Sample records for priority setting success
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Priority setting: what constitutes success? A conceptual framework for successful priority setting.
Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K
2009-03-05
The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.
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Setting priorities in health care organizations: criteria, processes, and parameters of success.
Gibson, Jennifer L; Martin, Douglas K; Singer, Peter A
2004-09-08
Hospitals and regional health authorities must set priorities in the face of resource constraints. Decision-makers seek practical ways to set priorities fairly in strategic planning, but find limited guidance from the literature. Very little has been reported from the perspective of Board members and senior managers about what criteria, processes and parameters of success they would use to set priorities fairly. We facilitated workshops for board members and senior leadership at three health care organizations to assist them in developing a strategy for fair priority setting. Workshop participants identified 8 priority setting criteria, 10 key priority setting process elements, and 6 parameters of success that they would use to set priorities in their organizations. Decision-makers in other organizations can draw lessons from these findings to enhance the fairness of their priority setting decision-making. Lessons learned in three workshops fill an important gap in the literature about what criteria, processes, and parameters of success Board members and senior managers would use to set priorities fairly.
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Priority setting: what constitutes success? A conceptual framework for successful priority setting
Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K
2009-01-01
Background The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Methods Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). Results This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. Conclusion The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts. PMID:19265518
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Implementing priority setting frameworks: Insights from leading researchers.
Angell, Blake; Pares, Jennie; Mooney, Gavin
2016-12-01
In spite of a substantial literature developing frameworks for policymakers to use in resource allocation decisions in healthcare, there remains limited published work reporting on the implementation or evaluation of such frameworks in practice. This paper presents findings of a targeted survey of 18 leading researchers around the implementation and evaluation of priority-setting exercises. Approximately one third of respondents knew of situations where recommendations of priority-setting exercises had been implemented, one third knew that recommendations had not been implemented and the final third responded that they did not know whether recommendations had been adopted. The lack of evidence linking the implementation of priority-setting recommendations to equity and efficiency outcomes was highlighted by all respondents. Features identified as facilitating successful implementation of priority-setting recommendations included having a climate ready to accept priority-setting, good leadership or a 'champion' for the priority-setting process and having a health economist to guide the process. Successful disinvestment was very uncommon in the experience of the researchers surveyed. Recommendations emerging from Program Budgeting and Marginal Analysis exercises appeared to be more widely implemented than those coming from alternative processes. Identifying if the process was repeated following the initial process was suggested as a means to measure success. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Setting Priorities: Personal Values, Organizational Results. Ideas into Action Guidebooks
ERIC Educational Resources Information Center
Cartwright, Talula
2007-01-01
Successful leaders get results. To get results, you need to set priorities. This book can help you do a better job of setting priorities, recognizing the personal values that motivate your decision making, the probable trade-offs and consequences of your decisions, and the importance of aligning your priorities with your organization's…
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Cornelissen, Evelyn; Mitton, Craig; Davidson, Alan; Reid, Colin; Hole, Rachelle; Visockas, Anne-Marie; Smith, Neale
2014-08-01
Techniques to manage scarce healthcare resources continue to evolve in response to changing, growing and competing demands. Yet there is no standard definition in the priority setting literature of what might constitute the desired impact or success of resource management activities. In this 2006-09 study, using action research methodology, we determined the impact of implementing a formal priority setting model, Program Budgeting and Marginal Analysis (PBMA), in a Canadian health authority. Qualitative data were collected through post year-1 (n = 12) and year-2 (n = 9) participant interviews, meeting observation and document review. Interviews were analyzed using a constant comparison technique to identify major themes. Impact can be defined as effects at three levels: system, group, and individual. System-level impact can be seen in the actual selection of priorities and resource re-allocation. In this case, participants prioritized a list of $760,000 worth of investment proposals and $38,000 of disinvestment proposals; however, there was no clear evidence as to whether financial resources were reallocated as a result. Group and individual impacts, less frequently reported in the literature, included changes in priority setting knowledge, attitudes and practice. PBMA impacts at these three levels were found to be interrelated. This work argues in favor of attempts to expand the definition of priority setting success by including both desired system-level outcomes like resource re-allocation and individual or group level impacts like changes to priority setting knowledge, attitudes and practice. These latter impacts are worth pursuing as they appear to be intrinsic to successful system-wide priority setting. A broader definition of PBMA impact may also suggest conceptualizing PBMA as both a priority setting approach and as a tool to develop individual and group priority setting knowledge and practice. These results should be of interest to researchers and decision makers using or considering a formal priority setting approach to manage scarce healthcare resources. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Essue, Beverley M; Kapiriri, Lydia
2018-02-20
The double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and development priority. However, there are challenges for translating this global priority into local priorities and action. The aim of this study was to evaluate the influence of national, sub-national and global factors on priority setting for noncommunicable disease control in Uganda and examine the extent to which priority setting was successful. A mixed methods design that used the Kapiriri & Martin framework for evaluating priority setting in low income countries. The evaluation period was 2005-2015. Data collection included a document review (policy documents (n = 19); meeting minutes (n = 28)), media analysis (n = 114) and stakeholder interviews (n = 9). Data were analysed according to the Kapiriri & Martin (2010) framework. Priority setting for noncommunicable diseases was not entirely fair nor successful. While there were explicit processes that incorporated relevant criteria, evidence and wide stakeholder involvement, these criteria were not used systematically or consistently in the contemplation of noncommunicable diseases. There were insufficient resources for noncommunicable diseases, despite being a priority area. There were weaknesses in the priority setting institutions, and insufficient mechanisms to ensure accountability for decision-making. Priority setting was influenced by the priorities of major stakeholders (i.e. development assistance partners) which were not always aligned with national priorities. There were major delays in the implementation of noncommunicable disease-related priorities and in many cases, a failure to implement. This evaluation revealed the challenges that low income countries are grappling with in prioritizing noncommunicable diseases in the context of a double disease burden with limited resources. Strengthening local capacity for priority setting would help to support the development of sustainable and implementable noncommunicable disease-related priorities. Global support (i.e. aid) to low income countries for noncommunicable diseases must also catch up to align with NCDs as a global health priority.
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Chitama, Dereck; Baltussen, Rob; Ketting, Evert; Kamazima, Switbert; Nswilla, Anna; Mujinja, Phares G M
2011-10-21
Successful priority setting is increasingly known to be an important aspect in achieving better family planning, maternal, newborn and child health (FMNCH) outcomes in developing countries. However, far too little attention has been paid to capturing and analysing the priority setting processes and criteria for FMNCH at district level. This paper seeks to capture and analyse the priority setting processes and criteria for FMNCH at district level in Tanzania. Specifically, we assess the FMNCH actor's engagement and understanding, the criteria used in decision making and the way criteria are identified, the information or evidence and tools used to prioritize FMNCH interventions at district level in Tanzania. We conducted an exploratory study mixing both qualitative and quantitative methods to capture and analyse the priority setting for FMNCH at district level, and identify the criteria for priority setting. We purposively sampled the participants to be included in the study. We collected the data using the nominal group technique (NGT), in-depth interviews (IDIs) with key informants and documentary review. We analysed the collected data using both content analysis for qualitative data and correlation analysis for quantitative data. We found a number of shortfalls in the district's priority setting processes and criteria which may lead to inefficient and unfair priority setting decisions in FMNCH. In addition, participants identified the priority setting criteria and established the perceived relative importance of the identified criteria. However, we noted differences exist in judging the relative importance attached to the criteria by different stakeholders in the districts. In Tanzania, FMNCH contents in both general development policies and sector policies are well articulated. However, the current priority setting process for FMNCH at district levels are wanting in several aspects rendering the priority setting process for FMNCH inefficient and unfair (or unsuccessful). To improve district level priority setting process for the FMNCH interventions, we recommend a fundamental revision of the current FMNCH interventions priority setting process. The improvement strategy should utilize rigorous research methods combining both normative and empirical methods to further analyze and correct past problems at the same time use the good practices to improve the current priority setting process for FMNCH interventions. The suggested improvements might give room for efficient and fair (or successful) priority setting process for FMNCH interventions.
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Setting research priorities by applying the combined approach matrix.
Ghaffar, Abdul
2009-04-01
Priority setting in health research is a dynamic process. Different organizations and institutes have been working in the field of research priority setting for many years. In 1999 the Global Forum for Health Research presented a research priority setting tool called the Combined Approach Matrix or CAM. Since its development, the CAM has been successfully applied to set research priorities for diseases, conditions and programmes at global, regional and national levels. This paper briefly explains the CAM methodology and how it could be applied in different settings, giving examples and describing challenges encountered in the process of setting research priorities and providing recommendations for further work in this field. The construct and design of the CAM is explained along with different steps needed, including planning and organization of a priority-setting exercise and how it could be applied in different settings. The application of the CAM are described by using three examples. The first concerns setting research priorities for a global programme, the second describes application at the country level and the third setting research priorities for diseases. Effective application of the CAM in different and diverse environments proves its utility as a tool for setting research priorities. Potential challenges encountered in the process of research priority setting are discussed and some recommendations for further work in this field are provided.
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Waldau, Susanne; Lindholm, Lars; Wiechel, Anna Helena
2010-08-01
In the Västerbotten County Council in Sweden a priority setting process was undertaken to reallocate existing resources for funding of new methods and activities. Resources were created by limiting low priority services. A procedure for priority setting was constructed and fully tested by engaging the entire organisation. The procedure included priority setting within and between departments and political decision making. Participants' views and experiences were collected as a basis for future improvement of the process. Results indicate that participants appreciated the overall approach and methodology and wished to engage in their improvement. Among the improvement proposals is prolongation of the process in order to improve the knowledge base quality. The procedure for identification of new items for funding also needs to be revised. The priority setting process was considered an overall success because it fulfilled its political goals. Factors considered crucial for success are a wish among managers for an economic strategy that addresses existing internal resource allocation; process management characterized by goal orientation and clear leadership; an elaborate communications strategy integrated early in the process and its management; political unity in support of the procedure, and a strong political commitment throughout the process. Generalizability has already been demonstrated by several health care organisations that performed processes founded on this working model. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
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Method and apparatus for granting processors access to a resource
Blumrich, Matthias A.; Salapura, Valentina
2010-03-16
An apparatus and method for granting one or more requesting entities access to a resource in a predetermined time interval. The apparatus includes a first circuit receiving one or more request signals, and implementing logic for assigning a priority to the one or more request signals, and, generating a set of first_request signals based on the priorities assigned. One or more priority select circuits for receiving the set of first_request signals and generating corresponding one or more fixed grant signals representing one or more highest priority request signals when asserted during the predetermined time interval. A second circuit device receives the one or more fixed grant signals generates one or more grant signals associated with one or more highest priority request signals assigned, the grant signals for enabling one or more respective requesting entities access to the resource in the predetermined time interval, wherein the priority assigned to the one or more request signals changes each successive predetermined time interval. In one embodiment, the assigned priority is based on a numerical pattern, the first circuit changing the numerical pattern with respect to the first_request signals generated at each successive predetermined time interval.
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Kapiriri, Lydia
2017-06-19
While there have been efforts to develop frameworks to guide healthcare priority setting; there has been limited focus on evaluation frameworks. Moreover, while the few frameworks identify quality indicators for successful priority setting, they do not provide the users with strategies to verify these indicators. Kapiriri and Martin (Health Care Anal 18:129-147, 2010) developed a framework for evaluating priority setting in low and middle income countries. This framework provides BOTH parameters for successful priority setting and proposes means of their verification. Before its use in real life contexts, this paper presents results from a validation process of the framework. The framework validation involved 53 policy makers and priority setting researchers at the global, national and sub-national levels (in Uganda). They were requested to indicate the relative importance of the proposed parameters as well as the feasibility of obtaining the related information. We also pilot tested the proposed means of verification. Almost all the respondents evaluated all the parameters, including the contextual factors, as 'very important'. However, some respondents at the global level thought 'presence of incentives to comply', 'reduced disagreements', 'increased public understanding,' 'improved institutional accountability' and 'meeting the ministry of health objectives', which could be a reflection of their levels of decision making. All the proposed means of verification were assessed as feasible with the exception of meeting observations which would require an insider. These findings results were consistent with those obtained from the pilot testing. These findings are relevant to policy makers and researchers involved in priority setting in low and middle income countries. To the best of our knowledge, this is one of the few initiatives that has involved potential users of a framework (at the global and in a Low Income Country) in its validation. The favorable validation of all the parameters at the national and sub-national levels implies that the framework has potential usefulness at those levels, as is. The parameters that were disputed at the global level necessitate further discussion when using the framework at that level. The next step is to use the validated framework in evaluating actual priority setting at the different levels.
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Peacock, Stuart J; Mitton, Craig; Ruta, Danny; Donaldson, Cam; Bate, Angela; Hedden, Lindsay
2010-10-01
Economists' approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) priority setting exercise. PBMA is a framework that explicitly recognizes the need to balance pragmatic and ethical considerations with economic rationality when making resource allocation decisions. While the ten guidelines are drawn from the PBMA framework, they may be generalized across a range of economic approaches to priority setting.
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Patient and public engagement in priority setting: A systematic rapid review of the literature.
Manafò, Elizabeth; Petermann, Lisa; Vandall-Walker, Virginia; Mason-Lai, Ping
2018-01-01
Current research suggests that while patients are becoming more engaged across the health delivery spectrum, this involvement occurs most often at the pre-preparation stage to identify 'high-level' priorities in health ecosystem priority setting, and at the preparation phase for health research. The purpose of this systematic rapid review of the literature is to describe the evidence that does exist in relation to patient and public engagement priority setting in both health ecosystem and health research. HealthStar (via OVID); CINAHL; Proquest Databases; and Scholar's Portal. i) published in English; ii) published within the timeframe of 2007-Current (10 years) unless the report/article was formative in synthesizing key considerations of patient engagement in health ecosystem and health research priority setting; iii) conducted in Canada, the US, Europe, UK, Australia/New Zealand, or Scandinavian countries. i) Is the research valid, sound, and applicable?; ii) what outcomes can we potentially expect if we implement the findings from this research?; iii) will the target population (i.e., health researchers and practitioners) be able to use this research?. A summary of findings from each of the respective processes was synthesized to highlight key information that would support decision-making for researchers when determining the best priority setting process to apply for their specific patient-oriented research. Seventy articles from the UK, US, Canada, Netherlands and Australia were selected for review. Results were organized into two tiers of public and patient engagement in prioritization: Tier 1-Deliberative and Tier 2-Consultative. Highly structured patient and public engagement planning activities include the James Lind Alliance Priority Setting Partnerships (UK), Dialogue Method (Netherlands), Global Evidence Mapping (Australia), and the Deep Inclusion Method/CHoosing All Together (US). The critical study limitations include challenges in comprehensively identifying the patient engagement literature for review, bias in article selection due to the identified scope, missed information due to a more limited use of exhaustive search strategies (e.g., in-depth hand searching), and the heterogeneity of reported study findings. The four public and patient engagement priority setting processes identified were successful in setting priorities that are inclusive and objectively based, specific to the priorities of stakeholders engaged in the process. The processes were robust, strategic and aimed to promote equity in patient voices. Key limitations identified a lack of evaluation data on the success and extent in which patients were engaged. Issues pertaining to feasibility of stakeholder engagement, coordination, communication and limited resources were also considered.
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Sustaining Changes that Support Student Success in Community College
ERIC Educational Resources Information Center
Burdman, Pamela
2009-01-01
Because of the increasingly prominent role of foundations in supporting improved opportunities for community college students, it may be helpful to understand how foundations set priorities and make decisions. Some foundations engage in responsive grant making, whereby they outline priority areas and then respond to proposals received from the…
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Brownfields Shifting Gears: Driving Toward Auto Sector Property Revitalization
This is an overview of community success stories. By building strong partnerships and setting priorities for recovery and revitalization, the public and private sectors are realizing a great deal of success in addressing idle industrial brownfields.
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Patient and public engagement in priority setting: A systematic rapid review of the literature
Vandall-Walker, Virginia; Mason-Lai, Ping
2018-01-01
Background Current research suggests that while patients are becoming more engaged across the health delivery spectrum, this involvement occurs most often at the pre-preparation stage to identify ‘high-level’ priorities in health ecosystem priority setting, and at the preparation phase for health research. Objective The purpose of this systematic rapid review of the literature is to describe the evidence that does exist in relation to patient and public engagement priority setting in both health ecosystem and health research. Data sources HealthStar (via OVID); CINAHL; Proquest Databases; and Scholar’s Portal. Study eligibility criteria i) published in English; ii) published within the timeframe of 2007—Current (10 years) unless the report/article was formative in synthesizing key considerations of patient engagement in health ecosystem and health research priority setting; iii) conducted in Canada, the US, Europe, UK, Australia/New Zealand, or Scandinavian countries. Study appraisal and synthesis i) Is the research valid, sound, and applicable?; ii) what outcomes can we potentially expect if we implement the findings from this research?; iii) will the target population (i.e., health researchers and practitioners) be able to use this research?. A summary of findings from each of the respective processes was synthesized to highlight key information that would support decision-making for researchers when determining the best priority setting process to apply for their specific patient-oriented research. Results Seventy articles from the UK, US, Canada, Netherlands and Australia were selected for review. Results were organized into two tiers of public and patient engagement in prioritization: Tier 1—Deliberative and Tier 2—Consultative. Highly structured patient and public engagement planning activities include the James Lind Alliance Priority Setting Partnerships (UK), Dialogue Method (Netherlands), Global Evidence Mapping (Australia), and the Deep Inclusion Method/CHoosing All Together (US). Limitations The critical study limitations include challenges in comprehensively identifying the patient engagement literature for review, bias in article selection due to the identified scope, missed information due to a more limited use of exhaustive search strategies (e.g., in-depth hand searching), and the heterogeneity of reported study findings. Conclusion The four public and patient engagement priority setting processes identified were successful in setting priorities that are inclusive and objectively based, specific to the priorities of stakeholders engaged in the process. The processes were robust, strategic and aimed to promote equity in patient voices. Key limitations identified a lack of evaluation data on the success and extent in which patients were engaged. Issues pertaining to feasibility of stakeholder engagement, coordination, communication and limited resources were also considered. PMID:29499043
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Aeyels, Daan; Seys, Deborah; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Bruyneel, Luk; Vanhaecht, Kris
2018-02-01
A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.
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Priority setting in health care: trends and models from Scandinavian experiences.
Hofmann, Bjørn
2013-08-01
The Scandinavian welfare states have public health care systems which have universal coverage and traditionally low influence of private insurance and private provision. Due to raises in costs, elaborate public control of health care, and a significant technological development in health care, priority setting came on the public agenda comparatively early in the Scandinavian countries. The development of health care priority setting has been partly homogeneous and appears to follow certain phases. This can be of broader interest as it may shed light on alternative models and strategies in health care priority setting. Some general trends have been identified: from principles to procedures, from closed to open processes, and from experts to participation. Five general approaches have been recognized: The moral principles and values based approach, the moral principles and economic assessment approach, the procedural approach, the expert based practice defining approach, and the participatory practice defining approach. There are pros and cons with all of these approaches. For the time being the fifth approach appears attractive, but its lack of true participation and the lack of clear success criteria may pose significant challenges in the future.
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Setting stroke research priorities: The consumer perspective.
Sangvatanakul, Pukkaporn; Hillege, Sharon; Lalor, Erin; Levi, Christopher; Hill, Kelvin; Middleton, Sandy
2010-12-01
To test a method of engaging consumers in research priority-setting using a quantitative approach and to determine consumer views on stroke research priorities for clinical practice recommendations with lower levels of evidence (Level III and Level IV) and expert consensus opinion as published in the Australian stroke clinical practice guidelines. Survey Urban community Eighteen stroke survivors (n = 12) and carers (n = 6) who were members of the "Working Aged Group - Stroke" (WAGS) consumer support group. Phase I: Participants were asked whether recommendations were "worth" researching ("yes" or "no"); and, if researched, what potential impact they likely would have on patient outcomes. Phase II: Participants were asked to rank recommendations rated by more than 75% of participants in Phase I as "worth" researching and "highly likely" or "likely" to generate research with a significant effect on patient outcomes (n = 13) in order of priority for future stroke research. All recommendations were rated by at least half (n = 9, 50%) of participants as "worth" researching. The majority (67% to 100%) rated all recommendations as "highly likely" or "likely" that research would have a significant effect on patient outcomes. Thirteen out of 20 recommendations were ranked for their research priorities. Recommendations under the topic heading Getting to hospital were ranked highest and Organization of care and Living with stroke were ranked as a lower priority for research. This study provided an example of how to involve consumers in research priority setting successfully using a quantitative approach. Stroke research priorities from the consumer perspective were different from those of health professionals, as published in the literature; thus, consumer opinion should be considered when setting research priorities. Copyright © 2010 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.
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Naval Supply Systems Command Fleet Logistics Center
2012-08-08
Partial small business set - aside is a potential consideration 12-month Base plus two options Synopsis N00604-11-R-3006 on NECO and FedBizOpps...2012 Navy Gold Coast Small Business Procurement Event 8 August 2012 #1 PRIORITY = Operating Forces Support …while ensuring Joint...while ensuring Joint Base Success FedBid.com Reverse Auction Website 8 Small Business Assistance #1 PRIORITY = Operating Forces
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ERIC Educational Resources Information Center
Association of American Colleges and Universities, 2015
2015-01-01
The Association of American Colleges and Universities (AAC&U) surveyed Chief Academic Officers at member institutions from July-October 2015 concerning priorities related to learning outcomes, assessment, general education design, high-impact practices, and data tracking and goal setting around equity and quality learning. With support from…
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A Timeline for Reroofing Success.
ERIC Educational Resources Information Center
Koontz, Jim
1998-01-01
Explains why timing is critical in reroofing educational facilities and saving costs. Provides an example of the planning process in the areas of priority setting, creating construction documents, bidding, and construction. Reroofing tips are highlighted. (GR)
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ERIC Educational Resources Information Center
Davies, Peter; Coates, Gwen; Hammersley-Fletcher, Linda; Mangan, Jean
2005-01-01
Using the perspective of principal-agent theory, we suggest that the target setting process imposed by the government has shifted teachers' focus away from their personal educational priorities. Our evidence suggests that schools with a higher proportion of students with high academic achievement differ in their practice of target setting from…
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Kuziemsky, Craig; Jewers, Heather; Appleby, Brenda; Foshay, Neil; Maccaull, Wendy; Miller, Keith; Macdonald, Madonna
2012-01-01
There is a need to better understand the specific settings in which health information technology (HIT) is used and implemented. Factors that will determine the successful implementation of HIT are context-specific and often reside not at the technical level but rather at the process and people level. This paper provides the results of a needs assessment for HIT to support hospice palliative care (HPC) delivery in rural settings. Roundtable discussions using the nominal group technique were done to identify priority issues regarding HIT usage to support rural HPC delivery. Qualitative content analysis was then used to identify sociotechnical themes from the roundtable data. Twenty priority issues were identified at the roundtable session. Content analysis grouped the priority issues into one central theme and five supporting themes to form a sociotechnical framework for patient-centered care in rural settings. There are several sociotechnical themes and associated issues that need to be considered prior to implementing HIT in rural HPC settings. Proactive evaluation of these issues can enhance HIT implementation and also help to make ethical aspects of HIT design more explicit.
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Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C
2018-05-03
Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.
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Tom Leuschen; Dale Wade; Paula Seamon
2001-01-01
The success of a fire use program is in large part dependent on a solid foundation set in clear and concise planning. The planning process results in specific goals and measurable objectives for fire application, provides a means of setting priorities, and establishes a mechanism for evaluating and refining the process to meet the desired future condition. It is an...
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A strategy to improve priority setting in developing countries.
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.
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Priority Setting for Improvement of Cervical Cancer Prevention in Iran.
Majidi, Azam; Ghiasvand, Reza; Hadji, Maryam; Nahvijou, Azin; Mousavi, Azam-Sadat; Pakgohar, Minoo; Khodakarami, Nahid; Abedini, Mehrandokht; Amouzegar Hashemi, Farnaz; Rahnamaye Farzami, Marjan; Shahsiah, Reza; Sajedinejhad, Sima; Mohagheghi, Mohammad Ali; Nadali, Fatemeh; Rashidian, Arash; Weiderpass, Elisabete; Mogensen, Ole; Zendehdel, Kazem
2015-11-22
Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran. © 2016 by Kerman University of Medical Sciences.
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Priority Setting for Improvement of Cervical Cancer Prevention in Iran
Majidi, Azam; Ghiasvand, Reza; Hadji, Maryam; Nahvijou, Azin; Mousavi, Azam-Sadat; Pakgohar, Minoo; Khodakarami, Nahid; Abedini, Mehrandokht; Amouzegar Hashemi, Farnaz; Rahnamaye Farzami, Marjan; Shahsiah, Reza; Sajedinejhad, Sima; Mohagheghi, Mohammad Ali; Nadali, Fatemeh; Rashidian, Arash; Weiderpass, Elisabete; Mogensen, Ole; Zendehdel, Kazem
2016-01-01
Background: Cervical cancer is the fourth most common cancer among women worldwide. Organized cervical screening and vaccination against human papilloma virus (HPV) have been successful interventions for prevention of invasive cervical cancer (ICC). Because of cultural and religious considerations, ICC has low incidence in Iran and many other Muslim countries. There is no organized cervical screening in these countries. Therefore, ICC is usually diagnosed in advanced stages with poor prognosis in these countries. We performed a priority setting exercise and suggested priorities for prevention of ICC in this setting. Methods: We invited experts and researchers to a workshop and asked them to list important suggestions for ICC prevention in Iran. After merging similar items and removing the duplicates, we asked the experts to rank the list of suggested items. We used a strategy grid and Go-zone analysis to determine final list of priorities for ICC prevention in Iran. Results: From 26 final items suggested as priorities for prevention of ICC, the most important priorities were developing national guidelines for cervical screening and quality control protocol for patient follow-up and management of precancerous lesions. In addition, we emphasized considering insurance coverage for cervical screening, public awareness, and research priorities, and establishment of a cervical screening registry. Conclusion: A comprehensive approach and implementation of organized cervical screening program is necessary for prevention of ICC in Iran and other low incidence Muslim countries. Because of high cost for vaccination and low incidence of cervical cancer, we do not recommend HPV vaccination for the time being in Iran. PMID:27239863
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ERIC Educational Resources Information Center
Hansen, Karen K.
1992-01-01
Fourteen principles for successful operation of a small collegiate alumni program are presented. They address such issues as planning, setting priorities, making decisions, routinizing procedures, using technology, creating a climate for cooperation and productivity, getting volunteers, keeping staff longer, and maintaining a balance between…
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Rowbotham, Nicola J; Smith, Sherie; Leighton, Paul A; Rayner, Oli C; Gathercole, Katie; Elliott, Zoe C; Nash, Edward F; Daniels, Tracey; Duff, Alistair J A; Collins, Sarah; Chandran, Suja; Peaple, Ursula; Brownlee, Keith
2018-01-01
There remain many treatment uncertainties in cystic fibrosis (CF). With limited resources, research should focus on questions which are most important to the CF community. We conducted a James Lind Alliance Priority Setting Partnership in CF. Research questions were elicited and then prioritised in successive surveys. A workshop agreed the final top 10. Online methods avoided cross infection and widened participation. The elicitation survey had 482 respondents (1080 questions) and prioritisation survey 677 respondents. Participants were drawn equally from the patient and clinical communities globally. We have achieved a consensus on 10 research priorities which will be attractive to funders. PMID:28778919
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Prioritizing conservation investments for mammal species globally
Wilson, Kerrie A.; Evans, Megan C.; Di Marco, Moreno; Green, David C.; Boitani, Luigi; Possingham, Hugh P.; Chiozza, Federica; Rondinini, Carlo
2011-01-01
We need to set priorities for conservation because we cannot do everything, everywhere, at the same time. We determined priority areas for investment in threat abatement actions, in both a cost-effective and spatially and temporally explicit way, for the threatened mammals of the world. Our analysis presents the first fine-resolution prioritization analysis for mammals at a global scale that accounts for the risk of habitat loss, the actions required to abate this risk, the costs of these actions and the likelihood of investment success. We evaluated the likelihood of success of investments using information on the past frequency and duration of legislative effectiveness at a country scale. The establishment of new protected areas was the action receiving the greatest investment, while restoration was never chosen. The resolution of the analysis and the incorporation of likelihood of success made little difference to this result, but affected the spatial location of these investments. PMID:21844046
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Slowing the flow: Setting priorities and defining success in Lake Superior’s South Shore watersheds
For over 60 years, watershed conservation efforts to improve water quality have largely focused on restoring and protecting hydrology under the mantra “slow the flow”. This approach seeks to reduce peak flows with landscape scale watershed restoration approaches that ...
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Mitton, Craig; Dionne, Francois; Donaldson, Cam
2014-04-01
Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members.
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Reeleder, David; Martin, Douglas K; Keresztes, Christian; Singer, Peter A
2005-01-01
Background Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system. Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness', which links priority setting to theories of democratic deliberation. Fairness is a key goal of priority setting. According to 'accountability for reasonableness', health care institutions engaged in priority setting have a claim to fairness if they satisfy four conditions of relevance, publicity, appeals/revision, and enforcement. This is the first study which has surveyed the views of hospital decision makers throughout an entire health system about the fairness of priority setting in their institutions. The purpose of this study is to elicit hospital decision-makers' self-report of the fairness of priority setting in their hospitals using an explicit conceptual framework, 'accountability for reasonableness'. Methods 160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used. Results Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%). Conclusions For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the conceptual framework 'accountability for reasonableness'. Although many hospital CEOs felt that their priority setting was fair, ample room for improvement was noted, especially for the enforcement condition. PMID:15663792
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Leadership and priority setting: the perspective of hospital CEOs.
Reeleder, David; Goel, Vivek; Singer, Peter A; Martin, Douglas K
2006-11-01
The role of leadership in health care priority setting remains largely unexplored. While the management leadership literature has grown rapidly, the growing literature on priority setting in health care has looked in other directions to improve priority setting practices--to health economics and ethical approaches. Consequently, potential for improvement in hospital priority setting practices may be overlooked. A qualitative study involving interviews with 46 Ontario hospital CEOs was done to describe the role of leadership in priority setting through the perspective of hospital leaders. For the first time, we report a framework of leadership domains including vision, alignment, relationships, values and process to facilitate priority setting practices in health services' organizations. We believe this fledgling framework forms the basis for the sharing of good leadership practices for health reform. It also provides a leadership guide for decision makers to improve the quality of their leadership, and in so doing, we believe, the fairness of their priority setting.
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Setting health priorities in a community: a case example
Sousa, Fábio Alexandre Melo do Rego; Goulart, Maria José Garcia; Braga, Antonieta Manuela dos Santos; Medeiros, Clara Maria Oliveira; Rego, Débora Cristina Martins; Vieira, Flávio Garcia; Pereira, Helder José Alves da Rocha; Tavares, Helena Margarida Correia Vicente; Loura, Marta Maria Puim
2017-01-01
ABSTRACT OBJECTIVE To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults. METHODS Based on the results of a health diagnosis related to active aging, a prioritization process was conceived to select the priority intervention problem. The process comprised four successive phases of problem analysis and classification: (1) grouping by level of similarity, (2) classification according to epidemiological criteria, (3) ordering by experts, and (4) application of the Hanlon method. These stages combined, in an integrated manner, the views of health team professionals, community nursing and gerontology experts, and the actual community. RESULTS The first stage grouped the identified problems by level of similarity, comprising a body of 19 issues for analysis. In the second stage these problems were classified by the health team members by epidemiological criteria (size, vulnerability, and transcendence). The nine most relevant problems resulting from the second stage of the process were submitted to expert analysis and the five most pertinent problems were selected. The last step identified the priority issue for intervention in this specific community with the participation of formal and informal community leaders: Low Social Interaction in Community Participation. CONCLUSIONS The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in a given community at a given time. There are no default formulas for selecting priority issues. It is up to each community intervention team to define its own process with different methods/techniques that allow the identification of and intervention in needs classified as priority by the community. PMID:28273229
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Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation
Barasa, Edwine W.; Molyneux, Sassy; English, Mike; Cleary, Susan
2015-01-01
Background: Priority setting in healthcare is a key determinant of health system performance. However, there is no widely accepted priority setting evaluation framework. We reviewed literature with the aim of developing and proposing a framework for the evaluation of macro and meso level healthcare priority setting practices. Methods: We systematically searched Econlit, PubMed, CINAHL, and EBSCOhost databases and supplemented this with searches in Google Scholar, relevant websites and reference lists of relevant papers. A total of 31 papers on evaluation of priority setting were identified. These were supplemented by broader theoretical literature related to evaluation of priority setting. A conceptual review of selected papers was undertaken. Results: Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities (reallocation of resources), and (d) Implementation of decisions. (2) Priority setting processes should also meet the procedural conditions of (a) Stakeholder engagement, (b) Stakeholder empowerment, (c) Transparency, (d) Use of evidence, (e) Revisions, (f) Enforcement, and (g) Being grounded on community values. Conclusion: Available frameworks for the evaluation of priority setting are mostly grounded on procedural requirements, while few have included outcome requirements. There is, however, increasing recognition of the need to incorporate both consequential and procedural considerations in priority setting practices. In this review, we adapt an integrative approach to develop and propose a framework for the evaluation of priority setting practices at the macro and meso levels that draws from these complementary schools of thought. PMID:26673332
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Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation.
Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan
2015-09-16
Priority setting in healthcare is a key determinant of health system performance. However, there is no widely accepted priority setting evaluation framework. We reviewed literature with the aim of developing and proposing a framework for the evaluation of macro and meso level healthcare priority setting practices. We systematically searched Econlit, PubMed, CINAHL, and EBSCOhost databases and supplemented this with searches in Google Scholar, relevant websites and reference lists of relevant papers. A total of 31 papers on evaluation of priority setting were identified. These were supplemented by broader theoretical literature related to evaluation of priority setting. A conceptual review of selected papers was undertaken. Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities (reallocation of resources), and (d) Implementation of decisions. (2) Priority setting processes should also meet the procedural conditions of (a) Stakeholder engagement, (b) Stakeholder empowerment, (c) Transparency, (d) Use of evidence, (e) Revisions, (f) Enforcement, and (g) Being grounded on community values. Available frameworks for the evaluation of priority setting are mostly grounded on procedural requirements, while few have included outcome requirements. There is, however, increasing recognition of the need to incorporate both consequential and procedural considerations in priority setting practices. In this review, we adapt an integrative approach to develop and propose a framework for the evaluation of priority setting practices at the macro and meso levels that draws from these complementary schools of thought. © 2015 by Kerman University of Medical Sciences.
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Macias, Darryl J; Williams, Jason
2013-01-01
Medical care in resource-limited environments (austere settings) can occur in the context of a disaster, wilderness, or a tactical field operation. Regardless of the type of environment, there are common organizational themes in most successful humanitarian missions that occur in harsh natural or manmade environmental conditions. These principles prioritize the initiation and execution of any given deployment in austere or remote settings, diverging from priorities that would occur in a situation in which change to the existing medical structure is intact and operating well. Attention to these priorities not only helps providers to deliver medical care to people in need during a period of resource limitations but it also can keep providers, teams, the public, and patients safe during and after a deployment.
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Setting Our Sights on a Culture of Safety
ERIC Educational Resources Information Center
Cowart, Kerry; Miller, Karin; Strasburger, Tom
2012-01-01
Providing a comprehensive approach for achieving the goal of a safe environment where the priority can be teaching and learning is vital to every district's success. To attain this goal, school districts must educate students, staff, and the community and provide tools that help anticipate potential problems and prevent them from escalating into…
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Setting priorities for research on pollution reduction functions of agricultural buffers
Michael G. Dosskey
2002-01-01
The success of buffer installation initiatives and programs to reduce nonpoint source pollution of streams on agricultural lands will depend the ability of local planners to locate and design buffers for specific circumstances with substantial and predictable results. Current predictive capabilities are inadequate, and major sources of uncertainty remain. An...
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Priority Setting in Government: Beyond the Magic Bullet.
ERIC Educational Resources Information Center
Bosin, Morris Robert
1992-01-01
Priority setting is examined from the perspective of planning practitioners operating in a major federal regulatory agency. Causes of ambivalence in setting priorities are considered, and ways to reduce ambivalence are suggested. Three models are proposed for setting priorities in the public sector. (SLD)
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Priority setting in clinical nursing practice: literature review.
Hendry, Charles; Walker, Anne
2004-08-01
Time is a valuable resource. When nurses experience demands on their services which exceed their available time, then 'rationing' must occur. In clinical practice such rationing requires practitioners to set priorities for care. The aim of this paper is establish what is currently known about priority setting in nursing, including how nurses set priorities and what factors influence this. CINAHL, Medline, ASSIA, and PsychLit databases for the years 1982-2002 were searched, using the terms (clinical decision-making or problem-solving or planning) and (setting priorities or prioriti*). The publications found were used in a selective, descriptive review. Priority setting is an important skill in nursing, and a skill deficit can have serious consequences for patients. Recent studies have suggested that it is a difficult skill for newly qualified nurses to acquire and may not be given sufficient attention in nurse education. Priority setting can be defined as the ordering of nursing problems using notions of urgency and/or importance, in order to establish a preferential order for nursing actions. A number of factors that may impact on priority setting have been identified in the literature. These include: the expertise of the nurse; the patient's condition; the availability of resources; ward organization; philosophies and models of care; the nurse-patient relationship; and the cognitive strategy used by the nurse to set priorities. However, very little empirical work has been conducted in this area. Further study of priority setting in a range of clinical practice settings is necessary. This could inform both practice and education, promote better use of limited resources and maximize patient outcomes.
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Effective Planning, Delegating, and Priority Setting.
ERIC Educational Resources Information Center
St. John, Walter
1982-01-01
Offers advice to administrators for increasing their effectiveness in an era of shrinking resources. Stresses the necessity for careful planning, delegation of tasks, and setting of priorities. Includes a guide for setting priorities and a priority planning chart. (WD)
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Wood, Robin; Richardson, Eugene T
2013-09-01
Nowhere are the barriers to a functional health infrastructure more clearly on display than in the Goma region of Democratic Republic of Congo. Kaboru et al. report poorly integrated services for HIV and TB in this war-torn region. Priorities in conflict zones include provision of security, shelter, food, clean water and prevention of sexual violence. In Goma, immediate health priorities include emergency treatment of cholera, malaria, respiratory illnesses, provision of maternal care, millions of measles vaccinations, and management of an ongoing rabies epidemic. It is a daunting task to determine an essential package of medical services in a setting where there are so many competing priorities, where opportunity costs are limited and epidemiologic information is scarce. Non-governmental agencies sometimes add to the challenge via an insidious reduction of state sovereignty and the creation of new levels of income inequality. Kaboru et al. have successfully highlighted many of the complexities of rebuilding and prioritizing healthcare in a conflict zone.
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[The Danish Debate on Priority Setting in Medicine--An Update].
Pornak, S C; Raspe, H
2015-09-01
In the last years, the Danish debate about priority setting in medicine has gained new strength. This paper shows the main focuses of the current discussion based on a research of Danish primary literature. For the first time since the 1990s the Danish Council of Ethics has been involved with priority setting in medicine in a project running from 2011 to 2013. The Council emphasises the importance of legitimate processes and calls for visible values and criteria. A focus of the debate is how to deal with new expensive drugs. Politicians, physicians, health economists and the Council of Ethics have called for a national institution for priority setting in medicine. They have mainly looked to the Norwegian National Council for Priority Setting in Health Care and the British National Institute for Health and Care Excellence for inspiration. The Danish Government considered establishing a national institute for priority setting, but the plans were not put into practice. In the year 2012 a new national project was launched to create clinical guidelines. Danish doctors welcome the guidelines as a good basis for priority setting. Just like in earlier Danish priority setting debates, a coordinating institution is lacking to bundle the discussion and keep it going. The debate seems to have come to an end once again. The fact that it was seriously considered to establish an institute for priority setting is a new development. It can be expected that the discussion will be resumed in the near future, possibly the idea of an institute for priority setting will be readopted. The general conditions for priority setting in health care have improved. © Georg Thieme Verlag KG Stuttgart · New York.
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Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin
2010-08-01
Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. (c) 2010 Elsevier Ltd. All rights reserved.
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Mador, Rebecca L; Kornas, Kathy; Simard, Anne; Haroun, Vinita
2016-03-23
Given the context-specific nature of health research prioritization and the obligation to effectively allocate resources to initiatives that will achieve the greatest impact, evaluation of priority setting processes can refine and strengthen such exercises and their outcomes. However, guidance is needed on evaluation tools that can be applied to research priority setting. This paper describes the adaption and application of a conceptual framework to evaluate a research priority setting exercise operating within the public health sector in Ontario, Canada. The Nine Common Themes of Good Practice checklist, described by Viergever et al. (Health Res Policy Syst 8:36, 2010) was used as the conceptual framework to evaluate the research priority setting process developed for the Locally Driven Collaborative Projects (LDCP) program in Ontario, Canada. Multiple data sources were used to inform the evaluation, including a review of selected priority setting approaches, surveys with priority setting participants, document review, and consultation with the program advisory committee. The evaluation assisted in identifying improvements to six elements of the LDCP priority setting process. The modifications were aimed at improving inclusiveness, information gathering practices, planning for project implementation, and evaluation. In addition, the findings identified that the timing of priority setting activities and level of control over the process were key factors that influenced the ability to effectively implement changes. The findings demonstrate the novel adaptation and application of the 'Nine Common Themes of Good Practice checklist' as a tool for evaluating a research priority setting exercise. The tool can guide the development of evaluation questions and enables the assessment of key constructs related to the design and delivery of a research priority setting process.
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Atkins, David; Perez-Padilla, Rogelio; Macnee, William; Buist, A Sonia; Cruz, Alvaro A
2012-12-01
Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. Priority setting is an essential component of developing clinical practice guidelines informed by the best available research evidence. It ensures that resources and attention are devoted to those areas in which clinical recommendations will provide the greatest benefit to patients, clinicians, and policy makers. This is the second of a series of 14 articles that methodologists and researchers from around the world prepared to advise guideline developers in respiratory and other diseases. This review focuses on priority setting, addressing five key questions. In this review, we addressed the following questions. (1) At which steps of guideline development should priorities be considered? (2) How do we create an initial list of potential topics within the guideline? (3) What criteria should be used to establish priorities? (4) What parties should be involved and what processes should be used to set priorities? (5)What are the potential challenges of setting priorities? We updated an existing review on priority setting, and searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on available evidence, our own experience working with guideline developers, and workshop discussions. Existing literature on priority setting largely applies to identifying priorities for which guidelines to develop rather than setting priorities for recommendations within a guideline. Nonetheless, there is substantial consensus about the general factors that should be considered in setting priorities. These include the burdens and costs of illness, potential impact of a recommendation, identified deficits or weak points in practice, variation or uncertainty in practice, and availability of evidence. The input of a variety of stakeholders is useful in setting priorities, although informal consultation is used more often than formal methods. Processes for setting priorities remains poorly described in most guidelines.
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Nurse practitioners in aged care: documentary analysis of successful project proposals.
Clark, Shannon J; Parker, Rhian M; Davey, Rachel
2014-11-01
Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner-Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: "The right care," "in the right place," and "at the right time." In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program's applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding. © The Author(s) 2014.
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Rowbotham, Nicola J; Smith, Sherie; Leighton, Paul A; Rayner, Oli C; Gathercole, Katie; Elliott, Zoe C; Nash, Edward F; Daniels, Tracey; Duff, Alistair J A; Collins, Sarah; Chandran, Suja; Peaple, Ursula; Hurley, Matthew N; Brownlee, Keith; Smyth, Alan R
2018-04-01
There remain many treatment uncertainties in cystic fibrosis (CF). With limited resources, research should focus on questions which are most important to the CF community. We conducted a James Lind Alliance Priority Setting Partnership in CF. Research questions were elicited and then prioritised in successive surveys. A workshop agreed the final top 10. Online methods avoided cross infection and widened participation. The elicitation survey had 482 respondents (1080 questions) and prioritisation survey 677 respondents. Participants were drawn equally from the patient and clinical communities globally. We have achieved a consensus on 10 research priorities which will be attractive to funders. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Cost-effective priorities for global mammal conservation.
Carwardine, Josie; Wilson, Kerrie A; Ceballos, Gerardo; Ehrlich, Paul R; Naidoo, Robin; Iwamura, Takuya; Hajkowicz, Stefan A; Possingham, Hugh P
2008-08-12
Global biodiversity priority setting underpins the strategic allocation of conservation funds. In identifying the first comprehensive set of global priority areas for mammals, Ceballos et al. [Ceballos G, Ehrlich PR, Soberón J, Salazar I, Fay JP (2005) Science 309:603-607] found much potential for conflict between conservation and agricultural human activity. This is not surprising because, like other global priority-setting approaches, they set priorities without socioeconomic objectives. Here we present a priority-setting framework that seeks to minimize the conflicts and opportunity costs of meeting conservation goals. We use it to derive a new set of priority areas for investment in mammal conservation based on (i) agricultural opportunity cost and biodiversity importance, (ii) current levels of international funding, and (iii) degree of threat. Our approach achieves the same biodiversity outcomes as Ceballos et al.'s while reducing the opportunity costs and conflicts with agricultural human activity by up to 50%. We uncover shortfalls in the allocation of conservation funds in many threatened priority areas, highlighting a global conservation challenge.
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Evaluating healthcare priority setting at the meso level: A thematic review of empirical literature
Waithaka, Dennis; Tsofa, Benjamin; Barasa, Edwine
2018-01-01
Background: Decentralization of health systems has made sub-national/regional healthcare systems the backbone of healthcare delivery. These regions are tasked with the difficult responsibility of determining healthcare priorities and resource allocation amidst scarce resources. We aimed to review empirical literature that evaluated priority setting practice at the meso (sub-national) level of health systems. Methods: We systematically searched PubMed, ScienceDirect and Google scholar databases and supplemented these with manual searching for relevant studies, based on the reference list of selected papers. We only included empirical studies that described and evaluated, or those that only evaluated priority setting practice at the meso-level. A total of 16 papers were identified from LMICs and HICs. We analyzed data from the selected papers by thematic review. Results: Few studies used systematic priority setting processes, and all but one were from HICs. Both formal and informal criteria are used in priority-setting, however, informal criteria appear to be more perverse in LMICs compared to HICs. The priority setting process at the meso-level is a top-down approach with minimal involvement of the community. Accountability for reasonableness was the most common evaluative framework as it was used in 12 of the 16 studies. Efficiency, reallocation of resources and options for service delivery redesign were the most common outcome measures used to evaluate priority setting. Limitations: Our study was limited by the fact that there are very few empirical studies that have evaluated priority setting at the meso-level and there is likelihood that we did not capture all the studies. Conclusions: Improving priority setting practices at the meso level is crucial to strengthening health systems. This can be achieved through incorporating and adapting systematic priority setting processes and frameworks to the context where used, and making considerations of both process and outcome measures during priority setting and resource allocation. PMID:29511741
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[The Danish debate on priority setting in medicine - characteristics and results].
Pornak, S; Meyer, T; Raspe, H
2011-10-01
Priority setting in medicine helps to achieve a fair and transparent distribution of health-care resources. The German discussion about priority setting is still in its infancy and may benefit from other countries' experiences. This paper aims to analyse the Danish priority setting debate in order to stimulate the German discussion. The methods used are a literature analysis and a document analysis as well as expert interviews. The Danish debate about priority setting in medicine began in the 1970s, when a government committee was constituted to evaluate health-care priorities at the national level. In the 1980s a broader debate arose in politics, ethics, medicine and health economy. The discussions reached a climax in the 1990s, when many local activities - always involving the public - were initiated. Some Danish counties tried to implement priority setting in the daily routine of health care. The Council of Ethics was a major player in the debate of the 1990s and published a detailed statement on priority setting in 1996. With the new century the debate about priority setting seemed to have come to an end, but in 2006 the Technology Council and the Danish Regions resumed the discussion. In 2009 the Medical Association called for a broad debate in order to achieve equity among all patients. The long lasting Danish debate on priority setting has entailed only very little practical consequences on health care. The main problems seem to have been the missing effort to bundle the various local initiatives on a national level and the lack of powerful players to put results of the discussion into practice. Nevertheless, today the attitude towards priority setting is predominantly positive and even politicians talk freely about it. © Georg Thieme Verlag KG Stuttgart · New York.
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Waldau, Susanne
2015-09-01
Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation. Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge. An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys. Vertical and horizontal priority setting occurred and resources were reallocated. Participants' attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge. Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Taxing soft drinks in the Pacific: implementation lessons for improving health.
Thow, Anne Marie; Quested, Christine; Juventin, Lisa; Kun, Russ; Khan, A Nisha; Swinburn, Boyd
2011-03-01
A tax on soft drinks is often proposed as a health promotion strategy for reducing their consumption and improving health outcomes. However, little is known about the processes and politics of implementing such taxes. We analysed four different soft drink taxes in Pacific countries and documented the lessons learnt regarding the process of policy agenda-setting and implementation. While local social and political context is critically important in determining policy uptake, these case studies suggest strategies for health promotion practitioners that can help to improve policy uptake and implementation. The case studies reveal interaction between the Ministries of Health, Finance and Revenue at every stage of the policy making process. In regard to agenda-setting, relevance to government fiscal priorities was important in gaining support for soft drink taxes. The active involvement of health policy makers was also important in initiating the policies, and the use of existing taxation mechanisms enabled successful policy implementation. While the earmarking of taxes for health has been widely recommended, the revenue may be redirected as government priorities change. Health promotion practitioners must strategically plan for agenda-setting, development and implementation of intersectoral health-promoting policies by engaging with stakeholders in finance at an early stage to identify priorities and synergies, developing cross-sectoral advocacy coalitions, and basing proposals on existing legislative mechanisms where possible.
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Priority setting and economic appraisal: whose priorities--the community or the economist?
Green, A; Barker, C
1988-01-01
Scarce resources for health require a process for setting priorities. The exact mechanism chosen has important implications for the type of priorities and plans set, and in particular their relationship to the principles of primary health care. One technique increasingly advocated as an aid to priority setting is economic appraisal. It is argued however that economic appraisal is likely to reinforce a selective primary health care approach through its espousal of a technocratic medical model and through its hidden but implicit value judgements. It is suggested that urgent attention is needed to develop approaches to priority setting that incorporate the strengths of economic appraisal, but that are consistent with comprehensive primary health care.
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Priority setting in the provincial health services authority: survey of key decision makers
Teng, Flora; Mitton, Craig; MacKenzie, Jennifer
2007-01-01
Background In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. Methods A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. Results Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. Conclusion This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts. PMID:17565691
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A checklist for health research priority setting: nine common themes of good practice.
Viergever, Roderik F; Olifson, Sylvie; Ghaffar, Abdul; Terry, Robert F
2010-12-15
Health research priority setting processes assist researchers and policymakers in effectively targeting research that has the greatest potential public health benefit. Many different approaches to health research prioritization exist, but there is no agreement on what might constitute best practice. Moreover, because of the many different contexts for which priorities can be set, attempting to produce one best practice is in fact not appropriate, as the optimal approach varies per exercise. Therefore, following a literature review and an analysis of health research priority setting exercises that were organized or coordinated by the World Health Organization since 2005, we propose a checklist for health research priority setting that allows for informed choices on different approaches and outlines nine common themes of good practice. It is intended to provide generic assistance for planning health research prioritization processes. The checklist explains what needs to be clarified in order to establish the context for which priorities are set; it reviews available approaches to health research priority setting; it offers discussions on stakeholder participation and information gathering; it sets out options for use of criteria and different methods for deciding upon priorities; and it emphasizes the importance of well-planned implementation, evaluation and transparency.
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Analysis of Decision Making Skills for Large Scale Disaster Response
2015-08-21
Capability to influence and collaborate Compassion Teamwork Communication Leadership Provide vision of outcome / set priorities Confidence, courage to make...project evaluates the viability of expanding the use of serious games to augment classroom training, tabletop and full scale exercise, and actual...training, evaluation, analysis, and technology ex- ploration. Those techniques have found successful niches, but their wider applicability faces
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Health literacy and chronic disease management: drawing from expert knowledge to set an agenda
Poureslami, Iraj; Nimmon, Laura; Rootman, Irving; Fitzgerald, Mark J.
