity, laboratory policies, and strategic plans; and limited synergies between clinical and research laboratories. Together, these factors compromise the quality of test results and impact patient management. With increased funding, the target of laboratory strengthening efforts in resource-poor countries should be the integrating of laboratory services across major diseases to leverage resources with respect to physical infrastructure; types of assays; supply chain management of reagents and equipment; and maintenance of equipment.

A strategy to improve priority setting in developing countries.

PubMed

Kapiriri, Lydia; Martin, Douglas K

2007-09-01

Because the demand for health services outstrips the available resources, priority setting is one of the most difficult issues faced by health policy makers, particularly those in developing countries. Priority setting in developing countries is fraught with uncertainty due to lack of credible information, weak priority setting institutions, and unclear priority setting processes. Efforts to improve priority setting in these contexts have focused on providing information and tools. In this paper we argue that priority setting is a value laden and political process, and although important, the available information and tools are not sufficient to address the priority setting challenges in developing countries. Additional complementary efforts are required. Hence, a strategy to improve priority setting in developing countries should also include: (i) capturing current priority setting practices, (ii) improving the legitimacy and capacity of institutions that set priorities, and (iii) developing fair priority setting processes.

Restraint and the question of validity.

PubMed

Paterson, Brodie; Duxbury, Joy

2007-07-01

Restraint as an intervention in the management of acute mental distress has a long history that predates the existence of psychiatry. However, it remains a source of controversy with an ongoing debate as to its role. This article critically explores what to date has seemingly been only implicit in the debate surrounding the role of restraint: how should the concept of validity be interpreted when applied to restraint as an intervention? The practice of restraint in mental health is critically examined using two post-positivist constructions of validity, the pragmatic and the psychopolitical, by means of a critical examination of the literature. The current literature provides only weak support for the pragmatic validity of restraint as an intervention and no support to date for its psychopolitical validity. Judgements regarding the validity of any intervention that is coercive must include reference to the psychopolitical dimensions of both practice and policy.

Combating Terrorism: A Compendium of Recent Counterterrorism Recommendations From Authoritative Commissions and Subject Matter Experts

DTIC Science & Technology

2001-09-16

technologies to improve airport security - e.g. biometrics systems and explosive detections systems (Page 5) 4. Allocate additional resources to airport and...been debated are the policy of allowing knives on aircraft, weak cockpit security, and the possibility of federalizing airport security staff.6 A...Improve staff selection and training Airport security staff, and particularly screeners, who are responsible for identifying weapons and explosive

Quantum Computing Graduate Fellowship

DTIC Science & Technology

2005-05-31

SUBTITLE 6. AUTHORS 7. PERFORMING ORGANIZATION NAMES AND ADDRESSES 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) U.S. Army Research...those of the author( s ) and should not contrued as an official Department of the Army position, policy or decision, unless so designated by other...laser pulse," Physical Review A 69, 042308 (2004). 4. G. Smith, S . Chaudhury, P. S . Jessen, A. Silberfarb, and I. H. Deutsch, “Continuous Weak

Ways to Improve Strategic Planning within the Tourist Industry (in the Case Study of the Republic of Kazakhstan)

ERIC Educational Resources Information Center

Shilibekova, Balzhan; Syzdykbayeva, Bakyt; Ayetov, Sayat; Agybetova, Rina; Baimbetova, Assel

2016-01-01

Kazakhstan has a great tourist potential, but it is still partly fulfilled. That is why very important to find the weakness in the state's policy and to develop this industry in the best way. The aim of the research is to formulate a hypothesis with regard to the possible content of measures to improve the strategic planning and marketing…

Renewable portfolio standards: still No good reasons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michaels, Robert J.

2008-10-15

The rebuttals by Christopher Cooper and Benjamin K. Sovacool to my article questioning the need for a national RPS leave their case as weak as ever. They provide no model that might help readers approach the foundational question: why should Congress enact this economically inefficient environmental policy when wide-ranging regulations, implementation plans, and emissions markets are in place, functioning reasonably well, and can be modified as new information arrives? (author)

Job Attitudes of Air National Guard Personnel.

DTIC Science & Technology

1986-04-01

organizational behavior literature. 2. To compare OAP-measured demographic characteristics and job attitudes of Air National Guard personnel with the ...thought to represent official ideas, attitudes , or policies of any agency of the United States Government. The author has rot had special access to...day that they are drawn together as a total force. ANG commanders studying this report will see the job attitude strengths and weaknesses of ANG

Deciphering the Balkan Enigma: Using History to Inform Policy. Revised Edition,

DTIC Science & Technology

1995-11-07

After long experience with German interference in Serbian/Yugoslav affairs (1878, 1908, 1914 - 1918 ), it should not be surprising that the Yugoslav...background to the religious, as well as political differences between the various branches of the church and the division, see Robert R. Palmer and Joel...comprehensive solution prior to embarking on incremental ways to resolve issues. _ Political institutions are weak. This condition complicates

Kuwait: Governance, Security, and U.S. Policy

DTIC Science & Technology

2016-09-29

money laundering . In May 2014, the Ministry of Social Affairs warned Kuwaiti citizens that the fundraising campaigns for Syrian factions was...several years apparently were the product of an action plan Kuwait developed with the broader FATF to address Kuwait’s weaknesses on anti- money ... laundering and counter terrorism financing (AML/CTF). As of mid-2014, Kuwait was no longer considered deficient on AML/CFT by the FATF. Although Kuwait

Bridging analytical approaches for low-carbon transitions

NASA Astrophysics Data System (ADS)

Geels, Frank W.; Berkhout, Frans; van Vuuren, Detlef P.

2016-06-01

Low-carbon transitions are long-term multi-faceted processes. Although integrated assessment models have many strengths for analysing such transitions, their mathematical representation requires a simplification of the causes, dynamics and scope of such societal transformations. We suggest that integrated assessment model-based analysis should be complemented with insights from socio-technical transition analysis and practice-based action research. We discuss the underlying assumptions, strengths and weaknesses of these three analytical approaches. We argue that full integration of these approaches is not feasible, because of foundational differences in philosophies of science and ontological assumptions. Instead, we suggest that bridging, based on sequential and interactive articulation of different approaches, may generate a more comprehensive and useful chain of assessments to support policy formation and action. We also show how these approaches address knowledge needs of different policymakers (international, national and local), relate to different dimensions of policy processes and speak to different policy-relevant criteria such as cost-effectiveness, socio-political feasibility, social acceptance and legitimacy, and flexibility. A more differentiated set of analytical approaches thus enables a more differentiated approach to climate policy making.

A comprehensive conceptual framework for road safety strategies.

PubMed

Hughes, B P; Anund, A; Falkmer, T

2016-05-01

Road safety strategies (generally called Strategic Highway Safety Plans in the USA) provide essential guidance for actions to improve road safety, but often lack a conceptual framework that is comprehensive, systems theory based, and underpinned by evidence from research and practice. This paper aims to incorporate all components, policy tools by which they are changed, and the general interactions between them. A framework of nine mutually interacting components that contribute to crashes and ten generic policy tools which can be applied to reduce the outcomes of these crashes was developed and used to assess 58 road safety strategies from 22 countries across 15 years. The work identifies the policy tools that are most and least widely applied to components, highlighting the potential for improvements to any individual road safety strategy, and the potential strengths and weaknesses of road safety strategies in general. The framework also provides guidance for the development of new road safety strategies, identifying potential consequences of policy tool based measures with regard to exposure and risk, useful for both mobility and safety objectives. Copyright © 2016 Elsevier Ltd. All rights reserved.

Diversity and carbon storage across the tropical forest biome

NASA Astrophysics Data System (ADS)

Sullivan, Martin J. P.; Talbot, Joey; Lewis, Simon L.; Phillips, Oliver L.; Qie, Lan; Begne, Serge K.; Chave, Jerôme; Cuni-Sanchez, Aida; Hubau, Wannes; Lopez-Gonzalez, Gabriela; Miles, Lera; Monteagudo-Mendoza, Abel; Sonké, Bonaventure; Sunderland, Terry; Ter Steege, Hans; White, Lee J. T.; Affum-Baffoe, Kofi; Aiba, Shin-Ichiro; de Almeida, Everton Cristo; de Oliveira, Edmar Almeida; Alvarez-Loayza, Patricia; Dávila, Esteban Álvarez; Andrade, Ana; Aragão, Luiz E. O. C.; Ashton, Peter; Aymard C., Gerardo A.; Baker, Timothy R.; Balinga, Michael; Banin, Lindsay F.; Baraloto, Christopher; Bastin, Jean-Francois; Berry, Nicholas; Bogaert, Jan; Bonal, Damien; Bongers, Frans; Brienen, Roel; Camargo, José Luís C.; Cerón, Carlos; Moscoso, Victor Chama; Chezeaux, Eric; Clark, Connie J.; Pacheco, Álvaro Cogollo; Comiskey, James A.; Valverde, Fernando Cornejo; Coronado, Eurídice N. Honorio; Dargie, Greta; Davies, Stuart J.; de Canniere, Charles; Djuikouo K., Marie Noel; Doucet, Jean-Louis; Erwin, Terry L.; Espejo, Javier Silva; Ewango, Corneille E. N.; Fauset, Sophie; Feldpausch, Ted R.; Herrera, Rafael; Gilpin, Martin; Gloor, Emanuel; Hall, Jefferson S.; Harris, David J.; Hart, Terese B.; Kartawinata, Kuswata; Kho, Lip Khoon; Kitayama, Kanehiro; Laurance, Susan G. W.; Laurance, William F.; Leal, Miguel E.; Lovejoy, Thomas; Lovett, Jon C.; Lukasu, Faustin Mpanya; Makana, Jean-Remy; Malhi, Yadvinder; Maracahipes, Leandro; Marimon, Beatriz S.; Junior, Ben Hur Marimon; Marshall, Andrew R.; Morandi, Paulo S.; Mukendi, John Tshibamba; Mukinzi, Jaques; Nilus, Reuben; Vargas, Percy Núñez; Camacho, Nadir C. Pallqui; Pardo, Guido; Peña-Claros, Marielos; Pétronelli, Pascal; Pickavance, Georgia C.; Poulsen, Axel Dalberg; Poulsen, John R.; Primack, Richard B.; Priyadi, Hari; Quesada, Carlos A.; Reitsma, Jan; Réjou-Méchain, Maxime; Restrepo, Zorayda; Rutishauser, Ervan; Salim, Kamariah Abu; Salomão, Rafael P.; Samsoedin, Ismayadi; Sheil, Douglas; Sierra, Rodrigo; Silveira, Marcos; Slik, J. W. Ferry; Steel, Lisa; Taedoumg, Hermann; Tan, Sylvester; Terborgh, John W.; Thomas, Sean C.; Toledo, Marisol; Umunay, Peter M.; Gamarra, Luis Valenzuela; Vieira, Ima Célia Guimarães; Vos, Vincent A.; Wang, Ophelia; Willcock, Simon; Zemagho, Lise

2017-01-01

Tropical forests are global centres of biodiversity and carbon storage. Many tropical countries aspire to protect forest to fulfil biodiversity and climate mitigation policy targets, but the conservation strategies needed to achieve these two functions depend critically on the tropical forest tree diversity-carbon storage relationship. Assessing this relationship is challenging due to the scarcity of inventories where carbon stocks in aboveground biomass and species identifications have been simultaneously and robustly quantified. Here, we compile a unique pan-tropical dataset of 360 plots located in structurally intact old-growth closed-canopy forest, surveyed using standardised methods, allowing a multi-scale evaluation of diversity-carbon relationships in tropical forests. Diversity-carbon relationships among all plots at 1 ha scale across the tropics are absent, and within continents are either weak (Asia) or absent (Amazonia, Africa). A weak positive relationship is detectable within 1 ha plots, indicating that diversity effects in tropical forests may be scale dependent. The absence of clear diversity-carbon relationships at scales relevant to conservation planning means that carbon-centred conservation strategies will inevitably miss many high diversity ecosystems. As tropical forests can have any combination of tree diversity and carbon stocks both require explicit consideration when optimising policies to manage tropical carbon and biodiversity.

Illegal drugs, anti-drug policy failure, and the need for institutional reforms in Colombia.

PubMed

Thoumi, Francisco E

2012-01-01

This paper is inspired by two anomalies encountered in the study of the illegal drugs industry. First, despite the very high profits of coca/cocaine and poppy/opium/heroin production, most countries that can produce do not. Why, for example, does Colombia face much greater competition in the international coffee, banana, and other legal product markets than in cocaine? And second, though illegal drugs are clearly associated with violence, why is it that illegal drug trafficking organizations have been so much more violent in Colombia and Mexico than in the rest of the world? The answers to these questions cannot be found in factors external to Colombia (and Mexico). They require identifying the societal weaknesses of each country. To do so, the history of the illegal drugs industry is surveyed, a simple model of human behavior that stresses the conflict between formal (legal) and informal (socially accepted) norms as a source of the weaknesses that make societies vulnerable is formulated. The reasons why there is a wide gap between formal and informal norms in Colombia are explored and the effectiveness of anti-drug policies is considered to explain why they fail to achieve their posited goals. The essay ends with reflections and conclusion on the need for institutional change.

Diversity and carbon storage across the tropical forest biome.

PubMed

Sullivan, Martin J P; Talbot, Joey; Lewis, Simon L; Phillips, Oliver L; Qie, Lan; Begne, Serge K; Chave, Jerôme; Cuni-Sanchez, Aida; Hubau, Wannes; Lopez-Gonzalez, Gabriela; Miles, Lera; Monteagudo-Mendoza, Abel; Sonké, Bonaventure; Sunderland, Terry; Ter Steege, Hans; White, Lee J T; Affum-Baffoe, Kofi; Aiba, Shin-Ichiro; de Almeida, Everton Cristo; de Oliveira, Edmar Almeida; Alvarez-Loayza, Patricia; Dávila, Esteban Álvarez; Andrade, Ana; Aragão, Luiz E O C; Ashton, Peter; Aymard C, Gerardo A; Baker, Timothy R; Balinga, Michael; Banin, Lindsay F; Baraloto, Christopher; Bastin, Jean-Francois; Berry, Nicholas; Bogaert, Jan; Bonal, Damien; Bongers, Frans; Brienen, Roel; Camargo, José Luís C; Cerón, Carlos; Moscoso, Victor Chama; Chezeaux, Eric; Clark, Connie J; Pacheco, Álvaro Cogollo; Comiskey, James A; Valverde, Fernando Cornejo; Coronado, Eurídice N Honorio; Dargie, Greta; Davies, Stuart J; De Canniere, Charles; Djuikouo K, Marie Noel; Doucet, Jean-Louis; Erwin, Terry L; Espejo, Javier Silva; Ewango, Corneille E N; Fauset, Sophie; Feldpausch, Ted R; Herrera, Rafael; Gilpin, Martin; Gloor, Emanuel; Hall, Jefferson S; Harris, David J; Hart, Terese B; Kartawinata, Kuswata; Kho, Lip Khoon; Kitayama, Kanehiro; Laurance, Susan G W; Laurance, William F; Leal, Miguel E; Lovejoy, Thomas; Lovett, Jon C; Lukasu, Faustin Mpanya; Makana, Jean-Remy; Malhi, Yadvinder; Maracahipes, Leandro; Marimon, Beatriz S; Junior, Ben Hur Marimon; Marshall, Andrew R; Morandi, Paulo S; Mukendi, John Tshibamba; Mukinzi, Jaques; Nilus, Reuben; Vargas, Percy Núñez; Camacho, Nadir C Pallqui; Pardo, Guido; Peña-Claros, Marielos; Pétronelli, Pascal; Pickavance, Georgia C; Poulsen, Axel Dalberg; Poulsen, John R; Primack, Richard B; Priyadi, Hari; Quesada, Carlos A; Reitsma, Jan; Réjou-Méchain, Maxime; Restrepo, Zorayda; Rutishauser, Ervan; Salim, Kamariah Abu; Salomão, Rafael P; Samsoedin, Ismayadi; Sheil, Douglas; Sierra, Rodrigo; Silveira, Marcos; Slik, J W Ferry; Steel, Lisa; Taedoumg, Hermann; Tan, Sylvester; Terborgh, John W; Thomas, Sean C; Toledo, Marisol; Umunay, Peter M; Gamarra, Luis Valenzuela; Vieira, Ima Célia Guimarães; Vos, Vincent A; Wang, Ophelia; Willcock, Simon; Zemagho, Lise

2017-01-17

Tropical forests are global centres of biodiversity and carbon storage. Many tropical countries aspire to protect forest to fulfil biodiversity and climate mitigation policy targets, but the conservation strategies needed to achieve these two functions depend critically on the tropical forest tree diversity-carbon storage relationship. Assessing this relationship is challenging due to the scarcity of inventories where carbon stocks in aboveground biomass and species identifications have been simultaneously and robustly quantified. Here, we compile a unique pan-tropical dataset of 360 plots located in structurally intact old-growth closed-canopy forest, surveyed using standardised methods, allowing a multi-scale evaluation of diversity-carbon relationships in tropical forests. Diversity-carbon relationships among all plots at 1 ha scale across the tropics are absent, and within continents are either weak (Asia) or absent (Amazonia, Africa). A weak positive relationship is detectable within 1 ha plots, indicating that diversity effects in tropical forests may be scale dependent. The absence of clear diversity-carbon relationships at scales relevant to conservation planning means that carbon-centred conservation strategies will inevitably miss many high diversity ecosystems. As tropical forests can have any combination of tree diversity and carbon stocks both require explicit consideration when optimising policies to manage tropical carbon and biodiversity.

A comparison of the impact of U.S. and Canadian cigarette pack warning label requirements on tobacco industry profitability and the public health.

PubMed

Givel, Michael

2007-10-01

Since the early 1980s, neo-liberals have argued that command and control regulation (such as modern tobacco control programs) are costly in supporting corporate markets and profits. Some recent social constructionists have also argued that weak and symbolic command and control policies are necessary to maintain corporate productivity. This paper examines whether the command and control-oriented United States cigarette warning label law is symbolic thus helping to maintain corporate profitability. This paper compares United States and Canadian requirements that promote significant smoking cessation such as color pictures or graphics on cigarette packs. This paper also provides a detailed overview of the respective cigarette pack warning label laws through an archival and content analysis of tobacco industry documents, LexisNexis, web pages, and peer reviewed journal articles. Cigarette pack warning label requirements under the command and control United States Cigarette Labeling and Advertising Act are currently fairly symbolic and weak in promoting tobacco cessation when compared with the much stronger Canadian warning label requirements. Contrary to the arguments of neo-liberals, symbolic command and control policies can actually support corporate private profit making, which for the tobacco industry occurs at the expense of the public health.

The health effects of economic insecurity.

PubMed Central

Catalano, R

1991-01-01

BACKGROUND. Interest in the health and behavioral effects of economic insecurity appears to vary with the performance of the economy. The current recession in the United States and Western Europe and growing unemployment in Eastern Europe make it timely to analytically review the recent research concerned with the health effects of economic contraction. METHODS. The research concerned with the health and behavioral effects of economic insecurity is organized by dependent variable and method. Rules for determining which effects are supported by strong and which by weak evidence are developed and applied to the literature. RESULTS. Evidence for effects on symptoms of psychological distress, seeking help for psychological distress, and nonspecific physiological illness is strong. Evidence for effects on suicide, child abuse, adverse birth outcomes, and heart disease is characterized as weak or sufficiently controversial to warrant skepticism. CONCLUSIONS. The health effects of economic security are undoubtedly mediated by economic policies. Estimating the effect of policy alternatives on the incidence of various outcomes is, however, very difficult given the current state of the research. The effect of rising unemployment on health in Eastern Europe cannot, moreover, be estimated from existing research. Effects estimated from Western economies probably do not generalize to situations in which the meaning of economic insecurity is conditioned by profound social and political reforms. PMID:1951825

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis.

PubMed

Buttigieg, Sandra C; Schuetz, Marcus; Bezzina, Frank

2016-01-01

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state's health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.

Diversity and carbon storage across the tropical forest biome

PubMed Central

Sullivan, Martin J. P.; Talbot, Joey; Lewis, Simon L.; Phillips, Oliver L.; Qie, Lan; Begne, Serge K.; Chave, Jerôme; Cuni-Sanchez, Aida; Hubau, Wannes; Lopez-Gonzalez, Gabriela; Miles, Lera; Monteagudo-Mendoza, Abel; Sonké, Bonaventure; Sunderland, Terry; ter Steege, Hans; White, Lee J. T.; Affum-Baffoe, Kofi; Aiba, Shin-ichiro; de Almeida, Everton Cristo; de Oliveira, Edmar Almeida; Alvarez-Loayza, Patricia; Dávila, Esteban Álvarez; Andrade, Ana; Aragão, Luiz E. O. C.; Ashton, Peter; Aymard C., Gerardo A.; Baker, Timothy R.; Balinga, Michael; Banin, Lindsay F.; Baraloto, Christopher; Bastin, Jean-Francois; Berry, Nicholas; Bogaert, Jan; Bonal, Damien; Bongers, Frans; Brienen, Roel; Camargo, José Luís C.; Cerón, Carlos; Moscoso, Victor Chama; Chezeaux, Eric; Clark, Connie J.; Pacheco, Álvaro Cogollo; Comiskey, James A.; Valverde, Fernando Cornejo; Coronado, Eurídice N. Honorio; Dargie, Greta; Davies, Stuart J.; De Canniere, Charles; Djuikouo K., Marie Noel; Doucet, Jean-Louis; Erwin, Terry L.; Espejo, Javier Silva; Ewango, Corneille E. N.; Fauset, Sophie; Feldpausch, Ted R.; Herrera, Rafael; Gilpin, Martin; Gloor, Emanuel; Hall, Jefferson S.; Harris, David J.; Hart, Terese B.; Kartawinata, Kuswata; Kho, Lip Khoon; Kitayama, Kanehiro; Laurance, Susan G. W.; Laurance, William F.; Leal, Miguel E.; Lovejoy, Thomas; Lovett, Jon C.; Lukasu, Faustin Mpanya; Makana, Jean-Remy; Malhi, Yadvinder; Maracahipes, Leandro; Marimon, Beatriz S.; Junior, Ben Hur Marimon; Marshall, Andrew R.; Morandi, Paulo S.; Mukendi, John Tshibamba; Mukinzi, Jaques; Nilus, Reuben; Vargas, Percy Núñez; Camacho, Nadir C. Pallqui; Pardo, Guido; Peña-Claros, Marielos; Pétronelli, Pascal; Pickavance, Georgia C.; Poulsen, Axel Dalberg; Poulsen, John R.; Primack, Richard B.; Priyadi, Hari; Quesada, Carlos A.; Reitsma, Jan; Réjou-Méchain, Maxime; Restrepo, Zorayda; Rutishauser, Ervan; Salim, Kamariah Abu; Salomão, Rafael P.; Samsoedin, Ismayadi; Sheil, Douglas; Sierra, Rodrigo; Silveira, Marcos; Slik, J. W. Ferry; Steel, Lisa; Taedoumg, Hermann; Tan, Sylvester; Terborgh, John W.; Thomas, Sean C.; Toledo, Marisol; Umunay, Peter M.; Gamarra, Luis Valenzuela; Vieira, Ima Célia Guimarães; Vos, Vincent A.; Wang, Ophelia; Willcock, Simon; Zemagho, Lise

2017-01-01

Tropical forests are global centres of biodiversity and carbon storage. Many tropical countries aspire to protect forest to fulfil biodiversity and climate mitigation policy targets, but the conservation strategies needed to achieve these two functions depend critically on the tropical forest tree diversity-carbon storage relationship. Assessing this relationship is challenging due to the scarcity of inventories where carbon stocks in aboveground biomass and species identifications have been simultaneously and robustly quantified. Here, we compile a unique pan-tropical dataset of 360 plots located in structurally intact old-growth closed-canopy forest, surveyed using standardised methods, allowing a multi-scale evaluation of diversity-carbon relationships in tropical forests. Diversity-carbon relationships among all plots at 1 ha scale across the tropics are absent, and within continents are either weak (Asia) or absent (Amazonia, Africa). A weak positive relationship is detectable within 1 ha plots, indicating that diversity effects in tropical forests may be scale dependent. The absence of clear diversity-carbon relationships at scales relevant to conservation planning means that carbon-centred conservation strategies will inevitably miss many high diversity ecosystems. As tropical forests can have any combination of tree diversity and carbon stocks both require explicit consideration when optimising policies to manage tropical carbon and biodiversity. PMID:28094794

Achieving Millennium Development Goals for health: building understanding, trust and capacity to respond.

