4,468 research outputs found

    Effective and proportionate implementation of the DMA

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    A new frontier for the study of the commons:Open-source hardware

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    A Tale of Two Incentives: How divergent incentives, for opportunism and restraint, collectively shape state behavior

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    This study explains how divergent incentives, for opportunism and restraint, shape state behavior. Divergent incentives arise when states exist within two Hobbesian systems that have different material structures. China, for example, is the second-ranked global power, but lacking an effective local counterweight, it remains unbalanced in East Asia. Thus, Beijing receives a restraining incentive from the international system and an opportunistic local incentive. Neorealism cannot explain how these incentives interact: because its principal theories employ extreme parsimony, to the point that they can only consider single incentives in isolation. Neorealism contains a useful metaphor though, that likens incentives to the Newtonian principle of force. Extending this metaphor in accordance with Newtonian mechanics, I create a framework for evaluating concurrent incentives. Since divergent incentives only occur under a single set of conditions, I use this framework to derive a theory-of-constraints that explains how regional aspirants should behave when they enjoy a local military advantage but face a more powerful extra-regional balancer. To this end, divergent incentives theory argues: 1) divergent incentives encourage moderated opportunism – a restrained power-maximizing behavior, that seeks incremental gains in a manner that minimizes the risks of escalation and retaliation; 2) divergent incentives facilitate challenges to the regional status quo, that do not end in voluntary withdrawal or hegemonic war; and 3) noncompliance with incentives has adverse consequences. The theory enjoys strong empirical support. Across three cases (the US ascent to regional hegemony, Japan’s quest for regional hegemony, and the Soviet menace to Europe), aspirants exhibited moderated opportunism in 24 of 26 instances, and in the other two, aspirants were punished relative to the extent of their noncompliance. Each case outcome was also broadly consistent with the theory’s expectations

    Authentic Alignment: Toward an Interpretative Phenomenological Analysis (IPA) informed model of the learning environment in health professions education

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    It is well established that the goals of education can only be achieved through the constructive alignment of instruction, learning and assessment. There is a gap in research interpreting the lived experiences of stakeholders within the UK learning environment toward understanding the real impact – authenticity – of curricular alignment. This investigation uses a critical realist framework to explore the emergent quality of authenticity as a function of alignment. This project deals broadly with alignment of anatomy pedagogy within UK undergraduate medical education. The thread of alignment is woven through four aims: 1) to understand the alignment of anatomy within the medical curriculum via the relationships of its stakeholders; 2) to explore the apparent complexity of the learning environment (LE); 3) to generate a critical evaluation of the methodology, Interpretative Phenomenological Analysis as an approach appropriate for realist research in the complex fields of medical and health professions education; 4) to propose a functional, authentic model of the learning environment. Findings indicate that the complexity and uncertainty inherent in the LE can be reflected in spatiotemporal models. Findings meet the thesis aims, suggesting: 1) the alignment of anatomy within the medical curriculum is complex and forms a multiplicity of perspectives; 2) this complexity is ripe for phenomenological exploration; 3) IPA is particularly suitable for realist research exploring complexity in HPE; 4) Authentic Alignment theory offers a spatiotemporal model of the complex HPE learning environment: the T-icosa

    Implementing Health Impact Assessment as a Required Component of Government Policymaking: A Multi-Level Exploration of the Determinants of Healthy Public Policy

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    It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level. The three integrated articles of this dissertation provide insights into specific aspects of the policy process as they relate to HIA. Chapter one details a case study of purposive information-seeking among public servants within Ontario’s Ministry of Education (MOE). Situated within Ontario’s Ministry of Health (MOH), chapter two presents a case study of policy collaboration between health and ‘non-health’ ministries. Finally, chapter three details a framework analysis of the political factors supporting health impact tool use in two sub-national jurisdictions – namely, QuĂ©bec and South Australia. MOE respondents (N=9) identified four components of policymaking ‘due diligence’, including evidence retrieval, consultation and collaboration, referencing, and risk analysis. As prospective HIA users, they also confirmed that information is not routinely sought to mitigate the potential negative health impacts of education-based policies. MOH respondents (N=8) identified the bureaucratic hierarchy as the brokering mechanism for inter-ministerial policy development. As prospective HIA stewards, they also confirmed that the ministry does not proactively flag the potential negative health impacts of non-health sector policies. Finally, ‘lessons learned’ from case articles specific to QuĂ©bec (n=12) and South Australia (n=17) identified the political factors supporting tool use at different stages of the policy cycle, including agenda setting (‘policy elites’ and ‘political culture’), implementation (‘jurisdiction’), and sustained implementation (‘institutional power’). This work provides important insights into ‘real life’ policymaking. By highlighting existing facilitators of and barriers to HIA use, the findings offer a useful starting point from which proponents may tailor context-specific strategies to sustainably implement HIA at the sub-national government level

