Rethinking fuelwood: people, policy and the anatomy of a charcoal supply chain in a decentralizing Peru

In Peru, as in many developing countries, charcoal is an important source of fuel. We examine the commercial charcoal commodity chain from its production in Ucayali, in the Peruvian Amazon, to its sale in the national market. Using a mixed-methods approach, we look at the actors involved in the commodity chain and their relationships, including the distribution of benefits along the chain. We outline the obstacles and opportunities for a more equitable charcoal supply chain within a multi-level governance context. The results show that charcoal provides an important livelihood for most of the actors along the supply chain, including rural poor and women. We find that the decentralisation process in Peru has implications for the formalisation of charcoal supply chains, a traditionally informal, particularly related to multi-level institutional obstacles to equitable commerce. This results in inequity in the supply chain, which persecutes the poorest participants and supports the most powerful actors

Building a Water Quality Trading Program: Options and Considerations

The United States has made significant progress in cleaning its rivers, lakes, and oceans. Investment in wastewater treatment plant technology, conservation practices with land managers, and restoration of natural systems is working in many places. The public supports clean water, yet there is still a long way to go in achieving the vision of fishable, swimmable waters. More than half of the country's streams, lakes, and estuaries are not meeting the water quality standards established under the Clean Water Act to provide clean drinking water, recreation, fish and wildlife habitat, and other designated uses.The work that lies ahead to achieve clean water will require additional tools and new approaches that can account for watershed dynamics, allow flexibility on how to achieve clear, enforceable goals, and target investment where it can most effectively improve water quality. Water quality trading, under the right conditions, can fit these criteria

Summary of WTC Health Program research : NIOSH research compendium

"This research compendium describes the World Trade Center Research Program and the extraordinary contribution of researchers, responders, and survivors in providing research information necessary to ensure excellence in the clinical care for the population affected by the 9/11 attacks. It is intended as a resource to assist the WTC Health Program staff with activities such as planning future research directions, assessing the impact of current studies, identifying gaps in the research, and coordinating external program reviews." - NIOSHTIC-2NIOSH number 20054311WTC_Health_Program_Research_Compendium_November_2018_1.2.pdf201

Topics in construction safety and health : lead : an interdisciplinary annotated bibliography

"These referenced articles provide literature on lead exposures of workers in the construction industry and the possible health effects they experience from these exposures." - NIOSHTIC-2NIOSHTIC no. 20068250Production of this document was supported by cooperative agreement OH 009762 from the National Institute for Occupational Safety and Health (NIOSH). The contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH.Lead-annotated-bibliography.pdfcooperative agreement OH 009762 from the National Institute for Occupational Safety and Healt

Summary of WTC Health Program research : NIOSH research compendium 20/21 August

Suggested citation: Kubale T, Katruska A, Brown EP, Santiago-Col\uf3n A, Daniels RD, Reissman DB [2021]. Summary of World Trade Center Health Program research: NIOSH research compendium. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health:1\u2013595.Summary-of-WTC-Health-Program-Research-2021-03282022.pd

Barriers to clinical adoption of next generation sequencing: Perspectives of a policy Delphi panel

AbstractThis research aims to inform policymakers by engaging expert stakeholders to identify, prioritize, and deliberate the most important and tractable policy barriers to the clinical adoption of next generation sequencing (NGS). A 4-round Delphi policy study was done with a multi-stakeholder panel of 48 experts. The first 2 rounds of online questionnaires (reported here) assessed the importance and tractability of 28 potential barriers to clinical adoption of NGS across 3 major policy domains: intellectual property, coverage and reimbursement, and FDA regulation. We found that: 1) proprietary variant databases are seen as a key challenge, and a potentially intractable one; 2) payer policies were seen as a frequent barrier, especially a perceived inconsistency in standards for coverage; 3) relative to other challenges considered, FDA regulation was not strongly perceived as a barrier to clinical use of NGS. Overall the results indicate a perceived need for policies to promote data-sharing, and a desire for consistent payer coverage policies that maintain reasonably high standards of evidence for clinical utility, limit testing to that needed for clinical care decisions, and yet also flexibly allow for clinician discretion to use genomic testing in uncertain circumstances of high medical need

Communication in sudden-onset major incidents. Patterns and challenges. A scoping review.

Major incidents and disasters are rare occurrences that challenge society and health care systems substantially. The mobilization of extraordinary resources calls for robust preparedness plans, regular training and funding. Command & control is essential in major incident management. To achieve, maintain and execute command & control, communication within emergency medical services and between authorities involved in major incident and disaster management is paramount. The main aim of the master thesis is to explore communication between emergency medical services professionals in sudden-onset major incidents in a broader perspective. The thesis focuses on previous patterns and challenges in communication to provide policymakers with data for the improvement of future major incident preparedness. A scoping review of existing scientific and non-indexed literature describing communication in sudden-onset major incidents provides the sources of information in the thesis. Based on the included literature, this scoping review has found that the patterns in major incident communication are frequent breakdown with potential and actual consequences for patient survival, outcome and management and for the expedited return to a normal state. The challenges in major incident communication are predominantly inter-authority communication difficulties, system overload and lack of introduction and training in the use of communication devices. Cross-border incidents challenge communication substantively. The scoping review has shown that focus has been on describing the operational and tactical approach in sudden-onset major incidents and that communication challenges have not been assessed systematically. A general agreement that communication has been challenging exists; however, it remains mainly unquantified and improvised means of communication have been used extensively

