Areas Of Need Research Articles

Practitioner perspectives on the challenges of implementing ‘alternative’ early childhood education (ECE) provision for nomadic children in Mongolia

Investment in early childhood education (ECE) is seen as key to improving life chances for children from economically disadvantaged backgrounds. Children from nomadic backgrounds often face difficulties in accessing ECE services because of geography, lack of services and the mobility of families. However, the provision of these services is seen as important in reducing educational inequalities between nomadic and non-nomadic children as well as in improving school readiness. Mongolia’s alternative provision policy for nomadic children is often presented as a case study of how ECE services can be provided for nomadic peoples. However, there is little to no literature on how this alternative provision policy is experienced on the ground by practitioners and the subsequent impact on front line staff and children. This research explored the perspectives of ECE practitioners in Mongolia, who are engaged in providing services to nomadic children, to understand their views on how the policy on alternative provision was experienced. Semi-structured interviews with 24 key informants were undertaken in 4 areas of Mongolia over the period 2019–2020. Practitioners highlighted issues around the funding of ECE alternative provision which impacted not only on sustainability of the programs but also impacted on access to programs, the resources available, the duration of programs and the quality of programs. Moreover, factors such as the qualifications of staff and a lack of teachers were highlighted. We conclude that appropriate funding is key in ensuring effective implementation of provision and identify areas of need in relation to ECE practitioner training as well as factors related to practitioner terms and conditions that require attention. Furthermore, some rethinking of the policy of ‘one child one type of provision’ needs to be undertaken as it leads to a lack of equity in relation to access and quality of provision between nomadic and non-nomadic children.

The United Nations Sustainable Development Goals: Aspirational or obtainable?

The <scp>United Nations</scp> Sustainable Development Goals: Aspirational or obtainable?

Neuromonitoring During ECMO Support in Children.

Extracorporeal membrane oxygenation is a potentially lifesaving intervention for children with severe cardiac or respiratory failure. It is used with increasing frequency and in increasingly more complex and severe diseases. Neurological injuries are important causes of morbidity and mortality in children treated with extracorporeal membrane oxygenation and include ischemic stroke, intracranial hemorrhage, hypoxic-ischemic injury, and seizures. In this review, we discuss the epidemiology and pathophysiology of neurological injury in patients supported with extracorporeal membrane oxygenation, and we review the current state of knowledge for available modalities of monitoring neurological function in these children. These include structural imaging with computed tomography and ultrasound, cerebral blood flow monitoring with near-infrared spectroscopy and transcranial Doppler ultrasound, and physiological monitoring with electroencephalography and plasma biomarkers. We highlight areas of need and emerging advances that will improve our understanding of neurological injury related to extracorporeal membrane oxygenation and help to reduce the burden of neurological sequelae in these children.

The road to pandemic recovery: Tracking COVID-19's impact on cirrhosis care and outcomes among 111,558 Veterans.

This study aimed to evaluate quarterly trends in process and health outcomes among Veterans with cirrhosis and assess the factors associated with cirrhosis outcomes before and during the COVID-19 pandemic. US Veterans with cirrhosis were identified using the Veterans Health Administration Corporate Data Warehouse. Quarterly measures were evaluated from September 30, 2018, through March 31, 2022, including twice yearly screening for hepatocellular carcinoma (HCC-6), new HCC, surveillance for or treatment of esophageal varices, variceal bleeding, all-cause hospitalization, and mortality. Joinpoint analyses were used to assess the changes in trends over time. Logistic regression models were used to identify the demographic and medical factors associated with each outcome over time. Among 111,558 Veterans with cirrhosis with a mean Model for End-stage Liver Disease-Sodium of 11±5, rates of HCC-6 sharply declined from a prepandemic peak of 41%, to a nadir of 28%, and rebounded to 36% by March 2022. All-cause mortality did not significantly change over the pandemic, but new HCC diagnosis, EVST, variceal bleeding, and all-cause hospitalization significantly declined over follow-up. Quarterly HCC diagnosis declined from 0.49% to 0.38%, EVST from 50% to 41%, variceal bleeding from 0.15% to 0.11%, and hospitalization from 9% to 5%. Rurality became newly, significantly associated with nonscreening over the pandemic (aOR for HCC-6=0.80, 95% CI 0.74 to 0.86; aOR for EVST=0.95, 95% CI 0.90 to 0.997). The pandemic continues to impact cirrhosis care. Identifying populations at the highest risk of care disruptions may help to address ongoing areas of need.

