General Research Question Research Articles

A consensus guideline on preferred items for reporting case series in homeopathy: The PITCH statement

BackgroundCase series is a valuable tool for sharing clinical experiences and generating research questions in the field of medicine. However, there is a lack of standardized reporting guideline for case series in homeopathy, which limits their utility and comparability. The aim of this study is to develop a reporting guideline for case series in homeopathy using a Delphi consensus process. MethodA group of 21 experts, with experience in reviewing, publishing, or editing case reports or series in homeopathy, were participated in the study. A modified Delphi consensus process was conducted with three rounds of electronic surveys to gather feedback and opinions on the items to be included in the reporting guideline. The GRADE group's nine-point Likert scale was used to rate each item's importance and criticality. ResultThe Delphi process resulted in a consensus-based reporting guideline for case series in homeopathy, which includes recommendations for reporting case series in eleven sections, including 'Title,' 'Abstract,' 'Keywords,' 'Introduction,' 'Methods,' 'Results,' 'Discussion,' 'Conclusion,' 'Patient Perspectives,' 'References,' and 'Additional Information.' PITCH comprises a total of 59 items that achieved consensus agreement. Of these, 13 are optional items and 14 items are exclusively applicable for prospective type of case series. ConclusionThe PITCH reporting guideline provides a structured and standardized approach for reporting case series in homeopathy. The authors, journal editors, reviewers, and educators are encouraged to adopt and implement the guideline to enhance the quality of case series in homeopathic publications.

Shortest path or random walks? A framework for path weights in network meta-analysis.

Quantifying the contributions, or weights, of comparisons or single studies to the estimates in a network meta-analysis (NMA) is an active area of research. We extend this work to include the contributions of paths of evidence. We present a general framework, based on the path-design matrix, that describes the problem of finding path contributions as a linear equation. The resulting solutions may have negative coefficients. We show that two known approaches, called shortestpath and randomwalk, are special solutions of this equation, and both meet an optimization criterion, as they minimize the sum of absolute path contributions. In general, there is an infinite set of solutions, which can be identified using the generalized inverse (Moore-Penrose pseudoinverse). We consider two further special approaches. For large networks we find that shortestpath is superior with respect to run time and variability, compared to the other approaches, and is thus recommended in practice. The path-weights framework also has the potential to answer more general research questions in NMA.

Desarrollo y consenso de un cuadro de mando para evaluar la actividad investigadora en los servicios de farmacia hospitalaria en España

ObjectiveTo develop by consensus a dashboard model to standardize and promote the evaluation of research activity in Spanish Hospital Pharmacy Services. MethodsThe study was carried out in 5 phases following the modified Delphi methodology: constitution of the coordinating group, elaboration of a list of scenarios, selection of participating centers, evaluation of the list of scenarios, and analysis of the results.The coordinating group designed a questionnaire with 114 questions. General research questions and different scenarios (indicators) were included to form the dashboard. The Hospital Pharmacy Services with the highest number of publications were identified to participate in the Delphi consultation. Two rounds of consultations were conducted in which the "Need" and/or "Feasibility" of their measurement was evaluated for each of the scenarios, using a numerical scale from 1 (lowest score) to 9 (highest score). ResultsSixteen Hospital Pharmacy Services, belonging to 8 different autonomous communities, participated in the Delphi consultation. A total of 100% of them responded to all the questions in the 2 rounds of consultations. It was considered that the Hospital Pharmacy Services should have a research dashboard (need = 100%) with a basic structure and a common minimum set of data for all them (need = 87.5%). The consensus was reached on distinguishing research projects led by the Hospital Pharmacy Services from those led by other groups in which the Hospital Pharmacy Services collaborate (need = 87.5%), and a definition was approved on the leadership of these projects according to whether they are single-center or multicenter.A consensus was reached on 40 indicators to form the dashboard, which evaluates publications (13 indicators), human resources (12 indicators), research projects (9 indicators), doctoral theses (4 indicators), and patents and intellectual property registrations (2 indicators). ConclusionsThis is the first consensus dashboard developed to evaluate the research activity of the Hospital Pharmacy Services, which will help to analyze the productivity and impact of research systematically and continuously. In addition, it will allow comparison between them and will help to establish synergies and identify trends, patterns, and challenges.

