WorldWideScience

Sample records for challenges priority settings

  1. Health care priority setting: principles, practice and challenges

    Directory of Open Access Journals (Sweden)

    Donaldson Cam

    2004-04-01

    Full Text Available Abstract 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.

  2. Public involvement in health priority setting: future challenges for policy, research and society.

    Science.gov (United States)

    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.

  3. Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services.

    Science.gov (United States)

    Norheim, Ole F

    2016-05-11

    Priority setting is inevitable on the path towards universal health coverage. All countries experience a gap between their population's health needs and what is economically feasible for governments to provide. Can priority setting ever be fair and ethically acceptable? Fairness requires that unmet health needs be addressed, but in a fair order. Three criteria for priority setting are widely accepted among ethicists: cost-effectiveness, priority to the worse-off, and financial risk protection. Thus, a fair health system will expand coverage for cost-effective services and give extra priority to those benefiting the worse-off, whilst at the same time providing high financial risk protection. It is considered unacceptable to treat people differently according to their gender, race, ethnicity, religion, sexual orientation, social status, or place of residence. Inequalities in health outcomes associated with such personal characteristics are therefore unfair and should be minimized. This commentary also discusses a third group of contested criteria, including rare diseases, small health benefits, age, and personal responsibility for health, subsequently rejecting them. In conclusion, countries need to agree on criteria and establish transparent and fair priority setting processes.

  4. Setting quality and safety priorities in a target-rich environment: an academic medical center's challenge.

    Science.gov (United States)

    Mort, Elizabeth A; Demehin, Akinluwa A; Marple, Keith B; McCullough, Kathryn Y; Meyer, Gregg S

    2013-08-01

    Hospitals are continually challenged to provide safer and higher-quality patient care despite resource constraints. With an ever-increasing range of quality and safety targets at the national, state, and local levels, prioritization is crucial in effective institutional quality goal setting and resource allocation.Organizational goal-setting theory is a performance improvement methodology with strong results across many industries. The authors describe a structured goal-setting process they have established at Massachusetts General Hospital for setting annual institutional quality and safety goals. Begun in 2008, this process has been conducted on an annual basis. Quality and safety data are gathered from many sources, both internal and external to the hospital. These data are collated and classified, and multiple approaches are used to identify the most pressing quality issues facing the institution. The conclusions are subject to stringent internal review, and then the top quality goals of the institution are chosen. Specific tactical initiatives and executive owners are assigned to each goal, and metrics are selected to track performance. A reporting tool based on these tactics and metrics is used to deliver progress updates to senior hospital leadership.The hospital has experienced excellent results and strong organizational buy-in using this effective, low-cost, and replicable goal-setting process. It has led to improvements in structural, process, and outcomes aspects of quality.

  5. Healthcare priority setting in Kenya

    DEFF Research Database (Denmark)

    Bukachi, Salome A.; Onyango-Ouma, Washington; Siso, Jared Maaka

    2014-01-01

    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...

  6. Involving decision-makers in the research process: Challenges of implementing the accountability for reasonableness approach to priority setting at the district level in Tanzania.

    Science.gov (United States)

    Maluka, Stephen; Kamuzora, Peter; Ndawi, Benedict; Hurtig, Anna-Karin

    2014-01-01

    The past two decades have seen a growing call for researchers, policy-makers and health care providers to collaborate in efforts to bridge the gaps between research, policy and practice. However, there has been a little attention focused on documenting the challenges of dealing with decision-makers in the course of implementing a research project. This paper highlights a collaborative research project aiming to implement the accountability for reasonableness (AFR) approach to priority setting in accordance with the Response to Accountable Priority Setting for Trust in Health Systems (REACT) project in Tanzania. Specifically, the paper examines the challenges of dealing with decision-makers during the project-implementation process and shows how the researchers dealt with the decision-makers to facilitate the implementation of the REACT project. Key informant interviews were conducted with the Council Health Management Team (CHMT), local government officials and other stakeholders, using a semi-structured interview guide. Minutes of the Action Research Team and CHMT were analysed. Additionally, project-implementation reports were analysed and group priority-setting processes in the district were observed. The findings show that the characteristics of the REACT research project, the novelty of some aspects of the AFR approach, such as publicity and appeals, the Action Research methodology used to implement the project and the traditional cultural contexts within which the project was implemented, created challenges for both researchers and decision-makers, which consequently slowed down the implementation of the REACT project. While collaboration between researchers and decision-makers is important in bridging gaps between research and practice, it is imperative to understand the challenges of dealing with decision-makers in the course of implementing a collaborative research project. Such analyses are crucial in designing proper strategies for improved communication

  7. Promoting community participation in priority setting in district health systems

    DEFF Research Database (Denmark)

    Kamuzora, Peter; Maluka, Stephen; Ndawi, Benedict

    2013-01-01

    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...... of implementing community participation and the challenges of promoting it in the context of resource-poor settings, weak organizations, and fragile democratic institutions....... 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...

  8. Setting Priorities Personal Values, Organizational Results

    CERN Document Server

    (CCL), Center for Creative Leadership

    2011-01-01

    To be a successful leader, you need to 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 expectations. In this way you can successfully meet organizational objectives and consistently produce results.

  9. Priority setting in the REACH system.

    Science.gov (United States)

    Hansson, Sven Ove; Rudén, Christina

    2006-04-01

    Due to the large number of chemicals for which toxicological and ecotoxicological information is lacking, priority setting for data acquisition is a major concern in chemicals regulation. In the current European system, two administrative priority-setting criteria are used, namely novelty (i.e., time of market introduction) and production volume. In the proposed Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) system, the novelty criterion is no longer used, and production volume will be the main priority-setting criterion for testing requirements, supplemented in some cases with hazard indications obtained from QSAR modelling. This system for priority setting has severe weaknesses. In this paper we propose that a multicriteria system should be developed that includes at least three additional criteria: chemical properties, results from initial testing in a tiered system, and voluntary testing for which efficient incentives can be created. Toxicological and decision-theoretical research is needed to design testing systems with validated priority-setting mechanisms.

  10. Decentralized health care priority-setting in Tanzania

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San

    2010-01-01

    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......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...... 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...

  11. Priority setting: what constitutes success? A conceptual framework for successful priority setting

    Directory of Open Access Journals (Sweden)

    Sibbald Shannon L

    2009-03-01

    Full Text Available Abstract 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.

  12. Setting priorities for space research: An experiment in methodology

    Science.gov (United States)

    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.

  13. Six common mistakes in conservation priority setting.

    Science.gov (United States)

    Game, Edward T; Kareiva, Peter; Possingham, Hugh P

    2013-06-01

    A vast number of prioritization schemes have been developed to help conservation navigate tough decisions about the allocation of finite resources. However, the application of quantitative approaches to setting priorities in conservation frequently includes mistakes that can undermine their authors' intention to be more rigorous and scientific in the way priorities are established and resources allocated. Drawing on well-established principles of decision science, we highlight 6 mistakes commonly associated with setting priorities for conservation: not acknowledging conservation plans are prioritizations; trying to solve an ill-defined problem; not prioritizing actions; arbitrariness; hidden value judgments; and not acknowledging risk of failure. We explain these mistakes and offer a path to help conservation planners avoid making the same mistakes in future prioritizations.

  14. Priority Setting, Cost-Effectiveness, and the Affordable Care Act.

    Science.gov (United States)

    Persad, Govind

    2015-01-01

    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  15. Priority setting for health in emerging markets.

    Science.gov (United States)

    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.

  16. Priority setting and cardiac surgery: a qualitative case study.

    Science.gov (United States)

    Walton, Nancy A; Martin, Douglas K; Peter, Elizabeth H; Pringle, Dorothy M; Singer, Peter A

    2007-03-01

    The purpose of this study is to describe priority setting in cardiac surgery and evaluate it using an ethical framework, "accountability for reasonableness". Cardiac surgery is an expensive part of hospital budgets. Priority setting decisions are made daily regarding ever increasing volumes of patients. While much attention has been paid to the management of cardiac surgery waiting lists, little empirical research exists into the way actual decision makers deliberate upon and resolve priority setting decisions on a daily basis. A key goal of priority setting, in cardiac surgical areas as well as others, is fairness. "Accountability for reasonableness" is a leading ethical framework for fair priority setting, and can be used to identify opportunities for improvement (i.e. make it fairer) and highlight good practices. A case study was conducted to examine the process of priority setting processes at three University of Toronto affiliated cardiac surgery centres. Relevant documents were examined, weekly triage rounds were observed for 27 months, and interviews were carried out with 23 key participants including cardiac surgeons, cardiologists, and triage nurses. In data analysis, the conditions of "accountability for reasonableness" (relevance, publicity, appeals and enforcement) were used as an analytic lens. While decisions may appear to be based strictly upon clinical criteria (e.g. coronary anatomy); non-clinical criteria also have an impact upon decision-making (e.g. patients' lifestyle choices, type of surgical practice and departmental constraints on resource use). Participants stated that these factors influence their decision-making and can result in unfair and inconsistent decisions. PUBLICITY: Non-clinical reasons are not publicly accessible, nor are they clearly acknowledged in discussions between cardiac clinicians. APPEALS: There are mechanisms for challenging decisions however without access to the non-clinical reasons, this can be problematic

  17. Priority setting and the 'neglected' tropical diseases.

    Science.gov (United States)

    Canning, David

    2006-06-01

    In this paper David Canning argues that interventions against 'neglected' tropical diseases should be thought of as investments in human capital and form an integral part of global poverty reduction. He argues that overall burden of disease should not be the criterion for priority setting; if the goal is to maximize health benefits from a fixed health budget then cost-effective interventions should be prioritized. Whilst many people find objectionable the assignment of a monetary value to health, a cost-benefit approach, combining health and economic benefits, would allow the health sector to present arguments to policy makers, based on the rate of return on investment. Since many health interventions in low-income countries have exceptionally high rankings in terms of cost-benefit ratios, this should result in large flows from other sectors to the health sector.

  18. Six Common Mistakes in Conservation Priority Setting

    Science.gov (United States)

    Game, Edward T; Kareiva, Peter; Possingham, Hugh P

    2013-01-01

    Abstract A vast number of prioritization schemes have been developed to help conservation navigate tough decisions about the allocation of finite resources. However, the application of quantitative approaches to setting priorities in conservation frequently includes mistakes that can undermine their authors’ intention to be more rigorous and scientific in the way priorities are established and resources allocated. Drawing on well-established principles of decision science, we highlight 6 mistakes commonly associated with setting priorities for conservation: not acknowledging conservation plans are prioritizations; trying to solve an ill-defined problem; not prioritizing actions; arbitrariness; hidden value judgments; and not acknowledging risk of failure. We explain these mistakes and offer a path to help conservation planners avoid making the same mistakes in future prioritizations. Seis Errores Comunes en la Definición de Prioridades de Conservación Resumen Se ha desarrollado un vasto número de esquemas de priorización para ayudar a que la conservación navegue entre decisiones difíciles en cuanto a la asignación de recursos finitos. Sin embargo, la aplicación de métodos cuantitativos para la definición de prioridades en la conservación frecuentemente incluye errores que pueden socavar la intención de sus autores de ser más rigurosos y científicos en la manera en que se establecen las prioridades y se asignan los recursos. Con base en los bien establecidos principios de la ciencia de la decisión, resaltamos seis errores comúnmente asociados con la definición de prioridades para la conservación: no reconocer que los planes de conservación son priorizaciones; tratar de resolver un problema mal definido; no priorizar acciones; arbitrariedad; juicios de valor ocultos y no reconocer el riesgo de fracasar. Explicamos estos errores y ofrecemos un camino para que planificadores de la conservación no cometan los mismos errores en priorizaciones

  19. Public Health Challenges and Priorities for Kazakhstan

    Directory of Open Access Journals (Sweden)

    Altyn Aringazina

    2012-11-01

    Full Text Available The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region.

  20. Priority setting for new technologies in medicine: A transdisciplinary study

    Science.gov (United States)

    Gibson, Jennifer L; Martin, Douglas K; Singer, Peter A

    2002-01-01

    Background Decision makers in health care organizations struggle with how to set priorities for new technologies in medicine. Traditional approaches to priority setting for new technologies in medicine are insufficient and there is no widely accepted model that can guide decision makers. Discussion Daniels and Sabin have developed an ethically based account about how priority setting decisions should be made. We have developed an empirically based account of how priority setting decisions are made. In this paper, we integrate these two accounts into a transdisciplinary model of priority setting for new technologies in medicine that is both ethically and empirically based. Summary We have developed a transdisciplinary model of priority setting that provides guidance to decision makers that they can operationalize to help address priority setting problems in their institution. PMID:12126482

  1. Priority setting for new technologies in medicine: A transdisciplinary study

    Directory of Open Access Journals (Sweden)

    Gibson Jennifer L

    2002-07-01

    Full Text Available Abstract Background Decision makers in health care organizations struggle with how to set priorities for new technologies in medicine. Traditional approaches to priority setting for new technologies in medicine are insufficient and there is no widely accepted model that can guide decision makers. Discussion Daniels and Sabin have developed an ethically based account about how priority setting decisions should be made. We have developed an empirically based account of how priority setting decisions are made. In this paper, we integrate these two accounts into a transdisciplinary model of priority setting for new technologies in medicine that is both ethically and empirically based. Summary We have developed a transdisciplinary model of priority setting that provides guidance to decision makers that they can operationalize to help address priority setting problems in their institution.

  2. Setting Priorities: Personal Values, Organizational Results. Ideas into Action Guidebooks

    Science.gov (United States)

    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…

  3. Setting Priorities: Personal Values, Organizational Results. Ideas into Action Guidebooks

    Science.gov (United States)

    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…

  4. Priority setting for existing chemicals : automated data selection routine

    NARCIS (Netherlands)

    Haelst, A.G. van; Hansen, B.G.

    2000-01-01

    One of the four steps within Council Regulation 793/93/EEC on the evaluation and control of existing chemicals is the priority setting step. The priority setting step is concerned with selecting high-priority substances from a large number of substances, initially starting with 2,474 high-production

  5. Setting priorities for EU healthcare workforce IT skills competence improvement.

    Science.gov (United States)

    Li, Sisi; Bamidis, Panagiotis D; Konstantinidis, Stathis Th; Traver, Vicente; Car, Josip; Zary, Nabil

    2017-04-01

    A major challenge for healthcare quality improvement is the lack of IT skills and knowledge of healthcare workforce, as well as their ambivalent attitudes toward IT. This article identifies and prioritizes actions needed to improve the IT skills of healthcare workforce across the EU. A total of 46 experts, representing different fields of expertise in healthcare and geolocations, systematically listed and scored actions that would improve IT skills among healthcare workforce. The Child Health and Nutrition Research Initiative methodology was used for research priority-setting. The participants evaluated the actions using the following criteria: feasibility, effectiveness, deliverability, and maximum impact on IT skills improvement. The leading priority actions were related to appropriate training, integrating eHealth in curricula, involving healthcare workforce in the eHealth solution development, improving awareness of eHealth, and learning arrangement. As the different professionals' needs are prioritized, healthcare workforce should be actively and continuously included in the development of eHealth solutions.

  6. Priority setting and health policy and systems research

    Directory of Open Access Journals (Sweden)

    Bennett Sara C

    2009-12-01

    Full Text Available Abstract Health policy and systems research (HPSR has been identified as critical to scaling-up interventions to achieve the millennium development goals, but research priority setting exercises often do not address HPSR well. This paper aims to (i assess current priority setting methods and the extent to which they adequately include HPSR and (ii draw lessons regarding how HPSR priority setting can be enhanced to promote relevant HPSR, and to strengthen developing country leadership of research agendas. Priority setting processes can be distinguished by the level at which they occur, their degree of comprehensiveness in terms of the topic addressed, the balance between technical versus interpretive approaches and the stakeholders involved. When HPSR is considered through technical, disease-driven priority setting processes it is systematically under-valued. More successful approaches for considering HPSR are typically nationally-driven, interpretive and engage a range of stakeholders. There is still a need however for better defined approaches to enable research funders to determine the relative weight to assign to disease specific research versus HPSR and other forms of cross-cutting health research. While country-level research priority setting is key, there is likely to be a continued need for the identification of global research priorities for HPSR. The paper argues that such global priorities can and should be driven by country level priorities.

  7. Priority-setting for achieving universal health coverage.

    Science.gov (United States)

    Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Teerawattananon, Yot; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J

    2016-06-01

    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.

  8. Priority Setting for Improvement of Cervical Cancer Prevention in Iran

    DEFF Research Database (Denmark)

    Majidi, A.; Ghiasvand, R.; Hadji, M.

    2016-01-01

    , 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...

  9. Priority-setting in health systems

    DEFF Research Database (Denmark)

    Byskov, Jens

    2013-01-01

    , and surveys in nearby villages have shown a high prevalence of intestinal helminthiasis and schistosomiasis. The HIV prevalence in similar rural settings is about 10% in her age group. She has been losing weight over the last months and now her one-year-old child feels hot and is not eating well. She has...

  10. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania

    Directory of Open Access Journals (Sweden)

    Stephen Maluka

    2011-11-01

    Full Text Available 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

  11. Community Priority Index: utility, applicability and validation for priority setting in community-based participatory research

    Directory of Open Access Journals (Sweden)

    Hamisu M. Salihu

    2015-07-01

    Full Text Available Background. Providing practitioners with an intuitive measure for priority setting that can be combined with diverse data collection methods is a necessary step to foster accountability of the decision-making process in community settings. Yet, there is a lack of easy-to-use, but methodologically robust measures, that can be feasibly implemented for reliable decision-making in community settings. To address this important gap in community based participatory research (CBPR, the purpose of this study was to demonstrate the utility, applicability, and validation of a community priority index in a community-based participatory research setting. Design and Methods. Mixed-method study that combined focus groups findings, nominal group technique with six key informants, and the generation of a Community Priority Index (CPI that integrated community importance, changeability, and target populations. Bootstrapping and simulation were performed for validation. Results. For pregnant mothers, the top three highly important and highly changeable priorities were: stress (CPI=0.85; 95%CI: 0.70, 1.00, lack of affection (CPI=0.87; 95%CI: 0.69, 1.00, and nutritional issues (CPI=0.78; 95%CI: 0.48, 1.00. For non-pregnant women, top priorities were: low health literacy (CPI=0.87; 95%CI: 0.69, 1.00, low educational attainment (CPI=0.78; 95%CI: 0.48, 1.00, and lack of self-esteem (CPI=0.72; 95%CI: 0.44, 1.00. For children and adolescents, the top three priorities were: obesity (CPI=0.88; 95%CI: 0.69, 1.00, low self-esteem (CPI=0.81; 95%CI: 0.69, 0.94, and negative attitudes toward education (CPI=0.75; 95%CI: 0.50, 0.94. Conclusions. This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR.

  12. Priority setting in the provincial health services authority: survey of key decision makers

    Directory of Open Access Journals (Sweden)

    Mitton Craig

    2007-06-01

    Full Text Available Abstract 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.

  13. Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania.

    Science.gov (United States)

    Kamuzora, Peter; Maluka, Stephen; Ndawi, Benedict; Byskov, Jens; Hurtig, Anna-Karin

    2013-11-25

    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. 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. 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. Community participation in

  14. Promoting community participation in priority setting in district health systems: experiences from Mbarali district, Tanzania

    Directory of Open Access Journals (Sweden)

    Peter Kamuzora

    2013-11-01

    Full Text Available 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

  15. Priority setting in health - a political economy perspective.

    Science.gov (United States)

    Goddard, Maria; Hauck, Katharina; Smith, Peter C

    2006-01-01

    Most countries face high demands on their health care systems and have limited resources with which to meet them. Priority setting seeks to address these problems by proposing rules to decide which groups of patients or disease areas should secure favoured access to limited health care resources. The economic approach towards priority setting, particularly in the form of cost-effectiveness analysis, is commonly advocated. However, despite many decades of refinement of the technical and methodological issues arising from the use of economic evaluation in priority setting, decision makers continue to diverge frequently from the principles of economic evaluation. Our approach in this paper is to highlight the potential contribution of models of political economy to understanding what constitutes rational behaviour when agents operate within political and institutional constraints. We argue that there may be potentially greater benefits to be gained from exploration and analysis of priority setting using models based on concepts such as median voter and competing interest groups, than from further efforts to refine the techniques of economic evaluation.

  16. Communitarian claims and community capabilities: furthering priority setting?

    Science.gov (United States)

    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.

  17. Health care priority setting in Norway a multicriteria decision analysis

    NARCIS (Netherlands)

    Defechereux, T.; Paolucci, F.; Mirelman, A.; Youngkong, S.; Botten, G.; Hagen, T.P.; Niessen, L.W.

    2012-01-01

    BACKGROUND: Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and tr

  18. Priority Setting for Improvement of Cervical Cancer Prevention in Iran

    Directory of Open Access Journals (Sweden)

    Azam Majidi

    2016-04-01

    Full Text Available 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.

  19. Setting research priorities across science, technology, and health sectors: the Tanzania experience.

    Science.gov (United States)

    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.

  20. Setting health priorities in a community: a case example

    Science.gov (United States)

    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

  1. Setting health priorities in a community: a case example

    Directory of Open Access Journals (Sweden)

    Fábio Alexandre Melo do Rego Sousa

    Full Text Available 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.

  2. The implications of fundamental cause theory for priority setting.

    Science.gov (United States)

    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.

  3. Priority Settings in patients with Chronic Diseases and Cancer

    DEFF Research Database (Denmark)

    Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Søndergaard, Jens

    datasets: 1) video recordings of consultations in general practice, 2) semi-structured interviews with patients who have a chronic disease and who have recently finished primary treatment for a non-metastatic cancer, 3) semi-structured interviews with general practitioners. Video recordings......Priority setting in patients with cancer and comorbidities Background and aim As both the cancer incidence and the number of patients diagnosed with chronic diseases are increasing, a growing population of cancer survivors will also deal with comorbid chronic diseases. The period after completed...... cancer treatment, where patients are transitioning to survivorship, might be a vulnerable time. Uncertainty about health status, physical- and emotional symptoms from cancer disease and treatment, and perhaps uncertainty about which doctor to consult, might influence patients’ priorities and attention...

  4. The setting of healthcare priorities through public engagement.

    Science.gov (United States)

    Meetoo, Danny

    Global fiscal constraints mean that the UK healthcare system of the 21st century can no longer provide all possible services and treatment for all the people it serves. Currently, more than ever, there is a need to set priorities in terms of resources. The allocation of scarce healthcare resources will result in some care programmes being supported while others are not. Decision makers are increasingly engaging the public in policy making and priority-setting processes. Advocates of increased public engagement argue that public services are paid for by the people and, therefore, should be shaped more extensively by them, preferably by a fully representative sample. Central to the concept of public engagement is a desire for open dialogue and debate between groups that might not ordinarily have the channels to understand or speak to one another. Public engagement activities aim to link the healthcare community with the general public, community groups, civil society organisations and any other groups or communities in the outside world where healthcare decision-making gains its relevance. This article, therefore, aims to discuss the importance of promoting public engagement.

  5. Fair Processes for Priority Setting: Putting Theory into Practice

    Science.gov (United States)

    Jansen, Maarten P.; Helderman, Jan-Kees; Boer, Bert; Baltussen, Rob

    2017-01-01

    Embedding health technology assessment (HTA) in a fair process has great potential to capture societal values relevant to public reimbursement decisions on health technologies. However, the development of such processes for priority setting has largely been theoretical. In this paper, we provide further practical lead ways on how these processes can be implemented. We first present the misconception about the relation between facts and values that is since long misleading the conduct of HTA and underlies the current assessment-appraisal split. We then argue that HTA should instead be explicitly organized as an ongoing evidence-informed deliberative process, that facilitates learning among stakeholders. This has important consequences for whose values to consider, how to deal with vested interests, how to consider all values in the decision-making process, and how to communicate decisions. This is in stark contrast to how HTA processes are implemented now. It is time to set the stage for HTA as learning. PMID:28005541

  6. A review of selected research priority setting processes at national level in low and middle income countries: towards fair and legitimate priority setting

    Directory of Open Access Journals (Sweden)

    Hoosain Naeema

    2011-05-01

    Full Text Available Abstract Background It is estimated that more than $130 billion is invested globally into health research each year. Increasingly, there is a need to set priorities in health research investments in a fair and legitimate way, using a sound and transparent methodology. In this paper we review selected priority setting processes at national level in low and middle income countries. We outline a set of criteria to assess the process of research priority setting and use these to describe and evaluate priority setting exercises that have taken place at country level. Based on these insights, recommendations are made regarding the constituents of a good priority setting process. Methods Data were gathered from presentations at a meeting held at the World Health Organization (WHO in 2008 and a web-based search. Based on this literature review a number of criteria were developed to evaluate the priority setting processes. Results Across the countries surveyed there was a relative lack of genuine stakeholder engagement; countries varied markedly in the extent to which the priority setting processes were documented; none of the countries surveyed had a systematic or operational appeals process for outlined priorities; and in all countries (except South Africa the priorities that were outlined described broad disease categories rather than specific research questions. Conclusions Country level priority setting processes differed significantly in terms of the methods used. We argue that priority setting processes must have in-built mechanisms for publicizing results, effective procedures to enforce decisions as well as processes to ensure that the revision of priorities happens in practice.

  7. Health care priority setting in Norway a multicriteria decision analysis

    Directory of Open Access Journals (Sweden)

    Defechereux Thierry

    2012-02-01

    Full Text Available Abstract Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

  8. Increased fairness in priority setting processes within the health sector

    DEFF Research Database (Denmark)

    Zulu, Joseph M.; Michelo, Charles; Msoni, Carol

    2014-01-01

    to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled 'Response to Accountable priority setting for Trust in health systems' (REACT). The project aimed to strengthen fairness and accountability in the PS...... processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district...... administration, in non-governmental organizations (NGO) and in health facilities. RESULTS: During the baseline study, concepts of legitimacy and fairness in PS processes were found to be grounded in local values of equity and impartiality. Government and other organizational strategies strongly supported...

  9. Setting health priorities in a community: a case example.

    Science.gov (United States)

    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

    2017-03-02

    To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults. 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. 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. 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. Descrever a metodologia utilizada no processo de estabelecimento de prioridades em saúde para intervenção comunitária, numa comunidade idosa. Partindo dos resultados de um diagnóstico de saúde no âmbito da promoção do envelhecimento

  10. Between credit claiming and blame avoidance: the changing politics of priority-setting for Korea's National Health Insurance System.

    Science.gov (United States)

    Kang, Minah; Reich, Michael R

    2014-03-01

    Priority-setting involves diverse parties with intense and often conflicting interests and values. Still, the political aspects of priority-setting are largely unexplored in the literature on health policy. In this paper, we examine how policy makers in Korea changed their strategies as the policy context for priority setting changed from only expanding benefits to a double burden of benefit expansion plus cost containment. This analysis shows that priority-setting is a profoundly political process. The policy context shapes how policy makers choose their political strategies. In particular, we find that policy makers sway between "credit claiming" and "blame avoidance" strategies. Korean policy makers resorted to three types of political strategies when confronted with a double burden of benefit expansion and cost containment: delegating responsibility to other institutions (agency strategies), replacing judgment-based decisions with automatic rules (policy strategies), and focusing on the presentation of how decisions are made (presentational strategies). The paper suggests implications for future studies on priority-setting in the Korean health care system and in other countries that face similar challenges, and concludes that Korean policy makers need to put more effort into developing transparent and systematic priority-setting processes, especially in times of double burden of benefit expansion and cost containment. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Fit for purpose? Introducing a rational priority setting approach into a community care setting.

    Science.gov (United States)

    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.

  12. Norwegian Priority Setting in Practice – an Analysis of Waiting Time Patterns Across Medical Disciplines

    Directory of Open Access Journals (Sweden)

    Jurgita Januleviciute Gangstøe

    2016-06-01

    Full Text Available Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients that had been through the process of priority setting: (i high priority with assigned individual maximum waiting time; (ii low priority without a maximum waiting time; and (iii refusal (not in need for specialized services. We study variation in priority status and waiting time of the first two groups across different medical disciplines. Methods: Data was extracted from the Norwegian Patient Register (NPR and contains information on elective referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across different specialties was measured by patient priority status and waiting times. The distributions of assigned maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The perspective of the planning process was studied by measuring the time interval between the actual start of healthcare and the maximum waiting time. Results: Considerable variation was found across medical specialties concerning proportion of priority patients and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time. Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority status. Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have contributed to push the actual

  13. The accountability for reasonableness approach to guide priority setting in health systems within limited resources

    DEFF Research Database (Denmark)

    Byskov, Jens; Marchal, Bruno; Maluka, Stephen;

    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...... 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....

  14. Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation

    Directory of Open Access Journals (Sweden)

    Edwine W. Barasa

    2015-11-01

    Full Text Available 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

  15. Groundwater Governance in the United States: Common Priorities and Challenges.

    Science.gov (United States)

    Megdal, Sharon B; Gerlak, Andrea K; Varady, Robert G; Huang, Ling-Yee

    2015-01-01

    Groundwater is a critical component of the water supply for agriculture, urban areas, industry, and ecosystems, but managing it is a challenge because groundwater is difficult to map, quantify, and evaluate. Until recently, study and assessment of governance of this water resource has been largely neglected. A survey was developed to query state agency officials about the extent and scope of groundwater use, groundwater laws and regulations, and groundwater tools and strategies. Survey responses revealed key findings: states' legal frameworks for groundwater differ widely in recognizing the hydrologic connection between surface water and groundwater, the needs of groundwater-dependent ecosystems, and the protection of groundwater quality; states reported a range in capacity to enforce groundwater responsibilities; and states have also experienced substantial changes in groundwater governance in the past few decades. Overall, groundwater governance across the United States is fragmented. States nevertheless identified three common priorities for groundwater governance: water quality and contamination, conflicts between users, and declining groundwater levels. This survey represents an initial step in a broader, continuing effort to characterize groundwater governance practices in the United States.

  16. Setting numerical population objectives for priority landbird species

    Science.gov (United States)

    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...

  17. Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastián, Miguel San

    2010-01-01

    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...

  18. Priority setting in HIV/AIDS control in West Java Indonesia: an evaluation based on the accountability for reasonableness framework.

    Science.gov (United States)

    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.

  19. Setting Priorities for Space Research: Opportunities and Imperatives

    Science.gov (United States)

    Dutton, John A.; Abelson, Philip H.; Beckwith, Steven V. W.; Bishop, William P.; Byerly, Radford, Jr.; Crowe, Lawson; Dews, Peter; Garriott, Owen K.; Lunine, Jonathan; Macauley, Molly K.

    1992-01-01

    This report represents 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). The report argues 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 report advocates the establishment of priorities to enhance effective management of the nation's scientific research program in space. It argues that scientific objectives and purposes should determine how and under what circumstances scientific research should be done. The report does not take a position on the controversy between advocates of manned space exploration and those who favor the exclusive use of unmanned space vehicles. Nor does the report address questions about the value or appropriateness of Space Station Freedom or proposals to establish a permanent manned Moon base or to undertake a manned mission to Mars. These issues lie beyond the charge to the task group.

  20. [The Danish Debate on Priority Setting in Medicine--An Update].

    Science.gov (United States)

    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.

  1. [The Danish debate on priority setting in medicine - characteristics and results].

    Science.gov (United States)

    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.

  2. Mapping of Florida's Coastal and Marine Resources: Setting Priorities Workshop

    Science.gov (United States)

    Robbins, Lisa; Wolfe, Steven; Raabe, Ellen

    2008-01-01

    The importance of mapping habitats and bioregions as a means to improve resource management has become increasingly clear. Large areas of the waters surrounding Florida are unmapped or incompletely mapped, possibly hindering proper management and good decisionmaking. Mapping of these ecosystems is among the top priorities identified by the Florida Oceans and Coastal Council in their Annual Science Research Plan. However, lack of prioritization among the coastal and marine areas and lack of coordination of agency efforts impede efficient, cost-effective mapping. A workshop on Mapping of Florida's Coastal and Marine Resources was sponsored by the U.S. Geological Survey (USGS), Florida Department of Environmental Protection (FDEP), and Southeastern Regional Partnership for Planning and Sustainability (SERPPAS). The workshop was held at the USGS Florida Integrated Science Center (FISC) in St. Petersburg, FL, on February 7-8, 2007. The workshop was designed to provide State, Federal, university, and non-governmental organizations (NGOs) the opportunity to discuss their existing data coverage and create a prioritization of areas for new mapping data in Florida. Specific goals of the workshop were multifold, including to: * provide information to agencies on state-of-the-art technology for collecting data; * inform participants of the ongoing mapping programs in waters off Florida; * present the mapping needs and priorities of the State and Federal agencies and entities operating in Florida; * work with State of Florida agencies to establish an overall priority for areas needing mapping; * initiate discussion of a unified classification of habitat and bioregions; * discuss and examine the need to standardize terminology and data collection/storage so that data, in particular habitat data, can be shared; 9 identify opportunities for partnering and leveraging mapping efforts among agencies and entities; * identify impediments and organizational gaps that hinder collection

  3. A checklist for health research priority setting: nine common themes of good practice

    Directory of Open Access Journals (Sweden)

    Terry Robert F

    2010-12-01

    Full Text Available Abstract 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.

  4. Managing multiple projects: a literature review of setting priorities and a pilot survey of healthcare researchers in an academic setting.

    Science.gov (United States)

    Hopkins, Robert Borden; Campbell, Kaitryn; O'Reilly, Daria; Tarride, Jean-Eric; Bowen, Jim; Blackhouse, Gord; Goerre, Ron

    2007-05-16

    To summarize and then assess with a pilot study the use of published best practice recommendations for priority setting during management of multiple healthcare research projects, in a resource-constrained environment. Medical, economic, business, and operations literature was reviewed to summarize and develop a survey to assess best practices for managing multiple projects. Fifteen senior healthcare research project managers, directors, and faculty at an urban academic institution were surveyed to determine most commonly used priority rules, ranking of rules, characteristics of their projects, and availability of resources. Survey results were compared to literature recommendations to determine use of best practices. Seven priority-setting rules were identified for managing multiple projects. Recommendations on assigning priorities by project characteristics are presented. In the pilot study, a large majority of survey respondents follow best practice recommendations identified in the research literature. However, priority rules such as Most Total Successors (MTS) and Resource Scheduling Method (RSM) were used "very often" by half of the respondents when better performing priority rules were available. Through experience, project managers learn to manage multiple projects under resource constraints. Best practice literature can assist project managers in priority setting by recommending the most appropriate priority given resource constraints and project characteristics. There is room for improvement in managing multiple projects.

  5. Challenges and priorities for modelling livestock health and pathogens in the context of climate change.

    Science.gov (United States)

    Özkan, Şeyda; Vitali, Andrea; Lacetera, Nicola; Amon, Barbara; Bannink, André; Bartley, Dave J; Blanco-Penedo, Isabel; de Haas, Yvette; Dufrasne, Isabelle; Elliott, John; Eory, Vera; Fox, Naomi J; Garnsworthy, Phil C; Gengler, Nicolas; Hammami, Hedi; Kyriazakis, Ilias; Leclère, David; Lessire, Françoise; Macleod, Michael; Robinson, Timothy P; Ruete, Alejandro; Sandars, Daniel L; Shrestha, Shailesh; Stott, Alistair W; Twardy, Stanislaw; Vanrobays, Marie-Laure; Ahmadi, Bouda Vosough; Weindl, Isabelle; Wheelhouse, Nick; Williams, Adrian G; Williams, Hefin W; Wilson, Anthony J; Østergaard, Søren; Kipling, Richard P

    2016-11-01

    Climate change has the potential to impair livestock health, with consequences for animal welfare, productivity, greenhouse gas emissions, and human livelihoods and health. Modelling has an important role in assessing the impacts of climate change on livestock systems and the efficacy of potential adaptation strategies, to support decision making for more efficient, resilient and sustainable production. However, a coherent set of challenges and research priorities for modelling livestock health and pathogens under climate change has not previously been available. To identify such challenges and priorities, researchers from across Europe were engaged in a horizon-scanning study, involving workshop and questionnaire based exercises and focussed literature reviews. Eighteen key challenges were identified and grouped into six categories based on subject-specific and capacity building requirements. Across a number of challenges, the need for inventories relating model types to different applications (e.g. the pathogen species, region, scale of focus and purpose to which they can be applied) was identified, in order to identify gaps in capability in relation to the impacts of climate change on animal health. The need for collaboration and learning across disciplines was highlighted in several challenges, e.g. to better understand and model complex ecological interactions between pathogens, vectors, wildlife hosts and livestock in the context of climate change. Collaboration between socio-economic and biophysical disciplines was seen as important for better engagement with stakeholders and for improved modelling of the costs and benefits of poor livestock health. The need for more comprehensive validation of empirical relationships, for harmonising terminology and measurements, and for building capacity for under-researched nations, systems and health problems indicated the importance of joined up approaches across nations. The challenges and priorities identified can

  6. Setting Priorities for Monitoring and Managing Non-native Plants: Toward a Practical Approach

    Science.gov (United States)

    Koch, Christiane; Jeschke, Jonathan M.; Overbeck, Gerhard E.; Kollmann, Johannes

    2016-09-01

    Land managers face the challenge to set priorities in monitoring and managing non-native plant species, as resources are limited and not all non-natives become invasive. Existing frameworks that have been proposed to rank non-native species require extensive information on their distribution, abundance, and impact. This information is difficult to obtain and often not available for many species and regions. National watch or priority lists are helpful, but it is questionable whether they provide sufficient information for environmental management on a regional scale. We therefore propose a decision tree that ranks species based on more simple albeit robust information, but still provides reliable management recommendations. To test the decision tree, we collected and evaluated distribution data from non-native plants in highland grasslands of Southern Brazil. We compared the results with a national list from the Brazilian Invasive Species Database for the state to discuss advantages and disadvantages of the different approaches on a regional scale. Out of 38 non-native species found, only four were also present on the national list. If management would solely rely on this list, many species that were identified as spreading based on the decision tree would go unnoticed. With the suggested scheme, it is possible to assign species to active management, to monitoring, or further evaluation. While national lists are certainly important, management on a regional scale should employ additional tools that adequately consider the actual risk of non-natives to become invasive.

  7. Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastián, Miguel San;

    2010-01-01

    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....

  8. What do District Health Planners in Tanzania think about improving priority setting using 'Accountability for Reasonableness'?

    Directory of Open Access Journals (Sweden)

    Olsen Oystein

    2007-11-01

    Full Text Available Abstract 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.

  9. A new proposal for priority setting in Norway: Open and fair.

    Science.gov (United States)

    Ottersen, Trygve; Førde, Reidun; Kakad, Meetali; Kjellevold, Alice; Melberg, Hans Olav; Moen, Atle; Ringard, Ånen; Norheim, Ole Frithjof

    2016-03-01

    Health systems worldwide struggle to meet increasing demands for health care, and Norway is no exception. This paper discusses the new, comprehensive framework for priority setting recently laid out by the third Norwegian Committee on Priority Setting in the Health Sector. The framework posits that priority setting should pursue the goal of "the greatest number of healthy life years for all, fairly distributed" and centres on three criteria: 1) The health-benefit criterion: The priority of an intervention increases with the expected health benefit (and other relevant welfare benefits) from the intervention; 2) The resource criterion: The priority of an intervention increases, the less resources it requires; and 3) The health-loss criterion: The priority of an intervention increases with the expected lifetime health loss of the beneficiary in the absence of such an intervention. Cost-effectiveness plays a central role in this framework, but only alongside the health-loss criterion which incorporates a special concern for the worse off and promotes fairness. In line with this, cost-effectiveness thresholds are differentiated according to health loss. Concrete implementation tools and open processes with user participation complement the three criteria. Informed by the proposal, the Ministry of Health and Care Services is preparing a report to the Parliament, with the aim of reaching political consensus on a new priority-setting framework for Norway.

  10. Priority setting in family change and clinical practice: the Family FIRO Model.

    Science.gov (United States)

    Doherty, W J; Colangelo, N; Hovander, D

    1991-06-01

    We update a theoretical framework for understanding priority setting for the management of family change, with special emphasis on developmental change. We propose that three core dimensions of family interaction--inclusion, control, and intimacy--constitute an optimal priority sequence for managing major family change stemming from life-cycle transitions and other stressful experiences. In the next section of the article, we compare the Family FIRO Model and other models of family change. Finally, we suggest that therapists can benefit from an explicit, clinical decision-making model for setting priorities in treatment: issues of inclusion take precedence over issues of control, which in turn take precedence over issues of intimacy.

  11. Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

    Directory of Open Access Journals (Sweden)

    Silva Diego S

    2012-03-01

    Full Text Available Abstract 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.

  12. Dengue fever in Pakistan:Challenges, priorities and measures

    Institute of Scientific and Technical Information of China (English)

    Javid Ali

    2015-01-01

    Currently, there is no huge scale study on threat aspects and incidence of dengue fever in Pakistan, as a result it must be carried out on a priority source. It is the responsibility of the government to establish local community based laboratories and excellence research center for dengue cure, awareness and prevalence. The ailment could be cured in proper and better way. The treatment of dengue is extremely difficult due to lack of available vaccines. A developing country like Pakistan cannot handle the problems due to lake of awareness, behavior of people, terrorisms and other socioeconomic factors of the country as well as government interest to cope the other problems as compared to this one. Therefore, more measures should be carried out to prevent the disease.

  13. Dengue fever in Pakistan: Challenges, priorities and measures

    Directory of Open Access Journals (Sweden)

    Javid Ali

    2015-10-01

    Full Text Available Currently, there is no huge scale study on threat aspects and incidence of dengue fever in Pakistan, as a result it must be carried out on a priority source. It is the responsibility of the government to establish local community based laboratories and excellence research center for dengue cure, awareness and prevalence. The ailment could be cured in proper and better way. The treatment of dengue is extremely difficult due to lack of available vaccines. A developing country like Pakistan cannot handle the problems due to lake of awareness, behavior of people, terrorisms and other socioeconomic factors of the country as well as government interest to cope the other problems as compared to this one. Therefore, more measures should be carried out to prevent the disease.

  14. IMPORTANCE OF MULTIPLE CRITERIA FOR PRIORITY SETTING OF HIV/AIDS INTERVENTIONS.

    Science.gov (United States)

    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.

  15. Setting priorities in global child health research investments: assessment of principles and practice.

    Science.gov (United States)

    Rudan, Igor; Gibson, Jennifer; Kapiriri, Lydia; Lansang, Mary Ann; Hyder, Adnan A; Lawn, Joy; Darmstadt, Gary L; Cousens, Simon; Bhutta, Zulfiqar A; Brown, Kenneth H; Hess, Sonja Y; Black, Maureen; Gardner, Julie Meeks; Webster, Jayne; Carneiro, Ilona; Chandramohan, Daniel; Kosek, Margaret; Lanata, Claudio F; Tomlinson, Mark; Chopra, Mickey; Ameratunga, Shanthi; Campbell, Harry; El Arifeen, Shams; Black, Robert E

    2007-10-01

    This article reviews theoretical and practical approaches for setting priorities in global child health research investments. It also provides an overview of previous attempts to develop appropriate tools and methodologies to define priorities in health research investments. A brief review of the most important theoretical concepts that should govern priority setting processes is undertaken, showing how different perspectives, such as medical, economical, legal, ethical, social, political, rational, philosophical, stakeholder driven, and others will necessarily conflict each other in determining priorities. We specially address present research agenda in global child health today and how it relates to United Nation's (UN) Millennium Development Goal 4, which is to reduce child mortality by two-thirds between 1990 and 2015. The outcomes of these former approaches are evaluated and their benefits and shortcomings presented. The case for a new methodology for setting priorities in health research investments is presented, as proposed by Child Health and Nutrition Research Initiative, and a need for its implementation in global child health is outlined. A transdisciplinary approach is needed to address all the perspectives from which investments into health research can be seen as priorities. This prioritization requires a process that is transparent, systematic, and that would take into account many perspectives and build on advantages of previous approaches.

  16. SARS and hospital priority setting: a qualitative case study and evaluation

    Directory of Open Access Journals (Sweden)

    Upshur Ross EG

    2004-12-01

    Full Text Available Abstract Background 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'. Methods 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. Results 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. Conclusions '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.

  17. Managing protected areas under climate change: challenges and priorities.

    Science.gov (United States)

    Rannow, Sven; Macgregor, Nicholas A; Albrecht, Juliane; Crick, Humphrey Q P; Förster, Michael; Heiland, Stefan; Janauer, Georg; Morecroft, Mike D; Neubert, Marco; Sarbu, Anca; Sienkiewicz, Jadwiga

    2014-10-01

    The implementation of adaptation actions in local conservation management is a new and complex task with multiple facets, influenced by factors differing from site to site. A transdisciplinary perspective is therefore required to identify and implement effective solutions. To address this, the International Conference on Managing Protected Areas under Climate Change brought together international scientists, conservation managers, and decision-makers to discuss current experiences with local adaptation of conservation management. This paper summarizes the main issues for implementing adaptation that emerged from the conference. These include a series of conclusions and recommendations on monitoring, sensitivity assessment, current and future management practices, and legal and policy aspects. A range of spatial and temporal scales must be considered in the implementation of climate-adapted management. The adaptation process must be area-specific and consider the ecosystem and the social and economic conditions within and beyond protected area boundaries. However, a strategic overview is also needed: management at each site should be informed by conservation priorities and likely impacts of climate change at regional or even wider scales. Acting across these levels will be a long and continuous process, requiring coordination with actors outside the "traditional" conservation sector. To achieve this, a range of research, communication, and policy/legal actions is required. We identify a series of important actions that need to be taken at different scales to enable managers of protected sites to adapt successfully to a changing climate.

  18. Setting health research priorities using the CHNRI method: III. Involving stakeholders

    Directory of Open Access Journals (Sweden)

    Sachiyo Yoshida

    2016-06-01

    Full Text Available Setting health research priorities is a complex and value–driven process. The introduction of the Child Health and Nutrition Research Initiative (CHNRI method has made the process of setting research priorities more transparent and inclusive, but much of the process remains in the hands of funders and researchers, as described in the previous two papers in this series. However, the value systems of numerous other important stakeholders, particularly those on the receiving end of health research products, are very rarely addressed in any process of priority setting. Inclusion of a larger and more diverse group of stakeholders in the process would result in a better reflection of the system of values of the broader community, resulting in recommendations that are more legitimate and acceptable.

  19. A simplified approach to the PROMETHEE method for priority setting in management of mine action projects

    Directory of Open Access Journals (Sweden)

    Marko Mladineo

    2016-12-01

    Full Text Available In the last 20 years, priority setting in mine actions, i.e. in humanitarian demining, has become an increasingly important topic. Given that mine action projects require management and decision-making based on a multi -criteria approach, multi-criteria decision-making methods like PROMETHEE and AHP have been used worldwide for priority setting. However, from the aspect of mine action, where stakeholders in the decision-making process for priority setting are project managers, local politicians, leaders of different humanitarian organizations, or similar, applying these methods can be difficult. Therefore, a specialized web-based decision support system (Web DSS for priority setting, developed as part of the FP7 project TIRAMISU, has been extended using a module for developing custom priority setting scenarios in line with an exceptionally easy, user-friendly approach. The idea behind this research is to simplify the multi-criteria analysis based on the PROMETHEE method. Therefore, a simplified PROMETHEE method based on statistical analysis for automated suggestions of parameters such as preference function thresholds, interactive selection of criteria weights, and easy input of criteria evaluations is presented in this paper. The result is web-based DSS that can be applied worldwide for priority setting in mine action. Additionally, the management of mine action projects is supported using modules for providing spatial data based on the geographic information system (GIS. In this paper, the benefits and limitations of a simplified PROMETHEE method are presented using a case study involving mine action projects, and subsequently, certain proposals are given for the further research.