PubMed

Downs, Timothy John; Larson, Heidi Jane

2007-10-01

Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: (1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems, including social drivers; (2) a lack of multi-criteria evaluation of alternative interventions; (3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: (1) participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; (2) selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; (3) integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health.

Rating maternal and neonatal health services in developing countries.

PubMed Central

Bulatao, Rodolfo A.; Ross, John A.

2002-01-01

OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution. PMID:12378290

A scoping review of nursing workforce planning and forecasting research.

PubMed

Squires, Allison; Jylhä, Virpi; Jun, Jin; Ensio, Anneli; Kinnunen, Juha

2017-11-01

This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches. Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important. A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review. Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies. Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling. Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce. © 2017 John Wiley & Sons Ltd.

Methane Leakage from Natural Gas Systems: Comparisons, Communication, and Policy Relevance (Invited)

NASA Astrophysics Data System (ADS)

Weber, C.; Clavin, C.; Mueller, K. L.

2013-12-01

Increases in domestic natural gas production from shale gas and tight oil resources have ignited a scientific and policy debate about the climate implications of increasing levels of natural gas utilization on a national and global scale. The debate has primarily centered on characterizing the life-cycle greenhouse gas emissions associated with natural gas electricity generation or transportation. As such, there has been significant recent attention to estimating upstream methane and CO2 emissions from natural gas production, processing, transmission, and distribution using either bottom-up inventory or top-down atmospheric methods ranging from regional to global scales. Due to the general scarcity of measured data, the highly variable production practices of the oil & gas industry, and the different geological conditions under which the industry operates, determining methane emissions (sometimes calculated as a 'leakage rate') and overall climate impact over a policy-relevant spatial and temporal scale has been highly challenging. This unsettled state of the science exists as energy and climate policy decisions are being made in tandem with scientific knowledge generation, while at the same time production practices continue to change in a quickly innovating industry. This research critically reviews the work to date on quantifying methane leakage and life-cycle greenhouse gas implications of unconventional onshore oil & gas compared to other fuels such as coal. We take the perspective of a national-level U.S. decision-maker and ask how different methods (inventories, device-level measurements, regional and national inversions) can contribute to the information needed to make informed energy and climate policy decision regarding unconventional resources. Different methods have different strengths, weaknesses, and uncertainties, and such differences must be accounted for properly to ensure usefulness. We find that most work to date has suffered from one or more of several flaws that decrease the policy applicability of scientific results. These include inconsistent metric definitions (particularly related to the 'methane leakage' metric), inconsistent comparisons between studies with different scopes and temporal and spatial boundaries, and a failure to properly distinguish between emissions associated with oil, gas, and other co-products. We conclude that in order for policy decisions to be made in the needed timeframe given the current speed of development, scientists from different communities must work together to develop common strategies for communicating results and interpreting differences between highly different methods. This represents a significant challenge but one that is imperative for atmospheric scientists, engineers, and policy analysts to jointly solve in order to better inform national energy policy needs.

NARSTO critical review of photochemical models and modeling

NASA Astrophysics Data System (ADS)

Russell, Armistead; Dennis, Robin

Photochemical air quality models play a central role in both schentific investigation of how pollutants evlove in the atmosphere as well as developing policies to manage air quality. In the past 30 years, these models have evolved from rather crude representations of the physics and chemistry impacting trace species to their current state: comprehensive, but not complete. The evolution has included advancements in not only the level of process descriptions, but also the computational implementation, including numerical methods. As part of the NARSTO Critical Reviews, this article discusses the current strengths and weaknesses of air quality models and the modeling process. Current Eulerian models are found to represent well the primary processes impacting the evolution of trace species in most cases though some exceptions may exist. For example, sub-grid-scale processes, such as concentrated power plant plumes, are treated only approximately. It is not apparent how much such approximations affect their results and the polices based upon those results. A significant weakness has been in how investigators have addressed, and communicated, such uncertainties. Studies find that major uncertainties are due to model inputs, e.g., emissions and meteorology, more so than the model itself. One of the primary weakness identified is in the modeling process, not the models. Evaluation has been limited both due to data constraints. Seldom is there ample observational data to conduct a detailed model intercomparison using consistent data (e.g., the same emissions and meteorology). Further model advancement, and development of greater confidence in the use of models, is hampered by the lack of thorough evaluation and intercomparisons. Model advances are seen in the use of new tools for extending the interpretation of model results, e.g., process and sensitivity analysis, modeling systems to facilitate their use, and extension of model capabilities, e.g., aerosol dynamics capabilities and sub-grid-scale representations. Another possible direction that is the development and widespread use of a community model acting as a platform for multiple groups and agencies to collaborate and progress more rapidly.

Resident Perspectives on Work-Life Policies and Implications for Burnout.

PubMed

Westercamp, Nicole; Wang, Raziya S; Fassiotto, Magali

2018-02-01

As resident burnout increases, there is a need for better awareness, resources, and interventions. Challenges in balancing work and life priorities have been implicated in contributing to physician burnout. Institutional work-life policies (WLPs) are critical tools to meet work-life needs. This study investigates the influence of WLPs on residents' experiences. The authors emailed a SurveyMonkey link to the APA chief resident and Minority Fellow listservs and directly to 94 psychiatry program directors and 52 fellowship directors nationwide to distribute a survey to residents regarding WLP use and barriers, as well as burnout. Estimated response rate was 12-23%. The authors assessed the anonymous responses using SPSS to evaluate for relationships between awareness of WLPs, perceptions/barriers surrounding their usage, and burnout. The authors analyzed 255 responses. Awareness and use of policies ranged from 2 to 33%. A prominent barrier to WLPs is that use results in shifting workload to co-residents (48% agree). Respondents who perceived leadership to view use of WLPs as a sign of weakness (16% agree) were less likely to use WLPs (t (89) = -3.52, p < 0.001, d = 0.61). Residents with burnout (41%) perceived vastly higher barriers to using WLPs as compared to those without burnout. This study supports the need for further investigation of WLPs to mitigate resident burnout and identifies important perceived barriers that affect the use of WLPs including low awareness, potential for shifting workload to co-residents, and negative perceptions of leadership attitudes toward WLPs.

Local smoke-free policy development in Santa Fe, Argentina

PubMed Central

Glantz, Stanton A

2010-01-01

Objective To describe the process of approval and implementation of a comprehensive smoke-free law in the province of Santa Fe, Argentina, between 2005 and 2009. Methods Review of the Santa Fe smoke-free legislation, articles published in local newspapers and documentation on two lawsuits filed against the law, and interviews with key individuals in Santa Fe. Results Efforts to implement smoke-free policies in Santa Fe began during the 1990s without success, and resumed in 2005 when the provincial Legislature approved the first 100% smoke-free subnational law in Argentina. There was no strong opposition during the discussions within the legislature. As in other parts of the world, pro-tobacco industry interests attempted to block the implementation of the law using well known strategies. These efforts included a controversy media campaign set up, the creation of a hospitality industry association and a virtual smokers' rights group, the introduction of a counterproposal seeking modification of the law, the challenge of the law in the Supreme Court, and the proposal of a weak national bill that would ‘conflict’ with the subnational law. Tobacco control advocates sought media attention as a strategy to protect the law. Conclusions Santa Fe is the first subnational jurisdiction in Latin America to have enacted a comprehensive smoke-free policy following the recommendations of the World Health Organization (WHO) Framework Convention on Tobacco Control. After 3 years of implementation, pro-tobacco industry forces failed to undermine the law. Other subnational jurisdictions in Argentina, as well as in Mexico and Brazil are following the Santa Fe example. PMID:19955534

Adaptive policy responses to water shortage mitigation in the arid regions--a systematic approach based on eDPSIR, DEMATEL, and MCDA.

PubMed

Azarnivand, Ali; Chitsaz, Nastaran

2015-02-01

Most of the arid and semi-arid regions are located in the developing countries, while the availability of water in adequate quantity and quality is an essential condition to approach sustainable development. In this research, "enhanced Driving force-Pressure-State-Impact-Response (eDPSIR)" sustainability framework was applied to deal with water shortage in Yazd, an arid province of Iran. Then, the Decision Making Trial and Evaluation Laboratory (DEMATEL) technique was integrated into the driven components of eDPSIR, to quantify the inter-linkages among fundamental anthropogenic indicators (i.e. causes and effects). The paper's structure included: (1) identifying the indicators of DPSIR along with structuring eDPSIR causal networks, (2) using the DEMATEL technique to evaluate the inter-relationships among the causes and effects along with determining the key indicators, (3) decomposing the problem into a system of hierarchies, (4) employing the analytic hierarchy process (AHP) technique to evaluate the weight of each criterion, and (5) applying complex proportional assessment with Grey interval numbers (COPRAS-G) method to obtain the most conclusive adaptive policy response. The systematic quantitative analysis of causes and effects revealed that the root sources of water shortage in the study area were the weak enforcement of law and regulations, decline of available freshwater resources for development, and desertification consequences. According to the results, mitigating the water shortage in Yazd could be feasible by implementation of such key adaptive policy-responses as providing effective law enforcement, updating the standards and regulations, providing social learning, and boosting stakeholders' collaboration.

Local smoke-free policy development in Santa Fe, Argentina.

PubMed

Sebrié, Ernesto M; Glantz, Stanton A

2010-04-01

To describe the process of approval and implementation of a comprehensive smoke-free law in the province of Santa Fe, Argentina, between 2005 and 2009. Review of the Santa Fe smoke-free legislation, articles published in local newspapers and documentation on two lawsuits filed against the law, and interviews with key individuals in Santa Fe. Efforts to implement smoke-free policies in Santa Fe began during the 1990s without success, and resumed in 2005 when the provincial Legislature approved the first 100% smoke-free subnational law in Argentina. There was no strong opposition during the discussions within the legislature. As in other parts of the world, pro-tobacco industry interests attempted to block the implementation of the law using well known strategies. These efforts included a controversy media campaign set up, the creation of a hospitality industry association and a virtual smokers' rights group, the introduction of a counterproposal seeking modification of the law, the challenge of the law in the Supreme Court, and the proposal of a weak national bill that would 'conflict' with the subnational law. Tobacco control advocates sought media attention as a strategy to protect the law. Santa Fe is the first subnational jurisdiction in Latin America to have enacted a comprehensive smoke-free policy following the recommendations of the World Health Organization (WHO) Framework Convention on Tobacco Control. After 3 years of implementation, pro-tobacco industry forces failed to undermine the law. Other subnational jurisdictions in Argentina, as well as in Mexico and Brazil are following the Santa Fe example.

Elderly persons with ICU-acquired weakness: the potential role for β-hydroxy-β-methylbutyrate (HMB) supplementation?

PubMed

Rahman, Adam; Wilund, Kenneth; Fitschen, Peter J; Jeejeebhoy, Khursheed; Agarwala, Ravi; Drover, John W; Mourtzakis, Marina

2014-07-01

Intensive care unit (ICU)-acquired weakness is common and characterized by muscle loss, weakness, and paralysis. It is associated with poor short-term outcomes, including increased mortality, but the consequences of reduced long-term outcomes, including decreased physical function and quality of life, can be just as devastating. ICU-acquired weakness is particularly relevant to elderly patients who are increasingly consuming ICU resources and are at increased risk for ICU-acquired weakness and complications, including mortality. Elderly patients often enter critical illness with reduced muscle mass and function and are also at increased risk for accelerated disuse atrophy with acute illness. Increasingly, intensivists and researchers are focusing on strategies and therapies aimed at improving long-term neuromuscular function. β-Hydroxy-β-methylbutyrate (HMB), an ergogenic supplement, has shown efficacy in elderly patients and certain clinical populations in counteracting muscle loss. The present review discusses ICU-acquired weakness, as well as the unique physiology of muscle loss and skeletal muscle function in elderly patients, and then summarizes the evidence for HMB in elderly patients and in clinical populations. We subsequently postulate on the potential role and strategies in studying HMB in elderly ICU patients to improve muscle mass and function. © 2013 American Society for Parenteral and Enteral Nutrition.

Some Viable Techniques for Assessing and Counselling Cognitive Processing Weakness

ERIC Educational Resources Information Center

Haruna, Abubakar Sadiq

2016-01-01

Cognitive Processing weakness (CPW) is a psychological problem that impedes students' ability to learn effectively in a normal school setting. Such weakness may include; auditory, visual, conceptual, sequential, speed and attention processing. This paper therefore examines the basic assessment or diagnostic approaches such as Diagnosis by…

Interprofessional education in maternity services: Is there evidence to support policy?

PubMed

Davies, Nigel; Fletcher, Simon; Reeves, Scott

2016-11-01

Against a backdrop of poor maternity and obstetric care, identified in the Morecambe Bay Inquiry, the UK government has recently called for improvements and heralded investment in training. Given the complex mix of professionals working closely together in maternity services addressing the lack of joined up continuing professional development (CPD) is necessary. This led us to ask whether there is evidence of IPE in maternity services. As part of a wider systematic review of IPE, we searched for studies related to CPD in maternity services between May 2005 and June 2014. A total of 206 articles were identified with 24 articles included after initial screening. Further review revealed only eight articles related to maternity care, none of which met the inclusion criteria for the main systematic review. The main reasons for non-inclusion included weak evaluation, a focus on undergraduate IPE, and articles referring to paediatric/neonatal care only. Fewer articles were found than anticipated given the number of different professions working together in maternity services. This gap suggests further investigation is warranted.

Russia SimSmoke: the long-term effects of tobacco control policies on smoking prevalence and smoking-attributable deaths in Russia

PubMed Central

Maslennikova, Galina Ya; Oganov, Rafael G; Boytsov, Sergey A; Ross, Hana; Huang, An-Tsun; Near, Aimee; Kotov, Alexey; Berezhnova, Irina; Levy, David T

2015-01-01

Background Russia has high smoking rates and weak tobacco control policies. A simulation model is used to examine the effect of tobacco control policies on past and future smoking prevalence and premature mortality in Russia. Methods The Russia model was developed using the SimSmoke tobacco control model previously developed for the USA and other nations. The model inputs population size, birth, death and smoking rates specific to Russia. It assesses, individually and in combination, the effect of seven types of policies consistent with the WHO Framework Convention on Tobacco Control (FCTC): taxes, smoke-free air, mass media campaign, advertising bans, warning labels, cessation treatment and youth access policies. Outcomes are smoking prevalence and the number of smoking-attributable deaths by age and gender from 2009 to 2055. Results Increasing cigarette taxes to 70% of retail price, stronger smoke-free air laws, a high-intensity media campaign and comprehensive treatment policies are each potent policies to reduce smoking prevalence and smoking-attributable premature deaths in Russia. With the stronger set of policies, the model estimates that, relative to the status quo trend, smoking prevalence can be reduced by as much as 30% by 2020, with a 50% reduction projected by 2055. This translates into 2 684 994 male and 1 011 985 female premature deaths averted from 2015–2055. Conclusions SimSmoke results highlight the relative contribution of policies to reducing the tobacco health burden in Russia. Significant inroads to reducing smoking prevalence and premature mortality can be achieved through strengthening tobacco control policies in line with FCTC recommendations. PMID:23853252

Improving Dementia Long-Term Care

PubMed Central

Shih, Regina A.; Concannon, Thomas W.; Liu, Jodi L.; Friedman, Esther M.

2014-01-01

Abstract In 2010, 15 percent of Americans older than age 70 had dementia, and the number of new dementia cases among those 65 and older is expected to double by the year 2050. As the baby boomer generation ages, many older adults will require dementia-related long-term services and supports (LTSS). This blueprint is the only national document to date that engages local, state, and national stakeholders to specifically focus on policy options at the intersection of dementia and LTSS. The authors undertook five major tasks that resulted in a prioritized list of policy options and research directions to help decisionmakers improve the dementia LTSS delivery system, workforce, and financing. These were to (1) identify weaknesses in the LTSS system that may be particularly severe for persons with dementia; (2) review national and state strategies addressing dementia or LTSS policy; (3) identify policy options from the perspective of a diverse group of stakeholders; (4) evaluate the policy options; and (5) prioritize policy options by impact and feasibility. Stakeholders identified 38 policy options. RAND researchers independently evaluated these options against prespecified criteria, settling on 25 priority options. These policy options can be summarized into five objectives for the dementia LTSS system: (1) increase public awareness of dementia to reduce stigma and promote earlier detection; (2) improve access to and use of LTSS; (3) promote high-quality, person- and caregiver-centered care; (4) provide better support for family caregivers of people with dementia; and (5) reduce the burden of dementia LTSS costs on individuals and families. This policy blueprint provides a foundation upon which to build consensus among a larger set of stakeholders to set priorities and the sequencing of policy recommendations. PMID:28083331

Russia SimSmoke: the long-term effects of tobacco control policies on smoking prevalence and smoking-attributable deaths in Russia.

PubMed

Maslennikova, Galina Ya; Oganov, Rafael G; Boytsov, Sergey A; Ross, Hana; Huang, An-Tsun; Near, Aimee; Kotov, Alexey; Berezhnova, Irina; Levy, David T

2014-11-01

Russia has high smoking rates and weak tobacco control policies. A simulation model is used to examine the effect of tobacco control policies on past and future smoking prevalence and premature mortality in Russia. The Russia model was developed using the SimSmoke tobacco control model previously developed for the USA and other nations. The model inputs population size, birth, death and smoking rates specific to Russia. It assesses, individually and in combination, the effect of seven types of policies consistent with the WHO Framework Convention on Tobacco Control (FCTC): taxes, smoke-free air, mass media campaign, advertising bans, warning labels, cessation treatment and youth access policies. Outcomes are smoking prevalence and the number of smoking-attributable deaths by age and gender from 2009 to 2055. Increasing cigarette taxes to 70% of retail price, stronger smoke-free air laws, a high-intensity media campaign and comprehensive treatment policies are each potent policies to reduce smoking prevalence and smoking-attributable premature deaths in Russia. With the stronger set of policies, the model estimates that, relative to the status quo trend, smoking prevalence can be reduced by as much as 30% by 2020, with a 50% reduction projected by 2055. This translates into 2 684 994 male and 1 011 985 female premature deaths averted from 2015-2055. SimSmoke results highlight the relative contribution of policies to reducing the tobacco health burden in Russia. Significant inroads to reducing smoking prevalence and premature mortality can be achieved through strengthening tobacco control policies in line with FCTC recommendations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effects of user fee exemptions on the provision and use of maternal health services: a review of literature.

PubMed

Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M

2013-12-01

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.

Somerville Charter School: Management Issues and Recommendations.

ERIC Educational Resources Information Center

Massachusetts State Office of the Inspector General, Boston.

Somerville Charter School was among 24 Massachusetts charter schools included in a study undertaken by the Office of the Inspector General in March 1998. The office identified weaknesses in the contracting practices, procurement procedures, and financial management of some schools, including Somerville. These weaknesses could undermine the…

Methods for Evaluating Natural Experiments in Obesity: A Systematic Review.

PubMed

Bennett, Wendy L; Wilson, Renee F; Zhang, Allen; Tseng, Eva; Knapp, Emily A; Kharrazi, Hadi; Stuart, Elizabeth A; Shogbesan, Oluwaseun; Bass, Eric B; Cheskin, Lawrence J

2018-06-05

Given the obesity pandemic, rigorous methodological approaches, including natural experiments, are needed. To identify studies that report effects of programs, policies, or built environment changes on obesity prevention and control and to describe their methods. PubMed, CINAHL, PsycINFO, and EconLit (January 2000 to August 2017). Natural experiments and experimental studies evaluating a program, policy, or built environment change in U.S. or non-U.S. populations by using measures of obesity or obesity-related health behaviors. 2 reviewers serially extracted data on study design, population characteristics, data sources and linkages, measures, and analytic methods and independently evaluated risk of bias. 294 studies (188 U.S., 106 non-U.S.) were identified, including 156 natural experiments (53%), 118 experimental studies (40%), and 20 (7%) with unclear study design. Studies used 106 (71 U.S., 35 non-U.S.) data systems; 37% of the U.S. data systems were linked to another data source. For outcomes, 112 studies reported childhood weight and 32 adult weight; 152 had physical activity and 148 had dietary measures. For analysis, natural experiments most commonly used cross-sectional comparisons of exposed and unexposed groups (n = 55 [35%]). Most natural experiments had a high risk of bias, and 63% had weak handling of withdrawals and dropouts. Outcomes restricted to obesity measures and health behaviors; inconsistent or unclear descriptions of natural experiment designs; and imperfect methods for assessing risk of bias in natural experiments. Many methodologically diverse natural experiments and experimental studies were identified that reported effects of U.S. and non-U.S. programs, policies, or built environment changes on obesity prevention and control. The findings reinforce the need for methodological and analytic advances that would strengthen evaluations of obesity prevention and control initiatives. National Institutes of Health, Office of Disease Prevention, and Agency for Healthcare Research and Quality. (PROSPERO: CRD42017055750).

The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis.

PubMed

Barlow, Pepita; McKee, Martin; Basu, Sanjay; Stuckler, David

2017-03-08

Regional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes. Seventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics. We identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.

Strategic model of national rabies control in Korea.

