Context Of Implementation Research Articles

Designing a Digital Health Solution: A Platform for Automated Surveillance of Fungal Infection.

Surveillance of invasive fungal infection (IFI) requires laborious review of multiple sources of clinical information, while applying complex criteria to effectively identify relevant infections. These processes can be automated using artificial intelligence (AI) methodologies, including applying natural language processing (NLP) to clinical reports. However, developing a practically useful automated IFI surveillance tool requires consideration of the implementation context. We employed the Design Thinking Framework (DTF) to focus on the needs of end users of the tool to ensure sustained user engagement and enable its prospective validation. DTF allowed iterative generation of ideas and refinement of the final digital health solution. We believe this approach is key to increasing the likelihood that the solution will be implemented in clinical practice.

Assessing the Implementation Determinants of Pilot Malaria Vaccination Programs in Ghana, Kenya, and Malawi through a Complexity Lens: A Rapid Review Using a Consolidated Framework for Implementation Research.

In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can provide useful insights for enhancing implementation outcomes in new countries. There has not yet been a proper synthesis of the implementation determinants of malaria vaccination programs. A rapid review was conducted to identify the implementation determinants of the pilot malaria vaccination programs in Ghana, Kenya, and Malawi, and describe the mechanism by which these determinants interact with each other. A literature search was conducted in November 2023 in PubMed and Google Scholar to identify those studies that described the factors affecting malaria vaccine implementation in Ghana, Kenya, and Malawi. Thirteen studies conducted between 2021 and 2023 were included. A total of 62 implementation determinants of malaria vaccination across all five domains of the consolidated framework for implementation research (CFIR) were identified. A causal loop diagram showed that these factors are interconnected and interrelated, identifying nine reinforcing loops and two balancing loops. As additional countries in Africa prepare for a malaria vaccine roll-out, it is pertinent to ensure that they have access to adequate information about the implementation context of countries that are already implementing malaria vaccination programs so that they understand the potential barriers and facilitators. This information can be used to inform context-specific systems enhancement to maximize implementation success. Going forward, primary implementation studies that incorporate the causal loop diagram should be integrated into the malaria vaccine implementation program to enable immunization program managers and other key stakeholders to identify and respond to emerging implementation barriers in a timely and systematic manner, to improve overall implementation performance.

Planning and implementing community-based drug checking services in Scotland: a qualitative exploration using the consolidated framework for implementation research

BackgroundDrug checking services (DCS) provide harm reduction support and advice to individuals based on chemical analysis of submitted substances of concern. Whilst there are currently no DCS in Scotland, community-based services are being planned in three cities.MethodsIn this paper, we report qualitative findings based on interviews with 43 participants, focused on perceptions of DCS and their implementation. Participants were relevant professionals, those with experience of drug use, and family members of those with experience of drug use. The Consolidated Framework for Implementation Research (CFIR) was used to inform data collection and analysis. We report findings under nine constructs/themes across the five CFIR domains.ResultsParticipants noted the importance of DCS being implemented in low-threshold, trusted services with a harm reduction ethos, and outlined a range of further service design considerations such as speed of testing, and information provided through the analysis process. In relation to the ‘inner setting’, a key finding related to the potential value of leveraging existing resources in order to expand both reach and effectiveness of drug trend communication. The approach of local and national police to DCS, and the attitudes of the public and local community, were described as important external factors which could influence the success (or otherwise) of implementation. Bringing together a range of stakeholders in dialogue and developing tailored communication strategies were seen as ways to build support for DCS. Overall, we found high levels of support and perceived need for DCS amongst all stakeholder groups.ConclusionsOur findings present initial implementation considerations for Scotland which could be further explored as DCS are operationalised. Further, our focus on implementation contexts is relevant to research on DCS more generally, given the minimal consideration of such issues in the literature.

Remote monitoring of implementation fidelity using log-file data from multiple online learning platforms

The impact of educational programs on student learning is contingent upon the quality and fidelity of their implementations. Yet, the most reliable method of implementation monitoring, direct observation, may be infeasible for large-scale efficacy studies. Here, we use log-file data from an efficacy study assessing the impact of gamified learning technologies on algebraic knowledge to measure the fidelity of implementations remotely within and across multiple programs. We employ exploratory-data-analysis to identify measures of fidelity, multilevel models to evaluate which levels of implementation contexts (i.e. classrooms, teachers, students) were associated with variance in fidelity metrics, and latent profile analysis to identify high and low-fidelity contexts. These analyses illustrate how log-file data may be used to remotely monitor and evaluate the implementations of online learning platforms.