  20. Setting practical conservation priorities for birds in the Western Andes of Colombia.

    Science.gov (United States)

    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.

  1. Setting research priorities to improve global newborn health and prevent stillbirths by 2025

    Directory of Open Access Journals (Sweden)

    José Martines

    2016-06-01

    Full Text Available 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.

  2. Theories of justice and their implications for priority setting in health care.

    Science.gov (United States)

    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.

  3. Managing Challenging Behaviors in Preschool Settings

    Science.gov (United States)

    Mitchell, Bridgitt Lenore

    2014-01-01

    Despite state mandated early childhood education (ECE) teacher competencies, many children are removed from preschool settings for behaviors related to socioemotional problems. This study's rationale was the propensity of expulsions among children exhibiting challenging behaviors in preschool programs. Guided by Bronfenbrenner's ecological model…

  4. Research priorities for administrative challenges of integrated networks of care.

    Science.gov (United States)

    Pilgrim, Randy; Hilton, Joshua A; Carrier, Emily; Pines, Jesse M; Hufstetler, Greg; Thorby, Suzette; Milling, T J; Cesta, Beth; Hsia, Renee Y

    2010-12-01

    In 2006, the Institute of Medicine (IOM) advanced the concept of "coordinated, regionalized, and accountable emergency care systems" to address significant problems with the delivery of emergency medical care in the United States. Achieving this vision requires the thoughtful implementation of well-aligned, system-level structures and processes that enhance access to emergency care and improve patient outcomes at a sustainable cost. Currently, the delivery of emergency medical care is supported by numerous administrative systems, including economic; reimbursement; legal and regulatory structures; licensure, credentialing, and accreditation processes; medicolegal systems; and quality reporting mechanisms. In addition, many regionalized systems may not optimize patient outcomes because of current administrative barriers that make it difficult for providers to deliver the best care. However, certain administrative barriers may also threaten the sustainability of integration efforts or prevent them altogether. This article identifies significant administrative challenges to integrating networks of emergency care in four specific areas: reimbursement, medical-legal, quality reporting mechanisms, and regulatory aspects. The authors propose a research agenda for indentifying optimal approaches that support consistent access to quality emergency care with improved outcomes for patients, at a sustainable cost. Researching administrative challenges will involve careful examination of the numerous natural experiments in the recent past and will be crucial to understand the impact as we embark on a new era of health reform.

  5. Decision maker views on priority setting in the Vancouver Island Health Authority

    Directory of Open Access Journals (Sweden)

    Mitton Craig

    2008-07-01

    Full Text Available Abstract Background Decisions regarding the allocation of available resources are a source of growing dissatisfaction for healthcare decision-makers. This dissatisfaction has led to increased interest in research on evidence-based resource allocation processes. An emerging area of interest has been the empirical analysis of the characteristics of existing and desired priority setting processes from the perspective of decision-makers. Methods We conducted in-depth, face-to-face interviews with 18 senior managers and medical directors with the Vancouver Island Health Authority, an integrated health care provider in British Columbia responsible for a population of approximately 730,000. Interviews were transcribed and content-analyzed, and major themes and sub-themes were identified and reported. Results Respondents identified nine key features of a desirable priority setting process: inclusion of baseline assessment, use of best evidence, clarity, consistency, clear and measurable criteria, dissemination of information, fair representation, alignment with the strategic direction and evaluation of results. Existing priority setting processes were found to be lacking on most of these desired features. In addition, respondents identified and explicated several factors that influence resource allocation, including political considerations and organizational culture and capacity. Conclusion This study makes a contribution to a growing body of knowledge which provides the type of contextual evidence that is required if priority setting processes are to be used successfully by health care decision-makers.

  6. Setting research priorities to reduce global mortality from preterm birth and low birth

    Directory of Open Access Journals (Sweden)

    Rajiv Bahl Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

    2012-06-01

    Full Text Available This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW, as set out in the UN's Millennium Development Goal 4.

  7. Towards a multi-criteria approach for priority setting: an application to Ghana.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.; Stolk, E.; Chisholm, D.; Aikins, M.

    2006-01-01

    BACKGROUND: Many criteria have been proposed to guide priority setting in health, but their relative importance has not yet been determined in a way that allows a rank ordering of interventions. METHODS: In an explorative study, a discrete choice experiment was carried out to determine the relative

  8. Generation of global political priority for early childhood development: the challenges of framing and governance.

    Science.gov (United States)

    Shawar, Yusra Ribhi; Shiffman, Jeremy

    2017-01-07

    Despite progress, early childhood development (ECD) remains a neglected issue, particularly in resource-poor countries. We analyse the challenges and opportunities that ECD proponents face in advancing global priority for the issue. We triangulated among several data sources, including 19 semi-structured interviews with individuals involved in global ECD leadership, practice, and advocacy, as well as peer-reviewed research, organisation reports, and grey literature. We undertook a thematic analysis of the collected data, drawing on social science scholarship on collective action and a policy framework that elucidates why some global initiatives are more successful in generating political priority than others. The analysis indicates that the ECD community faces two primary challenges in advancing global political priority. The first pertains to framing: generation of internal consensus on the definition of the problem and solutions, agreement that could facilitate the discovery of a public positioning of the issue that could generate political support. The second concerns governance: building of effective institutions to achieve collective goals. However, there are multiple opportunities to advance political priority for ECD, including an increasingly favourable political environment, advances in ECD metrics, and the existence of compelling arguments for investment in ECD. To advance global priority for ECD, proponents will need to surmount the framing and governance challenges and leverage these opportunities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Viral hepatitis in Pakistan:challenges and priorities

    Institute of Scientific and Technical Information of China (English)

    Sadia; Ashraf; Aftab; Ahmad

    2015-01-01

    Hepatitis B and C are big health issues worldwide as more than 400 million people arc suffering from chronic hepatitis B and C which result in more than 1.4 million deaths each year.According to a study done by Pakistan Medical Research Council in 2007-08,7.6%Pakistani population suffered with hepatitis B and C.with around 4.8%with hepatitis C only.Government of Pakistan has taken different initiatives like vaccination,patient safety,blood screening,education and awareness about disease but still there is high prevalence of hepatitis in Pakistan.According to some studies injecting drug users have the highest prevalence of hepatilis B and C in the country.The follow-up studies and documentation of hepatitis patients was not very good which need to be improved.There is no recent large scale study on risk factors and prevalence of hepatitis B and C in Pakistan so it should be done on an urgent basis.If government set up regional laboratories for prevalence study and also a central institute for hepatitis research and treatment,the disease could be prevented in better and proper way.The treatment of hepatitis is very costly and a developing country like Pakistan cannot afford such high costs.Therefore more focus should be on preventive measures.

  10. Implementation and evaluation of local-level priority setting for stroke.

    Science.gov (United States)

    Chappel, D; Bailey, J; Stacy, R; Rodgers, H; Thomson, R

    2001-01-01

    We aimed to develop and evaluate a prioritisation process to combine the evidence base with stakeholder involvement within a stroke programme for a Health Improvement Programme (HImP). Implementation involved: formation of a district stroke group (DSG); review of the evidence; survey of DSG members; survey of other key professionals; consensus within the DSG; consultation with local users of the service. Evaluation was through semi-structured interviews and documentary analysis. The process was accepted as appropriate and valuable by the majority of participants, and a district HImP implementation group allocated pound sterling 100 000 for stroke development as a result of this process. However, some felt that stroke itself had been an imposed, rather than an agreed, local priority. The priority setting process was not clear to all participants and change of personnel, particularly in the NHS trusts, led to some perceived lack of ownership. Professionals from secondary care participated, but later criticised the process when they felt that the priorities in the HImP could limit their ability to access money for other service developments. The user consultation days occurred too late to influence the 1999/2002 HImP. We have shown that it is possible to develop an approach that is broadly accepted by stakeholders and balance the evidence base with local ownership. The participation of stakeholders, clarity of procedures, local ownership and awareness of local politics are important in effective priority setting. The model developed will be of value in other settings.

  11. Setting health research priorities using the CHNRI method: I. Involving funders

    Directory of Open Access Journals (Sweden)

    Igor Rudan

    2016-06-01

    Full Text Available In 2007 and 2008, the World Health Organization's Department for Child and Adolescent Health and Development commissioned five large research priority setting exercises using the CHNRI (Child Health and Nutrition Research Initiative method. The aim was to define research priorities related to the five major causes of child deaths for the period up to the year 2015. The selected causes were childhood pneumonia, diarrhoea, birth asphyxia, neonatal infections and preterm birth/low birth weight. The criteria used for prioritization in all five exercises were the “standard” CHNRI criteria: answerability, effectiveness, deliverability, potential for mortality burden reduction and the effect on equity. Having completed the exercises, the WHO officers were left with another question: how “fundable” were the identified priorities, i.e. how attractive were they to research funders?

  12. Health-care needs and shared decision-making in priority-setting.

    Science.gov (United States)

    Gustavsson, Erik; Sandman, Lars

    2015-02-01

    In this paper we explore the relation between health-care needs and patients' desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patient's need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.

  13. Priority setting for horizon scanning of new health technologies in Denmark:

    DEFF Research Database (Denmark)

    Douw, Karla; Vondeling, Hindrik; Oortwijn, Wija

    2006-01-01

     impact on health policy; such as the educational needs and organisational changes associated with the new technology. The proposed changes are regarded as an intermediate step in the process of producing a fully adapted instrument that can serve as a formal support for priority setting of new health technologies......In the context of the establishment of a Danish Horizon Scanning System (HSS) the views of health care stakeholders and health economists were solicitated by means of postal survey on the need for adaptation of a priority setting instrument for health technology assessment (HTA). The aim...... differing views between the two groups. The results show that the instrument should apply a health care perspective, and that technologies should be prioritised on the basis of the criteria: marginal benefits, marginal costs, budget impact, impact on access to care, and additional criteria with an...

  14. Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations.

    Science.gov (United States)

    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.

  15. Personalised medicine: Priority setting and opportunity costs in European public health care systems

    OpenAIRE

    Vollmann, Jochen

    2015-01-01

    “Personalised medicine” is currently attracting considerable attention and raising high hopes and expectations in modern medicine. The term “personalised medicine” denotes the use of genetic or other biomarker information, and it does not focus on a more personal patient-doctor relationship. Furthermore, personalised medicine is associated with ethical problems like priority setting and opportunity costs in solidarity-based public health care systems. Personalised medicine provides modern,...

  16. Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers

    Directory of Open Access Journals (Sweden)

    Tromp Noor

    2012-12-01

    Full Text Available Abstract Background In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context. Methods We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country’s health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this. Results Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and. Conclusions This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

  17. Evaluation of the Use of QSARS for Priority Setting and Risk Assessment.

    Science.gov (United States)

    Feijtel, T C

    1995-09-01

    Abstract Impending changes in EEC legislation have accelerated the need to define the principles and practical considerations of the use of QSARs in priority setting and risk assessment. It is important to delineate the limitations of this approach and to review whether and how this information should be used in the risk assessment. The value and limitations of QSARs for use in priority setting and risk assessment will not be discussed in detail since the European Chemical Industry Ecology and Toxicology Centre (ECETOC) has only recently established a Task Force to tackle this issue. The terms of reference of the Task Force are: (1) compare the predictions obtained with QSARs to measured data using ECETOC databases and other sources of data and comment on the validity and applicability of such QSARs; (2) identify and review software packages which are available for accessing and using appropriate QSARs; (3) identify those aspects of environmental distribution, fate and effects where the further development of QSARs is desirable and feasible; and (4) provide a scientific basis for ECETOC's contribution to the activities of the European Chemicals Bureau (ECB) in this area. In this short paper, only an initial and personal evaluation is made of when and where to use QSARs in the priority setting and risk assessment process within the regulatory framework. Some critical remarks and suggestions are provided to guide future developments and integration of QSARs in the risk assessment process.

  18. A population-based model for priority setting across the care continuum and across modalities

    Directory of Open Access Journals (Sweden)

    Mortimer Duncan

    2006-03-01

    Full Text Available Abstract 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

  19. Allocating limited resources in a time of fiscal constraints: a priority setting case study from Dalhousie University Faculty of Medicine.

    Science.gov (United States)

    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.

  20. Integrating habitat status, human population pressure, and protection status into biodiversity conservation priority setting

    Science.gov (United States)

    Shi, H.; Singh, A.; Kant, S.; Zhu, Z.; 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.

  1. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015.

    Science.gov (United States)

    Bahl, Rajiv; Martines, Jose; Bhandari, Nita; Biloglav, Zrinka; Edmond, Karen; Iyengar, Sharad; Kramer, Michael; Lawn, Joy E; Manandhar, D S; Mori, Rintaro; Rasmussen, Kathleen M; Sachdev, H P S; Singhal, Nalini; Tomlinson, Mark; Victora, Cesar; Williams, Anthony F; Chan, Kit Yee; Rudan, Igor

    2012-06-01

    This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4. We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method. The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of

  2. Congestion Control in WMSNs by Reducing Congestion and Free Resources to Set Accurate Rates and Priority

    Directory of Open Access Journals (Sweden)

    Akbar Majidi

    2014-08-01

    Full Text Available The main intention of this paper is focus on mechanism for reducing congestion in the network by free resources to set accurate rates and priority data needs. If two nodes send their packets in the shortest path to the parent node in a crowded place, a source node must prioritize the data and uses data that have lower priorities of a suitable detour nodes consisting of low or non- active consciously. The proposed algorithm is applied to the nodes near the base station (which convey more traffic after the congestion detection mechanism detected the congestion. Obtained results from simulation test done by NS-2 simulator demonstrate the innovation and validity of proposed method with better performance in comparison with CCF, PCCP and DCCP protocols.

  3. Key challenges and priorities for modelling European grasslands under climate change.

    Science.gov (United States)

    Kipling, Richard P; Virkajärvi, Perttu; Breitsameter, Laura; Curnel, Yannick; De Swaef, Tom; Gustavsson, Anne-Maj; Hennart, Sylvain; Höglind, Mats; Järvenranta, Kirsi; Minet, Julien; Nendel, Claas; Persson, Tomas; Picon-Cochard, Catherine; Rolinski, Susanne; Sandars, Daniel L; Scollan, Nigel D; Sebek, Leon; Seddaiu, Giovanna; Topp, Cairistiona F E; Twardy, Stanislaw; Van Middelkoop, Jantine; Wu, Lianhai; Bellocchi, Gianni

    2016-10-01

    Grassland-based ruminant production systems are integral to sustainable food production in Europe, converting plant materials indigestible to humans into nutritious food, while providing a range of environmental and cultural benefits. Climate change poses significant challenges for such systems, their productivity and the wider benefits they supply. In this context, grassland models have an important role in predicting and understanding the impacts of climate change on grassland systems, and assessing the efficacy of potential adaptation and mitigation strategies. In order to identify the key challenges for European grassland modelling under climate change, modellers and researchers from across Europe were consulted via workshop and questionnaire. Participants identified fifteen challenges and considered the current state of modelling and priorities for future research in relation to each. A review of literature was undertaken to corroborate and enrich the information provided during the horizon scanning activities. Challenges were in four categories relating to: 1) the direct and indirect effects of climate change on the sward 2) climate change effects on grassland systems outputs 3) mediation of climate change impacts by site, system and management and 4) cross-cutting methodological issues. While research priorities differed between challenges, an underlying theme was the need for accessible, shared inventories of models, approaches and data, as a resource for stakeholders and to stimulate new research. Developing grassland models to effectively support efforts to tackle climate change impacts, while increasing productivity and enhancing ecosystem services, will require engagement with stakeholders and policy-makers, as well as modellers and experimental researchers across many disciplines. The challenges and priorities identified are intended to be a resource 1) for grassland modellers and experimental researchers, to stimulate the development of new research

  4. Care priorities- Registered Nurses' clinical daily work in municipal elderly care settings.

    Science.gov (United States)

    Norell, Margaretha; Ziegert, Kristina; Kihlgren, Annica

    2013-06-01

    Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation.

  5. Priority Setting Meets Multiple Streams: A Match to Be Further Examined?; Comment on “Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory”

    Directory of Open Access Journals (Sweden)

    Jacqueline Margaret Cumming

    2016-08-01

    Full Text Available With demand for health services continuing to grow as populations age and new technologies emerge to meet health needs, healthcare policy-makers are under constant pressure to set priorities, ie, to make choices about the health services that can and cannot be funded within available resources. In a recent paper, Smith et al apply an influential policy studies framework – Kingdon’s multiple streams approach (MSA – to explore the factors that explain why one health service delivery organization adopted a formal priority setting framework (in the form of programme budgeting and marginal analysis [PBMA] to assist it in making priority setting decisions. MSA is a theory of agenda-setting, ie, how it is that different issues do or do not reach a decision-making point. In this paper, I reflect on the use of the MSA framework to explore priority setting processes and how the framework might be applied to similar cases in future.

  6. Improving the use of research evidence in guideline development: 2. Priority setting

    Directory of Open Access Journals (Sweden)

    Fretheim Atle

    2006-11-01

    Full Text Available Abstract Background The World Health Organization (WHO, like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the second of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives We reviewed the literature on priority setting for health care guidelines, recommendations and technology assessments. Methods We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. Key questions and answers There is little empirical evidence to guide the choice of criteria and processes for establishing priorities, but there are broad similarities in the criteria that are used by various organisations and practical arguments for setting priorities explicitly rather than implicitly, What criteria should be used to establish priorities? • WHO has limited resources and capacity to develop recommendations. It should use these resources where it has the greatest chance of improving health, equity, and efficient use of healthcare resources. • We suggest the following criteria for establishing priorities for developing recommendations based on WHO's aims and strategic advantages: • Problems associated with a high burden of illness in low and middle-income countries, or new and emerging diseases. • No existing recommendations of good quality. • The feasibility of developing recommendations that will improve health outcomes, reduce inequities or reduce unnecessary costs if they are implemented. • Implementation is feasible, will not exhaustively

  7. The public's and doctors' perceived role in participation in setting health care priorities in Greece.

    Science.gov (United States)

    Theodorou, Mamas; Samara, Katerina; Pavlakis, Andreas; Middleton, Nikos; Polyzos, Nikos; Maniadakis, Nikos

    2010-01-01

    The Greek public is currently not represented at any level of the healthcare system's organisational structure. This study aimed to investigate the opinions of Greek citizens as well as doctors regarding their representation in priority setting and to compare these two groups' preferences when prioritising competing resources. A sample of 300 citizens and 100 doctors were asked by means of a standardised questionnaire: (a) whether their views should inform healthcare decisions; (b) to rank in terms of importance other groups that should participate in the process; and (c) to allocate competing resources to a series of alternative prevention programmes, medical procedures or across different population groups. As many as 83% of the citizens stated that their opinions should inform decisions regarding prevention and population-group programmes, while a slightly lower 70% believed their opinions should also be heard regarding medical procedures. However, when asked to rank six different population groups in terms of their importance, the public ranked their role quite low. Generally, doctors and patients, and their families were ranked highest, while politicians were ranked last by both groups. Regarding allocation of funds, a remarkable consensus was observed between doctors and the public. This study documents for the first time in Greece the clear preference for active involvement of both the public and healthcare professionals in the process of priority setting and resource allocation. There is great urgency in complementing these findings with qualitative research methods, such as in-depth interviews and discussions with focus groups, so that a more democratic, participative and transparent process for healthcare priority setting can be initiated, based on the actual needs and health problems of the public.

  8. Priority-setting tools for rheumatology disease referrals: a review of the literature.

    Science.gov (United States)

    De Coster, Carolyn; Fitzgerald, Avril; Cepoiu, Monica

    2008-11-01

    As part of a larger body of work to develop a rheumatology priority referral score, a literature review was conducted. The objective of the literature review was to identify preexisting priority-setting, triage, and referral tools/scales developed to guide referrals from primary care to specialist care/consultation usually provided by a rheumatologist. Using a combination of database, citation, Internet, and hand-searching, 20 papers were identified that related to referral prioritization in three areas: rheumatoid arthritis (RA; 5), musculoskeletal (MSK) diseases other than RA (3), and MSK diseases in general (12). No single set of priority-setting criteria was identified for rheumatologic disorders across the spectrum of patients who may be referred from primary care providers (PCPs) to rheumatologists. There appears to be more congruence on conditions at either end of the urgency spectrum with conditions such as suspected cranial arteritis or systemic vasculitis deemed to be emergency referrals and fibromyalgia and other soft-tissue syndromes deemed to be more routine referrals. Between these two extremes, there is a divergence of opinion about urgency and few papers on the issue. The exception to this is referral for early RA for which several criteria have been established. Despite the inherent complexities in developing a tool to prioritize patients referred by PCPs to rheumatologists, there are compelling reasons to proceed. With the aging of the population, the number of patients being referred to rheumatologists is expected to increase. With pharmaceutical advances, there are demonstrable benefits in early referral for some conditions. These trends have led to increased pressure on scarce rheumatological human resources. A tool to prioritize referrals is a critical component of improving access and the referral process.

  9. Monitoring drinking water, sanitation, and hygiene in non-household settings: Priorities for policy and practice.

    Science.gov (United States)

    Cronk, Ryan; Slaymaker, Tom; Bartram, Jamie

    2015-11-01

    -household settings as a priority. National and international monitoring systems will be important to better understand status, trends, to identify priorities and target resources accordingly, and to improve accountability for progressive improvements in WaSH in non-household settings. Copyright © 2015 Elsevier GmbH. All rights reserved.

  10. Accountable priority setting for trust in health systems - the need for research into a new approach for strengthening sustainable health action in developing countries

    Directory of Open Access Journals (Sweden)

    Olsen Øystein E

    2009-10-01

    Full Text Available Abstract 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

  11. Introduction: priority setting, equitable access and public involvement in health care.

    Science.gov (United States)

    Weale, Albert; Kieslich, Katharina; Littlejohns, Peter; Tugendhaft, Aviva; Tumilty, Emma; Weerasuriya, Krisantha; Whitty, Jennifer A

    2016-08-15

    Purpose - The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach - The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings - The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value - The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as "contestatory participation". This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world.

  12. The accountability for reasonableness approach to guide priority setting in health systems within limited resources

    DEFF Research Database (Denmark)

    Byskov, Jens; Marchal, Bruno; Maluka, Stephen

    2014-01-01

    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...... 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 on one hand and the local realities and demands of the served...... communities on the other 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...

  13. National Priority Setting of Clinical Practice Guidelines Development for Chronic Disease Management.

    Science.gov (United States)

    Jo, Heui-Sug; Kim, Dong Ik; Oh, Moo-Kyung

    2015-12-01

    By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer's disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver.

  14. Plasma nanoscience: setting directions, tackling grand challenges

    Science.gov (United States)

    (Ken Ostrikov, Kostya; Cvelbar, Uros; Murphy, Anthony B.

    2011-05-01

    This review paper presents historical perspectives, recent advances and future directions in the multidisciplinary research field of plasma nanoscience. The current status and future challenges are presented using a three-dimensional framework. The first and the largest dimension covers the most important classes of nanoscale objects (nanostructures, nanofeatures and nanoassemblies/nanoarchitectures) and materials systems, namely carbon nanotubes, nanofibres, graphene, graphene nanoribbons, graphene nanoflakes, nanodiamond and related carbon-based nanostructures; metal, silicon and other inorganic nanoparticles and nanostructures; soft organic nanomaterials; nano-biomaterials; biological objects and nanoscale plasma etching. In the second dimension, we discuss the most common types of plasmas and plasma reactors used in nanoscale plasma synthesis and processing. These include low-temperature non-equilibrium plasmas at low and high pressures, thermal plasmas, high-pressure microplasmas, plasmas in liquids and plasma-liquid interactions, high-energy-density plasmas, and ionized physical vapour deposition as well as some other plasma-enhanced nanofabrication techniques. In the third dimension, we outline some of the 'Grand Science Challenges' and 'Grand Socio-economic Challenges' to which significant contributions from plasma nanoscience-related research can be expected in the near future. The urgent need for a stronger focus on practical, outcome-oriented research to tackle the grand challenges is emphasized and concisely formulated as from controlled complexity to practical simplicity in solving grand challenges.

  15. Plasma nanoscience: setting directions, tackling grand challenges

    Energy Technology Data Exchange (ETDEWEB)

    Ostrikov, Kostya [Plasma Nanoscience Centre Australia (PNCA), CSIRO Materials Science and Engineering, PO Box 218, Lindfield NSW 2070 (Australia); Cvelbar, Uros [Jozef Stefan Institute, 39 Jamova cesta, Ljubljana, SI-1000 (Slovenia); Murphy, Anthony B, E-mail: Kostya.Ostrikov@csiro.au, E-mail: Uros.Cvelbar@ijs.si, E-mail: Tony.Murphy@csiro.au [CSIRO Materials Science and Engineering, PO Box 218, Lindfield NSW 2070 (Australia)

    2011-05-04

    This review paper presents historical perspectives, recent advances and future directions in the multidisciplinary research field of plasma nanoscience. The current status and future challenges are presented using a three-dimensional framework. The first and the largest dimension covers the most important classes of nanoscale objects (nanostructures, nanofeatures and nanoassemblies/nanoarchitectures) and materials systems, namely carbon nanotubes, nanofibres, graphene, graphene nanoribbons, graphene nanoflakes, nanodiamond and related carbon-based nanostructures; metal, silicon and other inorganic nanoparticles and nanostructures; soft organic nanomaterials; nano-biomaterials; biological objects and nanoscale plasma etching. In the second dimension, we discuss the most common types of plasmas and plasma reactors used in nanoscale plasma synthesis and processing. These include low-temperature non-equilibrium plasmas at low and high pressures, thermal plasmas, high-pressure microplasmas, plasmas in liquids and plasma-liquid interactions, high-energy-density plasmas, and ionized physical vapour deposition as well as some other plasma-enhanced nanofabrication techniques. In the third dimension, we outline some of the 'Grand Science Challenges' and 'Grand Socio-economic Challenges' to which significant contributions from plasma nanoscience-related research can be expected in the near future. The urgent need for a stronger focus on practical, outcome-oriented research to tackle the grand challenges is emphasized and concisely formulated as from controlled complexity to practical simplicity in solving grand challenges.

  16. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature.

    Science.gov (United States)

    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

  17. Individual responsibility as ground for priority setting in shared decision-making.

    Science.gov (United States)

    Sandman, Lars; Gustavsson, Erik; Munthe, Christian

    2016-10-01

    Given healthcare resource constraints, voices are being raised to hold patients responsible for their health choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control over healthcare decisions. More power and control over decisions is usually taken to mean more responsibility for them. The trend of shared decision-making would therefore seem to strengthen the case for invoking individual responsibility in the healthcare priority setting. To analyse whether the implementation of shared decision-making would strengthen the argument for invoking individual responsibility in the healthcare priority setting using normative analysis. Shared decision-making does not constitute an independent argument in favour of employing individual responsibility since these notions rest on different underlying values. However, if a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside professional standards and goals. If a healthcare system employs individual responsibility, high level dynamic shared decision-making implying a joint deliberation resulting in a decision where both parties are willing to revise initial standpoints may disarm common objections to the applicability of individual responsibility by virtue of making patients more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, arguments against individual responsibility might, on the other hand, gain strength. 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/

  18. Using Multicriteria Decision Analysis to Support Research Priority Setting in Biomedical Translational Research Projects

    Directory of Open Access Journals (Sweden)

    Gimon de Graaf

    2015-01-01

    Full Text Available Translational research is conducted to achieve a predefined set of economic or societal goals. As a result, investment decisions on where available resources have the highest potential in achieving these goals have to be made. In this paper, we first describe how multicriteria decision analysis can assist in defining the decision context and in ensuring that all relevant aspects of the decision problem are incorporated in the decision making process. We then present the results of a case study to support priority setting in a translational research consortium aimed at reducing the burden of disease of type 2 diabetes. During problem structuring, we identified four research alternatives (primary, secondary, tertiary microvascular, and tertiary macrovascular prevention and a set of six decision criteria. Scoring of these alternatives against the criteria was done using a combination of expert judgement and previously published data. Lastly, decision analysis was performed using stochastic multicriteria acceptability analysis, which allows for the combined use of numerical and ordinal data. We found that the development of novel techniques applied in secondary prevention would be a poor investment of research funds. The ranking of the remaining alternatives was however strongly dependent on the decision maker’s preferences for certain criteria.

  19. How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS

    Directory of Open Access Journals (Sweden)

    Jenniskens Françoise

    2012-12-01

    Full Text Available Abstract 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

  20. The conservation and management of tunas and their relatives: setting life history research priorities.

    Directory of Open Access Journals (Sweden)

    Maria José Juan-Jordá

    Full Text Available Scombrids (tunas, bonitos, Spanish mackerels and mackerels support important fisheries in tropical, subtropical and temperate waters around the world, being one of the most economically- and socially-important marine species globally. Their sustainable exploitation, management and conservation depend on accurate life history information for the development of quantitative fisheries stock assessments, and in the fishery data-poor situations for the identification of vulnerable species. Here, we assemble life history traits (maximum size, growth, longevity, maturity, fecundity, spawning duration and spawning interval for the 51 species of scombrids globally. We identify major biological gaps in knowledge and prioritize life history research needs in scombrids based on their biological gaps in knowledge, the importance of their fisheries and their current conservation status according to the International Union for Conservation of Nature Red List. We find that the growth and reproductive biology of tunas and mackerel species have been more extensively studied than for Spanish mackerels and bonitos, although there are notable exceptions in all groups. We also reveal that reproductive biology of species, particular fecundity, is the least studied biological aspect in scombrids. We identify two priority groups, including 32 species of scombrids, and several populations of principal market tunas, for which life history research should be prioritized following the species-specific life history gaps identified in this study in the coming decades. By highlighting the important gaps in biological knowledge and providing a priority setting for life history research in scombrid species this study provides guidance for management and conservation and serves as a guide for biologists and resource managers interested in the biology, ecology, and management of scombrid species.

  1. Achieving the health Millennium Development Goals for South Africa: challenges and priorities.

    Science.gov (United States)

    Chopra, Mickey; Lawn, Joy E; Sanders, David; Barron, Peter; Abdool Karim, Salim S; Bradshaw, Debbie; Jewkes, Rachel; Abdool Karim, Quarraisha; Flisher, Alan J; Mayosi, Bongani M; Tollman, Stephen M; Churchyard, Gavin J; Coovadia, Hoosen

    2009-09-19

    15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. We discuss the type of vision, leadership, and priority actions needed to achieve such a change. We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country--will they do so or will another opportunity and many more lives be lost?

  2. Disparities in hospital utilization in an urban county: use of local consumer marketing data for priority setting.

    Science.gov (United States)

    Zuber, P L; Dignam, T A; Caldwell, M B; Wiesner, P J

    2000-11-01

    National data sets are often insufficient for priority setting by local public health systems and the communities they serve. We used marketing data to conduct an ecological analysis of hospital discharge rates in DeKalb County, Georgia, during 1996. Persons living in poorer areas had significantly higher discharge rates for the following conditions: hypertensive disease, blood-related conditions, pneumonia/influenza, diabetes, and chronic obstructive pulmonary diseases. Local marketing data helped identify conditions associated with higher hospital utilization in poorer areas of this urban county. This identification of priority issues informs plans for behavior modification, access to primary care and a healthy environment.

  3. An assessment of priority setting process and its implication on availability of emergency obstetric care services in Malindi District, Kenya.

    Science.gov (United States)

    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.

  4. Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Ryan Li

    2017-03-01

    Full Text Available 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

  5. Setting priorities for action plans at Los Alamos National Laboratory. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Miller, A.C.

    1992-09-30

    This report summarizes work done by Applied Decision Analysis (ADA) for Los Alamos National Laboratory (LANL) under Subcontract Number 9-XQ2-Y3837-1 with the University of California. The purpose of this work was to develop a method of setting priorities for environmental, safety, and health (ES&H) deficiencies at Los Alamos. The deficiencies were identified by a DOE Tiger Team that visited LANL in the fall of 1991, and by self assessments done by the Laboratory. ADA did the work described here between October 1991 and the end of September 1992. The ADA staff working on this project became part of a Risk Management Team in the Laboratory`s Integration and Coordination Office (ICO). During the project, the Risk Management Team produced a variety of documents describing aspects of the action-plan prioritization system. Some of those documents are attached to this report. Rather than attempt to duplicate their contents, this report provides a guide to those documents, and references them whenever appropriate.

  6. The Ebola epidemic in West Africa: challenges, opportunities, and policy priority areas.

    Science.gov (United States)

    Buseh, Aaron G; Stevens, Patricia E; Bromberg, Mel; Kelber, Sheryl T

    2015-01-01

    The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in particular the inadequacies of health care systems in sub-Saharan African countries for appropriately managing and containing infectious diseases. The purpose of this article is to examine the sociopolitical and economic conditions that created the environment for the Ebola epidemic to occur, identify challenges to and opportunities for the prevention and control of Ebola and future outbreaks, and discuss policy recommendations and priority areas for addressing the Ebola epidemic and future outbreaks in West Africa. Articles in peer-reviewed journals on health system reforms in developing countries and periodicals of international organizations were used to gather the overview reported in this article. We identify individual, structural, and community challenges that must be addressed in an effort to reduce the spread of Ebola in West Africa. The Ebola epidemic in West Africa underscores the need for the overhaul and transformation of African health care systems to build the capacity in these countries to address infectious diseases. Public-private partnerships for investment in developing countries' health care systems that involve the international community are critical in addressing the current Ebola epidemic and future outbreaks.

  7. Setting health research priorities using the CHNRI method: VI. Quantitative properties of human collective opinion.

    Science.gov (United States)

    Yoshida, Sachiyo; Rudan, Igor; Cousens, Simon

    2016-06-01

    Crowdsourcing has become an increasingly important tool to address many problems - from government elections in democracies, stock market prices, to modern online tools such as TripAdvisor or Internet Movie Database (IMDB). The CHNRI method (the acronym for the Child Health and Nutrition Research Initiative) for setting health research priorities has crowdsourcing as the major component, which it uses to generate, assess and prioritize between many competing health research ideas. We conducted a series of analyses using data from a group of 91 scorers to explore the quantitative properties of their collective opinion. We were interested in the stability of their collective opinion as the sample size increases from 15 to 90. From a pool of 91 scorers who took part in a previous CHNRI exercise, we used sampling with replacement to generate multiple random samples of different size. First, for each sample generated, we identified the top 20 ranked research ideas, among 205 that were proposed and scored, and calculated the concordance with the ranking generated by the 91 original scorers. Second, we used rank correlation coefficients to compare the ranks assigned to all 205 proposed research ideas when samples of different size are used. We also analysed the original pool of 91 scorers to to look for evidence of scoring variations based on scorers' characteristics. The sample sizes investigated ranged from 15 to 90. The concordance for the top 20 scored research ideas increased with sample sizes up to about 55 experts. At this point, the median level of concordance stabilized at 15/20 top ranked questions (75%), with the interquartile range also generally stable (14-16). There was little further increase in overlap when the sample size increased from 55 to 90. When analysing the ranking of all 205 ideas, the rank correlation coefficient increased as the sample size increased, with a median correlation of 0.95 reached at the sample size of 45 experts (median of the rank

  8. Using programme budgeting and marginal analysis (PBMA) to set priorities: reflections from a qualitative assessment in an English Primary Care Trust.

    Science.gov (United States)

    Goodwin, Elizabeth; Frew, Emma J

    2013-12-01

    In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment

  9. Fair processes for priority setting: Putting theory into practice: Comment on “expanded HTA: Enhancing fairness and legitimacy”

    NARCIS (Netherlands)

    Jansen, M.P. (Maarten P.); J.-K. Helderman (Jan-Kees); Boer, B. (Bert); R. Baltussen (R.)

    2017-01-01

    textabstractEmbedding health technology assessment (HTA) in a fair process has great potential to capture societal values relevant to public reimbursement decisions on health technologies. However, the development of such processes for priority setting has largely been theoretical. In this paper, we

  10. Fair Processes for Priority Setting: Putting Theory into Practice; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy"

    NARCIS (Netherlands)

    Jansen, M.P.; Helderman, J.K.; Boer, B.; Baltussen, R.

    2017-01-01

    Embedding health technology assessment (HTA) in a fair process has great potential to capture societal values relevant to public reimbursement decisions on health technologies. However, the development of such processes for priority setting has largely been theoretical. In this paper, we provide

  11. Increased fairness in priority setting processes within the health sector: the case of Kapiri-Mposhi District, Zambia.

    Science.gov (United States)

    Zulu, Joseph M; Michelo, Charles; Msoni, Carol; Hurtig, Anna-Karin; Byskov, Jens; Blystad, Astrid

    2014-02-18

    The challenge of priority setting (PS) in health care within contexts of severe resource limitations has continued to receive attention. Accountability for Reasonableness (AFR) has emerged as a useful framework to guide the implementation of PS processes. In 2006, the AFR approach to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled 'Response to Accountable priority setting for Trust in health systems' (REACT). The project aimed to strengthen fairness and accountability in the PS processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district level in Kapiri-Mposhi District in Zambia. Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district administration, in non-governmental organizations (NGO) and in health facilities. During the baseline study, concepts of legitimacy and fairness in PS processes were found to be grounded in local values of equity and impartiality. Government and other organizational strategies strongly supported devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing in the study district, which was partly attributed to the AFR based intervention. The study findings suggest that increased attention was given to fairness in PS processes at district level. The changes were linked to a

  12. Incorporating Cost-Effectiveness Data in a Fair Process for Priority Setting Efforts; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden”

    Directory of Open Access Journals (Sweden)

    Sitaporn Youngkong

    2015-07-01

    Full Text Available Cost-effectiveness data is useful for use in priority setting decisions in order to improve the efficiency of resources used. This paper thereby responds to Eckard et al. which addressed the use of cost-effectiveness data in the actual prioritization decisions in the Swedish national clinical guidelines for heart diseases. Based on a set of experiences on the use of economic evaluation in priority setting processes, this paper emphasizes the potential approach to incorporating cost-effectiveness data in the prioritization process to enhance transparency of the decisions, and highlights the importance of designing a fair decision-making process that can enforce the sustained implementation of cost-effectiveness data.

  13. Pharmacoeconomics and its implication on priority-setting for essential medicines in Tanzania: a systematic review

    Directory of Open Access Journals (Sweden)

    Mori Amani

    2012-09-01

    the ability to interpret and utilise pharmacoeconomic evidence. Relevant health authorities in Tanzania should also consider how to apply pharmacoeconomic analyses more consistently in the future priority-setting decisions for selection of essential medicines.

  14. Disseminating evidence-based treatments for PTSD in organizational settings: A high priority focus area.

    Science.gov (United States)

    Ruzek, Josef I; Rosen, Raymond C

    2009-11-01

    Dissemination of evidence-based treatments for PTSD has become an important focus of activity in the aftermath of recent terrorist attacks (e.g., London underground and U.S. 9/11 attacks), natural disasters (e.g., Indian Ocean tsunami and Hurricane Katrina), and wars (e.g., in Iraq and Afghanistan). This has become a high priority need for all mental health training and service delivery organizations. Researchers and educators have begun to examine clinician and client perceptions and preferences regarding PTSD treatment processes, and health care systems are organizing more comprehensive efforts at training and system change. As this evolution of services moves forward, effective dissemination should be a major focus of health policy research for the next decade or more. This review critically evaluates the PTSD-related research and emerging theory related to four major sets of variables that affect dissemination: (1) Practitioner factors, (2) Training methods, (3) The practice innovation(s) being disseminated; and (4) Organization or system factors. We evaluate findings from recent studies in light of emerging models of dissemination, and in the final section of the paper, we consider five broad topics with particular implications for dissemination of PTSD-specific treatments. They are: (1) The content of dissemination (i.e., which treatment protocols or intervention methods should be prioritized); (2) Strict adherence versus flexibility in the use of treatment manuals and the role of fidelity assessment; (3) The need for collaboration with user audiences; (4) The potential role of web-based technologies in increasing the effectiveness and efficiency of dissemination; and (5) Development of dissemination infrastructures within organizations.

  15. Massage Therapy and Canadians’ Health Care Needs 2020: Proceedings of a National Research Priority Setting Summit

    Science.gov (United States)

    Dryden, Trish; Sumpton, Bryn; Shipwright, Stacey; Kahn, Janet; Reece, Barbara (Findlay)

    2014-01-01

    Background The health care landscape in Canada is changing rapidly as forces, such as an aging population, increasingly complex health issues and treatments, and economic pressure to reduce health care costs, bear down on the system. A cohesive national research agenda for massage therapy (MT) is needed in order to ensure maximum benefit is derived from research on treatment, health care policy, and cost effectiveness. Setting A one-day invitational summit was held in Toronto, Ontario to build strategic alliances among Canadian and international researchers, policy makers, and other stakeholders to help shape a national research agenda for MT. Method Using a modified Delphi method, the summit organizers conducted two pre-summit surveys to ensure that time spent during the summit was relevant and productive. The summit was facilitated using the principles of Appreciative Inquiry which included a “4D” strategic planning approach (defining, discovery, dreaming, designing) and application of a SOAR framework (strengths, opportunities, aspirations, and results). Participants Twenty-six researchers, policymakers, and other stakeholders actively participated in the events. Results Priority topics that massage therapists believe are important to the Canadian public, other health care providers, and policy makers and massage therapists themselves were identified. A framework for a national massage therapy (MT) research agenda, a grand vision of the future for MT research, and a 12-month action plan were developed. Conclusion The summit provided an excellent opportunity for key stakeholders to come together and use their experience and knowledge of MT to develop a much-needed plan for moving the MT research and professionalization agenda forward. PMID:24592299

  16. Overcoming All-Too-Common Challenges of Community Collaboration: Research Fatigue and Integration of Local Priorities

    Science.gov (United States)

    Brinkman, T. J.; Cold, H.; Stinchcomb, T.; Brown, C.; Hollingsworth, T. N.

    2016-12-01

    Indigenous communities in the Arctic have received increased attention from scientists in recent decades because of rapid climate change and resource development. Although many successful collaborations have occurred, some communities have been overwhelmed by the volume of research activity and frustrated with inadequate integration of local priorities into the research agenda. We present a northern case study to demonstrate how these challenges can be overcome through innovative community-based research and responsive scientific study designs. We collaborated with the community of Nuiqsut, Alaska to pilot a monitoring program that used camera-equipped GPS units to document social-ecological changes important to the community. Nuiqsut residents embraced an engagement strategy that avoided common methods of community collaboration (e.g., interviews), and that utilized novel and locally-accessible tools for documenting change. The monitoring program structure facilitated integration of indigenous knowledge (e.g., TEK) with western science. Scientists from diverse disciplines benefitted from local narratives on biophysical and social disturbances relevant to their research. The community benefitted from several subsequent scientific investigations that were launched to address the most pressing concerns voiced by local residents. Our community-based research strategy expanded to ten rural communities within the last year. We share our story and provide specific recommendations for enhancing community collaborations.

  17. Water, sanitation and hygiene in health care facilities: Challenges and priorities

    Directory of Open Access Journals (Sweden)

    Jovanović Dragana

    2017-01-01

    Full Text Available The microbial agents that cause infectious diseases are highly prevalent in health care facilities. Adequate water supply, sanitation and hygiene are the key elements for the provision of basic health services. The consequences of poor sanitary and hygienic conditions and inadequate water supply are numerous in health care facilities. The importance of improving water supply, sanitation and hygiene in health care facilities has been recognized as an international priority and set in the 2030 Agenda for Sustainable Development, particularly through goal 3.8 and 6. The establishment and maintenance of safe water supply and adequate sanitary and hygienic conditions has multiple benefits for health care facilities. It is necessary to introduce and implement risk assessment and risk management approach as effective way of continuously ensuring and maintaining the safety of drinking water quality in health care facilities as recommended by the World Health Organization, in order to reduce the risks associated with inadequate water supply and protect health of patients and staff. Realization of activities on the improvement requires a multidisciplinary approach and good inter-sectoral cooperation at all levels local, national and global.

  18. Setting research priorities to improve global newborn health and prevent stillbirths by 2025

    DEFF Research Database (Denmark)

    Yoshida, Sachiyo; Martines, José; Lawn, Joy E

    2016-01-01

    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...

  19. A Model for Gathering Stakeholder Input for Setting Research Priorities at the Land-Grant University.

    Science.gov (United States)

    Kelsey, Kathleen Dodge; Pense, Seburn L.

    2001-01-01

    A model for collecting and using stakeholder input on research priorities is a modification of Guba and Lincoln's model, involving preevaluation preparation, stakeholder identification, information gathering and analysis, interpretive filtering, and negotiation and consensus. A case study at Oklahoma State University illustrates its applicability…

  20. Setting priorities for research in medical nutrition education: an international approach.

    Science.gov (United States)

    Ball, Lauren; Barnes, Katelyn; Laur, Celia; Crowley, Jennifer; Ray, Sumantra

    2016-12-14

    To identify the research priorities for medical nutrition education worldwide. A 5-step stakeholder engagement process based on methodological guidelines for identifying research priorities in health. 277 individuals were identified as representatives for 30 different stakeholder organisations across 86 countries. The stakeholder organisations represented the views of medical educators, medical students, doctors, patients and researchers in medical education. Each stakeholder representative was asked to provide up to three research questions that should be deemed as a priority for medical nutrition education. Research questions were critically appraised for answerability, sustainability, effectiveness, potential for translation and potential to impact on disease burden. A blinded scoring system was used to rank the appraised questions, with higher scores indicating higher priority (range of scores possible 36-108). 37 submissions were received, of which 25 were unique research questions. Submitted questions received a range of scores from 62 to 106 points. The highest scoring questions focused on (1) increasing the confidence of medical students and doctors in providing nutrition care to patients, (2) clarifying the essential nutrition skills doctors should acquire, (3) understanding the effectiveness of doctors at influencing dietary behaviours and (4) improving medical students' attitudes towards the importance of nutrition. These research questions can be used to ensure future projects in medical nutrition education directly align with the needs and preferences of research stakeholders. Funders should consider these priorities in their commissioning of research. 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/.

  1. Priority setting for universal health coverage: We need evidence-informed deliberative processes, not just more evidence on cost-effectiveness

    NARCIS (Netherlands)

    R. Baltussen (R.); Jansen, M.P. (Maarten P.); T.S. Mikkelsen; N. Tromp; J.A.C. Hontelez (Jan A.C.); Bijlmakers, L. (Leon); G.-J. van der Wilt (Gert-Jan)

    2016-01-01

    textabstractPriority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of m

  2. Political strategies in difficult times - The "backstage" experience of Swedish politicians on formal priority setting in healthcare.

    Science.gov (United States)

    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.