2017-01-01
Summary Understanding the nature and impact of health literacy is a priority in health promotion and chronic disease prevention and treatment. Health literacy comprises the application of a broad set of skills to access, comprehend, evaluate, communicate and act on health information for improved health and well-being. A complex concept, it involves multiple participants and is enacted across a wide variety of contexts. Health literacy's complexity has given rise to challenges achieving a standard definition and developing means to measure all its dimensions. In May 2013, a group of health literacy experts, clinicians and policymakers convened at an Expert Roundtable to review the current state of health literacy research and practice, and make recommendations about refining its definition, expanding its measurement and integrating best practices into chronic disease management. The four-day knowledge exchange concluded that the successful integration of health literacy into policy and practice depends on the development of a more substantial evidence base. A review of the successes and gaps in health literacy research, education and interventions culminated in the identification of key priorities to further the health literacy agenda. The workshop was funded by the UBC Peter Wall Institute for Advanced Studies, Vancouver. PMID:26873913
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Hacking, Damian; Cleary, Susan
2016-02-09
Setting priorities is important in health research given the limited resources available for research. Various guidelines exist to assist in the priority setting process; however, priority setting still faces significant challenges such as the clear ranking of identified priorities. The World Health Organization (WHO) proposed a Disability Adjusted Life Year (DALY)-based model to rank priorities by research area (basic, health systems and biomedical) by dividing the DALYs into 'unavertable with existing interventions', 'avertable with improved efficiency' and 'avertable with existing but non-cost-effective interventions', respectively. However, the model has conceptual flaws and no clear methodology for its construction. Therefore, the aim of this paper was to amend the model to address these flaws, and develop a clear methodology by using tuberculosis in South Africa as a worked example. An amended model was constructed to represent total DALYs as the product of DALYs per person and absolute burden of disease. These figures were calculated for all countries from WHO datasets. The lowest figures achieved by any country were assumed to represent 'unavertable with existing interventions' if extrapolated to South Africa. The ratio of 'cost per patient treated' (adjusted for purchasing power and outcome weighted) between South Africa and the best country was used to calculate the 'avertable with improved efficiency section'. Finally, 'avertable with existing but non-cost-effective interventions' was calculated using Disease Control Priorities Project efficacy data, and the ratio between the best intervention and South Africa's current intervention, irrespective of cost. The amended model shows that South Africa has a tuberculosis burden of 1,009,837.3 DALYs; 0.009% of DALYs are unavertable with existing interventions and 96.3% of DALYs could be averted with improvements in efficiency. Of the remaining DALYs, a further 56.9% could be averted with existing but non-cost-effective interventions. The amended model was successfully constructed using limited data sources. The generalizability of the data used is the main limitation of the model. More complex formulas are required to deal with such potential confounding variables; however, the results act as starting point for development of a more robust model.
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Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods*
Devendra, C.
2013-01-01
The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which goats, with a capacity to cope with heat tolerance, can be the entry point for development. Networks and networking are very important for the diffusion of information and can add value to R and D. Well formulated projects with clear priority setting and participatory R and D ensure success and the realisation of food security, improved livelihoods and self-reliance in the future. PMID:25049700
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Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods.
Devendra, C
2013-01-01
The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which goats, with a capacity to cope with heat tolerance, can be the entry point for development. Networks and networking are very important for the diffusion of information and can add value to R and D. Well formulated projects with clear priority setting and participatory R and D ensure success and the realisation of food security, improved livelihoods and self-reliance in the future.
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The Emergency Medical Services Safety Champions
Patterson, P. Daniel; Anderson, Michelle S.; Zionts, Nancy D.; Paris, Paul M.
2014-01-01
The overarching mission of prehospital Emergency Medical Services (EMS) is to deliver life-saving care for people when their needs are greatest. Fulfilling this mission is challenged by threats to patient and provider safety. The EMS setting is high-risk because care is delivered rapidly in the out-of-hospital setting where patient-benefiting resources are limited. There is growing evidence that safety culture varies widely across EMS agencies. A poor safety culture may manifest as error in medication, back injuries, and other poor outcomes for patient and provider. Recently, federal and national leaders of EMS (i.e., the National Highway Traffic Safety Administration) have made improving EMS safety culture a national priority. Unfortunately, there are few initiatives that can help local EMS leaders achieve that priority. We describe the successful EMS Champs Fellowship program supported by the Jewish Healthcare Foundation (JHF) designed to train EMS leaders to improve safety for patients and providers. PMID:23150883
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Monk, Johanna M; Rowley, Kevin G; Anderson, Ian Ps
2009-11-20
Priority setting is about making decisions. Key issues faced during priority setting processes include identifying who makes these decisions, who sets the criteria, and who benefits. The paper reviews the literature and history around priority setting in research, particularly in Aboriginal health research. We explore these issues through a case study of the Cooperative Research Centre for Aboriginal Health (CRCAH)'s experience in setting and meeting priorities.Historically, researchers have made decisions about what research gets done. Pressures of growing competition for research funds and an increased public interest in research have led to demands that appropriate consultation with stakeholders is conducted and that research is of benefit to the wider society. Within Australian Aboriginal communities, these demands extend to Aboriginal control of research to ensure that Aboriginal priorities are met.In response to these demands, research priorities are usually agreed in consultation with stakeholders at an institutional level and researchers are asked to develop relevant proposals at a project level. The CRCAH's experience in funding rounds was that scientific merit was given more weight than stakeholders' priorities and did not necessarily result in research that met these priorities. After reviewing these processes in 2004, the CRCAH identified a new facilitated development approach. In this revised approach, the setting of institutional priorities is integrated with the development of projects in a way that ensures the research reflects stakeholder priorities.This process puts emphasis on identifying projects that reflect priorities prior to developing the quality of the research, rather than assessing the relevance to priorities and quality concurrently. Part of the CRCAH approach is the employment of Program Managers who ensure that stakeholder priorities are met in the development of research projects. This has enabled researchers and stakeholders to come together to collaboratively develop priority-driven research. Involvement by both groups in project development has been found to be essential in making decisions that will lead to robust and useful research.
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Setting Priorities: A Handbook of Alternative Techniques.
ERIC Educational Resources Information Center
Price, Nelson C.
Six models for setting priorities are presented in a workbook format with exercises for evaluating or practicing five techniques. In the San Mateo model one sets priorities, clarifies priority purpose, lists items, determines criteria, lists items and criteria on a rating sheet, studies all information on items, rates each item, tallies results,…
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Neiger, Brad L; Thackeray, Rosemary; Fagen, Michael C
2011-03-01
Priority setting is an important component of systematic planning in health promotion and also factors into the development of a comprehensive evaluation plan. The basic priority rating (BPR) model was introduced more than 50 years ago and includes criteria that should be considered in any priority setting approach (i.e., use of predetermined criteria, standardized comparisons, and a rubric that controls bias). Although the BPR model has provided basic direction in priority setting, it does not represent the broad array of data currently available to decision makers. Elements in the model also give more weight to the impact of communicable diseases compared with chronic diseases. For these reasons, several modifications are recommended to improve the BPR model and to better assist health promotion practitioners in the priority setting process. The authors also suggest a new name, BPR 2.0, to represent this revised model.
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Setting conservation priorities.
Wilson, Kerrie A; Carwardine, Josie; Possingham, Hugh P
2009-04-01
A generic framework for setting conservation priorities based on the principles of classic decision theory is provided. This framework encapsulates the key elements of any problem, including the objective, the constraints, and knowledge of the system. Within the context of this framework the broad array of approaches for setting conservation priorities are reviewed. While some approaches prioritize assets or locations for conservation investment, it is concluded here that prioritization is incomplete without consideration of the conservation actions required to conserve the assets at particular locations. The challenges associated with prioritizing investments through time in the face of threats (and also spatially and temporally heterogeneous costs) can be aided by proper problem definition. Using the authors' general framework for setting conservation priorities, multiple criteria can be rationally integrated and where, how, and when to invest conservation resources can be scheduled. Trade-offs are unavoidable in priority setting when there are multiple considerations, and budgets are almost always finite. The authors discuss how trade-offs, risks, uncertainty, feedbacks, and learning can be explicitly evaluated within their generic framework for setting conservation priorities. Finally, they suggest ways that current priority-setting approaches may be improved.
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Bukachi, Salome A; Onyango-Ouma, Washington; Siso, Jared Maaka; Nyamongo, Isaac K; Mutai, Joseph K; Hurtig, Anna Karin; Olsen, Oystein Evjen; Byskov, Jens
2014-01-01
In resource-poor settings, the accountability for reasonableness (A4R) has been identified as an important advance in priority setting that helps to operationalize fair priority setting in specific contexts. The four conditions of A4R are backed by theory, not evidence, that conformance with them improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In-depth interviews and focus group discussions with key players in the Malindi district health system and a review of key policy documents and national guidelines show that the priority setting process in the district relies heavily on guidelines from the national level, making it more of a vertical, top-down orientation. Multilateral and donor agencies, national government, budgetary requirements, traditions and local culture influence the process. The four conditions of A4R are present within the priority setting process, albeit to varying degrees and referred to by different terms. There exists an opportunity for A4R to provide a guiding approach within which its four conditions can be strengthened and assessed to establish whether conformance helps improve on the priority setting process. Copyright © 2013 John Wiley & Sons, Ltd.
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Wallace, Lauren; Kapirir, Lydia
2017-01-01
Background: To date, research on priority-setting for new vaccines has not adequately explored the influence of the global, national and sub-national levels of decision-making or contextual issues such as political pressure and stakeholder influence and power. Using Kapiriri and Martin’s conceptual framework, this paper evaluates priority setting for new vaccines in Uganda at national and sub-national levels, and considers how global priorities can influence country priorities. This study focuses on 2 specific vaccines, the human papilloma virus (HPV) vaccine and the pneumococcal conjugate vaccine (PCV). Methods: This was a qualitative study that involved reviewing relevant Ugandan policy documents and media reports, as well as 54 key informant interviews at the global level and national and sub-national levels in Uganda. Kapiriri and Martin’s conceptual framework was used to evaluate the prioritization process. Results: Priority setting for PCV and HPV was conducted by the Ministry of Health (MoH), which is considered to be a legitimate institution. While respondents described the priority setting process for PCV process as transparent, participatory, and guided by explicit relevant criteria and evidence, the prioritization of HPV was thought to have been less transparent and less participatory. Respondents reported that neither process was based on an explicit priority setting framework nor did it involve adequate representation from the districts (program implementers) or publicity. The priority setting process for both PCV and HPV was negatively affected by the larger political and economic context, which contributed to weak institutional capacity as well as power imbalances between development assistance partners and the MoH. Conclusion: Priority setting in Uganda would be improved by strengthening institutional capacity and leadership and ensuring a transparent and participatory processes in which key stakeholders such as program implementers (the districts) and beneficiaries (the public) are involved. Kapiriri and Martin’s framework has the potential to guide priority setting evaluation efforts, however, evaluation should be built into the priority setting process a priori such that information on priority setting is gathered throughout the implementation cycle. PMID:29172378
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Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Ndukwe, Chinwendu Daniel; Oyibo, Patrick Gold; Onwe, Friday; Aulakh, Bhupinder Kaur
2013-01-01
Nigeria is one of the low and middle income countries (LMICs) facing severe resource constraint, making it impossible for adequate resources to be allocated to the health sector. Priority setting becomes imperative because it guides investments in health care, health research and respects resource constraints. The objective of this study was to enhance the knowledge and understanding of policymakers on research priority setting and to conduct a research priority setting exercise. A one-day evidence-to-policy research priority setting meeting was held. The meeting participants included senior and middle level policymakers and key decision makers/stakeholders in the health sector in Ebonyi State southeastern Nigeria. The priorities setting meeting involved a training session on priority setting process and conduction of priority setting exercise using the essential national health research (ENHR) approach. The focus was on the health systems building blocks (health workforce; health finance; leadership/governance; medical products/technology; service delivery; and health information/evidence). Of the total of 92 policymakers invited 90(97.8%) attended the meeting. It was the consensus of the policymakers that research should focus on the challenges of optimal access to health products and technology; effective health service delivery and disease control under a national emergency situation; the shortfalls in the supply of professional personnel; and the issues of governance in the health sector management. Research priority setting exercise involving policymakers is an example of demand driven strategy in the health policymaking process capable of reversing inequities and strengthening the health systems in LMICs.
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Mshana, Simon; Shemilu, Haji; Ndawi, Benedict; Momburi, Roman; Olsen, Oystein Evjen; Byskov, Jens; Martin, Douglas K
2007-01-01
Background Priority setting in every health system is complex and difficult. In less wealthy countries the dominant approach to priority setting has been Burden of Disease (BOD) and cost-effectiveness analysis (CEA), which is helpful, but insufficient because it focuses on a narrow range of values – need and efficiency – and not the full range of relevant values, including legitimacy and fairness. 'Accountability for reasonableness' is a conceptual framework for legitimate and fair priority setting and is empirically based and ethically justified. It connects priority setting to broader, more fundamental, democratic deliberative processes that have an impact on social justice and equity. Can 'accountability for reasonableness' be helpful for improving priority setting in less wealthy countries? Methods In 2005, Tanzanian scholars from the Primary Health Care Institute (PHCI) conducted 6 capacity building workshops with senior health staff, district planners and managers, and representatives of the Tanzanian Ministry of Health to discussion improving priority setting in Tanzania using 'accountability for reasonableness'. The purpose of this paper is to describe this initiative and the participants' views about the approach. Results The approach to improving priority setting using 'accountability for reasonableness' was viewed by district decision makers with enthusiastic favour because it was the first framework that directly addressed their priority setting concerns. High level Ministry of Health participants were also very supportive of the approach. Conclusion Both Tanzanian district and governmental health planners viewed the 'accountability for reasonableness' approach with enthusiastic favour because it was the first framework that directly addressed their concerns. PMID:17997824
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Setting healthcare priorities in hospitals: a review of empirical studies
Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan
2015-01-01
Priority setting research has focused on the macro (national) and micro (bedside) level, leaving the meso (institutional, hospital) level relatively neglected. This is surprising given the key role that hospitals play in the delivery of healthcare services and the large proportion of health systems resources that they absorb. To explore the factors that impact upon priority setting at the hospital level, we conducted a thematic review of empirical studies. A systematic search of PubMed, EBSCOHOST, Econlit databases and Google scholar was supplemented by a search of key websites and a manual search of relevant papers’ reference lists. A total of 24 papers were identified from developed and developing countries. We applied a policy analysis framework to examine and synthesize the findings of the selected papers. Findings suggest that priority setting practice in hospitals was influenced by (1) contextual factors such as decision space, resource availability, financing arrangements, availability and use of information, organizational culture and leadership, (2) priority setting processes that depend on the type of priority setting activity, (3) content factors such as priority setting criteria and (4) actors, their interests and power relations. We observe that there is need for studies to examine these issues and the interplay between them in greater depth and propose a conceptual framework that might be useful in examining priority setting practices in hospitals. PMID:24604831
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Process is the point: justice and human rights: priority setting and fair deliberative process.
Gruskin, Sofia; Daniels, Norman
2008-09-01
Most people responsible for setting priorities in health have considerable expertise relevant to deciding how to use resources effectively and the kinds of improvements that should be emphasized. Most are also concerned with distributing improvements equitably. Accordingly, they often invoke human rights or principles of distributive justice to legitimize choices that create winners and losers. We propose an approach that draws on the strengths of both perspectives as a way to add legitimacy to efforts to set priorities in health. Our proposal provides a process for setting priorities but is not a formula or an algorithm for generating particular priorities. We propose an approach that would do away with the process through which priorities are set and decisions made, and suggest the value of a focus on the process of legitimizing these decisions.
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Setting priorities for space research: An experiment in methodology
NASA Technical Reports Server (NTRS)
1995-01-01
In 1989, the Space Studies Board created the Task Group on Priorities in Space Research to determine whether scientists should take a role in recommending priorities for long-term space research initiatives and, if so, to analyze the priority-setting problem in this context and develop a method by which such priorities could be established. After answering the first question in the affirmative in a previous report, the task group set out to accomplish the second task. The basic assumption in developing a priority-setting process is that a reasoned and structured approach for ordering competing initiatives will yield better results than other ways of proceeding. The task group proceeded from the principle that the central criterion for evaluating a research initiative must be its scientific merit -- the value of the initiative to the proposing discipline and to science generally. The group developed a two-stage methodology for priority setting and constructed a procedure and format to support the methodology. The first of two instruments developed was a standard format for structuring proposals for space research initiatives. The second instrument was a formal, semiquantitative appraisal procedure for evaluating competing proposals. This report makes available complete templates for the methodology, including the advocacy statement and evaluation forms, as well as an 11-step schema for a priority-setting process. From the beginning of its work, the task group was mindful that the issue of priority setting increasingly pervades all of federally supported science and that its work would have implications extending beyond space research. Thus, although the present report makes no recommendations for action by NASA or other government agencies, it provides the results of the task group's work for the use of others who may study priority-setting procedures or take up the challenge of implementing them in the future.
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Setting research priorities for Type 1 diabetes.
Gadsby, R; Snow, R; Daly, A C; Crowe, S; Matyka, K; Hall, B; Petrie, J
2012-10-01
Research priorities are often set by academic researchers or the pharmaceutical industry. The interests of patients, carers and clinicians may therefore be overlooked and research questions that matter may be neglected. The aims of this study were to collect uncertainties about the treatment of Type 1 diabetes from patients, carers and health professionals, and to collate and prioritize these uncertainties to develop a top 10 list of research priorities, using a structured priority-setting partnership of patients, carers, health professionals and diabetes organizations, as described by the James Lind Alliance. A partnership of interested organizations was set up, and from this a steering committee of 10 individuals was formed. An online and paper survey was used to identify uncertainties. These were collated, and the steering group carried out an interim priority-setting exercise with partner organizations. This group of uncertainties was then voted on to give a smaller list that went forward to the final priority-setting workshop. At this meeting, a final list of the top 10 research priorities was agreed. An initial 1141 uncertainties were described. These were reduced to 88 indicative questions, 47 of which went out for voting. Twenty-four were then taken forward to a final priority-setting workshop. This workshop resulted in a list of top 10 research priorities in Type 1 diabetes. We have shown that it is possible using the James Lind Alliance process to develop an agreed top 10 list of research priorities for Type 1 diabetes from health professionals, patients and carers. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
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Priority-setting for achieving universal health coverage
Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J
2016-01-01
Abstract Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation’s resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost–effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities – implicitly or explicitly – it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC. PMID:27274598
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Setting healthcare priorities in hospitals: a review of empirical studies.
Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan
2015-04-01
Priority setting research has focused on the macro (national) and micro (bedside) level, leaving the meso (institutional, hospital) level relatively neglected. This is surprising given the key role that hospitals play in the delivery of healthcare services and the large proportion of health systems resources that they absorb. To explore the factors that impact upon priority setting at the hospital level, we conducted a thematic review of empirical studies. A systematic search of PubMed, EBSCOHOST, Econlit databases and Google scholar was supplemented by a search of key websites and a manual search of relevant papers' reference lists. A total of 24 papers were identified from developed and developing countries. We applied a policy analysis framework to examine and synthesize the findings of the selected papers. Findings suggest that priority setting practice in hospitals was influenced by (1) contextual factors such as decision space, resource availability, financing arrangements, availability and use of information, organizational culture and leadership, (2) priority setting processes that depend on the type of priority setting activity, (3) content factors such as priority setting criteria and (4) actors, their interests and power relations. We observe that there is need for studies to examine these issues and the interplay between them in greater depth and propose a conceptual framework that might be useful in examining priority setting practices in hospitals. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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Strengthening expertise for health technology assessment and priority-setting in Africa
Doherty, Jane E; Wilkinson, Thomas; Edoka, Ijeoma; Hofman, Karen
2017-01-01
ABSTRACT Background: Achieving sustainable universal health coverage depends partly on fair priority-setting processes that ensure countries spend scarce resources wisely. While general health economics capacity-strengthening initiatives exist in Africa, less attention has been paid to developing the capacity of individuals, institutions and networks to apply economic evaluation in support of health technology assessment and effective priority-setting. Objective: On the basis of international lessons, to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. Methods: A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Results: Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Conclusions: Research organisations have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. These would help to meet the priority-setting needs of African countries and contribute to sustainable universal health coverage. PMID:29035166
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Kamuzora, Peter; Maluka, Stephen; Ndawi, Benedict; Byskov, Jens; Hurtig, Anna-Karin
2013-01-01
Background Community participation in priority setting in health systems has gained importance all over the world, particularly in resource-poor settings where governments have often failed to provide adequate public-sector services for their citizens. Incorporation of public views into priority setting is perceived as a means to restore trust, improve accountability, and secure cost-effective priorities within healthcare. However, few studies have reported empirical experiences of involving communities in priority setting in developing countries. The aim of this article is to provide the experience of implementing community participation and the challenges of promoting it in the context of resource-poor settings, weak organizations, and fragile democratic institutions. Design Key informant interviews were conducted with the Council Health Management Team (CHMT), community representatives, namely women, youth, elderly, disabled, and people living with HIV/AIDS, and other stakeholders who participated in the preparation of the district annual budget and health plans. Additionally, minutes from the Action Research Team and planning and priority-setting meeting reports were analyzed. Results A number of benefits were reported: better identification of community needs and priorities, increased knowledge of the community representatives about priority setting, increased transparency and accountability, promoted trust among health systems and communities, and perceived improved quality and accessibility of health services. However, lack of funds to support the work of the selected community representatives, limited time for deliberations, short notice for the meetings, and lack of feedback on the approved priorities constrained the performance of the community representatives. Furthermore, the findings show the importance of external facilitation and support in enabling health professionals and community representatives to arrive at effective working arrangement. Conclusion Community participation in priority setting in developing countries, characterized by weak democratic institutions and low public awareness, requires effective mobilization of both communities and health systems. In addition, this study confirms that community participation is an important element in strengthening health systems. PMID:24280341
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Wallace, Lauren; Kapirir, Lydia
2017-04-08
To date, research on priority-setting for new vaccines has not adequately explored the influence of the global, national and sub-national levels of decision-making or contextual issues such as political pressure and stakeholder influence and power. Using Kapiriri and Martin's conceptual framework, this paper evaluates priority setting for new vaccines in Uganda at national and sub-national levels, and considers how global priorities can influence country priorities. This study focuses on 2 specific vaccines, the human papilloma virus (HPV) vaccine and the pneumococcal conjugate vaccine (PCV). This was a qualitative study that involved reviewing relevant Ugandan policy documents and media reports, as well as 54 key informant interviews at the global level and national and sub-national levels in Uganda. Kapiriri and Martin's conceptual framework was used to evaluate the prioritization process. Priority setting for PCV and HPV was conducted by the Ministry of Health (MoH), which is considered to be a legitimate institution. While respondents described the priority setting process for PCV process as transparent, participatory, and guided by explicit relevant criteria and evidence, the prioritization of HPV was thought to have been less transparent and less participatory. Respondents reported that neither process was based on an explicit priority setting framework nor did it involve adequate representation from the districts (program implementers) or publicity. The priority setting process for both PCV and HPV was negatively affected by the larger political and economic context, which contributed to weak institutional capacity as well as power imbalances between development assistance partners and the MoH. Priority setting in Uganda would be improved by strengthening institutional capacity and leadership and ensuring a transparent and participatory processes in which key stakeholders such as program implementers (the districts) and beneficiaries (the public) are involved. Kapiriri and Martin's framework has the potential to guide priority setting evaluation efforts, however, evaluation should be built into the priority setting process a priori such that information on priority setting is gathered throughout the implementation cycle. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Using evaluation theory in priority setting and resource allocation.
Smith, Neale; Mitton, Craig; Cornelissen, Evelyn; Gibson, Jennifer; Peacock, Stuart
2012-01-01
Public sector interest in methods for priority setting and program or policy evaluation has grown considerably over the last several decades, given increased expectations for accountable and efficient use of resources and emphasis on evidence-based decision making as a component of good management practice. While there has been some occasional effort to conduct evaluation of priority setting projects, the literatures around priority setting and evaluation have largely evolved separately. In this paper, the aim is to bring them together. The contention is that evaluation theory is a means by which evaluators reflect upon what it is they are doing when they do evaluation work. Theories help to organize thinking, sort out relevant from irrelevant information, provide transparent grounds for particular implementation choices, and can help resolve problematic issues which may arise in the conduct of an evaluation project. A detailed review of three major branches of evaluation theory--methods, utilization, and valuing--identifies how such theories can guide the development of efforts to evaluate priority setting and resource allocation initiatives. Evaluation theories differ in terms of their guiding question, anticipated setting or context, evaluation foci, perspective from which benefits are calculated, and typical methods endorsed. Choosing a particular theoretical approach will structure the way in which any priority setting process is evaluated. The paper suggests that explicitly considering evaluation theory makes key aspects of the evaluation process more visible to all stakeholders, and can assist in the design of effective evaluation of priority setting processes; this should iteratively serve to improve the understanding of priority setting practices themselves.
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A Nuts and Bolts Guide to College Success for Students Who Are Deaf or Hard of Hearing
ERIC Educational Resources Information Center
PEPNet 2, 2012
2012-01-01
Beginning your college education means you'll be exploring a new place, making new friends, learning new things and setting your own priorities. You are going to face a lot of big changes in a short time. That's exciting--and challenging. The more prepared you are for college when you get there, the more ready you'll be to address these new…
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2006-10-31
Catholic Bishops. + Associate Professor, Department of Social Sciences, United States Military Academy, West Point, New York and Lieutenant Colonel...detailed form explaining their affiliations and travel history, and undergo consular interviews. In addition, the United States instituted new ...completed, but the task assumed a new life following the September 11th attacks. By the end of 2005, DHS had instituted “entry” (check-in
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Health literacy and chronic disease management: drawing from expert knowledge to set an agenda.
Poureslami, Iraj; Nimmon, Laura; Rootman, Irving; Fitzgerald, Mark J
2017-08-01
Understanding the nature and impact of health literacy is a priority in health promotion and chronic disease prevention and treatment. Health literacy comprises the application of a broad set of skills to access, comprehend, evaluate, communicate and act on health information for improved health and well-being. A complex concept, it involves multiple participants and is enacted across a wide variety of contexts. Health literacy's complexity has given rise to challenges achieving a standard definition and developing means to measure all its dimensions. In May 2013, a group of health literacy experts, clinicians and policymakers convened at an Expert Roundtable to review the current state of health literacy research and practice, and make recommendations about refining its definition, expanding its measurement and integrating best practices into chronic disease management. The four-day knowledge exchange concluded that the successful integration of health literacy into policy and practice depends on the development of a more substantial evidence base. A review of the successes and gaps in health literacy research, education and interventions culminated in the identification of key priorities to further the health literacy agenda. The workshop was funded by the UBC Peter Wall Institute for Advanced Studies, Vancouver. © The Author 2016. Published by Oxford University Press.
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Nasser, Mona; Welch, Vivian; Tugwell, Peter; Ueffing, Erin; Doyle, Jodie; Waters, Elizabeth
2013-05-01
The purpose of this study was to assess the presence and effectiveness of existing systems of prioritization for Cochrane review topics and to explore methods of improving those systems. We surveyed groups of Cochrane review authors and recorded any evidence of their use of priority-setting processes or policies. To evaluate the effectiveness of the policies we encountered, we assessed them using two frameworks from the literature: "Accountability for Reasonableness" (1) and Sibbald's 2009 framework (2) for successful priority setting. We then held two workshops with the subject groups to discuss our findings and their implications. Of the 66 groups surveyed, 29 had a system in place to inform the selection or prioritization of topics for Cochrane reviews. Fifteen groups used a more comprehensive structured approach that eventually resulted in a list of ranked priority titles for authoring, updating, or disseminating Cochrane reviews. Most groups involved researchers, practitioners, and patients in their prioritization processes. Groups within The Cochrane Collaboration currently use a range of different priority-setting systems, some of which are more detailed than others. These differences often reflect the nature of The Cochrane Collaboration itself: given the topic breadth, history, and variety of international contexts present in the organization, a single unified system would not always be appropriate. All Cochrane entities, however, should have or develop strategic plans to improve the inclusiveness and transparency of their own prioritization processes, increase the number of finished prioritized reviews, and make more effective use of feedback from end users to increase the likelihood of producing reviews that have positive effects on health outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.
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Discovering Socialization Priorities in Turkish Society Based on What the Value of Success Means
ERIC Educational Resources Information Center
Aypay, Ayse
2016-01-01
The purpose of this study is to discover socialization priorities based on what the value of success means in Turkish society. For this purpose, two related scales have been developed to identify the beliefs of adults in Turkish society towards defining the value of success and the areas in which adults perceive themselves as successful based on…
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McNeely, Clea A; Morland, Lyn; Doty, S Benjamin; Meschke, Laurie L; Awad, Summer; Husain, Altaf; Nashwan, Ayat
2017-02-01
The US education system must find creative and effective ways to foster the healthy development of the approximately 2 million newly arrived immigrant and refugee adolescents, many of whom contend with language barriers, limited prior education, trauma, and discrimination. We identify research priorities for promoting the school success of these youth. The study used the 4-phase priority-setting method of the Child Health and Nutrition Research Initiative. In the final stage, 132 researchers, service providers, educators, and policymakers based in the United States were asked to rate the importance of 36 research options. The highest priority research options (range 1 to 5) were: evaluating newcomer programs (mean = 4.44, SD = 0.55), identifying how family and community stressors affect newly arrived immigrant and refugee adolescents' functioning in school (mean = 4.40, SD = 0.56), identifying teachers' major stressors in working with this population (mean = 4.36, SD = 0.72), and identifying how to engage immigrant and refugee families in their children's education (mean = 4.35, SD = 0.62). These research priorities emphasize the generation of practical knowledge that could translate to immediate, tangible benefits for schools. Funders, schools, and researchers can use these research priorities to guide research for the highest benefit of schools and the newly arrived immigrant and refugee adolescents they serve. © 2017, American School Health Association.
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O'Meara, Wendy Prudhomme; Tsofa, Benjamin; Molyneux, Sassy; Goodman, Catherine; McKenzie, F Ellis
2011-03-01
Health systems reform processes have increasingly recognized the essential contribution of communities to the success of health programs and development activities in general. Here we examine the experience from Kilifi district in Kenya of implementing annual health sector planning guidelines that included community participation in problem identification, priority setting, and planning. We describe challenges in the implementation of national planning guidelines, how these were met, and how they influenced final plans and budgets. The broad-based community engagement envisaged in the guidelines did not take place due to the delay in roll out of the Ministry of Health-trained community health workers. Instead, community engagement was conducted through facility management committees, though in a minority of facilities, even such committees were not involved. Some overlap was found in the priorities highlighted by facility staff, committee members and national indicators, but there were also many additional issues raised by committee members and not by other groups. The engagement of the community through committees influenced target and priority setting, but the emphasis on national health indicators left many local priorities unaddressed by the final work plans. Moreover, it appears that the final impact on budgets allocated at district and facility level was limited. The experience in Kilifi highlights the feasibility of engaging the community in the health planning process, and the challenges of ensuring that this engagement feeds into consolidated plans and future implementation. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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Maluka, Stephen Oswald
2011-01-01
Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader and more detailed analysis of health system elements, and socio-cultural context is imperative in fostering sustainability. Additionally, the study stresses the need to deal with power asymmetries among various actors in priority-setting contexts. PMID:22072991
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Khayatzadeh-Mahani, Akram; Fotaki, Marianna; Harvey, Gillian
2013-08-01
The question of how priority setting processes work remains topical, contentious and political in every health system across the globe. It is particularly acute in the context of developing countries because of the mismatch between needs and resources, which is often compounded by an underdeveloped capacity for decision making and weak institutional infrastructures. Yet there is limited research into how the process of setting and implementing health priorities works in developing countries. This study aims to address this gap by examining how a national priority setting programme works in the centralized health system of Iran and what factors influence its implementation at the meso and micro levels. We used a qualitative case study approach, incorporating mixed methods: in-depth interviews at three levels and a textual analysis of policy documents. The data analysis showed that the process of priority setting is non-systematic, there is little transparency as to how specific priorities are decided, and the decisions made are separated from their implementation. This is due to the highly centralized system, whereby health priorities are set at the macro level without involving meso or micro local levels or any representative of the public. Furthermore, the two main benefit packages are decided by different bodies (Ministry of Health and Medical Education and Ministry of Welfare and Social Security) and there is no co-ordination between them. The process is also heavily influenced by political pressure exerted by various groups, mostly medical professionals who attempt to control priority setting in accordance with their interests. Finally, there are many weaknesses in the implementation of priorities, resulting in a growing gap between rural and urban areas in terms of access to health services.
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Bhaumik, Soumyadeep; Rana, Sangeeta; Karimkhani, Chante; Welch, Vivian; Armstrong, Rebecca; Pottie, Kevin; Dellavalle, Robert; Dhakal, Purushottam; Oliver, Sandy; Francis, Damian K; Nasser, Mona; Crowe, Sally; Aksut, Baran; Amico, Roberto D
2015-01-01
A transparent and evidence-based priority-setting process promotes the optimal use of resources to improve health outcomes. Decision-makers and funders have begun to increasingly engage representatives of patients and healthcare consumers to ensure that research becomes more relevant. However, disadvantaged groups and their needs may not be integrated into the priority-setting process since they do not have a "political voice" or are unable to organise into interest groups. Equitable priority-setting methods need to balance patient needs, values, experiences with population-level issues and issues related to the health system.
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A new methodology for surcharge risk management in urban areas (case study: Gonbad-e-Kavus city).
Hooshyaripor, Farhad; Yazdi, Jafar
2017-02-01
This research presents a simulation-optimization model for urban flood mitigation integrating Non-dominated Sorting Genetic Algorithm (NSGA-II) with Storm Water Management Model (SWMM) hydraulic model under a curve number-based hydrologic model of low impact development technologies in Gonbad-e-Kavus, a small city in the north of Iran. In the developed model, the best performance of the system relies on the optimal layout and capacity of retention ponds over the study area in order to reduce surcharge from the manholes underlying a set of storm event loads, while the available investment plays a restricting role. Thus, there is a multi-objective optimization problem with two conflicting objectives solved successfully by NSGA-II to find a set of optimal solutions known as the Pareto front. In order to analyze the results, a new factor, investment priority index (IPI), is defined which shows the risk of surcharging over the network and priority of the mitigation actions. The IPI is calculated using the probability of pond selection for candidate locations and average depth of the ponds in all Pareto front solutions. The IPI can help the decision makers to arrange a long-term progressive plan with the priority of high-risk areas when an optimal solution has been selected.
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Noorani, Hussein Z; Husereau, Donald R; Boudreau, Rhonda; Skidmore, Becky
2007-01-01
This study sought to identify and compare various practical and current approaches of health technology assessment (HTA) priority setting. A literature search was performed across PubMed, MEDLINE, EMBASE, BIOSIS, and Cochrane. Given an earlier review conducted by European agencies (EUR-ASSESS project), the search was limited to literature indexed from 1996 onward. We also searched Web sites of HTA agencies as well as HTAi and ISTAHC conference abstracts. Agency representatives were contacted for information about their priority-setting processes. Reports on practical approaches selected through these sources were identified independently by two reviewers. A total of twelve current priority-setting frameworks from eleven agencies were identified. Ten countries were represented: Canada, Denmark, England, Hungary, Israel, Scotland, Spain, Sweden, The Netherlands, and United States. Fifty-nine unique HTA priority-setting criteria were divided into eleven categories (alternatives; budget impact; clinical impact; controversial nature of proposed technology; disease burden; economic impact; ethical, legal, or psychosocial implications; evidence; interest; timeliness of review; variation in rates of use). Differences across HTA agencies were found regarding procedures for categorizing, scoring, and weighing of policy criteria. Variability exists in the methods for priority setting of health technology assessment across HTA agencies. Quantitative rating methods and consideration of cost benefit for priority setting were seldom used. These study results will assist HTA agencies that are re-visiting or developing their prioritization methods.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-09-21
... enforcement action at any time, without prior notice and without regard to the enforcement priorities set... the enforcement priorities set forth in CPG 440.100 for unapproved new drugs marketed prior to September 19, 2011. The revision to CPG 440.100 excludes from the enforcement priorities set forth in the...
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Szilard, Istvan; Cserti, Arpad; Hoxha, Ruhija; Gorbacheva, Olga; O'Rourke, Thomas
2002-04-01
The International Organization for Migration (IOM) developed and implemented a three-month project entitled Priority Medical Screening of Kosovar Refugees in Macedonia, within the Humanitarian Evacuation Program (HEP) for Kosovar refugees from FR Yugoslavia, which was adopted in May 1999. The project was based on an agreement with the office of United Nations High Commission for Refugees (UNHCR) and comprised the entry of registration data of refugees with medical condition (Priority Medical Database), and classification (Priority Medical Screening) and medical evacuation of refugees (Priority Medical Evacuation) in Macedonia. To realize the Priority Medical Screening project plan, IOM developed and set up a Medical Database linked to IOM/UNHCR HEP database, recruited and trained a four-member data entry team, worked out and set up a referral system for medical cases from the refugee camps, and established and staffed medical contact office for refugees in Skopje and Tetovo. Furthermore, it organized and staffed a mobile medical screening team, developed and implemented the system and criteria for the classification of referred medical cases, continuously registered and classified the incoming medical reports, contacted regularly the national delegates and referred to them the medically prioritized cases asking for acceptance and evacuation, and co-operated and continuously exchanged the information with UNHCR Medical Co-ordination and HEP team. Within the timeframe of the project, 1,032 medical cases were successfully evacuated for medical treatment to 25 host countries throughout the world. IOM found that those refugees suffering from health problems, who at the time of the termination of the program were still in Macedonia and had not been assisted by the project, were not likely to have been priority one cases, whose health problems could be solved only in a third country. The majority of these vulnerable people needed social rather than medical care and assistance a challenge that international aid agencies needed to address in Macedonia and will need to address elsewhere.
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McGregor, Skye; Henderson, Klara J.; Kaldor, John M.
2014-01-01
Background Priority setting is increasingly recognised as essential for directing finite resources to support research that maximizes public health benefits and drives health equity. Priority setting processes have been undertaken in a number of low- and middle-income country (LMIC) settings, using a variety of methods. We undertook a critical review of reports of these processes. Methods and Findings We searched electronic databases and online for peer reviewed and non-peer reviewed literature. We found 91 initiatives that met inclusion criteria. The majority took place at the global level (46%). For regional or national initiatives, most focused on Sub Saharan Africa (49%), followed by East Asia and Pacific (20%) and Latin America and the Caribbean (18%). A quarter of initiatives aimed to cover all areas of health research, with a further 20% covering communicable diseases. The most frequently used process was a conference or workshop to determine priorities (24%), followed by the Child Health and Nutrition Initiative (CHNRI) method (18%). The majority were initiated by an international organization or collaboration (46%). Researchers and government were the most frequently represented stakeholders. There was limited evidence of any implementation or follow-up strategies. Challenges in priority setting included engagement with stakeholders, data availability, and capacity constraints. Conclusions Health research priority setting (HRPS) has been undertaken in a variety of LMIC settings. While not consistently used, the application of established methods provides a means of identifying health research priorities in a repeatable and transparent manner. In the absence of published information on implementation or evaluation, it is not possible to assess what the impact and effectiveness of health research priority setting may have been. PMID:25275315
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Byskov, Jens; Bloch, Paul; Blystad, Astrid; Hurtig, Anna-Karin; Fylkesnes, Knut; Kamuzora, Peter; Kombe, Yeri; Kvåle, Gunnar; Marchal, Bruno; Martin, Douglas K; Michelo, Charles; Ndawi, Benedict; Ngulube, Thabale J; Nyamongo, Isaac; Olsen, Oystein E; Onyango-Ouma, Washington; Sandøy, Ingvild F; Shayo, Elizabeth H; Silwamba, Gavin; Songstad, Nils Gunnar; Tuba, Mary
2009-10-24
Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met.REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research framework to examine the potential of AFR to support sustainable improvements to health systems performance.This paper reports on the project design and progress and argues that there is a high need for research into legitimate and fair priority setting to improve the knowledge base for achieving sustainable improvements in health outcomes.
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75 FR 74053 - Availability of Final Toxicological Profiles
Federal Register 2010, 2011, 2012, 2013, 2014
2010-11-30
... priority hazardous substances comprising the twenty-first set prepared by ATSDR. FOR FURTHER INFORMATION... final toxicological profiles of priority hazardous substances comprising the twenty-first set prepared... that are most commonly found at facilities on the CERCLA National Priorities List (NPL). Among these...
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Setting priorities in primary health care--on whose conditions? A questionnaire study.
Arvidsson, Eva; André, Malin; Borgquist, Lars; Andersson, David; Carlsson, Per
2012-11-26
In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs', nurses', and patients' prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. The challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.
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Setting research priorities across science, technology, and health sectors: the Tanzania experience.
de Haan, Sylvia; Kingamkono, Rose; Tindamanyire, Neema; Mshinda, Hassan; Makandi, Harun; Tibazarwa, Flora; Kubata, Bruno; Montorzi, Gabriela
2015-03-12
Identifying research priorities is key to innovation and economic growth, since it informs decision makers on effectively targeting issues that have the greatest potential public benefit. As such, the process of setting research priorities is of pivotal importance for favouring the science, technology, and innovation (STI)-driven development of low- and middle-income countries. We report herein on a major cross-sectoral nationwide research priority setting effort recently carried out in Tanzania by the Tanzania Commission for Science and Technology (COSTECH) in partnership with the Council on Health Research for Development (COHRED) and the NEPAD Agency. The first of its type in the country, the process brought together stakeholders from 42 sub-sectors in science, technology, and health. The cross-sectoral research priority setting process consisted of a 'training-of-trainers' workshop, a demonstration workshop, and seven priority setting workshops delivered to representatives from public and private research and development institutions, universities, non-governmental organizations, and other agencies affiliated to COSTECH. The workshops resulted in ranked listings of research priorities for each sub-sector, totalling approximately 800 priorities. This large number was significantly reduced by an expert panel in order to build a manageable instrument aligned to national development plans that could be used to guide research investments. The Tanzania experience is an instructive example of the challenges and issues to be faced in when attempting to identify research priority areas and setting an STI research agenda in low- and middle-income countries. As countries increase their investment in research, it is essential to increase investment in research management and governance as well, a key and much needed capacity for countries to make proper use of research investments.
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2015-10-01
stress and burnout will also be discussed. GOAL: If successful, we plan to maintain and expand the PTSD Practitioner Registry as a novel mechanism...a compelling priority for clinicians working with active-duty Warriors and Veterans with Post Traumatic Stress Disorder (PTSD). The PTSD...Warriors and Veterans with PTSD as well as their families. It will also provide a way of monitoring the levels of burnout among PTSD treatment
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Reveiz, Ludovic; Elias, Vanessa; Terry, Robert F; Alger, Jackeline; Becerra-Posada, Francisco
2013-07-01
To compare health research priority-setting methods and characteristics among countries in Latin America and the Caribbean during 2002 - 2012. This was a systematic review that identified national health research policies and priority agendas through a search of ministry and government databases related to health care institutions. PubMed, LILACS, the Health Research Web, and others were searched for the period from January 2002 - February 2012. The study excluded research organized by governmental institutions and specific national strategies on particular disease areas. Priority-setting methods were compared to the "nine common themes for good practice in health research priorities." National health research priorities were compared to those of the World Health Organization's Millennium Development Goals (MDG). Of the 18 Latin American countries assessed, 13 had documents that established national health research priorities; plus the Caribbean Health Research Council had a research agenda for its 19 constituents. These 14 total reports varied widely in terms of objectives, content, dissemination, and implementation; most provided a list of strategic areas, suggestions, and/or sub-priorities for each country; however, few proposed specific research topics and questions. Future reports could be improved by including more details on the comprehensive approach employed to identify priorities, on the information gathering process, and on practices to be undertaken after priorities are set. There is a need for improving the quality of the methodologies utilized and coordinating Regional efforts as countries strive to meet the MDG.
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Finer, S; Robb, P; Cowan, K; Daly, A; Shah, K; Farmer, A
2018-07-01
To describe processes and outcomes of a priority setting partnership to identify the 'top 10 research priorities' in Type 2 diabetes, involving people living with the condition, their carers, and healthcare professionals. We followed the four-step James Lind Alliance Priority Setting Partnership process which involved: gathering uncertainties using a questionnaire survey distributed to 70 000 people living with Type 2 diabetes and their carers, and healthcare professionals; organizing the uncertainties; interim priority setting by resampling of participants with a second survey; and final priority setting in an independent group of participants, using the nominal group technique. At each step the steering group closely monitored and guided the process. In the first survey, 8227 uncertainties were proposed by 2587 participants, of whom 18% were from black, Asian and minority ethnic groups. Uncertainties were formatted and collated into 114 indicative questions. A total of 1506 people contributed to a second survey, generating a shortlist of 24 questions equally weighted to the contributions of people living with diabetes and their carers and those of healthcare professionals. In the final step the 'top 10 research priorities' were selected, including questions on cure and reversal, risk identification and prevention, and self-management approaches in Type 2 diabetes. Systematic and transparent methodology was used to identify research priorities in a large and genuine partnership of people with lived and professional experience of Type 2 diabetes. The top 10 questions represent consensus areas of research priority to guide future research, deliver responsive and strategic allocation of research resources, and improve the future health and well-being of people living with, and at risk of, Type 2 diabetes. © 2018 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
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Brown, Kenneth H; Hess, Sonja Y; Boy, Erick; Gibson, Rosalind S; Horton, Susan; Osendarp, Saskia J; Sempertegui, Fernando; Shrimpton, Roger; Rudan, Igor
2009-03-01
To make the best use of limited resources for supporting health-related research to reduce child mortality, it is necessary to apply a suitable method to rank competing research options. The Child Health and Nutrition Research Initiative (CHNRI) developed a new methodology for setting health research priorities. To broaden experience with this priority-setting technique, we applied the method to rank possible research priorities concerning the control of Zn deficiency. Although Zn deficiency is not generally recognized as a direct cause of child mortality, recent research indicates that it predisposes children to an increased incidence and severity of several of the major direct causes of morbidity and mortality. Leading experts in the field of Zn research in child health were identified and invited to participate in a technical working group (TWG) to establish research priorities. The individuals were chosen to represent a wide range of expertise in Zn nutrition. The seven TWG members submitted a total of ninety research options, which were then consolidated into a final list of thirty-one research options categorized by the type of resulting intervention. The identified priorities were dominated by research investment options targeting Zn supplementation, and were followed by research on Zn fortification, general aspects of Zn nutrition, dietary modification and other new interventions. In general, research options that aim to improve the efficiency of an already existing intervention strategy received higher priority scores. Challenges identified during the implementation of the methodology and suggestions to modify the priority-setting procedures are discussed.
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Past, present and future challenges in health care priority setting.
Hall, William; Williams, Iestyn; Smith, Neale; Gold, Marthe; Coast, Joanna; Kapiriri, Lydia; Danis, M; Mitton, Craig
2018-05-21
Purpose Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a "magic bullet" is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and identification of areas where knowledge and practice require attention most urgently. The paper aims to discuss these issues. Design/methodology/approach An international survey was administered to experts in the area of priority setting. The survey consisted of open-ended questions focusing on notable achievements, policy and practice challenges, and areas for future research in the discipline of priority setting. It was administered online between February and March of 2015. Findings "Decision-making frameworks" and "Engagement" were the two most frequently mentioned notable achievements. "Priority setting in practice" and "Awareness and education" were the two most frequently mentioned policy and practical challenges. "Priority setting in practice" and "Engagement" were the two most frequently mentioned areas in need of future research. Research limitations/implications Sampling bias toward more developed countries. Future study could use findings to create a more concise version to distribute more broadly. Practical implications Globally, these findings could be used as a platform for discussion and decision making related to policy, practice, and research in this area. Originality/value Whilst this study reaffirmed the continued importance of many longstanding themes in the priority setting literature, it is possible to also discern clear shifts in emphasis as the discipline progresses in response to new challenges.
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Bratzke, Lisa C.; Muehrer, Rebecca J.; Kehl, Karen A.; Lee, Kyoung Suk; Ward, Earlise C.; Kwekkeboom, Kristine L.
2014-01-01
Objectives The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making in among adults with multimorbidity. Design A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. Data sources A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Review methods Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors and processes of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Results Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals’ self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Conclusions Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity. PMID:25468131
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Bratzke, Lisa C; Muehrer, Rebecca J; Kehl, Karen A; Lee, Kyoung Suk; Ward, Earlise C; Kwekkeboom, Kristine L
2015-03-01
The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity. A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Lawrence, Vanessa; Fossey, Jane; Ballard, Clive; Moniz-Cook, Esme; Murray, Joanna
2012-11-01
Psychosocial interventions can improve behaviour and mood in people with dementia, but it is unclear how to maximise their effectiveness or acceptability in residential settings. To understand what underlies the successful implementation of psychosocial interventions in care homes. Systematic review and meta-synthesis of qualitative research. The synthesis of 39 qualitative papers revealed that beneficial psychosocial interventions met the needs of people with dementia to connect with others, make a meaningful contribution and reminisce. Successful implementation rested on the active engagement of staff and family and the continuing provision of tailored interventions and support. This necessitated staff time, and raised issues around priorities and risk, but ultimately helped redefine staff attitudes towards residents and the caregiving role. The findings from the meta-synthesis can help to inform the development and evaluation of psychosocial interventions in care homes and support their widespread implementation in clinical settings.
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40 CFR 35.2015 - State priority system and project priority list.
Code of Federal Regulations, 2010 CFR
2010-07-01
... achieve optimum water quality management consistent with the goals and requirements of the Act. All..., needs and priorities set forth in areawide water quality management plans, and any other factors... priority to projects in priority water quality areas. The priority system may also include the...
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15 CFR 2301.4 - Types of projects and broadcast priorities.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Broadcast Priorities are set forth in order of priority for funding. (1) Priority 1—Provision of Public... priorities. 2301.4 Section 2301.4 Commerce and Foreign Trade Regulations Relating to Telecommunications and... TELECOMMUNICATIONS FACILITIES PROGRAM Application Requirements § 2301.4 Types of projects and broadcast priorities...
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Replacement-ready? Succession planning tops health care administrators' priorities.
Husting, P M; Alderman, M
2001-09-01
Nurses' increasing age coupled with health care's rapidly changing environment moves succession planning, originally only a business sector tool, to a top administrative priority. Through active support of your facility's executive leadership and a clear linkage to long range organization objectives, you can implement this progressive procedure.
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A Mathematical Analysis of Air Traffic Priority Rules
NASA Technical Reports Server (NTRS)
Nakawicz, Anthony J.; Munoz, Cesar A.; Maddalon, Jeffrey M.
2012-01-01
This paper analyzes priority rules, such as those in Part 91.113 of the Federal Aviation Regulations. Such rules determine which of two aircraft should maneuver in a given conflict scenario. While the rules in 91.113 are well accepted, other concepts of operation for NextGen, such as self separation, may allow for different priority rules. A mathematical framework is presented that can be used to analyze a general set of priority rules and enables proofs of important properties. Specific properties considered in this paper include safety, effectiveness, and stability. A set of rules is said to be safe if it ensures that it is never the case that both aircraft have priority. They are effective if exactly one aircraft has priority in every situation. Finally, a set of rules is called stable if it produces compatible results even under small changes to input data.
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15 CFR 700.11 - Priority ratings.
Code of Federal Regulations, 2010 CFR
2010-01-01
... DO-A1 or DX-A1 priority rating. A contract for a radar set will contain a DO-A7 or DX-A7 priority... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Priority ratings. 700.11 Section 700... DEFENSE PRIORITIES AND ALLOCATIONS SYSTEM Industrial Priorities § 700.11 Priority ratings. (a) Levels of...
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2009-01-01
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers have limited resources for developing – or supporting the development of – evidence-informed policies and programmes. These required resources include staff time, staff infrastructural needs (such as access to a librarian or journal article purchasing), and ongoing professional development. They may therefore prefer instead to contract out such work to independent units with more suitably skilled staff and appropriate infrastructure. However, policymakers may only have limited financial resources to do so. Regardless of whether the support for evidence-informed policymaking is provided in-house or contracted out, or whether it is centralised or decentralised, resources always need to be used wisely in order to maximise their impact. Examples of undesirable practices in a priority-setting approach include timelines to support evidence-informed policymaking being negotiated on a case-by-case basis (instead of having clear norms about the level of support that can be provided for each timeline), implicit (rather than explicit) criteria for setting priorities, ad hoc (rather than systematic and explicit) priority-setting process, and the absence of both a communications plan and a monitoring and evaluation plan. In this article, we suggest questions that can guide those setting priorities for finding and using research evidence to support evidence-informed policymaking. These are: 1. Does the approach to prioritisation make clear the timelines that have been set for addressing high-priority issues in different ways? 2. Does the approach incorporate explicit criteria for determining priorities? 3. Does the approach incorporate an explicit process for determining priorities? 4. Does the approach incorporate a communications strategy and a monitoring and evaluation plan? PMID:20018110
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Lavis, John N; Oxman, Andrew D; Lewin, Simon; Fretheim, Atle
2009-12-16
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. Policymakers have limited resources for developing--or supporting the development of--evidence-informed policies and programmes. These required resources include staff time, staff infrastructural needs (such as access to a librarian or journal article purchasing), and ongoing professional development. They may therefore prefer instead to contract out such work to independent units with more suitably skilled staff and appropriate infrastructure. However, policymakers may only have limited financial resources to do so. Regardless of whether the support for evidence-informed policymaking is provided in-house or contracted out, or whether it is centralised or decentralised, resources always need to be used wisely in order to maximise their impact. Examples of undesirable practices in a priority-setting approach include timelines to support evidence-informed policymaking being negotiated on a case-by-case basis (instead of having clear norms about the level of support that can be provided for each timeline), implicit (rather than explicit) criteria for setting priorities, ad hoc (rather than systematic and explicit) priority-setting process, and the absence of both a communications plan and a monitoring and evaluation plan. In this article, we suggest questions that can guide those setting priorities for finding and using research evidence to support evidence-informed policymaking. These are: 1. Does the approach to prioritisation make clear the timelines that have been set for addressing high-priority issues in different ways? 2. Does the approach incorporate explicit criteria for determining priorities? 3. Does the approach incorporate an explicit process for determining priorities? 4. Does the approach incorporate a communications strategy and a monitoring and evaluation plan?