A mixed-methods evaluation of a state-wide outreach perinatal mental health service

BackgroundAccess to perinatal mental health services in rural and remote areas is scarce, particularly perinatal psychiatry services. Telehealth, together with psychiatry consultation-liaison services are one way to improve access to areas of need. The New South Wales State-wide Outreach Perinatal Services – Mental Health (SwOPS) program is a Sydney-based program, offering specialist perinatal consultation-liaison services to rural and remote community mental health clinicians caring for perinatal women with significant mental health problems. This study aimed to evaluate healthcare practitioners’ perceptions of the SwOPS program.MethodHealthcare practitioners (N = 31) were purposely recruited to participate in the study. Data were analysed using a mixed-methods cross-sectional design.ResultsMost participants reported being familiar with and satisfied with the service. As a result of accessing the service, participants reported an increase in knowledge and confidence regarding caring for women with moderate-to-severe or complex mental health conditions. Qualitative comments highlight the participant’s perceptions of the program.ConclusionThis study provides useful insights about a state-wide telehealth psychiatry consultation-liaison service from the perspective of practitioners. It highlights the benefits, facilitators, and barriers associated with implementing such services.

Barriers and Facilitators to the Implementation of Personalised Medicine across Europe

(1) Background: Personalised medicine (PM) is an innovative way to produce better patient outcomes by using an individualised or stratified approach to disease and treatment rather than a collective approach to treating patients. PM is a major challenge for all European healthcare systems. This article aims to identify the needs of citizens in terms of PM adaptation, as well as to provide insights into the barriers and facilitators categorised in relation to key stakeholders of their implementation. (2) Methods: This article presents data obtained from the survey "Barriers and facilitators of Personalised Medicine implementation-qualitative study under Regions4PerMed (H2020) project". Semi-structured questions were included in the above-mentioned survey. The questions included both structured and unstructured segments in an online questionnaire (Google Forms). Data were compiled into a data base. The results of the research were presented in the study. The number of people who participated in the survey can be considered an insufficient sample size for statistical measurement. In order to avoid collecting unreliable data, the questionnaires were sent to various stakeholders of the Regions4PerMed project, which includes members of the Advisory Board of the Regions4PerMed Project, but also speakers of conferences and workshops, and participants in these events. The professional profiles of the respondents are also diverse. (3) Results: The insights on what would help in the adaptation of Personal Medicine to citizen needs have been categorised into 7 areas of need: education; finances; dissemination; data protection/IT/data sharing; system changes/governmental level; cooperation/collaboration; public/citizens. Barriers and facilitators have been categorised into ten key stakeholders of the implementation barriers: government and government agencies; medical doctors/practitioners; healthcare system; healthcare providers; patients and patient organisations; medical sector, scientific community, researchers, stakeholders; industry; technology developers; financial institutions; media. (4) Conclusions: Barriers to the implementation of Personalised Medicine are observed across Europe. The barriers and facilitators mentioned in the article need to be effectively managed in healthcare systems across Europe. There is an urgent need to remove as many barriers as possible and create as many facilitators as possible to implement personalized medicine in the European system.

10 of the Most Asked Questions and Challenges in Obesity

The objective of this supplement is to outline 10 of the most commonly asked questions and challenges in obesity. This will be structured in a succinct question-and-answer format to allow readers to quickly identify areas of need or interest while covering a wide breadth of topics focused on the obesity assessment, patho-physiology, and barriers to successful treatment (see details below). We have outlined an objective for each topic so that a specific subject in knowledge translation is achieved for each question.