  3. Comparing two sampling methods to engage hard-to-reach communities in research priority setting.

    Science.gov (United States)

    Valerio, Melissa A; Rodriguez, Natalia; Winkler, Paula; Lopez, Jaime; Dennison, Meagen; Liang, Yuanyuan; Turner, Barbara J

    2016-10-28

    Effective community-partnered and patient-centered outcomes research needs to address community priorities. However, optimal sampling methods to engage stakeholders from hard-to-reach, vulnerable communities to generate research priorities have not been identified. In two similar rural, largely Hispanic communities, a community advisory board guided recruitment of stakeholders affected by chronic pain using a different method in each community: 1) snowball sampling, a chain- referral method or 2) purposive sampling to recruit diverse stakeholders. In both communities, three groups of stakeholders attended a series of three facilitated meetings to orient, brainstorm, and prioritize ideas (9 meetings/community). Using mixed methods analysis, we compared stakeholder recruitment and retention as well as priorities from both communities' stakeholders on mean ratings of their ideas based on importance and feasibility for implementation in their community. Of 65 eligible stakeholders in one community recruited by snowball sampling, 55 (85 %) consented, 52 (95 %) attended the first meeting, and 36 (65 %) attended all 3 meetings. In the second community, the purposive sampling method was supplemented by convenience sampling to increase recruitment. Of 69 stakeholders recruited by this combined strategy, 62 (90 %) consented, 36 (58 %) attended the first meeting, and 26 (42 %) attended all 3 meetings. Snowball sampling recruited more Hispanics and disabled persons (all P sampling group and for city improvements/transportation services (P = 0.004) which was higher for the snowball sampling group. In each of the two similar hard-to-reach communities, a community advisory board partnered with researchers to implement a different sampling method to recruit stakeholders. The snowball sampling method achieved greater participation with more Hispanics but also more individuals with disabilities than a purposive-convenience sampling method. However, priorities for

  4. Can wide consultation help with setting priorities for large-scale biodiversity monitoring programs?

    Directory of Open Access Journals (Sweden)

    Frédéric Boivin

    Full Text Available Climate and other global change phenomena affecting biodiversity require monitoring to track ecosystem changes and guide policy and management actions. Designing a biodiversity monitoring program is a difficult task that requires making decisions that often lack consensus due to budgetary constrains. As monitoring programs require long-term investment, they also require strong and continuing support from all interested parties. As such, stakeholder consultation is key to identify priorities and make sound design decisions that have as much support as possible. Here, we present the results of a consultation conducted to serve as an aid for designing a large-scale biodiversity monitoring program for the province of Québec (Canada. The consultation took the form of a survey with 13 discrete choices involving tradeoffs in respect to design priorities and 10 demographic questions (e.g., age, profession. The survey was sent to thousands of individuals having expected interests and knowledge about biodiversity and was completed by 621 participants. Overall, consensuses were few and it appeared difficult to create a design fulfilling the priorities of the majority. Most participants wanted 1 a monitoring design covering the entire territory and focusing on natural habitats; 2 a focus on species related to ecosystem services, on threatened and on invasive species. The only demographic characteristic that was related to the type of prioritization was the declared level of knowledge in biodiversity (null to high, but even then the influence was quite small.

  5. Setting health research priorities using the CHNRI method: V. Quantitative properties of human collective knowledge.

    Science.gov (United States)

    Rudan, Igor; Yoshida, Sachiyo; Wazny, Kerri; Chan, Kit Yee; Cousens, Simon

    2016-06-01

    The CHNRI method for setting health research priorities has crowdsourcing as the major component. It uses the collective opinion of a group of experts to generate, assess and prioritize between many competing health research ideas. It is difficult to compare the accuracy of human individual and collective opinions in predicting uncertain future outcomes before the outcomes are known. However, this limitation does not apply to existing knowledge, which is an important component underlying opinion. In this paper, we report several experiments to explore the quantitative properties of human collective knowledge and discuss their relevance to the CHNRI method. We conducted a series of experiments in groups of about 160 (range: 122-175) undergraduate Year 2 medical students to compare their collective knowledge to their individual knowledge. We asked them to answer 10 questions on each of the following: (i) an area in which they have a degree of expertise (undergraduate Year 1 medical curriculum); (ii) an area in which they likely have some knowledge (general knowledge); and (iii) an area in which they are not expected to have any knowledge (astronomy). We also presented them with 20 pairs of well-known celebrities and asked them to identify the older person of the pair. In all these experiments our goal was to examine how the collective answer compares to the distribution of students' individual answers. When answering the questions in their own area of expertise, the collective answer (the median) was in the top 20.83% of the most accurate individual responses; in general knowledge, it was in the top 11.93%; and in an area with no expertise, the group answer was in the top 7.02%. However, the collective answer based on mean values fared much worse, ranging from top 75.60% to top 95.91%. Also, when confronted with guessing the older of the two celebrities, the collective response was correct in 18/20 cases (90%), while the 8 most successful individuals among the

  6. Can frameworks inform knowledge about health policy processes? Reviewing health policy papers on agenda setting and testing them against a specific priority-setting framework.

    Science.gov (United States)

    Walt, Gill; Gilson, Lucy

    2014-12-01

    This article systematically reviews a set of health policy papers on agenda setting and tests them against a specific priority-setting framework. The article applies the Shiffman and Smith framework in extracting and synthesizing data from an existing set of papers, purposively identified for their relevance and systematically reviewed. Its primary aim is to assess how far the component parts of the framework help to identify the factors that influence the agenda setting stage of the policy process at global and national levels. It seeks to advance the field and inform the development of theory in health policy by examining the extent to which the framework offers a useful approach for organizing and analysing data. Applying the framework retrospectively to the selected set of papers, it aims to explore influences on priority setting and to assess how far the framework might gain from further refinement or adaptation, if used prospectively. In pursuing its primary aim, the article also demonstrates how the approach of framework synthesis can be used in health policy analysis research.

  7. What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

    Directory of Open Access Journals (Sweden)

    Martin Douglas K

    2005-01-01

    Full Text Available Abstract 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

  8. Comparing two sampling methods to engage hard-to-reach communities in research priority setting

    Directory of Open Access Journals (Sweden)

    Melissa A. Valerio

    2016-10-01

    Full Text Available Abstract Background Effective community-partnered and patient-centered outcomes research needs to address community priorities. However, optimal sampling methods to engage stakeholders from hard-to-reach, vulnerable communities to generate research priorities have not been identified. Methods In two similar rural, largely Hispanic communities, a community advisory board guided recruitment of stakeholders affected by chronic pain using a different method in each community: 1 snowball sampling, a chain- referral method or 2 purposive sampling to recruit diverse stakeholders. In both communities, three groups of stakeholders attended a series of three facilitated meetings to orient, brainstorm, and prioritize ideas (9 meetings/community. Using mixed methods analysis, we compared stakeholder recruitment and retention as well as priorities from both communities’ stakeholders on mean ratings of their ideas based on importance and feasibility for implementation in their community. Results Of 65 eligible stakeholders in one community recruited by snowball sampling, 55 (85 % consented, 52 (95 % attended the first meeting, and 36 (65 % attended all 3 meetings. In the second community, the purposive sampling method was supplemented by convenience sampling to increase recruitment. Of 69 stakeholders recruited by this combined strategy, 62 (90 % consented, 36 (58 % attended the first meeting, and 26 (42 % attended all 3 meetings. Snowball sampling recruited more Hispanics and disabled persons (all P < 0.05. Despite differing recruitment strategies, stakeholders from the two communities identified largely similar ideas for research, focusing on non-pharmacologic interventions for management of chronic pain. Ratings on importance and feasibility for community implementation differed only on the importance of massage services (P = 0.045 which was higher for the purposive/convenience sampling group and for city improvements

  9. Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

    Directory of Open Access Journals (Sweden)

    Norheim Ole

    2004-01-01

    Full Text Available Abstract Introduction Several studies carried out to establish the relative preference of cost-effectiveness of interventions and severity of disease as criteria for priority setting in health have shown a strong preference for severity of disease. These preferences may differ in contexts of resource scarcity, as in developing countries, yet information is limited on such preferences in this context. Objective This study was carried out to identify the key players in priority setting in health and explore their relative preference regarding cost-effectiveness of interventions and severity of disease as criteria for setting priorities in Uganda. Design 610 self-administered questionnaires were sent to respondents at national, district, health sub-district and facility levels. Respondents included mainly health workers. We used three different simulations, assuming same patient characteristics and same treatment outcome but with varying either severity of disease or cost-effectiveness of treatment, to explore respondents' preferences regarding cost-effectiveness and severity. Results Actual main actors were identified to be health workers, development partners or donors and politicians. This was different from what respondents perceived as ideal. Above 90% of the respondents recognised the importance of both severity of disease and cost-effectiveness of intervention. In the three scenarios where they were made to choose between the two, a majority of the survey respondents assigned highest weight to treating the most severely ill patient with a less cost-effective intervention compared to the one with a more cost-effective intervention for a less severely ill patient. However, international development partners in in-depth interviews preferred the consideration of cost-effectiveness of intervention. Conclusions In a survey among health workers and other actors in priority setting in Uganda, we found that donors are considered to have more say than

  10. Information resources for assessing health effects from chemical exposure: Challenges, priorities, and future issues

    Energy Technology Data Exchange (ETDEWEB)

    Seigel, S. [National Library of Medicine, Bethesda, MD (United States)

    1990-12-31

    Issues related to developing information resources for assessing the health effects from chemical exposure include the question of how to address the individual political issues relevant to identifying and determining the timeliness, scientific credibility, and completeness of such kinds of information resources. One of the important ways for agencies to share information is through connection tables. This type of software is presently being used to build information products for some DHHS agencies. One of the challenges will be to convince vendors of data of the importance of trying to make data files available to communities that need them. In the future, information processing will be conducted with neural networks, object-oriented database management systems, and fuzzy-set technologies, and meta analysis techniques.

  11. Implementation Challenges in Translating Pivotal Response Training into Community Settings

    Science.gov (United States)

    Suhrheinrich, Jessica; Stahmer, Aubyn C.; Reed, Sarah; Schreibman, Laura; Reisinger, Erica; Mandell, David

    2013-01-01

    Implementing evidence-based practices (EBPs) for children with autism is challenging for teachers because these practices are often complex, requiring significant training and resources that are not available in most school settings. This brief investigation was designed to identify areas of strength and difficulty for teachers implementing one…

  12. Life goes on - Priority settings in patients with cancer and comorbidities

    DEFF Research Database (Denmark)

    Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Søndergaard, Jens

    . Method General practitioners in Region Zealand have included eligible patients, who have one or more chronic diseases, and who have recently finished primary treatment for a non-metastatic cancer. Thirteen patients have been included in the study. Semi-structured interviews have been carried out......Background As the number of patients living with cancer is increasing, a growing population of cancer patients will also deal with comorbid chronic diseases. The period after completed cancer treatment can be a vulnerable time including uncertainty about health status, physical and emotional...... symptoms from cancer disease and treatment. This might influence patients’ priorities and attention to comorbidities. Some studies show that the quality of care for the comorbid chronic diseases and participation in regular follow-up consultations are lower among patients with a cancer diagnosis compared...

  13. The health systems' priority setting criteria for selecting health technologies: A systematic review of the current evidence

    Science.gov (United States)

    Mobinizadeh, Mohammadreza; Raeissi, Pouran; Nasiripour, Amir Ashkan; Olyaeemanesh, Alireza; Tabibi, Seyed Jamaleddin

    2016-01-01

    Background: In the recent years, using health technologies to diagnose and treat diseases has had a considerable and accelerated growth. The proper use of these technologies may considerably help in the diagnosis and treatment of different diseases. On the other hand, unlimited and unrestricted entry of these technologies may result in induced demand by service providers. The aim of this study was to determine the appropriate criteria used in health technologies priority-setting models in the world. Methods: Using MESH and free text, we sought and retrieved the relevant articles from the most appropriate medical databases (the Cochrane Library, PubMed and Scopus) through three separate search strategies up to March 2015. The inclusion criteria were as follows: 1) Studies with specific criteria; 2) Articles written in English; 3) Those articles conducted in compliance with priority setting of health technologies. Data were analyzed qualitatively using a thematic synthesis technique. Results: After screening the retrieved papers via PRISMA framework, from the 7,012 papers, 40 studies were included in the final phase. Criteria for selecting health technologies (in pre assessment and in the assessment phase) were categorized into six main themes: 1) Health outcomes; 2) Disease and target population; 3) Technology alternatives; 4) Economic aspects; 5) Evidence; 6) and other factors. "Health effects/benefits" had the maximum frequency in health outcomes (8 studies); "disease severity" had the maximum frequency in disease and target population (12 studies); "the number of alternatives" had the maximum frequency in alternatives (2 studies); "cost-effectiveness" had the maximum frequency in economic aspects (15 studies); "quality of evidence" had the maximum frequency in evidence (4 studies); and "issues concerning the health system" had the maximum frequency in other factors (10 studies). Conclusion: The results revealed an increase in the number of studies on health

  14. Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities.

    Science.gov (United States)

    Boccia, Delia; Pedrazzoli, Debora; Wingfield, Tom; Jaramillo, Ernesto; Lönnroth, Knut; Lewis, James; Hargreaves, James; Evans, Carlton A

    2016-06-21

    Cash transfer interventions are forms of social protection based on the provision of cash to vulnerable households with the aim of reduce risk, vulnerability, chronic poverty and improve human capital. Such interventions are already an integral part of the response to HIV/AIDS in some settings and have recently been identified as a core element of World Health Organization's End TB Strategy. However, limited impact evaluations and operational evidence are currently available to inform this policy transition. This paper aims to assist national tuberculosis (TB) programs with this new policy direction by providing them with an overview of concepts and definitions used in the social protection sector and by reviewing some of the most critical operational aspects associated with the implementation of cash transfer interventions. These include: 1) the various implementation models that can be used depending on the context and the public health goal of the intervention; 2) the main challenges associated with the use of conditionalities and how they influence the impact of cash transfer interventions on health-related outcomes; 3) the implication of targeting diseases-affected households and or individuals versus the general population; and 4) the financial sustainability of including health-related objectives within existing cash transfer programmes. We aimed to appraise these issues in the light of TB epidemiology, care and prevention. For our appraisal we draw extensively from the literature on cash transfers and build upon the lessons learnt so far from other health outcomes and mainly HIV/AIDS. The implementation of cash transfer interventions in the context of TB is still hampered by important knowledge gaps. Initial directions can be certainly derived from the literature on cash transfers schemes and other public health challenges such as HIV/AIDS. However, the development of a solid research agenda to address persisting unknowns on the impact of cash transfers on

  15. United States academic medical centers: priorities and challenges amid market transformation.

    Science.gov (United States)

    Thompson, Irene M; Anason, Barbara

    2012-01-01

    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation.

  16. Challenges of research recruitment in a university setting in England.

    Science.gov (United States)

    Vadeboncoeur, Claudia; Foster, Charlie; Townsend, Nick

    2017-05-20

    The recruitment is an integral part of most research projects in medical sciences involving human participants. In health promotion research, there is increasing work on the impact of environments. Settings represent environments such as schools where social, physical and psychological development unfolds. In this study, we investigated weight gain in students within a university setting. Barriers to access and recruitment of university students within a specific setting, in the context of health research are discussed. An online survey on health behaviours of first year students across 101 universities in England was developed. Ethics committees of each institutions were contacted to obtain permission to recruit and access their students. Recruitment adverts were standardized and distributed within restrictions imposed by universities. Three time points and incentives were used. Several challenges in recruiting from a university setting were found. These included (i) ethics approval, (ii) recruitment approval, (iii) navigating restrictions on advertisement and (iv) logistics of varying university academic calendars. We also faced challenges of online surveys including low recruitment, retention and low eligibility of respondents. From the 101 universities, 28 allowed dissemination of adverts. We obtained 1026 responses at T1, 599 at T2 and 497 at T3. The complete-case sample represented 13% of those originally recruited at T1. Conducting research on students within the university setting is a time consuming and challenging task. To improve research-based health promotion, universities could work together to increase consistency as to their policies on student recruitment. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Multi-criteria decision analysis for setting priorities on HIV/AIDS interventions in Thailand.

    NARCIS (Netherlands)

    Youngkong, S.; Teerawattananon, Y.; Tantivess, S.; Baltussen, R.M.

    2012-01-01

    BACKGROUND: A wide range of preventive, treatment, and care programs for HIV/AIDS are currently available and some of them have been implemented in Thailand. Policy makers are now facing challenges on how the scarce resources for HIV/AIDS control can be spent more wisely. Although effectiveness and

  18. Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya.

    Science.gov (United States)

    Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan

    2017-02-01

    There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through 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 of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence.

  19. Quantum chemistry based QSAR prediction and priority setting for toxicity of nitrobenzenes on EINECS list

    NARCIS (Netherlands)

    Zvinavashe, E.; Murk, A.J.; Vervoort, J.J.M.; Soffers, A.E.M.F.; Freidig, A.; Rietjens, I.M.C.M.

    2006-01-01

    Fifteen experimental literature data sets on the acute toxicity of substituted nitrobenzenes to algae (Scenedesmus obliquus, Chlorella pyrenoidosa, C. vulgaris), daphnids (Daphnia magna, D. carinata), fish (Cyprinus carpio, Poecilia reticulata), protozoa (Tetrahymena pyriformis), bacteria (Phosphoba

  20. Setting Priorities for Urban Forest Planning. A Comprehensive Response to Ecological and Social Needs for the Metropolitan Area of Rome (Italy

    Directory of Open Access Journals (Sweden)

    Giulia Capotorti

    2015-04-01

    Full Text Available Urban forests represent key elements of green infrastructure and provide essential ecosystem services in both the ecological and social spheres. Therefore, forestation planning plays a decisive role in the sustainable development strategies of metropolitan areas and addresses the challenge of maintaining biodiversity while improving human health and well-being. The aim of this work is to present a methodological approach that can be used to identify priorities in urban forest planning and can provide comprehensive responses to ecological and social needs in any metropolitan context. The approach, which is based on interdisciplinary principles of landscape ecology, ecosystem geography and dynamic plant sociology, has been adopted in the Municipality of Rome (Italy. The first step entails defining an ecological framework for forestation plans by means of the ecological land classification and assessment of landscape conservation status. The second step entails setting forestation priorities according to both ecological and social criteria. The application of the method proved to effectively select limited areas requiring intervention within an extensive metropolitan area. Furthermore, it provided responses to sustainability issues such as long-term maintenance of restored habitats, landscape perspective of planning, greening of urban agriculture, improvement in urban resilience, and cost-effective improvement in ecosystem services provision.

  1. The impact of Sika deer on vegetation in Japan: setting management priorities on a national scale.

    Science.gov (United States)

    Ohashi, Haruka; Yoshikawa, Masato; Oono, Keiichi; Tanaka, Norihisa; Hatase, Yoriko; Murakami, Yuhide

    2014-09-01

    Irreversible shifts in ecosystems caused by large herbivores are becoming widespread around the world. We analyzed data derived from the 2009-2010 Sika Deer Impact Survey, which assessed the geographical distribution of deer impacts on vegetation through a questionnaire, on a scale of 5-km grid-cells. Our aim was to identify areas facing irreversible ecosystem shifts caused by deer overpopulation and in need of management prioritization. Our results demonstrated that the areas with heavy impacts on vegetation were widely distributed across Japan from north to south and from the coastal to the alpine areas. Grid-cells with heavy impacts are especially expanding in the southwestern part of the Pacific side of Japan. The intensity of deer impacts was explained by four factors: (1) the number of 5-km grid-cells with sika deer in neighboring 5 km-grid-cells in 1978 and 2003, (2) the year sika deer were first recorded in a grid-cell, (3) the number of months in which maximum snow depth exceeded 50 cm, and (4) the proportion of urban areas in a particular grid-cell. Based on our model, areas with long-persistent deer populations, short snow periods, and fewer urban areas were predicted to be the most vulnerable to deer impact. Although many areas matching these criteria already have heavy deer impact, there are some areas that remain only slightly impacted. These areas may need to be designated as having high management priority because of the possibility of a rapid intensification of deer impact.

  2. Fair Processes for Priority Setting: Putting Theory into Practice; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”

    Directory of Open Access Journals (Sweden)

    Maarten P. Jansen

    2017-01-01

    Full Text Available Embedding health technology assessment (HTA in a fair process has great potential to capture societal values relevant to public reimbursement decisions on health technologies. However, the development of such processes for priority setting has largely been theoretical. In this paper, we provide further practical lead ways on how these processes can be implemented. We first present the misconception about the relation between facts and values that is since long misleading the conduct of HTA and underlies the current assessmentappraisal split. We then argue that HTA should instead be explicitly organized as an ongoing evidenceinformed deliberative process, that facilitates learning among stakeholders. This has important consequences for whose values to consider, how to deal with vested interests, how to consider all values in the decisionmaking process, and how to communicate decisions. This is in stark contrast to how HTA processes are implemented now. It is time to set the stage for HTA as learning.

  3. Iraqi health system in kurdistan region: medical professionals' perspectives on challenges and priorities for improvement

    Directory of Open Access Journals (Sweden)

    Saleh Abubakir M

    2010-11-01

    Full Text Available Abstract Background The views of medical professionals on efficiency of health system and needs for any changes are very critical and constitute a cornerstone for any health system improvement. This is particularly relevant to Iraqi Kurdistan case as the events of the last few decades have significantly devastated the national Iraqi health system while the necessity for adopting a new health care system is increasingly recognized since 2004. This study aims to examine the regional health system in Iraqi Kurdistan from medical professionals' perspectives and try to define its problems and priorities for improvement. Methods A survey questionnaire was developed and administered to a convenience sample of 250 medical professionals in Erbil governorate. The questionnaire included four items; rating of the quality of services and availability of resources in the health institutions, view on different aspects of the health system, the perceived priority needs for health system improvement and gender and professional characteristics of the respondents. Results The response rate to the survey was 83.6%. A high proportion of respondents rated the different aspects of services and resources in the health institutions as weak or very weak including the availability of the required quantity and quality of medicines (68.7%, the availability of sufficient medical equipment and investigation tools (68.7%, and the quality of offered services (65.3%. Around 72% of respondents had a rather negative view on the overall health system. The weak role of medical research, the weak role of professional associations in controlling the system and the inefficient health education were identified as important problems in the current health system (87.9%, 87.1% and 84.9%, respectively. The priority needs of health system improvement included adoption of social insurance for medical care of the poor (82%, enhancing the role of family medicine (77.2%, adopting health

  4. Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries

    Science.gov (United States)

    Nugent, Rachel A

    2017-01-01

    Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC. PMID:28321266

  5. Priority setting of public spending in developing countries: do not try to do everything for everybody.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.

    2006-01-01

    BACKGROUND: Public spending on health care in many developing countries falls short to provide a comprehensive set of essential health services, which indicates the need to target and prioritize resources. However, governments often attempt to provide free services to the whole population, and often

  6. Integration: valuing stakeholder input in setting priorities for socially sustainable egg production.

    Science.gov (United States)

    Swanson, J C; Lee, Y; Thompson, P B; Bawden, R; Mench, J A

    2011-09-01

    Setting directions and goals for animal production systems requires the integration of information achieved through internal and external processes. The importance of stakeholder input in setting goals for sustainable animal production systems should not be overlooked by the agricultural animal industries. Stakeholders play an integral role in setting the course for many aspects of animal production, from influencing consumer preferences to setting public policy. The Socially Sustainable Egg Production Project (SSEP) involved the development of white papers on various aspects of egg production, followed by a stakeholder workshop to help frame the issues for the future of sustainable egg production. Representatives from the environmental, food safety, food retail, consumer, animal welfare, and the general farm and egg production sectors participated with members of the SSEP coordination team in a 1.5-d workshop to explore socially sustainable egg production. This paper reviews the published literature on values integration methodologies and the lessons learned from animal welfare assessment models. The integration method used for the SSEP stakeholder workshop and its outcome are then summarized. The method used for the SSEP stakeholder workshop can be used to obtain stakeholder input on sustainable production in other farm animal industries.

  7. Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness

    Directory of Open Access Journals (Sweden)

    Rob Baltussen

    2016-11-01

    Full Text Available Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs in their strive for universal health coverage (UHC. However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection and learning among local stakeholders (‘contextual’ criteria. We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.

  8. The ICF as a common language for rehabilitation goal-setting: comparing client and professional priorities

    Directory of Open Access Journals (Sweden)

    van der Merwe Aletia

    2011-10-01

    Full Text Available Abstract Background Joint rehabilitation goals are an important component for effective teamwork in the rehabilitation field. The activities and participation domain of the ICF provides a common language for professionals when setting these goals. Involving clients in the formulation of rehabilitation goals is gaining momentum as part of a person-centred approach to rehabilitation. However, this is particularly difficult when clients have an acquired communication disability. The expressive communication difficulties negatively affect the consensus building process. As a result, obtaining information regarding rehabilitation goals from professionals and their clients warrants further investigation for this particular population. Methods This comparative study investigated clients and their assigned rehabilitation professionals' perception of the importance of ICF activities and participation domains for inclusion in their rehabilitation program. Twelve clients in an acute rehabilitation centre and twenty of their corresponding rehabilitation professionals participated in an activity using the Talking Mats™ visual framework for goal setting. Each participant rated the importance of the nine activities and participation domains of the ICF for inclusion in their current rehabilitation program. Results The ICF domains which consistently appear as very important across these groups are mobility, self-care and communication. Domains which consistently appear in the lower third of the rankings include spare time, learning and thinking and domestic life. Results indicate however that no statistical significant differences exist in terms of the individual domains across each of the participant groups. Within group differences however indicated that amongst the speech-language therapists and physiotherapists there was a statistical significant difference between spare time activities and communication and mobility. Conclusions Findings indicate that

  9. Progress and priorities in the health of women and girls: a decade of advances and challenges.

    Science.gov (United States)

    Garcia, Francisco A R; Freund, Karen M; Berlin, Michelle; Digre, Kathleen B; Dudley, Donald J; Fife, Rose S; Gabeau, Geralde; Geller, Stacie E; Magnus, Jeanette H; Trott, Justina A; White, Hilary F

    2010-04-01

    Following the initial wave of federal support to address women's health, there is a need to assess successes and determine the next priorities to advance the health of women. The objective of this study was to systematically collect expert opinion on the major advances in women's health in the past decade and priorities for women's health research and service in the coming decade. We utilized a Delphi method to query the leadership from academic and community Centers of Excellence in Women's Health, as designated by the Department of Health and Human Services. Leaders from 36 of the 48 centers responded to a series of questions about the major advances and critical indicators to evaluate future needs in women's health. We utilized a social ecology model framework to organize the responses to each question. The experts identified increased health education for women and increased empowerment of women across multiple spheres as the major advances positively impacting the health of women. The experts selected the following areas as the most important indicators to measure the status of the health of women in the future: health education and promotion, rates and impact of interpersonal violence against women, and access to healthcare. The major advances and measures of the health of women did not focus on specific changes to individual women in illness management, clinical care, or individual behavioral change. As we move to address health reform, we must be able to recognize and incorporate a broad perspective on public health and policy initiatives critical to the health and wellness of women and girls and, therefore, central to the well-being of the nation.

  10. Reproductive isolation, evolutionary distinctiveness and setting conservation priorities: The case of European lake whitefish and the endangered North Sea houting (Coregonus spp.

    Directory of Open Access Journals (Sweden)

    Mensberg Karen-Lise D

    2008-05-01

    Full Text Available Abstract Background Adaptive radiation within fishes of the Coregonus lavaretus complex has created numerous morphs, posing significant challenges for taxonomy and conservation priorities. The highly endangered North Sea houting (C. oxyrhynchus; abbreviated NSH has been considered a separate species from European lake whitefish (C. lavaretus; abbreviated ELW due to morphological divergence and adaptation to oceanic salinities. However, its evolutionary and taxonomic status is controversial. We analysed microsatellite DNA polymorphism in nine populations from the Jutland Peninsula and the Baltic Sea, representing NSH (three populations, two of which are reintroduced and ELW (six populations. The objectives were to: 1 analyse postglacial recolonization of whitefish in the region; 2 assess the evolutionary distinctiveness of NSH, and 3 apply several approaches for defining conservation units towards setting conservation priorities for NSH. Results Bayesian cluster analyses of genetic differentiation identified four major groups, corresponding to NSH and three groups of ELW (Western Jutland, Central Jutland, Baltic Sea. Estimates of historical migration rates indicated recolonization in a north-eastern direction, suggesting that all except the Baltic Sea population predominantly represent postglacial recolonization via the ancient Elbe River. Contemporary gene flow has not occurred between NSH and ELW, with a divergence time within the last 4,000 years suggested from coalescence methods. NSH showed interbreeding with ELW when brought into contact by stocking. Thus, reproductive isolation of NSH was not absolute, although possible interbreeding beyond the F1 level could not be resolved. Conclusion Fishes of the C. lavaretus complex in the Jutland Peninsula originate from the same recolonization event. NSH has evolved recently and its species status may be questioned due to incomplete reproductive isolation from ELW, but it was shown to merit

  11. The (Ir)relevance of Group Size in Health Care Priority Setting: A Reply to Juth.

    Science.gov (United States)

    Sandman, Lars; Gustavsson, Erik

    2017-03-01

    How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze Juth's argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for (if anything).

  12. A risk-based approach to setting priorities in protecting bridges against terrorist attacks.

    Science.gov (United States)

    Leung, Maria; Lambert, James H; Mosenthal, Alexander

    2004-08-01

    This article presents an approach to the problem of terrorism risk assessment and management by adapting the framework of the risk filtering, ranking, and management method. The assessment is conducted at two levels: (1) the system level, and (2) the asset-specific level. The system-level risk assessment attempts to identify and prioritize critical infrastructures from an inventory of system assets. The definition of critical infrastructures offered by Presidential Decision Directive 63 was used to determine the set of attributes to identify critical assets--categorized according to national, regional, and local impact. An example application is demonstrated using information from the Federal Highway Administration National Bridge Inventory for the State of Virginia. Conversely, the asset-specific risk assessment performs an in-depth analysis of the threats and vulnerabilities of a specific critical infrastructure. An illustration is presented to offer some insights in risk scenario identification and prioritization, multiobjective evaluation of management options, and extreme-event analysis for critical infrastructure protection.

  13. Competing Priorities and Challenges: Principal Leadership for Social Justice along the U.S.-Mexico Border

    Science.gov (United States)

    DeMatthews, David Edward

    2016-01-01

    Background/Context: Previous research has focused on the importance of a social justice leadership approach to improve schools that serve marginalized students, but less attention has been focused on potential dilemmas associated with social justice leadership and the ways in which principals prioritize when dilemmas or challenges arise.…

  14. The foreign policy of the Gabonese Republic: new priorities and challenges

    Directory of Open Access Journals (Sweden)

    F Ch Ndakissa Onkassa

    2016-12-01

    Full Text Available The article considers the features of formation and realization of foreign policy and the basic characteristics of the international image of modern Gabon are considered. It is shown, that the foreign policy is the important direction in the state activity of Gabon and is intended to offer the General public all over the world complete and reliable information on the situation in the country on key international issues, activities and initiatives of Gabon in the field of political space and the processes and projects of socio-economic development, its cultural and scientific achievements. Foreign policy activity is aimed at creating favorable conditions for the realization of the historic choice of the Gabonese people to strengthen the rule of law, market economy and democratic society, to focus on the social dimension. Нerewith this article analyzes the main provisions of the foreign policy of the Gabonese Republic, considered in conjunction with the country's development objectives defined in the strategic plan “A prosperous Gabon”. Particular attention is paid to the role of the President in making foreign policy decisions and ideas about the prospects for the development of Gabon's foreign policy. Key value of principles of maintenance of the sovereignty and the international inclusiveness, influence of the factor of the French language and policy of multilateral diplomacy is underlined at definition of objectives and priorities of foreign policy of Gabon during an epoch of new international realities. It is noted, that foreign policy activity of Gabon is aimed at creation a wide range of the international partnership in interests of national development in in the context of globalization.

  15. Priorities for children and young people - opportunities and challenges for children and young people's nurses.

    Science.gov (United States)

    Smith, Fiona

    2016-05-09

    Across Europe children's nurses today face many challenges, including rising childhood obesity, the soaring incidence of issues with the mental health of children and young people, the effects of social media, child maltreatment and the impact of poverty, war and conflict on children and families. There are opportunities for children's nurses to undertake new roles and to influence both policy and practice to improve the health outcomes of children and young people, and thereby the future health of the population.

  16. Habitat evaluation of wild Amur tiger (Panthera tigris altaica) and conservation priority setting in north-eastern China.

    Science.gov (United States)

    Xiaofeng, Luan; Yi, Qu; Diqiang, Li; Shirong, Liu; Xiulei, Wang; Bo, Wu; Chunquan, Zhu

    2011-01-01

    The Amur Tiger (Panthera tigris altaica) is one of the world's most endangered species. Recently, habitat fragmentation, food scarcity and human hunting have drastically reduced the population size and distribution areas of Amur tigers in the wild, leaving them on the verge of extinction. Presently, they are only found in the north-eastern part of China. In this study, we developed a reference framework using methods and technologies of analytic hierarchy process (AHP), remote sensing (RS), geographic information system (GIS), GAP analysis and Natural Break (Jenks) classification to evaluate the habitat and to set the conservation priorities for Amur tigers in eastern areas of Heilongjiang and Jilin Provinces of northeast China. We proposed a Habitat Suitability Index (HSI) incorporating 7 factors covering natural conditions and human disturbance. Based on the HSI values, the suitability was classified into five levels from the most to not suitable. Finally, according to results of GAP analysis, we identified six conservation priorities and designed a conservation landscape incorporating four new nature reserves, enlarging two existing ones, and creating four linkages for Amur tigers in northeast China. The case study showed that the core habitats (the most suitable and highly suitable habitats) identified for Amur tigers covered 35,547 km(2), accounting for approximately 26.71% of the total study area (1,33,093 km(2)). However, existing nature reserves protected only (7124 km(2) or) 20.04% of the identified core habitats. Thus, enlargement of current reserves is necessary and urgent for the tiger's conservation and restoration. Moreover, the establishment of wildlife corridors linking core habitats will provide an efficient reserve network for tiger conservation to maintain the evolutionary potential of Amur tigers facing environmental changes. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Key performance indicators (KPIs) and priority setting in using the multi-attribute approach for assessing sustainable intelligent buildings

    Energy Technology Data Exchange (ETDEWEB)

    ALwaer, H. [The University of Dundee, School of Architecture, Matthew Building, 13 Perth Road, Dundee DD1 4HT (United Kingdom); Clements-Croome, D.J. [School of Construction Management and Engineering, The University of Reading, Whiteknights, PO Box 219, Reading RG6 6AW (United Kingdom)

    2010-04-15

    The main objectives of this paper are to: firstly, identify key issues related to sustainable intelligent buildings (environmental, social, economic and technological factors); develop a conceptual model for the selection of the appropriate KPIs; secondly, test critically stakeholder's perceptions and values of selected KPIs intelligent buildings; and thirdly develop a new model for measuring the level of sustainability for sustainable intelligent buildings. This paper uses a consensus-based model (Sustainable Built Environment Tool- SuBETool), which is analysed using the analytical hierarchical process (AHP) for multi-criteria decision-making. The use of the multi-attribute model for priority setting in the sustainability assessment of intelligent buildings is introduced. The paper commences by reviewing the literature on sustainable intelligent buildings research and presents a pilot-study investigating the problems of complexity and subjectivity. This study is based upon a survey perceptions held by selected stakeholders and the value they attribute to selected KPIs. It is argued that the benefit of the new proposed model (SuBETool) is a 'tool' for 'comparative' rather than an absolute measurement. It has the potential to provide useful lessons from current sustainability assessment methods for strategic future of sustainable intelligent buildings in order to improve a building's performance and to deliver objective outcomes. Findings of this survey enrich the field of intelligent buildings in two ways. Firstly, it gives a detailed insight into the selection of sustainable building indicators, as well as their degree of importance. Secondly, it tesst critically stakeholder's perceptions and values of selected KPIs intelligent buildings. It is concluded that the priority levels for selected criteria is largely dependent on the integrated design team, which includes the client, architects, engineers and facilities managers

  18. Challenges Associated With Using Large Data Sets for Quality Assessment and Research in Clinical Settings.

    Science.gov (United States)

    Cohen, Bevin; Vawdrey, David K; Liu, Jianfang; Caplan, David; Furuya, E Yoko; Mis, Frederick W; Larson, Elaine

    2015-08-01

    The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution's admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges.

  19. Using Economic Evidence to Set Healthcare Priorities in Low-Income and Lower-Middle-Income Countries: A Systematic Review of Methodological Frameworks.

    Science.gov (United States)

    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.

  20. What Are the Top 10 Research Questions in the Treatment of Inflammatory Bowel Disease? A Priority Setting Partnership with the James Lind Alliance.

    Science.gov (United States)

    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.

  1. Maternal mortality in developing countries: challenges in scaling-up priority interventions.

    Science.gov (United States)

    Prata, Ndola; Passano, Paige; Sreenivas, Amita; Gerdts, Caitlin Elisabeth

    2010-03-01

    Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.

  2. The influence of spatial grain size on the suitability of the higher-taxon approach in continental priority-setting

    DEFF Research Database (Denmark)

    Larsen, Frank Wugt; Rahbek, Carsten

    2005-01-01

    The higher-taxon approach may provide a pragmatic surrogate for the rapid identification of priority areas for conservation. To date, no continent-wide study has examined the use of higher-taxon data to identify complementarity-based networks of priority areas, nor has the influence of spatial gr...

  3. North Korea's nuclear weapons program:verification priorities and new challenges.

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Duk-ho (Korean Consulate General in New York)

    2003-12-01

    A comprehensive settlement of the North Korean nuclear issue may involve military, economic, political, and diplomatic components, many of which will require verification to ensure reciprocal implementation. This paper sets out potential verification methodologies that might address a wide range of objectives. The inspection requirements set by the International Atomic Energy Agency form the foundation, first as defined at the time of the Agreed Framework in 1994, and now as modified by the events since revelation of the North Korean uranium enrichment program in October 2002. In addition, refreezing the reprocessing facility and 5 MWe reactor, taking possession of possible weapons components and destroying weaponization capabilities add many new verification tasks. The paper also considers several measures for the short-term freezing of the North's nuclear weapon program during the process of negotiations, should that process be protracted. New inspection technologies and monitoring tools are applicable to North Korean facilities and may offer improved approaches over those envisioned just a few years ago. These are noted, and potential bilateral and regional verification regimes are examined.

  4. Balancing priorities

    DEFF Research Database (Denmark)

    Mønsted, Troels; Johansen, Andreas Kaas; Lauridsen, Frederik Vahr Bjarnø

    2016-01-01

    a heterogeneous ensemble of care providers. In this paper, we present findings from a field study of coordinative work in distributed elder care in Denmark. The purpose of this study is to further our understanding of the coordinative challenges of distributed elder care, and to inform design of new care......, that are needed by the healthcare system, but also the work involved in balancing priorities....

  5. Salvadoran gangs and extortion. Challenges and priorities related to the extortion phenomenon

    Directory of Open Access Journals (Sweden)

    Karla Andrade

    2015-08-01

    Full Text Available During the last few years extortion has garnered a somber relevance for society as a whole, aside from the preponderance it already possessed from law enforcement agents and criminal investigators. The generation of income both in cash and in kind destined for criminal structures, particularly amongst gangs/maras, as well as its implications concerning danger levels and future potential, have made the agencies responsible of public security take a closer look at this crime and ensure there is a full comprehensive assessment made regarding the extortion phenomenon. The above, involved looking into this crime’s different forms of execution, existing enabling factors and the different criminal scenarios it fits into; reviewing how police and prosecutors address these offenses, all operative, investigative and legal implications, as well as the results achieved in the fight against it. Nonetheless, extortionremains a challenge, not only for the institutions involved (Police and the Prosecutor’s Office, but also for the key stakeholders and all those responsible of making strategic decisions for the country.Revista Policía y Seguridad Pública 5(1 2015: 103-148

  6. The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study.

    Science.gov (United States)

    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

  7. The accountability for reasonableness approach to guide priority setting in health systems within limited resources--findings from action research at district level in Kenya, Tanzania, and Zambia.

    Science.gov (United States)

    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

  8. The accountability for reasonableness approach to guide priority setting in health systems within limited resources – findings from action research at district level in Kenya, Tanzania, and Zambia

    Science.gov (United States)

    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

  9. Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?

    Science.gov (United States)

    Kapiriri, Lydia; Norheim, Ole F; Martin, Douglas K

    2009-02-01

    Accountability for reasonableness is an ethical framework for fair priority setting process. This framework has been used to evaluate fairness in several contexts, and a few studies have evaluated its acceptability to decision makers. However, no studies have compared the acceptability of the four conditions of the framework to decision makers across health systems and levels of priority setting. This paper reports the elements of fairness described by 184 decision makers involved in priority setting at the macro-, meso- and micro-levels of priority setting in the Canadian (Ontario), Norwegian and Ugandan health care systems and compares them against the four conditions of 'Accountability for Reasonableness' and across levels of decision making, and health care systems. Our respondents identified 23 elements of fair priority setting. Most of these (17) were well aligned with the four conditions of Accountability for Reasonableness; six were not. Comparisons across health care system and levels of decision making revealed that four elements (transparency, participatory and among the criteria-need based and objective) were common to all and the rest were common to only the health care systems (but not at all levels), or only the levels of decision making (but not to all health are systems). Perceptions varied remarkably across levels of decision making. The overlap between the elements of fairness found in this study and the conditions of Accountability for Reasonableness demonstrates that the four conditions are recognizable and applicable across health care systems and levels of decision making. However, the framework should be used with flexibility to allow for identification of elements and relevant explicit criteria (such as those identified in this study) - that may not directly fit under any of the four conditions.

  10. Risk perception and priority setting for intervention among hepatitis C virus and environmental risks: a cross-sectional survey in the Cairo community

    Directory of Open Access Journals (Sweden)

    Dewedar Sahar

    2010-12-01

    Full Text Available Abstract Background Hepatitis C virus (HCV recently emerged as a major public health hazard in Egypt. However, dramatic healthcare budget constraints limit access to the costly treatment. We assessed risk perception and priority setting for intervention among HCV, unsafe water, and outdoor air pollution in Cairo city. Methods A survey was conducted in the homes of a representative sample of household heads in Cairo city. Risk perception was assessed using the "psychometric paradigm" where health hazards are evaluated according to several attributes and then summarized by principal component analysis. Priority setting was assessed by individual ranking of interventions reducing health hazards by 50% over five years. The Condorcet method was used to aggregate individual rankings of the three interventions (main study or two of three interventions (validation study. Explanatory factors of priority setting were explored in multivariate generalized logistic models. Results HCV was perceived as having the most severe consequences in terms of illness and out-of-pocket costs, while outdoor air pollution was perceived as the most uncontrollable risk. In the main study (n = 2,603, improved water supply received higher priority than both improved outdoor air quality (60.1%, P P Conclusions The Cairo community prefers to further improving water supply as compared to improved outdoor air quality and screening and treatment of chronic hepatitis C.

  11. Risk perception and priority setting for intervention among hepatitis C virus and environmental risks: a cross-sectional survey in the Cairo community.

    Science.gov (United States)

    Schwarzinger, Michaël; Mohamed, Mostafa K; Gad, Rita R; Dewedar, Sahar; Fontanet, Arnaud; Carrat, Fabrice; Luchini, Stéphane

    2010-12-20

    Hepatitis C virus (HCV) recently emerged as a major public health hazard in Egypt. However, dramatic healthcare budget constraints limit access to the costly treatment. We assessed risk perception and priority setting for intervention among HCV, unsafe water, and outdoor air pollution in Cairo city. A survey was conducted in the homes of a representative sample of household heads in Cairo city. Risk perception was assessed using the "psychometric paradigm" where health hazards are evaluated according to several attributes and then summarized by principal component analysis. Priority setting was assessed by individual ranking of interventions reducing health hazards by 50% over five years. The Condorcet method was used to aggregate individual rankings of the three interventions (main study) or two of three interventions (validation study). Explanatory factors of priority setting were explored in multivariate generalized logistic models. HCV was perceived as having the most severe consequences in terms of illness and out-of-pocket costs, while outdoor air pollution was perceived as the most uncontrollable risk. In the main study (n = 2,603), improved water supply received higher priority than both improved outdoor air quality (60.1%, P < .0001) and screening and treatment of chronic hepatitis C (66.3%, P < .0001), as confirmed in the validation study (n = 1,019). Higher education, report of HCV-related diseases in the household, and perception of HCV as the most severe risk were significantly associated to setting HCV treatment as the first priority. The Cairo community prefers to further improving water supply as compared to improved outdoor air quality and screening and treatment of chronic hepatitis C.

  12. Setting priorities for mental health research in Brazil Agenda de prioridades de pesquisa para saúde mental no Brasil

    Directory of Open Access Journals (Sweden)

    Guilherme Gregório

    2012-12-01

    Full Text Available BACKGROUND: The main aim of this study is to review the agenda for research priorities of mental health in Brazil. METHODOLOGY: The first step was to gather 28 experts (22 researchers, five policy makers, and the coordinator representing all mental health fields from different geographical areas of the country. Participants were asked to list what they considered to be the most relevant mental health research questions for the country to address in the next 10 years. Seventeen participants answered this question; after redundancies were excluded, a total of 110 responses were collected. As the second step, participants were asked to rank which questions were the 35 most significant. The final step was to score 15 items for each of the 35 selected questions to determine whether it would be a answerable, b effective, c deliverable, d equitable, and e effective at reducing the burden of mental health. The ten highest ranked questions were then selected. RESULTS: There were four questions addressing primary care with respect to a the effectiveness of interventions, b "matrix support", c comparisons of different models of stepped care, and d interventions to enhance identification and treatment of common mental disorders at the Family Health Program. The other questions were related to the evaluation of mental health services for adults and children/adolescents to clarify barriers to treatment in primary care, drug addiction, and severe mental disorders; to investigate the cost-benefit relationship of anti-psychotics; to design interventions to decrease alcohol consumption; and to apply new technologies (telemedicine for education and supervision of non-specialists. CONCLUSION: This priority-setting research exercise highlighted a need for implementing investments at the primary-care level, particularly in the family health program; the urgent need to evaluate services; and policies to improve equity by increasing accessibility to services and

  13. Disease management index of potential years of life lost as a tool for setting priorities in national disease control using OECD health data.

    Science.gov (United States)

    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.

  14. Accountable priority setting for trust in health systems--the need for research into a new approach for strengthening sustainable health action in developing countries

    DEFF Research Database (Denmark)

    Byskov, Jens; Bloch, Paul; Blystad, Astrid

    2009-01-01

    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.......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...

  15. Risk perception and priority setting for intervention among hepatitis C virus and environmental risks: a cross-sectional survey in the Cairo community

    OpenAIRE

    Dewedar Sahar; Gad Rita R; Mohamed Mostafa K; Schwarzinger Michaël; Fontanet Arnaud; Carrat Fabrice; Luchini Stéphane

    2010-01-01

    Abstract Background Hepatitis C virus (HCV) recently emerged as a major public health hazard in Egypt. However, dramatic healthcare budget constraints limit access to the costly treatment. We assessed risk perception and priority setting for intervention among HCV, unsafe water, and outdoor air pollution in Cairo city. Methods A survey was conducted in the homes of a representative sample of household heads in Cairo city. Risk perception was assessed using the "psychometric paradigm" where he...

  16. Challenges of collecting baseline data in emergency settings

    Directory of Open Access Journals (Sweden)

    Jennifer Schlecht

    2007-12-01

    Full Text Available Although the humanitarian community acknowledgesthe need for good quality data in programme design andmonitoring, the challenges and demands of field settingshave too often led to the argument that “we just don’thave time” or “it is too difficult”. Yet without the allocationof time and resources to the collection of baseline andmonitoring data, project activities cannot be groundedin strong evidence from programme evaluation.

  17. Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival.