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Rowat, Anne; Pollock, Alex; St George, Bridget; Cowey, Eileen; Booth, Joanne; Lawrence, Maggie
2016-11-01
To determine the top 10 research priorities specific to stroke nursing. It is important that stroke nurses build their research capability and capacity. This project built on a previous James Lind Alliance prioritization project, which established the shared stroke research priorities of stroke survivors, carers and health professionals. Research priority setting project using James Lind Alliance methods; a survey for interim prioritization and a consensus meeting for final priority setting. Between September - November 2014, stroke nurses were invited to select their top 10 priorities from a previously established list of 226 unique unanswered questions. These data were used to generate a list of shared research priorities (interim priority setting stage). A purposefully selected group of stroke nurses attended a final consensus meeting (April 2015) to determine the top 10 research priorities. During the interim prioritization stage, 97 stroke nurses identified 28 shared priority treatment uncertainties. At the final consensus meeting, 27 stroke nurses reached agreement on the top 10 stroke nursing research priorities. Five of the top 10 questions relate to stroke-specific impairments and five relate to rehabilitation and long-term consequences of stroke. The research agenda for stroke nursing has now been clearly defined, facilitating nurses to undertake research, which is of importance to stroke survivors and carers and central to supporting optimal recovery and quality of life after stroke. © 2016 John Wiley & Sons Ltd.
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2015-10-01
practice-related stress and burnout will also be discussed. GOAL: If successful, we plan to maintain and expand the PTSD Practitioner Registry as a...related disorders is a compelling priority for clinicians working with active-duty Warriors and Veterans with Post Traumatic Stress Disorder (PTSD). The...quality of care for Warriors and Veterans with PTSD as well as their families. It will also provide a way of monitoring the levels of burnout among PTSD
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1992-12-01
segmented, target marketing can occur and priorities can be established ( Kotler & Clarke, 1987). Any successful re-capturing of CHAMPUS workload or...introduction, one of the new challenges confronting MTF commanders is the need to engage in target marketing . Kotler and Clarke (1987) pointed out...cardiovascu’ar claims paid during CY 1991 (n=57) and all CHAMPUS tc’dae:et cardi :vascular claims -aid rim;- Se-,t.... E... 19,9 L** onal, an" market area
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Research and management priorities for Hawaiian forest birds
Paxton, Eben H.; Laut, Megan; Vetter, John P.; Kendall, Steve J.
2018-01-01
Hawai‘i's forest birds face a number of conservation challenges that, if unaddressed, will likely lead to the extinction of multiple species in the coming decades. Threats include habitat loss, invasive plants, non-native predators, and introduced diseases. Climate change is predicted to increase the geographic extent and intensity of these threats, adding urgency to implementation of tractable conservation strategies. We present a set of actionable research and management approaches, identified by conservation practitioners in Hawai'i, that will be critical for the conservation of Hawaiian forest birds in the coming years. We also summarize recent progress on these conservation priorities. The threats facing Hawai‘i's forest birds are not unique to Hawai‘i, and successful conservation strategies developed in Hawai‘i can serve as a model for other imperiled communities around the world, especially on islands.
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Hubbard, Gill; Taylor, Claire; Beeken, Becca; Campbell, Anna; Gracey, Jackie; Grimmett, Chloe; Fisher, Abi; Ozakinci, Gozde; Slater, Sarah; Gorely, Trish
2017-12-01
There is a recognized need to include patients in setting research priorities. Research priorities identified by people with a stoma are rarely elicited. To improve the quality of life of people with a stoma through use of evidence-based practice based on research priorities set by patients. Online pilot survey publicized in 2016 via United Kingdom stoma charities. People ranked nine stoma-related quality of life topics in order of research priority. People 16 years of age and over who currently have or have had a stoma for treatment for any medical condition. Distributions of the priority scores for each of the nine research topics were examined. Group differences were explored using either the Mann-Whitney U-test or the Kruskal-Wallis test depending on the number of groups. In total, 225 people completed the survey. The most important research priority was pouch leak problems and stoma bag/appliance problems followed by hernia risk. There were statistically significant differences in ranking research priorities between males and females, age, underlying disease that led to a stoma, stoma type and length of time with a stoma. People with a stoma are willing to engage in and set research priorities. The results should contribute towards future research about setting the research agenda for the study of stoma-related concerns that impact quality of life. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
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7 CFR 623.9 - Easement priority.
Code of Federal Regulations, 2011 CFR
2011-01-01
... restored, (e) Wetland function or values, (f) Likelihood of successful restoration of wetland values, (g... AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.9 Easement priority. The State... government expenditure on restoration and easement purchase. The factors for determining the priority for...
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Setting priorities for reducing risk and advancing patient safety.
Gaffey, Ann D
2016-04-01
We set priorities every day in both our personal and professional lives. Some decisions are easy, while others require much more thought, participation, and resources. The difficult or less appealing priorities may not be popular, may receive push-back, and may be resource intensive. Whether personal or professional, the urgency that accompanies true priorities becomes a driving force. It is that urgency to ensure our patients' safety that brings many of us to work each day. This is not easy work. It requires us to be knowledgeable about the enterprise we are working in and to have the professional skills and competence to facilitate setting the priorities that allow our organizations to minimize risk and maximize value. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.
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Kapiriri, Lydia; Chanda-Kapata, Pascalina
2018-02-17
Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers' understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability.
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Barasa, Edwine W; Cleary, Susan; English, Mike; Molyneux, Sassy
2016-09-30
Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findings RESULTS: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.
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Byskov, Jens; Marchal, Bruno; Maluka, Stephen; Zulu, Joseph M; Bukachi, Salome A; Hurtig, Anna-Karin; Blystad, Astrid; Kamuzora, Peter; Michelo, Charles; Nyandieka, Lillian N; Ndawi, Benedict; Bloch, Paul; Olsen, Oystein E
2014-08-20
Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.
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Maluka, Stephen; Kamuzora, Peter; San Sebastián, Miguel; Byskov, Jens; Ndawi, Benedict; Hurtig, Anna-Karin
2010-12-01
In 2006, researchers and decision-makers launched a five-year project - Response to Accountable Priority Setting for Trust in Health Systems (REACT) - to improve planning and priority-setting through implementing the Accountability for Reasonableness framework in Mbarali District, Tanzania. The objective of this paper is to explore the acceptability of Accountability for Reasonableness from the perspectives of the Council Health Management Team, local government officials, health workforce and members of user boards and committees. Individual interviews were carried out with different categories of actors and stakeholders in the district. The interview guide consisted of a series of questions, asking respondents to describe their perceptions regarding each condition of the Accountability for Reasonableness framework in terms of priority setting. Interviews were analysed using thematic framework analysis. Documentary data were used to support, verify and highlight the key issues that emerged. Almost all stakeholders viewed Accountability for Reasonableness as an important and feasible approach for improving priority-setting and health service delivery in their context. However, a few aspects of Accountability for Reasonableness were seen as too difficult to implement given the socio-political conditions and traditions in Tanzania. Respondents mentioned: budget ceilings and guidelines, low level of public awareness, unreliable and untimely funding, as well as the limited capacity of the district to generate local resources as the major contextual factors that hampered the full implementation of the framework in their context. This study was one of the first assessments of the applicability of Accountability for Reasonableness in health care priority-setting in Tanzania. The analysis, overall, suggests that the Accountability for Reasonableness framework could be an important tool for improving priority-setting processes in the contexts of resource-poor settings. However, the full implementation of Accountability for Reasonableness would require a proper capacity-building plan, involving all relevant stakeholders, particularly members of the community since public accountability is the ultimate aim, and it is the community that will live with the consequences of priority-setting decisions.
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2014-01-01
Background Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). Methods This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. Results The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. Conclusions District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications. PMID:25142148
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29 CFR 1990.131 - Priority lists for regulating potential occupational carcinogens.
Code of Federal Regulations, 2010 CFR
2010-07-01
... POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.131 Priority lists for regulating potential occupational carcinogens. The Secretary shall establish two priority lists for regulating potential... 29 Labor 9 2010-07-01 2010-07-01 false Priority lists for regulating potential occupational...
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Hart, Ailsa L; Lomer, Miranda; Verjee, Azmina; Kemp, Karen; Faiz, Omar; Daly, Ann; Solomon, Julie; McLaughlin, John
2017-02-01
Many uncertainties remain regarding optimal therapies and strategies for the treatment of inflammatory bowel disease. Setting research priorities addressing therapies requires a partnership between health care professionals, patients and organisations supporting patients. We aimed to use the structure of the James Lind Alliance Priority Setting Partnership, which has been used in other disease areas, to identify and prioritise unanswered questions about treatments for inflammatory bowel disease. The James Lind Priority Setting Partnership uses methods agreed and adopted in other disease areas to work with patients and clinicians: to identify uncertainties about treatments; to agree by consensus a prioritised list of uncertainties for research; then to translate these uncertainties into research questions which are amenable to hypothesis testing; and finally to take results to research commissioning bodies to be considered for funding. A total of 1636 uncertainties were collected in the initial survey from 531 respondents, which included 22% health care professionals and 78% patients and carers. Using the rigorously applied processes of the priority setting partnership, this list was distilled down to the top 10 research priorities for inflammatory bowel disease. The top priorities were: identifying treatment strategies to optimise efficacy, safety and cost-effectiveness; and stratifying patients with regard to their disease course and treatment response. Diet and symptom control [pain, incontinence and fatigue] were also topics which were prioritised. A partnership involving multidisciplinary clinicians, patients and organisations supporting patients has identified the top 10 research priorities in the treatment of patients with inflammatory bowel disease. © European Crohn’s and Colitis Organisation 2016.
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SARS and hospital priority setting: a qualitative case study and evaluation.
Bell, Jennifer A H; Hyland, Sylvia; DePellegrin, Tania; Upshur, Ross E G; Bernstein, Mark; Martin, Douglas K
2004-12-19
Priority setting is one of the most difficult issues facing hospitals because of funding restrictions and changing patient need. A deadly communicable disease outbreak, such as the Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, amplifies the difficulties of hospital priority setting. The purpose of this study is to describe and evaluate priority setting in a hospital in response to SARS using the ethical framework 'accountability for reasonableness'. This study was conducted at a large tertiary hospital in Toronto, Canada. There were two data sources: 1) over 200 key documents (e.g. emails, bulletins), and 2) 35 interviews with key informants. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Participants described the types of priority setting decisions, the decision making process and the reasoning used. Although the hospital leadership made an effort to meet the conditions of 'accountability for reasonableness', they acknowledged that the decision making was not ideal. We described good practices and opportunities for improvement. 'Accountability for reasonableness' is a framework that can be used to guide fair priority setting in health care organizations, such as hospitals. In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less.
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Hug, K; Hermerén, G
2013-06-01
The problems of allocation of scarce resources and priority setting in health care have so far not been much studied in the context of stem cell-based therapeutic applications. If and when competitive cost effective stem cell-based therapies are available, the problem of priority setting - to whom should stem cellbased therapies be offered and on what grounds - is discussed in this article using the examples of Parkinson's Disease (PD) and Huntington's Disease (HD). The aim of this paper is to examine the presently known differences between PD and HD and analyze the role of these differences for setting priorities of stem cell-based therapeutic applications to treat these diseases. To achieve this aim, we (1) present the theoretical framework used in the analysis; (2) compare PD and HD in terms of health related and non-health related consequences of these diseases for patients, their relatives and third parties; (3) analyze the ethical relevance of observed differences for priority setting given different values and variables; (4) compare PD and HD in terms of social justice related consequences of stem cell-based therapies; and (5) analyze the ethical relevance of these differences for priority setting given different values and variables. We argue that the steps of analysis applied in this paper could be helpful when setting priorities among treatments of other diseases with similar differences as those between PD and HD.
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IMPORTANCE OF MULTIPLE CRITERIA FOR PRIORITY SETTING OF HIV/AIDS INTERVENTIONS.
Tromp, Noor; Prawiranegara, Rozar; Siregar, Adiatma; Sunjaya, Deni; Baltussen, Rob
2015-01-01
This study describes the views of various stakeholders on the importance of different criteria for priority setting of HIV/AIDS interventions in Indonesia. Based on a general list of criteria and a focus group discussion with stakeholders (n = 6), a list was developed of thirty-two criteria that play a role in priority setting in HIV/AIDS control in West-Java province. Criteria were categorized according to the World Health Organization's health system goals and building block frameworks. People living with HIV/AIDS (n = 49), healthcare workers (HCW) (n = 41), the general population (n = 43), and policy makers (n = 22) rated the importance of thirty-two criteria on a 5-point Likert-scale. Thereafter, respondents ranked the highest rated criteria to express more detailed preferences. Stakeholders valued the following criteria as most important for the priority setting of HIV/AIDS interventions: an intervention's impact on the HIV/AIDS epidemic, reduction of stigma, quality of care, effectiveness on individual level, and feasibility in terms of current capacity of the health system (i.e., HCW, product, information, and service requirements), financial sustainability, and acceptance by donors. Overall, stakeholders' preferences for the importance of criteria are similar. Our study design outlines an approach for other settings to identify which criteria are important for priority setting of health interventions. For Indonesia, these study results may be used in priority setting processes for HIV/AIDS control and may contribute to more transparent and systematic allocation of resources.
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Nyandieka, Lilian Nyamusi; Kombe, Yeri; Ng'ang'a, Zipporah; Byskov, Jens; Njeru, Mercy Karimi
2015-01-01
In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities.
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Application of economic principles in healthcare priority setting.
Bate, Angela; Mitton, Craig
2006-06-01
In healthcare, resources are often insufficient to meet all claims on them. In this respect, resources are considered scarce and have to be managed by prioritizing between competing claims. Economics as a discipline explicitly addresses this reality by acknowledging resource scarcity. However, the extent to which economics actually influences such prioritizing decisions in healthcare is unclear. The purpose of this paper is to review the use of economics in priority setting decision making. We outline the key principles of economics as they apply to priority setting and review the methods reported in the literature with respect to these. We find that these methods, even economic methods (e.g., those typically used in conducting economic evaluations such as cost-effectiveness analyses) do not tend to explicitly incorporate economic principles. We argue therefore that these methods, when applied to the context of priority setting, are not sufficient and that what is required is a broader framework that can incorporate the output from economic methods yet also be pragmatically applicable. We then go on to present an alternative approach - namely program budgeting and marginal analysis. Finally, we put forward our case for using program budgeting and marginal analysis in priority setting practice and set out some future research challenges.
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40 CFR 146.9 - Criteria for establishing permitting priorities.
Code of Federal Regulations, 2010 CFR
2010-07-01
....9 Criteria for establishing permitting priorities. In determining priorities for setting times for... priorities. 146.9 Section 146.9 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER... (a), (c), (g) or § 144.22(f), the Director shall base these priorities upon consideration of the...
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2015 Pediatric Research Priorities in Prehospital Care.
Browne, Lorin R; Shah, Manish I; Studnek, Jonathan R; Farrell, Brittany M; Mattrisch, Linda M; Reynolds, Stacy; Ostermayer, Daniel G; Brousseau, David C; Lerner, E Brooke
2016-01-01
Pediatric prehospital research has been limited, but work in this area is starting to increase particularly with the growth of pediatric-specific research endeavors. Given the increased interest in pediatric prehospital research, there is a need to identify specific research priorities that incorporate the perspective of prehospital providers and other emergency medical services (EMS) stakeholders. To develop a list of specific research priorities that is relevant, specific, and important to the practice of pediatric prehospital care. Three independent committees of EMS providers and researchers were recruited. Each committee developed a list of research topics. These topics were collated and used to initiate a modified Delphi process for developing consensus on a list of research priorities. Participants were the committee members. Topics approved by 80% were retained as research priorities. Topics that were rejected by more than 50% were eliminated. The remaining topics were modified and included on subsequent surveys. Each survey allowed respondents to add additional topics. The surveys were continued until all topics were either successfully retained or rejected and no new topics were suggested. Fifty topics were identified by the three independent committees. These topics were included on the initial electronic survey. There were 5 subsequent surveys. At the completion of the final survey a total of 29 research priorities were identified. These research priorities covered the following study areas: airway management, asthma, cardiac arrest, pain, patient-family interaction, resource utilization, seizure, sepsis, spinal immobilization, toxicology, trauma, training and competency, and vascular access. The research priorities were very specific. For example, under airway the priorities were: "identify the optimal device for effectively managing the airway in the prehospital setting" and "identify the optimal airway management device for specific disease processes." This project developed a list of relevant, specific, and important research priorities for pediatric prehospital care. Some similarities exist between this project and prior research agendas but this list represents a current, more specific research agenda and reflects the opinions of working EMS providers, researchers, and leaders. emergency medical technician; research; emergency medical services; priorities.
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Towards deep inclusion for equity-oriented health research priority-setting: A working model.
Pratt, Bridget; Merritt, Maria; Hyder, Adnan A
2016-02-01
Growing consensus that health research funders should align their investments with national research priorities presupposes that such national priorities exist and are just. Arguably, justice requires national health research priority-setting to promote health equity. Such a position is consistent with recommendations made by the World Health Organization and at global ministerial summits that health research should serve to reduce health inequalities between and within countries. Thus far, no specific requirements for equity-oriented research priority-setting have been described to guide policymakers. As a step towards the explication and defence of such requirements, we propose that deep inclusion is a key procedural component of equity-oriented research priority-setting. We offer a model of deep inclusion that was developed by applying concepts from work on deliberative democracy and development ethics. This model consists of three dimensions--breadth, qualitative equality, and high-quality non-elite participation. Deep inclusion is captured not only by who is invited to join a decision-making process but also by how they are involved and by when non-elite stakeholders are involved. To clarify and illustrate the proposed dimensions, we use the sustained example of health systems research. We conclude by reviewing practical challenges to achieving deep inclusion. Despite the existence of barriers to implementation, our model can help policymakers and other stakeholders design more inclusive national health research priority-setting processes and assess these processes' depth of inclusion. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Integrating economic costs and biological traits into global conservation priorities for carnivores.
Loyola, Rafael Dias; Oliveira-Santos, Luiz Gustavo Rodrigues; Almeida-Neto, Mário; Nogueira, Denise Martins; Kubota, Umberto; Diniz-Filho, José Alexandre Felizola; Lewinsohn, Thomas Michael
2009-08-27
Prioritization schemes usually highlight species-rich areas, where many species are at imminent risk of extinction. To be ecologically relevant these schemes should also include species biological traits into area-setting methods. Furthermore, in a world of limited funds for conservation, conservation action is constrained by land acquisition costs. Hence, including economic costs into conservation priorities can substantially improve their conservation cost-effectiveness. We examined four global conservation scenarios for carnivores based on the joint mapping of economic costs and species biological traits. These scenarios identify the most cost-effective priority sets of ecoregions, indicating best investment opportunities for safeguarding every carnivore species, and also establish priority sets that can maximize species representation in areas harboring highly vulnerable species. We compared these results with a scenario that minimizes the total number of ecoregions required for conserving all species, irrespective of other factors. We found that cost-effective conservation investments should focus on 41 ecoregions highlighted in the scenario that consider simultaneously both ecoregion vulnerability and economic costs of land acquisition. Ecoregions included in priority sets under these criteria should yield best returns of investments since they harbor species with high extinction risk and have lower mean land cost. Our study highlights ecoregions of particular importance for the conservation of the world's carnivores defining global conservation priorities in analyses that encompass socioeconomic and life-history factors. We consider the identification of a comprehensive priority-set of areas as a first step towards an in-situ biodiversity maintenance strategy.
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The contention within health economics: a micro-economic foundation using a macro-economic analysis.
Yaxley, I L
1998-03-01
Health economists claim to use market economics combined with the micro-economic concepts of opportunity cost and the margin to advise on priority setting. However, they are advising on setting priorities through a macro-economic analysis using the costs of the supplier, thus prioritising the producer and not the consumer as the dynamic of economic activity. For health economists any contention within priority setting is due to lack of data not their confusion over fundamental concepts.
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Madi, Banyana Cecilia; Hussein, Julia; Hounton, Sennen; D'Ambruoso, Lucia; Achadi, Endang; Arhinful, Daniel Kojo
2007-09-01
A participatory approach to priority setting in programme evaluation may help improve the allocation and more efficient use of scarce resources especially in low-income countries. Research agendas that are the result of collaboration between researchers, programme managers, policy makers and other stakeholders have the potential to ensure rigorous studies are conducted on matters of local priority, based on local, expert knowledge. This paper describes a process involving key stakeholders to elicit and prioritise evaluation needs for safe motherhood in three developing countries. A series of reiterative consultations with safe motherhood stakeholders from each country was conducted over a period of 36 months. In each country, the consultation process consisted of a series of participatory workshops; firstly, stakeholder's views on evaluation were elicited with parallel descriptive work on the contexts. Secondly, priorities for evaluation were identified from stakeholders; thirdly, the evaluation-priorities were refined; and finally, the evaluation research questions, reflecting the identified priorities, were agreed and finalised. Three evaluation-questions were identified in each country, and one selected, on which a full scale evaluation was undertaken. While there is a great deal written about the importance of transparent and participatory priority setting in evaluation; few examples of how such processes could be implemented exist, particularly for maternal health programmes. Our experience demonstrates that the investment in a participatory priority-setting effort is high but the process undertaken resulted in both globally and contextually-relevant priorities for evaluation. This experience provides useful lessons for public health practitioners committed to bridging the research-policy interface.
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Jaramillo, Alejandra; Welch, Vivian A; Ueffing, Erin; Gruen, Russell L; Bragge, Peter; Lyddiatt, Anne; Tugwell, Peter
2013-05-01
To identify high-priority research questions for osteoarthritis systematic reviews with consideration of health equity and the social determinants of health (SDH). We consulted with experts and conducted a literature search to identify a priority-setting method that could be adapted to address the health equity and SDH. We selected the Global Evidence Mapping priority-setting method, and through consultations and consensus, we adapted the method to meet our objectives. This involves developing an evidence map of the existing systematic reviews on osteoarthritis; conducting one face-to-face workshop with patients and another one with clinicians, researchers, and patients; and conducting an online survey of patients to rank the top 10 research questions. We piloted the adapted method with the Cochrane Musculoskeletal Review Group to set research priorities for osteoarthritis. Our focus was on systematic reviews: we identified 34 high-priority research questions for osteoarthritis systematic reviews. Prevention and self-management interventions, mainly diet and exercise, are top priorities for osteoarthritis systematic reviews. Evaluation against our predefined objectives showed that this method did prioritize SDH (50% of the research questions considered SDH). There were marked gaps: no high-priority topics were identified for access to care until patients had advanced disease-lifestyle changes once the disease was diagnosed. This method was felt feasible if conducted annually. We confirmed the utility of an adapted priority-setting method that is feasible and considers SDH. Further testing of this method is needed to assess whether considerations of health equity are prioritized and involve disadvantaged groups of the population. Copyright © 2013 Elsevier Inc. All rights reserved.
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Smith, Neale; Mitton, Craig; Peacock, Stuart; Cornelissen, Evelyn; MacLeod, Stuart
2009-01-01
Background To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation. Methods The researchers enlisted decision-maker partners from each of British Columbia's six health authorities. Three forums were held, at which researchers and decision-makers from various levels in the health authorities considered possible research areas related to three key focus areas: (1) generation and use of decision criteria and measurement of 'benefit' against such criteria; (2) identification of so-called 'disinvestment' opportunities; and (3) evaluation of the effectiveness of priority setting procedures. Detailed notes were taken from each forum and synthesized into a set of qualitative themes. Results Forum participants suggested that future research into healthcare priority setting would benefit from studies that were longitudinal, comparative, and/or interdisciplinary. As well, participants identified two broad theme areas in which specific research projects were deemed desirable. First, future research might usefully consider how formal priority setting and resource allocation projects are situated within a larger organizational and political context. Second, additional research efforts should be devoted to better understanding and improving the actual implementation of priority setting frameworks, particularly with respect to issues of change management and the resolution of impediments to action on recommendations for resource allocation. Conclusion We were able to validate the importance of initial areas posed to the group and observed emergence of additional concerns and directions of critical importance to these decision-makers at this time. It is likely that the results are broadly applicable to other healthcare contexts. The implementation of this research agenda in British Columbia will depend upon the ability of the researchers and decision-makers to develop particular projects that fit within the constraints of existing funding opportunities. The process of engagement itself had benefits in terms of connecting decision-makers with their peers and sparking increased interest in the use and refinement of priority setting frameworks. PMID:19754969
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2014-01-01
Introduction The health of Indigenous Australians is worse than that of other Australians. Most of the determinants of health are preventable and the poor health outcomes are inequitable. The Australian Government recently pledged to close that health gap. One possible way is to improve the priority setting process to ensure transparency and the use of evidence such as epidemiology, equity and economic evaluation. The purpose of this research was to elicit the perceptions of Indigenous and non-Indigenous decision-makers on several issues related to priority setting in Indigenous-specific health care services. Specifically, we aimed to: 1. identify the criteria used to set priorities in Indigenous-specific health care services; 2. determine the level of uptake of economic evaluation evidence by decision-makers and how to improve its uptake; and 3. identify how the priority setting process can be improved from the perspective of decision-makers. Methods We used a paper survey instrument, adapted from Mitton and colleagues’ work, and a face-to-face interview approach to elicit decision-makers’ perceptions in Indigenous-specific health care in Victoria, Australia. We used mixed methods to analyse data from the survey. Responses were summarised using descriptive statistics and content analysis. Results were reported as numbers and percentages. Results The size of the health burden; sustainability and acceptability of interventions; historical trends/patterns; and efficiency are key criteria for making choices in Indigenous health in Victoria. There is a need for an explicit priority setting approach, which is systematic, and is able to use available data/evidence, such as economic evaluation evidence. The involvement of Indigenous Australians in the process would potentially make the process acceptable. Conclusions An economic approach to priority setting is a potentially acceptable and useful tool for Aboriginal Community Controlled Health Services (ACCHS). It has the ability to use evidence and ensure due process at the same time. The use of evidence can ensure that health outcomes for Indigenous peoples can be maximised – hence, increase the potential for ‘closing the gap’ between Indigenous and other Australians. PMID:24906391
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Involving patients in setting priorities for healthcare improvement: a cluster randomized trial
2014-01-01
Background Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. Methods Design: Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). Setting: Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. Intervention: Patients were consulted in writing, before participating in face-to-face deliberation with professionals. Control: Professionals established priorities among themselves, without patient involvement. Participants: A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. Outcomes: The primary outcome was the level of agreement between patients’ and professionals’ priorities. Secondary outcomes included professionals’ intention to use the selected quality indicators, and the costs of patient involvement. Results Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p < 0.01). Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). Professionals’ intention to use the selected quality indicators was similar in intervention and control sites. Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. Conclusions Patient involvement can change priorities driving healthcare improvement at the population level. Future research should test the generalizability of these findings to other contexts, and assess its impact on patient care. Trial registration The Netherlands National Trial Register #NTR2496. PMID:24555508
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Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda.
Kapiriri, Lydia; Norheim, Ole Frithjof; Martin, Douglas K
2007-06-01
The objectives of this study were (1) to describe the process of healthcare priority setting in Ontario-Canada, Norway and Uganda at the three levels of decision-making; (2) to evaluate the description using the framework for fair priority setting, accountability for reasonableness; so as to identify lessons of good practices. We carried out case studies involving key informant interviews, with 184 health practitioners and health planners from the macro-level, meso-level and micro-level from Canada-Ontario, Norway and Uganda (selected by virtue of their varying experiences in priority setting). Interviews were audio-recorded, transcribed and analyzed using a modified thematic approach. The descriptions were evaluated against the four conditions of "accountability for reasonableness", relevance, publicity, revisions and enforcement. Areas of adherence to these conditions were identified as lessons of good practices; areas of non-adherence were identified as opportunities for improvement. (i) at the macro-level, in all three countries, cabinet makes most of the macro-level resource allocation decisions and they are influenced by politics, public pressure, and advocacy. Decisions within the ministries of health are based on objective formulae and evidence. International priorities influenced decisions in Uganda. Some priority-setting reasons are publicized through circulars, printed documents and the Internet in Canada and Norway. At the meso-level, hospital priority-setting decisions were made by the hospital managers and were based on national priorities, guidelines, and evidence. Hospital departments that handle emergencies, such as surgery, were prioritized. Some of the reasons are available on the hospital intranet or presented at meetings. Micro-level practitioners considered medical and social worth criteria. These reasons are not publicized. Many practitioners lacked knowledge of the macro- and meso-level priority-setting processes. (ii) Evaluation-relevance: medical evidence and economic criteria were thought to be relevant, but lobbying was thought to be irrelevant. Publicity: all cases lacked clear and effective mechanisms for publicity. REVISIONS: formal mechanisms, following the planning hierarchy, were considered less effective, informal political mechanisms were considered more effective. Canada and Norway had patients' relations officers to deal with patients' dissensions; however, revisions were more difficult in Uganda. Enforcement: leadership for ensuring decision-making fairness was not apparent. The different levels of priority setting in the three countries fulfilled varying conditions of accountability for reasonableness, none satisfied all the four conditions. To improve, decision makers at the three levels in all three cases should engage frontline practitioners, develop more effectively publicized reasons, and develop formal mechanisms for challenging and revising decisions.
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Hagen, Suzanne; McClurg, Doreen; Pollock, Alex
2018-01-01
Objectives To identify the shared priorities for future research of women affected by and clinicians involved with pessary use for the management of prolapse. Design A priority setting project using a consensus method. Setting A James Lind Alliance Pessary use for prolapse Priority Setting Partnership (JLA Pessary PSP) conducted from May 2016 to September 2017 in the UK. Participants The PSP was run by a Steering Group of three women with experience of pessary use, three experienced clinicians involved with management of prolapse, two researchers with relevant experience, a JLA adviser and a PSP leader. Two surveys were conducted in 2016 and 2017. The first gathered questions about pessaries, and the second asked respondents to prioritise a list of questions. A final workshop was held on 8 September 2017 involving 10 women and 13 clinician representatives with prolapse and pessary experience. Results A top 10 list of priorities for future research in pessary use for prolapse was agreed by consensus. Conclusions Women with experience of pessary use and clinicians involved with prolapse management have worked together to determine shared priorities for future research. Aligning the top 10 results with existing research findings will highlight the gaps in current evidence and signpost future research to areas of priority. Effective dissemination of the results will enable research funding bodies to focus on gathering the evidence to answer the questions that matter most to those who will be affected. PMID:29705767
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49 CFR 554.7 - Investigation priorities.
Code of Federal Regulations, 2010 CFR
2010-10-01
... Investigation priorities. (a) Compliance investigation priorities are reviewed annually and are set according to... 49 Transportation 6 2010-10-01 2010-10-01 false Investigation priorities. 554.7 Section 554.7 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY...
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Code of Federal Regulations, 2010 CFR
2010-10-01
... priorities; mechanisms which will be utilized to ensure effective client participation in priority-setting... Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION PRIORITIES IN USE OF RESOURCES... information on all emergency cases or matters undertaken that were not within the recipient's priorities, and...
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Development of a new model to engage patients and clinicians in setting research priorities.
Pollock, Alex; St George, Bridget; Fenton, Mark; Crowe, Sally; Firkins, Lester
2014-01-01
Equitable involvement of patients and clinicians in setting research and funding priorities is ethically desirable and can improve the quality, relevance and implementation of research. Survey methods used in previous priority setting projects to gather treatment uncertainties may not be sufficient to facilitate responses from patients and their lay carers for some health care topics. We aimed to develop a new model to engage patients and clinicians in setting research priorities relating to life after stroke, and to explore the use of this model within a James Lind Alliance (JLA) priority setting project. We developed a model to facilitate involvement through targeted engagement and assisted involvement (FREE TEA model). We implemented both standard surveys and the FREE TEA model to gather research priorities (treatment uncertainties) from people affected by stroke living in Scotland. We explored and configured the number of treatment uncertainties elicited from different groups by the two approaches. We gathered 516 treatment uncertainties from stroke survivors, carers and health professionals. We achieved approximately equal numbers of contributions; 281 (54%) from stroke survivors/carers; 235 (46%) from health professionals. For stroke survivors and carers, 98 (35%) treatment uncertainties were elicited from the standard survey and 183 (65%) at FREE TEA face-to-face visits. This contrasted with the health professionals for whom 198 (84%) were elicited from the standard survey and only 37 (16%) from FREE TEA visits. The FREE TEA model has implications for future priority setting projects and user-involvement relating to populations of people with complex health needs. Our results imply that reliance on standard surveys may result in poor and unrepresentative involvement of patients, thereby favouring the views of health professionals.
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Tromp, Noor; Prawiranegara, Rozar; Subhan Riparev, Harris; Siregar, Adiatma; Sunjaya, Deni; Baltussen, Rob
2015-04-01
Indonesia has insufficient resources to adequately respond to the HIV/AIDS epidemic, and thus faces a great challenge in prioritizing interventions. In many countries, such priority setting processes are typically ad hoc and not transparent leading to unfair decisions. Here, we evaluated the priority setting process in HIV/AIDS control in West Java province against the four conditions of the accountability for reasonableness (A4R) framework: relevance, publicity, appeals and revision, and enforcement. We reviewed government documents and conducted semi-structured qualitative interviews based on the A4R framework with 22 participants of the 5-year HIV/AIDS strategy development for 2008-13 (West Java province) and 2007-11 (Bandung). We found that criteria for priority setting were used implicitly and that the strategies included a wide range of programmes. Many stakeholders were involved in the process but their contribution could be improved and particularly the public and people living with HIV/AIDS could be better engaged. The use of appeal and publicity mechanisms could be more transparent and formally stated. Public regulations are not yet installed to ensure fair priority setting. To increase fairness in HIV/AIDS priority setting, West Java should make improvements on all four conditions of the A4R framework. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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29 CFR 4044.14 - Priority category 4 benefits.
Code of Federal Regulations, 2010 CFR
2010-07-01
... priority category 4 with respect to a participant is not limited by the aggregate benefits limitations set... 29 Labor 9 2010-07-01 2010-07-01 false Priority category 4 benefits. 4044.14 Section 4044.14 Labor... Priority category 4 benefits. The benefits assigned to priority category 4 with respect to each participant...
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-01-04
... Assurance, is collecting external comment on a set of candidate enforcement and compliance priorities for FY... National Enforcement and Compliance Assurance Priorities for Fiscal Years 2011-2013 AGENCY: Environmental... national priorities to be addressed for fiscal years 2011-2013. EPA selects these priority areas every...
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10 CFR 600.111 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-01-01
... and Priority Setting. DOE will, whenever practical, notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by Federal statute. ...
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Mather, Carey; Cummings, Elizabeth
2017-01-01
Successful implementation of mobile technology for informal learning and continuing professional development within healthcare settings cannot be achieved or sustained, until end-users recognise that the benefits of using this innovation, outweigh the issues of non-use. At a systems level there is a need for standards, guidelines and codes of conduct to support deployment of mobile technology at an individual level. The aim of this research was to explore findings of a previous focus group study to elucidate priorities for action, provide evidence and focus impetus for advocating progression of the installation of standards and guidelines at an organisation level. The study confirms nurse supervisors' preparedness and readiness to employ mobile learning at point of care. However, successful implementation requires organisations engaging with, and embracing the evolving digital landscape, and supporting this new andragogy. Organisational level commitment will promote contemporary nursing practice, support the best clinical outcomes for patients, and provide educational support for nurses. Nurse leaders and professional bodies must drive and guide development of robust standards, guidelines, and codes of conduct to prioritise mobile learning as a component of digital professionalism within healthcare organisations.
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Colleges and universities: survival in the information age
NASA Astrophysics Data System (ADS)
Huff, Warren D.
2000-07-01
Coping with information technology (IT) planning is one of the more important, expensive, time-consuming and potentially disastrous exercises an academic institution can undertake. Those institutions that are successful in establishing administrative and academic frameworks within which rapid technological change and adaptation can occur will survive and those who stubbornly adhere to archaic styles of management and decision-making will not. IT strategies, priorities and plans must be driven by and integrated with on-going academic planning. Cross-department/unit collaboration must be encouraged and facilitated by university resources and processes. Long-range planning and identification of reasonable and attainable goals requires a leadership and governance structure in which all major stakeholders participate in setting information technology strategies, priorities, plans, standards and performance measures. A successful technology funding strategy must ensure budgeting for adequate network facilities, including assets and the people and processes to support them. Accompanying these administrative procedures should be an open dialogue on the issues brought about by apparent conflicts between University wide standardization of basic policy, procedures and technologies and the pedagogical and research initiatives which address unique collegiate or departmental needs. Network capabilities should be integrated, timely, accurate, secure and easily accessible to all who need it.
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38 CFR 49.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-07-01
...) Public notice and priority setting. Federal awarding agencies shall notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by Federal...
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29 CFR 95.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-07-01
... policies. Public Notice and Priority Setting. Federal awarding agencies shall notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by...
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Setting Research Priorities for Kidney Cancer.
Jones, Jennifer M; Bhatt, Jaimin; Avery, Jonathan; Laupacis, Andreas; Cowan, Katherine; Basappa, Naveen S; Basiuk, Joan; Canil, Christina; Al-Asaaed, Sohaib; Heng, Daniel Y C; Wood, Lori; Stacey, Dawn; Kollmannsberger, Christian; Jewett, Michael A S
2017-12-01
Defining disease-specific research priorities in cancer can facilitate better allocation of limited resources. Involving patients and caregivers as well as expert clinicians in this process is of value. We undertook this approach for kidney cancer as an example. The Kidney Cancer Research Network of Canada sponsored a collaborative consensus-based priority-setting partnership that identified ten research priorities in the management of kidney cancer. These are discussed in the context of current initiatives and gaps in knowledge. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Cartier, Yuri; Creatore, Maria I; Hoffman, Steven J; Potvin, Louise
2018-06-22
Priority-driven funding streams for population and public health are an important part of the health research landscape and contribute to orienting future scholarship in the field. While research priorities are often made public through targeted calls for research, less is known about how research funding organisations arrive at said priorities. Our objective was to explore how public health research funding organisations develop priorities for strategic extramural research funding programmes. Content analysis of published academic and grey literature and key informant interviews for five public and private funders of public health research in the United Kingdom, Australia, the United States and France were performed. We found important distinctions in how funding organisations processed potential research priorities through four non-sequential phases, namely idea generation, idea analysis, idea socialisation and idea selection. Funders generally involved the public health research community and public health decision-makers in idea generation and socialisation, but other groups of stakeholders (e.g. the public, advocacy organisations) were not as frequently included. Priority-setting for strategic funding programmes in public health research involves consultation mainly with researchers in the early phase of the process. There is an opportunity for greater breadth of participation and more transparency in priority-setting mechanisms for strategic funding programmes in population and public health research.
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29 CFR 1990.131 - Priority lists for regulating potential occupational carcinogens.
Code of Federal Regulations, 2014 CFR
2014-07-01
... carcinogens. 1990.131 Section 1990.131 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND... POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.131 Priority lists for regulating potential occupational carcinogens. The Secretary shall establish two priority lists for regulating potential...
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29 CFR 1990.131 - Priority lists for regulating potential occupational carcinogens.
Code of Federal Regulations, 2013 CFR
2013-07-01
... carcinogens. 1990.131 Section 1990.131 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND... POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.131 Priority lists for regulating potential occupational carcinogens. The Secretary shall establish two priority lists for regulating potential...
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29 CFR 1990.131 - Priority lists for regulating potential occupational carcinogens.
Code of Federal Regulations, 2012 CFR
2012-07-01
... carcinogens. 1990.131 Section 1990.131 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND... POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.131 Priority lists for regulating potential occupational carcinogens. The Secretary shall establish two priority lists for regulating potential...
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29 CFR 1990.131 - Priority lists for regulating potential occupational carcinogens.
Code of Federal Regulations, 2011 CFR
2011-07-01
... carcinogens. 1990.131 Section 1990.131 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND... POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.131 Priority lists for regulating potential occupational carcinogens. The Secretary shall establish two priority lists for regulating potential...
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Integrating Economic Costs and Biological Traits into Global Conservation Priorities for Carnivores
Loyola, Rafael Dias; Oliveira-Santos, Luiz Gustavo Rodrigues; Almeida-Neto, Mário; Nogueira, Denise Martins; Kubota, Umberto; Diniz-Filho, José Alexandre Felizola; Lewinsohn, Thomas Michael
2009-01-01
Background Prioritization schemes usually highlight species-rich areas, where many species are at imminent risk of extinction. To be ecologically relevant these schemes should also include species biological traits into area-setting methods. Furthermore, in a world of limited funds for conservation, conservation action is constrained by land acquisition costs. Hence, including economic costs into conservation priorities can substantially improve their conservation cost-effectiveness. Methodology/Principal Findings We examined four global conservation scenarios for carnivores based on the joint mapping of economic costs and species biological traits. These scenarios identify the most cost-effective priority sets of ecoregions, indicating best investment opportunities for safeguarding every carnivore species, and also establish priority sets that can maximize species representation in areas harboring highly vulnerable species. We compared these results with a scenario that minimizes the total number of ecoregions required for conserving all species, irrespective of other factors. We found that cost-effective conservation investments should focus on 41 ecoregions highlighted in the scenario that consider simultaneously both ecoregion vulnerability and economic costs of land acquisition. Ecoregions included in priority sets under these criteria should yield best returns of investments since they harbor species with high extinction risk and have lower mean land cost. Conclusions/Significance Our study highlights ecoregions of particular importance for the conservation of the world's carnivores defining global conservation priorities in analyses that encompass socioeconomic and life-history factors. We consider the identification of a comprehensive priority-set of areas as a first step towards an in-situ biodiversity maintenance strategy. PMID:19710911
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40 CFR 30.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-07-01
... and priority setting. EPA shall notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by Federal statute. (c) By submitting an...
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2 CFR 215.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Government. (b) Public Notice and Priority Setting. Federal awarding agencies shall notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by...
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Jones, Jennifer; Bhatt, Jaimin; Avery, Jonathan; Laupacis, Andreas; Cowan, Katherine; Basappa, Naveen; Basiuk, Joan; Canil, Christina; Al-Asaaed, Sohaib; Heng, Daniel; Wood, Lori; Stacey, Dawn; Kollmannsberger, Christian; Jewett, Michael A S
2017-12-01
It is critically important to define disease-specific research priorities to better allocate limited resources. There is growing recognition of the value of involving patients and caregivers, as well as expert clinicians in this process. To our knowledge, this has not been done this way for kidney cancer. Using the transparent and inclusive process established by the James Lind Alliance, the Kidney Cancer Research Network of Canada (KCRNC) sponsored a collaborative consensus-based priority-setting partnership (PSP) to identify research priorities in the management of kidney cancer. The final result was identification of 10 research priorities for kidney cancer, which are discussed in the context of current initiatives and gaps in knowledge. This process provided a systematic and effective way to collaboratively establish research priorities with patients, caregivers, and clinicians, and provides a valuable resource for researchers and funding agencies.
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Priority setting in developing countries health care institutions: the case of a Ugandan hospital
Kapiriri, Lydia; Martin, Douglas K
2006-01-01
Background 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. However, there is lack of literature that describes and evaluates priority setting in these contexts. The objective of this paper is to describe priority setting in a teaching hospital in Uganda and evaluate the description against an ethical framework for fair priority setting processes – Accountability for Reasonableness. Methods A case study in a 1,500 bed national referral hospital receiving 1,320 out patients per day and an average budget of US$ 13.5 million per year. We reviewed documents and carried out 70 in-depth interviews (14 health planners, 40 doctors, and 16 nurses working at the hospital). Interviews were recorded and transcribed. Data analysis employed the modified thematic approach to describe priority setting, and the description was evaluated using the four conditions of Accountability for Reasonableness: relevance, publicity, revisions and enforcement. Results Senior managers, guided by the hospital strategic plan make the hospital budget allocation decisions. Frontline practitioners expressed lack of knowledge of the process. Relevance: Priority is given according to a cluster of factors including need, emergencies and patient volume. However, surgical departments and departments whose leaders "make a lot of noise" are also prioritized. Publicity: Decisions, but not reasons, are publicized through general meetings and circulars, but this information does not always reach the frontline practitioners. Publicity to the general public was through ad hoc radio programs and to patients who directly ask. Revisions: There were no formal mechanisms for challenging the reasoning. Enforcement: There were no mechanisms to ensure adherence to the four conditions of a fair process. Conclusion Priority setting decisions at this hospital do not satisfy the conditions of fairness. To improve, the hospital should: (i) engage frontline practitioners, (ii) publicize the reasons for decisions both within the hospital and to the general public, and (iii) develop formal mechanisms for challenging the reasoning. In addition, capacity strengthening is required for senior managers who must accept responsibility for ensuring that the above three conditions are met. PMID:17026761
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37 CFR 1.451 - The priority claim and priority document in an international application.
Code of Federal Regulations, 2010 CFR
2010-07-01
... set forth in § 1.19(b)(1). (c) If a certified copy of the priority document is not submitted together... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false The priority claim and priority document in an international application. 1.451 Section 1.451 Patents, Trademarks, and Copyrights...
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Strategic emphases for tropical diseases research: a TDR perspective.
Remme, Jan H F; Blas, Erik; Chitsulo, Lester; Desjeux, Philippe M P; Engers, Howard D; Kanyok, Thomas P; Kengeya Kayondo, Jane F; Kioy, Deborah W; Kumaraswami, Vasanthapuram; Lazdins, Janis K; Nunn, Paul P; Oduola, Ayoade; Ridley, Robert G; Toure, Yeya T; Zicker, Fabio; Morel, Carlos M
2002-10-01
Setting priorities for health research is a difficult task, especially for the neglected diseases of the poor. A new approach to priority setting for tropical diseases research has been adopted by the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (known as the TDR). Priorities are defined on the basis of a comprehensive analysis of research needs and research opportunities for each of the ten major tropical diseases in the TDR portfolio. The resulting strategic emphases matrix reflects the priorities for tropical diseases research from the perspective of the TDR. Its purpose is not to impose global research priorities, but we believe the results could be useful to other organizations.
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Botti, Mari; Redley, Bernice; Nguyen, Lemai; Coleman, Kimberley; Wickramasinghe, Nilmini
2015-01-01
This research focuses on a major health priority for Australia by addressing existing gaps in the implementation of nursing informatics solutions in healthcare. It serves to inform the successful deployment of IT solutions designed to support patient-centered, frontline acute healthcare delivery by multidisciplinary care teams. The outcomes can guide future evaluations of the contribution of IT solutions to the efficiency, safety and quality of care delivery in acute hospital settings.
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Improving Uptake of Key Perinatal Interventions Using Statewide Quality Collaboratives.
Pai, Vidya V; Lee, Henry C; Profit, Jochen
2018-06-01
Regional and statewide quality improvement collaboratives have been instrumental in implementing evidence-based practices and facilitating quality improvement initiatives within neonatology. Statewide collaboratives emerged from larger collaborative organizations, like the Vermont Oxford Network, and play an increasing role in collecting and interpreting data, setting priorities for improvement, disseminating evidence-based clinical practice guidelines, and creating regional networks for synergistic learning. In this review, we highlight examples of successful statewide collaborative initiatives, as well as challenges that exist in initiating and sustaining collaborative efforts. Copyright © 2018 Elsevier Inc. All rights reserved.
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Advancing LGBT Health at an Academic Medical Center: A Case Study.
Yehia, Baligh R; Calder, Daniel; Flesch, Judd D; Hirsh, Rebecca L; Higginbotham, Eve; Tkacs, Nancy; Crawford, Beverley; Fishman, Neil
2015-12-01
Academic health centers are strategically positioned to impact the health of lesbian, gay, bisexual and transgender (LGBT) populations by advancing science, educating future generations of providers, and delivering integrated care that addresses the unique health needs of the LGBT community. This report describes the early experiences of the Penn Medicine Program for LGBT Health, highlighting the favorable environment that led to its creation, the mission and structure of the Program, strategic planning process used to set priorities and establish collaborations, and the reception and early successes of the Program.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-11-18
... the Regional Entities set priorities of what to audit, and are they doing a good job setting priorities? Do audits focus too much on documentation? Would alternative auditing methods also demonstrate...
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Accounting and Financial Planning--Top Priorities for School Business Administrators.
ERIC Educational Resources Information Center
Walters, Donald L.
Success for the business administrator depends largely on ability to identify priorities and to direct time, energy, and know-how accordingly. This study attempted to find out the priorities of the tasks of accounting and financial planning for school business administrators and the precise nature of the school business administrator's…
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34 CFR 263.21 - What priority is given to certain projects and applicants?
Code of Federal Regulations, 2014 CFR
2014-07-01
... 34 Education 1 2014-07-01 2014-07-01 false What priority is given to certain projects and... PROGRAMS Demonstration Grants for Indian Children Program § 263.21 What priority is given to certain... subject matters, including math and science, to enable Indian students to successfully transition to...
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Fee, Christopher; Hall, Kendall; Morrison, J. Bradley; Stephens, Robert; Cosby, Karen; Fairbanks, Rollin (Terry) J.; Youngberg, Barbara; Lenehan, Gail; Abualenain, Jameel; O’Connor, Kevin; Wears, Robert
2012-01-01
This article describes the results of the Interventions to Safeguard Safety breakout session of the 2011 Academic Emergency Medicine (AEM) consensus conference entitled “Interventions to Assure Quality in the Crowded Emergency Department.” Using a multistep nominal group technique, experts in emergency department (ED) crowding, patient safety, and systems engineering defined knowledge gaps and priority research questions related to the maintenance of safety in the crowded ED. Consensus was reached for seven research priorities related to interventions to maintain safety in the setting of a crowded ED. Included among these are: 1) How do routine corrective processes and compensating mechanism change during crowding? 2) What metrics should be used to determine ED safety? 3) How can checklists ensure safer care and what factors contribute to their success or failure? 4) What constitutes safe staffing levels / ratios? 5) How can we align emergency medicine (EM)-specific patient safety issues with national patient safety issues? 6) How can we develop metrics and skills to recognize when an ED is getting close to catastrophic overload conditions? and 7) What can EM learn from experts and modeling from fields outside of medicine to develop innovative solutions? These priorities have the potential to inform future clinical and human factors research and extramural funding decisions related to this important topic. PMID:22168192
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Stresses and satisfactions of the two-pharmacist relationship.
Stanton, A L; Berger, B A
1987-12-01
Potential advantages and disadvantages of dual-career relationships are identified, and strategies for addressing common issues encountered by dual-career couples are presented. With regard to career issues, clarification of expectations and discussion between partners regarding career commitment, job selection and mobility, and maintenance of professional identity is emphasized. Benefits of dual-career relationships include shared occupational interests, financial rewards, and respect for each partner's professional expertise. Strategies for managing domestic responsibilities include modifying standards, setting priorities, and distributing tasks evenly among family members. Pharmacist couples who are parents have chosen several routes in managing child-care issues, including postponing childbearing until each adult's career is established, decreasing one partner's career involvement, and hiring community or in-home caretakers. Sharing equally in child care can help prevent an excessive workload for one parent. Progressive family-oriented employment practices may also aid dual-career couples with children. Striking a balance between career and family is identified as perhaps the most challenging task facing the dual-career couple; time distribution must be adjusted according to the couple's priorities. Identifying realistic priorities, negotiating honestly regarding attainment of mutual and individual goals, and maintaining flexibility are key in achieving success in the professional and private lives of two-pharmacist couples.
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40 CFR 300.317 - National response priorities.
Code of Federal Regulations, 2010 CFR
2010-07-01
... from additional discharges. (e) The priorities set forth in this section are broad in nature, and... 40 Protection of Environment 27 2010-07-01 2010-07-01 false National response priorities. 300.317... PLAN Operational Response Phases for Oil Removal § 300.317 National response priorities. (a) Safety of...
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44 CFR 209.7 - Priorities for project selection.
Code of Federal Regulations, 2010 CFR
2010-10-01
... appropriate means may identify buyout and elevation projects. (b) States will set priorities in their State... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Priorities for project... ASSISTANCE § 209.7 Priorities for project selection. (a) It is the State's responsibility to identify and...
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Wendelberger, Joanne Roth
2014-11-05
This presentation will provide career advice for individuals seeking to go beyond just having a job to building a successful career in the areas of Science, Technology, Engineering, and Mathematics. Careful planning can be used to turn a job into a springboard for professional advancement and personal satisfaction. Topics to be addressed include setting priorities, understanding career ladders, making tough choices, overcoming stereotypes and assumptions by others, networking, developing a professional identify, and balancing a career with family and other personal responsibilities. Insights on the transition from individual technical work to leadership will also be provided. The author will drawmore » upon experiences gained in academic, industrial, and government laboratory settings, as well as extensive professional service and community involvement.« less
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Theories of justice and their implications for priority setting in health care.
Olsen, J A
1997-12-01
The paper aims to show how three theories of distributive justice; utilitarianism, egalitarianism and maximum, can provide a clearer understanding of the normative basis of different priority setting regimes in the health service. The paper starts with a brief presentation of the theories, followed by their prescriptions for distribution, as illustrated with their respective preferred points on a utility possibility frontier. After this general discussion, attention is shifted from utils to health. The paper discusses how the recent Norwegian guidelines for priority setting can be understood in the light of the theories.
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Earle-Richardson, Giulia; Scribani, Melissa; Wyckoff, Lynae; Strogatz, David; May, John; Jenkins, Paul
2015-01-01
New York, like many other states, provides county-level health statistics for use in local priority settings but does not provide any data on public views about priority health issues. This study assessed whether health department priorities are notably different from community concerns about health, and how both groups' priorities compare with local health statistics. Data from a 2009 rural survey on community health concerns were compared to priorities named by the seven area county health departments, and to local health indicator data. Health care/insurance cost (60%), obesity (53%), and prescription cost (41%) were leading community concerns, regardless of age, education, sex, or Internet in the home. Six of seven county health departments selected access to quality health care (which includes health care/insurance cost) as a leading public health priority, but only three identified obesity. The following leading local health issues were suggested by health indicators: Physical activity and nutrition, Smoking, and Unintentional injury. Health departments diverged from community priorities, from health indicator data, and from one another in choosing priorities. Adding a question about community health priorities to existing state telephone surveys on health behavior and lifestyle would provide an important tool to local health departments. © 2014 Society for Public Health Education.
