Departures from cost-effectiveness recommendations: The impact of health system constraints on priority setting

The methods and application of cost-effectiveness analysis have reached an advanced stage of development. Many decision makers consider cost-effectiveness analysis to be a valid and feasible approach towards setting health priorities, and it has been extensively applied in evaluating interventions and developing evidence based clinical guidelines. However, the recommendations arising from cost-effectiveness analysis are often not implemented as intended. A fundamental reason for the failure to implement is that CEA assumes a single constraint, in the form of the budget constraint, whilst in reality decision-makers may be faced with numerous other constraints. The objective of this paper is to develop a typology of constraints that may act as barriers to implementation of cost-effectiveness recommendations. Six categories of constraints are considered: the design of the health system; costs of implementing change; system interactions between interventions; uncertainty in estimates of costs and benefits; weak governance; and political constraints. Where possible -and if applicable- for each class of constraint, the paper discusses ways in which these constraints can be taken into account by a decision maker wishing to pursue the principles of cost-effectiveness

Intergroup reconciliation between Flemings and Walloons : the predictive value of cognitive style, authoritarian ideology, and intergroup emotions

Testifying to the gap in fundamental research on positive intergroup outcomes, we investigated reconciliation attitudes in a non-violent intergroup context (i.e., the linguistic conflict in Belgium). By incorporating both important predictors of negative outgroup attitudes (i.e., individual differences in rigid cognitive styles and authoritarian ideologies), and important predictors of reconciliation (i.e., intergroup emotions), we aimed to contribute to a more comprehensive theoretical framework for the analysis of intergroup relations. We recruited one Flemish ('N' = 310) and one Walloon ('N' = 365) undergraduate students sample to test the proposed model. Structural equation analyses with maximum likelihood estimation were conducted using the Lavaan package. In both samples, similar patterns were found. More in particular, the need for cognitive closure appeared to be the basic predictor of right-wing attitudes (i.e., right-wing authoritarianism and social dominance orientation) and essentialist thinking, which were then associated with less outgroup empathy and trust, and more outgroup anger. Furthermore, outgroup trust and empathy were positively related to reconciliation. Interestingly, some differences between the Flemish and Walloon sample were found, such as the direct effects of need for closure and social dominance orientation in the first sample, and the non-significant effects of essentialism in the latter sample. Considering the ongoing public and political debate about the linguistic conflict in Belgium, these findings shed a new light on how individual differences relate to specific outgroup emotions, and how these are associated with important intergroup outcomes in the face of intergroup conflict

SensorCloud: Towards the Interdisciplinary Development of a Trustworthy Platform for Globally Interconnected Sensors and Actuators

Although Cloud Computing promises to lower IT costs and increase users' productivity in everyday life, the unattractive aspect of this new technology is that the user no longer owns all the devices which process personal data. To lower scepticism, the project SensorCloud investigates techniques to understand and compensate these adoption barriers in a scenario consisting of cloud applications that utilize sensors and actuators placed in private places. This work provides an interdisciplinary overview of the social and technical core research challenges for the trustworthy integration of sensor and actuator devices with the Cloud Computing paradigm. Most importantly, these challenges include i) ease of development, ii) security and privacy, and iii) social dimensions of a cloud-based system which integrates into private life. When these challenges are tackled in the development of future cloud systems, the attractiveness of new use cases in a sensor-enabled world will considerably be increased for users who currently do not trust the Cloud.Comment: 14 pages, 3 figures, published as technical report of the Department of Computer Science of RWTH Aachen Universit

Actions speak louder than words: designing transdisciplinary approaches to enact solutions

Sustainability science uses a transdisciplinary research process in which academic and non-academic partners collaborate to identify a common problem and co-produce knowledge to develop more sustainable solutions. Sustainability scientists have advanced the theory and practice of facilitating collaborative efforts such that the knowledge created is usable. There has been less emphasis, however, on the last step of the transdisciplinary process: enacting solutions. We analyzed a case study of a transdisciplinary research effort in which co-produced policy simulation information shaped the creation of a new policy mechanism. More specifically, by studying the development of a mechanism for conserving vernal pool ecosystems, we found that four factors helped overcome common challenges to acting upon new information: creating a culture of learning, co-producing policy simulations that acted as boundary objects, integrating research into solution development, and employing an adaptive management approach. With an increased focus on these four factors that enable action, we can better develop the same level of nuanced theoretical concepts currently characterizing the earlier phases of transdisciplinary research, and the practical advice for deliberately designing these efforts

Decision makers\u27 experience of participatory dynamic simulation modelling: Methods for public health policy

Background: Systems science methods such as dynamic simulation modelling are well suited to address questions about public health policy as they consider the complexity, context and dynamic nature of system-wide behaviours. Advances in technology have led to increased accessibility and interest in systems methods to address complex health policy issues. However, the involvement of policy decision makers in health-related simulation model development has been lacking. Where end-users have been included, there has been limited examination of their experience of the participatory modelling process and their views about the utility of the findings. This paper reports the experience of end-user decision makers, including senior public health policy makers and health service providers, who participated in three participatory simulation modelling for health policy case studies (alcohol related harm, childhood obesity prevention, diabetes in pregnancy), and their perceptions of the value and efficacy of this method in an applied health sector context. Methods: Semi-structured interviews were conducted with end-user participants from three participatory simulation modelling case studies in Australian real-world policy settings. Interviewees were employees of government agencies with jurisdiction over policy and program decisions and were purposively selected to include perspectives at different stages of model development. Results: The ‘co-production’ aspect of the participatory approach was highly valued. It was reported as an essential component of building understanding of the modelling process, and thus trust in the model and its outputs as a decision-support tool. The unique benefits of simulation modelling included its capacity to explore interactions of risk factors and combined interventions, and the impact of scaling up interventions. Participants also valued simulating new interventions prior to implementation in the real world, and the comprehensive mapping of evidence and its gaps to prioritise future research. The participatory aspect of simulation modelling was time and resource intensive and therefore most suited to high priority complex topics with contested options for intervening. Conclusion: These findings highlight the value of a participatory approach to dynamic simulation modelling to support its utility in applied health policy settings

Thought for Food: the impact of ICT on agribusiness

This report outlines the impact of ICT on the food economy. On the basis of a literature review from four disciplines - knowledge management, management information systems, operations research and logistics, and economics - the demand for new ICT applications, the supply of new applications and the match between demand and supply are identified. Subsequently the impact of new ICT applications on the food economy is discussed. The report relates the development of new technologies to innovation and adoption processes and economic growth, and to concepts of open innovations and living lab

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

eCustoms Case Study: Mechanisms behind Co-operation Planning

Members of existing e-commerce trading networks constantly assess their network to identify opportunities for increased co-operation and integration of e-commerce IT systems. Failing to identify the mechanisms involved in co-operation compromises correct investment decisions. In this paper, we use Systems Thinking as a reasoning model that helps decision makers to uncover such mechanisms. We use Systems Thinking to analyse a real-world case called eCustoms, an inter-organisational network of customs organisations. The resulting model explains the mechanism of planning co-operation in terms of a feedback loop that comprises political support, operational potential, and information flow. This mechanism also explains why it is important to select potential partners for closer co-operation as early as possible, the importance of willingness to participate, and the gain or loss of decision power that joining a network implies