Implementation Of Action Plan Research Articles

Advancing CAR T-Cell Care in Relapsed/Refractory Multiple Myeloma: Insights from a Collaborative Quality Improvement Initiative

Background Multiple myeloma (MM) is most often diagnosed in late stages where the risk of relapse or progression is highest. Treatment of patients with relapsed disease refractory to many available treatment options poses a substantial clinical challenge for providers. Recently approved chimeric antigen receptor (CAR) T-cell therapies have proven efficacious in highly relapsed/refractory MM. Despite CAR T-cell therapy's efficacy, many challenges and barriers to optimal treatment exist in the integration, communication, and care collaboration between centers related to CAR T-cell therapy for MM patients. To improve quality care related to T-cell therapy treatment in MM, we conducted a quality initiative (QI) study focused on evidence-based integration of CAR T-cell therapy, communication, and care coordination between community oncology clinics and regional CAR T-cell therapy performing centers. Methods Building on the design of our prior QI programs (Hussein ASCO 2020), this initiative includes baseline (n = 93) and follow-up provider surveys, and small-group, team-based audit-feedback (AF) sessions. Survey questions were designed to assess knowledge, confidence, and experiences using CAR T-cell therapy in MM treatment. Care teams from each clinic, along with a CAR T-cell expert from the regional center and nationally renowned expert CAR T-cell physician, participated in audit and feedback sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Additional surveys completed before and after the AF sessions will measure changes in participants’ beliefs and confidence in care delivery. Results Provider Surveys: Providers top reported challenges encountered with CAR T-cell therapy include identifying patients eligible for treatment with CAR T-cell therapy (63%), transferring the patient to a CAR T-cell center for infusion (24%), gaining approval from the insurance company for CAR T-cell therapy (23%) and managing the patient post-CAR T-cell therapy (22%). When asked about the level of communication and collaboration between centers, most providers rated very good/excellent (49%) versus good (29%) and poor/fair (22%). Barriers to very good/excellent communication are insufficient sharing of patient information including test results, premedication documents and details of CAR T-cell therapy administration (30%) followed by lack of expertise in CAR T-cell therapy administration among infusion faculty/clinic staff and lack of time for our clinic's staff to communicate with infusion facility staff (figure 1). HCPs reported vastly different frequencies of referring eligible patients for treatment with CAR T-cell therapy, with a combined 36% often or always referring eligible patients and 34% rarely/never initiating a referral. Small Group A/F Sessions: HCPs participating in the small group A/F sessions also reported identifying patients eligible for treatment with CAR T-cell therapy as the biggest challenge regarding treatment with CAR T-cell therapy. Very high/high confidence in identifying eligible patients for CAR T-cell therapy treatment reported by providers increased from 37% to 72%. HCPs also noted increases in their confidence in managing adverse/late effects of CAR T-cell therapy in patients with MM (38% to 63% very high/high confidence). Conclusions Through this QI initiative, clinical teams created and implemented action plans to close gaps in identifying eligible patients, coordinating CAR T-cell therapy referral and approval, and providing counseling and obtaining consent among hematology/oncology team members. Following the initiative, meaningful confidence gains were observed in identifying eligible patients for CAR T-cell therapy and managing adverse/late effects of treatment. Follow-up surveys will assess self-reported practice changes stemming from the action plans. These data underscore clinical practice gaps that can be addressed in future initiatives to support safe, effective, and evidence-based integration of CAR T-cell therapies into MM care to optimize patient outcomes. Study Sponsor Statement The study reported in this abstract was funded by independent educational grants from Bristol Myers Squibb, who had no role in the study design, execution, analysis, or reporting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Examining the Determinants of Continuance Intention to Use Mobile Payment Service

