7,860 research outputs found

    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, Québec 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 Québec (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

    Towards a more just refuge regime: quotas, markets and a fair share

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    The international refugee regime is beset by two problems: Responsibility for refuge falls disproportionately on a few states and many owed refuge do not get it. In this work, I explore remedies to these problems. One is a quota distribution wherein states are distributed responsibilities via allotment. Another is a marketized quota system wherein states are free to buy and sell their allotments with others. I explore these in three parts. In Part 1, I develop the prime principles upon which a just regime is built and with which alternatives can be adjudicated. The first and most important principle – ‘Justice for Refugees’ – stipulates that a just regime provides refuge for all who have a basic interest in it. The second principle – ‘Justice for States’ – stipulates that a just distribution of refuge responsibilities among states is one that is capacity considerate. In Part 2, I take up several vexing questions regarding the distribution of refuge responsibilities among states in a collective effort. First, what is a state’s ‘fair share’? The answer requires the determination of some logic – some metric – with which a distribution is determined. I argue that one popular method in the political theory literature – a GDP-based distribution – is normatively unsatisfactory. In its place, I posit several alternative metrics that are more attuned with the principles of justice but absent in the political theory literature: GDP adjusted for Purchasing Power Parity and the Human Development Index. I offer an exploration of both these. Second, are states required to ‘take up the slack’ left by defaulting peers? Here, I argue that duties of help remain intact in cases of partial compliance among states in the refuge regime, but that political concerns may require that such duties be applied with caution. I submit that a market instrument offers one practical solution to this problem, as well as other advantages. In Part 3, I take aim at marketization and grapple with its many pitfalls: That marketization is commodifying, that it is corrupting, and that it offers little advantage in providing quality protection for refugees. In addition to these, I apply a framework of moral markets developed by Debra Satz. I argue that a refuge market may satisfy Justice Among States, but that it is violative of the refugees’ welfare interest in remaining free of degrading and discriminatory treatment

    Simulation and Optimization of Scheduling Policies in Dynamic Stochastic Resource-Constrained Multi-Project Environments

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    The goal of the Project Management is to organise project schedules to complete projects before their completion dates, specified in their contract. When a project is beyond its completion date, organisations may lose the rewards from project completion as well as their organisational prestige. Project Management involves many uncertain factors such as unknown new project arrival dates and unreliable task duration predictions, which may affect project schedules that lead to delivery overruns. Successful Project Management could be done by considering these uncertainties. In this PhD study, we aim to create a more comprehensive model which considers a system where projects (of multiple types) arrive at random to the resource-constrained environment for which rewards for project delivery are impacted by fees for late project completion and tasks may complete sooner or later than expected task duration. In this thesis, we considered two extensions of the resource-constrained multi-project scheduling problem (RCMPSP) in dynamic environments. RCMPSP requires scheduling tasks of multiple projects simultaneously using a pool of limited renewable resources, and its goal usually is the shortest make-span or the highest profit. The first extension of RCMPSP is the dynamic resource-constrained multi-project scheduling problem. Dynamic in this problem refers that new projects arrive randomly during the ongoing project execution, which disturbs the existing project scheduling plan. The second extension of RCMPSP is the dynamic and stochastic resource-constrained multi-project scheduling problem. Dynamic and stochastic represent that both random new projects arrivals and stochastic task durations. In these problems, we assumed that projects generate rewards at their completion; completions later than a due date cause tardiness costs, and we seek to maximise average profits per unit time or the expected discounted long-run profit. We model these problems as infinite-horizon discrete-time Markov decision processes

    'There's lots of suffering in here, but some people are suffering more': Age, Gender and the Pains of Imprisonment

