Access Project Research Articles

Integrating mifepristone into primary care in Canada's capital: A multi-methods exploration of the Medical Abortion Access Project

ObjectivesFollowing the 2017 introduction of mifepristone in Canada and both ensuing regulatory changes and increased demand for medication abortion care, Planned Parenthood Ottawa created the Medical Abortion Access Project (MAAP). This study aimed to document outcomes, identify facilitators and barriers, and distill learnings from an initiative that sought to recruit and support primary care clinicians in providing mifepristone/misoprostol in Canada's capital. Study designWe employed a multi-methods evaluation strategy that included reviewing MAAP-related documents, evaluating the project log, and conducting in-depth interviews with clinicians at 5 sites. In the final analytic phase, we integrated the findings from the different evaluation components. ResultsFrom May 2017 through July 2018, the MAAP helped 14 primary care facilities in Ottawa become medication abortion providers; 9 began providing mifepristone/misoprostol to existing patients and 5 began offering mifepristone/misoprostol to the public. The program recruited 4 new pharmacies to stock the combination package and trained 2 sonography clinics in abortion-related protocols. Program participants identified patient demand as a key driver of medication abortion provision but required information and logistical support from the MAAP to operationalize service delivery. New abortion providers reflected positively on the community of practice that the MAAP created, which enabled them to offer and receive technical and emotional support from colleagues across the city. ConclusionsA number of primary care clinicians in Ottawa were able to successfully integrate medication abortion care into their practices with MAAP support. Future research should explore whether this type of community-based intervention can be replicated in other settings. ImplicationsEvidence-based regulation of mifepristone by health authorities is a critical step to increasing access to medication abortion care. However, deregulation alone was insufficient to integrate medication abortion services into primary care in Ottawa. Community-based programs like the MAAP can help providers make sense of shifting regulations and practice guidelines, overcome logistical barriers, and ultimately increase access to this medically necessary service. Establishing and facilitating communities of practice is especially important for new primary care providers.

EU Accession to the ECHR – an Equation with Many Unknowns

This article aims to present the status of the accession project eight years after the CJEU‘s opinion: the long way it has come, what has been done since then, the possible obstacles that remain, starting with the long procedure of ratification of the accession agreement, including by countries outside the European Union. The vicissitudes that this project has gone through, as well as the challenges that continue to face it, turn its realization into an equation with many unknowns, for which solutions are still being sought and will be sought.

Co-designing with visually impaired people in the museum

This article aims to conduct an analysis of the use of co-design methodologies in accessibility projects for the visually impaired in museums. The article presents a discussion of the practices of participatory methodologies in museum projects, in particular the co-design approach. It proceeds with a comparative case study, analyzing articles that describe the implementation of co-design projects in museum and educational contexts. The purpose of this comparative study is to present different methods of co-design, what goals can be achieved by these methodologies and to analyze and compare the results and challenges found. The authors selected four co-design projects for this comparative study, analyzing their differences and similarities. The conclusion of this analysis is that participatory projects bring as a benefit not only the creation of new audiences, but the enrichment of the museum object itself, promoting new forms of enjoyment and acquisition of knowledge. This article aims to contribute to the development of future studies and projects on accessibility that may represent better

Co-designing with visually impaired people in the museum

This article aims to conduct an analysis of the use of co-design methodologies in accessibility projects for the visually impaired in museums. The article presents a discussion of the practices of participatory methodologies in museum projects, in particular the co-design approach. It proceeds with a comparative case study, analyzing articles that describe the implementation of co-design projects in museum and educational contexts. The purpose of this comparative study is to present different methods of co-design, what goals can be achieved by these methodologies and to analyze and compare the results and challenges found. The authors selected four co-design projects for this comparative study, analyzing their differences and similarities. The conclusion of this analysis is that participatory projects bring as a benefit not only the creation of new audiences, but the enrichment of the museum object itself, promoting new forms of enjoyment and acquisition of knowledge. This article aims to contribute to the development of future studies and projects on accessibility that may represent better

The power of language: Exploring values, empowerment dynamics and communication strategies for gender-inclusive energy service design in rural Uganda