Innovation in finance and advances in payment sytems are very important to boost remittances and encourage the successful development of electronic businesses around the world. Thus, many leading companies use mobile payment services to improve the customer experience of their customers. This study aims to identify the factors that influence consumers to continue using mobile payment in Indonesia. Several influencing factors include Service Quality, Perceived Ease of Use, Security, Perceived Usefulness, and Trust. This research was conducted in Madiun City, one of the big cities in Indonesia, with a total of 176 respondents. The study results can help mobile payment companies understand factors that are relevant to increasing volume usage in the context of merchants. The findings of this research is Continuance Intention influenced by Trust. Trust is significantly influenced by the independent variables such as Service Quality, Perceived Ease of Use, Security, and Perceived Usefulness. However, perceived risk has no significant effect on continuance intention. Therefore, mobile Payment service providers should be able to implement action plans related to the quality of their services, user experience to customers, security of an application, and the functions and features implemented by a Mobile Payment. Hopefully those things will generate trust in customers to continue to use Mobile Payment services.

High prevalence of resistance to third-generation cephalosporins detected among clinical isolates from sentinel healthcare facilities in Lagos, Nigeria

BackgroundAntimicrobial resistance (AMR) in bacterial pathogens is a worldwide concern that demands immediate attention. Most information on AMR originates from high-income countries and little is known about the burden in Africa, particularly Nigeria. Using four sentinel sites (General hospitals) in Lagos State, this study sought to estimate the burden of AMR.MethodsThis is a hospital-based surveillance using secondary health care centres. Four sites were randomly selected and included in the study. Clinical isolates were collected over a period of 6 months for each site from August 2020 to March 2021. All isolates were characterised and analysed for resistance to 15 antibiotics using the Kirby-Baur method. Multiplex PCR assay was used for the detection of Extended spectrum beta lactamase genes. Data analysis was done using SPSS version 27.0.ResultsFour hundred and ninety-nine (499) patients consented and participated in this study, consisting of 412 (82.6%) females and 87 (17.4%) males. The mean age ± SD of the participants was 33.9 ± 13.8 with a range of 1–89 years. The majority (90.8%) of the participants were outpatients. Two hundred and thirty-two (232) isolates were obtained from 219 samples, comprising of 120 (51.7%) Gram positive and 112 (48.3%) Gram negative organisms. Key bacterial pathogens isolated from this study included Staphylococcus aureus (22.8%), Escherichia coli (16.4%), Staphylococcus spp. (15.9%), Enterococcus spp. (7.3%) and Klebsiella pneumoniae (6.5%). There was high prevalence of multi-drug resistance (79.3%) among the isolates with 73.6% of Staphylococcus aureus phenotypically resistant to methicillin and 70% possessed the MecA gene. 76.5% of Enterococcus spp. isolated were Vancomycin resistant. Overall, resistance to Cephalosporins was most frequently/commonly observed (Cefotaxime 87.5%).ConclusionA high incidence of AMR was identified in clinical bacteria isolates from selected general hospitals in Lagos State, highlighting the necessity for the implementation of national action plans to limit the prevalence of AMR. Surveillance via collection of isolates has a lot of promise, especially in resource-limited environments.

Implementasi Reformasi Birokrasi

This study aims to describe the implementation model of bureaucratic reform that has been carried out, both in Indonesia and several other countries. Provide a comprehensive understanding of the importance of bureaucratic reform. The research method used is a library research method from various sources related to bureaucratic reform. The results of this literature review illustrate that bureaucratic reforms that have been carried out in several countries are generally related to two dimensions, namely the organizational dimension and the apparatus human resource dimension. In the context of implementing the implementation of bureaucratic reform at the Provincial Bawaslu and Regency/City Bawaslu, it is necessary to immediately make and determine the Decree of the Bureaucratic Reform Team, make and determine the Decree of Role Models and Agents of Change of Bureaucratic Reform which includes 8 areas of change, preparation of an implementation action plan. bureaucratic reform, filling out the bureaucratic reform evaluation worksheet, monitoring and evaluating the implementation of bureaucratic reform every month.

Emergency Action Planning in Kasas High Schools.

