Linking Research and Policy: Assessing a Framework for Organic Agricultural Support in Ireland

This paper links social science research and agricultural policy through an analysis of support for organic agriculture and food. Globally, sales of organic food have experienced 20% annual increases for the past two decades, and represent the fastest growing segment of the grocery market. Although consumer interest has increased, farmers are not keeping up with demand. This is partly due to a lack of political support provided to farmers in their transition from conventional to organic production. Support policies vary by country and in some nations, such as the US, vary by state/province. There have been few attempts to document the types of support currently in place. This research draws on an existing Framework tool to investigate regionally specific and relevant policy support available to organic farmers in Ireland. This exploratory study develops a case study of Ireland within the framework of ten key categories of organic agricultural support: leadership, policy, research, technical support, financial support, marketing and promotion, education and information, consumer issues, inter-agency activities, and future developments. Data from the Irish Department of Agriculture, Fisheries and Food, the Irish Agriculture and Food Development Authority (Teagasc), and other governmental and semi-governmental agencies provide the basis for an assessment of support in each category. Assessments are based on the number of activities, availability of information to farmers, and attention from governmental personnel for each of the ten categories. This policy framework is a valuable tool for farmers, researchers, state agencies, and citizen groups seeking to document existing types of organic agricultural support and discover policy areas which deserve more attention

Academic Health Science Centers and Health Disparities: A Qualitative Review of the Intervening Role of the Electronic Health Record and Social Determinants of Health

Literature on the magnitude of negative health outcomes from health disparities is voluminous. Defined as the health effects of racism, environmental injustice, forms of discrimination, biases in science, and sociological or socioeconomic predictors across populations, health disparities are part of an ongoing and complicated national problem that health equity programs are specifically designed to address. Academic Health Science Centers (AHC) institutions are a complex and unique educational-healthcare ecosystem that often serves as a safety net for patients in vulnerable and lower-income communities. These institutions are often viewed as one of the most uniquely positioned entities in the U.S. with an abundance of resources and networks to advance health equity as a high-impact goal and strategic imperative. Relatively little progress, however, has been made to better understand the potentially transformative nature of how digital health technologies (DHT)—such as mobile health apps, electronic health record (EHR) and electronic medical record (EMR) systems, smart ‘wearable’ devices, artificial intelligence, and machine learning—may be optimized to better capture and analyze social determinants of health (SDH) data elements in order to inform strategies to address health disparities. Even less has been explored about the challenging implementation of electronic SDH screening and data capture processes within AHCs and how they are used to better inform decisions for patient and community care. This research examines how AHC institutions, as complex education-healthcare bureaucracies, have prioritized this specific challenge amongst many other competing incentives and agendas in order to ultimately develop better evidence-based strategies to advance health equity. While there are clear moral, ethical, and clinical motives for improving health outcomes for vulnerable populations, when an AHC demonstrates that electronically screening and capturing SDH can improve the ability to understand the “upstream” factors impacting their patients\u27 health outcomes, this can inform and influence policy-level choices in government legislation directed at community-level factors. A qualitative thematic analysis of interview data from AHC administrators and leadership illustrates how AHCs have mobilized their EHR as a featured component of their healthcare delivery system to address health disparities, exposing other related, multifactorial dimensions of the Institution and region. Key findings indicated that: electronic SDH screening and updating workflow processes within an AHC’s clinical enterprise is a significant venture with multiple risks and the potential of failure. Universal adoption and awareness of SDH screening is hampered by notions of hesitancy, skepticism, and doubt as to an AHC’s ability to meaningfully extract and use the data for decision-support systems. Additional investment in resources and incentive structures for capturing SDH are needed for continued monitoring of patient health inequalities and community social factors. Data from this and future replicated studies can be used to inform AHC and government decisions around health and social protection, planning, and policy

Investigating opportunities for sustainability behaviours within Paramedic and Ambulance Service practice

The National Health Service (NHS) is under increasing pressure to adopt radical strategies for change, in order to meet UK national targets of net zero emissions by 2050. This thesis aimed to explore and investigate sustainability behaviours of UK ambulance service personnel and how they contribute to a reduce, re-use, recycle (RRR) ethos. Phase one, a systematic literature review (n=114 studies) explored sustainability in Emergency Medical Services (EMS). Phase two phenomenological study explored the role and experiences of NHS ambulance strategic managers (n=6 participants) in England, when implementing their organisational Green Plans. Phase three ethnographical observation explored the sustainability activities, attitudes and behaviours of operational ambulance personnel within two English NHS ASTs (n= 66 participants). Phase one findings identified that rising global temperatures, caused by worldwide carbon emissions, will place an amplified demand on EMS, through an increase in morbidity and mortality rates. It also showed a dearth of empiric sustainability research involving UK ambulance services. Phase two findings revealed an insight into the Sustainability Managers’ challenges of implementing sustainability policy, the factors that incentivise change, staff resistance and tactics to overcome it, short-term and long-term aims, and their opinions with future objectives. Phase three observational findings discovered a diversity of sustainability attitudes and behaviours amongst the staff, where three behavioural groups were identified: firstly, those who were already sustainability pro-active, secondly, those who were willing in attitude, but lacked the facilities, resources, support or means to apply behavioural changes in their practice and finally, those yet to be convinced to adjust towards sustainability behaviours. This thesis provides an original and valuable insight into the sustainability and carbon reduction strategies employed within EMS organisations. Further opportunities may be generated from the findings, which could lead to cost savings across other EMS settings and the wider business communities globally

