Agency Policy Research Articles

Climate therapy: Developing a climate change charter for Cancer Trials Ireland (CTI).

e23214 Background: Climate change is a threat to human existence. Healthcare is the 5th leading cause of CO2 emissions globally, while clinical trials generate the equivalent of half the CO2 emissions of Denmark. Consequently, both enterprises represent significant, potentially modifiable, causes of climate change. In response to this climate toxicity (PMID 36773799), CTI launched the National Green Cancer Clinical Trials Initiative in 2022. A climate charter, which was to consist of a living document of actionable areas, was commissioned by the CTI board to implement them. Methods: Carbon footprint touch points of CTI’s activity on climate change were identified such as travel, procurement, energy use, financial management. An online scoping review of existing academic and non-academic sustainability initiatives, funding agency and national policy documents, peer reviewed and grey literature sources was conducted using the terms climate change and sustainability. Action points were categorised and collated. No exemplar climate charters for clinical trial organisations were identified in the search. Results: 5 pillars of interaction with sustainability initiatives were evident. These were education, engagement, empowerment, embedding, and emphasising. These pillars related to 8 themes for climate smart involvement by CTI staff and members. Personal commitment to sustainability at an individual level eg dietary choices, EU climate pact participation. Trial design and management eg sustainability assessment & integration into protocols Recycling and waste management at central office and sites. Energy and water use eg optimise computing infrastructure, prioritise low carbon sources. Procurement and contracts eg promote green purchasing, integrate environmental and social sustainability clauses in contracts, sustainability assessment of financial services including pensions Meetings and conferences eg prioritising virtual meetings, select conference venues and accommodation with environmental certs. Commuting and business travel. Outreach eg, to University partners, trainees, network with Green Trial groups. Conclusions: The climate charter provides a structure to facilitate sustainability integration at CTI. This living document registers existing activities, highlights areas for engagement, facilitates horizon scanning and outreach to emerging initiatives, empowers staff , and demonstrates an organisational commitment to climate smart, clinical trial conduct.

Relationship between Civilian Injuries Caused during Contact with Law Enforcement and Community-Level Sociodemographic Characteristics.

Civilian injuries caused during contact with law enforcement personnel erode community trust in policing, impact individual well-being, and exacerbate existing health inequities. We assessed the relationship between ZIP code-level rates of civilian injuries caused during legal interventions and community-level sociodemographic characteristics using Illinois hospital data from 2016 to 2022. We developed multivariable Poisson regression models to examine whether legal intervention injury rates differed by race-ethnicity and community economic disadvantage across three geographic regions of Illinois representing different levels of urbanization. Over the study period, 4976 civilian injuries were treated in Illinois hospitals (rate of 5.6 per 100,000 residents). Compared to non-Hispanic white residents, non-Hispanic Black residents demonstrated 5.5-10.5 times higher injury rates across the three geographic regions, and Hispanic-Latino residents demonstrated higher rates in Chicago and suburban Cook County, but lower rates in the rest of the state. In most regions, models showed that as the percent of minority residents in a ZIP code increased, injury rates among non-Hispanic Black and Hispanic-Latino residents decreased. As community economic disadvantage increased at the ZIP code level, civilian injury rates increased. Communities with the highest injury rates involving non-Hispanic white residents were significantly more economically unequal and disadvantaged. While the injury rates were consistently and substantially higher among non-Hispanic Black residents throughout the state, the findings illustrate that the association between overall civilian injuries caused during contact with law enforcement and community sociodemographic characteristics varied across regions. Data on local law enforcement agency policies and procedures are needed to better identify appropriate interventions.