[Translated article] Development and consensus of a dashboard model to evaluate research activity in Spanish Hospital Pharmacy Services

ObjectiveTo develop by consensus a dashboard model to standardise and promote the evaluation of research activity in Spanish Hospital Pharmacy Services. MethodsThe study was carried out in 5 phases following the modified Delphi methodology: constitution of the coordinating group, elaboration of a list of scenarios, selection of participating centres, evaluation of the list of scenarios, and analysis of the results.The coordinating group designed a questionnaire with 114 questions. General research questions and different scenarios (indicators) were included to form the dashboard. The Hospital Pharmacy Services with the highest number of publications were identified to participate in the Delphi consultation. Two rounds of consultations were conducted in which the “Need” and/or “Feasibility” of their measurement was evaluated for each of the scenarios, using a numerical scale from 1 (lowest score) to 9 (highest score). ResultsSixteen Hospital Pharmacy Services, belonging to 8 different Autonomous Communities, participated in the Delphi consultation. A total of 100% of them responded to all the questions in the 2 rounds of consultations. It was considered that the Hospital Pharmacy Services should have a research dashboard (Need=100%) with a basic structure and a common minimum set of data for all them (Need=87.5%). The consensus was reached on distinguishing research projects led by the Hospital Pharmacy Services from those led by other groups in which the Hospital Pharmacy Services collaborate (Need=87.5%), and a definition was approved on the leadership of these projects according to whether they are single-centre or multicentre.A consensus was reached on 40 indicators to form the dashboard, which evaluates publications (13 indicators), human resources (12 indicators), research projects (9 indicators), doctoral theses (4 indicators), and patents and intellectual property registrations (2 indicators). ConclusionsThis is the first consensus dashboard developed to evaluate the research activity of the Hospital Pharmacy Services, which will help to analyse the productivity and impact of research systematically and continuously. In addition, it will allow comparison between them and will help to establish synergies and identify trends, patterns, and challenges.

Large Language Models (LLMs) in Engineering Education: A Systematic Review and Suggestions for Practical Adoption

The use of large language models (LLMs) is now spreading in several areas of research and development. This work is concerned with systematically reviewing LLMs’ involvement in engineering education. Starting from a general research question, two queries were used to select 370 papers from the literature. Filtering them through several inclusion/exclusion criteria led to the selection of 20 papers. These were investigated based on eight dimensions to identify areas of engineering disciplines that involve LLMs, where they are most present, how this involvement takes place, and which LLM-based tools are used, if any. Addressing these key issues allowed three more specific research questions to be answered, offering a clear overview of the current involvement of LLMs in engineering education. The research outcomes provide insights into the potential and challenges of LLMs in transforming engineering education, contributing to its responsible and effective future implementation. This review’s outcomes could help address the best ways to involve LLMs in engineering education activities and measure their effectiveness as time progresses. For this reason, this study addresses suggestions on how to improve activities in engineering education. The systematic review on which this research is based conforms to the rules of the current literature regarding inclusion/exclusion criteria and quality assessments in order to make the results as objective as possible and easily replicable.

Splicing the SEED and Delphi Methods: A Tutorial for Conducting Patient-Centered, Engagement Quality Improvement Projects

Conducting patient-centered engagement quality improvement projects requires careful consideration of methodologies that will allow a core project team to fully include participants as partners. Engagement activities must ensure that heterogeneous members of the project team are given an equal voice in investigation processes and that potential barriers to meaningful participation are reduced. This tutorial provides a model for intentionally blending elements of the Stakeholder Engagement in quEstion Development and prioritization (SEED) and Delphi methods to maximize participant engagement in a patient-centered quality improvement project to generate research questions related to patient-clinician communication of neurocognitive late effects of childhood cancers.

Insights into the nutritional prevention of macular degeneration based on a comparative topic modeling approach.

