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Many institutions evaluate applications for local seed funding by recruiting peer reviewers from their own institutional community. Smaller institutions, however, often face difficulty locating qualified local reviewers who are not in conflict with the proposal. As a larger pool of reviewers may be accessed through a cross-institutional collaborative process, nine Clinical and Translational Science Award (CTSA) hubs formed a consortium in 2016 to facilitate reviewer exchanges. Data were collected to evaluate the feasibility and preliminary efficacy of the consortium.
The CTSA External Reviewer Exchange Consortium (CEREC) has been supported by a custom-built web-based application that facilitates the process and tracks the efficiency and productivity of the exchange.
All nine of the original CEREC members remain actively engaged in the exchange. Between January 2017 and May 2019, CEREC supported the review process for 23 individual calls for proposals. Out of the 412 reviews requested, 368 were received, for a fulfillment ratio of 89.3%. The yield on reviewer invitations has remained consistently high, with approximately one-third of invitations being accepted, and of the reviewers who agreed to provide a review, 88.3% submitted a complete review. Surveys of reviewers and pilot program administrators indicate high satisfaction with the process.
These data indicate that a reviewer exchange consortium is feasible, adds value to participating partners, and is sustainable over time.
With increasing disaster risks from extreme weather, climate change, and emerging infectious diseases, the public health system plays a crucial role in community health protection. The disproportionate impacts of disaster risks demonstrate the need to consider ethics and values in public health emergency preparedness (PHEP) activities. Established PHEP frameworks from many countries do not integrate ethics into operational approaches.
To explore the ethical dimensions of all-hazards public health emergency preparedness in Canada.
A qualitative study design was employed to explore key questions relating to PHEP. Six focus groups, using the Structured Interview Matrix (SIM) format, were held across Canada with 130 experts from local, provincial, or federal levels, with an emphasis on local/regional public health. An inductive approach to content analysis was used to develop emergent themes, and iteratively examined based on the literature. This paper presents analyses examining the dimensions of ethics and values that emerged from the focus group discussions.
Thematic analysis resulted in the identification of four themes. The themes highlight the importance of proactive consideration of values in PHEP planning: challenges in balancing competing priorities, the need for transparency around decision-making, and consideration for how emergencies impact both individuals and communities.
Lack of consideration for the ethical dimensions of PHEP in operational frameworks can have important implications for communities. If decisions are made ad-hoc during an evolving emergency situation, the ethical implications may increase the risk for some populations, and lead to compromised trust in the PHEP system. The key findings from this study may be useful in influencing PHEP practice and policy to incorporate fairness and values at the core of PHEP to ensure readiness for emergencies with community health impacts.
Public health emergency management involves the timely translation of relevant evidence and effective coordination of diverse actors. In practice, this can be challenging in the absence of a common framework for action among diverse actors.
To apply an Integrated Knowledge Translation (iKT) approach throughout the development of a conceptual framework and performance measurement indicators for public health emergency preparedness (PHEP), to ensure knowledge generated is relevant and useful to the field.
The iKT approach was initiated by identifying a research question based on priorities from the field. The two phases of the study used participatory research methods as well as active engagement with potential end users at key study milestones. The Structured Interview Matrix (SIM) facilitation technique for focus groups and an expert panel using Delphi methodology were used to define the PHEP framework and performance measurement indicators, respectively. An advisory committee was assembled consisting of potential end-users of the research, in senior positions in applied and decision-making roles.
iKT was an essential component for this applied public health project, contributing to and enhancing the relevance of the knowledge generated. iKT contributed to the following: broad national engagement and interest in the study, successful recruitment in both phases, and engagement with decision-makers. This multi-dimensional participatory approach successfully generated knowledge that was important to the field demonstrated by relevance to practice and policy in jurisdictions across Canada. Furthermore, the approach fostered building resilience in local and national communities through collaboration.
The iKT approach was essential to generating knowledge that is relevant and useful to the field, mainly to promote health system preparedness and resilience. Future research to study the implementation of knowledge will be important to continue addressing the knowledge-to-action gap in health emergency management research.