Current evidence showed a variable rate of emergency action plan (EAP) implementation and a low rate of compliance to EAP guidelines in United States secondary schools. Compliance to EAP recommendations in Kansas high schools is not known. The purpose of this study was to identify the emergency preparedness of high school athletics in the state of Kansas and identify prevailing characteristics of schools that correlate with decreased compliance of an EAP. Athletic directors for high schools in the state of Kansas were asked to participate in a web-based questionnaire that was emailed to each athletic director. The questionnaire identified demographics of the study population, EAP implementation rates, compliance to national EAP guidelines, access to certified medical personnel, and training received by athletics personnel. Descriptive statistics were then compiled and reported. The response rate for the survey was 96% (341/355). A total of 94.1% (320/340) of schools have an EAP, 81.4% (276/339) of schools have an automated external defibrillator (AED) at all athletic venues, and 51.8% (176/340) of schools had an athletic trainer (AT) on staff. Urban schools were significantly more likely than rural schools to have an AT on staff (OR = 11.10, 95% CI = [6.42, 19.18], p < 0.0001), have an EAP (OR = 3.69, 95% CI = [1.05, 13.02], p = 0.0303), require additional training for coaches (OR = 2.69, 95% CI = [1.42, 5.08], p = 0.0017), and have an AED on-site for some events (OR = 2.18, 95% CI = [1.24, 3.81], p = 0.0057). Most Kansas high schools have an EAP in place and have at least one AED. Emergency planning should be improved through venue specific EAPs, access to early defibrillation, and additional training. Rural and lower division schools had less AT staffing and consequently were impacted more significantly than urban and higher division schools by these factors. These factors should be taken into account in future improvement strategies.

The German national public health institute’s journey to becoming a Key Climate Actor: The Robert Koch Institute’s strategy development process

Abstract The Robert Koch Institute (RKI) is Germany's national public health institute. It has been working for a number of years on One Health topics such as zoonotic diseases and antimicrobial resistance, as well as wider areas relevant to climate change such as environmental health. Climate change has, however, only been a specific area of focus since 2019. This was signalled through the creation of a coordination role called One Health Climate Change (OHCC). In addition, a number of projects on climate change have been initiated independently of one another during this time across the RKI. Since summer 2021, RKI has been more active in its strategic development and set up a climate change and health working group of over 50 members of staff representing all departments. This offers a hub structure for pulling the relevant work and activities together under one umbrella, thereby promoting exchange, cooperation and cohesion across RKI. The RKI is currently at an early and dynamic phase in its journey as a key Climate Actor. It is developing a strategy on the topic, guided by the “IANPHI Roadmap for Action on Health and Climate Change” in order to further strengthen its contribution in this area. This presentation will share how RKI has developed its strategy and its action plan for implementation, as well as some of the successes and challenges in their development. The presentation aims to: • promote shared learning between national public health institutes on climate change and health strategy development; • provide an opportunity for shaping future planning at RKI through audience input; • stimulate thinking on how national public health institutes can remain in exchange with key stakeholder groups and open to learning and adaptation of their strategies in order to be effective Key Climate Actors over the long term.

8.J. Workshop: Transfer and adoption of digitally enabled integrated care good practices: the JADECARE Joint Action