Scaling-up sustainable commodity governance through jurisdictional initiatives: Political pathways to sector transformation in the Indonesian palm oil sector?

Voluntary systems of sustainable commodity governance have come under intensified criticism for failing to catalyse transformative change beyond directly regulated supply chains. In response, there has been a surge of efforts to ‘scale-up’ sustainability impacts through governance interventions at landscape and jurisdictional scales. While these ambitious, scaled-up approaches are attracting significant interest, such approaches demand substantial changes to established repertoires of policy interventions and associated understandings of the pathways through which these contribute to sustainability outcomes. Drawing theoretical insights from scholarship on multi-stakeholder sustainability governance together with findings from a qualitative study of jurisdictional governance experiments in the Indonesian palm oil sector, this paper explores how emerging jurisdictional initiatives are promoting change pathways towards more sustainable commodity production, and how the political, environmental governance and economic contexts in which these interventions are implemented influence these pathways. Analysis shows that by integrating a distinctive mix of market and policy-driven interventions, jurisdictional approaches are contributing to three core pathways of change, centred respectively on network and coalition-building, collaborative governance, and resource mobilisation. However, which of these pathways are most influential, how interventions are sequenced and operationalised, and how the pathways interact in shaping change is highly sensitive to varied subnational implementation contexts, with important implications for the impact and resilience of jurisdictional programs. These findings highlight the need for jurisdictional policy interventions to respond flexibly to contextually-variable configurations of actor interests, coalitions and power relations within contested multi-scalar processes of sustainable commodity governance.

Digital technologies to prevent falls in people living with dementia or mild cognitive impairment: a rapid systematic overview of systematic reviews.

Falls are a common cause of potentially preventable death, disability and loss of independence with an annual estimated cost of £4.4bn. People living with dementia (PlwD) or mild cognitive impairment (MCI) have an increased fall risk. This overview evaluates evidence for technologies aiming to reduce falls and fall risk for PlwD or MCI. In October 2022, we searched five databases for evidence syntheses. We used standard methods to rapidly screen, extract data, assess risk of bias and overlap, and synthesise the evidence for each technology type. We included seven systematic reviews, incorporating 22 relevant primary studies with 1,412 unique participants. All reviews had critical flaws on AMSTAR-2: constituent primary studies were small, heterogeneous, mostly non-randomised and assessed as low or moderate quality. Technologies assessed were: wearable sensors, environmental sensor-based systems, exergaming, virtual reality systems. We found no evidence relating to apps. Review evidence for the direct impact on falls was available only from environmental sensors, and this was inconclusive. For wearables and virtual reality technologies there was evidence that technologies may differentiate PlwD who fell from those who did not; and for exergaming that balance may be improved. The evidence for technology to reduce falls and falls risk for PlwD and MCI is methodologically weak, based on small numbers of participants and often indirect. There is a need for higher-quality RCTs to provide robust evidence for effectiveness of fall prevention technologies. Such technologies should be designed with input from users and consideration of the wider implementation context.

Determination of Development Policy Based on the Aggregation of thoughts of Legislative Members

As one of the regional government administrators, the position of DPRD (Provincial Legislatives Council) members is very strategic and critical in their relationship with the people and communities they represent. DPRD members accommodate and follow up on aspirations in the form of DPRD main ideas from voters (constituents) through a recess mechanism. From observations and interviews, the Malang Regency DPRD has carried out primary input from 3 elements of the Public Works Department: Highways, Human Settlements and Water Resources Public Works. Communication related to primary idea input has generally gone well. Using a qualitative approach, this research examines the process of aggregating DPRD main ideas in determining the direction of development policyin Malang Regency based on the public policy implementation model proposed by Grindle (1980: 7), namely the process of successful policy implementation, the results of which depend on the program activities that have been designed and adequate funding, apart from being influenced by Content of Policy (the content of the policy) and Context of Implementation (context of implementation). This research shows that the process of aggregating the main ideas in the Malang Regency DPRD has gone well. However, according to several respondents, there are still inhibiting factors, such as the council's human resources from educational and professional backgrounds and the limited budget provided

Vinte anos do Sistema Nacional de Avaliação da Educação Superior – SINAES no Brasil: trajetória, princípios, dilemas e tendências

Abstract The main objective of this work is to promote a reflection on the twenty years of implementation of the National Higher Education Assessment System - SINAES, with a view to carrying out the historical rescue of its formulation and implementation context, in addition to discussing the evaluation principles, the characteristics, tensions, dilemmas and perspectives for the system. It was found that SINAES incorporated into its structure, over two decades, divergent evaluation visions and principles, which bring the evaluation closer to its objective and regulatory aspects. As trends, we see the weakening of institutional evaluation, in loco external evaluation, and of the system itself, as a basis for regulating the provision of higher education in the country.