Records management and the accountability of governance

Governance is the process by which power and authority are exercised in a society by which government, the private sector, and citizens' groups articulate their interests, mediate their differences, and exercise their legal rights and obligations. Governance in public organisations is different from that in private organisations as they both possess different types of institutional stakeholders. Governments are directly answerable to the public. Therefore, it is essential for governments to be transparent in order to avoid any triggers in the accountability process that might adversely affect people's trust. The proper creation, capture, distribution and preservation of judicial evidence in the form of records can help avoid these problems. A trusted government is one that can demonstrate its accountability and transparency and is continually striving to improve value delivery and increase cost-effectiveness. The freedom of information demands governments to be more transparent and accountable for their actions and decisions. Whilst governments promote corporate governance to provide transparency and objectivity it can only give stakeholders better tools to do their job, it does not and cannot do it for them. The need for managing risk and audit culture is imperative to balance and satisfy the expectation of citizen and stakeholders. The accountability of a government can arguably only be achieved when it demonstrates considerable transparency, which in turn can only happen when trust is supported by authentic and reliable records. The records management community claims that records have to be preserved for accountability, but they rarely explore what 'accountability' is and what role records play in the accountability processes. In addition, the contribution of records management to good governance and accountability are often not recognised by other professions and management. In an age where corporate governance and transparency is a global agenda, it is imperative for the records management community to scrutinise their present role and approach in order to change the perception by other professions about their contribution towards achieving organisational goals in a highly regulated and compliant bound environment in the public and private sectors. The contention of this thesis is that record keeping is just a tool that ensures the availability of evidence for the accountability of governance, which in turn relies on the ethical standard of those involved

A Sustainability planning guide for healthy communities

"The Sustainability Planning Guide is a synthesis of science- and practice-based evidence designed to help coalitions, public-health professionals, and other community stakeholders develop, implement, and evaluate a successful sustainability plan. The Guide provides a process for sustaining policy strategies and related activities, introduces various approaches to sustainability, and demonstrates sustainability planning in action with real-life examples." - p. 7Section 1: Sustaining coalition efforts -- Section 2: Sustainability approaches (Summaries) -- Section 3: Sustainability approaches (Modules) -- Section 4: AppendixDate from document properties.CDC's Healthy Communities Program maintained by the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion."In October 2003, as part of the U.S. Department of Health and Human Services' Steps to a HealthierUS initiative (Steps), the CDC began funding communities nationwide through 5-year cooperative agreements, with YMCA of the USA (Y-USA) as a national partner. Building on successes and lessons learned from Steps, CDC broadened its investment in communities through the creation of CDC's Healthy Communities Program in January 2009. To date, more than 300 communities nationwide have been selected by CDC to implement policy, systems, and environmental change (PSE) strategies. CDC's Healthy Communities Program works with these communities, as well as with state and local health departments and national partners, to help create a culture of healthy living while building national networks for sustainable change." - 6Mode of access: Internet from the CDC web site as an Acrobat .pdf file (1.17 MB, 112 p.).Includes bibliographical references (p. 106-112)

The Design, implementation and Evaluation of a Technology Solution to Improve Discharge Planning Communication in a Complex Patient Population

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges. Following a complete assessment of the current discharge planning process, a web-based interactive discharge checklist was designed, implemented and evaluated in the attempt to provide guided communications to the essential partners of the patient’s team in an effort to reduce LOS and readmissions. After a six-month rollout of the new technology and concomitant procedures, the analyses revealed improvement in both the patient’s perception of discharge planning and the ability to discharge patients by noon. Results for LOS and readmission demonstrated inconsistent improvement. The use of an electronic checklist as a communication tool did reduce variability in discharge procedures and provided for continuity in handoff communication between team members. Staff agreed it promoted continuity and improved efficiency

A New Paradigm for Ministry in the World: Spiritual Care Services of Maine

With dwindling church attendance in the State of Maine, people’s spiritual needs are often unattended to, especially in times of struggle. Clergy are serving shrinking congregations with shrinking budgets, leading to reduced hours. They don’t often have time to provide pastoral care to their flock, let alone people outside of their flock. This project creates a mechanism to organize a chaplain team and make them available by contract to organizations and their staff and clients. I have conceptualized, designed, and birthed a community-based per diem chaplain/spiritual care organization that can match the world’s soulful need with professional, competent chaplains. The initial focus of the project identified this same problem but approached the solution by creating a training program that would place chaplain trainees in community-based organizations (cbos) to meet the need for ministry in the world. As I moved the idea from concept to design, a stakeholder pointed out that the need in the community-based organizations would continue after the chaplain trainee had completed their unit of training and moved on. I realized that my project could have a greater impact if it addressed placing professionally trained chaplains and spiritual care givers in organizations on a longer-term basis beyond the 400 hours of a unit of clinical pastoral education/training. The project transformed into creating and launching a nonprofit organization to provide a contracting mechanism to place professional, compassionate, clinically trained clergy in service of outside organizations. The benchmarks were based on creating a nonprofit to act as a contracting mechanism to recruit and screen ministers and chaplains with clinical training to provide care in community-based organizations. This project portfolio will detail my journey from discovery, design, prototype, and project for launching Spiritual Care Services of Maine