Understanding consumer needs and values is crucial to the sustainable delivery and uptake of energy access projects in Low-and Middle-Income Countries (LMICs). Nevertheless, many energy projects aim to empower women without first assessing gendered roles, needs, values, and relations for both men and women in project communities. Neglecting these can be detrimental to the end-users of energy projects, exacerbating conflict within households rather than empowering vulnerable groups. We propose a value-based approach to elicit the varying priorities and values of men and women and assess how these may shape energy access project design and communication in LMICs. Data from 84 qualitative individual interviews, equally split between men and women, and 28 gender-disaggregated focus-group discussions in seven rural Ugandan communities were used. We find that men and women in rural Uganda held largely the same high-priority underlying values focused on basic human needs such as income, healthcare, information services, food security, and water security. However, the language used to communicate these values differed in small but significant ways. Based on this, we offer two potential solutions for a more balanced gender-inclusive approach to energy service project design and communication: (1) Design projects and messaging based on underlying values of both genders while avoiding inadvertently reproducing patriarchal norms; and (2) use gender-specific messaging and vocabulary11In this research, vocabulary refers to the words, which vary from person to person, used to form associated meanings around the UPVs. linking energy projects to underlying values to increase buy-in. This work constitutes a first step in better understanding the importance of gender-disaggregated data in decision-making for energy access initiatives in LMICs.

Sharing electronically and accessibly in library-led instruction.

The electronic information and technology accessibility project is a strategic overhauling of the digital instructional materials of the Health Sciences Library System (HSLS) to comply with the accessibility standards established in a 2020 University of Pittsburgh policy. Though these technologies have existed for quite some time, library instructors were not skilled in the actual creation and design of documents, web content, and presentations with accessibility in mind. Over the past year and a half, a team within HSLS developed detailed guidance and education on universal design and creating an inclusive online learning environment. These guidelines were developed in accordance with Section 508 and the WCAG2.1, with a focus on an improved experience for the D/deaf community and those with visual impairments. We initially made accessibility improvements to online subject guides, in-person presentations, and digitally shared class materials. The COVID-19 pandemic and complete shift to virtual instruction then necessitated the evaluation of platforms used in remote learning (such as Zoom and Panopto), where accessibility best practices needed to be incorporated. This article highlights going beyond in-program accessibility checkers and describes how library technology experts and content creators worked together to bridge the gap of accessibility in the information we share.

An exploration of the Personal Relationship Advisory Group in a community learning disability service: A service development project

Accessible summary The project aimed to explore discussions from the Personal Relationship Advisory Group (PRAG) meetings in a community adult learning disability team to influence the development of new relationship resources. All meeting minutes within a 12‐month period were analysed to find themes. The themes suggest the importance of the service looking at the whole person, such as their physical, emotional and social well‐being, when there are relationship concerns. New resources that focus on personal sexuality, different types of relationships and Internet safety may be of benefit to the service. Resources for carers may also be useful, such as helping carers to support people with learning disabilities to safely access relationships online. AbstractBackgroundAdults with learning disabilities often face barriers when accessing relationships and can require additional support. The Personal Relationship Advisory Group (PRAG) is a provision in a community learning disability service in North England, which offers multidisciplinary advice regarding relationship concerns. The current project aimed to identify common themes within PRAG to influence the development of new resources in the service.Materials and MethodsAll meeting minutes within a 12‐month period were analysed using thematic analysis. There were a total of 16 minutes, which discussed 11 people with learning disabilities. This included six females and five males with a mean age of 30 (SD = 14.97).ResultsIndividuals often had limited opportunity to develop relationships. There was a lack of understanding of sex and of how to behave appropriately in different types of relationships, with a need for individualised, accessible education. The Internet was commonly used to seek relationships, with many concerns regarding safety from carers or family. There were some unhelpful responses from others, such as the implementing of restrictions. Factors that may have an impact on the person's overall well‐being, such as their health, social issues and trauma, were often discussed.ConclusionsThe identified themes suggest the need for the service to take a holistic, biopsychosocial and individualised approach when supporting individuals with any relationship concerns. A multidisciplinary approach and collaboration with the individual and family/carers is key. It may be useful for the service to develop resources on topics such as personal sexuality, different types of relationships and Internet safety. Carer‐specific resources would also be beneficial, such as advice on how to safely support individuals to seek relationships on the Internet.