PubMed

Cheong, Yeotaek; Kim, Bongjun; Lee, Ki Joong; Park, Donghwa; Kim, Sooyeon; Kim, Hyeoncheol; Park, Eunyeon; Lee, Hyeongchan; Bae, Chaewun; Oh, Changin; Park, Seung-Yong; Song, Chang-Seon; Lee, Sang-Won; Choi, In-Soo; Lee, Joong-Bok

2014-01-01

Rabies is an important zoonosis in the public and veterinary healthy arenas. This article provides information on the situation of current rabies outbreak, analyzes the current national rabies control system, reviews the weaknesses of the national rabies control strategy, and identifies an appropriate solution to manage the current situation. Current rabies outbreak was shown to be present from rural areas to urban regions. Moreover, the situation worldwide demonstrates that each nation struggles to prevent or control rabies. Proper application and execution of the rabies control program require the overcoming of existing weaknesses. Bait vaccines and other complex programs are suggested to prevent rabies transmission or infection. Acceleration of the rabies control strategy also requires supplementation of current policy and of public information. In addition, these prevention strategies should be executed over a mid- to long-term period to control rabies.

Russia’s Conventional Military Weakness and Substrategic Nuclear Policy

DTIC Science & Technology

2011-01-01

to risk, and fewer in the security elite dare to contemplate. As Lieutenant-General Vladimir Chirkin, the former Commander of the Siberian Mili- tary...Speaking of the deployment of two new brigades near the Russian-Chinese border, Lieutenant-General Vladimir Chirkin, Commander of the Siberian ...Roger McDermott, “Bat or Mouse ? The Strange Case of Reforming Spetsnaz,” Eurasia Daily Monitor, Volume 7, Issue 198, November 2, 2010. Author

Project Scheduling to Maximize Positive Impacts of Reconstruction Operations

DTIC Science & Technology

2009-03-01

within weak and failing states than by the borders between strong and aggressive ones” [Rice 2005]. 1 [Heldt 2008:11] Figure 1 Trends in Peacekeeping...UNLIMITED. The views expressed in this thesis are those of the author and do not reflect the official policy or position of the United States Air Force...University Air Education and Training Command in Partial Fulfillment of the Requirements for the Degree of Master of Science in Operations Research

Policy and Practice in Deaf Education: Views and Experiences of Teachers, and of Young People Who Are Deaf in Northern Ireland and Sweden

ERIC Educational Resources Information Center

Doherty, Marie

2012-01-01

Due to the fact that the outcomes of education for most school leavers who are deaf in Northern Ireland are weak literacy skills and below average reading ages, a study was undertaken to investigate this situation. The views and experiences of teachers of children who are deaf, and of young people who are deaf in Northern Ireland, where oral and…

China and Proliferation of Weapons of Mass Destruction and Missiles: Policy Issues

DTIC Science & Technology

2009-07-27

Isfahan Nuclear Research Center to provide “a lifelong supply” of hundreds of tons of anhydrous hydrogen fluoride (AHF), or hydrofluoric acid ...Nuclear Tests, 1964-1996,” Physics Today, September 2008; Alex Kingsbury, “ Why China Helped Countries Like Pakistan, North Korea Build Bombs,” U.S...that PRC export controls are weak , even as government repression can be harsh (e.g., against journalists or dissidents). They also doubt that trade

Can a Dove prism change the past of a single photon

DTIC Science & Technology

2015-05-21

author( s ) and should not contrued as an official Department of the Army position, policy or decision, unless so designated by other documentation. 9...SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS (ES) U.S. Army Research Office P.O. Box 12211 Research Triangle Park, NC 27709-2211 Weak...values, interpretation REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 10. SPONSOR/MONITOR’S ACRONYM( S ) ARO 8. PERFORMING

Greece’s Debt Crisis: Overview, Policy Responses, and Implications

DTIC Science & Technology

2010-04-07

inefficient public administration in Greece, costly pension and healthcare systems, tax evasion , and a general “absence of the will to maintain fiscal...2005 to 24% of GDP in 2050. Weak revenue collection has also contributed to Greece’s budget deficits. Many economists identify tax evasion and...the informal economy in Greece to represent between 25%-30% of GDP.24 Observers offer a variety of explanations for the prevalence of tax evasion in

Understanding Mali: Lessons for Policy Makers

DTIC Science & Technology

2014-06-01

and health care . By the same token, the corruption and ethnic inequalities that are rampant in weak and failed states show an obvious lack of social ...one of the means used to take care of the terrorist threat. However, conflicts against terrorists groups such as in Afghanistan have proven long and...instability that led to the present situation in Mali, this study aspires to provide decision makers with concrete factors that should deserve careful

Health care privatization in Latin America: comparing divergent privatization approaches in Chile, Colombia, and Mexico.

PubMed

Bustamante, Arturo Vargas; Méndez, Claudio A

2014-08-01

The public-private mix in Chile, Colombia, and Mexico was very similar until the early 1980s when Chile undertook health care privatization as part of comprehensive health care reform. Since then, health care privatization policies have diverged in these countries. In this study we characterize health care privatization in Latin America and identify the main factors that promoted and hindered privatization by comparing the experiences of these countries. We argue that policy elites took advantage of specific policy environments and the diffusion of privatization policies to promote health care privatization while political mobilization against privatization, competing policy priorities, weak market and government institutions, and efforts to reach universal health insurance hindered privatization. The privatization approaches of Chile and Colombia were classified as "big-bang," since these countries implemented health care privatization more rapidly and with a wider scope compared with the case of Mexico, which was classified as gradualist, since the privatization path followed by this country adopted a slower pace and became more limited and focalized over time. We conclude that the emphasis on policy-driven privatization diminished in the 1990s and 2000s because of increased public health care financing and a shift in health care reform priorities. Health care privatization in the region, however, continued as a consequence of demand-driven privatization. Copyright © 2014 by Duke University Press.

Relationship between urbanization and CO2 emissions depends on income level and policy.

PubMed

Ponce de Leon Barido, Diego; Marshall, Julian D

2014-04-01

We investigate empirically how national-level CO2 emissions are affected by urbanization and environmental policy. We use statistical modeling to explore panel data on annual CO2 emissions from 80 countries for the period 1983-2005. Random- and fixed-effects models indicate that, on the global average, the urbanization-emission elasticity value is 0.95 (i.e., a 1% increase in urbanization correlates with a 0.95% increase in emissions). Several regions display a statistically significant, positive elasticity for fixed- and random-effects models: lower-income Europe, India and the Sub-Continent, Latin America, and Africa. Using two proxies for environmental policy/outcomes (ratification status for the Kyoto Protocol; the Yale Environmental Performance Index), we find that in countries with stronger environmental policy/outcomes, urbanization has a more beneficial (or, a less negative) impact on emissions. Specifically, elasticity values are -1.1 (0.21) for higher-income (lower-income) countries with strong environmental policy, versus 0.65 (1.3) for higher-income (lower-income) countries with weak environmental policies. Our finding that the urbanization-emissions elasticity may depend on the strength of a country's environmental policy, not just marginal increases in income, is in contrast to the idea of universal urban scaling laws that can ignore local context. Most global population growth in the coming decades is expected to occur in urban areas of lower-income countries, which underscores the importance of these findings.

Memory Skills of Deaf Learners: Implications and Applications

ERIC Educational Resources Information Center

Hamilton, Harley

2011-01-01

This paper will review research on working memory and short-term memory abilities of deaf individuals delineating strengths and weaknesses. The areas of memory reviewed include weaknesses such as sequential recall, processing speed, attention, and memory load. Strengths include free recall, visuospatial recall, imagery and dual encoding.…

Preventing unintentional injuries to children under 15 years in the outdoors: a systematic review of the effectiveness of educational programs

PubMed Central

Hunt, Harriet; Garside, Ruth; Moxham, Tiffany; Peters, Jaime; Anderson, Rob

2011-01-01

Introduction Unintentional injuries to children in the outdoors have a significant impact on child mortality, development and healthcare costs. This paper presents the findings of a systematic review about the effectiveness of programs that provided information, advice or education about the prevention of unintentional injuries to children under 15 years during outdoor play and leisure. Methods A structured search strategy was conducted in a range of databases. All report titles and abstracts were screened using pre-defined criteria. Included reports were quality appraised using a modified Graphical Appraisal Tool for Epidemiological studies (GATE) tool. All quality appraisals and data extraction were checked by a second reviewer. If not provided in the original reports, ORs and mean differences were calculated, where sufficient data were available. Results Twenty-three studies met the inclusion criteria. There was a paucity of robust study designs. The majority of studies only reported a short-term follow-up of intermediate outcome measures. Only two studies measured injury rates; both reported a reduction, but both studies also had considerable methodological weaknesses. The five studies that measured the use of protective equipment reported mixed results, although there is some evidence that suggests that more extensive educational programs (such as health fairs and media campaigns) increase their use. The 20 studies that measured behaviour, attitude or knowledge outcomes reported highly mixed results. Discussion Methodological weaknesses of the included studies limit support for a particular course of action. To better inform policy and practice, future research should (1) use robust study designs and (2) not rely on short-term proxy outcome measures. PMID:21890579

The Lebanese-Syrian crisis: impact of influx of Syrian refugees to an already weak state.

PubMed

Cherri, Zeinab; Arcos González, Pedro; Castro Delgado, Rafael

2016-01-01

Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese-Syrian borders since 2011 as "displaced", emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016. Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation. The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves. Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon.

Rates, levels, and determinants of electronic health record system adoption: a study of hospitals in Riyadh, Saudi Arabia.

PubMed

Aldosari, Bakheet

2014-05-01

Outside a small number of OECD countries, little information exists regarding the rates, levels, and determinants of hospital electronic health record (EHR) system adoption. This study examines EHR system adoption in Riyadh, Saudi Arabia. Respondents from 22 hospitals were surveyed regarding the implementation, maintenance, and improvement phases of EHR system adoption. Thirty-seven items were graded on a three-point scale of preparedness/completion. Measured determinants included hospital size, level of care, ownership, and EHR system development team composition. Eleven of the hospitals had implemented fully functioning EHR systems, eight had systems in progress, and three had not adopted a system. Sixteen different systems were being used across the 19 adopting hospitals. Differential adoption levels were positively related to hospital size and negatively to the level of care (secondary versus tertiary). Hospital ownership (nonprofit versus private) and development team composition showed mixed effects depending on the particular adoption phase being considered. Adoption rates compare favourably with those reported from other countries and other districts in Saudi Arabia, but wide variations exist among hospitals in the levels of adoption of individual items. General weaknesses in the implementation phase concern the legacy of paper data systems, including document scanning and data conversion; in the maintenance phase concern updating/maintaining software; and in the improvement phase concern the communication and exchange of health information. This study is the first to investigate the level and determinants of EHR system adoption for public, other nonprofit, and private hospitals in Saudi Arabia. Wide interhospital variations in adoption bear implications for policy-making and funding intervention. Identified areas of weakness require action to increase the degree of adoption and usefulness of EHR systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state

PubMed Central

Cherri, Zeinab; Arcos González, Pedro; Castro Delgado, Rafael

2016-01-01

Background Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese–Syrian borders since 2011 as “displaced”, emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016. Methods Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation. Results The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves. Conclusion Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon. PMID:27471417

Titration Curves: Fact and Fiction.

ERIC Educational Resources Information Center

Chamberlain, John

1997-01-01

Discusses ways in which datalogging equipment can enable titration curves to be measured accurately and how computing power can be used to predict the shape of curves. Highlights include sources of error, use of spreadsheets to generate titration curves, titration of a weak acid with a strong alkali, dibasic acids, weak acid and weak base, and…

Strategic Directions in Heliophysics Research Related to Weakly Ionized Plasmas

NASA Technical Reports Server (NTRS)

Spann, James F.

2010-01-01

In 2009, the Heliophysics Division of NASA published its triennial roadmap entitled "Heliophysics; the solar and space physics of a new era." In this document contains a science priority that is recommended that will serve as input into the recently initiated NRC Heliophysics Decadal Survey. The 2009 roadmap includes several science targets recommendations that are directly related to weakly ionized plasmas, including on entitled "Ion-Neutral Coupling in the Atmosphere." This talk will be a brief overview of the roadmap with particular focus on the science targets relevant to weakly ionized plasmas.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review.

PubMed

Driessen, C E; Cameron, A J; Thornton, L E; Lai, S K; Barnett, L M

2014-12-01

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies. © 2014 World Obesity.

Water storage equity and safety assurance policy to mitigate potential 'dual-extreme cumulative threats' in agricultural catchments

NASA Astrophysics Data System (ADS)

Pisaniello, John D.; Tingey-Holyoak, Joanne L.

2017-02-01

Farm dams that are not managed properly at the individual level can create water storage equity and safety threats to downstream communities and the environment that aggregate at the catchment level: a potential 'dual-extreme cumulative' problem. The paper provides indicative evidence and develops understanding of this novel phenomenon and associated policy needs within the Australian setting comprising dual hydrologic extremes of floods and droughts, further exacerbated by climate change. This is achieved through comparative case studies involving surveys of both dam owner perceptions and dam management practices in four States representing a complete range of integrated policy approaches from weak to strong. Survey results find most farmers do not believe dam maintenance is important, will undertake spillway blocking and do not plan for emergencies. These results are supported by physical on-site findings of farmers neglecting dams and blocking or under-designing spillways, in turn storing more water than they are entitled and creating unsafe dams at both the individual and cumulative levels. From detailed cross-case comparative assessment against policy context, it emerges that on-farm perceptions and practices form a range of 'acceptability' of dam management that directly reflects policy strength and integration in each setting. The paper advances the international small dams policy, agricultural water management and hydrology literatures, evidencing the need for effective integrated policy to mitigate dual extreme cumulative threats. Importantly, guidance is provided to jurisdictions internationally with high inter-annual rainfall variation on how best to design integrated policy that can achieve both water storage equity and safety in agricultural catchments.

River Water Pollution Status and Water Policy Scenario in Ethiopia: Raising Awareness for Better Implementation in Developing Countries.

PubMed

Awoke, Aymere; Beyene, Abebe; Kloos, Helmut; Goethals, Peter L M; Triest, Ludwig

2016-10-01

Despite the increasing levels of pollution in many tropical African countries, not much is known about the strength and weaknesses of policy and institutional frameworks to tackle pollution and ecological status of rivers and their impacts on the biota. We investigated the ecological status of four large river basins using physicochemical water quality parameters and bioindicators by collecting samples from forest, agriculture, and urban landscapes of the Nile, Omo-Gibe, Tekeze, and Awash River basins in Ethiopia. We also assessed the water policy scenario to evaluate its appropriateness to prevent and control pollution. To investigate the level of understanding and implementation of regulatory frameworks and policies related to water resources, we reviewed the policy documents and conducted in-depth interviews of the stakeholders. Physicochemical and biological data revealed that there is significant water quality deterioration at the impacted sites (agriculture, coffee processing, and urban landscapes) compared to reference sites (forested landscapes) in all four basins. The analysis of legal, policy, and institutional framework showed a lack of cooperation between stakeholders, lack of knowledge of the policy documents, absence of enforcement strategies, unavailability of appropriate working guidelines, and disconnected institutional setup at the grass root level to implement the set strategies as the major problems. In conclusion, river water pollution is a growing challenge and needs urgent action to implement intersectoral collaboration for water resource management that will eventually lead toward integrated watershed management. Revision of policy and increasing the awareness and participation of implementers are vital to improve ecological quality of rivers.

Weak values in collision theory

NASA Astrophysics Data System (ADS)

de Castro, Leonardo Andreta; Brasil, Carlos Alexandre; Napolitano, Reginaldo de Jesus

2018-05-01

Weak measurements have an increasing number of applications in contemporary quantum mechanics. They were originally described as a weak interaction that slightly entangled the translational degrees of freedom of a particle to its spin, yielding surprising results after post-selection. That description often ignores the kinetic energy of the particle and its movement in three dimensions. Here, we include these elements and re-obtain the weak values within the context of collision theory by two different approaches, and prove that the results are compatible with each other and with the results from the traditional approach. To provide a more complete description, we generalize weak values into weak tensors and use them to provide a more realistic description of the Stern-Gerlach apparatus.

[Scientific Research Policy for Health in Portugal: II - Facts and Suggestions].

PubMed

Guerreiro, Cátia Sá; Hartz, Zulmira; Sambo, Luís; Conceição, Cláudia; Dussault, Gilles; Russo, Giuliano; Viveiros, Miguel; Silveira, Henrique; Pita Barros, Pedro; Ferrinho, Paulo

2017-03-31

After more than 40 years of democracy and 30 years of European integration, Portugal has bridged the research gap it had previously. However, when compared to global and European research policies, Portugal still has a long way go regarding investment in research and development. Health Research in Portugal has been managed by the Fundação para a Ciência e Tecnologia and the National Health Institute Doctor Ricardo Jorge, and it has not been a political priority, emphasized by the absence of a national scientific research plan for health, resulting in a weak coordination of actors in the field. The strategic guidelines of the 2004 - 2010 National Health Plan are what comes closest to a health research policy, but these were not implemented by the institutions responsible for scientific research for the health sector. Trusting that adopting a strategy of incentives to stimulate health research is an added-value for the Portuguese health system, the authors present five strategic proposals for research in health in Portugal.

Legal and institutional tools to mitigate plastic pollution affecting marine species: Argentina as a case study.

PubMed

González Carman, Victoria; Machain, Natalia; Campagna, Claudio

2015-03-15

Plastics are the most common form of debris found along the Argentine coastline. The Río de la Plata estuarine area is a relevant case study to describe a situation where ample policy exists against a backdrop of plastics disposed by populated coastal areas, industries, and vessels; with resultant high impacts of plastic pollution on marine turtles and mammals. Policy and institutions are in place but the impact remains due to ineffective waste management, limited public education and awareness, and weaknesses in enforcement of regulations. This context is frequently repeated all over the world. We list possible interventions to increase the effectiveness of policy that require integrating efforts among governments, the private sector, non-governmental organizations and the inhabitants of coastal cities to reduce the amount of plastics reaching the Río de la Plata and protect threatened marine species. What has been identified for Argentina applies to the region and globally. Copyright © 2015 Elsevier Ltd. All rights reserved.

Based on the development status of British BIM, exploring China’s BIM road

NASA Astrophysics Data System (ADS)

Tiangang, Chu; hui, Li; shanjun, Zhang; Ningshan, Jiang; Dan, Zhang; Yu, Zhang; Guibo, Bao

2018-05-01

This article mainly analyses the development and application status and development trend of BIM technology after the implementation of the British government, to explore the policies and methods that our government should carry out in the development of BIM. The article also summarizes and analyses the relevant policies and standards implemented by various provincial and municipal governments in promoting BIM technology in China and summarizes the strengths and weaknesses of each other by comparing the development status of the implementation of BIM policies in various provinces and cities. The article also analysed the obstacles encountered in the implementation of some specific projects at the current stage of BIM technology, and summarized the feasible solutions. The article mainly analyses the application prospects of BIM from the technical aspects of design, the application of technology in the construction process, and the strategic implementation and operation of the company, and provides a reference for promoting the application of BIM in the construction industry in China, especially in the western region.

Health sector operational planning and budgeting processes in Kenya—“never the twain shall meet”

PubMed Central

Molyneux, Sassy; Goodman, Catherine

2015-01-01

Summary Operational planning is considered an important tool for translating government policies and strategic objectives into day‐to‐day management activities. However, developing countries suffer from persistent misalignment between policy, planning and budgeting. The Medium Term Expenditure Framework (MTEF) was introduced to address this misalignment. Kenya adopted the MTEF in the early 2000s, and in 2005, the Ministry of Health adopted the Annual Operational Plan process to adapt the MTEF to the health sector. This study assessed the degree to which the health sector Annual Operational Plan process in Kenya has achieved alignment between planning and budgeting at the national level, using document reviews, participant observation and key informant interviews. We found that the Kenyan health sector was far from achieving planning and budgeting alignment. Several factors contributed to this problem including weak Ministry of Health stewardship and institutionalized separation between planning and budgeting processes; a rapidly changing planning and budgeting environment; lack of reliable data to inform target setting and poor participation by key stakeholders in the process including a top‐down approach to target setting. We conclude that alignment is unlikely to be achieved without consideration of the specific institutional contexts and the power relationships between stakeholders. In particular, there is a need for institutional integration of the planning and budgeting processes into a common cycle and framework with common reporting lines and for improved data and local‐level input to inform appropriate and realistic target setting. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd. PMID:25783862

Educational Needs on Palliative Care for Cancer Patients in Iran: A SWOT Analysis

PubMed Central

Ansari, Mojgan; Rassouli, Maryam; Akbari, Mohamad Esmaiel; Abbaszadeh, Abbas; Akbari Sari, Ali

2018-01-01

ABSTRACT Background: By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder’s educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran. Methods: This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes. Result: A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included: ”academic education planning”, “workforce education”, “public awareness”, and “patient and caregiver empowerment” that contained our subcategories as follows: “strengths”, “weaknesses”, “opportunities” and “threats” (SWOT). Conclusion: Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced. PMID:29607340

"Never mind the logic, give me the numbers": former Australian health ministers' perspectives on the social determinants of health.

PubMed

Baum, Frances E; Laris, Paul; Fisher, Matthew; Newman, Lareen; Macdougall, Colin

2013-06-01

The articulation of strong evidence and moral arguments about the importance of social determinants of health (SDH) and health equity has not led to commensurate action to address them. Policy windows open when, simultaneously, an issue is recognised as a problem, policy formulation and refinement happens and the political will for action is present. We report on qualitative interviews with 20 former Australian Federal, State or Territory health ministers conducted between September 2011 and January 2012 concerning their views about how and why the windows of policy opportunity on the SDH did or did not open during their tenure. Almost all ex-health ministers were aware of the existence of health inequalities and SDH but their complexity meant that this awareness rarely crystalised into a clear problem other than as a focus on high needs groups, especially Aboriginal people. Formulation of policies about SDH was assisted by cross-portfolio structures, policy entrepreneurs, and evidence from reviews and reports. It was hindered by the complexity of SDH policy, the dominance of medical power and paradigms and the weakness of the policy community advocating for SDH. The political stream was enabling when the general ideological climate was supportive of redistributive policies, the health care sector was not perceived to be in crisis, there was support for action from the head of government and cabinet colleagues, and no opposition from powerful lobby groups. There have been instances of Australian health policy which addressed the SDH over the past twenty five years but they are rare and the windows of opportunity that made them possible did not stay open for long. Copyright © 2013 Elsevier Ltd. All rights reserved.

$$\\chi$$EFT studies of few-nucleon systems: a status report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schiavilla, Rocco

2016-06-01

A status report onmore » $$\\chi$$EFT studies of few-nucleon electroweak structure and dynamics is provided, including electromagnetic elastic form factors of few-nucleon systems, the $pp$ weak fusion and muon weak captures on deuteron and $^3$He, and a number of parity-violating processes induced by hadronic weak interactions.« less

Experimental investigations of weak definite and weak indefinite noun phrases

PubMed Central

Klein, Natalie M.; Gegg-Harrison, Whitney M.; Carlson, Greg N.; Tanenhaus, Michael K.