The mouth may be presented and understood in different ways, be subject to judgement by others and, as we age, may intrude on everyday life due to problems that affect oral health. However, research that considers older people's experiences concerning their mouths and teeth is limited. This paper reports on qualitative research with 43 people in England and Scotland, aged 65–91, exploring the significance of the mouth over the lifecourse. It uses the concept of ‘mouth talk’ to explore narratives of maintaining, losing and replacing teeth. Participants engaged in ‘mouth talk’ to downplay the impact of the mouth, demonstrate socially appropriate ageing, and distance themselves from ‘real’ old age by retaining a moral identity and sense of self. They also found means to challenge dominant discourses of ageing in how they spoke about missing teeth. Referring to Leder's notion of ‘dys-appearance’ and Gilleard and Higgs’ work on the social imaginary of the fourth age, the study illustrates the ways in which ‘mouth talk’ can contribute to sustaining a sense of self in later life, presenting the ageing mouth, with and without teeth, as an absent presence. It also argues for the importance of listening to stories of the mouth in order to expand understanding of people's approaches to oral health in older age.
As a workforce evolves, it is important for employers to consider how trends and changes in the workforce have implications for organizational processes such as recruiting, selecting, training, and rewarding a cohort of workers (Costanza & Finkelstein, 2015). This article examines the practical aspects of workforce changes on organizations’ recruitment efforts. Particularly in the face of recruiting shortages, it is important to understand how to best to develop a large and qualified pool of applicants.
Many successful organisations consider Internet recruitment to be an important element of their recruitment strategy, in order to promote, attract, manage and inform applicants in what is seen to be a cost and time effective manner (Anderson, 2003; Bartram, 2000; Parry & Tyson, 2008). This article contributes to the understanding of this subject by considering the content and characteristics of online recruitment resources within the cruise industry with reference to the resultant attitudes and behaviours of prospective employees. This study sought to critically analyse the effectiveness of online resources to attract and inform future employees within the hotel sector of the cruise industry and make recommendations to employers in relation to developing practice. A research plan was formulated that aimed to take a multimethod approach to revealing practice and potential client perceptions. This approach included conducting a comparative analysis of cruise websites using a modified version of a conceptual e-recruiting model, as defined by Young and Foot (2005). In addition, a cruise industry recruitment specialist was interviewed to capture key contextual and strategic data. Thereafter, data from a focus group involving final year Cruise Management students from the University of Plymouth, were collected to highlight perceptions of online recruitment resources from the potential employees' perspective. The investigation reveals that many elements such as content usefulness, web site attractiveness and usability have a major influence on prospective employees' perceptions and opinions of a company or cruise brand and that cruise brands have yet to harness the full capability of the medium to best effect.
We have observed the existence of medium range order via fluctuation microscopy in amorphous silicon grown at 230°C. We hypothesize that this structure develops during the highly non-equilibrium growth process; high densities of ordered surface nuclei are produced which are subsequently buried and forced into an unfavorable energy state. These nm sized regions are distorted in the bulk due to strain, but remain topologically crystalline. In this work, we alter the growth energetics both at the surface and sub-surface during magnetron sputter film deposition with two kinds of particle bombardment, respectively: a controllable flux of low-energy (20eV) Ar+ ions, and higher energy (100eV) D vs. H neutrals. With this method, we demonstrate for the first time control over the intensity of this medium-range structural order at a constant substrate temperature as seen primarily with fluctuation electron microscopy, but also Raman scattering, spectroscopic ellipsometry, and SAXS. We suggest that these bombardments can increase adspecie surface mobility or drive local sub-surface restructuring (“kinetic annealing”), thus increasing or decreasing the size, density and/or strength of the ordered regions.
In 2006, the Midwest Invasive Plant Network's Research Committee conducted a web-based survey to help identify research needs and interactions between land managers and researchers working to manage invasive plants in the Midwest. Of 192 responses, 30% identified themselves as researchers and 70% identified themselves as managers. Researchers and managers rated working together on invasive plant issues as high or medium in importance, but neither group rated the current level of cooperation as high, with over 90% describing current cooperation as low or medium. Both groups self-associate, with 89% of researchers working with other researchers and 77% of managers working with other managers. “Lack of time” and “lack of money” were the main issues limiting researchers and land managers from working more closely together: money was a greater constraint for researchers and time was more important for land managers. To help researchers and land managers work more effectively together, both groups favored opportunities to develop research-based projects at land managers' sites, with funding from a cooperative grant program. Open-ended responses suggest that on-site experiments and demonstrations of management methods could help researchers and land managers interact more effectively. Researchers rated basic biology as more important than land managers did, but neither group judged testing theories of invasion as a high priority. “Social/political factors” and “risk assessment” were viewed as less important despite their clear relevance in the introduction and spread of invasive plants.
