Outcomes of a funding initiative to promote allied health research activity: a qualitative realist evaluation

Providing funding for clinicians to have protected time to undertake research can address a commonly cited barrier to research - lack of time. However, limited research has evaluated the impact or mechanisms of such funding initiatives. In the current economic environment, it is important that funding is used efficiently and judiciously and that mechanisms and contexts that may assist with maximising outcomes of funding initiatives are identified. This study aimed to describe the medium-term outcomes of a funding initiative to promote allied health research activity and to identify the key mechanisms and contexts that facilitated these outcomes.We used a qualitative research design informed by a realist evaluation, to conduct 10 semi-structured interviews with allied health professionals who had participated in a funding initiative 1-3 years ago. Questions explored outcomes, mechanisms and contexts of the funding initiative. Data was thematically coded into context-mechanism-outcome configurations.Medium term outcomes included increased individual research opportunities, influence on team research culture and impact on clinical work/practice. Other outcomes included increased clinician confidence, knowledge and skill, and research outputs. However, some participants still had difficulties progressing research. Four context-mechanism-outcome configurations were identified to explain which contexts and mechanisms produced these outcomes. Examples of contexts included perception of managerial support, undertaking a research-based higher degree and joint applications, while mechanisms included accessing infrastructure and resources as well as individual researcher factors like motivation.Providing funding to allied health professionals to undertake and complete research can lead to important outcomes, including increased research opportunities, capacity and culture, increased research outputs, and changes to clinical practice. Outcomes are influenced by unique contexts and mechanisms and these should be considered in future implementation of similar funding initiatives

Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis CHEST Guideline and Expert Panel Report

BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged METHODS: We used the CHEST expert cough panel\u27s protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients\u27 values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made. RESULTS: Combining data from the systematic reviews, we found high-quality evidence in children aged 4 weeks\u27 duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, there is moderate-quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis. CONCLUSIONS: Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required

Fast-Track Remedial Design of Full-Scale ISCO Application Using Pilot Scale Testing and Field Screening Parameters

As a result of drum re-finishing operations, soil and groundwater at the Ottati and Goss Superfund Site in Kingston, NH are contaminated with chlorinated volatile organic compounds (VOCs); benzene, toluene, ethylbenzene, and xylene (BTEX); and 1,4-dioxane. After re-evaluation of the selected remedy for groundwater, pump and treat, EPA changed the remediation approach to in-situ chemical oxidation (ISCO) through an Amended Record of Decision in September 2007. At that time, EPA established a goal for the site to attain construction complete status within one year, by September 30, 2008. Activated persulfate was selected as the chemical oxidant for its capability to oxidize 1,4-dioxane, in addition to the other VOC contaminants of concern. Bench-scale and field pilot scale test were completed in three source areas to collect site-specific information to evaluate persulfate\u27s ability to destroy the contaminants of concern and to optimize full-scale remediation design in three discrete source areas at the site. Base-activated persulfate was injected in Areas A and B in December 2007, and pilot test injection was completed in Area C in early February 2008, after vertical profiling was completed throughout Area C. Groundwater sampling for laboratory analysis was planned for 6 and 12 weeks after injection in each area; however, it was known during pilot test planning that the full-scale design would need to be completed by the end of March 2008, before all laboratory results would be available. In order to complete the design, an intensive evaluation of field geochemistry parameters and field screening chemical analysis was performed to assess radius of influence, oxidant persistence, and aquifer behavior. Field screening analyses included residual persulfate via a permanganate titration, sulfate via colorimetry, and sodium via an ion-selective electrode. The field screening and field geochemistry results were used heavily in completing the full-scale ISCO design. The laboratory analytical results noted significant decreases in concentrations of chemicals of concern in wells where geochemistry and field parameters were observed to change. This article discusses pilot test planning, performance monitoring, and full-scale design using data collected from the pilot test for this fast-track remediation. The full-scale application was completed between July and September 2008, and was the third largest single-site application of persulfate performed to date