Expert insights into future trajectories: assessing cost reductions and scalability of carbon dioxide removal technologies

IntroductionTo achieve net-zero targets, it is essential to evaluate and model the costs and scalability of emerging carbon dioxide removal technologies like direct air capture with CO2 storage (DACCS) and bioenergy with carbon capture and storage (BECCS). Yet such efforts are often impeded by varying assessments of the climate impact and potential contributions of these technologies. This study explores the future costs and scalability of DACCS and BECCS to advance net-zero goals.MethodsWe analyze expert opinions on these technologies’ potential costs and deployment scales for 2030, 2040, and 2050. Data was collected from 34 experts, comprising 21 DACCS and 13 BECCS specialists. They provided 90% confidence interval estimates and ‘best estimates’ for future costs and deployment under two International Energy Agency (IEA) policy scenarios—Stated Policies (STEPS) and Net Zero Emissions by 2050 (NZE).ResultsWe find that BECCS costs start at a lower level but decrease more slowly, whereas DACCS costs decline more steeply from a higher initial cost. However, DACCS estimates varied significantly among experts, showing no convergence over time. Regarding potential scalability, both technologies are associated with substantially higher deployment under the NZE scenario. Yet the combined estimated capacity of DACCS and BECCS by 2050 is only about a quarter of the CO2 removals projected by the IEA for its NZE scenario (1.9 GtCO2).DiscussionThis study provides valuable insights into the future of DACCS and BECCS technologies in Europe, especially since our experts expect that DACCS and BECCS costs will be even higher (and deployment scales lower) than those predicted by recent IEA tracking, opening future research directions.

Evaluation of an end-of-life teaching programme for unregistered domiciliary care staff.

With increased focus on people being supported to die at home, and increased numbers of people predicted to die in the coming years in the UK, it is recognised that domiciliary carers need to be trained and supported to give end-of-life care. Recent reports suggest that this is not happening. To introduce and evaluate a training programme to upskill unregulated domiciliary care agency staff and integrate them into the palliative care teams, supporting registered nurses in caring for end-of-life patients. A training course was devised and implemented. This report covers the first 3 years of running the course, and evaluates the difference that it made to the first 210 recipients' ability and confidence in delivering end-of-life care, using a mixed-methods approach. Pre- and post-course confidence questionnaires, evaluations, post-course testimonials, and managers' comments all identified improvements in knowledge, skills and attitudes following training. Agency policies were re-written with up-to-date guidance on how to respond to death in the community. This article demonstrates that this model is effective in achieving its aims.

Language policy on the ground in Norwegian kindergartens

The study explores literacy conditions for preschool children acquiring Nynorsk, a lesser used Norwegian written language. Norway has no official language policy for the use of Nynorsk and Bokmål, the majority written language, in preschool education. By observing when and how Nynorsk, Bokmål, and other varieties are involved in activities where texts and print play a role, we examine language policy appropriation in kindergartens in a community where the children are going to have Nynorsk as first written language when they attend formal education. The study shows that the predominant literacy practices create spaces for kindergarten staff's language policy agency, but that their choices are limited – especially by textual artefacts. Teacher-made materials are often in Nynorsk, while materials from the outside are in Bokmål. The lack of official language policy results in kindergarten staff being the ones, if anyone, to ensure written language stimulation for ‘the Nynorsk children’.

SMART SUSTAINABLE URBAN DEVELOPMENT FOR THE NEW CAPITAL CITY OF INDONESIA

It is critical to do research on the concept of Smart Sustainable Urban Development and its implementation. This is primarily important to support the urban future and urban governance in Nusantara Capital City, Indonesia, and the relation to the concept of urban sustainability and smart city. This research is aimed to analyse the implementation of the smart sustainable urban development concept to support the urban future through the New Urban Agenda and Sustainable Development Goals and urban governance in Nusantara Capital City. The data were obtained by conducting in-depth interviews and Focus Group Discussions (FGD) with the policy stakeholders and agencies relevant to the development plan for Nusantara Capital City and field surveys in the form of observations as well. The results show that the urban future from the national government is envisaged through six domain services encapsulating the sustainability and smart city elements. In the regional and local level, challenges are met including the environmental and social impact but through government collaboration and devising Information and Communication Technology, the authority has been able to design the solution. Sustainability, ICT, smart city, and urban governance constitute critical elements in the process of urban development, especially for the development of a new capital city.

A new measure of US public agency policy discretion

Abstract The US bureaucracy routinely issues major public policy decisions that affect Americans’ lives. Government agency leaders make those decisions based on a subjective understanding of their agency’s available policy discretion. Over time, discretion has become a prominent theoretical construct in the bureaucratic politics and public administration literature, but it is rarely measured directly. In this article, we create a new measure of agency policy discretion. We draw on research suggesting that discretion is derived from the bureaucracy’s key political principals: the elected executive, legislators, and interest groups. We use data from the American State Administrators Project and trigonometry to calculate the discretion area scores for 8,955 state agencies between 1978 and 2018. We then evaluate the measure through a series of construct validation assessments. The article offers an innovative and generalizable way to operationalize discretion that will advance future scholarship in organizational behavior, public administration, and bureaucratic decision-making.

