The Social Sciences Interdisciplinarity for Astronomy and Astrophysics -- Lessons from the History of NASA and Related Fields

In this paper we showcase the importance of understanding and measuring interdisciplinarity and other -disciplinarity concepts for all scientists, the role social sciences have historically played in NASA research and missions, the sparsity of social science interdisciplinarity in space and planetary sciences, including astronomy and astrophysics, while there is an imperative necessity for it, and the example of interdisciplinarity between social sciences and astrobiology. Ultimately we give voice to the scientists across all fields with respect to their needs, aspirations and experiences in their interdisciplinary work with social sciences through an ad-hoc survey we conducted within the Astro2020 Decadal Survey scientific community

Gepotidacin for the Treatment of Uncomplicated Urogenital Gonorrhea: A Phase 2, Randomized, Dose-Ranging, Single-Oral Dose Evaluation

Background: In this phase 2 study, we evaluated the efficacy and safety of oral gepotidacin, a novel triazaacenaphthylene bacterial type II topoisomerase inhibitor, for the treatment of uncomplicated urogenital gonorrhea. Methods: Adult participants with suspected urogenital gonorrhea were enrolled and completed baseline (day 1) and test-of-cure (days 4-8) visits. Pretreatment and posttreatment urogenital swabs were collected for Neisseria gonorrhoeae (NG) culture and susceptibility testing. Pharyngeal and rectal swab specimens were collected if there were known exposures. Participants were stratified by gender and randomized 1:1 to receive a 1500-mg or 3000-mg single oral dose of gepotidacin. Results: The microbiologically evaluable population consisted of 69 participants, with NG isolated from 69 (100%) urogenital, 2 (3%) pharyngeal, and 3 (4%) rectal specimens. Microbiological eradication of NG was achieved by 97%, 95%, and 96% of participants (lower 1-sided exact 95% confidence interval bound, 85.1%, 84.7%, and 89.1%, respectively) for the 1500-mg, 3000-mg, and combined dose groups, respectively. Microbiological cure was achieved in 66/69 (96%) urogenital infections. All 3 failures were NG isolates that demonstrated the highest observed gepotidacin minimum inhibitory concentration of 1 µg/mL and a common gene mutation. At the pharyngeal and rectal sites, 1/2 and 3/3 NG isolates, respectively, demonstrated microbiological cure. There were no treatment-limiting adverse events for either dose. Conclusions: This study demonstrated that single, oral doses of gepotidacin were ≥95% effective for bacterial eradication of NG in adult participants with uncomplicated urogenital gonorrhea

Specialist training in Fiji: Why do graduates migrate, and why do they remain? A qualitative study

<p>Abstract</p> <p>Background</p> <p>Specialist training was established in the late 1990s at the Fiji School of Medicine. Losses of graduates to overseas migration and to the local private sector prompted us to explore the reasons for these losses from the Fiji public workforce.</p> <p>Methods</p> <p>Data were collected on the whereabouts and highest educational attainments of the 66 Fiji doctors who had undertaken specialist training to at least the diploma level between 1997 and 2004. Semistructured interviews focusing on career decisions were carried out with 36 of these doctors, who were purposively sampled to include overseas migrants, temporary overseas trainees, local private practitioners and public sector doctors.</p> <p>Results</p> <p>120 doctors undertook specialist training to at least the diploma level between 1997 and 2004; 66 of the graduates were Fiji citizens or permanent residents; 54 originated from other countries in the region. Among Fiji graduates, 42 completed a diploma and 24 had either completed (21) or were enrolled (3) in a master's programme. Thirty-two (48.5%) were working in the public sectors, four (6.0%) were temporarily training overseas, 30.3% had migrated overseas and the remainder were mostly in local private practice. Indo-Fijian ethnicity and non-completion of full specialist training were associated with lower retention in the public sectors, while gender had little impact. Decisions to leave the public sectors were complex, with concerns about political instability and family welfare predominating for overseas migrants, while working conditions not conducive to family life or frustrations with career progression predominated for local private practitioners. Doctors remaining in the public sectors reported many satisfying aspects to their work despite frustrations, though 40% had seriously considered resigning from the public service and 60% were unhappy with their career progression.</p> <p>Conclusion</p> <p>Overall, this study provides some support for the view that local or regional postgraduate training may increase retention of doctors. Attention to career pathways and other sources of frustration, in addition to encouragement to complete training, should increase the likelihood of such programmes' reaching their full potentials.</p

Should I migrate or should I remain? : professional satisfaction and career decisions of doctors who have undertaken specialist training in Fiji