2013-01-01

Definite noun phrases typically refer to entities that are uniquely identifiable in the speaker and addressee’s common ground. Some definite noun phrases (e.g. the hospital in Mary had to go the hospital and John did too) seem to violate this uniqueness constraint. We report six experiments that were motivated by the hypothesis that these “weak definite” interpretations arise in “incorporated” constructions. Experiments 1-3 compared nouns that seem to allow for a weak definite interpretation (e.g. hospital, bank, bus, radio) with those that do not (e.g. farm, concert, car, book). Experiments 1 and 2 used an instruction-following task and picture-judgment task, respectively, to demonstrate that a weak definite need not uniquely refer. In Experiment 3 participants imagined scenarios described by sentences such as The Federal Express driver had to go to the hospital/farm. The imagined scenarios following weak definite noun phrases were more likely to include conventional activities associated with the object, whereas following regular nouns, participants were more likely to imagine scenarios that included typical activities associated with the subject; similar effects were observed with weak indefinites. Experiment 4 found that object-related activities were reduced when the same subject and object were used with a verb that does not license weak definite interpretations. In Experiment 5, a science fiction story introduced an artificial lexicon for novel concepts. Novel nouns that shared conceptual properties with English weak definite nouns were more likely to allow weak reference in a judgment task. Experiment 6 demonstrated that familiarity for definite articles and anti- familiarity for indefinite articles applies to the activity associated with the noun, consistent with predictions made by the incorporation analysis. PMID:23685208

Weak gauge boson radiation in parton showers

NASA Astrophysics Data System (ADS)

Christiansen, Jesper R.; Sjöstrand, Torbjörn

2014-04-01

The emission of W and Z gauge bosons off quarks is included in a traditional QCD + QED shower. The unitarity of the shower algorithm links the real radiation of the weak gauge bosons to the negative weak virtual corrections. The shower evolution process leads to a competition between QCD, QED and weak radiation, and allows for W and Z boson production inside jets. Various effects on LHC physics are studied, both at low and high transverse momenta, and effects at higher-energy hadron colliders are outlined.

Supervising community health workers in low-income countries – a review of impact and implementation issues

PubMed Central

Hill, Zelee; Dumbaugh, Mari; Benton, Lorna; Källander, Karin; Strachan, Daniel; Asbroek, Augustinus ten; Tibenderana, James; Kirkwood, Betty; Meek, Sylvia

2014-01-01

Background Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention. Objective To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs. Design A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature. Results A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak. Conclusion Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective. PMID:24815075

Joint cosmic microwave background and weak lensing analysis: constraints on cosmological parameters.

PubMed

Contaldi, Carlo R; Hoekstra, Henk; Lewis, Antony

2003-06-06

We use cosmic microwave background (CMB) observations together with the red-sequence cluster survey weak lensing results to derive constraints on a range of cosmological parameters. This particular choice of observations is motivated by their robust physical interpretation and complementarity. Our combined analysis, including a weak nucleosynthesis constraint, yields accurate determinations of a number of parameters including the amplitude of fluctuations sigma(8)=0.89+/-0.05 and matter density Omega(m)=0.30+/-0.03. We also find a value for the Hubble parameter of H(0)=70+/-3 km s(-1) Mpc(-1), in good agreement with the Hubble Space Telescope key-project result. We conclude that the combination of CMB and weak lensing data provides some of the most powerful constraints available in cosmology today.

How far is mixed methods research in the field of health policy and systems in Africa? A scoping review.

PubMed

De Allegri, M; Sieleunou, I; Abiiro, G A; Ridde, V

2018-04-01

Both the academic and the policy community are calling for wider application of mixed methods research, suggesting that combined use of quantitative and qualitative methods is most suitable to assess and understand the complexities of health interventions. In spite of recent growth in mixed methods studies, limited efforts have been directed towards appraising and synthetizing to what extent and how mixed methods have been applied specifically to Health Policy and Systems Research (HPSR) in low- and middle-income countries (LMICs). We aimed at filling this gap in knowledge, by exploring the scope and quality of mixed methods research in the African context. We conducted a scoping review applying the framework developed by Arksey and O'Malley and modified by Levac et al. to identify and extract data from relevant studies published between 1950 and 2013. We limited our search to peer-reviewed HPSR publications in English, which combined at least one qualitative and one quantitative method and focused on Africa. Among the 105 studies that were retained for data extraction, over 60% were published after 2010. Nearly 50% of all studies addressed topics relevant to Health Systems, while Health Policy and Health Outcomes studies accounted respectively for 40% and 10% of all publications. The quality of the application of mixed methods varied greatly across studies, with a relatively small proportion of studies stating clearly defined research questions and differentiating quantitative and qualitative elements, including sample sizes and analytical approaches. The methodological weaknesses observed could be linked to the paucity of specific training opportunities available to people interested in applying mixed methods to HPSR in LMICs as well as to the limitations on word limit, scope and peer-review processes at the journals levels. Increasing training opportunities and enhancing journal flexibility may result in more and better quality mixed methods publications.

Joint impacts of minimum legal drinking age and beer taxes on US youth traffic fatalities, 1975 to 2001.

PubMed

Ponicki, William R; Gruenewald, Paul J; LaScala, Elizabeth A

2007-05-01

There is a considerable body of prior research indicating that a number of public policies that limit alcohol availability affect youth traffic fatalities. These limitations can be economic (e.g., beverage taxation), physical (e.g., numbers or operating hours of alcohol outlets), or demographic (e.g., minimum legal drinking age). The estimated impacts of these policies differ widely across studies. A full-price theoretical approach suggests that people weigh the benefits of drinking against the sum of all the associated costs, including the price of the beverages themselves plus the difficulty of obtaining them and any additional risks of injury or punishment related to their use. This study tested one prediction of this model, namely that the impact from changing one availability-related cost depends on the level of other components of full cost. The current analyses concentrate on 2 forms of limitations on availability that have been shown to affect youth traffic fatalities: minimum legal drinking age (MLDA) laws and beer taxes. The interdependence between the impacts of MLDA and taxes is investigated using a panel of 48 US states over the period 1975 to 2001. All age-group-specific models control for numerous other variables previously shown to affect vehicle fatalities, as well as fixed effects to account for unexplained crosssectional and time-series variation. The analyses showed that raising either MLDA or beer taxes in isolation led to fewer youth traffic fatalities. As expected, a given change in MLDA causes a larger proportional change in fatalities when beer taxes are low than when they are high. These findings suggest that a community's expected benefit from a proposed limitation on alcohol availability depends on its current regulatory environment. Specifically, communities with relatively strong existing policies might expect smaller impacts than suggested by prior research, while places with weak current regulations might expect larger benefits from the same policy initiative.

Three Types of Social Integration Status among Children of Migrant Workers in China: Scenes of Superiority of City Residents, Co-Existence of Urban Culture and Rural Hometown Culture, and Weak Social Capital under Strong Policy Discourse

ERIC Educational Resources Information Center

Qian, Liu

2017-01-01

Based on surveys and field work conducted in District C of Beijing City, the author identifies migrant children's social assimilation obstacles according to distinct school types: each school type offers different quality educational resources and is composed of migrant students at different socioeconomic levels. The survey data show that migrant…

Weak and Failing States: Evolving Security Threats and U.S. Policy

DTIC Science & Technology

2007-11-15

operate in both “ caves ” (i.e., failed states, where militant groups can exist CRS-6 11 Rabasa (2007), ibid. 12 U.S. Government Interagency Working Group...Support to Low-Income Countries Under Stress (Washington, DC: The World Bank, 2006); Chauvet and Collier, “Helping Hand? Aid to Failing States...Oxford University Working Paper (2006). 24 See Chauvet and Collier (2004), op. cit.; Francois Bourguignon, “Broadening Progress Toward the MDGs,” Speech

Weak and Failing States: Evolving Security Threats and U.S. Policy

DTIC Science & Technology

2008-04-18

Instability Task Force, a research group commissioned by the Central Intelligence Agency, found in a 2003 report that terrorists operate in both “ caves ...Bank Support to Low-Income Countries Under Stress (Washington, DC: The World Bank, 2006); Chauvet and Collier, “Helping Hand? Aid to Failing States...income, 50% higher debt-to-gross domestic product ratios, and double the poverty CRS-9 27 See Chauvet and Collier (2004), op. cit.; Francois Bourguignon

Weak and Failing States: Evolving Security Threats and U.S. Policy

DTIC Science & Technology

2007-11-15

operate in both “ caves ” (i.e., failed states, where militant groups can exist CRS-6 11 Rabasa (2007), ibid. 12 U.S. Government Interagency Working Group...Support to Low-Income Countries Under Stress (Washington, DC: The World Bank, 2006); Chauvet and Collier, “Helping Hand? Aid to Failing States,” Oxford...University Working Paper (2006). 24 See Chauvet and Collier (2004), op. cit.; Francois Bourguignon, “Broadening Progress Toward the MDGs,” Speech

Weak and Failing States: Evolving Security Threats and U.S. Policy

DTIC Science & Technology

2008-08-28

terrorists operate in both “ caves ” (i.e., failed states, where militant groups can exist with impunity) and “condos” (i.e., states that have the...of World Bank Support to Low-Income Countries Under Stress (Washington, DC: The World Bank, 2006); Chauvet and Collier, “Helping Hand? Aid to Failing...States,” Oxford University Working Paper (2006). 29 See Chauvet and Collier (2004), op. cit.; Francois Bourguignon, “Broadening Progress Toward the

The Soviet Union and German Reunification.

DTIC Science & Technology

1985-10-17

1983) 343-370. McAdams, A.J. " Bridging the German Divide". The Iew Leaader (Oct. 3, 1983) 9-11. McLaughlin, John. " Germany Reunified". National Review...POLICY TOWARDS THE GERMAN QUESTION.. 6 A. Desire to Keep Germany Weak .............. 7 B. Reparations: The Driving Force .......... 12 C. Soviet...of discussion between the superpowers. Willy Brandt’s Ostpolitik of the late 1960’s and early 1970’s further solidified the postwar division of Germany

Optimal startup control of a jacketed tubular reactor.

NASA Technical Reports Server (NTRS)

Hahn, D. R.; Fan, L. T.; Hwang, C. L.

1971-01-01

The optimal startup policy of a jacketed tubular reactor, in which a first-order, reversible, exothermic reaction takes place, is presented. A distributed maximum principle is presented for determining weak necessary conditions for optimality of a diffusional distributed parameter system. A numerical technique is developed for practical implementation of the distributed maximum principle. This involves the sequential solution of the state and adjoint equations, in conjunction with a functional gradient technique for iteratively improving the control function.

Materials Processing and Manufacturing Technologies for Diamond Substrates Multichip Modules

DTIC Science & Technology

1994-10-14

document are those of the authors and should not be intepreted as representing the official policies, either express or implied, of the Defense Advanced...release of the diamond at the end of the deposition step, "* deposition of non-uniform films for stress/flatness control. 75kW Reactor & Modelling Studies...too strong (the film releases partially or not at all) to too weak (the film delaminates during the run from growth stresses), and are continuing to

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis

PubMed Central

Buttigieg, Sandra C.; Schuetz, Marcus; Bezzina, Frank

2016-01-01

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta. PMID:27683658

Perspectives on the policy 'black box': a comparative case study of orthopaedics services in England.

PubMed

McLeod, Hugh; Millar, Ross; Goodwin, Nick; Powell, Martin

2014-10-01

There has been much recent debate on the impact of competition on the English National Health Service (NHS). However, studies have tended to view competition in isolation and are controversial. This study examines the impact of programme theories associated with the health system reforms, which sought to move from a dominant target-led 'central control' programme theory, to one based on 'market forces', on orthopaedics across six case-study local health economies. It draws on a realistic evaluation approach to open up the policy 'black box' across different contexts using a mixed methods approach: analysis of 152 interviews with key informants and analysis of waiting times and admissions. We find that the urban health economies were more successful in reaching the access targets than the rural health economies, although the gap in performance closed over time. Most interviewees were aware of the policies to increase choice and competition, but their role appeared comparatively weak. Local commissioners' ability to influence demand appeared limited with providers' incentives dominating service delivery. Looking forward, it is clear that the role of competition in the NHS has to be considered alongside, rather than in isolation from, other policy mechanisms.

Innovative market-based policy instruments for waste management: A case study on shredder residues in Belgium.

PubMed

Dubois, Maarten; Hoogmartens, Rob; Van Passel, Steven; Van Acker, Karel; Vanderreydt, Ive

2015-10-01

In an increasingly complex waste market, market-based policy instruments, such as disposal taxes, can give incentives for sustainable progress while leaving flexibility for innovation. However, implementation of disposal taxes is often criticised by domestic waste handlers that fear to be outcompeted by competitors in other countries. The article discusses three innovative market-based instruments that limit the impact on international competitiveness: Tradable recycling credits, refunded disposal taxes and differentiated disposal taxes. All three instruments have already been implemented for distinct environmental policies in Europe. In order to illustrate how these instruments can be used for waste policy, the literature review is complemented with a case study on shredder residues from metal-containing waste streams in Belgium. The analysis shows that a conventional disposal tax remains the most efficient, simple and transparent instrument. However, if international competition is a significant issue or if political support is weak, refunded and differentiated disposal taxes can have an added value as second-best instruments. Tradable recycling credits are not an appropriate instrument for use in small waste markets with market power. In addition, refunded taxes create similar incentives, but induce lower transactions costs. © The Author(s) 2015.

A review of the present state and future policy alternatives for home visit nursing services in Korea.

PubMed

Lim, Ji Young; Noh, Wonjung; Kim, Eunjoo; Choi, Kyung Won

2014-01-01

The aim of this study was to describe the current state of home visit nursing services in the Korean context and to suggest future policy directions. First, the three home visit nursing services that have developed in Korea are compared using the analytic framework provided by Gilbert and Terrell in 2012. The framework is based on four dimensions of social welfare: users, services, source of funds, and service delivery process. Second, we perform a strength, weakness, opportunity, and threat analysis to suggest comprehensive and constructive home visit nursing service policies for the future. Specifically, we advocate the creation of an organization that steers the central government to operate an integrated management organization to distribute services and reduce redundancy for preventing the waste of both medical and state financial resources. This study also recommends the development of educational programs to improve the quality of services and service evaluation criteria for the objective assessment of those services. These policy guidelines may prove useful both for Korea and for other countries that intend to prepare or revise their home visit nursing service systems. © 2014 Wiley Periodicals, Inc.

“A preferred consultant and partner to the Royal Government, NGOs, and the community”: British American Tobacco’s access to policymakers in Cambodia

PubMed Central

Collin, Jeff

2017-01-01

British American Tobacco Cambodia (BATC) has dominated the country’s tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC’s in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia’s increasingly controversial political and business leadership that is centred around the Cambodian People’s Party with the aim of gaining access to policy makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company’s ostensible contribution to Cambodia’s economic and social development and, more significantly, provided BATC with opportunities to petition policy makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia’s economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia’s compliance with the Framework Convention on Tobacco Control. PMID:27079136

Ten years after "Worrying trends in econophysics": developments and current challenges

NASA Astrophysics Data System (ADS)

Ormerod, Paul

2016-12-01

Econophysics has made a number of important additions to scientific knowledge. Yet it continues to lack influence with both economists and policy makers. Ten years ago, I and three other economists sympathetic to econophysics wrote a paper on worrying trends within the discipline. For example, its lack of awareness of the economics literature, and shortfalls in the use of statistical analysis. These continue to be obstacles to wider acceptance by economists. Like all agents, policy makers respond to incentives, and economists understand this very well. Much of the econophysics community appears to think that simply doing good science is sufficient to have the work recognised, rather than relating to the motivations and incentives of policy makers. Nevertheless, econophysics now has three major opportunities to advance knowledge in areas where policy makers perceive weaknesses in what they are presented with by economists. All can benefit from the analysis of Big Data. The first is a core model of agent behaviour which is more relevant to cyber society than the rational agent model of economics. Second, extending our understanding of the business cycle, primarily by incorporating the importance of networks into models. Third, devising proper measures of output in cyber society.

Avoiding Implementation Failure in Catchment Landscapes: A Case Study in Governance of the Great Barrier Reef.

PubMed

Dale, Allan P; Vella, Karen; Gooch, Margaret; Potts, Ruth; Pressey, Robert L; Brodie, Jon; Eberhard, Rachel

2017-10-04

Water quality outcomes affecting Australia's Great Barrier Reef (GBR) are governed by multi-level and multi-party decision-making that influences forested and agricultural landscapes. With international concern about the GBR's declining ecological health, this paper identifies and focuses on implementation failure (primarily at catchment scale) as a systemic risk within the overall GBR governance system. There has been limited integrated analysis of the full suite of governance subdomains that often envelop defined policies, programs and delivery activities that influence water quality in the GBR. We consider how the implementation of separate purpose-specific policies and programs at catchment scale operate against well-known, robust design concepts for integrated catchment governance. We find design concerns within ten important governance subdomains that operate within GBR catchments. At a whole-of-GBR scale, we find a weak policy focus on strengthening these delivery-oriented subdomains and on effort integration across these subdomains within catchments. These governance problems when combined may contribute to failure in the implementation of major national, state and local government policies focused on improving water quality in the GBR, a lesson relevant to landscapes globally.

Elephants, people, parks and development: the case of the Luangwa Valley, Zambia

NASA Astrophysics Data System (ADS)

Abel, Nick; Blaikie, Piers

1986-11-01

New ideas about conserving wildlife are emerging to compete with conventional national park policies. But methods of analyzing wildlife conservation problems in Africa are inadequate for the analysis of complex issues of policy. Much of the analysis of conservation policy attempts to be ‘apolitical’ on issues charged with social conflict. Analyses are too often ahistorical when history can say a great deal about the origins of present-day ecological problems. Further-more, problems are commonly analyzed within narrow discilinary frameworks which predetermine the nature of conclusions and lead to professionally biased proposals. This case study of the Luangwa Valley, Zambia, is used to demonstrate a method which attempts to remedy these weaknesses, In the first part of the article we examine the role of the Luangwa National Parks in the context of the Zambian political economy, and identify social groups which compete for the resources of the national parks. Next we trace the historical origins of present-day ecological changes. These analyses lead toward a model of the Parks and some of their relationships with the national economy. We end with a proposal for communal use of wildlife which attempts to resolve some of the contradictions inherent in current policy.

Atmospheric Quantum Channels with Weak and Strong Turbulence.

PubMed

Vasylyev, D; Semenov, A A; Vogel, W

2016-08-26

The free-space transfer of high-fidelity optical signals between remote locations has many applications, including both classical and quantum communication, precision navigation, clock synchronization, etc. The physical processes that contribute to signal fading and loss need to be carefully analyzed in the theory of light propagation through the atmospheric turbulence. Here we derive the probability distribution for the atmospheric transmittance including beam wandering, beam shape deformation, and beam-broadening effects. Our model, referred to as the elliptic beam approximation, applies to weak, weak-to-moderate, and strong turbulence and hence to the most important regimes in atmospheric communication scenarios.

Measurement issues associated with using survey data matched with administrative data from the Social Security Administration.

PubMed

Davies, Paul S; Fisher, T Lynn

2009-01-01

Researchers using survey data matched with administrative data benefit from the rich demographic and economic detail available from survey data combined with detailed programmatic data from administrative records. The research benefits of using these matched data are too numerous to mention. But there are drawbacks as well, and those drawbacks have received less systematic attention from researchers. We focus on survey data matched with administrative data from the Social Security Administration and address the strengths and weaknesses of each in four specific areas: (1) program participation and benefits, (2) disability and health information, (3) earnings, and (4) deferred compensation. We discuss the implications of these strengths and weaknesses for decisions that researchers must make regarding the appropriate data source and definition for the concepts in question. From this discussion, some general conclusions are drawn about measurement issues associated with using matched survey and administrative data for research, policy evaluation, and statistics.

Big Data and Health Economics: Strengths, Weaknesses, Opportunities and Threats.

PubMed

Collins, Brendan

2016-02-01

'Big data' is the collective name for the increasing capacity of information systems to collect and store large volumes of data, which are often unstructured and time stamped, and to analyse these data by using regression and other statistical techniques. This is a review of the potential applications of big data and health economics, using a SWOT (strengths, weaknesses, opportunities, threats) approach. In health economics, large pseudonymized databases, such as the planned care.data programme in the UK, have the potential to increase understanding of how drugs work in the real world, taking into account adherence, co-morbidities, interactions and side effects. This 'real-world evidence' has applications in individualized medicine. More routine and larger-scale cost and outcomes data collection will make health economic analyses more disease specific and population specific but may require new skill sets. There is potential for biomonitoring and lifestyle data to inform health economic analyses and public health policy.

State of the fight against informal market of medicines in Togo: approaches and limitations.

PubMed

Gnassingbe, A; Flahault, A; Geissbuhler, A; Sprumont, D; Awesso, A

2018-02-01

The extent of medicines sales and consumption in the informal market in Togo raises many ethical and public health issues. In order to report on the situation of public action in the fight against this practice, we conducted a qualitative survey from 15 to 25 February 2016 in the commune of Lomé and in the Maritime Region among the actors of control system and resource people in the general population. This was supplemented by an analysis of Togo's pharmaceutical and health policy documents and a literature review on the illicit drug market issues relating to public health, political science, the social sciences applied to health. In spite of the existence of national and international tools, household poverty, cultural self-medication, ignorance of the population concerning the health risks of informal market medicines, weak political commitment, weakness regulation and enforcement, corruption, constitute obstacles to the success of actions to combat this practice.

Population and population policy in Pakistan.

PubMed

Mauldin, W P

1963-02-01

Pakistan is a divided country with different religious groups represented. Since independence in 1941, the Muslim population has increased more rapidly than the Hindu population, the West Pakistan population more rapidly and steadily than the East Pakistan population. In the late 1950s the Pakistan government initiated a family planning program. The program has trained medical and paramedical personnel in family planning, added family planning services to existing medical centers, planned for a National Research Institute of Family Planning, employed mobile units to reach outlying areas, conducted limited clinical studies on some contraceptives, and used mass media advertising. Only India and Japan are doing more with government-sponsored family planning. A weak organizational structure and an inadequate number of trained personnel are the main weakness of the program. It is too early to assess the success of the program. A 10-point reduction in annual birth rates will be considered successful.