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    Older offenders are the fastest growing group in the prison population in England and Wales. While most age groups of prisoners have been falling the number of prisoners over the age of 50 has continued to increase. Older prisoners have different needs to the general prison population; however, at the time of writing, the government has yet to implement a policy outlining standards of care for this group of prisoners. This thesis is the result of and nine-month long ethnography that took place in two prisons, a man's, and a woman's, in England from June 2017 to February 2018. It explores the challenges faced by older people in prison, and how this lack of policy impacted on the older prisoner population. It also examines if those difficulties were experienced equally by the older men and women or if, in a system designed for young men, there were gendered differences in the challenges they faced. The findings highlight how the older men and women suffered from three additional pains of imprisonment as a result of their incarceration: the Pains of Isolation, the Pains of Loss and the Pains of Ageing and Deteriorating Health. These additional pains, experienced by the older people, were exacerbated by a prison system that did not make any accommodation for their additional needs. However, these ageing pains of imprisonment were not felt equally by the older prisoner population. There was a gendered aspect to many of them and the older women experienced additional gendered ageing pains of imprisonment. Where possible, the older people attempted to mitigate their ageing pains of imprisonment; by forming social networks, by working, or by finding a benefit to their incarceration. However, their ability to use their limited agency was impacted by the policies of the prison regime. This thesis considered if institutional thoughtlessness assisted in understanding why older people were experiencing additional ageing pains of imprisonment; but concluded that, as a concept, institutional thoughtlessness could not sufficiently explain why these prisoners' needs were overlooked. Moving beyond institutional thoughtlessness, the thesis explores the concept of institutional ageism and how it manifests itself at a macro, meso and micro level; concluding that the ageist policies of the prison service were making the time of older people in prison more difficult and increasing their additional ageing pains of imprisonment. Moreover, when these ageist policies intersected with gender, the ageing pains of imprisonment were experienced more keenly by the older women

    Developing end-of-life care at a Portuguese nursing home through participatory action research

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    Background: Nursing homes are places where older people live and often die but little is known about the needs of those who care for them, in Portugal. Aim: to identify the needs of nursing home staff when caring for older people at the end of life; to understand the cultural nuances of providing care at the end-of-life in nursing homes; to develop, with nursing home staff, a culturally appropriate programme that meets their needs; and to plan for future development. Methods: Participatory Action Research was used to identify needs and to develop interventions, designed by the staff themselves, aimed at improving care. Up to ten nursing home staff participated in a six-cycle research process, with data collected, analysed, and used in sequential plan-act-reflect steps. Findings: The silence that surrounds a resident’s death has a severe impact on the lives of those who survive him/her. Lacking competencies in grief management, and with no emotional and relational space to express grief emotions, staff strive to manage their loss, while trying to support other residents. Acknowledging the existence of death and its impact on nursing home life made the invisibility of death and mourning visible, and interventions possible, providing closure to all. Conclusion: The impact of death and dying on nursing home life needs to be recognised. If adequately supported, nursing home staff can develop strategies to manage grief and mourning, to improve their knowledge of the residents’ needs and wishes, improve communication among staff, and ultimately improve care

    To be or not to be: a critical realist exploration of factors motivating doctors in their commitment to improve their teaching practice in a clinical setting in Oman