Evaluation and collaboration in creating online audio descriptions of visual art

AccesArte is an accessibility project that is part of the internship programme at Kaleidoscope, a non-profit organization founded by the authors to apply audio description (AD) research to developing accessibility programmes. The project consists of ADs of a thematic selection of visual artworks, and the development of eclectic and experience-oriented AD types. It uses online, open access videos and performs a formative and summative evaluation of the resources, with the latter being online, open and ongoing. The goal of this article is to offer a detailed description and critical analysis of the project, with an emphasis on the formative evaluation process. In this regard, the formative evaluation has allowed us to include blind and partially sighted (BPS) consultants in the process, improve resource quality, and enrich the interns’ learning experience.

21.1 ACCESS MENTAL HEALTH CONNECTICUT: FAMILY-CENTERED PEDIATRIC MENTAL HEALTH CONSULTATIONS

The objective of this presentation is to review the family-centered, well-being-focused nature of the ACCESS (Access to all of Connecticut’s Children of Every Socioeconomic Status) Mental Health program and its contributions to improving mental health treatment for children in the state of Connecticut. ACCESS Mental Health Connecticut is a state-funded initiative created as a line item in the Department of Children and Families’ budget as a component of the gun-control legislation passed in the wake of the Sandy Hook school shooting. Initiated in June 2014 and modeled after the Massachusetts Child Psychiatry Access Project (MCPAP), the Connecticut model includes 3 Hubs to support mental health education and the well-being of pediatric primary care providers, and to support families regardless of insurance status. The model incorporates a team of child and adolescent psychiatrists, licensed social work clinicians, a program coordinator, and, uniquely, a peer specialist. The peer specialist is a parent with a child with mental health challenges who can support pediatric patients’ parents emotionally and practically as they attempt to process and navigate the mental health landscape. Since its inception in June 2014, the ACCESS Mental Health Hubs have provided over 36,700 consultations supporting over 7000 youth and their families. During the early months of the COVID-19 pandemic, the ACCESS Mental Health Teams initiated weekly well-being support Zoom meetings for the state’s pediatric primary care physicians (PPCPs). Now monthly, the Zoom “Clinical Conversations with ACCESS Mental Health” provides mental health education to address the PPCP’s unique needs. Hub child and adolescent psychiatrists also participate in Project ECHO (Extension of Community Healthcare Outcomes), AAP Connecticut webinars, grand rounds, and other venues. PPCP mental health education and early access to mental healthcare promises to identify, support, and treat children and families experiencing mental health challenges that have previously been unable to access services. The trusting personal relationships between the Hub teams and the PPCPs is a cherished component of the ACCESS Mental Health program service.

Doctrinal Implications of Computational Antitrust

Utilizing antitrust decisions extracted from the Caselaw Access Project, we aggregate—or embed—layers of topic modeling into a single set of visualizations. Aggregated models can provide new perspectives on how courts tackle thorny doctrinal questions, such as the measure of market power and the balance between antitrust and regulation. Our central contribution is the improvement of natural language processing to provide greater context for key terms. Our secondary contribution is a new suite of tools to assess the weighty policy arguments that currently dominate antitrust.

Academic-Community Partnership to Improve Pediatric Mental Health Access: Missouri Child Psychiatry Access Project.

Because of significant shortages in the behavioral health workforce, primary care providers (PCPs) have become the de facto mental health providers to address poor access to mental health care. Child psychiatry access programs (CPAPs) could support PCPs through case consultations. This column describes the innovative Missouri Child Psychiatry Access Project, highlighting the unique enhancements to existing CPAPs and the partnership between community and academic settings to support behavioral health access in primary care. Using an implementation science approach, the authors applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to disseminate replicable steps for other systems; they also discuss future directions for expanding utility and scope.

INTEGRATED METHODS FOR THE CONSERVATION AND RESTORATION OF ARCHAEOLOGICAL SITES. AN EXPERIMENTAL APPLICATION ON THE “BALNEUM” OF PIAZZA DANTE IN CATANIA (ITALY)