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Whitty, Jennifer A; Littlejohns, Peter
2015-02-01
To describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia. The processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting. Transparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity. Priority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens' Jury. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Implementing accountability for reasonableness--the case of pharmaceutical reimbursement in Sweden.
Jansson, Sandra
2007-04-01
This paper aims to describe the priority-setting procedure for new original pharmaceuticals practiced by the Swedish Pharmaceutical Benefits Board (LFN), to analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles, and to examine the reactions of stakeholders. All the 'principally important' decisions made by the LFN during its first 33 months of operation were analysed. The study is theoretically anchored in the theory of fair and legitimate priority-setting procedures by Daniels and Sabin, and is based on public documents, media articles, and semi-structured interviews. Only nine cases resulted in a rejection of a subsidy by the LFN and 15 in a limited or conditional subsidy. Total rejections rather than limitations gave rise to actions by stakeholders. Primarily, the principle of cost-effectiveness was used when limiting/conditioning or totally rejecting a subsidy. This study suggests that implementing a priority-setting process that fulfils the conditions of accountability for reasonableness can result in a priority-setting process which is generally perceived as fair and legitimate by the major stakeholders and may increase social learning in terms of accepting the necessity of priority setting in health care. The principle of cost-effectiveness increased in importance when the demand for openness and transparency increased.
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2013-01-01
Background In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. Methods This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Results Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. Conclusion The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery. PMID:23849730
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Diffin, Janet; Spence, Michael; Spencer, Rebecca; Mellor, Peter; Grande, Gunn
2017-02-02
It is important to ensure regional variances are considered when setting future end-of-life research priorities, given the differing demographics and service provision. This project sought to identify end-of-life research priorities within Greater Manchester (United Kingdom). Following an initial scoping exercise, six topics within the 10 national priorities outlined by The Palliative and end-of-life care Priority Setting Partnership were selected for exploration. A workshop involving 32 healthcare professionals and a consultation process with 26 family carers was conducted. Healthcare professionals and carers selected and discussed the topics important to them. The topics selected most frequently by both healthcare professionals and carers were 'Access to 24 hour care', 'Planning end-of-life care in advance' and 'Staff and carer education'. Healthcare professionals also developed research questions for their topics of choice which were refined to incorporate carers' views. These questions are an important starting point for future end-of-life research within Greater Manchester.
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The National Occupational Research Agenda: a model of broad stakeholder input into priority setting.
Rosenstock, L; Olenec, C; Wagner, G R
1998-01-01
OBJECTIVES: No single organization has the resources necessary to conduct occupational safety and health research to adequately serve the needs of workers in the United States. The National Institute for Occupational Safety and Health (NIOSH) undertook the task of setting research priorities in response to a broadly perceived need to systematically address those topics most pressing and most likely to yield gains to workers and to the nation. METHODS: NIOSH and its public and private partners used a consensus-building process to set priorities for the next decade for occupational safety and health research--the National Occupational Research Agenda. RESULTS: The process resulted in the identification of 21 research priorities grouped into 3 categories: disease and injury, work environment and workforce, and research tools and approaches. CONCLUSIONS: Although the field of occupational safety and health is often contentious and adversarial, these research priorities reflect a remarkable degree of concurrence among a broad range of stakeholders who provided input into a clearly defined and open process. PMID:9518963
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Involving patients in setting priorities for healthcare improvement: a cluster randomized trial.
Boivin, Antoine; Lehoux, Pascale; Lacombe, Réal; Burgers, Jako; Grol, Richard
2014-02-20
Patients are increasingly seen as active partners in healthcare. While patient involvement in individual clinical decisions has been extensively studied, no trial has assessed how patients can effectively be involved in collective healthcare decisions affecting the population. The goal of this study was to test the impact of involving patients in setting healthcare improvement priorities for chronic care at the community level. Cluster randomized controlled trial. Local communities were randomized in intervention (priority setting with patient involvement) and control sites (no patient involvement). Communities in a canadian region were required to set priorities for improving chronic disease management in primary care, from a list of 37 validated quality indicators. Patients were consulted in writing, before participating in face-to-face deliberation with professionals. Professionals established priorities among themselves, without patient involvement. A total of 172 individuals from six communities participated in the study, including 83 chronic disease patients, and 89 health professionals. The primary outcome was the level of agreement between patients' and professionals' priorities. Secondary outcomes included professionals' intention to use the selected quality indicators, and the costs of patient involvement. Priorities established with patients were more aligned with core generic components of the Medical Home and Chronic Care Model, including: access to primary care, self-care support, patient participation in clinical decisions, and partnership with community organizations (p < 0.01). Priorities established by professionals alone placed more emphasis on the technical quality of single disease management. The involvement intervention fostered mutual influence between patients and professionals, which resulted in a 41% increase in agreement on common priorities (95%CI: +12% to +58%, p < 0.01). Professionals' intention to use the selected quality indicators was similar in intervention and control sites. Patient involvement increased the costs of the prioritization process by 17%, and required 10% more time to reach consensus on common priorities. Patient involvement can change priorities driving healthcare improvement at the population level. Future research should test the generalizability of these findings to other contexts, and assess its impact on patient care. The Netherlands National Trial Register #NTR2496.
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Global Conservation Priorities for Marine Turtles
Wallace, Bryan P.; DiMatteo, Andrew D.; Bolten, Alan B.; Chaloupka, Milani Y.; Hutchinson, Brian J.; Abreu-Grobois, F. Alberto; Mortimer, Jeanne A.; Seminoff, Jeffrey A.; Amorocho, Diego; Bjorndal, Karen A.; Bourjea, Jérôme; Bowen, Brian W.; Briseño Dueñas, Raquel; Casale, Paolo; Choudhury, B. C.; Costa, Alice; Dutton, Peter H.; Fallabrino, Alejandro; Finkbeiner, Elena M.; Girard, Alexandre; Girondot, Marc; Hamann, Mark; Hurley, Brendan J.; López-Mendilaharsu, Milagros; Marcovaldi, Maria Angela; Musick, John A.; Nel, Ronel; Pilcher, Nicolas J.; Troëng, Sebastian; Witherington, Blair; Mast, Roderic B.
2011-01-01
Where conservation resources are limited and conservation targets are diverse, robust yet flexible priority-setting frameworks are vital. Priority-setting is especially important for geographically widespread species with distinct populations subject to multiple threats that operate on different spatial and temporal scales. Marine turtles are widely distributed and exhibit intra-specific variations in population sizes and trends, as well as reproduction and morphology. However, current global extinction risk assessment frameworks do not assess conservation status of spatially and biologically distinct marine turtle Regional Management Units (RMUs), and thus do not capture variations in population trends, impacts of threats, or necessary conservation actions across individual populations. To address this issue, we developed a new assessment framework that allowed us to evaluate, compare and organize marine turtle RMUs according to status and threats criteria. Because conservation priorities can vary widely (i.e. from avoiding imminent extinction to maintaining long-term monitoring efforts) we developed a “conservation priorities portfolio” system using categories of paired risk and threats scores for all RMUs (n = 58). We performed these assessments and rankings globally, by species, by ocean basin, and by recognized geopolitical bodies to identify patterns in risk, threats, and data gaps at different scales. This process resulted in characterization of risk and threats to all marine turtle RMUs, including identification of the world's 11 most endangered marine turtle RMUs based on highest risk and threats scores. This system also highlighted important gaps in available information that is crucial for accurate conservation assessments. Overall, this priority-setting framework can provide guidance for research and conservation priorities at multiple relevant scales, and should serve as a model for conservation status assessments and priority-setting for widespread, long-lived taxa. PMID:21969858
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Morris, Christopher; Simkiss, Doug; Busk, Mary; Morris, Maureen; Allard, Amanda; Denness, Jacob; Janssens, Astrid; Stimson, Anna; Coghill, Joanna; Robinson, Kelly; Fenton, Mark; Cowan, Katherine
2015-01-01
Objectives To engage young people, parent carers and clinicians in a systematic process to identify and prioritise research questions regarding ways to improve the health and well-being of children and young people with neurodisability. Design British Academy of Childhood Disability (BACD)-James Lind Alliance research priority setting partnership bringing together patients, carers and clinicians as equal stakeholders. Setting UK health service and community. Methods The BACD Strategic Research Group formed the partnership. A Steering Group was established; charity and professional partner organisations were recruited. Suggestions were gathered in an open survey and from research recommendations for statutory guidance. Items were aggregated to formulate indicative research questions and verified as uncertainties from research evidence. An interim survey was used to rank the questions to shortlist topics. A mixed group of stakeholders discussed the top 25 questions at the final priority setting workshop agreeing a final rank order and the top 10 research priorities. Participants Partner organisations were 13 charities and 8 professional societies. 369 people submitted suggestions (40% non-clinicians). 76 people participated in the interim prioritisation (26 parents, 1 young person, 10 charity representatives, 39 clinicians); 22 took part in the final workshop (3 young people, 7 parents, 3 charity representatives, 9 professionals). Results The top three research priorities related to (1) establishing the optimal frequency and intensity (dose) for mainstream therapies, (2) means for selecting and encouraging use of communication strategies and (3) ways to improve children's attitudes towards disability. The top 10 included evaluating interventions to promote mobility, self-efficacy, mental health, continence, physical fitness, educational inclusion and reduce impacts of sleep disturbance. Conclusions The methodology provided a systematic and transparent process to identify research priorities that included stakeholders that have typically not contributed to setting the research agenda. The top 10 and other topics identified provide a resource for researchers and agencies that fund research PMID:25631309
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Public engagement in setting healthcare priorities: a ranking exercise in Cyprus.
Farmakas, Antonis; Theodorou, Mamas; Galanis, Petros; Karayiannis, Georgios; Ghobrial, Stefanos; Polyzos, Nikos; Papastavrou, Evridiki; Agapidaki, Eirini; Souliotis, Kyriakos
2017-01-01
In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. It was revealed that the "severity of the disease" and the " age of the patient" were the key prioritization criteria. Participants assigned the smallest relative value to the criterion " healthy lifestyle" . More precisely, participants older than 35 years old assigned higher relative importance to " age" , while younger participants to the " severity of the disease". The " healthy lifestyle" criterion was assigned to the lowest relative importance to by all participants. In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public's participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance.
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12 CFR 269b.220 - Priority; acceleration of proceedings.
Code of Federal Regulations, 2010 CFR
2010-01-01
... the setting aside of an election or the conduct of a new election shall be given priority. (b) The... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Priority; acceleration of proceedings. 269b.220... RESERVE SYSTEM CHARGES OF UNFAIR LABOR PRACTICES Preliminary Investigation § 269b.220 Priority...
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46 CFR 295.12 - Priority for awarding agreements.
Code of Federal Regulations, 2010 CFR
2010-10-01
... to all vessels within a priority set forth herein, MARAD shall award to each eligible applicant in... 46 Shipping 8 2010-10-01 2010-10-01 false Priority for awarding agreements. 295.12 Section 295.12... OPERATORS MARITIME SECURITY PROGRAM (MSP) Establishment of MSP Fleet and Eligibility § 295.12 Priority for...
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ERIC Educational Resources Information Center
Capoor, Madan
The use of the Community College Goals Inventory (CCGI) to assess priorities assigned to institutional goals and to estimate priority changes required to reach intended outcomes was studied. The CCGI consists of goal statements that mainly cover outcome and process goal areas. Respondents indicate their perceptions of how much importance is…
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49 CFR 19.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-10-01
... benefit or use of the Federal Government. (b) Public notice and priority setting. Federal awarding agencies shall notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by Federal statute. ...
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22 CFR 518.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-04-01
... benefit or use of the Federal Government. (b) Public Notice and Priority Setting. Federal awarding agencies shall notify the public of its intended funding priorities for discretionary grant programs, unless funding priorities are established by Federal statute. ...
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2014-01-01
Background Panama is, economically, the fastest growing country in Central America and is making efforts to improve management mechanisms for research and innovation. However, due to contextual factors, the Panamanian Health Research System is not well developed and is poorly coordinated with the Health System. Likewise, despite recent efforts to define a National Health Research Agenda, implementing this agenda and aligning it with Panamanians’ health needs remains difficult. This articles aims to review Panama’s experience in health research priority setting by analyzing the fairness of previous prioritization processes in order to promote an agreed-upon national agenda aligned with public health needs. Methods The three health research prioritization processes performed in Panama between 2006 and 2011 were analyzed based on the guidelines established by the four “Accountability for Reasonableness” principles, namely “relevance”, “publicity”, “revision”, and “enforcement”, which provide a framework for evaluating priority-setting fairness. Results The three health research priority-setting events performed in Panama during the reference period demonstrated a heterogeneous pattern of decision-making strategies, stakeholder group composition, and prioritization outcomes. None of the three analyzed events featured an open discussion process with the scientific community, health care providers, or civil society in order to reach consensus. Conclusions This investigation makes evident the lack of a strategy to encourage open discussion by the multiple stakeholders and interest groups that should be involved during the priority-setting process. The analysis reveals the need for a new priority-setting exercise that validates the National Agenda, promotes its implementation by the National Secretariat for Science, Technology and Innovation in conjunction with the Ministry of Health, and empowers multiple stakeholders; such an exercise would, in turn, favor the implementation of the agenda. PMID:25117661
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Varela-Lema, Leonor; Atienza-Merino, Gerardo; López-García, Marisa
This study was carried out to develop an explicit health priority setting methodology to support decision-making regarding the technologies to be assessed for inclusion in the National Health Service service portfolio. The primary objective is to identify and analyse the criteria, approaches and conceptual frameworks used for national/international priority setting. An exhaustive review of the literature was carried out. For this purpose, a search of the main biomedical databases was performed and assessment agency websites were reviewed, among other sources. In general terms, it was found that there are no standardised criteria for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domains were identified: 1) need for intervention; 2) health outcomes; 3) type of benefit of the intervention; 4) economic consequences; 5) existing knowledge on the intervention/quality of and uncertainties regarding the evidence; 6) implementation and complexity of the intervention/feasibility; 7) priority, justice and ethics; and 8) overall context. The review provides a thorough analysis of the relevant issues and offers key recommendations regarding considerations for developing a national prioritisation framework. Findings are envisioned to be useful for different public organisations that are aiming to establish healthcare priorities. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
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A Global Health Research Checklist for clinicians.
Sawaya, Rasha D; Breslin, Kristen A; Abdulrahman, Eiman; Chapman, Jennifer I; Good, Dafina M; Moran, Lili; Mullan, Paul C; Badaki-Makun, Oluwakemi
2018-04-19
Global health research has become a priority in most international medical projects. However, it is a difficult endeavor, especially for a busy clinician. Navigating the ethics, methods, and local partnerships is essential yet daunting.To date, there are no guidelines published to help clinicians initiate and complete successful global health research projects. This Global Health Research Checklist was developed to be used by clinicians or other health professionals for developing, implementing, and completing a successful research project in an international and often low-resource setting. It consists of five sections: Objective, Methodology, Institutional Review Board and Ethics, Culture and partnerships, and Logistics. We used individual experiences and published literature to develop and emphasize the key concepts. The checklist was trialed in two workshops and adjusted based on participants' feedback.
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Smith, Jason; Keating, Liza; Flowerdew, Lynsey; O'Brien, Rachel; McIntyre, Sam; Morley, Richard; Carley, Simon
2017-07-01
Defining research priorities in a specialty as broad as emergency medicine is a significant challenge. In order to fund and complete the most important research projects, it is imperative that we identify topics that are important to all clinicians, society and to our patients. We have undertaken a priority setting partnership to establish the most important questions facing emergency medicine. The top 10 questions reached through a consensus process are discussed. © 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.
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77 FR 28467 - Identifying and Reducing Regulatory Burdens
Federal Register 2010, 2011, 2012, 2013, 2014
2012-05-14
... online wherever practicable. Sec. 3. Setting Priorities. In implementing and improving their... regulatory priorities, to promote public participation in retrospective review, to modernize our regulatory..., agencies shall give priority, consistent with law, to those initiatives that will produce significant...
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29 CFR 1990.133 - Publication.
Code of Federal Regulations, 2010 CFR
2010-07-01
...) IDENTIFICATION, CLASSIFICATION, AND REGULATION OF POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.133...) The Secretary shall publish the Priority Lists in the Federal Register at least every six months and... notice requesting information concerning the classification and establishment of priorities for...
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Bagness, Carmel; Brewin, Jane; Coomarasamy, Arri; Easthope, Lucy; Hepworth-Jones, Barbara; Hinshaw, Kim; O'Toole, Emily; Orford, Julie; Regan, Lesley; Raine-Fenning, Nick; Shakespeare, Judy; Small, Rachel; Thornton, Jim; Metcalf, Leanne
2017-01-01
Objectives To identify and prioritise important research questions for miscarriage. Design A priority setting partnership using prospective surveys and consensus meetings following methods advocated by the James Lind Alliance. Setting UK. Participants Women and those affected by miscarriage working alongside healthcare professionals. Results In the initial survey, 1093 participants (932 women who have experienced miscarriage, 8 partners, 17 family members, friends or colleagues, 104 healthcare professionals and eight charitable organisations) submitted 3279 questions. A review of existing literature identified a further 64. Non-questions were removed, and the remaining questions were categorised and summarised into 58 questions. In an interim electronic survey, 2122 respondents chose their top 10 priorities from the 58 summary questions. The 25 highest ranked in the survey were prioritised at a final face-to-face workshop. In summary, the top 10 priorities were ranked as follows: research into preventative treatment, emotional aspects in general, investigation, relevance of pre-existing medical conditions, emotional support as a treatment, importance of lifestyle factors, importance of genetic and chromosomal causes, preconception tests, investigation after different numbers of miscarriage and male causal factors. Conclusions These results should be the focus of future miscarriage research. Presently, studies are being conducted to address the top priority; however, many other priorities, especially psychological and emotional support, are less well researched areas. We hope our results will encourage both researchers and funders to focus on these priorities. PMID:28838896
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Ranson, Kent; Law, Tyler J; Bennett, Sara
2010-06-01
Donor funding for health systems financing (HSF) research is inadequate and often poorly aligned with national priorities. This study aimed to generate consensus about a core set of research issues that urgently require attention in order to facilitate policy development. There were three key inputs into the priority setting process: key-informant interviews with health policy makers, researchers, community and civil society representatives across twenty-four low- and middle-income countries in four regions; an overview of relevant reviews to identify research completed to date; and inputs from 12 key informants (largely researchers) at a consultative workshop. Nineteen priority research questions emerged from key-informant interviews. The overview of reviews was instructive in showing which health financing topics have had comparatively little written about them, despite being identified as important by key informants. The questions ranked as most important at the consultative workshop were: It is hoped that this work on HSF research priorities will complement calls for increased health systems research and evaluation by providing specific suggestions as to where new and existing research resources can best be invested. The list of high priority HSF research questions is being communicated to research funders and researchers in order to seek to influence global patterns of HSF research funding and activity. A "bottom up" approach to setting global research priorities such as that employed here should ensure that priorities are more sensitive to user needs. Copyright 2010 Elsevier Ltd. All rights reserved.
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14 CFR 250.3 - Boarding priority rules.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Boarding priority rules. 250.3 Section 250...) ECONOMIC REGULATIONS OVERSALES § 250.3 Boarding priority rules. (a) Every carrier shall establish priority... rules and criteria shall reflect the obligations of the carrier set forth in §§ 250.2a and 250.2b to...
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42 CFR 56.107 - Priorities for grants.
Code of Federal Regulations, 2010 CFR
2010-10-01
... of this part will be made in accordance with priorities set forth in paragraphs (a)(2) through (a)(6... 42 Public Health 1 2010-10-01 2010-10-01 false Priorities for grants. 56.107 Section 56.107 Public... SERVICES General Provisions § 56.107 Priorities for grants. (a) Grants under sections 319(c) (1)(A), 319(d...
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37 CFR 1.55 - Claim for foreign priority.
Code of Federal Regulations, 2010 CFR
2010-07-01
... accompanied by the processing fee set forth in § 1.17(i), but the patent will not include the priority claim... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Claim for foreign priority. 1... Application § 1.55 Claim for foreign priority. (a) An applicant in a nonprovisional application may claim the...
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40 CFR 35.1620-5 - State work programs and lake priority lists.
Code of Federal Regulations, 2010 CFR
2010-07-01
... lakes according to trophic condition (§ 35.1630) and to set priorities for implementing clean lakes... 40 Protection of Environment 1 2010-07-01 2010-07-01 false State work programs and lake priority... Publicly Owned Freshwater Lakes § 35.1620-5 State work programs and lake priority lists. (a)(1) A State...
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Makundi, Emmanuel; Kapiriri, Lydia; Norheim, Ole Frithjof
2007-09-24
Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.
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Manufacturing in America: Crisis and Opportunity
1993-04-01
Management November-December 1991: 39-45. 13 Chubb, John E. and Eric A. Hanushek . Setting National Priorities: Policy for the Nineties. Ed. Henry J. Aaron...A. Hanushek . Setting National Priorities: Policy for the Nineties. Ed. Henry J. Aaron. Washington, D.C.: The Brookings Institution,1990. 16 ’Training
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-12-13
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Priority Setting for the Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program--Notice of Correction On pages 75469 and 75470, Volume 75, Number 232, Federal Register...
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Using Multiattribute Utility Theory as a Priority-Setting Tool in Human Services Planning.
ERIC Educational Resources Information Center
Camasso, Michael J.; Dick, Janet
1993-01-01
The feasibility of applying multiattribute utility theory to the needs assessment and priority-setting activities of human services planning councils was studied in Essex County (New Jersey). Decision-making and information filtering processes are explored in the context of community planning. (SLD)
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Setting Priorities Among Educational Objectives.
ERIC Educational Resources Information Center
Sutjipto, Sudijarto; And Others
This publication is intended to aid educational planners in developing nations in translating national goals and aspirations into educational objectives and in establishing and quantifying priorities among educational objectives. Much of the content is based on a model for setting educational objectives that was developed in Indonesia in 1972. The…
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10 CFR 217.35 - Extension of priority ratings.
Code of Federal Regulations, 2014 CFR
2014-01-01
..., and needs to purchase a transformer for its manufacture, that person must use a DO-F1 rated order to obtain the needed transformer. (b) The priority rating must be included on each successive order placed...
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10 CFR 217.35 - Extension of priority ratings.
Code of Federal Regulations, 2012 CFR
2012-01-01
..., and needs to purchase a transformer for its manufacture, that person must use a DO-F1 rated order to obtain the needed transformer. (b) The priority rating must be included on each successive order placed...
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10 CFR 217.35 - Extension of priority ratings.
Code of Federal Regulations, 2013 CFR
2013-01-01
..., and needs to purchase a transformer for its manufacture, that person must use a DO-F1 rated order to obtain the needed transformer. (b) The priority rating must be included on each successive order placed...
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Communitarian claims and community capabilities: furthering priority setting?
Mooney, Gavin
2005-01-01
Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.
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Silva, Diego S; Gibson, Jennifer L; Robertson, Ann; Bensimon, Cécile M; Sahni, Sachin; Maunula, Laena; Smith, Maxwell J
2012-03-26
Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.
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Rudan, Igor; Gibson, Jennifer L.; Ameratunga, Shanthi; El Arifeen, Shams; Bhutta, Zulfiqar A.; Black, Maureen; Black, Robert E.; Brown, Kenneth H.; Campbell, Harry; Carneiro, Ilona; Chan, Kit Yee; Chandramohan, Daniel; Chopra, Mickey; Cousens, Simon; Darmstadt, Gary L.; Gardner, Julie Meeks; Hess, Sonja Y.; Hyder, Adnan A.; Kapiriri, Lydia; Kosek, Margaret; Lanata, Claudio F.; Lansang, Mary Ann; Lawn, Joy; Tomlinson, Mark; Tsai, Alexander C.; Webster, Jayne
2008-01-01
This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global. PMID:19090596
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Macklin, Ruth; Cowan, Ethan
2013-01-01
Striking advances in HIV prevention have set the stage for renewed debate on setting priorities in the fight against HIV/AIDS. Two new prevention strategies preexposure prophylaxis and treatment as prevention—use antiretroviral drugs for prevention of HIV/AIDS in addition to treating patients. The potential for success of these new prevention strategies sets up an ethical dilemma: where resources are limited and supplies of lifesaving antiretroviral medications are insufficient to treat those currently living with HIV, how should these resources be divided between treatment and prevention? This article explores several ethical principles used in formulating public health policy. Assuming that limited resources are available for spending on drugs, we conclude that it would be unethical to watch patients with treatable AIDS worsen and die, even with supportive care, so that medications for treatment can be diverted for prevention. PMID:22778343
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Mitton, Craig; Doyle‐Waters, Mary M.; Drake, Tom; Conteh, Lesong; Newall, Anthony T.; Onwujekwe, Obinna; Jan, Stephen
2016-01-01
Abstract Policy makers in low‐income and lower‐middle‐income countries (LMICs) are increasingly looking to develop ‘evidence‐based’ frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks – which incorporate economic evaluation evidence – for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of ‘efficiency’ defined as cost per disability‐adjusted life year averted. Ranking of health interventions using multi‐criteria decision analysis and generalised cost‐effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision‐makers to act on this evidence. PMID:26804361
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NASA's Office of Space Science and Applications: Process, priorities, and goals
NASA Technical Reports Server (NTRS)
1992-01-01
Summarized here are the activities of a one-day workshop convened to assess the effectiveness and priority setting mechanisms used by NASA's Office of Space Science and Applications in carrying out its diverse scientific programs. Among the topics discussed were strategic planning, decision making, and goal setting.
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Priority setting for health in emerging markets.
Glassman, Amanda; Giedion, Ursula; McQueston, Kate
2013-05-01
The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes.
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Avian Conservation Areas as a Proxy for Contaminated Soil Remediation
Lin, Wei-Chih; Lin, Yu-Pin; Anthony, Johnathen; Ding, Tsun-Su
2015-01-01
Remediation prioritization frequently falls short of systematically evaluating the underlying ecological value of different sites. This study presents a novel approach to delineating sites that are both contaminated by any of eight heavy metals and have high habitat value to high-priority species. The conservation priority of each planning site herein was based on the projected distributions of eight protected bird species, simulated using 900 outputs of species distribution models (SDMs) and the subsequent application of a systematic conservation tool. The distributions of heavy metal concentrations were generated using a geostatistical joint-simulation approach. The uncertainties in the heavy metal distributions were quantified in terms of variability among 1000 realization sets. Finally, a novel remediation decision-making approach was presented for delineating contaminated sites in need of remediation based on the spatial uncertainties of multiple realizations and the priorities of conservation areas. The results thus obtained demonstrate that up to 42% of areas of high conservation priority are also contaminated by one or more of the heavy metal contaminants of interest. Moreover, as the proportion of the land for proposed remediated increased, the projected area of the pollution-free habitat also increased. Overall uncertainty, in terms of the false positive contamination rate, also increased. These results indicate that the proposed decision-making approach successfully accounted for the intrinsic trade-offs among a high number of pollution-free habitats, low false positive rates and robustness of expected decision outcomes. PMID:26193297
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Priority issues for pressure injury research: An Australian consensus study.
Haesler, Emily; Carville, Keryln; Haesler, Paul
2018-06-08
Pressure injuries are a significant health concern in all clinical settings. The current body of research on pressure injuries reported in the literature presents primarily low level evidence. The purpose of the current study was to identify and prioritize pressure injury research issues. The approach entailed evidence scoping and implementing a formal consensus process using a modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. Sixteen Australian pressure injury experts participated in five consensus voting rounds in May to June 2015. From 60 initial research issues, the experts reached agreement that 26 issues are a priority for future pressure injury research. The highest priorities were strategies to assess skin and tissues, appropriate outcome measures for indicators of pressure injury healing and recurrence, heel pressure off-loading and shear reduction strategies, economic cost of pressure injuries and their management and effectiveness of skin moisturizers and barrier products. Developing a prioritized research agenda, informed by clinical and academic pressure injury experts, can assist in reducing the burden of pressure injuries by identifying topics of the highest need for further research. A web-based nominal group voting process was successful in engaging expert decision-making and has wide-reaching international appeal in facilitating cost-effective consensus methodologies. The priority list generated from this research is currently used in Australia to inform government investment in pressure injury research. © 2018 Wiley Periodicals, Inc.
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John R. Sauer; Jennifer Casey; Harold Laskowski; Jan D. Taylor; Jane Fallon
2005-01-01
National Wildlife Refuges must manage habitats to support a variety of species that often have conflicting needs. To make reasonable management decisions, managers must know what species are priorities for their refuges and the relative importance of the species. Unfortunately, species priorities are often set regionally, but refuges must develop local priorities that...
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Charting the landscape of priority problems in psychiatry, part 1: classification and diagnosis.
Stephan, Klaas E; Bach, Dominik R; Fletcher, Paul C; Flint, Jonathan; Frank, Michael J; Friston, Karl J; Heinz, Andreas; Huys, Quentin J M; Owen, Michael J; Binder, Elisabeth B; Dayan, Peter; Johnstone, Eve C; Meyer-Lindenberg, Andreas; Montague, P Read; Schnyder, Ulrich; Wang, Xiao-Jing; Breakspear, Michael
2016-01-01
Contemporary psychiatry faces major challenges. Its syndrome-based disease classification is not based on mechanisms and does not guide treatment, which largely depends on trial and error. The development of therapies is hindered by ignorance of potential beneficiary patient subgroups. Neuroscientific and genetics research have yet to affect disease definitions or contribute to clinical decision making. In this challenging setting, what should psychiatric research focus on? In two companion papers, we present a list of problems nominated by clinicians and researchers from different disciplines as candidates for future scientific investigation of mental disorders. These problems are loosely grouped into challenges concerning nosology and diagnosis (this Personal View) and problems related to pathogenesis and aetiology (in the companion Personal View). Motivated by successful examples in other disciplines, particularly the list of Hilbert's problems in mathematics, this subjective and eclectic list of priority problems is intended for psychiatric researchers, helping to re-focus existing research and providing perspectives for future psychiatric science. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Identifying species threat hotspots from global supply chains.
Moran, Daniel; Kanemoto, Keiichiro
2017-01-04
Identifying hotspots of species threat has been a successful approach for setting conservation priorities. One important challenge in conservation is that, in many hotspots, export industries continue to drive overexploitation. Conservation measures must consider not just the point of impact, but also the consumer demand that ultimately drives resource use. To understand which species threat hotspots are driven by which consumers, we have developed a new approach to link a set of biodiversity footprint accounts to the hotspots of threatened species on the IUCN Red List of Threatened Species. The result is a map connecting consumption to spatially explicit hotspots driven by production on a global scale. Locating biodiversity threat hotspots driven by consumption of goods and services can help to connect conservationists, consumers, companies and governments in order to better target conservation actions.
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Setting practical conservation priorities for birds in the Western Andes of Colombia.
Ocampo-Peñuela, Natalia; Pimm, Stuart L
2014-10-01
We aspired to set conservation priorities in ways that lead to direct conservation actions. Very large-scale strategic mapping leads to familiar conservation priorities exemplified by biodiversity hotspots. In contrast, tactical conservation actions unfold on much smaller geographical extents and they need to reflect the habitat loss and fragmentation that have sharply restricted where species now live. Our aspirations for direct, practical actions were demanding. First, we identified the global, strategic conservation priorities and then downscaled to practical local actions within the selected priorities. In doing this, we recognized the limitations of incomplete information. We started such a process in Colombia and used the results presented here to implement reforestation of degraded land to prevent the isolation of a large area of cloud forest. We used existing range maps of 171 bird species to identify priority conservation areas that would conserve the greatest number of species at risk in Colombia. By at risk species, we mean those that are endemic and have small ranges. The Western Andes had the highest concentrations of such species-100 in total-but the lowest densities of national parks. We then adjusted the priorities for this region by refining these species ranges by selecting only areas of suitable elevation and remaining habitat. The estimated ranges of these species shrank by 18-100% after accounting for habitat and suitable elevation. Setting conservation priorities on the basis of currently available range maps excluded priority areas in the Western Andes and, by extension, likely elsewhere and for other taxa. By incorporating detailed maps of remaining natural habitats, we made practical recommendations for conservation actions. One recommendation was to restore forest connections to a patch of cloud forest about to become isolated from the main Andes. © 2014 Society for Conservation Biology.
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Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective
2016-01-01
When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare. PMID:27775247
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SU-E-T-551: Monitor Unit Optimization in Stereotactic Body Radiation Therapy for Stage I Lung Cancer
DOE Office of Scientific and Technical Information (OSTI.GOV)
Huang, B-T; Lu, J-Y
2015-06-15
Purpose: The study aims to reduce the monitor units (MUs) in the stereotactic body radiation therapy (SBRT) treatment for lung cancer by adjusting the optimizing parameters. Methods: Fourteen patients suffered from stage I Non-Small Cell Lung Cancer (NSCLC) were enrolled. Three groups of parameters were adjusted to investigate their effects on MU numbers and organs at risk (OARs) sparing: (1) the upper objective of planning target volume (UOPTV); (2) strength setting in the MU constraining objective; (3) max MU setting in the MU constraining objective. Results: We found that the parameters in the optimizer influenced the MU numbers in amore » priority, strength and max MU dependent manner. MU numbers showed a decreasing trend with the UOPTV increasing. MU numbers with low, medium and high priority for the UOPTV were 428±54, 312±48 and 258±31 MU/Gy, respectively. High priority for UOPTV also spared the heart, cord and lung while maintaining comparable PTV coverage than the low and medium priority group. It was observed that MU numbers tended to decrease with the strength increasing and max MU setting decreasing. With maximum strength, the MU numbers reached its minimum while maintaining comparable or improved dose to the normal tissues. It was also found that the MU numbers continued to decline at 85% and 75% max MU setting but no longer to decrease at 50% and 25%. Combined with high priority for UOPTV and MU constraining objectives, the MU numbers can be decreased as low as 223±26 MU/Gy. Conclusion:: The priority of UOPTV, MU constraining objective in the optimizer impact on the MU numbers in SBRT treatment for lung cancer. Giving high priority to the UOPTV, setting the strength to maximum value and the max MU to 50% in the MU objective achieves the lowest MU numbers while maintaining comparable or improved OAR sparing.« less
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48 CFR 808.603 - Purchase priorities.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase priorities. 808... Industries, Inc. (FPI) 808.603 Purchase priorities. Contracting officers may purchase supplies and services... small businesses, in accordance with procedures set forth in subpart 819.70, without seeking a waiver...
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36 CFR 230.4 - State program administration.
Code of Federal Regulations, 2010 CFR
2010-07-01
... and set priorities for achieving the goals and objectives identified for the State for each year. (2... planting, maintenance, and improvement, and other high priority practices within the State that will result... appropriate Service Representative; (9) Guidelines for establishing annual priorities for the approval of...
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Code of Federal Regulations, 2010 CFR
2010-10-01
... Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION PRIORITIES IN USE OF RESOURCES § 1620.1 Purpose. This part is designed to provide guidance to recipients for setting priorities and to ensure that a recipient's governing body adopts written priorities for the types of cases and matters...
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Priority to End of Life Treatments? Views of the Public in the Netherlands.
Wouters, Sofie; van Exel, Job; Baker, Rachel; B F Brouwer, Werner
2017-01-01
Recent debates in the Netherlands on health care priority setting have focused on the relative value of gains generated by life-extending medicines for people with a terminal illness, mostly new cancer drugs. These treatments are generally expensive, provide relatively small health gains, and therefore usually do not meet common cost per QALY thresholds. Nevertheless, these drugs may be provided under the assumption that there is public support for making a special case for treatments for people with a terminal illness. This study investigated the views of the public in the Netherlands on a range of equity and efficiency considerations relevant to priority setting and examines whether there is public support for making such a special case. Using Q methodology, three viewpoints on important principles for priority setting were identified. Data were collected through ranking exercises conducted by 46 members of the general public in the Netherlands, including 11 respondents with personal experience with cancer. Viewpoint 1 emphasized that people have equal rights to healthcare and opposed priority setting on any ground. Viewpoint 2 emphasized that the care for terminal patients should at all times respect the patients' quality of life, which sometimes means refraining from invasive treatments. Viewpoint 3 had a strong focus on effective and efficient care and had no moral objection against priority setting under certain circumstances. Overall, we found little public support for the assumption that health gains in terminally ill patients are more valuable than those in other patients. This implies that the assumption that society is prepared to pay more for health gains in people who have only a short period of lifetime left does not correspond with societal preferences in the Netherlands. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
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Allard, Julie; Durand, Céline; Anthony, Samantha J; Dumez, Vincent; Hartell, David; Hébert, Marie-Josée; West, Lori J; Wright, Linda; Fortin, Marie-Chantal
2017-02-01
It is vitally important to seek input from key stakeholders to increase the quality and relevance of health-related research and accelerate its adoption into practice. Patients and caregivers have rarely been involved in setting research priorities in the transplantation and donation field. The objectives of this explorative study are: (i) to discuss research priorities within the Canadian National Transplant Research Program during a priority-setting exercise with patients, caregivers, organ donors and researchers and (ii) to compare the identified priorities with research published in 2 prestigious transplantation journals. A pilot workshop attended by 10 patients and caregivers and 5 researchers was held in Montréal (Quebec, Canada) in August 2014 to identify research priorities. Priorities were identified using a thematic analysis of the workshop transcription conducted by multiple coders. These priorities were compared with the topics of research articles published in 2 major transplantation journals between 2012 and 2014. The themes of the 10 research priorities identified by study participants were related to different research domains: social, cultural, and environmental health factors (4); biomedical or clinical (4); and research about health systems and services (2). 26.7% of the research articles published were related to the identified priorities. Thirteen percent looked at ways to improve graft survival and 8.5% looked at the development of tolerance, 2 priorities identified by participants. Fewer than 5% examined the other 8 research priorities identified as important by workshop participants. This is the first study reporting patients' and researchers' priorities in the field of transplantation and donation in Canada. There is a discrepancy between topics that key stakeholders find important and research published in 2 major transplantation journals. The research priorities identified during our initial workshop will be validated through a national survey and workshop.
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McKenzie, Emily; Potestio, Melissa L; Boyd, Jamie M; Niven, Daniel J; Brundin-Mather, Rebecca; Bagshaw, Sean M; Stelfox, Henry T
2017-12-01
Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus. Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
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Lomer, M C; Hart, A L; Verjee, A; Daly, A; Solomon, J; Mclaughlin, J
2017-12-01
Treatment of inflammatory bowel disease (IBD) involves a multidisciplinary approach comprising medical management and sometimes surgery. Although diet is central to IBD management, the optimal diet for patients with IBD is uncertain. A UK collaborative partnership within the James Lind Alliance was set up between patients, clinicians and other stakeholders to develop research priorities in IBD. The aim of this short report is to provide a comprehensive summary of the research priority findings relating to diet in the treatment of IBD. The James Lind Alliance Priority Setting Partnership process was used to develop research priorities in IBD. In brief, patients, clinicians and other stakeholders were invited to provide up to five treatment uncertainties in IBD. These uncertainties were collated, revised and ranked, leading to a final top 10 research questions in IBD. A total of 1671 uncertainties from 531 participants were collected and refined to exclude duplicates leaving 1253 uncertainties. Of these, 348 were categorised as diet-related and grouped according to topic. There were 206 uncertainties related to how diet can be used to treat IBD or alleviate symptoms. Seventy-two percent of diet-related questions came from patients. One broadly diet-related and two diet-specific treatment uncertainties were included in the top 10 research priorities for IBD. Dietary treatment options in the management of IBD are important research priorities. Almost three-quarters of diet related questions came from patients, who were particularly interested in how diet can impact disease activity and symptom control. © 2017 The British Dietetic Association Ltd.
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Lough, Kate; Hagen, Suzanne; McClurg, Doreen; Pollock, Alex
2018-04-28
To identify the shared priorities for future research of women affected by and clinicians involved with pessary use for the management of prolapse. A priority setting project using a consensus method. A James Lind Alliance Pessary use for prolapse Priority Setting Partnership (JLA Pessary PSP) conducted from May 2016 to September 2017 in the UK. The PSP was run by a Steering Group of three women with experience of pessary use, three experienced clinicians involved with management of prolapse, two researchers with relevant experience, a JLA adviser and a PSP leader. Two surveys were conducted in 2016 and 2017. The first gathered questions about pessaries, and the second asked respondents to prioritise a list of questions. A final workshop was held on 8 September 2017 involving 10 women and 13 clinician representatives with prolapse and pessary experience. A top 10 list of priorities for future research in pessary use for prolapse was agreed by consensus. Women with experience of pessary use and clinicians involved with prolapse management have worked together to determine shared priorities for future research. Aligning the top 10 results with existing research findings will highlight the gaps in current evidence and signpost future research to areas of priority. Effective dissemination of the results will enable research funding bodies to focus on gathering the evidence to answer the questions that matter most to those who will be affected. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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2013-06-19
The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for a Rehabilitation Engineering Research Center (RERC) on Technologies to Support Successful Aging with Disability under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). The Assistant Secretary may use this priority for a competition in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend to use this priority to improve outcomes for individuals with disabilities.
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Corridor-wide Safety Data Analysis and Identification of Existing Successful Safety Programs
DOT National Transportation Integrated Search
2010-06-01
Many diverse factors contribute to motor vehicle crashes. States have multiple competing priorities and limited resources to address these priorities, so there is a need, particularly in our current economic climate, to prioritize interventions and s...
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Fit for purpose? Introducing a rational priority setting approach into a community care setting.
Cornelissen, Evelyn; Mitton, Craig; Davidson, Alan; Reid, Colin; Hole, Rachelle; Visockas, Anne-Marie; Smith, Neale
2016-06-20
Purpose - Program budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers with allocating resources. Previous PBMA work establishes its efficacy and indicates that contextual factors complicate priority setting, which can hamper PBMA effectiveness. The purpose of this paper is to gain qualitative insight into PBMA effectiveness. Design/methodology/approach - A Canadian case study of PBMA implementation. Data consist of decision-maker interviews pre (n=20), post year-1 (n=12) and post year-2 (n=9) of PBMA to examine perceptions of baseline priority setting practice vis-à-vis desired practice, and perceptions of PBMA usability and acceptability. Findings - Fit emerged as a key theme in determining PBMA effectiveness. Fit herein refers to being of suitable quality and form to meet the intended purposes and needs of the end-users, and includes desirability, acceptability, and usability dimensions. Results confirm decision-maker desire for rational approaches like PBMA. However, most participants indicated that the timing of the exercise and the form in which PBMA was applied were not well-suited for this case study. Participant acceptance of and buy-in to PBMA changed during the study: a leadership change, limited organizational commitment, and concerns with organizational capacity were key barriers to PBMA adoption and thereby effectiveness. Practical implications - These findings suggest that a potential way-forward includes adding a contextual readiness/capacity assessment stage to PBMA, recognizing organizational complexity, and considering incremental adoption of PBMA's approach. Originality/value - These insights help us to better understand and work with priority setting conditions to advance evidence-informed decision making.
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Health care priority setting: principles, practice and challenges
Mitton, Craig; Donaldson, Cam
2004-01-01
Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA). Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated. PMID:15104792
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Lynn, Sabrina E; Borkovic, Benjamin P; Russell, Anthony P
2013-01-01
Caudal autotomy is a widespread phenomenon among lizards, and similar processes occur in other groups of vertebrates and invertebrates. Many costs have been associated with autotomy, including the regeneration of lost biomass. For lizards, it is not known whether resources are preferentially directed toward caudal regeneration or whether regeneration occurs only when resources are abundant. Conflicting information is present in the literature, and an absence of controlled experiments prevents determination of what pattern of regeneration may occur under a given set of circumstances. We employed the leopard gecko, a fat-tailed species, to examine whether tail regeneration is a priority and, if so, whether it remains so when resources become limiting. We explored this through caudal autotomy and dietary manipulation under conditions that ensured that differences in diet were sufficient to permit differential growth. We examined juvenile leopard geckos because these animals are rapidly growing and allocation of energy is not compromised by reproductive investment. The effects of dietary resource availability and the demands of caudal regeneration were compared in intact and regenerating animals. Our evidence indicates that caudal regeneration is a priority, even when resources are limiting. We conclude that tail regrowth is a priority that is associated with long-term survival and possibly reproductive success.
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Setting Priorities for Gerontological Social Work Research: A National Delphi Study
ERIC Educational Resources Information Center
Burnette, Denise; Morrow-Howell, Nancy; Chen, Li-Mei
2003-01-01
Purpose: An increasingly important task for all disciplines involved in aging research is to identify and prioritize areas for investigation. This article reports the results of a national Delphi study on setting research priorities for gerontological social work. Design and Methods: Delphi methodology, a structured process for eliciting and…
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Integrating Public Input into Healthcare Priority-Setting Decisions
ERIC Educational Resources Information Center
Mitton, Craig; Smith, Neale; Peacock, Stuart; Evoy, Brian; Abelson, Julia
2011-01-01
Decision makers are pressed to involve the public in priority setting. However, public input is only one form of evidence. So, how can information from the public be combined with other knowledge? The authors qualitatively analysed articles that explicitly address this question. We identified the other forms of information that tend to be used in…
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Priority-setting and hospital strategic planning: a qualitative case study.
Martin, Douglas; Shulman, Ken; Santiago-Sorrell, Patricia; Singer, Peter
2003-10-01
To describe and evaluate the priority-setting element of a hospital's strategic planning process. Qualitative case study and evaluation against the conditions of 'accountability for reasonableness' of a strategic planning process at a large urban university-affiliated hospital. The hospital's strategic planning process met the conditions of 'accountability for reasonableness' in large part. Specifically: the hospital based its decisions on reasons (both information and criteria) that the participants felt were relevant to the hospital; the number and type of participants were very extensive; the process, decisions and reasons were well communicated throughout the organization, using multiple communication vehicles; and the process included an ethical framework linked to an effort to evaluate and improve the process. However, there were opportunities to improve the process, particularly by giving participants more time to absorb the information relevant to priority-setting decisions, more time to take difficult decisions and some means to appeal or revise decisions. A case study linked to an evaluation using 'accountability for reasonableness' can serve to improve priority-setting in the context of hospital strategic planning.
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Turner, Grace M; Backman, Ruth; McMullan, Christel; Mathers, Jonathan; Marshall, Tom; Calvert, Melanie
2018-01-01
What is the problem and why is this important? Mini-strokes are similar to full strokes, but symptoms last less than 24 h. Many people (up to 70%) have long-term problems after a mini-stroke, such as anxiety; depression; problems with brain functioning (like memory loss); and fatigue (feeling tired). However, the current healthcare pathway only focuses on preventing another stroke and care for other long-term problems is not routinely given. Without proper treatment, people with long-term problems after a mini-stroke could have worse quality of life and may find it difficult to return to work and their social activities. What is the aim of the research? We wanted to understand the research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of mini-stroke. How did we address the problem? We invited patients, clinicians, researchers and other stakeholders to attend a meeting. At the meeting people discussed the issues relating to the long-term impact of mini-stroke and came to an agreement on their research priorities. There were three stages: (1) people wrote down their individual research suggestions; (2) in smaller groups people came to an agreement on what their top research questions were; and (3) the whole group agreed final research priorities. What did we find? Eleven people attended who were representatives for patients, GPs, stroke consultants, stroke nurses, psychologists, the Stroke Association (charity) and stroke researchers, The group agreed on eleven research questions which they felt were the most important to improve health and well-being for people who have had a mini-stroke.The eleven research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals. Background Clinical management after transient ischaemic attack (TIA) and minor stroke focuses on stroke prevention. However, evidence demonstrates that many patients experience ongoing residual impairments. Residual impairments post-TIA and minor stroke may affect patients' quality of life and return to work or social activities. Research priorities of patients, health care professionals and key stakeholders relating to the long-term impact of TIA and minor stroke are unknown. Methods Our objective was to establish the top shared research priorities relating to the long-term impact of TIA and minor stroke through stakeholder-centred consensus. A one-day priority setting consensus meeting took place with representatives from different stakeholder groups in October 2016 (Birmingham, UK). Nominal group technique was used to establish research priorities. This involved three stages: (i) gathering research priorities from individual stakeholders; (ii) interim prioritisation in three subgroups; and (iii) final priority setting. Results The priority setting consensus meeting was attended by 11 stakeholders. The individual stakeholders identified 34 different research priorities. During the interim prioritisation exercise, the three subgroups generated 24 unique research priorities which were discussed as a whole group. Following the final consensus discussion, 11 shared research priorities were unanimously agreed.The 11 research questions encompass a range of categories, including: understanding the existing care patients receive (according to diagnosis and geographical location); exploring what optimal care post-TIA/minor stroke should comprise (identifying and treating impairments, information giving and support groups) and how that care should be delivered (clinical setting and follow-up pathway); impact on family members; and education/training for health care professionals. Conclusions Eleven different research priorities were established through stakeholder-centred consensus. These research questions could usefully inform the research agenda and policy decisions for TIA and minor stroke. Inclusion of stakeholders in setting research priorities is important to increase the relevance of research and reduce research waste.
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34 CFR 74.11 - Pre-award policies.
Code of Federal Regulations, 2010 CFR
2010-07-01
... services for the direct benefit or use of the Federal Government. (b) Public notice and priority setting. The Secretary notifies the public of intended funding priorities for discretionary grant programs, unless funding priorities are established by Federal statute. (Authority: 20 U.S.C. 1221e-3, 3474; OMB...
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45 CFR 1620.5 - Annual review.
Code of Federal Regulations, 2010 CFR
2010-10-01
... Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION PRIORITIES IN USE OF RESOURCES § 1620.5 Annual review. (a) Priorities shall be set periodically and shall be reviewed by the... number of emergency cases outside of its priorities. (b) The following factors should be among those...
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75 FR 34249 - Centers for Independent Living Program-Training and Technical Assistance
Federal Register 2010, 2011, 2012, 2013, 2014
2010-06-16
... rural settings. To meet this priority, applicants must demonstrate all of the following in their... and Rehabilitative Services, Department of Education. ACTION: Notice of final priority. SUMMARY: The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Centers...
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Future Research Priorities for Morbidity Control of Lymphedema.
Narahari, S R; Aggithaya, Madhur Guruprasad; Moffatt, Christine; Ryan, T J; Keeley, Vaughan; Vijaya, B; Rajendran, P; Karalam, S B; Rajagopala, S; Kumar, N K; Bose, K S; Sushma, K V
2017-01-01
Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients' priorities. One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP.
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Future Research Priorities for Morbidity Control of Lymphedema
Narahari, S R; Aggithaya, Madhur Guruprasad; Moffatt, Christine; Ryan, T J; Keeley, Vaughan; Vijaya, B; Rajendran, P; Karalam, S B; Rajagopala, S; Kumar, N K; Bose, K S; Sushma, K V
2017-01-01
Background: Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. Methods: A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients’ priorities. Results: One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. Conclusion: A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP. PMID:28216723
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2012-01-01
Background Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. Methods To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Results Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Conclusions Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans. PMID:22449119
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"Quitting like a Turk:" How political priority developed for tobacco control in Turkey.
Hoe, Connie; Rodriguez, Daniela C; Üzümcüoğlu, Yeşim; Hyder, Adnan A
2016-09-01
In recent years, tobacco control emerged as a political priority in Turkey and today the country is widely regarded as one of the global leaders in tackling tobacco use. Although political priority is considered a facilitating factor to the success of addressing public health issues, there is a paucity of research to help us understand how it is developed in middle-income countries. The primary aim of this study is to understand the process and determinants of how tobacco control became a political priority in Turkey using the Multiple Streams Framework. A mixed-methods case study approach was used whereby data were gathered from three different sources: in-depth interviews (N = 19), document reviews (N = 216), and online self-administered surveys (N = 61). Qualitative data were collected for the purpose of understanding the processes and determinants that led to political prioritization of tobacco control and were analyzed using deductive and inductive coding. Quantitative data were collected to examine the actors and were analyzed using descriptive statistics and network nominations. Data were triangulated. Findings revealed that tobacco control achieved political priority in Turkey as a result of the development and convergence of multiple streams, including a fourth, separate global stream. Findings also shed light on the importance of Turkey's foreign policy in the transformation of the political stream. The country's desire for European Union accession and global visibility helped generate a political environment that was receptive to global norms for tobacco control. A diverse but cohesive network of actors joined forces with global allies to capitalize on this opportunity. Results suggest (1) the importance of global-agenda setting activities on political priority development, (2) the utility of aligning public health and foreign policy goals and (3) the need to build a strong global incentive structure to help entice governments to take action on public health issues. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Wiseman, Virginia; Mitton, Craig; Doyle-Waters, Mary M; Drake, Tom; Conteh, Lesong; Newall, Anthony T; Onwujekwe, Obinna; Jan, Stephen
2016-02-01
Policy makers in low-income and lower-middle-income countries (LMICs) are increasingly looking to develop 'evidence-based' frameworks for identifying priority health interventions. This paper synthesises and appraises the literature on methodological frameworks--which incorporate economic evaluation evidence--for the purpose of setting healthcare priorities in LMICs. A systematic search of Embase, MEDLINE, Econlit and PubMed identified 3968 articles with a further 21 articles identified through manual searching. A total of 36 papers were eligible for inclusion. These covered a wide range of health interventions with only two studies including health systems strengthening interventions related to financing, governance and human resources. A little under half of the studies (39%) included multiple criteria for priority setting, most commonly equity, feasibility and disease severity. Most studies (91%) specified a measure of 'efficiency' defined as cost per disability-adjusted life year averted. Ranking of health interventions using multi-criteria decision analysis and generalised cost-effectiveness were the most common frameworks for identifying priority health interventions. Approximately a third of studies discussed the affordability of priority interventions. Only one study identified priority areas for the release or redeployment of resources. The paper concludes by highlighting the need for local capacity to conduct evaluations (including economic analysis) and empowerment of local decision-makers to act on this evidence. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.