Dr. B is on the seventh day of his rotation as medical director of the intensive care unit (ICU) when he receives a referral call about a patient in emergency who needs ICU admission for ventilation support. Dr. B examines his ICU census and notes that not only are there no ICU beds available but there is also a request from a thoracic surgeon for an ICU bed for a patient currently in the observation room, and there is a request from a nearby hospital to transfer one of their patients to Dr. B's ICU.
Dr. C, a pediatrician, has been asked to chair her hospital drug formulary committee to examine new drugs and determine which ones should be provided from the hospital budget. She is aware that these decisions are complex and often controversial and is unsure how to proceed.
What is priority setting?
Priority setting involves deciding which resources to allocate to competing needs. It is a key component of every health system because, whether wealthy or poor, no system can afford to provide every service that it may wish to provide. Both publicly and privately funded systems have the challenge of delivering quality care within the limits of government budgets or enrollee and employer contributions.
Within health systems, priority setting occurs at each decision level: micro (at the bedside or in clinical programs), meso (in hospitals or regional institutions), and macro (at the system-wide level).
A hospital has faced significant resource constraints over the last five years. After making significant cuts in administrative costs, the hospital senior management team is exploring revenue-generating options to help fund its clinical programs. One option under consideration involves renting cafeteria space to a popular fast-food restaurant. In the past, hospital cardiologists and endocrinologists have opposed similar proposals on the grounds that offering fast food is inconsistent with the hospital's patient care mission and its national reputation in the treatment of cardiac disease and non-insulin-dependent diabetes. The Clinical Operations Committee, which includes clinical and administrative leaders from across the organization, considers whether it should support or oppose the current proposal.
Mr. A is a 62-year-old male, who presents at the emergency department with severe chest pain. Mr. A is stabilized and diagnostic tests indicate triple vessel coronary artery disease. Bypass surgery is recommended. Prior to admission, it is discovered that Mr. A is a non-resident on a short visit to his son, who immigrated four years ago. As a non-resident, Mr. A is not covered by the national public health insurance plan and he did not purchase medical insurance for his trip. Neither he nor his son has the financial resources to pay for the bypass surgery. Although Mr. A is sufficiently stable to survive a flight home, he would not have access to the necessary medical treatment in his home country. The treating clinician wonders if the hospital should cover the cost of the surgery.
Jennifer L. Gibson, Assistant Professor University of Toronto,
M. Dianne Godkin, Clinical Ethicist and Manager Center for Clinical Ethics Toronto, Canada,
C. Shawn Tracy, Research Associate, Primary Care Research Unit University of Toronto, Canada,
Susan K. MacRae, Deputy Director and the Director of the Clinical Ethics Fellowship University of Toronto, Canada
A large tertiary healthcare organization has a full-time clinical ethicist who is responsible for ethics consultation, education, policy development, and research. A recent accreditation survey identified a number of gaps in clinical ethics services across the organization. The clinical ethicist is already over-extended and is at risk of burning out. The Vice-President responsible for overseeing the ethics portfolio wonders what can be done to enhance support for the clinical ethicist, strengthen ethics capacity across the organization, and improve the overall effectiveness of clinical ethics services.
What is clinical ethics effectiveness?
The ultimate goal of any clinical ethics delivery model is improved patient care. As more healthcare resources are invested in clinical ethics services, questions are increasingly raised about whether these services are effective in improving the quality of patient care and whether they justify investments of limited healthcare resources. In this chapter, we identify some key challenges to existing clinical ethics delivery models and suggest four innovative strategies to improve effectiveness in clinical ethics services in healthcare organizations.