    Science.gov (United States)

    Smith, Stephanie L; Shiffman, Jeremy

    2016-10-01

    This study investigates a puzzle concerning global health priorities-why do comparable issues receive differential levels of attention and resources? It considers maternal and neonatal mortality, two high-burden issues that pertain to groups at risk at birth and whose lives could be saved with effective intrapartum care. Why did maternal survival gain status as a global health priority earlier and to a greater degree than newborn survival? Higher mortality and morbidity burdens among newborns and the cost-effectiveness of interventions would seem to predict that issue's earlier and higher prioritization. Yet maternal survival emerged as a priority two decades earlier and had attracted considerably more attention and resources by the close of the Millennium Development Goals era. This study uses replicative process-tracing case studies to examine the emergence and growth of political priority for these two issues, probing reasons for unexpected variance. The study finds that maternal survival's grounding as a social justice issue spurred growth of a strong and diverse advocacy network and aligned the issue with powerful international norms (e.g. expectations to advance women's rights and the Millennium Development Goals), drawing attention and resources to the issue over three decades. Newborn survival's disadvantage stems from its long status as an issue falling under the umbrellas of maternal and child survival but not fully adopted by these networks, and with limited appeal as a public health issue advanced by a small and technically focused network; network expansion and alignment with child survival norms have improved the issue's status in the past few years.

  18. The Challenges of Genome Analysis in the Health Care Setting

    Directory of Open Access Journals (Sweden)

    Anneke Lucassen

    2014-07-01

    Full Text Available Genome sequencing is now a sufficiently mature and affordable technology for clinical use. Its application promises not only to transform clinicians’ diagnostic and predictive ability, but also to improve preventative therapies, surveillance regimes, and tailor patient treatment to an individual’s genetic make-up. However, as with any technological advance, there are associated fresh challenges. While some of the ethical, legal and social aspects resulting from the generation of data from genome sequencing are generic, several nuances are unique. Since the UK government recently announced plans to sequence the genomes of 100,000 Health Service patients, and similar initiatives are being considered elsewhere, a discussion of these nuances is timely and needs to go hand in hand with formulation of guidelines and public engagement activities around implementation of sequencing in clinical practice.

  19. Challenges and Ideas to Achieve Wireless 100 Gb/s Transmission: An Overview of Challenges and Solutions within the German Research Foundation (DFG) Special Priority Program SPP1655

    Science.gov (United States)

    Kraemer, Rolf

    2017-08-01

    Wireless communications is one of the fastest growing technology fields, driving numerous other innovations in electronics. One challenging research area within the wireless field is to achieve much higher transmission rates. First products with up to 3 Gb/s are in the market. In the coming years we predict this speed growing quickly up to and beyond 100 Gb/s. Today it is an open question how we can realize a wireless system at this speed. If we intend to use such systems in a mobile environment, we can only afford to spend approximately 1-10 pW/b for the end-to-end communication. This includes RF-transmission and all processing and protocol steps. The SPP1655 of the DFG was set up to investigate new paradigms for achieving the 100 Gb/s wireless transmission goal. Within 11 coordinated projects researchers from all over Germany are addressing several relevant issues ranging from the antennas and RF-Frontend, baseband-processing and error correction to protocol processing. A number of limitations of current approaches have to be investigated and new algorithms must be found in order to achieve the intended goal. One of the big challenges is finding the correct balance between analog and digital signal processing to achieve an extremely high performance at very low energy consumption. Another challenge is to find a good balance between bandwidth and bandwidth efficiency to achieve the 100 Gbps goal. Finally, protocol processing will need new approaches to decouple the central processor of a computer from the high-end input/output operations. Within this editorial we will address the main challenges and briefly outline the approaches of the running projects. The rest of this special issue will be devoted to more detailed descriptions and achievements of the individual projects of SPP1655.

  20. Set-based Tasks within the Singularity-robust Multiple Task-priority Inverse Kinematics Framework: General Formulation, Stability Analysis and Experimental Results

    Directory of Open Access Journals (Sweden)

    Signe eMoe

    2016-04-01

    Full Text Available Inverse kinematics algorithms are commonly used in robotic systems to transform tasks to joint references, and several methods exist to ensure the achievement of several tasks simultaneously. The multiple task-priority inverse kinematicsframework allows tasks to be considered in a prioritized order by projecting task velocities through the nullspaces of higherpriority tasks. This paper extends this framework to handle setbased tasks, i.e. tasks with a range of valid values, in addition to equality tasks, which have a specific desired value. Examples of set-based tasks are joint limit and obstacle avoidance. The proposed method is proven to ensure asymptotic convergence of the equality task errors and the satisfaction of all high-priority set-based tasks. The practical implementation of the proposed algorithm is discussed, and experimental results are presented where a number of both set-based and equality tasks have been implemented on a 6 degree of freedom UR5 which is an industrial robotic arm from Universal Robots. The experiments validate thetheoretical results and confirm the effectiveness of the proposed approach.

  1. Challenges and Opportunities for International Cooperative Studies in Pediatric Hematopoeitic Cell Transplantation: Priorities of the Westhafen Intercontinental Group

    Science.gov (United States)

    Schultz, Rudolph Kirk R.; Baker, Kevin Scott; Boelens, Jaap J.; Bollard, Catherine M.; Egeler, R. Maarten; Cowan, Mort; Ladenstein, Ruth; Lankester, Arjan; Locatelli, Franco; Lawitschka, Anita; Levine, John E.; Loh, Mignon; Nemecek, Eneida; Niemeyer, Charlotte; Prasad, Vinod K.; Rocha, Vanderson; Shenoy, Shalini; Strahm, Brigitte; Veys, Paul; Wall, Donna; Bader, Peter; Grupp, Stephan A.; Pulsipher, Michael A.; Peters, Christina

    2014-01-01

    More than 20% of allogeneic hematopoietic cell transplantations (HCTs) are performed in children and adolescents at a large number of relatively small centers. Unlike adults, at least one-third of HCTs in children are performed for rare, nonmalignant indications. Clinical trials to improve HCT outcomes in children have been limited by small numbers and these pediatric-specific features. The need for a larger number of pediatric HCT centers to participate in trials has led to the involvement of international collaborative groups. Representatives of the Pediatric Blood and Marrow Transplant Consortium, European Group for Blood and Marrow Transplantation’s Pediatric Working Group, International Berlin-Frankfurt-Munster (iBFm) Stem Cell Transplantation Committee, and Children’s Oncology Group’s Hematopoietic Stem Cell Transplantation Discipline Committee met on October 3, 2012, in Frankfurt, Germany to develop a consensus on the highest priorities in pediatric HCT. In addition, it explored the creation of an international consortium to develop studies focused on HCT in children and adolescents. This meeting led to the creation of an international HCT network, dubbed the Westhafen Intercontinental Group, to develop worldwide priorities and strategies to address pediatric HCT issues. This review outlines the priorities of need as identified by this consensus group. PMID:23883618

  2. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

    NARCIS (Netherlands)

    M. Chersich (Matthew); S. Luchters (Stanley); I. Ntaganira (Innocent); A. Gerbase (Antonio); Y-R. Lo (Ying-Ru); F. Scorgie (Fiona); R. Steen (Richard)

    2012-01-01

    textabstractIntroduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for

  3. Quantitative benefit-harm assessment for setting research priorities: the example of roflumilast for patients with COPD.

    Science.gov (United States)

    Puhan, Milo A; Yu, Tsung; Boyd, Cynthia M; Ter Riet, Gerben

    2015-07-02

    When faced with uncertainties about the effects of medical interventions regulatory agencies, guideline developers, clinicians, and researchers commonly ask for more research, and in particular for more randomized trials. The conduct of additional randomized trials is, however, sometimes not the most efficient way to reduce uncertainty. Instead, approaches such as value of information analysis or other approaches should be used to prioritize research that will most likely reduce uncertainty and inform decisions. In situations where additional research for specific interventions needs to be prioritized, we propose the use of quantitative benefit-harm assessments that illustrate how the benefit-harm balance may change as a consequence of additional research. The example of roflumilast for patients with chronic obstructive pulmonary disease shows that additional research on patient preferences (e.g., how important are exacerbations relative to psychiatric harms?) or outcome risks (e.g., what is the incidence of psychiatric outcomes in patients with chronic obstructive pulmonary disease without treatment?) is sometimes more valuable than additional randomized trials. We propose that quantitative benefit-harm assessments have the potential to explore the impact of additional research and to identify research priorities Our approach may be seen as another type of value of information analysis and as a useful approach to stimulate specific new research that has the potential to change current estimates of the benefit-harm balance and decision making.

  4. Using stochastic risk assessment in setting information priorities for managing dioxin impact from a municipal waste incinerator.

    Science.gov (United States)

    Ma, Hwong-wen

    2002-09-01

    The objectives of this study were to assess site-specific carcinogenic risk of incinerator-emitted dioxins in a manner reflecting pollutant transfer across multimedia and multi-pathways. The study used site-specific environmental and exposure information and combined the Monte Carlo method with multimedia modeling to produce probability distributions of risk estimates. The risk estimates were further categorized by contaminated environmental media and exposure pathways that are experienced by human receptors in order to pinpoint significant sources of risk. Rank correlation coefficients were also calculated along with the Monte Carlo sampling to identify key factors that influenced estimation of risk. The results showed that ingestion accounted for more than 90% of the total risk and that risk control on ingestion of eggs, aboveground vegetables, and poultry should receive priority. It was also found that variation of parameters with variability accounted for around 35% of the total risk variance, while uncertainty contributed to the remaining 65%. Intake rates of aboveground vegetables, eggs, and poultry were the key parameters with the largest contribution to variance. In addition, sufficient sampling and analysis of dioxin contents in eggs, aboveground vegetables, poultry, soil, and fruit should be performed to improve risk estimation because the variation in concentrations in these media accounted for the largest overall risk variance. Finally, focus should be placed on reduction of uncertainty associated with the risk estimation through ingestion of aboveground vegetables, eggs, poultry, fruit, and soil because the risk estimates associated with these exposure pathways had the largest variance.

  5. Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory.

    Science.gov (United States)

    Smith, Neale; Mitton, Craig; Dowling, Laura; Hiltz, Mary-Ann; Campbell, Matthew; Gujar, Shashi Ashok

    2015-09-24

    In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA) processes at a Canadian healthcare institution reached the decision agenda of the organization's senior leadership. We adopt key concepts from an established policy studies framework - Kingdon's multiple streams theory - to inform our analysis. Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process - Program Budgeting and Marginal Analysis (PBMA) - in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon's model as a template. The introduction of PBMA can be understood as the opening of a policy window. A problem stream - defined as lack of broad engagement and information sharing across service lines in past practice - converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes. Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources. © 2016 by Kerman University of Medical Sciences.

  6. Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory

    Directory of Open Access Journals (Sweden)

    Neale Smith

    2016-01-01

    Full Text Available Background In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA processes at a Canadian healthcare institution reached the decision agenda of the organization’s senior leadership. We adopt key concepts from an established policy studies framework – Kingdon’s multiple streams theory – to inform our analysis. Methods Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process – Program Budgeting and Marginal Analysis (PBMA – in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon’s model as a template. Results The introduction of PBMA can be understood as the opening of a policy window. A problem stream – defined as lack of broad engagement and information sharing across service lines in past practice – converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes. Conclusion Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources.

  7. Research priorities for public mental health in Europe

    DEFF Research Database (Denmark)

    Forsman, Anna K; Wahlbeck, Kristian; Aarø, Leif Edvard

    2015-01-01

    BACKGROUND: The ROAdmap for MEntal health Research in Europe project aimed to create an integrated European roadmap for mental health research. Leading mental health research experts across Europe have formulated consensus-based recommendations for future research within the public mental health...... experts were involved in the priority setting process. RESULTS: Twenty priorities for public mental health research were identified through the consensus process. The research priorities were divided into summary principles-encompassing overall recommendations for future public mental health research...... in Europe-and thematic research priorities, including area-specific top priorities on research topics and methods. The priorities represent three overarching goals mirroring societal challenges, that is, to identify causes, risk and protective factors for mental health across the lifespan; to advance...

  8. Conceptualizations of fairness and legitimacy in the context of Ethiopian health priority setting: Reflections on the applicability of accountability for reasonableness.

    Science.gov (United States)

    Petricca, Kadia; Bekele, Asfaw

    2017-05-22

    A critical element in building stronger health systems involves strengthening good governance to build capacity for transparent and fair health planning and priority setting. Over the past 20 years, the ethical framework Accountability for Reasonableness (A4R) has been a prominent conceptual guide in strengthening fair and legitimate processes of health decision-making. While many of the principles embedded within the framework are congruent with Western conceptualizations of what constitutes procedural fairness, there is a paucity in the literature that captures the degree of resonance between these principles and the views of decision makers from non-Western settings; particularly in Africa, where many countries have only recently, within the last 20-30 years, become more democratic. This paper contributes to the ethics literature by examining how Ethiopian decision makers conceptualize fair and legitimate health decision-making, and reflects on the degree of conceptual resonance between these views and the principles embedded in A4R. A qualitative case study approach from three districts in Ethiopia was undertaken. Fifty-eight decision makers from district, regional, zonal, and national levels were interviewed to describe their conceptualization of fairness and legitimacy in the district health planning process. Findings revealed that Ethiopians have a broad conception of fairness and legitimacy that while congruent with procedural justice, also aligned with principles of distributive and organizational justice. Researchers and practitioners seeking to strengthen procedural fairness in health priority setting must therefore recognize the significance of other philosophical dimensions influencing how fairness and legitimacy of health decision-making are constructed within the Ethiopian setting. © 2017 John Wiley & Sons Ltd.

  9. Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Chapman, Glyn

    2008-01-01

    estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997...... if more research resources were available. Conclusions: The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.......Background: This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life...

  10. Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Chapman, Glyn

    2008-01-01

    estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997...... if more research resources were available. CONCLUSION: The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.......BACKGROUND: This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life...

  11. Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a “mission impossible”?

    Directory of Open Access Journals (Sweden)

    Carlsson, Per

    2009-02-01

    Full Text Available In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity, and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a a literature review, (b a register study, based on a unique population-based register of inpatient care in Sweden, and (c a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.

  12. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

    Directory of Open Access Journals (Sweden)

    Matthew F Chersich

    2013-03-01

    Full Text Available Introduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods: We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed and non-indexed journals were searched for studies with quantitative study outcomes. Results: We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART, but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions: There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers

  13. Implementing evidence-based psychotherapies in settings serving older adults: challenges and solutions.

    Science.gov (United States)

    Arean, Patricia A; Raue, Patrick J; Sirey, Jo Anne; Snowden, Mark

    2012-06-01

    This Open Forum addresses challenges--insurance limitations, staff and setting limitations, and training and sustainability issues--in the implementation of psychotherapy interventions in settings serving older adults and provides solutions for ensuring that they have access to effective mental health services. There is considerable movement toward developing the geriatric mental health workforce, and it is important that these efforts include a discussion of implementation issues with regard to evidence-based psychotherapies as they are provided in services for aging populations.

  14. Distributed Priority Synthesis

    Directory of Open Access Journals (Sweden)

    Harald Ruess

    2012-11-01

    Full Text Available Given a set of interacting components with non-deterministic variable update and given safety requirements, the goal of priority synthesis is to restrict, by means of priorities, the set of possible interactions in such a way as to guarantee the given safety conditions for all possible runs. In distributed priority synthesis we are interested in obtaining local sets of priorities, which are deployed in terms of local component controllers sharing intended next moves between components in local neighborhoods only. These possible communication paths between local controllers are specified by means of a communication architecture. We formally define the problem of distributed priority synthesis in terms of a multi-player safety game between players for (angelically selecting the next transition of the components and an environment for (demonically updating uncontrollable variables. We analyze the complexity of the problem, and propose several optimizations including a solution-space exploration based on a diagnosis method using a nested extension of the usual attractor computation in games together with a reduction to corresponding SAT problems. When diagnosis fails, the method proposes potential candidates to guide the exploration. These optimized algorithms for solving distributed priority synthesis problems have been integrated into the VissBIP framework. An experimental validation of this implementation is performed using a range of case studies including scheduling in multicore processors and modular robotics.

  15. Diplomatic Priorities

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    China-Russia relations Our relationship with Russia is one of the priorities of China’s diplomacy. The two countries have enjoyed mutual support on issues that concern each other’s core interests. We have

  16. Exemplary Leadership in Challenging Urban Public School Settings It's the Principal of the Thing

    Science.gov (United States)

    Gutelius, Harry

    2011-01-01

    This research examined exemplary principals in ten public schools that are located in challenging urban settings; schools in six cities located in four different states were studied. As a result, ten emerging themes have been identified that are shared by these exemplary principals, themes that can serve as a basis for improving and/or evaluating…

  17. Challenging Behaviors in Early Childhood Settings: Creating a Place for All Children

    Science.gov (United States)

    Hart Bell, Susan; Carr, Victoria W.; Denno, Dawn; Johnson, Lawrence J.; Phillips, Louise R.

    2004-01-01

    Learn to manage a wide range of challenging behaviors in early childhood settings with this strategy-filled resource for teachers and other professionals. Based on the latest research and the authors' classroom experience, the book helps early childhood teams assess the classroom environment and link effective behavioral interventions to…

  18. Exemplary Leadership in Challenging Urban Public School Settings It's the Principal of the Thing

    Science.gov (United States)

    Gutelius, Harry

    2011-01-01

    This research examined exemplary principals in ten public schools that are located in challenging urban settings; schools in six cities located in four different states were studied. As a result, ten emerging themes have been identified that are shared by these exemplary principals, themes that can serve as a basis for improving and/or evaluating…

  19. Institutional Care of Children in Low- and Middle-Income Settings: Challenging the Conventional Wisdom of Oliver Twist

    OpenAIRE

    Braitstein, Paula

    2015-01-01

    Whether institutions or extended families are better suited to care for orphans depends on the specific circumstances. Reported rates of traumatic experiences among orphans and vulnerable children are high in both institutions and extended families; improving the quality of care for such children should be the paramount priority in all settings.

  20. Vaccination priorities.

    Science.gov (United States)

    Steffen, Robert; Baños, Ana; deBernardis, Chiara

    2003-02-01

    priorities need to be set correctly.

  1. Implementing Distributed Controllers for Systems with Priorities

    CERN Document Server

    Ben-Hafaiedh, Imene; Khairallah, Hammadi; 10.4204/EPTCS.30.3

    2010-01-01

    Implementing a component-based system in a distributed way so that it ensures some global constraints is a challenging problem. We consider here abstract specifications consisting of a composition of components and a controller given in the form of a set of interactions and a priority order amongst them. In the context of distributed systems, such a controller must be executed in a distributed fashion while still respecting the global constraints imposed by interactions and priorities. We present in this paper an implementation of an algorithm that allows a distributed execution of systems with (binary) interactions and priorities. We also present a comprehensive simulation analysis that shows how sensitive to changes our algorithm is, in particular changes related to the degree of conflict in the system.

  2. A systematic review of evidence-based interventions for students with challenging behaviors in school settings.

    Science.gov (United States)

    Thompson, Aaron M

    2011-05-01

    The author's systematic review of 2,294 articles from 10 journals in the fields of education, special education, school social work, school psychology, and school counseling identified 42 articles meeting search criteria of addressing evidence-based interventions for students with challenging behaviors in school settings. Interventions were considered evidence-based if they were (a) manualized or structured to facilitate replication; (b) evaluated with an experimental design; and (c) demonstrated to be effective. Current practices available to address students who require evidence-based interventions for challenging behaviors are summarized. Suggestions for intervention development to address the needs of students with difficult behaviors are offered.

  3. The Challenge of Handling Big Data Sets in the Sensor Web

    Science.gov (United States)

    Autermann, Christian; Stasch, Christoph; Jirka, Simon

    2016-04-01

    More and more Sensor Web components are deployed in different domains such as hydrology, oceanography or air quality in order to make observation data accessible via the Web. However, besides variability of data formats and protocols in environmental applications, the fast growing volume of data with high temporal and spatial resolution is imposing new challenges for Sensor Web technologies when sharing observation data and metadata about sensors. Variability, volume and velocity are the core issues that are addressed by Big Data concepts and technologies. Most solutions in the geospatial sector focus on remote sensing and raster data, whereas big in-situ observation data sets relying on vector features require novel approaches. Hence, in order to deal with big data sets in infrastructures for observational data, the following questions need to be answered: 1. How can big heterogeneous spatio-temporal datasets be organized, managed, and provided to Sensor Web applications? 2. How can views on big data sets and derived information products be made accessible in the Sensor Web? 3. How can big observation data sets be processed efficiently? We illustrate these challenges with examples from the marine domain and outline how we address these challenges. We therefore show how big data approaches from mainstream IT can be re-used and applied to Sensor Web application scenarios.

  4. The challenge of setting risk-based microbiological criteria for Listeria monocytogenes

    DEFF Research Database (Denmark)

    Andersen, Jens Kirk; Nørrung, Birgit

    2011-01-01

    After more than 20 years of work with discussing the setting of microbiological criteria for Listeria monocytogenes in foods, Codex Alimentarius on Food Hygiene has finalised a proposal that was recently adopted by the Codex Alimentarius Commission. The effort of developing procedures for making...... the microbiological criteria risk-based to the greatest extent possible has challenged scientists and managers during this long time period. Yet, the establishment of microbiological criteria for L. monocytogenes is still being discussed and several approaches are possible. Setting of microbiological criteria...

  5. The challenge of treating conduct disorder in low-resourced settings: rap music to the rescue.

    Science.gov (United States)

    Evans, Dylan J

    2010-12-01

    Conduct disorder is one of the most frequent serious childhood problems that present for treatment in community clinic settings. Evidence-based treatments for conduct disorder are intensive and require considerable resources to implement. In low-resourced contexts it is often not feasible to implement evidence-based treatments in their current form, which poses significant challenges for clinicians attempting to treat children in these settings. This article explores these challenges using a case study of the treatment of a young adolescent boy with a short-term multisystem intervention where rap music was employed as a powerful tool to facilitate an empathic connection in therapy and as a projective technique to explore underlying emotional difficulties.

  6. Challenges for Nurses with Regard to Domestic Violence Intervention: Nursing Practices in Medical Settings

    OpenAIRE

    藤田, 景子; 島田, 啓子

    2016-01-01

    The present study was performed to examine the challenges to nursing practices and skills related to the support of domestic violence victims in medical settings.  A questionnaire survey was performed using a descriptive exploratory study design. The subjects were nurses and midwives who participated in a meeting regarding domestic violence (DV) between March and December 2012. A content analysis approach was applied to the comments.  Ninety-five of the 126 participants in the DV meeting...

  7. Diplomatic Priorities

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ China-Russia relations Our relationship with Russia is one of the priorities of China's diplomacy.The two countries have enjoyed mutual support on issues that concern each other's core interests.We have the same or similar views on many major international and regional issues.And we coordinate and communicate closely.

  8. High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context.

    Science.gov (United States)

    Smith, Neale; Mitton, Craig; Hall, William; Bryan, Stirling; Donaldson, Cam; Peacock, Stuart; Gibson, Jennifer L; Urquhart, Bonnie

    2016-08-01

    Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.

  9. Challenges in managing elderly people with diabetes in primary care settings in Norway.

    Science.gov (United States)

    Graue, Marit; Dunning, Trisha; Hausken, Marie Fjelde; Rokne, Berit

    2013-12-01

    To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Focus-group interviews. Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32-59 years with clinical experience ranging from 1.5 to 38 years. Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

  10. Defining priorities

    CERN Multimedia

    2013-01-01

    Last week the European Strategy Group met in Erice (Italy) to distil reams of input and months of discussion into a concise document outlining an updated Strategy for European Particle Physics. The result is a document that will be presented to the Council for feedback next month, before final approval by the Council at a special meeting in Brussels on 29 May. The Strategy process was important when it began in 2005, and is even more so today with important discoveries behind us and a changing global landscape for particle physics ahead.   The draft update, it’s fair to say, contains few surprises, but there are nevertheless some weighty issues for the Council to deliberate. The top priority is, of course, the full exploitation of the LHC, but the Strategy goes further, stating unambiguously that Europe’s top priority should be the high-luminosity upgrade of the machine. Other high-priority items are accelerator R&D to ensure the long-term global future of the field. O...

  11. Membrane Automata with Priorities

    Institute of Scientific and Technical Information of China (English)

    Luděk Cienciala; Lucie Ciencialová

    2004-01-01

    In this paper the one-way P automata with priorities are introduced. Such automata are P systemshere the membranes are only allowed to consume objects from parent membranes, under the given conditions. The result of computation of these systems is the set of multiset sequences consumed by skin membrane intc the system. The rules associated in some order with each membrane cannot modify any objects, they can only move them through membrane. We show that P automata with priorities and two membranes can accept every recursively enumerated language.

  12. Research Priorities for Endometriosis

    DEFF Research Database (Denmark)

    Rogers, Peter A W; Adamson, G David; Al-Jefout, Moamar;

    2016-01-01

    The 3rd International Consensus Workshop on Research Priorities in Endometriosis was held in São Paulo on May 4, 2014, following the 12th World Congress on Endometriosis. The workshop was attended by 60 participants from 19 countries and was divided into 5 main sessions covering pathogenesis...... stratification, and research in emerging nations, in addition to an increased focus on translational research. A revised and updated set of research priorities that builds on this document will be developed at the 13th World Congress on Endometriosis to be held on May 17-20, 2017, in Vancouver, British Columbia...

  13. Challenges in measuring measles case fatality ratios in settings without vital registration

    Directory of Open Access Journals (Sweden)

    Nandy Robin

    2010-07-01

    Full Text Available Abstract Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies.

  14. Supporting research sites in resource-limited settings: challenges in implementing information technology infrastructure.

    Science.gov (United States)

    Whalen, Christopher J; Donnell, Deborah; Tartakovsky, Michael

    2014-01-01

    As information and communication technology infrastructure becomes more reliable, new methods of electronic data capture, data marts/data warehouses, and mobile computing provide platforms for rapid coordination of international research projects and multisite studies. However, despite the increasing availability of Internet connectivity and communication systems in remote regions of the world, there are still significant obstacles. Sites with poor infrastructure face serious challenges participating in modern clinical and basic research, particularly that relying on electronic data capture and Internet communication technologies. This report discusses our experiences in supporting research in resource-limited settings. We describe examples of the practical and ethical/regulatory challenges raised by the use of these newer technologies for data collection in multisite clinical studies.

  15. Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting.

    Science.gov (United States)

    Shao, Elichilia R; Joseph, Pantaleo M; Slootweg, Piet; Mkwizu, Elifuraha W; Kilonzo, Kajiru G; Mwasamwaja, Amos O

    2015-08-01

    Spontaneous oesophageal rupture after swallowing a bolus of food is a very rare condition. In resource-limited settings, it is very challenging to diagnose this condition especially when its presentation is atypical. Its prognosis is very poor when diagnosis is delayed due to risk of mediastinitis. We report a case of 37-year-old man who was admitted to our hospital complaining of sudden onset of chest tightness and pain after a meal 8 h prior to admission. Urgent chest radiograph revealed right hydropneumothorax with collapsed lung. Water-seal drainage was established gushing 1200 ml of food materials. Definitive diagnosis of oesophageal rupture was reached after post-mortem.

  16. Radial velocity fitting challenge. I. Simulating the data set including realistic stellar radial-velocity signals

    Science.gov (United States)

    Dumusque, X.

    2016-08-01

    Context. Stellar signals are the main limitation for precise radial-velocity (RV) measurements. These signals arise from the photosphere of the stars. The m s-1 perturbation created by these signals prevents the detection and mass characterization of small-mass planetary candidates such as Earth-twins. Several methods have been proposed to mitigate stellar signals in RV measurements. However, without precisely knowing the stellar and planetary signals in real observations, it is extremely difficult to test the efficiency of these methods. Aims: The goal of the RV fitting challenge is to generate simulated RV data including stellar and planetary signals and to perform a blind test within the community to test the efficiency of the different methods proposed to recover planetary signals despite stellar signals. Methods: In this first paper, we describe the simulation used to model the measurements of the RV fitting challenge. Each simulated planetary system includes the signals from instrumental noise, stellar oscillations, granulation, supergranulation, stellar activity, and observed and simulated planetary systems. In addition to RV variations, this simulation also models the effects of instrumental noise and stellar signals on activity observables obtained by HARPS-type high-resolution spectrographs, that is, the calcium activity index log (R'HK) and the bisector span and full width at half maximum of the cross-correlation function. Results: We publish the 15 systems used for the RV fitting challenge including the details about the planetary systems that were injected into each of them. Based on observations collected at the La Silla Parana Observatory, ESO (Chile), with the HARPS spectrograph at the 3.6-m telescope.The simulated data sets are available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/593/A5 and at the wiki of the RV fitting challenge http://https://rv-challenge.wikispaces.com.

  17. Challenges and strategies for implementing genomic services in diverse settings: experiences from the Implementing GeNomics In pracTicE (IGNITE) network.

    Science.gov (United States)

    Sperber, Nina R; Carpenter, Janet S; Cavallari, Larisa H; J Damschroder, Laura; Cooper-DeHoff, Rhonda M; Denny, Joshua C; Ginsburg, Geoffrey S; Guan, Yue; Horowitz, Carol R; Levy, Kenneth D; Levy, Mia A; Madden, Ebony B; Matheny, Michael E; Pollin, Toni I; Pratt, Victoria M; Rosenman, Marc; Voils, Corrine I; W Weitzel, Kristen; Wilke, Russell A; Ryanne Wu, R; Orlando, Lori A

    2017-05-22

    To realize potential public health benefits from genetic and genomic innovations, understanding how best to implement the innovations into clinical care is important. The objective of this study was to synthesize data on challenges identified by six diverse projects that are part of a National Human Genome Research Institute (NHGRI)-funded network focused on implementing genomics into practice and strategies to overcome these challenges. We used a multiple-case study approach with each project considered as a case and qualitative methods to elicit and describe themes related to implementation challenges and strategies. We describe challenges and strategies in an implementation framework and typology to enable consistent definitions and cross-case comparisons. Strategies were linked to challenges based on expert review and shared themes. Three challenges were identified by all six projects, and strategies to address these challenges varied across the projects. One common challenge was to increase the relative priority of integrating genomics within the health system electronic health record (EHR). Four projects used data warehousing techniques to accomplish the integration. The second common challenge was to strengthen clinicians' knowledge and beliefs about genomic medicine. To overcome this challenge, all projects developed educational materials and conducted meetings and outreach focused on genomic education for clinicians. The third challenge was engaging patients in the genomic medicine projects. Strategies to overcome this challenge included use of mass media to spread the word, actively involving patients in implementation (e.g., a patient advisory board), and preparing patients to be active participants in their healthcare decisions. This is the first collaborative evaluation focusing on the description of genomic medicine innovations implemented in multiple real-world clinical settings. Findings suggest that strategies to facilitate integration of genomic

  18. A Needs Assessment Model for Establishing Personnel Training Priorities.

    Science.gov (United States)

    Gable, Robert K.; And Others

    1981-01-01

    The article presents the Special Education Needs Assessment Priorities model which establishes training priorities for both regular and special educators. The model consists of four stages: identification of competencies, development of discrepancies, setting training priorities, and resource allocation. (SB)

  19. Political priorities

    DEFF Research Database (Denmark)

    Ren, Jingzheng

    2016-01-01

    …THE POLITICAL LEADERS of the local government of Chongqing, China, vigorously promote a low-carbon economy and sustainable development to mitigate environmental pollution. Accordingly, research grants focused on this issue were supported by the government, and our group obtained a grant for a pr......…THE POLITICAL LEADERS of the local government of Chongqing, China, vigorously promote a low-carbon economy and sustainable development to mitigate environmental pollution. Accordingly, research grants focused on this issue were supported by the government, and our group obtained a grant...... for a project about industrial park planning and design.…In my view, political priorities based on correct decision-making and market requirements are beneficial for researchers....

  20. Challenges with controlling varicella in prison settings: Experience of California, 2010–2011

    Science.gov (United States)

    Leung, Jessica; Lopez, Adriana S.; Tootell, Elena; Baumrind, Nikki; Mohle-Boetani, Janet; Leistikow, Bruce; Harriman, Kathleen H.; Preas, Christopher P.; Cosentino, Giorgio; Bialek, Stephanie R.; Marin, Mona

    2015-01-01

    We describe the epidemiology of varicella in one state prison in California during 2010–2011, control measures implemented, and associated costs. Eleven varicella cases were reported, 9 associated with 2 outbreaks. One outbreak consisted of 3 cases and the second consisted of 6 cases with 2 generations of spread. Among exposed inmates serologically tested, 98% (643/656) were VZV sero-positive. The outbreaks resulted in >1,000 inmates exposed, 444 staff exposures, and >$160,000 in costs. We documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary for managing cases and outbreaks. PMID:25201912

  1. Challenges with controlling varicella in prison settings: experience of California, 2010 to 2011.

    Science.gov (United States)

    Leung, Jessica; Lopez, Adriana S; Tootell, Elena; Baumrind, Nikki; Mohle-Boetani, Janet; Leistikow, Bruce; Harriman, Kathleen H; Preas, Christopher P; Cosentino, Giorgio; Bialek, Stephanie R; Marin, Mona

    2014-10-01

    This article describes the epidemiology of varicella in one state prison in California during 2010 and 2011, control measures implemented, and associated costs. Eleven varicella cases were reported, of which nine were associated with two outbreaks. One outbreak consisted of three cases and the second consisted of six cases with two generations of spread. Among exposed inmates serologically tested, 98% (643/656) were varicella-zoster virus seropositive. The outbreaks resulted in > 1,000 inmates exposed, 444 staff exposures, and > $160,000 in costs. The authors documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary to manage cases and outbreaks.

  2. DISCOVERY OF LATENT STRUCTURES: EXPERIENCE WITH THE COIL CHALLENGE 2000 DATA SET

    Institute of Scientific and Technical Information of China (English)

    Nevin L. ZHANG; Yi WANG; Tao CHEN

    2008-01-01

    The authors present a case study to demonstrate the possibility of discovering complex and interesting latent structures using hierarchical latent class (HLC) models. A similar effort was made earlier by Zhang (2002), but that study involved only small applications with 4 or 5 observed variables and no more than 2 latent variables due to the lack of efficient learning algorithms. Significant progress has been made since then on algorithmic research, and it is now possible to learn HLC models with dozens of observed variables. This allows us to demonstrate the benefits of HLC models more convincingly than before. The authors have successfully analyzed the CoIL Challenge 2000 data set using HLC models. The model obtained consists of 22 latent variables, and its structure is intuitively appealing. It is exciting to know that such a large and meaningful latent structure can be automatically inferred from data.

  3. Introducing RFID technology in dynamic and time-critical medical settings: requirements and challenges.

    Science.gov (United States)

    Parlak, Siddika; Sarcevic, Aleksandra; Marsic, Ivan; Burd, Randall S

    2012-10-01

    We describe the process of introducing RFID technology in the trauma bay of a trauma center to support fast-paced and complex teamwork during resuscitation. We analyzed trauma resuscitation tasks, photographs of medical tools, and videos of simulated resuscitations to gain insight into resuscitation tasks, work practices and procedures. Based on these data, we discuss strategies for placing RFID tags on medical tools and for placing antennas in the environment for optimal tracking and activity recognition. Results from our preliminary RFID deployment in the trauma bay show the feasibility of our approach for tracking tools and for recognizing trauma team activities. We conclude by discussing implications for and challenges to introducing RFID technology in other similar settings characterized by dynamic and collocated collaboration. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Encouraging Consumption of Water in School and Child Care Settings: Access, Challenges, and Strategies for Improvement

    Science.gov (United States)

    Hampton, Karla E.

    2011-01-01

    Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area. PMID:21680941

  5. Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting.

    Science.gov (United States)

    Campbell, Grace B; Skidmore, Elizabeth R; Whyte, Ellen M; Matthews, Judith T

    2015-10-01

    There is a shortage of published empirical studies conducted in acute inpatient stroke rehabilitation, though such studies are greatly needed in order to shed light on the most efficacious inpatient stroke rehabilitation interventions. The inherent challenges of inpatient research may dissuade researchers from undertaking this important work. This paper describes our institution's experience devising practical solutions to research barriers in this setting. Through concentrated efforts to overcome research barriers, such as by cultivating collaborative relationships and capitalizing on unanticipated benefits, we successfully facilitated conduct of five simultaneous inpatient stroke studies. Tangible benefits realized include increased effectiveness of research participant identification and enrollment, novel collaborative projects, innovative clinical care initiatives, and enhanced emotional and practical support for patients and their families. We provide recommendations based on lessons learned during our experience, and discuss benefits of this collaboration for our research participants, clinical staff, and the research team.

  6. A novel inhalation challenge set to study animal model of allergic alveolitis.

    Science.gov (United States)

    Golec, Marcin; Skórska, Czesława; Lemieszek, Marta; Dutkiewicz, Jacek

    2009-01-01

    A novel inhalation challenge set for the study of experimental allergic alveolitis (hypersensitivity pneumonitis) in mice was designed. A finely dispersed aerosol of allergenic extract generated by the commercial ultrasonic nebulizer "TAJFUN MU1" (produced by Medbryt, Warsaw, Poland) was transported to the airtight inhalation chamber. In the chamber were placed 15 perforated containers made of transparent plastic, each containing one mouse. They were coupled in 3 units, each consisted of 5 containers. The constant flow of aerosol through the chamber was assured by commercial vacuum pump "PL 2/3" (AGA LABOR S.C., Warsaw, Poland). The applied set enabled the natural exposure of mice via the inhalation route to known quantities of allergen (usually microbial) suspended in saline, and then dispersed in form of fine aerosol by ultrasonic nebulizer. This method assures the penetration of allergen into the deep parts of lungs, alveoli and bronchioli. The detailed study of histopathological and biochemical changes in the lungs of exposed animals will be the subject of further publications. So far, the retention of endotoxin in the lungs of mice exposed to the extract of a Gram-negative bacterium Pantoea agglomerans and appearance of positive serologic reactions to this extract indicate the effectiveness of the method.

  7. Challenges and opportunities: using a science-based video game in secondary school settings

    Science.gov (United States)

    Muehrer, Rachel; Jenson, Jennifer; Friedberg, Jeremy; Husain, Nicole

    2012-12-01

    Simulations and games are not new artifacts to the study of science in secondary school settings (Hug, Kriajcik and Marx 2005), however teachers remain skeptical as to their value, use and appropriateness (Rice 2006). The difficulty is not only the design and development of effective play environments that produce measurable changes in knowledge and/or understanding, but also in their on-the-ground use (Jaipal and Figg 2010). This paper reports on the use of a science-focused video game in five very different secondary school settings in Ontario, Canada. A mixed-methods approach was used in the study, and included data gathered on general gameplay habits and technology use, as well as informal interviews with teachers and students who played the game. In total, 161 participants played a series of games focused on the "life of a plant", and were given both a pre and post quiz to determine if the game helped them retain and/or change what they knew about scientific processes like plant cell anatomy and photosynthesis. Participants showed statistically significant improvement on quizzes that were taken after playing the game for approximately one-hour sessions, despite difficulties in some cases both accessing and playing the game for the full hour. Our findings also reveal the ongoing challenges in making use of technology in a variety of school sessions, even when using a browser-based game, that demanded very little other than a reliable internet connection.

  8. Tool for evaluating research implementation challenges: a sense-making protocol for addressing implementation challenges in complex research settings.

    Science.gov (United States)

    Simpson, Kelly M; Porter, Kristie; McConnell, Eleanor S; Colón-Emeric, Cathleen; Daily, Kathryn A; Stalzer, Alyson; Anderson, Ruth A

    2013-01-02

    Many challenges arise in complex organizational interventions that threaten research integrity. This article describes a Tool for Evaluating Research Implementation Challenges (TECH), developed using a complexity science framework to assist research teams in assessing and managing these challenges. During the implementation of a multi-site, randomized controlled trial (RCT) of organizational interventions to reduce resident falls in eight nursing homes, we inductively developed, and later codified the TECH. The TECH was developed through processes that emerged from interactions among research team members and nursing home staff participants, including a purposive use of complexity science principles. The TECH provided a structure to assess challenges systematically, consider their potential impact on intervention feasibility and fidelity, and determine actions to take. We codified the process into an algorithm that can be adopted or adapted for other research projects. We present selected examples of the use of the TECH that are relevant to many complex interventions. Complexity theory provides a useful lens through which research procedures can be developed to address implementation challenges that emerge from complex organizations and research designs. Sense-making is a group process in which diverse members interpret challenges when available information is ambiguous; the groups' interpretations provide cues for taking action. Sense-making facilitates the creation of safe environments for generating innovative solutions that balance research integrity and practical issues. The challenges encountered during implementation of complex interventions are often unpredictable; however, adoption of a systematic process will allow investigators to address them in a consistent yet flexible manner, protecting fidelity. Research integrity is also protected by allowing for appropriate adaptations to intervention protocols that preserve the feasibility of 'real world

  9. Setting research priorities for maternal, newborn, child health and nutrition in India by engaging experts from 256 indigenous institutions contributing over 4000 research ideas: a CHNRI exercise by ICMR and INCLEN.

    Science.gov (United States)

    Arora, Narendra K; Mohapatra, Archisman; Gopalan, Hema S; Wazny, Kerri; Thavaraj, Vasantha; Rasaily, Reeta; Das, Manoj K; Maheshwari, Meenu; Bahl, Rajiv; Qazi, Shamim A; Black, Robert E; Rudan, Igor

    2017-06-01

    Health research in low- and middle- income countries (LMICs) is often driven by donor priorities rather than by the needs of the countries where the research takes place. This lack of alignment of donor's priorities with local research need may be one of the reasons why countries fail to achieve set goals for population health and nutrition. India has a high burden of morbidity and mortality in women, children and infants. In order to look forward toward the Sustainable Development Goals, the Indian Council of Medical Research (ICMR) and the INCLEN Trust International (INCLEN) employed the Child Health and Nutrition Research Initiative's (CHNRI) research priority setting method for maternal, neonatal, child health and nutrition with the timeline of 2016-2025. The exercise was the largest to-date use of the CHNRI methodology, both in terms of participants and ideas generated and also expanded on the methodology. CHNRI is a crowdsourcing-based exercise that involves using the collective intelligence of a group of stakeholders, usually researchers, to generate and score research options against a set of criteria. This paper reports on a large umbrella CHNRI that was divided into four theme-specific CHNRIs (maternal, newborn, child health and nutrition). A National Steering Group oversaw the exercise and four theme-specific Research Sub-Committees technically supported finalizing the scoring criteria and refinement of research ideas for the respective thematic areas. The exercise engaged participants from 256 institutions across India - 4003 research ideas were generated from 498 experts which were consolidated into 373 research options (maternal health: 122; newborn health: 56; child health: 101; nutrition: 94); 893 experts scored these against five criteria (answerability, relevance, equity, innovation and out-of-box thinking, investment on research). Relative weights to the criteria were assigned by 79 members from the Larger Reference Group. Given India's diversity

  10. Feasibility of HIV point-of-care tests for resource-limited settings: challenges and solutions.

    Science.gov (United States)

    Stevens, Wendy; Gous, Natasha; Ford, Nathan; Scott, Lesley E

    2014-09-08

    Improved access to anti-retroviral therapy increases the need for affordable monitoring using assays such as CD4 and/or viral load in resource-limited settings. Barriers to accessing treatment, high rates of loss to initiation and poor retention in care are prompting the need to find alternatives to conventional centralized laboratory testing in certain countries. Strong advocacy has led to a rapidly expanding repertoire of point-of-care tests for HIV. point-of-care testing is not without its challenges: poor regulatory control, lack of guidelines, absence of quality monitoring and lack of industry standards for connectivity, to name a few. The management of HIV increasingly requires a multidisciplinary testing approach involving hematology, chemistry, and tests associated with the management of non-communicable diseases, thus added expertise is needed. This is further complicated by additional human resource requirements and the need for continuous training, a sustainable supply chain, and reimbursement strategies. It is clear that to ensure appropriate national implementation either in a tiered laboratory model or a total decentralized model, clear country-specific assessments need to be conducted.

  11. Setting Occupational Exposure Limits for Chemical Allergens--Understanding the Challenges.

    Science.gov (United States)

    Dotson, G S; Maier, A; Siegel, P D; Anderson, S E; Green, B J; Stefaniak, A B; Codispoti, C D; Kimber, I

    2015-01-01

    Chemical allergens represent a significant health burden in the workplace. Exposures to such chemicals can cause the onset of a diverse group of adverse health effects triggered by immune-mediated responses. Common responses associated with workplace exposures to low molecular weight (LMW) chemical allergens range from allergic contact dermatitis to life-threatening cases of asthma. Establishing occupational exposure limits (OELs) for chemical allergens presents numerous difficulties for occupational hygiene professionals. Few OELs have been developed for LMW allergens because of the unique biological mechanisms that govern the immune-mediated responses. The purpose of this article is to explore the primary challenges confronting the establishment of OELs for LMW allergens. Specific topics include: (1) understanding the biology of LMW chemical allergies as it applies to setting OELs; (2) selecting the appropriate immune-mediated response (i.e., sensitization versus elicitation); (3) characterizing the dose (concentration)-response relationship of immune-mediated responses; (4) determining the impact of temporal exposure patterns (i.e., cumulative versus acute exposures); and (5) understanding the role of individual susceptibility and exposure route. Additional information is presented on the importance of using alternative exposure recommendations and risk management practices, including medical surveillance, to aid in protecting workers from exposures to LMW allergens when OELs cannot be established.

  12. Quality Teaching in a Managerial Setting: Higher Education Challenges in Australia

    Directory of Open Access Journals (Sweden)

    Therese Demediuk

    2011-02-01

    Full Text Available Australian universities face increased challenges in a global higher education marketplace. They have responded to this competitive environment by introducing greater efficiency and accountability measures. One key measure is the quality of teaching and in particular, the delivery of student-centred teaching. However, the reforms have changed the working lives of academic teachers who now have greater reporting and administrative responsibilities with less sense of collegiality in the sector. In these circumstances, it is not clear that teaching staff will share the same perceptions of quality teaching as their institutions expect. This paper examines the utility of role theory and learning organization theory as part of a project which will examine the ways in which implicit knowledge can be made explicit and shared in the organization as part of academic teachers’ roles. The paper hypothesizes that when academics share their perceptions of good teaching, universities will benefit from a coherent set of quality teaching indicators which are aligned with their organizational cultures.

  13. Antecedents to agenda setting and framing in health news: an examination of priority, angle, source, and resource usage from a national survey of U.S. health reporters and editors.

    Science.gov (United States)

    Wallington, Sherrie Flynt; Blake, Kelly; Taylor-Clark, Kalahn; Viswanath, K

    2010-01-01

    The influence of news media on audience cognitions, attitudes, and behaviors in the realm of politics, race relations, science, and health has been extensively documented.Agenda setting and framing studies show that news media influence how people develop schema and place priorities on issues, with media stories serving as a major source of issue frames. Although news media are an important intermediary in the translation of scientific knowledge to different publics, little has been documented about the production of health news and factors that may predict media agenda setting and framing in health journalism. We used data from a 2005 national survey of U.S. health reporters and editors to examine predictors of source, resource, story angle, and frame usage among reporters and editors by variables such as organizational structure, individual characteristics of respondents (such as education and years working as a journalist),and perceptions of occupational autonomy. Multivariable logistic regression models revealed several differences among U.S. health reports and editors in the likelihood of using a variety of news sources, resources, priorities, and angles in reporting. Media agenda setting and framing theories suggest that practitioners familiar with media processes can work with journalists to frame messages, thereby increasing the probability of accurate and effective reporting. Results from this study may help to inform interactions between public health and medical practitioners and the press [corrected].

  14. [Interdisciplinarity in the hospital setting: between daily challenge and group stakes].