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Protecting Biodiversity when Money Matters: Maximizing Return on Investment
Underwood, Emma C.; Shaw, M. Rebecca; Wilson, Kerrie A.; Kareiva, Peter; Klausmeyer, Kirk R.; McBride, Marissa F.; Bode, Michael; Morrison, Scott A.; Hoekstra, Jonathan M.; Possingham, Hugh P.
2008-01-01
Background Conventional wisdom identifies biodiversity hotspots as priorities for conservation investment because they capture dense concentrations of species. However, density of species does not necessarily imply conservation ‘efficiency’. Here we explicitly consider conservation efficiency in terms of species protected per dollar invested. Methodology/Principal Findings We apply a dynamic return on investment approach to a global biome and compare it with three alternate priority setting approaches and a random allocation of funding. After twenty years of acquiring habitat, the return on investment approach protects between 32% and 69% more species compared to the other priority setting approaches. To correct for potential inefficiencies of protecting the same species multiple times we account for the complementarity of species, protecting up to three times more distinct vertebrate species than alternate approaches. Conclusions/Significance Incorporating costs in a return on investment framework expands priorities to include areas not traditionally highlighted as priorities based on conventional irreplaceability and vulnerability approaches. PMID:18231601
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Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K
2007-11-16
As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives.
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Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K
2007-01-01
Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives. PMID:18021393
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Sauer, J.R.; Casey, J.; Laskowski, H.; Taylor, J.D.; Fallon, J.; Ralph, C. John; Rich, Terrell D.
2005-01-01
National Wildlife Refuges must manage habitats to support a variety of species that often have conflicting needs. To make reasonable management decisions, managers must know what species are priorities for their refuges and the relative importance of the species. Unfortunately, species priorities are often set regionally, but refuges must develop local priorities that reconcile regional priorities with constraints imposed by refuge location and local management options. Some species cannot be managed on certain refuges, and the relative benefit of management to regional populations of species can vary greatly among refuges. We describe a process of 'stepping down' regional priorities to local priorities for bird species of management interest. We define three primary scales of management interest: regional (at which overall priority species are set); 'Sepik Blocks' (30 min blocks of latitude and longitude, which provide a landscape level context for a refuge); and the refuge. Regional surveys, such as the North American Breeding Bird Survey, provide information that can be summarized at regional and Sepik Block scales, permitting regional priorities to be focused to landscapes near refuges. However, refuges manage habitats, and managers need information about how the habitat management is likely to collectively influence the priority species. The value of the refuge for a species is also influenced by the availability of habitats within refuges and the relative amounts of those habitats at each scale. We use remotely-sensed data to assess proportions of habitats at the three geographic scales. These data provide many possible approaches for developing local priorities for management. Once these are defined, managers can use the priorities, in conjunction with predictions of the consequences of management for each species, to assess the overall benefit of alternative management actions for the priority species.
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Full value documentation in the Czech Food Composition Database.
Machackova, M; Holasova, M; Maskova, E
2010-11-01
The aim of this project was to launch a new Food Composition Database (FCDB) Programme in the Czech Republic; to implement a methodology for food description and value documentation according to the standards designed by the European Food Information Resource (EuroFIR) Network of Excellence; and to start the compilation of a pilot FCDB. Foods for the initial data set were selected from the list of foods included in the Czech Food Consumption Basket. Selection of 24 priority components was based on the range of components used in former Czech tables. The priority list was extended with components for which original Czech analytical data or calculated data were available. Values that were input into the compiled database were documented according to the EuroFIR standards within the entities FOOD, COMPONENT, VALUE and REFERENCE using Excel sheets. Foods were described using the LanguaL Thesaurus. A template for documentation of data according to the EuroFIR standards was designed. The initial data set comprised documented data for 162 foods. Values were based on original Czech analytical data (available for traditional and fast foods, milk and milk products, wheat flour types), data derived from literature (for example, fruits, vegetables, nuts, legumes, eggs) and calculated data. The Czech FCDB programme has been successfully relaunched. Inclusion of the Czech data set into the EuroFIR eSearch facility confirmed compliance of the database format with the EuroFIR standards. Excel spreadsheets are applicable for full value documentation in the FCDB.
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Prioritized Contact Transport Stream
NASA Technical Reports Server (NTRS)
Hunt, Walter Lee, Jr. (Inventor)
2015-01-01
A detection process, contact recognition process, classification process, and identification process are applied to raw sensor data to produce an identified contact record set containing one or more identified contact records. A prioritization process is applied to the identified contact record set to assign a contact priority to each contact record in the identified contact record set. Data are removed from the contact records in the identified contact record set based on the contact priorities assigned to those contact records. A first contact stream is produced from the resulting contact records. The first contact stream is streamed in a contact transport stream. The contact transport stream may include and stream additional contact streams. The contact transport stream may be varied dynamically over time based on parameters such as available bandwidth, contact priority, presence/absence of contacts, system state, and configuration parameters.
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38 CFR 61.44 - Awarding special needs grants.
Code of Federal Regulations, 2010 CFR
2010-07-01
...) Applicants will first be grouped in categories according to the funding priorities set forth in the NOFA, if... highest-ranked applications for which funding is available, within highest priority funding category if... order, as determined under § 61.43 of this part. If funding priorities have been established and funds...
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38 CFR 61.32 - Ranking non-capital grant recipients for per diem.
Code of Federal Regulations, 2010 CFR
2010-07-01
... Availability will be reviewed and grouped in categories according to the funding priorities set forth in the... available, within highest priority funding category if applicable, will be conditionally selected for eligibility to receive per diem payments in accordance with their ranked order. If funding priorities have...
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38 CFR 61.54 - Awarding technical assistance grants.
Code of Federal Regulations, 2010 CFR
2010-07-01
...) Applicants will first be grouped in categories according to the funding priorities set forth in the NOFA, if... highest-ranked applications for which funding is available, within highest priority funding category if... ranked order, as determined under § 61.53 of this part. If funding priorities have been established and...
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38 CFR 61.14 - Selecting applications for capital grants.
Code of Federal Regulations, 2010 CFR
2010-07-01
... capital grants. (a) Applicants will first be grouped in categories according to the funding priorities set... applicable. The highest-ranked applications for which funding is available, within highest priority funding... ranked order, as determined under § 61.13 of this part. If funding priorities have been established and...
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12 CFR 1806.203 - Selection Process, actual award amounts.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Community Financing Activities, ranked in the order set forth in the applicable NOFA. (3) Third Priority. If... amounts based on the process described in this section. (c) Priority of Awards. The Fund will rank Applicants in each category of Qualified Activity according to the priorities described in this paragraph (c...
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The evolution of PBMA: towards a macro-level priority setting framework for health regions.
Mitton, Craig R; Donaldson, Cam; Waldner, Howard; Eagle, Chris
2003-11-01
To date, relatively little work on priority setting has been carried out at a macro-level across major portfolios within integrated health care organizations. This paper describes a macro marginal analysis (MMA) process for setting priorities and allocating resources in health authorities, based on work carried out in a major urban health region in Alberta, Canada. MMA centers around an expert working group of managers and clinicians who are charged with identifying areas for resource re-allocation on an ongoing basis. Trade-offs between services are based on locally defined criteria and are informed by multiple inputs such as evidence from the literature and local expert opinion. The approach is put forth as a significant improvement on historical resource allocation patterns.
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van Middendorp, J J; Allison, H C; Ahuja, S; Bracher, D; Dyson, C; Fairbank, J; Gall, A; Glover, A; Gray, L; Masri, W El; Uttridge, A; Cowan, K
2016-05-01
This is a mixed-method consensus development project. The objective of this study was to identify a top ten list of priorities for future research into spinal cord injury (SCI). The British Spinal Cord Injury Priority Setting Partnership was established in 2013 and completed in 2014. Stakeholders included consumer organisations, healthcare professional societies and caregivers. This partnership involved the following four key stages: (i) gathering of research questions, (ii) checking of existing research evidence, (iii) interim prioritisation and (iv) a final consensus meeting to reach agreement on the top ten research priorities. Adult individuals with spinal cord dysfunction because of trauma or non-traumatic causes, including transverse myelitis, and individuals with a cauda equina syndrome (henceforth grouped and referred to as SCI) were invited to participate in this priority setting partnership. We collected 784 questions from 403 survey respondents (290 individuals with SCI), which, after merging duplicate questions and checking systematic reviews for evidence, were reduced to 109 unique unanswered research questions. A total of 293 people (211 individuals with SCI) participated in the interim prioritisation process, leading to the identification of 25 priorities. At a final consensus meeting, a representative group of individuals with SCI, caregivers and health professionals agreed on their top ten research priorities. Following a comprehensive, rigorous and inclusive process, with participation from individuals with SCI, caregivers and health professionals, the SCI research agenda has been defined by people to whom it matters most and should inform the scope and future activities of funders and researchers for the years to come. The NIHR Oxford Biomedical Research Centre provided core funding for this project.
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Prioritizing and Funding Nepal's Multisector Nutrition Plan.
Pomeroy-Stevens, Amanda; Shrestha, Madhukar B; Biradavolu, Monica; Hachhethu, Kusum; Houston, Robin; Sharma, Indu; Wun, Jolene
2016-12-01
Nepal has a long tradition of designing good multisectoral nutrition policy. However, success of policy implementation has varied. More evidence on how to successfully carry out multisector nutrition policy is needed. We tracked the influence of Nepal's multisectoral nutrition plan (MSNP) on the process of priority setting and budgeting from 2014 to 2016. This study used a mixed-method longitudinal design to track qualitative and budgetary changes related to MSNP processes nationally as well as in 3 districts. Qualitative changes in each study area were assessed through interviews, observation, news content, and meeting notes. Changes in allocations and expenditures were calculated based on budget documents, work plans, and validation interviews. Improved understanding of the MSNP was documented nationally and in study districts but not in VDCs. Human resources, ownership, bottom-up planning, coordination, advocacy, and sustainable structures all emerged as important factors within the enabling environment. Evidence suggests the MSNP influenced improvements in the last 3 factors. We also found notable increases in activities and financing for nutrition-allocations increased steadily between FY 2013-2014 and FY 2015-2016, and 28% of total nutrition allocations in the final year came from new or expanded MSNP-affiliated activities. Data from 3 districts highlight challenges linking local planning and budgeting to central-level structures. The MSNP appears to have strengthened the nutrition system in Nepal and increased priority and funding for nutrition. Next steps include strengthening linkages to the districts and below. Other countries can learn from the MSNP's success in increasing investment for nutrition. © The Author(s) 2016.
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2012-01-01
Background Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. Methods A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Results Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics. In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners′ lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Conclusions Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS. PMID:23231820
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Jenniskens, Françoise; Tiendrebeogo, Georges; Coolen, Anne; Blok, Lucie; Kouanda, Seni; Sataru, Fuseini; Ralisimalala, Andriamampianina; Mwapasa, Victor; Kiyombo, Mbela; Plummer, David
2012-12-11
Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders' perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics.In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners' lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS.
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Finding consensus on frailty assessment in acute care through Delphi method
2016-01-01
Objective We seek to address gaps in knowledge and agreement around optimal frailty assessment in the acute medical care setting. Frailty is a common term describing older persons who are at increased risk of developing multimorbidity, disability, institutionalisation and death. Consensus has not been reached on the practical implementation of this concept to assess clinically and manage older persons in the acute care setting. Design Modified Delphi, via electronic questionnaire. Questions included ranking items that best recognise frailty, optimal timing, location and contextual elements of a successful tool. Intraclass correlation coefficients for overall levels of agreement, with consensus and stability tested by 2-way ANOVA with absolute agreement and Fisher's exact test. Participants A panel of national experts (academics, front-line clinicians and specialist charities) were invited to electronic correspondence. Results Variables reflecting accumulated deficit and high resource usage were perceived by participants as the most useful indicators of frailty in the acute care setting. The Acute Medical Unit and Care of the older Persons Ward were perceived as optimum settings for frailty assessment. ‘Clinically meaningful and relevant’, ‘simple (easy to use)’ and ‘accessible by multidisciplinary team’ were perceived as characteristics of a successful frailty assessment tool in the acute care setting. No agreement was reached on optimal timing, number of variables and organisational structures. Conclusions This study is a first step in developing consensus for a clinically relevant frailty assessment model for the acute care setting, providing content validation and illuminating contextual requirements. Testing on clinical data sets is a research priority. PMID:27742633
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A population-based model for priority setting across the care continuum and across modalities
Segal, Leonie; Mortimer, Duncan
2006-01-01
Background The Health-sector Wide (HsW) priority setting model is designed to shift the focus of priority setting away from 'program budgets' – that are typically defined by modality or disease-stage – and towards well-defined target populations with a particular disease/health problem. Methods The key features of the HsW model are i) a disease/health problem framework, ii) a sequential approach to covering the entire health sector, iii) comprehensiveness of scope in identifying intervention options and iv) the use of objective evidence. The HsW model redefines the unit of analysis over which priorities are set to include all mutually exclusive and complementary interventions for the prevention and treatment of each disease/health problem under consideration. The HsW model is therefore incompatible with the fragmented approach to priority setting across multiple program budgets that currently characterises allocation in many health systems. The HsW model employs standard cost-utility analyses and decision-rules with the aim of maximising QALYs contingent upon the global budget constraint for the set of diseases/health problems under consideration. It is recognised that the objective function may include non-health arguments that would imply a departure from simple QALY maximisation and that political constraints frequently limit degrees of freedom. In addressing these broader considerations, the HsW model can be modified to maximise value-weighted QALYs contingent upon the global budget constraint and any political constraints bearing upon allocation decisions. Results The HsW model has been applied in several contexts, recently to osteoarthritis, that has demonstrated both its practical application and its capacity to derive clear evidenced-based policy recommendations. Conclusion Comparisons with other approaches to priority setting, such as Programme Budgeting and Marginal Analysis (PBMA) and modality-based cost-effectiveness comparisons, as typified by Australia's Pharmaceutical Benefits Advisory Committee process for the listing of pharmaceuticals for government funding, demonstrate the value added by the HsW model notably in its greater likelihood of contributing to allocative efficiency. PMID:16566841
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Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List
Klassen, David K.; Kucheryavaya, Anna Y.; Stewart, Darren E.
2016-01-01
Background and objectives Prior living donors (PLDs) receive very high priority on the Organ Procurement and Transplantation Network (OPTN) kidney waiting list. Program delays in adding PLDs to the waiting list, setting their status to active, and submitting requests for PLD priority can affect timely access to transplantation. Design, setting, participants, & measurements We used the OPTN and the Centers for Medicare and Medicaid Services data to examine timing of (1) listing relative to start of dialysis, (2) activation on the waiting list, and (3) requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the OPTN kidney waiting list between January 1, 2010 and July 31, 2015. Results As of September 4, 2015, 167 of the 210 PLDs received deceased donor transplants, six received living donor transplants, two died, five were too sick to transplant, and 29 were still waiting. Median waiting time to deceased donor transplant for PLDs was 98 days. Only 40.7% of 221 PLD registrations (n=90) were listed before they began dialysis; 68.3% were in inactive status for <90 days, 17.6% were in inactive status for 90–365 days, 8.6% were in inactive status for 1–2 years, and 5.4% were in inactive status for >2 years. Median time of PLDs waiting in active status before receiving PLD priority was 2 days (range =0–1450); 67.4% of PLDs received PLD priority within 7 days after activation, but 15.4% waited 8–30 days, 8.1% waited 1–3 months, 4.1% waited 3–12 months, and 5.0% waited >1 year in active status for PLD priority. After receiving priority, most were transplanted quickly. Median time in active status with PLD priority before deceased donor transplant was 23 days. Conclusions Fewer than one half of listed PLDs were listed before starting dialysis. Most listed PLDs are immediately set to active status and receive PLD priority quickly, but a substantial number spends time in active status without PLD priority or a large amount of time in inactive status, which affects access to timely transplants. PMID:27591296
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Allen, Michele L; Garcia-Huidobro, Diego; Bastian, Tiana; Hurtado, G Ali; Linares, Roxana; Svetaz, María Veronica
2017-06-01
Participatory research (PR) trials aim to achieve the dual, and at times competing, demands of producing an intervention and research process that address community perspectives and priorities, while establishing intervention effectiveness. To identify research and community priorities that must be reconciled in the areas of collaborative processes, study design and aim and study implementation quality in order to successfully conduct a participatory trial. We describe how this reconciliation was approached in the smoking prevention participatory trial Padres Informados/Jovenes Preparados (Informed Parents/Prepared Youth) and evaluate the success of our reconciled priorities. Data sources to evaluate success of the reconciliations included a survey of all partners regarding collaborative group processes, intervention participant recruitment and attendance and surveys of enrolled study participants assessing intervention outcomes. While we successfully achieved our reconciled collaborative processes and implementation quality goals, we did not achieve our reconciled goals in study aim and design. Due in part to the randomized wait-list control group design chosen in the reconciliation process, we were not able to demonstrate overall efficacy of the intervention or offer timely services to families in need of support. Achieving the goals of participatory trials is challenging but may yield community and research benefits. Innovative research designs are needed to better support the complex goals of participatory trials. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Setting Priorities in Global Child Health Research Investments: Addressing Values of Stakeholders
Kapiriri, Lydia; Tomlinson, Mark; Gibson, Jennifer; Chopra, Mickey; El Arifeen, Shams; Black, Robert E.; Rudan, Igor
2007-01-01
Aim To identify main groups of stakeholders in the process of health research priority setting and propose strategies for addressing their systems of values. Methods In three separate exercises that took place between March and June 2006 we interviewed three different groups of stakeholders: 1) members of the global research priority setting network; 2) a diverse group of national-level stakeholders from South Africa; and 3) participants at the conference related to international child health held in Washington, DC, USA. Each of the groups was administered different version of the questionnaire in which they were asked to set weights to criteria (and also minimum required thresholds, where applicable) that were a priori defined as relevant to health research priority setting by the consultants of the Child Health and Nutrition Research initiative (CHNRI). Results At the global level, the wide and diverse group of respondents placed the greatest importance (weight) to the criterion of maximum potential for disease burden reduction, while the most stringent threshold was placed on the criterion of answerability in an ethical way. Among the stakeholders’ representatives attending the international conference, the criterion of deliverability, answerability, and sustainability of health research results was proposed as the most important one. At the national level in South Africa, the greatest weight was placed on the criterion addressing the predicted impact on equity of the proposed health research. Conclusions Involving a large group of stakeholders when setting priorities in health research investments is important because the criteria of relevance to scientists and technical experts, whose knowledge and technical expertise is usually central to the process, may not be appropriate to specific contexts and in accordance with the views and values of those who invest in health research, those who benefit from it, or wider society as a whole. PMID:17948948
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2013-01-01
Background Politics plays a critical role in agenda setting in health affairs; therefore, understanding the priorities of the political agenda in health is very important. The political priority for safe motherhood has been investigated at the national level in different countries. The objective of this study was to explore why and how maternal health became a political priority at sub-national level in the state of Madhya Pradesh in India. Methods This study followed a qualitative design. Data were collected by carrying out interviews and review of documents. Semi-structured interviews were carried out with twenty respondents from four stakeholder groups: government officials, development partners, civil society and academics. Data analysis was performed using thematic analysis. The analysis was guided by Kingdon’s multiple streams model. Results The emergence of maternal health as a political priority in Madhya Pradesh was the result of convergence in the developments in different streams: the development of problem definition, policy generation and political change. The factors which influenced this process were: emerging evidence of the high magnitude of maternal mortality, civil society’s positioning of maternal mortality as a human rights violation, increasing media coverage, supportive policy environment and launch of the National Rural Health Mission (NRHM), the availability of effective policy solutions, India’s aspiration of global leadership, international influence, maternal mortality becoming a hot debate topic and political transition at the national and state levels. Most of these factors first became important at national level which then cascaded to the state level. Currently, there is a supportive policy environment in the state for maternal health backed by greater political will and increased resources. However, malnutrition and population stabilization are the competing priorities which may push maternal health off the agenda. Conclusions The influence of the events and factors evolving from international and national levels significantly contributed to the development of maternal health as a priority in Madhya Pradesh. This led to several opportunities in terms of policies, guidelines and programmes for improving maternal health. These efforts were successful to some extent in improving maternal health in the state but several implementation challenges still require special attention. PMID:24079699
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Jat, Tej Ram; Deo, Prakash Ramchandra; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel
2013-09-30
Politics plays a critical role in agenda setting in health affairs; therefore, understanding the priorities of the political agenda in health is very important. The political priority for safe motherhood has been investigated at the national level in different countries. The objective of this study was to explore why and how maternal health became a political priority at sub-national level in the state of Madhya Pradesh in India. This study followed a qualitative design. Data were collected by carrying out interviews and review of documents. Semi-structured interviews were carried out with twenty respondents from four stakeholder groups: government officials, development partners, civil society and academics. Data analysis was performed using thematic analysis. The analysis was guided by Kingdon's multiple streams model. The emergence of maternal health as a political priority in Madhya Pradesh was the result of convergence in the developments in different streams: the development of problem definition, policy generation and political change. The factors which influenced this process were: emerging evidence of the high magnitude of maternal mortality, civil society's positioning of maternal mortality as a human rights violation, increasing media coverage, supportive policy environment and launch of the National Rural Health Mission (NRHM), the availability of effective policy solutions, India's aspiration of global leadership, international influence, maternal mortality becoming a hot debate topic and political transition at the national and state levels. Most of these factors first became important at national level which then cascaded to the state level. Currently, there is a supportive policy environment in the state for maternal health backed by greater political will and increased resources. However, malnutrition and population stabilization are the competing priorities which may push maternal health off the agenda. The influence of the events and factors evolving from international and national levels significantly contributed to the development of maternal health as a priority in Madhya Pradesh. This led to several opportunities in terms of policies, guidelines and programmes for improving maternal health. These efforts were successful to some extent in improving maternal health in the state but several implementation challenges still require special attention.
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37 CFR 41.202 - Suggesting an interference.
Code of Federal Regulations, 2010 CFR
2010-07-01
... examiner sets will operate as a concession of priority for the subject matter of the claim. If the...(a), (4) Explain in detail why the applicant will prevail on priority, (5) If a claim has been added... this section. The claim the examiner proposes to have added must, apart from the question of priority...
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Program budgeting and marginal analysis: a case study in chronic airflow limitation.
Crockett, A; Cranston, J; Moss, J; Scown, P; Mooney, G; Alpers, J
1999-01-01
Program budgeting and marginal analysis is a method of priority-setting in health care. This article describes how this method was applied to the management of a disease-specific group, chronic airflow limitation. A sub-program flow chart clarified the major cost drivers. After assessment of the technical efficiency of the sub-programs and careful and detailed analysis, incremental and decremental wish lists of activities were established. Program budgeting and marginal analysis provides a framework for rational resource allocation. The nurturing of a vigorous program management group, with members representing all participants in the process (including patients/consumers), is the key to a successful outcome.
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Joost, S; Colli, L; Baret, P V; Garcia, J F; Boettcher, P J; Tixier-Boichard, M; Ajmone-Marsan, P
2010-05-01
In livestock genetic resource conservation, decision making about conservation priorities is based on the simultaneous analysis of several different criteria that may contribute to long-term sustainable breeding conditions, such as genetic and demographic characteristics, environmental conditions, and role of the breed in the local or regional economy. Here we address methods to integrate different data sets and highlight problems related to interdisciplinary comparisons. Data integration is based on the use of geographic coordinates and Geographic Information Systems (GIS). In addition to technical problems related to projection systems, GIS have to face the challenging issue of the non homogeneous scale of their data sets. We give examples of the successful use of GIS for data integration and examine the risk of obtaining biased results when integrating datasets that have been captured at different scales.
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OGUPSA sensor scheduling architecture and algorithm
NASA Astrophysics Data System (ADS)
Zhang, Zhixiong; Hintz, Kenneth J.
1996-06-01
This paper introduces a new architecture for a sensor measurement scheduler as well as a dynamic sensor scheduling algorithm called the on-line, greedy, urgency-driven, preemptive scheduling algorithm (OGUPSA). OGUPSA incorporates a preemptive mechanism which uses three policies, (1) most-urgent-first (MUF), (2) earliest- completed-first (ECF), and (3) least-versatile-first (LVF). The three policies are used successively to dynamically allocate and schedule and distribute a set of arriving tasks among a set of sensors. OGUPSA also can detect the failure of a task to meet a deadline as well as generate an optimal schedule in the sense of minimum makespan for a group of tasks with the same priorities. A side benefit is OGUPSA's ability to improve dynamic load balance among all sensors while being a polynomial time algorithm. Results of a simulation are presented for a simple sensor system.
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42 CFR 494.110 - Condition: Quality assessment and performance improvement.
Code of Federal Regulations, 2010 CFR
2010-10-01
... time. (c) Standard: Prioritizing improvement activities. The dialysis facility must set priorities for performance improvement, considering prevalence and severity of identified problems and giving priority to...
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Research priority setting in childhood chronic disease: a systematic review.
Odgers, Harrison Lindsay; Tong, Allison; Lopez-Vargas, Pamela; Davidson, Andrew; Jaffe, Adam; McKenzie, Anne; Pinkerton, Ross; Wake, Melissa; Richmond, Peter; Crowe, Sally; Caldwell, Patrina Ha Yuen; Hill, Sophie; Couper, Jennifer; Haddad, Suzy; Kassai, Behrouz; Craig, Jonathan C
2018-04-11
To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals. We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas. We identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life/psychosocial impact (48%), disease onset/prevention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations. Research priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Setting Priorities for Graduate Medical Education,
1996-02-01
assist the work of these staffs. 14. SUBJECT TERMS Attrition, data bases, education , mathematical models, medical personnel, military medicine, naval...CRM 95-209 / February 1996 Setting Priorities for Graduate Medical Education Neil B. Carey • Marjorie D. Curia • Oliver A. Smith 19960718 027...the tirae for reviewing instructions, searching existing data sources gathering and maintaining the data needed, and reviewing the collection of
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City and County Solar PV Training Program, Module 1: Goal Setting and Clarification
DOE Office of Scientific and Technical Information (OSTI.GOV)
McLaren, Joyce A.
This module will help attendees understand nuances between different types of renewable energy goals, the importance of terminology when setting and announcing goals, the value of formally clarifying priorities, and how priorities may impact procurement options. It is the first training in a series intended to help municipal staff procure solar PV for their land and buildings.
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ERIC Educational Resources Information Center
Kapiriri, Lydia; Sinding, Christina; Arnold, Emmy
2017-01-01
There is limited literature on how donors conceptualise and prioritise evidence in healthcare priority setting (PS) affecting low income countries (LICs). We interviewed 35 donors and reviewed their websites to describe how they conceptualise, prioritise and perceive the role evidence plays in their organisation's healthcare prioritisation…
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Priority setting for orphan drugs: an international comparison.
Rosenberg-Yunger, Zahava R S; Daar, Abdallah S; Thorsteinsdóttir, Halla; Martin, Douglas K
2011-04-01
To describe the process of priority setting for two orphan drugs - Cerezyme and Fabrazyme - in Canada, Australia and Israel, in order to understand and improve the process based on stakeholder perspectives. We conducted qualitative case studies of how three independent drug advisory committees made decisions relating to the funding of Cerezyme and Fabrazyme. Interviews were conducted with 22 informants, including committee members, patient groups and industry representatives. (1) DESCRIPTION: Orphan drugs reimbursement recommendations by expert panels were based on clinical evidence, cost and cost-effectiveness analysis. (2) EVALUATION: Committee members expressed an overall preference for the current drug review process used by their own committee, but were concerned with the fairness of the process particularly for orphan drugs. Other informants suggested the inclusion of other relevant values (e.g. lack of alternative treatments) in order to improve the priority setting process. Some patient groups suggested the use of an alternative funding mechanism for orphan drugs. Priority setting for drugs is not solely a technical process (involving cost-effective analysis, evidence-based medicine, etc.). Understanding the process by which reimbursement decisions are made for orphan drugs may help improve the system for future orphan drugs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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Priority setting and evidence based purchasing.
Frith, L
1999-01-01
The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements of value. However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements--a patient's own assessment of the value of the treatment--then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them.
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Morris, Christopher; Simkiss, Doug; Busk, Mary; Morris, Maureen; Allard, Amanda; Denness, Jacob; Janssens, Astrid; Stimson, Anna; Coghill, Joanna; Robinson, Kelly; Fenton, Mark; Cowan, Katherine
2015-01-28
To engage young people, parent carers and clinicians in a systematic process to identify and prioritise research questions regarding ways to improve the health and well-being of children and young people with neurodisability. British Academy of Childhood Disability (BACD)-James Lind Alliance research priority setting partnership bringing together patients, carers and clinicians as equal stakeholders. UK health service and community. The BACD Strategic Research Group formed the partnership. A Steering Group was established; charity and professional partner organisations were recruited. Suggestions were gathered in an open survey and from research recommendations for statutory guidance. Items were aggregated to formulate indicative research questions and verified as uncertainties from research evidence. An interim survey was used to rank the questions to shortlist topics. A mixed group of stakeholders discussed the top 25 questions at the final priority setting workshop agreeing a final rank order and the top 10 research priorities. Partner organisations were 13 charities and 8 professional societies. 369 people submitted suggestions (40% non-clinicians). 76 people participated in the interim prioritisation (26 parents, 1 young person, 10 charity representatives, 39 clinicians); 22 took part in the final workshop (3 young people, 7 parents, 3 charity representatives, 9 professionals). The top three research priorities related to (1) establishing the optimal frequency and intensity (dose) for mainstream therapies, (2) means for selecting and encouraging use of communication strategies and (3) ways to improve children's attitudes towards disability. The top 10 included evaluating interventions to promote mobility, self-efficacy, mental health, continence, physical fitness, educational inclusion and reduce impacts of sleep disturbance. The methodology provided a systematic and transparent process to identify research priorities that included stakeholders that have typically not contributed to setting the research agenda. The top 10 and other topics identified provide a resource for researchers and agencies that fund research. 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.
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Male dominance rank and reproductive success in chimpanzees, Pan troglodytes schweinfurthii.
Wroblewski, Emily E; Murray, Carson M; Keele, Brandon F; Schumacher-Stankey, Joann C; Hahn, Beatrice H; Pusey, Anne E
2009-01-01
Competition for fertile females determines male reproductive success in many species. The priority of access model predicts that male dominance rank determines access to females, but this model has been difficult to test in wild populations, particularly in promiscuous mating systems. Tests of the model have produced variable results, probably because of the differing socioecological circumstances of individual species and populations. We tested the predictions of the priority of access model in the chimpanzees of Gombe National Park, Tanzania. Chimpanzees are an interesting species in which to test the model because of their fission-fusion grouping patterns, promiscuous mating system and alternative male mating strategies. We determined paternity for 34 offspring over a 22-year period and found that the priority of access model was generally predictive of male reproductive success. However, we found that younger males had higher success per male than older males, and low-ranking males sired more offspring than predicted. Low-ranking males sired offspring with younger, less desirable females and by engaging in consortships more often than high-ranking fathers. Although alpha males never sired offspring with related females, inbreeding avoidance of high-ranking male relatives did not completely explain the success of low-ranking males. While our work confirms that male rank typically predicts male chimpanzee reproductive success, other factors are also important; mate choice and alternative male strategies can give low-ranking males access to females more often than would be predicted by the model. Furthermore, the success of younger males suggests that they are more successful in sperm competition.
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Bjegovic-Mikanovic, Vesna; Santric-Milicevic, Milena; Cichowska, Anna; von Krauss, Martin Krayer; Perfilieva, Galina; Rebac, Boris; Zuleta-Marin, Ingrid; Dieleman, Marjolein; Zwanikken, Prisca
2018-06-01
To map out the Public Health Workforce (PHW) involved in successful public health interventions. We did a pilot assessment of human resources involved in successful interventions addressing public health challenges in the countries of South-Eastern Europe (SEE). High-level representatives of eight countries reported about success stories through the coaching by experts. During synthesizing qualitative data, experts applied triangulation by contacting additional sources of evidence and used the framework method in data analysis. SEE countries tailored public health priorities towards social determinants, health equalities, and prevention of non-communicable diseases. A variety of organizations participated in achieving public health success. The same applies to the wide array of professions involved in the delivery of Essential Public Health Operations (EPHOs). Key enablers of the successful work of PHW were staff capacities, competences, interdisciplinary networking, productivity, and funding. Despite diversity across countries, successful public health interventions have similar ingredients. Although PHW is aligned with the specific public health success, a productive interface between health and other sectors is crucial for rolling-out successful interventions.
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Groves, Kevin S
2017-08-03
Spearheaded by the industry's transition from volume- to value-based care, the health care reform movement has spurred both unprecedented challenges and opportunities for developing more effective and sustainable health care delivery organizations. Whereas the formidable challenges of leading hospitals and health systems have been widely discussed, including reimbursement degradation, the rapidly aging workforce, and the imminent wave of executive retirements, the opportunity to leverage succession management and talent development capabilities to overcome these challenges has been largely overlooked. To address this key research and practice need, this multiphase study develops and validates an assessment of succession management practices for health care organizations. Utilizing data collected from two national samples of hospital organizations, the results provide a 32-item succession management assessment comprising seven distinct sets of succession management practices. The results indicate that succession management practices are strongly associated with multiple hospital performance metrics, including patient satisfaction and Medicare Spending per Beneficiary, leadership bench strength, and internal/external placement rate for executive level positions. The author concludes this article with a discussion of several practical implications for health care executives and boards, including employing the succession management assessment for diagnosing development opportunities, benchmarking succession planning and talent development practices against similar hospitals or health systems, and elevating the profile of succession management as a strategic priority in today's increasingly uncertain health care landscape.
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Allard, Julie; Durand, Céline; Anthony, Samantha J.; Dumez, Vincent; Hartell, David; Hébert, Marie-Josée; West, Lori J.; Wright, Linda; Fortin, Marie-Chantal
2017-01-01
Background It is vitally important to seek input from key stakeholders to increase the quality and relevance of health-related research and accelerate its adoption into practice. Patients and caregivers have rarely been involved in setting research priorities in the transplantation and donation field. The objectives of this explorative study are: (i) to discuss research priorities within the Canadian National Transplant Research Program during a priority-setting exercise with patients, caregivers, organ donors and researchers and (ii) to compare the identified priorities with research published in 2 prestigious transplantation journals. Methods A pilot workshop attended by 10 patients and caregivers and 5 researchers was held in Montréal (Quebec, Canada) in August 2014 to identify research priorities. Priorities were identified using a thematic analysis of the workshop transcription conducted by multiple coders. These priorities were compared with the topics of research articles published in 2 major transplantation journals between 2012 and 2014. Results The themes of the 10 research priorities identified by study participants were related to different research domains: social, cultural, and environmental health factors (4); biomedical or clinical (4); and research about health systems and services (2). 26.7% of the research articles published were related to the identified priorities. Thirteen percent looked at ways to improve graft survival and 8.5% looked at the development of tolerance, 2 priorities identified by participants. Fewer than 5% examined the other 8 research priorities identified as important by workshop participants. Conclusions This is the first study reporting patients' and researchers' priorities in the field of transplantation and donation in Canada. There is a discrepancy between topics that key stakeholders find important and research published in 2 major transplantation journals. The research priorities identified during our initial workshop will be validated through a national survey and workshop. PMID:28361111
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7 CFR 625.6 - Establishing priority for enrollment in HFRP.
Code of Federal Regulations, 2012 CFR
2012-01-01
... contribution of non-Federal funds; (6) Significance of forest ecosystem functions and values; (7) Estimated... place higher priority on certain forest ecosystems based regions of the State or multi-State area where... is essential to the successful restoration of the forest ecosystem and those adjacent landowners are...
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7 CFR 625.6 - Establishing priority for enrollment in HFRP.
Code of Federal Regulations, 2013 CFR
2013-01-01
... contribution of non-Federal funds; (6) Significance of forest ecosystem functions and values; (7) Estimated... place higher priority on certain forest ecosystems based regions of the State or multi-State area where... is essential to the successful restoration of the forest ecosystem and those adjacent landowners are...
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7 CFR 625.6 - Establishing priority for enrollment in HFRP.
Code of Federal Regulations, 2014 CFR
2014-01-01
... contribution of non-Federal funds; (6) Significance of forest ecosystem functions and values; (7) Estimated... place higher priority on certain forest ecosystems based regions of the State or multi-State area where... is essential to the successful restoration of the forest ecosystem and those adjacent landowners are...
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7 CFR 625.6 - Establishing priority for enrollment in HFRP.
Code of Federal Regulations, 2011 CFR
2011-01-01
... contribution of non-Federal funds; (6) Significance of forest ecosystem functions and values; (7) Estimated... place higher priority on certain forest ecosystems based regions of the State or multi-State area where... is essential to the successful restoration of the forest ecosystem and those adjacent landowners are...
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7 CFR 1467.6 - Establishing priority for enrollment of properties in WRP.
Code of Federal Regulations, 2010 CFR
2010-01-01
... higher priority on certain geographic regions of the State where restoration of wetlands may better... participation of the adjacent landowners is essential to the successful restoration of the wetlands and those... with other Federal, State, and nonprofit organizations to encourage the restoration of wetlands on...
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7 CFR 1467.6 - Establishing priority for enrollment of properties in WRP.
Code of Federal Regulations, 2011 CFR
2011-01-01
... higher priority on certain geographic regions of the State where restoration of wetlands may better... participation of the adjacent landowners is essential to the successful restoration of the wetlands and those... with other Federal, State, and nonprofit organizations to encourage the restoration of wetlands on...
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34 CFR 280.32 - How is priority given to applicants?
Code of Federal Regulations, 2012 CFR
2012-07-01
... points awarded under § 280.31, the Secretary gives priority to the factors listed in paragraphs (b) through (d) of this section by awarding additional points for these factors. The Secretary indicates in..., the location of the magnet school within the LEA—impacts on the applicant's ability to successfully...
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34 CFR 280.32 - How is priority given to applicants?
Code of Federal Regulations, 2014 CFR
2014-07-01
... points awarded under § 280.31, the Secretary gives priority to the factors listed in paragraphs (b) through (d) of this section by awarding additional points for these factors. The Secretary indicates in..., the location of the magnet school within the LEA—impacts on the applicant's ability to successfully...
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Tomlinson, Mark; Jordans, Mark; MacMillan, Harriet; Betancourt, Theresa; Hunt, Xanthe; Mikton, Christopher
2017-10-01
Child development in low and middle income countries (LMIC) is compromised by multiple risk factors. Reducing children's exposure to harmful events is essential for early childhood development (ECD). In particular, preventing violence against children - a highly prevalent risk factor that negatively affects optimal child development - should be an intervention priority. We used the Child Health and Nutrition Initiative (CHNRI) method for the setting of research priorities in integrated Early Childhood Development and violence prevention programs (ECD+). An expert group was identified and invited to systematically list and score research questions. A total of 186 stakeholders were asked to contribute five research questions each, and contributions were received from 81 respondents. These were subsequently evaluated using a set of five criteria: answerability; effectiveness; feasibility and/or affordability; applicability and impact; and equity. Of the 400 questions generated, a composite group of 50 were scored by 55 respondents. The highest scoring research questions related to the training of Community Health Workers (CHW's) to deliver ECD+ interventions effectively and whether ECD+ interventions could be integrated within existing delivery platforms such as HIV, nutrition or mental health platforms. The priority research questions can direct new research initiatives, mainly in focusing on the effectiveness of an ECD+ approach, as well as on service delivery questions. To the best of our knowledge, this is the first systematic exercise of its kind in the field of ECD+. The findings from this research priority setting exercise can help guide donors and other development actors towards funding priorities for important future research related to ECD and violence prevention. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
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42 CFR 403.732 - Condition of participation: Quality assessment and performance improvement.
Code of Federal Regulations, 2010 CFR
2010-10-01
... performance improvement program. (3) The RNHCI must set priorities for performance improvement, considering... assessment and performance improvement program addresses identified priorities in the RNHCI and are...
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Setting research priorities to improve global newborn health and prevent stillbirths by 2025
Yoshida, Sachiyo; Martines, José; Lawn, Joy E; Wall, Stephen; Souza, Joăo Paulo; Rudan, Igor; Cousens, Simon; Aaby, Peter; Adam, Ishag; Adhikari, Ramesh Kant; Ambalavanan, Namasivayam; Arifeen, Shams EI; Aryal, Dhana Raj; Asiruddin, Sk; Baqui, Abdullah; Barros, Aluisio JD; Benn, Christine S; Bhandari, Vineet; Bhatnagar, Shinjini; Bhattacharya, Sohinee; Bhutta, Zulfiqar A; Black, Robert E; Blencowe, Hannah; Bose, Carl; Brown, Justin; Bührer, Christoph; Carlo, Wally; Cecatti, Jose Guilherme; Cheung, Po–Yin; Clark, Robert; Colbourn, Tim; Conde–Agudelo, Agustin; Corbett, Erica; Czeizel, Andrew E; Das, Abhik; Day, Louise Tina; Deal, Carolyn; Deorari, Ashok; Dilmen, Uğur; English, Mike; Engmann, Cyril; Esamai, Fabian; Fall, Caroline; Ferriero, Donna M; Gisore, Peter; Hazir, Tabish; Higgins, Rosemary D; Homer, Caroline SE; Hoque, DE; Irgens, Lorentz; Islam, MT; de Graft–Johnson, Joseph; Joshua, Martias Alice; Keenan, William; Khatoon, Soofia; Kieler, Helle; Kramer, Michael S; Lackritz, Eve M; Lavender, Tina; Lawintono, Laurensia; Luhanga, Richard; Marsh, David; McMillan, Douglas; McNamara, Patrick J; Mol, Ben Willem J; Molyneux, Elizabeth; Mukasa, G. K; Mutabazi, Miriam; Nacul, Luis Carlos; Nakakeeto, Margaret; Narayanan, Indira; Olusanya, Bolajoko; Osrin, David; Paul, Vinod; Poets, Christian; Reddy, Uma M; Santosham, Mathuram; Sayed, Rubayet; Schlabritz–Loutsevitch, Natalia E; Singhal, Nalini; Smith, Mary Alice; Smith, Peter G; Soofi, Sajid; Spong, Catherine Y; Sultana, Shahin; Tshefu, Antoinette; van Bel, Frank; Gray, Lauren Vestewig; Waiswa, Peter; Wang, Wei; Williams, Sarah LA; Wright, Linda; Zaidi, Anita; Zhang, Yanfeng; Zhong, Nanbert; Zuniga, Isabel; Bahl, Rajiv
2016-01-01
Background In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025. Methods We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Results Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. Conclusion These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed. PMID:26401272
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Setting research priorities to improve global newborn health and prevent stillbirths by 2025.
Yoshida, Sachiyo; Martines, José; Lawn, Joy E; Wall, Stephen; Souza, Joăo Paulo; Rudan, Igor; Cousens, Simon; Aaby, Peter; Adam, Ishag; Adhikari, Ramesh Kant; Ambalavanan, Namasivayam; Arifeen, Shams Ei; Aryal, Dhana Raj; Asiruddin, Sk; Baqui, Abdullah; Barros, Aluisio Jd; Benn, Christine S; Bhandari, Vineet; Bhatnagar, Shinjini; Bhattacharya, Sohinee; Bhutta, Zulfiqar A; Black, Robert E; Blencowe, Hannah; Bose, Carl; Brown, Justin; Bührer, Christoph; Carlo, Wally; Cecatti, Jose Guilherme; Cheung, Po-Yin; Clark, Robert; Colbourn, Tim; Conde-Agudelo, Agustin; Corbett, Erica; Czeizel, Andrew E; Das, Abhik; Day, Louise Tina; Deal, Carolyn; Deorari, Ashok; Dilmen, Uğur; English, Mike; Engmann, Cyril; Esamai, Fabian; Fall, Caroline; Ferriero, Donna M; Gisore, Peter; Hazir, Tabish; Higgins, Rosemary D; Homer, Caroline Se; Hoque, D E; Irgens, Lorentz; Islam, M T; de Graft-Johnson, Joseph; Joshua, Martias Alice; Keenan, William; Khatoon, Soofia; Kieler, Helle; Kramer, Michael S; Lackritz, Eve M; Lavender, Tina; Lawintono, Laurensia; Luhanga, Richard; Marsh, David; McMillan, Douglas; McNamara, Patrick J; Mol, Ben Willem J; Molyneux, Elizabeth; Mukasa, G K; Mutabazi, Miriam; Nacul, Luis Carlos; Nakakeeto, Margaret; Narayanan, Indira; Olusanya, Bolajoko; Osrin, David; Paul, Vinod; Poets, Christian; Reddy, Uma M; Santosham, Mathuram; Sayed, Rubayet; Schlabritz-Loutsevitch, Natalia E; Singhal, Nalini; Smith, Mary Alice; Smith, Peter G; Soofi, Sajid; Spong, Catherine Y; Sultana, Shahin; Tshefu, Antoinette; van Bel, Frank; Gray, Lauren Vestewig; Waiswa, Peter; Wang, Wei; Williams, Sarah LA; Wright, Linda; Zaidi, Anita; Zhang, Yanfeng; Zhong, Nanbert; Zuniga, Isabel; Bahl, Rajiv
2016-06-01
In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts. Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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Engaging patients in health research: identifying research priorities through community town halls.
Etchegary, Holly; Bishop, Lisa; Street, Catherine; Aubrey-Bassler, Kris; Humphries, Dale; Vat, Lidewij Eva; Barrett, Brendan
2017-03-11
The vision of Canada's Strategy for Patient-Oriented Research is that patients be actively engaged as partners in health research. Support units have been created across Canada to build capacity in patient-oriented research and facilitate its conduct. This study aimed to explore patients' health research priorities in the province of Newfoundland and Labrador (NL). Eight town halls were held with members of the general public in rural and urban settings across the province. Sessions were a hybrid information-consultation event, with key questions about health research priorities and outcomes guiding the discussion. Sixty eight members of the public attended town hall sessions. A broad range of health experiences in the healthcare system were recounted. Key priorities for the public included access and availability of providers and services, disease prevention and health promotion, and follow-up support and community care. In discussing their health research priorities, participants spontaneously raised a broad range of suggestions for improving the healthcare system in our jurisdiction. Public research priorities and suggestions for improving the provision of healthcare provide valuable information to guide Support Units' planning and priority-setting processes. A range of research areas were raised as priorities for patients that are likely comparable to other healthcare systems. These create a number of health research questions that would be in line with public priorities. Findings also provide lessons learned for others and add to the evidence base on patient engagement methods.
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Grepperud, Sverre; Holman, Per Arne; Wangen, Knut Reidar
2014-12-14
Clinicians at Norwegian community mental health centres assess referrals from general practitioners and classify them into three priority groups (high priority, low priority, and refusal) according to need where need is defined by three prioritization criteria (severity, effect, and cost-effectiveness). In this study, we seek to operationalize the three criteria and analyze to what extent they have an effect on clinical-level priority setting after controlling for clinician characteristics and organisational factors. Twenty anonymous referrals were rated by 42 admission team members employed at 14 community mental health centres in the South-East Health Region of Norway. Intra-class correlation coefficients were calculated and logistic regressions were performed. Variation in clinicians' assessments of the three criteria was highest for effect and cost-effectiveness. An ordered logistic regression model showed that all three criteria for prioritization, three clinician characteristics (education, being a manager or not, and "guideline awareness"), and the centres themselves (fixed effects), explained priority decisions. The relative importance of the explanatory factors, however, depended on the priority decision studied. For the classification of all admitted patients into high- and low-priority groups, all clinician characteristics became insignificant. For the classification of patients, into those admitted and non-admitted, one criterion (effect) and "being a manager or not" became insignificant, while profession ("being a psychiatrist") became significant. Our findings suggest that variation in priority decisions can be reduced by: (i) reducing the disagreement in clinicians' assessments of cost-effectiveness and effect, and (ii) restricting priority decisions to clinicians with a similar background (education, being a manager or not, and "guideline awareness").
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Odaga, John; Henriksson, Dorcus K; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K; Valadez, Joseph J
2016-01-01
Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.
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Odaga, John; Henriksson, Dorcus K.; Nkolo, Charles; Tibeihaho, Hector; Musabe, Richard; Katusiime, Margaret; Sinabulya, Zaccheus; Mucunguzi, Stephen; Mbonye, Anthony K.; Valadez, Joseph J.
2016-01-01
Background Local health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions. Design Although the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project. Results All five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans. Conclusions In the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival. PMID:27225791
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Establishing a successful clinical research program.
Scoglio, Daniele; Fichera, Alessandro
2014-06-01
Clinical research (CR) is a natural corollary to clinical surgery. It gives an investigator the opportunity to critically review their results and develop new strategies. This article covers the critical factors and the important components of a successful CR program. The first and most important step is to build a dedicated research team to overcome time constraints and enable a surgical practice to make CR a priority. With the research team in place, the next step is to create a program on the basis of an original idea and new clinical hypotheses. This often comes from personal experience supported by a review of the available evidence. Randomized controlled (clinical) trials are the most stringent way of determining whether a cause-effect relationship exists between the intervention and the outcome. In the proper setting, translational research may offer additional avenues allowing clinical application of basic science discoveries.
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Contemporary management of stage I and II seminoma.
Chung, Peter; Warde, Padraig
2013-10-01
Seminoma represents about 60 % of all testicular germ cell tumors. At presentation about 80 % of patients have stage I and about 15 % have stage II disease. The last three decades have seen a substantial change in the philosophy of management with the success of surveillance as a strategy to minimize unnecessary treatment, recognition of the late effects of radiation therapy, and the success of cisplatin-based chemotherapy as curative treatment either in the first-line or salvage setting. Overall, in stage I disease where 80-85 % are cured with orchiectomy alone, efforts now are directed at reducing the burden of the disease and its diagnosis on patients with increasing utilization of surveillance and decreased employment of adjuvant therapy. For stage II disease, balancing the relative toxicities of radiation and chemotherapy while avoiding the use of multimodality therapy due to the additive long-term toxicity has become the priority.
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2010-01-01
Despite increasing efforts and support for anti-malarial drug R&D, globally anti-malarial drug discovery and development remains largely uncoordinated and fragmented. The current window of opportunity for large scale funding of R&D into malaria is likely to narrow in the coming decade due to a contraction in available resources caused by the current economic difficulties and new priorities (e.g. climate change). It is, therefore, essential that stakeholders are given well-articulated action plans and priorities to guide judgments on where resources can be best targeted. The CRIMALDDI Consortium (a European Union funded initiative) has been set up to develop, through a process of stakeholder and expert consultations, such priorities and recommendations to address them. It is hoped that the recommendations will help to guide the priorities of the European anti-malarial research as well as the wider global discovery agenda in the coming decade. PMID:20626844
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Top 40 priorities for science to inform conservation and management policy in the United States
Fleishman, Erica; Blockstein, David E.; Hall, John A.; Mascia, Michael B.; Rudd, Murray A.; Scott, J. Michael; Sutherland, William J.; Bartuska, Ann M.; Brown, A. Gordon; Christen, Catherine A.; Clement, Joel P.; DellaSala, Dominick; Duke, Clifford D.; Fiske, Shirley J.; Gosnell, Hannah; Haney, J. Christopher; Hutchins, Michael; Klein, Mary L.; Marqusee, Jeffrey; Noon, Barry R.; Nordgren, John R.; Orbuch, Paul M.; Powell, Jimmie; Quarles, Steven P.; Saterson, Kathryn A.; Stein, Bruce A.; Webster, Michael S.; Vedder, Amy
2011-01-01
To maximize the utility of research to decisionmaking, especially given limited financial resources, scientists must set priorities for their efforts. We present a list of the top 40 high-priority, multidisciplinary research questions directed toward informing some of the most important current and future decisions about management of species, communities, and ecological processes in the United States. The questions were generated by an open, inclusive process that included personal interviews with decisionmakers, broad solicitation of research needs from scientists and policymakers, and an intensive workshop that included scientifically oriented individuals responsible for managing and developing policy related to natural resources. The process differed from previous efforts to set priorities for conservation research in its focus on the engagement of decisionmakers in addition to researchers. The research priorities emphasized the importance of addressing societal context and exploration of trade-offs among alternative policies and actions, as well as more traditional questions related to ecological processes and functions.
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Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L
2017-09-01
The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.
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Establishing Priorities for Oncology Nursing Research: Nurse and Patient Collaboration.