Since 1995, when James Tulsky and Ellen Fox convened the Conference on Evaluation of Case Consultation in Clinical Ethics (AHCPR, 1995), there has been a marked increase in scholarly attention to the study and evaluation of clinical ethics, particularly related to the ethics consultation component of clinical ethics (e.g., McClung et al., 1996; Orr et al., 1996; Schneiderman et al., 2000). This has been described as a new phase in the clinical ethics movement (Aulisio, 1999).
The isoflavone genistein is found predominantly in soyabeans and is thought to possess various potent biological properties, including anti-carcinogenic effects. Studies have shown that genistein is extensively degraded by the human gut microflora, presumably with a loss of its anti-carcinogenic action. The aim of the present study was to investigate the potential of a prebiotic to divert bacterial metabolism away from genistein breakdown: this may be of benefit to the host. Faecal samples were obtained from healthy volunteers and fermented in the presence of a source of soyabean isoflavones (Novasoy™ (10g/l); ADM Neutraceuticals, Erith, Kent, UK). Bacterial genera of the human gut were enumerated using selective agars and genistein was quantified by HPLC. The experiment was repeated with the addition of glucose (10g/l) or fructo-oligosaccharide (10g/l; FOS) to the fermentation medium. The results showed most notably that counts of Bifidobacterium spp. and Lactobacillus spp. were significantly increased (P<0·05 and P<0·01 respectively) under steady-state conditions in the presence of FOS. Counts of Bacteroides spp. and Clostridium spp. were, however, both significantly reduced (P<0·05) during the fermentation. A decline in genistein concentration by about 52 and 56% over the 120h culture period was observed with the addition of glucose or FOS to the basal medium (P<0·01), compared with about 91% loss of genistein in the vessels containing Novasoy™ (ADM Neutraceuticals) only. Similar trends were obtained using a three-stage chemostat (gut model), in which once again the degradation of genistein was about 22% in vessel one, about 24% in vessel two and about 26% in vessel three in the presence of FOS, compared with a degradation of genistein of about 67% in vessel one, about 95% in vessel two and about 93% in vessel three in the gut model containing Novasoy™ (ADM Neutraceuticals) only. The present study has shown that the addition of excess substrate appeared to preserve genistein in vitro. In particular, the use of FOS not only augmented this effect, but also conferred an additional benefit in selectively increasing numbers of purportedly beneficial bacteria such as bifidobacteria and lactobacilli.
The Maillard reaction produces coloured, macromolecular materials (melanoidins) in a variety of foods, on heating. Significant quantities may enter the human gut on a daily basis, but there is little information on their metabolism in the human colon. As the large bowel contains a diverse population of bacteria involved in normal bowel function, it is possible that melanoidins are metabolized therein. Depending on the bacteria involved, there may be disease or health implications. The aim of the present study was to use in vitro models to determine the digestibility of melanoidins and the effect of melanoidins on colonic bacteria in the gastrointestinal tract. Melanoidins were prepared and the effects of simulated upper-gut secretions on their stability determined in a model system. The effects of faecal bacteria were also determined, in batch culture, with a combination of phenotypic and genotypic (probes) criteria being used to identify the microbial diversity involved. Simulation of peptic and pancreatic digestion showed that the melanoidins did not produce detectable amounts of low-molecular-mass degradation products. However, melanoidins affected the growth of gut bacteria during mixed culture growth. The effect was to cause a non-specific increase in the anaerobic bacteria enumerated. This in vitro study indicates that melanoidins can affect the growth of human large-bowel bacteria and serves to demonstrate possible effects that may occur in vivo. Given the large and varied number of food items that contain Maillard reaction products, this may have relevance for lower-gut health.
In Christoph Wetzel's 1988 painting, An Everyday Story, the divided canvas proudly depicts women's accomplishments in the German Democratic Republic (Figure 1). On one side, a woman operates a large piece of heavy machinery in a rolling mill, cool and competent behind the enormous mass of metal and gears. On the other side, the same woman helps her two children prepare for school in the morning. In the act of combing her daughter's hair, she looks out directly at the viewer, her expression asking: “And what are you surprised at?” This painting, displayed as part of a 1995 exposition on art commissioned by government agencies in the GDR, graphically displays that government's ideological commitment to women's paid labor, especially in jobs that, in capitalist societies, are often thought to be inappropriate for women.
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