Introduction: \ud Fiji is a Pacific Island nation that prior to the mid-1990s relied mostly on expatriates for its specialist workforce, and few Fiji doctors who obtained overseas specialist qualifications returned home to work. To address this problem, regional specialist training for the Pacific was established at the Fiji School of Medicine (FSMed) in 1998, and it was assumed that local training along with a non-exportable specialist qualification, would lead to improved retention. After several years, it became apparent that many doctors who started training resigned from the public service, with most migrating. While this accelerated around the time of the coup of 2000, it has continued since then. This coincided with a worldwide increase in the migration of health workers. The purpose of this study was to determine why doctors who undertook specialist training at FSMed chose to migrate or stay, with a focus on the issues of professional satisfaction and dissatisfaction. It was hoped that a deeper understanding of the situations of these doctors would suggest interventions that could improve their retention and overall satisfaction.\ud \ud Methodology: \ud The research was carried out as a mixed method, though predominantly qualitative study. The study focused on the “case” of the establishment of postgraduate specialist training in Fiji. Altogether, 47 Fiji doctors were interviewed, including 36 of 66 doctors who attained an FSMed Diploma or higher. Doctors in the public sectors, in private practice, as well as migrants were included. Semistructured exploratory interviews were carried out between 2004 and 2006 and were taped, transcribed, coded and analysed using a constant comparative method, with the identification of emerging themes from the interview data.\ud \ud Results: \ud The results are presented over 3 chapters exploring professional satisfaction, migration, and career pathways. A model of professional satisfaction was developed that included three major elements of professional growth, service and recognition. Professional dissatisfaction could be conceptualised as the absence of or the blocking of the elements of professional satisfaction. Dissatisfaction was particularly directed at the Ministry of Health, and a failure to reliably provide basic medications and supplies, as well as problems with career advancement, were frequently mentioned. Of the 66 doctors, 20 had migrated permanently and the 7 who were interviewed cited family security (mainly related to the coup of 2000) or spousal career or family issues as being central to their decision-making. Fijian but not Indo-Fijian doctors also cited the contributing factors of limited career advancement opportunities, low salaries and poor working conditions. Nine of these doctors entered private practice in Fiji. The four who were interviewed generally cited desires to spend more time with their families and gain control of their working lives, though frustrations with career advancement were also mentioned. No doctor who resigned cited higher salaries or improved training opportunities as the predominant factors in their decision-making. The doctors who remained in the public sectors usually mentioned a service ethic, often grounded in religious belief, as well as close attachments to family, extended family and culture. Overall, while many spoke positively about postgraduate training, most cited significant stress from managing their academic loads on top of very busy public hospital postings. Some trainees, mainly in the procedural disciplines, complained about inadequate clinical supervision. Of the 42 doctors who left training with a Diploma as their highest qualification, only 13 have remained in the public sectors. Family issues predominated as reasons for leaving training, especially time pressures for female doctors, and difficulties in supporting families on low salaries for male doctors, though some resigned in order to migrate. Of the Masters graduates, 18 of 21 (plus three current students) are still in the public sectors, some of whom still remain at the lowest career grades. Overall, doctors complained of unpredictable career advancement, with a Masters or Diploma seeming to have little impact, as well as bottlenecks from limited numbers of senior postings.\ud \ud Discussion: \ud A constructivist approach to these interviews suggested that overall these doctors saw public hospital work as an expected “norm” that offered many satisfying career aspects, while other career options were to some extent compromises. One of the few “justifiable” reasons for leaving the public system seemed to be family welfare. The blocking of professional development and advancement was cited by doctors who considered resigning, but by fewer who actually resigned. This suggested a centrality of the professional values of service, patient welfare and treating patients regardless of their ability to pay, and these values overlapped considerably with the elements of professional satisfaction. The findings from this study fit with and expand on previous research from Fiji, and also fit well with the world literature, where there was agreement on the frustrating elements of lack of infrastructure support (especially drugs and supplies), difficult working conditions, staff shortages and problems with career advancement. Salaries in Fiji are modest though arguably “liveable”, and were less of an issue than elsewhere. This study expanded somewhat on satisfying aspects of medical practice, including camaraderie, mentoring, being of service and making a difference. While health worker motivation is widely mentioned in the literature, there was at best an uncomfortable fit with existing theories, possibly related to much of the literature being focused on worker alignment with organisations, while health workers are more likely to be aligned to their professions. This study was limited by having studied only specialist doctors from a small country, and this may limit applicability elsewhere. Overall, the study suggested that retention in Fiji could be increased through improved provision of basic medications and supplies as well as through the development of transparent career pathways, through tying advancement to postgraduate training, and through trying to make workloads for trainees more tolerable in order to increase Masters completions. While in other countries the provision of a liveable wage may be more important, these interventions may also prove to be effective elsewhere in the world

Postgraduate specialist training at the Fiji School of Medicine: what do the students think?