Cox, Anna; Arber, Anne; Gallagher, Ann; MacKenzie, Mairead; Ream, Emma
2017-03-01
To obtain consensus on priorities for oncology nursing research in the United Kingdom. . A three-round online Delphi survey. . Oncology nurses were invited via the United Kingdom Oncology Nursing Society (UKONS) database. Patient participation was invited through patient organizations. . 50 oncology nurses and 18 patients. . Eligible and consenting individuals reported five priorities for oncology nursing research (round 1), rated their level of agreement with them (round 2), and restated and revised their responses in light of the group's responses (round 3). Consensus was defined as 80% agreement. . Research priorities for oncology nursing as reported by oncology nurses and patients. . Consensus was reached on 50 of 107 research priorities. These priorities reflected the entire cancer pathway, from diagnosis to palliative care. Highest agreement was reached within and across groups on the need for research relating to prevention, screening, early diagnosis, and psychological care across the cancer trajectory. Little consensus was reached regarding symptoms and side effects. Some evident divergence existed. Oncology nurses and patients do not necessarily prioritize the same research areas. Prevention, screening, and early diagnosis are of the highest priority for future research among oncology nurses and patients. . Patients usually play little part in priority setting for research. This study provided the opportunity for meaningful patient and nurse involvement in setting a research agenda for oncology nursing that is relevant and beneficial to oncology nurses and patients.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-16
... set forth in the First R&O, the Priority is premised on the unique ability of Tribes and Tribal... services the Tribal Priority generally operates as a dispositive preference in the application process... Tribal Priority operates as a dispositive preference in the AM commercial and FM NCE application contexts...
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Stakeholder views on criteria and processes for priority setting in Norway: a qualitative study.
Aidem, Jeremy M
2017-06-01
Since 2013, Norway has engaged in political processes to revise criteria for priority setting. These processes have yielded key efficiency and equity criteria, but excluded potentially relevant social values. This study describes the views of 27 stakeholders in Norway's health system regarding a wider set of priority-setting criteria and procedural characteristics. Between January and February 2016, semi-structured interviews and focus groups were conducted with a purposive sample of policymakers, hospital administrators, practitioners, university students and seniors. Improving health among low-socioeconomic-status groups was considered an important policy objective: some favored giving more priority to diseases affecting socioeconomically disadvantaged groups, and some believed inequalities in health could be more effectively addressed outside the health sector. Age was not widely accepted as an independent criterion, but deemed relevant as an indicator of capacity to benefit, cost-effectiveness and health loss. Cost-effectiveness, severity and health-loss measures were judged relevant to policymaking, but cost-effectiveness and health loss were considered less influential to clinical decision-making. Public engagement was seen as essential yet complicated by media and stakeholder pressures. This study highlights how views on the relevance and implementation of criteria can vary significantly according to the health system level being evaluated. Further, the findings suggest that giving priority to socioeconomically disadvantaged groups and reducing inequalities in health may be relevant preferences not captured in recent policy proposals. Copyright © 2017 Elsevier B.V. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
This volume contains working papers written for Office of Technology Assessment (OTA) to assist in preparation of the report Environmental Contaminants in Food. The contents include: (1) Priority setting of toxic substances for guiding monitoring programs; and (2) Five case studies of environmental food contamination.
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Girschik, Jennifer; Miller, Laura Jean; Addiscott, Tony; Daube, Mike; Katris, Paul; Ransom, David; Slevin, Terry; Threlfall, Tim; Weeramanthri, Tarun Stephen
2017-01-01
Cancer will continue to be a leading cause of ill health and death unless we can capitalize on the potential for 30-40% of these cancers to be prevented. In this light, cancer prevention represents an enormous opportunity for public health, potentially saving much of the pain, anguish, and cost associated with treating cancer. However, there is a challenge for governments, and the wider community, in prioritizing cancer prevention activities, especially given increasing financial constraints. This paper describes a method for identifying cancer prevention priorities. This method synthesizes detailed cancer statistics, expert opinion, and the published literature for the priority setting process. The process contains four steps: assessing the impact of cancer types; identifying cancers with the greatest impact; considering opportunities for prevention; and combining information on impact and preventability. The strength of our approach is that it is straightforward, transparent and reproducible for other settings. Applying this method in Western Australia produced a priority list of seven adult cancers which were identified as having not only the biggest impact on the community but also the best opportunities for prevention. Work conducted in an additional project phase went on to present data on these priority cancers to a public consultation and develop an agenda for action in cancer prevention.
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Precision in Setting Cancer Prevention Priorities: Synthesis of Data, Literature, and Expert Opinion
Girschik, Jennifer; Miller, Laura Jean; Addiscott, Tony; Daube, Mike; Katris, Paul; Ransom, David; Slevin, Terry; Threlfall, Tim; Weeramanthri, Tarun Stephen
2017-01-01
Cancer will continue to be a leading cause of ill health and death unless we can capitalize on the potential for 30–40% of these cancers to be prevented. In this light, cancer prevention represents an enormous opportunity for public health, potentially saving much of the pain, anguish, and cost associated with treating cancer. However, there is a challenge for governments, and the wider community, in prioritizing cancer prevention activities, especially given increasing financial constraints. This paper describes a method for identifying cancer prevention priorities. This method synthesizes detailed cancer statistics, expert opinion, and the published literature for the priority setting process. The process contains four steps: assessing the impact of cancer types; identifying cancers with the greatest impact; considering opportunities for prevention; and combining information on impact and preventability. The strength of our approach is that it is straightforward, transparent and reproducible for other settings. Applying this method in Western Australia produced a priority list of seven adult cancers which were identified as having not only the biggest impact on the community but also the best opportunities for prevention. Work conducted in an additional project phase went on to present data on these priority cancers to a public consultation and develop an agenda for action in cancer prevention. PMID:28634579
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Potential High Priority Subaerial Environments for Mars Sample Return
NASA Astrophysics Data System (ADS)
iMOST Team; Bishop, J. L.; Horgan, B.; Benning, L. G.; Carrier, B. L.; Hausrath, E. M.; Altieri, F.; Amelin, Y.; Ammannito, E.; Anand, M.; Beaty, D. W.; Borg, L. E.; Boucher, D.; Brucato, J. R.; Busemann, H.; Campbell, K. A.; Czaja, A. D.; Debaille, V.; Des Marais, D. J.; Dixon, M.; Ehlmann, B. L.; Farmer, J. D.; Fernandez-Remolar, D. C.; Fogarty, J.; Glavin, D. P.; Goreva, Y. S.; Grady, M. M.; Hallis, L. J.; Harrington, A. D.; Herd, C. D. K.; Humayun, M.; Kleine, T.; Kleinhenz, J.; Mangold, N.; Mackelprang, R.; Mayhew, L. E.; McCubbin, F. M.; Mccoy, J. T.; McLennan, S. M.; McSween, H. Y.; Moser, D. E.; Moynier, F.; Mustard, J. F.; Niles, P. B.; Ori, G. G.; Raulin, F.; Rettberg, P.; Rucker, M. A.; Schmitz, N.; Sefton-Nash, E.; Sephton, M. A.; Shaheen, R.; Shuster, D. L.; Siljestrom, S.; Smith, C. L.; Spry, J. A.; Steele, A.; Swindle, T. D.; ten Kate, I. L.; Tosca, N. J.; Usui, T.; Van Kranendonk, M. J.; Wadhwa, M.; Weiss, B. P.; Werner, S. C.; Westall, F.; Wheeler, R. M.; Zipfel, J.; Zorzano, M. P.
2018-04-01
The highest priority subaerial environments for Mars Sample Return include subaerial weathering (paleosols, periglacial/glacial, and rock coatings/rinds), wetlands (mineral precipitates, redox environments, and salt ponds), or cold spring settings.
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Priority setting in purchasing.
Carroll, G
The NHS cannot deliver full comprehensive health care to all the population. In this article the need to define a range of basic health services is emphasized. Agreement on priorities requires ethical, economic and clinical debate.
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California Report Card, 2001: Factors for School Success.
ERIC Educational Resources Information Center
Richards, Jayleen; Dominguez-Arms, Amy
Noting that children's educational success is a high priority for California parents, voters, public officials, and business leaders, this report card documents how economic, health, and other conditions affect California children's learning and well-being. The report's introduction discusses factors influencing educational success, including…
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Five Strategies of Successful Part-Time Work.
ERIC Educational Resources Information Center
Corwin, Vivien; Lawrence, Thomas B.; Frost, Peter J.
2001-01-01
Identifies commonalities in the approaches of successful part-time professionals. Discusses five strategies for success: (1) communicating work-life priorities and schedules to the organization; (2) making the business case for part-time arrangements; (3) establishing time management routines; (4) cultivating advocates in senior management; and…
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Palliative care, public health and justice: setting priorities in resource poor countries.
Blinderman, Craig
2009-12-01
Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries.
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Developing plans and priorities for climate science in service to society
NASA Astrophysics Data System (ADS)
Asrar, Ghassem; Busalacchi, Antonio; Hurrell, James
2012-03-01
World Climate Research Programme (WCRP) Open Science Conference; Denver, Colorado, 24-28 October 2011 The WCRP Open Science Conference (OSC), which had the theme "Climate Research in Service to Society," was held to consult with the international community of experts on future plans and priorities for the WCRP. More than 1900 participants, including 541 young scholars from 86 nations and 300 scientists from developing nations, made the conference a success. Several major scientific priorities emerged from OSC.
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Elfeddali, Iman; van der Feltz-Cornelis, Christina M.; van Os, Jim; Knappe, Susanne; Vieta, Eduard; Wittchen, Hans-Ulrich; Obradors-Tarragó, Carla; Haro, Josep Maria
2014-01-01
Within the ROAMER project, which aims to provide a Roadmap for Mental Health Research in Europe, a two-stage Delphi survey among 86 European experts was conducted in order to identify research priorities in clinical mental health research. Expert consensus existed with regard to the importance of three challenges in the field of clinical mental health research: (1) the development of new, safe and effective interventions for mental disorders; (2) understanding the mechanisms of disease in order to be able to develop such new interventions; and (3) defining outcomes (an improved set of outcomes, including alternative outcomes) to use for clinical mental health research evaluation. Proposed actions involved increasing the utilization of tailored approaches (personalized medicine), developing blended eHealth/mHealth decision aids/guidance tools that help the clinician to choose between various treatment modalities, developing specific treatments in order to better target comorbidity and (further) development of biological, psychological and psychopharmacological interventions. The experts indicated that addressing these priorities will result in increased efficacy and impact across Europe; with a high probability of success, given that Europe has important strengths, such as skilled academics and a long research history. Finally, the experts stressed the importance of creating funding and coordinated networking as essential action needed in order to target the variety of challenges in clinical mental health research. PMID:25337940
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Public views on a wait time management initiative: a matter of communication
2010-01-01
Background Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative - the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Methods Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Results Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Conclusions Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management. PMID:20687952
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Optimizing in a complex world: A statistician's role in decision making
Anderson-Cook, Christine M.
2016-08-09
As applied statisticians increasingly participate as active members of problem-solving and decision-making teams, our role continues to evolve. Historically, we may have been seen as those who can help with data collection strategies or answer a specific question from a set of data. Nowadays, we are or strive to be more deeply involved throughout the entire problem-solving process. An emerging role is to provide a set of leading choices from which subject matter experts and managers can choose to make informed decisions. A key to success is to provide vehicles for understanding the trade-offs between candidates and interpreting the meritsmore » of each choice in the context of the decision-makers priorities. To achieve this objective, it is helpful to be able (a) to help subject matter experts identify quantitative criteria that match their priorities, (b) eliminate non-competitive choices through the use of a Pareto front, and (c) provide summary tools from which the trade-offs between alternatives can be quantitatively evaluated and discussed. A structured but flexible process for contributing to team decisions is described for situations when all choices can easily be enumerated as well as when a search algorithm to explore a vast number of potential candidates is required. In conclusion, a collection of diverse examples ranging from model selection, through multiple response optimization, and designing an experiment illustrate the approach.« less
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Optimizing in a complex world: A statistician's role in decision making
DOE Office of Scientific and Technical Information (OSTI.GOV)
Anderson-Cook, Christine M.
As applied statisticians increasingly participate as active members of problem-solving and decision-making teams, our role continues to evolve. Historically, we may have been seen as those who can help with data collection strategies or answer a specific question from a set of data. Nowadays, we are or strive to be more deeply involved throughout the entire problem-solving process. An emerging role is to provide a set of leading choices from which subject matter experts and managers can choose to make informed decisions. A key to success is to provide vehicles for understanding the trade-offs between candidates and interpreting the meritsmore » of each choice in the context of the decision-makers priorities. To achieve this objective, it is helpful to be able (a) to help subject matter experts identify quantitative criteria that match their priorities, (b) eliminate non-competitive choices through the use of a Pareto front, and (c) provide summary tools from which the trade-offs between alternatives can be quantitatively evaluated and discussed. A structured but flexible process for contributing to team decisions is described for situations when all choices can easily be enumerated as well as when a search algorithm to explore a vast number of potential candidates is required. In conclusion, a collection of diverse examples ranging from model selection, through multiple response optimization, and designing an experiment illustrate the approach.« less
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Public views on a wait time management initiative: a matter of communication.
Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K
2010-08-05
Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative--the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative. Two qualitative studies: 1) an analysis of all emails sent by the public to the (OWTS) email address; and 2) in-depth interviews with members of the Ontario public. Email correspondents and interview participants supported the intent of the OWTS. However they wanted more information about the Strategy and its actions. Interview participants did not feel they were sufficiently made aware of the Strategy and email correspondents requested additional information beyond what was offered on the Strategy's website. Moreover, the email correspondents believed that some of the information that was provided on the Strategy's website and through the media was inaccurate, misleading, and even dishonest. Interview participants strongly supported public involvement in the OWTS priority setting. Findings suggest the public wanted increased communication from and with the OWTS. Effective communication can facilitate successful public engagement, and in turn fair and legitimate priority setting. Based on the study's findings we developed concrete recommendations for improving public involvement in wait time management.
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Ghandour, Rula; Shoaibi, Azza; Khatib, Rana; Abu Rmeileh, Niveen; Unal, Belgin; Sözmen, Kaan; Kılıç, Bülent; Fouad, Fouad; Al Ali, Radwan; Ben Romdhane, Habiba; Aissi, Wafa; Ahmad, Balsam; Capewell, Simon; Critchley, Julia; Husseini, Abdullatif
2015-01-01
To explore the feasibility of using a simple multi-criteria decision analysis method with policy makers/key stakeholders to prioritize cardiovascular disease (CVD) policies in four Mediterranean countries: Palestine, Syria, Tunisia and Turkey. A simple multi-criteria decision analysis (MCDA) method was piloted. A mixed methods study was used to identify a preliminary list of policy options in each country. These policies were rated by different policymakers/stakeholders against pre-identified criteria to generate a priority score for each policy and then rank the policies. Twenty-five different policies were rated in the four countries to create a country-specific list of CVD prevention and control policies. The response rate was 100% in each country. The top policies were mostly population level interventions and health systems' level policies. Successful collaboration between policy makers/stakeholders and researchers was established in this small pilot study. MCDA appeared to be feasible and effective. Future applications should aim to engage a larger, representative sample of policy makers, especially from outside the health sector. Weighting the selected criteria might also be assessed.
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A priority system model for sanitation management in food service establishments.
Wodi, B E; Mill, R A
1985-12-01
We set out to develop a sanitation management scheme that will enable health regulatory authorities to utilize available personnel more efficiently in the regulation of the food service industry given the current budgetary and manpower constraints. Previous analyses of the Annual Food Service Establishment Sanitation Inspection Summary records from a large County Department of Health for fiscal years 1979, 1980, and 1981 indicated a cut-off point at about two to four visits for a productive follow-up sanitation inspection of food service establishments. Revisits after this point seemed counter-productive. Revisits of up to 13 times in some establishments and a high uninspection rate of others were noted. The above data, the population at risk for each establishment (generated by a prescribed method), and various control criteria were integrated into the model. Application of the model to a sample of 82 food service establishments was successful in ensuring that those operations that pose high risk to patrons are given priority in a sanitation management program while also facilitating the inspection of all food service establishments within a jurisdiction at some point.
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A priority system model for sanitation management in food service establishments.
Wodi, B E; Mill, R A
1985-01-01
We set out to develop a sanitation management scheme that will enable health regulatory authorities to utilize available personnel more efficiently in the regulation of the food service industry given the current budgetary and manpower constraints. Previous analyses of the Annual Food Service Establishment Sanitation Inspection Summary records from a large County Department of Health for fiscal years 1979, 1980, and 1981 indicated a cut-off point at about two to four visits for a productive follow-up sanitation inspection of food service establishments. Revisits after this point seemed counter-productive. Revisits of up to 13 times in some establishments and a high uninspection rate of others were noted. The above data, the population at risk for each establishment (generated by a prescribed method), and various control criteria were integrated into the model. Application of the model to a sample of 82 food service establishments was successful in ensuring that those operations that pose high risk to patrons are given priority in a sanitation management program while also facilitating the inspection of all food service establishments within a jurisdiction at some point. PMID:4061711
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Call for a change in research funding priorities: the example of mental health in Costa Rica.
Contreras, Javier; Raventós, Henriette; Rodríguez, Gloriana; Leandro, Mauricio
2014-10-01
The World Health Organization (WHO) Mental Health Action Plan 2013-2020 urges its Member States to strengthen leadership in mental health, ensure mental and social health interventions in community-based settings, promote mental health and strengthen information systems, and increase evidence and research for mental health. Although Costa Rica has strongly invested in public health and successfully reduced the burden of nutritional and infectious diseases, its transitional epidemiological pattern, population growth, and immigration from unstable neighboring countries has shifted the burden to chronic disorders. Although policies for chronic disorders have been in place for several decades, mental disorders have not been included. Recently, as the Ministry of Health of Costa Rica developed a Mental Health Policy for 2013-2020, it became evident that the country needs epidemiological data to prioritize evidence-based intervention areas. This article stresses the importance of conducting local epidemiological studies on mental health, and calls for changes in research funding priorities by public and private national and international funding agencies in order to follow the WHO Mental Health Action Plan.
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Yedla, Sudhakar
2012-01-01
Dhaka's community-based decentralized composting (DCDC) is a successful demonstration of solid waste management by adopting low-cost technology, local resources community participation and partnerships among the various actors involved. This paper attempts to understand the model, necessary conditions, strategies and their priorities to replicate DCDC in the other developing cities of Asia. Thirteen strategies required for its replication are identified and assessed based on various criteria, namely transferability, longevity, economic viability, adaptation and also overall replication. Priority setting by multi-criteria analysis by applying analytic hierarchy process revealed that immediate transferability without long-term and economic viability consideration is not advisable as this would result in unsustainable replication of DCDC. Based on the analysis, measures to ensure the product quality control; partnership among stakeholders (public-private-community); strategies to achieve better involvement of the private sector in solid waste management (entrepreneurship in approach); simple and low-cost technology; and strategies to provide an effective interface among the complementing sectors are identified as important strategies for its replication.
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Intelligent Advanced Communications IP Telephony Feasibility for the US Navy - Phase 3
2011-03-01
atlanta.example.com CSeq: 1 BYE Content-Length: 0 Figure 2- 4 SIP Message Details 2.6.8 Implementation of Selected Features Below we examine a set of...34.priority" where priority is one of the following values: 0 Routine (lowest priority) 2 Priority 4 Immediate 6 Flash 8 Flash...cm/dial?poolId= 0 &uri=5553002 HTTPC: <-- : 192.168.0.135:8080 /cm/dial?poolId= 0 &uri=5553002 HTTPC: Closed : 192.168.0.135:8080 4
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2013-01-01
South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment. Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders’ views and evidences of all sorts. We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa. PMID:24107435
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Development of research priorities in paediatric pain and palliative care
Liossi, Christina; Anderson, Anna-Karenia; Howard, Richard F
2016-01-01
Priority setting for healthcare research is as important as conducting the research itself because rigorous and systematic processes of priority setting can make an important contribution to the quality of research. This project aimed to prioritise clinical therapeutic uncertainties in paediatric pain and palliative care in order to encourage and inform the future research agenda and raise the profile of paediatric pain and palliative care in the United Kingdom. Clinical therapeutic uncertainties were identified and transformed into patient, intervention, comparison and outcome (PICO) format and prioritised using a modified Nominal Group Technique. Members of the Clinical Studies Group in Pain and Palliative Care within National Institute for Health Research (NIHR) Clinical Research Network (CRN)-Children took part in the prioritisation exercise. There were 11 clinically active professionals spanning across a wide range of paediatric disciplines and one parent representative. The top three research priorities related to establishing the safety and efficacy of (1) gabapentin in the management of chronic pain with neuropathic characteristics, (2) intravenous non-steroidal anti-inflammatory drugs in the management of post-operative pain in pre-schoolers and (3) different opioid formulations in the management of acute pain in children while at home. Questions about the long-term effect of psychological interventions in the management of chronic pain and various pharmacological interventions to improve pain and symptom management in palliative care were among the ‘top 10’ priorities. The results of prioritisation were included in the UK Database of Uncertainties about the Effects of Treatments (DUETS) database. Increased awareness of priorities and priority-setting processes should encourage clinicians and other stakeholders to engage in such exercises in the future. PMID:28386399
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Shi, Hua; Singh, Ashbindu; Kant, S.; Zhu, Zhiliang; Waller, E.
2005-01-01
Priority setting is an essential component of biodiversity conservation. Existing methods to identify priority areas for conservation have focused almost entirely on biological factors. We suggest a new relative ranking method for identifying priority conservation areas that integrates both biological and social aspects. It is based on the following criteria: the habitat's status, human population pressure, human efforts to protect habitat, and number of endemic plant and vertebrate species. We used this method to rank 25 hotspots, 17 megadiverse countries, and the hotspots within each megadiverse country. We used consistent, comprehensive, georeferenced, and multiband data sets and analytical remote sensing and geographic information system tools to quantify habitat status, human population pressure, and protection status. The ranking suggests that the Philippines, Atlantic Forest, Mediterranean Basin, Caribbean Islands, Caucasus, and Indo-Burma are the hottest hotspots and that China, the Philippines, and India are the hottest megadiverse countries. The great variation in terms of habitat, protected areas, and population pressure among the hotspots, the megadiverse countries, and the hotspots within the same country suggests the need for hotspot- and country-specific conservation policies.
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A National Effort to Integrate Math and Science with CTE
ERIC Educational Resources Information Center
Hyslop, Alisha
2008-01-01
National activities focus on priority areas and are often designed to develop, improve and identify the most successful methods and techniques for providing career and technical education (CTE) programs under Perkins. One of these priority areas under the 2006 Perkins Act is the integration of academic and technical education. Since the early…
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Deane, Katherine H O; Flaherty, Helen; Daley, David J; Pascoe, Roland; Penhale, Bridget; Clarke, Carl E; Sackley, Catherine; Storey, Stacey
2014-01-01
Objectives This priority setting partnership was commissioned by Parkinson's UK to encourage people with direct and personal experience of the condition to work together to identify and prioritise the top 10 evidential uncertainties that impact on everyday clinical practice for the management of Parkinson's disease (PD). Setting The UK. Participants Anyone with experience of PD including: people with Parkinson's (PwP), carers, family and friends, healthcare and social care professionals. Non-clinical researchers and employees of pharmaceutical or medical devices companies were excluded. 1000 participants (60% PwP) provided ideas on research uncertainties, 475 (72% PwP) initially prioritised them and 27 (37% PwP) stakeholders agreed a final top 10. Methods Using a modified nominal group technique, participants were surveyed to identify what issues for the management of PD needed research. Unique research questions unanswered by current evidence were identified and participants were asked to identify their top 10 research priorities from this list. The top 26 uncertainties were presented to a consensus meeting with key stakeholders to agree the top 10 research priorities. Results 1000 participants provided 4100 responses, which contained 94 unique unanswered research questions that were initially prioritised by 475 participants. A consensus meeting with 27 stakeholders agreed the top 10 research priorities. The overarching research aspiration was an effective cure for PD. The top 10 research priorities for PD management included the need to address motor symptoms (balance and falls, and fine motor control), non-motor symptoms (sleep and urinary dysfunction), mental health issues (stress and anxiety, dementia and mild cognitive impairments), side effects of medications (dyskinesia) and the need to develop interventions specific to the phenotypes of PD and better monitoring methods. Conclusions These research priorities identify crucial gaps in the existing evidence to address everyday practicalities in the management of the complexities of PD. PMID:25500772
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34 CFR 263.21 - What priority is given to certain projects and applicants?
Code of Federal Regulations, 2010 CFR
2010-07-01
... successful entry into school at the kindergarten school level. (2) Early childhood and kindergarten programs... subject matters, including math and science, to enable Indian students to successfully transition to...
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Dynamic autonomous routing technology for IP-based satellite ad hoc networks
NASA Astrophysics Data System (ADS)
Wang, Xiaofei; Deng, Jing; Kostas, Theresa; Rajappan, Gowri
2014-06-01
IP-based routing for military LEO/MEO satellite ad hoc networks is very challenging due to network and traffic heterogeneity, network topology and traffic dynamics. In this paper, we describe a traffic priority-aware routing scheme for such networks, namely Dynamic Autonomous Routing Technology (DART) for satellite ad hoc networks. DART has a cross-layer design, and conducts routing and resource reservation concurrently for optimal performance in the fluid but predictable satellite ad hoc networks. DART ensures end-to-end data delivery with QoS assurances by only choosing routing paths that have sufficient resources, supporting different packet priority levels. In order to do so, DART incorporates several resource management and innovative routing mechanisms, which dynamically adapt to best fit the prevailing conditions. In particular, DART integrates a resource reservation mechanism to reserve network bandwidth resources; a proactive routing mechanism to set up non-overlapping spanning trees to segregate high priority traffic flows from lower priority flows so that the high priority flows do not face contention from low priority flows; a reactive routing mechanism to arbitrate resources between various traffic priorities when needed; a predictive routing mechanism to set up routes for scheduled missions and for anticipated topology changes for QoS assurance. We present simulation results showing the performance of DART. We have conducted these simulations using the Iridium constellation and trajectories as well as realistic military communications scenarios. The simulation results demonstrate DART's ability to discriminate between high-priority and low-priority traffic flows and ensure disparate QoS requirements of these traffic flows.
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D. Todd Jones-Farrand; John M. Tirpak; Frank R. Thompson; Daniel J. Twedt; Charles K. Baxter; Jane A. Fitzgerald; William B. Uihlein
2009-01-01
Setting and achieving population objectives for priority landbirds must be informed by, 1) the quantity, quality, and spatial confi guration of available habitat, 2) an explicit linkage between habitat condition and population response, and 3) expected future habitat conditions. Based on this philosophy, the Central Hardwoods and Lower Mississippi Valley Joint Ventures...
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Innovation and Transformation in California’s Safety-net Healthcare Settings: An Inside Perspective
Lyles, Courtney R.; Aulakh, Veenu; Jameson, Wendy; Schillinger, Dean; Yee, Hal; Sarkar, Urmimala
2016-01-01
Background Health reform requires safety-net settings to transform care delivery, but how they will innovate in order to achieve this transformation is unknown. Methods We conducted two series of key informant interviews (N= 28) in 2012 with leadership from both California’s public hospital systems and community health centers. Interviews focused on how innovation was conceptualized and solicited examples of successful innovations. Results In contrast to disruptive innovation, interviewees often defined innovation as improving implementation, making incremental changes, and promoting integration. Many leaders gave examples of existing innovative practices such as patient-centered approaches to meeting their diverse patient needs. Participants expressed challenges to adapting quickly, but a desire to partner together. Conclusions Safety-net systems have already begun implementing innovative practices supporting their key priority areas. However, more support is needed, specifically to accelerate the change needed to succeed under health reform. PMID:24170938
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Integration at the round table: marine spatial planning in multi-stakeholder settings.
Olsen, Erik; Fluharty, David; Hoel, Alf Håkon; Hostens, Kristian; Maes, Frank; Pecceu, Ellen
2014-01-01
Marine spatial planning (MSP) is often considered as a pragmatic approach to implement an ecosystem based management in order to manage marine space in a sustainable way. This requires the involvement of multiple actors and stakeholders at various governmental and societal levels. Several factors affect how well the integrated management of marine waters will be achieved, such as different governance settings (division of power between central and local governments), economic activities (and related priorities), external drivers, spatial scales, incentives and objectives, varying approaches to legislation and political will. We compared MSP in Belgium, Norway and the US to illustrate how the integration of stakeholders and governmental levels differs among these countries along the factors mentioned above. Horizontal integration (between sectors) is successful in all three countries, achieved through the use of neutral 'round-table' meeting places for all actors. Vertical integration between government levels varies, with Belgium and Norway having achieved full integration while the US lacks integration of the legislature due to sharp disagreements among stakeholders and unsuccessful partisan leadership. Success factors include political will and leadership, process transparency and stakeholder participation, and should be considered in all MSP development processes.
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Integration at the Round Table: Marine Spatial Planning in Multi-Stakeholder Settings
Olsen, Erik; Fluharty, David; Hoel, Alf Håkon; Hostens, Kristian; Maes, Frank; Pecceu, Ellen
2014-01-01
Marine spatial planning (MSP) is often considered as a pragmatic approach to implement an ecosystem based management in order to manage marine space in a sustainable way. This requires the involvement of multiple actors and stakeholders at various governmental and societal levels. Several factors affect how well the integrated management of marine waters will be achieved, such as different governance settings (division of power between central and local governments), economic activities (and related priorities), external drivers, spatial scales, incentives and objectives, varying approaches to legislation and political will. We compared MSP in Belgium, Norway and the US to illustrate how the integration of stakeholders and governmental levels differs among these countries along the factors mentioned above. Horizontal integration (between sectors) is successful in all three countries, achieved through the use of neutral ‘round-table’ meeting places for all actors. Vertical integration between government levels varies, with Belgium and Norway having achieved full integration while the US lacks integration of the legislature due to sharp disagreements among stakeholders and unsuccessful partisan leadership. Success factors include political will and leadership, process transparency and stakeholder participation, and should be considered in all MSP development processes. PMID:25299595
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Wetland restoration and birds: lessons from Florida, San Francisco Bay, and Chesapeake Bay
Erwin, R.M.; Frederick, P.C.
2005-01-01
Many wetland restoration projects are underway across the North American landscape, ranging from small, community - based projects of less than 1 ha, to thousands of ha, as in San Francisco Bay or the Everglades. The goals of small projects are generally focused on replanting and sustaining native wetland vegetation, while larger projects often incorporate populations of birds and other vertebrates as part of the criteria for 'success.' Here, I use examples from a number of larger restoration projects from Florida, San Francisco Bay, and Chesapeake Bay, to illustrate several major challenges in planning and implementing those parts of the projects that include waterbirds. These include: (1) setting species priorities at the onset of the project, (2) negotiating among various stakeholders the goals that support wetland ecosystem structural elements (i.e. species and communities) versus those more functionally driven, (3) monitoring reproductive and survival parameters, as well as abundance, to avoid 'sink' situations, and (4) rationalizing control measures for opportunistic species that are not part of the restoration plan. Such projects often provide an ideal setting for the application of adaptive management, but long-term data management and oversight are required to ensure that project 'success' (or failure) is not short-term only.
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Modeling Student Success in Engineering Education
ERIC Educational Resources Information Center
Jin, Qu
2013-01-01
In order for the United States to maintain its global competitiveness, the long-term success of our engineering students in specific courses, programs, and colleges is now, more than ever, an extremely high priority. Numerous studies have focused on factors that impact student success, namely academic performance, retention, and/or graduation.…
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Succession Planning Demystified. IES Report 372.
ERIC Educational Resources Information Center
Hirsh, W.
This book, which is designed for human resource (HR) practitioners, details the principles and applications of succession planning, shows how succession planning is conducted, and explains its place in relation to other HR processes and business priorities. The introduction describes the book's intended audience and provides a brief overview of…
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DOT National Transportation Integrated Search
2011-01-01
Developing computer models of land use and : integrated transportation-land use are high : priorities for Florida transportation planners. : Land use information is fundamental to siting : roadways, signaling, setting maintenance : priorities, routin...
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42 CFR 416.43 - Conditions for coverage-Quality assessment and performance improvement.
Code of Federal Regulations, 2010 CFR
2010-10-01
... and changes in its patient care. (c) Standard: Program activities. (1) The ASC must set priorities for... by the ASC. (2) Addresses the ASC's priorities and that all improvements are evaluated for...
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12 CFR 650.50 - Payment of claims.
Code of Federal Regulations, 2010 CFR
2010-01-01
... other equities in accordance with the priorities for impairment set forth in section 8.4(e)(3) of the... claim of a lesser priority. If there are insufficient funds to pay all claims in a class in full...
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What criteria do decision makers in Thailand use to set priorities for vaccine introduction?
Pooripussarakul, Siriporn; Riewpaiboon, Arthorn; Bishai, David; Muangchana, Charung; Tantivess, Sripen
2016-08-02
There is a need to identify rational criteria and set priorities for vaccines. In Thailand, many licensed vaccines are being considering for introduction into the Expanded Program on Immunization; thus, the government has to make decisions about which vaccines should be adopted. This study aimed to set priorities for new vaccines and to facilitate decision analysis. We used a best-worst scaling study for rank-ordering of vaccines. The candidate vaccines were determined by a set of criteria, including burden of disease, target age group, budget impact, side effect, effectiveness, severity of disease, and cost of vaccine. The criteria were identified from a literature review and by in-depth, open-ended interviews with experts. The priority-setting model was conducted among three groups of stakeholders, including policy makers, healthcare professionals and healthcare administrators. The vaccine data were mapped and then calculated for the probability of selection. From the candidate vaccines, the probability of hepatitis B vaccine being selected by all respondents (96.67 %) was ranked first. This was followed, respectively, by pneumococcal conjugate vaccine-13 (95.09 %) and Haemophilus influenzae type b vaccine (90.87 %). The three groups of stakeholders (policy makers, healthcare professionals and healthcare administrators) showed the same ranking trends. Most severe disease, high fever rate and high disease burden showed the highest coefficients for criterion levels being selected by all respondents. This result can be implied that a vaccine which can prevent most severe disease with high disease burden and has low safety has a greater chance of being selected by respondents in this study. The priority setting of vaccines through a multiple-criteria approach could contribute to transparency and accountability in the decision-making process. This is a step forward in the development of an evidence-based approach that meets the need of developing country. The methodology is generalizable but its application to another country would require the criteria as relevant to that country.
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Li, Ryan; Ruiz, Francis; Culyer, Anthony J; Chalkidou, Kalipso; Hofman, Karen J
2017-01-01
Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders - not only the technical capacity to "do" research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE) framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values); academics need to understand and respond to decision-makers' needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England's National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand) and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country) to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to their own capacity development in order to sustain and improve impact.
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Li, Ryan; Ruiz, Francis; Culyer, Anthony J; Chalkidou, Kalipso; Hofman, Karen J
2017-01-01
Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders – not only the technical capacity to “do” research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE) framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values); academics need to understand and respond to decision-makers’ needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England’s National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand) and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country) to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to their own capacity development in order to sustain and improve impact. PMID:28721199
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Achieving excellence in veterans healthcare--a balanced scorecard approach.
Biro, Lawrence A; Moreland, Michael E; Cowgill, David E
2003-01-01
This article provides healthcare administrators and managers with a framework and model for developing a balanced scorecard and demonstrates the remarkable success of this process, which brings focus to leadership decisions about the allocation of resources. This scorecard was developed as a top management tool designed to structure multiple priorities of a large, complex, integrated healthcare system and to establish benchmarks to measure success in achieving targets for performance in identified areas. Significant benefits and positive results were derived from the implementation of the balanced scorecard, based upon benchmarks considered to be critical success factors. The network's chief executive officer and top leadership team set and articulated the network's primary operating principles: quality and efficiency in the provision of comprehensive healthcare and support services. Under the weighted benchmarks of the balanced scorecard, the facilities in the network were mandated to adhere to one non-negotiable tenet: providing care that is second to none. The balanced scorecard approach to leadership continuously ensures that this is the primary goal and focal point for all activity within the network. To that end, systems are always in place to ensure that the network is fully successful on all performance measures relating to quality.
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Dyess, Susan Mac Leod; Prestia, Angela S; Marquit, Doren-Elyse; Newman, David
2018-03-01
Acute care practice settings are stressful. Nurse leaders face stressful demands of numerous competing priorities. Some nurse leaders experience unmanageable stress, but success requires self-care. This article presents a repeated measures intervention design study using mixed methods to investigate a self-care simple meditation practice for nurse leaders. Themes and subthemes emerged in association with the three data collection points: at baseline (pretest), after 6 weeks, and after 12 weeks (posttest) from introduction of the self-care simple meditation practice. An analysis of variance yielded a statistically significant drop in perceived stress at 6 weeks and again at 12 weeks. Conducting future research is merited.
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The use of the German V-2 in US for upper atmosphere research
NASA Technical Reports Server (NTRS)
Curtis, S. A.
1979-01-01
Early U.S. space experiments involving the liquid propellant German V-2 are discussed. Although the primary objective of the experiments conducted under project Hermes after World War II was initially the development of missile technology, scientific objectives were soon given the priority. The missile was modified for scientific experiments and the payload increased from 6.8% to 47% between 1946 and 1949. Among other instruments, the payload included a cosmic ray telescope, ionosphere transmitter and spectrograph for solar spectral measurements. While the scientific success of the program established a positive public attitude towards space research, the Upper Atmosphere Research Panel, formed to coordinate the project, set a pattern for future scientific advisory bodies.
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Treatment costs and priority setting in health care: A qualitative study
McKie, John; Shrimpton, Bradley; Richardson, Jeff; Hurworth, Rosalind
2009-01-01
Background The aim of this study is to investigate whether the public believes high cost patients should be a lower priority for public health care than low cost patients, other things being equal, in order to maximise health gains from the health budget. Semi-structured group discussions were used to help participants reflect critically upon their own views and gain exposure to alternative views, and in this way elicit underlying values rather than unreflective preferences. Participants were given two main tasks: first, to select from among three general principles for setting health care priorities the one that comes closest to their own views; second, to allocate a limited hospital budget between two groups of imaginary patients. Forty-one people, varying in age, occupation, income and education level, participated in a total of six group discussions with each group comprising between six and eight people. Results After discussion and deliberation, 30 participants rejected the most cost-effective principle for setting priorities, citing reasons such as 'moral values' and 'a personal belief that we shouldn't discriminate'. Only three participants chose to allocate the entire hospital budget to the low cost patients. Reasons for allocating some money to inefficient (high cost) patients included 'fairness' and the desire to give all patients a 'chance'. Conclusion Participants rejected a single-minded focus on efficiency – maximising health gains – when setting priorities in health care. There was a concern to avoid strategies that deny patients all hope of treatment, and a willingness to sacrifice health gains for a 'fair' public health system. PMID:19416546
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Boney, Oliver; Bell, Madeline; Bell, Natalie; Conquest, Ann; Cumbers, Marion; Drake, Sharon; Galsworthy, Mike; Gath, Jacqui; Grocott, Michael P W; Harris, Emma; Howell, Simon; Ingold, Anthony; Nathanson, Michael H; Pinkney, Thomas; Metcalf, Leanne
2015-12-16
To identify research priorities for Anaesthesia and Perioperative Medicine. Prospective surveys and consensus meetings guided by an independent adviser. UK. 45 stakeholder organisations (25 professional, 20 patient/carer) affiliated as James Lind Alliance partners. First 'ideas-gathering' survey: Free text research ideas and suggestions. Second 'prioritisation' survey: Shortlist of 'summary' research questions (derived from the first survey) ranked by respondents in order of priority. Final 'top ten': Agreed by consensus at a final prioritisation workshop. First survey: 1420 suggestions received from 623 respondents (49% patients/public) were refined into a shortlist of 92 'summary' questions. Second survey: 1718 respondents each nominated up to 10 questions as research priorities. Top ten: The 25 highest-ranked questions advanced to the final workshop, where 23 stakeholders (13 professional, 10 patient/carer) agreed the 10 most important questions: ▸ What can we do to stop patients developing chronic pain after surgery? ▸ How can patient care around the time of emergency surgery be improved? ▸ What long-term harm may result from anaesthesia, particularly following repeated anaesthetics?▸ What outcomes should we use to measure the 'success' of anaesthesia and perioperative care? ▸ How can we improve recovery from surgery for elderly patients? ▸ For which patients does regional anaesthesia give better outcomes than general anaesthesia? ▸ What are the effects of anaesthesia on the developing brain? ▸ Do enhanced recovery programmes improve short and long-term outcomes? ▸ How can preoperative exercise or fitness training, including physiotherapy, improve outcomes after surgery? ▸ How can we improve communication between the teams looking after patients throughout their surgical journey? Almost 2000 stakeholders contributed their views regarding anaesthetic and perioperative research priorities. This is the largest example of patient and public involvement in shaping anaesthetic and perioperative research to date. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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2014-06-05
The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation Engineering Research Center (RERC) on Technologies to Enhance Independence in Daily Living for Adults with Cognitive Impairments. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus research attention on an area of national need. We intend the priority to contribute to improved outcomes related to independence in daily activities in the home, community, or workplace setting for adults with cognitive impairments.
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Yano, Elizabeth M; Bastian, Lori A; Frayne, Susan M; Howell, Alexandra L; Lipson, Linda R; McGlynn, Geraldine; Schnurr, Paula P; Seaver, Margaret R; Spungen, Ann M; Fihn, Stephan D
2006-03-01
The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.
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Yano, Elizabeth M; Bastian, Lori A; Frayne, Susan M; Howell, Alexandra L; Lipson, Linda R; McGlynn, Geraldine; Schnurr, Paula P; Seaver, Margaret R; Spungen, Ann M; Fihn, Stephan D
2006-01-01
The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research. PMID:16637953
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Predicting international medical graduate success on college certification examinations
Schabort, Inge; Mercuri, Mathew; Grierson, Lawrence E.M.
2014-01-01
Abstract Objective To determine predictors of international medical graduate (IMG) success in accordance with the priorities highlighted by the Thomson and Cohl judicial report on IMG selection. Design Retrospective assessment using regression analyses to compare the information available at the time of resident selection with those trainees’ national certification examination outcomes. Setting McMaster University in Hamilton, Ont. Participants McMaster University IMG residents who completed the program between 2005 and 2011. Main outcome measures Associations between IMG professional experience or demographic characteristics and examination outcomes. Results The analyses revealed that country of study and performance on the Medical Council of Canada Evaluating Examination are among the predictors of performance on the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada certification examinations. Of interest, the analyses also suggest discipline-specific relationships between previous professional experience and examination success. Conclusion This work presents a useful technique for further improving our understanding of the performance of IMGs on certification examinations in North America, encourages similar interinstitutional analyses, and provides a foundation for the development of tools to assist with IMG education. PMID:25316762
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Consensus and contention in the priority setting process: examining the health sector in Uganda.
Colenbrander, Sarah; Birungi, Charles; Mbonye, Anthony K
2015-06-01
Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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Whiteford, Harvey; Weissman, Ruth Striegel
2017-03-01
Worldwide, the demand for healthcare exceeds what individuals and governments are able to afford. Priority setting is therefore inevitable, and mental health services have often been given low priority in the decision-making process. Drawing on established economic criteria, and specifically the work of Philip Musgrove, key factors which influence government decision-making about health priorities are reviewed. These factors include the size of the health burden, the availability of cost-effective interventions to reduce the burden, whether private markets can provide the necessary treatment efficiently, whether there are "catastrophic costs" incurred in accessing treatment, whether negative externalities arise from not providing care, and if the "rule of rescue" applies. Beyond setting priorities for resource allocation, governments also become involved where there is a need for regulation to maintain quality in the delivery of healthcare. By providing field-specific examples for each factor, we illustrate how advocates in the eating disorder field may use evidence to inform government policy about resource allocation and regulation in support of individuals with an eating disorder. © 2017 Wiley Periodicals, Inc.
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Wouters, S; van Exel, N J A; Rohde, K I M; Vromen, J J; Brouwer, W B F
2017-05-01
Health care systems are challenged in allocating scarce health care resources, which are typically insufficient to fulfil all health care wants and needs. One criterion for priority setting may be the 'acceptable health' approach, which suggests that society may want to assign higher priority to health benefits in people with "unacceptable" than in people with "acceptable" health. A level of acceptable health then serves as a reference point for priority setting. Empirical research has indicated that people may be able and willing to define health states as "unacceptable" or "acceptable", but little attention has been given to the normative implications of evaluating health benefits in relation to a reference level of acceptable health. The current paper aims to address this gap by relating insights from the distributive justice literature, i.e. the sufficientarian literature, to the acceptable health approach, as we argue that these approaches are related. We specifically focus on the implications of an 'acceptability' approach for priority weighting of health benefits, derived from sufficientarian reasoning and debates, and assess the moral implications of such weighting. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Brainard, Julii Suzanne; Al Assaf, Enana; Omasete, Judith; Leach, Steve; Hammer, Charlotte C; Hunter, Paul R
2017-01-01
The UK's National Institute for Health Research (NIHR) Health Protection Research Unit in Emergency Preparedness and Response was asked to undertake research on how to reduce the impact of complex national/international emergencies on public health. How to focus the research and decide on priority topics was challenging, given the nature of complex events. Using a type of structured brain-storming, the researchers identified the ongoing UK, European and international migration crisis as both complex and worthy of deeper research. To further focus the research, two representatives of forced migrant communities were invited to join the project team as patient and public (PPI) representatives. They attended regular project meetings, insightfully contributed to and advised on practical aspects of potential research areas. The representatives identified cultural obstacles and community needs and helped choose the final research study design, which was to interview forced migrants about their strategies to build emotional resilience and prevent mental illness. The representatives also helped design recruitment documents, and undertake recruitment and interviewer training. Many events with wide-ranging negative health impacts are notable for complexity: lack of predictability, non-linear feedback mechanisms and unexpected consequences. A multi-disciplinary research team was tasked with reducing the public health impacts from complex events, but without a pre-specified topic area or research design. This report describes using patient and public involvement within an adaptable but structured development process to set research objectives and aspects of implementation. An agile adaptive development approach, sometimes described as swarm , was used to identify possible research areas. Swarm is meant to quickly identify strengths and weaknesses of any candidate project, to accelerate early failure before resources are invested. When aspects of the European migration crisis were identified as a potential priority topic area, two representatives of forced migrant communities were recruited to explore possible research ideas. These representatives helped set the specific research objectives and advised on aspects of implementation, still within the swarm framework for project development. Over ten months, many research ideas were considered by the collaborative working group in a series of six group meetings, supplemented by email contact in between. Up to four possible research ideas were scrutinised at any one meeting, with a focus on identifying practical or desirable aspects of each proposed project. Interest settled on a study to solicit original data about successful strategies that forced migrants use to adapt to life in the UK, with an emphasis on successfully promoting resilience and minimizing emotional distress. "Success in resettlement" was identified to be a more novel theme than "barriers to adaption" research. A success approach encourages participation when individuals may find discussion of mental illness stigmatising. The patient representatives helped with design of patient-facing and interview training materials, interviewer training (mock interviews), and aspects of the recruitment. Using patient and public involvement (PPI) within an early failure development approach that itself arises from theory on complex adaptive systems, we successfully implemented a dynamic development process to determine research topic and study design. The PPI representatives were closely involved in setting research objectives and aspects of implementation.
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Diarrhoeal diseases and the global health agenda: measuring and changing priority.
Bump, Jesse B; Reich, Michael R; Johnson, Anne M
2013-12-01
We investigate priority setting and the global health agenda by analysing the control of diarrhoeal diseases (CDD). CDD was one of the 'twin engines' of the 1980s' child survival movement, but now has a low priority on the global health agenda, even though diarrhoeal diseases still claim around 1.5 million children annually. In this article, we develop a framework and four indicators of priority to measure CDD's overall prominence on the global health agenda over the last three decades: trends in treatment coverage, changes in perceived priority, changes in financial support and institutional involvement and bibliographic trends. We find that CDD's priority is now one-sixth to one-third of its level in 1985. We then use political analysis to suggest strategies for reframing CDD as an issue and promoting its priority on the global health agenda.
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van de Wetering, E J; Stolk, E A; van Exel, N J A; Brouwer, W B F
2013-02-01
Economic evaluations are increasingly used to inform decisions regarding the allocation of scarce health care resources. To systematically incorporate societal preferences into these evaluations, quality-adjusted life year gains could be weighted according to some equity principle, the most suitable of which is a matter of frequent debate. While many countries still struggle with equity concerns for priority setting in health care, the Netherlands has reached a broad consensus to use the concept of proportional shortfall. Our study evaluates the concept and its support in the Dutch health care context. We discuss arguments in the Netherlands for using proportional shortfall and difficulties in transitioning from principle to practice. In doing so, we address universal issues leading to a systematic consideration of equity concerns for priority setting in health care. The article thus has relevance to all countries struggling with the formalization of equity concerns for priority setting.
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Utilization Bound of Non-preemptive Fixed Priority Schedulers
NASA Astrophysics Data System (ADS)
Park, Moonju; Chae, Jinseok
It is known that the schedulability of a non-preemptive task set with fixed priority can be determined in pseudo-polynomial time. However, since Rate Monotonic scheduling is not optimal for non-preemptive scheduling, the applicability of existing polynomial time tests that provide sufficient schedulability conditions, such as Liu and Layland's bound, is limited. This letter proposes a new sufficient condition for non-preemptive fixed priority scheduling that can be used for any fixed priority assignment scheme. It is also shown that the proposed schedulability test has a tighter utilization bound than existing test methods.
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Nagata, Jason M; Hathi, Sejal; Ferguson, B Jane; Hindin, Michele J; Yoshida, Sachiyo; Ross, David A
2018-06-01
In order to clarify priorities and stimulate research in adolescent health in low- and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHNRI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda. All of the 116 top-ranked questions presented in each exercise were analyzed by two independent reviewers. Word clouds were generated based on keywords from the top-ranked questions. Questions were coded and content analysis was conducted based on type of delivery platform, vulnerable populations, and the Survive, Thrive, and Transform framework from the United Nations Global Strategy for Women's, Children's, and Adolescents' Health, 2016-2030. Within the 53 top-ranked intervention-related questions that specified a delivery platform, the platforms specified were schools (n = 17), primary care (n = 12), community (n = 11), parenting (n = 6), virtual media (n = 5), and peers (n = 2). Twenty questions specifically focused on vulnerable adolescents, including those living with HIV, tuberculosis, mental illness, or neurodevelopmental disorders; victims of gender-based violence; refugees; young persons who inject drugs; sex workers; slum dwellers; out-of-school youth; and youth in armed conflict. A majority of the top-ranked questions (108/116) aligned with one or a combination of the Survive (n = 39), Thrive (n = 67), and Transform (n = 28) agendas. This study advances the CHNRI methodology by conducting the first mixed-methods synthesis of multiple research priority-setting exercises by analyzing keywords (using word clouds) and themes (using content analysis).
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Tacconelli, Evelina; Carrara, Elena; Savoldi, Alessia; Harbarth, Stephan; Mendelson, Marc; Monnet, Dominique L; Pulcini, Céline; Kahlmeter, Gunnar; Kluytmans, Jan; Carmeli, Yehuda; Ouellette, Marc; Outterson, Kevin; Patel, Jean; Cavaleri, Marco; Cox, Edward M; Houchens, Chris R; Grayson, M Lindsay; Hansen, Paul; Singh, Nalini; Theuretzbacher, Ursula; Magrini, Nicola
2018-03-01
The spread of antibiotic-resistant bacteria poses a substantial threat to morbidity and mortality worldwide. Due to its large public health and societal implications, multidrug-resistant tuberculosis has been long regarded by WHO as a global priority for investment in new drugs. In 2016, WHO was requested by member states to create a priority list of other antibiotic-resistant bacteria to support research and development of effective drugs. We used a multicriteria decision analysis method to prioritise antibiotic-resistant bacteria; this method involved the identification of relevant criteria to assess priority against which each antibiotic-resistant bacterium was rated. The final priority ranking of the antibiotic-resistant bacteria was established after a preference-based survey was used to obtain expert weighting of criteria. We selected 20 bacterial species with 25 patterns of acquired resistance and ten criteria to assess priority: mortality, health-care burden, community burden, prevalence of resistance, 10-year trend of resistance, transmissibility, preventability in the community setting, preventability in the health-care setting, treatability, and pipeline. We stratified the priority list into three tiers (critical, high, and medium priority), using the 33rd percentile of the bacterium's total scores as the cutoff. Critical-priority bacteria included carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae. The highest ranked Gram-positive bacteria (high priority) were vancomycin-resistant Enterococcus faecium and meticillin-resistant Staphylococcus aureus. Of the bacteria typically responsible for community-acquired infections, clarithromycin-resistant Helicobacter pylori, and fluoroquinolone-resistant Campylobacter spp, Neisseria gonorrhoeae, and Salmonella typhi were included in the high-priority tier. Future development strategies should focus on antibiotics that are active against multidrug-resistant tuberculosis and Gram-negative bacteria. The global strategy should include antibiotic-resistant bacteria responsible for community-acquired infections such as Salmonella spp, Campylobacter spp, N gonorrhoeae, and H pylori. World Health Organization. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Identifying research priorities with nurses at a tertiary children's hospital in the United Kingdom.
