Letting Go: Conceptualizing intervention de-implementation in public health and social service settings

The discontinuation of interventions that should be stopped, or de-implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de-implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de-implemented. We identify three criteria for identifying interventions appropriate for de-implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well-documented examples illustrate each of the criteria. We describe de-implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de-implementation research as a supplement. Finally, we conclude with a discussion of de-implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de-implementation research, especially identifying interventions appropriate for de-implementation in a systematic manner; and highlight special ethical considerations to advance the field of de-implementation research

The Future of Hydrocarbon Development in Greenland: Perspectives from Residents of the North Slope of Alaska

 Although Greenland has pursued hydrocarbon development over the last four decades, no viable reserves have been found to date. Therefore, local Greenland communities have little experience or knowledge of how such development might affect their way of life or how to influence project development and outcomes should a significant reserve be found. On the North Slope of Alaska, in contrast, hydrocarbon extraction was commercialized in the 1970s, and the industry is now highly developed. North Slope residents have experienced dramatic influences on their everyday lives and well-being as a result of large-scale hydrocarbon projects. Some consequences have been welcomed, such as economic development and higher employment rates; however, other impacts are harmful, such as reduced ability of local peoples to maintain subsistence hunting practices. The villages on Alaska’s North Slope share many features in common with settlements in Greenland, such as small size, isolation, and limited political influence. In this study, we explore how Greenlanders might learn from the Alaska experience by examining the comments of North Slope residents. We propose that increased local-to-local recommendation-sharing across the Arctic would better guide sustainable development practices and benefits into potential future projects in Greenland. We conclude that an Arctic “Community Guide” and the process to create one could improve planning and implementation of hydrocarbon projects across the Arctic and promote locally appropriate sustainable development in the affected communities. Bien que le Groenland se soit adonné à l’exploration d’hydrocarbures ces quatre dernières décennies, aucune réserve rentable n’a été trouvée à ce jour. Par conséquent, les communautés du Groenland possèdent peu d’expérience ou de connaissances pour savoir comment des travaux de mise en valeur pourraient modifier leur mode de vie ou comment elles pourraient influencer le développement et les résultats d’un projet en cas de découverte de réserves importantes. En revanche, sur le North Slope de l’Alaska, l’extraction d’hydrocarbures a été commercialisée dans les années 1970, si bien que cette industrie y est maintenant fortement développée. La vie de tous les jours et le bien-être des résidents du North Slope ont connu des influences dramatiques en raison d’importants projets de mise en valeur d’hydrocarbures. Certaines incidences ont été bien accueillies, comme le développement économique et la hausse des taux d’emploi, mais d’autres ont été nuisibles, comme la diminution des occasions de pratiquer la chasse de subsistance dans la région. Les villages du North Slope de l’Alaska ont de nombreuses caractéristiques en commun avec ceux du Groenland, comme leur petite taille, leur isolement et leur influence politique restreinte. Dans cette étude, nous explorons la façon dont les Groenlandais pourraient tirer profit de l’expérience de l’Alaska en dépouillant les commentaires des gens du North Slope. Nous proposons que le partage accru de recommandations locales à l’échelle de l’Arctique permettrait de mieux orienter les pratiques de développement durable et leurs retombées dans le cadre de projets susceptibles de se concrétiser plus tard au Groenland. Nous concluons en affirmant qu’un « guide communautaire » de l’Arctique et le processus de création d’un tel guide pourraient améliorer la planification et la mise en oeuvre de projets d’hydrocarbures dans l’Arctique, en plus de favoriser un développement durable local adéquat dans les localités concernées