Pay as you throw

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dahlen, Lisa, E-mail: lisa.dahlen@ltu.s; Lagerkvist, Anders

2010-01-15

Householders' response to weight-based billing for the collection of household waste was investigated with the aim of providing decision support for waste management policies. Three questions were addressed: How much and what kind of information on weight-based billing is discernible in generic Swedish waste collection statistics? Why do local authorities implement weight-based billing, and how do they perceive the results? and, Which strengths and weaknesses of weight-based billing have been observed on the local level? The study showed that municipalities with pay-by-weight schemes collected 20% less household waste per capita than other municipalities. Surprisingly, no part of this difference couldmore » be explained by higher recycling rates. Nevertheless, the majority of waste management professionals were convinced that recycling had increased as a result of the billing system. A number of contradicting strengths and weaknesses of weight-based billing were revealed.« less

The Weak Stability Boundary, A Gateway for Human Exploration of Space

NASA Technical Reports Server (NTRS)

Mendell, Wendell W.

2000-01-01

NASA plans for future human exploration of the Solar System describe only missions to Mars. Before such missions can be initiated, much study remains to be done in technology development, mission operations and human performance. While, for example, technology validation and operational experience could be gained in the context of lunar exploration missions, a NASA lunar program is seen as a competitor to a Mars mission rather than a step towards it. The recently characterized Weak Stability Boundary in the Earth-Moon gravitational field may provide an operational approach to all types of planetary exploration, and infrastructure developed for a gateway to the Solar System may be a programmatic solution for exploration that avoids the fractious bickering between Mars and Moon advocates. This viewpoint proposes utilizing the concept of Greater Earth to educate policy makers, opinion makers and the public about these subtle attributes of our space neighborhood.

Analysis of environmental communication and its implication for sustainable development in Ethiopia.

PubMed

Zikargae, Mekonnen Hailemariam

2018-09-01

Environmental issues have been causing debates around the globe. These issues have also got much attention in Ethiopia. Ethiopia has been adversely affected by the environmental crisis. Developing countries and the poor were depicted as unfortunate victims of climate change. The causes of climate change include deforestation, industries, mismanagement of the environment, and utilization of natural resources. One of the effects of climate change brought natural disaster what we call a drought. Drought affected many people, even recently, in Ethiopia. Concerning the environmental problems and issues in Ethiopia, there are beginnings at the policy level. However, the practical aspects of communicating and addressing these issues could not get much attention from the authority. The aim of the research is to analyze environmental communication of Amhara National Regional State-Environmental Protection Authority. Case study as a qualitative research method is used. The case design type is descriptive. The researcher selected two techniques of collecting data: in-depth interview and documents. The results show that the authority is unable to communicate environmental issues which were stated in the different conventions and policies. There are gaps that could be considered from the outcome of the research. The major gaps and challenges in addressing practical issues of environment are identified namely poor environmental information systems, lack of awareness creation through communications, and weak public dialogue and genuine participation consideration. Copyright © 2018 Elsevier B.V. All rights reserved.

NAS Panel faults export controls

NASA Astrophysics Data System (ADS)

Katzoff, Judith A.

A study prepared by a top-level panel says that current export controls on militarily sensitive U.S. technology may be “overcorrecting” previous weaknesses in that system, resulting in “a complex and confusing control system” that makes it more difficult for U.S. businesses to compete in international markets. Moreover, this control system has “an increasingly corrosive effect” on U.S. relations with allies. The panel recommended that the United States concentrate more effort on bringing about uniformity in the export control policies of countries belonging to the Coordinating Committee on Multilateral Export Controls (CoCom), i.e., most of the member nations in NATO (the North Atlantic Treaty Organization) and Japan.The 21-member panel was appointed by the Committee on Science, Engineering, and Public Policy (COSEPUP), a joint unit of the National Academy of Sciences (NAS), the National Academy of Engineering (NAE), and the Institute of Medicine (IOM). The panel, composed of administrators, researchers, and former government officials, was chaired by AGU member Lew Allen, Jr., director of the Jet Propulsion Laboratory (Pasadena, Calif.) and former chief of staff of the U.S. Air Force. Their report was supported by NAS funds, by a number of private organizations (including AGU), by the U.S. Departments of Commerce, Defense, Energy, and State, by the National Science Foundation, and by the National Aeronautics and Space Administration.

Five challenges to reconcile agricultural land use and forest ecosystem services in Southeast Asia.

PubMed

Carrasco, L R; Papworth, S K; Reed, J; Symes, W S; Ickowitz, A; Clements, T; Peh, K S-H; Sunderland, T

2016-10-01

Southeast Asia possesses the highest rates of tropical deforestation globally and exceptional levels of species richness and endemism. Many countries in the region are also recognized for their food insecurity and poverty, making the reconciliation of agricultural production and forest conservation a particular priority. This reconciliation requires recognition of the trade-offs between competing land-use values and the subsequent incorporation of this information into policy making. To date, such reconciliation has been relatively unsuccessful across much of Southeast Asia. We propose an ecosystem services (ES) value-internalization framework that identifies the key challenges to such reconciliation. These challenges include lack of accessible ES valuation techniques; limited knowledge of the links between forests, food security, and human well-being; weak demand and political will for the integration of ES in economic activities and environmental regulation; a disconnect between decision makers and ES valuation; and lack of transparent discussion platforms where stakeholders can work toward consensus on negotiated land-use management decisions. Key research priorities to overcome these challenges are developing easy-to-use ES valuation techniques; quantifying links between forests and well-being that go beyond economic values; understanding factors that prevent the incorporation of ES into markets, regulations, and environmental certification schemes; understanding how to integrate ES valuation into policy making processes, and determining how to reduce corruption and power plays in land-use planning processes. © 2016 Society for Conservation Biology.

Looking for Evidence of the Impact of Introducing a Human Rights-Based Approach in Health: The SaluDerecho Experience.

PubMed

Escobar, María-Luisa; Cubillos, Leonardo; Iunes, Roberto

2015-12-10

This paper summarizes the background, methodology, results, and lessons learned from SaluDerecho, the Initiative on Priority Setting, Equity and Constitutional Mandates in Health. Originally facilitated by the capacity-building arm of the World Bank in 2010, it was implemented in Latin American countries and later expanded to other regions of the world. Segmentation, decentralization, and lack of coordination in health systems; weak information systems; stratified societies; and hierarchical power relations in participating countries are some of the characteristics that inhibit a human rights-based approach to health. Hence, deliberate interventions like SaluDerecho are vital. Facilitating the participation of multiple stakeholders in a more informed and transparent dialogue creates a "safe" working environment to co-create policy solutions to improve transparency and accountability. The proposed evaluation methodology involves several steps that begin with an assessment of behavioral changes in actors (including policy makers, citizens, payers, and health care providers) that reshape relationships and, over time, change the functioning of health systems. Despite certain limitations, SaluDerecho has provided evidence of positive change among participating countries. Copyright © 2015 Escobar, Cubillos, Iunes. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

The current structure of key actors involved in research on land and soil degradation

NASA Astrophysics Data System (ADS)

Escadafal, Richard; Barbero, Celia; Exbrayat, Williams; Marques, Maria Jose; Ruiz, Manuel; El Haddadi, Anass; Akhtar-Schuster, Mariam

2013-04-01

Land and soil conservation topics, the final mandate of the United Convention to Combat desertification in drylands, have been diagnosed as still suffering from a lack of guidance. On the contrary, climate change and biodiversity issues -the other two big subjects of the Rio Conventions- seem to progress and may benefit from the advice of international panels. Arguably the weakness of policy measures and hence the application of scientific knowledge by land users and stakeholders could be the expression of an inadequate research organization and a lack of ability to channel their findings. In order to better understand the size, breadth and depth of the scientific communities involved in providing advice to this convention and to other bodies, this study explores the corpus of international publications dealing with land and/or with soils. A database of several thousands records including a significant part of the literature published so far was performed using the Web of Science and other socio-economic databases such as FRANCIS and CAIRN. We extracted hidden information using bibliometric methods and data mining applied to these scientific publications to map the key actors (laboratories, teams, institutions) involved in research on land and on soils. Several filters were applied to the databases in combination with the word "desertification". The further use of Tetralogie software merges databases, analyses similarities and differences between keywords, disciplines, authors and regions and identifies obvious clusters. Assessing their commonalities and differences, the visualisation of links and gaps between scientists, organisations, policymakers and other stakeholders is possible. The interpretation of the 'clouds' of disciplines, keywords, and techniques will enhance the understanding of interconnections between them; ultimately this will allow diagnosing some of their strengths and weaknesses. This may help explain why land and soil degradation remains a serious global problem that lacks sufficient attention. We hope that this study will contribute to clarify the scientific landscape at stake to remediate possible weaknesses in the future.

Drug policy and harm reduction in the Middle East and North Africa: The role of civil society.

PubMed

Aaraj, Elie; Jreij Abou Chrouch, Micheline

2016-05-01

Civil society organizations (CSOs) in Middle East and North Africa (MENA) are the principal partners of government in scaling up the response to HIV and in implementing national policies. In return, CSOs expect endorsement of their work by the governments. Some CSOs face weaknesses and need capacity-building in order for them to reach the level of response required for reducing drug-related harm in this region. Substance use and the transmission of HIV are increasing in the MENA region. The limited data available on drug use show that there are approximately 630,000 people who inject drugs (PWID) across the region. The HIV epidemic remains concentrated among PWID and other key populations in the region. Comprehensive harm reduction programs which include prevention, care, and HIV treatment for PWID are being implemented by CSOs. This could not happen without the presence of a conducive environment which has been facilitated by the CSOs, and which aims to lead to a positive response in health policies, and thus to harm reduction programs in some countries in the region. However, based on the international data, antiretroviral therapy (ART) coverage remains low in these countries, even if the number of people living with HIV (PLHIV) receiving ART is increasing. This increase can sometimes mask important challenges in equity: in several countries PWID are the most likely to be infected with HIV while being the least likely to be receiving care and ART. Therefore, concentrated efforts need to continue toward the goal of having mainstream harm reduction approaches in region. Copyright © 2016. Published by Elsevier B.V.

Demand response to improved walking infrastructure: A study into the economics of walking and health behaviour change.

PubMed

Longo, Alberto; Hutchinson, W George; Hunter, Ruth F; Tully, Mark A; Kee, Frank

2015-10-01

Walking is the most common form of moderate-intensity physical activity among adults, is widely accessible and especially appealing to obese people. Most often policy makers are interested in valuing the effect on walking of changes in some characteristics of a neighbourhood, the demand response for walking, of infrastructure changes. A positive demand response to improvements in the walking environment could help meet the public health target of 150 min of at least moderate-intensity physical activity per week. We model walking in an individual's local neighbourhood as a 'weak complement' to the characteristics of the neighbourhood itself. Walking is affected by neighbourhood characteristics, substitutes, and individual's characteristics, including their opportunity cost of time. Using compensating variation, we assess the economic benefits of walking and how walking behaviour is affected by improvements to the neighbourhood. Using a sample of 1209 respondents surveyed over a 12 month period (Feb 2010-Jan 2011) in East Belfast, United Kingdom, we find that a policy that increased walkability and people's perception of access to shops and facilities would lead to an increase in walking of about 36 min/person/week, valued at £13.65/person/week. When focussing on inactive residents, a policy that improved the walkability of the area would lead to guidelines for physical activity being reached by only 12.8% of the population who are currently inactive. Additional interventions would therefore be needed to encourage inactive residents to achieve the recommended levels of physical activity, as it appears that interventions that improve the walkability of an area are particularly effective in increasing walking among already active citizens, and, among the inactive ones, the best response is found among healthier, younger and wealthier citizens. Copyright © 2015 Elsevier Ltd. All rights reserved.

A framework for evaluation of flood management strategies.

PubMed

Hansson, K; Danielson, M; Ekenberg, L

2008-02-01

The resulting impact of disasters on society depends on the affected country's economic strength prior to the disaster. The larger the disaster and the smaller the economy, the more significant is the impact. This is clearest seen in developing countries, where weak economies become even weaker afterwards. Deliberate strategies for the sharing of losses from hazardous events may aid a country or a community in efficiently using scarce prevention and mitigation resources, thus being better prepared for the effects of a disaster. Nevertheless, many governments lack an adequate institutional system for applying cost effective and reliable technologies for disaster prevention, early warnings, and mitigation. Modelling by event analyses and strategy models is one way of planning ahead, but these models have so far not been linked together. An approach to this problem was taken during a large study in Hungary, the Tisza case study, where a number of policy strategies for spreading of flood loss were formulated. In these strategies, a set of parameters of particular interest were extracted from interviews with stakeholders in the region. However, the study was focused on emerging economies, and, in particular, on insurance strategies. The scope is now extended to become a functional framework also for developing countries. In general, they have a higher degree of vulnerability. The paper takes northern Vietnam as an example of a developing region. We identify important parameters and discuss their importance for flood strategy formulations. Based on the policy strategies in the Tisza case, we extract data from the strategies and propose a framework for loss spread in developing and emerging economies. The parameter set can straightforwardly be included in a simulation and decision model for policy formulation and evaluation, taking multiple stakeholders into account.

Health policies on dialysis modality selection: a nationwide population cohort study

PubMed Central

Lin, Yi-Chun; Lin, Yen-Chung; Kao, Chih-Chin; Chen, Hsi-Hsien; Hsu, Chih-Cheng; Wu, Mai-Szu

2017-01-01

Objectives In Taiwan, peritoneal dialysis (PD) and haemodialysis are fully accessible to patients with end-stage renal disease. However, the usage of PD is considered low in Taiwan. Since 2005, 4 major policies have been implemented by Taiwan's Ministry of Health and Welfare, namely a multidisciplinary predialysis care programme and usage increasing the PD incidence as a key performance indicator (KPI) for hospital accreditation, both of which were implemented in 2006; reimbursement of the glucose-free dialysate, icodextrin that was implemented in 2007; and insurance reimbursement for renting automated PD machines that was implemented in 2008. The aim of this study was to analyse the associations between the PD promotional policies and the actual PD selection rates. Setting We analysed data within the Taiwan Renal Registry Data System from 2006 to 2013, focusing on the PD incidence in relation to the timings of the 4 PD promotional policies; then we stratified the results according to age, sex and the presence of diabetes mellitus. Participants From 2006 to 2013, 115 565 patients were enrolled in this study. The mean (SD) age of patients on PD was 54.6 (15.7) years. Results During the time frame in which the 4 PD promotional policies were implemented, the PD incidence increased from 12.8% in 2006 to 15.1% in 2009. The PD incidence started to decline in 2010 (13.8%) when the hospital accreditation policy was repealed. The 3 remaining policies were weakly associated with the PD incidence. The observational analysis determined that the patients' ages, sexes and diabetes mellitus incidence rates were relatively stable from 2006 to 2013. Conclusions Of the 4 health policies intended to promote PD usage, using increasing the PD incidence as a KPI for hospital accreditation had the strongest association with the PD incidence. PMID:28077410

Capitalising upon political opportunities to reform drug policy: a case study into the development of the Australian "Tough on Drugs-Illicit Drug Diversion Initiative".

PubMed

Hughes, Caitlin Elizabeth

2009-09-01

The introduction of political "war on drug" strategies and Prime Ministerial advisory groups increase opportunities for drug policy reform. Yet the strengths and limitations of capitalising upon political opportunities remain unclear. This paper provides a unique insight into the development of an Australian reform, the "Tough on Drugs-Illicit Drug Diversion Initiative." This reform was one of the major policies to emerge out of the Federal Coalition "Tough on Drugs" strategy. In spite of the rhetoric the Illicit Drug Diversion Initiative (IDDI) has diverted minor drug users away from the traditional criminal justice system. This paper draws upon interviews with 16 expert policy makers involved in the advocacy and negotiations leading up to the adoption of the IDDI to examine what drove the reform and how and why a pragmatic reform emerged. The IDDI culminated from the presence of five main drivers: a crisis in relation to heroin and crime, antagonism towards the government, a weak but growing evidence-base on the merits of drug diversion, a shift in law enforcement attitudes and persuasive advocacy by a group of non-government experts. This paper contends that the Prime Minister's new "Tough on Drugs" strategy and expanded governance arrangements created new space for policy actors to intervene in the policy formulation process and to convert the governments proposed "zero tolerance" response into a more humane and potentially effective response. This paper concludes that contrary to popular opinion political venues and politicisation may offer valuable opportunities for drug policy reform. The challenge for researchers and policy advocates is to see how they can best utilise political venues to obtain pragmatic reform.

Semantic policy and adversarial modeling for cyber threat identification and avoidance

NASA Astrophysics Data System (ADS)

DeFrancesco, Anton; McQueary, Bruce

2009-05-01

Today's enterprise networks undergo a relentless barrage of attacks from foreign and domestic adversaries. These attacks may be perpetrated with little to no funding, but may wreck incalculable damage upon the enterprises security, network infrastructure, and services. As more services come online, systems that were once in isolation now provide information that may be combined dynamically with information from other systems to create new meaning on the fly. Security issues are compounded by the potential to aggregate individual pieces of information and infer knowledge at a higher classification than any of its constituent parts. To help alleviate these challenges, in this paper we introduce the notion of semantic policy and discuss how it's use is evolving from a robust approach to access control to preempting and combating attacks in the cyber domain, The introduction of semantic policy and adversarial modeling to network security aims to ask 'where is the network most vulnerable', 'how is the network being attacked', and 'why is the network being attacked'. The first aspect of our approach is integration of semantic policy into enterprise security to augment traditional network security with an overall awareness of policy access and violations. This awareness allows the semantic policy to look at the big picture - analyzing trends and identifying critical relations in system wide data access. The second aspect of our approach is to couple adversarial modeling with semantic policy to move beyond reactive security measures and into a proactive identification of system weaknesses and areas of vulnerability. By utilizing Bayesian-based methodologies, the enterprise wide meaning of data and semantic policy is applied to probability and high-level risk identification. This risk identification will help mitigate potential harm to enterprise networks by enabling resources to proactively isolate, lock-down, and secure systems that are most vulnerable.

Overlapping features of polymyositis and inclusion body myositis in HIV-infected patients

PubMed Central

Lloyd, Thomas E.; Pinal-Fernandez, Iago; Michelle, E. Harlan; Christopher-Stine, Lisa; Pak, Katherine; Sacktor, Ned

2017-01-01

Objective: To characterize patients with myositis with HIV infection. Methods: All HIV-positive patients with myositis seen at the Johns Hopkins Myositis Center from 2003 to 2013 were included in this case series. Muscle biopsy features, weakness pattern, serum creatine kinase (CK) level, and anti–nucleotidase 1A (NT5C1A) status of HIV-positive patients with myositis were assessed. Results: Eleven of 1,562 (0.7%) patients with myositis were HIV-positive. Myositis was the presenting feature of HIV infection in 3 patients. Eight of 11 patients had weakness onset at age 45 years or less. The mean time from the onset of weakness to the diagnosis of myositis was 3.6 years (SD 3.2 years). The mean of the highest measured CK levels was 2,796 IU/L (SD 1,592 IU/L). On muscle biopsy, 9 of 10 (90%) had endomysial inflammation, 7 of 10 (70%) had rimmed vacuoles, and none had perifascicular atrophy. Seven of 11 (64%) patients were anti-NT5C1A-positive. Upon presentation, all had proximal and distal weakness. Five of 6 (83%) patients followed 1 year or longer on immunosuppressive therapy had improved proximal muscle strength. However, each eventually developed weakness primarily affecting wrist flexors, finger flexors, knee extensors, or ankle dorsiflexors. Conclusions: HIV-positive patients with myositis may present with some characteristic polymyositis features including young age at onset, very high CK levels, or proximal weakness that improves with treatment. However, all HIV-positive patients with myositis eventually develop features most consistent with inclusion body myositis, including finger and wrist flexor weakness, rimmed vacuoles on biopsy, or anti-NT5C1A autoantibodies. PMID:28283597

Open Tools for Integrated Modelling to Understand SDG development - The OPTIMUS program

NASA Astrophysics Data System (ADS)

Howells, Mark; Zepeda, Eduardo; Rogner, H. Holger; Sanchez, Marco; Roehrl, Alexander; Cicowiez, Matrin; Mentis, Dimitris; Korkevelos, Alexandros; Taliotis, Constantinos; Broad, Oliver; Alfstad, Thomas

2016-04-01

The recently adopted Sustainable Development Goals (SDGs) - a set of 17 measurable and time-bound goals with 169 associated targets for 2030 - are highly inclusive challenges before the world community ranging from eliminating poverty to human rights, inequality, a secure world and protection of the environment. Each individual goal or target by themselves present enormous tasks, taken together they are overwhelming. There strong and weak interlinkages, hence trade-offs and complementarities among goals and targets. Some targets may affect several goals while other goals and targets may conflict or be mutually exclusive (Ref). Meeting each of these requires the judicious exploitation of resource, with energy playing an important role. Such complexity demands to be addressed in an integrated way using systems analysis tools to support informed policy formulation, planning, allocation of scarce resources, monitoring progress, effectiveness and review at different scales. There is no one size fits all methodology that conceivably could include all goal and targets simultaneously. But there are methodologies encapsulating critical subsets of the goal and targets with strong interlinkages with a 'soft' reflection on the weak interlinkages. Universal food security or sustainable energy for all inherently support goals and targets on human rights and equality but possibly at the cost of biodiversity or desertification. Integrated analysis and planning tools are not yet commonplace at national universities - or indeed in many policy making organs. What is needed is a fundamental realignment of institutions and integrations of their planning processes and decision making. We introduce a series of open source tools to support the SDG planning and implementation process. The Global User-friendly CLEW Open Source (GLUCOSE) tool optimizes resource interactions and constraints; The Global Electrification Tool kit (GETit) provides the first global spatially explicit electrification simulator; A national CLEW tool allows for the optimization of national level integrated resource use and Macro-CLEW presents the same allowing for detailed economic-biophysical interactions. Finally open Model Management Infrastructure (MoManI) is presented that allows for the rapid prototyping of new additions to, or new resource optimization tools. Collectively these tools provide insights to some fifteen of the SDGs and are made publicly available with support to governments and academic institutions.

Comparison of the Determinants of the Health Service System and the Health Status of the People in the Greater Mekong Subregion (GMS).

PubMed

Phanphairoj, Kanjanee; Loa, Ritzmond

2017-12-01

Health is influenced by numerous factors that affect the health service system and health status of the people in every country. This article aims to compare the determinants of the health service system and the health status of the people in Thailand, the Lao PDR, Vietnam, and Cambodia; and to recommend policies that impact the population's health and the country's development. Methods: A comprehensive search of the literature from a variety of online search and academic databases, and synthesis of previous study was used in this paper. Data on country indicators were taken from published online databases of the Ministry of Public Health of Cambodia, Lao PDR, Thailand,and Vietnam; the World Health Organization, and the World Bank. In Thailand, the determinants of the health service system and health status of the people are medical information and technology because of the government initiatives to improve the quality of healthcare services through the use of modern technology. In Vietnam, the society and culture, and the strengths and weaknesses of the hospital significantly affect the health status and health service system there because of the religious beliefs of the people. However, in Cambodia, the strengths and weaknesses of the hospital are the primary determinant of the health service system and health status of the people due to the condition of the hospitals, the availability of new medical devices, and the number of healthcare professionals. In the Lao PDR, trade and investment, and medical information and technology, significantly influence the health service system and health status of the people because of the government efforts to outsource capital expenditures and medical technology. The strengths and weaknesses of the hospital are the key determinants of the health service system and health status of the people in all GMS countries. Understanding the determinants of health is essential in order to develop policies and programs that impact the population's health and the country's development.