Abstract. Archaeological sites in urban areas are often poorly integrated with the modern urban fabric and appear as “trenches” at a lower level than the road. They become neglected and unvalued places. The study of archaeological ruins in urban centres must involve archaeologists and architects to integrate restoration, enhancement and improvement of physical and visual accessibility projects. New digital technologies can improve these activities thanks to 3D models, “digital replicas” that allow even remote study (especially during a pandemic). The paper presents the case study of a private Roman-imperial bath in Catania. The open-air site is located at a depth of 3 metres above the road level and is not exploited. Our study consisted of historical-bibliographical research, direct and SfM surveys that allowed creating a high-resolution textured 3D model. We have extracted orthophotos and sections for geometric and technical-constructive analyses and recognition of decay from this model. We drew up an archaeological restoration and valorisation design. In addition, we imported the model into the Sketchfab portal. So, we enriched the mesh with information from the analyses employing specific tags about annotations, 2D drawings, historical and technical-scientific information. In this way, the model becomes an interactive document to monitor over time the conservation state, validate the restoration design and contribute to the valorisation of the site. This is an easy tool of exchange between all involved users (researchers, professions and students). Thus, the digital replica also represents a very high potential for dissemination purposes.

Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports

BackgroundSchizophrenia and bipolar disorder are severe mental illnesses which are highly prevalent worldwide. Risperidone and Paliperidone are treatments for either illnesses, but their efficacy compared to other antipsychotics and growing reports of hormonal imbalances continue to raise concerns. As existing evidence on both antipsychotics are solely based on aggregate data, we aimed to assess the benefits and harms of Risperidone and Paliperidone in the treatment of patients with schizophrenia or bipolar disorder, using individual participant data (IPD), clinical study reports (CSRs) and publicly available sources (journal publications and trial registries).MethodsWe searched MEDLINE, Central, EMBASE and PsycINFO until December 2020 for randomised placebo-controlled trials of Risperidone, Paliperidone or Paliperidone palmitate in patients with schizophrenia or bipolar disorder. We obtained IPD and CSRs from the Yale University Open Data Access project. The primary outcome Positive and Negative Syndrome Scale (PANSS) score was analysed using one-stage IPD meta-analysis. Random-effect meta-analysis of harm outcomes involved methods for coping with rare events. Effect-sizes were compared across all available data sources using the ratio of means or relative risk. We registered our review on PROSPERO, CRD42019140556.ResultsOf the 35 studies, IPD meta-analysis involving 22 (63%) studies showed a significant clinical reduction in the PANSS in patients receiving Risperidone (mean difference − 5.83, 95% CI − 10.79 to − 0.87, I2 = 8.5%, n = 4 studies, 1131 participants), Paliperidone (− 6.01, 95% CI − 8.7 to − 3.32, I2 = 4.3%, n = 13, 3821) and Paliperidone palmitate (− 7.89, 95% CI − 12.1 to − 3.69, I2 = 2.9%, n = 5, 2209). CSRs reported nearly two times more adverse events (4434 vs. 2296 publication, relative difference (RD) = 1.93, 95% CI 1.86 to 2.00) and almost 8 times more serious adverse events (650 vs. 82; RD = 7.93, 95% CI 6.32 to 9.95) than the journal publications. Meta-analyses of individual harms from CSRs revealed a significant increased risk among several outcomes including extrapyramidal disorder, tardive dyskinesia and increased weight. But the ratio of relative risk between the different data sources was not significant. Three treatment-related gynecomastia events occurred, and these were considered mild to moderate in severity.ConclusionIPD meta-analysis conclude that Risperidone and Paliperidone antipsychotics had a small beneficial effect on reducing PANSS score over 9 weeks, which is more conservative than estimates from reviews based on journal publications. CSRs also contained significantly more data on harms that were unavailable in journal publications or trial registries. Sharing of IPD and CSRs are necessary when performing meta-analysis on the efficacy and safety of antipsychotics.

Characteristics of available studies and dissemination of research using major clinical data sharing platforms.