Abstract The ageing population and the burden of chronic conditions is increasing the demand for more comprehensive, efficient and smarter healthcare. The EU funded Joint Action JADECARE (Joint Action on implementation of Digitally Enabled integrated person-centred CARE) intends to reinforce the capacity of health authorities to successfully address the health system transition to digitally enabled integrated person-centred care. JADECARE involves 45 organisations from 16 different EU countries covering different funding systems (both Bismarck, Beveridge and mixed) holding different levels of penetration, adoption and maturity of integrated care. It focuses on the transfer and adoption of four original Good Practices (oGPs) to the contexts of 21 Next Adopters (NA). The project started on October 1 2020 and ends on September 30 2023. The oGPs that are being transferred in JADECARE concern integrated care, chronic conditions, self-care, prevention and population health. They are: The Basque Health strategy in ageing and chronicity: integrated care (Spain), the Catalan open innovation hub on ICT-supported integrated care services for chronic patients (Spain), the OptiMedis Model-Population-based integrated care (Germany) and the Digital roadmap towards an integrated health care sector (Denmark). Due to the heterogeneity of the NA, the transfer strategy of JADECARE enables them to customize the parts of the oGPs that will be transferred and adapted to its local context, considering its needs, local strategies and implementation goals. The JADECARE three-step implementation strategy has been designed to be appropriate from the scientific point of view, applicable considering data availability and feasible according to project's timeline and resources: • Pre-implementation: definition of Local interventions and action plans. • Implementation: roll-out and operation, based on two Plan-Do-Study-Act cycles. • Post-implementation: result analysis, impact assessment and reporting on learnings. By the end of 2022, the implementation phase will be completed, and all NA will start analyzing their results and reporting on learnings. Currently, NAs have defined their interventions and action plans for implementation and are finalizing the first of the two PDSA cycles that they will be performing within JADECARE. 3 of the NAs are implementing interventions at national level, 14 at regional level and 4 at local level. Most of the NAs implement interventions related to digitally enabled integrated care (36), 11 are related to risk stratification and 9 to patient empowerment. This workshop explores the key elements and challenges to be addressed when transferring Good Practices (GP) to heterogeneous health systems with different needs, aims and scopes. It will also highlight the experience of two NA: Marche region, in Italy and Olomouc, in Czech Republic and promote the discussion among speakers and attendees to highlight the challenges and key elements to enable the transfer of GPs. Key messages • JADECARE will impact on EU health systems by implementing innovative solutions and helping to change the model of care provision. It will also settle the basis to implement them at large scale. • The long-term effect of JADECARE is supported by involving stakeholders at regional and national levels to provide political support and commitment to sustained integrated care.

The role of public health services in implementing heat health action plans in Germany

Abstract Background The rise in extreme heat periods is a major public health challenge of climate change and the World Health Organization therefore recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are not implemented in a comprehensive manner nor nationwide. Public health authorities have been identified as key actors with regards to heat and health. This study aims at assessing the role of public health services in the implementation of HHAPs in Germany. Methods First, a review of the scientific and grey literature on the role of public health services in heat adaptation in Europe was conducted. Second, a policy document analysis of the legislation of Germany's federal states for public health services and their potential role in the implementation of HHAPs was carried out. Finally, semi-structured interviews with selected experts from multiple sectors at the local, federal and national level on their perception of the role of public health services in the implementation of HHAPs in Germany were undertaken. Results Preliminary findings show that the legal framework for public health services in the different federal states addresses environmental health and civil protection to varying extents, but that climate change-specific health risks are barely mentioned. The expert interviews revealed perceived barriers for the public health services to implement HHAPs, notably with regards to personnel (e.g. competencies, time), organizational structures (e.g. financial resources, administrative structures, legal mandates) and competing other tasks (e.g. COVID-19 response). Facilitators included motivated individuals, funding opportunities for cross-sectoral collaboration and political support. Conclusions The role of public health services in HHAP implementation in Germany varies widely between the different geographic settings and is influenced by several factors at the individual, organizational and political level. Key messages

Mitigating effects of desert dust storms in asthmatic children: health visitors’ perceptions, Cyprus