Williams, A; Sell, D; Oulton, K; Wilson, N; Wray, J; Gibson, F
2017-03-01
The objective of this study was to undertake a research priority setting exercise with the aim of maximizing efficiency and impact in research activity undertaken by nurses at one children's tertiary healthcare institution by ensuring the clinical staff directly shaped a coherent, transparent and consensus driven nurse-led research agenda. In Round 1, the research topics of 147 nurses were elicited using a modified nominal group technique as the consensus method. The number of participants in the 24 separate discussions ranged from 3 to 21, generating lists of between 6 and 23 topics. In Round 2, nurses from the clinical areas ranked topics of importance resulting in a set of four to five priorities. In Round 3, the divisional heads of nursing consulted with staff in all of their clinical areas to each finalize their five divisional priorities. The Nursing Research Working Group discussed and refined the divisions' priorities and voted on the final list to agree the top five research priorities for the organization. A total of 269 research topics were initially generated. Following three rounds of ranking and prioritizing, five priorities were agreed at Divisional level, and from these, the five top organizational priorities were selected. These were (i) understanding and improving all aspects of the patient journey through the hospital system; (ii) play; (iii) staff wellbeing, patient care and productivity; (iv) team work - linking to a more efficient service; and (v) supporting parents/parent pathway. Divisional priorities have been disseminated widely to clinical teams to inform a patient-specific nurse-led research agenda. Organizational priorities agreed upon have been disseminated through management structures and processes to ensure engagement at all levels. A subgroup of the Nursing Research Working Group has been delegated to take this work forward so that the agreed priorities continue to contribute towards shaping nurse-led research activity, thereby going some way to inform and embed an evidence-based culture of inquiry. © 2016 John Wiley & Sons Ltd.
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Elwell, Laura; Powell, Jane; Wordsworth, Sharon; Cummins, Carole
2014-03-13
Research exists examining the challenges of delivering lifestyle behaviour change initiatives in practice. However, at present much of this research has been conducted with primary care health professionals, or in acute adult hospital settings. The purpose of this study was to identify barriers and facilitators associated with implementing routine lifestyle behaviour change brief advice into practice in an acute children's hospital. Thirty-three health professionals (nurses, junior doctors, allied health professionals and clinical support staff) from inpatient and outpatient departments at a UK children's hospital were interviewed about their attitudes and beliefs towards supporting lifestyle behaviour change in hospital patients and their families. Responses were analysed using thematic framework analysis. Health professionals identified a range of barriers and facilitators to supporting lifestyle behaviour change in a children's hospital. These included (1) personal experience of effectiveness, (2) constraints associated with the hospital environment, (3) appropriateness of advice delivery given the patient's condition and care pathway and (4) job role priorities, and (5) perceived benefits of the advice given. Delivery of lifestyle behaviour change advice was often seen as an educational activity, rather than a behaviour change activity. Factors underpinning the successful delivery of routine lifestyle behaviour change support must be understood if this is to be implemented effectively in paediatric acute settings. This study reveals key areas where paediatric health professionals may need further support and training to achieve successful implementation.
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Criteria-Based Resource Allocation: A Tool to Improve Public Health Impact.
Graham, J Ross; Mackie, Christopher
2016-01-01
Resource allocation in local public health (LPH) has been reported as a significant challenge for practitioners and a Public Health Services and Systems Research priority. Ensuring available resources have maximum impact on community health and maintaining public confidence in the resource allocation process are key challenges. A popular strategy in health care settings to address these challenges is Program Budgeting and Marginal Analysis (PBMA). This case study used PBMA in an LPH setting to examine its appropriateness and utility. The criteria-based resource allocation process PBMA was implemented to guide the development of annual organizational budget in an attempt to maximize the impact of agency resources. Senior leaders and managers were surveyed postimplementation regarding process facilitators, challenges, and successes. Canada's largest autonomous LPH agency. PBMA was used to shift 3.4% of the agency budget from lower-impact areas (through 34 specific disinvestments) to higher-impact areas (26 specific reinvestments). Senior leaders and managers validated the process as a useful approach for improving the public health impact of agency resources. However, they also reported the process may have decreased frontline staff confidence in senior leadership. In this case study, PBMA was used successfully to reallocate a sizable portion of an LPH agency's budget toward higher-impact activities. PBMA warrants further study as a tool to support optimal resource allocation in LPH settings.
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Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke
2014-01-01
Background: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208
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ERIC Educational Resources Information Center
Smith, Clayton
2016-01-01
This article, with a focus on North American postsecondary education, identifies international students as a strategic enrollment management institutional priority; presents themes in the international student retention, satisfaction, and success research literature; and describes related best practices. It also presents the findings from an…
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McConkey, R; Collins, S
2010-08-01
Past studies have found that people supported in more individualised housing options tend to have levels of community participation and wider social networks than those in other accommodation options. Yet, the contribution of support staff in facilitating social inclusion has received relatively scant attention. In all 245 staff working in either supported living schemes, or shared residential and group homes, or in day centres completed a written questionnaire in which they rated in terms of priority to their job, 16 tasks that were supportive of social inclusion and a further 16 tasks that related to the care of the person they supported. In addition staff identified those tasks that they considered were not appropriate to their job. Across all three service settings, staff rated more care tasks as having higher priority than they did the social inclusion tasks. However, staff in supported living schemes rated more social inclusion tasks as having high priority than did staff in the other two service settings. Equally the staff who were most inclined to rate social inclusion tasks as not being applicable to their job were those working day centres; female rather than male staff, those in front-line staff rather than senior staff, and those in part-time or relief positions rather than full-time posts. However, within each service settings, there were wide variations in how staff rated the social inclusion tasks. Staff working in more individualised support arrangements tend to give greater priority to promoting social inclusion although this can vary widely both across and within staff teams. Nonetheless, staff gave greater priority to care tasks especially in congregated service settings. Service managers may need to give more emphasis to social inclusion tasks and provide the leadership, training and resources to facilitate support staff to re-assess their priorities.
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Mütsch, Margot; Kien, Christina; Gerhardus, Ansgar; Lhachimi, Stefan K
2017-01-01
Introduction The Cochrane Collaboration aims to produce relevant and top priority evidence that responds to existing evidence gaps. Hence, research priority setting (RPS) is important to identify which potential research gaps are deemed most important. Moreover, RPS supports future health research to conform both health and health evidence needs. However, studies that are prioritising systematic review topics in public health are surprisingly rare. Therefore, to inform the research agenda of Cochrane Public Health Europe (CPHE), we introduce the protocol of a priority setting study on systematic review topics in several European countries, which is conceptualised as pilot. Methods and analysis We will conduct a two-round modified Delphi study in Switzerland, incorporating an anonymous web-based questionnaire, to assess which topics should be prioritised for systematic reviews in public health. In the first Delphi round public health stakeholders will suggest relevant assessment criteria and potential priority topics. In the second Delphi round the participants indicate their (dis)agreement to the aggregated results of the first round and rate the potential review topics with the predetermined criteria on a four-point Likert scale. As we invite a wide variety of stakeholders we will compare the results between the different stakeholder groups. Ethics and dissemination We have received ethical approval from the ethical board of the University of Bremen, Germany (principal investigation is conducted at the University of Bremen) and a certificate of non-objection from the Canton of Zurich, Switzerland (fieldwork will be conducted in Switzerland). The results of this study will be further disseminated through peer reviewed publication and will support systematic review author groups (i.a. CPHE) to improve the relevance of the groups´ future review work. Finally, the proposed priority setting study can be used as a framework by other systematic review groups when conducting a priority setting study in a different context. PMID:28780546
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Souza, Joao Paulo; Widmer, Mariana; Gülmezoglu, Ahmet Metin; Lawrie, Theresa Anne; Adejuyigbe, Ebunoluwa Aderonke; Carroli, Guillermo; Crowther, Caroline; Currie, Sheena M; Dowswell, Therese; Hofmeyr, Justus; Lavender, Tina; Lawn, Joy; Mader, Silke; Martinez, Francisco Eulógio; Mugerwa, Kidza; Qureshi, Zahida; Silvestre, Maria Asuncion; Soltani, Hora; Torloni, Maria Regina; Tsigas, Eleni Z; Vowles, Zoe; Ouedraogo, Léopold; Serruya, Suzanne; Al-Raiby, Jamela; Awin, Narimah; Obara, Hiromi; Mathai, Matthews; Bahl, Rajiv; Martines, José; Ganatra, Bela; Phillips, Sharon Jelena; Johnson, Brooke Ronald; Vogel, Joshua P; Oladapo, Olufemi T; Temmerman, Marleen
2014-08-07
Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required. We adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025. Priority research questions were received from various international stakeholders constituting a large reference group, and consolidated into a final list of research questions by a technical working group. Questions on this list were then scored by the reference working group according to five independent and equally weighted criteria. Normalized research priority scores (NRPS) were calculated, and research priority questions were ranked accordingly. A list of 190 priority research questions for improving maternal and perinatal health was scored by 140 stakeholders. Most priority research questions (89%) were concerned with the evaluation of implementation and delivery of existing interventions, with research subthemes frequently concerned with training and/or awareness interventions (11%), and access to interventions and/or services (14%). Twenty-one questions (11%) involved the discovery of new interventions or technologies. Key research priorities in maternal and perinatal health were identified. The resulting ranked list of research questions provides a valuable resource for health research investors, researchers and other stakeholders. We are hopeful that this exercise will inform the post-2015 Development Agenda and assist donors, research-policy decision makers and researchers to invest in research that will ultimately make the most significant difference in the lives of mothers and babies.
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Bourbakis, N G
1997-01-01
This paper presents a generic traffic priority language, called KYKLOFORTA, used by autonomous robots for collision-free navigation in a dynamic unknown or known navigation space. In a previous work by X. Grossmman (1988), a set of traffic control rules was developed for the navigation of the robots on the lines of a two-dimensional (2-D) grid and a control center coordinated and synchronized their movements. In this work, the robots are considered autonomous: they are moving anywhere and in any direction inside the free space, and there is no need of a central control to coordinate and synchronize them. The requirements for each robot are i) visual perception, ii) range sensors, and iii) the ability of each robot to detect other moving objects in the same free navigation space, define the other objects perceived size, their velocity and their directions. Based on these assumptions, a traffic priority language is needed for each robot, making it able to decide during the navigation and avoid possible collision with other moving objects. The traffic priority language proposed here is based on a set of primitive traffic priority alphabet and rules which compose pattern of corridors for the application of the traffic priority rules.
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Fagnan, Lyle J; Michaels, LeAnn; Ramsey, Katrina; Shearer, Stefan; Droppers, Oliver; Gallia, Charles
2015-01-01
Responding to quality metrics is an accepted and expected component of the current health care environment. Little is known about which measures physicians identify as a priority when reporting the quality of care to their patients, especially the care of children in rural settings. The objective of this study is for physicians caring for children in rural communities to identify which of the initial core sets of 24 child health quality measures are useful and are a priority for reporting and improving care. A survey was sent to rural Oregon physicians who provide care to children. Of 955 eligible physicians, 172 (18%) completed the survey. The majority of respondents were family physicians (84%), and most respondents (58%) were in private practice. The child health measures stratified into 3 priority tiers: high, medium, and low priority. The top-tier priority measures included childhood immunization status, well-child visits, adolescent immunization status, body mass index assessment, and developmental screening. Dental treatment services, adequate prenatal care, and lower-birth-weight infants were among the lower-tier measures. The priority measures identified by rural family physicians reflect the relevance of the selected measures to their daily practice responsibilities, with missed opportunities to improve community health. © Copyright 2015 by the American Board of Family Medicine.
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Birnbaum, Michael H
2008-01-01
E. Brandstätter, G. Gigerenzer, and R. Hertwig (2006) contended that their priority heuristic, a type of lexicographic semiorder model, is more accurate than cumulative prospect theory (CPT) or transfer of attention exchange (TAX) models in describing risky decisions. However, there are 4 problems with their argument. First, their heuristic is not descriptive of certain data that they did not review. Second, their analysis relied on a global index of fit, percentage of correct predictions of the modal choice. Such analyses can lead to wrong conclusions when parameters are not properly estimated from the data. When parameters are estimated from the data, CPT and TAX fit the D. Kahneman and A. Tversky (1979) data perfectly. Reanalysis shows that TAX and CPT do as well as the priority heuristic for 2 of the data sets reviewed and outperform the priority heuristic for the other 3. Third, when 2 of these sets of data are reexamined, the priority heuristic is seen to make systematic violations. Fourth, new critical implications have been devised for testing the family of lexicographic semiorders including the priority heuristic; new results with these critical tests show systematic evidence against lexicographic semiorder models. (c) 2008 APA, all rights reserved
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Region 6's 2016 Strategic Plan and 2015 Accomplishment Report
The EPA Region 6 Strategic Plan highlights the goals we have set out to accomplish in 2016 based on each of our priorities. areas. Our Accomplishment Report summarizes our work in meeting these priorities during the prior year.
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29 CFR 1990.122 - Response to petitions.
Code of Federal Regulations, 2010 CFR
2010-07-01
... (CONTINUED) IDENTIFICATION, CLASSIFICATION, AND REGULATION OF POTENTIAL OCCUPATIONAL CARCINOGENS Priority Setting § 1990.122 Response to petitions. Whenever the Secretary receives any information submitted in... publishing the Candidate List and Priority Lists and to reconsider the criteria used in establishing the...
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Complementarity and Area-Efficiency in the Prioritization of the Global Protected Area Network.
Kullberg, Peter; Toivonen, Tuuli; Montesino Pouzols, Federico; Lehtomäki, Joona; Di Minin, Enrico; Moilanen, Atte
2015-01-01
Complementarity and cost-efficiency are widely used principles for protected area network design. Despite the wide use and robust theoretical underpinnings, their effects on the performance and patterns of priority areas are rarely studied in detail. Here we compare two approaches for identifying the management priority areas inside the global protected area network: 1) a scoring-based approach, used in recently published analysis and 2) a spatial prioritization method, which accounts for complementarity and area-efficiency. Using the same IUCN species distribution data the complementarity method found an equal-area set of priority areas with double the mean species ranges covered compared to the scoring-based approach. The complementarity set also had 72% more species with full ranges covered, and lacked any coverage only for half of the species compared to the scoring approach. Protected areas in our complementarity-based solution were on average smaller and geographically more scattered. The large difference between the two solutions highlights the need for critical thinking about the selected prioritization method. According to our analysis, accounting for complementarity and area-efficiency can lead to considerable improvements when setting management priorities for the global protected area network.
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Rudan, Igor; Yoshida, Sachiyo; Chan, Kit Yee; Sridhar, Devi; Wazny, Kerri; Nair, Harish; Sheikh, Aziz; Tomlinson, Mark; Lawn, Joy E; Bhutta, Zulfiqar A; Bahl, Rajiv; Chopra, Mickey; Campbell, Harry; El Arifeen, Shams; Black, Robert E; Cousens, Simon
2017-06-01
Several recent reviews of the methods used to set research priorities have identified the CHNRI method (acronym derived from the "Child Health and Nutrition Research Initiative") as an approach that clearly became popular and widely used over the past decade. In this paper we review the first 50 examples of application of the CHNRI method, published between 2007 and 2016, and summarize the most important messages that emerged from those experiences. We conducted a literature review to identify the first 50 examples of application of the CHNRI method in chronological order. We searched Google Scholar, PubMed and so-called grey literature. Initially, between 2007 and 2011, the CHNRI method was mainly used for setting research priorities to address global child health issues, although the first cases of application outside this field (eg, mental health, disabilities and zoonoses) were also recorded. Since 2012 the CHNRI method was used more widely, expanding into the topics such as adolescent health, dementia, national health policy and education. The majority of the exercises were focused on issues that were only relevant to low- and middle-income countries, and national-level applications are on the rise. The first CHNRI-based articles adhered to the five recommended priority-setting criteria, but by 2016 more than two-thirds of all conducted exercises departed from recommendations, modifying the CHNRI method to suit each particular exercise. This was done not only by changing the number of criteria used, but also by introducing some entirely new criteria (eg, "low cost", "sustainability", "acceptability", "feasibility", "relevance" and others). The popularity of the CHNRI method in setting health research priorities can be attributed to several key conceptual advances that have addressed common concerns. The method is systematic in nature, offering an acceptable framework for handling many research questions. It is also transparent and replicable, because it clearly defines the context and priority-setting criteria. It is democratic, as it relies on "crowd-sourcing". It is inclusive, fostering "ownership" of the results by ensuring that various groups invest in the process. It is very flexible and adjustable to many different contexts and needs. Finally, it is simple and relatively inexpensive to conduct, which we believe is one of the main reasons for its uptake by many groups globally, particularly those in low- and middle-income countries.
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Prior, Matthew; Bagness, Carmel; Brewin, Jane; Coomarasamy, Arri; Easthope, Lucy; Hepworth-Jones, Barbara; Hinshaw, Kim; O'Toole, Emily; Orford, Julie; Regan, Lesley; Raine-Fenning, Nick; Shakespeare, Judy; Small, Rachel; Thornton, Jim; Metcalf, Leanne
2017-08-23
To identify and prioritise important research questions for miscarriage. A priority setting partnership using prospective surveys and consensus meetings following methods advocated by the James Lind Alliance. UK. Women and those affected by miscarriage working alongside healthcare professionals. In the initial survey, 1093 participants (932 women who have experienced miscarriage, 8 partners, 17 family members, friends or colleagues, 104 healthcare professionals and eight charitable organisations) submitted 3279 questions. A review of existing literature identified a further 64. Non-questions were removed, and the remaining questions were categorised and summarised into 58 questions. In an interim electronic survey, 2122 respondents chose their top 10 priorities from the 58 summary questions. The 25 highest ranked in the survey were prioritised at a final face-to-face workshop. In summary, the top 10 priorities were ranked as follows: research into preventative treatment, emotional aspects in general, investigation, relevance of pre-existing medical conditions, emotional support as a treatment, importance of lifestyle factors, importance of genetic and chromosomal causes, preconception tests, investigation after different numbers of miscarriage and male causal factors. These results should be the focus of future miscarriage research. Presently, studies are being conducted to address the top priority; however, many other priorities, especially psychological and emotional support, are less well researched areas. We hope our results will encourage both researchers and funders to focus on these priorities. © 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.
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Scanlan, Justin Newton; Pépin, Geneviève; Haracz, Kirsti; Ennals, Priscilla; Webster, Jayne S; Meredith, Pamela J; Batten, Rachel; Bowman, Siann; Bonassi, Marianne; Bruce, Rosie
2015-10-01
The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice. © 2015 Occupational Therapy Australia.
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Kapiriri, Lydia; Razavi, Donya
2017-09-01
There is a growing body of literature on systematic approaches to healthcare priority setting from various countries and different levels of decision making. This paper synthesizes the current literature in order to assess the extent to which program budgeting and marginal analysis (PBMA), burden of disease & cost-effectiveness analysis (BOD/CEA), multi-criteria decision analysis (MCDA), and accountability for reasonableness (A4R), are reported to have been institutionalized and influenced policy making and practice. We searched for English language publications on health care priority setting approaches (2000-2017). Our sources of literature included PubMed and Ovid databases (including Embase, Global Health, Medline, PsycINFO, EconLit). Of the four approaches PBMA and A4R were commonly applied in high income countries while BOD/CEA was exclusively applied in low income countries. PBMA and BOD/CEA were most commonly reported to have influenced policy making. The explanations for limited adoption of an approach were related to its complexity, poor policy maker understanding and resource requirements. While systematic approaches have the potential to improve healthcare priority setting; most have not been adopted in routine policy making. The identified barriers call for sustained knowledge exchange between researchers and policy-makers and development of practical guidelines to ensure that these frameworks are more accessible, applicable and sustainable in informing policy making. Copyright © 2017 Elsevier B.V. All rights reserved.
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Norheim, Ole F; Baltussen, Rob; Johri, Mira; Chisholm, Dan; Nord, Erik; Brock, DanW; Carlsson, Per; Cookson, Richard; Daniels, Norman; Danis, Marion; Fleurbaey, Marc; Johansson, Kjell A; Kapiriri, Lydia; Littlejohns, Peter; Mbeeli, Thomas; Rao, Krishna D; Edejer, Tessa Tan-Torres; Wikler, Dan
2014-01-01
This Guidance for Priority Setting in Health Care (GPS-Health), initiated by the World Health Organization, offers a comprehensive map of equity criteria that are relevant to health care priority setting and should be considered in addition to cost-effectiveness analysis. The guidance, in the form of a checklist, is especially targeted at decision makers who set priorities at national and sub-national levels, and those who interpret findings from cost-effectiveness analysis. It is also targeted at researchers conducting cost-effectiveness analysis to improve reporting of their results in the light of these other criteria. THE GUIDANCE WAS DEVELOP THROUGH A SERIES OF EXPERT CONSULTATION MEETINGS AND INVOLVED THREE STEPS: i) methods and normative concepts were identified through a systematic review; ii) the review findings were critically assessed in the expert consultation meetings which resulted in a draft checklist of normative criteria; iii) the checklist was validated though an extensive hearing process with input from a range of relevant stakeholders. The GPS-Health incorporates criteria related to the disease an intervention targets (severity of disease, capacity to benefit, and past health loss); characteristics of social groups an intervention targets (socioeconomic status, area of living, gender; race, ethnicity, religion and sexual orientation); and non-health consequences of an intervention (financial protection, economic productivity, and care for others).
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[The national public discourse on priority setting in health care in German print media].
Liesching, Florian; Meyer, Thorsten; Raspe, Heiner
2012-01-01
Germany's Central Ethics Committee of the Federal Chamber of Physicians (FCP) and other relevant national actors called for a public discourse on priority setting in health care. Politicians, members of a Federal Joint Committee and health insurance representatives, however, refused to promote or participate in the establishment of a public discussion. A change to that attitude only became apparent after former FCP President Hoppe's opening speech at the annual FCP assembly in Mainz in 2009. The present paper applies the Sociology of Knowledge Approach to Discourse, implemented through Qualitative Content Analysis and elements of Grounded Theory, to examine the development of the national public discourse in leading German print media. It creates a matrix that represents the discourse development between May 2009 and May 2010 and reflects central actors, their "communicative phenomena" and their interactions. Additionally, the matrix has been extended to cover the period until December 2011. Hoppe's arguments for priority setting in health care are faced with a wide opposition assuming opposing prerequisites and thus demanding alternative remedies. The lack of interaction between the different parties prevents any development of the speakers' positions. Incorrect accounts, reductions and left-outs in the media representation add to this effect. Consequently, the public discussion on priority setting is far from being an evolving rational discourse. Instead, it constitutes an exchange of preformed opposing positions. Copyright © 2012. Published by Elsevier GmbH.
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ERIC Educational Resources Information Center
Ryan, Mary; Gwinner, Karleen; Mallan, Kerry; Livock, Cheryl
2016-01-01
Economic success and commitment to the social benefits of inclusive training opportunities are important goals for public Vocational Education and Training (VET). Currently in Australia, VET policy is a shared responsibility between the Commonwealth and the States and Territories. Priorities for investment are juggled between improving efficiency…
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Pssst … pass the algae: Succession in lichen soil crusts
Heather T. Root; Erich Kyle Dodson
2016-01-01
Recovery of ecological communities following disturbance is a central theme of ecology and may be mediated by priority effects, in which the species or individuals that first arrive at a site alter the biotic or abiotic environment in ways that affect the establishment and growth of species or individuals that arrive at a later time. Priority effects are...
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Hiltz, Mary-Ann; Mitton, Craig; Smith, Neale; Dowling, Laura; Campbell, Matthew; Magee, J Fergall; Gibson, Jennifer L; Gujar, Shashi Ashok; Levy, Adrian
2015-01-01
There are powerful arguments for increased investment in child and youth health. But the extent to which these benefits can be realized is shaped by health institutions' priority setting processes. We asked, "What are the unique features of a pediatric care setting that should influence choice and implementation of a formal priority setting and resource allocation process?" Based on multiple sources of data, we created a "made-for-child-health" lens containing three foci reflective of the distinct features of pediatric care settings: the diversity of child and youth populations, the challenges in measuring outcomes and the complexity of patient and public engagement.
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Setting priorities for research on pollution reduction functions of agricultural buffers.
Dosskey, Michael G
2002-11-01
The success of buffer installation initiatives and programs to reduce nonpoint source pollution of streams on agricultural lands will depend the ability of local planners to locate and design buffers for specific circumstances with substantial and predictable results. Current predictive capabilities are inadequate, and major sources of uncertainty remain. An assessment of these uncertainties cautions that there is greater risk of overestimating buffer impact than underestimating it. Priorities for future research are proposed that will lead more quickly to major advances in predictive capabilities. Highest priority is given for work on the surface runoff filtration function, which is almost universally important to the amount of pollution reduction expected from buffer installation and for which there remain major sources of uncertainty for predicting level of impact. Foremost uncertainties surround the extent and consequences of runoff flow concentration and pollutant accumulation. Other buffer functions, including filtration of groundwater nitrate and stabilization of channel erosion sources of sediments, may be important in some regions. However, uncertainty surrounds our ability to identify and quantify the extent of site conditions where buffer installation can substantially reduce stream pollution in these ways. Deficiencies in predictive models reflect gaps in experimental information as well as technology to account for spatial heterogeneity of pollutant sources, pathways, and buffer capabilities across watersheds. Since completion of a comprehensive watershed-scale buffer model is probably far off, immediate needs call for simpler techniques to gage the probable impacts of buffer installation at local scales.
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Setting high-impact clinical research priorities for the Society for Vascular Surgery.
Kraiss, Larry W; Conte, Michael S; Geary, Randolph L; Kibbe, Melina; Ozaki, C Keith
2013-02-01
With the overall goal of enhancing the effectiveness and efficiency of vascular care, the Society for Vascular Surgery (SVS) recently completed a process by which it identified its top clinical research priorities to address critical gaps in knowledge guiding practitioners in prevention and treatment of vascular disease. After a survey of the SVS membership, a panel of SVS committee members and opinion leaders considered 53 distinct research questions through a structured process that resulted in identification of nine clinical issues that were felt to merit immediate attention by vascular investigators and external funding agencies. These are, in order of priority: (1) define optimal management of asymptomatic carotid stenosis, (2) compare the effectiveness of medical vs invasive treatment (open or endovascular) of vasculogenic claudication, (3) compare effectiveness of open vs endovascular infrainguinal revascularization as initial treatment of critical limb ischemia, (4) develop and compare the effectiveness of clinical strategies to reduce cardiovascular and other perioperative complications (eg, wound) after vascular intervention, (5) compare the effectiveness of strategies to enhance arteriovenous fistula maturation and durability, (6) develop best practices for management of chronic venous ulcer, (7) define optimal adjunctive medical therapy to enhance the success of lower extremity revascularization, (8) identify and evaluate medical therapy to prevent abdominal aortic aneurysm growth, and (9) evaluate ultrasound vs computed tomographic angiography surveillance after endovascular aneurysm repair. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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Research priority setting in Barrett's oesophagus and gastro-oesophageal reflux disease.
Britton, James; Gadeke, Lisa; Lovat, Laurence; Hamdy, Shaheen; Hawkey, Chris; McLaughlin, John; Ang, Yeng
2017-11-01
The incidence of gastro-oesophageal reflux disease and Barrett's oesophagus is increasing. Barrett's oesophagus is the main precursor to oesophageal adenocarcinoma, which has a poor prognosis. In view of the vast potential burden of these diseases on patients and health-care resources, there is a real need to define and focus research efforts. This priority setting exercise aimed to produce a list of the top ten uncertainties in the field that reflect the priorities of patients and health-care providers. We adopted the robust and transparent methodologies previously outlined by the James Lind Alliance. This qualitative approach firstly involves an ideas gathering survey that, once distilled, generates a longlist of research uncertainties. These uncertainties are then prioritised via an interim ranking survey and a final workshop to achieve consensus agreement. The initial 629 uncertainties, generated from a survey of 170 individual respondents (47% professional, 53% non-professional) and one workshop, were narrowed down to the final top ten uncertainties of priority for future research. These priorities covered a range of issues, including a need for improved patient risk stratification, alternative diagnostic and surveillance tests, efficacy of a dedicated service for Barrett's oesophagus, cost-effectiveness and appropriateness of current surveillance, advances in development of non-drug treatments for gastro-oesophageal reflux disease, safety of long-term drug treatment, and questions regarding the durability and role of different endoscopic therapies for dysplastic Barrett's oesophagus. This is the first patient-centred assessment of priorities for researchers in this chronic disease setting. We hope that recognition and dissemination of these results will shape the future direction of research and translate into meaningful gains for patients. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Paquette-Warren, Jann; Tyler, Marie; Fournie, Meghan; Harris, Stewart B
2017-06-01
In order to scale-up successful innovations, more evidence is needed to evaluate programs that attempt to address the rising prevalence of diabetes and the associated burdens on patients and the healthcare system. This study aimed to assess the construct and content validity of the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE), a tool developed to guide the evaluation, design and implementation with built-in knowledge translation principles. A modified Delphi method, including 3 individual rounds (questionnaire with 7-point agreement/importance Likert scales and/or open-ended questions) and 1 group round (open discussion) were conducted. Twelve experts in diabetes, research, knowledge translation, evaluation and policy from Canada (Ontario, Quebec and British Columbia) and Australia participated. Quantitative consensus criteria were an interquartile range of ≤1. Qualitative data were analyzed thematically and confirmed by participants. An importance scale was used to determine a priority multi-level indicator set. Items rated very or extremely important by 80% or more of the experts were reviewed in the final group round to build the final set. Participants reached consensus on the content and construct validity of DEFINE, including its title, overall goal, 5-step evaluation approach, medical and nonmedical determinants of health schematics, full list of indicators and associated measurement tools, priority multi-level indicator set and next steps in DEFINE's development. Validated by experts, DEFINE has the right theoretic components to evaluate comprehensively diabetes prevention and management programs and to support acquisition of evidence that could influence the knowledge translation of innovations to reduce the burden of diabetes. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
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Dare, Anna J.; Lee, Katherine C.; Bleicher, Josh; Elobu, Alex E.; Kamara, Thaim B.; Liko, Osborne; Luboga, Samuel; Danlop, Akule; Kune, Gabriel; Hagander, Lars; Leather, Andrew J. M.; Yamey, Gavin
2016-01-01
Background Little is known about the social and political factors that influence priority setting for different health services in low- and middle-income countries (LMICs), yet these factors are integral to understanding how national health agendas are established. We investigated factors that facilitate or prevent surgical care from being prioritized in LMICs. Methods and Findings We undertook country case studies in Papua New Guinea, Uganda, and Sierra Leone, using a qualitative process-tracing method. We conducted 74 semi-structured interviews with stakeholders involved in health agenda setting and surgical care in these countries. Interviews were triangulated with published academic literature, country reports, national health plans, and policies. Data were analyzed using a conceptual framework based on four components (actor power, ideas, political contexts, issue characteristics) to assess national factors influencing priority for surgery. Political priority for surgical care in the three countries varies. Priority was highest in Papua New Guinea, where surgical care is firmly embedded within national health plans and receives significant domestic and international resources, and much lower in Uganda and Sierra Leone. Factors influencing whether surgical care was prioritized were the degree of sustained and effective domestic advocacy by the local surgical community, the national political and economic environment in which health policy setting occurs, and the influence of international actors, particularly donors, on national agenda setting. The results from Papua New Guinea show that a strong surgical community can generate priority from the ground up, even where other factors are unfavorable. Conclusions National health agenda setting is a complex social and political process. To embed surgical care within national health policy, sustained advocacy efforts, effective framing of the problem and solutions, and country-specific data are required. Political, technical, and financial support from regional and international partners is also important. PMID:27186645
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Garpenby, Peter; Nedlund, Ann-Charlotte
2016-08-01
This paper contributes to the knowledge on the governing of healthcare in a democratic context in times of austerity. Resource allocation in healthcare is a highly political issue but the political nature of healthcare is not always made clear and the role of politicians is often obscure. The absence of politicians in rationing/disinvestment arrangements is usually explained with blame-shifting arguments; they prefer to delegate "the burden of responsibility" to administrative agencies or professionals. Drawing on a case where Swedish regional politicians involved themselves in setting priorities at a more detailed level than previously, the findings suggest that the subject of "blame avoidance" is more complicated than usually assumed. A qualitative case study was designed, involving semi-structured interviews with 14 regionally elected politicians in one Swedish health authority, conducted in June 2011. The interviews were analysed through a thematic analysis in accordance with the "framework approach" by Ritchie and Lewis. Findings show that an overarching strategy among the politicians was to appear united and to suppress conflict, which served to underpin the vital strategy of bringing the medical profession into the process. A key finding is the importance that politicians, when appearing "backstage", attach to the prevention of blame from the medical profession. This case illustrates that one has to take into account that priority settings requires various types of skills and knowledges - not only technical but also political and social. Another important lesson points toward the need to broaden the political leadership repertoire, as leadership in the case of priority setting is not about politicians being all in or all out. The results suggest that in a priority-setting process it is of importance to have politics on-board at an early stage to secure loyalty to the process, although not necessarily being involved in all details. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Exploring stakeholders' views of medical education research priorities: a national survey.
Dennis, Ashley A; Cleland, Jennifer A; Johnston, Peter; Ker, Jean S; Lough, Murray; Rees, Charlotte E
2014-11-01
Setting research priorities is important when exploring complex issues with limited resources. Only two countries (Canada and New Zealand) have previously conducted priority-setting exercises for medical education research (MER). This study aimed to identify the views of multiple stakeholders on MER priorities in Scotland. This study utilised a two-stage design to explore the views of stakeholders across the medical education continuum using online questionnaires. In Stage 1, key informants outlined their top three MER priorities and justified their choices. In Stage 2, participants rated 21 topics generated in Stage 1 according to importance and identified or justified their top priorities. A combination of qualitative (i.e. framework analysis) and quantitative (e.g. exploratory factor analysis) data analyses were employed. Views were gathered from over 1300 stakeholders. A total of 21 subthemes (or priority areas) identified in Stage 1 were explored further in Stage 2. The 21 items loaded onto five factors: the culture of learning together in the workplace; enhancing and valuing the role of educators; curriculum integration and innovation; bridging the gap between assessment and feedback, and building a resilient workforce. Within Stage 2, the top priority subthemes were: balancing conflicts between service and training; providing useful feedback; promoting resiliency and well-being; creating an effective workplace learning culture; selecting and recruiting doctors to reflect need, and ensuring that curricula prepare trainees for practice. Participant characteristics were related to the perceived importance of the factors. Finally, five themes explaining why participants prioritised items were identified: patient safety; quality of care; investing for the future; policy and political agendas, and evidence-based education. This study indicates that, across the spectrum of stakeholders and geography, certain MER priorities are consistently identified. These priority areas are in harmony with a range of current drivers in UK medical education. They provide a platform of evidence on which to base decisions about MER programmes in Scotland and beyond. © 2014 John Wiley & Sons Ltd.
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Factors Associated with the Academic Success of First Year Health Science Students
ERIC Educational Resources Information Center
Mills, Christina; Heyworth, Jane; Rosenwax, Lorna; Carr, Sandra; Rosenberg, Michael
2009-01-01
The academic success of students is a priority for all universities. This study identifies factors associated with first year academic success (performance and retention) that can be used to improve the quality of the student learning experience. A retrospective cohort study was conducted with a census of all 381 full time students enrolled in the…
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The implications of fundamental cause theory for priority setting.
Goldberg, Daniel S
2014-10-01
Application of fundamental cause theory to Powers and Faden's model of social justice highlights the ethical superiority of upstream public health interventions. In this article, I assess the ramifications of fundamental cause theory specifically in context of public health priority setting. Ethically optimal public health policy simultaneously maximizes overall population health and compresses health inequalities. The fundamental cause theory is an important framework in helping to identify which categories of public health interventions are most likely to advance these twin goals.
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Miró, Òscar; Tost, Josep; Herrero, Pablo; Jacob, Javier; Martín-Sánchez, Francisco Javier; Gil, Víctor; Fernández-Pérez, Cristina; Escoda, Rosa; Llorens, Pere
2016-12-01
To evaluate whether prioritization of patients with acute heart failure (AHF) in the Andorran Triage Model/Spanish Triage System (MAT/SET) and the Manchester Triage System (MTS) also allows the identification of different profiles of outcome and prognosis and determine whether either system has a better predictive capacity of outcomes. Patients with AHF included in the Spanish EAHFE registry from hospitals using the MAT/SET or MTS were selected and divided according to the triage system used. Outcome variables included hospital admission, length of stay, death during admission, 3, 7, and 30-day all-cause mortality, and emergency department (ED) reconsultation at 30 days. The results were compared according to the level of priority and the triage system used. We included 3837 patients (MAT/SET=2474; MTS=1363) classified as follows: 4.0% level 1; 34.7% level 2; 55.1% level 3; and 6.3% levels 4-5. Both systems associated greater priority with higher rates of admission and mortality; the MTS associated greater priority with greater ED reconsultation and the MAT/SET found greater priority to be associated with less ED reconsultation. The discriminative capacity of the two scales for adverse outcomes was statistically significant, albeit poor, for almost all the outcome events and it was of scarce clinical relevance (Area under the curve of the receiver operating characteristic between 0.458 and 0.661). The prediction of the outcome of patients with AHF determined with the MAT/SET or MTS showed scarce differences between the two systems, and their discriminative capacity does not seem to be clinically relevant.
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Jang, Sung-In; Nam, Jung-Mo; Choi, Jongwon; Park, Eun-Cheol
2014-03-01
Limited healthcare resources make it necessary to maximize efficiency in disease management at the country level by priority-setting according to disease burden. To make the best priority settings, it is necessary to measure health status and have standards for its judgment, as well as consider disease management trends among nations. We used 17 International Classification of Diseases (ICD) categories of potential years of life lost (YPLL) from Organization for Economic Co-operation and Development (OECD) health data for 2012, 37 disease diagnoses YPLL from OECD health data for 2009 across 22 countries and disability-adjusted life years (DALY) from the World Health Organization (WHO). We set a range of 1-1 for each YPLL per disease in a nation (position value for relative comparison, PARC). Changes over 5 years were also accounted for in this disease management index (disease management index, DMI). In terms of ICD categories, the DMI indicated specific areas for priority setting for different countries with regard to managing disease treatment and diagnosis. Our study suggests that DMI is a realistic index that reflects trend changes over the past 5 years to the present state, and PARC is an easy index for identifying relative status. Moreover, unlike existing indices, DMI and PARC make it easy to conduct multiple comparisons among countries and diseases. DMI and PARC are therefore useful tools for policy implications and for future studies incorporating them and other existing indexes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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Dovlo, Delanyo
2015-12-03
The editorial is commendable and I agree with many of the points raised. Management is an important aspect of health system strengthening which is often overlooked. In order to build the capacity of management, we need to consider other factors such as, the environment within which managers work, their numbers, support systems and distribution. Effective leadership is an issue which cannot be overemphasized as part of management capacity in resource deprived settings as difficult settings require leadership skills in order to achieve managerial success. A primary issue of importance highlighted in the editorial is country ownership of management effectiveness initiatives, which may be very difficult when the health sector is dependent on support and funding from donors and influential partners, who drive change often without a good understanding of the context. How partners finance health programmes is another dilemma as it can distract from locally determined priorities. Further research should help us to understand better what works and under different settings. © 2016 by Kerman University of Medical Sciences.
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Mouw, Mary Sherwyn; Taboada, Arianna; Steinert, Scarlett; Willis, Stephanie; Lightfoot, Alexandra F.
2016-01-01
Background A theater-based HIV prevention intervention developed in urban California was piloted with a new partnership in North Carolina. Objectives To describe the experience of translating a complex program with an enhanced partnership approach; barriers and facilitators of implementation in the new setting; and challenges and benefits of interdisciplinary, collaborative interventions. Methods We gathered perspectives of local stakeholders involved in program implementation through process evaluation interviews and focus groups with undergraduates, a college instructor, school district administrators, and high school teachers. Results Implementing the intervention in a new setting proved feasible and successful; however, mistaken assumptions and unrecognized similarities about teaching priorities, philosophies, and values produced latent tensions amongst stakeholder groups, and were a limiting factor in partnership functioning. Conclusions Implementing a cross-disciplinary intervention in a new setting is best achieved through a local community-engaged process, with active involvement of relevant stakeholders. We suggest strategies to strengthen community partnerships cooperating in implementation of complex, context-tailored interventions. PMID:27346770
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NASA Technical Reports Server (NTRS)
Ryan, Robert S.
1994-01-01
Structural dynamics and its auxiliary fields are the most progressive and challenging areas space system engineering design and operations face. Aerospace systems are dependent on structural dynamicists for their success. Past experiences (history) are colored with many dynamic issues, some producing ground or flight test failures. The innovation and creativity that was brought to these issues and problems are the aura from the past that lights the path to the future. Using this illumination to guide understanding of the dynamic phenomena and designing for its potential occurrence are the keys to successful space systems. Our great paradox, or challenge, is how we remain in depth specialists, yet become generalists to the degree that we make good team members and set the right priorities. This paper will deal with how we performed with acclaim in the past, the basic characteristics of structural dynamics (loads cycle, for example), and the challenges of the future.
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Tranexamic Acid and Trauma: Current Status and Knowledge Gaps with Recommended Research Priorities
2013-01-01
Review Article TRANEXAMIC ACID AND TRAUMA: CURRENT STATUS AND KNOWLEDGE GAPS WITH RECOMMENDED RESEARCH PRIORITIES Anthony E. Pusateri,* Richard B...on the use of tranexamic acid (TXA) for trauma reported important survival benefits. Subsequently, successful use of TXA for combat casualties in...refinement of practice guidelines over time. KEYWORDS— Tranexamic acid , trauma, efficacy, safety, research requirements INTRODUCTION Tranexamic acid (TXA
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Managing resources in NHS dentistry: the views of decision-makers in primary care organisations.
Holmes, R D; Donaldson, C; Exley, C; Steele, J G
2008-09-27
To investigate priority setting and decision-making in primary care organisations and to determine how resources are managed in order to meet the oral health needs of local populations. This is a qualitative study. The purposive sample comprised twelve dental public health consultants and six senior finance representatives from contrasting care systems across the United Kingdom. Participants completed a written information sheet followed by a recorded semi-structured telephone interview. Conversations were professionally transcribed verbatim and analysed independently by two investigators using the constant comparative method. The emergent themes focused upon: the role of participants in decision-making; professional relationships; managing change; information needs; and identifying and managing priorities. There was wide interpretation with respect to participants' roles and perceived information needs for decision-making and commissioning. A unifying factor was the importance placed by participants upon trust and the influence of individuals on the success of relationships forged between primary care organisations and general dental practitioners. To facilitate decision-making in primary care organisations, commissioners and managers could engage further with practitioners and incorporate them into commissioning and resource allocation processes. Greater clarity is required regarding the role of dental public health consultants within primary care organisations and commissioning decisions.
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The technology roadmap for plant/crop-based renewable resources 2020
DOE Office of Scientific and Technical Information (OSTI.GOV)
McLaren, J.
1999-02-22
The long-term well-being of the nation and maintenance of a sustainable leadership position in agriculture, forestry, and manufacturing, clearly depend on current and near-term support of multidisciplinary research for the development of a reliable renewable resource base. This document sets a roadmap and priorities for that research. America needs leadership that will continue to recognize, support, and move rapidly to meet the need to expand the use of sustainable renewable resources. This roadmap has highlighted potential ways for progress and has identified goals in specific components of the system. Achieving success with these goals will provide the opportunity to hitmore » the vision target of a fivefold increase in renewable resource use by 2020.« less
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The Technology Roadmap for Plant/Crop-Based Renewable Resources 2020
DOE Office of Scientific and Technical Information (OSTI.GOV)
None
1999-02-01
The long-term well-being of the nation and maintenance of a sustainable leadership position in agriculture, forestry, and manufacturing, clearly depend on current and near-term support of multidisciplinary research for the development of a reliable renewable resource base. This document sets a roadmap and priorities for that research. America needs leadership that will continue to recognize, support, and move rapidly to meet the need to expand the use of sustainable renewable resources. This roadmap has highlighted potential ways for progress and has identified goals in specific components of the system. Achieving success with these goals will provide the opportunity to hitmore » the vision target of a fivefold increase in renewable resource use by 2020.« less
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Medical ethics and new public management in Sweden.
Hansson, Sven Ove
2014-07-01
In order to shorten queues to healthcare, the Swedish government has introduced a yearly "queue billion" that is paid out to the county councils in proportion to how successful they are in reducing queues. However, only the queues for first visits are covered. Evidence has accumulated that queues for return visits have become longer. This affects the chronically and severely ill. Swedish physicians, and the Swedish Medical Association, have strongly criticized the queue billion and have claimed that it conflicts with medical ethics. Instead they demand that their professional judgments on priority setting and medical urgency be respected. This discussion provides an interesting illustration of some of the limitations of new public management and also more generally of the complicated relationships between medical ethics and public policy.
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Wilson, R T
1998-01-01
As corporations are eagerly pursuing reengineering and reorganization, leadership functions are changing to champion these efforts. Traditionally, organizations have had a "top-down" management approach, however, there is a gradual shift to other leadership models. Servant leadership is being successfully implemented in many settings. Servant leadership, first popularized by Robert Greenleaf in 1970, puts serving others as the number one priority. Ten characteristics of a servant leader include: Listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of people, and building community. Both servant leadership and the chaos theory have in common the central tenet of relationships. Since America is now approximately 80 percent a "service-economy," servant leadership can greatly benefit the individual employees, as well as help to facilitate the organization's pursuit of its changing strategic plans.
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Yu, Catherine H; Stacey, Dawn; Sale, Joanna; Hall, Susan; Kaplan, David M; Ivers, Noah; Rezmovitz, Jeremy; Leung, Fok-Han; Shah, Baiju R; Straus, Sharon E
2014-01-22
Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.4. Usability testing: This will be done using cognitive task analysis.5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.
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2014-01-01
Background Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. Objectives To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. Methods 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice. 2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness. 3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity. 4. Usability testing: This will be done using cognitive task analysis. 5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. Discussion Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach. PMID:24450385
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The factors affecting Nigeria's success toward implementation of global public health priorities.
Echebiri, Vitalis C
2015-06-01
This paper examines the challenges facing the Nigerian government toward the implementation of global public health priories. The Nigerian government recognizes the need to implement these priorities by putting in place the necessary policy framework, but political instability, poor infrastructural development and inadequate funding have remained barriers toward the achievement of success in implementing these priorities. The rest of the paper elucidates the fact that despite leadership and influence from the World Health Organization and other United Nations agencies, and some responses from the Nigerian government, tackling these public health problems requires much more fundamental reform to primary health services and a reduction in poverty. Although the government has shown enough political will to tackle these problems, it is expected that a better result will be achieved through injecting more funds into the Nigerian health sector, and deploying astute health administrators to manage the sector rather than pure health professionals without managerial acumen. © The Author(s) 2014.
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Explaining process orientation failure and success in health care--three case studies.
Hellman, Stefan; Kastberg, Gustaf; Siverbo, Sven
2015-01-01
In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs. The authors conducted three case studies and applied Actor-Network Theory as an analytic lens. The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities. Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.
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Dolan, James G.; Boohaker, Emily; Allison, Jeroan; Imperiale, Thomas F.
2013-01-01
Background Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multi-criteria decision analysis (MCDA) is an established methodology well suited for supporting shared decision making. Our study goal was to determine if a streamlined form of MCDA using rank order based judgments can accurately assess patients’ colorectal cancer screening priorities. Methods We converted priorities for four decision criteria and three sub-criteria regarding colorectal cancer screening obtained from 484 average risk patients using the Analytic Hierarchy Process (AHP) in a prior study into rank order-based priorities using rank order centroids. We compared the two sets of priorities using Spearman rank correlation and non-parametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank order-based versus the AHP-based priorities on the results of a full MCDA comparing three currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation. Results Correlations between the two sets of priorities for the seven criteria ranged from 0.55 to 0.92. The proportions of absolute differences between rank order-based and AHP-based priorities that were more than ± 0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal and the relative rankings of the three screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar. Conclusion Rank order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making. PMID:24300851
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Khan, Nadia; Bacon, Simon L; Khan, Samia; Perlmutter, Sara; Gerlinsky, Carline; Dermer, Mark; Johnson, Lonni; Alves, Finderson; McLean, Donna; Laupacis, Andreas; Pui, Mandy; Berg, Angelique; Flowitt, Felicia
2017-11-01
Patient- and stakeholder-oriented research is vital to improving the relevance of research. The authors aimed to identify the 10 most important research priorities of patients, caregivers, and healthcare providers (family physicians, nurses, nurse practitioners, pharmacists, and dietitians) for hypertension management. Using the James Lind Alliance approach, a national web-based survey asked patients, caregivers, and care providers to submit their unanswered questions on hypertension management. Questions already answered from randomized controlled trial evidence were removed. A priority setting process of patient, caregiver, and healthcare providers then ranked the final top 10 research priorities in an in-person meeting. There were 386 respondents who submitted 598 questions after exclusions. Of the respondents, 78% were patients or caregivers, 29% lived in rural areas, 78% were aged 50 to 80 years, and 75% were women. The 598 questions were distilled to 42 unique questions and from this list, the top 10 research questions prioritized included determining the combinations of healthy lifestyle modifications to reduce the need for antihypertensive medications, stress management interventions, evaluating treatment strategies based on out-of-office blood pressure compared with conventional (office) blood pressure, education tools and technologies to improve patient motivation and health behavior change, management strategies for ethnic groups, evaluating natural and alternative treatments, and the optimal role of different healthcare providers and caregivers in supporting patients with hypertension. These priorities can be used to guide clinicians, researchers, and funding bodies on areas that are a high priority for hypertension management research for patients, caregivers, and healthcare providers. This also highlights priority areas for improved knowledge translation and delivering patient-centered care. ©2017 Wiley Periodicals, Inc.
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40 CFR 35.915 - State priority system and project priorty list.
Code of Federal Regulations, 2010 CFR
2010-07-01
... State priority system and list must be designed to achieve optimum water quality management consistent... water quality management (WQM) plans. The State shall hold a public hearing before submission of the... also sets forth the administrative, management, and public participation procedures required to develop...
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Enrollees Choose Priorities for Medicare
ERIC Educational Resources Information Center
Danis, Marion; Biddle, Andrea K.; Goold, Susan Dorr
2004-01-01
Purpose: The purpose of this study was to demonstrate the feasibility and results of ascertaining Medicare enrollees' priorities for insured medical benefits. Design and Methods: Structured group exercises were conducted with Medicare enrollees from clinical and community settings in central North Carolina. By participating in a decision exercise,…
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Code of Federal Regulations, 2010 CFR
2010-01-01
... PRIORITY SUPPLY OF CRUDE OIL AND PETROLEUM PRODUCTS TO THE DEPARTMENT OF DEFENSE UNDER THE DEFENSE PRODUCTION ACT General § 221.1 Scope. This part sets forth the procedures to be utilized by the Economic Regulatory Administration of the Department of Energy and the Department of Defense whenever the priority...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... DoD Component having accountability for real property shall extend priority on such property to the blind when implementing the Randolph-Sheppard Act, as set out in the following paragraphs: (a) The blind shall be given priority in the establishment and operation of vending facilities. (b) The blind shall be...
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Institutional considerations in priority setting: transactions cost perspective on PBMA.
Jan, S
2000-10-01
Programme budgeting and marginal analysis (PBMA) is increasingly being used as a method of priority setting in the health care sector. Despite this, PBMA has, on occasions, been subject to problems in its application which can be seen as being 'institutional' in nature. This paper examines the extent to which the institutional setting of PBMA affects the way in which it can be conducted. In particular, a transactions costs perspective is taken to analyse the extent to which variation in such costs can alter the incentives of the individual participants. A number of recommendations for improving the sustainability of such projects is then provided. Following this, the implications which this 'institutional' approach has for the evaluation of PBMA are set out.
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The No-Destination Ship of Priority-Setting in Healthcare: A Call for More Democracy
Seixas, Brayan V.
2018-01-01
In dealing with scarcity of resources within healthcare systems, decision-makers inevitably have to make choices about which services to fund. Setting priorities represents a challenging task that requires systematic, explicit and transparent methodologies with focus on economic efficiency. In addition, the engagement of the general public in the process of decision-making has been regarded as one of the most important aspects of the management of publicly-funded health systems in liberal democracies. In the current essay, we aim to discuss the problematics of public engagement in the process of resource allocation and priority-setting within the context of publiclyfunded health systems. Our central argument is that although there may be a conflict between democratic mechanisms of citizen participation and economic efficiency, in the extra-welfarist sense, expected for/from the system, the solution for this tension does not seem to rely on more or novel authoritative technocratic approaches, but rather on the deepening and betterment of democratic participation. PMID:29626402
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Ranking the Project Management Success Factors for Construction Project in South India
NASA Astrophysics Data System (ADS)
Aneesha, K.; Haridharan, M. K.
2017-07-01
In Today’s construction industry, to achieve a greater advantage over the firms, success of each project and efficiency is required. Effective Project Management overcomes these types of challenges. This study identifies the success factors which are important for project management in construction project success. From the literature review, 26 factors were found to be critical. Project managers, construction managers, civil engineers, contractors and site engineers were the respondents. After analyzing the data in SPSS software, the dominant factors from the regression analysis are top management support, competent project team, abilities to solve problems, realistic cost and time estimates, information/communication, competency of the project manager are the 6 factors out of 12 in 26 factors. Effective communication between stakeholders got highest priority and client involvement, good leadership, clarity of project goals got second priority. Informal communication gives better results compared to formal communications like written formats. To remove communication barrier with the stakeholders, informal communication like speaking face-to-face with the language this fits for the stakeholders.