How to Evaluate Online Education for General Practitioners: Development of a Tailored Questionnaire for Heart Failure Education.

Physician-oriented online education could be a pathway to improve care for patients with heart failure, however, it is difficult to measure the impact of such education. Self-efficacy is a potential outcome measure. In this article, we develop a methodology for analyzing an educational intervention for general practitioners (GPs) using self-efficacy as a concept. This study was partly conducted within the setting of an observational study, IMPACT-B, where we developed online education for GPs. We designed and refined a 24-item questionnaire using item analysis, and exploratory and confirmatory factor analysis. Ninety-one GPs completed the questionnaire before and after the online education. Follow-up data after 6 months was available for 13 GPs. Item analysis revealed a high degree of internal consistency (coefficient alpha 0.95) and validity. Each additional year of experience was associated with an average baseline self-efficacy score of 0.50 points (95% CI [0.21-0.80]), and each additional patient in HF follow-up with an average score of 2.0 points (95% CI [0.48-3.5]). Items that differentiated most between GPs with high and low self-efficacy were the treatment of congestion as well as titrating medication and MRA in heart failure with reduced ejection fraction. Factor analysis reduced the number of questions to 14, mapping to three factors (diagnosis, treatment, and follow-up), and improved the model fit as measured by the goodness-of-fit indicator comparative-fit-index (from 0.83 to 0.91). We demonstrated a method to assess the impact of online education on general practitioners. This led to a questionnaire that was reliable, valid, and convenient to use in an implementation context.

Mixed methods study supporting the piloting and scaling of a Gender-Responsive Play-Based Learning training package for pre-primary teachers in Rwanda and Mozambique

Despite significant investments to increase access to and improve the quality of primary school education, fewer than half of the world's primary-level pupils have gained grade-level literacy and numeracy skills. While the learning crisis is complex, high-quality early childhood education (ECE) can be a critical piece of this puzzle. Integrating the use of gender equitable, gender responsive and play-based pedagogies into ECE curricula can be an important step towards enhancing the quality of ECE and supporting the school readiness of girls and boys, also in low-income contexts. This study explored the effectiveness of a Gender-Responsive Play-Based Learning (GRPBL) training package for ECE teachers Rwanda and Mozambique on classroom environment and child early learning and development. The study was mixed methods and used Focus Group Discussions, in-depth interviews and standardized classroom and child assessments using the globally validated International Development Early Learning Assessment (IDELA) toolkit. The study showed that in Mozambique, the training had positive effects on classroom environment and consequently on child early learning outcomes, with the strongest effect found on emergent literacy. The training did not succeed at improving the same outcomes in Rwanda. Contextual factors such as high student to teacher ratios, lack of teaching experience and limited support by school leaders and parents, likely constrained teachers in Rwanda to make deep changes to their instructional practices while we did see evidence of such changes in Mozambique. A training on GRPBL, can thus have powerful effects on classroom and child outcomes, even in low resource settings. However, effects may vary depending on the implementation context. To support policymakers, local and international implementers in their journey to improve the quality of ECE, more time needs to go into understanding what type of Continuous Professional Development (CPD) aligns with the existing ECE context and systems so that teachers, children and parents can optimally benefit from CPD opportunities.

Taxonomy of wealth taxation literature: A study of implementation, effects, responses and regulatory policy context

This paper presents a systematic review of wealth tax literature examining the challenges of wealth taxes for countries that have implemented and repealed them. We comprehensively analyzed 96 papers published in 14 reputable journals from 2000 to 2023. These papers are classified into three primary thematic areas: wealth tax implementation, effects of wealth tax (EWT), and taxpayer behavioral responses (BRT). We find that most countries that have implemented wealth taxes face challenges of accurate valuation of net worth (NW) and assets and high administrative costs (ADCs) due to the high ADCs associated with implementing and enforcing wealth taxes and double taxation. The implication of the results is to enhance understanding of the challenges influencing wealth tax implementation for researchers and policymakers and also bridge historical experiences into the present context, offering practical guidance for the United States of America (USA) states considering wealth tax adoption, thereby supporting their decision-making process.