Abstract Background Countries of the Mediterranean basin such as Cyprus are experiencing frequent desert dust storm (DDS) events that adversely impact children with asthma. As school health visitors (SHVs) have important role in asthma management, we examined SHVs practices and perceptions on asthma management and their level of engagement in school-based interventions to mitigate DDS- health effects. Methods A descriptive cross-sectional survey was conducted among SHVs across state schools in Cyprus via an anonymous questionnaire, which rated the importance of asthma management measures (10-point scale), current implementation of these practices (1=never - 5=always), and regulatory authorities’ preparedness to respond to DDS events (1-5 Likert scale). Results Responses from 78 of the 93 SHVs (84%), with an average work experience of 13.5 years (SD 7.3), revealed discordance between high perception of the importance of asthma management measures and their actual implementation, with poor scoring especially in assessment of asthma control (M = 2.4, SD = 1.5), tracking school absenteeism (M = 2.1, SD = 1.0) and monitoring of asthma triggers (M = 1.9, SD = 1.4). Any DDS-related measures (e.g. air quality real-time monitoring, warnings, recommendations, awareness campaigns, etc) were implemented very infrequently. Ratings of authorities’ preparedness were moderate (&amp;lt;3.5), and only slightly higher in the health versus the educational or other government services. SHVs who recognized the severity of DDS and potential impact on asthmatic children were more likely to support school-based interventions for DDS events (OR = 7.3, 95% CI: 2.1-25.3). Conclusions Asthma management practices in school settings in Cyprus are suboptimal and responses during DDS are fragmented. While SHV’s awareness and support for interventions is high, this is not reflected in current practices. A concerted effort is needed for adoption of policies and implementation of action plans for DDS within school settings. Key messages • Suboptimal asthma management policies and practices were found to be implemented in schools in Cyprus, a country highly exposed to dust events. • School health visitors recognize the health impact of desert dust on asthmatic children and support the plan for dust-mitigation programmes in schools, despite authorities’ low preparedness.

Systematic review of surveillance systems for AMR in Africa.

Surveillance is a useful tool for tracking antimicrobial resistance (AMR) trends, patterns, therapeutic and policy interventions. Proper correlation of surveillance data gives meaningful insight into the underlying epidemiology and facilitates development of rational interventions. This comprehensive review aims to identify, classify and assess gaps in Global Antimicrobial Resistance and Use Surveillance System (GLASS) reporting and national action plan (NAP) implementation in Africa. Articles published in English were searched across five electronic databases (PubMed, Scopus, Embase, AJOL and Cochrane) and grey literature. Articles were screened against inclusion/exclusion criteria and data from eligible studies were retrieved and analysed. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 31 July 2020 under protocol CRD42020192165. Of the 4304 records found, only 32 met the initial inclusion criteria (4 peer reviews and 28 were grey literature). From these records, 41 surveillance systems were identified (30 national and 11 transnational). After final review of reported outcomes, only 23 national surveillance systems met the inclusion criteria. Indicators recorded from these systems shows lack of external quality assessment (EQA) in some systems and limited reporting of parameters such as infection origin, patient population and pathogen types. The outcome of the review shows that although AMR surveillance has been implemented in 23 out of the 47 countries in the region, a number of limitations exist in the surveillance methods and reporting protocols that can impair the usefulness, validity and trustworthiness of data generated from these surveillance systems.

Disability epidemiology and health policy in Korea

Background: There are more than 1,000 million people with disability worldwide, about 15% of the global population. The prevalence of disability has been rising because of aging populations and the increase in people with chronic diseases. Even though it is well known that people with disability have an increased risk of chronic diseases and mortality at a younger age, health policies have not been developed correspondingly.Current Concepts: Disability epidemiology is a study of the patterns, distributions, determinants, and outcomes of disabling conditions. From the medical model perspective, people with disabilities are just ill or abnormal. To overcome the limitations of the medical model, the World Health Organization developed the International Classification of Functioning, Disability and Health.Discussion and Conclusion: Using the International Classification of Functioning, Disability and Health model based on a biopsychosocial framework, the healthcare community should work together to develop and implement action plans to improve the health of those with disabilities. These policies are essential to care for acute-stage disabilities, build an integrated care system, and provide a better environment for people with disability.

Result of low student enrolment on the sustainability of Seventh-Day Adventist secondary schools in Western Kenya

This study examines the effect of low student enrolment on the sustainability of SDA secondary schools in the West Kenya Conference of Seventh Day Adventist Church. The study was underpinned by the sustainability transformation in education theory which postulates the identification of sustainability strategies and action plans for implementation. Therefore, the mixed methods research approach was adopted in this study. This study utilised the descriptive research design and was conducted in WKUC of the SDA church, covering 15 out of 47 counties in Kenya. The test-retest and the split-half reliabilities of the questionnaires were ascertained by use of Cronbach Alpha Coefficient, and reliability of 0.7 and 0.65 was arrived at, respectively. Study findings revealed that student enrolment trends in SDA schools were on a downward trend, and this needs to be addressed as soon as possible. This study recommends that the church administration and schools' management should address issues that affect low student enrolments, such as the high fees charged by sourcing funds from other sources such as engaging in income generating activities or partnering with the government so that it can provide and pay the teachers in the schools.