Experiences of research-policy engagement in policy-making processes.

Objectives and importance of study: For public policy to respond effectively to social, economic, and health challenges, there is an urgent need for research-policy collaboration to advance evidence-informed policy. Many organisations seek to promote these engagement activities, but little is known about how this is experienced by researchers and policy actors. This study aimed to understand how policy actors and researchers in Australia experience collaboration and the impediments and enablers they encounter. Study type and methods: An online survey was developed, and using convenience sampling, self-identified Australian policy actors and researchers were invited to participate. Results: In total, 170 responses were analysed, comprising 58% policy actors and 42% researchers. Respondents reported the primary purpose for collaboration was evidence-informed policy making. Policy actors reported that the most common barrier to collaboration with academics was 'budget constraints' while academics reported 'budget, 'political risk' and 'structural barriers'. Reported enablers were 'leadership' and 'connections'. Conclusions: Our findings build upon existing evidence that highlights the importance of collaboration for facilitating evidence-informed policy. Structural deficits in both policy agencies and research funding systems and environments continue to present challenges to policy-research partnerships. Future initiatives could use these findings to implement preferred collaboration methods, alongside rigorous evaluation, to explore 'what works' in promoting engagement for evidence-informed policy.

Bibliometric Review of Teacher Professional Identity Scholarship Over Two Decades

This study presents a bibliometric review of teacher professional identity (TPI) research from 2004 to 2023. 4,066 SSCI-indexed papers retrieved from the Web of Science database were identified for analysis using CiteSpace. The major findings are: (1) The publications have increased significantly from 2004 to 2021, there is a slight decline in recent 2 years. (2) Top contributing country, institution, and journal are the US, University of London, Teaching and Teacher Education respectively. (3) The top productive authors are Yuan Rui, Trent John, and Nazari Mostafa respectively, the top cited authors are Beijaard D, Gee JP, and Lave J. (4) TPI research has evolved in terms of multiple theoretical lens, diversity of discipline and participants, and methodological shift. (5) Emerging trends include teacher agency, positioning theory, and English-medium instruction (EMI) policy. This study has implications for future researchers.

The occupation of self-employment in South African informal micro-enterprises

Introduction: Self-employment, in which individuals work for themselves in a small business or microenterprise to earn an income or generate a salary, has been encouraged to facilitate employment opportunities in South Africa. However, participation in self-employment within the community served by professionals such as occupational therapists is limited by many factors, including effective government initiatives, such as implementing the Small Enterprise Development Agency (SEDA) policies. To enable individuals and community participation in this type of work for those with occupational dysfunction, mainly persons with disabilities, professionals such as occupational therapists need to understand the structural, contextual and occupational outcomes related to self-employment. Based on the Framework for Occupational Justice, this study explored the occupation of self-employment in microenterprises in the low-resourced urban community of Alexandra Township.
 Method: A quantitative descriptive non-experimental design study was used to identify informal microenterprises in the community using a transect walk and community mapping. Structured interviews were conducted to complete a questionnaire with key informants (service providers and business owners) who provided perceptions on factors that impacted the occupational outcomes of microenterprises.
 Results: Structural and contextual factors from the participants' experience resulted in unjust occupational outcomes, which indicates that occupational rights, particularly participation, choice and balance, were negatively affected by the lack of opportunities, such as jobs. Occupational marginalisation and imbalance were reported since many businesses lacked adequate and appropriate space for trade. Some business owners, however, reported just occupational outcomes related to the occupational right for meaningful occupation in providing a service to the community and financial income to support themselves and their families.
 Conclusion: Occupational therapists need to play various active roles in raising the consciousness of unjust occupational outcomes and support for just occupational outcomes that are achieved in engagement in self-employment in informal microenterprises.
 Implications for practice
 Occupational therapists should take note of the factors and occupational outcomes of being self-employed identified in this study and consider the roles they could play in expediting success in this occupation for clients. Occupational therapists could assume:
 
 A collaborative role, such as referring and working with various key role players or sectors in the interest of sourcing and providing opportunities for skills development for those entering self- employment, particularly in entrepreneurial training. This may include working with the government (e.g., Department of Labour and Small Enterprise Development Agency), private sector (e.g., yes4youth), other professions (social workers and industrial psychologists) and organisations for persons with disabilities (e.g., Disabled People, South Africa
 

Demographic bias in misdiagnosis by computational pathology models.