Topic modeling and text mining are subsets of natural language processing (NLP) with relevance for conducting meta-analysis (MA) and systematic review (SR). For evidence synthesis, the above NLP methods are conventionally used for topic-specific literature searches or extracting values from reports to automate essential phases of SR and MA. Instead, this work proposes a comparative topic modeling approach to analyze reports of contradictory results on the same general research question. Specifically, the objective is to identify topics exhibiting distinct associations with significant results for an outcome of interest by ranking them according to their proportional occurrence in (and consistency of distribution across) reports of significant effects. Macular degeneration (MD) is a disease that affects millions of people annually, causing vision loss. Augmenting evidence synthesis to provide insight into MD prevention is therefore of central interest in this article. The proposed method was tested on broad-scope studies addressing whether supplemental nutritional compounds significantly benefit macular degeneration. Six compounds were identified as having a particular association with reports of significant results for benefiting MD. Four of these were further supported in terms of effectiveness upon conducting a follow-up literature search for validation (omega-3 fatty acids, copper, zeaxanthin, and nitrates). The two not supported by the follow-up literature search (niacin and molybdenum) also had scores in the lowest range under the proposed scoring system. Results therefore suggest that the proposed method's score for a given topic may be a viable proxy for its degree of association with the outcome of interest, and can be helpful in the systematic search for potentially causal relationships. Further, the compounds identified by the proposed method were not simultaneously captured as salient topics by state-of-the-art topic models that leverage document and word embeddings (Top2Vec) and transformer models (BERTopic). These results underpin the proposed method's potential to add specificity in understanding effects from broad-scope reports, elucidate topics of interest for future research, and guide evidence synthesis in a scalable way. All of this is accomplished while yielding valuable and actionable insights into the prevention of MD.

The Atypical Forms of Employment Acceptance by Polish Full-Time Employees as per Modern Labour Market Rules in an EU-Country Context

This manuscript is dedicated to atypical forms of employment which are a response to transactional relations between the employee and the employer on the modern labour market. The general research question is whether employees who accept atypical forms of employment (or “AFE”; readiness to providing work) obtain benefits in the form of high employability and well-being as well as low levels of job insecurity. The assumptions and the research scheme are new compared to previous studies. A quantitative CAWI study was conducted on a sample of Polish full-time employees (N = 543), as potentially voluntarily declaring their acceptance of AFE. In addition, well-being was operationalised according to C. Ryff ’s approach as a sense of agency in the creation of the professional environment. The respondents were divided into two groups – those accepting AFE and those accepting traditional, long-term employment, in reference to the concept of transactional and relational psychological contract. The regression analysis shows that the first group had a high level of employability. However, they achieved low levels of well-being, and job insecurity was not significant. These are individuals in managerial positions in the private sector. On the other hand, the group that accepts the traditional form of relationships are public sector employees and have high job insecurity only. An important determinant of the acceptance of AFE is the so-called “Big Five trait” openness. In addition, the level of acceptance decreases with age. Gender and education are not statistically significant. The focus in this paper on full-time employees, and the benefits of AFE, fill the research gap in this area. It also delivers recommendations for labour market practices and policy on how to support employees on the modern labour market in EU countries.

Sustainability through digital transformation: EU practices

<p>The significance of sustainability efforts has been reaffirmed by negative circumstances, such as the escalating visible consequences of climate change, floods resulting from erratic weather patterns in certain areas, and fires and extreme droughts in other regions. The logical rationale behind employing digital tools for sustainability purposes lies in the efficiency of digital transformation, supported by artificial intelligence, in improving remote access, control, and decision-making processes, as well as accomplishing tasks that are unachievable through human effort alone. Upon analyzing practices worldwide, it becomes apparent that the European Union (EU) is the singular entity that places utmost importance on digitalization as a means to ensure sustainability. Additionally, it provides comprehensive allocations for projects pertaining to this subject and supports the collective wisdom of its members through the established union. Hence, the purpose of this study is to examine the current literature in detail via a systematic review to extract the EU practices of sustainability through digitalization. Findings reveal the particular EU focuses and key themes on achieving sustainability with a visual representation of the results. Besides, the EU practices with other well-known countries on sustainability through digitalization efforts are compared and discussed. Thus, a practitioner can understand the findings of this research to use as the first step when generating research questions to start a new study.<strong></strong></p>

The Implementation of a Sustainable Online Course for the Development of Digital Citizenship Skills in Higher Education