Result of low student enrolment on the sustainability of Seventh-Day Adventist secondary schools in Western Kenya

This study examines the effect of low student enrolment on the sustainability of SDA secondary schools in the West Kenya Conference of Seventh Day Adventist Church. The study was underpinned by the sustainability transformation in education theory which postulates the identification of sustainability strategies and action plans for implementation. Therefore, the mixed methods research approach was adopted in this study. This study utilised the descriptive research design and was conducted in WKUC of the SDA church, covering 15 out of 47 counties in Kenya. The test-retest and the split-half reliabilities of the questionnaires were ascertained by use of Cronbach Alpha Coefficient, and reliability of 0.7 and 0.65 was arrived at, respectively. Study findings revealed that student enrolment trends in SDA schools were on a downward trend, and this needs to be addressed as soon as possible. This study recommends that the church administration and schools' management should address issues that affect low student enrolments, such as the high fees charged by sourcing funds from other sources such as engaging in income generating activities or partnering with the government so that it can provide and pay the teachers in the schools.

A conceptual model for energy management in the steel industry: A Soft System Methodology (SSM) approach

This paper aims to use Soft Systems Methodology (SSM) to develop the steel industry's energy management framework. It proposes a soft system approach to analyze the complex situation of developing a support system for energy management. This approach consists of identifying the system scope, discovering underlying problems within, deriving a conceptual model from the complex situation, and identifying possible actors and activities to bring the conceptual model closer to reality. The identified activities could serve as a guideline for designing and developing an effective energy management framework in the steel industry. The result might also be further developed to drive the feasible, desirable changes into real implementation strategies and action plans. Currently, there is very limited SSM academic research in energy management. Hence the researchers sincerely hope that this study might help to drive the SSM methodology application in this field, in conjunction with the body of knowledge of Industrial and Systems Engineering (IISE).

Theoretical foundations and practical implementation of monitoring the accessibility state of ­facilities and services in the field of health care

Background.By decision of the Commission under the President of the Russian Federation for the Disabled, the Ministry of Labor of Russia was entrusted with monitoring the implementation of federal and regional action plans road maps to increase the accessibility of facilities to people with disabilities.&#x0D; Aim.Monitoring the implementation by state authorities of the constituent entities of the Russian Federationof action plans (road maps) to increase the values of accessibility indicators for disabled people in healthcare facilities.&#x0D; Material and methods.The indicators of accessibility for disabled people of facilities in the healthcare system based on the results of implementation of action plans by executive authorities of 85constituent entities of the Russian Federation in the field of healthcare, obtained as a result of monitoring the achieved values in the indicators of accessibility for disabled people of facilities in 2019 and 2020, were analyzed. The availability of facilities was calculated on the basis of information from the state authorities of the constituent entities of the Russian Federation, prepared in accordance with the recommendations of the Ministry of Labor of Russia, using the analysis and generalization of the received materials, using the method of comparing absolute and relative indicators.&#x0D; Results.The accessibility of medical organizations for the disabled is created in two ways from the standpoint of universal design (inclusion of measures to organize the accessibility of facilities and services for the disabled when designing and building new facilities, as well as during reconstruction and major repairs) and using the principle of reasonable accommodation for existing facilities (before their overhaul and reconstruction). Ranking the indicators of the e150domain (design, nature of design, construction and arrangement of buildings for public use) on the basis of a unified assessment scale of the International Classification of the Functioning of Disabilities and Health made it possible to identify regions of the Russian Federation with varying degrees of accessibility of healthcare facilities: absolutely accessible in 10(11.8%) regions of the country; with a significant levelof accessibility in 53(62.4%) regions; with a moderate level of accessibility in 8(9.4%) regions; with a low or insignificant level of accessibility in 9(10.6%) regions of the Russian Federation; with a very low levelof accessibility of healthcare facilities in 5(5.8%) regions of the Russian Federation, respectively.&#x0D; Conclusion.According to the monitoring of the state of accessibility of facilities for the disabled in the healthcare sector in the constituent entities of the Russian Federation, the level of accessibility varied from 100% to 0.5%. The planned indicators of increasing the availability of facilities in the healthcare sector have reached 100% in 52constituent entities of the Russian Federation.