    Science.gov (United States)

    Moutet, Marius; Guisado, Huguette; Butel, Jacques; Vuagnat, Hubert; Zulian, Gilbert

    2014-01-15

    Group functioning may limit interdisciplinarity. Four scenarios of health professionals' meetings are described. A) If priority is timing, the group isn't interdisciplinary any longer; decisions are endorsed without questioning or criticism. B) When positions' stakes aren't clarified, speaking helps active persons to take power and passive ones to strengthen their criticisms. C) If caregivers are turned to their duties and territory, recourse to interdisciplinary process is only made in case of difficulties. D) When the group is moved by implicit standards, resources are underutilized. In conclusion, added value of interdisciplinary work is superior when divergent options are brought without influence of recurring problems or protocols.

  15. Preservation Priority

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    China ratified the UNESCO Convention Concerning the Protection of World Cultural and Natural Heritage in 1985. This set the tone for a course of action aimed at protecting the common heritage of mankind in tandem with the international community. Recently, Chao Huashan, a renowned expert on world heritage studies in China, spoke to Beijing Review reporter Zan Jifang, sharing his understanding about the value of the World Heritage Convention and his suggestions for China’s future work on preserving its heritage. Excerpts follow:

  16. How to set challenging goals and conduct fair evaluation in regional public health systems. Insights from Valencia and Tuscany Regions.

    Science.gov (United States)

    Vainieri, Milena; Vola, Federico; Gomez Soriano, Gregorio; Nuti, Sabina

    2016-11-01

    The definition of "the right targets" and the way the evaluation of results is performed affect the willingness to commit to new challenges, which is a factor that influences the relationship between goal setting and performance results. Indeed, some authors claim that the choice of an inappropriate goal-setting procedure is a major cause of failure of management control systems. Goal setting theorists found that assigning a specific and challenging goal leads to higher performance than (a) an easy goal, (b) a general goal or (c) no goal setting. Despite this evidence, yet, few proposals concern the definition of what is "challenging". This paper focuses on two issues: (a) what is to be considered a challenging goal and (b) what is a "fair evaluation" in the health care sector. This work suggests that benchmarking is a valid support to solve the previous dilemmas. Relying on two Regional European advanced experiences - Valencia in Spain and Tuscany in Italy -, this paper aims to provide conceptual methods that can help managers define challenging goals and conduct fair evaluation about their achievement. Although these Regions adopted different governance models, both of them applied very similar techniques, which seem to be associated to an improvement of their performance and a reduction of unwarranted variation.

  17. Priorities for Venus Exploration

    Science.gov (United States)

    Glaze, L. S.; Beauchamp, P. M.; Chin, G.; Crisp, D.; Grimm, R. E.; Herrick, R. R.; Johnston, S.; Limaye, S. S.; Smrekar, S. E.; Ocampo, A.; Thompson, T. W.

    2013-12-01

    Venus remains one of the most enigmatic bodies in our Solar System. Important questions remain regarding the origin and evolution of the atmosphere, the history of the surface and interior, and how the surface and atmosphere interact. In a broader context, understanding Venus has implications for understanding the evolution of terrestrial planets in our Solar System as well as for interpreting the growing set of observations of extra-solar planets. The Venus Exploration Analysis Group (VEXAG), established in 2005, is chartered by NASA's Planetary Science Division and reports its findings to the NASA Advisory Council. Open to all interested scientists, VEXAG regularly evaluates Venus exploration goals, scientific objectives, investigations and critical measurement requirements, including especially recommendations in the NRC Decadal Survey and the Solar System Exploration Strategic Roadmap. At the last general meeting in November 2012, VEXAG resolved to update the scientific priorities and strategies for Venus exploration. To achieve this goal, three major tasks were defined for 2013, (1) update the document prioritizing Goals, Objectives and Investigations for Venus Exploration, (2) develop a Roadmap for Venus exploration that is consistent with VEXAG priorities as well as Planetary Decadal Survey priorities, and (3) develop a white paper on technologies for Venus missions. Proposed versions of all three documents were presented at the VEXAG general meeting in November 2013. Here, we present the findings and final versions of all three documents for community comment and feedback. A follow-on Workshop on Venus Exploration Targets is also being planned for the early summer of 2014. The workshop will provide a forum for the Venus science community to discuss approaches for addressing high priority investigations. Participants will be encouraged to present their ideas for specific targets on Venus (interior, surface and atmosphere) as well as to present specific data

  18. Child Care Teachers' Perspectives on Including Children with Challenging Behavior in Child Care Settings

    Science.gov (United States)

    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira

    2014-01-01

    In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…

  19. Bridging the Gap: The Challenges of Employing Entrepreneurial Processes within University Settings

    Science.gov (United States)

    Wardale, Dorothy; Lord, Linley

    2016-01-01

    In Australia and elsewhere, universities face increasing pressure to improve research output and quality, particularly through partnerships with industry. This raises interesting challenges for academic staff with considerable industry experience who are "new" to academe. Some of these challenges were faced by the authors who have been…

  20. Coping with Challenging Behaviours of Children with Autism: Effectiveness of Brief Training Workshop for Frontline Staff in Special Education Settings

    Science.gov (United States)

    Ling, C. Y. M.; Mak, W. W. S.

    2012-01-01

    Background: The present study examined the effectiveness of three staff training elements: psychoeducation (PE) on autism, introduction of functional behavioural analysis (FBA) and emotional management (EM), on the reaction of challenging behaviours for frontline staff towards children with autism in Hong Kong special education settings. Methods:…

  1. Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru

    Directory of Open Access Journals (Sweden)

    Soto Giselle

    2008-11-01

    Full Text Available Abstract Background Infectious disease surveillance is a primary public health function in resource-limited settings. In 2003, an electronic disease surveillance system (Alerta was established in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment (NMRCD. Many challenges arose during the implementation process, and a variety of solutions were applied. The purpose of this paper is to identify and discuss these issues. Methods This is a retrospective description of the Alerta implementation. After a thoughtful evaluation according to the Centers for Disease Control and Prevention (CDC guidelines, the main challenges to implementation were identified and solutions were devised in the context of a resource-limited setting, Peru. Results After four years of operation, we have identified a number of challenges in implementing and operating this electronic disease surveillance system. These can be divided into the following categories: (1 issues with personnel and stakeholders; (2 issues with resources in a developing setting; (3 issues with processes involved in the collection of data and operation of the system; and (4 issues with organization at the central hub. Some of the challenges are unique to resource-limited settings, but many are applicable for any surveillance system. For each of these challenges, we developed feasible solutions that are discussed. Conclusion There are many challenges to overcome when implementing an electronic disease surveillance system, not only related to technology issues. A comprehensive approach is required for success, including: technical support, personnel management, effective training, and cultural sensitivity in order to assure the effective deployment of an electronic disease surveillance system.

  2. A Descriptive Analysis of Music Therapists' Perceptions of Delivering Services in Inclusive Settings: A Challenge to the Field.

    Science.gov (United States)

    Jones; Cardinal

    1999-01-01

    The purpose of this study was to examine the perceptions of music therapists toward inclusion (providing services within general education settings) and to determine their willingness to provide their services in these settings. A questionnaire was sent to 560 music therapists of which 373 responded (67%). A descriptive analysis indicated that although the vast majority of music therapists are providing their services in a segregated setting, they (a) overwhelmingly know about inclusion, (b) perceive benefits to clients with and without disabilities, and (c) are willing to provide their services within an inclusive setting. Why then do therapists so overwhelmingly provide their services in noninclusive settings? Possible answers to this question as well as the challenge this creates to the field of music therapy are discussed.

  3. Definición de prioridades para las intervenciones de salud en el Sistema de Protección Social en Salud de México Priority setting for health interventions in Mexico's System of Social Protection in Health

    Directory of Open Access Journals (Sweden)

    Eduardo González-Pier

    2007-01-01

    Full Text Available La definición explícita de prioridades en intervenciones de salud representa una oportunidad para México de equilibrar la presión y la complejidad de una transición epidemiológica avanzada, con políticas basadas en evidencias generadas por la inquietud de cómo optimizar el uso de los recursos escasos para mejorar la salud de la población. La experiencia mexicana en la definición de prioridades describe cómo los enfoques analíticos estandarizados en la toma de decisiones, principalmente los de análisis de la carga de la enfermedad y de costo-efectividad, se combinan con otros criterios -tales como dar respuesta a las expectativas legítimas no médicas de los pacientes y asegurar un financiamiento justo para los hogares-, para diseñar e implementar un grupo de tres paquetes diferenciados de intervenciones de salud. Éste es un proceso clave dentro de un conjunto más amplio de elementos de reforma dirigidos a extender el aseguramiento en salud, especialmente a los pobres. Las implicaciones más relevantes en el ámbito de políticas públicas incluyen lecciones sobre el uso de las herramientas analíticas disponibles y probadas para definir prioridades nacionales de salud; la utilidad de resultados que definan prioridades para guiar el desarrollo de capacidades a largo plazo; la importancia de favorecer un enfoque para institucionalizar el análisis ex-ante de costo-efectividad; y la necesidad del fortalecimiento de la capacidad técnica local como un elemento esencial para equilibrar los argumentos sobre maximización de la salud con criterios no relacionados con la salud en el marco de un ejercicio sistemático y transparente.Explicit priority setting presents Mexico with the opportunity to match the pressure and complexity of an advancing epidemiological transition with evidence-based policies driven by a fundamental concern for how to make the best use of scarce resources to improve population health. The Mexican priority-setting

  4. Fighting through Resistance: Challenges Faced by African American Women Principals in Predominately White School Settings

    Science.gov (United States)

    Jackson, Alicia D.

    2013-01-01

    African American women represented a growing proportion within the field of education in attaining leadership roles as school principals. As the numbers continued to rise slowly, African American women principals found themselves leading in diverse or even predominately White school settings. Leading in such settings encouraged African American…

  5. Anesthesia information management systems in the ambulatory setting: benefits and challenges.

    Science.gov (United States)

    Gottlieb, Ori

    2014-06-01

    Adopting an anesthesia information management system (AIMS) is a challenge for anesthesia departments. The transition requires a physician champion and the support of members in every section. This change can be facilitated by visiting similar institutions that are already using AIMS, shadow charting for a sufficient period of time, and understanding that optimization continues after the go-live date. Once implemented, the benefits outweigh the challenges, but understanding where the potential obstacles lie is critical to removing them efficiently and effectively. As different AIMS continue to spread throughout the medical world, so will their benefits. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Exploring Citizen Infrastructure and Environmental Priorities in Mumbai, India

    Energy Technology Data Exchange (ETDEWEB)

    Sperling, Joshua; Romero-Lankao, Patricia; Beig, Gufran

    2016-06-01

    Many cities worldwide seek to understand local policy priorities among their general populations. This study explores how differences in local conditions and among citizens within and across Mumbai, India shape local infrastructure (e.g. energy, water, transport) and environmental (e.g. managing pollution, climate-related extreme weather events) policy priorities for change that may or may not be aligned with local government action or global environmental sustainability concerns such as low-carbon development. In this rapidly urbanizing city, multiple issues compete for prominence, ranging from improved management of pollution and extreme weather to energy and other infrastructure services. To inform a broader perspective of policy priorities for urban development and risk mitigation, a survey was conducted among over 1200 citizens. The survey explored the state of local conditions, the challenges citizens face, and the ways in which differences in local conditions (socio-institutional, infrastructure, and health-related) demonstrate inequities and influence how citizens perceive risks and rank priorities for the future design and implementation of local planning, policy, and community-based efforts. With growing discussion and tensions surrounding the new urban sustainable development goal, announced by the UN in late September 2015, and a new global urban agenda document to be agreed upon at 'Habitat III', issues on whether sustainable urbanization priorities should be set at the international, national or local level remain controversial. As such, this study aims to first understand determinants of and variations in local priorities across one city, with implications discussed for local-to-global urban sustainability. Findings from survey results indicate the determinants and variation in conditions such as age, assets, levels of participation in residential action groups, the health outcome of chronic asthma, and the infrastructure service of piped

  7. Classroom Management Strategies for Young Children with Challenging Behavior within Early Childhood Settings

    Science.gov (United States)

    Jolivette, Kristine; Steed, Elizabeth A.

    2010-01-01

    Many preschool, Head Start, and kindergarten educators of young children express concern about the number of children who exhibit frequent challenging behaviors and report that managing these behaviors is difficult within these classrooms. This article describes research-based strategies with practical applications that can be used as part of…

  8. Priority Education Zones in Mauritius

    Science.gov (United States)

    Kumar, Mahadeo Santosh; Gurrib, Mahomed Aniff

    2008-01-01

    This article discusses the Priority Education Zones project (ZEP) in Mauritius. The original and innovative dimensions of the project are described, together with the difficulties encountered during the setting-up of the ZEP schools. The article covers five main issues: the status of the ZEP project; the minimal conditions for success; the…

  9. Don’t Discount Societal Value in Cost-Effectiveness; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”

    Directory of Open Access Journals (Sweden)

    William Hall

    2017-09-01

    Full Text Available As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA-based processes including ‘evidence-informed deliberative processes.’ However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like ‘evidence-informed deliberative processes’ could be one way of achieving this laudable goal.

  10. Radial Velocity Fitting Challenge. I. Simulating the data set including realistic stellar radial-velocity signals

    CERN Document Server

    Dumusque, X

    2016-01-01

    Stellar signals are the main limitation for precise radial-velocity (RV) measurements. These signals arise from the photosphere of the stars. The m/s perturbation created by these signals prevents the detection and mass characterization of small-mass planetary candidates such as Earth-twins. Several methods have been proposed to mitigate stellar signals in RV measurements. However, without precisely knowing the stellar and planetary signals in real observations, it is extremely difficult to test the efficiency of these methods. The goal of the RV fitting challenge is to generate simulated RV data including stellar and planetary signals and to perform a blind test within the community to test the efficiency of the different methods proposed to recover planetary signals despite stellar signals. In this first paper, we describe the simulation used to model the measurements of the RV fitting challenge. Each simulated planetary system includes the signals from instrumental noise, stellar oscillations, granulation,...

  11. Markov chain Monte Carlo searches for Galactic binaries in Mock LISA Data Challenge 1B data sets

    CERN Document Server

    Trias, Miquel; Veitch, John

    2008-01-01

    We are developing a Bayesian approach based on Markov chain Monte Carlo techniques to search for and extract information about white dwarf binary systems with the Laser Interferometer Space Antenna (LISA). Here we present results obtained by applying an initial implementation of this method to some of the data sets released in Round 1B of the Mock LISA Data Challenges. For Challenges 1B.1.1a and 1b the signals were recovered with parameters lying within the 95.5% posterior probability interval and the correlation between the true and recovered waveform is in excess of 99%. Results were not submitted for Challenge 1B.1.1c due to some convergence problems of the algorithms, despite the signal was detected in a search over a 2 mHz band.

  12. Long Standing Esophageal Perforation due to Foreign Body Impaction in Children: A Therapeutic Challenge in a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Ngo Nonga Bernadette

    2017-01-01

    Full Text Available Late presentation of foreign body impaction in the esophagus, complicated by perforation in children, has rarely been reported in the literature. Esophageal surgery is very difficult and challenging in Cameroon (a resource limited setting. We are reporting herein 2 cases of esophageal perforation in children seen very late (12 days and 40 days after foreign body impaction, complicated with severe sepsis, who were successfully operated upon with very good results.

  13. Identifying and priority setting indicators of integration and integrable units in hospitals of Tabriz University of Medical Sciences from the perspective of health experts

    Directory of Open Access Journals (Sweden)

    yalda mousazadeh

    2013-12-01

    Full Text Available BACKGROUND: Hospitals face major challenges such as lack of resources, increase in costs, and particularly severelimitations by sanctions that lead to integration in hospitals. This study was conducted to identify and prioritize theindicators of integration and integrable hospital units based on the experts' perspective. METHODS: The present study was a three phase qualitative, applied survey. The first phase included a review of thefundamental concepts. The second phase included three focus group discussions with presence of experts to identifynecessary indicators for the implementation of integration strategy and the hospital units that can be integrated based onindicators. In the third phase, Delphi's questionnaire was prepared based on Likert's scale for prioritizing and choosingthe indicators and hospital units. RESULTS: 9 indicators and 29 hospital units were identified during focus group discussions. Consensus was achievedon 9 indicators and 23 units out of 29 units based on the three stages of Delphi's questionnaire. The most importantindicators were cost and parallelism in tasks (consensus = 95.2%. Service availability and responsibility(consensus = 71.4% were the least important indicators. The supporting units had the greatest potential (45.45% oftotal units of merging. Emergency, inpatient wards, management, and chairmanship units were not candidates forintegration according to the viewpoint of experts. CONCLUSIONS: Integration will lead to efficiency in resources management, avoids parallelism in tasks, increasesservice availability, and reduces costs. Integration capability exists in many parts of the hospital; therefore, it can beused in the hospitals. Furthermore, it is necessary to define clear indicators for measuring the success of this strategy.

  14. Challenges and Opportunities: Using a Science-Based Video Game in Secondary School Settings

    Science.gov (United States)

    Muehrer, Rachel; Jenson, Jennifer; Friedberg, Jeremy; Husain, Nicole

    2012-01-01

    Simulations and games are not new artifacts to the study of science in secondary school settings (Hug, Kriajcik and Marx 2005), however teachers remain skeptical as to their value, use and appropriateness (Rice 2006). The difficulty is not only the design and development of effective play environments that produce measurable changes in knowledge…

  15. Challenges and Opportunities: Using a Science-Based Video Game in Secondary School Settings

    Science.gov (United States)

    Muehrer, Rachel; Jenson, Jennifer; Friedberg, Jeremy; Husain, Nicole

    2012-01-01

    Simulations and games are not new artifacts to the study of science in secondary school settings (Hug, Kriajcik and Marx 2005), however teachers remain skeptical as to their value, use and appropriateness (Rice 2006). The difficulty is not only the design and development of effective play environments that produce measurable changes in knowledge…

  16. Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

    Science.gov (United States)

    Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K. M.; Zafar, Afia

    2015-01-01

    We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities. PMID:25882388

  17. Diagnostic challenges of sexually transmitted infections in resource-limited settings.

    Science.gov (United States)

    Peeling, Rosanna W; Ronald, Allan

    2009-12-01

    The global burden of sexually transmitted infections (STIs) is highest in the developing world where access to laboratory services is limited. Sophisticated laboratory diagnostic tests using noninvasive specimens have enabled developed countries to screen and diagnose curable STIs in a variety of settings, but control programs in resource-limited settings continue to struggle to find simple rapid tests that can provide adequate performance in the absence of laboratory services. While recent technological advances and investments in research and development may soon yield improved STI tests that can make an impact, these tests will need to be deployed within a health system that includes: regulatory oversight, quality assurance, good supply-chain management, effective training, information systems and a sound surveillance system to monitor disease trends, inform policy decisions and assess the impact of interventions.

  18. Hospital preparedness in community measles outbreaks-challenges and recommendations for low-resource settings.

    Science.gov (United States)

    Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K M; Zafar, Afia

    2015-01-01

    We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

  19. The health promoting sports club in Finland--a challenge for the settings-based approach.

    Science.gov (United States)

    Kokko, Sami; Kannas, Lasse; Villberg, Jari

    2006-09-01

    The purpose of this article is, first, to compile a frame of reference for the health promoting sports club and, second, to develop standards for the concept. This concept is based on the settings-based health promotion approach. Sports clubs are a new setting for health promotion, which until now has been little examined from a settings point of view. Nevertheless, this concept has much potential. For example, sports clubs attract a large number of children and adolescents and their educational nature can be considered to be informal. The present standards were developed using the Delphi method. The researcher, in cooperation with a panel of experts (experts in health promotion, n = 11, and experts in sports clubs, n = 16), sought to create a consensus statement on the standards. At the preliminary stage of the study 64 original standards were created on the basis of existing literature and the principles of the Ottawa Charter. During the three rounds of the Delphi process 15 standards were evaluated as the most important. After the Delphi process, the researcher modified the standards by eliminating overlap, interpolating seven standards to involve all strategic areas of the Ottawa Charter and creating a preliminary typology of the standards. At the subsequent stages of the study, indicators for these standards will be drafted and tested in practice. Therefore, this study would provide tools for determining and evaluating how health promoting a particular sports club is.

  20. Radial-Velocity Fitting Challenge. II. First results of the analysis of the data set

    CERN Document Server

    Dumusque, X; Damasso, M; Diaz, R; Gregory, P C; Hara, N C; Hatzes, A; Rajpaul, V; Tuomi, M; Aigrain, S; Anglada-Escude, G; Bonomo, A S; Boue, G; Dauvergne, F; Frustagli, G; Giacobbe, P; Haywood, R D; Jones, H R A; Pinamonti, M; Poretti, E; Rainer, M; Segransan, D; Sozzetti, A; Udry, S

    2016-01-01

    Radial-velocity (RV) signals induce RV variations an order of magnitude larger than the signal created by the orbit of Earth-twins, thus preventing their detection. The goal of this paper is to compare the efficiency of the different methods used to deal with stellar signals to recover extremely low-mass planets despite. However, because observed RV variations at the m/s precision level or below is a combination of signals induced by unresolved orbiting planets, by the star, and by the instrument, performing such a comparison using real data is extremely challenging. To circumvent this problem, we generated simulated RV measurements including realistic stellar and planetary signals. Different teams analyzed blindly those simulated RV measurements, using their own method to recover planetary signals despite stellar RV signals. By comparing the results obtained by the different teams with the planetary and stellar parameters used to generate the simulated RVs, it is therefore possible to compare the efficiency ...

  1. Priority arbitration mechanism

    Science.gov (United States)

    Garmire, Derrick L.; Herring, Jay R.; Stunkel, Craig B.

    2007-03-06

    A method is provided for selecting a data source for transmission on one of several logical (virtual) lanes embodied in a single physical connection. Lanes are assigned to either a high priority class or to a low priority class. One of six conditions is employed to determine when re-arbitration of lane priorities is desired. When this occurs a next source for transmission is selected based on a the specification of the maximum number of high priority packets that can be sent after a lower priority transmission has been interrupted. Alternatively, a next source for transmission is selected based on a the specification of the maximum number of high priority packets that can be sent while a lower priority packet is waiting. If initialized correctly, the arbiter keeps all of the packets of a high priority packet contiguous, while allowing lower priority packets to be interrupted by the higher priority packets, but not to the point of starvation of the lower priority packets.

  2. Nanomaterials in the aquatic environment: A European Union–United States perspective on the status of ecotoxicity testing, research priorities, and challenges ahead

    DEFF Research Database (Denmark)

    Selck, Henriette; Handy, Richard D; Fernandes, Teresa F.;

    2016-01-01

    on bioavailability and toxicity; 5) development of more environmentally realistic bioassays; and 6) uptake, internal distribution, and depuration of NMs. Research addressing these key topics will reduce uncertainty in ecological risk assessment and support the sustainable development of nanotechnology....... on work within the Ecotoxicology Community of Research (2012–2015) the present Focus article provides an overview of the state of the art of nanomaterials (NMs) in the aquatic environment by addressing different research questions, with a focus on ecotoxicological test systems and the challenges faced...

  3. Social Priorities as Data

    Science.gov (United States)

    Grubert, E.

    2015-12-01

    Decision makers' responses to local risks and expected changes to a community from circumstances like natural hazards, human developments, and demographic changes can greatly affect social and environmental outcomes in a community. Translating physical data based in disciplines like engineering and geosciences into positive outcomes for communities can be challenging and often results in conflict that appears to pit "science" against "the public." Scientists can be reluctant to offer recommendations for action based on their work, often (and often correctly) noting that their role is not to make value judgments for a community - particularly for a community that is not their own. Conversely, decision makers can be frustrated by the lack of guidance they receive to help translate data into effective and acceptable action. The solution posed by this submission, given the goal of co-production of knowledge by scientists and decision makers to foster better community outcomes, is to involve the community directly by integrating social scientific methods that address decision making and community engagement to the scientist-decision maker interaction. Specifically, the missing dataset in many scientist-decision maker interactions is the nature of community priorities. Using scientifically valid methods to rigorously collect and characterize community priorities to help recommend tradeoffs between different outcomes indicated by the work of physical and natural scientists can bridge the gap between science and action by involving the community in the process. This submission presents early work on US preferences for different types of social and environmental outcomes designed to integrate directly with engineering and physical science frameworks like Life Cycle Assessment and Environmental Impact Statements. Cardinal preference data are based on surveys of US adults using tools like the Analytical Hierarchy Process, budget allocation, and ranking.

  4. SIB health psychology in Brazil: The challenges for working in public health settings.

    Science.gov (United States)

    Spink, Mary-Jane P; Brigagão, Jacqueline M; Menegon, Vera M; Vicentin, Maria-Cristina G

    2016-03-01

    Considering the diversity of theoretical approaches and settings for psychological practice, this editorial provides a background for the articles that have been included in this special issue concerning health psychology in the context of the Brazilian Unified Health System (Sistema Unico de Saude). We addressed issues concerning the national curricular outline for undergraduate training in psychology and historical data on the social movements that led to the creation of the Sistema Unico de Saude and the Psychiatric Reform which created an important area for psychological work absorbing a considerable number of psychologists.

  5. Setting up of a cerebral visual impairment clinic for children: Challenges and future developments.

    Science.gov (United States)

    Philip, Swetha Sara

    2017-01-01

    The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service.

  6. Radial-velocity fitting challenge. II. First results of the analysis of the data set

    Science.gov (United States)

    Dumusque, X.; Borsa, F.; Damasso, M.; Díaz, R. F.; Gregory, P. C.; Hara, N. C.; Hatzes, A.; Rajpaul, V.; Tuomi, M.; Aigrain, S.; Anglada-Escudé, G.; Bonomo, A. S.; Boué, G.; Dauvergne, F.; Frustagli, G.; Giacobbe, P.; Haywood, R. D.; Jones, H. R. A.; Laskar, J.; Pinamonti, M.; Poretti, E.; Rainer, M.; Ségransan, D.; Sozzetti, A.; Udry, S.

    2017-02-01

    Context. Radial-velocity (RV) signals arising from stellar photospheric phenomena are the main limitation for precise RV measurements. Those signals induce RV variations an order of magnitude larger than the signal created by the orbit of Earth-twins, thus preventing their detection. Aims: Different methods have been developed to mitigate the impact of stellar RV signals. The goal of this paper is to compare the efficiency of these different methods to recover extremely low-mass planets despite stellar RV signals. However, because observed RV variations at the meter-per-second precision level or below is a combination of signals induced by unresolved orbiting planets, by the star, and by the instrument, performing such a comparison using real data is extremely challenging. Methods: To circumvent this problem, we generated simulated RV measurements including realistic stellar and planetary signals. Different teams analyzed blindly those simulated RV measurements, using their own method to recover planetary signals despite stellar RV signals. By comparing the results obtained by the different teams with the planetary and stellar parameters used to generate the simulated RVs, it is therefore possible to compare the efficiency of these different methods. Results: The most efficient methods to recover planetary signals take into account the different activity indicators, use red-noise models to account for stellar RV signals and a Bayesian framework to provide model comparison in a robust statistical approach. Using the most efficient methodology, planets can be found down to K/N= Kpl/RV_{rms×√{Nobs}=5} with a threshold of K/N = 7.5 at the level of 80-90% recovery rate found for a number of methods. These recovery rates drop dramatically for K/N smaller than this threshold. In addition, for the best teams, no false positives with K/N > 7.5 were detected, while a non-negligible fraction of them appear for smaller K/N. A limit of K/N = 7.5 seems therefore a safe

  7. The challenge of objective scar colour assessment in a clinical setting: using digital photography.

    Science.gov (United States)

    Anderson, J C; Hallam, M-J; Nduka, C; Osorio, D

    2015-08-01

    Scar assessment in the clinical setting is typically impeded by a lack of quantitative data and most systems rely on subjective rating scales which are user dependant and show considerable variability between raters. The growing use of digital photography in medicine suggests a more objective approach to scar evaluation. Our objective was to determine if cameras could be of practical use for measuring colour in a clinical setting. The measurement of colour and reflectance spectra in photographs faces two difficulties: firstly the effects of variable illumination spectra, and secondly to recover accurate colour and spectral information from the sparse red, green and blue (RGB) camera signals. As a result the colour rendition is often inaccurate, and spectral information is lost. To deal with variable illumination and other factors that systematically affect all reflectance spectra ColourWorker (a method for image-based colour measurement implemented in software) calibrates the spectral responses of the camera's RGB sensors using a colour standard in the image. To make best use of the calibrated signals, it takes advantage of the fact that although a given RGB signal can be caused by an infinite number of spectra, most natural reflectance spectra vary smoothly and have predictable forms. This means given a set of examples of spectra produced by the materials of interest, it is possible to estimate the specific spectrum that produced a given RGB signal once corrected for the illumination. We describe a method for recovering spectral and chromatic information relating to surface reflectance from ordinary digital images and apply this to analyse photographs of surgical scars, taken as part of a clinical trial, in an attempt to better quantify clinical scar assessment. It should be noted the pre-existing trial protocol did not allow for a comprehensive evaluation of the accuracy of the method which would require the spectrophotometric measurement of skin regions

  8. Parenting challenges in the setting of terminal illness: a family-focused perspective.

    Science.gov (United States)

    Zaider, Talia I; Salley, Christina G; Terry, Rachel; Davidovits, Michael

    2015-03-01

    In the advanced stages of illness, families with dependent children experience disruption across all dimensions of family life. The need for family support during palliative care is well recognized, yet little is understood about how parents and their children navigate these difficult circumstances. This review summarizes the current body of research on parenting challenges in advanced cancer. To date, the study of parental cancer has focused predominantly on the early stages of disease and its impact on children and adolescents. Less is known about how families with minor children prepare for parental loss. Evidence suggests that having dependent children influences parents' treatment decisions at the end of life, and that a central concern for children and parents is optimizing time spent together. Parents may feel an urgency to engage in accelerated parenting, and maintaining normalcy remains a consistent theme for the ill and healthy parent alike. There is a growing evidence base affirming the importance of responsive communication prior to death. Advancing knowledge about the parenting experience at the end of life is critical for ensuring effective support to the entire family, as it accommodates and prepares for the loss of a vital member.

  9. Setting health insurance remuneration rates of private providers in Kenya: the role of costing, challenges and implications.

    Science.gov (United States)

    Mathauer, Inke

    2011-01-01

    Successful health financing depends on prudent design of resource collection, pooling and purchasing. One of the critical purchasing design issues is the provider payment mechanism and the remuneration rates, which need to set appropriate incentives to health providers. In order to set remuneration rates, cost information is required, but this is not known in many developing countries. This paper illuminates the role of costing and the challenges of resetting health insurance remuneration rates for private hospitals in Kenya and discusses the implications and lessons. The results and proceedings of costing studies from Kenya are reviewed, which reveals methodological and practical challenges as to revising remuneration rates. The costing results are characterized by high variability, which is, among other factors, due to suboptimal resource use at some hospitals and provider payment mechanisms that incentivise over-provision. In such a context, hospital-specific remuneration rates are advisable. In conclusion, remuneration rate setting is not just about translating costing results into a price tag, but other factors have to be considered in a low-income country context in order to balance out health sector objectives and provider interests. Inclusion of providers in developing the costing methodology proves important to increase acceptability of results.

  10. Applying theory across settings, behaviors, and populations: translational challenges and opportunities.

    Science.gov (United States)

    Mermelstein, Robin J; Revenson, Tracey A

    2013-05-01

    Basic social psychological theories have much to contribute to our understanding of health problems and health-related behaviors and may provide potential avenues for intervention development. However, for these theories to have broader reach and applicability to the field of health psychology, more work needs to be done in integrating contexts into these theories and addressing more specifically their application across settings, behaviors, and populations. We argue that integration of these theories into a broader multidisciplinary and multilevel ecological framework is needed to enhance their translation into real-world applications. To enhance this translation, we make several recommendations, including breaking down silos between disciplinary perspectives and enhancing bidirectional communication and translation; analyzing boundary conditions of theories; expanding research approaches to move outside the laboratory and maintain a focus on external validity; and conducting efficacy testing of theories with meaningful, relevant endpoints. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  11. Setting up of a cerebral visual impairment clinic for children: Challenges and future developments

    Science.gov (United States)

    Philip, Swetha Sara

    2017-01-01

    Aim: The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. Materials and Methods: The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. Results: One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Conclusions: Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service. PMID:28300737

  12. Оn the issue of setting priorities in the organization of risk-based supervision over the safety of consumer products traded on the common economic space of Russia, Belarus and Kazakhstan

    OpenAIRE

    А.Yu. Popova; N. V. Zaitseva; I.V. May; P.Z. Shur

    2015-01-01

    Significant volumes of mutual trade between the countries of the Eurasian Economic Union, combined with the urgency of protecting the population against the risks of negative impacts on the health products are aiming to optimize the supervision of the products traded in the market. One of the ways to optimize is the transition to a risk-based model of health service activities and choice of products for top-priority (priority) control. The approaches to the selection of priorities are offered...

  13. An evaluation of positive behavioural support for people with very severe challenging behaviours in community-based settings.

    Science.gov (United States)

    McClean, Brian; Grey, Ian M; McCracken, Margaret

    2007-09-01

    This study employs a multiple baseline across individual design to describe positive behaviour support for five people in community settings. The individuals represent all people with intellectual disability residing in one county with long-standing challenging behaviour resulting in serious physical injury. Five types of outcome are presented: rates of behaviour, rates of medication, psychiatric symptomatology, quality of life and revenue costs. The systems of support required to maintain outcomes and develop real lifestyles include behaviour support planning, mental health review, on-call intensive support and emergency respite care. Behaviours reduced to near-zero levels following implementation of positive behaviour support and improvements were sustained over 24 months. The use of psychotropic medications reduced by 66 percent over the same period. Quality of Life Questionnaire scores improved significantly for three of the five participants. The results are discussed in the context of a framework for supporting people with severe challenging behaviours in the community.

  14. Challenges in Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Greber, Eric M; Pelt, Christopher E; Gililland, Jeremy M; Anderson, Mike B; Erickson, Jill A; Peters, Christopher L

    2017-09-01

    Developmental dysplasia of the hip (DDH) is a recognized cause of secondary arthritis, which may eventually lead to total hip arthroplasty (THA). An understanding of the common acetabular and femoral morphologic abnormalities will aid the surgeon in preparing for the complexity of the surgical case. We present the challenges associated with acetabular and femoral morphologies that may be present in the dysplastic hip and discuss surgical options to consider when performing THA. In addition, common complications associated with this population are reviewed. The complexity of THA in the DDH patient is due to a broad range of pathomorphologic changes of the acetabulum and femur, as well as the diverse and often younger age of these patients. As such, THA in the DDH patient may offer a typical primary hip arthroplasty or be a highly complex reconstruction. It is important to be familiar with all the subtleties associated with DDH in the THA population. The surgeon must be prepared for bone deficiency when reconstructing the acetabulum and should place the component low and medial (at the anatomic hip center), and avoid oversizing the acetabular component. Femoral dysplasia is also complex and variable, and the surgeon must be prepared for different stem choices that allow for decoupling of the metaphyseal stem fit from the implanted stem version. In Crowe III and IV dysplasia, femoral derotation/shortening osteotomy may be required. Many complications associated with THA in the DDH patient may be mitigated with careful planning and surgical technique. Performed correctly, THA can yield excellent results in this complex patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Identification of sources of priority substances set out in Article 16 of the Water Framework Directive and estimation of their discharges into the German aquatic environment; Ermittlung der Quellen fuer die prioritaeren Stoffe nach Artikel 16 der Wasserrahmenrichtlinie und Abschaetzung ihrer Eintragsmengen in die Gewaesser in Deutschland

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, E.; Hillenbrand, T.; Marscheider-Weidemann, F.; Mueller, B.; Wiederhold, J.; Herrchen, M.; Klein, M.

    2002-12-01

    The Water Framework Directive (2000/60/EC) is a new instrument, that inter alia has replaced, harmonized and further developed the control and reduction of point and diffuse discharges of dangerous substances according to Council Directive 76/464/EEC. Article 16 of the Water Framework Directive set out a 'Strategy against pollution of water' which demands specific measures against pollution of water by individual pollutants or groups of pollutants presenting a significant risk to or via the aquatic environment (e.g. by drinking water consumed). For these priority substances community-wide water quality standards and emission controls have to be established. On the basis of Article 16 of Directive 2000/60/EC a list of 33 priority substances has been adopted by the decision of the European Parliament and of the Council of November 2001. This list identifies 11 priority hazardous substances, 14 substances subject to a review for identification as possible priority hazardous substance and 8 priority substances. The Commission will make a proposal for the final classification of the 'substances subject to a review' (priority hazardous or priority substances) not later than 12 months after adoption of this list. The planned measures aim at the cessation or phasing out of discharges, emissions and losses to the aquatic environment within 20 years for the priority hazardous substances and at the progressive reduction for the priority substances. In this project the available data for these 33 substances resp. groups of substances for the Federal Republic of Germany were put forward and described in a standardized pattern. This pattern includes the following items: nomenclature and properties of the substances, monitoring data, production and fields of application of these substances, existing regulations in Germany, releases to environment and possibilities to reduce discharges to the aquatic environment. The basis of the data is the year 2000 as far as

  16. Democracy and Teacher Education: Setting Priorities

    Science.gov (United States)

    Goodman, Jesse H.

    2009-01-01

    As John Dewey noted in his last book, each generation, in its turn, must assume responsibility as caretaker of democracy. He noted that one should never take democracy for granted. Everyone lives in an imperfect democracy, and teacher educators should play their part in protecting, nurturing, and advancing democratic ideals, rituals, values, and…

  17. Planning & Priority Setting for Basic Research

    Science.gov (United States)

    2010-05-05

    Metamaterials – Integrated Computational Material Sciences – Nano-Manufacturing • Counter IED Sciences O F F I C E O F...Biologically-inspired Intelligent Metamaterials – Computing with Natural Language – The Micro-physics of a Liquid-Solid-Gas Interaction – Acoustical...Science Examples of cutting-edge Basic Research at ONR (PE 0601153N) • Code 31: Fast Multipole Methods Reversible Hydrogenation of Graphene • Code 32

  18. Priority-setting in health systems

    DEFF Research Database (Denmark)

    Byskov, Jens

    2013-01-01

    tried herbal remedies for both of them for a week but without effect. The family permits her to travel with her child quite some distance to a fairly run down health centre ---- (Cont. with her meeting services, but going home unserved) WHAT ARE HEALTH SYSTEMS AND HEALTH SYSTEMS RESEARCH? Health systems...... and constraints. This effectively leaves policy-makers.without scientifically sound ideas of what they can and should actually strengthen within ever limited resources. Within such unmapped and misunderstood systems, interventions – even the very simplest – often fail to achieve their goals and no recommeded...

  19. Nanomaterials in the aquatic environment: An EU-USA perspective on the status of ecotoxicity testing, research priorities and challenges ahead

    Science.gov (United States)

    Selck, Henriette; Handy, Richard D.; Fernandes, Teresa F.; Klaine, Stephen J.; Petersen, Elijah J.

    2016-01-01

    The US-EU Community of Research (CoR) was established in 2012 to provide a platform for scientists to develop a ‘shared repertoire of protocols and methods to overcome nanotechnology environmental health and safety (nanoEHS) research gaps and barriers’ (www.us-eu.org/). Based on work within the Ecotoxicology CoR (2012–2015) we provide here an overview of the state-of-the-art of nanomaterials (NMs) in the aquatic environment by addressing different research questions with a focus on ecotoxicological test systems and the challenges faced when assessing nanomaterial (NM) hazards (e.g., uptake routes, bioaccumulation, toxicity, test protocols and model organisms). Our recommendation is to place particular importance on studying the ecological effects of aged/weathered NMs, as-manufactured NMs, as well as NMs released from consumer products in addressing the following overarching research topics: i) NM characterization and quantification in environmental and biological matrices, ii) NM transformation in the environment and consequences for bioavailability and toxicity, iii) alternative methods to assess exposure, iv) influence of exposure scenarios on bioavailability and toxicity, v) development of more environmentally realistic bioassays and vi) uptake, internal distribution, and depuration of NMs. Research addressing these key topics will reduce uncertainty in ecological risk assessment and support the sustainable development of nanotechnology. PMID:27089437

  20. 内分泌干扰物层级筛选中的定量构效关系%Quantitative Structure-Activity Relationships (QSARs) for Priority Setting of Endocrine Disrupting compounds (EDCs)

    Institute of Scientific and Technical Information of China (English)

    童伟达

    2014-01-01

    大量的科学研究、监管和大众媒体一直关注于内分泌干扰物,它们主要是能够模仿天然激素功能的合成化学物质。法律要求开发一种程序,用以筛选和测试水和食品添加剂中是否含有潜在内分泌干扰物。根据法规,大量的化学品将会接受各种体外和体内的实验用以测试其潜在荷尔蒙的活性,例如雌激素活性。因此,需要对这些化学物质进行分层筛选,以降低测试成本及加快筛选和测试的速度。在已经开发的内分泌干扰物知识数据库(EDKB)项目中,将实验和建模进行了整合,以便于更加高效地进行优先级的设置。%Considerable scientific, regulatory and popular press attention has been devoted to the Endocrine Disrupting Chemicals (EDCs) which are predominantly synthetic chemicals with an ability of mimicking the functions of natural hormones. The legislation requires development of a screening and testing program for potential EDCs in drinking water and food additives. Under the legislation, a large number of chemicals will undergo various in vitro and in vivo assays for their potential hormonal activities such as estrogenicity. There is a crucial need to set priority for these chemicals to reduce the cost and speed the screening and testing process. We have developed an Endocrine Disruptor Knowledge Base (EDKB) project where experimentation and modeling were integrated to assist the priority setting process.

  1. Global health priorities - priorities of the wealthy?

    Science.gov (United States)

    Ollila, Eeva

    2005-04-22

    Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. I argue that the arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.

  2. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    Directory of Open Access Journals (Sweden)

    Afolabi Muyiwa Owojuyigbe

    2016-01-01

    Full Text Available Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4% presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32% followed by ventriculoperitoneal shunt insertion (26.4% for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32% belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

  3. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

    Science.gov (United States)

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

  4. Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting

    Directory of Open Access Journals (Sweden)

    Abubakar Auwal

    2011-01-01

    Full Text Available Background: Despite the advances in management, congenital diaphragmatic hernia (CDH has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. Methods: All confirmed cases of CDH were prospectively documented from 2003 till date. Results: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8% and on the right side in one (17.7%. All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. Conclusion: With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

  5. An international eDelphi study identifying the research and education priorities in wound management and tissue repair.

    LENUS (Irish Health Repository)

    2012-02-01

    Aim. To incorporate an international and multidisciplinary consensus in the determination of the research and education priorities for wound healing and tissue repair. Background. 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. Design. The study used a survey method. Methods. A four-round eDelphi technique was used to collect responses from an international population of health professionals across 24 countries. Results. 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. Relevance to clinical practice. 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

  6. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2016-06-01

    Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

  7. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting.

    Science.gov (United States)

    Piper, Llewellyn E

    2011-01-01

    The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.

  8. Resonance assignment for a particularly challenging protein based on systematic unlabeling of amino acids to complement incomplete NMR data sets

    Energy Technology Data Exchange (ETDEWEB)

    Bellstedt, Peter, E-mail: pbell@fli-leibniz.de; Seiboth, Thomas; Haefner, Sabine; Kutscha, Henriette; Ramachandran, Ramadurai; Goerlach, Matthias [Leibniz Institute for Age Research, Fritz Lipmann Institute, Biomolecular NMR Spectroscopy (Germany)

    2013-09-15

    NMR-based structure determination of a protein requires the assignment of resonances as indispensable first step. Even though heteronuclear through-bond correlation methods are available for that purpose, challenging situations arise in cases where the protein in question only yields samples of limited concentration and/or stability. Here we present a strategy based upon specific individual unlabeling of all 20 standard amino acids to complement standard NMR experiments and to achieve unambiguous backbone assignments for the fast precipitating 23 kDa catalytic domain of human aprataxin of which only incomplete standard NMR data sets could be obtained. Together with the validation of this approach utilizing the protein GB1 as a model, a comprehensive insight into metabolic interconversion ('scrambling') of NH and CO groups in a standard Escherichia coli expression host is provided.

  9. Priority One: Environment. The Energy Challenge.

    Science.gov (United States)

    Augis, Lynne; And Others

    This unit is one of a series in environmental education for grades 1-12. The unit is designed to be used with secondary school students and includes the following sections: (1) Preface; (2) Foods, Fuels, and You; (3) Blackout in the City; (4) Conservation and Efficiency; (5) Our Present Sources; (6) The Oil Crisis; (7) The Nculear Controversy; (8)…

  10. Agricultural water management: Priorities and challenges (Preface)

    CSIR Research Space (South Africa)

    Todorovic, M

    2014-09-01

    Full Text Available of fresh water resources and the sustainable use of soil resources are under increasing pressure. Given the physical limitations of natural resources (e.g. land and water), the link between food security, land use and water resources is inevitable. New...

  11. Priority List : Beaver Creek

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Priority list of water rights at Beaver Creek owned by the State of Colorado or federal Fish and Wildlife. This document also has designs for Parshall flumes and...

  12. Patient involvement in research priorities (PIRE)

    DEFF Research Database (Denmark)

    Piil, Karin; Jarden, Mary

    2016-01-01

    Introduction: Patient involvement in healthcare has expanded from the clinical practice setting to include collaboration during the research process. There has been a growing international interest in patient and public involvement in setting research priorities to reduce the risk of discrepancy ...

  13. Оn the issue of setting priorities in the organization of risk-based supervision over the safety of consumer products traded on the common economic space of Russia, Belarus and Kazakhstan

    Directory of Open Access Journals (Sweden)

    А.Yu. Popova

    2015-09-01

    Full Text Available Significant volumes of mutual trade between the countries of the Eurasian Economic Union, combined with the urgency of protecting the population against the risks of negative impacts on the health products are aiming to optimize the supervision of the products traded in the market. One of the ways to optimize is the transition to a risk-based model of health service activities and choice of products for top-priority (priority control. The approaches to the selection of priorities are offered, based on the account of the product use, consumer contingent specificity, known types of hazards, results of inspection and enforcement activities. It was found that the priority products exported by EASE member countries on the common market and forming potentially the greatest risk of harm to the health of consumers may include: dairy products; bird eggs (FEACN group 04; fats and oils of animal or vegetable origin and their cleavage products; prepared edible fats; waxes of animal or vegetable origin (FEACN group 15; sugar and sugar confectionery (FEACN group 17; meat, fish or crustaceans, mollusks or other aquatic invertebrates (FEACN group 16; alcoholic and soft drinks and so on. (FEACN group 22; vegetables, roots and tubers (FEACN group 07; toys, games and sports equipment (FEACN group 95. In relation to these groups of products the priority study of the risk profile required, as well as the development of algorithms and regulations of the supervisory and control measures and improvement of laboratory support methods.