Invasive mediastinal nodal staging of resectable non-small cell lung cancer

Patients with resectable non-small cell lung cancer and increased risk of mediastinal nodal involvement require invasive staging to exclude patients with N2-3 metastases for surgical resection. The current guidelines recommend endosonography as initial staging procedure followed by confirmatory mediastinoscopy in case of absence of N2-3 metastases after endosonography. The role of confirmatory mediastinoscopy is however under debate due to its limited additional diagnostic value and its associated morbidity, hospital admission and delay in definite lung cancer treatment.The first part of the thesis focusses on the daily practice of invasive mediastinal nodal staging and adherence to the (inter)national guidelines. We performed a multicenter retrospective analysis, a nationwide Dutch Lung Cancer Audit analysis and a nationwide Netherlands Cancer Registry analysis which showed poor adherence to the guidelines regarding performance of endosonography followed by confirmatory mediastinoscopy. The use of endosonography significantly increased over the years, while the use of mediastinoscopy decreased, despite these changes unforeseen N2 metastases after resection remained stable.The second part focusses on the value of confirmatory mediastinoscopy after tumor negative endosonography. A patient preferences study showed that the length of the staging period was significantly the most important attribute. A meta-analysis showed comparable unforeseen N2 results after staging by endosonography with or without confirmatory mediastinoscopy. The randomised MEDIASTrial ultimately showed that on the basis of non-inferiority in unforeseen N2 (as surrogate marker of clinically relevant diagnostic accuracy) confirmatory mediastinoscopy after negative systematic endosonography can be omitted in patients with resectable NSCLC and an indication for mediastinal staging

Supporting and Scaling Change: Lessons From the First Round of the Investing in Innovation (i3) Program

Assesses the degree to which the i3 program helped advance innovation in public education. Outlines takeaways, challenges, and recommendations for the Education Department and grantmakers, including optimizing support for different stages of innovation

Sickness absence among patients with chronic pain in Swedish specialist healthcare

Background: Chronic pain beyond three months is a global public health problem. Every third adult suffers from a chronic pain condition, resulting in a socioeconomic burden that corresponds to 3-10% of gross domestic product in western economies. This burden can be largely attributed to absenteeism-related productivity loss where a few highly impaired individuals are the most resource-intensive. Simultaneously, a detailed overview of sickness absence (SA) associated with chronic pain is complicated by incongruent classification due to conflicting perspectives on the condition as either a symptom or a disease in its own right. Aim: Based on a well-defined chronic pain population in the Swedish specialist healthcare, this thesis primarily aims to provide a SA overview, to explore the possibility of SA prevention, and to evaluate interdisciplinary treatment (IDT) as a SA intervention. A secondary objective was to assess the psychometric properties of three questionnaires that measure the core domains of the chronic pain experience. Methods: The aims were addressed in three register-based studies using microdata from five Swedish national registers. Study I used sequence analysis to describe SA in 44,241 patients over a 7-year period and subsequently developed a machine learning-based model to predict chronic pain-related SA in the final two years. Study II emulated a target trial to compare the total SA duration over a 5-year period for 25,613 patients that were either included in an IDT program or in other/no interventions. Study III analyzed the properties of the Short Form-36 Health Survey (SF-36), the EuroQol 5-Dimensions instrument (EQ-5D), and the Hospital Anxiety and Depression Scale (HADS) within the item response theory-framework. Results: SA increased from 17% to 48% over the five years before specialist healthcare entry to then decrease to 38% over the final two years. With information on eight predictors, it was possible to discriminate between patients that would have low or high SA in the coming two years with 80% accuracy. SA trends were similar for patients in IDT programs and other/no interventions, albeit the IDT patients had 67 (95% CI: 48, 87) more SA days over the complete 5-year period. Finally, the psychometric evaluation revealed that SF-36 adequately captured physical and mental health, while HADS was suitable as a measure of overall emotional distress, and EQ-5D had insufficient precision for any meaningful application. Conclusion: Our findings are most useful to guide policy and research. SA in the studied patients remained high over the entire observation period. Decision support tools could prove valuable in identifying patients at risk of high SA earlier in the healthcare chain in order to direct preventative measures. We found no support for IDT decreasing SA more than other/no interventions, but it is possible that this was a consequence of our methodology. Further studies of the IDT effects are needed, but uncontrolled designs that attribute SA change over time to IDT are inappropriate for this purpose, as the SA peak observed around specialist healthcare entry is likely to be driven by the referral procedure. Finally, SF-36 and HADS are psychometrically sound measures of the chronic pain experience core domains