MEASURING SPATIAL ACCESSIBILITY TO HEALTHCARE FACILITIES IN ISFAHAN METROPOLITAN AREA IN IRAN

Abstract. Appropriate spatial accessibility to healthcare facilities is an important component of the efficient delivery of healthcare. This study aims to measure spatial accessibility to healthcare facilities in Isfahan Metropolitan Area, a rapidly growing megacity in Iran. We used two methods of population-weighted fuzzy analytic hierarchy process and the two-step floating catchment area (2SFCA) to measure spatial accessibility to urban healthcare facilities, including hospitals, pharmacies, clinics, and laboratories. The results of these two methods were compared. Not surprisingly, the center of Isfahan has the highest accessibility scores for healthcare facilities, and the peripheral areas of the city have the lowest levels. Despite the existence of higher numbers of healthcare facilities in northern parts of Isfahan, accessibility to healthcare facilities is low because of the large population. Both methods show that healthcare services are not evenly distributed in Isfahan. Some areas with a high population have low accessibility to health facilities. Ideally, these areas would be prioritized for future health infrastructure investment. The methods used here can help urban healthcare policymakers identify spatial inequalities in access to care and thus target the areas in need.

Honoring What We Say We Do: Developing Real-World Tools for Routine Family Caregiver Assessment and Support in Outpatient Palliative Care.

Background: Family caregivers are essential to the care of patients with serious illness and supporting caregivers alongside patients is a core tenet of palliative care. While there is increasing recognition of the need to support family caregivers, there are limited resources to assess and support their needs in a systematic way in outpatient palliative care practice. Objectives: The aim of this study is to develop an approach to conducting assessments of routine needs and support of family caregivers in outpatient palliative care practice using a quality improvement framework. Setting: Seven, interdisciplinary, outpatient palliative care teams in California collaborated in this study. Measurements: Family caregivers were surveyed about levels of distress and support using a 10-point scale and asked about specific areas of need for support. Usefulness of a supportive caregiver resource was also measured on a 10-point scale, in addition to qualitative assessment of clinician satisfaction and feasibility of routine caregiver assessment and support. Results: Seven hundred thirty-six caregiver needs assessments were conducted and 44 supportive tool kits were distributed. A majority of family caregivers reported moderate or severe distress related to caregiving (score ≥4 on a 10-point scale). The most common sources of distress included emotional distress, worry caregiving was negatively impacting their own health, and planning for the future. Most caregivers reported feeling moderately or very well supported, most commonly by family, friends, and faith/spirituality. Caregivers rated the supportive tool kit an 8.4 on a 10-point usefulness scale and 92% would recommend it to others. Conclusions: We successfully developed and piloted practical clinical tools for routine family caregiver screening and support.

The Time Course of Health, Fitness, and Occupational Performance Changes in Recruits across a Fire Academy.

The purpose of this study was to examine the time course of health, fitness, and occupational performance changes in firefighter recruits across a fire academy. Nineteen recruits (24.9 ± 4.3 yr; 26.7 ± 3.1 kg·m -2 ) had their body composition, balance, vertical jump (VJ) performance, cardiorespiratory fitness (CRF), upper and lower body strength, hamstrings-to-quadriceps (H/Q) ratio, lower back endurance, and weighted stair climb (SC) performance assessed at the beginning (week 1 [W1]), midpoint (week 15 [W15]), and end (week 30 [W30]) of a fire academy. The fire academy improved body composition, balance, CRF, leg extension strength, and SC performance from W1 to W15 ( P ≤ 0.042) which then plateaued at W30 ( P ≥ 0.314). Leg flexion strength and the H/Q ratio decreased from W1 to W15 ( P ≤ 0.035) and plateaued at W30 ( P ≥ 0.947). Upper body strength was similar at W1 and W15 ( P ≥ 0.999), but decreased at W30 ( P ≤ 0.033). However, no significant changes occurred across the academy for VJ performance or lower back endurance ( P ≥ 0.090). These findings highlight the positive effect of the academy on body composition, CRF, balance, SC performance, and leg extension strength. However, the decreases in upper body and leg flexion strength, the H/Q ratio, and lack of changes in VJ performance and low back endurance may highlight key areas of need to maximize injury prevention and performance enhancement efforts in the academy. Further, the varied time course of changes may help fire departments identify opportunities to modify exercise programming across their academies.