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    Adopting a critical realist framework, this study explored how medical doctors come to understand and espouse, or resist, their roles as teachers in clinical settings and how they seek to become more proficient in that role. This work builds on earlier research on doctors’ professional development as teachers and extends it into the particular cultural context of medical practice and education in the Sultanate of Oman. A qualitative approach was adopted. Data were collected in 2016 through semi-structured in-depth interviews with 27 senior clinicians and by the examination of relevant institutional policy documents. Interviews were conducted in two hospital settings: the Sultan Qaboos University Hospital (SQUH) and the Royal Hospital (RH), which is a Ministry of Health Hospital (MoHH). The findings suggest that Omani medical doctors’ orientation to their roles as teachers and their understanding of their responsibility to prepare the next generation of medical professionals have been transformed by three main events over the last 3 decades. First was the establishment of Sultan Qaboos University College of Medicine and Health Sciences (CoMHS) in 1986. Next came the governmental authorities’ decision to train medical doctors in the overseas hospitals that have structured postgraduate clinical training since the 1990s. Thus, while the senior doctors contributing to this study had received some or all of their medical training outside of Oman, they were helping to build a medical education system which sought to raise the next generations of doctors at home. Finally came the establishment of the Oman Medical Speciality Board (OMSB) in 2006 as the official body responsible for the graduate medical education in Oman. However, due to a lack of clear policy regarding their teaching roles, the Ministry of Health (MoH) doctors felt that they, as compared to their colleagues in the university teaching hospital (SQUH), were being expected to make an extra effort to teach in their clinical setting. All respondents, whether recruited from RH or SQUH, recognised the influence their own experience of being taught had on their personal development as clinical teachers on their return to Oman. Respondents’ exposures to different teaching and learning cultures and styles contributed to their motivation to teach and learn about teaching. In particular, many respondents believed that the religious culture of the country contributed to a pervasive attitude of altruism in the orientation of doctors to both their patients and their students. However, demotivators such as the health system’s hierarchical structure, unclear educational roles, lack of resources—time, human and suitable facilities—for teaching in their hospitals are significant challenges in accomplishing their multiple roles and developing themselves for their educational roles. What emerged as a fundamental challenge for the RH respondents was the lack of any clear policy regarding the doctor’s role as a teacher. The respondents believed that having a clear policy would empower the doctors and give them the support they need for their multiple roles in the clinical setting. Such policy would also guide the administrators and decision-makers in the support and resourcing that they provide to doctors, which they believed were so essential to ensure the next generation of doctors developed according to Oman’s mission and vision. This study’s findings show clearly the need to establish and standardise national medical education policy and procedures for the MoH doctors, thus giving them a clarity of roles and responsibilities they believe to exist for their SQUH colleagues. Having such national standards and policy is an essential part of a health organisation, and hence its implication for the doctors will be to provide them with the road map for the day-to-day management of their multiple complex roles. It is also clear that the Ministry of Health and the educational institutions (governmental and private at both the undergraduate and the postgraduate levels) need to collaborate and cooperate to establish an integrated medical education system for clinical settings, not just for the learners but also for the doctors who teach them, and thus to establish a stable teaching and learning environment. The presence of such a national policy for medical education will have a positive impact upon the quality of medical education, patient care, and upon junior doctors’ willingness to pursue careers as medical educators in clinical settings

    B/order work: recomposing relations in the seamful carescapes of health and social care integration in Scotland