China and Proliferation of Weapons of Mass Destruction and Missiles: Policy Issues

DTIC Science & Technology

2009-05-26

hundreds of tons of anhydrous hydrogen fluoride (AHF), or hydrofluoric acid , under falsified documents about end-users. (The AHF chemical could be used to...Kingsbury, “ Why China Helped Countries Like Pakistan, North Korea Build Bombs,” U.S. News & World Report, January 5, 2009. 9 Senate Select Committee...the issue of U.S. arms sales to Taiwan. They stress that PRC export controls are weak , even as government repression can be harsh (e.g., against

Present Status and Future Prospects in Bulk Processing of HIGH-Tc Superconductors

NASA Astrophysics Data System (ADS)

Jin, S.; Chu, C. W.

The following sections are included: * INTRODUCTION * HIGH SUPERCONDUCTING TRANSITION TEMPERATURE * HIGH CRITICAL CURRENT DENSITY * Grain Boundary Weak Links * Nature of Weak Links * Possible Processing Approaches for Weak Link Problem * Processing Techniques for Texture Formation * Flux Creep in HTSC * Desirable Pinning Defects * Processing for Flux Pinning Enhancement * PROSPECTS FOR BULK APPLICATIONS * Magnetic Field Gener * Energy Storage * Magnetic Shielding * Other Applications * CONCLUDING REMARKS * ACKNOWLEDGMENT * REFERENCES

On the Conservation and Convergence to Weak Solutions of Global Schemes

NASA Technical Reports Server (NTRS)

Carpenter, Mark H.; Gottlieb, David; Shu, Chi-Wang

2001-01-01

In this paper we discuss the issue of conservation and convergence to weak solutions of several global schemes, including the commonly used compact schemes and spectral collocation schemes, for solving hyperbolic conservation laws. It is shown that such schemes, if convergent boundedly almost everywhere, will converge to weak solutions. The results are extensions of the classical Lax-Wendroff theorem concerning conservative schemes.

Risk factors for mobility limitation in community-dwelling older adults: a social ecological perspective.

PubMed

Yeom, Hye A; Fleury, Julie; Keller, Colleen

2008-01-01

Although a variety of risk factors for mobility limitation in older adults have been examined, a collective review of relevant literature has not been reported. The purposes of this review are to report the intrapersonal, interpersonal, environmental, and organizational risk factors related to mobility limitation using a social ecological perspective and to discuss the direction of future clinical practice consistent with current literature on mobility limitation of community-dwelling older adults. Intrapersonal risk factors related to mobility limitation include advanced age, female gender, low socioeconomic status, comorbidity, lack of motivation (i.e., dependent personality, decreased self-efficacy), lifestyle factors (i.e., sedentary lifestyle, smoking, obesity), and physiological factors (i.e., vitamin D deficiency, inflammation, poor nutritional status). Interpersonal risk factors related to mobility limitation include weak social networks and limited social activities. Geriatric clients may also experience a decline in mobility when they encounter environmental challenges such as an inconvenient home environment and lack of availability of services in their community, as well as lack of organizational resources stemming from social policy. Potential intervention strategies focused on modifiable risk factors may include lifestyle modifications, social networking programs, and enhancing awareness of environmental and organizational resources in the community for older adults at risk for mobility limitation.

Narrative review of frameworks for translating research evidence into policy and practice.

PubMed

Milat, Andrew J; Li, Ben

2017-02-15

A significant challenge in research translation is that interested parties interpret and apply the associated terms and conceptual frameworks in different ways. The purpose of this review was to: a) examine different research translation frameworks; b) examine the similarities and differences between the frameworks; and c) identify key strengths and weaknesses of the models when they are applied in practice. The review involved a keyword search of PubMed. The search string was (translational research OR knowledge translation OR evidence to practice) AND (framework OR model OR theory) AND (public health OR health promotion OR medicine). Included studies were published in English between January 1990 and December 2014, and described frameworks, models or theories associated with research translation. The final review included 98 papers, and 41 different frameworks and models were identified. The most frequently applied knowledge translation framework in the literature was RE-AIM, followed by the knowledge translation continuum or 'T' models, the Knowledge to Action framework, the PARiHS framework, evidence based public health models, and the stages of research and evaluation model. The models identified in this review stem from different fields, including implementation science, basic and medical sciences, health services research and public health, and propose different but related pathways to closing the research-practice gap.

Bridging the Gap between Climate Research and Policy

NASA Astrophysics Data System (ADS)

Weiss, M.; Lambert, K. F.; Buonocore, J.; Driscoll, C. T.

2016-12-01

The weak link between science and policy jeopardizes the wellbeing of people and the planet. Climate change is a pressing example of this disconnect. Policies are not keeping pace with the best of our knowledge from climate change research. We are working to bridge the science-policy divide and advance climate solutions by focusing on the positive health, ecosystem, and economic benefits of policy action. In 2013, we brought together an interdisciplinary team to estimate the co-benefits of U.S. power plant carbon standards for air quality and health, plus the economic value of the benefits. The results demonstrate that strong carbon standards with flexible compliance options can change the power sector, yielding substantial air quality and health benefits nationwide. The results also show that the economic value of these benefits outweighs the costs nationally and regionally. We advanced the policy applications of this research through a strategic campaign with three key elements: media communication, targeted outreach, and information for policymakers. Our strategy was to build widespread awareness of the research outcomes via media engagement, amplify our message via targeted outreach to citizens groups, and inform policy solutions by sharing research results with decision makers. The research was reported in more than 600 unique news stories in mainstream media outlets and received social media posts by members of Congress and senior White House officials. We amplified the messages via 14 webinars for citizens groups. We also held 16 briefings for policymakers and the public, in addition to meetings with relevant policy staff. Regional, state and federal policy leaders have used the research to understand air quality and health benefits of power plant carbon standards. This model of pairing research with media communication, targeted outreach, and information for policymakers is effective for bridging the gap between climate research and policy, and can be applied to other climate research projects.

Pharmaceutical interventions for mitigating an influenza pandemic: modeling the risks and health-economic impacts.

PubMed

Postma, Maarten J; Milne, George; Nelson, E Anthony S; Pyenson, Bruce; Basili, Marcello; Coker, Richard; Oxford, John; Garrison, Louis P

2010-12-01

Model-based analyses built on burden-of-disease and cost-effectiveness theory predict that pharmaceutical interventions may efficiently mitigate both the epidemiologic and economic impact of an influenza pandemic. Pharmaceutical interventions typically encompass the application of (pre)pandemic influenza vaccines, other vaccines (notably pneumococcal), antiviral treatments and other drug treatment (e.g., antibiotics to target potential complications of influenza). However, these models may be too limited to capture the full macro-economic impact of pandemic influenza. The aim of this article is to summarize current health-economic modeling approaches to recognize the strengths and weaknesses of these approaches, and to compare these with more recently proposed alternative methods. We conclude that it is useful, particularly for policy and planning purposes, to extend modeling concepts through the application of alternative approaches, including insurers' risk theories, human capital approaches and sectoral and full macro-economic modeling. This article builds on a roundtable meeting of the Pandemic Influenza Economic Impact Group that was held in Boston, MA, USA, in December 2008.

Breast cancer in Brazil: epidemiology and treatment challenges

PubMed Central

Cecilio, Adma Poliana; Takakura, Erika Tomie; Jumes, Jaqueline Janaina; dos Santos, Jeane Wilhelm; Herrera, Ana Cristina; Victorino, Vanessa Jacob; Panis, Carolina

2015-01-01

Notwithstanding the advances in tumor research, diagnosis, and treatment, breast cancer is still a challenge worldwide. This global burden of disease has been associated with population aging and the persistence of cancer-related behaviors. The number of women diagnosed with breast cancer has been estimated as increasing, especially in middle-income countries such as Brazil. Estimates from the Instituto Nacional de Câncer (INCA) point to breast cancer as the major malignant neoplasia in Brazilian women and the main cause of death from cancer in the country. This fact has been associated with increased life expectancy, urbanization, and cancer-related behaviors. Given this scenario, it is clear that there is a need for identifying and discussing which factors have substantially contributed to this growing number of cases in Brazil, including access to treatment, prevention and early diagnosis, weaknesses of the local health policy, and intrinsic genetic peculiarities of the Brazilian population. This review aims to address the role of such factors. PMID:25678813

Indoor fuel exposure and the lung in both developing and developed countries: An update

PubMed Central

2012-01-01

Synopsis Almost 3 billion people worldwide burn solid fuels indoors. These fuels include biomass and coal. Although indoor solid fuel smoke is likely a greater problem in developing countries, wood burning populations in developed countries may also be at risk from these exposures. Despite the large population at risk worldwide, the effect of exposure to indoor solid fuel smoke has not been adequately studied. Indoor air pollution from solid fuel use is strongly associated with COPD (both emphysema and chronic bronchitis), acute respiratory tract infections, and lung cancer (primarily coal use) and weakly associated with asthma, tuberculosis, and interstitial lung disease. Tobacco use further potentiates the development of respiratory disease among subjects exposed to solid fuel smoke. There is a need to perform additional interventional studies in this field. It is also important to increase awareness about the health effects of solid fuel smoke inhalation among physicians and patients as well as trigger preventive actions through education, research, and policy change in both developing and developed countries. PMID:23153607

Tracing health system challenges in post-conflict Côte d'Ivoire from 1893 to 2013.

PubMed

Gaber, Sabrina; Patel, Preeti

2013-07-01

While scholarship on health in conflict-affected countries is growing, there has been relatively little analysis of how armed conflict affects health systems in specific African countries, especially former French colonies. There is even less literature on the role of history in shaping health systems and how historical factors such as inequity may influence health impacts of armed conflict. Based on Côte d'Ivoire, this article argues that historical multidisciplinary analysis can provide valuable insight into the macro-level political, economic and social determinants of the health system over time. It explores how armed conflict has affected health services and exacerbates historically inherited challenges to the health system including unequal distribution of health services, bias towards curative care in urban areas, inadequate human resources and weak health governance. In the post-conflict period, this understanding may assist governments and other stakeholders to develop more appropriate health policies that address both urgent and long-term health needs.

Work-related abuse: a replication, new items, and persistent questions.

PubMed

Brush, Lisa D

2002-12-01

This study compared independently developed tools to measure work-related control, abuse, and sabotage. Interviewers administered the Work/School Abuse Scale (W/SAS; Riger, Ahrens, & Blickenstaff, 2000) to 40 welfare recipients, and a Work-Related Control, Abuse, and Sabotage Checklist (WORCASC) to a total of 162 welfare recipients, including the same 40 who answered the W/SAS. I report and compare results on W/SAS and WORCASC with 40 non-sheltered (i.e., not residing in a shelter) respondents and discuss instrument strengths and weaknesses. Measurement analyses provided preliminary empirical answers to questions about the relationship between battering and work. Findings confirmed the reliability of the two instruments, the extent to which they measure something distinct from physical abuse, and their association with relevant outcomes such as being written up, reprimanded, or losing pay at work. Measurement questions are salient in the context of debates over welfare reforms and efforts to reconcile the ways researchers, advocates, service providers, and policy makers understand and address the costs of taking a beating.

After the oil boom: The holiday ends in the gulf

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zanoyan, V.

1995-11-01

The most unmanageable risk facing American interests in the Persian Gulf is the slow but sure decay of the economic and political structure of the United States` key regional allies. They are the Gulf Cooperation Council (GCC) states: Saudia Arabia, Kuwait, Bahrain, Qatar, Oman, and the United Arab Emirates (UAE). External threats to these friendly governments and the direct risks to the continued flow of oil has blinded Washington to the end of these countries 20-year holiday from politics and economics. The holiday from economics was characterized by, among other syndromes, the lack of binding budget constraints, which reduced andmore » sometimes even eliminated the need to set spending priorities and allocate scarce economic resources. It is no longer possible to cover up structural weaknesses and policy inconsistencies. All major interest groups, including governments, ruling families, merchant families, and the population at large, are under pressure to earn not only their privileges but their keep. The need for Washington to address these new threats is examined.« less

Interdependency Assessment of Coupled Natural Gas and Power Systems in Energy Market

NASA Astrophysics Data System (ADS)

Yang, Hongzhao; Qiu, Jing; Zhang, Sanhua; Lai, Mingyong; Dong, Zhao Yang

2015-12-01

Owing to the technological development of natural gas exploration and the increasing penetration of gas-fired power generation, gas and power systems inevitably interact with each other from both physical and economic points of view. In order to effectively assess the two systems' interdependency, this paper proposes a systematic modeling framework and constructs simulation platforms for coupled gas and power systems in an energy market environment. By applying the proposed approach to the Australian national electricity market (NEM) and gas market, the impacts of six types of market and system factors are quantitatively analyzed, including power transmission limits, gas pipeline contingencies, gas pipeline flow constraints, carbon emission constraints, power load variations, and non-electric gas load variations. The important interdependency and infrastructure weakness for the two systems are well studied and identified. Our work provides a quantitative basis for grid operators and policy makers to support and guide operation and investment decisions for electric power and natural gas industries.

Identifying Demand Responses to Illegal Drug Supply Interdictions.

PubMed

Cunningham, Scott; Finlay, Keith

2016-10-01

Successful supply-side interdictions into illegal drug markets are predicated on the responsiveness of drug prices to enforcement and the price elasticity of demand for addictive drugs. We present causal estimates that targeted interventions aimed at methamphetamine input markets ('precursor control') can temporarily increase retail street prices, but methamphetamine consumption is weakly responsive to higher drug prices. After the supply interventions, purity-adjusted prices increased then quickly returned to pre-treatment levels within 6-12 months, demonstrating the short-term effects of precursor control. The price elasticity of methamphetamine demand is -0.13 to -0.21 for self-admitted drug treatment admissions and between -0.24 and -0.28 for hospital inpatient admissions. We find some evidence of a positive cross-price effect for cocaine, but we do not find robust evidence that increases in methamphetamine prices increased heroin, alcohol, or marijuana drug use. This study can inform policy discussions regarding other synthesized drugs, including illicit use of pharmaceuticals. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

A total ban on alcohol advertising: presenting the public health case.

PubMed

Parry, Charles; Burnhams, Nadine Harker; London, Leslie

2012-05-28

Evidence from burden of disease and economic costing studies amply indicate that the public health burden from hazardous and harmful use of alcohol in South Africa warrants drastic action. Evidence that banning alcohol advertising is likely to be an effective intervention is reflected in WHO strategy documents on non-communicable diseases and harmful use of alcohol. Studies on young people furthermore support arguments refuting the claim that advertising only influences brand choice. Given the weakness of relying on industry self-regulation, the government is considering legislation to ban alcohol advertising, resulting in heated debate. Tobacco control and studies investigating the effect of alcohol advertising bans on consumption and alcohol-related deaths point to the effectiveness of such action - ideally supplemented by other policy interventions. Arguments against an advertising ban include possible communication sector job losses, but these are likely to have been exaggerated. Banning alcohol advertising will necessitate greater scrutiny of digital media, satellite television and merchandising to reduce the likelihood of subverting the ban.

What is at stake? Status and threats to South China Sea marine fisheries.

PubMed

Teh, Louise S L; Witter, Allison; Cheung, William W L; Sumaila, U Rashid; Yin, Xueying

2017-02-01

Governance of South China Sea (SCS) fisheries remains weak despite acknowledgement of their widespread overexploitation for the past few decades. This review incorporates unreported fish catches to provide an improved baseline of the current status and societal contribution of SCS marine fisheries, so that the socio-economic and ecological consequences of continued fisheries unsustainability may be understood. Potential fisheries contribution to food and livelihoods include 11-17 million t in fisheries catch and USD 12-22 × 10 9 in fisheries landed value annually in the 2000s, and close to 3 million jobs. However, overfishing has resulted in biodiversity and habitat loss, and altered ecosystem trophic structures to a 'fished down' state. The present situation reiterates the urgency for fisheries policies that simultaneously address multiple political, social, economic, and biological dimensions at regional, national, and local scales. Importantly, improved cooperation between SCS nations, particularly in overcoming territorial disputes, is essential for effective regional fisheries governance.

Cheap carbon and biodiversity co-benefits from forest regeneration in a hotspot of endemism

NASA Astrophysics Data System (ADS)

Gilroy, James J.; Woodcock, Paul; Edwards, Felicity A.; Wheeler, Charlotte; Baptiste, Brigitte L. G.; Medina Uribe, Claudia A.; Haugaasen, Torbjørn; Edwards, David P.

2014-06-01

Climate change and biodiversity loss can be addressed simultaneously by well-planned conservation policies, but this requires information on the alignment of co-benefits under different management actions. One option is to allow forests to naturally regenerate on marginal agricultural land: a key question is whether this approach will deliver environmental co-benefits in an economically viable manner. Here we report on a survey of carbon stocks, biodiversity and economic values from one of the world's most endemic-rich and threatened ecosystems: the western Andes of Colombia. We show that naturally regenerating secondary forests accumulate significant carbon stocks within 30 years, and support biodiverse communities including many species at risk of extinction. Cattle farming, the principal land use in the region, provides minimal economic returns to local communities, making forest regeneration a viable option despite weak global carbon markets. Efforts to promote natural forest regeneration in the tropical Andes could therefore provide globally significant carbon and biodiversity co-benefits at minimal cost.

The politics of drug control in Nigeria: Exclusion, repression and obstacles to policy change.

PubMed

Klantschnig, Gernot

2016-04-01

International agencies have viewed West Africa as a major player in the global trade in cocaine and heroin and in efforts to control that trade, as there have been reports of escalating arrests of drug smugglers, large-scale drug seizures and 'narco-states' in the subregion. It is claimed that a substantial share of the drugs available in Western markets transit through West Africa today and are increasingly used there as well. Notwithstanding this growing alarm, there is little serious scholarship addressing the issue of drugs and drug policy in West Africa. The article assesses and challenges some of the existing depictions of drugs and drug policy in West Africa through an empirical case study of drug control in Nigeria - one of West Africa's most notorious 'drug hubs' and recently hailed as a policy model by international experts. Based on previously inaccessible government documents, interviews with key officials in Nigeria, as well as ethnographic work at Nigeria's key drug agency, the article provides a unique insight into the politics of drug policy-making and implementation in West Africa. After describing the dominant official narratives of Nigeria's drug control, the article shows how the key political dynamics underlying drug policy remain obscured by these narratives. Nigerian drug policy has been characterised by a highly exclusive policy-making process, repression as the sole means of implementation and a strong bond with international drug agencies. This policy emerged in the 1980s and 1990s and has remained the unchallenged norm until today. The political processes underlying Nigerian drug policy also explain why policy reform has been and will be difficult to accomplish. These domestic political processes have largely been ignored in the existing depictions of drugs in West Africa, as they have mainly focused on externally driven drug threats and foreign policy responses. Most importantly, they have ignored the role played by the state. Rather than being too weak, the Nigerian state has shown a clear tendency towards repressive and coercive drug policy, which has received little popular support. Copyright © 2015 Elsevier B.V. All rights reserved.

Cardiovascular effects of environmental noise: research in The Netherlands.

PubMed

Kempen, Elise van

2011-01-01

The impact of environmental noise on public health, in The Netherlands, is limited: Less than 1% of the myocardial infarction cases per year are attributable to long-term exposure to road traffic noise. Furthermore, although the Dutch noise policy is not directed to prevent cardiovascular disease due to noise exposure, health does play a role in Dutch noise policy. These are the main conclusions of a systematic review of Dutch observational studies, investigating the possible impact of road traffic and aircraft noise exposure on the cardiovascular system. Since 1970, 14 Dutch studies were published investigating the possible impact of road traffic and aircraft noise exposure on the cardiovascular system. Within these studies a large variety of outcomes were investigated, ranging from blood pressure changes to cardiovascular mortality. The results of the studies were not consistent and only weak associations were found.

A multimethod approach to examining usability of Web privacy polices and user agents for specifying privacy preferences.

PubMed

Proctor, Robert W; Vu, Kim-Phuong L

2007-05-01

Because all research methods have strengths and weaknesses, a multimethod approach often provides the best way to understand human behavior in applied settings. We describe how a multimethod approach was employed in a series of studies designed to examine usability issues associated with two aspects of online privacy: comprehension of privacy policies and configuration of privacy preferences for an online user agent. Archival research, user surveys, data mining, quantitative observations, and controlled experiments each yielded unique findings that, together, contributed to increased understanding of online-privacy issues for users. These findings were used to evaluate the accessibility of Web privacy policies to computer-literate users, determine whether people can configure user agents to achieve specific privacy goals, and discover ways in which the usability of those agents can be improved.

[eHealth in Peru: implementation of policies to strengthen health information systems].

PubMed

Curioso, Walter H

2014-01-01

Health information systems play a key role in enabling high quality, complete health information to be available in a timely fashion for operational and strategic decision-making that makes it possible to save lives and improve the health and quality of life of the population. In many countries, health information systems are weak, incomplete, and fragmented. However, there is broad consensus in the literature of the need to strengthen health information systems in countries around the world. The objective of this paper is to present the essential components of the conceptual framework to strengthen health information systems in Peru. It describes the principal actions and strategies of the Ministry of Health of Peru during the process of strengthening health information systems. These systems make it possible to orient policies for appropriate decision-making in public health.

Socioeconomic determinants of health: community marginalisation and the diffusion of disease and disorder in the United States.

PubMed Central

Wallace, R.; Wallace, D.

1997-01-01

This article describes the cascading diffusion of "inner city problems" of disease and disorder in the United States--from the huge marginalised inner city communities of the largest municipalities, first along national travel routes to smaller cities, and then from central cities into surrounding more affluent suburbs-following the pattern of the daily journey to work. Public policies and economic practices which increase marginalisation act to damage the "weak ties" of the community social networks which bind central city neighbourhoods into functioning units. Spreading disease and disorder can be interpreted as indices of the resulting social disintegration, which is driven by policy. This "failure of containment" in the United States should serve as a warning for cities in Europe against reducing the municipal and other services that they provide to "unpopular" subpopulations. PMID:9158474

Active superconducting devices formed of thin films

DOEpatents

Martens, Jon S.; Beyer, James B.; Nordman, James E.; Hohenwarter, Gert K. G.

1991-05-28

Active superconducting devices are formed of thin films of superconductor which include a main conduction channel which has an active weak link region. The weak link region is composed of an array of links of thin film superconductor spaced from one another by voids and selected in size and thickness such that magnetic flux can propagate across the weak link region when it is superconducting. Magnetic flux applied to the weak link region will propagate across the array of links causing localized loss of superconductivity in the links and changing the effective resistance across the links. The magnetic flux can be applied from a control line formed of a superconducting film deposited coplanar with the main conduction channel and weak link region on a substrate. The devices can be formed of any type to superconductor but are particularly well suited to the high temperature superconductors since the devices can be entirely formed from coplanar films with no overlying regions. The devices can be utilized for a variety of electrical components, including switching circuits, amplifiers, oscillators and modulators, and are well suited to microwave frequency applications.