Selected Properties of Reinforcing Composite Bars for Concrete Elements Prepared from Waste Polyethylene Terephthalate (PET) Bottles

A concept of producing reinforcing bars for concrete elements from waste polyethylene terephthalate (PET) bottles is presented in the paper. The proposed technology of production harnesses strips of PET cut from bottles and thermal treatment. Finally, a sand-resin coating is applied to the composite bars. Produced bars can be differentiated by utilising different numbers of strips influencing the diameter of a bar. The key mechanical properties of the bars containing 3 to 8 strips were tested during the research program. Maximum loadings and displacements were established. Problems regarding the future application of the bars in question were discussed. Areas of need for further research were pointed out.

The Future of INCOG (Is Now).

The Future of INCOG (Is Now).

Dialogues on nursing curriculum and pedagogy: a critical planning activity for global educational collaboration.

We describe the experience of a collaborative, dialogical process on nursing pedagogy to identify the best process for creating a mutually beneficial international nursing education exchange. Faculty from two universities in Sucre, Bolivia and in Seattle, Washington, US engaged in planned virtual dialogues to share their nursing curricula, course content, teaching methodologies, and contextual challenges and strengths. From the dialogues, a thematic analysis using a modified conventional content analysis approach was completed, and four themes emerged: 1) similarities in course content, pedagogy, and curricular challenges; 2) differences in teaching competencies; 3) teaching methodologies responsive to national trends; and 4) benefits from and alternatives to the use of educational technology. Early dialogues among participants allowed them to discern areas of need and interest for future planning. Intentional academic dialogues should be the first step to enter in an exchange program to enable participants from different hemispheres to contribute equally as partners in the formation of nurses able to respond the current global health concerns.

Geospatial distribution of tertiary hospitals across Australian cities.

Objective This study aimed to map the geographic distribution of tertiary hospitals in Australia's most populous cities. Good access to hospital facilities improves the health and welfare of a community. The use of geographic information system (GIS) technology can assist in understanding spacial accessibility to services. Methods Using Quantum GIS, a geodatabase was constructed to incorporate hospital locations and demographic distribution data throughout Australia's 20 most populous cities. Data on the population's age groups were integrated into the geodatabase to investigate the distribution of age groups and their utilisation of access to emergency departments in tertiary public health care. Overall this study reported the geospatial distribution of 89 tertiary hospitals and the demographics of the population in areas around these hospitals. Results The majority of hospitals were located in the three most populated cities of New South Wales (NSW), Sydney, Wollongong and Newcastle, which contain a total of 32 hospitals, with 23 (72%) of the hospitals in Sydney. There were 7.8, 24.0, 53.4 and 81.0% of the population in NSW within 1.5, 3, 6 and 50 km of the hospitals, respectively. The second-highest number of hospitals was in Victoria (n = 22), with 18 (82%) hospitals located in Melbourne. This was followed by Queensland (n = 14), with eight (57%) hospitals located in Brisbane. Conclusions The results indicate that 82.2% of the Australian population lives within a 50 km radius of a tertiary hospital, with NSW having higher age distribution percentages than the other states. The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services.

Strategies for Strengthening the Resilience of Public Health Systems for Pandemics, Disasters, and Other Emergencies.

The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach. The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations. Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions. The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.

Adult education needs inventory: Construction and application.

The article presents the psychometric parameters and implementation of the adult education needs inventory (AENI) questionnaire, which is designed to measure the key competences of adult educators. It was constructed on the concept of key competences as proposed by the Council of the European Union. This model of competences is inscribed in the concept of lifelong learning and does not concentrate on the compensatory functions of the competences but merely promotes the insight of educators into their self-development. This article presents the construction process and psychometrical properties of AENI. The reliability of the test is confirmed by the inter-correlated results. The accuracy of the questionnaire was confirmed through principal component analysis (PCA). Apart from this, the accuracy of the theory was verified by a correlation between AENI and the Social Skills Profile (PROKOS), which measures the level of such social skills as assertiveness, cooperativeness, sociability, social resourcefulness, and social activeness. To check the accuracy of the theory, hypotheses were formulated which were related to both the correlated overall results (AENI and PROKOS) and the chosen scales. Six areas of need in development were distinguished: communication skills, multilingual and multicultural skills, digital skills, entrepreneurial skills, openness to science and culture, and social and civic skills. A low result on the scale indicates a need to develop a given skill because the respondent's skills are weak. Such information is vital for employers and educators who wish to diagnose the areas that need improvement. The measures of reliability and accuracy allow us to state that the questionnaire possesses acceptable psychometrical factors. This study contains propositions for further improvement of the questionnaire and a key to interpreting the research results. Adult education needs inventory questionnaire is a reliable research tool that can be used to assess the competences of adult educators. Also, it can be considered a voice of discussion regarding the necessity of raising the quality of education and raising the awareness of the education needs of individual adult educators and organizations that benefit from their services.