  14. Highest priority in Pakistan.

    Science.gov (United States)

    Adil, E

    1968-01-01

    Responding to the challenge posed by its population problem, Pakistan's national leadership gave the highest priority to family planning in its socioeconomic development plan. In Pakistan, as elsewhere in the world, the first family planning effort originated in the private sector. The Family Planning Association of Pakistan made a tentative beginning in popularizing family planning in the country. Some clinics were opened and some publicity and education were undertaken to emphasize the need for family limitation. It was recognized soon that the government needed to assume the primarily responsibility if family planning efforts were to be successful. For the 1st plan period, 1955-60, about $10 million was allocated by the central government in the social welfare sector for voluntary family planning. The level of support continued on the same basis during the 2nd plan, 1960-65, but has been raised 4-fold in the 1965-70 scheme of family planning. Pakistan's Family Planning Association continues to play vital collaborative roles in designing and pretesting of prototype publicity material, involvement of voluntary social workers, and functional research in the clinical and public relations fields. The real breakthrough in the program came with the 3rd 5-year plan, 1965-70. High priority assigned to family planning is reflected by the total initial budget of Rs.284 million (about $60,000,000) for the 5-year period. Current policy is postulated on 6 basic assumptions: family planning efforts need to be public relations-oriented; operations should be conducted through autonomous bodies with decentralized authority at all tiers down to the grassroots level, for expeditious decision making; monetary incentives play an important role; interpersonal motivation in terms of life experience of the clientele through various contacts, coupled with mass media for publicity, can produce a sociological breakthrough; supplies and services in all related disciplines should be

  15. Global conservation priorities for marine turtles.

    Directory of Open Access Journals (Sweden)

    Bryan P Wallace

    Full Text Available 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

  16. Global Conservation Priorities for Marine Turtles

    Science.gov (United States)

    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

  17. On RAM priority queues

    Energy Technology Data Exchange (ETDEWEB)

    Thorup, M. [Univ. of Coepnhagen (Denmark)

    1996-12-31

    Priority queues are some of the most fundamental data structures. They are used directly for, say, task scheduling in operating systems. Moreover, they are essential to greedy algorithms. We study the complexity of priority queue operations on a RAM with arbitrary word size. We present exponential improvements over previous bounds, and we show tight relations to sorting. Our first result is a RAM priority queue supporting insert and extract-min operations in worst case time O(log log n) where n is the current number of keys in the queue. This is an exponential improvement over the O({radical}log n) bound of Redman and Willard from STOC`90. Our algorithm is simple, and it only uses AC{sup 0} operations, meaning that there is no hidden time dependency on the word size. Plugging this priority queue into Dijkstra`s algorithm gives an 0(mloglogm) algorithm for the single source shortest path problem on a graph with m edges, as compared with the previous O(m {radical} log m) bound based on Redman and Willard`s priority queue.

  18. 'Midwives are the backbone of our health system': lessons from Afghanistan to guide expansion of midwifery in challenging settings.

    Science.gov (United States)

    Turkmani, Sabera; Currie, Sheena; Mungia, Jaime; Assefi, Nassim; Javed Rahmanzai, Ahmed; Azfar, Pashtun; Bartlett, Linda

    2013-10-01

    readiness of programmes to commence education. Insecurity and geographical remoteness are perceived as challenges with clients' access to care and the ability of midwives to make home visits. the depth of midwives' contribution in Afghanistan - from increased maternal health care service utilisation to changing community's perceptions of women's education and professional independence - is overwhelmingly positive. Lessons learned can serve as a model to other low resource, post-conflict settings that are striving to increase the workforce of skilled providers. © 2013 The Authors. Published by Elsevier Ltd. All rights reserved.

  19. Solid Earth: The priorities

    Science.gov (United States)

    Paquet, P.

    1991-10-01

    The European Space Agency's strategy concerning the solid Earth program is reviewed. Improvement of current knowledge of the global geopotential fields, both gravity and magnetic, was stressed as the highest priority. It was agreed that the objectives and goals of the planned Aristoteles mission correspond to this priority, and the need to realize this part of the program was stated. The interdisciplinary links of the program were identified, and it was decided that this program could make substantial contributions to research of oceans, climate and global change, atmosphere, ice and land surfaces.

  20. Scientists’ perspectives on global ocean research priorities

    Directory of Open Access Journals (Sweden)

    Murray Alan Rudd

    2014-08-01

    Full Text Available Diverse natural and social science research is needed to support policies to recover and sustain healthy oceans. While a wide variety of expert-led prioritization initiatives have identified research themes and priorities at national and regional scale, over the past several years there has also been a surge in the number of scanning exercises that have identified important environmental research questions and issues ‘from the bottom-up’. From those questions, winnowed from thousands of contributions by scientists and policy-makers around the world who participated in terrestrial, aquatic and domain-specific horizon scanning and big question exercises, I identified 657 research questions potentially important for informing decisions regarding ocean governance and sustainability. These were distilled to a short list of 67 distinctive research questions that, in an internet survey, were ranked by 2179 scientists from 94 countries. Five of the top 10 research priorities were shared by respondents globally. Despite significant differences between physical and ecological scientists’ priorities regarding specific research questions, they shared seven common priorities among their top 10. Social scientists’ priorities were, however, much different, highlighting their research focus on managerial solutions to ocean challenges and questions regarding the role of human behavior and values in attaining ocean sustainability. The results from this survey provide a comprehensive and timely assessment of current ocean research priorities among research-active scientists but highlight potential challenges in stimulating crossdisciplinary research. As ocean and coastal research necessarily becomes more transdisciplinary to address complex ocean challenges, it will be critical for scientists and research funders to understand how scientists from different disciplines and regions might collaborate and strengthen the overall evidence base for ocean

  1. Use of email in a family practice setting: opportunities and challenges in patient- and physician-initiated communication

    Directory of Open Access Journals (Sweden)

    Scannell Margaret A

    2006-08-01

    Full Text Available Abstract Background Electronic mail (email has the potential to improve communication between physicians and patients. Methods We conducted two research studies in a family practice setting: 1 a brief, anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email, and 2 a randomized, controlled pilot study to assess the feasibility of providing health education via email to family practice patients. Results Sixty-eight percent of patients used email, and the majority of those (80% were interested in using email to communicate with the clinic. The majority also reported that their email address changed less frequently than their home address (65%, n = 173 or telephone number (68%, n = 181. Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians. When evaluating email initiated by the clinic, 26% of otherwise eligible patients could not participate because they lacked email access; those people were more likely to be black and to be insured through Medicaid. Twenty-four subjects agreed to participate, but one-third failed to return the required consent form by mail. All participants who received the intervention emails said they would like to receive health education emails in the future. Conclusion Our survey results show that patients are interested in email communication with the family practice clinic. Our feasibility study also illustrates important challenges in physician-initiated electronic communication. The 'digital divide' – decreased access to electronic technologies in lower income groups – is an ethical concern in the use of email for patient-physician communication.

  2. Fast meldable priority queues

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting

    1995-01-01

    We present priority queues that support the operations Find-Min, Insert, MakeQueue and Meld in worst case time O(1) and Delete and DeleteMin in worst case time O(log n). They can be implemented on the pointer machine and require linear space. The time bounds are optimal for all implementations wh...

  3. Millennial Perspectives and Priorities

    Science.gov (United States)

    Therrell, James A.; Dunneback, Staci K.

    2015-01-01

    Through prioritizing student voice, this study investigated the perspectives of millennial students in relation to their preferences and priorities for how they desired to experience teaching and learning. While not experts, our assumption was that undergraduate students, because of their relatively long experience as students, would be closely in…

  4. Preference, priorities and belief

    NARCIS (Netherlands)

    de Jongh, D.; Liu, F.; Grüne-Yanoff, T.; Hansson, S.O.

    2009-01-01

    In this paper we consider preference over objects. We show how this preference can be derived from priorities, properties of these objects, a concept which is initially from optimality theory. We do this both in the case when an agent has complete information and in the case when an agent only has b

  5. The Challenges Faced by Eastern European Students within a 16-19 Education Setting in the United Kingdom

    Science.gov (United States)

    Babalola, Shade

    2015-01-01

    To examine the challenges encountered by Eastern European students within a sixth form college in the United Kingdom. This paper aims to consider the difficulties encountered by this particular ethnic group examining the impact the challenges may have on their performance, success and achievement. This paper will also highlight equality and…

  6. When Bible and Science Interact: Teachers' Pedagogic and Value Challenges in Teaching Religious Minority Students in Higher Education Settings

    Science.gov (United States)

    Novis-Deutsch, Nurit; Lifshitz, Chen

    2016-01-01

    The integration of highly religious minority students into institutions of higher education poses significant pedagogical and value challenges for students and teachers alike. We offer a framework for analyzing such challenges, distinguishing between practical concerns, identity issues and value conflicts. By contrasting a deficit perspective to…

  7. Patient question set proliferation: scope and informatics challenges of patient question set management in a large multispecialty practice with case examples pertaining to tobacco use, menopause, and Urology and Orthopedics specialties.

    Science.gov (United States)

    Vande Loo, Sarah J; North, Frederick

    2016-04-12

    Health care institutions have patient question sets that can expand over time. For a multispecialty group, each specialty might have multiple question sets. As a result, question set governance can be challenging. Knowledge of the counts, variability and repetition of questions in a multispecialty practice can help institutions understand the challenges of question set proliferation. We analyzed patient-facing question sets that were subject to institutional governance and those that were not. We examined question variability and number of repetitious questions for a simulated episode of care. In addition to examining general patient question sets, we used specific examples of tobacco questions, questions from two specialty areas, and questions to menopausal women. In our analysis, there were approximately 269 institutionally governed patient question sets with a mean of 74 questions per set accounting for an estimated 20,000 governed questions. Sampling from selected specialties revealed that 50 % of patient question sets were not institutionally governed. We found over 650 tobacco-related questions in use, many with only slight variations. A simulated use case for a menopausal woman revealed potentially over 200 repeated questions. A group practice with multiple specialties can have a large volume of patient questions that are not centrally developed, stored or governed. This results in a lack of standardization and coordination. Patients may be given multiple repeated questions throughout the course of their care, and providers lack standardized question sets to help construct valid patient phenotypes. Even with the implementation of a single electronic health record, medical practices may still have a health information management gap in the ability to create, store and share patient-generated health information that is meaningful to both patients and physicians.

  8. A Mathematical Analysis of Air Traffic Priority Rules

    Science.gov (United States)

    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.

  9. A unifying property for distribution-sensitive priority queues

    DEFF Research Database (Denmark)

    Elmasry, Amr Ahmed Abd Elmoneim; Farzan, Arash; Iacono, John

    2011-01-01

    , before) the last access of x and are still in the priority queue at the time when the corresponding operation is performed. Our priority queue then has both the working-set and the queueish properties; and, more strongly, it satisfies these properties in the worst-case sense. We also argue...... that these bounds are the best possible with respect to the considered measures. Moreover, we modify our priority queue to satisfy a new unifying property - the time-finger property - which encapsulates both the working-set and the queueish properties. In addition, we prove that the working-set bound...

  10. A Survey on Priority Queues

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting

    2013-01-01

    Back in 1964 Williams introduced the binary heap as a basic priority queue data structure supporting the operations Insert and ExtractMin in logarithmic time. Since then numerous papers have been published on priority queues. This paper tries to list some of the directions research on priority...

  11. 15 CFR 700.11 - Priority ratings.

    Science.gov (United States)

    2010-01-01

    ... OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE NATIONAL SECURITY INDUSTRIAL BASE REGULATIONS DEFENSE PRIORITIES AND ALLOCATIONS SYSTEM Industrial Priorities § 700.11 Priority ratings. (a) Levels of...

  12. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

    LENUS (Irish Health Repository)

    Elmusharaf, Khalifa

    2015-09-01

    Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

  13. Prioridades de investigación en servicios sanitarios en el Sistema Nacional de Salud: Una aproximación por consenso de expertos Setting health services research priorities in the public health system: An approach through expert consensus

    Directory of Open Access Journals (Sweden)

    Enrique Bernal-Delgado

    2006-08-01

    Technique features. Health Services Research Priorities were identified and scored (7 to 9, high relevance; 4 to 6 mild relevance and 1 to 3, low or no relevance. Results were sorted regarding the median score and its dispersion. Results: 53 research issues were identified. Strategies to improve effectiveness in health care, information to patients, health care quality and safety, equity, access and sustainability were considered of high priority and high consensus; just 4 items had remarkable dispersion (Intercuartile interval (ICI ≥ 2. Organizational improvement, productivity and efficiency enhancement, workforce and equipments were classified of mild priority. Additionally, this group of items reached very low consensus: 59% of them reached ICI ≥ 2. Conclusions: Our approach offers reference about priorities to Spanish health services researchers, and also, orientation to financers and users of this kind of research, though several limitations have been described.

  14. Top EHR challenges in light of the stimulus. Enabling effective interdisciplinary, intradisciplinary and cross-setting communication.

    Science.gov (United States)

    Boyd, Andrew D; Funk, Elizabeth A; Schwartz, Steven M; Kaplan, Bonnie; Keenan, Gail M

    2010-01-01

    US healthcare is undergoing a transformation. The economic stimulus plan is intended to transform healthcare through health IT. The government has defined "meaningful use" of health IT. Healthcare is a team activity, and as such presents a challenge to the concept of meaningful use. While encoding clinical data into a computer is a positive step, it is not enough. A continuity-of-care record is needed to document and measure care; support clinical care; and coordinate care with public health agencies. This paper examines current research to assist decisionmakers moving forward. To realize the promise, integration across all clinical disciplines is critical. There are many challenges. These include: the threat of information overload, both at the transitions of care and between disciplines; the need to provide for data-sharing between clinical and public health agencies, an important component in both local community and national health issues; how to use health IT to improve the delivery of healthcare, especially with unintended outcomes of any change in healthcare and paper persistence; and addressing different views of "meaningful" for different uses and users of health IT. All of these challenges need to be considered for wise installation of health IT. In addition, attention must be paid to weaknesses in the current healthcare system to prevent codifying them in health IT.

  15. Engaging Patients and Clinicians in Establishing Research Priorities for Gestational Diabetes Mellitus.

    Science.gov (United States)

    Rees, Sandra E; Chadha, Rati; Donovan, Lois E; Guitard, Adrienne L T; Koppula, Sudha; Laupacis, Andreas; Simpson, Sara; Johnson, Jeffrey A

    2017-04-01

    We involved patients and clinicians in Alberta, Canada, to establish research priorities in gestational diabetes mellitus (GDM), using an approach based on a model proposed by the James Lind Alliance (JLA). We adapted the 4-step JLA process to engage women with GDM and clinicians to identify uncertainties about the management of GDM. Uncertainties were identified through a survey and a review of the clinical practice guidelines (CPG). Uncertainties were short-listed by a steering committee, followed by a 1-day facilitated workshop using a nominal group format and involving a similar number of patients and clinicians, who identified the top 10 research priorities. Across the various survey formats, 75 individuals submitted 389 uncertainties, the majority (44; 59%) coming from patients. We removed 9 questions as being out of scope or unclear, and 41 were identified on a review of CPG, resulting in a total of 421 uncertainties. After the priority setting process, the final top 10 research priorities included questions about a simpler, more accurate and convenient screening test; risk factors for GDM; improving postpartum diabetes screening; the impact of GDM on the future health of the children; lifestyle challenges and mental health issues; safety, effectiveness and/or impact of diet and/or medication treatments; appropriate timing for delivery; and how care is provided, organized or communicated. These top 10 research priorities were informed through a comprehensive and transparent process involving women who have experienced GDM as well as clinicians, and they may be regarded as research priorities for GDM. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  16. The Record-Setting Flood of 2014 in Kelantan: Challenges and Recommendations from an Emergency Medicine Perspective and Why the Medical Campus Stood Dry

    OpenAIRE

    Baharuddin, Kamarul Aryffin; ABDULL WAHAB, Shaik Farid; Nik Ab Rahman, Nik Hisamuddin; NIK MOHAMAD, Nik Arif; TUAN KAMAUZAMAN, Tuan Hairulnizam; Md Noh, Abu Yazid; ABDUL MAJOD, Mohd Roslani

    2015-01-01

    Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a ‘tsunami-like disaster’. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a prepa...

  17. Some Challenges to the Rough-set Approach to Knowledge Discovery Arising from Real-life Data

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    Since the inception of rough set, significant advances have been made in the theoretical underpinning of the model in general and a large variety of its derivatives in particular. Though some applications have been made with various degrees of success over the years ,the rough set approach to data mining and knowledge discovery in large scale real-life data has not,in the strict sense,been tested. The purpose of rough set is to let data speak for themselves. Thus ,it is intrinsically a theoretical framework catered for real-life data mining and knowledge discovery. However,evidence substantiating such a purpose has been scanty. Often time,theoretical models or arguments are only substantiated by pedagogic examples constructed by the investigators. With the rapid advancement on the theoretical front,it is timely to have a critical scrutiny on the pragmatic side of the research.

  18. Privatization Priorities of Iranian Football Clubs from the Perspective of Experts

    Directory of Open Access Journals (Sweden)

    Javad Shahlaee

    2015-07-01

    Full Text Available Today, the role of government is considered so much precise regulations, foresight and initiative of the public sector in the economy can trigger market growth. But usually because the private sector activity is affected by interactions of the market and government, markets' development process is slow and governmental clubs have become a consumer of financial resources by their inefficient function and do not allow the private sector to carry out economic productive activities in a competitive environment. Under these conditions, privatization puts forward a clear and obvious solution. The study purpose is applied and data collection method is a descriptive survey. The study population consists of football managers, university professors of physical education and sports’ experts. In order to determine factors' priority, Mean Rank technique from AHP, TOPSIS, SAW ranking technique was used and software Excel and Expert choice were used to identify the challenges. According to the findings of the present study, the most important challenges are prioritizing, political-legal challenges, economic challenges, socio-cultural challenges and technological challenges. Privatization with no program and step was the most important legal and political challenge, lack of importance of sport in socio-economic development programs' set was the most important socio-cultural challenge, non-realization of television broadcast as a source of income was the most important criterion of economic challenge and lack of facilities granted by the government to the private sector, such as electricity and gas was considered the most important criterion of technological challenge.

  19. Challenges in conditioning a stochastic geological model of a heterogeneous glacial aquifer to a comprehensive soft data set

    DEFF Research Database (Denmark)

    Koch, Julian; He, Xin; Jensen, Karsten Høgh

    2014-01-01

    density spectrum: sparse borehole data and abundant SkyTEM data. In the latter the data have a strong spatial correlation caused by its high data density, which triggers the problem of overconditioning. This problem is addressed by a work-around utilizing a sampling/decimation of the data set...

  20. Future Research Priorities for Morbidity Control of Lymphedema

    Science.gov (United States)

    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

  1. Priority nutrition messages.

    Science.gov (United States)

    1991-01-01

    The Philippine Food and Nutrition Program deliver priority short, simple, clear, and action filled nutrition messages in different languages and dialects to different audiences. Its 1st priority task is to promote breast feeding. It informs mothers that breast milk is the most nutritious food for infants and that it protects them from infectious diseases. The program also encourages breast feeding as long as possible. If mothers cannot breast feed, they should talk to an infant nutrition expert to help them choose the best formula and learn about proper preparation. A 4-6 month infant needs to begin eating small amounts of semisolid nutritious foods. Moreover these foods must include body building foods, such as meat and eggs, and energy providing foods, such as corn and rice. Mothers must 1st attend to food needs of infants and preschoolers since they are more likely to suffer malnutrition than older children and adults. This is especially important when they suffer from an infection. Specifically, the very young need a variety of foods each day including the vitamin and mineral rich vegetables and fruits. In fact, families should grow their own fruits and vegetables to ensure an adequate supply. Hands must be cleaned with soap and water after defecation and before preparing foods. Mothers should add fats and oils when preparing foods because they provide concentrated energy, fatty acids, and fat soluble vitamins. Pregnant mothers must consume increased amounts of fish, beans, and other body building foods as well as regulating foods (vegetables and fruits). Mothers must also space births. They should weigh children each month to monitor nutritional levels. Moreover they must pay attention to signs indicating inadequate and insufficient food intake e.g., underweight and night blindness.

  2. New Challenges for Participation in Participatory Design in Family, Clinical and Other Asymmetrical, Non-work Settings

    DEFF Research Database (Denmark)

    Bertelsen, Olav Wedege; Hedvall, Per-Oluf

    2009-01-01

    Participatory design (PD) has taken as its ideal that designers and users should engage in an equal language game. When we apply PD in contexts where some of the users involved are weak, ill, or have impairments, this assumed equality can no longer be an ideal. The workshop explores new ideals fo...... for participatory design in non-work settings with highly heterogeneous user constellations....

  3. Experiences, opportunities and challenges of implementing task shifting in underserved remote settings: the case of Kongwa district, central Tanzania

    Directory of Open Access Journals (Sweden)

    Munga Michael A

    2012-11-01

    Full Text Available Abstract Background Tanzania is experiencing acute shortages of Health Workers (HWs, a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers’ shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. Methods We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants’ practical experiences of implementing task shifting in their respective health facilities (district level and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Results Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy

  4. Publishing priorities of biomedical research funders

    OpenAIRE

    Collins, Ellen

    2013-01-01

    Objectives To understand the publishing priorities, especially in relation to open access, of 10 UK biomedical research funders. Design Semistructured interviews. Setting 10 UK biomedical research funders. Participants 12 employees with responsibility for research management at 10 UK biomedical research funders; a purposive sample to represent a range of backgrounds and organisation types. Conclusions Publicly funded and large biomedical research funders are committed to open access publishin...

  5. 77 FR 65002 - Best Pharmaceuticals for Children Act (BPCA) Priority List of Needs in Pediatric Therapeutics

    Science.gov (United States)

    2012-10-24

    ...: Cardiovascular Disease Priorities Table 3: Respiratory Disease Priorities Table 4: Intensive Care Priorities..., which can be a group of conditions, a subgroup of the population, or a setting of care. The first... pediatric therapeutics. The Obstetric and Pediatric Pharmacology Branch of the NICHD has developed...

  6. Validation of antibiotic susceptibility testing guidelines in a routine clinical microbiology laboratory exemplifies general key challenges in setting clinical breakpoints.

    Science.gov (United States)

    Hombach, Michael; Courvalin, Patrice; Böttger, Erik C

    2014-07-01

    This study critically evaluated the new European Committee for Antimicrobial Susceptibility Testing (EUCAST) antibiotic susceptibility testing guidelines on the basis of a large set of disk diffusion diameters determined for clinical isolates. We report several paradigmatic problems that illustrate key issues in the selection of clinical susceptibility breakpoints, which are of general importance not only for EUCAST but for all guidelines systems, i.e., (i) the need for species-specific determinations of clinical breakpoints/epidemiological cutoffs (ECOFFs), (ii) problems arising from pooling data from various sources, and (iii) the importance of the antibiotic disk content for separating non-wild-type and wild-type populations.

  7. Plant conservation priorities of Xinjiang region, China

    Science.gov (United States)

    Li, L. P.; Cui, W. H.; Wang, T.; Tian, S.; Xing, W. J.; Yin, L. K.; Abdusalih, N.; Jiang, Y. M.

    2017-02-01

    As an important region in the Silk Road, Xinjiang is getting a good chance of developing economy. However at the same time, its natural environment is facing a big challenge. To better protect the plant diversity, it is urgent to make a thorough conservation plan. With a full database of vascular and medicinal plant distributions and nature reserve plant lists and boundaries in Xinjiang of China, we analysed the plant diversity hotspots, protection gaps and proposed the plant conservation priorities of this region. Differed from the widely accepted viewpoints that lots of plants were not included in nature reserves, we found that most of the plants ( > 90%) were actually included in the current nature reserves. We believe that compared with establishing more nature reserves, improving the management of the existing ones is also important. Furthermore, the very few unprotected plants ( < 10%) were distributed mostly in the regions of Aletai, Tacheng, Zhaosu, Manasi, Qitai and Hetian which could be the future conservation priorities.

  8. Breast cancer clinicopathological presentation, gravity and challenges in Eritrea, East Africa: management practice in a resource-poor setting.

    Science.gov (United States)

    Tesfamariam, Asmerom; Gebremichael, Andemariam; Mufunda, Jacob

    2013-06-05

    In Africa, breast cancer closely compares with cervical cancer as the most common malignancy affecting women and the incidence rates appear to be rising. Early detection of breast cancer is a key strategy for a good treatment outcome. However, there is no established protocol or guideline for management of breast cancer in Eritrea, East Africa. To assess the clinicopathological presentation, gravity and management challenges presented in breast cancer treatment in Eritrea. Methods. Our investigation was a retrospective, descriptive study to assess the clinical features and severity of breast cancer at time of presentation. We reviewed the medical records of all patients who presented with breast malignancies over the 2-year period from 1 January 2007 to 31 December 2008. Eighty-two patients ranging in age from 26 - 80 years (mean 48 years) were included in the study. Of these 51% were premenopausal women; 61% of the patients presented with breast mass only and the remainder with manifestations of local (mass plus discharge, breast pain or breast ulceration) or distant metastatic disease. More than 60% of the patients presented after >2 years following onset of symptoms. Two-thirds of patients had late stage (III or IV) disease. All except one case was managed surgically. Most cases presented at younger age and advanced stage. These findings call for strengthening health education to promote early health-seeking behaviour and advocacy for the introduction of national screening, implementation of a management protocol and establishment of a radio-chemotherapy centre.

  9. Management Priorities of College Presidents.

    Science.gov (United States)

    Patrick, Cathleen; Caruthers, J. Kent

    1980-01-01

    Based on 900 returns from a survey of all U.S. college and university presidents, priorities were found to reflect needs to deal with retrenchment. Priorities included: communicating institutional strengths to students, parents, public, and state legislatures; integrating program review results; resource allocation; faculty vitality and renewal;…

  10. Our top priority

    CERN Document Server

    2012-01-01

    After three years of LHC running, we are still at the beginning of a long research programme with our flagship facility, and hopefully 4 July 2012 will go down in history as the date of one of many landmark discoveries spanning several years. CERN’s top priority for the next decade and more is the full exploitation of the LHC. With speculation about potential future facilities mounting in the light of the discovery of a new Higgs-like particle, it’s important to state that most clearly. Of course, this will rely on continued global collaboration, and it’s important that CERN engage constructively with other regions.   It is important to plan ahead, particularly since the lead times for new projects in particle physics are long, and our field is increasingly global in nature. That’s why the European particle physics community is currently engaged in updating its long-term strategy. Planning ahead allowed us to be ready technologically to build the LHC whe...

  11. The Evolution of School Nursing Data Indicators in Massachusetts: Recommendations for a National Data Set

    Science.gov (United States)

    Gapinski, Mary Ann; Sheetz, Anne H.

    2014-01-01

    The National Association of School Nurses' research priorities include the recommendation that data reliability, quality, and availability be addressed to advance research in child and school health. However, identifying a national school nursing data set has remained a challenge for school nurses, school nursing leaders, school nurse professional…

  12. The Evolution of School Nursing Data Indicators in Massachusetts: Recommendations for a National Data Set

    Science.gov (United States)

    Gapinski, Mary Ann; Sheetz, Anne H.

    2014-01-01

    The National Association of School Nurses' research priorities include the recommendation that data reliability, quality, and availability be addressed to advance research in child and school health. However, identifying a national school nursing data set has remained a challenge for school nurses, school nursing leaders, school nurse professional…

  13. The record-setting flood of 2014 in kelantan: challenges and recommendations from an emergency medicine perspective and why the medical campus stood dry.

    Science.gov (United States)

    Baharuddin, Kamarul Aryffin; Abdull Wahab, Shaik Farid; Nik Ab Rahman, Nik Hisamuddin; Nik Mohamad, Nik Arif; Tuan Kamauzaman, Tuan Hairulnizam; Md Noh, Abu Yazid; Abdul Majod, Mohd Roslani

    2015-01-01

    Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.

  14. Pertussis outbreak in Papua New Guinea: the challenges of response in a remote geo-topographical setting

    Directory of Open Access Journals (Sweden)

    William Lagani

    2012-10-01

    Full Text Available Introduction: A large outbreak of pertussis was detected during March 2011 in Goilala, a remote district of the Central Province in Papua New Guinea, characterized by rugged topography with no road access from the provincial headquarters. This outbreak investigation highlights the difficulties in reporting and responding to outbreaks in these settings.Method: The suspected pertussis cases, reported by health workers from the Ononge health centre area, were investigated and confirmed for the presence of Bordetella pertussis DNA using the polymerase chain reaction (PCR method.Results: There were 205 suspected pertussis cases, with a case-fatality rate (CFR of 3%. All cases were unvaccinated. The Central Province conducted a response vaccination programme providing 65% of children less than five years of age with diphtheria–pertussis-tetanus-HepB-Hib vaccine at a cost of US$ 12.62 per child.Discussion: The incurred cost of vaccination in response to this outbreak was much higher than the US$ 3.80 per child for routine outreach patrol. To prevent further outbreaks of vaccine-preventable diseases in these areas, local health centres must ensure routine vaccination is strengthened through the “Reaching Every District” initiative of the National Department of Health.

  15. Priority pricing in electricity supply. An application for Israel

    Energy Technology Data Exchange (ETDEWEB)

    Beenstock, Michael; Goldin, Ephraim [Hebrew University of Jerusalem, Department of Economics, Mount Scopus, Jerusalem (Israel)

    1997-06-01

    It is well known that in the event of a shortage in generation capacity, it is inefficient if the electricity utility cuts off customers randomly. It is preferable to set up a market in service priority in which customers who have a greater need pay more for the right not to be cut off. We use an econometric model of outage costs in Israel to calculate the menu of priority rates by season and time of day. Top priority rates range from zero, when the loss-of-load probability (LOLP) is zero, to 8 cents (US) per kWh when the LOLP is greatest

  16. PRIORITIES OF REGIONAL ENVIRONMENTAL POLICY: THE ISSUES OF DIAGNOSTICS

    Directory of Open Access Journals (Sweden)

    T. I. Kudryavtseva

    2010-03-01

    Full Text Available Methods of eliciting priority ecological problems are analyzed in the article. The problem of air pollution is considered to be the foreground issue for both the Ural Federal District and Russia; that was due substantiated. An extended technique of setting priorities for air pollutants and techniques for integral ecological and social assessment of air pollution acuteness extent in the region have been offered; calculations for the Ural Federal District have been made according to the techniques mentioned.

  17. Geostrategic priorities of Ukraine

    Directory of Open Access Journals (Sweden)

    A. B. Mіschenko

    2016-08-01

    Full Text Available A new world order requires acquisition of an increased level of own geopolitical subjectivity in the international arena and a determination of priority level and type of own geostrategy from Ukraine. The article proves that the political system of global dimension is built as a division of the states into large (The USA, Russia, China, etc., middle (Canada, Italy, Turkey, South Korea, etc., small (Georgia, Ukraine, Azerbaijan, etc. and the dependent states that are unable to self-sufficient development and protection of national sovereignty. Understanding of the states is also distinguished as geopolitical players that carry out the influence on countries by political, economic or in a civilized manner-mental expansion and geostrategic centers that do not have possibilities but have the special location to press on countries-leaders changing their geostrategy, internal and external policy. Ukraine here is the country of the second type and, thus, carries out unconscious influence and determines the actions of Russian Federation. It has been analyzed that Ukraine and other geostrategic centers always oriented on position and level of neighbour countries, studies their strengths and weaknesses, adopts the best elements of development and internal control, distances from negative tendencies and becomes certain symbiosis, mediator, in civilized manner-mental, socio-demographic and politically-economic influences. It is well-proven that rational, objective and pragmatic realization by the country of its place and role discovers additional possibilities for obtaining and providing of own subjectivity in the international arena. For this purpose, Ukraine has to accept and confirm the type of own geostrategy in a corresponding format – deterrent (protective, - and define the level of its extension: subregional. Thus, going beyond the limits of the regional display and distribution of national interests, broadening to the bilateral collaboration with

  18. VT Priority Lake/Pond

    Data.gov (United States)

    Vermont Center for Geographic Information — Vermont List of Priority Surface Waters outside CWA Section 303(d) is divided in to 4 parts; Parts B, D, E and F. The four-part list has managed by the Vermont...

  19. VT Priority Stream/River

    Data.gov (United States)

    Vermont Center for Geographic Information — Vermont List of Priority Surface Waters outside CWA Section 303(d) is divided in to 4 parts; Parts B, D, E and F. The four-part list has managed by the Vermont...

  20. NRPC ServCat priorities

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This document lists the Natural Resource Program Center’s priority ServCat documents. It is recommended that these documents- which include annual narrative reports,...

  1. La oferta de la prueba rápida del VIH en la calle dentro del ámbito universitario: ¿una estrategia prioritaria? Street outreach rapid HIV testing in university settings: a priority strategy?

    Directory of Open Access Journals (Sweden)

    Juan Hoyos

    2012-04-01

    analyzing the prevalence of infection, risk behaviors and history of sexually transmitted infections and by performing HIV tests. Methods: During October-November of 2008 and November-December of 2009, 1668 persons received rapid HIV testing in a mobile unit located in university campuses in the cities of Madrid, Málaga and Salamanca (Spain. While waiting for the test results, participants completed a brief questionnaire. Results: A total of 15.7% were men who had sex with men (MSM, 28.6% were exclusively heterosexual men (HTX, and 55.7% were women. Nearly three-quarters (73.3% were under 25 years of age, 8.5% were born abroad and only 4% had no secondary education. Fifty-one percent of HTX, 42% of women and 6.3% of MSM had casual sexual partners in the past 12 months without always using a condom. This behavior was also reported by 41.5% of MSM with same sex partners. A sexually transmitted infection had previously been diagnosed in 24.7% of MSMs, 14.7% of women and 5.6% of HTX. Four positive results were found, all in MSM who had been tested in the previous 2 years. The prevalence was 1.6% (95% CI: 0.43-3.95 within this group, and 0.2% overall (95% CI: 0.07-0.62. Conclusions: Despite the high frequency of risk behaviors, the low prevalence of HIV infection and the history of HIV testing suggest that university campuses are not a priority location to develop these programs, which would achieve greater impact and efficiency in more vulnerable populations.

  2. Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.

    Science.gov (United States)

    Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

    2015-01-01

    There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC.

  3. AGRIBUSINESS: KNOWLEDGE AND INNOVATION PRIORITIES; ASPIRATIONS FOR THE 21ST CENTURY

    OpenAIRE

    Anonymous,

    1998-01-01

    The present report presents the NRLO views on knowledge and innovation priorities for Dutch agribusiness in the years ahead as seen in an international perspective. Knowledge and innovation priorities are highlighted against the backdrop of key challenges facing Dutch agribusiness in the years to come. Major challenges include: To turn from reactive to proactive policy-making based on a broad range of values. The challenge facing agribusiness is that it should assume partial responsibility fo...

  4. Global health prioritiespriorities of the wealthy?

    Science.gov (United States)

    Ollila, Eeva

    2005-01-01

    Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. I argue that the arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions. PMID:15847685

  5. Global climate change adaptation priorities for biodiversity and food security.

    Science.gov (United States)

    Hannah, Lee; Ikegami, Makihiko; Hole, David G; Seo, Changwan; Butchart, Stuart H M; Peterson, A Townsend; Roehrdanz, Patrick R

    2013-01-01

    International policy is placing increasing emphasis on adaptation to climate change, including the allocation of new funds to assist adaptation efforts. Climate change adaptation funding may be most effective where it meets integrated goals, but global geographic priorities based on multiple development and ecological criteria are not well characterized. Here we show that human and natural adaptation needs related to maintaining agricultural productivity and ecosystem integrity intersect in ten major areas globally, providing a coherent set of international priorities for adaptation funding. An additional seven regional areas are identified as worthy of additional study. The priority areas are locations where changes in crop suitability affecting impoverished farmers intersect with changes in ranges of restricted-range species. Agreement among multiple climate models and emissions scenarios suggests that these priorities are robust. Adaptation funding directed to these areas could simultaneously address multiple international policy goals, including poverty reduction, protecting agricultural production and safeguarding ecosystem services.

  6. NEW MULTIANUAL FINANCIAL FRAMEWORK: PRIORITIES FOR THE EUROPEAN UNION, PRIORITIES FOR ROMANIA

    Directory of Open Access Journals (Sweden)

    ROXANA-DANIELA PĂUN

    2013-05-01

    Full Text Available This article proposes a brief foray into the situation of the European economy, but especially of the banking system of the Member States affected differently by the current world economic crisis, or recession, but especially for a detailed analysis of the New Multiannual Financial Framework for the period 2014-2020, with the priorities which appear to be distinct for the EU and for Romania. After a comparative analysis of European regulations on the agreements of the previous financial negotiated for the period 2014-2020, and Delors I (1988-1992, Delors II (1993-1999, the Agenda 2000 (2000-2006 and multiannual financial framework (2007- 2013 and ultimately the provisions of the Treaty of Lisbon (which convert multiannual financial framework in an essential act from a legal point of view; express personal opinions on Romania’s priorities and on the challenges and perspectives in the actual European and global context.

  7. Separate goals, converging priorities: on the ethics of treatment as prevention.

    Science.gov (United States)

    Ostmann, Florian; Saenz, Carla

    2013-08-01

    Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV-infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm-shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic? Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV-infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm-shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug-allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs.

  8. The challenges and opportunities of conducting a clinical trial in a low resource setting: The case of the Cameroon mobile phone SMS (CAMPS trial, an investigator initiated trial

    Directory of Open Access Journals (Sweden)

    Ongolo-Zogo Pierre

    2011-06-01

    Full Text Available Abstract Conducting clinical trials in developing countries often presents significant ethical, organisational, cultural and infrastructural challenges to researchers, pharmaceutical companies, sponsors and regulatory bodies. Globally, these regions are under-represented in research, yet this population stands to gain more from research in these settings as the burdens on health are greater than those in developed resourceful countries. However, developing countries also offer an attractive setting for clinical trials because they often have larger treatment naive populations with higher incidence rates of disease and more advanced stages. These factors can present a reduction in costs and time required to recruit patients. So, balance needs to be found where research can be encouraged and supported in order to bring maximum public health benefits to these communities. The difficulties with such trials arise from problems with obtaining valid informed consent, ethical compensation mechanisms for extremely poor populations, poor health infrastructure and considerable socio-economic and cultural divides. Ethical concerns with trials in developing countries have received attention, even though many other non-ethical issues may arise. Local investigator initiated trials also face a variety of difficulties that have not been adequately reported in literature. This paper uses the example of the Cameroon Mobile Phone SMS trial to describe in detail, the specific difficulties encountered in an investigator-initiated trial in a developing country. It highlights administrative, ethical, financial and staff related issues, proposes solutions and gives a list of additional documentation to ease the organisational process.

  9. Strategic Priorities for Physical Activity Surveillance in the United States.

    Science.gov (United States)

    Fulton, Janet E; Carlson, Susan A; Ainsworth, Barbara E; Berrigan, David; Carlson, Cynthia; Dorn, Joan M; Heath, Gregory W; Kohl, Harold W; Lee, I-Min; Lee, Sarah M; Másse, Louise C; Morrow, James R; Gabriel, Kelley Pettee; Pivarnik, James M; Pronk, Nicolaas P; Rodgers, Anne B; Saelens, Brian E; Sallis, James F; Troiano, Richard P; Tudor-Locke, Catrine; Wendel, Arthur

    2016-10-01

    Develop strategic priorities to guide future physical activity surveillance in the United States. The Centers for Disease Control and Prevention and the American College of Sports Medicine convened a scientific roundtable of physical activity and measurement experts. Participants summarized the current state of aerobic physical activity surveillance for adults, focusing on practice and research needs in three areas: 1) behavior, 2) human movement, and 3) community supports. Needs and challenges for each area were identified. At the conclusion of the meeting, experts identified one overarching strategy and five strategic priorities to guide future surveillance. The identified overarching strategy was to develop a national plan for physical activity surveillance similar to the U.S. National Physical Activity Plan for promotion. The purpose of the plan would be to enhance coordination and collaboration within and between sectors, such as transportation and public health, and to address specific strategic priorities identified at the roundtable. These strategic priorities were used 1) to identify and prioritize physical activity constructs; 2) to assess the psychometric properties of instruments for physical activity surveillance; 3) to provide training and technical assistance for those collecting, analyzing, or interpreting surveillance data; 4) to explore accessing data from alternative sources; and 5) to improve communication, translation, and dissemination about estimates of physical activity from surveillance systems. This roundtable provided strategic priorities for physical activity surveillance in the United States. A first step is to develop a national plan for physical activity surveillance that would provide an operating framework from which to execute these priorities.

  10. 42 CFR 51.24 - Program priorities.

    Science.gov (United States)

    2010-10-01

    ... Priorities § 51.24 Program priorities. (a) Program priorities and policies shall be established annually by... program goals and objectives, with measurable outcomes, to implement the established priorities. In... availability of staff and monetary resources, and special problems and cultural barriers faced by...

  11. Identifying priority healthcare trainings in frozen conflict situations: The case of Nagorno Karabagh

    Directory of Open Access Journals (Sweden)

    Dorian Alina H

    2010-12-01

    Full Text Available Abstract Introduction Health care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities. Case description Nagorno Karabagh (NK is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health and MAPP (Mobilizing for Action through Planning and Partnerships, this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles. Discussion and Evaluation A unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor. Conclusions Programming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.

  12. TALENT MANAGEMENT - A STRATEGIC PRIORITY

    Directory of Open Access Journals (Sweden)

    Matei Mirabela-Constanta

    2009-05-01

    Full Text Available Companies facing the new economic world, dominated by demographic, macroeconomic, and technological changes need to see talent management as a business priority in order to survive. At the same time, the world economic crisis ads pressure over managers, f

  13. Autism Research: Prospects and Priorities.

    Science.gov (United States)

    Rutter, Michael

    1996-01-01

    Research prospects and priorities in autism are discussed with respect to: (1) diagnosis, classification, and epidemiology; (2) clinical research; (3) neuropsychological research; (4) genetics; (5) structural and functional brain imaging; (6) postmortem studies; (7) other biological research; and (8) treatment research. Application of research…

  14. Benefit / Cost priorities : achieving commensurability

    NARCIS (Netherlands)

    Wedley, W.C.; Choo, E.U.; Wijnmalen, D.J.D.

    2003-01-01

    Traditional Benefit/Cost analysis requires benefits and costs to be expressed in a common currency, usually dollars. More recently, benefits and costs have been expressed and compared as relative priorities. This process has been criticized because there is no guarantee that the two sources of prior

  15. PRIORITY SETTING IN AN ACUTE CARE HOSPITAL IN ARGENTINA: A QUALITATIVE CASE STUDY DISTRIBUCIÓN PRIORITARIA EN UN HOSPITAL DE CUIDADOS INTENSIVOS EN ARGENTINA: ESTUDIO CUALITATIVO DE UN CASO DISTRIBUIÇÃO PRIORITÁRIA EM UM HOSPITAL DE CUIDADOS INTENSIVOS NA ARGENTINA: ESTUDO QUALITATIVO DE UM CASO

    Directory of Open Access Journals (Sweden)

    Heather Gordon

    2009-11-01

    Full Text Available Purpose: To describe and evaluate priority setting in an Acute Care hospital in Argentina, using Accountability for Reasonableness, an ethical framework for fair priority setting. Methods: Case Study involving key informant interviews and document review. Thirty respondents were identified using a snowball sampling strategy. A modified thematic approach was used in analyzing the data. Results: Priorities are primarily determined at the Department of Health. The committee which is supposed to set priorities within the hospital was thought not to have much influence. Decisions were based on government policies and objectives, personal relationships, economic, political, historical and arbitrary reasons. Decisions at the DOH were publicized through internet; however, apart from the tenders and a general budget, details of hospital decisions were not publicized. CATA provided an accessible but ineffective forum for appeals. There were no clear mechanisms for appeals and leadership to ensure adherence to a fair process. Conclusions: In spite of their efforts to ensure fairness, Priority setting in the study hospital did not meet all the four conditions of a fair process. Policy discussions on improving legitimacy and fairness provided an opportunity for improving fairness in the hospital and Accountability for Reasonableness might be a useful framework for analysis and for identifying and improving strategies.Propósito: Describir y evaluar el establecimiento de prioridades en un hospital de cuidados intensivos en Argentina, empleando la Administración Razonable como marco ético para una justa asignación. Métodos: Estudio de un Caso que incluía entrevistas a un informante y revisión de documentos. Se identificó a treinta participantes empleando la estrategia de muestras tipo "bola de nieve". Al analizar los datos, se empleó un enfoque temático modificado. Resultados: Las prioridades se determinan principalmente en el Departamento de Salud

  16. Final priority; Rehabilitation Training: Rehabilitation Long-Term Training program--rehabilitation specialty areas. Final priority.

    Science.gov (United States)

    2014-07-23

    The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Rehabilitation Training: Rehabilitation Long-Term Training program. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years in order to fund any of the rehabilitation specialty areas listed in this notice. The specific rehabilitation specialty areas to be funded in a given year will be listed in a notice inviting applications. This priority is designed to ensure that the Department funds high-quality rehabilitation programs in the following nine rehabilitation specialty areas of national need: Rehabilitation Administration (84.129C); Rehabilitation Technology (84.129E); Vocational Evaluation and Work Adjustment (84.129F); Rehabilitation of Individuals Who Are Mentally Ill (84.129H); Rehabilitation Psychology (84.129J); Rehabilitation of Individuals Who are Blind or Have Vision Impairments (84.129P); Rehabilitation of Individuals Who are Deaf or Hard of Hearing (84.129Q); Job Development and Job Placement Services (84.129R); and Comprehensive System of Personnel Development (84.129W). These programs must meet rigorous standards in order to provide rehabilitation professionals the training and qualifications necessary to meet the current challenges facing State vocational rehabilitation (VR) agencies and related agencies and assist individuals with disabilities in achieving high-quality employment outcomes.

  17. Loop-mediated isothermal DNA amplification for asymptomatic malaria detection in challenging field settings: Technical performance and pilot implementation in the Peruvian Amazon.

    Science.gov (United States)

    Serra-Casas, Elisa; Manrique, Paulo; Ding, Xavier C; Carrasco-Escobar, Gabriel; Alava, Freddy; Gave, Anthony; Rodriguez, Hugo; Contreras-Mancilla, Juan; Rosas-Aguirre, Angel; Speybroeck, Niko; González, Iveth J; Rosanas-Urgell, Anna; Gamboa, Dionicia

    2017-01-01

    Loop-mediated isothermal DNA amplification (LAMP) methodology offers an opportunity for point-of-care (POC) molecular detection of asymptomatic malaria infections. However, there is still little evidence on the feasibility of implementing this technique for population screenings in isolated field settings. Overall, we recruited 1167 individuals from terrestrial ('road') and hydric ('riverine') communities of the Peruvian Amazon for a cross-sectional survey to detect asymptomatic malaria infections. The technical performance of LAMP was evaluated in a subgroup of 503 samples, using real-time Polymerase Chain Reaction (qPCR) as reference standard. The operational feasibility of introducing LAMP testing in the mobile screening campaigns was assessed based on field-suitability parameters, along with a pilot POC-LAMP assay in a riverine community without laboratory infrastructure. LAMP had a sensitivity of 91.8% (87.7-94.9) and specificity of 91.9% (87.8-95.0), and the overall accuracy was significantly better among samples collected during road screenings than riverine communities (p≤0.004). LAMP-based diagnostic strategy was successfully implemented within the field-team logistics and the POC-LAMP pilot in the riverine community allowed for a reduction in the turnaround time for case management, from 12-24 hours to less than 5 hours. Specimens with haemolytic appearance were regularly observed in riverine screenings and could help explaining the hindered performance/interpretation of the LAMP reaction in these communities. LAMP-based molecular malaria diagnosis can be deployed outside of reference laboratories, providing similar performance as qPCR. However, scale-up in remote field settings such as riverine communities needs to consider a number of logistical challenges (e.g. environmental conditions, labour-intensiveness in large population screenings) that can influence its optimal implementation.

