Aspirational Goal Research Articles

Fierce Advocates for Building All-Hazards Resurgence and Resilience: NYC Health + Hospitals' COVID-19 Experiences Applied.

Fierce Advocates for Building All-Hazards Resurgence and Resilience: NYC Health + Hospitals' COVID-19 Experiences Applied.

Operational measurement of diagnostic safety: state of the science.

Reducing the incidence of diagnostic errors is increasingly a priority for government, professional, and philanthropic organizations. Several obstacles to measurement of diagnostic safety have hampered progress toward this goal. Although a coordinated national strategy to measure diagnostic safety remains an aspirational goal, recent research has yielded practical guidance for healthcare organizations to start using measurement to enhance diagnostic safety. This paper, concurrently published as an Issue Brief by the Agency for Healthcare Research and Quality, issues a "call to action" for healthcare organizations to begin measurement efforts using data sources currently available to them. Our aims are to outline the state of the science and provide practical recommendations for organizations to start identifying and learning from diagnostic errors. Whether by strategically leveraging current resources or building additional capacity for data gathering, nearly all organizations can begin their journeys to measure and reduce preventable diagnostic harm.

Establishing a Multi-Institutional Quality and Patient Safety Consortium: Collaboration Across Affiliates in a Community-Based Medical School.

The landscape of health care delivery and medical education is evolving. Institutions must continually reassess priorities, strategies, and partnerships to align the knowledge and skills of the health care workforce with the delivery of quality, socially accountable, collaborative health care that meets the needs of diverse populations in communities. This article describes the development, implementation, and early outcomes of the University of Missouri-Kansas City's Health Care Quality and Patient Safety Consortium. Inspired by an actual patient safety event, the consortium aimed to improve patient outcomes by establishing quality improvement and patient safety (QIPS) education and scholarship as foundational within its unique, horizontal-matrix academic health center, which comprises 6 affiliated hospitals and 4 university-based health sciences schools. The consortium established a governance structure with leaders who, collectively, represent the diverse members and stakeholders of the consortium. The members share a common agenda and mutual goals. The consortium measures success by applying published conceptual frameworks for evaluating the outcomes of educational programs on learners (Kirkpatrick) and patients (Bzowyckyj and colleagues). Consortium learner and patient outcomes span all levels of these frameworks. Undergraduate and graduate QIPS-based projects with meaningful health system or improved individual health outcomes signify a Level 4 outcome (the highest level) for learners and patients alike. Factors critical to success include a financial gift, leadership buy-in and support, a clear champion, shared goals and a united vision, a willingness to collaborate across health systems with varied strengths and priorities, and a stable communication platform. Aspirational goals of the consortium include increasing involvement across health professional schools, incorporating simulation into QIPS activities, and aligning the consortium's projects with broader community needs.

Organophotoredox Hydrodefluorination of Trifluoromethylarenes with Translational Applicability to Drug Discovery.

Molecular editing such as insertion, deletion, and single atom exchange in highly functionalized compounds is an aspirational goal for all chemists. Here, we disclose a photoredox protocol for the replacement of a single fluorine atom with hydrogen in electron-deficient trifluoromethylarenes including complex drug molecules. A robustness screening experiment shows that this reductive defluorination tolerates a range of functional groups and heterocycles commonly found in bioactive molecules. Preliminary studies allude to a catalytic cycle whereby the excited state of the organophotocatalyst is reductively quenched by the hydrogen atom donor, and returned in its original oxidation state by the trifluoromethylarene.

Spotlight: Rising stars in cytology.

Spotlight: Rising stars in cytology.

