889 research outputs found
Transforming towards sustainable health and wellbeing systems:Eight guiding principles based on the experiences of nine Dutch Population Health Management initiatives
Introduction Population Health Management initiatives are increasingly introduced, aiming to develop towards sustainable health and wellbeing systems. Yet, little is known about which strategies to implement during this development. This study provides insights into which strategies are used, why, and when, based on the experiences of nine Dutch Population Health Management initiatives. Methods The realist evaluation approach was used to gain an understanding of the relationships between context, mechanisms and outcomes when Population Health Management strategies were implemented. Data were retrieved from three interview rounds (n = 207) in 2014, 2016 and 2017. Data was clustered into guiding principles, underpinned with strategy-context-mechanism-outcome configurations. Results The Dutch initiatives experienced different developments, varying between immediate large-scale collaborations with eventual relapse, and incremental growth towards cross-sector collaboration. Eight guiding principles for development towards health and wellbeing systems were identified, focusing on: 1. Shared commitment for a Population Health Management-vision; 2. Mutual understanding and trust; 3. Accountability; 4. Aligning politics and policy; 5. Financial incentives; 6. A learning cycle based on a data-infrastructure; 7. Community input and involvement; and 8. Stakeholder representation and leadership. Conclusion Development towards a sustainable health and wellbeing system is complex and time-consuming. Its success not only depends on the implementation of all eight guiding principles, but is also influenced by applying the right strategies at the right moment in the development
Implementing population health managemen
Purpose The purpose of this paper is to gain insight into how population health management (PHM) strategies can successfully integrate and reorganize public health, health care, social care and community services to improve population health and quality of care while reducing costs growth, this study compared four large-scale transformation programs: Greater Manchester Devolution, Vancouver Healthy City Strategy, Gen-H Cincinnati and Gesundes Kinzigtal. Design/methodology/approach Following the realist methodology, this explorative comparative case-study investigated PHM initiatives' key features and participants' experiences of developing such initiatives. A semi-structured interview guideline based on a theoretical framework for PHM guided the interviews with stakeholders (20) from different sectors. Findings Five initial program theories important to the development of PHM were formulated: (1) create trust in a shared vision and understanding of the PHM rationale to establish stakeholders' commitment to the partnership; (2) create shared ownership for achieving the initiative's goals; (3) create shared financial interest that reduces perceived financial risks to provide financial sustainability; (4) create a learning environment to secure initiative's credibility and (5) create citizens' and professionals' awareness of the required attitudes and behaviours. Originality/value The study highlights initial program theories for the implementation of PHM including different strategies and structures underpinning the initiatives. These insights provide a deeper understanding of how large-scale transformation could be developed
N-nitrosamine rejection by nanofiltration and reverse osmosis membranes: The importance of membrane characteristics
The influence of membrane characteristics on the rejection of eight N-nitrosamines was investigated using one nanofiltration (NF), one seawater reverse osmosis (SWRO) and six low pressure reverse osmosis (LPRO) membranes. The rejection of the two lowest molecular weight N-nitrosamines, namely N-nitrosodimethylamine (NDMA) and N-nitrosomethylethylamine (NMEA), varied in the range from 8-82% to 23-94%, respectively. In general, the rejection of NDMA and NMEA increased with decreasing membrane permeability. The impact of membrane characteristics became less important for higher molecular weight N-nitrosamines. Among the four LPRO membranes (i.e. ESPA2, LFC3, TFC-HR and 70LW) that are commonly used for water reclamation applications, similar rejections were obtained for NDMA (37-52%) and NMEA (69-82%). In addition, rejection values of NDMA and NMEA among two LPRO membranes (i.e. ESPA2 and 70LW) were almost identical when compared under variable permeate flux and feed temperature conditions. However, it is noteworthy that the ESPABmembrane could achieve very high rejection of NDMA (as high as 71%) despite having a similar permeability to the LPRO membranes. Results reported here suggest that membrane characteristics associated with permeability such as the pore size and thickness of the active skin layer can be a key factor determining N-nitrosamine rejection
Seasonal variations in fate and removal of trace organic chemical contaminants while operating a full-scale membrane bioreactor
Alzheimer-like paired helical filaments and antiparallel dimers formed from microtubule-associated protein tau in vitro.
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