Over the past decade, numerous data sharing platforms have been launched, providing access to de-identified individual patient-level data and supporting documentation. We evaluated the characteristics of prominent clinical data sharing platforms, including types of studies listed as available for request, data requests received, and rates of dissemination of research findings from data requests. We reviewed publicly available information listed on the websites of six prominent clinical data sharing platforms: Biological Specimen and Data Repository Information Coordinating Center, ClinicalStudyDataRequest.com, Project Data Sphere, Supporting Open Access to Researchers-Bristol Myers Squibb, Vivli, and the Yale Open Data Access Project. We recorded key platform characteristics, including listed studies and available supporting documentation, information on the number and status of data requests, and rates of dissemination of research findings from data requests (i.e. publications in a peer-reviewed journals, preprints, conference abstracts, or results reported on the platform's website). The number of clinical studies listed as available for request varied among five data sharing platforms: Biological Specimen and Data Repository Information Coordinating Center (n = 219), ClinicalStudyDataRequest.com (n = 2,897), Project Data Sphere (n = 154), Vivli (n = 5426), and the Yale Open Data Access Project (n = 395); Supporting Open Access to Researchers did not provide a list of Bristol Myers Squibb studies available for request. Individual patient-level data were nearly always reported as being available for request, as opposed to only Clinical Study Reports (Biological Specimen and Data Repository Information Coordinating Center = 211/219 (96.3%); ClinicalStudyDataRequest.com = 2884/2897 (99.6%); Project Data Sphere = 154/154 (100.0%); and the Yale Open Data Access Project = 355/395 (89.9%)); Vivli did not provide downloadable study metadata. Of 1201 data requests listed on ClinicalStudyDataRequest.com, Supporting Open Access to Researchers-Bristol Myers Squibb, Vivli, and the Yale Open Data Access Project platforms, 586 requests (48.8%) were approved (i.e. data access granted). The majority were for secondary analyses and/or developing/validating methods (ClinicalStudyDataRequest.com = 262/313 (83.7%); Supporting Open Access to Researchers-Bristol Myers Squibb = 22/30 (73.3%); Vivli = 63/84 (75.0%); the Yale Open Data Access Project = 111/159 (69.8%)); four were for re-analyses or corroborations of previous research findings (ClinicalStudyDataRequest.com = 3/313 (1.0%) and the Yale Open Data Access Project = 1/159 (0.6%)). Ninety-five (16.1%) approved data requests had results disseminated via peer-reviewed publications (ClinicalStudyDataRequest.com = 61/313 (19.5%); Supporting Open Access to Researchers-Bristol Myers Squibb = 3/30 (10.0%); Vivli = 4/84 (4.8%); the Yale Open Data Access Project = 27/159 (17.0%)). Forty-two (6.8%) additional requests reported results through preprints, conference abstracts, or on the platform's website (ClinicalStudyDataRequest.com = 12/313 (3.8%); Supporting Open Access to Researchers-Bristol Myers Squibb = 3/30 (10.0%); Vivli = 2/84 (2.4%); Yale Open Data Access Project = 25/159 (15.7%)). Across six prominent clinical data sharing platforms, information on studies and request metrics varied in availability and format. Most data requests focused on secondary analyses and approximately one-quarter of all approved requests publicly disseminated their results. To further promote the use of shared clinical data, platforms should increase transparency, consistently clarify the availability of the listed studies and supporting documentation, and ensure that research findings from data requests are disseminated.

Oncology Expanded Access and FDA's Project Facilitate.

The Oncology Center of Excellence at the U.S. Food and Drug Administration launched Project Facilitate on May 31, 2019, to assist oncology health care providers with Expanded Access requests for investigational drugs. Expanded Access, sometimes called "compassionate use," is a regulatory pathway for physicians caring for patients who have a life-threatening condition or a serious disease to gain access to an investigational drug for treatment when no comparable or satisfactory alternative treatment options are available. Herein we describe the Project Facilitate program and the process for requesting Expanded Access to an investigational drug.

Sysrev: A FAIR Platform for Data Curation and Systematic Evidence Review.

Well-curated datasets are essential to evidence based decision making and to the integration of artificial intelligence with human reasoning across disciplines. However, many sources of data remain siloed, unstructured, and/or unavailable for complementary and secondary research. Sysrev was developed to address these issues. First, Sysrev was built to aid in systematic evidence reviews (SER), where digital documents are evaluated according to a well defined process, and where Sysrev provides an easy to access, publicly available and free platform for collaborating in SER projects. Secondly, Sysrev addresses the issue of unstructured, siloed, and inaccessible data in the context of generalized data extraction, where human and machine learning algorithms are combined to extract insights and evidence for better decision making across disciplines. Sysrev uses FAIR - Findability, Accessibility, Interoperability, and Reuse of digital assets - as primary principles in design. Sysrev was developed primarily because of an observed need to reduce redundancy, reduce inefficient use of human time and increase the impact of evidence based decision making. This publication is an introduction to Sysrev as a novel technology, with an overview of the features, motivations and use cases of the tool.Methods: Sysrev. com is a FAIR motivated web platform for data curation and SER. Sysrev allows users to create data curation projects called “sysrevs” wherein users upload documents, define review tasks, recruit reviewers, perform review tasks, and automate review tasks.Conclusion: Sysrev is a web application designed to facilitate data curation and SERs. Thousands of publicly accessible Sysrev projects have been created, accommodating research in a wide variety of disciplines. Described use cases include data curation, managed reviews, and SERs.