This study aims to develop and evaluate the effectiveness of a digital citizenship curriculum developed using online teaching for undergraduate students. For this purpose, answers were sought to the following general research questions: “How are students performing their digital citizenship skills?”, “What is the efficiency level of the developed digital citizenship curriculum?”, “What are the students’ self-evaluations during the implementation process of the developed digital citizenship curriculum?” and “What are student opinions about the implemented digital citizenship course?”. A “parallel-simultaneous design”, one of the mixed research methods, was used in this research. The content of the curriculum was determined within the framework of a needs analysis consisting of university students and field experts, and a document review. A quasi-experimental design method was used to implement the programme. A total of 39 teacher candidates, registered in the spring semester of the 2022 academic year, participated in the experimental process. A Moodle learning management system was used as the teaching environment. Participants’ digital citizenship behaviours and attitude levels were measured before and after the experimental application. It was observed that there was a significant (positive) difference between the pre-test and post-test average scores in favour of the post-test scores, and the effect value of this difference was high. It turned out that the teacher candidates’ opinions on the effectiveness of the online digital citizenship programme were positive. It is understood that the digital citizenship teaching curriculum developed for higher education can be used sustainably for similar university student groups as in this study. However, it is anticipated that the developed programme can be updated along with technological evolutions.

Quantifying the distribution of feature values over data represented in arbitrary dimensional spaces.

Identifying the structured distribution (or lack thereof) of a given feature over a point cloud is a general research question. In the neuroscience field, this problem arises while investigating representations over neural manifolds (e.g., spatial coding), in the analysis of neurophysiological signals (e.g., sensory coding) or in anatomical image segmentation. We introduce the Structure Index (SI) as a directed graph-based metric to quantify the distribution of feature values projected over data in arbitrary D-dimensional spaces (defined from neurons, time stamps, pixels, genes, etc). The SI is defined from the overlapping distribution of data points sharing similar feature values in a given neighborhood of the cloud. Using arbitrary data clouds, we show how the SI provides quantification of the degree and directionality of the local versus global organization of feature distribution. SI can be applied to both scalar and vectorial features permitting quantification of the relative contribution of related variables. When applied to experimental studies of head-direction cells, it is able to retrieve consistent feature structure from both the high- and low-dimensional representations, and to disclose the local and global structure of the angle and speed represented in different brain regions. Finally, we provide two general-purpose examples (sound and image categorization), to illustrate the potential application to arbitrary dimensional spaces. Our method provides versatile applications in the neuroscience and data science fields.

Employing AI in Academia: the Role of ChatGPT in Generating Research Questions

Employing AI in Academia: the Role of ChatGPT in Generating Research Questions

NextGenerationEU and the European Semester: Comparing National Plans and Country‐Specific Recommendations

This article examines the main features of the Recovery and Resilience Plans (RRPs) that member states have presented to access NextGenerationEU (NGEU) funds, and it explores the relationship between NGEU and the European Semester. Relying on a dataset collected for this purpose, which coded all RRPs and all recommendations received by the member states in the years preceding NGEU, we explore quantitatively the variation in the countries’ resource allocation and reform agendas and the congruence between RRPs and the recommendations issued in the European Semester. Our analysis reveals three key findings. First, substantial variation exists across member states, reflecting the diverse economic and political contexts shaped by a decade of crises. Second, by disaggregating RRPs into the six policy pillars indicated by the Commission, we show differences in the member states’ patterns of intervention. Third, we offer insights into the extent to which member states address the Semester recommendations. The data we present is a relevant tool for understanding NGEU and generating research questions aimed at exploring its nature and its implementation in the years to come.

SCIENCE AND CARE PARTNERSHIPS: THE ROLE OF THE SCIENTIFIC LINKING PIN RESEARCHER

Abstract Background Science and care partnerships work on promoting quality of life, care and work in long-term-care (LTC) settings. The Scientific Linking Pin (SLP) is an academic employed by a university and works one day per week in a LTC organisation. The SLP role is pivotal to the success of partnerships; the nature of this role has not yet been captured. Methods Fifteen SLPs took part in semi-structured interviews. Data were thematically analysed. Results Data are presented over two themes. The first theme, the SLP experience, outlines that SLPs have rich insights into what matters to, and the challenges experienced in LTC organisations. SLPs are well positioned to impact practice, and develop their professional careers. SLPs do experience doubts and insecurities and require mentorship/supervision. The second theme, navigating in a SLP role, outlines the multifaceted tasks involved: relationship building, raising awareness, identifying priorities, generating research questions, building committees, brokering knowledge, developing research studies, generating academic output, building links and connections, and assisting with internal projects. The challenges SLPs face in their work include mistrust and poor engagement from care staff, working with staff from different professional backgrounds, research not being a priority, multiple and rapidly changing priorities, and differences in expectations. Relationship building, creating a ‘safe’ space for care staff, building engagement, and expectation management helped to address these challenges. Conclusion Partnership working in the care sector is gaining international recognition and adoption. This study described one key role that contributes to the success of the partnership model: the SLP.

