A process-oriented language for describing aspects of reading comprehension

Includes bibliographical references (p. 36-38)The research described herein was supported in part by the National Institute of Education under Contract No. MS-NIE-C-400-76-011

Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods.

Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage

The influence of expertise on perceived and actual household disaster preparedness

Household preparedness is critical if frontline responders are to avoid role conflict and report for duty during a disaster. Although differences between expert and non-expert risk assessment are well documented, the extent to which expertise impacts on household preparedness is less studied. To address this gap, 2087 Irish households, 678 of which are the homes of experts, are surveyed to ascertain their level of preparedness. The findings show that expertise has a positive and significant effect on both perceived and actual preparedness. However, experts are no more accurate than non-experts in judging the level of actual preparedness in their homes

The impact of gender on risk perception: Implications for EU member states’ national risk assessment processes

This study examined the influence of gender on individual risk perception. The analysis covered 17 involuntary risks and examined the effects of gender on three dimensions - likelihood, impact and overall risk rating. The results showed that while the magnitude and significance of the gender coefficients varied by risk, a general pattern was apparent: females judged involuntary risks as being more likely, having a greater impact, or having a higher overall risk rating than their male counterparts. The impact rating for Fire was the one significant exception to this pattern. These findings highlight how the composition of National Risk Assessment (NRA) focus groups may impact the outputs from Ireland’s NRA process and the importance of EU Member States ensuring gender representation within NRA focus groups

Fire safety protection motivation and preparedness in Irish apartments: a post-Grenfell analysis

This study used an extended version of Protection Motivation Theory (PMT) to identify the variables that influence fire safety preparedness in apartment buildings. PMT was extended to include an individual’s perceived responsibility for fire safety within their building. A survey of 455 respondents living in apartments in Dublin, Ireland, was undertaken to ascertain the level of fire safety awareness and preparedness among residents. Data analysis included correlations, ordinary least squares regressions and probit analysis. The findings reveal a worrying lack of preparedness and that fire safety preparedness motivation is complex, sometimes producing counterintuitive results. For example, a high level of worry about a fire increased the probability that a respondent tested their smoke detector(s) by 27.4 pp, yet was associated with a 33.3 pp reduction in the probability that a respondent acted in line with the building evacuation policy. The factors which influenced preparedness motivation also varied depending on the specific safety measure. For instance, assuming a personal responsibility for fire safety in the building was positively associated with perceived preparedness and having an extinguisher or fire blanket. Conversely, no relationship was observed between personal responsibility for fire safety and the presence of household fire plans, appropriate fire alarm response behaviour, or smoke detector testing. The critical contribution of this study is the identification of factors that act as barriers to, or facilitators of, fire safety in residential apartments. Understanding what drives fire safety can be used to enhance the effectiveness of preparedness messaging to inform public fire safety campaigns

LISTEN: Capturing learning from the frontline response to COVID-19

This project LISTENs to the prehospital first responders who must complete testing, medical assessment, triage, and initial treatment of suspected COVID-19 cases in a range of settings from individuals’ homes, nursing homes, to clinical settings. The challenges and good practice observed by those closest to the patients are documented, collated, and analysed. This research captures learning opportunities which can inform the current response to COVID-19, risk management in the medium term, and help build longer-term national resilience

The internal microstructure and fibrous mineralogy of fly-ash from coal-burning power stations

Coal fly-ash (CFA) is a significant environmental pollutant that presents a respiratory hazard when airborne. Although previous studies have identified the mineral components of CFA, there is a paucity of information on the structural habits of these minerals. Samples from UK, Polish and Chinese power stations were studied to further our understanding of the factors that affect CFA geochemistry and mineralogy. ICP-MS, FE-SEM/EDX, XRD, and laser diffraction were used to study physicochemical characteristics. Analysis revealed important differences in the elemental compositions and particle size distributions of samples between sites. Microscopy of HF acid-etched CFA revealed the mullite present possesses a fibrous habit; fibres ranged in length between 1–10μm. Respirable particles (<10μm) were frequently observed to contain fibrous mullite. We propose that the biopersistence of these refractory fibres in the lung environment could be contributing towards chronic lung diseases seen in communities and individuals continually exposed to high levels of CFA

Toward zero net energy buildings : optimized for energy use and cost

Thesis (Ph. D. in Building Technology)--Massachusetts Institute of Technology, Dept. of Architecture, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 119-125).Recently, there has been a push toward zero net energy buildings (ZNEBs). While there are many options to reduce the energy used in buildings, it is often difficult to determine which are the most appropriate technologies to implement. To reach zero energy, some designs extensively rely on the use of photovoltaics (PV) to meet the building load, without first exploring the benefits of deep energy efficiency measures. To minimize energy use in a cost effective manner, a tool has been developed to help compare distributed generation (DG) alternatives with energy efficiency measures early in the design process. It was designed to be accessible to non-technical users and to allow them to set up and run simulations in just a few minutes. The tool was built on top of Design Advisor, which provides the capability to analyze a suite of energy efficiency measures such as insulation, window type, schedules, and HVAC types, as well as green and cool roofs. New modules that have been developed for Design Advisor include: heat pumps, absorption chillers, PV, cogeneration, and cost. Using capital cost above baseline as the independent variable, the tool outputs the net annual energy use and total cost (capital and energy) for each case analyzed in the optimization. This allows the user to understand the range of technologies and costs involved along the path from the basecase to a ZNEB.by Carrie Ann Brown.Ph.D.in Building Technolog