“It’s not the same without you:” Exploring the experience and perception of transition for people with intellectual disabilities and dementia

Accessible Summary This project focuses on people with intellectual disabilities and dementia that live in group homes or care facilities in the United States. People in this project shared how their life changed as they got older. They talked about where they live, what they do for work and how they get to spend their day. All the people in this project talked about how it was important for them to see their friends, even if where they lived or worked changed. People in this project worried that they would have to move or stop doing activities that were important to them if they started to need more help. People with intellectual disabilities and dementia should receive support to continue to see friends and do their favourite activities as they get older. AbstractBackgroundFor people with intellectual disabilities and dementia, transitions are likely to become increasingly common as they age. While transitions experienced by people with intellectual disabilities in young adulthood are frequently studied, less is known about transitions in older adults, including residential, vocational and leisure changes. This article aims to explore the experiences of transition from the perspectives of people with intellectual disabilities and dementia, including the impact on their daily lives.MethodologyThree women with intellectual disabilities and dementia living in residential settings participated in participant observations and informal interviews across a variety of environments and activities. Field notes and interview transcripts underwent a thematic analysis focusing on transitions.FindingsParticipants experienced the impact of transitions in their residential placements, day programming, leisure activities and relationships. Themes related to their experiences of transitions included making sense of transitions, utilising peer care networks for support and tackling the looming threat of loss and transition.ConclusionsPeer care networks and friendships are crucial in supporting people during and after transitions. Receiving effective supports to maintain relationships, roles and activities, even in seemingly minor ways, is an important right for people with intellectual disabilities and dementia, particularly as care needs increase.

A knowledge-centered framework for exploration and retrieval of legal documents

Automated legal knowledge extraction systems are strongly demanded, to support annotation of legal documents as well as knowledge extraction from them, to provide useful and relevant suggestions to legal actors (e.g., judges, lawyers) for managing incoming new cases.In this paper, we propose CRIKE (CRIme Knowledge Extraction), a knowledge-based framework conceived to support legal knowledge extraction from a collection of legal documents, based on a reference legal ontology called LATO (Legal Abstract Term Ontology). We first introduce LATO-KM, the knowledge model of LATO where legal knowledge featuring documents in the collection is properly formalized as conceptual knowledge, in form of legal concepts and relationships, and terminological knowledge, in form of term-sets associated with legal concepts. Then, we present the bootstrapping cycle of CRIKE that aims to progressively enrich the terminological knowledge layer of LATO by extracting new terms from legal documents to be used for enriching the term-set associated with a corresponding legal concept. Finally, to evaluate the results obtained through CRIKE, we discuss experimental results on a real dataset of 180,000 court decisions of the State of Illinois taken from the Caselaw Access Project (CAP).

Editorial: Will Teledentistry Improve Access to and Quality of Dentistry?