Exploring the Causes of Gendered Elder Care Burden in South Korea

This paper investigates the reasons behind gender inequality in the responsibility for elder care in the case of South Korea. Specifically, to address this general research question, three sub-questions have been proposed: whether the differences in social resources by gender, or the different responses to similar resources by gender, are responsible for heavier elder care burdens for female members in the family. In addition, to what extent did the Korean welfare policies promote gender quality in elder care? Using quantitative data from Statistics Korea (KOSIS) and OECD, along with qualitative data from preceding research conducted by Sirin Sung in 2003, the study reveals that the results support the different resource argument to a great extent, whilst the data less support the different response argument. The study also finds that the current welfare policy implemented by the Korean government had alleviated the burden of providing elder care by family, but the effect of which on gender equality was limited.

Understanding How Reservoir Operations Influence Methane Emissions: A Conceptual Model

Because methane is a potent greenhouse gas (GHG), understanding controls on methane emissions from reservoirs is an important goal. Yet, reservoirs are complex ecosystems, and mechanisms by which reservoir operations influence methane emissions are poorly understood. In part, this is because emissions occur in ‘hot spots’ and ‘hot moments’. In this study, we address three research questions, ‘What are the causal pathways through which reservoir operations and resulting water level fluctuations (WLF) influence methane emissions?’; ‘How do influences from WLF differ for seasonal drawdown and diurnal hydropeaking operations?’; and ‘How does understanding causal pathways inform practical options for mitigation?’. A graphical conceptual model is presented that links WLF in reservoirs to methane emissions via four causal pathways: (1) water-column mixing (2) drying–rewetting cycles, (3) sediment delivery and redistribution, and (4) littoral vegetation. We review what is known about linkages for WLF at seasonal and diurnal resolutions generate research questions, and hypothesize strategies for moderating methane emissions by interrupting each causal pathway. Those related to flow management involve basin-scale management of tributary flows, seasonal timing of hydropeaking (pathway #1), timing and rates of drawdown (pathway #2). In addition, we describe how sediment (pathway #3) and vegetation management (pathway #4) could interrupt linkages between WLF and emissions. We demonstrate the strength of conceptual modeling as a tool for generating plausible hypotheses and suggesting mitigation strategies. Future research is needed to develop simpler models at appropriate timescales that can be validated and used to manage flow releases from reservoirs.

Bridging the gap between science and care: a qualitative exploration of the role of the Scientific Linking Pin researcher working in research and practice partnerships

Context: The Living Lab in Ageing and Long-Term Care (Netherlands) and Nurturing Innovation in Care Homes Excellence in Leeds (NICHE-Leeds; UK) are partnerships between science and care. The Scientific Linking Pin (SLP), a senior researcher employed by a university, works one day per week in a LTC organization, and has a pivotal role in the partnership.
 Objective: To explore the nature of the SLP role
 Methods: A qualitative approach was used. Fifteen individuals with at least one year’s experience as a SLP in the Living Lab or NICHE-Leeds participated in a semi-structured interview. Data were thematically analyzed. 
 Findings: Participants described how the SLP role gave them insight into what matters to care organizations, and how it enabled them to impact LTC practice. Participants experienced the role to be multifaceted. Goals and activities performed by SLPs included developing relationships, raising awareness of the practice-science partnership, identifying (research) priorities and generating research questions, building committees, brokering knowledge, developing research studies, generating academic output, building links and connections, and assisting with internal projects. Challenges faced were mistrust by care staff and poor engagement, working with staff from different professional backgrounds, research not being a priority, multiple and rapidly changing priorities, and differences in expectations. SLPs addressed these challenges through relationship building, creating a ‘safe’ space for care staff, building engagement, and expectation management.
 Implications: Partnership working in the care sector is gaining international recognition and adoption, and therefore it is useful to capture and share learning about successful implementation of our approach.