  18. Setting priorities for waste management strategies in developing countries.

    Science.gov (United States)

    Brunner, Paul H; Fellner, Johann

    2007-06-01

    This study aimed to determine whether the waste management systems, that are presently applied in affluent countries are appropriate solutions for waste management in less developed regions. For this purpose, three cities (Vienna, Damascus and Dhaka) which differ greatly in their gross domestic product and waste management were compared. The criteria for evaluation were economic parameters, and indicators as to whether the goals of waste management (protection of human health and the environment, the conservation of resources) were reached. Based on case studies, it was found that for regions spending 1-10 Euro capita(-1) year(-1) for waste management, the 'waste hierarchy' of prevention, recycling and disposal is not an appropriate strategy. In such regions, the improvement of disposal systems (complete collection, upgrading to sanitary landfilling) is the most cost-effective method to reach the objectives of solid waste management. Concepts that are widely applied in developed countries such as incineration and mechanical waste treatment are not suitable methods to reach waste management goals in countries where people cannot spend more than 10 Euro per person for the collection, treatment and disposal of their waste. It is recommended that each region first determines its economic capacity for waste management and then designs its waste management system according to this capacity and the goals of waste management.

  19. Model for setting priority construction project objectives aligned with ...

    African Journals Online (AJOL)

    revealed that the provision of work opportunities to Small, Micro- and Medium. Enterprises ...... Both males and females equally view the maintenance of performance to ...... Journal of the South African Institution of Civil Engineering,. 47(2), pp.

  20. Increased fairness in priority setting processes within the health sector

    DEFF Research Database (Denmark)

    Zulu, Joseph M.; Michelo, Charles; Msoni, Carol;

    2014-01-01

    level in Kapiri-Mposhi District in Zambia. METHODS: Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district...... devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing...

  1. Setting priorities for land management to mitigate climate change

    Directory of Open Access Journals (Sweden)

    Böttcher Hannes

    2012-03-01

    Full Text Available Abstract Background No consensus has been reached how to measure the effectiveness of climate change mitigation in the land-use sector and how to prioritize land use accordingly. We used the long-term cumulative and average sectorial C stocks in biomass, soil and products, C stock changes, the substitution of fossil energy and of energy-intensive products, and net present value (NPV as evaluation criteria for the effectiveness of a hectare of productive land to mitigate climate change and produce economic returns. We evaluated land management options using real-life data of Thuringia, a region representative for central-western European conditions, and input from life cycle assessment, with a carbon-tracking model. We focused on solid biomass use for energy production. Results In forestry, the traditional timber production was most economically viable and most climate-friendly due to an assumed recycling rate of 80% of wood products for bioenergy. Intensification towards "pure bioenergy production" would reduce the average sectorial C stocks and the C substitution and would turn NPV negative. In the forest conservation (non-use option, the sectorial C stocks increased by 52% against timber production, which was not compensated by foregone wood products and C substitution. Among the cropland options wheat for food with straw use for energy, whole cereals for energy, and short rotation coppice for bioenergy the latter was most climate-friendly. However, specific subsidies or incentives for perennials would be needed to favour this option. Conclusions When using the harvested products as materials prior to energy use there is no climate argument to support intensification by switching from sawn-wood timber production towards energy-wood in forestry systems. A legal framework would be needed to ensure that harvested products are first used for raw materials prior to energy use. Only an effective recycling of biomaterials frees land for long-term sustained C sequestration by conservation. Reuse cascades avoid additional emissions from shifting production or intensification.

  2. The emergence of maternal health as a political priority in Madhya Pradesh, India: a qualitative study.

    Science.gov (United States)

    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

  3. Tackling the climate targets set by the Paris Agreement (COP 21): Green leadership empowers public hospitals to overcome obstacles and challenges in a resource-constrained environment.

    Science.gov (United States)

    Weimann, E; Patel, B

    2016-12-21

    The healthcare sector itself contributes to climate change, the creation of hazardous waste, use of toxic metals such as mercury, and water and air pollution. To mitigate the effect of healthcare provision on the deteriorating environment and avoid creating further challenges for already burdened health systems, Global Green Hospitals was formed as a global network. Groote Schuur Hospital (GSH), as the leading academic hospital in Africa, joined the network in 2014. Since then, several projects have been initiated to reduce the amount of general waste, energy consumption and food waste, and create an environmentally friendlier and more sustainable hospital in a resource-constrained public healthcare setting. We outline the various efforts made to reduce the carbon footprint of GSH and reduce waste and hazardous substances such as mercury and polystyrene, and elaborate how obstacles and resistance to change were overcome. The hospital was able to halve the amount of coal and water used, increase recycling by 50% over 6 months, replace polystyrene cups and packaging with Forest Stewardship Council recyclable paper-based products, reduce the effect of food wastage by making use of local farmers, and implement measures to reduce the amount of expired pharmaceutical drugs. To improve commitment from all involved roleplayers, political leadership, supportive government policies and financial funding is mandatory, or public hospitals will be unable to tackle the exponentially increasing costs related to climate change and its effects on healthcare.

  4. Using Ostrom’s DPs as Fuzzy Sets to Analyse How Water Policies Challenge Community-Based Water Governance in Colombia

    Directory of Open Access Journals (Sweden)

    María Mar Delgado-Serrano

    2017-07-01

    Full Text Available Ostrom’s design principles have been broadly used to analyse the governance of common pool resources. However, they are normally assessed as present or absent. We challenge this assumption by considering them as fuzzy sets where membership scores range from 0 to 1, because, in real situations, the design principles can be present at a certain level. We define categories to assess the level of membership and apply it to a single case study analysing how changes in water policy can affect the community-based management of the Water User Association of Mondomo (Colombia. In rural areas of Colombia, most water and sanitation services are provided by water user associations, wherein civil society has developed governance systems based on active citizen involvement and community-based management. Some of these associations have been operating for decades and are essential pillars of the local social fabric. However, recent changes in the country’s policy and legal framework threaten these long-lasting governance systems. The results show that most of the design principles would suffer important changes that undermine the governance system. Essential principles for sustainable community-based governance, such as the congruence of the rules with local conditions, the local monitoring and sanctioning capacities, the internal conflict-resolution mechanisms and the recognition of the rights to organize, are dramatically reduced after the policy implementation.

  5. Tackling the climate targets set by the Paris Agreement (COP 21: Green leadership empowers public hospitals to overcome obstacles and challenges in a resource-constrained environment

    Directory of Open Access Journals (Sweden)

    E Weimann

    2017-01-01

    Full Text Available The healthcare sector itself contributes to climate change, the creation of hazardous waste, use of toxic metals such as mercury, and water and air pollution. To mitigate the effect of healthcare provision on the deteriorating environment and avoid creating further challenges for already burdened health systems, Global Green Hospitals was formed as a global network. Groote Schuur Hospital (GSH, as the leading academic hospital in Africa, joined the network in 2014. Since then, several projects have been initiated to reduce the amount of general waste, energy consumption and food waste, and create an environmentally friendlier and more sustainable hospital in a resource-constrained public healthcare setting. We outline the various efforts made to reduce the carbon footprint of GSH and reduce waste and hazardous substances such as mercury and polystyrene, and elaborate how obstacles and resistance to change were overcome. The hospital was able to halve the amount of coal and water used, increase recycling by 50% over 6 months, replace polystyrene cups and packaging with Forest Stewardship Council recyclable paper-based products, reduce the effect of food wastage by making use of local farmers, and implement measures to reduce the amount of expired pharmaceutical drugs. To improve commitment from all involved roleplayers, political leadership, supportive government policies and financial funding is mandatory, or public hospitals will be unable to tackle the exponentially increasing costs related to climate change and its effects on healthcare.

  6. A large proportion of asymptomatic Plasmodium infections with low and sub-microscopic parasite densities in the low transmission setting of Temotu Province, Solomon Islands: challenges for malaria diagnostics in an elimination setting

    Directory of Open Access Journals (Sweden)

    Harris Ivor

    2010-09-01

    Full Text Available Abstract Background Many countries are scaling up malaria interventions towards elimination. This transition changes demands on malaria diagnostics from diagnosing ill patients to detecting parasites in all carriers including asymptomatic infections and infections with low parasite densities. Detection methods suitable to local malaria epidemiology must be selected prior to transitioning a malaria control programme to elimination. A baseline malaria survey conducted in Temotu Province, Solomon Islands in late 2008, as the first step in a provincial malaria elimination programme, provided malaria epidemiology data and an opportunity to assess how well different diagnostic methods performed in this setting. Methods During the survey, 9,491 blood samples were collected and examined by microscopy for Plasmodium species and density, with a subset also examined by polymerase chain reaction (PCR and rapid diagnostic tests (RDTs. The performances of these diagnostic methods were compared. Results A total of 256 samples were positive by microscopy, giving a point prevalence of 2.7%. The species distribution was 17.5% Plasmodium falciparum and 82.4% Plasmodium vivax. In this low transmission setting, only 17.8% of the P. falciparum and 2.9% of P. vivax infected subjects were febrile (≥38°C at the time of the survey. A significant proportion of infections detected by microscopy, 40% and 65.6% for P. falciparum and P. vivax respectively, had parasite density below 100/μL. There was an age correlation for the proportion of parasite density below 100/μL for P. vivax infections, but not for P. falciparum infections. PCR detected substantially more infections than microscopy (point prevalence of 8.71%, indicating a large number of subjects had sub-microscopic parasitemia. The concordance between PCR and microscopy in detecting single species was greater for P. vivax (135/162 compared to P. falciparum (36/118. The malaria RDT detected the 12 microscopy and

  7. State S&T Plan Consultation Tops CASAD Priorities

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    @@ The Executive Committee of the CAS Presidium sets the consultative work on the State long-and medium-term S&T development plan the top priority for the CAS Academic Divisions (CASAD)in the coming two years. This was announced at the second session of the fourth CAS presidium executive committee convened on June 10 in Beijing.

  8. Incentives a Priority for New Secretary of Education

    Science.gov (United States)

    Klein, Alyson

    2009-01-01

    U.S. Secretary of Education Arne Duncan says he is eager to use a proposed $15 billion federal incentive-grant fund in part to reward states, districts, and even nonprofit organizations that have set high standards for the students they serve. Duncan's comments came in an interview in which he named as priorities reauthorization of the federal No…

  9. Development of research priorities in paediatric pain and palliative care.

    Science.gov (United States)

    Liossi, Christina; Anderson, Anna-Karenia; Howard, Richard F

    2017-02-01

    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.

  10. Quantum Process Algebra with Priorities

    Science.gov (United States)

    Ren, Xingtian; Wang, Yong; Dai, Guiping

    2017-08-01

    One of the most fascinating characteristics is the modularity of ACP (Algebra of Communicating Processes), that is, ACP can be extended easily. qACP also inherents the modularity characteristics of ACP. By introducing new operators or new constants, qACP can have more properties. In this paper, we extend the quantum process algebra qACP with priorities support in an elegant way. And we obtain the soundness and completeness of the extension.

  11. First Priority, an expert system for prioritizing

    Energy Technology Data Exchange (ETDEWEB)

    Morton, G.R.; Hopson, P.C.

    1991-01-01

    Prioritizing lists of diverse entities such as projects, tasks, documents, recommendations or physical locations is a necessary part of business at DOE facilities. A key issue is whether or not this necessary and problematic activity of prioritizing is performed in a methodical, defensible and traceable manner, especially when the goals are hard to compare and measure. Sound methods of prioritizing are often not employed because of their complexity or difficulty in implementation. To overcome these problems, WSRC is developing an expert system. First Priority, which will provide individuals or committees a comprehensive process for prioritizing lists of any sort. A set of windows, editors, and pull-down menus guide the user in building and modifying an (inverted) weighted tree structure which represents the goals the prioritization is to advance. The process of building this structure is divided into four stages which are generally followed in order. These stages are: building the goal tree, ordering the goal tree nodes, weighting the goal tree nodes, and designing measurement methods for each leaf node. Based on the resultant structure an evaluation module is generated to evaluate the items of the list. This list is then prioritized and grouped into user-defined categories, taking into account cost or other resources. Additional First Priority tools provide sensitivity analysis, graphical displays of data, and reporting.

  12. First Priority, an expert system for prioritizing

    Energy Technology Data Exchange (ETDEWEB)

    Morton, G.R.; Hopson, P.C.

    1991-12-31

    Prioritizing lists of diverse entities such as projects, tasks, documents, recommendations or physical locations is a necessary part of business at DOE facilities. A key issue is whether or not this necessary and problematic activity of prioritizing is performed in a methodical, defensible and traceable manner, especially when the goals are hard to compare and measure. Sound methods of prioritizing are often not employed because of their complexity or difficulty in implementation. To overcome these problems, WSRC is developing an expert system. First Priority, which will provide individuals or committees a comprehensive process for prioritizing lists of any sort. A set of windows, editors, and pull-down menus guide the user in building and modifying an (inverted) weighted tree structure which represents the goals the prioritization is to advance. The process of building this structure is divided into four stages which are generally followed in order. These stages are: building the goal tree, ordering the goal tree nodes, weighting the goal tree nodes, and designing measurement methods for each leaf node. Based on the resultant structure an evaluation module is generated to evaluate the items of the list. This list is then prioritized and grouped into user-defined categories, taking into account cost or other resources. Additional First Priority tools provide sensitivity analysis, graphical displays of data, and reporting.

  13. Priorities in pediatric epilepsy research

    Science.gov (United States)

    Baca, Christine B.; Loddenkemper, Tobias; Vickrey, Barbara G.; Dlugos, Dennis

    2013-01-01

    The Priorities in Pediatric Epilepsy Research workshop was held in the spirit of patient-centered and patient-driven mandates for developing best practices in care, particularly for epilepsy beginning under age 3 years. The workshop brought together parents, representatives of voluntary advocacy organizations, physicians, allied health professionals, researchers, and administrators to identify priority areas for pediatric epilepsy care and research including implementation and testing of interventions designed to improve care processes and outcomes. Priorities highlighted were 1) patient outcomes, especially seizure control but also behavioral, academic, and social functioning; 2) early and accurate diagnosis and optimal treatment; 3) role and involvement of parents (communication and shared decision-making); and 4) integration of school and community organizations with epilepsy care delivery. Key factors influencing pediatric epilepsy care included the child's impairments and seizure presentation, parents, providers, the health care system, and community systems. Care was represented as a sequential process from initial onset of seizures to referral for comprehensive evaluation when needed. We considered an alternative model in which comprehensive care would be utilized from onset, proactively, rather than reactively after pharmacoresistance became obvious. Barriers, including limited levels of evidence about many aspects of diagnosis and management, access to care—particularly epilepsy specialty and behavioral health care—and implementation, were identified. Progress hinges on coordinated research efforts that systematically address gaps in knowledge and overcoming barriers to access and implementation. The stakes are considerable, and the potential benefits for reduced burden of refractory epilepsy and lifelong disabilities may be enormous. PMID:23966254

  14. 76 FR 54244 - Telecommunications Service Priority System

    Science.gov (United States)

    2011-08-31

    ... SECURITY Telecommunications Service Priority System AGENCY: National Protection and Programs Directorate... currently approved collection: 1670-0005, Telecommunications Service Priority (TSP) System. DHS previously.... SUPPLEMENTARY INFORMATION: The purpose of the TSP System is to provide a legal basis for...

  15. Points mean prizes: priority points, preferential status and directed organ donation in Israel.

    Science.gov (United States)

    Cronin, Antonia J

    2014-02-24

    The introduction of Israel's new Organ Transplantation Act in 2010 has enabled the development of a unique priority point system aimed at motivating individual's to donate their organ. The priority point system rewards those who are willing to donate an organ with preferential status and an increased chance of receiving a donor organ, should they come to be in need of one. Preliminary evidence suggests it has considerable public support among Israelis, who appear willing to redress the challenge posed by those who are willing to accept an organ but not willing to donate. Since the Act's introduction Israel has witnessed record numbers signing donor cards and there has been a significant increase in the actual numbers of transplants.One aspect of the new Israeli system that has hitherto not much been considered is its tendency towards a communitarian model of organ donation and the implications this change in emphasis may have for the existing 'opt-in' model based upon autonomy and consent. Gil Siegel draws our attention to this aspect when he sets out his defence of a proposal he refers to as 'directed organ donation to other registered donors', which encourages community responsibility without affecting the established commitment to consent and individual freedom.This commentary provides a brief overview of the new Act and its priority point system. It also examines Siegel's proposal and considers the implications it may have for equity and justice, personal choice and dispositional authority. It is argued that although the proposal brings with it several inevitable hurdles for policy makers these are not insurmountable. Rather, its extraordinary potential to save life and avoid suffering should prompt urgent action at policy level. If such a scheme was successfully implemented in Israel it would represent a landmark change in organ donation and allocation policy, and set an example from which we all could learn.

  16. The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

    Directory of Open Access Journals (Sweden)

    Wondwossen A Gebreyes

    Full Text Available Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011 and the second congress (Porto de Galinhas, Brazil, 2013 were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1 development of adequate science-based risk management policies, (2 skilled-personnel capacity building, (3 accredited veterinary and public health diagnostic laboratories with a shared database, and (4 improved use of existing natural resources and implementation. The aim of this review is to

  17. The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

    Science.gov (United States)

    Gebreyes, Wondwossen A; Dupouy-Camet, Jean; Newport, Melanie J; Oliveira, Celso J B; Schlesinger, Larry S; Saif, Yehia M; Kariuki, Samuel; Saif, Linda J; Saville, William; Wittum, Thomas; Hoet, Armando; Quessy, Sylvain; Kazwala, Rudovick; Tekola, Berhe; Shryock, Thomas; Bisesi, Michael; Patchanee, Prapas; Boonmar, Sumalee; King, Lonnie J

    2014-01-01

    Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight

  18. Deep-Space Ka-Band Link Priority Data Protection: Pre-Emptive Retransmission vs. Margin

    Science.gov (United States)

    Shambayati, Shervin

    2009-01-01

    In this paper the performance of two preemptive retransmission schemes for protection of priority data over deep-space Ka-band links is evaluated. The first scheme merges the correctly received bit from each transmission to create the most complete set of priority data for each pass (bit merge). The second scheme (symbol combining) combines the soft symbols received from each transmission of the priority data to increase the priority data's signal to noise ratio (SNR), thus increasing the liklihood of the correct reception.

  19. 7 CFR 632.12 - Funding priorities.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURE LONG TERM CONTRACTING RURAL ABANDONED MINE PROGRAM Qualifications § 632.12 Funding priorities. (a.... Assignment of a priority and subpriority establishes the order in which the proposed reclamation work will be... extreme danger. (3) Priority 3. Restoration of the land and water resources and the environment where...

  20. 49 CFR 260.7 - Priority consideration.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Priority consideration. 260.7 Section 260.7... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.7 Priority consideration. When evaluating applications, the Administrator will give priority consideration (but not necessarily in the following...

  1. What are the macro-social health research priorities?

    Directory of Open Access Journals (Sweden)

    Narges Tabrizchi

    2016-10-01

    Full Text Available   Background: Setting research priorities is a scientific process to allocate resources to the best use. In low- and middle-income countries, allocation of limited resources to fundamental issues is more important. So, the present study was conducted to determine social health research priorities.  Methods: In the first step, important issues and research topics of social health were extracted from documents and studies conducted at the national level.In qualitative phase, reciprocating questionnaires were sent and interviews were conducted with experts and stakeholders, social health issues (as members of Delphi. In the next step, the research topics extracted were discussed in small groups (suggested by Council on Health Research for Development to score the proposed priority topics by Delphi members. Finally, the list of priorities (titles that acquired more than 80% of the total score was sent to Delphi members for final approval.  Results: During the study, 220 topics were obtained in four research domains: “description of the problem and its consequences”, “cause finding”, “intervention to eliminate or reduce problems”, and “Management-Policymaking”. Finally, 30 of these topics remained as priority topics. High priority research topics in social health were equity, happiness, economics, and ethics, respectively.  Conclusion: The findings provide a list of research priorities that help researchers carrying out studies that will have the greatest social health impact. Some targeting areas such as happiness and ethics were identified as less attended subjects that need more investment in research policies, management, and governance.

  2. A decadal view of biodiversity informatics : challenges and priorities

    NARCIS (Netherlands)

    Hardisty, Alex; Roberts, Dave; Addink, Wouter; Aelterman, Bart; Agosti, Donat; Amaral-Zettler, Linda; Ariño, Arturo H; Arvanitidis, Christos; Backeljau, Thierry; Bailly, Nicolas; Belbin, Lee; Berendsohn, Walter; Bertrand, Nic; Caithness, Neil; Campbell, David; Cochrane, Guy; Conruyt, Noël; Culham, Alastair; Damgaard, Christian; Davies, Neil; Fady, Bruno; Faulwetter, Sarah; Feest, Alan; Field, Dawn; Garnier, Eric; Geser, Guntram; Gilbert, Jack; Grosche, [No Value; Grosser, David; Hardisty, Alex; Herbinet, Bénédicte; Hobern, Donald; Jones, Andrew; de Jong, Yde; King, David; Knapp, Sandra; Koivula, Hanna; Los, Wouter; Meyer, Chris; Morris, Robert A; Morrison, Norman; Morse, David; Obst, Matthias; Pafilis, Evagelos; Page, Larry M; Page, Roderic; Pape, Thomas; Parr, Cynthia; Paton, Alan; Patterson, David; Paymal, Elisabeth; Penev, Lyubomir; Pollet, Marc; Pyle, Richard; von Raab-Straube, Eckhard; Robert, Vincent; Roberts, Dave; Robertson, Tim; Rovellotti, Olivier; Saarenmaa, Hannu; Schalk, Peter; Schaminee, Joop; Schofield, Paul; Sier, Andy; Sierra, Soraya; Smith, Vince; van Spronsen, Edwin; Thornton-Wood, Simon; van Tienderen, Peter; van Tol, Jan; Tuama, Éamonn Ó; Uetz, Peter; Vaas, Lea; Vignes Lebbe, Régine; Vision, Todd; Vu, Duong; De Wever, Aaike; White, Richard; Willis, Kathy; Young, Fiona

    2013-01-01

    Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the

  3. ' What. are the challenges and treatment priorities in '

    African Journals Online (AJOL)

    Hoe moet, brcinbeserings gcklassiliscer word op ... Inoet geskandeer word? ... The unique anatomical relationship of ... in young children (under 4 years old) ... short-terrn memory and concentration ... 3-8) the patient is comatose, unable to .... The child with a severe injury. [Mirror 7./'Z':'1'/1'. One of the most common ...

  4. A decadal view of biodiversity informatics : challenges and priorities

    NARCIS (Netherlands)

    Hardisty, Alex; Roberts, Dave; Addink, Wouter; Aelterman, Bart; Agosti, Donat; Amaral-Zettler, Linda; Ariño, Arturo H; Arvanitidis, Christos; Backeljau, Thierry; Bailly, Nicolas; Belbin, Lee; Berendsohn, Walter; Bertrand, Nic; Caithness, Neil; Campbell, David; Cochrane, Guy; Conruyt, Noël; Culham, Alastair; Damgaard, Christian; Davies, Neil; Fady, Bruno; Faulwetter, Sarah; Feest, Alan; Field, Dawn; Garnier, Eric; Geser, Guntram; Gilbert, Jack; Grosche, [No Value; Grosser, David; Hardisty, Alex; Herbinet, Bénédicte; Hobern, Donald; Jones, Andrew; de Jong, Yde; King, David; Knapp, Sandra; Koivula, Hanna; Los, Wouter; Meyer, Chris; Morris, Robert A; Morrison, Norman; Morse, David; Obst, Matthias; Pafilis, Evagelos; Page, Larry M; Page, Roderic; Pape, Thomas; Parr, Cynthia; Paton, Alan; Patterson, David; Paymal, Elisabeth; Penev, Lyubomir; Pollet, Marc; Pyle, Richard; von Raab-Straube, Eckhard; Robert, Vincent; Roberts, Dave; Robertson, Tim; Rovellotti, Olivier; Saarenmaa, Hannu; Schalk, Peter; Schaminee, Joop; Schofield, Paul; Sier, Andy; Sierra, Soraya; Smith, Vince; van Spronsen, Edwin; Thornton-Wood, Simon; van Tienderen, Peter; van Tol, Jan; Tuama, Éamonn Ó; Uetz, Peter; Vaas, Lea; Vignes Lebbe, Régine; Vision, Todd; Vu, Duong; De Wever, Aaike; White, Richard; Willis, Kathy; Young, Fiona

    2013-01-01

    Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the

  5. A decadal view of biodiversity informatics: challenges and priorities

    NARCIS (Netherlands)

    Hardisty, A.; Roberts, D.; Addink, W.; Aelterman, B; Agosti, D.; Amaral-Zettler, L.; Ariño, A.H.; Arvanitidis, C.; Backeljau, T.; Bailly, N.; Belbin, L.; Berendsohn, W.; Bertrand, N.; Caithness, N.; Campbell, D.; Cochrane, G.; Conruyt, N.; Culham, A.; Damgaard, C.; Davies, N.; Fady, B.; Faulwetter, S.; Feest, A.; Field, D.; Garnier, E.; Geser, G.; Gilbert, J.; Grosche, B.; Grosser, D.; Herbinet, B.; Hobern, D.; Jones, A.; de Jong, Y.; King, D.; Knapp, S.; Koivula, H.; Los, W.; Meyer, C; Morris, R.A.; Morrison, N.; Morse, D.; Obst, M.; Pafilis, E.; Page, L.M.; Page, R.; Pape, T.; Parr, C.; Paton, A.; Patterson, D.; Paymal, E.; Penev, L.; Pollet, M.; Pyle, R.; von Raab-Straube, E.; Robert, V.; Robertson, T.; Rovellotti, O.; Saarenmaa, H.; Schalk, P.; Schaminee, J.; Schofield, P.; Sier, A.; Sierra, S.; Smith, V.; van Spronsen, E.; Thornton-Wood, S.; van Tienderen, P.; van Tol, J.; Tuama, É.Ó.; Uetz, P.; Vaas, L.; Vignes Lebbe, R.; Vision, T.; Vu, D.; De Wever, A.; White, R.; Willis, K.; Young, F.

    2013-01-01

    Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the

  6. Operational research as implementation science: definitions, challenges and research priorities

    National Research Council Canada - National Science Library

    Monks, Thomas

    ...; and many other complex implementation problems of an operational or logistical nature. To date, there has been limited debate about the role that operational research should take within implementation science...

  7. A decadal view of biodiversity informatics: challenges and priorities

    Science.gov (United States)

    2013-01-01

    Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the most prominent discipline involved. To some extent this is inevitable, given the use of species names as the pivot around which information is organised. To address the urgent questions around conservation, land-use, environmental change, sustainability, food security and ecosystem services that are facing Governments worldwide, we need to understand how the ecosystem works. So, we need a systems approach to understanding biodiversity that moves significantly beyond taxonomy and species observations. Such an approach needs to look at the whole system to address species interactions, both with their environment and with other species. It is clear that some barriers to progress are sociological, basically persuading people to use the technological solutions that are already available. This is best addressed by developing more effective systems that deliver immediate benefit to the user, hiding the majority of the technology behind simple user interfaces. An infrastructure should be a space in which activities take place and, as such, should be effectively invisible. This community consultation paper positions the role of biodiversity informatics, for the next decade, presenting the actions needed to link the various biodiversity infrastructures invisibly and to facilitate understanding that can support both business and policy-makers. The community considers the goal in biodiversity informatics to be full integration of the biodiversity research community, including citizens’ science, through a commonly-shared, sustainable e-infrastructure across all sub-disciplines that reliably serves science and society alike. PMID:23587026

  8. A decadal view of biodiversity informatics: challenges and priorities.

    Science.gov (United States)

    Hardisty, Alex; Roberts, Dave; Addink, Wouter; Aelterman, Bart; Agosti, Donat; Amaral-Zettler, Linda; Ariño, Arturo H; Arvanitidis, Christos; Backeljau, Thierry; Bailly, Nicolas; Belbin, Lee; Berendsohn, Walter; Bertrand, Nic; Caithness, Neil; Campbell, David; Cochrane, Guy; Conruyt, Noël; Culham, Alastair; Damgaard, Christian; Davies, Neil; Fady, Bruno; Faulwetter, Sarah; Feest, Alan; Field, Dawn; Garnier, Eric; Geser, Guntram; Gilbert, Jack; Grosche; Grosser, David; Hardisty, Alex; Herbinet, Bénédicte; Hobern, Donald; Jones, Andrew; de Jong, Yde; King, David; Knapp, Sandra; Koivula, Hanna; Los, Wouter; Meyer, Chris; Morris, Robert A; Morrison, Norman; Morse, David; Obst, Matthias; Pafilis, Evagelos; Page, Larry M; Page, Roderic; Pape, Thomas; Parr, Cynthia; Paton, Alan; Patterson, David; Paymal, Elisabeth; Penev, Lyubomir; Pollet, Marc; Pyle, Richard; von Raab-Straube, Eckhard; Robert, Vincent; Roberts, Dave; Robertson, Tim; Rovellotti, Olivier; Saarenmaa, Hannu; Schalk, Peter; Schaminee, Joop; Schofield, Paul; Sier, Andy; Sierra, Soraya; Smith, Vince; van Spronsen, Edwin; Thornton-Wood, Simon; van Tienderen, Peter; van Tol, Jan; Tuama, Éamonn Ó; Uetz, Peter; Vaas, Lea; Vignes Lebbe, Régine; Vision, Todd; Vu, Duong; De Wever, Aaike; White, Richard; Willis, Kathy; Young, Fiona

    2013-04-15

    Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the most prominent discipline involved. To some extent this is inevitable, given the use of species names as the pivot around which information is organised. To address the urgent questions around conservation, land-use, environmental change, sustainability, food security and ecosystem services that are facing Governments worldwide, we need to understand how the ecosystem works. So, we need a systems approach to understanding biodiversity that moves significantly beyond taxonomy and species observations. Such an approach needs to look at the whole system to address species interactions, both with their environment and with other species.It is clear that some barriers to progress are sociological, basically persuading people to use the technological solutions that are already available. This is best addressed by developing more effective systems that deliver immediate benefit to the user, hiding the majority of the technology behind simple user interfaces. An infrastructure should be a space in which activities take place and, as such, should be effectively invisible.This community consultation paper positions the role of biodiversity informatics, for the next decade, presenting the actions needed to link the various biodiversity infrastructures invisibly and to facilitate understanding that can support both business and policy-makers. The community considers the goal in biodiversity informatics to be full integration of the biodiversity research community, including citizens' science, through a commonly-shared, sustainable e-infrastructure across all sub-disciplines that reliably serves science and society alike.

  9. Population priorities: the challenge of continued rapid population growth.

    Science.gov (United States)

    Turner, Adair

    2009-10-27

    Rapid population growth continues in the least developed countries. The revisionist case that rapid population could be overcome by technology, that population density was advantageous, that capital shallowing is not a vital concern and that empirical investigations had not proved a correlation between high population growth and low per capita income was both empirically and theoretically flawed. In the modern world, population density does not play the role it did in nineteenth-century Europe and rates of growth in some of today's least developed nations are four times than those in nineteenth-century Europe, and without major accumulation of capital per capita, no major economy has or is likely to make the low- to middle-income transition. Though not sufficient, capital accumulation for growth is absolutely essential to economic growth. While there are good reasons for objecting to the enforced nature of the Chinese one-child policy, we should not underestimate the positive impact which that policy has almost certainly had and will have over the next several decades on Chinese economic performance. And a valid reticence about telling developing countries that they must contain fertility should not lead us to underestimate the severely adverse impact of high fertility rates on the economic performance and prospects of many countries in Africa and the Middle East.

  10. Biodiversity, Urban Areas, and Agriculture: Locating Priority Ecoregions for Conservation

    Directory of Open Access Journals (Sweden)

    Taylor Ricketts

    2003-12-01

    Full Text Available Urbanization and agriculture are two of the most important threats to biodiversity worldwide. The intensities of these land-use phenomena, however, as well as levels of biodiversity itself, differ widely among regions. Thus, there is a need to develop a quick but rigorous method of identifying where high levels of human threats and biodiversity coincide. These areas are clear priorities for biodiversity conservation. In this study, we combine distribution data for eight major plant and animal taxa (comprising over 20,000 species with remotely sensed measures of urban and agricultural land use to assess conservation priorities among 76 terrestrial ecoregions in North America. We combine the species data into overall indices of richness and endemism. We then plot each of these indices against the percent cover of urban and agricultural land in each ecoregion, resulting in four separate comparisons. For each comparison, ecoregions that fall above the 66th quantile on both axes are identified as priorities for conservation. These analyses yield four "priority sets" of 6-16 ecoregions (8-21% of the total number where high levels of biodiversity and human land use coincide. These ecoregions tend to be concentrated in the southeastern United States, California, and, to a lesser extent, the Atlantic coast, southern Texas, and the U.S. Midwest. Importantly, several ecoregions are members of more than one priority set and two ecoregions are members of all four sets. Across all 76 ecoregions, urban cover is positively correlated with both species richness and endemism. Conservation efforts in densely populated areas therefore may be equally important (if not more so as preserving remote parks in relatively pristine regions.

  11. Generating global political priority for urban health: the role of the urban health epistemic community.

    Science.gov (United States)

    Shawar, Yusra Ribhi; Crane, Lani G

    2017-10-01

    Over the past decade there has been much discussion of the challenges posed by rapid urbanization in the developing world; yet the health of the urban poor, and especially those residing in low- and middle-income countries, continues to receive little political priority in most developing countries and at the global level. This research applies social science scholarship and a public policy analytical framework to assess the factors that have challenged efforts to make health in urban poor settings a priority. We conducted 19 semi-structured phone interviews with key urban health proponents and experts representing agencies that shape opinions and manage resources in global health. We also conducted a literature review, which included published scholarly literature and reports from organizations involved in urban health provision and advocacy. Utilizing a process-tracing method, we triangulated among these sources of data to create a historical narrative and analyse the factors that shape the global level of attention to and resources for urban health. The urban health agenda continues to be challenged by six factors, three of which concern the political context or characteristics of the issue: long-standing competition with the dominant development agenda that is rural health oriented; limited data and measurement tools that can effectively gauge the extent of the problem; and lack of evidence on how to best to address the issue. The other three factors are directly under the control of the urban health community: the community's ineffective governance; little common understanding among its members of the problem and how to address it; and an unconvincing framing of the issue to the public. The study offers suggestions as to what advocates can do to secure greater attention and resources in order to help address the health needs of the urban poor. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical

  12. [La Dore Reservoir water rights priority decree : Rocky Mountain Arsenal : 1919

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Issued in November of 1924, this decree sets forth the adjudication of priorities of water rights and usage for irrigation and other beneficial uses in Water...

  13. "How dare you question what I use to treat this patient?": Student pharmacists' reflections on the challenges of communicating recommendations to physicians in interdisciplinary health care settings.

    Science.gov (United States)

    Denvir, Paul; Brewer, Jeffrey

    2015-01-01

    A growing number of pharmacists practice within interdisciplinary health care teams, leading pharmacy educators to place increased emphasis on the development of interprofessional collaboration skills. In the pharmacist-physician relationship, pharmacists' medication therapy recommendations (MTRs) are a recurrent and significant interprofessional activity, one that can be challenging for both seasoned and student pharmacists. Drawing on in-depth ethnographic interviews with pharmacy preceptors and advanced student pharmacists, we identify and describe an important distinction between pharmacist-initiated MTRs and physician-initiated MTRs as contexts for interprofessional collaboration. We describe and illustrate a range of social, professional, and communication challenges that students experience in each context, as well as some strategies they use to navigate these challenges. Using the theoretical framework of dialectic tensions, we argue that the pharmacist-physician relationship is characterized by a tension between assertiveness and deference. We also offer recommendations to pharmacy preceptors, who can use this article to enhance the experiential education of pharmacists.

  14. Improving social functioning and challenging behaviors in adolescents with ASD and significant ID: A randomized pilot feasibility trial of reciprocal imitation training in a residential setting.

    Science.gov (United States)

    Ingersoll, Brooke; Berger, Natalie; Carlsen, Danielle; Hamlin, Theresa

    2016-08-11

    There is a lack of effective social interventions for youths with ASD and co-morbid intellectual disability (ID). A previous single-case design study indicated that reciprocal imitation training (RIT) may improve social interaction and challenging behavior in this population. The current pilot study examined the feasibility of conducting an RCT to investigate the effectiveness of RIT for improving social functioning and challenging behaviors in 20 adolescents with ASD and severe ID in a residential program. The assessment protocol was feasible. RIT was well-tolerated by the adolescents and implemented with fidelity by teaching staff. Preliminary findings indicate that treatment had moderate to large effects on social functioning and challenging behavior, with mixed findings for imitation skills. A larger RCT of RIT for this population is feasible and warranted.

  15. Engaging patients in health research: identifying research priorities through community town halls.

    Science.gov (United States)

    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.

  16. Collaborating on Global Priorities: Science Education for Everyone--Any Time and Everywhere

    Science.gov (United States)

    Tobin, Kenneth

    2016-01-01

    Building on the key ideas from Dana Zeidler's paper I expand the conversation from the standpoint that the challenges facing humanity and the capacity of Earth to support life suggest that changes in human lifestyles are a priority. Accordingly, there is an urgent need to educate all humans about some of the science-related grand challenges, such…

  17. Best Practices and Processes for Choosing Research Priorities

    Science.gov (United States)

    Briscoe, M. G.

    2015-12-01

    Individuals, teams, departments, organizations, funding agencies, committees, and others all need to select desirable research priorities from many possible alternatives. One cannot do everything, one cannot afford everything, so what to select? Essays and reports since Weinberg (1963) have suggested criteria for choosing science topics. Popper et al (2000) reviewed and summarized all that had gone before in the subject of setting priorities; their main conclusions were that the underlying principles were the promotion of excellence and relevance. Sea Change (2015) from the NRC/OSB focused on four criteria. From most important to least important, they were transformative science, societal impacts, readiness, and partnership potential; these four criteria embodied the essence of the suggestions from Weinberg on, framed with the pragmatism of ORPISS (2007). Getting to the final set of priorities from many candidates involves a sequence of formal or informal processes, only the last of which is the application of the selected, weighted criteria. As developed by professional prioritization experts, the best-practice steps and processes are: Collection of input candidates from the community. Clustering and parsing/rephrasing of the input to eliminate redundancy and repetition and develop statements at a useful level of specificity. (NOTE:there is no counting of input to see how many times a particular topic was mentioned. The goal is diversity in the input, not a popularity contest.) Development of the selection criteria, and weighting the chosen criteria. Application of the selection criteria to the clustered/adjusted candidates. Finally, two more best practices: Do continuing sanity checks, to avoid losing sight of the goals of the effort. Resist the temptation to just sit around a table and talk about it to arrive at the priorities, which depends too much on who the specific members of the prioritization team are, and provides no transparency or explanation of why

  18. Priorities for the national vaccine plan

    National Research Council Canada - National Science Library

    Committee on Review of Priorities in the National Vaccine Plan; Institute of Medicine

    .... Priorities for the National Vaccine Plan examines the extraordinarily complex vaccine enterprise, from research and development of new vaccines to financing and reimbursement of immunization services...

  19. Ethical Challenges in Psychiatric Administration and Leadership.

    Science.gov (United States)

    Moffic, H Steven; Saeed, Sy Atezaz; Silver, Stuart; Koh, Steve

    2015-09-01

    As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority.

  20. Conservation biogeography - foundations, concepts and challenges

    DEFF Research Database (Denmark)

    Richardson, Timothy; Whittaker, R.J.; Whittaker, Robert J.

    2010-01-01

    Conservation biogeography involves the application of biogeographical principles, theories, and analyses to problems regarding biodiversity conservation. The field was formally defined in 2005, and considerable research has been conducted in the ensuing 5 years. This editorial sets the context...... for 16 contributions in a special issue of Diversity and Distributions on developments and challenges in conservation biogeography. Papers are grouped into the following main themes: species distribution modelling; data requirements; approaches for assigning conservation priorities; approaches...... for integrating information from numerous disparate sources; special challenges involving invasive species; and the crucial issue of determining how elements of biodiversity are likely to respond to rapid climate change. One paper provides a synthesis of requirements for a robust conservation biogeography...

  1. Liver Transplantation: Past Accomplishments and Future Challenges

    Directory of Open Access Journals (Sweden)

    William J Wall

    1999-01-01

    Full Text Available Liver transplantation has evolved from a rare and risky operation of questionable therapeutic value to the preferred treatment for an extensive list of end-stage liver diseases. Superior immunosuppression (cyclosporine, and improvements in surgery and anesthesia brought liver grafting to its current level of success. Nearly 60,000 liver transplants have been performed, and survival rates are very good; however liver grafting faces serious immediate and long term challenges, mainly due to the widening gap between donor supply and recipient demand. Increasing numbers of sick candidates, recurrent disease (especially hepatitis C and recidivism rates after transplantation for alcoholic cirrhosis will force increasingly difficult decisions on candidate selection and priority listing of potential recipients. Although xenotransplantation may be the ultimate solution, it has its own specific set of biological and societal challenges - the full extent of which should be revealed in the next several years.

  2. Assessment of cold-climate environmental research priorities

    Energy Technology Data Exchange (ETDEWEB)

    States, J.B.

    1983-04-01

    The Environmental Protection Agency (EPA) has consistently recognized that cold regions pose unique environmental problems. This report sets forth the conceptual framework and research plans for several high priority research areas. It provides the fundamental basis for implementation of the EPA Cold-Climate Environmental Research Program. This three- to five-year program encompasses both short- and long-term research of high relevance to the EPA and to the cold regions that it serves.

  3. Mental health research priorities for Europe.

    Science.gov (United States)

    Wykes, Til; Haro, Josep Maria; Belli, Stefano R; Obradors-Tarragó, Carla; Arango, Celso; Ayuso-Mateos, José Luis; Bitter, István; Brunn, Matthias; Chevreul, Karine; Demotes-Mainard, Jacques; Elfeddali, Iman; Evans-Lacko, Sara; Fiorillo, Andrea; Forsman, Anna K; Hazo, Jean-Baptiste; Kuepper, Rebecca; Knappe, Susanne; Leboyer, Marion; Lewis, Shôn W; Linszen, Donald; Luciano, Mario; Maj, Mario; McDaid, David; Miret, Marta; Papp, Szilvia; Park, A-La; Schumann, Gunter; Thornicroft, Graham; van der Feltz-Cornelis, Christina; van Os, Jim; Wahlbeck, Kristian; Walker-Tilley, Tom; Wittchen, Hans-Ulrich

    2015-11-01

    Mental and brain disorders represent the greatest health burden to Europe-not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5-10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Challenges in Mathematical Cognition

    Directory of Open Access Journals (Sweden)

    Lara Alcock

    2016-04-01

    Full Text Available This paper reports on a collaborative exercise designed to generate a coherent agenda for research on mathematical cognition. Following an established method, the exercise brought together 16 mathematical cognition researchers from across the fields of mathematics education, psychology and neuroscience. These participants engaged in a process in which they generated an initial list of research questions with the potential to significantly advance understanding of mathematical cognition, winnowed this list to a smaller set of priority questions, and refined the eventual questions to meet criteria related to clarity, specificity and practicability. The resulting list comprises 26 questions divided into six broad topic areas: elucidating the nature of mathematical thinking, mapping predictors and processes of competence development, charting developmental trajectories and their interactions, fostering conceptual understanding and procedural skill, designing effective interventions, and developing valid and reliable measures. In presenting these questions in this paper, we intend to support greater coherence in both investigation and reporting, to build a stronger base of information for consideration by policymakers, and to encourage researchers to take a consilient approach to addressing important challenges in mathematical cognition.

  5. Antibiotic-Resistant Acinetobacter baumannii Increasing Success Remains a Challenge as a Nosocomial Pathogen

    OpenAIRE

    Ana Maria Gonzalez-Villoria; Veronica Valverde-Garduno

    2016-01-01

    Antibiotic-resistant infectious bacteria currently imply a high risk and therefore constitute a strong challenge when treating patients in hospital settings. Characterization of these species and of particular strains is a priority for the establishment of diagnostic tests and preventive procedures. The relevance of Acinetobacter baumannii as a problematic microorganism in inpatient facilities, particularly intensive care units, has increased over time. This review aims to draw attention to (...

  6. Current efforts in medical education to incorporate national health priorities.

    Science.gov (United States)

    Nair, Manisha; Fellmeth, Gracia

    2017-08-03

    As a reflection on the Edinburgh Declaration, this conceptual synthesis presents six important challenges in relation to the role of medical education in meeting current national health priorities. This paper presents a conceptual synthesis of current efforts in medical education to incorporate national health priorities as a reflection on how the field has evolved since the Edinburgh Declaration. Considering that health needs vary from country to country, our paper focuses on three broad and cross-cutting themes: health equity, health systems strengthening, and changing patterns of disease. Considering the complexity of this topic, we conducted a targeted search to broadly sample and critically review the literature in two phases. Phase 1: within each theme, we assessed the current challenges in the field of medical education to meet the health priority. Phase 2: a search for various strategies in undergraduate and postgraduate education that have been tested in an effort to address the identified challenges. We conducted a qualitative synthesis of the literature followed by mapping of the identified challenges within each of the three themes with targeted efforts. We identified six important challenges: (i) mismatch between the need for generalist models of health care and medical education curricula's specialist focus; (ii) attitudes of health care providers contributing to disparities in health care; (iii) the lack of a universal approach in preparing medical students for 21st century health systems; (iv) the inability of medical education to keep up with the abundance of new health care technologies; (v) a mismatch between educational requirements for integrated care and poorly integrated, specialised health care systems; and (vi) development of a globally interdependent education system to meet global health challenges. Examples of efforts being made to address these challenges are offered. Although strategies for combatting these challenges exist, the

  7. Integrating agricultural expansion into conservation biogeography: conflicts and priorities

    Directory of Open Access Journals (Sweden)

    Ricardo Dobrovolski

    2014-06-01

    Full Text Available Increasing food production without compromising biodiversity is one of the great challenges for humanity. The aims of my thesis were to define spatial priorities for biodiversity conservation and to evaluate conservation conflicts considering agricultural expansion in the 21st century. I also tested the effect of globalizing conservation efforts on both food production and biodiversity conservation. I found spatial conflicts between biodiversity conservation and agricultural expansion. However, incorporating agricultural expansion data into the spatial prioritization process can significantly alleviate conservation conflicts, by reducing spatial correlation between the areas under high impact of agriculture and the priority areas for conservation. Moreover, developing conservation blueprints at the global scale, instead of the usual approach based on national boundaries, can benefit both food production and biodiversity. Based on these findings I conclude that the incorporation of agricultural expansion as a key component for defining global conservation strategies should be added to the list of solutions for our cultivated planet.

  8. Reflecting on the methodological challenges of recruiting to a United Kingdom-wide, multi-centre, randomised controlled trial in gynaecology outpatient settings

    OpenAIRE

    2013-01-01

    Background Successful recruitment of participants to any trial is central to its success. Trial results are routinely published, and recruitment is often cited to be slower and more difficult than anticipated. This article reflects on the methodological challenges of recruiting women with prolapse attending United Kingdom (UK) gynaecology outpatient clinics to a multi-centre randomised controlled trial (RCT) of physiotherapy, and the systems put in place in an attempt to address them. Methods...

  9. Treatment of mental disorder in the primary care setting in the Netherlands in the light of the new reimbursement system: a challenge?