Irena Sailer, Editor-in-Chief: Teledentistry is a very interesting new area of dentistry that combines the use of electronic health records, recent telecommunication technology, digital imaging, and the internet to connect health care providers with each other or with patients in rural, less accessible, and/or undeserved regions.^{1</1> Teledentistry is a part of tlelmedicine initiated in 1994 as oart of a military project in the United States– the US Army’s Total Dental Access project. This program had the aim of improving the care of patients, the education of dentists, and the communication between dentists and dental laboratories,² aims that were successfully accomplished. Today, we can consider teledentistry as an important part of the science of telemedicine and a relevant, timely field for ambitious researchers. But what is teledentistry exactly, and how does it work? In simple words, teledentistry is a “real-time consultation” through online computer video telecommunication systems between dentists, hygienists, and/or patients in more remote communities and dentists/specialists in larger communities providing advice and supervision. But this is not the only way teledentistry consultations can be provided. These consultations can also be provided through a “store and forward” method.3 While real-time consultation involves videoconferencing between the involved parties, the “store and forward” method includes an exchange of collected clinical information and images forwarded to a specialist for consultation and treatment plan- ning. A third method described in the literature is the “remote monitoring” method, which involves patients that are monitored at a distance while they are either hospital- or home-based.4 Hence, teledentristry is multifaceted. The scope of teledentistry is certainly to improve access to oral health care and its delivery, as well as to reduce total health care costs. These aims have been subject to several research projects in past years, and numerous investigations have proven these specific benefits in different domains of dentistry, such as oral medicine and diagnosis, oral and maxillofacial sur- gery, orthodontics, periodontics, pediatric and preventive dentistry, and, last but not least, prosthodontics.² In our domain, prosthodontics, teledentistry can become a very powerful tool in the future; eg, to increase the amount of dental specialist treatments in sparsely populated areas. Specialist treatments can become accessible for the most remote parts of the world. The only prerequisite is a strong and stable high-speed internet connection. Another interesting benefit of teledentistry is that it not only has the po- tential to improve the quality of the treatment of patients, it can also serve as an important means to remotely deliver dental education throughout the world—which is truly a strong benefit, as these pandemic times have shown. Online video conferencing, webinars, and online training courses have become a substantial part of dental education since the breakout of COVID-19. An interesting more recent trend are long distance “hands-on” trainings, where participants receive boxes with the required materials and instruments for a certain practical exercise and then watch live online step- by-step demonstrations on how to perform the respective procedure.<sup1} While these are all the numerous benefits of teledentistry, challenges must be considered as well. One challenge is the increased time needed to perform teledentistry types of consultations.1 Furthermore, and more importantly, challenges also include ethical and legal issues that teledentistry may have. The electronic transfer of medical histories and records, as well as clinical images of patients, can raise concerns about the confidential- ity of teledentistry. On the one hand, users of teledentistry have to make sure that patient privacy is not compromised through unauthorized entities; on the other hand, patients should be made aware that their data will be transferred electronically to other professionals through teledentistry, and written consent is therefore advisable. Nevertheless, teledentristry—with its strong benefits of improving the access and delivery of oral health care and its education to anywhere in the world, as well as its potential for the increase of treatment efficiency and the reduction of treatment costs—will become more and more important in the future, and young, upcoming prosthodontic researchers are strongly encouraged to focus on this area. On behalf of the entire Editorial Board team, Irena Sailer Editor-in-Chief REFERENCES 1. Fricton J, Chen H. Using teledentistry to improve access to dental care for the underserved. Dent Clin North Am 2009;53:537–548. 2. Jampani ND, Nutalapati R, Dontula BSK, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent 2011;1:37–44. 3. Reddy KVG. Using teledentistry for providing the specialist access to rural Indians. Indian J Dent Res 2011;22:189. 4. Bagchi S. Telemedicine in rural India. PLoS Med 2006;3:e82.

The Sustainability of Decentralised Renewable Energy Projects in Developing Countries: Learning Lessons from Zambia

Decentralised renewable energy (RE) systems such as solar PV mini-grids (MG) are considered to be a cornerstone for the strategic achievement of the UN’s energy access goals in the developing world. Many of these systems implemented however face substantial technical, financial and social sustainability challenges which are also a recurring theme in the relevant literature. MG analyses however often lack detailed technical or financial data or apply ‘silo-approaches’ as a comprehensive review of MG case study literature presented in this article reveals. Consequently, this study aims to enhance the understanding of RE MG sustainability in the developing context based on the integrated evaluation of the technical, financial and social dimensions of MG operation through empirical data from community surveys on energy use from Uganda and Zambia and two in-depth MG case studies from Zambia. By presenting detailed technical and financial data in combination with energy consumer perception, the study aims to close existing data gaps on sustainable RE MG operation and offers an approach to evaluate and optimise the operational sustainability of an MG in its individual local context. The article finds that the complex rural community ecosystem is a central, but yet undervalued determinant of MG sustainability in rural developing contexts. The mismatch between energy affordability and MG tariffs threatens MG sustainability and the scaling of energy access projects if not addressed specifically during project development and implementation. Consequently, the article calls for a strategic inclusion of community-ecosystem parameters and MG planning based on realistic energy affordability levels and an added value approach that includes dynamic MG financing mechanisms and targeted measures to generate added value through energy consumption as integral parts of RE MG projects.