Policy implementation as a wicked problem: A study of the horse-world

The British Horse Industry Confederation and Department of Environment, Food & Rural Affairs’ (2005) Strategy for the Horse Industry in England and Wales (Strategy) expresses an ambitious vision to transform the traditional horse-world into a horse industry by 2015. The Horse Strategy calls for all equestrians to become stakeholders, responsible for implementing its central aims of increasing grassroots participation and encouraging engagement with the Horse Strategy. Since 2005, little is known about stakeholders’ experiences of the implementation process or what degree of progress has been made towards creating the horse industry. Given the complex number of groups involved each with their own sets of interests and motives to engage with the horse-world, it is expected that implementation of the Horse Strategy forms a complex wicked problem that is unforeseen and poorly treated. This thesis explores regional representatives, local authority council policy officers and grassroots equestrians’ experiences of implementing the Horse Strategy. A qualitative analysis of 59 (male and female) semi-structured interviews, diaries (33 adults and 27 children) and profiles, participant and nonparticipant observation, and documentary analysis of equine-related policies and articles is carried out. Sport England’s (2004) Framework for Sport was used to gain an understanding of what factors influence an individual’s choice to participate in equestrianism, and the CLEAR Framework diagnostic tool (Lowndes et al., 2006) was adopted to assess equestrians’ engagement with the Strategy. Interrelated factors were found to influence an individual’s choice to participate in grassroots equestrianism and these synergistically built on each other to increase participation. The notion of a ‘hook’ or bond with a horse emerged as the most influential factor. However, each group showed considerable competing vested interests that led to fragmentation of the horse-world, giving rise to implementation barriers, deficits, and inertia. Even if a shared language can be established around the icon of the horse to increase participation, problems remain in addressing resourcing, cost, and infrastructure constraints. An overarching complex wicked policy problem emerged as the vested interests among different equestrian groups served to constrain and hinder the policy implementation process. This thesis concludes by providing recommendations to the BHIC and Defra, policy officers, regional representatives and grassroots proprietors to increase participation and encourage engagement with policy at local-level

Large Scale Organizational Intervention to Improve Emergency Department Throughput in a Community Hospital

Abstract BACKGROUND: Emergency Department boarding is a well-documented systemic problem across the country. ED-2b, the time from decision to admit a patient to Emergency Department departure, is specified by the Joint Commission as a quality measure for Emergency Department boarding. ED-2b metrics have been a longstanding challenge at this community hospital outside the nation’s capital. The aim of this study was to reduce median ED-2b times by 10% compared to fiscal year 2020 (FY20). To accomplish the reduction in time, a multidisciplinary throughput committee was developed with subsequent action plans designed to improve Emergency Department throughput. METHODS: The Plan Do Study Act method of quality improvement was used for this project. Several tactics were developed to address a variety of known throughput challenges. Baseline assessment included a review of FY20 ED-2b metrics. These times were used as the comparative pre-intervention data. Literature review queries were conducted to identify tactics to improve hospital throughput. INTERVENTION: A multidisciplinary hospital throughput committee was developed along with a Plan Do Study Act action plan at the beginning of FY21. Improvement tactics included the standardization of workflows for care transitions, compliance with a telemetry discontinuation protocol, implementation of an early warning predictive model for Emergency Department overcrowding, and an inpatient discharge team. In addition, data was collected during the project period comparing bed request to bed assignment, bed assignment to unit arrival, and inpatient discharge order to depart times. Perceptions of the implications associated with Emergency Department boarding were assessed pre and post intervention. RESULTS: Eight months after implementing various tactics, ED-2b metrics were reviewed to assess effectiveness. Comparative data revealed a statistically significant improvement in ED-2b median times. In addition, implementing a discharge team demonstrated a 21% improvement in inpatient discharge departures by 1700. CONCLUSION: Implementing a multidisciplinary throughput committee with engaged participants and leaders, creates a forum for process improvement. By implementing several tactics with key stakeholder, the reduction of Emergency Department boarding time is achievable. Accomplishing frontline engagement supports the success of tactics, improvement of patient satisfaction, and aligns with organizational goal achievement

Engaging College Students in Experiential Learning Opportunities within Extension

Providing experiential learning opportunities within Extension for college students generates benefits for multiple parties. As two campus-based faculty and two Extension county-based faculty who have collaborated to increase public health student engagement through endeavors within Extension, we have gained perspective on this topic. We describe a continuum of relevant experiential learning options, from classroom experiences through full internships. We also provide input on associated best practices. Extension faculty across the nation are encouraged to use and adapt these tools to ensure success in offering experiential learning opportunities to college students

Effectiveness of a Targeted, Peer-Driven Skin Cancer Prevention Program for Lifeguards

Lifeguards working at outdoor pools typically receive high amounts of sun exposure, increasing their risk for developing skin cancer. This study evaluates the effectiveness of a targeted, peer-driven intervention for skin cancer prevention among lifeguards. Nine pools received the targeted intervention, Pool Cool Plus, and five received the standard Pool Cool prevention program. Lifeguards completed surveys at the beginning and end of the summer. Lifeguards in both the targeted intervention and standard program groups increased their sun safety practices and reported more sun-safe pool policies and environments. Sunburn rates decreased among lifeguards participating in Pool Cool Plus. Future research should test the feasibility and effectiveness of disseminating the Pool Cool Plus program

Role of IL-33 and ST2 signalling pathway in multiple sclerosis: expression by oligodendrocytes and inhibition of myelination in central nervous system