Despite increasing numbers of regulatory approvals, deep learning-based computational pathology systems often overlook the impact of demographic factors on performance, potentially leading to biases. This concern is all the more important as computational pathology has leveraged large public datasets that underrepresent certain demographic groups. Using publicly available data from The Cancer Genome Atlas and the EBRAINS brain tumor atlas, as well as internal patient data, we show that whole-slide image classification models display marked performance disparities across different demographic groups when used to subtype breast and lung carcinomas and to predict IDH1 mutations in gliomas. For example, when using common modeling approaches, we observed performance gaps (in area under the receiver operating characteristic curve) between white and Black patients of 3.0% for breast cancer subtyping, 10.9% for lung cancer subtyping and 16.0% for IDH1 mutation prediction in gliomas. We found that richer feature representations obtained from self-supervised vision foundation models reduce performance variations between groups. These representations provide improvements upon weaker models even when those weaker models are combined with state-of-the-art bias mitigation strategies and modeling choices. Nevertheless, self-supervised vision foundation models do not fully eliminate these discrepancies, highlighting the continuing need for bias mitigation efforts in computational pathology. Finally, we demonstrate that our results extend to other demographic factors beyond patient race. Given these findings, we encourage regulatory and policy agencies to integrate demographic-stratified evaluation into their assessment guidelines.

Opportunities and Challenges in Implementing Regional Public Service Agency Policy in Regional Hospitals: Systematic Review

Opportunities and Challenges in Implementing Regional Public Service Agency Policy in Regional Hospitals: Systematic Review

Cultural sustainability and Estonian community houses

This article explores the role of Estonian community houses in supporting sustainable cultural development and the vitality of communities in a turbulent era of global change. It poses the following questions: (1) How do the representatives of community houses perceive their roles and challenges? (2) How does organizational agency and cultural policy (at national and sub-national level) contribute to cultural sustainability in the context of such disruptions? To answer the first question, in 2022 an online questionnaire survey targeting representatives of Estonian community houses was conducted. The article is based on quantitative and qualitative analysis of 126 responses. The second question provides historical, political, and cultural context to address the first. Estonian community houses, numbering 376 in operation today, are a unique network to study. In the nineteenth century, these cultural hubs became the basis for the system of non-formal life-long education, arts and culture, and later regulated and developed within the subnational politics of culture and education in the Estonian nation-state (1918–40), in the Soviet Union (1940–91), and in today's Estonia (1991–2023) as part of the European Union. The COVID-19 pandemic added a new set of disruptions. In this light, the continuity of the functioning of community houses, alongside their ability to adapt, becomes particularly important for both local communities and sustainable cultural development.

Thematic Diversity of Regional News on the TASS News Feed

The article is devoted to the problem of thematic diversity of news content from the regions of the Russian Federation. Based on the agenda setting theory and its special direction “media diversity”, the author explores approaches to its measurement and operationalizes this concept in the context of the TASS regional editorial policy. The presented results of the content analysis allowed to draw conclusions about topics dominated the agency’s agenda for 10 years. Thematic priorities of news from various federal districts have been identified. Quantitative assessments examine the dynamics of the thematic spectrum, both for the country as a whole and at the level of macroregions. The conclusions are drawn that the concept of the agency's regional editorial policy, focused on the maximum variety of content and the disclosure of the information potential of the regions, is not fully implemented in practice, which, in particular, is expressed in an excess of news about emergency and criminal incidents. Nevertheless, the editors were able to introduce into routine practice active information support for topics chosen by the Russian government as strategic, which indicates the flexibility of the agency’s agenda and the potential for greater diversity. In interpreting the data, the author also relies on his own experience as a correspondent and editor of a news agency.