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Nagata, Jason M; Hathi, Sejal; Ferguson, B Jane; Hindin, Michele J; Yoshida, Sachiyo; Ross, David A
2018-01-01
Background In order to clarify priorities and stimulate research in adolescent health in low- and middle-income countries (LMICs), the World Health Organization (WHO) conducted two priority-setting exercises based on the Child Health and Nutrition Research Initiative (CHNRI) methodology related to 1) adolescent sexual and reproductive health and 2) eight areas of adolescent health including communicable diseases prevention and management, injuries and violence, mental health, non-communicable diseases management, nutrition, physical activity, substance use, and health policy. Although the CHNRI methodology has been utilized in over 50 separate research priority setting exercises, none have qualitatively synthesized the ultimate findings across studies. The purpose of this study was to conduct a mixed-method synthesis of two research priority-setting exercises for adolescent health in LMICs based on the CHNRI methodology and to situate the priority questions within the current global health agenda. Methods All of the 116 top-ranked questions presented in each exercise were analyzed by two independent reviewers. Word clouds were generated based on keywords from the top-ranked questions. Questions were coded and content analysis was conducted based on type of delivery platform, vulnerable populations, and the Survive, Thrive, and Transform framework from the United Nations Global Strategy for Women’s, Children’s, and Adolescents’ Health, 2016-2030. Findings Within the 53 top-ranked intervention-related questions that specified a delivery platform, the platforms specified were schools (n = 17), primary care (n = 12), community (n = 11), parenting (n = 6), virtual media (n = 5), and peers (n = 2). Twenty questions specifically focused on vulnerable adolescents, including those living with HIV, tuberculosis, mental illness, or neurodevelopmental disorders; victims of gender-based violence; refugees; young persons who inject drugs; sex workers; slum dwellers; out-of-school youth; and youth in armed conflict. A majority of the top-ranked questions (108/116) aligned with one or a combination of the Survive (n = 39), Thrive (n = 67), and Transform (n = 28) agendas. Conclusions This study advances the CHNRI methodology by conducting the first mixed-methods synthesis of multiple research priority-setting exercises by analyzing keywords (using word clouds) and themes (using content analysis). PMID:29497507
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Ethical Challenges in the Provision of Dialysis in Resource-Constrained Environments.
Luyckx, Valerie A; Miljeteig, Ingrid; Ejigu, Addisu M; Moosa, M Rafique
2017-05-01
The number of patients requiring dialysis by 2030 is projected to double worldwide, with the largest increase expected in low- and middle-income countries (LMICs). Dialysis is seldom considered a high priority by health care funders, consequently, few LMICs develop policies regarding dialysis allocation. Dialysis facilities may exist, but access remains highly inequitable in LMICs. High out-of-pocket payments make dialysis unsustainable and plunge many families into poverty. Patients, families, and clinicians suffer significant emotional and moral distress from daily life-and-death decisions imposed by dialysis. The health system's obligation to provide financial risk protection is an important component of global and national strategies to achieve universal health coverage. An ethical imperative therefore exists to develop transparent dialysis priority-setting guidelines to facilitate public understanding and acceptance of the realistic limits within the health system, and facilitate fair allocation of scarce resources. In this article, we present ethical challenges faced by patients, families, clinicians, and policy makers where dialysis is not universally accessible and discuss the potential ethical consequences of various dialysis allocation strategies. Finally, we suggest an ethical framework for use in policy development for priority setting of dialysis care. The accountability for reasonableness framework is proposed as a procedurally fair decision-making, priority-setting process. Copyright © 2017 Elsevier Inc. All rights reserved.
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Tomlinson, Mark; Yasamy, M. Taghi; Emerson, Eric; Officer, Alana; Richler, Diane; Saxena, Shekhar
2015-01-01
Objectives The prevalence of intellectual disabilities (ID) has been estimated at 10.4/1000 worldwide with higher rates among children and adolescents in lower income countries. The objective of this paper is to address research priorities for development disabilities, notably intellectual disabilities and autism, at the global level and to propose the more rational use of scarce funds in addressing this under-investigated area. Methods An expert group was identified and invited to systematically list and score research questions. They applied the priority setting methodology of the Child Health and Nutrition Research Initiative (CHNRI) to generate research questions and to evaluate them using a set of five criteria: answerability, feasibility, applicability and impact, support within the context and equity. Findings The results of this process clearly indicated that the important priorities for future research related to the need for effective and efficient approaches to early intervention, empowerment of families supporting a person with developmental disability and to address preventable causes of poor health in people with ID and autism. Conclusions For the public health and other systems to become more effective in delivering appropriate support to persons with developmental disabilities, greater (and more targeted) investment in research is required to produce evidence of what works consistent with international human rights standards. PMID:24397279
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Gonzalo, Jed D; Baxley, Elizabeth; Borkan, Jeffrey; Dekhtyar, Michael; Hawkins, Richard; Lawson, Luan; Starr, Stephanie R; Skochelak, Susan
2017-01-01
Educators, policy makers, and health systems leaders are calling for significant reform of undergraduate medical education (UME) and graduate medical education (GME) programs to meet the evolving needs of the health care system. Nationally, several schools have initiated innovative curricula in both classroom and workplace learning experiences to promote education in health systems science (HSS), which includes topics such as value-based care, health system improvement, and population and public health. However, the successful implementation of HSS curricula across schools is challenged by issues of curriculum design, assessment, culture, and accreditation, among others. In this report of a working conference using thematic analysis of workshop recommendations and experiences from 11 U.S. medical schools, the authors describe seven priority areas for the successful integration and sustainment of HSS in educational programs, and associated challenges and potential solutions. In 2015, following regular HSS workgroup phone calls and an Accelerating Change in Medical Education consortium-wide meeting, the authors identified the priority areas: partner with licensing, certifying, and accrediting bodies; develop comprehensive, standardized, and integrated curricula; develop, standardize, and align assessments; improve the UME to GME transition; enhance teachers' knowledge and skills, and incentives for teachers; demonstrate value added to the health system; and address the hidden curriculum. These priority areas and their potential solutions can be used by individual schools and HSS education collaboratives to further outline and delineate the steps needed to create, deliver, study, and sustain effective HSS curricula with an eye toward integration with the basic and clinical sciences curricula.
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Lane, India F
2010-03-01
Nontechnical competencies identified as essential to the health professional's success include ethical behavior, interpersonal, self-management, leadership, business, and thinking competencies. The literature regarding such diverse topics, and the literature regarding "professional success" is extensive and wide-ranging, crossing educational, psychological, business, medical and vocational fields of study. This review is designed to introduce ways of viewing nontechnical competence from the psychology of human capacity to current perspectives, initiatives and needs in practice. After an introduction to the tensions inherent in educating individuals for both biomedical competency and "bedside" or "cageside" manner, the paper presents a brief overview of the major lines of inquiry into intelligence theory and how theories of multiple intelligences can build a foundation for conceptualizing professional and life skills. The discussion then moves from broad concepts of intelligence to more specific workplace skill sets, with an emphasis on professional medical education. This section introduces the research on noncognitive variables in various disciplines, the growing emphasis on competency based education, and the SKA movement in veterinary education. The next section presents the evidence that nontechnical, noncognitive or humanistic skills influence achievement in academic settings, medical education and clinical performance, as well as the challenges faced when educational priorities must be made.
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Ratcliffe, Julie; Lancsar, Emily; Walker, Ruth; Gu, Yuanyuan
2017-06-01
Health care policy makers internationally are increasingly expressing commitment to consultation with, and incorporation of, the views of the general public into the formulation of health policy and the process of setting health care priorities. In practice, however, there are relatively few opportunities for the general public to be involved in health care decision-making. In making resource allocation decisions, funders, tasked with managing scarce health care resources, are often faced with difficult decisions in balancing efficiency with equity considerations. A mixed methods (qualitative and quantitative) approach incorporating focus group discussions and a ranking exercise was utilised to develop a comprehensive list of potential criteria for setting priorities in health care formulated from the perspective of members of the general public in Australia. A strong level of congruence was found in terms of the rankings of the key criteria with the size of the health gain, clinical effectiveness, and the ability to provide quality of life improvements identified consistently as the three most important criteria for prioritising the funding of an intervention. Findings from this study will be incorporated into a novel DCE framework to explore how decision makers and members of the general public prioritize and trade off different types of health gain and to quantify the weights attached to specific efficiency and equity criteria in the priority setting process. Copyright © 2017 Elsevier B.V. All rights reserved.
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Public involvement in health priority setting: future challenges for policy, research and society.
Hunter, David James; Kieslich, Katharina; Littlejohns, Peter; Staniszewska, Sophie; Tumilty, Emma; Weale, Albert; Williams, Iestyn
2016-08-15
Purpose - The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest that challenges emerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting. Design/methodology/approach - The paper draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society. Findings - At least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation. Originality/value - The paper concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand the understanding of public involvement in health prioritization.
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Clarifying the scope of Italian NHS coverage. Is it feasible? Is it desirable?
Fattore, G
1999-12-01
The reduction in National Health Service (NHS) expenditure as a share of total health care expenditure, the fragmentation of the NHS into 21 regional systems and the implementation of a 'quasi-market' on the provider side of the system has pressed the government to define and specify, in detail, the set of services that are to be guaranteed by the public sector. To understand whether rationing can be more rational and explicit in the Italian NHS, the following are analysed: (i) the new positive list of drugs, as a major example of limiting and making more rational NHS pharmaceutical coverage; (ii) the Di Bella case, as an example of the difficulties of rational policy-making on sensitive issues; (iii) what Italian people think about health care rationing and priority setting (using the 1998 Eurobarometer Survey);( iv) the criteria defining the set of 'essential services' to be guaranteed to all Italian citizens, which are contained in the recently released National Health Plan. The 'revolution' that has taken place in the pharmaceutical sector shows it is feasible to limit, in an explicit and rational way, the extent of NHS coverage. However, the re-classification of the positive list should be regarded as an exceptional event in the history of Italian social policy. The 'Di Bella' case, on the contrary, shows that limiting NHS coverage can be very unpopular, and that the Italian cultural and social context can be unfavourable for the implementation of hard choices. Public attitude toward rationing seems to confirm that Italians are not familiar with rationing issues. Thus, it is very difficult to predict whether the national government will really go ahead with the implementation of a 'list of essential services' and whether this attempt will be successful. Rationing and priority setting should be discussed in the context of a general debate concerning the future of the Italian NHS.
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ERIC Educational Resources Information Center
Valcour, Monique; Ladge, Jamie J.
2008-01-01
This study examined the effects of family and career path characteristics on objective and subjective career success among 916 employed mothers. Among family variables, age at first childbirth was positively related and career priority favoring the husband was negatively related to both income and subjective career success; number of children was…
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Setting Priorities for NIOSH Research
ERIC Educational Resources Information Center
Gallagher, Richard E.
1975-01-01
The National Institute for Occupational Safety and Health (NIOSH) is attempting to develop total programs of occupational safety and health protection. It has established research criteria and a priority system for evaluating the order of investigating suspect substances or agents based upon the expected gain of the health benefit. (Author/MW)
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National VET Research Priorities: 2010 and beyond. Discussion Paper
ERIC Educational Resources Information Center
National Centre for Vocational Education Research (NCVER), 2009
2009-01-01
National Centre for Vocational Education Research (NCVER) is undertaking a consultation process to determine the next set of National Research Priorities which will guide research activities in the post-compulsory education and training arena, particularly in relation to vocational education and training. This discussion paper, and the…
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Making a List and Checking It Twice?
ERIC Educational Resources Information Center
Jarrell, Andrea
1999-01-01
Discusses the components of strategic planning in developing a fund-raising campaign for a college or university. Emphasizes the importance of setting priorities, and defines the characteristics of good priorities, such as boldness, being grounded in the institution's mission, and culminating in visible results. Includes a case study of the…
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29 CFR 4044.10 - Manner of allocation.
Code of Federal Regulations, 2010 CFR
2010-07-01
... benefits under the plan using the rules and procedures set forth in paragraphs (b) through (f) of this... terminated plan shall be assigned to one or more priority categories in accordance with §§ 4044.11 through 4044.16. Benefits derived from voluntary employee contributions, which are assigned only to priority...
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13 CFR 313.8 - Competitive process.
Code of Federal Regulations, 2010 CFR
2010-01-01
... implementation grant shall be reviewed by EDA in accord with a competitive process as set forth in the applicable FFO, to ensure that EDA awards funds to the most merit-worthy projects. (b) Priority for grants to small- and medium-sized Communities. EDA shall give priority to an application submitted under this part...
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-06-03
... (E.O.) 13563, ``Improving Regulation and Regulatory Review.'' The E.O. sets forth principles and... resources and regulatory priorities, under which the agency will periodically review its existing... retrospective analysis. The Council's plan has tentatively identified eight priority initiatives for new or...
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5 CFR 302.105 - Special agency plans.
Code of Federal Regulations, 2010 CFR
2010-01-01
... preference or priority consideration referred to in sections 1302(c) or 8151 of title 5, United States Code, but which does not conform to all the procedural requirements set forth in this part. The agency establishing such a system must ensure that all eligible applicants entitled to veteran preference or priority...
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Long-term priority effects among insects and fungi colonizing decaying wood.
Weslien, Jan; Djupström, Line B; Schroeder, Martin; Widenfalk, Olof
2011-11-01
1. Priority effects have been hypothesized to have long-lasting impact on community structure in natural ecosystems. Long-term studies of priority effects in natural ecosystems are however sparse, especially in terrestrial ecosystems. 2. Wood decay is a slow process involving a high diversity of insect and fungus species. Species interactions that drive change in communities of insects and fungi during wood decay are poorly understood because of a lack of sufficient long-term studies. 3. In this paper, we followed the colonization and succession of wood-living insects and fungi on cut trees during 15 years, from tree death and onwards, in a boreal forest landscape. We test the long-term priority effects hypothesis that the identity and abundance of species that colonize first affect the colonization success of later-arriving species. We also hypothesize that species interact in both facilitative and inhibitory ways, which ultimately affect habitat quality for a red-listed late-succession beetle species. 4. Possible causal associations between species were explored by path analysis. The results indicate that one bark beetle species, Hylurgops palliatus, and one wood-borer species, Monochamus sutor, which colonized the wood during the first year after cutting, influenced the occurrence of a rare, wood-living beetle, Peltis grossa, that started to emerge from the stumps about 10 years later. The positive effects of Hylurgops palliatus and negative effects of M. sutor were largely mediated through the wood-decaying fungus species Fomitopsis pinicola. 5. The study shows that variable priority effects may have long-lasting impact on community assembly in decaying wood. The study also exemplifies new possibilities for managing populations of threatened species by exploring links between early, well-understood species guilds and late, more poorly understood species guilds. © 2011 The Authors. Journal of Animal Ecology © 2011 British Ecological Society.
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Social welfare and the Affordable Care Act: is it ever optimal to set aside comparative cost?
Mortimer, Duncan; Peacock, Stuart
2012-10-01
The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Discrimination and Health among Lesbian, Gay, Bisexual and Trans People in Puerto Rico.
Rodríguez-Díaz, Carlos E; Jovet-Toledo, Gerardo G; Vélez-Vega, Carmen M; Ortiz-Sánchez, Edgardo J; Santiago-Rodríguez, Edda I; Vargas-Molina, Ricardo L; Rodríguez Madera, Sheilla L; Mulinelli-Rodríguez, José J
2016-09-01
To identify the experiences of discrimination among and the perceived priorities for the health of lesbian, gay, bisexual, and trans (LGBT) people in Puerto Rico (PR). Data were collected during the 2013 LGBT Pride Parade in San Juan, using a brief self-administered survey that included questions on sociodemographic characteristics, the disclosure of sexual orientation/gender identity, experiences of discrimination, experiences while receiving social and health services, and perceived healthcare priorities and needs. Most participants reported that they had disclosed their sexual orientation to at least one person. Discrimination due to sexual orientation/gender identity was most frequently reported to have occurred in school settings. At least 25% of the sample reported regular or negative experiences based on sexual orientation/gender identity when receiving government services and when looking for support from relatives. HIV/AIDS, mental health, and sexual health were identified as healthcare priorities. In bivariate analyses, mental health services and aging were the priorities most frequently reported among older participants. HIV/AIDS was the main priority only for gay men; sexual health was the main priority for bisexuals; and mental health was the main priority for lesbians. Most participants reported that their preferred modalities for health service provision were support groups and health education. The experiences of discrimination among LGBT people in PR were consistent across age groups and sexual orientation/gender identity. Policies and interventions to address discrimination in different settings are necessary. The findings also suggest the need to prioritize HIV services among gay men and to address mental and sexual health needs among lesbian and bisexual people.
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Rehfuess, Eva A; Durão, Solange; Kyamanywa, Patrick; Meerpohl, Joerg J; Young, Taryn; Rohwer, Anke
2016-04-01
To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.
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Venhorst, Kristie; Zelle, Sten G; Tromp, Noor; Lauer, Jeremy A
2014-01-01
The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales. This study describes the development of a rating tool to assess breast cancer interventions in LMICs. Our tool can offer supporting knowledge for the use or development of rating tools as part of a broader (MCDA based) priority setting exercise in local settings. Further steps for improving the tool are proposed and should lead to its useful adoption in LMICs.
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Attentional priority determines working memory precision.
Klyszejko, Zuzanna; Rahmati, Masih; Curtis, Clayton E
2014-12-01
Visual working memory is a system used to hold information actively in mind for a limited time. The number of items and the precision with which we can store information has limits that define its capacity. How much control do we have over the precision with which we store information when faced with these severe capacity limitations? Here, we tested the hypothesis that rank-ordered attentional priority determines the precision of multiple working memory representations. We conducted two psychophysical experiments that manipulated the priority of multiple items in a two-alternative forced choice task (2AFC) with distance discrimination. In Experiment 1, we varied the probabilities with which memorized items were likely to be tested. To generalize the effects of priority beyond simple cueing, in Experiment 2, we manipulated priority by varying monetary incentives contingent upon successful memory for items tested. Moreover, we illustrate our hypothesis using a simple model that distributed attentional resources across items with rank-ordered priorities. Indeed, we found evidence in both experiments that priority affects the precision of working memory in a monotonic fashion. Our results demonstrate that representations of priority may provide a mechanism by which resources can be allocated to increase the precision with which we encode and briefly store information. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Successfully Adapting to Change.
ERIC Educational Resources Information Center
Baird, James R.
1989-01-01
Describes methods used to successfully adapt to reductions in budget allocations in the University of Utah's Instructional Media Services Department. Three main areas of concern are addressed: morale and staff development; adapting to change in the areas of funding, control, media priorities, and technology; and planning for the future. (LRW)
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Kreofsky, Beth L H; Blegen, R Nicole; Lokken, Troy G; Kapraun, Susan M; Bushman, Matthew S; Demaerschalk, Bart M
2018-04-16
Telemedicine services in medical institutions are often developed in isolation of one another and not as part of a comprehensive telemedicine program. The Center for Connected Care is the administrative home for a broad range of telehealth services at Mayo Clinic. This article speaks of real-time video services, referenced as telemedicine throughout. This article discusses how a large healthcare system designed and built the infrastructure to support a comprehensive telemedicine practice. Based on analysis of existing services, Mayo Clinic developed a multifaceted operational plan that addressed high-priority areas and outlined clear roles and responsibilities of the Center for Connected Care and that of the clinical departments. The plan set priorities and a direction that would lead to long-term success. The plan articulated the governing and operational infrastructure necessary to support telemedicine by defining the role of the Center for Connected Care as the owner of core administrative operations and the role of the clinical departments as the owners of clinical telemedicine services. Additional opportunities were identified to develop product selection processes, implementation services, and staffing models that would be applied to ensure successful telemedicine deployment. The telemedicine team within the Center for Connected Care completed 45 business cases resulting in 54 implementations. The standardization of core products along with key operational offerings around implementation services, and the establishment of a 24/7 support model resulted in improved provider satisfaction and fewer reported technical issues. The foundation for long-term scalability and growth was developed by centralizing operations of telemedicine services, implementing sustainable processes, employing dedicated qualified personnel, and deploying robust products.
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Chalmers, James D; Crichton, Megan; Goeminne, Pieter C; Loebinger, Michael R; Haworth, Charles; Almagro, Marta; Vendrell, Montse; De Soyza, Anthony; Dhar, Raja; Morgan, Lucy; Blasi, Francesco; Aliberti, Stefano; Boyd, Jeanette; Polverino, Eva
2017-09-01
In contrast to airway diseases like chronic obstructive pulmonary disease or asthma, and rare diseases such as cystic fibrosis, there has been little research and few clinical trials in bronchiectasis. Guidelines are primarily based on expert opinion and treatment is challenging because of the heterogeneous nature of the disease. In an effort to address decades of underinvestment in bronchiectasis research, education and clinical care, the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) was established in 2012 as a collaborative pan-European network to bring together bronchiectasis researchers. The European Respiratory Society officially funded EMBARC in 2013 as a Clinical Research Collaboration, providing support and infrastructure to allow the project to grow. EMBARC has now established an international bronchiectasis registry that is active in more than 30 countries both within and outside Europe. Beyond the registry, the network participates in designing and facilitating clinical trials, has set international research priorities, promotes education and has participated in producing the first international bronchiectasis guidelines. This manuscript article the development, structure and achievements of EMBARC from 2012 to 2017. To understand the role of Clinical Research Collaborations as the major way in which the European Respiratory Society can stimulate clinical research in different disease areasTo understand some of the key features of successful disease registriesTo review key epidemiological, clinical and translational studies of bronchiectasis contributed by the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) project in the past 5 yearsTo understand the key research priorities identified by EMBARC for the next 5 years.
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Crichton, Megan; Goeminne, Pieter C.; Loebinger, Michael R.; Haworth, Charles; Almagro, Marta; Vendrell, Montse; De Soyza, Anthony; Dhar, Raja ; Morgan, Lucy; Blasi, Francesco; Aliberti, Stefano; Boyd, Jeanette; Polverino, Eva
2017-01-01
In contrast to airway diseases like chronic obstructive pulmonary disease or asthma, and rare diseases such as cystic fibrosis, there has been little research and few clinical trials in bronchiectasis. Guidelines are primarily based on expert opinion and treatment is challenging because of the heterogeneous nature of the disease. In an effort to address decades of underinvestment in bronchiectasis research, education and clinical care, the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) was established in 2012 as a collaborative pan-European network to bring together bronchiectasis researchers. The European Respiratory Society officially funded EMBARC in 2013 as a Clinical Research Collaboration, providing support and infrastructure to allow the project to grow. EMBARC has now established an international bronchiectasis registry that is active in more than 30 countries both within and outside Europe. Beyond the registry, the network participates in designing and facilitating clinical trials, has set international research priorities, promotes education and has participated in producing the first international bronchiectasis guidelines. This manuscript article the development, structure and achievements of EMBARC from 2012 to 2017. Educational aims To understand the role of Clinical Research Collaborations as the major way in which the European Respiratory Society can stimulate clinical research in different disease areas To understand some of the key features of successful disease registries To review key epidemiological, clinical and translational studies of bronchiectasis contributed by the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) project in the past 5 years To understand the key research priorities identified by EMBARC for the next 5 years PMID:28894479
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Hoekstra, Dyon; Mütsch, Margot; Kien, Christina; Gerhardus, Ansgar; Lhachimi, Stefan K
2017-08-04
The Cochrane Collaboration aims to produce relevant and top priority evidence that responds to existing evidence gaps. Hence, research priority setting (RPS) is important to identify which potential research gaps are deemed most important. Moreover, RPS supports future health research to conform both health and health evidence needs. However, studies that are prioritising systematic review topics in public health are surprisingly rare. Therefore, to inform the research agenda of Cochrane Public Health Europe (CPHE), we introduce the protocol of a priority setting study on systematic review topics in several European countries, which is conceptualised as pilot. We will conduct a two-round modified Delphi study in Switzerland, incorporating an anonymous web-based questionnaire, to assess which topics should be prioritised for systematic reviews in public health. In the first Delphi round public health stakeholders will suggest relevant assessment criteria and potential priority topics. In the second Delphi round the participants indicate their (dis)agreement to the aggregated results of the first round and rate the potential review topics with the predetermined criteria on a four-point Likert scale. As we invite a wide variety of stakeholders we will compare the results between the different stakeholder groups. We have received ethical approval from the ethical board of the University of Bremen, Germany (principal investigation is conducted at the University of Bremen) and a certificate of non-objection from the Canton of Zurich, Switzerland (fieldwork will be conducted in Switzerland). The results of this study will be further disseminated through peer reviewed publication and will support systematic review author groups (i.a. CPHE) to improve the relevance of the groups´ future review work. Finally, the proposed priority setting study can be used as a framework by other systematic review groups when conducting a priority setting study in a different context. © 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.
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Cowman, Seamus; Gethin, Georgina; Clarke, Eric; Moore, Zena; Craig, Gerardine; Jordan-O'Brien, Julie; McLain, Niamh; Strapp, Helen
2012-02-01
To incorporate an international and multidisciplinary consensus in the determination of the research and education priorities for wound healing and tissue repair. A compelling reason for the study is the lack of an agreed list of priorities for wound care research and education. Furthermore, there is a growth in the prevalence of chronic wounds, a growth in wound care products and marketing, and an increase in clinician attendance at conferences and education programmes. The study used a survey method. A four-round eDelphi technique was used to collect responses from an international population of health professionals across 24 countries. Responses were obtained from 360 professionals representing many health care settings. The top education priorities related to the standardisation of all foundation education programmes in wound care, the inclusion of wound care in all professional undergraduate and postgraduate education programmes, selecting dressings and the prevention of pressure ulcers. The top research priorities related to the dressing selection, pressure ulcer prevention and wound infection. conclusion: Professionals from different backgrounds and countries who are engaged in wound management share a common set of priorities for research and education. Most notably, the priorities identified relate to long-established clinical challenges in wound care and underpin the principles of good patient care practices. The priorities are closely allied to an ageing population and identify many challenges ahead for practitioners engaged in wound management services. The provision of wound care is a major investment of health service resources and remains a clinical challenge today. Research is essential to building evidence-based practice and fundamental to development of quality in standards of practice; education is central to achieving competence to deliver effective care. The determination of research and education priorities is therefore an absolute requirement in developing services. © 2011 Blackwell Publishing Ltd.
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Priority service needs and receipt across the lifespan for individuals with autism spectrum disorder
Lai, Jonathan K. Y.
2017-01-01
Abstract Individuals with Autism Spectrum Disorder (ASD) have a range of health, community, and social support needs across the lifespan that create age‐specific challenges in navigating service sectors. In this study, we set out to identify the priority needs of individuals with ASD across the lifespan, and the factors that predict receiving priority services. Participants included 3,317 individuals with ASD from a Canada‐wide online caregiver survey, stratified into five age groups (preschool, elementary school age, adolescence, emerging adulthood, adulthood). Priority receipt was calculated as a ratio of current services that corresponded to individualized priority need. Age‐stratified Poisson regression analyses were used to identify the sociodemographic, clinical and systemic predictors of priority receipt. Results indicate that the distribution of priority need varied by age, except for social skills programming, which was a high across all groups. The number of high and moderate priority needs diversified with age. Overall, 30% of individuals had none of their priority needs met and priority receipt decreased with age. Systemic factors were most consistently related to priority receipt across the lifespan. Understanding patterns and correlates of priority needs and use that currently exist in different age groups can inform policies to improve service access. Autism Res 2017, 10: 1436–1447. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. PMID:28383156
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Lee, Rebekka M; Ramanadhan, Shoba; Kruse, Gina R; Deutsch, Charles
2018-01-01
Background: Strong partnerships are critical to integrate evidence-based prevention interventions within clinical and community-based settings, offering multilevel and sustainable solutions to complex health issues. As part of Massachusetts' 2012 health reform, The Prevention and Wellness Trust Fund (PWTF) funded nine local partnerships throughout the state to address hypertension, pediatric asthma, falls among older adults, and tobacco use. The initiative was designed to improve health outcomes through prevention and disease management strategies and reduce healthcare costs. Purpose: Describe the mixed-methods study design for investigating PWTF implementation. Methods: The Consolidated Framework for Implementation Research guided the development of this evaluation. First, the study team conducted semi-structured qualitative interviews with leaders from each of nine partnerships to document partnership development and function, intervention adaptation and delivery, and the influence of contextual factors on implementation. The interview findings were used to develop a quantitative survey to assess the implementation experiences of 172 staff from clinical and community-based settings and a social network analysis to assess changes in the relationships among 72 PWTF partner organizations. The quantitative survey data on ratings of perceived implementation success were used to purposively select 24 staff for interviews to explore the most successful experiences of implementing evidence-based interventions for each of the four conditions. Conclusions: This mixed-methods approach for evaluation of implementation of evidence-based prevention interventions by PWTF partnerships can help decision-makers set future priorities for implementing and assessing clinical-community partnerships focused on prevention.
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Evaluating International Research Ethics Capacity Development: An Empirical Approach
Ali, Joseph; Kass, Nancy E.; Sewankambo, Nelson K.; White, Tara D.; Hyder, Adnan A.
2014-01-01
The US National Institutes of health, Fogarty International Center (NIH-FIC) has, for the past 13 years, been a leading funder of international research ethics education for resource-limited settings. Nearly half of the NIH-FIC funding in this area has gone to training programs that train individuals from sub-Saharan Africa. Identifying the impact of training investments, as well as the potential predictors of post-training success, can support curricular decision-making, help establish funding priorities, and recognize the ultimate outcomes of trainees and training programs. Comprehensive evaluation frameworks and targeted evaluation tools for bioethics training programs generally, and for international research ethics programs in particular, are largely absent from published literature. This paper shares an original conceptual framework, data collection tool, and detailed methods for evaluating the inputs, processes, outputs, and outcomes of research ethics training programs serving individuals in resource-limited settings. This paper is part of a collection of papers analyzing the Fogarty International Center’s International Research Ethics Education and Curriculum Development program. PMID:24782071
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NASA Strategic Roadmap: Origin, Evolution, Structure, and Destiny of the Universe
NASA Technical Reports Server (NTRS)
White, Nicholas E.
2005-01-01
The NASA strategic roadmap on the Origin, Evolution, Structure and Destiny of the Universe is one of 13 roadmaps that outline NASA s approach to implement the vision for space exploration. The roadmap outlines a program to address the questions: What powered the Big Bang? What happens close to a Black Hole? What is Dark Energy? How did the infant universe grow into the galaxies, stars and planets, and set the stage for life? The roadmap builds upon the currently operating and successful missions such as HST, Chandra and Spitzer. The program contains two elements, Beyond Einstein and Pathways to Life, performed in three phases (2005-2015, 2015-2025 and >2025) with priorities set by inputs received from reviews undertaken by the National Academy of Sciences and technology readiness. The program includes the following missions: 2005-2015 GLAST, JWST and LISA; 2015-2025 Constellation-X and a series of Einstein Probes; and >2025 a number of ambitious vision missions which will be prioritized by results from the previous two phases.
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Predictors of Higher Technological Education Graduates' Labour Market Entrance Success
ERIC Educational Resources Information Center
Kostoglou, Vassilis; Garmpis, Aristogiannis; Koilias, Christos; Van der Heijden, Beatrice
2011-01-01
Nowadays, the successful transition of graduates from university into the world of work is one of the most important priorities of all involved stakeholders: governments, institutions of higher education, and individuals, as well as researchers. The present study analyzes the employability characteristics of higher technological education…
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A Comparison of Student Success by Faculty Qualifications
ERIC Educational Resources Information Center
Garner, Kristine A.
2012-01-01
Providing the best qualified faculty to ensure the most successful student outcomes is a priority in higher education. The use of adjunct faculty in colleges and universities is continually increasing, especially for lower level courses. Previous research has come to conflicting conclusions regarding the quality of adjunct faculty. Indicators of…
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Factors for Success: Academic Library Development Survey Results.
ERIC Educational Resources Information Center
Hoffman, Irene M.; Smith, Amy; DiBona, Leslie
2000-01-01
Discusses the results of a nationwide survey (57 survey questions) of academic libraries that investigated fund-raising programs, including personnel involved; goals and costs of fund-raising; library donors, friends, and advisory groups; priorities; and factors of success, including involvement of the director and time on task. A copy of the…
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Rangan, Amar; Upadhaya, Sheela; Regan, Sandra; Toye, Francine; Rees, Jonathan L
2016-04-11
To run a UK based James Lind Alliance Priority Setting Partnership for 'Surgery for Common Shoulder Problems'. This was a nationally funded and conducted process. It was organised from a musculoskeletal research centre and Biomedical Research Unit in Oxford. UK shoulder patients, carers and clinicians, involved in treating patients with shoulder pain and shoulder problems that might require surgery. These were national electronic and paper surveys capturing treatment uncertainties that are important to shoulder patients, carers and clinicians. The outcomes relevant to this study were the survey results and rankings. The process took 18 months to complete, with 371 participants contributing 404 in scope questions. The James Lind process then produced a final 10 research priorities and uncertainties that relate to the scope of 'Surgery for Common Shoulder Problems'. The final top 10 UK research priorities have been produced and are now being disseminated to partner organisations and funders to guide funding of shoulder research for the next 5-10 years on topics that are important to patients, their carers and clinicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Invasion resistance arises in strongly interacting species-rich model competition communities.
Case, T J
1990-01-01
I assemble stable multispecies Lotka-Volterra competition communities that differ in resident species number and average strength (and variance) of species interactions. These are then invaded with randomly constructed invaders drawn from the same distribution as the residents. The invasion success rate and the fate of the residents are determined as a function of community-and species-level properties. I show that the probability of colonization success for an invader decreases with community size and the average strength of competition (alpha). Communities composed of many strongly interacting species limit the invasion possibilities of most similar species. These communities, even for a superior invading competitor, set up a sort of "activation barrier" that repels invaders when they invade at low numbers. This "priority effect" for residents is not assumed a priori in my description for the individual population dynamics of these species; rather it emerges because species-rich and strongly interacting species sets have alternative stable states that tend to disfavor species at low densities. These models point to community-level rather than invader-level properties as the strongest determinant of differences in invasion success. The probability of extinction for a resident species increases with community size, and the probability of successful colonization by the invader decreases. Thus an equilibrium community size results wherein the probability of a resident species' extinction just balances the probability of an invader's addition. Given the distribution of alpha it is now possible to predict the equilibrium species number. The results provide a logical framework for an island-biogeographic theory in which species turnover is low even in the face of persistent invasions and for the protection of fragile native species from invading exotics. PMID:11607132
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Public purchasing and private priorities for healthcare in New Zealand.
Howden-Chapman, P; Ashton, T
2000-11-01
The 1993 Health and Disability Services Act heralded a range of structural reforms in the New Zealand health care system. Despite these reforms considerable resources being spent on convincing consumers of their merits, have failed to gain widespread public approval. This paper examines two key issues that have arisen during the reform process. These are the difficulties associated with trying to set priorities in ways which are effective and politically acceptable, and the relationship between the public and private sectors. Unacknowledged conflicts of interest have helped to undermine the priority setting process. The discussion suggests that it may be increasingly difficult for any government in future to determine the allocation of resources without taking private sector interests and rising public concern into account. It remains to be seen which of these factors is more powerful.
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Health Care Priorities: Opinions of One State's Citizens and Legislators.
ERIC Educational Resources Information Center
Jankel, Charlotte A.; And Others
1994-01-01
Reports a study that examined the attitudes of Georgia citizens and legislators toward funding for specific health care services and national health insurance. Legislators were less in favor of national health insurance than were citizens. Both groups set a high priority on providing a wide range of health care services to everyone. (SM)
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Robert S. Motroni; Daniel A. Airola; Robin K. Ma rose; Nancy D. Tosta
1991-01-01
A geographic information system was used to assess wildlife species richness (number of species) in valley-foothill hardwood habitats throughout California to set priorities for conservation attention. Species richness values were assessed and compared using three methods: one that included all species without considering canopy cover conditions and species preferences...
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Setting numerical population objectives for priority landbird species
Kenneth V. Rosenberg; Peter J. Blancher
2005-01-01
Following the example of the North American Waterfowl Management Plan, deriving numerical population estimates and conservation targets for priority landbird species is considered a desirable, if not necessary, element of the Partners in Flight planning process. Methodology for deriving such estimates remains in its infancy, however, and the use of numerical population...
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Ex situ conservation priorities for the wild relatives of potato (Solanum L. section Petota)
USDA-ARS?s Scientific Manuscript database
We analyzed the contemporary ex situ conservation coverage of the wild relatives of cultivated potato (Solanum section Petota) to set priorities and guide future collections and conservation. We conducted a gap analysis for 73 taxa involving seven, 63 and three species from the primary, secondary an...
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Rogge, Jana; Kittel, Bernhard
2016-01-01
The principle of distributing health care according to medical need is being challenged by increasing costs. As a result, many countries have initiated a debate on the introduction of explicit priority regulations based on medical, economic and person-based criteria, or have already established such regulations. Previous research on individual attitudes towards setting health care priorities based on medical and economic criteria has revealed consistent results, whereas studies on the use of person-based criteria have generated controversial findings. This paper examines citizens' attitudes towards three person-based priority criteria, patients' smoking habits, age and being the parent of a young child. Using data from the ISSP Health Module (2011) in 28 countries, logistic regression analysis demonstrates that self-interest as well as socio-demographic predictors significantly influence respondents' attitudes towards the use of person-based criteria for health care prioritization. This study contributes to resolving the controversial findings on person-based criteria by using a larger country sample and by controlling for country-level differences with fixed effects models.
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48 CFR 19.502-3 - Partial set-asides.
Code of Federal Regulations, 2010 CFR
2010-10-01
... non-set-aside part of the acquisition shall have first priority with respect to negotiations for the... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Partial set-asides. 19.502... SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS Set-Asides for Small Business 19.502-3 Partial set-asides. (a...
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Space astronomy and astrophysics program by NASA
NASA Astrophysics Data System (ADS)
Hertz, Paul L.
2014-07-01
The National Aeronautics and Space Administration recently released the NASA Strategic Plan 20141, and the NASA Science Mission Directorate released the NASA 2014 Science Plan3. These strategic documents establish NASA's astrophysics strategic objectives to be (i) to discover how the universe works, (ii) to explore how it began and evolved, and (iii) to search for life on planets around other stars. The multidisciplinary nature of astrophysics makes it imperative to strive for a balanced science and technology portfolio, both in terms of science goals addressed and in missions to address these goals. NASA uses the prioritized recommendations and decision rules of the National Research Council's 2010 decadal survey in astronomy and astrophysics2 to set the priorities for its investments. The NASA Astrophysics Division has laid out its strategy for advancing the priorities of the decadal survey in its Astrophysics 2012 Implementation Plan4. With substantial input from the astrophysics community, the NASA Advisory Council's Astrophysics Subcommittee has developed an astrophysics visionary roadmap, Enduring Quests, Daring Visions5, to examine possible longer-term futures. The successful development of the James Webb Space Telescope leading to a 2018 launch is an Agency priority. One important goal of the Astrophysics Division is to begin a strategic mission, subject to the availability of funds, which follows from the 2010 decadal survey and is launched after the James Webb Space Telescope. NASA is studying a Wide Field Infrared Survey Telescope as its next large astrophysics mission. NASA is also planning to partner with other space agencies on their missions as well as increase the cadence of smaller Principal Investigator led, competitively selected Astrophysics Explorers missions.
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Cleary, Susan; Molyneux, Sassy; English, Mike
2017-01-01
Abstract This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions. PMID:27679522
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Barasa, Edwine W; Cleary, Susan; Molyneux, Sassy; English, Mike
2017-04-01
This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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78 FR 43205 - Proposed Substances To Be Evaluated for Set 27 Toxicological Profiles
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-19
.... The Set 27 nomination process includes consideration of all substances on ATSDR's Priority List of... No. ATSDR-2013-0002] Proposed Substances To Be Evaluated for Set 27 Toxicological Profiles AGENCY...). ACTION: Request for comments on the proposed substances to be evaluated for Set 27 toxicological profiles...
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Setting priorities for space research: Opportunities and imperatives
NASA Technical Reports Server (NTRS)
1992-01-01
Discussed here is the first phase of a study by a task group convened by the Space Studies Board to ascertain whether it should attempt to develop a methodology for recommending priorities among the various initiatives in space research (that is, scientific activities concerned with phenomena in space or utilizing observations from space). It is argued that such priority statements by the space research community are both necessary and desirable and would contribute to the formulation and implementation of public policy. The establishment of priorities to enhance effective management of the nation's scientific research program in space is advocated. It is argued that scientific objectives and purposes should determine how and under what circumstances research should be done.
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Global land cover mapping and characterization: present situation and future research priorities
Giri, Chandra
2005-01-01
The availability and accessibility of global land cover data sets plays an important role in many global change studies. The importance of such science‐based information is also reflected in a number of international, regional, and national projects and programs. Recent developments in earth observing satellite technology, information technology, computer hardware and software, and infrastructure development have helped developed better quality land cover data sets. As a result, such data sets are increasingly becoming available, the user‐base is ever widening, application areas have been expanding, and the potential of many other applications are enormous. Yet, we are far from producing high quality global land cover data sets. This paper examines the progress in the development of digital global land cover data, their availability, and current applications. Problems and opportunities are also explained. The overview sets the stage for identifying future research priorities needed for operational land cover assessment and monitoring.
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Mitton, Craig; Levy, Adrian; Gorsky, Diane; MacNeil, Christina; Dionne, Francois; Marrie, Tom
2013-07-01
Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.
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Against proportional shortfall as a priority-setting principle.
Altmann, Samuel
2018-05-01
As the demand for healthcare rises, so does the need for priority setting in healthcare. In this paper, I consider a prominent priority-setting principle: proportional shortfall. My purpose is to argue that proportional shortfall, as a principle, should not be adopted. My key criticism is that proportional shortfall fails to consider past health.Proportional shortfall is justified as it supposedly balances concern for prospective health while still accounting for lifetime health, even though past health is deemed irrelevant. Accounting for this lifetime perspective means that the principle may indirectly consider past health by accounting for how far an individual is from achieving a complete, healthy life. I argue that proportional shortfall does not account for this lifetime perspective as it fails to incorporate the fair innings argument as originally claimed, undermining its purported justification.I go on to demonstrate that the case for ignoring past health is weak, and argue that past health is at least sometimes relevant for priority-setting decisions. Specifically, when an individual's past health has a direct impact on current or future health, and when one individual has enjoyed significantly more healthy life years than another.Finally, I demonstrate that by ignoring past illnesses, even those entirely unrelated to their current illness, proportional shortfall can lead to instances of double jeopardy, a highly problematic implication. These arguments give us reason to reject proportional shortfall. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Kitamura, Yuko
2010-12-01
In order to support patients' decision-making regarding cancer treatments, it is important to clarify which criteria that cancer patients use to set priorities in their treatment choices. Using the analytic hierarchy process (AHP), a mathematical decision-making method, this article investigates the criteria and the priorities of patients with gynecological cancer. In the AHP, multiple and hierarchical criteria in the decision-making process were organized by a repeated pairwise judgment of the participants so as to serialize the alternatives along with the rational order of the priorities. For the alternatives "to receive treatment" and "to not receive treatment," the following five criteria were set: "anxiety about relapse and metastasis", "distress about side-effects", "advice of family", "advice of medical staff", and "economic burden". The participants determined a pairwise priority scale, as well as a priority scale between the alternatives for every criterion. The logical consistency of their answers was checked by a consistency index (CI). The participants were 31 patients with ovarian or endometrial cancer who were being followed up after undergoing surgery and adjuvant chemotherapy. Of the participants who answered the questionnaire, 17 satisfied the logical consistency. Of the five criteria for the treatment choices, "anxiety about relapse and metastasis" and "advice of medical staff" were found to be the important factors for treatment choice; however, the weight attached to the priority criteria differed much among the patients. The AHP made it possible to support patients' decision-making in order to clarify their priority criteria and to quantitatively present their decision-making process. © 2010 The Author. Journal compilation © 2010 Japan Academy of Nursing Science.
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Simpson, Paul Leslie; Guthrie, Jill; Butler, Tony
2017-06-12
Purpose Given that prisoners have significant health needs across most areas, the paucity of prisoner health research, and the difficulties involved in the conduct of research in this setting, there is a need to develop research priorities that align with key stakeholder groups. One such group are those responsible for health service provision in prisons - prison health service directors. The paper aims to discuss these issues. Design/methodology/approach Prison health service directors in each Australian state and territory were invited to participate in a national (deliberative) roundtable where the consensus building nominal group technique was utilized. This involved the identification of research priorities and organizational issues in conducting research with prisoners, and ranking research priorities. A thematic analysis was conducted on organizational issues. Findings In total, 13 participants attended the roundtable. Participants identified 28 research priorities and 12 organizational issues. Top ranked research priorities were mental health, cognitive and intellectual disability, post-release health maintenance, ageing prisoners, chronic health conditions and Aboriginal and Torres Strait Islander health. Themes identified from the organizational issues included prisoner access to research participation, health and research literacy of custodial staff, and institutional protectionism in response to research that may discover negative information about the custodial setting. Research limitations/implications These findings should inform future efforts to improve research infrastructures to undertake research to improve the health of people in Australian prisons, and help to align researchers' efforts with those of a key organizational stakeholder. Originality/value This is the first paper to determine the research priorities and organizational issues in conducting research in prisons of prison health service directors.
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What to ask the person in the mirror.
Kaplan, Robert S
2007-01-01
Every leader gets off track from time to time. But as leaders rise through the ranks, they have fewer and fewer opportunities for honest and direct feedback. Their bosses are no longer monitoring their actions, and by the time management missteps have a negative impact on business results, it's usually too late to make course corrections that will set things right. Therefore, it is wise to go through a self-assessment, to periodically step back from the bustle of running a business and ask some key questions of yourself. Author Robert S. Kaplan, who during his 22-year career at Goldman Sachs chaired the firm's senior leadership training efforts and cochaired its partnership committee, identifies seven areas for self-reflection: vision and priorities, managing time, feedback, succession planning, evaluation and alignment, leading under pressure, and staying true to yourself. The author sets out a series of questions in each of the areas, illustrating the impact of self-assessment through vivid accounts of real executives. Although the questions sound simple, people are often shocked-even horrified- by their own answers. Executives are aware that they should be focusing on their most important priorities, for instance, but without stepping back to reflect, few actually know where they are allocating their time. Kaplan advocates writing down what you do every working hour for a week and checking how well your actions match up with your intentions. As for feedback, managers should ask themselves whether they're getting truthful evaluations from their subordinates. (In all likelihood, they aren't). It takes time and discipline to persuade your employees to tell you about your failings.
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Reinterpreting Responsiveness for Health Systems Research in Low and Middle-Income Countries.
Pratt, Bridget; Hyder, Adnan A
2015-07-01
The ethical concept of responsiveness has largely been interpreted in the context of international clinical research. In light of the increasing conduct of externally funded health systems research (HSR) in low- and middle-income countries (LMICs), this article examines how responsiveness might be understood for such research and how it can be applied. It contends that four features (amongst others) set HSR in LMICs apart from international clinical research: a focus on systems; being context-driven; being policy-driven; and being closely linked to development objectives. These features support reinterpreting responsiveness for HSR in LMICs as responsiveness to systems needs, where health system performance assessments can be relied upon to identify systems needs, and/or responsiveness to systems priorities, which entails aligning research with HSR priorities set through country-owned processes involving national and sub-national policymakers from host countries. Both concepts may be difficult to achieve in practice. Country ownership is not an established fact for many countries and alignment to their priorities may be meaningless without it. It is argued that more work is, therefore, needed to identify strategies for how the responsiveness requirement can be ethically fulfilled for HSR in LMICs under non-ideal conditions such as where host countries have not set HSR priorities via country-owned processes. Embeddedness is proposed as one approach that could be the focus of further development. © 2014 John Wiley & Sons Ltd.
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Tomlinson, M; Yasamy, M T; Emerson, E; Officer, A; Richler, D; Saxena, S
2014-12-01
The prevalence of intellectual disabilities (ID) has been estimated at 10.4/1000 worldwide with higher rates among children and adolescents in lower income countries. The objective of this paper is to address research priorities for development disabilities, notably ID and autism, at the global level and to propose the more rational use of scarce funds in addressing this under-investigated area. An expert group was identified and invited to systematically list and score research questions. They applied the priority setting methodology of the Child Health and Nutrition Research Initiative (CHNRI) to generate research questions and to evaluate them using a set of five criteria: answerability, feasibility, applicability and impact, support within the context and equity. The results of this process clearly indicated that the important priorities for future research related to the need for effective and efficient approaches to early intervention, empowerment of families supporting a person with developmental disability and to address preventable causes of poor health in people with ID and autism. For the public health and other systems to become more effective in delivering appropriate support to persons with developmental disabilities, greater (and more targeted) investment in research is required to produce evidence of what works consistent with international human rights standards. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
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Grebely, Jason; Bruneau, Julie; Lazarus, Jeffrey V; Dalgard, Olav; Bruggmann, Philip; Treloar, Carla; Hickman, Matthew; Hellard, Margaret; Roberts, Teri; Crooks, Levinia; Midgard, Håvard; Larney, Sarah; Degenhardt, Louisa; Alho, Hannu; Byrne, Jude; Dillon, John F; Feld, Jordan J; Foster, Graham; Goldberg, David; Lloyd, Andrew R; Reimer, Jens; Robaeys, Geert; Torrens, Marta; Wright, Nat; Maremmani, Icro; Norton, Brianna L; Litwin, Alain H; Dore, Gregory J
2017-09-01
Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7.5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection. Copyright © 2017 Elsevier B.V. All rights reserved.
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Identifying acne treatment uncertainties via a James Lind Alliance Priority Setting Partnership
Layton, Alison; Eady, E Anne; Peat, Maggie; Whitehouse, Heather; Levell, Nick; Ridd, Matthew; Cowdell, Fiona; Patel, Mahenda; Andrews, Stephen; Oxnard, Christine; Fenton, Mark; Firkins, Lester
2015-01-01
Objectives The Acne Priority Setting Partnership (PSP) was set up to identify and rank treatment uncertainties by bringing together people with acne, and professionals providing care within and beyond the National Health Service (NHS). Setting The UK with international participation. Participants Teenagers and adults with acne, parents, partners, nurses, clinicians, pharmacists, private practitioners. Methods Treatment uncertainties were collected via separate online harvesting surveys, embedded within the PSP website, for patients and professionals. A wide variety of approaches were used to promote the surveys to stakeholder groups with a particular emphasis on teenagers and young adults. Survey submissions were collated using keywords and verified as uncertainties by appraising existing evidence. The 30 most popular themes were ranked via weighted scores from an online vote. At a priority setting workshop, patients and professionals discussed the 18 highest-scoring questions from the vote, and reached consensus on the top 10. Results In the harvesting survey, 2310 people, including 652 professionals and 1456 patients (58% aged 24 y or younger), made submissions containing at least one research question. After checking for relevance and rephrasing, a total of 6255 questions were collated into themes. Valid votes ranking the 30 most common themes were obtained from 2807 participants. The top 10 uncertainties prioritised at the workshop were largely focused on management strategies, optimum use of common prescription medications and the role of non-drug based interventions. More female than male patients took part in the harvesting surveys and vote. A wider range of uncertainties were provided by patients compared to professionals. Conclusions Engaging teenagers and young adults in priority setting is achievable using a variety of promotional methods. The top 10 uncertainties reveal an extensive knowledge gap about widely used interventions and the relative merits of drug versus non-drug based treatments in acne management. PMID:26187120
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Metzler, Marilyn M.; Higgins, Donna L.; Beeker, Carolyn G.; Freudenberg, Nicholas; Lantz, Paula M.; Senturia, Kirsten D.; Eisinger, Alison A.; Viruell-Fuentes, Edna A.; Gheisar, Bookda; Palermo, Ann-Gel; Softley, Donald
2003-01-01
Objective. This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. Methods. We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships’ development. Results. Activities critical in partnership development include sharing decisionmaking, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. Conclusions. The URC experiences suggest that CBPR can be successfully implemented in diverse settings. PMID:12721148
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A real-time data-acquisition and analysis system with distributed UNIX workstations
NASA Astrophysics Data System (ADS)
Yamashita, H.; Miyamoto, K.; Maruyama, K.; Hirosawa, H.; Nakayoshi, K.; Emura, T.; Sumi, Y.
1996-02-01
A compact data-acquisition system using three RISC/UNIX™ workstations (SUN™/SPARCstation™) with real-time capabilities of monitoring and analysis has been developed for the study of photonuclear reactions with the large-acceptance spectrometer TAGX. One workstation acquires data from memory modules in the front-end electronics (CAMAC and TKO) with a maximum speed of 300 Kbytes/s, where data size times instantaneous rate is 1 Kbyte × 300 Hz. Another workstation, which has real-time capability for run monitoring, gets the data with a buffer manager called NOVA. The third workstation analyzes the data and reconstructs the event. In addition to a general hardware and software description, priority settings and run control by shell scripts are described. This system has recently been used successfully in a two month long experiment.
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Following Suit: Using Conversation Cards for Priority Setting in Pediatric Weight Management.
Kebbe, Maryam; Byrne, Jillian L S; Damanhoury, Samah; Ball, Geoff D C
To describe families' selections of Conversation Cards (CCs), a priority-setting tool in pediatric weight management, and examine CC-related differences based on families' anthropometric and sociodemographic characteristics. A retrospective medical record review was conducted of 2- to 17-year-olds with obesity and their families who enrolled in a pediatric weight management clinic between January, 2012 and September, 2016. Medical records of 146 children were included. On average, families selected 10 ± 6 CCs (range, 3-32 CCs); only 50% of families (n = 73) indicated perceived readiness to make healthy changes. Adolescents (vs children) revealed less healthy eating behaviors (P = .001) and physical activity habits (P = .002). Goal setting was perceived to be a motivator across several sociodemographic characteristics (all P < .05). The CCs were useful in describing families' priorities. The diversity of issues identified by families highlighted the importance of multidisciplinary expertise in pediatric weight management. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.