Preparedness for Matching into an Orthopaedic Surgery Residency: Student Perspectives as a Model for Institutional Progression

Objective With the increasingly competitive nature of matching into an orthopaedic surgery residency, there is an opportunity for medical schools and orthopaedic faculty to enhance their students’ candidacy. In this study, we aim to evaluate medical students’ satisfaction with our institution’s provision of resources, identify areas of strengths and weaknesses within our department, and use these findings to implement action plans for institutional advancement. Design This is a prospective, cross-sectional survey study of alumni from our institution, an allopathic medical school affiliated with a tertiary-care university teaching-hospital, who successfully matched into an orthopaedic surgery residency program between 2006 and 2021. Setting Robert Wood Johnson Medical School (RWJMS) Department of Orthopaedic Surgery, New Brunswick, NJ Participants The survey was distributed to 83 matched alumni from our institution, 45 (54.2%) responded to the survey. Results Forty-four (97.8%) survey respondents successfully matched into a PGY-1 orthopaedic surgery residency position on their first attempt. Nearly 70.0% of survey respondents matched into their top 3 ranked residency program while ~90.0% matched into their top 5 ranked residency program. Survey respondents reported that board exam scores (33.3%), performance on away rotations (28.9%), and letters of recommendation (15.6%) were their greatest strengths, while research experience (53.3%), lack of inclusion in AOA (17.8%), and board exam scores (15.6%) were their greatest weaknesses. On survey responses evaluated using a 1-5 Likert scale, survey respondents reported that their sub-internship at our home institution adequately prepared them to excel on away rotations (4.38 ± 0.912). Conversely, survey respondents from our institution rated faculty and resident’s receptiveness to students seeking research opportunities the lowest (3.38 ± 1.007). Conclusions An internal assessment of orthopaedic departments at medical institutions, utilizing student perspectives, can be a useful tool for identifying the strengths and weaknesses of a program’s ability to prepare students to successfully match into an orthopaedic residency. After identification, programs must be able to hone strengths and mitigate weaknesses by setting objectives for improvement and implementing action plans to ensure deficiencies are adequately addressed.

Leveraging Governance Performance to Enhance Climate Resilience

AbstractEnhancing the resilience of complex social‐ecological systems (SES) to climate change requires transformative changes. Yet, there are knowledge gaps on how best to achieve transformation. In this study, we present an approach for assessing governance performance in SES and identifying leverage points to ultimately enhance climate resilience. The approach combines three different methods including a capital approach framework, fuzzy cognitive mapping, and a leverage points analysis. Using a coastal case‐study in Algoa Bay, South Africa, the performance of governance processes contributing to different forms of capital is assessed. Subsequently, leverage points ‐ where a small shift may lead to transformative changes in the system as a whole ‐ are identified based on measures of centrality and performance. Results suggest that a range of leverage points can improve governance performance and therefore climate resilience in the case‐study. Leverage points include improving (a) support from the provincial government; (b) priority given to climate change in the integrated development plan; (c) frequency of collaborations; (d) participation in the implementation of climate action plans; (e) allocation of funding to climate change actions; (f) the overall level of preparedness in terms of staff with relevant expertise; (g) public awareness and understanding of climate change. The approach can also be used to analyze and model the relations and interactions between capitals. The study advances methodological and theoretical knowledge on the identification of leverage points for enabling transformations toward climate resilience and broader sustainability goals in SES.

