An Exploratory Qualitative Study of Service Provision to Survivors of Sex Trafficking in Mumbai, India

Objectives: To explore service provision to survivors of sex trafficking in Mumbai, India by two non-governmental organizations.Objectives: To explore service provision to survivors of sex trafficking in Mumbai, India by two non-governmental organizations. Methods: Interviews with staff were conducted (n=13) to determine client needs, program services, and challenges in service provision. Interviews were coded and common themes were explored. Results: Client needs were identified that are consistent with previous research. Programming is focused on trauma-focused counseling, building economic self-sufficiency, and supporting reintegration. Challenges include lack of trained service providers, strained relationships with government aftercare homes, and insufficient time to provide needed services. Conclusions: Aftercare for survivors of sex trafficking provides an opportunity for sustainable recovery and rehabilitation for this population. Research should be directed at identifying and evaluating evidence-based practices. National and global policies should support expansion of aftercare services.Master of Science in Public Healt

Innovative Approaches to Development and Ground Testing of Advanced Bimodal Space Power and Propulsion Systems

The last major development effort for nuclear power and propulsion systems ended in 1993. Currently, there is not an initiative at either the National Aeronautical and Space Administration (NASA) or the U.S. Department of Energy (DOE) that requires the development of new nuclear power and propulsion systems. Studies continue to show nuclear technology as a strong technical candidate to lead the way toward human exploration of adjacent planets or provide power for deep space missions, particularly a 15,000 lbf bimodal nuclear system with 115 kW power capability. The development of nuclear technology for space applications would require technology development in some areas and a major flight qualification program. The last major ground test facility considered for nuclear propulsion qualification was the U.S. Air Force/DOE Space Nuclear Thermal Propulsion Project. Seven years have passed since that effort, and the questions remain the same, how to qualify nuclear power and propulsion systems for future space flight. It can be reasonable assumed that much of the nuclear testing required to qualify a nuclear system for space application will be performed at DOE facilities as demonstrated by the Nuclear Rocket Engine Reactor Experiment (NERVA) and Space Nuclear Thermal Propulsion (SNTP) programs. The nuclear infrastructure to support testing in this country is aging and getting smaller, though facilities still exist to support many of the technology development needs. By renewing efforts, an innovative approach to qualifying these systems through the use of existing facilities either in the U.S. (DOE's Advance Test Reactor, High Flux Irradiation Facility and the Contained Test Facility) or overseas should be possible

Guidelines for managing people with lymphoedema remotely: a post-COVID-19 response document

During the COVID-19 pandemic it was initially not possible to see people with lymphoedema face-to-face at lymphoedema services, due to the potential risks of the virus, because they were shielding, because of redeployment of rooms or staff, and due to sporadic restrictions of movement. The pandemic therefore accelerated adjustments in lymphoedema service delivery, while ensuring effective and efficient care was paramount. This document presents a pragmatic guide for lymphoedema services. Although clinical and non-clinical staff need to comply with guidance from their own organisations/commissioners, this document aims to provide specific guidance and share good practice in relation to lymphoedema management. These guidelines are based on analysis of the national response of Lymphoedema Network Wales during the first few months of the COVID-19 pandemic and incorporate supporting contemporary advice. They have been used throughout NHS Wales, providing a standardised approach in supporting care for people with lymphoedema. In light of the enduring nature of COVID-19, it is imperative that lymphoedema services have a means to provide suitable care for patients. Although face-to-face appointments are sometimes deemed necessary, many patients can be suitably supported via telehealth consultations. These guidelines may help lymphoedema services restore and reset in a safe and acceptable manner

Exploring the impact of lymphoedema on individuals and if lymphatic venous anastomosis surgery effects perceptions on quality of life: A qualitative study