Commonwealth Fund 2012 Annual Report

Working toward the goal of a high performance health care system for all Americans, the Fund builds on its long tradition of scientific inquiry, a commitment to social progress, partnership with others who share common concerns, and the innovative use of communications to disseminate its work. The 2012 Annual Report offers highlights of the Fund's activities in the past year

Possible futures of health technologies for South Africa towards 2035

The purpose of this treatise is to develop four alternative scenarios for Possible Futures of Health Technologies for South Africa towards 2035. A desired future in the form of a future vision will be presented as well as recommendations made to the relevant decision-making stakeholders for implementation. This study employs a futures studies methodology known as the Six Pillars used in mapping the present and future, further deepening and broadening the future through the development of scenarios, and lastly, transforming the future by tapering it down to the preferred vision. The four scenarios in this study are informed by current affairs, a qualitative study with industry experts as well as global views and research. The scenarios are as follows: ‘Health Technology Hub’, which is the ‘best case’ scenario, to which the country aspires; ‘Medicating Backwards’, the ‘worst case’ scenario, in which everything turns negative; ‘Frozen Revolution’, in which no change occurs, making it ‘business as usual’ and ‘Trans-humans’, the outlier future based on a disruptive or emerging issue. The way the world works is changing rapidly due to disruptive technologies. Demographic shifts such as the high birth rate in Africa will bring about opportunities for the economy. Health technologies, for this study, is regarded as the application of knowledge and skills in the form of devices, medicines, vaccines, procedures and systems as well as the convergence of digital technologies with health to improve the efficiency of healthcare delivery, solve health issues, offer personalised medicines and improve the quality of lives. Technologies such as artificial intelligence (AI), virtual reality (VR), Internet of Things (IoT), 3D printing, robotics, nanotechnology are seen as the next disruptors. Healthcare in Africa is under pressure to transform, and future trends that stem from the Fourth Industrial Revolution will need to provide innovative, affordable, accessible, good quality, efficient and sustainable solutions. Along with these technologies comes the factors such as the fear of the impact on jobs, inequality, privacy, security and healthcare in South Africa. The outcomes of the extensive analysis of futures studies in this study provide credibility to the argument that current planning for the future of health technologies in South Africa needs intense modifications. The development of insightful plausible futures is essential to the planning process and is seen to be an effective strategic tool employed by businesses. It is the responsibility of private and public sectors to ascertain which path is preferred and what decisions need to be made to ensure that vision is realised and that SA progresses toward economic growth and sustainable development. The ‘Future Vision of Health Technologies in South Africa Towards 2035’ is attainable if all stakeholders agree to work collaboratively, communicate transparently, educate the people of the land, regulate appropriately, build trust, increase innovation, include communities and share the purpose

Manager’s and citizen’s perspective of positive and negative risks for small probabilities

So far „risk‟ has been mostly defined as the expected value of a loss, mathematically PL, being P the probability of an adverse event and L the loss incurred as a consequence of the event. The so called risk matrix is based on this definition. Also for favorable events one usually refers to the expected gain PG, being G the gain incurred as a consequence of the positive event. These “measures” are generally violated in practice. The case of insurances (on the side of losses, negative risk) and the case of lotteries (on the side of gains, positive risk) are the most obvious. In these cases a single person is available to pay a higher price than that stated by the mathematical expected value, according to (more or less theoretically justified) measures. The higher the risk, the higher the unfair accepted price. The definition of risk as expected value is justified in a long term “manager‟s” perspective, in which it is conceivable to distribute the effects of an adverse event on a large number of subjects or a large number of recurrences. In other words, this definition is mostly justified on frequentist terms. Moreover, according to this definition, in two extreme situations (high-probability/low-consequence and low-probability/high-consequence), the estimated risk is low. This logic is against the principles of sustainability and continuous improvement, which should impose instead both a continuous search for lower probabilities of adverse events (higher and higher reliability) and a continuous search for lower impact of adverse events (in accordance with the fail-safe principle). In this work a different definition of risk is proposed, which stems from the idea of safeguard: (1Risk)=(1P)(1L). According to this definition, the risk levels can be considered low only when both the probability of the adverse event and the loss are small. Such perspective, in which the calculation of safeguard is privileged to the calculation of risk, would possibly avoid exposing the Society to catastrophic consequences, sometimes due to wrong or oversimplified use of probabilistic models. Therefore, it can be seen as the citizen‟s perspective to the definition of risk