    ADVANCING THE QUADRUPLE AIM IN MEDI-CAL MANAGED CARE: PROVIDER AND HEALTH PLAN LEADER PERSPECTIVES REGARDING THE INCLUSION OF PARAPROFESSIONALS ON CARE TEAMS FOR DEVELOPMENTAL SCREENING AND CARE COORDINATION

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    Problem Approximately 25% of Medi-Cal enrollees receive a developmental screening in the first three years of life, a rate below the 33% national benchmark (DHCS 2020). Medi-Cal providers cite limited time as a barrier to completing developmental screenings (First 5 LA 2017). Literature supports inclusion of unlicensed paraprofessionals on teams to increase developmental screening and service referral rates (Minkovitz 2003, Warmels 2017). An understanding of facilitators and barriers to adding paraprofessionals such as community health workers (CHWs) and care coordinators to teams can inform pediatric transformation initiatives. Research regarding workforce transformation strategies is pivotal as California advances a CHW Medi-Cal benefit in 2022 and prepares for a physician shortage (Chapman 2017, LAO 2021, Spetz 2017). Pediatric paraprofessionals could advance the “quadruple aim”- improving population health, enhancing patient experience, reducing per capita cost of health care, and improving clinician work life (Bodenheimer 2014). As the majority of Medi-Cal enrollees face health disparities, ensuring pediatric members with developmental concerns are routed to services could address the “quintuple aim,” which includes improving health equity (Nundy 2022).Methodology This mixed methods study analyzed 10 Medi-Cal providers’ and 10 Medi-Cal plan clinical leaders’ perceptions of facilitators and barriers impacting timely developmental screening and coordination to services and supports. The study then identified facilitators and barriers to shifting developmental screening and care coordination tasks to paraprofessionals. Results Medi-Cal provider and health plan informants were receptive to incorporating paraprofessionals on teams to perform select developmental screening and care coordination tasks. Facilitators included leaders committed to early identification and intervention (EII), a training and supervisory infrastructure, and software optimized for screenings and referrals. The major barrier was a perception of inadequate reimbursement. Few respondents perceived health plans as drivers of successful EII, suggesting an opportunity for California regulators to enforce screening and coordination requirements, fund pediatric workforce transformation, and route families to care coordination resources.Recommendations The research suggests major reimbursement needs to adequately support of developmental screening and care coordination tasks. Study findings can inform leaders pursuing pediatric workforce transformation initiatives in Medi-Cal. Additional qualitative research with paraprofessionals and families is warranted to refine workforce transformation approaches.Doctor of Public Healt

    Special Topics in Information Technology

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    This open access book presents thirteen outstanding doctoral dissertations in Information Technology from the Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy. Information Technology has always been highly interdisciplinary, as many aspects have to be considered in IT systems. The doctoral studies program in IT at Politecnico di Milano emphasizes this interdisciplinary nature, which is becoming more and more important in recent technological advances, in collaborative projects, and in the education of young researchers. Accordingly, the focus of advanced research is on pursuing a rigorous approach to specific research topics starting from a broad background in various areas of Information Technology, especially Computer Science and Engineering, Electronics, Systems and Control, and Telecommunications. Each year, more than 50 PhDs graduate from the program. This book gathers the outcomes of the thirteen best theses defended in 2020-21 and selected for the IT PhD Award. Each of the authors provides a chapter summarizing his/her findings, including an introduction, description of methods, main achievements and future work on the topic. Hence, the book provides a cutting-edge overview of the latest research trends in Information Technology at Politecnico di Milano, presented in an easy-to-read format that will also appeal to non-specialists
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