Unregulated Social Work Practice in Botswana: A Risk to Professional Integrity and Clients’ Welfare

Through professional regulation, the aspirational goals of the Code of Ethics is to become a legal obligation with enforceable accountability for public protection. The professional regulation does not only protect the public but also gives integrity and respect to the profession. Social workers are licensed and they always know that malpractice may lead to losing their registration and licenses. The above is a reality in many countries, while in Botswana, after 74 years since the first social welfare officer started to work in the welfare department, the country has not yet established any regulatory body. Even though the regulation might not be a guarantee for ethical practice, but it is better to have a framework that can be used to regulate in terms of monitoring and evaluating practice. The education and practice of social work is unregulated and has left a vacuum where, anybody who government deems to be eligible can be employed as social worker. The above statement is buttressed by the Children’s Act, 2009 section 2, which says, ‘a social worker is a person who holds a qualification in social work, or such other qualification as may be prescribed, and is employed as such by government or such other institution as maybe approved under this Act and any other law’. This has brought challenges in dealing with values, principles and standards of social work, teaching and practice in Botswana [1]. The complaint is that social workers are unprofessional and not adhering to their own code of conduct. From the complaints, the assumption is that social work has a code of conduct as a heling profession. The reality is there is no code of conduct and there is no licensure in Botswana. This paper is a narrative of examples of cases where social workers were deemed not adhering to their professional ethics and not providing service to the most vulnerable at the time of need. These stories are used as a yardstick to argue for the establishment of an ACT of parliament which will establish the council of social work. The council will be a regulatory body of social work.

Diagnostic ileocolonoscopy: getting the basics right

Proficient colonoscopy technique that optimises patient comfort while simultaneously enhancing the timely detection of pathology and subsequent therapy is an aspirational and achievable goal for every endoscopist. This article aims...

The Overcooked Concept of Competitive Advantage

The concept of competitive advantage is argued to be not very useful to managers. At best it is an aspirational goal. Books that claim to present a route to competitive advantage give false hope – multiple competing firms in an industry cannot (each) realistically set out to build a competitive advantage.

The effect of receiving versus being denied an abortion on making and achieving aspirational 5-year life plans

BackgroundPopular support for access to abortion and contraceptive services is often based on the idea that they will help women determine the trajectory of their life course. This study examined...

Towards a ‘Women-Oriented’ Approach to Post-Conflict Policing: Interpreting National Experience(s) and Intergovernmental Aspirations

In regard to the United Nations’ (UN) framework for promoting gender equality in policing, including women in national police forces remains a global challenge. Even countries possessing a stable history of women’s involvement reveal that women are significantly under-represented in policing when compared to other professions—even though prior research has strongly suggested that women are important actors in establishing post-conflict democratic order. This article outlines the political, social and institutional challenges that are faced to achieve significant gender representation in national police forces. It also recommends countering these challenges by using a ‘women-oriented’ approach. Such an approach does not merely fulfil the aspirational UN goals of achieving greater gender balance, it also yields many practical advantages for improving policing, including 1) leveraging the unique skills that women offer in policing, 2) making better use of force decisions, 3) combatting police corruption and 4) increasing the gender responsiveness of police. Finally, several operational strategies for promoting more women into policing are suggested.

Where Are We in Bridging the Gender Leadership Gap in Academic Medicine?

In nearly all walks of life, leadership sets the tone for what gets done, who does it, and how it is achieved. In 2020, the top ranks of academic medicine have not yet attained gender parity-an aspirational goal set 7 years ago in this journal as "50:50 by 2020," and a vital aim for the United States' productivity and innovation as a leader in biomedical research. Parity in academic leadership for women and other groups underrepresented in science and medicine will seed the culture change necessary for inclusive excellence: environments in which individuals from all backgrounds thrive in their pursuit of new knowledge to benefit human health.In this Invited Commentary, the author describes the National Institutes of Health's (NIH's) current system-wide framework and tools for creating cultures of inclusive excellence through a set of guiding principles and integrated strategies. Successful efforts will recognize that individually focused solutions are necessary but not sufficient for institutional culture change. In keeping with a systems approach are implementing accountability and transparency; establishing clear metrics of inclusion, diversity, and equity; tracking and evaluating such metrics; as well as tying these metrics to institutional reward systems. These essential steps to institutional culture transformation require strong partnerships between NIH and the academic community. The author argues that with committed vision, focus, and energy, success is attainable, and soon.