Ground Support Strategies at the Turquoise Ridge Joint Venture, Nevada

NASA Astrophysics Data System (ADS)

Sandbak, L. A.; Rai, A. R.

2013-05-01

Weak rock masses of high grade Carlin-trend gold mineralization are encountered in the Turquoise Ridge Joint Venture underground mine. The sediments consist of very weak and altered limestone, mudstone, and carbon-rich clays. The rock mass ratings are described as very poor to poor (Bieniawski in Proceedings of the symposium on exploration for rock engineering, Johannesburg, South Africa, pp. 97-106, 1976). The undercut and fill or boxes stoping mining methods are used because of the low dipping ore body geometry, complex geology, and weak rock mass. Design criteria are chosen to keep openings in weak rock as small as possible to prevent unraveling and to minimize supplementary support. Typical ground support for drifting includes the use of bolts, mesh, spiling, and shotcrete. Quality control of cemented rock fill (CRF) through sampling and aggregate sieve testing is necessary to insure high support strength. Specific support may include shotcrete arches with steel ring sets and CRF "arches" as a replacement of weak rock masses around long-term mine openings. Movement monitoring is utilized in problem areas and is needed to quantify and validate computer modeling.

Septic Arthritis

MedlinePlus

... Weak immune system. People with a weak immune system are at greater risk of septic arthritis. This includes people with diabetes, kidney and liver problems, and those taking drugs that suppress their immune systems. Joint trauma. Animal bites, puncture woods or cuts ...

[On comparison of hospital performance].

PubMed

Kjekshus, L E

2000-10-20

The motivation to identify the causes of rising health care cost and variations across providers has intensified in all industrialized countries. These countries have an ongoing debate on efficiency and effectiveness in hospital production. In this debate, national and international comparative studies are important. There are very few international comparative studies that include Norwegian hospitals. Actually we know very little about how Norwegian hospitals are performing compared to others. This paper gives an introduction to comparative studies and to the DEA model which is often used in such studies and also a multilevel model which is not so common. A short review is given of a comparative study of Norwegian and North American hospitals. I also discuss the feasibility of comparative studies of hospitals from the Nordic countries, with references to several comparative studies performed in these countries. Comparative studies are often closely linked to national health politics, policy making and reforms; thus the outcome of such studies is important for the hospitals included. This makes such studies a sensitive field of research. It is important to be aware of the strength and weaknesses of comparative studies and acknowledge their importance beyond the development of new knowledge.

Linkages between public and non-government sectors in healthcare: A case study from Uttar Pradesh, India.

PubMed

Srivastava, Aradhana; Bhattacharyya, Sanghita; Gautham, Meenakshi; Schellenberg, Joanna; Avan, Bilal I

2016-12-01

Effective utilisation of collaborative non-governmental organisation (NGO)-public health system linkages in pluralistic health systems of developing countries can substantially improve equity and quality of services. This study explores level and types of linkages between public health sector and NGOs in Uttar Pradesh (UP), an underprivileged state of India, using a social science model for the first time. It also identifies gaps and challenges for effective linkage. Two NGOs were selected as case studies. Data collection included semi-structured in-depth interviews with senior staff and review of records and reporting formats. Formal linkages of NGOs with the public health system related to registration, participation in district level meetings, workforce linkages and sharing information on government-supported programmes. Challenges included limited data sharing, participation in planning and limited monitoring of regulatory compliances. Linkage between public health system and NGOs in UP was moderate, marked by frequent interaction and some reciprocity in information and resource flows, but weak participation in policy and planning. The type of linkage could be described as 'complementarity', entailing information and resource sharing but not joint action. Stronger linkage is required for sustained and systematic collaboration, with joint planning, implementation and evaluation.

Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

PubMed

Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

2016-02-01

Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Surveillance for leptospirosis in the Americas, 1996–2005: a review of data from ministries of health

PubMed Central

Costa, Federico; Martinez-Silveira, Martha Silvia; Hagan, José E.; Hartskeerl, Rudy A.; dos Reis, Mitermayer Galvão; Ko, Albert Icksang

2014-01-01

Objective To characterize current leptospirosis reporting practices in the Americas. Methods Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996–2005. Results A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for 83.1% (3 920 cases) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8%) were reported by Brazil. Conclusions Notification practices in the Americas for leptospirosis are limited. Therefore, the numbers of cases and deaths reported are not representative for the region. The lack of leptospirosis data for many countries/territories may reflect weaknesses in certain aspects of national surveillance systems, including mandatory reporting policies, clinical laboratory infrastructure for performing case confirmation, and capacity to collect reported cases. Improved surveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring of regional epidemiological patterns and to estimate the burden of this important disease. PMID:23183556

Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment.

PubMed

Li, Hui; Hilsenrath, Peter

2016-01-01

China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China's shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China's evolution, adding another layer of complexity to policy. © The Author(s) 2016.

Qualitative evaluation of a delirium prevention and management programme.

PubMed

Kang, Yun; Moyle, Wendy; Cooke, Marie; O'Dwyer, Siobhan

2017-12-01

To evaluate the effect of an educational programme on registered nurses' knowledge and attitude in delirium care for hospitalised older adults with and without dementia, and to examine the strengths and weaknesses of the programme from the participants' perspectives. Providing care for patients with delirium or delirium superimposed on dementia often poses particular challenges such as distinguishing between delirium and dementia for nurses. A descriptive qualitative study was used. A delirium educational programme based on adult learning principles was provided to the participants. A purposive sample of 12 registered nurses who participated in the educational programme undertook individual interviews. Content analysis was conducted to identify unique and common themes indicative of registered nurse perceptions. Registered nurses reported improved knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. Active learning in the programme facilitated the participants' learning processes. This active learning included deep learning, collaborative learning and application of new concepts to practice. Most participants felt that they had inadequate management support to apply their new knowledge in practice, and this included staff resource and policies and protocols. The qualitative findings indicated that the delirium education had benefited the participants by improving their knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. This study provided an understanding of the strengths and limitations of the educational programme delivered to registered nurses in South Korea. Registered nurses in South Korea should need not only appropriate education, but also adequate resources, policies and guidelines as well as support from managers and from all other healthcare professionals. © 2017 John Wiley & Sons Ltd.

Organization and Finance of China’s Health Sector

PubMed Central

Li, Hui; Hilsenrath, Peter

2016-01-01

China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China’s shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China’s evolution, adding another layer of complexity to policy. PMID:26831625

Health sector operational planning and budgeting processes in Kenya-"never the twain shall meet".

PubMed

Tsofa, Benjamin; Molyneux, Sassy; Goodman, Catherine

2016-07-01

Operational planning is considered an important tool for translating government policies and strategic objectives into day-to-day management activities. However, developing countries suffer from persistent misalignment between policy, planning and budgeting. The Medium Term Expenditure Framework (MTEF) was introduced to address this misalignment. Kenya adopted the MTEF in the early 2000s, and in 2005, the Ministry of Health adopted the Annual Operational Plan process to adapt the MTEF to the health sector. This study assessed the degree to which the health sector Annual Operational Plan process in Kenya has achieved alignment between planning and budgeting at the national level, using document reviews, participant observation and key informant interviews. We found that the Kenyan health sector was far from achieving planning and budgeting alignment. Several factors contributed to this problem including weak Ministry of Health stewardship and institutionalized separation between planning and budgeting processes; a rapidly changing planning and budgeting environment; lack of reliable data to inform target setting and poor participation by key stakeholders in the process including a top-down approach to target setting. We conclude that alignment is unlikely to be achieved without consideration of the specific institutional contexts and the power relationships between stakeholders. In particular, there is a need for institutional integration of the planning and budgeting processes into a common cycle and framework with common reporting lines and for improved data and local-level input to inform appropriate and realistic target setting. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

Childhood Sexual Violence in Indonesia: A Systematic Review.

PubMed

Rumble, Lauren; Febrianto, Ryan Fajar; Larasati, Melania Niken; Hamilton, Carolyn; Mathews, Ben; Dunne, Michael P

2018-01-01

There has been relatively little research into the prevalence of childhood sexual violence (CSV) as well as the risk and protective factors for CSV in low- and middle-income countries including Indonesia. Systematic searches conducted in English and Bahasa Indonesia in this review identified 594 records published between 2006 and 2016 in peer-reviewed journals and other literature including 299 Indonesian records. Fifteen studies, including nine prevalence studies, met the quality appraisal criteria developed for this review. The review found that CSV research is scarce: Only one study included nationally representative prevalence estimates. Varying definitions for CSV, survey methods, and sample characteristics limited the generalizability of the data. The available evidence points to significant risk of sexual violence affecting both girls and boys across many geographical and institutional settings. Married adolescent girls are vulnerable to sexual violence by partners in their homes. Children in schools are vulnerable to CSV by peers and adults. Victims seldom disclose incidents and rarely seek support. In addition, early childhood experiences of trauma were strongly associated with later perpetration of sexual violence and revictimization. Limited information is available about protective factors. This review synthesizes evidence about what is currently known about CSV in Indonesia and identifies the strengths and weaknesses of the existing research. A more robust evidence base regarding CSV is required to better inform policy and justify investment into prevention programs.

Simulation Models of Obesity: A Review of the Literature and Implications for Research and Policy

PubMed Central

Levy, David T.; Mabry, Patricia L.; Wang, Y. Claire; Gortmaker, Steve; Huang, Terry T-K; Marsh, Tim; Moodie, Marj; Swinburn, Boyd

2015-01-01

Simulation models (SMs) combine information from a variety of sources to provide a useful tool for examining how the effects of obesity unfold over time and impact population health. SMs can aid in the understanding of the complex interaction of the drivers of diet and activity and their relation to health outcomes. As emphasized in a recently released report of the Institute or Medicine, SMs can be especially useful for considering the potential impact of an array of policies that will be required to tackle the obesity problem. The purpose of this paper is to present an overview of existing SMs for obesity. First, a background section introduces the different types of models, explains how models are constructed, shows the utility of SMs, and discusses their strengths and weaknesses. Using these typologies, we then briefly review extant obesity SMs. We categorize these models according to their focus: health and economic outcomes, trends in obesity as a function of past trends, physiologically-based behavioral models, environmental contributors to obesity, and policy interventions. Finally, we suggest directions for future research. PMID:20973910

Tobacco promotion in the Pacific: the current state of tobacco promotion bans and options for accelerating progress.

PubMed

Cussen, Ashleigh; McCool, Judith

2011-01-01

Tobacco consumption is a major contributor to the burden of chronic noncommunicable disease within the Pacific region. Low and lower-middle income countries are acutely vulnerable to exploitation by the tobacco industry as they often lack the resources and capacity to implement protective tobacco control policies. The Framework Convention on Tobacco Control, which has been signed by 14 Pacific Island Countries and Territories, was introduced in 2004 to guide the priorities for tobacco control policy implementation. Legislation, tobacco industry documents, and peer-reviewed journals were evaluated to assess the current status of tobacco advertising bans of the 8 low and lower-middle income countries within the Pacific region. identified that of the 8 Pacific countries reviewed, 3 had comprehensive tobacco advertising bans that prohibit tobacco advertisements in 5 to 7 forms of media, and the remaining 5 countries have weak tobacco advertising bans that provide no protection for youth against tobacco advertising. This research reveals the need for resources to support the introduction of effective policies around tobacco advertising in the low and lower-middle income countries within the Pacific region.

[The Consiglio Nazionale delle Ricerche (National Research Council - C. N. R.) and the Italian medicine during fascism].

PubMed

Canali, S

2001-01-01

The foundation of C. N. R. in 1923 created in Italy a new public system of research, different from the university one. During fascism, the contribution of C. N. R. to the development of medical research in Italy was very poor. This was mainly due to insufficient means: structures and money. Moreover, the scientists who carried on medical research within the C. N. R. were the same who already held strong university positions, which mean a complete dependence on the academic system. The ideology of fascism also contribute to the weakness of the Italian medical research promoted by the C. N. R.. According to fascist view, science, and for its nature and aims above all medicine, had to addressed to technical, practical, or much better, social achievements. Consequently, the policy of medical research at the C.N.R. was to improve social or political medicine, mainly hygiene. This was in harmony with the demographic policy, which means the policy of reinforcement of "Italian race", and positive eugenics that fascism tried to pursue.

Toward a More Sustainable Trajectory for E-Waste Policy: A Review of a Decade of E-Waste Research in Accra, Ghana.

PubMed

Daum, Kurt; Stoler, Justin; Grant, Richard J

2017-01-29

Global flows of e-waste from the Global North to the Global South continue to damage local environments and harm human health. Weak e-waste regulations and limited use of safety measures for e-waste workers in Accra, Ghana, foster an exploitative environment within the industry, and pose health risks for those working and living near e-waste processing sites. This paper presents an integrated review of over 40 e-waste studies specific to Accra, with particular emphasis on the well-studied e-waste processing site in Agbogbloshie, and synthesizes the existing research base across interdisciplinary themes of human health, environmental health, globalization, trade and informalization, and public policy. Despite significant international attention to Accra's e-waste problem, loopholes within international environmental regulations and treaties provide few incentives and resources for Ghana to strengthen protections for human and environmental health. After a decade of e-waste research in Accra, the crisis continues to intensify; we present a renewed vision for sustainable e-waste policy reform in Ghana and beyond.

Toward a More Sustainable Trajectory for E-Waste Policy: A Review of a Decade of E-Waste Research in Accra, Ghana

PubMed Central

Daum, Kurt; Stoler, Justin; Grant, Richard J.

2017-01-01

Global flows of e-waste from the Global North to the Global South continue to damage local environments and harm human health. Weak e-waste regulations and limited use of safety measures for e-waste workers in Accra, Ghana, foster an exploitative environment within the industry, and pose health risks for those working and living near e-waste processing sites. This paper presents an integrated review of over 40 e-waste studies specific to Accra, with particular emphasis on the well-studied e-waste processing site in Agbogbloshie, and synthesizes the existing research base across interdisciplinary themes of human health, environmental health, globalization, trade and informalization, and public policy. Despite significant international attention to Accra’s e-waste problem, loopholes within international environmental regulations and treaties provide few incentives and resources for Ghana to strengthen protections for human and environmental health. After a decade of e-waste research in Accra, the crisis continues to intensify; we present a renewed vision for sustainable e-waste policy reform in Ghana and beyond. PMID:28146075

Bayesian Markov Chain Monte Carlo inversion for weak anisotropy parameters and fracture weaknesses using azimuthal elastic impedance

NASA Astrophysics Data System (ADS)

Chen, Huaizhen; Pan, Xinpeng; Ji, Yuxin; Zhang, Guangzhi

2017-08-01

A system of aligned vertical fractures and fine horizontal shale layers combine to form equivalent orthorhombic media. Weak anisotropy parameters and fracture weaknesses play an important role in the description of orthorhombic anisotropy (OA). We propose a novel approach of utilizing seismic reflection amplitudes to estimate weak anisotropy parameters and fracture weaknesses from observed seismic data, based on azimuthal elastic impedance (EI). We first propose perturbation in stiffness matrix in terms of weak anisotropy parameters and fracture weaknesses, and using the perturbation and scattering function, we derive PP-wave reflection coefficient and azimuthal EI for the case of an interface separating two OA media. Then we demonstrate an approach to first use a model constrained damped least-squares algorithm to estimate azimuthal EI from partially incidence-phase-angle-stack seismic reflection data at different azimuths, and then extract weak anisotropy parameters and fracture weaknesses from the estimated azimuthal EI using a Bayesian Markov Chain Monte Carlo inversion method. In addition, a new procedure to construct rock physics effective model is presented to estimate weak anisotropy parameters and fracture weaknesses from well log interpretation results (minerals and their volumes, porosity, saturation, fracture density, etc.). Tests on synthetic and real data indicate that unknown parameters including elastic properties (P- and S-wave impedances and density), weak anisotropy parameters and fracture weaknesses can be estimated stably in the case of seismic data containing a moderate noise, and our approach can make a reasonable estimation of anisotropy in a fractured shale reservoir.

Human resources for health policies: a critical component in health policies

PubMed Central

Dussault, Gilles; Dubois, Carl-Ardy

2003-01-01

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH): • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR) policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms. PMID:12904254

Human resources for health policies: a critical component in health policies.

PubMed

Dussault, Gilles; Dubois, Carl-Ardy

2003-04-14

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM.There are three broad arguments for modernizing the ways in which human resources for health are managed:bullet; the central role of the workforce in the health sector;bullet; the various challenges thrown up by health system reforms;bullet; the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems.The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs.Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH):bullet; to move beyond the traditional approach of personnel administration to a more global concept of HRM;bullet; to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy;bullet; to foster a more proactive attitude among human resources (HR) policy-makers and managers;bullet; to promote the full commitment of all professionals and sectors in all phases of the process.The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms.

On the local well-posedness of Lovelock and Horndeski theories

NASA Astrophysics Data System (ADS)

Papallo, Giuseppe; Reall, Harvey S.

2017-08-01

We investigate local well-posedness of the initial value problem for Lovelock and Horndeski theories of gravity. A necessary condition for local well-posedness is strong hyperbolicity of the equations of motion. Even weak hyperbolicity can fail for strong fields so we restrict to weak fields. The Einstein equation is known to be strongly hyperbolic in harmonic gauge so we study Lovelock theories in harmonic gauge. We show that the equation of motion is always weakly hyperbolic for weak fields but, in a generic weak-field background, it is not strongly hyperbolic. For Horndeski theories, we prove that, for weak fields, the equation of motion is always weakly hyperbolic in any generalized harmonic gauge. For some Horndeski theories there exists a generalized harmonic gauge for which the equation of motion is strongly hyperbolic in a weak-field background. This includes "k-essence" like theories. However, for more general Horndeski theories, there is no generalized harmonic gauge for which the equation of motion is strongly hyperbolic in a generic weak-field background. Our results show that the standard method used to establish local well-posedness of the Einstein equation does not extend to Lovelock or general Horndeski theories. This raises the possibility that these theories may not admit a well-posed initial value problem even for weak fields.

Weak values, quantum trajectories, and the cavity-QED experiment on wave-particle correlation

NASA Astrophysics Data System (ADS)

Wiseman, H. M.

2002-03-01

Weak values as introduced by Aharonov, Albert, and Vaidman (AAV) are ensemble-average values for the results of weak measurements. They are interesting when the ensemble is preselected on a particular initial state and postselected on a particular final measurement result. It is shown that weak values arise naturally in quantum optics, as weak measurements occur whenever an open system is monitored (as by a photodetector). The quantum-trajectory theory is used to derive a generalization of AAV's formula to include (a) mixed initial conditions, (b) nonunitary evolution, (c) a generalized (nonprojective) final measurement, and (d) a non-back-action-evading weak measurement. This theory is applied to the recent cavity-QED experiment demonstrating wave particle duality [G. T. Foster, L. A. Orozco, H. M. Castro-Beltran, and H. J. Carmichael, Phys. Rev. Lett. 85, 3149 (2000)]. It is shown that the ``fractional-order'' correlation function measured in that experiment can be recast as a weak value in a form as simple as that introduced by AAV.

Good governance in national solid waste management policy (NSWMP) implementation: A case study of Malaysia

NASA Astrophysics Data System (ADS)

Wee, Seow Ta; Abas, Muhamad Azahar; Mohamed, Sulzakimin; Chen, Goh Kai; Zainal, Rozlin

2017-10-01

The National Solid Waste Management Policy (NSWMP) was introduced in 2007 under the Act 672. The execution of NSWMP involves stakeholders from various government agencies and a collaboration with the private sectors. Despite the initiatives taken by the stakeholders, the objectives of NSWMP failed to materialise. One of the major constraints is weak governance among stakeholders with regards to the NSWMP implementation. This paper will explore the good governance practices implemented by the stakeholders. Identifying the current good governance practices implemented by the stakeholders is crucial as it will serve as a guideline to improve good governance practice in the future. An exploratory research approach is applied in this study through in-depth interviews with several government agencies and concessionaires involved in the NSWMP implementation. A total of six respondents took part in this study. The findings of this study show that there are several good governance practices implemented in policy promotion, participation of stakeholders, and capacity enhancement programme for the staff. This study also proposed some points on good governance practices in the context of policy promotion and staff development. A paradigm shift by the stakeholders is imperative so as to enhance the good governance practice in NSWMP implementation towards an efficient solid waste management in Malaysia.

The interplay between policy guidelines and local dynamics in shaping the scope of networks: the experience of the Italian Departments of Mental Health.

PubMed

Compagni, Amelia; Gerzeli, Simone; Bergamaschi, Mara

2011-02-01

In the mental health field, the creation of networks that can guarantee the smooth coordination of services and organizations across sectors is a priority in the policy agenda of several countries. In Italy, Departments of Mental Health (DMHs) have been designated responsible for the system of specialist mental health services, and also mandated as the conveners and leaders of interorganizational and cross-sectoral networks, by a system-wide reform. This study aims to understand how mental health networks have been assembled in this context and the factors and motivations that have shaped their scope. By combining an analysis of policies with a survey of DMH directors, we have determined that DMHs have preferentially formed collaborative relationships with social service providers (local governments) and the voluntary sector. In contrast, relationships with substance abuse and addiction services and primary care providers were weak and stifled by a lack of trust and by conflict about respective contributions to mental care. We explore the reasons for this selectivity in interorganizational relationships and propose that a lack of targeted incentives in policy guidelines, on the one hand, and the existence of a mandated network leadership, on the other, have led to a rather narrow range of collaborations.

Correlates of State Enactment of Elementary School Physical Education Laws

PubMed Central

Monnat, Shannon M.; Lounsbery, Monica A.F.; Smith, Nicole J.

2014-01-01

Objective To describe variation in U.S. state elementary school physical education (PE) policies and to assess associations between state PE policy enactment and education funding, academic achievement, sociodemographic disadvantage, and political characteristics. Methods U.S. state laws regarding school PE time, staffing, curriculum, fitness assessment, and moderate-to-vigorous physical activity (MVPA) in 2012 were classified as strong/specific, weak/nonspecific, or none based on codified law ratings within the Classification of Laws Associated with School Students (C.L.A.S.S.). Laws were merged with state-level data from multiple sources. Logistic regression was used to determine associations between state characteristics and PE laws (N=51). Results Laws with specific PE and MVPA time requirements and evidence-based curriculum standards were more likely in states with low academic performance and in states with sociodemographically disadvantaged populations. School day length was positively associated with enacting a PE curriculum that referenced evidence-based standards. School funding and political characteristics were not associated with PE laws. Conclusions Limited time and high-stakes testing requirements force schools to prioritize academic programs, posing barriers to state passage of specific PE laws. To facilitate PE policy enactment, it may be necessary to provide evidence of how PE policies can be implemented within existing time and staffing structures. PMID:25230368

Correlates of state enactment of elementary school physical education laws.