Informing Practice Through Professional Development: An Interstate Urban Programming Study Tour

Southeast Pennsylvania 4-H Extension educators identified a need for professional development in order to further develop current urban 4-H programs. The expectation was that increased awareness and knowledge would lead to increased skills competency in planning, implementing, and evaluating urban 4-H youth development programs. An interstate professional development program was developed to inform practitioners on positive youth development in urban communities. The 2-day program included on-site observations of urban programs and professional development on best practices. The event was scheduled as a study tour that involved intentional focus on practical applications of research theory for informal education. The Penn State Extension 4-H Urban Study Tour included on-site observations, program development, and networking leading to the successful development of action plans for local implementation. The program was evaluated for impact using pre- and post-tour survey tools. Results suggest that the participants gained value from the professional development study tour, thus similar opportunities may be warranted.

Factors impacting—stillbirth and neonatal death audit in Malawi: a qualitative study

BackgroundOver one million babies are stillborn or die within the first 28 days of life each year due to preventable causes and poor-quality care in resource-constrained countries. Death audit may be a valuable tool for improving quality of care and decreasing mortality. However, challenges in implementing audit and their subsequent action plans have been reported, with few successfully implemented and sustained. This study aimed to identify factors that affect stillbirth and neonatal death audit at the facility level in the southern region of Malawi.MethodsThirty-eight semi-structured interviews and seven focus group discussions with death audit committee members were conducted. Thematic analysis was guided by a conceptual framework applied deductively, combined with inductive line-by-line coding to identify additional emerging themes.ResultsThe factors that affected audit at individual, facility and national level were related to training, staff motivation, power dynamics and autonomy, audit organisation and data support. We found that factors were linked because they informed each other. Inadequate staff training was caused by a lack of financial allocation at the facility level and donor-driven approaches to training at the national level, with training taking place only with support from funders. Staff motivation was affected by the institutional norms of reliance on monetary incentives during meetings, gazetted at the national level so that audits happened only if such incentives were available. This overshadowed other benefits and non-monetary incentives which were not promoted at the facility level. Inadequate resources to support audit were informed by limited facility-level autonomy and decision-making powers which remained controlled at the national level despite decentralisation. Action plan implementation challenges after audit meetings resulted from inadequate support at the facility level and inadequate audit policy and guidelines at the national level. Poor documentation affected audit processes informed by inadequate supervision and promotion of data usage at both facility and national levels.ConclusionsGiven that the factors that facilitate or inhibit audits are interconnected, implementers, policymakers and managers need to be aware that addressing barriers is likely to require a whole health systems approach targeting all system levels. This will require behavioural and complex intervention approaches.

Challenges and opportunities in decarbonizing the U.S. energy system

The United States has pledged to develop a 100% carbon-free electric power system by 2035 and a net-zero-emissions economy by 2050. While important advancements have been made in the scale, performance, and economics of clean energy technologies, meeting the nation's ambitious goals will not only require their deployment at scale, but also additional innovation and effective integration of different solutions. Technological developments across the broad suite of low-carbon energy solutions are advancing rapidly, with ongoing innovations in renewable electricity generation, industrial processes, and energy-saving technologies and services, including LED lighting, induction heating, electric vehicles, energy storage solutions, and mobility as a service, plus smart devices, controls, and more efficient and smart buildings. Combining renewable electricity with biotic and abiotic pathways to produce chemicals, fuels, and materials promises to deliver new solutions. Grid-interactive buildings and communities, integrating transportation infrastructure and vehicles, are likely to be significant components of any zero-carbon energy strategy. Low-carbon industrial manufacturing will also make strong contributions to a net-zero economy. While the technical prospects appear promising, variations in the state of infrastructure, jurisdictional and social equity, pollution, economic and socio-cultural constraints, energy resource availability, and supply chain dynamics found in different locations present a range of challenges and demand customized solutions. This paper provides a critical review and offers new insights into the technical, infrastructure, analytic, political, and economic challenges faced in translating the nation's ambitious net-zero-emissions goals into feasible and reliable implementation action plans.