ЕКСТЕРНАЛІЗАЦІЯ КОРДОНУ ЄС: КООПЕРАЦІЯ ІТАЛІЇ ТА ЛІВІЇ У СФЕРІ МІГРАЦІЇ (2000 – 2010ті)

The article examines the policy of the EU border externalization, i.e. transfer of border control and responsibility for migration processes to third countries, namely the Italo-Libyan cooperation in the field of migration is examined in detail. Investigation of agreements and arrangements between the governments of the two countries in 2000–2010s was made. The terms of the agreements and methods of their implementation, the historical and political context in which these decisions were made are considered in detail. The author tries to find out whether Italy achieved the goals set by these agreements and whether the Italian government acted in accordance with European norms. Particular attention is paid to the legal aspects and principles on which the treaties between Italy and Libya are based. Attention is focused on the declared need for respect for human rights, and the lack of fulfillment of these obligations in practice. The article examines in detail the dynamics of relations between the two countries in the 2000s and their change after the outbreak of war in Libya, and the beginning of the active phase of the migration crisis in Europe. The article reveals important aspects of cooperation between these two countries, and the impact of this cooperation on migrants. The author also refers to relevant cases of the European Court of Human Rights considering claims for the forced expulsion of migrants to Libya based on bilateral agreements. Contradictions between the strategies of the EU and Italy regarding the migration crisis are also considered, the author draws attention to the lack of solidarity between EU member states, which forces states located on the external borders of the EU to cooperate with third countries in exchange for political and economic concessions. It is argued that the phenomenon of externalization of borders is complex and multidimensional, and decisions on migration regulation that include third countries require more comprehensive approaches, taking into account compliance with international obligations to protect human rights, which cannot be sacrificed solely on the basis of political necessity.

Exploring context for implementation of inclusive education for children with developmental disabilities in mainstream primary schools in Ethiopia.

A large gap in provision of services for children with developmental disabilities (DD) has been identified in Ethiopia, especially in the education system. Including children with disabilities in mainstream schools is encouraged by policies, but progress in this direction has been limited. This study aimed to explore stakeholders' perspectives on contextual factors relevant for inclusive education for children with DD in mainstream schools in Ethiopia, with a focus on Adis Ababa. Data were collected through semi-structured interviews with 39 local stakeholders, comprising caregivers of children with DD, school teachers and principals/managers, non-governmental organisation representatives, government officials, clinicians and academics/consultants. We used template analysis to code the data and map them onto domains of the Context and Setting dimensions of the Context and Implementation of Complex Interventions framework. Stakeholders discussed frameworks in the Legal and Ethical context endorsing the right of all children to education. However, they reported multiple reasons why children with DD in Ethiopia have limited access to education, either in special or mainstream schools. First, individual features, such as gender and support needs, discussed in the Epidemiological context, may affect the likelihood of a child with DD to be accepted in school. Transportation challenges are a key barrier in the Geographical context. Socio-economic and Socio-cultural contexts present barriers at the levels of the nation, school and family, mostly related to limited services and material and financial resources and limited awareness of DD. Stakeholders believe the currently limited but growing commitment in the Political context can support progress towards the removal of these barriers. Our findings can form the basis for development of an implementation plan that addresses such barriers and capitalises on existing facilitators.

Implementing peer support work in mental health care in Germany: The methodological framework of the collaborative, participatory, mixed-methods study (ImpPeer-Psy5).

Starting in the 1990s in the United States, individuals with lived experience of mental health crises and recovery have been employed as peer support workers (PSWs) internationally. However, the implementation of PSW in clinical contexts remains challenging. This manuscript presents and discusses the methodological framework of the ImpPeer-Psy5 study on the PSWimplementation in the German mental healthcare sector. This study used a mixed-methods and collaborative research approach, as well as participatory research strategies. After describing the study design, populations, teamworkand assessments, the epistemic challenges of its methodological framework will be critically discussedand how it has iteratively shaped the object of study. The healthcare, policyand funding context of PSW implementation as well as the study's methodological framework have differently influenced the ways in which the implementation of PSW has been conceived in this study. The choice of a collaborative or participatory methodological framework is advised to better align research questions and procedures to the specific needs and challenges of PSWs and other stakeholders concerned with PSW implementation. The research team of the ImpPeer-Psy5 study was collaboratively staffed by a portion of researchers who also identify as users or survivors of psychiatric services. A nonprofit organization for the training of PSWs served as a practice partner throughout the research process. Different participatory formats involve a significant number of diverse stakeholders relevant to PSW implementation.