PubMed

Monnat, Shannon M; Lounsbery, Monica A F; Smith, Nicole J

2014-12-01

To describe variation in U.S. state elementary school physical education (PE) policies and to assess associations between state PE policy enactment and education funding, academic achievement, sociodemographic disadvantage, and political characteristics. U.S. state laws regarding school PE time, staffing, curriculum, fitness assessment, and moderate-to-vigorous physical activity (MVPA) in 2012 were classified as strong/specific, weak/nonspecific, or none based on codified law ratings within the Classification of Laws Associated with School Students (C.L.A.S.S.). Laws were merged with state-level data from multiple sources. Logistic regression was used to determine associations between state characteristics and PE laws (N=51). Laws with specific PE and MVPA time requirements and evidence-based curriculum standards were more likely in states with low academic performance and in states with sociodemographically disadvantaged populations. School day length was positively associated with enacting a PE curriculum that referenced evidence-based standards. School funding and political characteristics were not associated with PE laws. Limited time and high-stake testing requirements force schools to prioritize academic programs, posing barriers to state passage of specific PE laws. To facilitate PE policy enactment, it may be necessary to provide evidence on how PE policies can be implemented within existing time and staffing structures. Copyright © 2014 Elsevier Inc. All rights reserved.

Systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care.

PubMed

Fluke, John D; Goldman, Philip S; Shriberg, Janet; Hillis, Susan D; Yun, Katherine; Allison, Susannah; Light, Enid

2012-10-01

This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries. For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers. For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care. Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design. Copyright © 2012 Elsevier Ltd. All rights reserved.

Variation in school health policies and programs by demographic characteristics of US schools, 2006.

PubMed

Balaji, Alexandra B; Brener, Nancy D; McManus, Tim

2010-12-01

To identify whether school health policies and programs vary by demographic characteristics of schools, using data from the School Health Policies and Programs Study (SHPPS) 2006. This study updates a similar study conducted with SHPPS 2000 data and assesses several additional policies and programs measured for the first time in SHPPS 2006. SHPPS 2006 assessed the status of 8 components of the coordinated school health model using a nationally representative sample of public, Catholic, and private schools at the elementary, middle, and high school levels. Data were collected from school faculty and staff using computer-assisted personal interviews and then linked with extant data on school characteristics. Results from a series of regression analyses indicated that a number of school policies and programs varied by school type (public, Catholic, or private), urbanicity, school size, discretionary dollars per pupil, percentage of white students, percentage of students qualifying for free lunch funds, and, among high schools, percentage of college-bound students. Catholic and private schools, smaller schools, and those with low discretionary dollars per pupil did not have as many key school health policies and programs as did schools that were public, larger, and had higher discretionary dollars per pupil. However, no single type of school had all key components of a coordinated school health program in place. Although some categories of schools had fewer policies and programs in place, all had both strengths and weaknesses. Regardless of school characteristics, all schools have the potential to implement a quality school health program. © Published 2010. This article is a US Government work and is in the public domain in the USA.

Hospital-Physician Collaboration: Landscape of Economic Integration and Impact on Clinical Integration

PubMed Central

Burns, Lawton Robert; Muller, Ralph W

2008-01-01

Context Hospital-physician relationships (HPRs) are an important area of academic research, given their impact on hospitals' financial success. HPRs also are at the center of several federal policy proposals such as gain sharing, bundled payments, and pay-for-performance (P4P). Methods This article analyzes the HPRs that focus on the economic integration of hospitals and physicians and the goals that HPRs are designed to achieve. It then reviews the literature on the impact of HPRs on cost, quality, and clinical integration. Findings The goals of the two parties in HPRs overlap only partly, and their primary aim is not reducing cost or improving quality. The evidence base for the impact of many models of economic integration is either weak or nonexistent, with only a few models of economic integration having robust effects. The relationship between economic and clinical integration also is weak and inconsistent. There are several possible reasons for this weak linkage and many barriers to further integration between hospitals and physicians. Conclusions Successful HPRs may require better financial conditions for physicians, internal changes to clinical operations, application of behavioral skills to the management of HPRs, changes in how providers are paid, and systemic changes encompassing several types of integration simultaneously. PMID:18798884

Policies | High-Performance Computing | NREL

Science.gov Websites

Use Learn about policy governing user accountability, resource use, use by foreign nationals states. Data Security Learn about the data security policy, including data protection, data security retention policy, including project-centric and user-centric data. Shared Storage Usage Learn about a policy

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: systematic review.

PubMed

Semrau, Maya; Lempp, Heidi; Keynejad, Roxanne; Evans-Lacko, Sara; Mugisha, James; Raja, Shoba; Lamichhane, Jagannath; Alem, Atalay; Thornicroft, Graham; Hanlon, Charlotte

2016-03-01

The involvement of mental health service users and their caregivers in health system policy and planning, service monitoring and research can contribute to mental health system strengthening, but as yet there have been very few efforts to do so in low- and middle-income countries (LMICs). This systematic review examined the evidence and experience of service user and caregiver involvement in mental health system strengthening, as well as models of best practice for evaluation of capacity-building activities that facilitate their greater participation. Both the peer-reviewed and the grey literature were included in the review, which were identified through database searches (MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, SciELO, Google Scholar and Cochrane), as well as hand-searching of reference lists and the internet, and a snowballing process of contacting experts active in the area. This review included any kind of study design that described or evaluated service user, family or caregiver (though not community) involvement in LMICs (including service users with intellectual disabilities, dementia, or child and adolescent mental health problems) and that were relevant to mental health system strengthening across five categories. Data were extracted and summarised as a narrative review. Twenty papers matched the inclusion criteria. Overall, the review found that although there were examples of service user and caregiver involvement in mental health system strengthening in numerous countries, there was a lack of high-quality research and a weak evidence base for the work that was being conducted across countries. However, there was some emerging research on the development of policies and strategies, including advocacy work, and to a lesser extent the development of services, service monitoring and evaluation, with most service user involvement having taken place within advocacy and service delivery. Research was scarce within the other health system strengthening areas. Further research on service user and caregiver involvement in mental health system strengthening in LMICs is recommended, in particular research that includes more rigorous evaluation. A series of specific recommendations are provided based on the review.

FAA computer security : concerns remain due to personnel and other continuing weaknesses

DOT National Transportation Integrated Search

2000-08-01

FAA has a history of computer security weaknesses in a number of areas, including its physical security management at facilities that house air traffic control (ATC) systems, systems security for both operational and future systems, management struct...

Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda.

PubMed

Nabyonga Orem, Juliet; Marchal, Bruno; Mafigiri, DavidKaawa; Ssengooba, Freddie; Macq, Jean; Da Silveira, Valeria Campos; Criel, Bart

2013-08-19

Stakeholder roles in the application of evidence are influenced by context, the nature of the evidence, the policy development process, and stakeholder interactions. Past research has highlighted the role of stakeholders in knowledge translation (KT) without paying adequate attention to the peculiarities of low-income countries. Here we identify the roles, relations, and interactions among the key stakeholders involved in KT in Uganda and the challenges that they face. This study employed qualitative approaches to examine the roles of and links among various stakeholders in KT. In-depth interviews were conducted with 21 key informants and focused on the key actors in KT, their perceived roles, and challenges. Major stakeholders included civil society organizations with perceived roles of advocacy, community mobilization, and implementation. These stakeholders may ignore unconvincing evidence. The community's role was perceived as advocacy and participation in setting research priorities. The key role of the media was perceived as knowledge dissemination, but respondents noted that the media may misrepresent evidence if it is received in a poorly packaged form. The perceived roles of policy makers were evidence uptake, establishing platforms for KT and stewardship; negative roles included ignoring or even misrepresenting evidence that is not in their favor. The roles of parliamentarians were perceived as advocacy and community mobilization, but they were noted to pursue objectives that may not be supported by the evidence. The researchers' main role was defined as evidence generation, but focusing disproportionately on academic interests was cited as a concern. The donors' main role was defined as funding research and KT, but respondents were concerned about the local relevance of donor-supported research. Respondents reported that links among stakeholders were weak due to the absence of institutionalized, inclusive platforms. Challenges facing the stakeholders in the process of KT were identified. Our investigation revealed the need to consider the roles that various stakeholders are best placed to play. Links and necessary platforms must be put in place to achieve synergy in KT. Relevant capacities need to be built to overcome the challenges faced by the various stakeholders.

Policymakers' experience of a capacity-building intervention designed to increase their use of research: a realist process evaluation.

PubMed

Haynes, Abby; Brennan, Sue; Redman, Sally; Williamson, Anna; Makkar, Steve R; Gallego, Gisselle; Butow, Phyllis

2017-11-23

An intervention's success depends on how participants interact with it in local settings. Process evaluation examines these interactions, indicating why an intervention was or was not effective, and how it (and similar interventions) can be improved for better contextual fit. This is particularly important for innovative trials like Supporting Policy In health with Research: an Intervention Trial (SPIRIT), where causal mechanisms are poorly understood. SPIRIT was testing a multi-component intervention designed to increase the capacity of health policymakers to use research. Our mixed-methods process evaluation sought to explain variation in observed process effects across the six agencies that participated in SPIRIT. Data collection included observations of intervention workshops (n = 59), purposively sampled interviews (n = 76) and participant feedback forms (n = 553). Using a realist approach, data was coded for context-mechanism-process effect configurations (retroductive analysis) by two authors. Intervention workshops were very well received. There was greater variation of views regarding other aspects of SPIRIT such as data collection, communication and the intervention's overall value. We identified nine inter-related mechanisms that were crucial for engaging participants in these policy settings: (1) Accepting the premise (agreeing with the study's assumptions); (2) Self-determination (participative choice); (3) The Value Proposition (seeing potential gain); (4) 'Getting good stuff' (identifying useful ideas, resources or connections); (5) Self-efficacy (believing 'we can do this!'); (6) Respect (feeling that SPIRIT understands and values one's work); (7) Confidence (believing in the study's integrity and validity); (8) Persuasive leadership (authentic and compelling advocacy from leaders); and (9) Strategic insider facilitation (local translation and mediation). These findings were used to develop tentative explanatory propositions and to revise the programme theory. This paper describes how SPIRIT functioned in six policy agencies, including why strategies that worked well in one site were less effective in others. Findings indicate a complex interaction between participants' perception of the intervention, shifting contextual factors, and the form that the intervention took in each site. Our propositions provide transferable lessons about contextualised areas of strength and weakness that may be useful in the development and implementation of similar studies.

Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions.

PubMed

Warren, Charlotte E; Njue, Rebecca; Ndwiga, Charity; Abuya, Timothy

2017-03-28

Disrespect and abuse or mistreatment of women by health care providers in maternity settings has been identified as a key deterrent to women seeking delivery care. Mistreatment includes physical and verbal abuse, stigma and discrimination, a poor relationship between women and providers and policy and health systems challenges. This paper uses qualitative data to describe mistreatment of women in Kenya. Data are drawn from implementation research conducted in 13 facilities and communities. Researchers conducted a range of in-depth interviews with women (n-50) who had given birth in a facility policy makers health managers and providers (n-63); and focus group discussions (19) with women and men living around study facilities. Data were captured on paper and audio tapes, transcribed and translated and exported into Nvivo for analysis. Subsequently we applied a typology of mistreatment which includes first order descriptive themes, second and third-order analytical themes. Final analysis was organized around description of the nature, manifestations and experiences, and factors contributing to mistreatment. Women describe: their negative experiences of childbirth; frustration with lack of confidentiality and autonomy; abandonment by the providers, and dirty maternity units. Providers admit to challenges but describe reasons for apparent abuse (slapped on thighs to encourage women to focus on birthing process) and 'detention' is because relatives have abandoned them. Men try to overcome challenges by paying providers to ensure they look after their wives. Drivers of mistreatment are perpetuated by social and gender norms at family and community levels. At facility level, poor managerial oversight, provider demotivation, and lack of equipment and supplies, contribute to a poor experience of care. Weak or non-existent legal redress perpetuate the problem. This paper builds on the expanding literature on mistreatment during labour and childbirth -outlining drivers from an individual, family, community, facility and policy level. New frameworks to group the manifestations into themes or components makes it increasingly more focused on specific interventions to promote respectful maternity care. The Kenya findings resonate with budding literature - demonstrating that this is indeed a global issue that needs a global solution.

[Correlation factors of 127 times pre-crisis state in patients with myasthenia gravis].

PubMed

Ou, C Y; Ran, H; Qiu, L; Huang, Z D; Lin, Z Z; Deng, J; Liu, W B

2017-10-10

Objective: To investigate the clinical features of the Pre-Crisis State and analyze the correlated risk factors of Pre-Crisis State of myasthenia crisis. Methods: We included 93 patients with myasthenia gravis (MG) who experienced 127 times Pre-Crisis State between October 2007 and July 2016. Those patients were hospitalized in the MG specialize center, Department of Neurological Science, first Affiliated Hospital of Sun Yat-sen University. The information of the general situation, the clinical manifestations and the blood gas analysis in those patients were collected using our innovated clinical research form. Statistic methods were applied including descriptive analysis, univariate logistic analysis, multivariate correlation logistic analysis, etc. Results: (1)The typical features of MG Pre-Crisis State included: dyspnea (127 times, 100% not requiring intubation or non-invasive ventilation), bulbar-muscle weakness (121 times, 95.28%), the increased blood partial pressure of carbon dioxide (PCO(2)) (94 times, 85.45%), expectoration weakness (99 times, 77.95%), sleep disorders (107 times, 84.25%) and the infection (99 times, 77.95%). The occurrence of dyspnea in combination with bulbar-muscle weakness ( P =0.002) or the increased blood PCO(2) ( P =0.042) often indicated the tendency of crisis. (2) The MG symptoms which were proportion to the occurrence of crisis includes: bulbar-muscle weakness ( P =0.028), fever ( P =0.028), malnutrition ( P =0.066), complications ( P =0.071), excess oropharyngeal secretions ( P =0.005) and the increased blood PCO(2) ( P =0.007). The perioperative period of thymectomy would not increase the risk of crisis. Conclusions: Dyspnea indicates the occurrence of the Pre-Crisis State of MG. In order to significantly reduce the morbidity of myasthenia crisis, the bulbar-muscle weakness, the increased blood PCO(2), expectoration weakness, sleep disorders, infection & fever and excess oropharyngeal secretions should be treated timely.

Evaluation of the Master’s curriculum for elderly nursing: a qualitative study

PubMed Central

Ghaffari, Fatemeh; Dehghan-Nayeri, Nahid; Navabi, Nasrin; Seylani, Khatereh

2016-01-01

Background Improving the quality of health care and rehabilitation for the elderly is one of the most important priorities of the health care system. Given the importance of evaluating the strengths and weaknesses of any program after its implementation, this study was conducted to identify the advantages and weaknesses of a geriatric nursing program at Tehran University of Medical Sciences. Methods This was a qualitative study, and the study population comprised students, graduates, and professors of geriatric nursing at the Master of Science level. Data were collected through face-to-face interviews and focus groups. Sixteen interviews were conducted. The interview guide was used as a research tool. Interviews continued until data saturation was reached. Conventional content analysis was used to analyze the data. Results Three main themes including “motivation to enter geriatric nursing”, “lack of employment groundwork”, and “lack of practical implementation of the curriculum” were the main findings of the study. Conclusion Efforts to restructure the administrative system and employment can deter geriatric nursing students from simply earning a degree and actually encourage them to learn the required content. Appraisal and improvement of education facilities for student recruitment can guarantee the practical implementation of the curriculum. Drafting policies to attract graduates in clinical environments, opening up employment opportunities, providing organizational positions for the recruitment of this group, as well as dedicating some wards for elderly special care and providing nursing care to elderly people only can increase students’ motivation to learn and their hopes of good job prospects. PMID:27713624

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities.

PubMed

Zajicek-Farber, Michaela L; Lotrecchiano, Gaetano R; Long, Toby M; Farber, Jon Matthew

2015-08-01

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

Interventions to reduce social isolation and loneliness among older people: an integrative review.

PubMed

Gardiner, Clare; Geldenhuys, Gideon; Gott, Merryn

2018-03-01

Loneliness and social isolation are major problems for older adults. Interventions and activities aimed at reducing social isolation and loneliness are widely advocated as a solution to this growing problem. The aim of this study was to conduct an integrative review to identify the range and scope of interventions that target social isolation and loneliness among older people, to gain insight into why interventions are successful and to determine the effectiveness of those interventions. Six electronic databases were searched from 2003 until January 2016 for literature relating to interventions with a primary or secondary outcome of reducing or preventing social isolation and/or loneliness among older people. Data evaluation followed Evidence for Policy and Practice Information and Co-ordinating Centre guidelines and data analysis was conducted using a descriptive thematic method for synthesising data. The review identified 38 studies. A range of interventions were described which relied on differing mechanisms for reducing social isolation and loneliness. The majority of interventions reported some success in reducing social isolation and loneliness, but the quality of evidence was generally weak. Factors which were associated with the most effective interventions included adaptability, a community development approach, and productive engagement. A wide range of interventions have been developed to tackle social isolation and loneliness among older people. However, the quality of the evidence base is weak and further research is required to provide more robust data on the effectiveness of interventions. Furthermore, there is an urgent need to further develop theoretical understandings of how successful interventions mediate social isolation and loneliness. © 2016 John Wiley & Sons Ltd.

Industry Speed Bumps on Local Tobacco Control in Japan? The Case of Hyogo.

PubMed

Yamada, Keiko; Mori, Nagisa; Kashiwabara, Mina; Yasuda, Sakiko; Horie, Rumi; Yamato, Hiroshi; Garçon, Loic; Armada, Francisco

2015-01-01

Despite being a signatory since 2004, Japan has not yet fully implemented Article 8 of the World Health Organization's Framework Convention on Tobacco Control regarding 100% protection against exposure to second-hand smoke (SHS). The Japanese government still recognizes designated smoking rooms (DSRs) in public space as a valid control measure. Furthermore, subnational initiatives for tobacco control in Japan are of limited effectiveness. Through an analysis of the Hyogo initiative in 2012, we identified key barriers to the achievement of a smoke-free environment. Using a descriptive case-study approach, we analyzed the smoke-free policy development process. The information was obtained from meeting minutes and other gray literature, such as public records, well as key informant interviews. Hyogo Prefecture established a committee to propose measures against SHS, and most committee members agreed with establishing completely smoke-free environments. However, the hospitality sector representatives opposed regulation, and tobacco companies were allowed to make a presentation to the committee. Further, political power shifted against completely smoke-free environments in the context of upcoming local elections, which was an obvious barrier to effective regulation. Throughout the approving process, advocacy by civil society for stronger regulation was weak. Eventually, the ordinance approved by the Prefectural Assembly was even weaker than the committee proposal and included wide exemptions. The analysis of Hyogo's SHS control initiative shed light on three factors that present challenges to implementing tobacco control regulations in Japan, from which other countries can also draw lessons: incomplete national legislation, the weakness of advocacy by the civil society, and the interference of the tobacco industry.

The Role of Stigma and Denormalization in Suicide-Prevention Laws in East Asia: A Sociocultural, Historical, and Ethical Perspective.

PubMed

Chen, Justin A; Courtwright, Andrew; Wu, Kevin Chien-Chang

In many Western countries, the criminalization and stigmatization of suicide has given way to a biomedical approach aimed at destigmatizing suicide and treating underlying mental illness. By contrast, in many East Asian countries, suicide has never historically been criminalized or stigmatized. High rates of suicide in Japan, South Korea, and Taiwan have recently led policy makers in those countries to pursue innovative suicide-prevention strategies. The intentional denormalization of harmful behaviors has been discussed in the public health and ethics literatures, particularly with regard to smoking cessation, and could represent a novel mechanism for preventing suicides in East Asia. Using examples from the sociocultural, historical, and legal discourses surrounding suicide in Western and East Asian contexts, we suggest that denormalization can be a justified, culturally relevant suicide-prevention strategy, but that care must be taken to avoid shaming or stigmatizing suicidal individuals. Specifically, we propose the term weak denormalization to refer to an ethically permissible strategy at the mildest end of a spectrum of denormalizing approaches-milder than the reintegrative shaming described in the criminal justice literature, and diametrically opposed to outright stigmatization, which is generally considered ethically impermissible. Given the severe stigma of mental illness in East Asia, adopting the dominant Western view of suicide as solely a psychiatric concern would not be justified. Weak denormalization strategies in East Asia should be culturally tailored and rigorously tested on a small scale. They should include social supports, praise for the bravery of those of who seek help, and strategies to reduce shame regarding perceived social failure.

What do medicine clerkship preceptors do best?

PubMed

Mazor, Kathleen M; Stone, Sarah L; Carlin, Michele; Alper, Eric

2002-08-01

Students' ratings of preceptors are widely used in medical education for feedback and evaluation purposes. The present study investigated students' ratings of the clinical teaching skills of inpatient attending physicians, inpatient residents, and outpatient attending physicians to assess differences among types of preceptors and relative strengths and weaknesses. A total of 268 students from three academic years (1997-2000) at one medical school rated preceptors on an end-of-clerkship evaluation, for a total of 1,680 ratings. When the ratings were aggregated by preceptors' names and types, there were 691 mean ratings of preceptors. Relative strengths and weaknesses were identified. Differences in mean ratings by preceptor type (inpatient attending physician, inpatient resident, and outpatient attending physician) were evaluated, and strengths and weaknesses were identified by rank ordering the items' means. Students tended to rate outpatient attending physicians higher than inpatient attending physicians or residents. Areas where ratings suggested relative strengths included showing an interest in teaching, respecting students' opinions, and being available to students. Areas of relative weakness included increasing physical examination and interviewing skills. Students' ratings are useful for identifying strengths and weakness for groups of preceptors and, as such, are important sources of information for setting priorities for faculty development efforts.

Social support and the working hours of employed mothers in Europe: The relevance of the state, the workplace, and the family.

PubMed

Abendroth, Anja-Kristin; van der Lippe, Tanja; Maas, Ineke

2012-05-01

This paper studies the influence of state, workplace, and family support on the working hours of employed mothers and how these different support sources interact. Data taken from the European Social Survey 2004/2005 as well as country-specific information were used to estimate several hierarchical models. We find evidence that the availability of supportive workplace arrangements and family support positively impact the working hours of employed mothers and that state policies facilitating the traditional family have a negative effect. There is weak support for a positive relationship between state policies facilitating the dual-earner family and working hours of employed mothers. In addition, most of the sources of support appear to be complementary. Supportive family role models and supportive workplace arrangements have a reinforcing relationship, as do publicly funded child care and supportive workplace arrangements. Copyright © 2012 Elsevier Inc. All rights reserved.