Challenges of a Data Ecosystem for scientific data

Data Ecosystems (DE) are used across various fields and applications. They facilitate collaboration between organizations, such as companies or research institutions, enabling them to share data and services. A DE can boost research outcomes by managing and extracting value from the increasing volume of generated and shared data in the last decades. However, the adoption of DE solutions for scientific data by R&D departments and scientific communities is still difficult. Scientific data are challenging to manage, and, as a result, a considerable part of this information still needs to be annotated and organized in order to be shared. This work discusses the challenges of employing DE in scientific domains and the corresponding potential mitigations. First, scientific data and their typologies are contextualized, then their unique characteristics are discussed. Typical properties regarding their high heterogeneity and uncertainty make assessing their consistency and accuracy problematic. In addition, this work discusses the specific requirements expressed by the scientific communities when it comes to integrating a DE solution into their workflow. The unique properties of scientific data and domain-specific requirements create a challenging setting for adopting DEs. The challenges are expressed as general research questions, and this work explores the corresponding solutions in terms of data management aspects. Finally, the paper presents a real-world scenario with more technical details.

5G is not Just Another G: A Review of the Managerial Literature

Due to the higher range of markets and applications opportunities it brings, the fifth generation of mobile communications (5G) cannot be considered just a technological transition, as it was for earlier generations of cellular technology, rather it represents a revolutionary phenomenon which could deeply change the competitive landscape for wireless services. According to the literature, it is “one of the most complex technologies seen over the past decade both in terms of technical development and business implications”. However, on one hand, the 5G is a hotly discussed topic from a technical perspective, on the other the managerial literature appears ambiguous and fragmented in the way it is presented. Such absence recalls for a paper whose purpose is to position the 5G search thread also in the managerial literature. For this reason, the work aims to systematize previous knowledge and identify potential research directions related to the strategic adoption of 5G technology. To answer the underlying research question regarding the state of the art of the 5G in the strategy domain, a systematic search has been done, then, on the selected papers, a conceptual review has been carried out to identify (i) the “business reconfigurations” of 5G technology, (ii) the boundary conditions, intended as the conditions of existence of a 5G business case, (iii) the barriers, which instead hinder the development of cases. The research provides useful implications to both the theory and practice: from a theoretical perspective, it represents one of the first studies concerning 5G which is not strictly related to a specific industry or scenario. Secondly, the challenges and gaps identified generate research questions which can be traceable also to a general and more theoretical context, such as the business model innovation literature, where the strategic adoption of new technological paradigms entails further investigations. From a practitioner’s perspective, it provides useful insights regarding 5G adoption for increasing actors’ awareness of such technological innovation, especially concerning their attitude change which is needed to seize the business opportunities it embraces.

Level of global preparedness to pandemics and responsiveness of health systems to pandemics: Lessons learned from Covid-19 and Monkeypox Outbreak

The monkeypox disease has been declared a global health emergency in the recent past by WHO since cases have been observed to be increasing in many countries where it is not common. Thus, epidemics and pandemics such as the novel coronavirus disease 2019 (COVID-19) have had adverse effects on populations, and healthcare systems, especially in Low and Middle-Income Countries (LMICs) because of borrowing or inadequate resources when compared to high-income countries. The Ebola and Covid-19 for instance have also revealed the existing deficiencies and vulnerabilities in the global structure of the pandemics’ prevention and control all in one. New epidemics are constantly emerging such as the current monkeypox outbreak that is ravaging the global population; hence it has dawned on the world that there is need for combined efforts at a global level and probably investing more in the health systems to be able to prevent and deal with other similar epidemics. Further, there is required more equal distribution of the resources and health intervention in all countries to build strong containment responses. Based on prior episodic outbreaks, there is the need for immediate coordinated response to the ongoing monkeypox outbreak. The purpose of this research article is to review and discuss the main underlying autopsies from past outbreaks, including Ebola and Covid-19 with emphasis on readiness, answering to the outbreak, coordination measures, health system robustness, risk communication and the international community. It also evaluates the readiness globally and by country to the present monkeypox outbreak based on other recent large viral epidemics. It also prevents social stigmatization, which is the negation of outbreaks, and rightful inequities that may arise from the same. As such, and with health system reforms launched now, countries can prepare themselves against present and future known and unknown urgencies and leave no one behind. As such the general research question of this study is to obtain strategies for enhancing pandemic preparedness taken from successes and failure noticed earlier and the focus placed on LMIC capacity strengthening.