Disentangling HIV and AIDS Stigma in Ethiopia,Tanzania and Zambia

The International Center for Research on Women (ICRW), in partnership with organizations in Ethiopia, Tanzania, and Zambia, led a study of HIV and AIDS-related stigma and discrimination in these three countries. This project, conducted from April 2001 to September 2003, unraveled the complexities around stigma by investigating the causes, manifestations and consequences of HIV and AIDS-related stigma and discrimination in sub-Saharan Africa. It then uses this analysis to suggest program interventions. Structured text analysis of 730 qualitative transcripts (650 interviews and 80 focus group discussions) and quantitative analysis of 400 survey respondents from rural and urban areas in these countries revealed the following main insights about the causes, context, experience and consequences of stigma: The main causes of stigma relate to incomplete knowledge, fears of death and disease, sexual norms and a lack of recognition of stigma. Insufficient and inaccurate knowledge combines with fears of death and disease to perpetuate beliefs in casual transmission and, thereby, avoidance of those with HIV. The knowledge that HIV can be transmitted sexually combines with an association of HIV with socially “improper” sex, such that people with HIV are stigmatized for their perceived immoral behavior. Finally, people often do not recognize that their words or actions are stigmatizing. Socio-economic status, age and gender all influence the experience of stigma. The poor are blamed less for their infection than the rich, yet they face greater stigma because they have fewer resources to hide an HIV-positive status. Youth are blamed in all three countries for spreading HIV through what is perceived as their highly risky sexual behavior. While both men and women are stigmatized for breaking sexual norms, gender-based power results in women being blamed more easily. At the same time, the consequences of HIV infection, disclosure, stigma and the burden of care are higher for women than for men. People living with HIV and AIDS face physical and social isolation from family, friends, and community; gossip, name-calling and voyeurism; and a loss of rights, decision-making power and access to resources and livelihoods. People with HIV internalize these experiences and consequently feel guilty, ashamed and inferior. They may, as a result, isolate themselves and lose hope. Those associated with people with HIV and AIDS, especially family members, friends and caregivers, face many of these same experiences in the form of secondary stigma. People living with HIV and AIDS and their families develop various strategies to cope with stigma. Decisions around disclosure depend on whether or not disclosing would help to cope (through care) or make the situation worse (through added stigma). Some cope by participating in networks of people with HIV and actively working in the field of HIV or by confronting stigma in their communities. Others look for alternative explanations for HIV besides sexual transmission and seek comfort, often turning to religion to do so. Stigma impedes various programmatic efforts. Testing, disclosure, prevention and care and support for people with HIV are advocated, but are impeded by stigma. Testing and disclosure are recognized as difficult because of stigma, and prevention is hampered because preventive methods such as condom use or discussing safe sex are considered indications of HIV infection or immoral behaviors and are thus stigmatized. Available care and support are accompanied by judgmental attitudes and isolating behavior, which can result in people with HIV delaying care until absolutely necessary. There are also many positive aspects of the way people deal with HIV and stigma. People express good intentions to not stigmatize those with HIV. Many recognize that their limited knowledge has a role in perpetuating stigma and are keen to learn more. Families, religious organizations and communities provide care, empathy and support for people with HIV and AIDS. Finally, people with HIV themselves overcome the stigma they face to challenge stigmatizing social norms. Our study points to five critical elements that programs aiming to tackle stigma need to address: Create greater recognition of stigma and discrimination. Foster in-depth, applied knowledge about all aspects of HIV and AIDS through a participatory and interactive process. Provide safe spaces to discuss the values and beliefs about sex, morality and death that underlie stigma. Find common language to talk about stigma. Ensure a central, contextually-appropriate and ethically-responsible role for people with HIV and AIDS While all individuals and groups have a role in reducing stigma, policymakers and programmers can start with certain key groups that our study suggests are a priority: Families caring for people living with HIV and AIDS: programs can help families both to cope with the burden of care and also to recognize and modify their own stigmatizing behavior. NGOs and other community-based organizations: NGOs can train their own staff to recognize and deal with stigma, incorporate ways to reduce stigma in all activities, and critically examine their communication methods and materials. Religious and faith-based organizations: these can be supportive of people living with HIV and AIDS in their role as religious leaders and can incorporate ways to reduce stigma in their community service activitie