Introduction: Postgraduate specialist training was established at the Fiji School of Medicine in 1998. Since then, most students who have earned a one-year specialist Diploma have not completed a Masters, and many have since migrated overseas, or entered local private practice. Because the retention of Masters graduates is much higher, it is important to understand the reasons why so many students have dropped out, and whether interventions could be put in place to improve Masters completion rates.\ud \ud Methods: Semi-structured interviews were carried out between 2004 and 2006 for 36 out of 66 Fiji doctors who had\ud trained to the Diploma level or higher by 2004. Nine senior consultants were also interviewed. All were asked to describe their experiences and impressions about postgraduate training in Fiji.\ud \ud Results: Feelings about the postgraduate programs were mixed. On a positive note, many felt they had learned a great deal and developed further as doctors because of the programs. Others expressed disappointments about under-resourcing of teaching, unsatisfactory clinical supervision, and distressing levels of conflict between their duties as a clinician in a public hospital and academic expectations. Many dropped out because of a combination of heavy clinical and academic workloads alongside disappointments about various aspects of the course.\ud \ud Discussion: The postgraduate programs at the Fiji School of Medicine hold considerable promise in helping to meet the specialist workforce needs for Fiji, but more attention needs to be paid to how to retain more enrollees through to Masters graduation. Attention to improved clinical supervision in the hospitals, ensuring manageable clinical workloads, and trying to avoid conflicts between academic and clinical expectations may help more students to continue through to graduation

Professional Satisfaction and Dissatisfaction Among Fiji Specialist Trainees: What Are the Implications for Preventing Migration?

The migration of doctors from developing countries threatens the health status of the populations left behind. This qualitative study was conducted to explore why an unexpected number of Fiji specialist trainees left the public sector, often to migrate, using a lens of professional satisfaction. Forty seven Fiji doctors, including 36 of 66 who undertook specialist training in Fiji, were interviewed about the factors that led to their own professional satisfaction and dissatisfaction. Three major components of professional satisfaction emerged: professional growth, service, and recognition, with considerable overlap between categories. The aspects of professional dissatisfaction were more varied but could be categorized as the absence or blocking of the elements of professional satisfaction. From the interviews, a professional satisfaction model was developed featuring the three overlapping central elements of satisfaction on a background of an enabling health system. This model might have implications for health systems seeking to retain their workers

Professional satisfaction and dissatisfaction among Fiji specialist trainees: what are the implications for preventing migration?

The migration of doctors from developing countries threatens the health status of the populations left behind. This\ud qualitative study was conducted to explore why an unexpected number of Fiji specialist trainees left the public sector,\ud often to migrate, using a lens of professional satisfaction. Forty seven Fiji doctors, including 36 of 66 who undertook\ud specialist training in Fiji, were interviewed about the factors that led to their own professional satisfaction and\ud dissatisfaction. Three major components of professional satisfaction emerged: professional growth, service, and\ud recognition, with considerable overlap between categories. The aspects of professional dissatisfaction were more\ud varied but could be categorized as the absence or blocking of the elements of professional satisfaction. From the\ud interviews, a professional satisfaction model was developed featuring the three overlapping central elements of\ud satisfaction on a background of an enabling health system. This model might have implications for health systems\ud seeking to retain their workers

Lack of coordination between health policy and medical education: a contributing factor to the resignation of specialist trainees in Fiji?

Aim: Specialist training was established in Fiji in 1998. This study explored whether health policy, and in particular mismatches between existing policy and the new realities of local specialist training, contributed to decisions by many trainees to ultimately leave the public sectors, often to migrate.\ud \ud Method: Data was collected on the whereabouts of all specialist trainees. Semi-structured interviews were carried out with 36 of 66 Fiji trainees in order to explore reasons for continuing or not completing training, as well as the reasons behind subsequent career choices.\ud \ud Results: Overall, 54.5% of doctors remained in the public sectors or were temporarily overseas. Completion of specialist training was particularly associated with improved retention. Policies that contributed to frustration and sometimes resignations included a lack of transparency in the selection of doctors to enter training pathways, and unreliable career progression following completion of training. Doctors who left training before completion mentioned family stresses, which were exacerbated by delayed age at entry into training and a lack of certainty in regards to the timing of improved working conditions through career advancement.\ud \ud Conclusion: Policy adjustments to expedite entry into training, as well as to establish predictable career progression as a reward for training may increase training completions and overall retention