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    As people, ageing and living with disabilities, struggle with how care is enacted through their lives, integrated care has gained policy purchase in many places, especially in the United Kingdom. Accordingly, there have been various (re)forms of care configurations instigated, in particular, promoting partnership and service redesign. Despite integrations apparent popularity, its contribution to improved service delivery and outcomes for people has been questioned, exposing ongoing uncertainties about what it entails and its associated benefits. Nonetheless, over decades, a remarkably consistent approach to integrated care has advanced collaboration as a solution. Equally, any (re)configurations emerge through wider infrastructures of care, in what might be regarded as dis-integrated care, as complex carescapes attempt to hold and aporias remain. In 2014, the Scottish Public Bodies (Joint Working) (Scotland) Act mandated Health and Social Care Integration (HSCI), as a means to mend fraying carescapes; a flagship policy epitomising public service reform in Scotland, in which normative aspirations of collaboration are central. What then are the accomplishments of this ambitious legislation? From the vantage point of 2021, HSCI has been assessed as slow and insubstantial, but this is not the complete picture. Narratives about failing to meet expectations obscure more complicated histories of cooperation and discord, successes and failures, and unintended consequences. Yet given collaborative ubiquity, if partnerships are contested how then are they practiced? To answer this question, I embarked on an interorganisational ethnography of the enactment of a Health and Social Care Partnership (HSCP), which went ‘live’ on April 1st, 2016; in a place I call ‘Kintra’. I interrogate what happened when several managers (from the NHS and Council) endeavoured to implement HSCI according to the precepts of the Act; working to both (re)configure and hold things together behind care frontiers; away from the bodywork of direct care, immersed in everyday arrangements in the spaces of governance and operations. I chart their efforts to comply with regulations, plan, and build governance apparatuses through documents. I explore through coalescent objects how distributed forms of governance, entwined in policy implementation, were subsequently both sustained, and challenged. I observed for seven months actors struggling to (re)configure care services embedded in a collaborative approach, as well as establish the legitimacy of the HSCP; exemplified through the fabrication of what was understood as a 'must-do' commissioning plan. In tracing documents, I show the ways in which HSCI was simultaneously materialised and constituted through documentation. I reveal how, in the mundane mattering of document manufacturing, possibilities for (re)forming the carescape emerged. By delving into inconspicuous, ‘seamful’ b/order work that both sustained distinctions between the NHS and Council and enabled b/order crossings, I expose how actors were knotted, and how this shaped efforts to recompose the contours of the carescape. While ‘Kintra’s story might be familiar, situated in concerns that may resonate across Scotland; I reveal how collaboration-as-practice is tangled in differing organisational practices, emerging from quotidian intra-actions in meeting rooms, offices, car parks and kitchenettes. I deploy a posthuman practice stance to show not only the way in which public administration ‘does’ care, but it’s world-making through a sociomaterial politics of anticipation. I was told legislation was the only way to make HSCI in ‘Kintra’ happen, nevertheless, there was resistance to limit the breadth and depth of integrating. Consequently, I show how the (re)organising of b/orders was an always-ongoing act of maintenance and repair of a (dis)integrating carescape; as I learnt at the end of my fieldwork, ‘it’s ‘Kintra, ‘it’s aye been!

    Examining the Potential for Isotope Analyses of Carbon, Nitrogen, and Sulphur in Burned Bone from Experimental and Archaeological Contexts.

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    The aim of this project was to determine whether isotope analyses of carbon, nitrogen and sulphur can be conducted on collagen extracted from burned bone. This project was conducted in two phases: a controlled heating experiment and an archaeological application. The controlled heating experiment used cow (Bos taurus) bone to test the temperature thresholds for the conservation of δ13C, δ15N, and δ34S values. These samples were also used to test the efficacy of Fourier Transform Infrared spectroscopy (FTIR) and colour analysis, for determining the burning intensities experienced by bone burned in unknown conditions. The experiment showed that δ13C values were relatively unchanged up to 400°C (<2‰ variation), while δ15N values were relatively stable up to 200°C (0.5‰ variation). Values of δ34S were also relatively stable up to 200°C (1.4‰ variation). Colour change and FTIR data were well correlated with the change in isotope ratios. Models estimating burning intensities were created from the FTIR data. For the archaeological application, samples were selected from two early Anglo-Saxon cemetery sites: Elsham and Cleatham. Samples were selected from both inhumed and cremated individuals. Among the inhumed individuals δ13C values suggested a C3 terrestrial diet and δ15N values suggested protein derived largely from terrestrial herbivores, as expected for the early Anglo-Saxon period. However, δ34S values suggested the consumption of freshwater resources and that this consumption was related to both the age and sex of the individual. The experimental data shows that there is potential for isotope analyses of cremated remains, as during the cremation process heat exposures are not uniform across the body. The samples selected for the archaeological application, however, were not successful. Bone samples heated in controlled conditions produced viable collagen for isotope analysis; however, there are several differences between experiments conducted in a muffle furnace and open-air pyre cremation that need to be investigated further. Additionally, the influence of taphonomy on collagen survival in burned bone needs to be quantified. Finally, methods of sample selection need to be improved to find bone samples from archaeologically cremated remains that are most likely to retain viable collagen. While there is significant research that must be conducted before this research can be widely applied there are a multitude of cultures that practised cremation throughout history and around the world that could be investigated through the analyses proposed in this project