Purpose: Lymphoedema is a chronic condition, a cancer consequence and causes physical, psychological, and social implications. A new super-micro surgical treatment Lymphatic Venous Anastomosis (LVA) may improve the symptoms of lymphoedema. This study aims to explore the impact of lymphoedema on individuals and if LVA Surgery changes perceptions on quality of life. Method: Semi-structured interviews were conducted with sixteen individual's pre-LVA surgery and repeated six months later post-LVA with ten of the participants. Transcripts were analysed using thematic analysis. Results: Themes identified pre-LVA included: Impact of Living with Lymphoedema, Being Different, and Future Hopes and Emotions. Participants reported making significant changes to ‘normal' life due to living with lymphoedema. Changes included alteration in shopping, cleaning, hobbies, familial roles, employment and sexual intimacy. The wearing of compression garments engendered feelings of being unattractive. Themes found post-LVA were: I am one of the Lucky Ones and Returning to Former Self. Post-LVA, participants described how life had become more normalised with fear and apprehension of developing cellulitis reduced. Positive changes had enabled usual activities of daily living to recommence. Some participants had decreased pain, aching, heaviness, stiffness and were wearing their compression garments less. Conclusion: The findings suggest that the real impact of living with lymphoedema is much more challenging than previously identified. The findings suggest that LVA can give a future of greater choice for some of its recipients, but further research should explore longer-term benefits. LVA could offer hope to some people with lymphoedema, but a realistic expectation is essential

Leadership Development to Advance Health Equity: An Equity-Centered Leadership Framework

Enduring questions about equity are front and center at this watershed moment in health care and public health. Inequities that became evident in the COVID-19 pandemic in 2020 have highlighted long-standing disparities in health by race and ethnicity. Current crises require examining and reorienting the systems that have, for decades, produced these health inequities; yet, public health and health care leaders are inadequately prepared to respond. The authors offer an equity-centered leadership framework to support the development of visionary leaders for tomorrow. This framework for leadership development programs interweaves traditional leadership and equity, diversity, and inclusion domains in both conceptual knowledge and skills-based teaching for health care and public health leaders, grouping competencies and skills into four domains: personal, interpersonal, organizational, and community and systems. A framework such as this will equip leaders with the mindset and skillset to challenge the paradigms that lead to inequity and health disparities

Audit to strategy: development of a national children and young people lymphoedema service

Lymphoedema in children and young people (CYP) can cause significant impact affecting physical, psychological and social wellbeing. This audit of 286 CYP with Lymphoedema (2015–2018) is the first national cohort reported and provides new information on patient reported outcome (PROM) changes over time. Conservative therapy produced statistically significant change in outcome measures relating to swelling, infection, appearance and compression garments. Almost half of the children had primary lymphoedema of varying types. An overall prevalence of 31 per 100 000 CYP with lymphoedema was found among a population aged 0–25 over a 3-year period. This finding suggests a higher occurrence of lymphoedema in children and young people than previously reported and is important for service planning and health professionals' education

Clinical Scholars: Using Program Evaluation to Inform Leadership Development

Leadership development programs are notoriously difficult to evaluate, and when evaluations are attempted, they often do not go beyond measuring low-level, short-term outcomes of the impacts experienced by participants. Many leadership development programs do not systematically assess changes that are catalyzed within the organizations, communities and systems in which participants lead. To address these challenges, evaluators of the Clinical Scholars National Leadership Institute (CNLI) have designed a comprehensive, mixed-methods evaluation approach to determine the effectiveness of the training and explore the impacts of participants in the spheres in which they lead. Guided by Michael Patton’s Developmental Evaluation approach and framed by Kirkpatrick’s Training Evaluation Model, the CSNLI evaluation collects data on multiple levels to provide a robust picture of the multiple outcomes of the program. The approach focuses on individual participant outcomes, by measuring competency changes over time and exploring how participants use the competencies gained through the training in their work. Social network analysis is utilized to measure the development and expansion of participants’ networks and collaboration within the teams, cohorts, and across sectors and disciplines throughout their time in the CSNLI. The Most Significant Change methodology and semi-structured alumni interviews are used to measure impacts participants identify as occurring as a result of their participation. Finally, Concept Mapping is implemented to explore how Fellows make meaning of the foundational concepts and values of the CSNLI. The outcome and impact evaluation activities employed by the CSNLI, in combination with quality improvement-focused process evaluation, support innovation and excellence in the provision of a health equity-grounded leadership development program