Invertebrate Diversity in Taylor Valley Soils and Sediments

Explaining how ecosystems function across variable landscapes will require knowledge of biodiversity patterns. In particular, biodiversity studies of soils and sediments will help in understanding the linkages between ecosystem processes in both of these habitats (Freckman et al. 1997). Soils and sediments are domains for ecosystem processes such as decomposition and trace gas exchange. There are few studies, however, that have compared abundance and diversity of organisms in adjacent soils and sediments (Freckman et al. 1997). The goal of this study was to increase understanding of how the biotic communities involved in ecosystem processes are organized within an important feature of the Antarctic dry valley landscape—a stream channel and the soils and sediments surrounding it

An X-ray investigation of some low-temperature solid phases of the systems Cu2S-Sb2S3, Cu2S-As2S3, Cu2S-FeS, and Cu2S-CuS

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Geology, 1953.Vita.Includes bibliographical references (leaves [65]-[67]).by Virginia F. Ross.Ph.D

Reflections on the process of using systematic review techniques to evaluate the literature regarding the neurotoxicity of low level exposure to organophosphate pesticides

We undertook a systematic review (incorporating meta-analysis) of the literature concerning the neurotoxicity of cumulative low level occupational exposure to organophosphate pesticides, which was published online by the journal Critical Reviews in Toxicology in 2012. As far as we are aware, we were the first research team to attempt quantitative evaluation of study findings on this topic, using meta-analysis. We wish to encourage others to apply systematic review techniques in chemical risk assessment to reduce bias, increase transparency and better inform public policy. We thought it would be useful to share our experience of undertaking a systematic review in the hope of dispelling misconceptions about the complexity, time and resource issues involved along with the view that meta-analysis is meaningless when studies are not homogeneous. In this commentary paper we reflect on aspects of the process which were relatively straightforward; aspects which were more challenging; the advantages of using systematic review techniques; and the advantages and limitations of using statistical techniques such as meta-analysis in this context

Neurobehavioral problems following low-level exposure to organophosphate pesticides: a systematic and meta-analytic review

Meta-analysis was carried out to determine the neurotoxic effects of long-term exposure to low levels of organophosphates (OPs) in occupational settings. Concern about the effects of OPs on human health has been growing as they are increasingly used throughout the world for a variety of agricultural, industrial and domestic purposes. The neurotoxic effects of acute poisoning are well established but the possibility that low-level exposure causes ill health is controversial. It is important to get a clear answer to this question as more individuals are at risk of low-level exposure than acute poisoning. Although a number of reviews on this topic have been published in the past, authors have come to conflicting conclusions. To date, none of these reviews have attempted quantitative evaluation of study findings using meta-analysis. This paper reviews the available evidence concerning the neurotoxicity of low-level occupational exposure to OPs and goes on to report the results of a meta-analysis of 14 studies which fulfilled criteria for this type of statistical analysis (means and standard deviations of dependant variables reported). Data were assimilated from more than 1600 participants. The majority of well designed studies found a significant association between low-level exposure to OPs and impaired neurobehavioral function which is consistent, small to moderate in magnitude and concerned primarily with cognitive functions such as psychomotor speed, executive function, visuospatial ability, working and visual memory. Unresolved issues in the literature which should become the focus of further studies are highlighted and discussed

Ecological Biogeography of the Terrestrial Nematodes of Victoria Land, Antarctica

The terrestrial ecosystems of Victoria Land, Antarctica are characteristically simple in terms of biological diversity and ecological functioning. Nematodes are the most commonly encountered and abundant metazoans of Victoria Land soils, yet little is known of their diversity and distribution. Herein we present a summary of the geographic distribution, habitats and ecology of the terrestrial nematodes of Victoria Land from published and unpublished sources. All Victoria Land nematodes are endemic to Antarctica, and many are common and widely distributed at landscape scales. However, at smaller spatial scales, populations can have patchy distributions, with the presence or absence of each species strongly influenced by specific habitat requirements. As the frequency of nematode introductions to Antarctica increases, and soil habitats are altered in response to climate change, our current understanding of the environmental parameters associated with the biogeography of Antarctic nematofauna will be crucial to monitoring and possibly mitigating changes to these unique soil ecosystems