Preservasi Digital Warisan Budaya: Sebuah Ulasan

<p align="justify">Digital preservation plays an important role in safeguarding cultural heritage. Along with the development of the times, cultural heritage as a valuableassetcannot be separated from potential threats in the form of damage and loss. Digital preservation is an aspect of opportunity in maintaining the sustainability of cultural heritage values. Through a qualitative approach with the literature study method, this research seeks to provide an overview of aspects of digital preservation in relation to efforts to protect cultural heritage. The results of the study illustrate that digital preservation has strong relevance in terms of protecting cultural heritage values from damage and loss. The involvement of technology in digital preservation results in convenience in efforts to save cultural heritage by representing cultural material in digital formats. Digital preservation has various challenges including technological obsolescence, loss or damage to data, intellectual property rights, preservation costs, metadata and contextual information, skills and expertise, social and ethical considerations, utilization, and various other things according to the context of implementation. A digital preservation strategy that includes aspects of technological environmental conservation for future use and handling of technical limitations is an integral part of overcoming existing challenges. By implementing various strategies and actively participating in the realm of digital preservation activities, the existence of cultural heritage with its noble values can be maintained and gain long-term accessibility for the sustainability of future generations.</p>

Policy Implementation Model of Accelerating Contamination and Destruction Management on Citarum River Flow (Study on the Policy Implementation of Regulation Number 15 Year 2018 concerning the Accelerating Contamination and Destruction Management on Citarum River Flow)

Introduction: The policy in Indonesia faces problems at the central government level (Coordinating Ministry for Maritime Affairs, Coordinating Ministry for PMK, Ministry of Health, and Ministry of Home Affairs); West Java Provincial Government level; as well as health policies at the district/city government level through which the Citarum River flows. This relationship pattern determines the pattern of interactions (pattern of interactions) of all stakeholders related to Citarum policies. This study uses Grindle's (1980) approach because policy (the content of policy) and implementation environment (context of implementation) are two things that influence the success of implementation. The purpose of this study was to analyze, describe, and find a model for implementing pollution and damage control program policies for the Citarum River Basin using the Grindle approach (1980). Theoretical Reference Framework: Previous research that supports this research is research conducted by Jung et al. (2021); Koch I, Reeves A. (2021); Tri N, Hau D, Duyen N, (2021); Dutta, et al., (2021); Wiryanto W, (2020); Idris, H. (2017); Rashid and Alfina. (2017; and Raharja, SJ (2015). Related to the implementation of public policy, Grindle (1980) introduces the implementation model as a political and administrative process, this model describes the decision-making process carried out by various actors where the final output is determined by both the program material used has been achieved as well as through the interaction of decision-makers in the context of administrative politics. The political process can be seen through the decision-making process involving various policy actors while the administrative process is seen through the general process regarding administrative actions that can be examined at a specific program level. Method: The type of research used in this study is qualitative the focus of the research consists of the Content of Policy, Context of Implementation, Output, and Outcome of policy implementation, as well as the Model of Policy implementation. This research was carried out in the Provincial Government of West Java and all Regencies and Cities which are also in the Citarum River Basin by collecting data on communities along the Citarum River, especially people who receive BPJS Health facilities along the Citarum River. Informants in this study were selected using a sampling technique, namely, purposive sampling, namely informants who understand the condition of the Citarum River, starting from implemented policies, pollution control, and destruction of the area. Data collection techniques were carried out through library research, observation, in-depth interviews, as well as documentation and analysis. Results: The results of this study indicate that: (1) In general, the study of the Health Insurance Policy Implementation Model and the Citarum Watershed Pollution and Damage Control Program Policy based on the Grindle perspective still has several obstacles in its implementation, (2) Judging from the implementation environment, there are strengths and interests will maintain the existing status at the research site, then some things that still leave problems, for example, the unclear authority in implementing the program needs serious attention, so that similar phenomena do not recur. The Citarum watershed problem has become a very serious waste problem locally and nationally. The issuance of Presidential Decree number 15 of 2018 shows the government's seriousness in solving the problem of pollution in the Citarum watershed area. Policy implementers are highly committed to preventing, controlling, and restoring the Citarum watershed so that it becomes clean, beautiful, and free of waste and pollution. Discussion: The implementation of the health insurance policy and pollution and damage control program policies for the Citarum River Basin does not yet have an implementing organizational structure, so this section needs to be completed. In addition, the supporting funds provided are not sufficient so financing factors need to be considered and supported. Conclusions: In the Recommended Model, in addition to proposing additional dimensions to the Grindle model, the author also proposes that it is necessary to complete the Grindle implementation model with policy output. This is important because when studying policy implementation, it does not only examine policy outcomes but also examines policy output. Given this, it occupies an important position in policy implementation.