Right heart catherisation – a virtual reality

Abstract Introduction Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors. Method We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed. The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system. We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis. Results The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion. Conclusion A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals

A Systematic Review of Indigenous Representation in School Psychology Research

Indigenous youth comprise a significant and diverse collection of populations. School psychologists are uniquely placed to serve Indigenous students and improve their long-term outcomes. However, in the face of longstanding colonial practices and systemic oppression, which have resulted in poor educational outcomes for Indigenous students, school psychology research broadly underrepresents Indigenous students. This proves problematic considering research informs practice. The goal of this review is to evaluate the current standing of school psychology research focused on Indigenous youth and identify areas of need. The current systematic review yielded 57 articles focusing on Indigenous youth from 10 indexed school psychology journals. A significant portion of the articles were published in the 1980s, with fewer than three publications per year in the two decades following. The articles demonstrated a preference for assessment and related topics, with limited research focused on intervention, culture, and equity. This focus on assessment to compare Indigenous youth with youth of other racial and ethnic backgrounds serves to support the systems of oppression in place. These findings highlight the need for school psychology research to exert a concentrated effort toward Indigenous-focused research with more varied topics beyond assessment. Implications for trainers, researchers, and school psychology journals are discussed.

FRIENDSHIP IN APHASIA

Abstract People living with aphasia (PLWA) have identified friendship as a key area of need, and any programs or interventions designed to support this priority should have the input of PLWA at the forefront. This portion of the symposium will outline steps that were taken to engage PLWA in the development of evidence-informed interventions and programming to support friendship for PLWA, despite the challenges PLWA face in communication. The process of developing and using a multi-stakeholder advisory board of clinicians, researchers, PLWA, and family members will be described. Data highlighting key themes from interviews of PLWA, their significant others, and their friends will be presented including reciprocity, persistence, and communication strategies. Finally, communication techniques to engage PLWA in research activities as informed by PLWA themselves, clinicians, and researchers will be provided.

Ensuring the Scientific Value and Feasibility of Clinical Trials: A Qualitative Interview Study

Background Ethical and scientific principles require that clinical trials address an important question and have the resources needed to complete the study. However, there are no clear standards for review that would ensure that these principles are upheld. Methods We conducted semi-structured interviews with a convenience sample of nineteen experts in clinical trial design, conduct, and/or oversight to elucidate current practice and identify areas of need with respect to ensuring the scientific value and feasibility of clinical trials prior to initiation and while ongoing. We used a priori and grounded theory to analyze the data and constant comparative method to induce higher order themes. Results Interviewees perceived determination of scientific value as the responsibility of the investigator and, secondarily, other parties who review or oversee research. Interviewees reported that ongoing trials are rarely reevaluated due to emerging evidence from external sources, evaluation is complex, and there would be value in the development of standards for monitoring and evaluating evidence systematically. Investigators, IRBs, and/or data monitoring committees (DMCs) could undertake these responsibilities. Feasibility assessments are performed but are typically inadequate; potential solutions are unclear. Conclusions There are three domains where current approaches are suboptimal and in which further guidance is needed. First, who has the responsibility for conducting scientific review, whether it be the investigator, IRB, and/or DMC is often unclear. Second, the standards for scientific review (e.g., appropriate search terms, data sources, and analytic plan) should be defined. Third, guidance is needed on the evaluation of ongoing studies in light of potentially new and evolving evidence, with particular reference to evidence from outside the trial itself.