Discretionary Trees: Understanding Street-Level Bureaucracy via Machine Learning

Street-level bureaucrats interact directly with people on behalf of government agencies to perform a wide range of functions, including, for example, administering social services and policing. A key feature of street-level bureaucracy is that the civil servants, while tasked with implementing agency policy, are also granted significant discretion in how they choose to apply that policy in individual cases. Using that discretion could be beneficial, as it allows for exceptions to policies based on human interactions and evaluations, but it could also allow biases and inequities to seep into important domains of societal resource allocation. In this paper, we use machine learning techniques to understand street-level bureaucrats' behavior. We leverage a rich dataset that combines demographic and other information on households with information on which homelessness interventions they were assigned during a period when assignments were not formulaic. We find that caseworker decisions in this time are highly predictable overall, and some, but not all of this predictivity can be captured by simple decision rules. We theorize that the decisions not captured by the simple decision rules can be considered applications of caseworker discretion. These discretionary decisions are far from random in both the characteristics of such households and in terms of the outcomes of the decisions. Caseworkers typically only apply discretion to households that would be considered less vulnerable. When they do apply discretion to assign households to more intensive interventions, the marginal benefits to those households are significantly higher than would be expected if the households were chosen at random; there is no similar reduction in marginal benefit to households that are discretionarily allocated less intensive interventions, suggesting that caseworkers are using their knowledge and experience to improve outcomes for households experiencing homelessness.

Democratizing social scientists’ impact on federal policy: Using the evidence act to help government and ourselves

It is common for social scientists to discuss the implications of our research for policy. However, what actions can we take to inform policy in more immediate and impactful ways, regardless of our existing institutional affiliations or personal connections? Focusing on federal policy, I suggest that the answer requires understanding a basic coordination problem. On the government side, the Foundations of Evidence-based Policymaking Act (2018) requires that large federal agencies pose, communicate, and answer research questions related to their effects on people and communities. This advancement has opened the black box of federal agency policy priorities, but it has not addressed capacity challenges: These agencies often do not have the financial resources or staff to answer the research questions they pose. On the higher education side, we have more than 150,000 academic social scientists who are knowledge producers and educators by training and vocation. However, especially among those in disciplinary departments, or those without existing institutional or personal connections to federal agencies, we often feel locked out of federal policymaking processes. In this article, I define the coordination problem and offer concrete actions that the academic and federal government communities can take to address it. I also offer leading examples of how academics and universities are making public policy impact possible in multiple governmental spheres. I conclude by arguing that both higher education institutions and all levels of government can do more to help academic social scientists put our knowledge to work in service of the public good.

Assessing Knowledge, Counseling, and Referral Patterns Regarding Fertility Preservation Before Gonadotoxic Treatments Among Physicians in the Military Health System.

Purpose: We sought to evaluate physicians' baseline knowledge of fertility preservation services available to patients with a cancer diagnosis within the military health system (MHS). Methods: Data on current cancer prevalence of over 31,000 unique cancer diagnoses were obtained from a comprehensive nationwide MHS dataset. Additionally, a 22-item survey was distributed to physicians practicing within the MHS assessing knowledge of reproductive health benefits, oncofertility counseling practices, and subspecialist referral patterns. Results: From 2020 to 2022, there were 31,103 individuals of reproductive age with cancer receiving care at a military treatment facility. One hundred fourteen physicians completed our survey, 76 obstetrician gynecologists (OB/GYNs), 18 oncologists, and 20 primary care physicians (PCPs). Ninety-three percent of respondents felt conversations about fertility preservation for reproductive-aged patients with cancer were very important. A total of 66.7% of oncologists, 35.5% of OB/GYNs, and 0% of PCPs felt comfortable counseling patients on coverage. A total of 33.3% of oncologists, 29.3% of OB/GYNs, and 0% of PCPs were familiar with oncofertility Defense Health Agency guidelines. Conclusion: Primary care, OB/GYN, and oncology practitioners are well situated to provide fertility preservation counseling to all individuals with a cancer diagnosis, but differences in counseling and referral patterns and a lack of knowledge of current agency policies may impair a patient's timely access to these resources. We propose implementation of an electronic patient navigator to address gaps in oncofertility care and standardize patient counseling in the MHS. This patient-focused guide would serve as a valuable model in all types of health care settings.