    Internationalisation dynamics in contemporary South American life sciences: the case of zebrafish

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    We tend to assume that science is inherently international. Geographical boundaries are not a matter of concern in science, and when they do – e.g. due to the rise of nationalist or populist movements – they are thought to constitute a threat to the essence of the scientific enterprise; namely, the global mobility of ideas, knowledge and researchers. Quite recently, we also started to consider that research could become ‘more international’ under the assumption that in doing so it becomes better, i.e. more collaborative, innovative, dynamic, and of greater quality. Such a positive conceptualisation of internationalisation, however, rests on interpretations coming almost exclusively from the Global North that systematically ignore power dynamics in scientific practice and that regard scientific internationalisation as an unproblematic transformative process and as a desired outcome. In Science and Technology Studies (STS), social research on model organisms is perhaps the clearest example of the influence of the dominant vision of internationalisation. This body of literature tends to describe model organism science and their research communities as uniform and harmonious international ecosystems governed by a strong collaborative ethos of sharing specimens, knowledge and resources. But beyond these unproblematic descriptions, how does internationalisation actually transform research on life? To what extent do the power dynamics of internationalisation intervene in contemporary practices of knowledge production and diffusion in this field of research? This thesis revisits the dynamics and practices of scientific internationalisation in contemporary science from the perspective of South American life sciences. It takes the zebrafish (Danio rerio), a small tropic freshwater fish, originally from the Ganges region in India and quite popular in pet shops, as a case study of how complex dynamics of internationalisation intervene in science. While zebrafish research has experienced a remarkable growth in recent years at the global scale, in South America its growth has been unprecedented, allowing average laboratories, which often operate with small budgets and with less well-developed science infrastructures, to conduct world-class research. My approach is based on a consideration of internationalisation as a conceptual model of change. I consider internationalisation to be a process essentially marked by tensions in the spatial, cognitive and evaluative dimensions of scientific practice. These tensions, I claim, are not just a key feature of internationalisation, but also aspects of a conceptual opposition that is geared towards explaining how change comes about in science. By studying the dynamics of internationalisation, I seek to understand various transformations of zebrafish research: from its construction as a research artefact to its diffusion across geographical boundaries. My focus on South America, on the other hand, helps me to understand the complexity of such dynamics beyond the lenses of the dominant discourse of internationalisation that prevails in the STS literature on model organisms. I use mixed-methods (i.e. semi-structured interviews, document analysis, bibliometrics and social network analysis) to observe and interpret transformations of internationalisation at different scales and levels. My analysis suggests first, that internationalisation played an important role in the construction of the zebrafish as a model organism and that, in the infrastructures and practices of resource exchange that sustain the scientific value of the organism internationally, dynamics of asymmetry and empowerment problematise the collaborative ethos of this community. Second, I found that collaborative networks – measured through co-authorships – also played an important role in the diffusion of zebrafish as a model organism in South America. However, I did not find a clear indication of international dependency in the diffusion of zebrafish, explained by a geographical concentration of scientific expertise in the zebrafish collaboration network. Rather than exposing peripheral researchers to novel ideas, networks of international collaboration seem to be more related to access to privileged material infrastructures resulting from the social organisation of scientific labour worldwide. Lastly, by examining practices of biological data curation and researchers’ international mobility trajectories, I describe how dynamics of internationalisation shape the notion of research excellence in model organism science. In this case, I found mobility trajectories to play a key role in boosting researchers’ contributions to the community’s database, especially among researchers from peripheral communities like South America. Overall, while these findings show the value of considering internationalisation as a conceptual model of change in science, more research is needed on the intervention of complex dynamics of internationalisation in other cases and fields of research
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