Clinical Scholars: Effective Approaches to Leadership Development

The Clinical Scholars (CS) National Leadership Institute (CSNLI) equips interprofessional teams of health care professionals through equity-centered leadership training, preparing them to be change leaders working to advance health equity in communities across the US and its territories. At the time of this writing, four cohorts consisting of 131 Fellows from 14 different disciplines, participating in 36 different teams of two to five members are working on “Wicked Problem Impact Projects”, an implementation science-based approach to action learning projects. This chapter reports on the design of the 3-year CS experience, the onsite and distance-based training support, and the subsequent learning responses of 98 participants, 30 of whom had completed the 3-year training (Cohort 1), 34 of whom had completed 2-years of the training (Cohort 2), and 34 who had completed 1-year of the training (Cohort 3). The training program is guided by 25 competencies that weave leadership and equity throughout, which are divided into four families: Personal, Interpersonal, Organizational, and Community & Systems. Learning outcomes indicated that Fellows are highly satisfied, with all participants rating their experience at 6.10-6.77 on a 7-point scale across all sessions, all years. Retrospective pre-and post-tests assessed learning gains on the competencies, indicating statistically significant changes from baseline to midpoint in participant knowledge, attitude, use, and self-efficacy in each of the 25 competencies and large and significant gains by competency family. The Clinical Scholars Program presents an in-depth, longitudinal, state-of-the-art approach to promoting the cultivation and development of a large and sophisticated set of skills that intentionally integrate leadership competencies with a focus on health equity. Taken together, these outcomes show how a logical and structured process, using widely available tools, can contribute to both learning and implementation of skills that lead to real world impacts in communities. Given the results reported at the close of their Clinical Scholars experience, the data suggest that investing in robust, intensive leadership development of interprofessional teams is a smart decision for impacting the culture of health in communities nationwide

Training "Pivots" from the Pandemic: Lessons Learned Transitioning from In-Person to Virtual Synchronous Training in the Clinical Scholars Leadership Program

Introduction: Since the inception of distance-based teaching modalities, a debate has ensued over the quality of online versus in-person instruction. Due to the COVID-19 pandemic, a number of teaching environments-including leadership development trainings for post-graduate learners-have been thrust into exploring the virtual learning environment more thoroughly. One three-year leadership development program for interdisciplinary healthcare professionals transitioned three simultaneous leadership intensives from in-person to online in the spring of 2020. Methods: Documented changes in overall training length, session length, and session format are described. Further, evaluative data were collected from participants at both retreats via post-session surveys. Ninety-three participants attended the 2019 retreat, and 92 participants attended the 2020 virtual retreat. Quantitative data of three rating questions per session are reported: 1) overall session satisfaction, 2) participants' reported knowledge gain, and 3) participants' reported ability gain. Qualitative data were obtained via two open-ended feedback questions per session. Results: In comparing pre/post scores for knowledge and ability, participants had meaningful (and in some cases higher) self-reported gains in knowledge and ability measures in the online environment, as compared to the in-person environment. Participants reported statistically significant gains in all sessions for both knowledge and ability. Qualitative data of participant feedback identified a number of positive themes similar across the in-person and virtual settings. Negative or constructive feedback of the virtual setting included time constraint issues (eg too much content in one session, a desire for more sessions overall), technical difficulties, and the loss of social connection and networking with fellow participants as compared to in-person trainings. Discussion: While meaningful shifts in knowledge and ability ratings indicate that the transition to successful online learning is possible, several disadvantages remain. The preparation time for both faculty and participants was considerable, there is a need to reduce overall content in each session due to time restraints, and participants indicated feeling the loss of one-on-one connections with their peers in the training. Lessons learned of transitioning leadership training from in-person to an online experience are highlighted

A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change

Background: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes. Methods: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework. Results: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes. Conclusion: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support