Securing Replacement Income with Goal-Based Retirement Investing Strategies

To supplement retirement benefits received from public and private pension systems, individuals need to make voluntary contributions and decide how to efficiently invest these contributions. In this article, the authors analyze the problem of how to secure minimum levels of replacement income in retirement while offering attractive probabilities of reaching higher levels. Such strategies can offer an interesting alternative to target date funds, which have no focus on the generation of replacement income, or annuities, which can be used to secure replacement income but at the cost of substantial rigidity. TOPICS:Retirement, pension funds, wealth management Key Findings • Goal-based investing principles can be used to create retirement solutions that secure a minimum level of replacement income while delivering a high probability of reaching higher levels defined as aspirational goals. • These “flexicure” retirement solutions use a dedicated safe portfolio, known as a retirement goal-hedging bond portfolio (or retirement bond in short), which is a fixed-income portfolio whose cash flows (or factor exposures) match those of the stream of replacement income for a fixed period of time, say 20 years, in retirement. • Such strategies use liquid building blocks, they reliably secure a clearly identified replacement income goal without requiring ad hoc parametric assumptions, and they offer upside potential; as such they represent an attractive alternative to existing retirement products such as annuities or target date funds.

Remarks by Jorge Kamine

If we focus on the past sixty years, which coincides with the founding of the Inter-American Development Bank (IADB), we can unequivocally say that there have been a number of notable and successful examples of “multilateralism” in Latin America in the context of economic development and integration. This assumes we define “multilateralism” broadly as groups of countries in Latin America (1) cooperating or participating in institutions, organizations, and initiatives that include more than two countries; (2) which include among their goals or objectives the advancement of economic development or economic integration in the region; and (3) which have produced or resulted in some economic outcome or benefit for the participating countries that we generally believe could not have been achieved by one country alone. While this definition may not perfectly follow John Ruggie's definition, my formulation of the definition of “multilateralism” ensures that we do not overlook or discount important examples of institutions formed by Latin American states and other states that are based on principles to address issues of common concern, namely economic development in the region. The advances and benefits that have been achieved through these institutions have been significant even if the more ambitious (and perhaps more aspirational) goals over the years of certain Latin American political leaders of a broader inter-American political and economic integration modeled on the European Union or even the narrower (but also ambitious) goal of projects focused on economic integration, like the Free Trade Agreement of the Americas (FTAA), have not been fully achieved. Based on the definition that I have proposed of “multilateralism” with its focus on economic development, I would highlight some common features of the examples and cases where we have seen successful multilateralism and common features of the challenges that have been encountered in advancing multilateralist projects.

“No Evidence of Disease Activity”: Is it An Aspirational Therapeutic Goal in MS?

Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the brain and spinal cord that leads to demyelination and neurodegeneration. The diagnosis is based on the integration of the clinical presentation and paraclinical markers with the most important being the magnetic resonance imaging (MRI). The clinical, radiological and underlying pathology of MS is highly heterogeneous, therefore the effectiveness of disease-modifying treatments (DMT) differs in patients. As multiple therapies are becoming available, there is a lower threshold to accept any disease activity or worsening and the importance to create a surrogate marker to evaluate the efficacy of the DMT is rising.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Sustainability assessment of concrete mixes

Since concrete is one of the most important and useful materials in the construction sector, which, unfortunately, has an adverse impact on the environment, it is evident that correct procedures for designing and/or assessing concrete structures need to be created. Model Code 2020 with the focus to sustainability stated to be one of main aspiration goals, which will have implications for subsidiary performance requirements critical to structural design, integrate life cycle perspective, reliability and performance based concepts and end-of-service-life issues. Evidently the combined impact of the service life and relevant safety level of structures on the economical and environmental aspects desire full consideration of engineers and stakeholders. Consideration is also given to energy and raw material costs, as well as to environmental impact throughout the life cycle – e.g. due to emissions.