An initial typology of approaches used by policy and practice agencies to achieve sustained implementation of interventions to improve health

BackgroundScientific investigation of how to sustain the implementation of evidence-based interventions (EBI) is emerging. Sustaining the implementation of EBIs helps ensure their effects on improving health endure. External policy or practice agencies, such as government health departments, are often tasked with supporting individual organisations with sustaining their delivery of EBIs, for example, through financing, training or the provision of other supports. However, to our knowledge, the approaches taken by policy and practice agencies to support the sustainment of EBIs have not been consolidated, categorised and described as a typology.Main bodyTo improve conceptual clarity and support both research and practice, we developed an initial working typology of the practical approaches to sustain implementation of EBIs (i.e. sustainment) in order to improve long term health from the perspective of these agencies. The working typology includes three broad approaches. The first, termed ‘Self-Sustainment’, is when implementation of the EBI by an organisation (e.g. hospital, clinic, school) is expected to continue (sustain) in the absence of external (agency) support. The second, termed ‘Static Sustainment Support’, involves the provision of pre-defined external (agency) support to assist organisations to continue implementation of an EBI. The final approach is termed ‘Dynamic Sustainment Support’, whereby support provided by an external agency is dynamic (continues to be adapted) overtime to assist organisations continue implementation of an intervention which may itself also evolve.ConclusionsWe describe the contexts and circumstances where each may be most appropriate in achieving sustained implementation and discuss their research and practice implications.

Mental Health Needs of SOGIE Refugees in Canada: A Rapid Review

This rapid review investigated the mental health concerns of sexual orientation and gender identity expression (SOGIE) refugees in Canada. Database searches yielded 365 results across five databases, providing 12 papers for final thematic analysis once inclusion criteria were applied. Three themes emerged: (1) Stigma and discrimination negatively affected mental health and well-being; (2) SOGIE refugees faced challenges accessing services; and (3) the refugee claims process adversely affected well-being. Recommendations to improve SOGIE refugee well-being include implementing culturally safe policies in agencies, life-skills programs, and supportive spaces; promoting inclusivity, interprofessional collaboration between services, and innovative agency outreach to refugees; addressing biases in refugee claims boards and extending the refugee claim eligibility period.

Consideration of sex as a biological variable in diabetes research across twenty years

BackgroundSex differences exist in the risk of developing type 1 and type 2 diabetes, and in the risk of developing diabetes-associated complications. Sex differences in glucose homeostasis, islet and β cell biology, and peripheral insulin sensitivity have also been reported. Yet, we lack detailed information on the mechanisms underlying these differences, preventing the development of sex-informed therapeutic strategies for persons living with diabetes. To chart a path toward greater inclusion of biological sex as a variable in diabetes research, we first need a detailed assessment of common practices in the field.MethodsWe developed a scoring system to evaluate the inclusion of biological sex in manuscripts published in Diabetes, a journal published by the American Diabetes Association. We chose Diabetes as this journal focuses solely on diabetes and diabetes-related research, and includes manuscripts that use both clinical and biomedical approaches. We scored papers published across 3 years within a 20-year period (1999, 2009, 2019), a timeframe that spans the introduction of funding agency and journal policies designed to improve the consideration of biological sex as a variable.ResultsOur analysis showed fewer than 15% of papers used sex-based analysis in even one figure across all study years, a trend that was reproduced across journal-defined categories of diabetes research (e.g., islet studies, signal transduction). Single-sex studies accounted for approximately 40% of all manuscripts, of which > 87% used male subjects only. While we observed a modest increase in the overall inclusion of sex as a biological variable during our study period, our data highlight significant opportunities for improvement in diabetes research practices. We also present data supporting a positive role for journal policies in promoting better consideration of biological sex in diabetes research.ConclusionsOur analysis provides significant insight into common practices in diabetes research related to the consideration of biological sex as a variable. Based on our analysis we recommend ways that diabetes researchers can improve inclusion of biological sex as a variable. In the long term, improved practices will reveal sex-specific mechanisms underlying diabetes risk and complications, generating knowledge to enable the development of sex-informed prevention and treatment strategies.