A survey of physiotherapist managers in Ireland and their views on the role of Advanced Practice Physiotherapists.

Within the current context of implementation of an Advanced Practice Grade, the Irish Society of Chartered Physiotherapists commissioned a survey of physiotherapy manager opinions regarding the role of Advanced Practice Physiotherapists. The aim of this survey was to explore the views of physiotherapist managers in relation to the characteristics, role, competencies and management of Advanced Practice Physiotherapists (APPs) in Ireland. Physiotherapist managers based in primary and secondary care settings in Ireland were invited to participate in a survey on Advanced Practice. Quantitative data from a custom designed online survey was analysed with descriptive statistics and qualitative data from open-ended survey questions were analysed using thematic analysis. The response rate to the survey was 32% (24/75). On average, respondents thought that 54% (range: 15%-80%) of an APPs time should be spent in clinical practice and between 17% and 20% variously on managerial and leadership, teaching and education and research and development duties. Four themes were identified from the surveys' open-ended questions related to the description of APP: 'Extended scope 'Advanced clinical training, knowledge, and decision-making', 'Autonomy, independence and responsibility', and 'Wider roles'. Irish physiotherapist managers recognised the extended scope of practice, expertise and multiple roles characteristic of APPs. They indicated the need for legislative changes and clarity around governance.

TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study.

Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site). TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.

A cross-country comparative analysis of congestion pricing systems: Lessons for decarbonizing transportation

Alongside national and sub-national climate action, local governments play a particularly important role in implementing climate change mitigation policy. While substantial efforts are being taken to reduce greenhouse gas emissions in some communities, additional efforts are needed to encourage behavioural change in driving demand and mode of transportation. Congestion pricing is a key policy which can motivate this change. Using a comparative analysis of congestion pricing systems worldwide, this study examines government policy documents and academic literature to identify policy design features that are most desirable for achieving GHG and air quality emissions targets. Specifically, congestion pricing policies are evaluated against the attributes of implementation context, design characteristics, effectiveness, and political acceptability. In total, 16 congestion pricing systems across 11 cities in OECD member countries are assessed. Findings suggest that area-based congestion pricing systems can provide local governments with a relatively cost-effective tool to implement consistent reductions in greenhouse gas emissions in areas with a pre-existing air quality concern. Congestion pricing policies can achieve broad acceptability with thoughtful design and implementation focusing on equity and user engagement.

Linguistic means of forming the image of the head of a foreign state in the American media (based on the material of The New York Times)

This article is devoted to the study of linguistic means of forming the image of the former president of the Federative Republic of Brazil – Jair Bolsonaro. The purpose of this study is to study the linguistic means of forming the image of the head of a foreign state, who receives representation on the pages of The New York Times. The subject of the study is the lexical and semantic field (LSF) of Personal Names as a model of representation of knowledge about the leader of a foreign state, as well as the contexts of the linguistic implementation of the core of the studied LSF. The main objectives of the study included the study of the structure and composition of the lexico-semantic field of Personal Names, as well as concordance analysis of the contexts of the linguistic implementation of the Personal Names LSF core. The research material is presented by The New York Times newspaper's 2019 issues of articles about Brazil. Using the method of corpus analysis of the texts of articles using the Wmatrix computer program made it possible to identify the lexical and semantic field of Personal Names in the structure of the cognitive matrix Brazil. Concordance analysis of the contexts of the linguistic implementation of the Bolsonaro lexical unit allowed us to identify 3 leading typical arguments that are formed by the newspaper around the name of the politician. The novelty of the study lies in the choice of the material and the subject of the study: the image of President Jair Bolsonaro in the American media has not been studied by linguists to date. The results of the study showed that the image of a politician is formed, among other things, by building contextual connections between the core of the lexico-semantic field under study and the units that make up the structure of this field, while the majority of lexical units relate to figures of political figures in Brazil and foreign countries who do not support the policy of J. Bolsonaro. The nature of the typical arguments identified by examining the concordance of the core of the studied LSF allows us to confirm that the image of this politician, formed by The New York Times newspaper, tends to be negatively biased. Readers are being shown the image of Jair Bolsonaro as a politician advocating the disappearance of the Amazon forests, being an ultra-right populist and not supporting the rights of the indigenous peoples of Brazil.