Recent research findings have provided convincing evidence indicating a role for Interleukin-33 (IL-33) signalling pathway in a number of central nervous system (CNS) diseases including multiple sclerosis (MS) and Alzheimer’s disease. However, the exact function of IL-33 molecule within the CNS under normal and pathological conditions is currently unknown. In this study, we have mapped cellular expression of IL-33 and its receptor ST2 by immunohistochemistry in the brain tissues of MS patients and appropriate controls; and investigated the functional significance of these findings in vitro using a myelinating culture system. Our results demonstrate that IL-33 is expressed by neurons, astrocytes and microglia as well as oligodendrocytes, while ST2 is expressed in the lesions by oligodendrocytes and within and around axons. Furthermore, the expression levels and patterns of IL-33 and ST2 in the lesions of acute and chronic MS patient brain samples are enhanced compared with the healthy brain tissues. Finally, our data using rat myelinating co-cultures suggest that IL-33 may play an important role in MS development by inhibiting CNS myelination

Colour alignment for relative colour constancy via non-standard references

Relative colour constancy is an essential requirement for many scientific imaging applications. However, most digital cameras differ in their image formations and native sensor output is usually inaccessible, e.g., in smartphone camera applications. This makes it hard to achieve consistent colour assessment across a range of devices, and that undermines the performance of computer vision algorithms. To resolve this issue, we propose a colour alignment model that considers the camera image formation as a black-box and formulates colour alignment as a three-step process: camera response calibration, response linearisation, and colour matching. The proposed model works with non-standard colour references, i.e., colour patches without knowing the true colour values, by utilising a novel balance-of-linear-distances feature. It is equivalent to determining the camera parameters through an unsupervised process. It also works with a minimum number of corresponding colour patches across the images to be colour aligned to deliver the applicable processing. Two challenging image datasets collected by multiple cameras under various illumination and exposure conditions were used to evaluate the model. Performance benchmarks demonstrated that our model achieved superior performance compared to other popular and state-of-the-art methods.Comment: 14 pages, 8 figures, 2 tables, accepted by IEEE Transactions on Image Processin

Free speech, tolerance, offence and diversity: A comparative study of France and Denmark using the cases of Dieudonné and Yahya Hassan

This thesis examines how notions of freedom of speech, tolerance, and diversity are negotiated and tested by media controversies prompted by provocative speech acts. The study draws upon two cases from the creative realm: French comedian Dieudonné and Danish poet Yahya Hassan, both of whom have engaged in transgressive speech acts. As country cases, France has a history of immigration and cultural diversity, but Denmark is relatively new to this; yet in recent years, both have engaged in debates about freedom of speech and minority groups. The ways that these issues are then addressed sheds light on how changing societies respond to controversy. This is where the research questions are located: How are the parameters of freedom of speech, tolerance and offence renegotiated in times of change? How do such renegotiations take shape in different national contexts, such as in France and Denmark? How do provocative speech acts in the creative realm test the boundaries of freedom of speech? Finally, how do nationhood, identity and diversity impact public debates about these provocative speech acts? Using a Thematic Analysis of 95 articles from one centre-left and one centre-right newspaper per country about the cases, as well as 21 in-person interviews held in Paris and Copenhagen with activists, journalists, politicians, lawyers and artists, the findings highlight how an expressive act might originate from one individual, but it can create tensions in different ways as it travels through various modes of interpretation and social discourse. What the findings show is that this mediated dynamic tests democratic values such as freedom of speech, because its parameters are being challenged, questioned, or renegotiated through these types of embodied communication, and they reveal how consensus on the acceptable parameters of speech must shift in order to accommodate the diversification of culture in each country context

Systematic Review of the Addition of Hip Strengthening Exercises for Adults with Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal disorder typically occurring in physically active people aged 40 years and younger, causing pain, functional deficits and lower limb weakness. Traditional treatment has been aimed at strengthening the knee, however recent research suggests the muscles around the hip also play an important role in the development and continuity of Patellofemoral Pain Syndrome. Purpose: To investigate the effectiveness of the addition of hip strengthening exercises to standard physiotherapy treatment (knee strengthening and stretching exercises) on reducing pain, and enhancing strength and function when compared to standard physiotherapy treatment alone in adults with Patellofemoral Pain Syndrome. Method: A systematic search of Cochrane, CINAHL, Embase, MEDLINE®, PEDro and SportDiscus was conducted. Studies of participants aged 18 to 44, diagnosed with Patellofemoral Pain Syndrome by a healthcare practitioner, or reporting peripatellar or retropatellar pain with common functional tasks, were included. A critical appraisal, using the Critical Appraisal Skills Program for Randomised Controlled Trials (CASP) was used to assess methodological quality. Results: Five randomised controlled trials of varying methodological quality met the inclusion criteria. The participants in these studies were aged between 18 to 40 years of age. The duration of the intervention ranged from four to six weeks consisting of 12 to 30 supervised exercise sessions. Studies used varying outcome measures for each of the three outcomes. Overall, the studies demonstrated that the addition of hip strengthening exercises to standard physiotherapy care consistently improved pain and function, but the impact on strength was variable. Conclusion: Previously, only a small number of studies have looked at the addition of hip exercises to standard physiotherapy care for treatment of Patellofemoral Pain Syndrome. While there is a growing body of evidence for the efficacy of hip strengthening exercises for Patellofemoral Pain Syndrome, this is constrained by bias towards female participants, lack of true controls in most studies, and low methodological quality of studies overall. Hip exercises added to standard physiotherapy care shows potential as a treatment method for improving outcomes of pain and function in adults with Patellofemoral Pain Syndrome