Using Technology to Enhance Rural Resilience in Pre-hospital Emergencies

The research presented in this paper is supported by RCUK dot.rural Digital Economy Research Hub, University of Aberdeen [grant number EP/G066051/1].Peer reviewedPublisher PD

Systematically Pinching Ideas: A Comparative Approach to Policy Design

Policy design,, whether conceptualized as a verb referring to the process of formulating policy ideas,, or as a noun describing the logic through which policy intends to achieve its objectives,, remains relatively uncharted territory.. This paper reviews what we know about how policy designs emerge,, and identifies the kinds of biases and weaknesses that are introduced into designs by the decision heuristics employed.. Theories of policy invention and expert decision--mmaking suggest that individuals search through large amounts of relevant information stored in memory,, reason by analogies,, make comparisons,, and either copy or simulate patterns of information.. Policy scholars may contribute to improved policy design by making more explicit the biases introduced through reliance on decision heuristics,, and by suggesting a more formal,, self conscious search and selection process that enables designers to be more discriminating when they pinch policy ideas from other contexts.. To perform this task,, comparative policy analysis is needed in which common elements that exist in virtually all policies are identified and the underlying structural logic of the policies is made explicit.. In this paperwe set forth generic elements found in policies,, describe and compare some of the more common design patterns,, and discuss the circumstances where these may be inappropriately copied or borrowed,, thereby thwarting the effectiveness of the policy

Designing a Mobile Device for Pre-hospital Care

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Behavioural Assumptions of Policy Tools

This paper provides a framework to analyze the implicit or explicit behavioral theories found in laws, regulations, and programs. The analysis focuses on policy tools or instruments and the underlying behavioral assumptions that guide their choice. We begin with the premise that public policy almost always attempts to get people to do things they otherwise would not have done, or it enables them to do things they might not have done otherwise. Policy tools are used to overcome impediments to policy-relevant actions. The five broad categories of tools we iden- tify-authority, incentives, capacity-building, symbolic and hortatory, and learning-make dif- ferent assumptions about how policy relevant behavior can be fostered. We contend that policy tools are essentially political phenomena, and that policy participation in the form of com- pliance, utilization, and other forms of "coproduction" is an important form of political behavior deserving of greater attention by political science

Social Construction of Target Populations: Implications for Politics and Policy

We argue that the social construction of target populations is an important, albeit overlooked, political phenomenon that should take its place in the study of public policy by political scientists. The theory contends that social constructions influence the policyagenda and the selection of policy tools, as well as the rationales that legitimate policy choices. Constructions become embedded in policy as messages that are absorbed by citizens and affect their orientations and participation. The theory is important because it helps explain why some groups are advantaged more than others independently of traditional notions of political power and how policy designs reinforce or alter such advantages. An understanding of social constructions of target populations augments conventional hypotheses about the dynamics of policy change, the determina- tion of beneficiaries and losers, the reasons for differing levels and types of participation among target groups, and the role of policy in democracy

Health system actors' perspectives of prescribing practices in public health facilities in Eswatini: A Qualitative Study

Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient's clinical needs. Policy-makers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. This study investigated perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini. Public sector healthcare service delivery is through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care. Methods A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored. Results Participants were aged between 21-57years, had been practicing for 1-30 years, and were a mix of doctors, nurses, pharmacists and pharmacy-technicians. Factors contributing to irrational medicines use included: Poor use of treatment guidelines, lack of RMU policies, poorly-functioning pharmaceutical and therapeutics committees, stock-outs of medicines, lack of pharmacy personnel in primary healthcare facilities, and restrictions of medicines by level of care. Provider-related factors included: Knowledge, experience and practice ethic, symptomatic prescribing, high patient numbers

TACI, unlike BAFF-R, is solely activated by oligomeric BAFF and APRIL to support survival of activated B cells and plasmablasts.

The cytokine BAFF binds to the receptors TACI, BCMA, and BAFF-R on B cells, whereas APRIL binds to TACI and BCMA only. The signaling properties of soluble trimeric BAFF (BAFF 3-mer) were compared with those of higher-order BAFF oligomers. All forms of BAFF bound BAFF-R and TACI, and elicited BAFF-R-dependent signals in primary B cells. In contrast, signaling through TACI in mature B cells or plasmablasts was only achieved by higher-order BAFF and APRIL oligomers, all of which were also po-tent activators of a multimerization-dependent reporter signaling pathway. These results indicate that, although BAFF-R and TACI can provide B cells with similar signals, only BAFF-R, but not TACI, can respond to soluble BAFF 3-mer, which is the main form of BAFF found in circulation. BAFF 60-mer, an efficient TACI agonist, was also detected in plasma of BAFF transgenic and nontransgenic mice and was more than 100-fold more active than BAFF 3-mer for the activation of multimerization-dependent signals. TACI supported survival of activated B cells and plasmablasts in vitro, providing a rational basis to explain the immunoglobulin deficiency reported in TACI-deficient persons

Adherence to thrombophilia testing guidelines and its influence on anticoagulation therapy: A single-center cross-sectional study.

INTRODUCTION The collected evidence on thrombophilia guidelines is scarce and data about their impact on clinical decisions are unknown. We aimed to investigate the adherence to thrombophilia testing guidelines, its therapeutic impact in patients with guideline-adherent and non-adherent testing and identify the patients' clinical characteristics mostly associated with treatment decisions. MATERIALS AND METHODS We conducted a single-center cross-sectional study of patients referred for thrombophilia testing at the outpatient clinic of a tertiary hospital between 01/2010-10/2020. We systematically evaluated the adherence of thrombophilia testing to internal guidelines and the influence of test results on anticoagulation therapy. Using multivariable logistic regression, we evaluated the association between clinical characteristics and influence of thrombophilia tests on anticoagulation therapy in the entire cohort and by indication for referral. RESULTS Of 3686 included patients, mostly referred for venous thromboembolism (2407, 65 %) or arterial thrombosis (591, 16 %), 3550 patients (96 %) underwent thrombophilia testing. Indication for testing was according to guidelines in 1208 patients (33 %). Test results influenced treatment decisions in 56 of 1102 work-ups (5.1 %) that were adherent to guidelines, and in 237 of 2448 (9.7 %) non-adherent work-ups (absolute difference, 4.3 %; 95 % confidence interval, 2.9-6.3 %). Age < 50 years, female sex, absence of risk factors and co-morbidities, weakly provoked venous thromboembolism and referral indication other than venous thromboembolism were associated with influence on anticoagulation therapy. CONCLUSIONS Adherence to guidelines for thrombophilia testing was poor and did not have an impact on treatment decisions. Refinement of selection criteria is needed to increase the therapeutic impact of thrombophilia testing