    Directory of Open Access Journals (Sweden)

    Christina M. van der Feltz-Cornelis

    2008-07-01

    Full Text Available Introduction: Different professionals provide health care for mental disorder in the primary care setting. In view of the changing reimbursement system in the Netherlands, information is needed on their specific expertise. Method: This study attempts to describe this by literature study, by assessment of expert opinions, and by consulting Associations of the relevant professions. Results: There is no clear differentiation of expertise and tasks amongst these professionals in primary care. Notably, distinction between different psychotherapeutic treatment modes provided by psychologists is unclear. Discussion: Research is needed to assess actual treatment modules in correlation with patient diagnostic classification for the different professions in primary care. An alternative way of classifying patients, that takes into account not only mental disorder or problems but especially the level of functioning, is proposed to discern which patients can be treated in primary care, and which patients should not. Integrated care models are promising, because many professionals can be involved in treatment of mental disorder in the primary care setting; especially for collaborative care models, evidence favours the treatment of common mental disorders in this setting. Conclusion: Integrated care models, such as collaborative care, provide a basis for multidisciplinary care for mental disorder in the primary care setting. Professional responsibilities should be clearly differentiated in order to facilitate integrated care. The level of functioning of patients with mental disorder can be used as indication criterion for treatment in the primary care setting or in Mental Health Institutions. Research to establish the feasibility of this model is needed.

  10. 40 CFR 35.2103 - Priority determination.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Priority determination. 35.2103 Section 35.2103 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2103 Priority determination...

  11. Reframing Recreation as a Public Policy Priority

    Science.gov (United States)

    Lovell, Phillip

    2011-01-01

    Issues pertaining to children often struggle to become public policy priorities. A clear demonstration of this phenomenon is the degree to which children are supported in the federal budget in comparison to other priorities. If issues pertaining to children struggle for the policy spotlight, subissues pertaining to them face an even greater…

  12. Reframing Recreation as a Public Policy Priority

    Science.gov (United States)

    Lovell, Phillip

    2011-01-01

    Issues pertaining to children often struggle to become public policy priorities. A clear demonstration of this phenomenon is the degree to which children are supported in the federal budget in comparison to other priorities. If issues pertaining to children struggle for the policy spotlight, subissues pertaining to them face an even greater…

  13. 48 CFR 808.603 - Purchase priorities.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Purchase priorities. 808.603 Section 808.603 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS COMPETITION... Industries, Inc. (FPI) 808.603 Purchase priorities. Contracting officers may purchase supplies and...

  14. 48 CFR 8.704 - Purchase priorities.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase priorities. 8.704... Blind or Severely Disabled 8.704 Purchase priorities. (a) The Javits-Wagner-O'Day Act requires the Government to purchase supplies or services on the Procurement List, at prices established by the...

  15. 48 CFR 8.603 - Purchase priorities.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase priorities. 8.603... REQUIRED SOURCES OF SUPPLIES AND SERVICES Acquisition From Federal Prison Industries, Inc. 8.603 Purchase... shall purchase supplies and services in the following priorities: (a) Supplies. (1) Federal...

  16. 78 FR 29785 - Priority Mail Pricing

    Science.gov (United States)

    2013-05-21

    ... Priority Mail Pricing AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is... using Merchandise Return Service, Priority Mail Open and Distribute, or Premium Forwarding Service. Id....452 percent. Id. at 5. The Postal Service indicates that after the price change, the unused pricing...

  17. Horizon 2020 Priorities in Clinical Mental Health Research: Results of a Consensus-Based ROAMER Expert Survey

    Directory of Open Access Journals (Sweden)

    Iman Elfeddali

    2014-10-01

    Full Text Available 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.

  18. The 50 Constellation Priority Sites

    Science.gov (United States)

    Noble, S.; Joosten, K.; Eppler, D.; Gruener, J.; Mendell, W.; French, R.; Plescia, J.; Spudis, P.; Wargo, M.; Robinson, M.; Lucey, P.

    2009-01-01

    The Constellation program (CxP) has developed a list of 50 sites of interest on the Moon which will be targeted by the LRO narrow angle camera. The list has also been provided to the M team to supplement their targeting list. This list does not represent a "site selection" process; rather the goal was to find "representative" sites and terrains to understand the range of possible surface conditions for human lunar exploration to aid engineering design and operational planning. The list compilers leveraged heavily on past site selection work (e.g. Geoscience and a Lunar Base Workshop - 1988, Site Selection Strategy for a Lunar Outpost - 1990, Exploration Systems Architecture Study (ESAS) - 2005). Considerations included scientific, resource utilization, and operational merits, and a desire to span lunar terrain types. The targets have been organized into two "tiers" of 25 sites each to provide a relative priority ranking in the event of mutual interference. A LEAG SAT (special action team) was established to validate and recommend modifications to the list. This SAT was chaired by Dr. Paul Lucey. They provided their final results to CxP in May. Dr. Wendell Mendell will organize an on-going analysis of the data as they come down to ensure data quality and determine if and when a site has sufficient data to be retired from the list. The list was compiled using the best available data, however, it is understood that with the flood of new lunar data, minor modifications or adjustments may be required.

  19. Distributed Priority Synthesis and its Applications

    CERN Document Server

    Cheng, Chih-Hong; Yan, Rongjie; Ruess, Harald

    2011-01-01

    We present an extension of the tool VissBIP, including a new algorithm which first references the communication architecture in component-based systems then synthesizes deployable priorities to ensure that the system is safe and deadlock-free. As the synthesized priorities are guaranteed to be deployable, our work reduces related efforts in finding strategies to execute priorities distributively. When the normal method of distributed priority synthesis fails, the tool proceeds by three refinement methods. The first is to equip static knowledge on selected components and resynthesize. The second method is to allow transmitting state information in the communication process. To reduce the amount of information transfer, we extract information from the unsatisfiable core (during the fix process) and successively increase the amount of additional information when required. The last method is to allow transitivity of priorities to only hold when the architecture is supported. To support complex updates, we explici...

  20. An Exploratory Factor Analysis and Construct Validity of the Resident Choice Assessment Scale with Paid Carers of Adults with Intellectual Disabilities and Challenging Behavior in Community Settings

    Science.gov (United States)

    Ratti, Victoria; Vickerstaff, Victoria; Crabtree, Jason; Hassiotis, Angela

    2017-01-01

    Introduction: The Resident Choice Assessment Scale (RCAS) is used to assess choice availability for adults with intellectual disabilities (ID). The aim of the study was to explore the factor structure, construct validity, and internal consistency of the measure in community settings to further validate this tool. Method: 108 paid carers of adults…

  1. Reducing violent injuries: priorities for pediatrician advocacy.

    Science.gov (United States)

    Dolins, J C; Christoffel, K K

    1994-10-01

    A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps: Setting policy objectives by narrowing the scope of policy, by reviewing policy options, and by examining options against selected criteria. Developing strategies for educating the public and for approaching legislative/regulatory bodies. Evaluating the effectiveness of the advocacy action plan as a process and as an agent for change. To illustrate the variety of ways in which pediatricians can be involved in the policy process to reduce violent injuries among children and adolescents, we apply this systematic approach to three priority areas. Prohibiting the use of corporal punishment in schools is intended to curb the institutionalized legitimacy of violence that has been associated with future use of violence. Efforts to remove handguns from the environments of children and adolescents are aimed at reducing the numbers of firearm injuries inflicted upon and by minors. Comprehensive treatment of adolescent victims of assault is intended to decrease the reoccurrence of violent injuries.

  2. Gender-Specific Health Challenges Facing Women

    Science.gov (United States)

    ... with twitter share with linkedin Gender-Specific Health Challenges Facing Women Global Research Global Research NIAID's Role ... Career Stage Postdocs' Guide to Gaining Independence Small Business Programs Compare NIAID’s Small Business Programs High-Priority ...

  3. Perspectives of Patients, Caregivers and Researchers on Research Priorities in Donation and Transplantation in Canada: A Pilot Workshop

    Science.gov (United States)

    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

  4. Top 40 priorities for science to inform conservation and management policy in the United States

    Science.gov (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. Chris; 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.

  5. Comparing public-health research priorities in Europe.

    Science.gov (United States)

    McCarthy, Mark; Harvey, Gabrielle; Conceição, Claudia; la Torre, Giuseppe; Gulis, Gabriel

    2009-07-14

    Despite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges. Public-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe). There was participation of ministries in 18 of 28 (64% response) European countries, from 22 of 39 (56% response) member national associations of the European Public Health Association, and from 80 civil society health organisations (53% of members of the European Public Health Alliance) Public-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied but well-defined areas for research in relation to national health plans and programmes. National public health associations reported research priorities across most fields of public health, although with some European regional differences. Civil society health organisations prioritised health promotion research nationally, but also health services research internationally. There was less research reported on methods, such as modelling and economic analysis, wider determinants of health, and public-health interventions. Systematic collaboration between stakeholders across European countries would enhance knowledge and promote innovation to address contemporary public-health challenges.

  6. Comparing public-health research priorities in Europe

    Directory of Open Access Journals (Sweden)

    la Torre Giuseppe

    2009-07-01

    Full Text Available Abstract Background Despite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges. Methods Public-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe. There was participation of ministries in 18 of 28 (64% response European countries, from 22 of 39 (56% response member national associations of the European Public Health Association, and from 80 civil society health organisations (53% of members of the European Public Health Alliance Results Public-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied but well-defined areas for research in relation to national health plans and programmes. National public health associations reported research priorities across most fields of public health, although with some European regional differences. Civil society health organisations prioritised health promotion research nationally, but also health services research internationally. There was less research reported on methods, such as modelling and economic analysis, wider determinants of health, and public-health interventions. Conclusion Systematic collaboration between stakeholders across European countries would enhance knowledge and promote innovation to address contemporary public-health challenges.

  7. [Science, health and education: a priority and a model].

    Science.gov (United States)

    Fúster, Valentin

    2010-01-01

    Myocardial infarction and brain infarction are personally dramatic events. However, these cardiovascular events are also globally dramatic not just for being the first cause of death all over the world. In addition, their prevalence is increasing and the high economic cost of treatment - technological and pharmacological - is already inaccessible in many regions of the world. In light of the above, we have established an international foundation under the priority concept "Science, Health and Education" (SHE). This fundation is based in a new Spanish research and funding model, the "Nacional Cardiovascular Research Center (CNIC). The research aspect is geared towards promoting cardiovascular health and disease management both individually and among the population. Funding is public and private, excluding the fharmaceutical industry, wich thus prevents conflicts of interest. In the cardiovascular setting, the entity SHE as conceptual priority, and the CNIC as Scientific basis or model can be pilot or applicable to other health and disease issues in general.

  8. 'Testing Together Challenges the Relationship': Consequences of HIV Testing as a Couple in a High HIV Prevalence Setting in Rural South Africa.

    Directory of Open Access Journals (Sweden)

    Hanani Tabana

    Full Text Available We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention.This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples.Learning about each other's status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised.Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed

  9. An Analysis of QoS in ZigBee Network Based on Deviated Node Priority

    Directory of Open Access Journals (Sweden)

    Md. Jaminul Haque Biddut

    2016-01-01

    Full Text Available ZigBee is an IEEE 802.15.4 standardized communication protocol. It forms a flawless Wireless Sensor Network (WSN standard for interoperability at all levels of the network, particularly the application level which most closely touches the user. A large number of devices from different vendors can work seamlessly. These devices act as a network and send huge data traffic to the Coordinator. End devices at different zones have different roles in communication with each other. There has been a lack in executing their requests in a synchronized way based on task priority. This lack leads to massive data traffic loss and degrades the Quality of Service (QoS. One of the challenges is to analyze the QoS parameters in ZigBee network that help to detect the overall network performance. The contribution of this paper is twofold; first, a ZigBee Network is implemented based on node priority. It demonstrates a method to generate a new priority of devices with respect to their existing priority and zones’ priority as well. Second, the QoS is analyzed based on the new priority status for tasks preference purposes. The outcome of this paper shows that the QoS of the network is more conspicuous than non-priority based network.

  10. Research Priorities for NCD Prevention and Climate Change: An International Delphi Survey

    Directory of Open Access Journals (Sweden)

    Ruth Colagiuri

    2015-10-01

    Full Text Available Climate change and non-communicable diseases (NCDs are arguably the greatest global challenges of the 21st Century. However, the confluence between them remains under-examined and there is little evidence of a comprehensive, systematic approach to identifying research priorities to mitigate their joint impact. Consequently, we: (i convened a workshop of academics (n = 25 from the Worldwide Universities Network to identify priority areas at the interface between NCDs and climate change; (ii conducted a Delphi survey of international opinion leaders in public health and relevant other disciplines; and (iii convened an expert panel to review and advise on final priorities. Three research areas (water security; transport; conceptualising NCD harms to support policy formation were listed among the top 10 priorities by >90% of Delphi respondents, and ranked among the top 12 priorities by >60% of respondents who ranked the order of priority. A fourth area (reducing the carbon footprint of cities was ranked highest by the same >60% of respondents. Our results are consistent with existing frameworks on health and climate change, and extends them by focusing specifically on NCDs. Researching these priorities could progress understanding of climate change and NCDs, and inform global and national policy decisions for mitigating associated harms.

  11. Vision-related research priorities and how to finance them

    Directory of Open Access Journals (Sweden)

    Catherine A McCarty

    2012-01-01

    Full Text Available A number of organizations have employed a consultative process with the vision community to engage relevant parties in identifying needs and opportunities for vision research. The National Eye Institute in the US and the European Commission are currently undergoing consultation to develop priorities for vision research. Once these priorities have been established, the challenge will be to identify the resources to advance these research agendas. Success rates for Federal funding for research have decreased recently in the USA, UK, and Australia. Researchers should consider various potential funding sources for their research. The universal consideration for funding is that the reason for funding should align with the mission of the funding organization. In addition to Federal research organizations that fund investigator-initiated research, other potential funding sources include nongovernmental organizations, for-profit companies, individual philanthropy, and service organizations. In addition to aligning with organizational funding priorities, researchers need to consider turn-around time and total funds available including whether an organization will cover institutional indirect costs. Websites are useful tools to find information about organizations that fund research, including grant deadlines. Collaboration is encouraged.

  12. Adapting Technological Interventions to Meet the Needs of Priority Populations.

    Science.gov (United States)

    Linke, Sarah E; Larsen, Britta A; Marquez, Becky; Mendoza-Vasconez, Andrea; Marcus, Bess H

    2016-01-01

    Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations.

  13. Navigating laboratory services quality in challenging environments: A perspective for implementation in small, low-income countries and post-conflict settings

    Directory of Open Access Journals (Sweden)

    Edward M. Kamau

    2013-03-01

    Full Text Available The need to establish and maintain good laboratory practices is recognised universally. However, due to differences in resources available for health services in different countries, allocation of financial and human resources in poor countries is severely constrained. The constraints faced by poor countries call for innovative approaches that would guarantee the minimum acceptable quality while striving to meet the highest standards. In resource-limited setting, it may be justifiable to develop and use ‘fit for purpose’ quality standards based on internationally-recognised laboratory quality management frameworks or protocols.

  14. To Duncan, Incentives a Priority

    Science.gov (United States)

    Klein, Alyson

    2009-01-01

    U.S. Secretary of Education Arne Duncan says he is eager to use a proposed $15 billion federal incentive-grant fund in part to reward states, districts, and even nonprofit organizations that have set high standards for the students they serve. "With this fund, we really have a chance to drive dramatic changes, to take to scale what works, invest…

  15. Women’s perception of accuracy of ultrasound dating in late pregnancy: a challenge to prevention of prolonged pregnancy in a resource-poor Nigerian setting

    Directory of Open Access Journals (Sweden)

    Ugwu EO

    2014-02-01

    Full Text Available Emmanuel O Ugwu,1 Godwin U Odoh,1 Cyril C Dim,1 Samuel N Obi,1 Euzebus C Ezugwu,1 Innocent I Okafor21Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Parklane, Enugu, NigeriaBackground: Expected date of delivery (EDD is estimated from the last menstrual period (LMP or ultrasound scan. Conflicts between these estimates especially on the part of the physician and his/her patient could pose a challenge to prevention of prolonged pregnancy. The objective of this study was to determine the perception and acceptability of menstrual dating (EDD derived from LMP with regard to timing of labor induction for postdatism by pregnant women who have a late pregnancy (≥23 weeks’ gestation ultrasound scan.Methods: This cross-sectional study included 443 consecutive pregnant women receiving antenatal care at two tertiary health institutions in Enugu, Nigeria, from January 1, 2013 to March 31, 2013.Results: The mean age of the women was 27.9±2.41 (range 17–45 years. Most ultrasound scans (90.8%, 357/389 were carried out in late pregnancy, and 41.9% (167/389 were self-referred. The majority of the respondents (51.7%, 229/443 did not accept induction of labor for postdatism at a certain menstrual dating-derived gestational age of 40 weeks plus 10 days if the late pregnancy ultrasound scan dating was less. Predictors of this poor attitude to timing of induction of labor for postdatism included low educational level, low social class, and poor knowledge of the limitations of ultrasound scan dating in late pregnancy (P<0.05.Conclusion: The worrisome confidence in ultrasound scan dating is a challenge to the prevention of prolonged pregnancy and its complications in our environment. Antenatal health education should discourage self-referral for ultrasound scan dating and emphasize its limitations in late pregnancy

  16. A novel organizational model to face the challenge of multimorbid elderly patients in an internal medicine setting: a case study from Parma Hospital, Italy.

    Science.gov (United States)

    Meschi, Tiziana; Ticinesi, Andrea; Prati, Beatrice; Montali, Arianna; Ventura, Antonio; Nouvenne, Antonio; Borghi, Loris

    2016-08-01

    Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay principles. In 2012-2014, this organizational model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.

  17. 76 FR 32980 - Telecommunications Service Priority (TSP) System

    Science.gov (United States)

    2011-06-07

    ... SECURITY Telecommunications Service Priority (TSP) System AGENCY: National Protection and Programs... telecommunications vendors to provide priority provisioning and restoration of telecommunications services supporting..., National Communications System. Title: Telecommunications Service Priority System. OMB Number:...

  18. SPECIATION AND DETERMINATION OF PRIORITY METALS IN ...

    African Journals Online (AJOL)

    locations and the samples were analyzed for some certain priority metals to determine the .... the use of a pestle, sieved with a laboratory test sieve of size 500 µm, ..... Hanoi. City,. Vietnam,. Seminar. Paper,. Institutional for markvetenskap,.

  19. Chemical carcinogenesis and chemoprevention: Scientific priority ...

    African Journals Online (AJOL)

    ... chemoprevention: Scientific priority area in rapidly industrializing developing ... considerably exceed regulatory limits established in industrialized countries. ... including humans to a substance that will reduce the incidence of cancer that ...

  20. 7 CFR 1466.4 - National priorities.

    Science.gov (United States)

    2010-01-01

    ..., will be used in EQIP implementation: (1) Reductions of nonpoint source pollution, such as nutrients... allocation of EQIP funds to the NRCS State offices, (2) Use the national priorities in conjunction with...

  1. CHALLENGES WITH INSULIN USE AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS: FOCUS ON A TERTIARY HEALTHCARE SETTING IN SOUTH-EAST NIGERIA.

    Science.gov (United States)

    Ezeani Ignatius, U; Onyeonoro Ugochukwu, U; Ugwu Theophilus, E; Chuku, Abali; Aihanuwa, Eregie

    2015-10-16

    Effective usage of insulin in the management of diabetes remains a challenge in developing countries like Nigeria. The objective of this study is to document the pattern of insulin prescription, frequency, storage, common regimen used, and attendant problems associated with its use in patients with type 2 diabetes mellitus (T2DM). This was a prospective, descriptive study in which consecutive T2DM patients seen at the medical out-patient clinic and medical wards and who fulfilled the criteria for inclusion were recruited. Participants provided information on their demographic characteristics, diabetes history, treatment and problems associated with treatment, type of insulin in use, number of daily injections, storage, method of insulin administration and problems associated with insulin use. Clinical examination was carried out basically to determine the anthropometric indices. about 84.3% have used insulin for less than 5 years. The thigh was the commonest site of insulin administration (95.3%). About 94.3% of subjects in this study store their insulin in a refrigerator. And Insulin dosing regimen ranged from less than once to four times daily while majority of patients (63%) were on twice daily insulin regimen. Insulin administration devices used were Insulin syringes 394 (98.5%) and Insulin pens 6 (1.5%). Thirty three percent of the subjects self inject insulin while about half of the study subjects (50.5%) receive insulin from a healthcare provider. The most common insulin used by patients was Mixed/ Premixed insulin (32.8%) and Regular/ Soluble insulin (38.8%). Hypoglycaemia was the most frequently documented problem encountered by subjects on insulin followed by weight gain. Majority of the study subjects (50.8%) practice self monitoring of blood glucose (SMBG). This study has demonstrated that majority of subjects with T2DM were on premixed insulin and that hypoglycaemia is the most common problem reported by patients. Insulin pens were not common among our

  2. Research priorities for zoonoses and marginalized infections.

    Science.gov (United States)

    2012-01-01

    This report provides a review and analysis of the research landscape for zoonoses and marginalized infections which affect poor populations, and a list of research priorities to support disease control. The work is the output of the Disease Reference Group on Zoonoses and Marginalized Infectious Diseases of Poverty (DRG6), which is part of an independent think tank of international experts, established and funded by the Special Programme for Research and Training in Tropical Diseases (TDR), to identify key research priorities through review of research evidence and input from stakeholder consultations. The report covers a diverse range of diseases, including zoonotic helminth, protozoan, viral and bacterial infections considered to be neglected and associated with poverty. Disease-specific research issues are elaborated under individual disease sections and many common priorities are identified among the diseases such as the need for new and/or improved drugs and regimens, diagnostics and, where appropriate, vaccines. The disease-specific priorities are described as micro priorities compared with the macro level priorities which will drive policy-making for: improved surveillance; interaction between the health, livestock, agriculture, natural resources and wildlife sectors in tackling zoonotic diseases; and true assessment of the burden of zoonoses. This is one often disease and thematic reference group reports that have come out of the TDR Think Tank, all of which have contributed to the development of the Global Report search on Infectious Diseases of Poverty, available at: w.who.int/tdr/stewardship/global_report/en/index.html.

  3. Priority wetland invertebrates as conservation surrogates.

    Science.gov (United States)

    Ormerod, S J; Durance, Isabelle; Terrier, Aurelie; Swanson, Alisa M

    2010-04-01

    Invertebrates are important functionally in most ecosystems, but seldom appraised as surrogate indicators of biological diversity. Priority species might be good candidates; thus, here we evaluated whether three freshwater invertebrates listed in the U.K. Biodiversity Action Plan indicated the richness, composition, and conservation importance of associated wetland organisms as defined respectively by their alpha diversity, beta diversity, and threat status. Sites occupied by each of the gastropods Segmentina nitida, Anisus vorticulus, and Valvata macrostoma had greater species richness of gastropods and greater conservation importance than other sites. Each also characterized species assemblages associated with significant variations between locations in alpha or beta diversity among other mollusks and aquatic macrophytes. Because of their distinct resource requirements, conserving the three priority species extended the range of wetland types under management for nature conservation by 18% and the associated gastropod niche-space by around 33%. Although nonpriority species indicated variations in richness, composition, and conservation importance among other organisms as effectively as priority species, none characterized such a wide range of high-quality wetland types. We conclude that priority invertebrates are no more effective than nonpriority species as indicators of alpha and beta diversity or conservation importance among associated organisms. Nevertheless, conserving priority species can extend the array of distinct environments that are protected for their specialized biodiversity and environmental quality. We suggest that this is a key role for priority species and conservation surrogates more generally, and, on our evidence, can best be delivered through multiple species with contrasting habitat requirements.

  4. NASA's Office of Space Science and Applications: Process, priorities, and goals

    Science.gov (United States)

    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.

  5. Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

    Directory of Open Access Journals (Sweden)

    Veen Robert ER

    2011-07-01

    Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

  6. 15 CFR 700.21 - Application for priority rating authority.

    Science.gov (United States)

    2010-01-01

    ... Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE NATIONAL SECURITY INDUSTRIAL BASE REGULATIONS DEFENSE PRIORITIES AND ALLOCATIONS SYSTEM Industrial Priorities for Energy Programs...

  7. Priorities for sustainable turfgrass management

    DEFF Research Database (Denmark)

    Strandberg, M.; Blombäck, K.; Jensen, Anne Mette Dahl

    2012-01-01

    and opportunities available for promoting and achieving more sustainable turfgrass management within the sports, landscape and amenity sectors. The analysis confirms that there are a number of key areas where a concerted research and industrial effort is required. These include responding to the pressures from...... government demands for greater environmental regulation, the increasing pressure on natural resources (notably water, energy and land), the emerging role of turf management in supporting ecosystem services and enhancing biodiversity, the continued need to promote integrated pest management, and the looming...... challenges posed by a changing climate, and urgent need to adapt. Whilst many of these externalities appear to be risks to the sports turf industry, there will also be significant opportunities, for those where the labour, energy and agronomic costs are minimized and where the drive to adopt...

  8. Range-wide connectivity of priority areas for Greater Sage-Grouse: Implications for long-term conservation from graph theory

    Science.gov (United States)

    Crist, Michele R.; Knick, Steven T.; Hanser, Steven E.

    2017-01-01

    The delineation of priority areas in western North America for managing Greater Sage-Grouse (Centrocercus urophasianus) represents a broad-scale experiment in conservation biology. The strategy of limiting spatial disturbance and focusing conservation actions within delineated areas may benefit the greatest proportion of Greater Sage-Grouse. However, land use under normal restrictions outside priority areas potentially limits dispersal and gene flow, which can isolate priority areas and lead to spatially disjunct populations. We used graph theory, representing priority areas as spatially distributed nodes interconnected by movement corridors, to understand the capacity of priority areas to function as connected networks in the Bi-State, Central, and Washington regions of the Greater Sage-Grouse range. The Bi-State and Central networks were highly centralized; the dominant pathways and shortest linkages primarily connected a small number of large and centrally located priority areas. These priority areas are likely strongholds for Greater Sage-Grouse populations and might also function as refugia and sources. Priority areas in the Central network were more connected than those in the Bi-State and Washington networks. Almost 90% of the priority areas in the Central network had ≥2 pathways to other priority areas when movement through the landscape was set at an upper threshold (effective resistance, ER12). At a lower threshold (ER4), 83 of 123 priority areas in the Central network were clustered in 9 interconnected subgroups. The current conservation strategy has risks; 45 of 61 priority areas in the Bi-State network, 68 of 123 in the Central network, and all 4 priority areas in the Washington network had ≤1 connection to another priority area at the lower ER4threshold. Priority areas with few linkages also averaged greater environmental resistance to movement along connecting pathways. Without maintaining corridors to larger priority areas or a clustered group

  9. Los nuevos entornos educativos: desafíos cognitivos para una inteligencia colectiva New Educational Settings. Cognitive Challenges for the Realization of a Collective Intelligence

    Directory of Open Access Journals (Sweden)

    María González Navarro

    2009-10-01

    Full Text Available Comprender las tecnologías de la comunicación a la luz de las redes con que se comunican y entran en cooperación las personas ha sido una constante en autores que no han disociado su visión acerca del significado de las tecnologías respecto a los nuevos movimientos sociales. Este artículo sostiene que las TIC no son sólo una red a la que se suman los individuos, sino que actúan como tecnologías sociales cuyo perfeccionamiento depende tanto de la diversidad de sus funciones (socio-políticas, cognitivas, etc. como de la flexibilidad con que se adapten a nuestra diversidad funcional (ciclos de la vida, motricidad, umbrales de percepción, etc.. Prueba de ello son desafíos tecnológicos como el diseño de dispositivos llevables, las redes de área personal, las interfaces de usuario de alta usabilidad, los sistemas de cuidado en el hogar, etc. Este artículo explora dichas tesis en relación con el entorno educativo. Understanding communication technologies through the networks by which people connect, communicate and cooperate has been a constant feature in the work of researchers who have not dissociated their view about the meaning of technologies within new social movements. This paper states that Information and Communication Technologies are not only networks that people join individually, but that they also act as social technologies. Their improvement depends both on the diversity of their functions (social, political, cognitive, etc. and on the flexibility they have to adapt to functional diversity (to lifecycles, changing and fluctuating mobility or to audiovisual perception thresholds, for example. This idea is supported by the new technological challenge represented by portable devices, the personal area network, high-use user interfaces, systems designed for home care, etc. All this will be tried and tested in this paper within the educational context.

  10. Challenges of establishing a Community Advisory Board (CAB in a low-income, low-resource setting: experiences from Bagamoyo, Tanzania

    Directory of Open Access Journals (Sweden)

    Shubis Kafuruki

    2009-06-01

    Full Text Available Abstract Objective Community Advisory Boards are now seen as standard practice for clinical vaccine and drug trials worldwide. In the past, most Community Advisory Boards (CABs were established by activists and lobbyists to monitor HIV/AIDS vaccine and drug trials in developed countries. In Africa the first CAB was established in Uganda in 1990 in conjunction with an HIV vaccine project and has since been followed by others in South Africa, Zimbabwe, and Kenya. In 2007, the Bagamoyo branch of the Ifakara Health Institute initiated the formation of a CAB. The aim was to properly educate and empower elected CAB members to become full partners in all research activities concerning the public within the Bagamoyo area. Methods and Results Beginning in 2007, staff visited each of the 24 villages within the study area to inform the communities about the proposed CAB and asked them to elect two individuals to represent their village on the CAB. The first attempt was hampered by community leaders selecting themselves, which led to inconsistent attendance, gender imbalance, and political infighting. New criteria for the selection of representatives were implemented to exclude governmental leaders, illiterate representatives and to promote a one-to-one gender balance. The newly appointed representatives underwent training and have participated in CAB meetings largely devoid of the negative issues previously encountered. Conclusion The successfully established CAB has led to improved relations with the community and facilitated the recruitment of study subjects. Our experiences show that, it is possible to establish a non-specific CAB in a low-income setting.

  11. Benefits of integrating complementarity into priority threat management.

    Science.gov (United States)

    Chadés, Iadine; Nicol, Sam; van Leeuwen, Stephen; Walters, Belinda; Firn, Jennifer; Reeson, Andrew; Martin, Tara G; Carwardine, Josie

    2015-04-01

    Conservation decision tools based on cost-effectiveness analysis are used to assess threat management strategies for improving species persistence. These approaches rank alternative strategies by their benefit to cost ratio but may fail to identify the optimal sets of strategies to implement under limited budgets because they do not account for redundancies. We devised a multiobjective optimization approach in which the complementarity principle is applied to identify the sets of threat management strategies that protect the most species for any budget. We used our approach to prioritize threat management strategies for 53 species of conservation concern in the Pilbara, Australia. We followed a structured elicitation approach to collect information on the benefits and costs of implementing 17 different conservation strategies during a 3-day workshop with 49 stakeholders and experts in the biodiversity, conservation, and management of the Pilbara. We compared the performance of our complementarity priority threat management approach with a current cost-effectiveness ranking approach. A complementary set of 3 strategies: domestic herbivore management, fire management and research, and sanctuaries provided all species with >50% chance of persistence for $4.7 million/year over 20 years. Achieving the same result cost almost twice as much ($9.71 million/year) when strategies were selected by their cost-effectiveness ranks alone. Our results show that complementarity of management benefits has the potential to double the impact of priority threat management approaches.

  12. A Guide to Addressing Multiple Priorities in Core Content Instruction for Students with Severe Disabilities

    Science.gov (United States)

    Root, Jenny R.; Knight, Victoria F.; Mims, Pamela J.

    2017-01-01

    Instruction in academic core content provides students with moderate to severe disabilities a full educational opportunity that promotes current and future options in the community and can complement acquisition of daily living skills. However, high school teachers face many challenges in balancing instructional priorities given the mission to…

  13. A Guide to Addressing Multiple Priorities in Core Content Instruction for Students with Severe Disabilities

    Science.gov (United States)

    Root, Jenny R.; Knight, Victoria F.; Mims, Pamela J.

    2017-01-01

    Instruction in academic core content provides students with moderate to severe disabilities a full educational opportunity that promotes current and future options in the community and can complement acquisition of daily living skills. However, high school teachers face many challenges in balancing instructional priorities given the mission to…

  14. PRIORITIES OF THE CONCEPT OF ENVIRONMENTAL SECURITY

    Directory of Open Access Journals (Sweden)

    Glushko O. A.

    2015-05-01

    Full Text Available The article examines the approaches to the legal definition of "priority" in the concept of environmental security, as well as the kinds of priorities the concept of ecological security. The given provisions give us the chance to formulate the concept of "priority of the concept of ecological safety" as a prime activity (situation of subjects of an administrative legal regime of ecological safety on ensuring normal functioning of ecological system of the country, i.e. all objects of live and inanimate nature, the developed ecological state and the happening changes of an ecological state. We have highlighted the problem of the legal regulation of the concept of environmental security. The extensive studied system of political and legal program acts allows considering all the variety of approaches to the problem of priorities of the Russian concept of ensuring ecological safety. The system of priorities of the concept of ensuring ecological safety given in article most fully reflects prime activities of subjects of an administrative legal regime of ensuring ecological safety

  15. California's "Bridge to Reform": identifying challenges and defining strategies for providers and policymakers implementing the Affordable Care Act in low-income HIV/AIDS care and treatment settings.

    Directory of Open Access Journals (Sweden)

    Patrick T Hazelton

    Full Text Available In preparation for full Affordable Care Act implementation, California has instituted two healthcare initiatives that provide comprehensive coverage for previously uninsured or underinsured individuals. For many people living with HIV, this has required transition either from the HIV-specific coverage of the Ryan White program to the more comprehensive coverage provided by the county-run Low-Income Health Programs or from Medicaid fee-for-service to Medicaid managed care. Patient advocates have expressed concern that these transitions may present implementation challenges that will need to be addressed if ambitious HIV prevention and treatment goals are to be achieved.30 semi-structured, in-depth interviews were conducted between October, 2012, and February, 2013, with policymakers and providers in 10 urban, suburban, and rural California counties. Interview topics included: continuity of patient care, capacity to handle payer source transitions, and preparations for healthcare reform implementation. Study team members reviewed interview transcripts to produce emergent themes, develop a codebook, build inter-rater reliability, and conduct analyses.Respondents supported the goals of the ACA, but reported clinic and policy-level challenges to maintaining patient continuity of care during the payer source transitions. They also identified strategies for addressing these challenges. Areas of focus included: gaps in communication to reach patients and develop partnerships between providers and policymakers, perceived inadequacy in new provider networks for delivering quality HIV care, the potential for clinics to become financially insolvent due to lower reimbursement rates, and increased administrative burdens for clinic staff and patients.California's new healthcare initiatives represent ambitious attempts to expand and improve health coverage for low-income individuals. The state's challenges in maintaining quality care and treatment for people

  16. Priority probability deceleration deadline-aware TCP

    Institute of Scientific and Technical Information of China (English)

    Jin Ye; Jing Lin; Jiawei Huang

    2015-01-01

    In modern data centers, because of the deadline-agnostic congestion control in transmission control protocol (TCP), many deadline-sensitive flows can not finish before their deadlines. Therefore, providing a higher deadline meeting ratio becomes a critical chal enge in the typical online data intensive (OLDI) ap-plications of data center networks (DCNs). However, a problem named as priority synchronization is found in this paper, which de-creases the deadline meeting ratio badly. To solve this problem, we propose a priority probability deceleration (P2D) deadline-aware TCP. By using the novel probabilistic deceleration, P2D prevents the priority synchronization problem. Simulation results show that P2 D increases the deadline meeting ratio by 20%compared with D2TCP.

  17. Priority Union and Generalization in Discourse Grammars

    CERN Document Server

    Grover, C; Manandhar, S; Moens, M; Grover, Claire; Brew, Chris; Manandhar, Suresh; Moens, Marc

    1994-01-01

    We describe an implementation in Carpenter's typed feature formalism, ALE, of a discourse grammar of the kind proposed by Scha, Polanyi, et al. We examine their method for resolving parallelism-dependent anaphora and show that there is a coherent feature-structural rendition of this type of grammar which uses the operations of priority union and generalization. We describe an augmentation of the ALE system to encompass these operations and we show that an appropriate choice of definition for priority union gives the desired multiple output for examples of VP-ellipsis which exhibit a strict/sloppy ambiguity.

  18. Continuous Swarm Surveillance via Distributed Priority Maps

    Science.gov (United States)

    Howden, David

    With recent and ongoing improvements to unmanned aerial vehicle (UAV) endurance and availability, they are in a unique position to provide long term surveillance in risky environments. This paper presents a swarm intelligence algorithm for executing an exhaustive and persistent search of a non-trivial area of interest using a decentralized UAV swarm without long range communication. The algorithm allows for an environment containing arbitrary arrangements of no-fly zones, non-uniform levels of priority and dynamic priority changes in response to target acquisition or external commands. Performance is quantitatively analysed via comparative simulation with another leading algorithm of its class.

  19. Democracy and environment: Rethinking our educational priorities

    Science.gov (United States)

    Goodlad, Stephen John

    Two groups of scholars have recently pined prominence. Both are concerned about what is taught in America's schools and how it is taught. One group is focused on the need to strengthen a democracy they see as weakening and under attack. A second is concerned about an impending ecological catastrophe. These two concerns are often regarded as separate, unrelated, even conflicting. This paper argues that democracy and environmental issues actually have much in common; that both are fundamentally concerned with relationships and both are threatened in similar ways, for similar reasons. Moreover, if fully and property understood, these two crises can be recognized as mere symptoms of a much deeper crisis of modern, industrialized cultures, which are defined as vast, paradigmatic "super-cultures" that share enough in common that they can be seen as unique in their own right. To address this cultural crisis will require deliberate, widespread intervention. This intervention should begin in our public schools: first, because a major purpose of public education is enculturation. Second, educators have moral and ethical obligations that suggest that such intervention is justified, perhaps even imperative. If public education is to play a proactive role in our cultural evolution, sweeping curricular and pedagogical reforms will be necessary. Cultural issues cannot be separated from other aspects of a curriculum, or set aside as a separate discipline. Therefore fundamental curricular and pedagogical changes will need to be made throughout the entire educational system. Democracy (how we interact with one another) and environment (how we interact with the world around us) ought to form the foundational priorities on which all such reforms rest. An undertaking of this magnitude will encounter a great many obstacles. Some of the most prominent of those obstacles are assessed and serve as broad indicators of certain key areas in which reform efforts might be initiated. Finally

  20. Infant Mortality: Priority for Social Work.

    Science.gov (United States)

    Combs-Orme, Terri

    1987-01-01

    Bemoans the failure of the social work profession to claim infant mortality as a professional priority in spite of evidence of the appropriateness of social work interventions. Stresses social work's role in the reduction of preventable infant deaths. (Author/KS)

  1. Priority environmental investment programme: Development and implementation

    Directory of Open Access Journals (Sweden)

    Njegovan Zoran M.

    2004-01-01

    Full Text Available This paper is created to serve as a methodological base and possible work plan for Assistance in Priority Environmental Investment Programme Development and Implementation in the Republic of Serbia. It will contribute to improved mechanisms for selection of priority environmental investments. Also, the paper should outline a scope of work for technical assistance for Republic of Serbia in developing mechanisms for identifying and selecting priority environmental investments. The main feature of the long-term environmental policy in the Republic of Serbia is absence of integrated approach, which goes hand by hand with the international environmental standards, and lack of efficient economic instruments and regulations. It causes an inadequate technology policy and location of the polluters. Besides that there has been a lack of appropriate environmental monitoring system good enough to provide efficient ex-ante and ex-post protection. It has caused a lot of environmental damages so that a completely new approach in the field of environment is expected to be created out of which the Priority Environmental Investment Programme (PEIP should be a main tool for experience of good environmental governance in the Republic of Serbia as well as in the region of SEE.

  2. Worst-case efficient priority queues

    Energy Technology Data Exchange (ETDEWEB)

    Brodal, G.S. [Aarhus Univ. (Denmark)

    1996-12-31

    An implementation of priority queues is presented that supports the operations MAKEQUEUE, FINDMIN, INSERT, MELD and DECREASEKEY in worst case time O(1) and DFLETEMIN and DELETE in worst case time O(log n). The space requirement is linear. The data structure presented is the first achieving this worst case performance.

  3. 10 CFR 580.03 - Curtailment priorities.

    Science.gov (United States)

    2010-01-01

    ... ESSENTIAL AGRICULTURAL USES § 580.03 Curtailment priorities. (a) Notwithstanding any provision of law other... curtailment of deliveries of natural gas for any essential agricultural use, unless: (1) Such curtailment does... practicable and that the fuel is reasonably available as an alternative for such essential agricultural...

  4. Packet models revisited: tandem and priority systems

    NARCIS (Netherlands)

    Mandjes, M.R.H.

    2004-01-01

    We examine two extensions of traditional single-node packet-scale queueing models: tandem networks and (strict) priority systems. Two generic input processes are considered: periodic and Poisson arrivals. For the two-node tandem, an exact expression is derived for the joint distribution of the total

  5. Packet models revisited: tandem and priority systems

    NARCIS (Netherlands)

    M.R.H. Mandjes

    2004-01-01

    Abstract : We examine two extensions of traditional single-node packet-scale queueing models: tandem networks and (strict) priority systems. Two generic input processes are considered: periodic and Poisson arrivals. For the two-node tandem, an exact expression is derived for the joint distribution o

  6. Observing programs, what are the priorities?

    NARCIS (Netherlands)

    Meynet, G.; Henrichs, H.

    2015-01-01

    This brief note reflects the exchanges that were made between the participants during the general discussion on the observing programs. Because of time constraints only two questions have been addressed: 1) What is the priority between large programs and detailed observations of one or only a few ob

  7. 7 CFR 636.5 - National priorities.

    Science.gov (United States)

    2010-01-01

    ... wildlife habitat to benefit at-risk species; (3) Reduce the impacts of invasive species on fish and... species' habitats. (b) NRCS, with advice of other Federal agencies, will undertake periodic reviews of the... AGRICULTURE LONG TERM CONTRACTING WILDLIFE HABITAT INCENTIVES PROGRAM § 636.5 National priorities. (a)...

  8. Priority-queue framework: Programs

    DEFF Research Database (Denmark)

    Katajainen, Jyrki

    2009-01-01

    This is an electronic appendix to the article "Generic-programming framework for benchmarking weak queues and its relatives". The report contains the programs related to our priority-queue framework. Look at the CPH STL reports 2009-3 and 2009-4 to see examples of other component frameworks....

  9. Mitigation assessment results and priorities in China

    Energy Technology Data Exchange (ETDEWEB)

    Wu Zongxin; Wei Zhihong [Tsinghua Univ., Beijing (China)

    1996-12-31

    In this paper energy related CO2 emission projections of China by 2030 are given. CO2 mitigation potential and technology options in main fields of energy conservation and energy substitution are analyzed. CO2 reduction costs of main mitigation technologies are estimated and the AHP approach is used for helping assessment of priority technologies.

  10. Public Opinion Poll on Community Priorities: Sacramento

    Science.gov (United States)

    Sierra Health Foundation, 2009

    2009-01-01

    The primary goal of this study was to measure public perceptions, opinions and priorities as they pertain to youth issues in Sacramento for the purposes of further developing public and private youth programming and public policy in the Sacramento region. By presenting a "statistically reliable" profile of public opinion on youth issues,…

  11. Research Priority of Clinical Linguistics in Iran

    OpenAIRE

    Ahadi MR

    2016-01-01

    Background Study in clinical linguistics can reflect and requirements of this area, and can contribute to effective and useful changes in this area. Objectives Since there have been a few studies in the field of clinical linguistics in Iran, this research can pave the way to find research priorities of clinical linguistics in our country. Materials and Methods Studies related to l...

  12. Funnel Heap - A Cache Oblivious Priority Queue

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting; Fagerberg, Rolf

    2002-01-01

    model. Arge et al. recently presented the first optimal cache oblivious priority queue, and demonstrated the importance of this result by providing the first cache oblivious algorithms for graph problems. Their structure uses cache oblivious sorting and selection as subroutines. In this paper, we devise...

  13. Gore's Controversial Priorities for Higher Education.

    Science.gov (United States)

    Gose, Ben

    2000-01-01

    Evaluates presidential candidate Al Gore's priorities for higher education, noting criticism by some educators of his emphasis on benefits for the middle class and the large number of specific proposals he has offered, including the College Opportunity Tax Cut, 21st Century Teachers' Corps, 401(j) Educational Savings Accounts, the National Tuition…

  14. Global priorities for marine biodiversity conservation.

    Science.gov (United States)

    Selig, Elizabeth R; Turner, Will R; Troëng, Sebastian; Wallace, Bryan P; Halpern, Benjamin S; Kaschner, Kristin; Lascelles, Ben G; Carpenter, Kent E; Mittermeier, Russell A

    2014-01-01

    In recent decades, many marine populations have experienced major declines in abundance, but we still know little about where management interventions may help protect the highest levels of marine biodiversity. We used modeled spatial distribution data for nearly 12,500 species to quantify global patterns of species richness and two measures of endemism. By combining these data with spatial information on cumulative human impacts, we identified priority areas where marine biodiversity is most and least impacted by human activities, both within Exclusive Economic Zones (EEZs) and Areas Beyond National Jurisdiction (ABNJ). Our analyses highlighted places that are both accepted priorities for marine conservation like the Coral Triangle, as well as less well-known locations in the southwest Indian Ocean, western Pacific Ocean, Arctic and Antarctic Oceans, and within semi-enclosed seas like the Mediterranean and Baltic Seas. Within highly impacted priority areas, climate and fishing were the biggest stressors. Although new priorities may arise as we continue to improve marine species range datasets, results from this work are an essential first step in guiding limited resources to regions where investment could best sustain marine biodiversity.

  15. Current Priorities of Soviet School Development.

    Science.gov (United States)

    Soviet Education, 1981

    1981-01-01

    Six articles discuss top priorities of Soviet education policy. Topics discussed include labor training, revision of the curriculum for the 10-year general education program, quantitative v qualitative demands on the educational system, and extended-day programs for the children of working mothers. (DB)

  16. School Discipline Inequities Become a Federal Priority

    Science.gov (United States)

    Zehr, Mary Ann

    2010-01-01

    Federal officials are getting the word out that addressing racial disparities in school discipline is a high priority, and they plan to use "disparate-impact analysis" in enforcing school discipline cases--a legal course of action that some civil rights lawyers contend was neglected under the administration of President George W. Bush. In…

  17. Performance of TCP with multiple Priority Classes

    NARCIS (Netherlands)

    Vranken, R.; Mei, van der R.D.; Kooij, R.E.; Berg, van den J.L.

    2002-01-01

    We consider the dimensioning problem for Internet access links carrying TCP traffic with two priority classes. To this end, we study the behaviour of TCP at the flow level described by a multiple-server Processor Sharing (PS) queueing model with two customer classes, where the customers represent fl

  18. 7 CFR 3431.14 - Priority.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE VETERINARY MEDICINE LOAN REPAYMENT PROGRAM Administration of the Veterinary Medicine Loan Repayment Program § 3431.14 Priority. Pursuant to NVMSA, the Secretary will give...

  19. Operational semantics of term rewriting with priorities

    NARCIS (Netherlands)

    Pol, J.C. van de

    2008-01-01

    We study the semantics of term rewriting systems with rule priorities (PRS), as introduced in [1]. Three open problems posed in that paper are solved, by giving counter examples. Moreover, a class of executable PRSs is identified. A translation of PRSs into transition system specifications (TSS) is

  20. 45 CFR 2531.20 - Funding priorities.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Funding priorities. 2531.20 Section 2531.20 Public Welfare Regulations Relating to Public Welfare (Continued) CORPORATION FOR NATIONAL AND COMMUNITY SERVICE PURPOSES AND AVAILABILITY OF GRANTS FOR INVESTMENT FOR QUALITY AND INNOVATION ACTIVITIES § 2531.20 Funding...