Fallen and Cross-Border Literary Commemoration, 1916

Abstract: We analyse the centenary-focused, jointly programmed, “One Book Two Cities” mass reading event organised around Lia Mills’ title, Fallen, in Dublin and Belfast in 2016. Drawing on Sarah Pink’s theory of the place-event, we analyse this mass reading event through event programmes, press releases, newspaper articles, and social media platforms. This mass reading event challenged readers to consider how books were changed by place, and challenged organisers to consider how places were transformed by readers and books. Based on analyses of programmatic activities, we argue that this cross-border activity allowed organisers to engage with the 1916 commemorative programme and participate in the aspirational goals of literary reconciliation, but it permitted them to do so in ways that avoided contested narratives about history, nation, and gender. Historical commemoration in “One Book Two Cities” demonstrates how contemporary politics of commemoration in the Republic of Ireland and Northern Ireland continue to be inflected with their historical entanglements.

Australian orthopaedic surgery training: Australian Orthopaedic Association's strategic education review.

The Australian Orthopaedic Association (AOA) is the peak professional body for orthopaedic surgeons in Australia and is responsible for their training and continuing medical education. The 2012 AOA strategic education review employed a gap analysis to identify issues and generate a roadmap for the enhancement of AOA's education and training activities. This paper describes the process and outcomes of this review, which led to the 'AOA 21' Education Re-design Project, and the review's relevance to surgical education in Australia. The AOA strategic education review was undertaken by international clinician education and orthopaedic experts, and involved AOA staff, fellows and trainee members throughout Australia. This review progressed through four phases: a review of current training; a global 'best-practice' perspective; a set of aspirational goals; and a roadmap for implementation. Seven key strengths (e.g. camaraderie in training and surgical skills teaching) and 15 challenges (e.g. 'non-technical' skills teaching, subjective methods of decision making and inadequate assessment practices) were identified in the review stage. Sixteen major recommendations for improvements incorporating current or emerging world's best education practices were targeted in an 8-year implementation framework. The AOA's strategic education review serves as a roadmap for other specialty training organizations to review their programmes and implement contemporary best practices in surgical training. The AOA 21 project has positioned orthopaedic surgery as a leader in competency-based surgical education and training in Australia.

Soil carbon enhancing practices: a systematic review of barriers and enablers of adoption

Sustained adoption of soil carbon enhancing practices (SCEPs) at scale remains an aspiration goal to maintain sufficient amount of soil carbon in household farms in order to impact on the sustained farm productivity caused by sustained soil fertility. The objective of this study is to systematically evaluate the current evidence base to identify: (a) which factors enable or constrain adoption of SCEPs and hence maintain soil carbon in Kenya and Ethiopia; (b) to be able to lessons learnt concerning what influences the adoption of the SCEPs for the purpose of maintaining soil fertility among smallholder farms; and (c) how this can be improved going into the future for the purpose of formulating appropriate policies in Kenya and Ethiopia in both the short and long run. A systematic review was conducted using established review methodology and extensive searches of published and unpublished literature sources. Data extraction and quality appraisal of quantitative, qualitative and case studies that met the inclusion criteria were conducted while checking for reliability. A broad range of interrelated enabling and constraining factors was identified for the SCEPs. All the factors matter, and some of most of these factors are important to be considered during planning and implementation of SCEPs aiming at promoting soil carbon sequestration. Despite the limitation in the quantity of evidence, this systematic review provides a useful starting point for the scaling up programmes to ensure more effective adoption of SCEPs. This review also underscores the need for a multidisciplinary approach in understanding what determines the adoption of SCEPs to capture a holistic view.

Looking Ahead: the SSAT Strategic Plan Version 2.0 for the Next Decade

The Society for Surgery of the Alimentary Tract is a robust clinical society with over 2500 members. As a society that is focused on the entire alimentary tract, we overlap with other more organ-centric societies. This has led to a constant struggle of knowing how the Society for Surgery of the Alimentary Tract can best serve the surgical community. The board of directors held its second strategic retreat in 10 years to develop aspirational goals in hopes to define the direction of the society for the next 5 years. The output of this meeting is presented in this document.